Three Beautiful Things 07-17-2025: Discussing Early Signs of Rejection with Dr. Bieber, I Found Them!, Pizza and Puzzles

1. I saw Dr. Bieber today. He's the kidney doctor from Kootenai Health I've been seeing since January, 2020. 

We talked at some length today about the early signs of my immune system rejecting my new kidney, how things look now, and what the plan is moving forward. 

I'm going to write at some length recounting, as best I can, our conversation. 

First of all, a vitally important aspect of transplantation is to keep the recipient's immune system from rejecting the new kidney. My immune system recognizes that the transplanted organ is not one I had at birth and its response is to attack it and shut it down -- that is, reject it. 

So, early on, when I received this new kidney, part of the process was to front load my system with a high volume of anti-rejection medicine(s) and to begin my lifelong regimen of taking anti-rejection meds daily. 

As a result, my body's immunity against infection of any kind was greatly diminished. 

From that point forward, and for as long as I am alive, the transplant team at Sacred Heart in Spokane and Dr. Bieber at Kootenai Health, will always be working to strike a balance between keeping enough anti-rejection meds in my system so that my immune system doesn't attack/reject my new kidney, but, at the same time, keeping my immune system strong enough to ward off infection. 

So here's what Dr. Bieber thinks happened in the last few months. It's not uncommon and this problem can be addressed and treated and that's what is happening with me right now.

Two viruses are of concern post-transplant: one is known as the BK virus and the other is the CMV.

My labs a while back revealed a low level presence of these two viruses in my system and so the transplant team lowered my anti-rejection dosage, thus increasing the strength of my immune system, so it could go after these viruses. 

That worked. 

But, my strengthened immune system also detected the unnatural organ in my body and began to do its job of going after my new kidney. 

The doctors caught this rejection activity early on.

This activity is what they and I refer to as early signs of rejection.

I had a biopsy performed. It confirmed that my immune system created some inflammation in my kidney. 

To tamp down that inflammation -- one way to put it would be to say to call off the dogs of immunity -- I went to the Kootenai Infusion Center two days in a row for a couple heavy doses of steroids and then for about five days, ingested an increased dosage of Prednisone that began at a high level and then tapered off until I was back to my regular dosage again. 

If I understood Dr. Bieber correctly today, the way my body is signaling that rejection is or has been under way is through my labs showing an increase of protein in my urine. 

It's atypical. Typically, the body signals this in other additional ways. 

Dr. Bieber hasn't seen a case like this since he was in medical school, but, as he put it, "I'm not a transplant nephrologist" and he is confident that the specialists in Spokane are more familiar with how my body is presenting these early signs of rejection. 

As with so many things in the world of medical treatment, the key to successfully intervening against this rejection is early detection.

That's happened. 

The next course of action is regular monitoring. 

And weekly labs. 

And working with the doctors to strike the right balance between an effective amount of daily anti-rejection meds while working to keep my immune system as strong as possible but not so strong that it's trying to reject my kidney, but strong enough to fend off other viruses (like BK and CMV) and other infections. 

So you might be wondering, while my new kidney has been hassled by my immune system, how is it functioning. 

The answer: really well. 

My renal panel results have been stable and positive. 

The docs aren't alarmed. 

They monitor how things are going.

When needed, they adjust dosages. 

I hope in this blog post I got this all pretty close to being right. 

If not, I'll write corrections in the future. 

2. Debbie wanted me to mail out a couple of items and asked me to look for them "somewhere in my piles of junk". I looked here and there and everywhere, upstairs, main floor, basement, and before I went to the doctor this morning, I found the items! 

I got them ready to mail and went to the Post Office and was very happy to get this little errand completed. 

3. Kidney talk tires me out a bit. 

I had saved myself a few slices of pizza from Tuesday night to relax me when I got home. 

They worked. 

I also hadn't worked Thursday's NYTimes crossword puzzle yet, so I relaxed with it. 

At 7:00, the Friday puzzle came on line and I worked it. 

The pizza and puzzles provided a welcome break from having my mind on medical matters, matters I'm maintaining my optimism about and am hoping my visit to Spokane on Thursday will bolster my optimism.  

 

Three Beautiful Things 07-16-2025: Ed and I Glide Down to Worley, More Swiss Cheese and Mushrooms, Slow Go Wednesday

1. It's not the money. 

I don't spend enough money on a visit to the CdA Casino to affect much in our family life and if I happen to win at the casino, it's always some very modest amount. 

I go to the casino to enjoy the suspense of spinning reels and the relaxation of leaving the other more serious matters of my life temporarily behind and enter into the world of silly sounds and computer generated visuals of the gaming floor. 

I mask up, slip on vinyl gloves, and keep the stakes low so that I can relax.

Today, I picked up Ed around 7:30 and so my visit to the CdA Casino today included the added bonus of yakkin' with Ed on the drive down and back and getting caught up on what's happening these days and offering each other our expert analysis and reasonable, iron clad, absolutely correct opinions 🤣. 

2. I also enjoy dining at the Red Tail Bar and Grill at the CdA Casino at lunch time, Ed and I sat down for a meal. 

I satisfied my recent months long jonesing for Swiss cheese and mushrooms by enjoying a Mushroom and Swiss Cheese burger, an order of fries, and a zero alcohol Michelob. 

More relaxation. 

More pleasure. 

3. I maintained the low key, slow go mood and tempo of the day when I returned home. 

I hadn't worked the puzzles I usually complete in the morning, so I enjoyed completing those.

While working these puzzles, I nodded off several times, unsurprisingly. I didn't sleep many hours last night, so I wrapped up my slow go day by going to bed early, hoping to sleep more hours tonight than I have been recently. 

Three Beautiful Things 07-15-2025: Heating and Cooling Checks Out, All-Star Game at The Lounge, Schwarber Is The Swing Off King

1, I had a good conversations about our heating and cooling system and our furnace with the technician who came to the house to do annual maintenance on both. Everything is spiffed up and operating well. 

2. Seth, Cas, and later on, Tracy, and I had a terrific time together at The Lounge late this afternoon and on into the evening watching the Major League Baseball All-Star game together. 

I devoured about a hundred and fifteen slices of delicious Dominio's pizza and enjoyed drinking about forty-seven cans of Bud Zero non-alcohol beer, or so it seemed. 

The game epitomized the beauty of baseball. The National League scored in a variety of ways, first scratching out a couple of runs early on and then, after a handful of ho-hum innings,  added four more tallies when Pete Alonso sent a three run parabola into the stands and Corbin Carroll launched a solo rocket of his own over the fence. 

Baseball is a game of lulls and surges and after hibernating for six innings, the AL squad woke up and roared to life in the seventh, themselves scoring in a variety of ways. Brent Rooker crushed a three-run roundtripper and Maikel Garcia turned a walk, a stolen base, an error, and an infield groundout into a run, and the awoken AL was within striking distance of the lead.

In the ninth, I loved how Byron Buxton and Bobby Witt Jr. hit consecutive opposite field doubles just inside the right field line and how Witt scored in the most small ball way possible when Steven Kwan legged out a weak chopper to third base for a game-tying RBI. 

3. No one else scored and with tonight's tilt tied at 6-6 after nine, the two teams each sent three batters to the plate. Each batter got three swings and earned a point for each home run he hit. The team who piled up the most points would win the tiebreaker and the 2025 MLB All-Star game. 

Kyle "I'm just here to have fun" Schwarber turned having a good time into earning the title of the game's Most Valuable Player by parking all three of his swings deep into the Atlanta night, earning the NL three of the team's tie-breaker winning four home runs, and a 4-3 Swing Off/Mini Home Run Derby victory. 

Our night in The Lounge featured a lot of first-rate yakkin' about baseball in the past and the present, travel, work, scammers, grandchildren, and a host of other topics, yakkin' made possible by the leisurely rhythms of a baseball game, the stretches of inaction between innings, and our enjoyment of one another's company. 

 

Three Beautiful Things 07-14-2025: Go Slow, Cooling Down the House, A Convenient Salad

1. Byrdman introduced me to the idea that, as we age, the sixties are the go go years, the seventies are the slow go (or is it go slow?) years, and the eighties are the no go years. 

I sure felt the go slow today as I worked my way from the upstairs to the main floor to the basement getting the house straightened up, swept, and vacuumed in preparation for having a routine check up/maintenance job done on Tuesday on our heating/cooling system and furnace. 

Slow. Slow. Slow. Rest. Rest. Rest. But, I got almost everything done as I worked away most of the day. 

2. The upstairs and the main floor were warm enough that I cooled them off with our cooling system before I worked in them and that turned out to be a good way to make sure they were working pretty well before the technician arrives on Tuesday. 

3. I had made a big vegetable and apple salad over the weekend and on a day when I was mostly cleaning house (and taking breaks), having that salad fixed and ready to munch on made my day much easier. Around dinner time, I added Greek seasoned chickpeas packed in oil to the salad and that worked really well. 

Three Beautiful Things 07-13-2025: Preparing Food for Family Dinner, Christy's River Tale, Sweet Memories from 2014-17

1. Today was a very busy day for Carol and Paul -- church, Paul preaching, a church meeting, a matinee performance at the Sixth Street Melodrama and Theater, and family dinner. 

Aware of all of this, Christy, tonight's dinner host, asked me to prepare two offerings for dinner and asked Carol and Paul to bring wine. 

Simple enough.  

Christy assigned me to bring an appetizer and a rice dish and told me she was making a citrus chicken dish and hoped what I brought would go well with the chicken. 

I had quite a bit of celery on hand, so I took out a bowl and mixed together whipped cream cheese, sour cream, bacon pieces, shredded cheddar cheese, green onion, and Everything but the Bagel Sesame Seasoning Blend, filled each celery stalk with this mixture, and then sprinkled more Everything blend on top of them. 

For my rice dish, I dreamed up a dish rather than using a recipe, for the most part. 

I used a recipe to make creamed spinach.

To meet Christy's request, I didn't technically make a rice dish, but, to me, couscous can act like rice even though it's a unique kind of pasta. 

So, I made a white sauce, wilted a bag of spinach, combined the sauce and the spinach and then I cooked u all the couscous I had on hand. 

I layered the creamed spinach and the couscous and I was very happy with how it turned out and I think it was a good compliment to Christy's chicken dish. 

2. Christy reported on the river float several of her classmates took on Friday on the CdA River and shared the good news that one of the floaters made a mistake and found himself separated from the rest of the group. 

After a period of anxiety, things worked out and he rejoined the Classs of 73ers. 

Christy didn't float (I wouldn't have either! I'll never float again!), but she and others who stayed on dry land joined with the floaters for a fun potluck in the afternoon. 

3. As we talked more over dinner, the subject of Baltimore came up and suddenly a rush of stirring memories swamped my mind. Some of them involved Baltimore, but, overall, I was reliving those great three years of living in Maryland, exploring Washington, DC,  New York, New Jersey, Maryland, Massachusetts, and Virginia, and I thought and talked a bit about some things I didn't do, feeling some regret, but knowing there was no way I'd be able to do everything I could have done. 

So I focused more on the fun and energizing things I did do, mostly within myself. Those thoughts included things as simple as going to senior water aerobics, walking to the Greenbelt library, and having many fun meals with Molly, Hiram, and family. 

Three Beautiful Things 07-12-2025: Life with Gibbs, *Lonesome Dove* and Self-Examination, Tofu is Back

1.  I attribute Gibbs' readiness to bark at people walking by, delivery people coming to our porch,  Copper on the other side of the pet gate, neighborhood dogs on the other sides of our back yard, and sometimes just at a breeze bending grass not to a character flaw, but to a virtue. He's earnest. In his own Maltese-Shih Tzu way, he's acting as a service dog, barking warnings. 

I do my best to as soon as I can to discourage Gibbs from barking too long in the back yard.

Recently, he's been remarkably cooperative with my efforts. 

I never yell at Gibbs and if I stand on the porch and, in a conversational voice, call his name, lately he's been really good about coming to me.

It helps that I'm also offering him Swiss cheese. 

I've been on a Swiss cheese jag for a few weeks.

Gibbs has joined me. 

Lately, he'd rather eat a few small pieces of Swiss cheese in the kitchen than bark his brains out in the back yard. 

2. One thing I'm experiencing while reading Lonesome Dove relates to Socrates' dictum that "the unexamined life is not worth living." 

This novel is moving me to self-examination in an unexpected way, through the observations and thoughts of Lorena Wood, who, for much of the Part I of this book, has been the prostitute at the Dry Bean Saloon.

Lorena is very perceptive, especially when it comes to the character weaknesses of men in general, but of one man in particular, Jake Spoon. 

Her observations have little to do with sex, but much more to do with immaturity, dependence, broken promises, flattery, manipulation through deception, and other similar qualities that Jake Spoon manifests, but so do other men in this story. 

Lorena has moved me to examine similar qualities in myself, especially as I reflect on my past and what I've done as I've aged to at least try to mature, be more independent, keep my word, eschew manipulation, and, generally be a more balanced and consistently kinder and more reliable person. 

When I started reading this book, I wasn't expecting to be putting it down as often as I do to have quiet periods of self-examination, but that's one of the very welcome effects Lonesome Dove is having on me. 

3. For the first time in months, tonight the stir fry I fixed in the wok included tofu. I've been enjoying tofu for about forty years now and I really don't know why I'd gone so long without having purchased and cooked it before tonight -- especially because it's really good for me and my kidney health. 

Three Beautiful Things 07-11-2025: Morning Walk, Return to the Lounge, The Soul of a Poet

1. After a day off on Thursday, I was was up walking this morning around six o'clock and enjoyed being in deep shade and cool air as I went up to the high school and back home via Jacobs Gulch Road. My hope at this point is to walk at least a mile on my walking days and my Fitbit told me at the end of the day that I walked just over a mile and half today. I'm happy with that. 

2. Have I written about why I try to avoid being in places where people smoke cigarettes? And why it is that I wear a mask if I go to a casino with smoking areas?

The concern is that if a smoker happens to be carrying something contagious, exhaling cigarette smoke broadcasts the contagion out widely. 

This afternoon, Ed called me and wondered if I'd like to go up to the Lounge with him for a beer. 

(For me, "for a beer" means drinking a non-alcoholic one so as not to compromise my anti-rejection medications.)

I did and I had a great time yakkin' with Ed, Cas, Fitz, and Brett F. 

I was a little bit anxious because about four or five people were smoking, but I decided to take my chances, hoping none of them were sick -- or, if they were, that I have enough horsepower in my immune system to fight it off.

I hope I'll be all right physically, because it was uplifting for my spirits to be with the guys I yakked with today and to be back in the Lounge again.

3.  So far, Lonesome Dove features one black character/cowboy. His name is Deets. 

I loved a passage featuring Deets that I read today. He and another character/cowboy, Dish, are guarding a pen full of horses. It's an all night job. After a while, Dish leaves his post, leaves Deets, having grown so restless with sexual desire that he has to go to the Dry Bean, the local saloon, hoping to satisfy himself with his favorite prostitute, Lorena. How that works out is another story altogether. 

So Deets is alone with the horses.

And the moon. 

As Deets admires the moon, Larry McMurtry gives us a listen to Deets' inner voice. We've learned earlier that Deets doesn't read or write, but in this passage of the novel, within himself, Deets expresses himself poetically and romantically as he muses upon his lifelong love of the moon, its mystical qualities, its eternal state of inconstancy and flux. 

If we were, as we read this novel, to experience Deets only in terms of his external appearance and by the words he speaks out loud, we'd hardly know that his is the soul of a poet. 

Along with being a superb story teller, it's this kind of deep and often surprising exploration of his characters that is helping me see what makes McMurtry such a highly respected novelist. 

I didn't expect to be moved by a tiny part of this huge novel dealing with one cowboy's horniness and another cowboy's willingness to guard horses alone through the night under the light of the moon. 

Three Beautiful Things 07-10-2025: Stable Labs, My Pill Schedule, One Day On -- One Off For Now

1. Nurse Jenn messaged me today and reported that this week's labs looked stable and that Dr. Murad would like to continue to increase the levels of Tacrolimus in my blood. So he raised my dosage one half of a mg. 

2. After my exchange with Nurse Jenn, I realized my pill box was empty and so I filled it for the next week and made the change she instructed me to make. 

I realized, as I filled my box, that I'm the only person, say, in our family, who knows what medications I'm taking and the dosage. 

I'm going to figure out a way to create a list of the various medicines and over counter pills and the dosage I take each day that I can carry with me -- in my wallet, I guess.

But today I decided that Christy and Carol should have this list and should know the numbers to call if I have problems or something happens and I can't call the transplant clinic myself.

With Debbie staying in New York indefinitely, I realized I would need my sisters' help.

So, this evening, I typed out a chart showing what pills I take in the morning, at noon, and in the evening and sent both Christy and Carol a copy with an email outlining some other information. 

That eased my mind. 

3. I actually hope this changes before long, but right now I'm on a one day on, one day off morning walking schedule. After my jaunt on Wednesday at the Medimont Trailhead and after accumulating some more steps at the casino and Trader Joe's, I woke up today with rubbery legs and I rested them. I'm hoping that by next week I'll feel fit enough to walk about a mile or so daily. 

 

Three Beautiful Things 07-09-2025: Walking Near Cave Lake, Breakfast and a Little Luck, Eating Like It's 1982-3

1. I spent a couple of hours or so until about 7:30 this morning tidying up the kitchen, taking care of Gibbs and Copper, and getting ready to head out the door. 

I'd read in a review from a biking business that the Medimont Trailhead on the Trail of the CdAs featured a stretch of shady trail as well as great views of Cave Lake. 

Because of my general intolerance of direct sunshine and heat, I perk right up whenever I read about shady trails.

To beat the heat, I left the house early-ish (my household jobs took longer than I planned) and when I arrived at the trailhead, it was, indeed, cool and shady and so, limited by the after effects of the slump I was in, I walked about 3000 or so steps out on the trail and back to the car again. Today I walked in an easterly direction and next time I go down, I'll try westerly.

2. Carol and Paul asked me to pick up a couple of boxes of theater programs at the Fed Ex office in CdA today, so to get there I decided to once again drive to St. Maries, go through Heyburn State Park to Plummer, and head north on Hiway 95. 

I hadn't eaten anything yet, so I stopped at the CdA Resort and Casino and refreshed myself with breakfast at the Red Tail Bar and Grill. 

After I ate, I played just three machines, won a little money which I will add to my Pendleton fund, and returned to the Camry and blasted north to CdA where I picked up Carol and Paul's theater order and stopped in to buy produce and rice and some tuna at Trader Joe's.

3. God only knows why what I'm about to write has stuck with me for over forty years, but here goes.

Back at Whitworth, I remember Bill Davie talking about what he fixed himself for meals as a student living in an apartment and how much he enjoyed making a box of Kraft Macaroni and Cheese and folding in a can of tuna.

This evening, I didn't have any boxes of mac and cheese in the house, but I had some twisty pasta, shredded cheddar cheese, shredded parmesan cheese, butter, and Frank's hot sauce. 

So, I boiled the pasta, poured the cheeses over it, added in a chunk of butter and as it melted, I folded in a can of tuna. To give this inspired-by-1982-3-Bill Davie dish a kick, I splashed hot sauce over the top. 

If I'd had a can of black beans on hand, I would have added some beans to this dish, but I'm happy to say that, as it was, this little creation of mine brought back fun memories of apartment living in N. Spokane (Bill and I lived across N. Colfax Rd from each other) and, moreover,

it worked! 

  

Three Beautiful Things 07-08-2025: "You're Just Chill", My Reward, Couscous Stir Fry

1. For some reason, one that I can't explain, but that is a huge relief, having needles inserted into my skin and veins doesn't bother me at all.

I couldn't begin to say how many times I've had blood drawn in the last ten years. Since 2015, every month I was active on the transplant list, I had blood drawn at least once a month and, since the transplant, I've never gone more than two weeks before it was time for another blood draw. 

Right now, I'm on a weekly schedule. 

I bring this up because twice in the last three weeks, the person poking me had trouble getting the vein they chose to cooperate. 

The first time was when I got my first steroid infusion.

The second time was today. 

Today the guy at Kootenai made two unsuccessful stabs, one in each arm, and then he did the right thing.

He found the woman who drew my blood a week ago. She remembered exactly where she'd poked me last week, repeated that poke, and PRESTO! my blood flowed generously out into the vials. 

I've had this same experience in Eugene, Springfield, Greenbelt, Kellogg, Spokane, and now Coeur d' Alene. 

Each time the first (or second or third) attempt didn't work, I was unruffled, patient, trusting, and calm -- and, as I believed would happen, each time things worked out fine.

The woman who succeeded today apologized for my trouble when she was done. 

I responded, "It's no problem."

I liked it when she then said, "You're just chill, aren't you?"

"I guess so."

2. I had one more deposit to provide for the lab.

I succeeded. 

Ah! 

Then I purchased my modest reward.

I strolled just outside Lab Services to Big Blue Coffee. 

I hadn't eaten for nearly thirteen hours and I didn't drink any black coffee before I hit the road this morning. 

So I was primed to snack on a chocolate croissant and sip a 16 oz latte.

They made me very happy.

3. Back home, inspired by today's successful phlebotomist, I chilled. 

My most ambitious accomplishments were reading some more Lonesome Dove and fixing another terrific stir fry in the wok, this time combining shrimp, broccoli, onion, yellow pepper, green beans, and couscous. 

I filled a bowl and topped my creation with a combination of Hoison sauce and Soy sauce. 

It worked.