The busy season…

Like many industries, here at Tharp Weddings and Events LTD (a tiny subsidiary of Giant Bureaucratic Organization, USA), we have a busy season. At the moment we are directly in the middle of it. Which explains the random nose bleeds and increasingly surly attitude.

The simple fact is the next five weeks are going to fuse into an undifferentiated and increasingly frenetic hail of emails, phone conversations, meetings, briefing slides, and random conversations in the halls. It’s like being inexorable pulled towards an earth-based black hole centered on the first week of May that’s doing its level best to suck in every element of reality that surrounds it while spewing anti-reality out on the other side of the event horizon.

For someone who has to work diligently at being civil and talkative in a crowded room, the whole thing is basically a preview of what my version of a hell dimension might look and act like. 

This time of year is something that is simply endured. If it feels like over the next few weeks that the writing here is suffering, it’s not your imagination. On the typical day I’m busy using every scrap of available energy to fend off the encroaching madness. Historically it doesn’t leave much in the tank to deliver the kind of online snark you’ve come to expect around here… and for that I am gravely sorry.

On the downhill slide…

Even though I should have been happily ensconced today in my home office, I walked in to the building this morning with a little extra spring in my step. Unremarked and unknown to anyone I have slid past an auspicious milestone and that knowledge has, at least for today, has helped give me a little better perspective. 

You see, I’ve rolled by the halfway mark of my anticipated career as a professional bureaucrat. That means, should everything go to plan, I’ve already spent more days sitting in a cubicle than I’ll have to spend sitting in a cubicle in the future. 

Yes, an extraordinary number of things have to go right to make this reality – the stock market needs to match or exceed its historic rates of return, I have to avoid doing anything egregious and getting fired, and I need to not drop dead or otherwise completely wreck my health. 

Still, though, for the first time I’m on the right side of the countdown and I have a rough plan for the way ahead. It’s hard to believe that finding myself on the downhill slide could possibly feel so good… but it does. 

What Annoys Jeff this Week?

1. Bathroom stall phone calls. Yes, you’re sitting down and probably bored, but the shitter in the public restroom really isn’t a conference room. And yet at least once a week I walk into the one down the hall from my little section of cube farm and there’s someone holed up in one of the stalls having a full blown conversation. First, it’s the one room in the building where I can mostly go to escape pointless conversation. Secondly, whoever you’ve got on the other end of the line doesn’t need to hear you dropping the kids off at the pool. Lastly, you can save the stink eye, because every time I walk in there and find you on the phone, I’m going to fart, belch, whistle a jaunty tune, and generally be as loud, obnoxious, and passive aggressive as possible… because I dare you to say something to justify yourself in the eyes of gods and men.

2. City slickers. In Paul Krugman’s recent screed in the New York Times, Getting Real About Rural America, his thesis seemed to be that things could get better if only people in rural America started thinking more like people living in urban America. The catch, of course, is that I’ve made the conscious decision to live in rural America precisely because it doesn’t think (or behave) like urban America. I could have just as easily decided to live in Baltimore, Wilmington, or Philadelphia but none of those places support the kind of lifestyle or the quality of life that’s important to me. If the capital “D” Democratic Party ever wants to make serious inroads into the vast swath of country beyond reliably Democratic voting cities and inner suburbs, they’re going to have to come up with a far better argument than “you should just think like us.” The day I declare I want to give up wide open ground, backyard wildlife, towering oaks, no traffic, and idyllic quiet for “everything the city has to offer,” consider this my written permission to begin proceedings to have me psychologically committed. 

3. Recognition. After spending the better part of six months mixed up in delivering a final product that’s “rolling off” the proverbial line next week, there’s nothing more cheering that sitting in a meeting where one of the Gods on Olympus turns to you quizzically and asks, “Ummm, why are you here?” Oh, no particular reason, I saw a meeting forming up and I didn’t have anything else to do this hour so I thought I’d hang. I don’t ever do things for public credit to see my name in lights – in fact I actively avoid those things. Still, though, sometimes it might be nice to know it’s recognized that I’m not just wandering the halls lacking anything better to do. You can just color my morale well boosted today.

Partial diagnostic credit…

After a morning road trip through some of Pennsylvania’s finest horse country and 30 minutes of abdominal scanning, it turns out that my regular vet had the diagnosis right, but gets only partial credit on the underlying cause. Still, I count that as exemplary work for a condition that presents as a shitload of things that don’t feel like they should really be logically related.

It turns out that Cushing’s is the correct diagnosis, but rather than a tumor of the adrenal glands, the glands themselves were “significantly” enlarge. In fact they’re currently 5 times bigger than they’re supposed to be and hammering out cortisol like its their full time job. Since we’ve ruled out an adrenal tumor, that basically leaves a growth on the pituitary glad as the last culprit standing.

In many ways, the adrenal tumor would have been easier to treat – open the abdomen, remove the tumor (and the accompanying gland), and the symptoms go away. It’s an invasive operation with good success if the dog survives surgery and the first week of recovery. The problem is that 30% of dogs that have this treatment don’t get past that first week. I’m a betting man, but when you’re looking at odds of one in three chambers having a live round, I’d have an awfully hard time pulling the trigger.

I’m waiting now for my regular vet to get the report and work up the treatment plan. My best estimate is that it will be to treat with daily medication to reduce the amount of cortisol being made rather than something surgical. My reading shows that surgery for pituitary-involved Cushing’s is possible, though exceedingly rare for dogs. What this really means for Maggie is she’s likely going to have to take some fairly high powered pills twice a day for the rest of her life. There’s going to be more home monitoring and increased testing at the vet to confirm that everything is working normally. Basically it’s nothing that life with a bulldog didn’t prepare me to deal with already.

There’s a catch, of course. Without dragging her back to the specialists and ordering up an MRI of her brain, there’s no absolute way to know if this tumor is benign or malignant. Research says the large majority of pituitary tumors in dogs are benign. With an average canine MRI running into several thousands of dollars, I’m inclined to let the odds dictate our response on this one. If it turns out to be something more aggressive, the options I’m willing to pursue decrease fairly dramatically anyway.

The prognosis for all of us is the same in the long run, so there’s very little advantage to be found in trying to plan against it. With all that said, I’m cautiously optimistic that we can strike on a way ahead that maintains or improves the brown dog’s quality of life in the short and may even mid-term.

A year and then some…

Back on the 21st of February, I published my usual Thursday edition of What Annoys Jeff this Week. It took me a few weeks to noice that the link for that post ended with /what-annoys-jeff-this-week-365.

It took me even longer than that to recognize the implication of what I was seeing. Somehow, I’ve managed to post a full years worth of weekly annoyances as part of the “blogging to keep myself sane” program instituted here long, long ago. Just let that sit there and sink in (or fester) for a moment.

Saved here in the never-really-goes-away electronic universe are 365+ weekly posts dedicated to telling the world what trifling ridiculousness has earned my ire that week. I mean you could read one a day starting tonight and not read the last one of the batch until some time in late March 2020.

Friends, that’s a lot of being annoyed, I can promise you that. Even so, what’s recorded here is just the stuff that made the cut on any given week. I shudder to imagine what the totals would look like if I bothered to write down everything that was ever in the running. Is it possible to clog the the internet with the sheer volume of bitching and complaining you’re trying to cram through its tubes?

Based on the comment section of most major news sites, I doubt it somehow.

Anyway, I’m currently taking an inordinate amount of pride in the amount of annoyed I’ve managed to rack up. I’m not quite sure it’s a badge of honor, but it’s something.

Specialists…

I’m old enough to remember taking the family dog to a vet who ran his practice out of a converted shed in his back yard. Treatment for most any ailment was a shot of antibiotics and a bland diet – his weapon of choice was boiled hamburger and rice. It was the middle 1980s and the very notion, at least in the mountains of western Maryland, that there should be anything remotely like a “specialty” vet didn’t cross any of our minds. Dogs got their rabies shot every 3rd year, ate table scraps mixed with their dry food, and all lasted for somewhere between 8 and 10 years.

Flash forward 30 years…

My bulldog, being typical of his breed, assembled an impressive roster of medical professionals on his “healthcare team.” Cardiologists, allergists, orthopedic surgeons, and anesthesiologists over the course of treating his many various conditions. My labrador, now into old age herself, has already acquired a opthmologist. In the coming weeks it’s likely we’ll add a radiologist, an oncologist, and a general surgeon to her list.

Veterinary medicine as it exists today – with the ability to diagnose and treat the family dog in a remarkably similar way to how how I’d be treated if I walked through the doors at Hopkins with the same symptoms – is a marvel. It’s also a money making juggernaught, but that’s a separate discussion. The practice I’m taking Maggie to this week in hopes of working up a final diagnosis and beginning outline of a treatment plan includes easily a thousand or more years of combined experience in emergency medicine, cardiology, dentistry, dermatology, radiology, neurology, oncology, and ophthalmology, in addition to maintaining six surgeons on staff. Their posted resumes are suitably impressive (yes, I’ve read them all). I’m cautiously optimistic that all this will translate into identifying what the best options look like for the road ahead.

I’m walking into this week with just enough knowledge based on internet deep diving and journal article reading to hopefully ask reasonably informed questions. I’ll be counting on this bunch to know the line between what science can do and what science should do. Don’t get me wrong here, I’m thankful that the state of the art has grown beyond crate rest along with boiled hamburger and rice, but there’s more than a little bit of me that misses simple, country diagnostics and treatment – and its inherent acceptance that the power of medical science to extend life has, and should have, logical limitations.


Diagnosis…

After several rounds of testing, we have a preliminary diagnosis for Maggie of adrenal-based Cushing’s disease. Not being a vet, but being one hell of a good researcher, I won’t attempt to explain exactly what Cushing’s is beyond the fact that it’s a disorder likely being caused by a small tumor located on the adrenal gland that’s making her cortisol levels to go wonky and producing a host of potential symptoms.

In Maggie’s case, the symptoms include excessive thirst / drinking and the accompanying excessive urination, hair loss, and general weakness. At this stage, the disease doesn’t make her feel bad or cause any pain. Based on my observation she’s giving absolutely no indication that she even knows she’s sick. The primary treatment, should it prove to be adrenal-based, seems to be surgical removal, although there are some non-invasive options based on my cursory reading.

I won’t dwell on details at this point, frankly because I don’t have many real details to dwell on yet regarding Maggie’s particular diagnosis. Next week, we’ll be taking a bit of a road trip to a specialty vet who will do an ultrasound to visualize the suspect area and, hopefully, confirm a diagnosis so we can identify the appropriate course of treatment.

I’m already racking up a list of research I need to do between now and then – the success rates of the surgery in question, post surgical life expectancy, impacts on quality of life, and so on. I’ll also have to take a long hard look at my personal ethics with regard to invasive surgery for a dog that by any standard definition has already reached into the “old age” range. Believe me when I tell you it’s times like this when I hate being an analyst by professional and disposition. It’s one of the rare moments when being dumb and happy would appear to be a blessing.

The research and worry is all for a bit later though. Right now it’s Friday evening and I have a happy and contented, if not exactly healthy, dog sitting next to me wanting undivided attention. Tending to that feels like it’ll probably be the most productive and cathartic thing I’ve done all day.