Tag Archives: medication

What Annoys Jeff this Week?

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1. AFGE Local 1904. Here we are 24 weeks past the “end of max telework” and the union, such as it is, still hasn’t come through on delivering the new and improved telework agreement. So, we’re still grinding along with only two days a week like pre-COVID barbarians… as if 30 months of operating nearly exclusively through telework didn’t prove that working from home works. All this is ongoing while hearing stories of other organizations tucked in next door that are offering their people four or five day a week work from home options. It’s truly a delight working for the sick man of the enterprise. I’m sure someone could make the case that there’s enough blame to go around, but since the updated and perfectly acceptable policy for supervisors was published 24 weeks ago, I’m going to continue to go ahead and put every bit of blame on Local 1904 for failing to deliver for their members (and those of us who they “represent” against our will) and for continuing to stand in the way like some bloody great, utterly misguided roadblock. No one’s interest is served by their continued intransigence. The elected “leaders” of AFGE Local 1904 should be embarrassed and ashamed of themselves.

2. Scheduling. Short of hiring an assistant there simply isn’t a mathematical way to give Anya her medication as scheduled on days when I can’t avoid being in the office. I suppose I could take a two hour lunch every day and double my commute to two 40 mile round trips a day. Maybe I could do that for a week or two, but if the meds end up running for a month? Longer? Yeah. No. I’m fairly fanatical about getting these guys the best care I can find, but after all these years and all these animals, I’ve never cracked the code on how the hell to give them medicine every eight hours, or worse, god forbid, every six. At least three times a week there’s a middle-of-the-day dose that just doesn’t happen, so if you’ve worked out a solution, I’m all ears.

3. Russia. Are we really supposed to take a country that rolls out 60-year-old tanks to replace their “modern” armor lost in combat and then uses a manned fighter jet to sideswipe an unmanned drone seriously as a country? That’s before we even consider their questionable standing as a regional power, let alone their once held status as one of the world’s two superpowers. The Russians, like the Soviets before them, have always been a little bit “different.” Maybe it’s just me, but lately the tired old antics of the ailing Russian bear seem to make it much more an object of mockery and scorn than any kind of fear or intimidation. If they haven’t been doing the work to maintain even their most basic equipment in fighting shape, I’m left to wonder what are the chances they’ve had the time, expertise, and money to maintain anything more than the illusion of a strategic deterrence force. 

Anxiety and frustration…

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The internet is truly a font of information. Need to know how to replace the front end on a 1953 Buick? There’s a YouTube video for that. Interested in watching other people play video games? There are more streams than any one person could ever hope to watch. There are endless “how to” blogs and videos on every topic you can imagine. The thing is, they should all probably warn you that your mileage may vary. 

Every veterinary video I’ve watched in the hopes of picking up tips and tricks for making our daily routine of eye drops and oral medication more tolerable has exactly one thing in common: They each use the most quiet, docile cat imaginable for the demonstration. No hissing, no spitting, no teeth or claws, barely even a head bob while the person fiddles and fools with their test subject. Not one single video I’ve seen has featured an angry, hostile, animal who has had minimal handling and only basic socialization with people.

The other comment, popular throughout Reddit, is that giving medication to cats “can be a two-person job.” Hey, that’s fantastic information and all, but is the expectation that I’m going to hire my own vet tech to drop by three times a fucking day for two weeks or more? Advice, it seems to me, is best when it’s practical.

That’s all a lot of words to say that the best advice available online hasn’t been particularly useful in my current situation. In the struggle just to get the job done, I’ve fallen back on the very old school (and frowned upon by those endorsing the modern, kinder and gentler approach) method of grabbing this poor cat up by the scruff of her neck and getting the treatment done by brute force. I don’t like it. She very much doesn’t like it. I have grave concerns that I’m poisoning what should be our prime time for bonding and trust building… But short of sending her off to medical boarding for the duration of the treatment, I’m simply at a loss of how else to proceed. 

I’m ending this week full of anxiety and deeply frustrated.

I’m going to get a lecture…

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I’ve been successfully avoiding the doctor since this whole COVID-19 dust up started.  Intentionally schlepping into a building designed to cater to sick people didn’t feel to me like a particularly good idea. Sure, my own brand of sickness is killing me slowly and needs attention from time to time, but avoiding the kind of sick that causes swift death from lack of oxygen was more of a priority. 

It’s been a year since my last checkup. I’ve mostly felt fine, or rather anything that’s bothered me pre-dates COVID-19 by a matter of years and been around long enough that it all feels like my version of normal. The doc kept refilling prescriptions on schedule and I was happy enough staying put until the world sorted itself out.  Apparently, though, doc has a philosophical problem with refilling scripts for someone he hasn’t personally seen in a year. That’s fair, I suppose. Inconvenient, but fair. 

I already know most of what he’s going to tell me. I’ve picked up weight during the plague. That’s likely a side effect of working my way through the comfort food cookbook half a dozen times over the last year. My blood sugar is running higher. Again, a result of the carb-heavy cooking and an increased intake of gin and tonic.

I’ve never been a paragon of healthy living. No one knows that more intuitively than I. When you add in my natural predilections and preferences to a world that has steadily condensed into only the pleasures I can find here inside the compound, well, the results shouldn’t be surprising to anyone. Trolling through flea markets, antique malls, old book shops, and secondhand stores have all been wholly replaced with the joy of tasty food and drink. It’s not optimal, but it’s what it is.

I’m going to get a lecture next week. I’m quite certain of that. I’m going to get a lecture, but I’m going to get my prescriptions refilled, so it’s probably a fair trade. 

A bloody mess…

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The morning feeding here starts most every morning at 5:30. It’s usually a completely uneventful part of the day. Today it wasn’t, of course. It was a bloodbath.

For the prior 24 hours Maggie had been growing a fearsome looking lump under her incision. It was worrying enough that I changed her follow up appointment to this afternoon rather than waiting for Thursday, when it was originally scheduled. We fell seven hours short of that appointment when she dove into her breakfast and the dam broke – leaving a trail of blood tinged fluid dripping down her shoulder and quickly spattering the floor.

“Not good,” my initial early morning response. Maggie didn’t seem bothered at all. She didn’t even slow up on inhaling her breakfast.

Over the next three hours, what I’ve now learned is a common post operative condition called a seroma, steadily grew smaller as the fluid continued to drain – mostly into the kitchen floor. I’ve mopped today. A lot.

Our vet assured me this is all fairly normal. He was happy enough with her progress to take her sutures out, and advising “just let it drain” while handing over another 10 days worth of antibiotics just to ward off any future issues.

So here we all are, confined once again to the kitchen in an effort to keep random canine bodily fluids from soaking in to more sensitive parts of the house. I can only hope this iteration won’t take nine months.

I’m happy my girl is on the mend… though I wish it would involve just a little less oozing.

Optimal control…

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We were back to the vet this past Friday with Maggie. She has to stick around with them for a few hours for a bit of follow-up testing for her Cushing’s. There’s no remission or recovering from it, but symptoms are treatable, so finding the best course of treatment for her is important to me.

This last test shows that we have the meds dialed in to the point of “optimal control” for her ACTH levels – meaning we’re able to hold her cortisol levels more or less where they need to be to reduce the laundry list of Cushing’s symptoms. Under the circumstances, it’s just about the best possible outcome available.

It was a long six months in getting here – with three or four visits to the regular vet for testing, schlepping across Pennsylvania for an ultrasound, and several variations on the medication of choice to get things under control. It hasn’t been an inexpensive proposition, though I refuse to do the math on either the amount of time or money expended. I know I’m incredibly fortunate that neither one of those factors drive the train when deciding what’s best for my sweet, lazy chocolate lab.

The fact is, Maggie is an old dog. She’s coming up on her 11th birthday in October. I’m under no delusions about how this ends – for her, for me, or for any of us. For now I’ll appreciate that I, through the marvel of modern veterinary medicine, was able to buy her some more quality time. Beyond that, everything else is background noise.

Stoned…

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One of the great perks of hoarding sick leave early in my career is now having a giant stack of it available to use when I’m not feeling up to snuff. Today is one of those days – when the better part of valor was parking myself on the couch and flooding the system with medication instead of dragging myself to the office as if I thought I still had anything to prove to anyone.

Instead, after breakfast, and a few odds and ends, I sat here muttering at the dogs, facing a few hours where I’m nearly stoned into inaction. I’m not sure I could operate heavy equipment even if I wanted to. They may be on to something with that warning.

What they’re not on to, apparently, is the definition of the phrase “non-drowsy.” Hey, I like being as blitzed as the next guy, really, but damned if it wouldn’t be nice to have a option that could dry out my sinuses without sending me face down on the kitchen table. Yeah. That would be great.

What Annoys Jeff this Week?

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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…

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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…

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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?

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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.