Throughout the several years I have been on Peritoneal Dialysis, I have neither found nor been presented with a Comprehensive Guide that addresses most, if not all, of the many questions that arise when informed that you, too, will be subject to the procedure(s). This blog is my first attempt to address this issue. Using Perplexity and experience, I have constructed a Comprehensive Guide, embedded below in PDF format. Feel free to download it and use it as you see fit. To my knowledge, it is accurate as of this date (12/07/2025). There is no trademark nor Copyright. Hank 12/07/2025. The lead picture was made using Nano-Banana.
First, yesterday I attended the school call at Texas Oncology, where my immunotherapy is scheduled to start for real on Monday, at 1315. The head nurse went over the schedule, what to expect, but spent most of the session on possible side effects, I assume per their law team, and what to do about them, basically notify them. Interestingly, if I am going to experience side effects, they are often immediate—obviously, more on this as we get into it.
Secondly, my labs are in. While my Albumin is still low, it did rise to 3.5 from 3.4, a big wow from the 5.0 goal. On a good note, my adequacy test came in at 1.99, up from 1.87 a quarter ago. This indicates I am getting enough dialysis. The remaining measurements, like phosphorus, were all within spec, which should make my team happy.
Lastly, I’m really enjoying playing around with a new AI music tool for me, Suno.com. You should check it out. Meanwhile, while on YouTube for something else, I ran into this song for your entertainment, which maps quite well to my current situation.
Consider the statement “AI presents an immense reduction in the reenactment costs of acquiring knowledge.” Write an intellectual blog entry expanding on this topic.
That’s an intriguing and sophisticated topic that fits well with your analytical writing style. Here’s a well-developed blog entry expanding on that statement with depth and clarity.
AI and the Diminished Cost of Knowledge Reenactment
The assertion that “AI presents an immense reduction in the reenactment costs of acquiring knowledge” captures one of the most transformative elements of our era. Knowledge, in economic terms, has long been constrained by the cost of reenactment—the time, labor, and resources required to rediscover, replicate, or internalize previously established understanding. Artificial intelligence disrupts this paradigm by decoupling the effort of human inquiry from the act of knowledge reproduction.
Historically, learning and mastery demanded iterative human reenactment. Apprentices watched, practiced, erred, and refined skills across years. Scholars sifted through archives to retrieve fragments of insight. Entire institutions arose to make the acquisition of knowledge more systematic, but inefficiency persisted. Each learner repeated a portion of the same journey their predecessors had already completed.
Artificial intelligence fundamentally alters this cost structure. Through large-scale model training and algorithmic generalization, AI systems can internalize patterns across massive informational domains—mathematics, language, biology, engineering—and instantly reenact those insights in new contexts. This compression transforms learning from an act of rediscovery to an act of retrieval. The friction that once defined intellectual progress now yields to automation.
Moreover, this compression scales. Where a human researcher might require months to synthesize prior literature before forming a hypothesis, an AI agent can parse thousands of papers in minutes, identifying conceptual linkages invisible to human cognition. Where artisans once internalized tacit knowledge through direct mentorship, generative models can simulate the procedural reasoning behind those skills, opening pathways for global access to expertise once confined to physical proximity.
This reduction in reenactment costs also reconfigures the economics of creativity. The artist, engineer, or scientist now operates within an augmented partnership rather than in isolation. By allowing AI to recall, recombine, and emulate learned knowledge instantaneously, humans are liberated to focus on contextual judgment, ethical discernment, and conceptual innovation—the domains where mechanistic reenactment still falters.
Yet this shift introduces philosophical tension. The lowered barrier to reenactment invites superficial engagement: instantaneous knowledge without experiential depth. A generation that can summon understanding without labor risks losing appreciation for the process that once cultivated intellectual resilience. The challenge, therefore, lies not in restraining the technology but in redefining the purpose of human learning itself—emphasizing not accumulation but interpretation, not recall but synthesis.
AI, in this sense, does not merely make knowledge more accessible. It collapses the traditional machinery of replication and opens a new frontier where the marginal cost of insight tends toward zero. The question ahead is not whether humanity will learn faster, but what it will choose to do when reenactment is no longer a prerequisite for understanding.
Is a phrase used by military to indicate potentially about to engage the enemy. That’s how my day went today. Started off with Fresenios labs which stretched to an hour or so. Across the street to CVS where my wife got a flue and COVID shot and I received the latter. The to a big box store, then to a dig rescue where we donated 88 lbs of dog food. To lunch then to IGA thence home fir very short stay, then walk Dickens then back home where shortly it was shower and dialysis time.
Yesterday, as scheduled, I went to Texas Oncology and met with Dr David D’Spain. Turns out he is very personable, but also direct and to the point, which I like and respect in a doctor. The waiting room was crowded, as it often is in my experience, since skin cancers are prevalent here due to months of sun beating down.
Six vials of blood were drawn. We have an education appointment for about an hour on Thursday, and tentatively, my actual treatment, called Cemiplimab-rslc Q21D, starts Monday. It is tentative because our health insurance provider must approve it before we can begin. It is scheduled to take place every three weeks for up to two years. The doc stated there is a distinct possibility that when I go off the treatment, there will be no remaining cancerous cells.
Since this is ME being treated, I turned to Perplexity to learn more about Cemiplimab-rslc Q21D with the following results:
For my blog at www.feeser.me tell me all about Cemiplimab-rslc Q21D.
Cemiplimab-rwlc (brand name Libtayo) is an intravenous PD‑1 immune checkpoint inhibitor used every 3 weeks (Q21D) to treat several cancers, most notably advanced cutaneous squamous cell carcinoma (CSCC), basal cell carcinoma (BCC), and some non–small cell lung cancers (NSCLC). It is a “3‑weekly anti–PD‑1 immunotherapy that reactivates T‑cells to attack cancer cells.”[1][2][3][4][5][6][7][8]
What Cemiplimab-rwlc Is
Cemiplimab-rwlc is a laboratory-made monoclonal antibody, in the same general family as pembrolizumab and nivolumab, but developed specifically as Libtayo by Regeneron/Sanofi. It targets the PD‑1 receptor on T‑cells and is supplied as a 350 mg/7 mL single‑dose IV formulation.[2][3][9][6][10]
“Q21D” Dosing Explained
“Q21D” means “every 21 days,” which corresponds to the standard 3‑weekly (Q3W) Libtayo schedule. The approved fixed dose for adults is 350 mg IV, infused over about 30 minutes, every 3 weeks until disease progression, unacceptable toxicity, or a defined maximum duration in some adjuvant settings.[11][12][3][13][6][1]
Typical regimen: 350 mg IV over 30 minutes, Q21D/Q3W.[3][6][11][1]
In adjuvant CSCC, one option is 350 mg every 3 weeks for 12 weeks, followed by 700 mg every 6 weeks, up to 48 weeks total.[14][3]
How It Works
Under normal conditions, PD‑1 on T‑cells acts like a “brake,” helping prevent excessive immune responses when it binds to its ligands, PD‑L1 or PD‑L2. Many tumors exploit this by expressing PD‑L1/PD‑L2, effectively turning T‑cells off at the tumor site.[5][7][8][2]
Cemiplimab binds to PD‑1 and blocks its interaction with PD‑L1/PD‑L2, releasing this brake. That disinhibition boosts T‑cell proliferation, cytokine production, and cytotoxic activity against cancer cells, which can result in tumor shrinkage or durable disease control.[9][7][8][2][5]
Main Approved Uses
Regulatory approvals (US and other regions) have expanded over time as data accumulated. Key adult indications include:[15][4][10][14]
Metastatic or locally advanced CSCC not amenable to curative surgery or radiation (the original landmark approval).[4][10][1][15]
Locally advanced or metastatic BCC after hedgehog inhibitor therapy or when such therapy is inappropriate.[3][4]
First‑line monotherapy for NSCLC with high PD‑L1 expression and no EGFR/ALK/ROS1 aberrations, in selected patients.[4][3]
Adjuvant treatment of CSCC at high risk of recurrence after surgery and radiation, as of an October 2025 FDA decision.[14][3]
Efficacy Highlights
In pivotal CSCC trials, cemiplimab produced objective response rates around the mid‑40% range, with a majority of responders maintaining benefit for at least 6 months. Extended or alternative schedules (such as 600 mg every 4 weeks) have shown pharmacokinetic and clinical activity consistent with standard Q3W, although 350 mg Q21D remains the core labeled regimen.[13][6][1][15][9][4]
Safety and Side Effects
Cemiplimab shares the class-immune-related toxicity profile of PD‑1 inhibitors, reflecting an overactivated immune system. Common issues include fatigue, rash, pruritus, diarrhea, and endocrine abnormalities such as thyroid dysfunction.[16][1][3]
More serious immune‑mediated events can involve the lungs (pneumonitis), liver (hepatitis), colon (colitis), kidneys (nephritis), and other organs, requiring treatment interruption, steroids, and occasionally permanent discontinuation. No formal dose-reduction scheme is recommended; instead, dosing is held or discontinued based on severity.[6][1][16][3]
Practical Q21D Points
For my readers, it may help to frame Q21D cemiplimab as:
A brief outpatient IV infusion every 3 weeks, usually without complicated premedication in most patients.[11][6][3]
A long‑term treatment: often continued for many months, or up to 1–2 years in adjuvant or certain advanced settings, if tolerated and effective.[1][13][3][14]
A systemic immune therapy: side effects can appear weeks to months after starting and sometimes after stopping, so ongoing monitoring is essential.[16][1][3]
Quick Comparison For Readers
This is how cemiplimab Q21D is positioned alongside other PD‑1 inhibitors using a simple comparison table:
This framing keeps the focus on what matters for patients and non‑specialist clinicians who might read your blog, while staying accurate to the Q21D cemiplimab‑rwlc data.
On several occasions, I have blogged about the central place dogs should occupy in dialysis patients’ lives. This blog expresses this belief in a song I composed on Suno. See below:
This past Friday, I blogged about the phrase “I’m Not Disabled, I’m enhanced” and how I related to it. I thought it would be instructive to use this blog to write a song, which I did, and it is embedded below.
How it was put together. I turned to the AI engine Poe and used a plugin named Music Generator by @CoolBotMakerGuy, into which I wrote a header prompt and pasted in input from Friday’s blog to base the song’s lyrics on. I then copied the generated lyrics and pasted them into the appropriate place in Suno to create the song below. I told Suno to use the blues genre, in the style of Jimmy Reed, from 1955. I downloaded the finished product as an MP4 file. Cool beans! Keep in mind that three AI engines were used to make the song! This is not a one and done process.
While browsing through the November 2025 issue of Defense News, I came across an article on p 36 by Tom Mutch titled “Recover, Resilience and Returning From War In Ukraine.” The lead sentence was “I’m not disabled, I’m upgraded.” This struck me as particularly interesting because, in so many words, I know many of my service associates feel this way, even though they bear many scars from their time in service, some not all visible. Based on “having been there” and myself currently living with these scars, the following expands on this phrase on behalf of my fellow service members who are also living with these scars, both seen and unseen.
“I’m not disabled, I’m enhanced.” That simple shift in language captures the heart of military resilience: the ability to turn damage into capability, fear into perspective, and limitation into a new form of strength. For many service men and women living with serious medical challenges like kidney failure and dialysis, this mindset is not a slogan but a survival skill.warriorallegiance+2
From battlefields to hospital rooms
Service members are trained from day one to adapt under pressure, improvise with limited resources, and keep moving toward the mission despite pain, fatigue, and uncertainty. That same training follows them home when the “enemy” is no longer an opposing force but chronic illness, toxic exposure, or the wear and tear of years in uniform.pmc.ncbi.nlm.nih+2
Veterans are more likely than the general population to live with chronic conditions such as kidney disease, heart disease, and mental health challenges, partly due to the physical and psychological stress of service. Yet clinicians who care for veterans routinely describe them as unusually determined, grateful, and gritty in their approach to treatment.kidneyfund+2
“Enhanced,” not “broken”
When a wounded or ill veteran says “I’m enhanced,” it reframes scars, prosthetics, mobility aids, and treatment schedules as upgrades to a warrior still in the fight. A prosthetic leg becomes specialized gear; a scar becomes a campaign ribbon written on skin. The question shifts from “What did I lose?” to “What did this experience give me—perspective, empathy, discipline, a new mission?”warriorallegiance+1
This mindset does not deny pain, fatigue, or frustration; it acknowledges them and still chooses purpose. In resilience research with veterans, a stronger sense of psychological resilience is linked with better physical function and recovery after setbacks, reinforcing that how one thinks about challenges shapes how one moves through them.agsjournals.onlinelibrary.wiley
Dialysis as a new kind of deployment
Kidney failure and dialysis bring their own demanding “operational tempo.” Many veterans on dialysis face multiple health issues, long travel distances, and frequent hospitalizations, yet they continue to show up, follow complex regimens, and thank their care teams. Currently, hundreds of thousands of veterans live with kidney disease, and tens of thousands live with kidney failure requiring ongoing treatment.va+3
Dialysis can feel like a standing deployment: fixed schedules, strict protocols, and the ever-present possibility of complications. But for many veteran patients, the same mindset that got them through deployments—routine, teamwork, gallows humor, and mission focus—helps them see each treatment not as punishment, but as life-sustaining logistics that keep them “in the fight” for more days with family and friends.pmc.ncbi.nlm.nih+2
Building resilience on the home front
Resilience is not just an individual trait; it is also a network. Veterans with strong social support, access to VA or community care, and clear information about their disease are better able to stick with complex treatment plans. Programs focused on veterans’ kidney health and patient engagement aim to strengthen that network, helping patients understand their options and advocate for themselves.aakp+2
For service members and veterans facing dialysis—or any serious medical condition—several habits reinforce the “enhanced, not disabled” mindset:
Treat appointments and treatments like mission-critical orders: non-negotiable, planned, and executed with discipline.sciencedirect+1
Lean on the unit: family, fellow veterans, dialysis staff, and support groups become your squad, not your audience.kidneyfund+1
Honor vulnerability as courage: asking for help, admitting fear, or talking about symptoms is not weakness; it is tactical honesty that keeps the mission going.agsjournals.onlinelibrary.wiley+1
Celebrate small wins: stable labs, a smoother session, or a good walk after treatment are quiet victories worth recognizing.pmc.ncbi.nlm.nih+1
A new mission, same warrior
Every veteran on dialysis or living with chronic illness carries a story of endurance that did not end when the uniform came off. Many have already faced events that would terrify the average person, giving them a sense of proportion that turns medical procedures into “just another operation,” not the end of the line.research.va+3
To say “I’m not disabled, I’m enhanced” is to claim authorship over that story—to insist that the injury, the diagnosis, or the dialysis chair does not define the warrior sitting in it. The body may be altered, the schedule constrained, and the energy limited, but the core qualities that made them a service member—courage, discipline, loyalty, and a stubborn refusal to quit—are not diminished; in many ways, they are upgraded for a new kind of battlefield.warriorallegiance+2
As a retired US Navy Commander, I spent far too many holidays away from my loved ones. Been there, done that. Today, on Thanksgiving 2025, this blog is dedicated to those away from home.
Thanksgiving Far From Home
Upon distant waves, across foreign land, Service and duty called, still you stand. While loved ones gather near hearth’s warm embrace, You keep the watch for freedom’s place.
Thanksgiving echoes across the miles, In letters, in prayers, in grateful smiles. Though holidays find you far from home, Your courage ensures we’re never alone.
At mess hall tables beneath foreign skies, A moment’s pause, reflection in eyes— We honor your sacrifice, steady and true, America’s heart beats always with you.
For those who serve—this holiday anew, Thanksgiving’s meaning deepens for you. With hope, with gratitude, across the sea, Your country remembers—thank you, from me.
