Wednesday, July 24, 2019

Taking the Long View

In general, I'm not one of those "shiny, happy people". English is only my second language: sarcasm is my first. I'm generally a contrarian ...but I'm consistent with it: not only do I find the clouds to other people's silver-linings, I'll find the silver linings to other people's clouds.

Recently, one of my dogs was afflicted with abdominal cancer. Originally, her primary veterinary-practice vet presumed insulinoma. Subsequent imaging – first a sonogram then a computerized axial tomography (I'd use the more common "CAT" but seems odd to do so in the context of a dog) scan – combined with a non-indicative test-result for overabundance of insulin seemed to indicate that it was probably a liver tumor. Today, she had surgery …and the tumor turned out not to be associated with her liver at all: was a tumor growing off her stomach that had butted up so snug against her liver that the imaging made it look like a liver tumor. Have to wait for histology results to come back to find out just what kind of beastie it is.

At any rate, the afflicted dog was the fourth rescue we adopted ...and the third to be afflicted with cancer. The first two were euthanized because of their (untreatable) cancers. The third dog died of sudden renal failure. In short, I've plenty to be "cloudy" about – particularly when it comes to my pup-luck.

That said, all five of the dogs we've adopted have been absolutely wonderful companions. So, my pup-luck isn't completely shitty. And, taking the long view of things, I've actually got plenty to be thankful for:

  • I've been employed at a sufficient-enough pay-scale that I've been able to save aggressively not only for retirement but for "rainy days".
  • Due to the previous point, my care-decisions for the current dog's treatment have, thus far, only needed to be driven by probable outcomes rather than financial considerations.
  • I have a wonderful set of friends and acquaintances who've been wishing us well with our current canine-health straits
  • I live someplace where I have access to a number of both day-to-day and specialty veterinary practitioners
  • I live close to said practitioners
  • Those practitioners have flexible enough schedules that:
    • I was able to have my dog be seen by an emergency veterinarian within an hour of the episode that ultimately uncovered the tumor
    • Prior to the oncology-referral, the emergency vet asked to do some additional diagnostics that could have included ICU charges, but for which I was only charged the actual lab fees.
    • I was able to have very frank discussions with the emergency vet about likely diagnoses and prognostics
    • I was able to have my dog be seen by a veterinary oncologist within a day of the emergency vet's lab results coming back.
    • I was able to have a CT scan performed the first business day after the oncology consult.
    • I was able to have very frank discussions with the oncology vets about likely diagnoses and prognostics resultant of all the preceding diagnostics
    • I was able to have a surgical-consult the day after the final imaging results came back
    • I was able to have surgery performed the same day as the consult.
  • I have a very understanding employer who's been able to accommodate me suddenly needing to take time away from the office so I could take advantage of all of the above scheduling flexibility
  • I have an employer who's trying to work within their legal frameworks to help me with the financial aspects of things
  • As noted previously, I have enough in the way of savings that I don't need my employer to come up with a financial hail-mary for me.
  • Because of my financial standing, even if I didn't have the liquid or semi-liquid savings as an immediate backstop, I could probably fairly trivially pick up a 0/0 credit card to help me bridge any savings-gaps I might have had.
Now, to hope that:
  • The pathology report comes back with results that allow me to be thankful to have my doggo for another few years.
  • All of the dog-related concerns can ebb soon enough that (what appear to be) incipient health-problems for my wife can be addressed free of worry about doggo. Basically, if wife does end up hospitalized, again (fuck you, Chron's), hopefully doggo will be sufficiently on the mend that I'll be able to visit wife during her hospitalization.
Lastly, as crap as 2019 has been from a medical and veterinary standpoint, there've been enough other positives – both those listed above and those that I've not explicitly stated – that I can easily see that things could be so much worse. And, no, I'm not asking the Universe for a demonstration of how much worse things could be. I would prefer to be able to remain thankful for the luck-detour being manageable.

Monday, July 8, 2019

Stating the Blindingly-Obvious

I was gonna title this "cancer sucks", but changed my mind for two reasons:

  1. This is may not be the only post in the coming weeks/months that would want that title.
  2. It's a statement of the blindingly-obvious (and, thusly, not terribly original)
Vet contacted me, today, about Lady. The initial test-results were not confirmative of insulinoma. He said this wasn't surprising because, while her blood sugar levels were quite low, they weren't in the range typically necessary for a blood-draw to be definitive for insulinoma. Worse, just because the sonogram showed a obvious, consolidated tumor in her liver, that no tumors were visible in her pancreas isn't definitive of primary hepatic cancer. It's notionally possible that she could have pancreatic tumors that are too small to see on sonogram - even if they were the primary source of the cancer in her liver. It's a concern because primary hepatic cancer is rare in dogs. So, while she could be lucky - inasmuch as having life-threatening cancer in the liver can be - and have primary cancer of the liver, the odds are against that.

This left me with a couple options:
  • Do the oncology consult (scheduled for the morning of July 15th) without doing more to eliminate the likelihood of insulinoma
  • Drop her off at the vet, tomorrow, for some additional testing
Since it would be horrible to subject her to liver surgery if one could know that it was both unnecessary and make her spend her remaining weeks recovering from major abdominal surgery, I'm opting for the additional testing. Unfortunately, those tests can still produce a non-definitive diagnosis: like many tests, they're ok for confirming a positive diagnosis (that she has insulinoma) but not for confirming a negative diagnosis (that she absolutely doesn't have insulinoma). For potential longevity sake, I obviously hope for lack of a positive diagnosis from the tests. 

Unfortunately, the tests aren't without risk. They have to fast her to see if her blood sugar drops enough to get a definitive positive test result. Fasting her to that point puts her at risk for seizures and worse. Primary thing going for her is that she'll notionally be being closely-enough observed during the fasting that (if she does have insulinoma) that she would be caught low enough to test yet not so low that she suffers neurological impairment (that would necessitate an even earlier departure than pancreatic cancer, by itself, would have caused).

Still even if the fasting-blood-tests don't prove confirmative of pancreatic cancer, proceeding with surgery isn't a slam-dunk. They could open her up, do the liver resection, send off the excised tissue for biopsy and still find that it wasn't primary hepatic cancer. Meaning, that I potentially put her through abdominal surgery for nothing and put her in pain for a non-trivial chunk of her remaining time with us.

I imagine, if tomorrow's tests are non-confirmative, one of the things that we'll discuss at the oncology consultation is further pre-surgical testing. And whether they could be conducted as part of a larger, contingent procedure. That might be something like, "do an MRI (or something) and, if that comes back clean, only then move on to the resection."

Problem is, dogs, unlike humans, can't really be given an MRI without general anaesthetic. That means either doing one, long sedation for the MRI and then surgery (if the MRI were clean). The longer anything is under general anaesthetic, the riskier things become. Notionally, could do separate procedures, but that has its own risks: 1) two applications of anaesthetic in a short period of time is risky; 2) liver cancer is aggressive enough that the delay between discreet procedures likely results in the growth of the existing tumor and/or possibly allow time for it to metastasize even if it has yet to do so. And, risks to Lady aside, there's also the financial impact: doing the additional testing also markedly increases the costs of an already expensive procedure.

My primary concern is that I do the most good for the least amount of harm. And, if I can't do her any good, I'd like to at least not do her any further harm than whatever bomb ticking in her abdomen is want to do.

There's just not a lot of good choices, here. 

Wednesday, July 3, 2019

Unwanted Curveballs

To open, I'm not going to say anything like "God is a bastard". I'm, at best, agnostic. Which is to say, while I suspect that the life we have is all there is and that there's no father-like figure out there overseeing my existence, I don't have what I'd consider sufficient proof to make the leap to full-on atheism. Atheism requires a degree of certitude I don't possess. Not really sure how anyone has that much. …But I digress: it's the long-winded way of saying "I don't think there's anyone to call a bastard" and I doubt that, if there is, I don't think he's out there trying to make my life hard. If there's a God, he's got far bigger fish to fry than singling me out for torment. And, really, my torment is small potatoes compared to millions – maybe billions – of others'.

What I do know is that, no matter how Right™ you try to live, no matter how hard you try to properly see to those in your care, no matter how much control you try to exert on existence, it doesn't seem to matter. Sometimes, it feels like the more you try, the more it blows back on you.

I'm one of those people that ascribes to the whole "live within your means" thing and "save for a rainy day" and "save for retirement" ethos. For the most part, I've been able to meet those aspirations. That said, watching how others live frequently makes me feel like people who don't are often rewarded for flauting the fable of the ant and the grasshopper …or, at least, aren't as penalized for spendthrift behavior in a way that's adequately proportionate (which can feel the same as being rewarded).

At any rate, while I don't lack for things I truly need – and it viscerally rankles me when people ascribe the term "need" to things that are, at best, "wants" – and I do indulge in occasional luxuries or self-pampering, I don't do so with the frequency that it seems many people I know do. I shepherd my money.

What I do tend to spend on are things like healthy diet for myself, my wife and my pets. Similarly, I spend for regular/prophylactic medical care for myself , my wife and my pets. Unfortunately, there's years like this one – and felt most acutely on days like today – where it all feels like wasted effort. It's like tilting at windmills. My autoimmune arthritis continues to progress – if more slowly than it otherwise might. My wife's been in the middle of a months-long Chron's flare that looks to have her on a trajectory to another hospitalization. And today?

Today I found out that my dog (we have two – one that's notionally my wife's and one that's notionally mine), Lady, has a large tumor in her liver. I found this out because, as I was working from home, writing automation for a customer's cloud environment, Lady started an episode of repeated pancaking.

In the span of a little less than 30 minutes (from a hair before 11:00 to around 11:25 or so), she was falling flat for no apparent reason. First, I'd seen her get up from her one pillow to go get a drink. On the way, I saw her pancake out of the corner of my eye. It didn't look normal, but, I told myself, "maybe she just stumbled and it looked wrong because you saw it from the corner of your eye. Best to keep an eye on her." Self-delusion is grand. Unfortunately, as I feared, it wasn't normal. After getting her drink and starting to walk back from the dish, she shuddered, briefly, then pancaked again. She got right back up, though, so I didn't immediately panic. But then she went to go lay with our other dog, and pancaked again while taking a step up onto the main stairs. At this point, the sinking feeling really set in: barely controlled panic. I SMSed my wife to tell her to hurry home with the car before calling the vet to arrange an emergency visit.  Between the SMS and call to the vet, Lady pancaked one more time before I brought her up on the couch. She had a worried look and I wanted to be able to soothe her. Donna eventually got home and sat on the arm of the couch next to Lady. Lady sat up to say hello ...then toppled back over against me.

Wife home, I went upstairs to get dressed so we could gather up the dog and head to the vet. The on-couch toppling was the last such event before heading to the vet.

We were able to run Lady and Kaiya (our other dog) outside to go to the bathroom without further pancaking from Lady. We were able to get them leashed and harnessed up for the trip (they actually had a scheduled appointment for booster shots, this afternoon) with no pancaking. Lady strode enthusiastically out to the car and hopped up into the back seat without any sign of lack of sure-footedness. Similarly, when we got to the vet, she hopped right down out of the car and did her boxery walk into the vet's office – all with no sign of problems.

The vet-tech took care of Kaiya's booster shot while we waited with Lady for the vet. Kaiya was in an irritable mood – she tends to be leash-reactive, especially at the vet's – so I had Donna run her home while I stayed with Lady. The office staff took us to a room to wait for an available vet.

Eventually he came into the examining room. We discussed what had prompted the change in plans for the day. He decided that some initial diagnostics were in order, but that it would take an hour or so to do them. So he offered the opportunity for us to leave rather than wait in the veterinary facility. Given that the pancaking happened a skosh before lunchtime and it was now 12:45 (and some of my panic had either semi-subsided or I'd been able to compartment it off), I was beginning to feel hangry. So, we took the opportunity to go home so I could get lunch.

Vet called a hair before 15:00 to come talk about Lady. We rushed back down. He indicated that there were some troubling indications in her initial bloodwork. Specifically, here blood sugar levels were critically low – and they'd tested twice to verify that there wasn't a labwork error. That had caused him to do some preliminary imaging. He indicated he wasn't an imaging specialist, but that it had looked like there might be a mass near her liver.

We discussed what this could mean – especially combined with the pancaking and blood sugar levels – and appropriate next steps. We opted to have their sonographer do a more-detailed imaging and analysis. This would take about an hour. Eventually, the results came back: a large, consolidated mass in her liver.

Obviously, my heart sunk through the floor and my voice wanted to betray me. But, I gritted through discussing prognosis and next steps. Because the mass seems to be consolidate/confined, he recommended an oncology consult and offered a referral. There's a chance that, given early enough surgery and that the tumor is as confined as it looks, she could potentially recover in a way where she'd have decent quality of life and not suffer from a premature-for-her-breed death ...but that the oncologist would likely be able to give a better idea.

We started talking numbers, both for today's vet visit, plus likely fees for consult, surgery, etc. Nice thing about numbers is it gives me something non-emotional to focus on. I was doing a running-tally of the current and projected numbers in my head versus how much I knew to be in our "rainy day"/vacation fund. The numbers were close but notionally wouldn't require making a life/death decision based solely on financial capability, and might not even require having to resort to credit cards or tapping into the investment-account (or, as I sometimes refer to it, "the really rainy-day account"). We agreed to a plan of action: he'd provide an oncology referral and steroids to help encourage her liver to release more sugar into her blood; we'd alter her diet to reduce simple carbs  and increase protein and fibre intake (irony is that, with a hypoglycemia-inducing liver tumor, the diet change isn't "give her more sweets" but "feed her like she has diabetes") while simultaneously changing from twice-a-day feeding to an every-four-hours schedule (though same basic daily caloric intake) to help smooth out the glycemic peaks-and-valleys; we'd schedule an appointment with a canine oncologist and proceed based on the outcome of that meeting.

Given that we didn't get home till after 17:30 and tomorrow being a national holiday, won't even be able to call to schedule the consult till Friday. I've asked for multiple referrals so that I can take her to whoever's able to see her first. Fortunately, there's enough in the "rainy day"/vacation fund that I'm able to accommodate a "speed trump costs" strategy. In the face of (personal) tragedy, it's always good to look for things to be thankful for where you can find them.

Obviously, as of this writing, haven't had the oncology consult: everything could turn out to be moot.

Regardless of this particular incident, this will make three dogs to have been afflicted with cancer:

  • Our first rescue-bullie, Lana, contracted a treatable cancer, but, it was discovered coincident to discovering she had advanced stenosis. Given her age, the stenosis and the toll treatment would take on her absent those other considerations, we opted to schedule a euthanization (so we could take her home for a few weeks of pampering).
  • A month later, our second rescue-bullie, Puckett, had manifested skin lesions. A vet visit revealed them to be from cutaneous lymphoma: an aggressive, untreatable (in dogs, at least) form of cancer. Vet predicted a possible remaining lifespan of six months. We got half that when the cancer spread to his lungs.
  • With Lady, our fourth rescue-bullie, I don't yet know the outcome. I suspect the worst, however. That seems to be the way of things.
By a small miracle (at least, it seems that way, at this point) our third rescue-bullie, Cira, was not afflicted with cancer. No... At just shy of nine years old (a skosh longer than six years after joining our household), she died of a sudden-onset, complete renal failure.

So, yeah, our pup-luck has been "not great". I mean, to date, we've been blessed with five really wonderful dogs, but three – and likely a fourth – we'll have only been able to share our home with for far shorter times than is normal for their main breeds' life-expectancies. And that's in spite of the previously mentioned attentive care.


In short, dog-owning life has had a way of really making us feel like the Universe is, at best, indifferent, many times cruelly-so.

Thursday, February 7, 2019

News flash: Virginia is an "Old South" state.

It's nickname is "Old Dominion" for a reason. Several of its most famous historical figures owned slaves and led Confederate forces. Hell, it was the seat of the Confederacy for a while.

I've lived here for a quarter century, now. "Northern Virginia" was a near pejorative for "real" Virginians when I first moved here.

I still remember how stark the difference between the 703 area code was from the rest of the state. It defined not just your dialing rates/locality but a noticable mind-set difference. Just beyond the 703, where you now find tech companies and  huge tractsA-friendly neighborhoods McMansions, you used to see farms and rustic stores Hawking souvenirs from "the War of Northern Aggression".

My point is, discovering that a politician that was born, raised and attended college in "Old South" Virginia before the 90s ever participated in black-face is utterly unsurprising. Not excusing it. Just pointing out some unfortunate reality. There's likely a lot of skeletons in the closets of a significant chunk of the Virginia state government's office-holders. It's likely to be another 15-20 years before that's no longer the case.

It's not just a Virginia thing, either. Hell, it's not even just a "South" problem. I grew up in what, as an adult, I refer to as Pennsyltucky. The vast majority of the state is/was rural ...and its main cities were never (on average) something you'd have confused for "cosmopolitan", "sophisticated" or particularly "progressive". I knew plenty of people my age that, even 20 years ago, would say things that might leave you gawping or scratching your head and wondering, "did you really just say that?" And if you were talking people a generation or two older than me? Fuuuuuck. I loved my grandmother dearly, but I don't have enough fingers to count the number of times she would use "the coloreds" or similar terminology in her speech. It wasn't meant in a particularly-racist way - it was normal for her generation and class - but would still leave me sometimes speechless.

I used to travel extensively, for work. I can tell you that Pennsylvania is not alone in this respect among Northern states.

So, yeah, the current news cycle about what's going on in Richmond is pretty fucking gross. However, as alluded to above, given the current composition of the elected body, summarily cashiering people who've had skeletons might not be the smartest thing. The replacements could easily be worse people. It's even likely that the people that dug those skeletons up have the same damned skeletons (that they think are burried a bit better than those of the recently-exposed) but also have something to gain by digging others' up.

I dunno. It sucks. Doesn't feel like there's a lot of good options inside the next decade or so. That said, I'd still probably prefer someone that claims repentance over someone still wearing a MAGA hat.

Friday, November 9, 2018

Going Nowhere

It's funny, I've spent a decent chunk of my working-life traveling:
  • 22 straight months for SGI
  • 6 straight months for NetApp
  • sporadically for Digex/WorldComm/MCI
  • 5 straight years for Wells Landers (on behalf of Veritas, Sun and VMware)
Given that the above accounts for all but the most-recent nine years of my career, that I have managed to completely duck traveling for both my current company or my prior company is kind of an aberration. That said, that desire to avoid traveling isn't without reason...

Having had to deal with the expensing systems for small items like tolls and similar costs for attending local event, certification exam costs and the like, I've felt compelled to avoid incurring any work-related expenses that I couldn't afford to not get reimbursed for. Worse, because said expenses are employee-fronted and their systems are/were such fucking disasters, there is/was the likelihood of incurring interest charges while waiting for the expense-processes to get worked out. I can cover a few $100s to pay off a credit card and avoid interest when the expensing-process is horribly broken and slow. Paying off airfare, hotel and meals for a week-long conference or training course (and the fees for attending the conference or course)? Not so much ...and I for damned sure ain't paying interest on that waiting for an expense check to get cut (or try to recover interest accrued due to said waiting).

So, over the last nine years, my travel has been limited to pleasure trips. Which is to say, travel that doesn't force me to have to deal with an expensing-nightmare. The only travel nightmares have been the horror-show that is the fucking TSA. With "TSA" accounting for why most of our vacations are "mini" vacations that are done either by car or train. Because of the TSA, a pleasure trip has to be really worth the hassle.

Thursday, November 8, 2018

Thanks For Nothing, Fuckers

Was kind of annoyed when I went to use my Hue app. Opened the app to control my lights, and the app announced to me, "you need to use the Bridge v1 application, now".

So, yeah, confirmation of why I'll never spend a huge amount on any given IoT device: deprecation. LED lightbulbs typically advertise lifetimes in excess of two decades. So, notionally, once you've paid the premium for Hue bulbs, you're done paying for bulbs for twenty or so years. EXCEPT! ...if you wish to continue being able to actually control those long-lived devices, Philips apparently wants you spend $100+, every few years, to buy a new damned bridge?

Fuck.

That.

Noise.

And, the thing is, you know that Philips won't be alone in that nonsense. So, sorry Samsung (et. al.): while I could maybe see my way to laying out $10K for a "smart" refrigerator that will last me a couple decades, I'm certainly not dropping that much, every few years, just so I can keep using all of those "smart" features.

Somehow, it feels like "IoT" is destined to become a further driver of burgeoning landfills.

Thursday, September 27, 2018

We're Going to Vegas, Baby!

Why it's sometimes worth making a polite call to an airline:

This past year, we went to the Las Vegas edition of the Electric Daisy Carnival. We had a fucking blast and wanted to do it again this coming year. However, for any such event, there's the problem of airfare expenses from the East Coast. This past year, we'd flown free by using a goodly chunk of the frequent flyer miles I'd banked from my days as a traveling professional services consultant. That chunk, however, left me a fair amount short for being able to do the same for 2019's EDC.

So, I signed up for an American Airlines rewards card so that I could pocket 60,000 frequent flyer miles. The cost of getting that bonus was spending across three months less than what I normally push through one of my cards in a few weeks' time. At any rate, those points finally posted a few weeks ago. So, I went to book the free trip for my wife and myself using those points. Unfortunately, by the time the points had posted to my account, the itinerary's cost in points had gone up (naturally) such that I was short, again.

One of my other credit cards is a hotel card. The chain has a transfer agreement with American that let me convert points. When I'd looked to see how many points I'd need to convert, I found a page that said "transfer before December 21st and get a 30% bonus." Score. That would let me book the trip with points to spare. So, I went to my hotel's site to initiate the conversion. The points showed up today. However, there was no 30% bonus present and I was still 500 points shy of the free itinerary. So, I called American.

The CSR was very helpful. She pulled up the page showing the bonus-offer and contacted her help desk. Since I was very close to my points needed and the help desk was potentially going to take a while, she comped me the necessary points to get me to my free trip. In the mean time, her help desk informed her that the bonus-offer web page we were both viewing was a 2017 offer that their web maintainers hadn't taken offline. However, since I'd acted in good faith (and have done a few hundred thousand miles of travel on the airlines that became the current incarnation of American), they comped me the bonus. Presumably, they'll be trying to figure out how to offline that stale page (since the page's terms only mentioned a month/day and not a year).

Now, to sort out hotel...