What Annoys Jeff this Week?

1. Office pot luck lunches. In my opinion there is no more sad and depressing sendoff into retirement than an office pot luck lunch. Somehow showing appreciation for years of dedicated service by taking over the conference room, piling the credenzas high with veggie trays, deli sandwiches, packaged deserts, and lukewarm entrees just doesn’t fill me with a sense of purposeful recognition… it’s more like getting away with a bare minimum level of acknowledgment. I’ve never liked office pot lucks. The “special occasion” pot lucks, though, smack of insult to injury. Al least when my time comes I know what I won’t be doing. Some day, when people come looking for me, there’s just going to be an empty cubicle where Tharp use to sit. No pot luck, no certificate of appreciation, just a vague memory – a shadow receding into the distance just as quickly as his little legs will carry him.

2. Being a sonofabitch. I know it doesn’t seem it, but I’m generally a reasonable individual. My expectations of people are usually limited, based on experience. I’m almost never looking for a fight. I’m almost the definition of live and let live because I so rarely feel the need to engage. There are some times, though, when I have to be the sonofabitch. I can do it. I’m good at it. But all things considered I’d rather be left alone.

3. $10 a pill. I’ve picked up Maggie’s next round of antibiotics… ten days to the tune of $10.34 a pill. I love these dogs and I appreciate the marvel of modern pharmaceuticals, but hells bells, I’m taking whole fists full of human grade medications that don’t carry that kind of price tag all in.

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.

Naw, we don’t need no logistics…

Hey, I know from experience that sometimes logistics can be hard. Getting an item from Point A to Point B in the right quantity at the right time can take a bit of work. When the chips are down and time is a factor, I’m glad I can count on the prowess of the United States Postal Service to let me down hard. 

My well-traveled package

But seriously, an item I ordered landed in Philadelphia last Saturday. In the four days since it has been transferred to Hyattsville, onward to Baltimore, from Baltimore to Washington (where it rattled around the Regional Destination Facility for 6 hours getting scanned repeatedly), back to Baltimore, and reverse coursed back to Washington where it has been sitting since 7:34 this morning. But I suppose I should be confident in the big bold promise of “Delivery by 29 November.”

I mean it’s not like the USPS has been charged with delivering mail and packages for well over 200 years now. Getting a little padded envelope from Philadelphia thirty miles down the road to Elkton is clearly one of the more logistically complex efforts every devised and executed by the mind of man. 

Thank the gods that the package in question absolutely does not contain medications that in any way are responsible for keeping me alive.

Sigh. Apparently, in mail, as in war, even the very simple things are so very hard to do.

What Annoys Jeff this Week?

1. Inefficiency. Look, I’m delighted that Big Pharma is reimbursing me 93% of my out of pocket costs for the meds that one of the smart docs from Hopkins tells me will contribute to being able to continue to living better through chemistry. I’d be even more appreciative if their reimbursement scheme allowed for ordering more than a 30-day supply of the stuff at a time. Everything else rolls in as a 3-month supply that’s simple enough to refill once a quarter except this one little pill. It feels like I’m online getting that one refilled or coordinating the refund about every seven days. If you’re going to spend the money either way you could save us both processing time and effort by doing it four times a year instead of 12.

2. Single points of failure. The world is full of people who want to gather all decision making and power unto themselves. I’ve never understood that particular logic for several reasons. First, the ones who seem to be drawn to absolute power are generally the last ones who should be engaged in decision making. Second, there’s nothing more ridiculous than a few dozen people standing around knowing what needs done but being paralyzed for lack of having someone explicitly telling them to do it.

3. Consistency in the space program. I really wish we lived in a country that had consistent and achievable, manned and unmanned space exploration goals. I want NASA to be above politics and be maybe the one instrument of government that is the best reflection of ourselves. I want to see big rockets with the stars and stripes plastered to the side hurtling American astronauts back to the moon and then getting their ass to Mars. To think that’s not the next logical step in exploration is nonsensical and flies in the face of humanity’s eternal struggle to expand into the unknown. Other people will tell you this should be way down on the list of priorities, but those people are wrong and should be quiet.

In recognition of Big Pharma…

I’m not going to lie here, I was a bit skeptical when I was given a link that promised a “significant rebate” on one of the more expensive meds that are currently keeping me alive. Sure it was all nice and official and came to me by way of bitching at my doctor about the ridiculous cost of this new pill, but the claims of being rebated almost 95% of my out of pocket expenses seemed outlandish and unrealistic.

After getting my second check back from the nice folks at Merck, though, I had to admit to being pleasantly surprised. Sure, they make they process convoluted and require a fair deal of bureaucracy, but in the end what would otherwise be an obnoxious monthly expense ends up costing a total of $5.00 out of pocket. I’m just going to ignore for the time being the small fortune I’m sure to be costing Blue Cross for all this, of course. I just think of myself as an insurance industry loss leader. They an feel free to use me as an example of someone who’s wildly pleased with their products and services.

As much as I like to bitch and complain, I think it’s worth doling out credit where and when it’s due. From my perch, kudos to Big Pharma for the solid work at delivering new and effective medication and for having a means and method to help offset costs for he end user. Well done.

New drugs…

One of the many exciting parts of my recent run of days off was a visit with my frighteningly Teutonic primary care doctor. I actually like the guy – Not just because he’s instrumental in keeping me alive despite my best efforts to the contrary, but also because he’s not a pushover. I’ve had docs in the past who were probably a bit too willing to give way in the face of a strong personality. This guy, well, he’s not a pushover. Even when I’m blatantly ignoring his advice, I appreciate his frank and direct approach.

This most recent visit resulted in a few tweaks to the daily chemical cocktail that’s doing its best to keep me from dropping dead. Although I’m feeling fine, we added a fairly new drug to the mix because some of the underlying numbers were starting to creep off target. Yeah, it’s another hundred bucks a month out of pocket, but when weighed against the previously mentioned dropping dead option, I suppose it’s really a bargain.

As a responsible drug user, I try to be at least minimally informed about what I’m swallowing down with my morning coffee. Reading the list of potential side effects checked off most of the usual unpleasant check boxes: May cause runny or stuffy nose, sore throat, headache, irritability, back pain, joint or muscle pain, nausea, stomach pain, or diarrhea. Basically what the helpful information packet told me is that the side effects are a subset of conditions I already expect to experience on a regular basis. Super.

Better living through chemistry, indeed.

Pain management…

I got a call today from a number I didn’t recognize. Usually I (not so) cheerfully ignore those, but since I was working from home today, I accepted the call… at which point I started down the rabbit hole.

Them: Hi, Mr. Tharp. I’m Casey from Whatever-the-Hell-Company. I’d like to talk to you today about your prescription pain management program?

Me: Uhhh. My what now?

Them: I’m Casey from Whatever-the-Hell-Company and I’d like to talk to you today about your prescription pain management program?

Me: Yeah, I don’t have one of those.

Them: Well, Mr. Tharp, I’d like to talk to you about…”

Me: *Ends call and wishes hanging up a cell phone felt any bit as good as slamming down the receiver of an old fashioned rotary telephone*

Now this was a live person who I’m assuming was working off a script based on my three days as an inbound tele-marketing center employee. Cold calls are fine and all and since she had a pleasant voice and didn’t immediately try to sell me on Amway I was trying to be cordial… but when I’ve told you for the second time that whatever information you have is incorrect, it’s best not to keep telling me that I do, in fact, have a prescription pain management program. Frankly I feel like that’s something I’d know about.

I’ll be reinstating my policy of letting all unknown numbers ring through to voicemail immediately. I should have known better.