The Hits Just Keep On Coming

My late December medical misadventures had mostly resolved only to be replaced by dental shenanigans. I’ve had some long neglected issues that I put off because they weren’t painful and I didn’t want to fork over hundreds or more likely thousands of dollars for what was mostly just an annoyance.

Whelp, as in the past, once a nerve root gets fully exposed even the most stalwart would likely put pain reduction over pocketbook. I’ve had both a broken tooth and crown (on separate teeth) for several years, but within the last month I had a cavity in my right upper first bicuspid (I think) which revealed itself when a cute little portal opened up in the bottom. Portals can be useful things, especially if they go to magical kingdoms or take you planetside, but they are less desirable in one’s chompers.

I scheduled a dental exam with a new clinic (it was the previous clinic, Monarch, that had soured both my wife and I from going for so long), and at the time time of the exam I wasn’t yet in a great deal of pain. Fast forward to three days ago and the pain started ramping up. It got bad enough that it woke me up at midnight on Thursday/Friday and I contacted the clinic requesting a same day/walk in appointment.

The clinic is normally closed on Friday, and additionally, Dr. Nguyen who performs the root canals is supposed to be on maternity leave, but they were willing to come into the clinic and take care of my problem. The procedure went smoothly and my only discomfort was due to bladder distension (don’t drink the coffee, you’ll soil yourself) (if you know that reference you’re old too). I had essentially no dental or oral pain once I was numbed up.

Once the anesthesia started to wear off yesterday and into last night the pain came back and was almost the same severity although the quality of the pain had changed since the nerve had been removed. Now the pain was spread over several teeth and also affected my mucosa. My face has swollen up to the point it looks like I’ve got a big chew in. I just need to throw on my baseball uniform and commence to spittin’.

Nothing has really touched the pain except for warm compresses and some Orajel cream that I had same-dayed (totes a word) this morning. Unfortunately it only seems to last about an hour when the recommended dosing schedule is 6 hours. Dosing schedule be damned until this pain and swelling start to decline.

I hope the succession of medical to dental chicanery was just random chance and not a sign of a larger problem. Meaning, it’s not typical for me to have big flare ups when I have injuries or illness. The shoulder/chest whatever it was accelerated above and beyond any notable triggers. Maybe there was something there that no one including my various providers or myself have been able to sus out. Maybe my immune system is getting more persnickety as I get older. I hope not.

This dental episode isn’t too removed from previous, although the severity has been higher not to mention the facial swelling which I’ve not had in the past. It was noted that I had a few elevated inflammatory markers during the shoulder/chest extravaganza (ESR, CRP), but these are non-specific and don’t clarify the source. I’m curious if they would be similarly elevated during this dental episode. As often happens, the diagnostic studies raise more questions than they provide answers.

Hopefully this dental shindig will start winding down and I can return to the regularly scheduled programming. It’s ironic because I had made several upgrades and fixed multiple issues in both my video studio and drum rooms, but I’ve been unable to enjoy them fully due to the pain and discomfort.

I should also mention that our girls have been very sweet in noting my discomfort. They are always quick to realize when their humans are distressed or in pain, and they adjust their behavior. Instead of negotiating (begging, harassing, etc.) for treats, walks, or playtime, they typically just lay down somehere near us and give us companionship without bothering us otherwise. Even Nynaeve, who is by far the most insistent for playtime, etc. has been following her sister’s lead and just staying close without asking for anything. Of course Aeyong is perpetually on the spot to give help or comfort when I’m in pain. I mostly deal with it myself, but her willing assistance is always appreciated.

The Cost of Healthcare

A quick addendum to the previous post…I was reviewing my health insurance account and a few of the claims had come through from this event. The hospital stay at Methodist Mansfield (which I assume to be all-inclusive but may not count the ER visit) ran up a bill of ~$33K. In the normal nebulous policy of insurance payouts, Tricare paid them ~$2.5K for the total amount. It looks like we’re on the hook for $73, which again, may be for everything or just the hospital stay. We paid a similar amount for the ER evaluation at Medical City, so who knows?

Suffice it to say that the cost of healthcare in this country is so beyond the pale it’s hard to fathom. We feel very fortunate to not only have medical insurance, but affordable insurance compared to many people. I think our yearly fees are equivalent to what many people pay each month. This was only an acute event and my total hospitalization was only about 36 hours. Granted, there were some expensive diagnostic studies included, but I can only imagine a long-term stay or the cost of a chronic disease with recurrent hospitalizations or expensive interventions.

A New Year and a Health Scare

Things are going fairly well as I type this on January 3rd, 2024. My health decided to close out the year by reminding me I’m not getting any younger. I’ve had this intermittent vague pain and paresthesias mostly in my left arm for years. I think I may have even posted about it several years ago when I had severe elbow and forearm issues that were aggravated by playing various musical instruments. That was more bilateral, but maybe the left was worse.

Fast forward to this last year and I’ve had recurrent mild issues almost solely in the left arm, starting at the shoulder and going all the way to my fingers. It seemed to predominate in a more ulnar distribution, but the entire limb can be affected. I think prolonged less than ergonomic fixed positions at my desk probably aggravated the issue.

On Christmas Eve we decided to drink the champagne that had been reserved for New Year’s Eve and that rolled into several glasses of wine as I had a pleasant evening watching the Police reunion concert and some other music videos. On Christmas Day I was slightly hungover, but not feeling too bad. I had a decent day - did some baking (rolls, cookies, pizza), walked the dogs, and felt better as the day progressed. As of dinner time, I was feeling fine, although maybe my arm had been acting up during the day, I hadn’t noted any change.

Around 6-7 pm, the pain in the arm increased in severity and was affecting the entire limb from the shoulder down. I couldn’t find a comfortable position and was unable to sit still. I got up and walked around, tried to move the arm through various rotations, and even went outside for a few minutes despite the cold. Nothing I could do was helping and the pain was spreading to my chest and then jaw, while also increasing in severity. I’d characterize the normal pain level at an annoying 2 most of the time, but this episode started as a 6 and was climbing towards 8-9.

I think I took some Tylenol and was still unable to sit still and get comfortable. I thought I might lie down and see if I could sleep it off. That aggravated the jaw and now neck pain, and the severity kept increasing. Being a PA, I recalled from my training in ACLS that one of the instructors referred to an acute myocardial infarction as “infarcting” as opposed to infarction. Meaning, the condition progresses if no actions are taken.

I was downstairs (I think to get Tylenol, but can’t remember the exact sequence of events) when Aeyong got up to get the dogs to go outside since they can be recalcitrant when the weather’s cold or rainy. She immediately noted something was wrong and I told her I thought I might need to go to the ER. She shifted to Defcon 1 in two seconds and was donning clothes and scurrying around the house to grab her purse and keys.

She was taking it more seriously than I was, although the fact this was my first ER trip in 29 years wasn’t lost on me. I decided to go to Medical City in Arlington since it had been recommended to us when Aeyong broke her wrist a few years ago. I think that recommendation was more based on the facility being a Level 1 trauma center as opposed to the quality of the ER.

To their credit, when I presented with chest pain they got me back for evaluation within a few minutes, performing an EKG, CXR, and drawing cardiac labs. We were sent back to the waiting room pending the results. I got a look at the EKG while still in the room and it was “abnormal” based on I think t wave inversion, but there was no significant ST elevation or Q waves that I could spot. Honestly, I had a low index of suspicion for cardiac since I still run regularly and although I have some risk factors, I don’t smoke and my blood pressure has been essentially normal during routine exams.

In the ER my BP was high - 162/98, and this trend would persist during most of this episode. We waited in the ER for several hours, although I think at one point one of the nurses came out and told us the cardiac enzymes were normal. This was my main concern, and with normal enzymes, I was relatively reassured that whatever was going on, it wasn’t cardiac. They kept us for six hours or so, primarily so that serial enzymes could be run and these were also normal.

Ironically, my pain was getting worse and was now becoming more diffuse across my chest, neck, and jaw. It stayed on the left side only, never crossing the midline in the chest, but it was bilateral in the neck and jaw area. Medical City did its main job, but other than that, I was underwhelmed. I was evaluated by a PA, and to his credit, he made sure the most life-threatening issue was cleared, but he never asked about my pain level from a therapeutic standpoint, and at the time he gave us the serial results his attitude was “enzymes are normal” as if there was nothing left to discuss. He never asked about whether my symptoms had changed or worsened, and he never offered any therapy or pain management.

In his defense, I didn’t ask or press the issue because I knew the ER wasn’t my PCM and it was 3:30 in the morning and we were ready to go home. The walk out to the car was some of the worst pain I had felt all night and Aeyong was asking me to go back in or to go to some other ER. I was inclined to believe it had to be neuropathic or musculoskeletal and although quite painful, not life-threatening.

We made it home and I think I took some Tylenol while we tried to get a few hours of sleep. I got up around 7ish and was able to book a follow-up with my PCM for the next morning. Throughout the day the pain never got much better so I tried a hot shower (which helped temporarily) and continued with Tylenol. Aeyong suggested her Robaxin which I tried but didn’t notice any difference. I think it was that night that I couldn’t sleep so I took some leftover Hydrocodone from a previous dental procedure. This gave me a good 4ish hours of uninterrupted sleep.

When I saw my PCM, she was concerned that this might still represent an undiagnosed cardiac or pulmonary issue so she recommended that we go across the street to the Mansfield Methodist ER. We followed her advice and were soon whisked in and went through the same initial workup. EKG, CXR, labs. The ER doc also wanted to run some additional inflammatory markers (ESR, CRP) as well as D-Dimer and BNP. Those markers were all elevated although the cardiac exam was still normal.

She then sent me for a CT Pulmonary Angiogram within the ER to rule out pulmonary embolus and this exam was essentially normal except for some nodules (benign) and a trace pleural effusion that was unlikely to be of any clinical concern. She suggested that there could still be underlying cardiac issues that would need a Cardiologist and further diagnostic studies to rule out. She recommended hospital admission to streamline and expedite the process, stating that it could take weeks or longer if pursued as an outpatient.

I was initially hesitant since this was my first ER visit and possible hospitalization since 1994, most importantly, my first since retirement and I was concerned about cost. Aeyong was adamant that I get a thorough workup and not leave questions unanswered. To her eternal credit, she is always going to push for me to get adequate healthcare and evaluation and not leave things to chance. Despite the possibility of a financially devastating hospital bill, I took Aeyong’s and the ER doc’s recommendation and decided to go forward with the admission.

Bed space was precious, so l was admitted to a just-opened room in the OB ward. The room was quite nice, almost more like a hotel with a private bathroom, desk, recliner, couch, and bed. I was kept under observation and offered some pain relief. I tried T3 with codeine which didn’t do much to blunt the pain. The pain had essentially continued but was coming in waves of severity and then settling down for no discernible reason. It seemed to be centered in the left shoulder and at times would shoot back up to a 7 or 8. After midnight the nurse offered pain relief and I said I didn’t want T3 and would prefer just a gram of Tylenol instead. She then said I could get Hydrocodone if I wanted and I related that it had helped at home, so I decided to have it.

Again, the Hydrocodone helped me get about four hours of sleep. I was NPO as of midnight so they could perform the cardiac stress test. I should mention they had given me nitroglycerin in the ER, and I think it helped some with my chest pain, but can’t state that with confidence. The one outcome I’m relatively sure about is that it gave me a headache and this persisted through the day into the evening. In the morning my primary pain was the headache, as the shoulder and chest pain had died down somewhat.

The night before and earlier that morning I was relatively certain I would need the chemical stress test as I would be unable to perform the treadmill stress test due to my headache and other pain. Once I got down to the testing suite in Radiology, my only pain was the headache and I felt capable of at least trying the TMST. I went through with it and was able to complete the test satisfactorily.

We went back to the room and Aeyong got some food so were able to share a brunch so to speak. Periodically throughout my stay, they would check vitals (Q4h I think) and at times of rest they would be more normal, but if I was up and moving around the BP especially would get higher. Thus far, most testing was normal, except for the D-Dimer, ESR, and CRP. These were all elevated, but they’re non-specific so they mostly only raised more questions rather than providing answers.

I eventually had another radiology tech come to my room in the late afternoon to conduct an echocardiogram there at my bedside. A little after 5 my nurse came in with some papers and notified me I had been discharged by the Cardiologist/Hospitalist. They were confident my issue was non-cardiac and didn’t warrant further testing or hospitalization. I agreed with them and had to get Aeyong out of bed back home to come pick me up. She had run herself ragged going back and forth between home to care for the dogs and coming to the hospital to look after me. Her gas tank is much smaller nowadays and she can quickly drive herself to exhaustion and pain when anything disrupts the normal schedule.

I’m now nine days past the initial episode. The shoulder and arm issues persist, albeit much decreased in severity. I have a follow-up pending on Friday with my PCM, Dr. Avenesyan. My working diagnosis is neuritis or radiculitis that flared up for whatever reason and spread to adjacent structures for reasons undetermined at this point. I’ve been able to walk the dogs every day and I even was able to run on the treadmill yesterday, although a bit slower (5 mph) and for only three miles. I made some changes in my office, removing the wheels from the desk so it’s slightly lower and even putting the keyboard in my lap as I type this long-winded explanation.

I’ll see on Friday whether my PCM wants to send me for further studies. I imagine a CT or MRI and possibly a Neuro/Pain Mgmt eval might be in the cards. All this rambling to relate the conclusion that my threshold for health problems is decreasing as the years pass. I had an acute episode of foot swelling this summer that I think was brought on by excessive sodium intake (snacks) as well as alcohol consumption. I hadn’t drunk any alcohol after that episode up until Thanksgiving. That week saw my frustration with Berklee at an all-time high and accelerated my previous holiday plans by nearly a month.

This rolled into drinking beer for about three weeks straight (we went through four cases of beer in that time frame) as well as not exercising or eating particularly healthy for over two weeks. Ironically, I had returned to my normal schedule for over a week and had run on Sunday without any significant issues. I don’t necessarily think the Christmas Eve champagne and wine were the direct cause of the episode, but a repeating theme in the past few years has been that my health isn’t quite as resilient as it was in my younger days.

I can no longer negate the alcohol and unhealthy food choices with exercise. Now, I have to manage my nutrition more closely than ever before. Alcohol and junk food can manifest as poor health outcomes within just a few days as opposed to being inconsequential (in the short-term) in the past. Whenever I drink now, almost every health metric starts to suffer - sleep quality, nutrition, activity level, mood, cognitive function, motivation, etc.

I haven’t sworn off alcohol permanently, but I’m going to need to shift to small amounts over brief periods, for example, a six-pack shared with Aeyong every few months and never the larger amounts consumed over consecutive days. I’m happy that I never became an alcoholic, but it’s easy for it to become more habitual if you’re complacent about it. To bring things back to the start of this novella, complacency is no longer an option when it comes to my health.

As we age, we have to an active role in managing our health or we’ll be forced to continually rely on the aid of others as we watch our health gradually decline. I’ve set a goal for myself that I won’t have any alcohol or junk food (like Doritos) until I get my weight back under 200 pounds. I had got it down under 210 just in November, but I think I probably gained back another 5-10 pounds since then. Hopefully, once I return to regular exercise and a better diet, those pounds will start coming off. I’ve been largely ambivalent about being overweight for a long time, but I’ve got to take a more holistic view because all aspects of my life tend to take their lead from my physical health.

A Few Weeks Hence

The Berklee fall semester came to a close this past Sunday, and while I’ve had a bit of time to reflect (since I finished all my work this time last week), my attitude hasn’t changed.

I had a brief conversation with my instructor Norm Zocher and he was supportive and tried to convince me that I should continue on at Berklee and that I was good enough to keep going. I appreciated the gesture, but I find myself disagreeing with his estimation, at least at this stage in my education. He was nice enough to send me a preview of the level four and five course material and it just reinforces that I’m not ready.

The guitar degree requires that each level builds on the previous and there’s a presumption that all previous material is retained and it will be tested on eventually. I realized that my approach has been a bit of smoke and mirrors and that this eventually will become my downfall if I don’t correct it. Specifically, I’ve never really embraced sight reading on the guitar and I’ve been using Guitar Pro as a crutch to allow me to just learn pieces via tablature rather than by standard notation.

I’m still not convinced of the utility of standard notation in my use case, but certainly the level of complexity only increases as the Berklee major progresses to where I wouldn’t be able to “fake it” and get away with it.

Right now the pervasive feeling is that I’m not going to respond well to a rigid schedule of assignments on a deadline. I’m disappointed in myself for not absorbing more of the material and I feel I’m well short of where I should be at this stage in my education and playing. Because I’ve got several creative disciplines of interest, I think I need a completely self-paced approach where I can be as deliberate as necessary with each step and never feel rushed as well as never needing to pause or subvert whatever was my primary project (music or otherwise) at any given moment.

Disillusionment

Despite some tentative optimism, this semester at Berklee has been more of the same vis á vis rigid application of theory, long lists of scales, arpeggios, chords to be swallowed and regurgitated for the sake of checking boxes. It occurred to me that, ironically, the most valuable musical courses for me have been those that were ostensibly a part of the production degree program.

Most of those courses were built on projects that we would create and develop throughout the semester, lending a sense of ownership and making the individual assignments that made up the whole possess a greater weight than another week’s bland arrangement of an old jazz standard to be played poorly and nitpicked for transcription and timing errors.

Most of the courses that make up the guitar degree program are of the jazzers, by the jazzers, for the jazzers. I shouldn’t be that surprised because it is Berklee and that’s kind of their calling card. I’ve found that I require a significant dose of creativity and ownership to be integral to effective learning, and without it, it’s just rote memorization that will evaporate in short order at semester’s end.

On that note(s), I’ve come to the conclusion that I’m not likely to continue at Berklee. I think I’ve mentioned previously that the main reason for my return last year was to get the additional income courtesy of the housing allowance. This hasn’t changed and hasn’t helped in my engagement for these classes. The other key issue is that I had used up so much of my credits that I could only take core requirements and so all the guitar courses that I would take by preference were no longer going to receive benefit payments since I’d used up all my electives.

At best, I have enough benefits for one full time semester where I would get that housing allowance. There are only two remaining courses I can take, and both are likely to be theory fire hydrant swallow and regurgitate types that I’ve come to dread. It would be one thing if my frustrations with these courses was self-contained but I find that needing to spend hours per day to digest course requirements and the weekly grind of transcription, practice and performance tends to suck away any motivation I have for my other artistic disciplines.

Everything besides Berklee has been suffering in the last year…drums, keys, bass, vocals, drawing. I’ve held on to reserving time to work on 3D projects and tutorials, but even these are tempered by the daily Berklee distraction. Although I don’t like the idea of forfeiting a semester’s worth of housing allowance payments, I don’t think it’s worth the negative impact it has on my creative disciplines and motivation in general.

I’m taking next semester off regardless, so I won’t say I’ve made a final decision as I still have time to change my mind before my benefits expire in 2025. As of now, this feels like my last semester at Berklee. I’ll probably give myself time to reflect and post again on this at a later date.

Not bad, but it could be better...

This should be a short one (famous last words). I’ve had to reflect on the amount of time it’s taken me to progress in my first big 3D project, the Moria environment for my Doors of Durin Legends Unboxed video. I was trying to remember when I started and coincidentally, the order from Weta actually shipped a year ago yesterday. That means the idea for the unboxing video is about that old now.

I’ve certainly made some progress in the last year, but there have been many starts and stops and several times I’ve rebooted the entire project. Which leads me to the post title. Often, I’ll set out to model a certain element, like the Doors themselves, and I’ll get a result that’s “satisfactory”, at least based on my current skillset at the time. I’ll then move on to the next logical step or two, and after I complete those I’ll likely have improved my overall skillset slightly, enough to look back a few steps and think “Not bad, but it could be better.”

It’s accurate to say that this project in many ways has been an education in 3D…from modeling to environment design to materials and textures, visual fx, fluid simulations, sculpture, and the list goes on. I’ve been slowly building on my foundational skills, and probably more importantly, my eye and ability to discern what’s mediocre, what’s okay, and what’s sublime. I’ve made many things in the first category, some in the middle, and as yet, none in the latter.

Learning to make the distinction and force myself to acknowledge that something is not bad, but could be better has become my approach to pushing my skillset further and hopefully achieving the results I see in my mind’s eye. The main downside is that it’s increasing the project size and time (noob hours?) and taking much longer to complete. And, I’m still in a place where nothing feels completely finished and will likely be revisited and improved or redone before I’m satisfied. What was meant to be a relatively short unboxing video with a bit of extra lore thrown in has evolved to become an education in itself.

A Tentative Change in Plans (for Berklee)

My plan had been that I would take one more semester, Winter 2025, and this would complete all my regular classes and up to level 4 (of 9) guitar lesson requirements. After emailing the financial advisors at Berklee, they worked out that I could take just the private lessons for four semesters and stretch out my benefits for longer than planned.

Since the private lesson is only 2 semester hours, it ends up not counting as much against my benefits as a full time course load would count. With this plan, I’d take just the private lesson for all four of the 2024 semesters, and then in the Winter 2025 semester I’d take my two remaining regular courses and the private lesson level 8 course.

Under that plan, when I get to Winter 2025 I’ll only have 13 days of benefits remaining, but the VA will extend your benefits to cover your last semester even if you only have one day remaining. The downside is that I won’t receive any housing benefits for those four semesters, but I would get them for the last semester. That’s just delaying the housing benefits by a year, so not really a significant change in that I’m not losing any potential benefits. Arguably I’m gaining a year of benefits that I handn’t planned on getting.

As it turns out, January 2025 is also our planned mortgage payoff date so we’ll be getting a few needed income bumps in that timeframe. Without the housing benefit for the next year, our cash balance will likely drop a bit, but we should be able to stretch things out enough until the house is paid off. Worst case scenario, we can dip into my 401K for a bit of cash to tide us over, but hopefully that won’t be necessary.

A Break for Gaming and then Back to the Grind...

I’ve been neck-deep in Baldur’s Gate III for nearly a month, and I just finished the game earlier this morning. It was one of the most satisfying experiences I’ve had in over forty years of gaming, dating back to the Atari 2600 and the nascent days of online gaming (Compuserve, anyone?) Larian Studios has had an incredible run since Divinity Original Sin I and II and now Baldur’s Gate III. In many ways, it’s the spiritual successor to DOS, with just a different setting.

Larian manages to get you heavily invested in the story of your main character as well as that of your allies. I found myself repeating boss battles that I had won just because one of the key allies had died and was unable to get brought back after the battle’s culmination. In the epilogue, a certain character’s story was drawing to the ultimate conclusion and I found myself overcome with emotion that it was truly over. Thankfully, they left an option open for future DLC or sequels and I’m looking forward to that day although it’s likely years away.

The game isn’t perfect, there are bugs in gameplay and quest lines and some weird NPC reactions to murder versus looting. Murder okay, looters go to jail? Inventory management could also use a big overhaul, but I’m hoping we’ll see those sorts of improvements in future updates. Those small complaints aside, Larian got so many things right. A compelling story and characters, flat-out amazing level design, architecture, modeling, sculpting, animations, VFX, etc. It’s one of those games where you repeatedly pause and just look around at the environment design and how much thought and care went into it.

I’ll be replaying it in the future, the variety of possibilities is essentially endless. I want to put it down after such a heavy time investment and give them time to keep updating it and maybe eventually announce DLC or a planned sequel. As of now, I can’t imagine I’ll want to go back for several months, maybe even a year. But, this feels like one of those games I’ll probably play multiple times over in the coming years.

Gaming news aside, I’ll be back at the grind with Berklee Online for likely my penultimate semester if not my last. I’m not highly motivated to go back, but another semester of housing allowance will get us that much closer to paying off our mortgage by the end of next year. I’m taking Private Guitar Lesson III, Solo Guitar (Performance, Accompaniment, and Arranging), and Game Design Principles. I would prefer to be taking a Blender course over the Game Design but they discontinued it and of the options I have for electives, Game Design was the only interesting one. Maybe I should have gone for the interpretative dance class?

The solo guitar course might be interesting, it’s something I want to get better at, but you never know how these courses are going to be presented. Hopefully, it’s not another theory fire hydrant and regurgitate course like so many of them are. I switched from Shaun Michaud to Norm Zocher for my guitar lessons. Shaun was a good teacher and an amazing guitarist/musician, but I don’t think his style combined with my goals was an ideal mixture. I’ve had a few classes with Norm and really appreciated how laid back and non-pedantic he is about the material. I find his style more conducive to learning, regardless of the material.

A New Era

While visitors here are demonstrably rare, today marks a significant milestone in that I’ve switched my domain to HighcastleofGeek.com from Strumzilla.com after having used that site title since its inception in 2007, sixteen years ago. The site is mostly unchanged other than updating the social media links, some individual pages and uploading most of my artwork from the past year.

The move to Highcastle of Geek as a brand (so to speak) has been in the works for a few years now. I think I purchased the domain a little over a year ago, around the same time I started a new Youtube channel of the same name. My online business, Highcastle Foundry has been active since 2021. Highcastle of Geek is primarily driven by the YouTube channel and my other social media presence that deals with my art and other creative content. This site has long been a glorified blog for everything under the sun, but mostly music-related content. I may eventually branch off the archival content to the Highcastle of Tone domain, but for now, it will remain here. Highcastle of Tone was just a rename for my longer-held YouTube channel that was previously just called, wait for it…Strumzilla.

Strumzilla was my attempt to create a unique domain name evocative of my music-related pursuits, but it was probably about my twentieth choice since all the others had been taken. While Highcastle of Geek isn’t the most original name (I’m aware of the more popular Den of Geek, but the idea didn’t come from them), it stemmed from an older idea. I had been brainstorming ideas for a pen name so that if and when I ever published anything fantasy or science fiction related, I wouldn’t be using the real name that I use professionally in my healthcare jobs. I settled on Darren Highcastle since it’s similar to my actual name, but to me a tad more evocative of fantasy although one could argue Hightower is evocative as well, look no further than GRRM or Robert Jordan for several named Hightower characters (of questionable moral integrity and motivations methinks).

All that rambling to say I still have that on reserve as well as a few other domain names, but since most of my creative pursuits are going to revolve around the Highcastle of Geek YT channel and brand, it made sense to make the switch. I’m probably going to just let the Strumzilla domain expire as it hasn’t necessarily been a successful brand or one that any significant number of people would associate with me or my content.

I’ve updated my social media links and added a few as well. More content to come…

Arry Starry…until we meet again

I don’t believe in heaven, but there are times I wish I did. Yesterday was another dark day. We had to let our sweet Arya cross the rainbow bridge to join her sisters in the beyond. We had grown accustomed to our dogs living for ~ fifteen years, but Arya was just reaching twelve when her health took a nosedive.

Similar to April, she stopped eating and could no longer stand and walk on her own. We knew she had liver problems, but she had been managing them for several years with no apparent symptoms. Her appetite, activity level, and personality were the same as they’d always been. She had gone to the vet for a checkup and ear infection but either that night or the following day she deteriorated significantly.

We tried to nurse her back to health over a few days, but with no improvement, we took her to the emergency vet. We didn’t learn much other than her liver function had continued to decline and she had an enlarged heart that was starting to press on her airway. The vet also looked at her liver but couldn’t identify anything discrete like a tumor. As luck would have it, this particular vet had to be the most insensitive and ambivalent vet we’ve ever encountered. We didn’t have any other choices, so when she recommended a long list of medications, we took her advice and tried for several days to see if Arya would improve.

Other than occasional brief bursts of energy and appetite, she continued just to lie down and sleep. She needed help to stand, and we had to coax her to walk outside just to use the bathroom and get a little exercise. Her appetite was mostly gone, but Aeyong would still spoon-feed her, at times having to force food by dragging the spoon against her front teeth so it would fall in her mouth. Arya would normally chew and swallow food at that point. Taking medication was an absolute ordeal for her. The vet prescribed what we now feel was a ridiculous amount of medication, and in hindsight, I feel she was just trying to check all the boxes that the workup indicated without considering how difficult and stressful this would be for Arya.

Arya endured these daily medications, although they distressed her visibly. Arya’s condition just slowly deteriorated over several weeks. She was in increasing pain and was more and more resistant when we would try to get her up to drink or go outside. At times she would cry and snip at both Aeyong and me. This was completely out of character for her and just demonstrated how bad she was feeling.

Just like our previous girls, there came a time when Arya’s quality of life was gone and she was no longer her real self. Truthfully this started when she took that first nosedive after the vet. She would have brief episodes of apparent improvement, but they were short-lived, typically just a few minutes of increased activity occurring only once or twice a week.

I spent her final weeks sleeping with her on the floor, typically by the front window, one of her favorite spots. At times her breathing was very labored, at times it would slow to nearly normal. I think the only time she wasn’t in pain was when she slept. After giving her enough time to improve, I knew we had reached her new normal, which was not normal at all. I will fight for my dogs for as long as they’re willing, but at some point, you can see the fight has left their eyes and they just want the pain to end. Aeyong would continue to nurse them for as long as they drew breath, and I know she’s never completely comfortable with making the hardest decision.

After going back and forth several times, I finally expressed to her that we just had to make that final decision and release Arya from her pain. We love our dogs more than anything in this world, and it’s the hardest decision by far. We draw some comfort from the amount of love we could give to Arya over her lifetime and especially in her last weeks. She was constantly attended to and showered with love around the clock. At times, she would show her old self with a loving look or kiss, but she mostly just looked tired and bereft of her old joy.

We decided yesterday would be the day, and after spending the morning with her we drove to the emergency vet around mid-morning. We learned that the same uncaring vet was on duty, so we decided to come back later when another vet would be available. We took her back home and brought her and Skittles to our little subdivision park where Arya and our dogs had taken so many walks. The drive back and forth from the vet and the visit to the park seemed to brighten Arya’s spirit for a while and she even was able to leave her mark in her home stomping ground (High Hawk Park) one last time.

We went back home to wait for a few hours and all the activity seemed to drain whatever gas Arya had in the tank so she immediately fell asleep and slept soundly for a few hours. When the time came we took her outside with her sister and snapped some final family photos and let Skittles and Arya say their final goodbyes. We drove her back to the emergency vet.

Things moved pretty quickly and this time the vet was much more caring and considerate. Arya did pretty well getting the catheter placed, but when they brought her back to us she was visibly stressed and wanted us to take her home. We spent several minutes just hugging and kissing her and she slowly calmed down. We had her home blanket that held her and Skittle’s smell for her to lay on. Soon we knew it was time. The vet came in and briefly discussed Arya’s condition and expressed sympathy and that she understood Arya’s quality of life was gone and it was time to release her from her pain.

The vet administered a sedative to first put Arya to sleep, and she quickly nodded off in our arms. At this point she was fully asleep and not feeling any pain anymore. The vet followed that with the euthanasia medication (presumably sodium pentathol) and in a few seconds Arya’s chest fell and her heart stopped. She was leaving her physical body and approaching the rainbow bridge. We told her to say hello to her Onis (big sisters) Bridget and April, and told her she would meet her new big sister Lucy. We told to her run and play and feel her young self again. We asked her to find a place for our family and told her we’d join her someday. It doesn’t matter whether I believe it or not, it’s a daydream that gives me comfort.

I’m sorry you had to go Arya, you were my shadow and constant companion these last twelve years. My life was so much better for having you in it. I’ll never forget you, my sweet girl.

Where I’ve been

It’s been over a year since we lost our dear April. I haven’t retreated from the world (any more than usual), but I’ve had little impetus to post here. I’ve been busy pursuing my various creative disciplines, including guitar, drums, bass, keys, and vocals. I’ve been increasing my focus on the various visual arts to include drawing, 3D environments & modeling, and dabbling in video editing and VFX. I’ve been busy, is what I’m saying.

I’ve been more active on social media with occasional creative posts, but nowhere near the level I need to build a community yet. I’ve mostly finished the Unreal Sensei course on UE5, although he has been updating content that I will revisit. I enrolled in Marc Brunet’s digital art course, a big commitment since I’m not bringing any additional money in now.

On that note, I’ll briefly explain. I’m no longer working with VES. They were bought out by a bigger defense contractor called Maximus last year. Word came down in March-ish that we would no longer be able to have schedule limitations and would need to let them schedule as they pleased.

The big issue with that (which I’m not sure I covered before) is that they have a policy where joint exams are all lumped together as a single worksheet for payment purposes. This means they get 6-7 worksheets for the price of one. As it happens, these are some of the most common claims we get. My experience in the past was that I would have my schedule filled with these types of exams, and the result was that I’d have 15-20 exams but end up getting paid like I did 3-5 exams. I had limited my schedule, so they couldn’t pile these exams on. Once, I decided to try opening my schedule up to get more exams, but I immediately got booked with those joint exams, so I reverted to my old policy. This was fine until Maximus required an open schedule.

At the time, I explained to them why I limited my schedule that way and that going forward, I would just be working less because this payment policy wasn’t sustainable. Why would I spend 8 hours in their clinic with only 1-2 hours’ worth of pay to show for it? I didn’t hear anything back and a month or so went by with no communication. Sometime in April or May, I find myself unable to log in to their system. I asked tech support, and their response was, “we’ll forward your request to the appropriate department.” Which is a very non-tech support kind of response.

I knew something was up. The answer I got (through an intermediary) was that “upper management” had decided for one of the following reasons: Veteran complaint, timeliness of reports, the accuracy of reports, employee/Veteran relations, and/or something else we’re not saying, blah, blah, blah, VES had decided to cut ties with you. I responded that this wasn’t satisfactory, and they could at least give me a specific reason (assuming it was possible it could be one of those reasons, although I didn’t believe so).

All I got back was that it was “schedule related,” but they might consider the matter again if I wanted to change my request. I said I never refused to work under the new policy, only that I would be working less because it wasn’t fair payment. I proposed that if they would alter my contract to pay fairly for the joint exams, I would be willing to work more often. My productivity was established over the past year (especially since I completed two of their travel weeks last year, and those are a slog). The intermediary said he’d forward it.

I had some residual emails from other departments about training and the like, and when I got those, I would cc this intermediary as a way to get updates on my proposal. After several weeks there was no answer, so I quit checking.

Since I have no specifics to go by, I think VES doesn’t tolerate any providers challenging their payment system, whether it’s done professionally or non-adversarial. I’ve never made any demands or ultimatums to them; I’ve only explained my reduced hours and why that policy is unfair, in my opinion. I’ve never been shown the courtesy of a response from management.

VES doesn’t hire providers, which prevents them from needing to provide any of the benefits or protections that a normal employer would be required by law to provide. They never hire you, so they don’t need to fire you; they can just say we’re no longer going to schedule appointments with you.

There was a precedent in my experience, my colleague from the VA fee basis days, Dr. Brooks, had experienced the same scenario, although his occurred within a few months while mine was over a year later. I think he may have been more direct in challenging them, going so far as to try and obtain a copy of their VA contract under the FOI act. I don’t think he ever got it, and not long afterward, he was “fired.”

He had been my collaborating physician, so maybe my dismissal was partly due to guilt by association in their minds, I don’t know. I never got a real answer, but I think I’m right in my thinking. Changing that policy to pay providers fairly would likely result in the loss of hundreds of thousands, if not millions, in revenue for them.

All that to say, I just decided to end it with them. I had never appreciated their culture. Despite all their flowery quotations about caring for Veterans, including those awful self-help and uplifting quote framed photos filling the walls in their clinic, their consistent behavior is that profits are the priority, not the Veteran. I often would have a Veteran who had an issue I could address in the clinic, but VES would never let me add or change the report even though it would likely save the Veteran months of waiting and potentially get them their benefits faster.

All this is anecdotal, but I felt that if there was ever a question of payment, their policy was to refuse the exam and make the VA request it formally to ensure they got their money. Whether it was the right thing to do for the Veteran didn’t matter. The other ongoing issue of frustration with them was their QA policy. They would go over each report and make these small corrections that were irrelevant, but I assume it was to ensure their reports were buffed to such a blinding shine that the VA would never question them and they could maintain their contract. Without their VA contract, they essentially have no business model.

I worked directly for the VA for nine years, and the issues that would be flagged by VES QA personnel never got questioned or challenged by VBA. Never. So, that was an ongoing frustration because they could commandeer your time and make you re-visit a report, and they weren’t going to pay you for it.

How’s that for a short explanation? Lol. Apparently, I still have some feelings about it. Mostly I find it frustrating that not only the VA (considering what happened to all of us fee basis providers) but VES and likely the other contractors truly don’t value hard work and competence and mostly want people who will swallow the corporate Kool-Aid and keep their heads down and their mouths shut.

The outcome is that this scenario has driven me into full-time creative pursuits and will eventually provide a means of income derived from the things I love, not the whims of some crass corporate entity.

In a forthcoming post, I’ll get back to the more important updates about my creative pursuits.

The Darkest Day

Yesterday, after a very brief illness, we said goodbye to our sweet girl April. A week ago today, we had a nice normal day, went for a morning walk, and she was eating and behaving as she always has. As the next few days passed, her appetite began to wane until by Sunday, she had effectively stopped accepting food. Anyone who knew April would see this was completely out of character. I worked this last weekend, and as is usual, on those days I typically fed them their dinner. On Saturday night, she initially wouldn’t approach her food bowl. Only after I placed some of her food in my hand and held it out did she try eating it, probably mostly out of instinct. But, she wasn’t able to finish the bowl. We knew something was wrong. Aeyong later told me she had thrown up her breakfast. She became more lethargic and listless over the following days, and by Sunday we were already talking about taking her to the Vet. We decided to watch and nurse her overnight and then make a decision in the morning.

It was only a few days ago, but I can’t remember if she came into the kitchen when I woke up. Usually, April was the first to come out when the lights came on. I’m fairly sure she did on Sunday, but wouldn’t accept food and only drank some water. I can’t remember if she did on Monday, I think I may have had to find her. I went to my office and was looking at same day appointment options. There weren’t any I could find other than the emergency Vet. I was able to use the Vet Chat feature from Banfield, and after a brief exchange, their recommendation was getting her evaluated acutely, as labs and imaging would likely reveal the problem. This was my thinking beforehand, so we decided to take her to the Animal Emergency Hospital in Mansfield.

She was taken in and evaluated by Dr. Paules, and the first step was lab work. All of the steps were discussed up front in regards to cost and getting our approval before they were performed. It’s a necessary step, and honestly it was good to just get it settled and out of the way up front, knowing that we would hopefully get an answer. I had been looking at Yelp reviews of the facility, and most of them were positive. All the complaints I saw seemed to stem from the cost. As those online reviews go, the dissatisfied typically post reviews much more often than the satisfied. I can’t imagine there’s a price I would balk at to save one of my children’s lives. It’s hard to even have an opinion about the cost. It didn’t seem unreasonable and we almost certainly would have paid whatever was required to get an answer. We were told it would be about an hour, so we said we would drive home and wait for her answer, since we could come back within fifteen minutes.

We got a call about thirty minutes later, and the labs were mostly normal, only showing some anemia and slightly decreased renal function. Dr Paules related that her anemia would likely worsen with rehydration as they had to give her some IV fluids. We had been trying regularly to help her over to the water bowl and she would sometimes drink, but sometimes just stare as if she wasn’t sure what to do or just couldn’t stomach trying to swallow water. Aeyong was regularly giving her water by syringe and she had been trying extra hard to prepare some bland liquid food that April would accept and be able to keep down. It was a struggle for April, but she was able to swallow a bit of water and liquid food every few hours. Despite this, she was still not getting an adequate intake of fluids.

Dr Paules recommended imaging as the next step in evaluating her issue, and wanted to start with the abdomen. She predicted it would be about thirty minutes before she would call us with the results. It was around an hour later that she called and said April’s abdomen looked okay, but she had noticed something off about the fringe of her chest, which wasn’t completely imaged with the abdominal x-ray series. She ordered a chest series and it was there she discovered a tumor in April’s lung. Based on its size and shape, it was most likely cancer. She also had a noticeably enlarged heart with a pericardial effusion (liquid filling the sac that surrounds the heart), which was making her heart work much harder to beat and making it more difficult to get oxygen to her tissues.

As soon as I heard the word tumor, I knew that this was a terminal diagnosis for April. Dr Paules predicted that the definitive treatment would have to be a partial lobectomy, a highly invasive type of surgery. From what I know of this surgery in humans, they would have to crack her chest, separating her sternum and ribs to get access to her lungs. Even with this, the nature of lung cancer is that by the time it becomes symptomatic and is identified, it’s more than likely that the cancer has had time to metastasize given how highly vascularized the lungs are. Even if the lobectomy was “successful” and April survived, she would likely need chemotherapy and it would only be extending her lifespan temporarily, maybe only for a few months at best.

April was fourteen, so she was already in the predicted end of lifespan for cocker spaniels, which is typically 12-15 years. I didn’t clarify, but it’s possible Dr Paules noted that she had cardiomegaly/LVH that was present before she deteriorated, presumably in large part due to the lung cancer. From our observation, she hadn’t shown any significant changes in behavior up until her rapid decline. The more I think about it though, there was a walk last week, and I’m not sure if it was her last walk on Thursday or the day or two before that, that she was not quite as energetic as usual. April would always be in the lead and darting back and forth to follow her nose. This day she was hanging back more, and just looked slightly less interested. She wasn’t struggling to breathe that I noticed, she just didn’t seem as interested in the walk, which is something that we’ve seen in all of our pets occasionally, but it’s always been a temporary, fleeting behavior.

Maybe this change was the first real evidence that something was off, although Aeyong says she was noticing things even before then. Aeyong had mentioned that April looked like she was having a seizure earlier in the week, I’m not sure what day, maybe Sunday or Monday. This didn’t immediately concern me because all of our dogs have exhibited seizure like activity on one or two rare occasions for reasons unknown, but the seizures never persisted. With April, it had been several years since the last time as far as we could remember, probably at least five if not ten. I’m not even really sure I had witnessed a seizure in April, I can only remember Lucy having one and Bridget had a few right at the end.

Our decision to let April go was based on the realization that her time was fleeting. Sadly, her life as it had been for fourteen idyllic years, had already passed before our eyes. Once she declined, she wasn’t likely going to make it back to her old self, and the thought of putting her through such an invasive surgery followed by chemotherapy was untenable. We already know from experience how devastating chemotherapy can be, it’s the medical equivalent of an atomic bomb. If dogs could understand these choices and communicate their desires, I wouldn’t hesitate to accept their wishes. But, we can’t ask these questions and it’s hard to know if dogs truly understand death. Certainly, dogs understand when one of them is gone and I’m sure all of our dogs remember their sisters and miss them. I just don’t know that they have a real grasp of dying and how it’s a natural part of life.

All we can be relatively certain about April is that she knew she was suffering, and she probably didn’t understand why. She would stare into our eyes, and it seemed like there was just a question or plea for help in them. For our dogs, we have been everything to them (and they to us). They look to us for shelter, food, love, protection, companionship. April knew she was hurting and she probably didn’t understand why Mommy and Daddy just couldn’t make it better. It kills me to write that, but it’s probably all that her simple mind could form. That is why we had to make the decision to let her go. It’s the hardest decision we’ve ever had to make, by far. Nothing has compared to the pain of losing our daughters, nothing. I’m sure I’ve posted about it before. Losing my parents and grandmother was sad, and I missed them and regretted the time lost and mourned for what could have been. But, losing my dogs has been tearing a part of my soul out of me. It’s the same for Aeyong.

The decision mostly depends on when our dogs are suffering. When they reach a point in their lives where most of their time is spent hurting in some way, I try to understand what my frame of mind would be in their situation. Our dogs have always been happy, affectionate, playful, active, and just a source of energy and joy in our lives. Lucy, Bridget, and April all went through a change in personality, whether it was a slow change over months, or a rapid change over a few days like with April. When they are no longer their happy self, I can’t accept that they are in pain. It’s largely based on what I said before, we have no way to ask them what they want, but if the sum of their days are largely suffering, I want them to be without pain and so I know I must let them go. Keeping them around just prolongs their suffering and it’s likely only for our benefit and not theirs.

Aeyong has expressed regret and sorrow for how Lucy and Bridget passed on. Both of their lives had deteriorated and they were no longer themselves. With Lucy, she was declining for a few years, and it ultimately got to the point where it was obvious she was no longer herself. Lucy was always the sweetest, and most affectionate companion. Just like April was Momma’s shadow, Lucy was Daddy’s girl. Near the end, nothing seemed to make her happy. For most of her life, she would soak up attention. She would just stare into your eyes and snuggle with you as if she wanted nothing else in life. At the end, she didn’t respond to attention any more, and the only real activity she would show was when there was food, but even eating seemed like she was just going through the motions.

With Bridget, she declined over a matter of a few weeks. She had a mass on her abdomen that was starting to affect her breathing and energy levels. It then led to a change in her personality, where she would just stare and seem unresponsive. She then started to go into the backyard and just start digging at all hours of the night, and you couldn’t get her to stop or respond to you. She wouldn’t come when called and would struggle if you tried to stop her digging. At this point she ceased to be the Bridget we had known for fifteen years, just like her sister Lucy. Could more have been done? Maybe. My problem with pursuing more treatment is that I feel that their quality of life is never going to get back like we want. That’s a feeling and not objective fact. I can’t argue that it’s not possible something could have been done, but at the time I didn’t think we would have extended their quality of life for a reasonable amount of time considering what the treatment needed to be. I look at that decision as a mistake on my part. We could have possibly learned more about her and at least confirmed that her condition wasn’t treatable before going forward. I know Aeyong regrets this, but any of the blame lays on me and not her.

My wish will always be that my dogs don’t suffer. So, the decision with April was that because her condition was more than likely terminal, we could only prolong the inevitable. A small note about lung cancer - I’ve been the original provider for at least one case in the past that I remember, and it was during PA school. We had a middle aged male come into the ER for shortness of breath and chest pain, and plain chest x-rays revealed several lung masses. I had to break the news to him and his wife that although we couldn’t confirm it yet, it was likely lung cancer. As I recall, it was lung cancer and he died within a few months. There are some predictable features to lung cancer that can be seen on plain films, and I’m assuming that Dr Pauels is experienced enough that she was correct in her predicted diagnosis.

We discussed our options and we just wanted to know if it was possible we could have a little more time to say goodbye. Dr Pauels said it was hard to predict how she would respond, but a course of steroids and anti-emetics might help her to breathe a bit easier and regain enough appetite to get her to eat for a few days. She stressed it was only temporary and that she would succumb sooner rather than later. We accepted this plan and they gave her some more IV fluids as well as given her some subcutaneous rehydration that I assume was expected to resorb over a few days. She was given IV steroids and anti-emetics in the clinic and we took her home with oral prednisone and anti-emetic.

That was Monday morning, and we got her back home a bit before noon. We just spent the rest of that day/night and Tuesday right by her side. Other than showering and preparing meals, one of us was right by her side continuously until the end. I slept with her Monday and Tuesday night. We initially tried to get her to sleep between us in bed, but she started getting overheated fairly quickly, so I carried her down to the floor where it was cooler and let her crawl up on her favorite pillow. Periodically I would carry her over to the water bowl and she would sometimes drink, but would sometimes just stand and stare as if she was unsure what to do or didn’t have any energy. I carried her into the back yard and a few times she would pee, but she would often just stand and several times she would eventually turn around and try to come back inside.

As far as we could tell, she was still lucid. She would lift her head and look around if one of us wasn’t with her, or if there was a noise in the kitchen or our other girls were barking at something. On Tuesday morning she was laying on her favorite spot on the couch, and her head was facing outside. She suddenly raised her head and was looking at the back fence, and it was there I saw one of our neighborhood squirrels. She was still aware and her natural instinct as a sporting dog was still there. She just didn’t have the energy to run outside. We’re sure she knew we were there and that we loved her. We couldn’t fix her, but we never stopped loving her.

The medical interventions only seemed to be delaying the inevitable. Her breathing had become more labored on Monday and this remained an issue through Tuesday. At times it would be ever so slightly better, but she never stopped breathing rapidly and at times she was using all the muscles in her torso to draw breath, always seeming to be starving for oxygen. That’s why on Tuesday I made sure to discuss it with Aeyong that we really needed to accept her passing and let her leave this suffering. I called Tuesday to clarify that AEHM could perform the service and find out whether Dr Paules was available. She was working Wednesday but not Thursday, so we decided it would be Wednesday morning. We also decided to do it relatively early so that we could just have an hour or two after waking up but then could just let her go without prolonging it.

She laid on the couch in her favorite spot as a beautiful orange sunrise poked over the top of our back fence. It was a cloudy day, but there was sliver of clear sky to let the sunlight come through. I don’t know if she saw it, but she was facing the sunrise in her final hours. Aeyong had given her the nausea medication just to hopefully help her feel a bit better, and I was able to get her to drink some water from her bowl. I had to hold her up though, her legs were to weak to stand on the tile floor. I carried her outside and she was able to shakily remain standing and she eventually peed. She was so weak that she just sat down on the ground to go, she wasn’t able to hold her butt up off the ground. It’s hard to know what she was thinking, but she kept on fighting until the end, she just ran out of gas.

Aeyoung brought her favorite blanket and a shirt of Aeyong’s and mine so it would smell like home. Aeyong held her close as we drove to the clinic. April would normally get a bit of anxiety whenever we drove anywhere, because most of the time it was the Vet, and like most dogs, she was never a big fan. On this last drive, she didn’t appear to have the energy to get very upset, but she did hold her head up and look around at other cars and the people inside. Once we got to the clinic, they were able to bring her in within a few minutes. I had to pass her off to one of the Vet techs, but after filling out some paperwork and paying for the procedure, they brought us back to a room and a few minutes later April was brought back to us.

She had looked slightly distraught going inside, but she seemed to calm down once she was back with us in the room. They had placed an IV port with a syringe, presumably filled with saline. They made a point to tell us that there was no medication in the syringe yet, which I’m assuming may have been an issue with people in the past. I knew the Vet would have to make the injection based on our approval. They would have given us all the time we needed, but after spending several minutes with her we decided it was best just to let her go. No matter whether we were there or not, she wasn’t going to completely settle down given her condition and being in a strange place. Dr Paules came in shortly and let us know that she would get a sedative first, and that would be followed by what I presume was potassium chloride to stop her heart. The sedative put her to sleep and her breathing seemed to slow down slightly. The sedative was a clear liquid, but the medication was a pinkish color, and I seem to remember that was the case when we had to let Lucy and Bridget go, although my memory is a bit fuzzy.

A few seconds passed and then April’s chest stopped moving. Her spirit took flight and she was free of pain. We love her more than life itself and we’ll never let her leave our hearts. We love you our sweet baby April. You were the best girl we’ve ever had and we hope to see you again. Give a kiss to Lucy and Bridget and find a place to play. Chase those squirrels and rabbits until you’re tired and then rest. Get plenty to eat and sleep all you want. We’ll save up our kisses, hugs and scritches for you. Until we meet again.

Developments or Not

We’re beginning the transition into Texas summer and the lovely swelter of many months. We still have some relatively mild weather for the next few weeks, so I’ve been checking off my yard reboot task list. As of yesterday, I’ve completed manual aeration of both front and back yards, and I fertilized and seeded the front on Tuesday. Today I’ll finish that off for the back yard. The ratios and spreader settings are a bit sketchy, but I was trying to follow the recommendations from the soil sample testing I had done. As I may have mentioned, our yard was deficient in most nutrients, with only calcium and sulfur being overly abundant. I’m curious if that’s an issue of toxicity, or it just lays inert, so to speak, if the plant life isn’t using it. This is based on the assumption that my core sample mixture was representative.

Core aeration is not something I wish to perform manually for the entire yard again. It’s a tedious and cumulatively arduous task that would go exponentially faster with a machine. I ran into enough roadblocks trying to rent one or get the service performed that I got fed up and just decided to pay $36 and do it myself. I don’t regret the decision and the tool will come in handy in the future, because I’m sure there are nooks and crevices that the machine can’t reach. That said, my plan for the future is to hire a guy (as you do) to have this service performed in the fall and spring. This is assuming I can see some tangible improvements. Hopefully, the assortment of interventions (dethatching, scarifying, raking, aeration, raking, seeding, fertilizing, mowing, watering) will pay off with a thick, and dark green lawn. I have some iron supplement to provide more color if needed, but I’m holding off on that until the new seed is established.

The soil test lab recommended potash and phosphorus as well as “my choice of micronutrients” to get the soil into shape. I’m not sure I got the ratios right, but hopefully there’s enough of the potassium and phosphorus in particular to make up the deficit. I followed those two select ratios with your more standard fertilizer comprised of nitrogen and the typical cross section of micronutrients. Hopefully this won’t burn out the lawn. It’s a lot of supplements at once, hopefully in the future I’ll only need one standard fertilizer to complement the overseeding.

Despite waxing agricultural, I don’t want to dedicate any more time to this than is absolutely necessary. Our yard/soil had been neglected or at least hadn’t had focused supplementation since we moved in, so it was due for more TLC than would normally be necessary. We’ll see how things go. I’ll be watering twice daily for the next few weeks (not counting rainy days) so hopefully the new bermuda seed will germinate and take root. We have a few large bare patches in the back yard that are competing with trees and a reduced amount of sunlight exposure. I’ll see how overseeding goes there. We may eventually decide those areas should just be patios. One project at a time.

I got a second set of overhead storage shelves for the garage, but I’m going to delay installation until next week. We also got a paint sprayer so we can hit the garage door and fence, but that’s also going to wait until at least next week. I’m only going to engage in time-swallowing projects one day at a time. Today I’ll complete the back yard fertilization and overseeding since there’s a limited amount of effective time after aeration that it will make a difference. I think the aeration should have some long term benefits beyond just the seeding/fertilization, mainly in drainage and water/nutrient distribution, but the time for overseeding/fertilization is within 48 hours of aeration.

Continuing on this post a day later - I discovered my core aeration efforts in the front yard are giving me some extra work and additional practice at sprinkler system repair. To my chagrin, I learned the drip tubing on the streetside strip is only buried about 3-4 inches deep, so the core aerator punctured the lines in several locations. I’m going to need to buy a roll of tubing and some connectors and perform several repairs. As I’ve stated before in many different contexts, failure can be a great teacher.

I had performed a few google searches about sprinkler pipe depth but I guess I was using the wrong nomenclature and I should have searched drip tubing. When I searched for underground sprinkler rubber tubing repair I eventually discovered it’s called drip tubing in the industry and now I know it’s buried at a shallower depth. Not a devastating error, just some more sweat equity and a serving or two of humble pie.

Although not my intention, each project seems to beget more projects. My hope is to get most of this lawn and short term DIY stuff knocked out so I can get back to my core (no pun intended) disciplines. I definitely plan on availing myself of the core aeration service in the fall.

I took the Pathfinder in for an estimate of repairs to fix the gas neck issue that’s plagued us for years. I had found a service bulletin which I assumed meant it was a recall type issue, but I’ve learned that even though a service bulletin might get published, it doesn’t equate to a recall. So, I paid $120 to have Don Davis Nissan tell me it will be an additional $405 just to get a look at what’s wrong in particular.

No idea of what additional costs I might have to pay to actually get it fixed. It’s a pain in the ass to fill it up, but not a $500 to possibly $1000 (or more depending on how gougy they feel on that particular day) of a pain in the ass. I’ll just suck it up with my slow fill ups every couple of weeks. I only use it two days a week and eventually I want to get an electric car, but I’m putting that off until well after we pay off the house if possible.

On the workfront, things have settle into a tolerably predictable flow with VES. I’m slowly learning the techniques to avoid QA addendums. It goes against my long established habits when working directly for the VA, but ultimately it’s a losing battle against their policies, so I’ve adjusted to their preferences. I’ve learned that you really only want to address exactly what’s on a claim unless it’s a gen med “all conditions found…” type of exam. They invariably will ask to remove any conditions not mentioned on the claim, whether they are valid or not.

The DBQs are so much more convoluted on the VES side, and just ripe with opportunities for errors of omission. That’s one of many things I preferred about the VA’s version. Auto-negative functions like greying out irrelevant follow-up question were pretty standard, but the QA on the actual forms themselves is significantly lacking at VES. I guess they prefer to pay people to do it rather than build it into the forms.

Also of note, I had gotten a text from a former co-worker stating that “they” were looking to bring me back on as fee-basis at FWOPC. Apparently the low productivity rate of the federales has caught up with them again. Amazing, considering how far their numbers have dropped since most exam requests have been diverted to outside contractors. From what this co-worker said, even the contractors can’t keep up. I’ve seen a few announcements on the VES website that corroborate this, they did request for providers to provide additional booking days if available since there was a backlog.

All that said, I haven’t heard a peep so far. The co-worker had said they only wanted to ask me to come back, which indicates it’s not an enormous backlog, but in my estimation it’s probably those big cases that all the federales avoid. One big issue is my credentials being expired. In typical VA timeframes, that means it would likely be another 2 months to get me back on board. I’m wondering if they’ll go with a second or third choice from any of the providers who still have active credentials. It wouldn’t surprise me if they’re going for a quick fix and not thinking long term. Letting my credentials expire proves how nearsighted they can be.

If they aren’t willing to make the effort to get my credentials renewed, I’m not confident it would be worth the trouble. I definitely prefer fee-basis as I’m sure I’ve said ad nauseam in the past. The pay is better, the schedule is preferable, and the frustration index is significantly lower. We’ll see. At least I’ve settled into a livable lifestyle with VES and we can maintain this indefinitely if needed.

Spring Has Sprung

In Texas, at least. After a slow start, it appears all of our trees, most of our shrubs and the lawn are making a full recovery from Snowmageddon ‘21. Our biggest tree, the one out front which was planted when they built the house, was probably the slowest to sprout buds. For awhile, I had serious concerns that it didn’t make it through the four day hard freeze back in February. Thankfully, it finally began to display some buds and eventually a full complement of leaves to get that good ‘ole photosynthesis jam going. By current estimates, it’s mainly some potted plants that appear to have met their demise. We have a few shrubs that look dead to me, but Aeyong is optimistic that by cutting them down to their base we’ll encourage some new growth from the roots. We’ll see. If they don’t recover, shrubs are easy enough to replace.

In that horticultural vein, I’ve taken a bit more interest in getting the yard in good trim. I apologize, that wasn’t intended as a pun, but now it is, so there. You’re welcome. We haven’t really gone to any great lengths with our yard, other than regular mowing and seasonal fertilization and occasional seeding. The front has remained pretty thick and healthy, but the backyard has some bare patches, including one large swath of dirt in the back corner. I’m going to try de-thatching and scarifying with, you guessed it, our new de-thatcher/scarifier. Hopefully it will clear up a lot of dead grass and leaves and open up the soil to allow more root growth and nutrient/water transfer where it’s needed. Along with that, I’ve got a big bag of Humic DG which is supposed to enhance nutrient absorption and improve soil structure. It’s a bunch of small spherical granules that disperse into the soil, some of which immediately break down into humic and fulvic acid, combining with essential nutrients and persisting in the soil to allow plant absorption for extended periods of time. The humate portion remains even longer, thereby further extending that nutrient cycle.

I’ve seen a few customer testimonials and just Humic DG alone can make a big difference to yards, plants, and larger agricultural applications. My plan is to de-thatch, scarify, mow up the detritus (I have so few opportunities to use that word, so back off), and then lay down probably half the 40 pound bag of Humic. I’ll be seeding and fertilizing in the near future, but I do want to give the yard a little time to recover so I’ll probably wait a few days to a week to do that. Not everyone recommends seeding in the spring, but our bare patches definitely need it. I probably need to get some peat moss to mix with the seed. Although it probably sounds like I’ve gone all 4H (when I was in school it was all farm kids, I’m probably showing my age), but I really just want a nice green lawn that I can maintain. I don’t want to spend a great deal of additional time keeping it in shape. Hopefully some well timed interventions will get it ready for summer.

In other developments, I got my second COVID vaccination last Wednesday, and the side effects were slightly worse, I suppose. The arm soreness was about the same, but I think I felt some more systemic effects this time. It’s a bit hard to tell because the day of the vaccination I also ran (a modified attempt at resumption that was triggered by the broken elliptical) and scalped the lawn. Scalping the lawn (and bagging the clippings) is something that’s useful to do 1-2 times per year based on the advice I’ve seen. It’s somewhat like de-thatching, I suppose. In my yard’s case, it takes considerably more effort to push the mower across high spots in the ground. All that to say, the additional fatigue I felt the day after was probably a combination of the vaccination and the physical efforts of the day before. I also woke up around midnight feeling febrile, but didn’t bother checking my temperature. I just took a gram of Tylenol every six hours for the first day or so and things slowly got better. As I’ve said, eminently better than getting sick with COVID.

Things at work are going well. I’ve worked in the new location the last two weekends, and it’s a nice setting. Essentially the same drive as before with the last two miles being on surface streets. VES has been keeping me gainfully scheduled, one weekend at a time. My no-show rate has dropped a bit, down to only 15% of the last two weekends. I’ve been averaging about $2500 per weekend, which is okay. I’ve been hoping to maintain closer to $3K per weekend, for a monthly total of $12K. Based on how they’ve been filling my schedule (partially) and the no-show rate, I’m not sure that’s achievable with only a two day workweek. At least it’s adequate for our financial goals of paying the house off slightly faster and maintaining a discretionary income. I only want to work enough for those two criteria, as I really value my free time.

Back to homefront matters, Aeyong is recovering fairly well. She had her cast removed the week before last, and she’s jumped back in to her normal routine. Maybe a bit too hard because she’s got some wrist swelling today and will need to rest a bit. She’s been catching up on several things she wanted to accomplish including trimming and bathing all the girls. She also has been out in the yard working, and this weekend she decided to help me out by dusting and cleaning the bathrooms upstairs. That was a nice surprise because it had been nagging me for several weeks and I had been too busy with regular work and work around the house. Still, she’s probably paying for the uptick in activity right now.

I’ve been trying to improve the garage layout the last few weeks to coincide with efforts in the yard. I installed some overhead storage shelves and moved the treadmill and elliptical all the way back against the wall. Not a huge change, but the added floor space has been nice. We took the vertical shelves that were previously on the back wall and moved them into the laundry room, giving us some more storage space in there. We had a little half shelf in the laundry room before, and now that has moved to the garage as a rolling storage cart for our air compressor and shop vac. I’ll eventually install another identical set of overhead shelves in the other garage slot and hopefully free up another section of the floor. Eventually I want to have a rolling workbench with some good working tools - table saw, miter saw, router, and maybe a few other tools depending on how things develop. I’m going to try to ease into woodworking, but I already have all sorts of ideas for projects. I don’t know if it’s just a natural part of aging, or a genetic thing I get from my father. He was definitely a DIYer at his core. Nature, nurture, or perhaps a bit of both?

After all this fairly mundane material, I haven’t stopped pursuing my core disciplines, although there have been more days “off” when I was working at VES or had my time manhandled by DIY, medical, etc. issues. I finished a Premiere Pro course, and I’ve just started a Photoshop course. I also signed up for a basic piano course, mostly to cover some fundamentals that I know I’ve been lacking. I’ve really only slowly learned songs and then just spent my time practicing them, but I haven’t spent any considerable time at learning scales, improvisation and some of the basic skill set I need if I want to advance further. The same could be said for my other disciplines as well. I’m alternating my drumming practice between Mike Michalkow’s course and trying to learn Xanadu for the eventual Rush AFTK deep dive video. Check back next year, probably. Then there’s also bass, guitar, singing, drawing, writing, learning to speak/read/write Korean. Not to mention maintaining my CMEs for work. The days are just packed, and that’s how I like it.

It's been one of those months...

I feel like I was thinking that through most of 2020, and 2021 is not showing any signs of let up. In 2020 there were times where days and weeks would seem to run together, but then there were many times that every day was a new reason the world was about to end. 2021 hasn’t been quite that severe, and by most metrics things are looking up, but February would prove to be a tremendously tumultuous month. Yes, I alliterated tumultuous. Gird yourself for more.

The weekend of February 13-14th would see me braving the oncoming winter storm to work on Saturday, but even by then I knew Sunday was going to be sketchy. I was already calling VES support to cancel my clinic for Sunday as I drove in for the Saturday clinic. Ironically, there would be multiple reasons why that was unnecessary because VES would ultimately decide to close down themselves as the severity of the winter storm developed. Even more importantly, I would be taking Aeyong to the emergency room. In a fit of youthful energy for the novelty of snow, she ventured out front, slid down the driveway (about two feet by my recollection); her feet went up and her right wrist came down. Hard.

The result was a displaced, angulated, comminuted, intra-articular fracture of her right radius. Hurts just saying it. We managed to get her into a nearby ER (thanks to USMD for actually being open when most places were closed), got her fracture partially reduced and splinted, and got her enough pain killers to tide her over until she could get seen by orthopedics, which would end up being nine days later. I cancelled my upcoming VES schedule for several weeks so I could tend to her needs while she recovered.

Thank Snowmageddon ‘21 and Texas’ feeble ability to cope for shutting down almost everything for a week. Not that we should complain too vociferously. All of our essential utilities remained functioning and by current accounts the only significant damage we incurred was a sprinkler system pipe and several plants and shrubs. Thanks to a frozen spigot, a neighbor sustained enough water damage that there were still reclamation trucks out in front of her house as of yesterday. I guess she had to hit the reset button on her ground floor.

The rest of February and early March was a challenging period of time. Aeyong underwent surgery on February 24th, and Dr. Niacaris was all we could have hoped for in an orthopedic surgeon. She has some extra hardware in the form of a plate and six screws, and it’s possible she may eventually need to get the plate removed as it was designed for bones larger than her relatively diminutive frame. She had her first post-op last week and things went well. She was gifted a new cast in sexy purple, although she’s been finding it a bit less comfortable than the splint she had before.

She was judged as lacking in her rehab milestones and I got a stern glance from Dr. Niacaris. She only responds so much to encouragement, so I try my best but it’s leading a horse to water doncha know. I went back to work at VES last weekend and things are going alright. I have one more weekend starting tomorrow, and then I’ll get yet another weekend off as they relocate to the new facility a few miles down the road in the Las Colinas area. As the crow flies it should be closer to home, but there are additional surface streets in the route, so based on google map’s prediction, it’s basically a wash in travel time compared to the current location.

Still, TXDot is adding lanes on the G-Dub, so it’s possible I might decide to switch to a weekday schedule in the future. With a slightly shorter drive and more lanes for traffic, it might not make as big a difference working weekends versus weekdays. While things progress with VES, things are finally about to completely shut down with the North Texas VA. I got a few text messages from Dr Hasan asking about my last workday, but when I asked what it was about, all he would say was “we’re trying to determine when fee basis last worked here”. Yeah, I gathered as much. When I got his message notification, I briefly felt optimistic, but clearly there’s no plan on bringing fee basis back at this point. To sort of bookend that interaction, I got an email from the VA remote access manager stating my authorization was about to expire. I wasn’t thinking about it, but I guess my access was approved the same day fee basis was laid off, 3/24/20.

So, it’s essentially been a year since me and my fellow fee basis examiners were laid off. What followed was in some ways a challenging year although we fared so much better than many people. The biggest frustration for us was being out of work and losing about 3/4ths of our income. It would be nine months later before I would return to income producing work with VES in December. After a few months, things seem to have stabilized. The treasury has helped restore our pre-pandemic checking balance thanks to a big refund as well as stimulus payments. I finally had the confidence to shift some more money to our mortgage payment, so we’ve gone from the minimum payment to one that will see the house paid off in three years. I might increase it yet again depending on our ability to continue running budget surpluses each month. This is contingent on a steady supply of exams from VES.

For giggles I checked with my former colleague, Dr C, who is working for QTC, to find out their current payment rates. I’m not sure if he gave me his rates or the PA rates, but they’re even less than VES. If they’re his MD rates, I can only imagine what they’re paying PAs. As I’ve said here before, it’s my strong feeling that VES is lowballing their payments to providers, but this is anecdotal based on what I previously received as a fee basis. There may be truth to their statements that they are having exams combined into one rate as the number of DBQs increases. Dr Brooks is still waiting on his FOIA request. My feeling is that it will reveal nothing or it won’t reveal enough to really discern whether VES is inappropriately paying their examiners.

One other positive development is that I was able to get my first of two COVID-19 vaccinations on Wednesday. I had signed up with Dallas County and I got a text message on Monday offering the shot. I took the first available appointment time on Wednesday and it was held at a joint Grand Prairie/Irving mass vaccination site being run at the Theatre at Grand Prairie. I was impressed with the efficiency and relative painlessness of the operation. The main side effect of the vaccination was pain at the injection site which was worst yesterday, the day after the shot. Today that pain has reduced substantially and I’m not really feeling any additional side effects. We’ve been told the second shot is worse for side effects, so I’ll see. It’s still exponentially better than getting COVID and potentially dying or suffering long term health effects from it.

'Supdates

After a tumultuous week in the aftermath of Aeyong’s injury, we finally got into to see her pcm and had the referral submitted right then. The office visit with the orthopedic surgeon was approved by the time we got in our car, and we went and saw him yesterday. We had to go to Harris Hospital in Ft Worth, where I had my right knee surgery back in ‘81ish. I’m not sure how old Harris is, but it’s pretty long in the tooth. As we tried to find our destination, we engaged in some of our age old raving and drooling as we negotiated the turns and twists that every hospital complex seems to build into its infrastructure.

The actual entrance to the Ben Hogan facility (I think it’s mostly sports medicine/ortho) was in a loading dock, I think selected for COVID flow control. We were checked in quickly and everyone rolled pretty smoothly. They shot new x-rays and gave her a new fiberglass splint that’s going to have a shelf life of less than 36 hours methinks. Her surgery was put on the schedule for the next day (today) and we’re heading over to check in at 0630.

Dr. Niacaris seemed nice and professional. He is planning on using a plate to stabilize her fracture and thinks it’s possible she’ll need the plate removed in four to six months, since it’s a little large for her wrist size. He’s not sure, but stated the possibility was higher given that her frame is small. All the medical treatment parts of this process have been pretty good. The USMD ER visit went about as well as it could - they got her in quick, managed her pain, got her sedated and partially reduced, and then got it adequately stabilized for her to get through the week until seen by ortho.

The ortho clinic itself went well - we didn’t wait long to get in and there was no part of the process where we were kept waiting very long for them to complete all their tasks. Interestingly, there was no real pre-op other than the x-rays. I think it’s a function of COVID now that she is getting all her pre-op labs done the morning of the procedure. I assume they want to minimize the number of hospital visits.

It’s a same-day surgery, so hopefully everything will go well and we’ll be back home this afternoon. I assume her pain will be worse for a few days, but hopefully she can start healing properly and I also hope she won’t need an additional surgery a few months down the line.

Progress never waits and I had my first IMO (independent medical opinion) from VES this morning. It’s a case from last month that I had seen, and I was surprised they presented it this way because it means they actually have to pay me for it. When I checked into my VES portal, I also saw they had added a patient for March 13th. I hadn’t told them to resume my schedule, but I think I must have mentioned that weekend as my likely return. That actually works with what I’ve been thinking, so I told them to resume scheduling. This will give us a few more free weekends to get her through the initial recovery stage.

Regardless, I’m only out of the house for about 8 hours on two days, so she should be able to attend to whatever she needs while I’m out. We’ve been engaging in a bit of nail biting and hair pulling while sweating out our Tricare approvals, but so far they’ve gone through okay. We paid our co-pay for the surgery and the lady in billing stated we had $54 left in our deductible. I’m still not sure what that means, because I can’t seen anything in our Tricare self-service portal that reflects that amount.

Outpatient surgeries are supposed to have a $63 deductible, so it’s not immediately clear to me why it’s slightly reduced. We have a catastrophic cap and point of service limit, but our information indicates there’s still plenty of room within those. All that said, the estimated cost of the surgery is $63,000 and we’re paying $54 so far, so it’s completely acceptable. I think that’s just an estimate for typical procedures like hers, we’ll know the actual costs after the fact. We’re very thankful to have good health insurance, we know there are many underinsured or non-insured people who would be financially devastated by an event like this.

Winter Whimperland

Continuing the running commentary del whinage, it’s been one of those weeks. A massive cold front has spread across most of the continental U.S., and when I say most, I mean like 98% or so (based on my highly scientific glance at a map on a weather site). With the cold came snow and ice, and in a fit of wintry novelty, I coaxed Aeyong into coming outside to check out the lovely white expanse.

Bad choice. In an uncharacteristic spree of high spirits, Aeyong decided to ski down the driveway and made it about a foot before disaster set in. I think she only made it to the first e of “Whee!” before her feet were launched skyward. Gravity is a harsh mistress and wasn’t offering any soft landings on the frozen driveway. I thought she landed directly on her tailbone, but it was her right wrist that bore most of the force of impact. And, in a contest between bone and frozen concrete, the latter almost always wins.

She sustained a comminuted, intra-articular, angulated and displaced distal radius fracture. In medical terms, we refer to that as “F&*# Me!” As I told her, she wasn’t fucking around. This is her first broken bone in her life as far as she remembers. If you wait until your mid-fifties to break your first bone, you should do it in style, you know the old saying. We both have now sustained orthopedic surgery inducing fractures, just in case anyone thinks we don’t go full throttle when the time is at hand.

The irony is that the rare cold front with snow/ice included that caused the injury in the first place has also shutdown most of our infrastructure, making medical follow up all the more complicated. We were fortunate enough to be able to get her all-wheel drive Toyota out and make it to the nearest ER in Arlington. We’ve subsequently learned that just another few blocks down the street is a Level II trauma center, which would have been the preferable place to go. Lesson learned. Although I’m still practicing medicine in the fringes of disability, local hospital and medical center infrastructure hasn’t been something I’ve investigated very thoroughly. I always kind of tangentially knew there was a medical center/hospital with an ER right there on the highway and down the street from our PCM, so that was always the default ER location we’d attempt first if it was beyond an acute/urgent care type visit.

Now we know to go a little further down the street if it’s trauma or more likely to require the services of a specialist. We don’t routinely need to avail ourselves of medical care in general (not counting prescription refills which are mostly remotely automated), so these aren’t issues we have a great deal of experience with in the recent past.

To add insult to extremity trauma, the infrastructure shutdown has carried across all sectors, so we couldn’t reach anyone to arrange follow up yesterday. I left messages on our primary care doctor’s site and the ER doctor had recommended several orthopedic surgeons, most of whom wouldn’t accept our insurance. Thankfully, one of them was part of our PCMs group and does accept our insurance. Their appointments department called me at the end of the day yesterday, and we’re in the process of coordinating a follow up appointment not with that doctor, but with the groups hand/wrist specialist.

Hopefully the doctor and his clinic will be open for business and we’ll be able to navigate the streets across town. The temperature hasn’t risen above freezing for a few days and that’s going to last a few more days before it slowly starts crawling back upwards. Right now it’s a sweltering 1°, and that’s Fahrenheit. But hey, no wind to speak of! We’ve had at least one set of pipes freeze for an upstairs bathroom sink that’s on the outside wall. Once I noticed, I went around and set all the other sinks to drip, but this one doesn’t seem to be budging. I really hope we don’t get burst pipes out of this, just to add onto all the other fun.

Because of the need for me to look after Aeyong, I requested VES to cancel all of my upcoming schedule until we get a better idea of her upcoming treatment schedule. Surgery will be a definite necessity and then there will likely be a great deal of physical therapy in her future. Hopefully most of that will be during the week, so I’ll eventually be able to return to work, but I imagine it’ll be several weeks before we’re on the other side of things.

I’m sure I’ve expressed my religious beliefs (lack of) here before, but I do like some of the wisdom found in tomes spiritual. “God laughs while you’re making plans.” This could also be expressed as “Life is what happens while you’re making plans.” We’ve had a year chock full of life happening in direct defiance of all our plans and expectations. COVID-19, layoff and eventual termination of my work with the VA, all the nail biting and teeth gnashing related to the state of politics and governance in this country, etc.

It’s not all bad, though. As I’ve said before, we’re among the fortunate in that we have a steady retirement income, a good home, and we haven’t truly suffered any deprivation this whole time. This injury has been the most devastating medical event in several years time, and it will be rough going for Aeyong for weeks and months to come, but we’re both still standing and we’ll come out this intact I’m sure.

The urge to dip into our retirement savings has reared it’s ugly head yet again, especially considering the prospect of not wanting to work for several weeks and wanting to maintain a positive cash flow. We’re not at a point that we need to make that decision just yet, though. Financially, this should hopefully just be a temporary setback while we get Aeyong healed and I can eventually get back to work and get some cash flow restored.

Nut Kickin'

In retrospect, I imagine this post will come across as first world bellyaching, but this is one of my preferred venting venues, so there.

I’ve been working for VES for over a month now, and as time passes I question how sustainable it will be. They show all the marks of a bureaucracy like the VA, but without most of the incentives. Working as fee basis for the VA, we had a very fair payment structure, a decent clinic and network infrastructure, and a mostly autonomous working environment including how we got paid. VES has built up an administrative behemoth for reasons not fully understood, and every exam is often beset by multiple follow up questions that can add as much time as it took to complete the exam in the first place. This might be tenable if the pay structure was adequate, but it’s averaging around half that of fee basis at best. The frustrating thing about the incessant follow ups (QA addendums) is that they’re mostly irrelevant questions that VBA has never cared about in my personal course of completing nearly 15,000 exams. Regardless, VES will insist that these are due to “VA policies” and “VA preferences”, when I’m pretty sure this is entirely made up or at least based on some subjective request from VBA that isn’t based in any sort of regulation or guidance.

An example from just yesterday - I had a case that involved a Veteran with a long history of knee surgeries that ultimately culminated in a knee replacement last year. When I entered in the diagnoses, I still included the past history, some of which he was already specifically connected for. I get a QA addendum because they wanted me to only put the knee replacement as his diagnosis, and remove all the other diagnoses. This isn’t how we document in medicine. A knee replacement doesn’t wipe the slate clean and eliminate the previous history. Not to mention that some of his issues were extra-articular and weren’t involved in the knee replacement. What this admin person didn’t understand is that “knee replacement” doesn’t mean you get a brand new knee and start over. It’s an artificial knee that will wear out and in some cases, the surgical outcome is no better and maybe even worse than before.

This is the typical run-around I get on probably at least half of my exams. Another point of frustration is that they hold us to a 48 hour window to complete exams, but I still have unprocessed work from two months ago, and they have failed to process several exams in time for our payday, so they get held over until the next pay period. Do as we say, not as we do.

Contiguous with this I have been having my recurring OS overhaul, triggered by random untraceable events. This seems to happen with me and OSX every year or two, where the only way I can get things functioning is to wipe the slate clean and start anew. Another major point of frustration is that Backblaze, who I’ve been using for several years, sent me a recovery drive for my OS disk, but the copy speeds are so slow, it’s going to take 3-4 weeks to copy around 1.5 terabytes. I’m at the point of just scrapping the restore process and falling back on time machine.

I’m also recently made a major switch in my studio setup, by swapping places between the video and craft rooms. The big drafting/craft desk moved into the closet and the bed from the craft room is now in what amounts to a basic guest room with TV. Ultimately, this will be a superior setup, but there are a lot of growing pains in the process. I’m trying to back into video recording with a plan to jump headfirst into a YouTube channel with the hope I can build enough quality content that I would earn a subscriber base leading to some passive income, even if a modest amount. We don’t need a great deal of additional money to keep us comfortable, and one major lesson of COVID is that I don’t want to depend on any corporate or bureaucratic structure for my livelihood.

All these events sort of running concurrently has felt like a kick in the nuts, figuratively speaking. I’m spending more time keeping things from burning down and it distracts me from working on my disciplines. I have renewed my efforts to study and improve my video editing and post processing, but right now I’m just trying to get things running normally, so it’s a bit frustrating. …and the microwave died. And a few other things that aren’t coming to mind right at the moment. Wahh Wahh.

Still, we have a home, the utilities are paid, we have food to eat, the dogs, Aeyoung and I are relatively healthy and not really wanting for anything critical. Like I said, first world problems…

2020 was a year

So much of the focus of this past year has been on the negative, overwhelmingly centered on the Coronavirus Pandemic and all of its effects. For me, the most unfortunate aspect was just how inadequate and irresponsible were the reactions of individuals, leaders, and governments. There was no escaping the impact that such a new and deadly virus was going to have on society, but the devastation could have been mitigated to a greater degree, and the loss of life, jobs, and social safety nets could have been greatly minimized.

An analysis of this fallout must include the myriad of consequences. I was, like many others, personally affected when I lost my primary means of income shortly after the pandemic made its full effect known in the US. Arguably the single most devastating acute change I’ve experienced in my adult life, at least from an economic standpoint. Thankfully, my choice to make the Army a career and the pension resulting from that became our primary safety net and kept us in good stead for the lean times to come. Even with this, it wasn’t permanently sustainable.

A result of the layoff (and ultimate termination) was a blank canvas upon which to fill each day. As I’ve discussed before, although I never succumbed to depression or an emotional breakdown, there was definitely a mild funk that persisted for several months. It ultimately was a lack of direction stemming from all the uncertainty. I long ago realized that I must have a target for which I’m aiming, whether it’s creative, financial, professional, etc. The loss of income put so many goals in doubt that it became difficult to focus my efforts.

I didn’t let it keep me from my core disciplines and I continued to practice guitar and drums. I can’t specifically recall what my typical days were like back then, although I started to spend more time playing video games and other sorts of passive activities as I’ve previously discussed. Prior to the pandemic I had renewed my efforts to learn writing, drawing, and studying the Korean language. These fell by the wayside for several months as I had problems finding the motivation to keep all these disciplines going.

Eventually, I think near late summer or early fall, the slow re-opening of medical care and society in general started to hint at better days to come. This slowly helped renew my desire to restart these pursuits and I’ve settled back into a routine encompassing all my disciplines - guitar, drums, keys, bass, vocals, writing, drawing, and studying Korean. I’m still trying to sort out the optimal battle rhythm since I only recently returned to work and that’s been a big shift from the previous eight months.

All this rambling to say that despite the negative consequences of last year, it hasn’t been all doom and gloom. The challenge of the virus was met with an unprecedented effort to develop a vaccine and in an achievement that I would compare to the Apollo Space Program for its audacity and technical wizardry, several companies developed not only viable, but highly effective versions of a vaccine, several of which were using mRna, a complete paradigm shift in vaccinations. Sadly, our current administration is screwing up the rollout, but I’m not sure anyone expected anything else.

The good news is that here in the US we elected a new president/vp and in a few weeks, we’ll usher in a new era and a return to normalcy, at least in the executive branch. Another positive change has been the demonstration that remote work and learning is not only viable, it’s likely a superior alternative to many traditional processes in business and education. Why should we make people drive day in and day out to an office or classroom when they could achieve the same goals and processes from their homes? There will always be industries and jobs that can’t be done remotely, but we’ve definitely shifted the focus more in the last year than we might have in ten years pre-pandemic.

The most important lesson I’ve learned is that we’re not really that far removed from being able to sustain our lifestyle without me working at all. I don’t plan on fully retiring anytime soon (if ever), but I know now that within a few years and having achieved a few economic milestones, we can sustain a fully retired lifestyle indefinitely. I’ll likely always want to work a little bit for discretionary income purposes, but now we have a better idea of how life would look with no additional income.

Reflecting on this, I’m grateful. I’m grateful for the life we’ve been able to carve out after many decades of hard work. We didn’t suffer or feel deprived in the least, and I know there are millions if not billions of people who had a much harder time of this last year, and in many cases have always had a harder time of it. The biggest burden on us was mild anxiety about our economic future and whether we’d be able to endure additional economic hardships beyond the loss of work. Thankfully, that was the worst of it as we managed to make it through without any big disasters.

I should also take the time to mention that we lost some of my all time most important musical influences this year, ironically not due to the pandemic but to other health issues, I think cancer in all three cases. Early this year in January we lost Neil Peart, arguably as big of an influence on me as any other musician, especially considering his lyrics and prose. Not long after, we lost the brilliant musician and composer, Lyle Mays, the longtime musical partner of Pat Metheny and an amazing artist in his own right. He brought so much joy and wonder to so many people over the years. Finally, in October the world of rock and guitar specifically lost a man who arguably had a bigger influence than any other in history, Eddie Van Halen. It’s impossible to calculate just how important and far reaching Eddie’s influence has been on rock guitar. Often cited for his revolutionary approach to tapping and soloing, it’s his rhythm, riffs, and songwriting that are probably the most important elements of his style. Losing these three greats was just another kick in the gut to add to the misery of this year.

Thankfully, the year ended on a high note as I finally was able to return to work, albeit for a different employer. The eventual dismissal from the VA, my employer for the last nine years, was handled pretty callously and lacking in respect from the leadership in my former clinic, but I suppose I was a bit naive in assuming the best about certain people. It’s in the past now. As part of that scenario, the work seems to have mostly shifted to the contractors, so that’s where I followed it and now find myself working for one of them. I never predicted anything as universally devastating as a pandemic, but my belief that there would always be work for disability examiners has been proven true thus far.

My goals for this year are largely consistent with what they’ve always been. I want to continue improving my craft at the various disciplines, ultimately in the service of storytelling in various mediums. I am hoping in the near term to finally record and submit that audition for the guitar program at Berklee and hopefully begin a dual major track starting with the spring semester in a few months. I’ll have to adapt my battle rhythm yet again, but I suppose that’s always going to be a more fluid aspect of my daily efforts.

I hope this year has helped distill what’s most important in everyone’s lives, I think it has in mine.

wisdom from the professor

A few days ago I had ordered a Guitar World tribute issue about Eddie Van Halen, and I realized that I had failed to do so for Neil Peart. My loss because it appears the Modern Drummer issue is sold out and it’s a scalper’s market at present. I did find a cover story compendium by MD, including the story from the tribue issue, so I’ve bought that but I assume the tribute issue is a more broad coverage of Neil’s career, so I’ll remain on the lookout for a more reasonably priced option. Right now, the cheapest is running around $150, which is a bit rich for a magazine that probably sold for under $20 at release. All that said, by chance a collection of Neil quotes popped into my news feed today, and there are some really good ones, a few I don’t remember hearing before.

The 11 best Neil Peart quotes about life

1 - ”The important thing is: if you fail once, or if your luck is bad this time, the dream is still there. A dream is only over if you give it up-or if it comes true.”

2 – “I can worship Nature, and that fulfills my need for miracles and beauty. Art gives a spiritual depth to existence — I can find worlds bigger and deeper than my own in music, paintings, and books. And from my friends and family I receive the highest benediction, emotional contact, and personal affirmation.”

“I can bow before the works of Man, from buildings to babies, and that fulfills my need for wonder. I can believe in the sanctity of Life, and that becomes the Revealed Word, to live my life as I believe it should be, not as I’m told to by self-appointed guides.”

3 – “It is impossible to follow the teachings of Jesus Christ and be a Republican. It’s philosophically absolutely opposed – if they could only think about what they were saying for a minute. That’s when you get caught up in the webs of what people call themselves and how they behave.”

4 – “I read recently that all of us can be defined in adult life by the way others perceived us in high school. I know [people] who had the popular, good-looking path in high school; they tend not to do so well. It was a little bit too easy for them, where for those of us who struggled in every sense, perhaps our determination and self-reliance and discipline were reinforced by that.”

5 – “You just become adaptable and try to lead a good life in ways that make sense, regardless. Because I know at the end of it, if I’m going to meet Jesus or Allah or Buddha, I’m going to be all right.”

6 – “I remain the optimist: you just do your best and hope for the best. But it’s an evolving state of mind.”

7 – “When I’m riding my motorcycle, I’m glad to be alive. When I stop riding my motorcycle, I’m glad to be alive.”

8 – “There’s a new reality born every minute. Unless one is a believer in predestination (in which case I’ll call the prestidigitator). Or other puppet-like restraints on our powers, one is free to imagine and effect changes on the world.”
“And if enough people do it, there are big changes. These things happen. Anything can.”

9 – “Adventures suck when you’re having them.”

10 – “If you want something done right, just forget it.”

11 – “With people too, you constantly think, “If I’m nice to people and treat them well, they’ll appreciate it and behave better.” They won’t. But it’s still not a bad way to live.”