Goodbye 2011

Goodbye 2011, outdoing your predecessor,wink,wink.

But then she smiles and it's genuine,
the best of the mind knows,
she's won a round on the 5 minute clock,
of those she loves and holds.

Like ingredients used for baking, a people mix can bake out badly

Pretend we're all spices: my favorite is cinnamon, next cloves, ginger, small amounts of nutmeg...all of these ingredients go into a cookie dough called family, not even 1 family, but several individual families.

Now your basic dough is going to consist of butter, sugar or a combination of white and brown sugar, vanilla or almond extract, eggs, blending in salt, baking soda, and flour after all the liquid is mixed....laughing.

Now you do this in a particular order for a reason, if you mixed all the dry ingredients first you would have a small white dust storm in your kitchen, especially if you use the hand mixer, still laughing.... I am.

So you mix the liquid or wet ingredients first, capoopoo? Then you start to add in the dry ingredients, oops you've forgotten your cinnamon, cloves, ginger and dahhhh do you really want any nutmeg in there at all?

This is a family gathering described in baking terms and so the child bakes your cookies just to have a memory surface, something real, some little magic for the kingdom, she takes some to each of the the holiday gatherings trying to bring some heart to the land. And that is why she laughs at herself. It never works, really, every time we make progress and try to go and give heart, someone of the ingredients be it flour who is a main ingredient and can turn any recipe into paste or be it cinnamon, or cloves or that damn nutmeg will be in just a bit of a stronger mood, and want to dominate the cookie dough, somehow when some of us most need heart, the cloves added or nutmeg will just over power it for reasons of their own and want to over power the rest of the batter, it could have been a bad measuring spoon at fault or too high of a temperature, but somehow the ingredients played out differently than planned, and the cookie becomes too soft, too hard, or worse yet burned.
The ruined cookie could actually say which of the ingredients over powered the rest of the recipe, but it doesn't matter because the next time the dough would be made, it could be another ingredient too strong. But we'll keep trying, cause sometimes they turn out almost perfect. We'll just stay away from the nutmeg and cloves should be lessened.

I will never be a great baker, but no one can ever question my love for the people in my life I bake for, I just have a hard time understanding how ingredients can try to ruin a recipe at Christmas time.

The Child Within, not laughing.

For You :)

Sometimes words can fail me, but music never does:

http://youtu.be/UKQpRgxyyqo

http://www.youtube.com/watch?v=UKQpRgxyyqo&feature=related

Hugs and my nephew: 12/31

I will start this with 1 solitary moment in my life and it was Sunshine who was viewing it: I am sitting on my brothers family room floor next to my niece & Her Husband, Christmas Greetings Exchanged, I am gently touching a little baby boys foot smiling as I look at those intense blue eyes so much like my brothers, someone touches my left shoulder I look up to see my nephew smiling down at me and he swoops down for a hug truly happy that we've made it for Christmas.

These hugs have gone the gauntlet throughout the years, holding them when they're babies, protecting them from furniture when they're toddlers...up & down out of that rocking chair as Ryan the toddler loved for us to applaud his achievement of up & rocking and back down that he had control over the chair, and how our Dad laughed watching this little ham perform for us that one Christmas.

Years of Squirt guns, Nurf Guns, and cousins chasing eachother around, or unwrapping gifts side by side in front of the tree, each of them growing taller each year, other years spent watching Christmas Story for 27th time, and still laughing together.

And then a young boy almost my own height dodging those damn Auntie Hugs, and me giving him grief telling him "You'll never be too old for Auntie Hug", and so he caved throughout the years, always knowing the hug was coming.

And so the years go on, college years we'd email back and forth keeping some type of communication going, and now we've arrived at adulthood, and his trying to shape his own life into a doable path for himself, his Capricorn logic still prevails with his library card for books he loves to read, he has always had a good self discipline within himself and if he fudges it up here or there he is his own worst judge and resets his discipline a little tougher.
He is one of my favorite people, with relative's you can love them but you don't always have to like them.....I've enjoyed every minute spent around this young man,
he's good people.

So swooping down on me for the hug, made an old Auntie very happy.
Happy Birthday I hope all your dreams shape up for you Capricorn:)

Christmas Day 2011,

Seanna Michaela born this past winter, and Will Archer born in August, are making their households very happy today as it is their first Christmas together. Many will know a deep happiness today, there is nothing like having another child in the family, it carries big warmth to all.

Today we will go spend some Christmas with one of our oldest and dearest friends, Rick's Dad, he's been our good pal through all kinds of seasons, he's had a rocky last few month but continues to combat what time can do to one's health, and hopefully this season he will be able to get an upper hand to some degree.

The point of my thinking is: I want to be everywhere today, I want to see it all, I want to see all of my family, I want to cherish every moment with everyone, in all of their households, family in and out of state, I love you all, and I do value that "TIME WAITS FOR NO MAN", it could be any of us, at any time, anywhere, and we never know who will walk through the portal next. Merry Christmas to you ALL.

But I do know that today we will go have a visit with Grandpa, aka: Rick's Dad, and my friend. The sun is out, the road's are clear, and it's a good place to start the day once we've got our acts together, dressed and ready to go.

Merry Christmas, a day of peace and happiness to you,

Alice through the looking glass, who am I?

Every once in awhile we converse and really gain a different perspective on how a close person perceives us, it can be very enlightening, and it can be an ass kicker. To some people your interests or your hobbies are bluntly: stupid, a waste. In the same week another conversation, might examine that you talk to much and don't get to a straight point, that there is always a story, a "preface, a why, an epilogue". (I think of you blog, I think of you and wonder.) I remark simply enough: "That gives me something to ponder". I sleep on it. I think on it. My rationale tells me it is in part because I am a woman, we've talked more our entire lives, we were most likely born talking some sort of gibberish, and yet I see the Greek tragedy side of Pop Eye run amuck: "I am, who I am, What I am!". I am a 56 year old woman, who thought she liked/loved conversing with the people she was closest to, I am too old to really want to change who I am, or how I tick, and yet I am not valued for who I am really. Now, do I really want to be anyone else? Could I really be anyone else? Most people wouldn't know what to do with a quiet me, when I am quiet I must be sleep walking, or in an extremely uncomfortable surrounding such as one where I've been admonished a ton, or one where I have to watch and weigh every word said. And so I ponder, how do you change yourself, and do you really want to change? Wouldn't two of you, become a very boring thing? If everyone had the same hobby would that not become very boring as well? Like's don't attract for long do they, isn't it opposite's attract for a long haul so that there is always contrast of character and ingredient? Yes, to ponder: I am I said - Written by Neil Diamond L.A.'s fine, the sun shines most the time And the feeling is 'lay back' Palm trees grow, and rents are low But you know I keep thinkin' about Making my way back Well I'm New York City born and raised But nowadays, I'm lost between two shores L.A.'s fine, but it ain't home New York's home, but it ain't mine no more "I am," I said To no one there An no one heard at all Not even the chair "I am," I cried "I am," said I And I am lost, and I can't even say why Leavin' me lonely still Did you ever read about a frog who dreamed of bein' a king And then became one Well except for the names and a few other changes I you talk about me, the story's the same one But I got an emptiness deep inside And I've tried, but it won't let me go And I'm not a man who likes to swear But I never cared for the sound of being alone "I am," I said To no one there An no one heard at all Not even the chair "I am," I cried "I am," said I And I am lost, and I can't even say why Leavin' me lonely still

Traditions , change, the passage of time. Jackie Paper

One summertime tradition shared with me since June of 1976 by my pre-marital partner at the time, and shortly thereafter husband was a June family party in the form of a backyard barbecue which would inevitably end up winding down as a front porch gathering to escape the sun. The celebrations in order for this gathering were his Mom's & Dad's June Birthdays, which also held their wedding anniversary, and Father's Day. Everyone in the family was there unless work and travel interfered, so many segments of the family to learn, so much fun in that backyard, so many memories of a tree that's no longer there, water hose fights, it was never the grandchildren who were a threat with that hose, it was the young adult children, laughingly chasing each other down the gangway. And over the years the cake fights, the laughter, everyone coming together for a day of fun, and little side conversations to catch up on lapsed time we'd missed with the other, pictures exchanged of other times. My own family held a similar gathering but we were so much smaller in number that we were a sedate group in nature, the years pass by one after another, life changes such as my Dad's transfer to Wisconsin changed our gatherings to a new location and different time table. Many years of doing that and then a move back to Illinois that would change all of our lives again. But my husbands family kept pulling together for this one self installed holiday and even last year we barbecued and sang songs in their backyard, although we have grown more sedate in our energies, and smaller in our numbers, many eyes still held that familiar twinkle of mischief or enjoyment. I believe most still had a nice outing, a chance to at least see each other, and have a few laughs, we have grown more tired, and we all have many responsibilities we did not have in those early days, jobs and schedule demands that probably have made us become more homebodies when the time is allowed, we are not as adventurous as we once were that is for certain. So we arrive at what I guess will be the first time of no clan gathering, time has moved on, and I guess as (Puff the Magic Dragon-by Pet, Paul & Mary) Jackie Paper learned from Puff: "Dragons live forever but not so little boys" the children grow up, these grownups now rear their own families and their children grow up and have their own families, and where we arrive to is the passage of time, many warm memories, yet many of us are just struggling with this economy trying to hang on for dear life or suffering from health problems which continue to plague, I think we've just grown too tired to have energy at the same time. We did get to visit the folks for a bit yesterday, and saw a few family members long loved and enjoyed, a few moments together picking on the poor neighbor Joe as his lawnmower wheel popped off-laughing at his expense for a moment, and we probably all wandered in thoughts a bit thinking back to our other June gatherings, when we were young and twenty. We have a spectacular picture of all the sisters from one year that I've still got a copy of, and it captured the kids we were at heart: Puff, the magic dragon lived by the sea And frolicked in the autumn mist in a land called honah lee, Little jackie paper loved that rascal puff,And brought him strings and sealing wax and other fancy stuff. oh Puff, the magic dragon lived by the sea And frolicked in the autumn mist in a land called honah lee, Puff, the magic dragon lived by the sea And frolicked in the autumn mist in a land called honah lee. Together they would travel on a boat with billowed sail Jackie kept a lookout perched on puff’s gigantic tail, Noble kings and princes would bow whene’er they came, Pirate ships would lower their flag when puff roared out his name. oh!Puff, the magic dragon lived by the sea And frolicked in the autumn mist in a land called honah lee,Puff, the magic dragon lived by the sea And frolicked in the autumn mist in a land called honah lee. A dragon lives forever but not so little boys Painted wings and giant rings make way for other toys. One grey night it happened, jackie paper came no more, And puff that mighty dragon, he ceased his fearless roar. His head was bent in sorrow, green scales fell like rain, Puff no longer went to play along the cherry lane. Without his life-long friend, puff could not be brave, So puff that mighty dragon sadly slipped into his cave. oh!Puff, the magic dragon lived by the seaAnd frolicked in the autumn mist in a land called honah lee,Puff, the magic dragon lived by the seaAnd frolicked in the autumn mist in a land called honah lee. More lyrics: http://www.lyricsfreak.com/p/peter+paul+mary/#share

Alice, falling through the looking glass, part II of sorts.

Words. The are little items that when strewn together, can be glorious, they can be fuzzy or exacting, They can tell a long tale like King's Gunslinger, they can be a poem about Anna Belle Lee, they could Bronte's Wuthering Heights, they could be a bill list or a grocery list to keep us on target. A person of few words, more than less, we are off at the races...where's the damn rabbit? Take them as they were meant - sunglasses on - an old trick to keep the expressions from being seen :

http://youtu.be/O8xapIuoFsY # Words Bee Gees # #

Smile an everlasting smile, a smile can bring you # Near to me. # Don't ever let me find you down, cause that would # Bring a tear to me. # [Lyrics from www.EasyLyrics.org] # This world has lost its glory, lets start a brand # New story now, my love. # Right now, there'll be no other time and I can show # You how, my love. # # Talk in everlasting words, and dedicate them all to # Me. # And I will give you all my life, I'm here if you # Should call to me. # You think that I don't even mean a single word i # Say. # Its only words, and words are all I have, to take # # And I will give you all my life, I'm here if you # Should call to me. # You think that I don't even mean a single word i # Say. # Its only words, and words are all I have, to take # Your heart away

The texted announcement

"Have you ever seen the Sunrise?" Yes, and sometimes we hide out from it all. This week we received a text from one of our kin, "We got married Wednesday" we sit and look at eachother. Next text: "are you surprised?" Hmmmm.... A while back this kin dropped into our lives via phone on a friday night, we were surprised by that. The next day they drove across two states to see us, kin and woman, we were surprised by that. They wanted to talk to their GodFather, and we were surprised by that, but gracefully welcomed all, including a dog. Courses of actions were thought out or so we were told, and then the following week through an accidental meeting rendered a totally different decision, a different partner, not even introduced to this one, but the same dog. (humor) But equal plans for this one:) Now about a month later we get the text, so we sit here smiling at the surprised question.....No we're too old and tired to ever be surprised by much. We have different problems on our table than you can toss at us, we've gotten to points in our life whereby we care, and we don't care, we can only care so much. All we see is that your indecision's have most likely looped us into a dung pile with someone - somewhere, and we want no part in your Shakespearean play. We are out and out tired, and reserve ourselves for real battles we must live through. We simply want to live in the pursuit of happiness, some good health, and some laughs while we ride our very own roller coaster. Nuff said, Sunshine (laughing and shaking her head)

A serious month, November was.

How the hell did we get here? Oh time brought us all here.
It's been a serious month of health issues and running, one of us almost went down, and I still can't wrap my head around how they quit doing regiments done for light years that are still coined as having safeguarded the very items that became affected, must have stopped doing them along time back. Everything I've read points to Apple Cider Vinegar or Cayenne Pepper capsules as a healer of the most damaged thing we face. Many hours of reflections and researching have only brought me more questions. The human body is a marveling entity, can knowledge be forgotten, and more important can it be remembered now that a better place has been gotten to? And so you have to pick up a spoon to eat. And then a second person becomes ailed, November has brought the cold with it.

The rules, who makes them, and who obeys them

Speaking briefly of politics last night, my other 1/2 mentions that the US has a flaw in the system of who makes the laws, and that Congress shouldn't make the laws any longer as they've only pushed through the ones that benefit themselves, and he is totally correct, another body of voters should make the laws that affect the lawmakers, this would keep the American Public protected from the greed and corruption of a limited few trying to line their pockets with extra perks, no voting for their own raises, pensions, double dips, and they can be the very first to test out the new healthcare rules, see how they like what they've butchered the bill to.

There's a place in the sun, where there's hope for everyone....

"When was the last time, you ever saw the sunrise?" It's coming up now! Christmas morning, an emotional morning, Days of future past, Many past memories floating this morning, the mind becomes crowded, years of trees and presents wrapped, special something for everyone in family sphere, years of faces now long gone, laughter floating everywhere, Golden years turned into tensions of when will this economic nightmare finally lessen, tree shirt bare except for the truffles, a favorite of our sons who lives the days we live, and sugar plumes really had once danced in their heads, so the best of last evening was plugging in lights and the little Christmas Trees still gave us some warmth, the human spirit so resilient from love, to simply still be here was found to be enough! And old song came to mind: http://youtu.be/ogaLWgE4kUI "A Place In The Sun" Like a long lonely stream I keep runnin' towards a dream Movin' on, movin' on Like a branch on a tree I keep reachin' to be free Movin' on, movin' on 'Cause there's a place in the sun Where there's hope for ev'ryone Where my poor restless heart's gotta run There's a place in the sun And before my life is done Got to find me a place in the sun Like an old dusty road I get weary from the load Movin' on, movin' on Like this tired troubled earth I've been rollin' since my birth Movin' on, movin' on There's a place in the sun Where there's hope for ev'ryone Where my poor restless heart's gotta run There's a place in the sun And before my life is done Got to find me a place in the sun You know when times are bad And you're feeling sad I want you to always remember Yes, there's a place in the sun Where there's hope for ev'ryone Where my poor restless heart's gotta run There's a place in the sun Where there's hope for ev'ryone Where my poor restless heart's gotta run There's a place in the sun Where there's hope for ev'ryone... We've got to find us a place in the sun.......

The Santa's of the 80's 90's early 2000's

A song for two of my best friends unrelated by blood, 1 here, 1 not, who taught me how to love better, and who taught the spirit of Christmas can live in your hearts all year long, my love for you two will always reach across whatever distances trying to separate us. You were the finest Santa's of our generation, a tear & a smile:) Anne Murray - You Needed Me www.youtube.com

Christmas week 2011, my day family:

Amazing to me these last 7 years, I work in an office Suite for 1 Boss an American Russian Jewish Gent and his brother he's adopted back into our insurance fold, but help several other businesses in the suite as well as a courtesy, two attorneys ( I seat their clients, look up phone numbers for them when they call in-stood up by a client at court, keep the shared machines running & unjammed) , Several of them are of the Jewish faith as well, another couple is from India with an IT Business, and I am their token Catholic who still has enough child within to love Christmas, and we have a Christmas Tree - it was there 2004 when I arrived, at times when the phones are quiet we talk football, baseball or shoot paper into the wastepaper basket the two brothers still acting as kids, talk politics, and our disappointments with this republican congress, they are my day family:). They all gave me bonuses this week with cards of thanks, and I and the proverbial stack of bills diminished for the month.... thank them from the bottom of my heart:) There is much beauty of souls out there! Our suite proves world peace would possible if all respected each others cultural differences, we are Chrismukhah at it's finest. In truth I couldn't have done it without you. Hugs to the day family from the 24/7 family:)

Vertigo Home Remedies

Home Remedies for Vertigo Tip 1: Soak 2 tbsp wheat grain, 1 tsp poppy seeds (khus-khus), 8 almonds,8 water melon seeds and make a paste. Heat 1 tsp ghee fry 2 cloves in this add to the paste mix with milk and drink everyday for a week. Tip 2: Soak 1 tsp of alma (gooseberry) powder along with 1 tsp coriander seeds. Leave over night. Strain and add 1/2 tsp sugar and drink. Read more: Home Remedies - Natural treatment for Vertigo http://www.medindia.net/homeremedies/vertigo.asp#remedy#ixzz1h9zFhzxz And more tips:Submitted by nomorevertigo at 2011-12-08 16:53:53 from 70.114.47.55 the best way i found for me to treat vertigo has been with large doses of fresh ginger, or lacking that, ginger pills! wow does it work! 0 comments | rating: 0 (0 votes) | Submitted at 2011-05-01 02:34:16 from 110.1.66.87 My vertigo is caused by allergies, gargle with listerene often and it will help drain the fluid from the ear. You must find the cause before you can treat it. 1 comments | rating: 4 (19 votes) | Submitted by LW at 2011-03-14 12:14:32 from 76.176.114.229 Wow, these are some really interesting ideas. I specialize in detoxification and what you want to achieve is drainage. This is best done with high quality supplements found at your local natural grocer. Use Ginkgo to increase the circulation and move dirty blood and lymph out. Use Bromelain to decrease inflammation and then if you like you can follow up with a liquid tincture of Lymph detox/drainage, any brand will do. Take this on an empty stomach for faster results. Start looking for a pattern of dizziness with something you've eaten or drank. Pollen will also cause vertigo and allergies too. Remember always keep your blood and lymph and bowels moving and you will always have good health. Best of Health! 1 comments | rating: 6 (15 votes) | Submitted by liz at 2010-08-23 05:43:14 from 59.183.187.212 Dizziness or light-headedness often not life threatening can lead to fatal injuries and accidents. Advances in natural vertigo treatments helps to alleviate your symptoms without depressing your nervous system or producing drowsiness. They are safe and do not cause dependence. The natural therapy kits (Biogetica) consist of time-tested resonance homeopathic, nutraceutical and biotechnology therapies. This integrated approach has shown wonderful results in most cases. 1 comments | rating: 4 (16 votes) | Submitted by SAM at 2008-05-14 04:59:07 from 219.77.65.157 SOAK ONE TSP WHOLE CORIANDER SEEDS IN A GLASS WATER WHOLE NIGHT,STRAIN AND DRINK FOR 3 TO 4 DAYS VERTIGO WILL GO AWAY. 8 comments | rating: 4 (46 votes) |

A little girl named Chicky and the magic of Christmas

One of my first memories of our 2 Flat located at 1627 N. Richmond involved the 1st floor and the first time we lived on that floor, I remembering waking and seeing a cold gray blue painted wall, I remember being cold. I didn't care for that flat. Where I was happy and remembered many good times of early childhood was when we moved up to the 2nd floor, it had warmth, and many good times to it. No doubts for me that was where my happiest childhood years would be spent with my brothers. In a time of westerns, I was a cowgirl, no shirt-just a Diaper, Cowboy hat & two guns in my holster shared by one brother or the other. Great keepsake pic:) My earliest memories of Christmas morning involved the 5 of us being together or some times Dad slept in a few minutes longer, mom would let us snoop around the tree and look for one present the package that we thought we'd treasure the most, I believe I knew how to spell Santa before I could spell Chicky, and Chicky was my name in those days......you had to do something real bad to hear the future Proverbial "Kathleen", so Chicky was with Bobby & Frannie on Christmas morning, they would become Rob & Frank eventually and I their sister would most days be Kathy, but for now we were the other earlier version of Chicky ,Frannie, and Bobby. When Dad got up we dressed for Christmas Mass, and went to Mass, it was an overwhelming place with a large crowd of people, a parking space was hard to come by so Dad would drop us off, find a space and meet up with us, I loved the Christmas Hymms, I loved the little baby in the manger up front, I just didn't care for the smells of all the people (holiday smell later to be known as leftover-next day alcohol reek), on ocassion I'd get into trouble shortly after arriving, mesmerize by a woman in front of us who had a FOX looking off of her shoulder, as she sat back I'd try to pet it, Church does not prevent you from being whacked and told to sit (not unlike a dog-she laughs). The best part of church was baby Jesus, they told of his parents journey, they told of an inn that had no space, they told of his birth in a stable with wise me, friendly animals, and a beautiful big star in the night. It was a beautiful story, and I would not learn of King Herod's slaughter of little babies town by town until much later. That would be my first conscious thought of some tragic, my 2nd biggest impression would be the story of holy thursday, what was shaping for Jesus, and trying to reason out why Judas would betray him for money, and why no one intervened, but all that would take place when I six. Then homeward bound to 1 present and dinner, and after dinner we could open all the presents which had mysteriously come to be under our Christmas Tree on Christmas morning. It would not be until years later I would realize how very tired my folks were each Christmas Morning, 2 genie's up all night trying to magically work at putting toys together, wrapping, and sometimes putting up an entire tree in one short night, whereby they had to pray hard that the children would remain sleeping. The fun I had with my brother's who would appropriately ooo and ahhh over my little toys, and then graciously let me try a new cowboy gun, or play with army men, and try on a new baseball mitt. There never comes a Christmas that my mind doesn't wander off to some special moment we all shared together, and with Ma and Dad long gone together, now side by side, I appreciate all they tried to do, I appreciate all the hardships they endured to keep us all together, making us stronger for our own families. Family really is in large part, the spirit of Christmas, and Baby Jesus a thank you to you too, whether real or invented, you taught me much, and my love for children has always stayed strong I do believe because of you.

Twp roads diverged into a wood

When I was 13 I visited the woods daily, I was a dreamer then, and still some part of the dreamer remains, we all need to be a bit dreamer, it puts our goals out onto the horizon. I came across this poem when I was a teen, it's a great piece of poetry that defines some of us, and how we arrive at our path: “The Road Not Taken Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same, And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted if I should ever come back. I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.” ― Robert Frost

Peritoneal Dialysis could be done in the home

Home Dialysis: With peritoneal dialysis (PD), you have some choices in treating advanced and permanent kidney failure. Since the 1980s, when PD first became a practical and widespread treatment for kidney failure, much has been learned about how to make PD more effective and minimize side effects. Since you don't have to schedule dialysis sessions at a center, PD gives you more control. You can give yourself treatments at home, at work, or on trips. But this independence makes it especially important that you work closely with your health care team: your nephrologist, dialysis nurse, dialysis technician, dietitian, and social worker. But the most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life. When Your Kidneys Fail Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys. How PD Works In PD, a soft tube called a catheter is used to fill your abdomen with a cleansing liquid called dialysis solution. The walls of your abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave your body when the dialysis solution is drained. The used solution, containing wastes and extra fluid, is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in your abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges. One form of PD, continuous ambulatory peritoneal dialysis (CAPD), doesn't require a machine. As the word ambulatory suggests, you can walk around with the dialysis solution in your abdomen. Another form of PD, continuous cycler-assisted peritoneal dialysis (CCPD), requires a machine called a cycler to fill and drain your abdomen, usually while you sleep. CCPD is also sometimes called automated peritoneal dialysis (APD). Illustration of a patient receiving peritoneal dialysis. Peritoneal dialysis. Getting Ready for PD Whether you choose an ambulatory or automated form of PD, you'll need to have a soft catheter placed in your abdomen. The catheter is the tube that carries the dialysis solution into and out of your abdomen. If your doctor uses open surgery to insert your catheter, you will be placed under general anesthesia. Another technique requires only local anesthetic. Your doctor will make a small cut, often below and a little to the side of your navel (belly button), and then guide the catheter through the slit into the peritoneal cavity. As soon as the catheter is in place, you can start to receive solution through it, although you probably won't begin a full schedule of exchanges for 2 to 3 weeks. This break-in period lets you build up scar tissue that will hold the catheter in place. The standard catheter for PD is made of soft tubing for comfort. It has cuffs made of a polyester material, called Dacron, that merge with your scar tissue to keep it in place. The end of the tubing that is inside your abdomen has many holes to allow the free flow of solution in and out. Illustration of two peritoneal catheters. Two double-cuff Tenckhoff peritoneal catheters: standard (A), curled (B). Types of PD The type of PD you choose will depend on the schedule of exchanges you would like to follow, as well as other factors. You may start with one type of PD and switch to another, or you may find that a combination of automated and nonautomated exchanges suits you best. Work with your health care team to find the best schedule and techniques to meet your lifestyle and health needs. Continuous Ambulatory Peritoneal Dialysis (CAPD) If you choose CAPD, you'll drain a fresh bag of dialysis solution into your abdomen. After 4 to 6 or more hours of dwell time, you'll drain the solution, which now contains wastes, into the bag. You then repeat the cycle with a fresh bag of solution. You don't need a machine for CAPD; all you need is gravity to fill and empty your abdomen. Your doctor will prescribe the number of exchanges you'll need, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) CCPD uses an automated cycler to perform three to five exchanges during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. Customizing Your PD If you've chosen CAPD, you may have a problem with the long overnight dwell time. It's normal for some of the dextrose in the solution to cross into your body and become glucose. The absorbed dextrose doesn't create a problem during short dwell times. But overnight, some people absorb so much dextrose that it starts to draw fluid from the peritoneal cavity back into the body, reducing the efficiency of the exchange. If you have this problem, you may be able to use a minicycler (a small version of a machine that automatically fills and drains your abdomen) to exchange your solution once or several times overnight while you sleep. These additional, shorter exchanges will minimize solution absorption and give you added clearance of wastes and excess fluid. If you've chosen CCPD, you may have a solution absorption problem with the daytime exchange, which has a long dwell time. You may find you need an additional exchange in the mid-afternoon to increase the amount of waste removed and to prevent excessive absorption of solution. Preventing Problems Infection is the most common problem for people on PD. Your health care team will show you how to keep your catheter bacteria-free to avoid peritonitis, which is an infection of the peritoneum. Improved catheter designs protect against the spread of bacteria, but peritonitis is still a common problem that sometimes makes continuing PD impossible. You should follow your health care team's instructions carefully, but here are some general rules: Store supplies in a cool, clean, dry place. Inspect each bag of solution for signs of contamination before you use it. Find a clean, dry, well-lit space to perform your exchanges. Wash your hands every time you need to handle your catheter. Clean the exit site with antiseptic every day. Wear a surgical mask when performing exchanges. Keep a close watch for any signs of infection and report them so they can be treated promptly. Here are some signs to watch for: Fever Nausea or vomiting Redness or pain around the catheter Unusual color or cloudiness in used dialysis solution A catheter cuff that has been pushed out Equipment and Supplies for PD Transfer Set A transfer set is tubing that connects the bag of dialysis solution to the catheter. When your catheter is first placed, the exposed end of the tube will be securely capped to prevent infection. Under the cap is a universal connector. When you start dialysis training, your dialysis nurse will provide a transfer set. The type of transfer set you receive depends on the company that supplies your dialysis solution. Different companies have different systems for connecting to your catheter. Connecting the transfer set requires sterile technique. You and your nurse will wear surgical masks. Your nurse will soak the transfer set and the end of your catheter in an antiseptic solution for 5 minutes before making the connection. The nurse will wear rubber gloves while making the connection. Depending on the company that supplies your solution, your transfer set may require a new cap each time you disconnect from the bag after an exchange. With a different system, the tubing that connects to the transfer set includes a piece that can be clamped at the end of an exchange and then broken off from the tubing so that it stays on the transfer set as a cap until it is removed for the next exchange. Your dialysis nurse will train you in the aseptic (germ-free) technique for connecting at the beginning of an exchange and disconnecting at the end. Follow instructions carefully to avoid infection. Close-up drawing of patient holding his catheter and transfer set in his left hand and a Y-tube in his right. Only the patient's lap and hands are visible. Labels indicate the catheter, transfer set, disposable cap, clamps, a tube running from the fresh bag of solution, and a tube running to the drain bag. Transfer set. Between exchanges, you can keep your catheter and transfer set hidden inside your clothing. At the beginning of an exchange, you will remove the disposable cap from the transfer set and connect it to a Y-tube. The branches of the Y-tube connect to the drain bag and the bag of fresh dialysis solution. Always wash your hands before handling your catheter and transfer set, and wear a surgical mask whenever you connect or disconnect. Drawing of a male patient sitting in chair, performing peritoneal dialysis exchange. Labels indicate fresh bag of dialysis solution, clamp, transfer set, disposable tubing, and drain bag. During an exchange, you can read, talk, watch television, or sleep. The first step of an exchange is to drain the used dialysis solution from the peritoneal cavity into the drain bag. Near the end of the drain, you may feel a mild The first step of an exchange is to drain the used dialysis solution from the peritoneal cavity into the drain bag. Near the end of the drain, you may feel a mild "tugging" sensation that tells you most of your fluid is gone. After the used solution is removed from your abdomen, you will close or clamp the transfer set and let some of the fresh solution flow directly into the drain bag. This flushing step removes air from the tubes. After the used solution is removed from your abdomen, you will close or clamp the transfer set and let some of the fresh solution flow directly into the drain bag. This flushing step removes air from the tubes. The final step of the exchange is to refill the peritoneal cavity with fresh dialysis solution from the hanging bag. The final step of the exchange is to refill the peritoneal cavity with fresh dialysis solution from the hanging bag. Dialysis Solution Dialysis solution comes in 1.5-, 2-, 2.5-, or 3-liter bags. A liter is slightly more than 1 quart. The dialysis dose can be increased by using a larger bag, but only within the limit of the amount your abdomen can hold. The solution contains a sugar called dextrose, which pulls extra fluid from your blood. Your doctor will prescribe a formula that fits your needs. You'll need a clean space to store your bags of solution and other supplies. You may also need a special heating device to warm each bag of solution to body temperature before use. Most solution bags come in a protective outer wrapper that allows for microwave heating. Do not microwave a bag of solution after it has been removed from its wrapper because microwaving can change the chemical makeup of the solution. Cycler The cycler-which automatically fills and drains your abdomen, usually at night while you sleep-can be programmed to deliver specified volumes of dialysis solution on a specified schedule. Most systems include the following components: Solution storage. At the beginning of the session, you connect bags of dialysis solution to tubing that feeds the cycler. Most systems include a separate tube for the last bag because this solution may have a higher dextrose content so that it can work for a day-long dwell time. Pump. The pump sends the solution from the storage bags to the heater bag before it enters the body and then sends it to the disposal container or drain line after it's been used. The pump doesn't fill and drain your abdomen; gravity performs that job more safely. Heater bag. Before the solution enters your abdomen, a measured dose is warmed to body temperature. Once the solution is the right temperature and the previous exchange has been drained, a clamp is released to allow the warmed solution to flow into your abdomen. Fluid meter. The cycler's timer releases a clamp to let the used dialysis solution drain from your abdomen into a disposal container or drain line. As the solution flows through the tube, a fluid meter in the cycler measures and records how much solution has been removed. Some systems compare the amount of solution inserted with the amount drained and display the net difference between the two volumes. This lets you know whether the treatment is removing enough fluid from your body. Disposal container or drain line. After the used solution is weighed, it's pumped to a disposal container that you can throw away in the morning. With some systems, you can dispose of the used fluid directly by stringing a long drain line from the cycler to a toilet or bathtub. Alarms. Sensors will trigger an alarm and shut off the machine if there's a problem with inflow or outflow. Drawing of patient sleeping in bed. A peritoneal dialysis cycler is on the dresser beside the bed. Labels indicate the heater bag sitting on top of the cycler, two bags of fluid beside the cycler, a drain line running from the cycler to the bathroom, and parts of the cycler, including the pump and fluid meter. Cycler. A cycler performs four or five exchanges overnight, while you sleep. Testing the Effectiveness of Your Dialysis To see if the exchanges are removing enough waste products, such as urea, your health care team must perform several tests. These tests are especially important during the first weeks of dialysis to determine whether you're receiving an adequate amount, or dose, of dialysis. The peritoneal equilibration test (often called the PET) measures how much sugar has been absorbed from a bag of infused dialysis solution and how much urea and creatinine have entered into the solution during a 4-hour exchange. The peritoneal transport rate varies from person to person. If you have a high rate of transport, you absorb sugar from the dialysis solution quickly and should avoid exchanges with a very long dwell time because you're likely to absorb too much solution from such exchanges. In the clearance test, samples of used solution drained over a 24-hour period are collected, and a blood sample is obtained during the day when the used solution is collected. The amount of urea in the used solution is compared with the amount in the blood to see how effective the PD schedule is in removing urea from the blood. For the first months or even years of PD treatment, you may still produce small amounts of urine. If your urine output is more than several hundred milliliters per day, urine is also collected during this period to measure its urea concentration. From the used solution, urine, and blood measurements, your health care team can compute a urea clearance, called Kt/V, and a creatinine clearance rate (adjusted to body surface area). The residual clearance of the kidneys is also considered. These measurements will show whether the PD prescription is adequate. If the laboratory results show that the dialysis schedule is not removing enough urea and creatinine, the doctor may change the prescription by increasing the number of exchanges per day for patients treated with CAPD or per night for patients treated with CCPD increasing the volume of each exchange (amount of solution in the bag) in CAPD adding an extra, automated middle-of-the-night exchange to the CAPD schedule adding an extra middle-of-the-day exchange to the CCPD schedule For more information about testing the effectiveness of your dialysis, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet Peritoneal Dialysis Dose and Adequacy. Compliance One of the big problems with PD is that patients sometimes don't perform all of the exchanges prescribed by their medical team. They either skip exchanges or sometimes skip entire treatment days when using CCPD. Skipping PD treatments has been shown to increase the risk of hospitalization and death. Remaining Kidney Function Normally the PD prescription factors in the amount of residual, or remaining, kidney function. Residual kidney function typically falls, although slowly, over months or even years of PD. This means that more often than not, the number of exchanges prescribed, or the volume of exchanges, needs to increase as residual kidney function falls. The doctor should determine your PD dose on the basis of practice standards established by the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI). Work closely with your health care team to ensure that you get the proper dose, and follow instructions carefully to make sure you get the most out of your dialysis exchanges. Conditions Related to Kidney Failure and Their Treatments Your kidneys do much more than remove wastes and extra fluid. They also make hormones and balance chemicals in your system. When your kidneys stop working, you may have problems with anemia and conditions that affect your bones, nerves, and skin. Some of the more common conditions caused by kidney failure are fatigue, bone problems, joint problems, itching, and restless legs. Anemia and Erythropoietin (EPO) Anemia is a condition in which the volume of red blood cells is low. Red blood cells carry oxygen to cells throughout the body. Without oxygen, cells can't use the energy from food, so someone with anemia may tire easily and look pale. Anemia can also contribute to heart problems. Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells. Diseased kidneys often don't make enough EPO, and so the bone marrow makes fewer red blood cells. EPO is available commercially and is commonly given to patients on dialysis. For more information about the causes of and treatments for anemia in kidney failure, see the NIDDK fact sheet Anemia in Kidney Disease and Dialysis. Renal Osteodystrophy The term "renal" describes things related to the kidneys. Renal osteodystrophy, or bone disease of kidney failure, affects up to 90 percent of dialysis patients. It causes bones to become thin and weak or malformed and affects both children and adults. Symptoms can be seen in growing children with kidney disease even before they start dialysis. Older patients and women who have gone through menopause are at greater risk for this disease. For more information about the causes of this bone disease and its treatment in dialysis patients, see the NIDDK fact sheet Renal Osteodystrophy. Itching (Pruritus) Many people treated with peritoneal dialysis complain of itchy skin. Itching is common even in people who don't have kidney disease; with kidney failure, however, itching can be made worse by uremic toxins in the blood that dialysis doesn't adequately remove. The problem can also be related to high levels of parathyroid hormone (PTH). Some people have found dramatic relief after having their parathyroid glands removed. But a cure that works for everyone has not been found. Phosphate binders seem to help some people; others find relief after exposure to ultraviolet light. Still others improve with EPO shots. A few antihistamines (Benadryl, Atarax, Vistaril) have been found to help; also, capsaicin cream applied to the skin may relieve itching by deadening nerve impulses. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help. Sleep Disorders Patients on dialysis often have insomnia, and some people have a specific problem called sleep apnea syndrome. Episodes of apnea are breaks in breathing during sleep. Over time, these sleep disturbances can lead to "day-night reversal" (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing. Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose, called nasal continuous positive airway pressure (CPAP). Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or restless legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. Theories about the causes of this syndrome include nerve damage and chemical imbalances. Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. A class of drugs called benzodiazepines, often used to treat insomnia or anxiety, may help as well. These prescription drugs include Klonopin, Librium, Valium, and Halcion. A newer and sometimes more effective therapy is levodopa (Sinemet), a drug used to treat Parkinson's disease. Sleep disorders may seem unimportant, but they can impair your quality of life. Don't hesitate to raise these problems with your nurse, doctor, or social worker. Amyloidosis Dialysis-related amyloidosis (DRA) is common in people who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit on joints and tendons, causing pain, stiffness, and fluid in the joints, as is the case with arthritis. Working kidneys filter out these proteins, but dialysis is not as effective. For more information, see the NIDDK fact sheet Amyloidosis and Kidney Disease. Adjusting to Changes You can do your exchanges in any clean space, and you can take part in many activities with solution in your abdomen. Even though PD gives you more flexibility and freedom than hemodialysis, which requires being connected to a machine for 3 to 5 hours three times a week, you must still stick to a strict schedule of exchanges and keep track of supplies. You may have to cut back on some responsibilities at work or in your home life. Accepting this new reality can be very hard on you and your family. A counselor or social worker can help you cope. Many patients feel depressed when starting dialysis, or after several months of treatment. Some people can't get used to the fact that the solution makes their body look larger. If you feel depressed, you should talk with your social worker, nurse, or doctor because depression is a common problem that can often be treated effectively. How Diet Can Help Eating the right foods can help improve your dialysis and your health. You may have chosen PD over hemodialysis because the diet is less restrictive. With PD, you're removing wastes from your body slowly but constantly, while in hemodialysis, wastes may build up for 2 or 3 days between treatments. You still need to be very careful about the foods you eat, however, because PD is much less efficient than working kidneys. Your clinic has a dietitian to help you plan meals. Follow the dietitian's advice closely to get the most from your dialysis treatments. You can also ask your dietitian for recipes and titles of cookbooks for patients with kidney disease. Following the restrictions of a diet for kidney failure might be hard at first, but with a little creativity, you can make tasty and satisfying meals. The National Kidney Foundation has a brochure on Nutrition and Peritoneal Dialysis, which gives general guidelines on calorie and nutrient intake. See the "Additional Reading" section for contact information. Financial Issues Treatment for kidney failure is expensive, but Federal health insurance programs pay much of the cost, usually up to 80 percent. Often, private insurance or State programs pay the rest. Your social worker can help you locate resources for financial assistance. For more information, see the NIDDK fact sheet Financial Help for Treatment of Kidney Failure. The End-Stage Renal Disease Program promotes research to reduce medical problems from bone, blood, nervous system, metabolic, gastrointestinal, cardiovascular, and endocrine abnormalities in kidney failure and to improve the effectiveness of dialysis and transplantation. The research focuses on reusing hemodialysis membranes and using alternative dialyzer sterilization methods; devising more efficient, biocompatible membranes; refining high-flux hemodialysis; and developing criteria for dialysis adequacy. The program also seeks to increase kidney graft and patient survival and to maximize quality of life. The U.S. Renal Data System (USRDS) collects, analyzes, and distributes information about the use of dialysis and transplantation to treat kidney failure in the United States. The USRDS is funded directly by the NIDDK in conjunction with the Health Care Financing Administration. The USRDS publishes an Annual Data Report, which characterizes the total population of people being treated for kidney failure; reports on incidence, prevalence, mortality rates, and trends over time; and develops data on the effects of various treatment modalities. The report also helps identify problems and opportunities for more focused special studies of renal research issues. Organizations That Can Help American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, MD 20852 Phone: 1-800-638-8299 Email: helpline@kidneyfund.org Internet: www.kidneyfund.org click to view disclaimer page Life Options Rehabilitation Program c/o Medical Education Institute Inc. 414 D'Onofrio Drive Suite 200 Madison, WI 53711-1074 Phone: 1-800-468-7777 Email: lifeoptions@MEIresearch.org Internet: www.lifeoptions.org click to view disclaimer page www.kidneyschool.org click to view disclaimer page National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Email: info@kidney.org Internet: www.kidney.org click to view disclaimer page Additional Reading If you would like to learn more about kidney failure and its treatment, you may be interested in reading AAKP Patient Plan This is a series of booklets and newsletters that cover the different phases of learning about kidney failure, choosing a treatment, and adjusting to changes. American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page Getting the Most From Your Treatment series This is a series of brochures based on the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF-DOQI). Titles include What You Need To Know About Peritoneal Dialysis, What You Need To Know Before Starting Dialysis, and What You Need To Know About Anemia. Additional patient education brochures include information on diet, work, and exercise. National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Email: info@kidney.org Internet: www.kidney.org click to view disclaimer page Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Publication Number CMS-10128 U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-1850 Phone: 1-800-MEDICARE (1-800-633-4227) TDD: 1-877-486-2048 Internet: www.medicare.gov/publications/pubs/pdf/10128.pdf (717 KB) * Nutrition and Peritoneal Dialysis National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Email: info@kidney.org Internet: www.kidney.org click to view disclaimer page Newsletters and Magazines Family Focus Newsletter (published quarterly) National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Email: info@kidney.org Internet: www.kidney.org click to view disclaimer page Renalife (published quarterly) American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: nkudic@info.niddk.nih.gov Internet: www.kidney.niddk.nih.gov

Dialysis, Hemodialysis

Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Since the 1960s, when hemodialysis first became a practical treatment for kidney failure, we've learned much about how to make hemodialysis treatments more effective and minimize side effects. In recent years, more compact and simpler dialysis machines have made home dialysis increasingly attractive. But even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort from your whole health care team, including your nephrologist, dialysis nurse, dialysis technician, dietitian, and social worker. The most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life. When Your Kidneys Fail Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys. How Hemodialysis Works In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body. One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule. Most patients go to a clinic-a dialysis center-three times a week for 3 to 5 or more hours each visit. For example, you may be on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule. You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments. Researchers are exploring whether shorter daily sessions, or longer sessions performed overnight while the patient sleeps, are more effective in removing wastes. Newer dialysis machines make these alternatives more practical with home dialysis. But the Federal Government has not yet established a policy to pay for more than three hemodialysis sessions a week. Several centers around the country teach people how to perform their own hemodialysis treatments at home. A family member or friend who will be your helper must also take the training, which usually takes at least 4 to 6 weeks. Home dialysis gives you more flexibility in your dialysis schedule. With home hemodialysis, the time for each session and the number of sessions per week may vary, but you must maintain a regular schedule by giving yourself dialysis treatments as often as you would receive them in a dialysis unit. Adjusting to Changes Even in the best situations, adjusting to the effects of kidney failure and the time you spend on dialysis can be difficult. Aside from the "lost time," you may have less energy. You may need to make changes in your work or home life, giving up some activities and responsibilities. Keeping the same schedule you kept when your kidneys were working can be very difficult now that your kidneys have failed. Accepting this new reality can be very hard on you and your family. A counselor or social worker can answer your questions and help you cope. Many patients feel depressed when starting dialysis, or after several months of treatment. If you feel depressed, you should talk with your social worker, nurse, or doctor because this is a common problem that can often be treated effectively. Getting Your Vascular Access Ready Arm with an arteriovenous fistula. Arteriovenous fistula. One important step before starting hemodialysis is preparing a vascular access, a site on your body from which your blood is removed and returned. A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient removal and replacement of your blood with fewer complications. For more information about the different kinds of vascular accesses and how to care for them, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet Vascular Access for Hemodialysis. Equipment and Procedures When you first visit a hemodialysis center, it may seem like a complicated mix of machines and people. But once you learn how the procedure works and become familiar with the equipment, you'll be more comfortable. The dialysis machine is about the size of a dishwasher. This machine has three main jobs: pump blood and watch flow for safety clean wastes from blood watch your blood pressure and the rate of fluid removal from your body Dialyzer Structure of a typical hollow fiber dialyzer. The dialyzer is a large canister containing thousands of small fibers through which your blood is passed. Dialysis solution, the cleansing fluid, is pumped around these fibers. The fibers allow wastes and extra fluids to pass from your blood into the solution, which carries them away. The dialyzer is sometimes called an artificial kidney. Reuse. Your dialysis center may use the same dialyzer more than once for your treatments. Reuse is considered safe as long as the dialyzer is cleaned before each use. The dialyzer is tested each time to make sure it's still working, and it should never be used for anyone but you. Before each session, you should be sure that the dialyzer is labeled with your name and check to see that it has been cleaned, disinfected, and tested. Dialysis Solution Dialysis solution, also known as dialysate, is the fluid in the dialyzer that helps remove wastes and extra fluid from your blood. It contains chemicals that make it act like a sponge. Your doctor will give you a specific dialysis solution for your treatments. This formula can be adjusted based on how well you handle the treatments and on your blood tests. Needles Many people find the needle sticks to be one of the hardest parts of hemodialysis treatments. Most people, however, report getting used to them after a few sessions. If you find the needle insertion painful, an anesthetic cream or spray can be applied to the skin. The cream or spray will numb your skin briefly so you won't feel the needle. Most dialysis centers use two needles-one to carry blood to the dialyzer and one to return the cleaned blood to your body. Some specialized needles are designed with two openings for two-way flow of blood, but these needles are less efficient and require longer sessions. Needles for high-flux or high-efficiency dialysis need to be a little larger than those used with regular dialyzers. Some people prefer to insert their own needles. You'll need training on inserting needles properly to prevent infection and protect your vascular access. You may also learn a "ladder" strategy for needle placement in which you "climb" up the entire length of the access session by session so that you don't weaken an area with a grouping of needle sticks. A different approach is the "buttonhole" strategy in which you use a limited number of sites but insert the needle back into the same hole made by the previous needle stick. Whether you insert your own needles or not, you should know these techniques to better care for your access. Tests to See How Well Your Dialysis Is Working About once a month, your dialysis care team will test your blood by using one of two formulas-URR or Kt/V-to see whether your treatments are removing enough wastes. Both tests look at one specific waste product, called blood urea nitrogen (BUN), as an indicator for the overall level of waste products in your system. For more information about these measurements, see the NIDDK fact sheet Hemodialysis Dose and Adequacy. Conditions Related to Kidney Failure and Their Treatments Your kidneys do much more than remove wastes and extra fluid. They also make hormones and balance chemicals in your system. When your kidneys stop working, you may have problems with anemia and conditions that affect your bones, nerves, and skin. Some of the more common conditions caused by kidney failure are extreme tiredness, bone problems, joint problems, itching, and "restless legs." Restless legs will keep you awake as you feel them twitching and jumping. Anemia and Erythropoietin (EPO) Anemia is a condition in which the volume of red blood cells is low. Red blood cells carry oxygen to cells throughout the body. Without oxygen, cells can't use the energy from food, so someone with anemia may tire easily and look pale. Anemia can also contribute to heart problems. Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin, or EPO, which stimulates the bone marrow to produce red blood cells. Diseased kidneys often don't make enough EPO, and so the bone marrow makes fewer red blood cells. EPO is available commercially and is commonly given to patients on dialysis. For more information about the causes of and treatments for anemia in kidney failure, see the NIDDK fact sheet Anemia in Kidney Disease and Dialysis. Renal Osteodystrophy The term "renal" describes things related to the kidneys. Renal osteodystrophy, or bone disease of kidney failure, affects 90 percent of dialysis patients. It causes bones to become thin and weak or formed incorrectly and affects both children and adults. Symptoms can be seen in growing children with kidney disease even before they start dialysis. Older patients and women who have gone through menopause are at greater risk for this disease. For more information about the causes of this bone disease and its treatment in dialysis patients, see the NIDDK fact sheet Renal Osteodystrophy. Itching (Pruritus) Many people treated with hemodialysis complain of itchy skin, which is often worse during or just after treatment. Itching is common even in people who don't have kidney disease; in kidney failure, however, itching can be made worse by wastes in the bloodstream that current dialyzer membranes can't remove from the blood. The problem can also be related to high levels of parathyroid hormone (PTH). Some people have found dramatic relief after having their parathyroid glands removed. The four parathyroid glands sit on the outer surface of the thyroid gland, which is located on the windpipe in the base of your neck, just above the collarbone. The parathyroid glands help control the levels of calcium and phosphorus in the blood. But a cure for itching that works for everyone has not been found. Phosphate binders seem to help some people; these medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Others find relief after exposure to ultraviolet light. Still others improve with EPO shots. A few antihistamines (Benadryl, Atarax, Vistaril) have been found to help; also, capsaicin cream applied to the skin may relieve itching by deadening nerve impulses. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help. Sleep Disorders Patients on dialysis often have insomnia, and some people have a specific problem called the sleep apnea syndrome, which is often signaled by snoring and breaks in snoring. Episodes of apnea are actually breaks in breathing during sleep. Over time, these sleep disturbances can lead to "day-night reversal" (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing. Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose (nasal continuous positive airway pressure, or CPAP). Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or "restless" legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. The causes of restless legs may include nerve damage or chemical imbalances. Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. A class of drugs called benzodiazepines, often used to treat insomnia or anxiety, may help as well. These prescription drugs include Klonopin, Librium, Valium, and Halcion. A newer and sometimes more effective therapy is levodopa (Sinemet), a drug used to treat Parkinson's disease. Sleep disorders may seem unimportant, but they can impair your quality of life. Don't hesitate to raise these problems with your nurse, doctor, or social worker. Amyloidosis Dialysis-related amyloidosis (DRA) is common in people who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit on joints and tendons, causing pain, stiffness, and fluid in the joints, as is the case with arthritis. Working kidneys filter out these proteins, but dialysis filters are not as effective. For more information, see the NIDDK fact sheet Amyloidosis and Kidney Disease. How Diet Can Help Eating the right foods can help improve your dialysis and your health. Your clinic has a dietitian to help you plan meals. Follow the dietitian's advice closely to get the most from your hemodialysis treatments. Here are a few general guidelines. Fluids. Your dietitian will help you determine how much fluid to drink each day. Extra fluid can raise your blood pressure, make your heart work harder, and increase the stress of dialysis treatments. Remember that many foods-such as soup, ice cream, and fruits-contain plenty of water. Ask your dietitian for tips on controlling your thirst. Potassium. The mineral potassium is found in many foods, especially fruits and vegetables. Potassium affects how steadily your heart beats, so eating foods with too much of it can be very dangerous to your heart. To control potassium levels in your blood, avoid foods like oranges, bananas, tomatoes, potatoes, and dried fruits. You can remove some of the potassium from potatoes and other vegetables by peeling and soaking them in a large container of water for several hours, then cooking them in fresh water. Potatoes soaking in water. You can remove some potassium from potatoes by soaking them in water. Phosphorus. The mineral phosphorus can weaken your bones and make your skin itch if you consume too much. Control of phosphorus may be even more important than calcium itself in preventing bone disease and related complications. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus and should be avoided. You'll probably need to take a phosphate binder with your food to control the phosphorus in your blood between dialysis sessions. Salt (sodium chloride). Most canned foods and frozen dinners contain high amounts of sodium. Too much of it makes you thirsty, and when you drink more fluid, your heart has to work harder to pump the fluid through your body. Over time, this can cause high blood pressure and congestive heart failure. Try to eat fresh foods that are naturally low in sodium, and look for products labeled "low sodium." Protein. Before you were on dialysis, your doctor may have told you to follow a low-protein diet to preserve kidney function. But now you have different nutritional priorities. Most people on dialysis are encouraged to eat as much high-quality protein as they can. Protein helps you keep muscle and repair tissue, but protein breaks down into urea (blood urea nitrogen, or BUN) in your body. Some sources of protein, called high-quality proteins, produce less waste than others. High-quality proteins come from meat, fish, poultry, and eggs. Getting most of your protein from these sources can reduce the amount of urea in your blood. Calories. Calories provide your body with energy. Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils-like olive, canola, and safflower oils-are good sources of calories and do not contribute to problems controlling your cholesterol. Hard candy, sugar, honey, jam, and jelly also provide calories and energy. If you have diabetes, however, be very careful about eating sweets. A dietitian's guidance is especially important for people with diabetes. Supplements. Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Dialysis also removes some vitamins from your body. Your doctor may prescribe a vitamin and mineral supplement designed specifically for people with kidney failure. Take your prescribed supplement after treatment on the days you have hemodialysis. Never take vitamins that you can buy off the store shelf, since they may contain vitamins or minerals that are harmful to you. You can also ask your dietitian for recipes and titles of cookbooks for patients with kidney disease. Following the restrictions of a diet for kidney disease might be hard at first, but with a little creativity, you can make tasty and satisfying meals. For more information, see the NIDDK booklet Eat Right to Feel Right on Hemodialysis. Financial Issues Treatment for kidney failure is expensive, but Federal health insurance plans pay much of the cost, usually up to 80 percent. Often, private insurance or State programs pay the rest. Your social worker can help you locate resources for financial assistance. For more information, see the NIDDK fact sheet Financial Help for Treatment of Kidney Failure. Hope through Research The NIDDK, through its Division of Kidney, Urologic, and Hematologic Diseases, supports several programs and studies devoted to improving treatment for patients with progressive kidney disease and permanent kidney failure, including patients on hemodialysis. The End-Stage Renal Disease Program promotes research to reduce medical problems from bone, blood, nervous system, metabolic, gastrointestinal, cardiovascular, and endocrine abnormalities in kidney failure and to improve the effectiveness of dialysis and transplantation. The research focuses on evaluating different hemodialysis schedules and on finding the most useful information for measuring dialysis adequacy. The program also seeks to increase kidney graft and patient survival and to maximize quality of life. The HEMO Study, completed in 2002, tested the theory that a higher dialysis dose and/or high-flux membranes would reduce patient mortality (death) and morbidity (medical problems). Doctors at 15 medical centers recruited more than 1,800 hemodialysis patients and randomly assigned them to high or standard dialysis doses and high- or low-flux filters. The study found no increase in the health or survival of patients who had a higher dialysis dose, who dialyzed with high-flux filters, or who did both. The U.S. Renal Data System (USRDS) collects, analyzes, and distributes information about the use of dialysis and transplantation to treat kidney failure in the United States. The USRDS is funded directly by the NIDDK in conjunction with the Centers for Medicare & Medicaid Services. The USRDS publishes an Annual Data Report click to view disclaimer page, which identifies the total population of people being treated for kidney failure; reports on incidence, prevalence, death rates, and trends over time; and develops data on the effects of various treatment approaches. The report also helps identify problems and opportunities for more focused special studies of renal research issues. The Hemodialysis Vascular Access Clinical Trials Consortium is conducting a series of multicenter, clinical trials of drug therapies to reduce the failure and complication rate of arteriovenous (AV) grafts and fistulas in hemodialysis. These studies are randomized and placebo ontrolled, which means the studies meet the highest standard for scientific accuracy. AV grafts and fistulas prepare the arteries and veins for regular dialysis. See the NIDDK fact sheet Vascular Access for Hemodialysis for more information. Recently developed drugs to prevent blood clots may be evaluated in these large clinical trials. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. Resources Organizations That Can Help American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, MD 20852 Phone: 1-800-638-8299 or 301-881-3052 Email: helpline@kidneyfund.org Internet: www.kidneyfund.org click to view disclaimer page Life Options Rehabilitation Program c/o Medical Education Institute, Inc. 414 D'Onofrio Drive Suite 200 Madison, WI 53719 Phone: 1-800-468-7777 or 608-232-2333 Email: lifeoptions@MEIresearch.org Internet: www.lifeoptions.org click to view disclaimer page www.kidneyschool.org click to view disclaimer page National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Internet: www.kidney.org click to view disclaimer page Additional Reading If you would like to learn more about kidney failure and its treatment, you may be interested in reading AAKP Patient Plan A series of booklets and newsletters that cover the different phases of learning about kidney failure, choosing a treatment, and adjusting to changes. American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page Getting the Most From Your Treatment series A series of brochures based on the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF-DOQI). Titles include What You Need to Know About Peritoneal Dialysis, What You Need to Know Before Starting Dialysis, and What You Need to Know About Anemia. Additional patient education brochures include information on diet, work, and exercise. National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Internet: www.kidney.org click to view disclaimer page Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Publication Number CMS-10128 U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244-1850 Phone: 1-800-MEDICARE (1-800-633-4227) TDD: 1-877-486-2048 Internet: www.medicare.gov/publications/pubs/pdf/10128.pdf (717 KB) * Newsletters and Magazines Family Focus Newsletter (published quarterly) National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or 212-889-2210 Internet: www.kidney.org click to view disclaimer page For Patients Only (published six times a year) ATTN: Subscription Department 18 East 41st Street 20th Floor New York, NY 10017-6222 Renalife (published quarterly) American Association of Kidney Patients 3505 East Frontage Road Suite 315 Tampa, FL 33607 Phone: 1-800-749-2257 Email: info@aakp.org Internet: www.aakp.org click to view disclaimer page About the Kidney Failure Series You and your doctor will work together to choose a treatment that's best for you. The booklets and fact sheets of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face. Booklets Eat Right to Feel Right on Hemodialysis Kidney Failure: Choosing a Treatment That's Right for You Kidney Failure Glossary Treatment Methods for Kidney Failure: Hemodialysis Treatment Methods for Kidney Failure: Peritoneal Dialysis Treatment Methods for Kidney Failure: Transplantation Fact Sheets Amyloidosis and Kidney Disease Anemia in Kidney Disease and Dialysis Financial Help for Treatment of Kidney Failure Hemodialysis Dose and Adequacy Kidney Failure: What to Expect Peritoneal Dialysis Dose and Adequacy Chronic Kidney Disease-Mineral and Bone Disorder (formerly Renal Osteodystrophy) Vascular Access for Hemodialysis Learning as much as you can about your treatment will help make you an important member of your health care team. www.kidney.niddk.nih.gov/kudiseases/pubs/kidneyfailure/index.aspx. National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: nkudic@info.niddk.nih.gov Internet: www.kidney.niddk.nih.gov The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. The NKUDIC Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: nkudic@info.niddk.nih.gov Internet: www.kidney.niddk.nih.gov

Thank you for the best parts of 2011

Thanksgiving Day, so many memories, so many years, so many families, all of the segments that have at one year or another encompassed our lives, and shaped us into who we are. Sometime after we met some of the people loved us and thought we were like a good peanut butter and jelly, and others wagered on our longevity. Child loss would make us or break us, so I rolled with your words of us being strengthened, and onward we walked. Midlife crises would have us wagering on ourselves, and throw others into sadness, yet hoping we would walk on. Sorrow brought us together with a depth of love, and yet some wonder at who we had become, yet we have happiness for all that we had remained. The best part of life is still seeing you walk through any doorway, any time of the day, the best part of the night is having your tired self beside mine. And so Thanksgiving Day is spent with Grandpa who was way happy to have the chance in the morning to talk with us, to show us the book he's re-reading in his quest for more knowledge of the human body and what could have brought this particular problem on, not for the purpose of hindsight but for the purpose of strengthening ,of doing as many right things as possible to correct it to it's best level. We take him for his adventure and on the way in the Asian man is dropped off by a taxi, you tell me you saw him wandering on the first floor looking disoriented so you asked him if he wasn't looking for the 2nd floor, and here 15 minutes later he wanders in , you say usually his son is with him, and that you're wondering why he came in a cab when he shouldn't really be out alone. The Acer provides us with time to do searches together to keep up with Grandpa's own research of Acupunture massage techniques, us looking for the corresponding point or Meridian, we have both come to believe in 1/2 natural/1/2 medical or possibly a blend of the two improving many things, we read of Stinging Nettle, Salvi, Cayenne and Cinnamon, ancient China, and it's old ways of mending people. You surprised me with humor during the wait feeding me pretzels and coke, sharing 50/50. And later when you go to get the car you spot the people park their newer car and walk the 1/2 block to stand in line at the Salvation army food line for the needy, and you wonder as do I why? How many do that? But really why? How? And so we have one more conversation with Grandpa batteries changed so he can know any progress of searches. We have dinner at the house with Grandma & Grandpa. It was a very humble Thanksgiving, everyone happy for what we have, today. We arrive back home, our son has been cooking for us as well, as we relax and update we have a 2nd meal made with equal love. We are lucky or blessed.

Yesterday my Boss'es email got hacked, so emotional...

"Have you ever seen the Sunrise?" I think this is a heart warming humorous story, all of it true, yet so funny, pitiful, and full of warmth all at the same time. These days to conserve on gas I am stuck in Buffalo Grove for lunch, so I take 15 minutes outside and return to my desk I thought to get ahead, I laugh, the phones start ringing off the hook and simultaneously my email starts populating with 1 liner subjects that all read the same: "It's me Ted I've been in a bad auto accident in the UK, my families been injured, my papers have been destroyed can you please help me?" I knew instantly my bosses email had been hacked, now these Hackers were excellent in the work, they sent this email out to all of our customers and all of our insurance carriers, I sounded like a like a good natured robot as I repeated over and over again that "he had been hacked, here was here in the office in the good old USA", OMG over 70-90 calls in 3 1/2 hours (yes, I am still laughing), I told my boss who is also a good friend to me most days that if he ever dies I will not go to his wake as I believe we held it yesterday afternoon (still laughing). Now his side of things: His contacts are all gone, all of his emailings and pending applications and forms sent to him by carriers, other agencies, and customers, everything in the inbox is gone permanently, all sents are gone, he changed his password, and called A T & T who can do nothing to restore this information, they claim they don't have it. And until late yesterday afternoon he couldn't receive emails either, so we believe the hacker kept receiving what should have been ours. Another 3 phone calls to A T & T to try to resolve something better. Oh was he mad, and understandably, he was more mad at himself than the hackers: Yesterday morning he received what he thought was an A T & T inquiry about recent work done (and we did have a new router installed 2 weeks back, sad to say), he answered the email, and WHALAA....Hacked, racked and rolled. Now back to my side, I cannot express how many of our friends from customers to insurance carriers called offering assistance if he really was injured, they all thought it might be a hacking, but they would never not call to check on him, and many emailed me as well, some people who had come from Europe originally were the most upset, as they now bad things can happen and in Europe you are lost if you don't have your papers, a few customers actually wrote back to the hacker poising as Ted offering to send money, the Hacker gave them his address in the UK C/O a Hospital of course, and for them to wire the money to them, hopefully all of these customers called through to me first.....and so I sent out 700-900 emails yesterday to people as a one liner that " Ted's email account had been hacked, he safe & sound in the U.S.A./Buffalo Grove Office" :) It was astoundingly beautiful how many people care for this one man who still donate's his time and money to Children's Memorial Hospital, Ted Wankovsky is Good People. A glass of wine at 6pm = Home to the safety of Rick.

Enough to be thankful for

"Have you ever seen the Sunrise?" This is only a blog, and yet it has parts of my soul in it, it always has going back to our conception of it which coincided with our Mike and all of our sadness for that particular chapter, he was a very good man, a very good friend to all of us, and yet so many days he must have chuckled at our own madness and moments of our insanity, we as a group and sub groups have so many quirks, how the hell did he stay so even with us all, I still am amazed and filled with wonder at that, with a smile for his deeds. So today my soul is wondering at the adequate good fortune which visited us this week, as one set of circumstances diminished, another set came along like a life boat that may save us from the unbeatable third round which would have been the landslide. And so we head in towards thanksgiving about a week out, and with tears that still won't shed, we give sincere thanks for 1 man we've gotten to retain for awhile longer, we give thanks to a group of men who remembered us at just the right time and give us a lifeline to hang in there with this upcoming season, men that we connect with safety and security of old, we've had two little babies born to our families this year and especially since they were very rocky in their entrances we give a grand thank you for their safety and continued development, and we give thanks for all our family members. And I especially give thanks for my time with you, I could never love anyone as much as I love you, you still simply amaze me. So I end with a story to make you wonder where I give my thanks to: “In the beginning, God created the earth, and he looked upon it in his cosmic loneliness. And God said, "Let Us make living creatures out of mud, so the mud can see what We have done." And God created every living creature that now moveth, and one was man. Mud as man alone could speak. God leaned close to mud as man sat, looked around, and spoke. "What is the purpose of all this?" he asked politely. "Everything must have a purpose?" asked God. "Certainly," said man. "Then I leave it to you to think of one for all this," said God. And He went away.” ― Kurt Vonnegut, Cat's Cradle

My other friend, home

"Have you ever seen the Sunrise?" Yes, and yes. My other friend who has been ill came home last night. I am happy for this. It is an opportunity for him, it is an opportunity for us. It is something we did not have a few weeks back. When you value someone, you look for the best to shape up, and for opportunities on level playing ground to be shaped. That is all I hoped for. And yes, I challenged a few times, not to be naughty but to get to today and this opportunity. It is all about unconditional love, and a man who has been a good teacher and friend. "I wish you enough". "I wish us enough"

11/15/2011 - 1st day of layoff 101, 102 & 103

I remember 2008 and the stock market going crazy, I remember trying to protect a now evaporated 401K, I remember hearing about crooks and ponzi schemes, I remember the 1st lay off of 2009, and the second one of 2010, and today we arrive at the new official one of 2011. It's already been such a long haul for so many including us, resources used up, penalties were paid, slowly household and people run down, repairs don't get made, clothing gets threadbare, and so at a very somber level we enter another challenge, but Dear America we enter it totally leveled, we clearly see that while one half is somber trying to meet the daily horizon, that the other half is still very oblivious to what we experience, what has become our norm, suffice it to say I added three new Mercedes yesterday onto various policies, and I worry for us about who will need the next repair, I already know of two vehicles in need of parts and labor. We haven't been to a restaurant in years, I simply worry about how to get reduced weekly groceries. So believe me we are not on the same playing ground here. The Band-aids are used up, and the people less resourceful, so diminish a little each year. But while we're out there, we have to be able to smile and shine with all the personality types encountered. That is getting harder too. If I was Sunshine today, I'd have a little cloud in front of me, and just be peeking out.

Thoughts conveyed, not always verbalized

Fathers and Friends: My own Father was actually quite a wonderful man, he was very hard working man working 1 1/2 jobs for a good 20 years as needed by the household, a printer by trade after having served in WWII As an American Army Artillery Sargent, he was in Belgium, experienced Antwerp and Buzz Bombs, traveled through France and into Germany, he was always a family man, loved fishing, gardening, and working on all types of remodeling projects around the house. When he retired he found out he enjoyed being a Grandpa, lots of imagination was funneled through to my youngster due to living duplex-ed. He passed away suddenly in 1990. I lucked out some 36 years back, and met the right person and married, and have journeyed long and far until now, plenty of growing spurts, plenty of hills to climb, we've had the good fortune to be similar in many personality traits, yet never at the same time, so we've stayed pretty well balance, we both have humor, we can both have a temperamental spell, but one is always sane, one is always finding something good, and this keeps the other on track. Now his Dad has been one of the most colorful characters throughout our adult lives. He has dabbled in painting pictures, learning how to play instruments, Herbal medicine knowledge has become through reading his personal preference, he has since the time of DOS and the first home computers constantly educated himself on the upgrades and programs developed for some 20 years, totally staying on top of this tremendous evolution that brought more knowledge to his doorstep, he has for many years learned about mulches, composts, and natural means to care for lawns, he has been a helpful neighbor to others less fortunate, he has tried to be an outstanding family person to all who have been family to him, his own bloodline, his wife's bloodline, and all of the people who married his offspring(s), all of the Grand Children, and now their children have all felt this mans humor, love, concern and kindness. I know we say things of importance to people, our I love you's and we show appreciation for all they've been to us, but sometimes isn't it simply amazing to see just how many lives have been affected by these men and / or women we call Family or Friend? Sometimes, when you're together in a larger grouping can you see all the strands of relationships that run back to one person and the beauty of it?

Thrashing the house

2 days of insomnia now. Yesterday morning I woke up at 2:15am, made coffee, read emails, but knew I had a lot I wanted to accomplish for the family, and some of it had to do with dreaded paperwork, trying on a long shot to better some situations before the income drop pending, so to put things to rights, sometimes you have to tear the house apart looking for those 2-3 elusive pieces of paper needed for review, it became quite a quest. While this never diagnosed child of addh looked, she encountered a good 43 other things she's wanted to work on or put to rights which included some books, shelving units in the bedroom, and more books and boxes in the basement, so needless to say I tore the place apart....and any Humpty-Dumpty could tell you that the damages I did by noon would take until late evening to correct, and all the heavy boxes lifted up and down & back up into the storage areas as I sought my mental solutions to how I wanted things re-arranged. Now I can say, okay Dear "I've found all of your construction related books you might need for those upcoming classes you're taking soon." Sometimes when I write I cannot even begin to put across the humor with which I view my own insane methods:)

A Persons Beliefs

The 100 years from now, always echoes, I observe my daily world, and also take into account what others must see or experience. Each of us grows up soaking in all that plays out in our environment. We sometimes marry and rear a family, we are still soaking in our environment, but now even better we try to give that knowledge to the people we encounter, especially our Children and Grandchildren once they evolve. We are teaching good things we've learned and we teach them to stay away from bad things. We teach them how to care for themselves, we teach them when to get help. We teach them their religion of choice. Along the way we find a few people who refuse to grow and learn, who refuse to really live, they close themselves off and think that the life they see displayed on a Television are reality, as they aren't out involved in real time life. They are perhaps simply afraid to live real life, to go out into the world, some become afraid to go out of their own homes,and prefer to hide out in the sanity of home surroundings, thus limiting contact with genuine humans and the commonality of man. So we all differ, yet carry on in our path of comfort and teach, and learn more information, we crave information, it's become a habit to try and add another tier to the knowledge bank. We delve, we explore, we reassemble our puzzled pieces when they don't fit, and then we move on. Our love is given by teaching and nurturing. It is a persons beliefs that draw us in or can on occasion push us out from them. It is our own beliefs that pull others to us, or repel them, or both. It is an okay process for this great journey called life, and yes 100 years from now at least 3-4 generations would be affected. Live it to the fullest.