Lily Update- No Good Options

Sorry about the bluntness of the headline, but I didn’t want to beat around the bush with what is ultimately just horrible and heartbreaking news. I just went up and visited Lily and spent a half hour in a consult with the Doctor (again, I can not say enough wonderful things about the doctors at the PVSEC– they’re really professionals), and she is just not doing very well at all and it does not look like there are any good options.

I’ve been crying for three hours and I had to stop four times on the ride home to pull over, so I will try to be as thorough as I can to explain what is going on. Yesterday afternoon after I left, she was given a blood transusion because her platelet count was virtually non-existent and rbc count was around 13. She is not being sedated, and this morning her RBC had rebounded to about 25, but her platelet count has not increased at all (and would not for some time were she to recover- it takes weeks for that). She had an ultrasound this morning, and none of the news is good.

Her liver is enlargened to twice to three times the size of a normal liver and is extending past her rib cage, and the surface looks abnormal. Her stomach and GI are thickened and also abnormal. She also has fluid in her chest/stomach cavity.

The doctor believes that she has cancer, but she can not actually make an absolute determination, because Lily’s platelet count is so low that if they so much as test the liver, she could bleed out. Even if they could make the determination that it is cancer, she is so weak that treatment is not really practical or feasible. The only real thing we could do is to try to extract some of the fluid and see if we could make a determination from that sample.

Unfortunately, the fluid is blood. Basically, there isn’t much that can be done for her, and the only real option is euthanasia. There are other options- we could have a CT scan, but then all that would show up is a non-operable tumor, because since her platelet counts are so low she would bleed out. Likewise, they could do a surgical procedure to investigate and determine the cause, but that might kill her, and even if they found the cause, they could not do much to help her.

It’s just shit all the way around. I asked the doctor what she would do were it her dog, and she said that surgery is out of the question, and she would be hard pressed to do the CT scan because if she found anything, she probably would not wake the dog up from the anesthesia because there is nothing that can be done.

Basically, I know what has to happen, the doctor knows what needs to happen, I was just not emotionally prepared to make the call today. Bringing her home and enjoying a few more days really is not an option either, because her platelet count is so low she is already at great risk of decompensate rather quickly, which is basically a sanitized way of stating she could just suddenly hemorrhage and exsanguinate, which is something I am not willing to risk nor something I would ever put her through.

When I went to visit her, she was not sedated, and barely even registered that I was there. She feels as if she has lost weight since yesterday, and barely has the strength to hold her head up. I held her for fifteen minutes and told her I loved her and cried, and then left before I decompensated in front of everyone.

I spoke with the doctor on the ride home, and they are going to keep her overnight because I can not risk taking her home tonight and having something happen to her leading to a painful and awful demise, and barring a miraculous recovery, I am going to pick her up tomorrow, spend a few hours with her and then go to my friend and vet Harry’s and put her to sleep. I’m devastated and sick to my stomach, but I know it is the right thing to do. I’m so sorry for all of you who love her like your own, but it just doesn’t look like there is anything that can be done.

I’m just crushed. She was doing the play boy and prancing around just last week, and this is all so sudden (which the doctor said happens all the time).

I doubt I will never love anything as much as I love Lily and I just don’t have words to describe how broken I am right now.








Russiagate Open Thread: Michael Cohen Decides Against Inviting Discovery

Politico:

Embattled attorney Michael Cohen has dropped a pair of much-touted libel suits against BuzzFeed and the private investigation firm Fusion GPS over publication of the so-called dossier detailing alleged ties between President Donald Trump and Russia.

Cohen abandoned the suits late Wednesday as he continues to fight to recover documents and electronic files seized from his home, office and hotel room last week by federal authorities as part of what appears to be a broad criminal investigation into his conduct.

“The decision to voluntarily discontinue these cases was a difficult one,” Cohen’s attorney David Schwartz said. “We believe the defendants defamed my client, and vindicating Mr. Cohen’s rights was — and still remains — important. But given the events that have unfolded, and the time, attention, and resources needed to prosecute these matters, we have dismissed the matters, despite their merits.”…

“If there’s one thing Democrats and Republicans agree on today, it’s that the dossier was an important part of the government’s investigation into potential collusion between the Trump Campaign and Russia,” BuzzFeed News said in a statement.

In a separate statement, Fusion GPS said: “With his decision, it appears that Mr. Cohen can now focus on his many other legal travails.”

Dropping the suits could help Cohen avoid being questioned by lawyers from Fusion GPS or having to turn over evidence related to the case — both steps that could undercut his defense in the criminal probe.

The move could also bolster Cohen’s effort to delay a suit brought in Los Angeles by porn star Stormy Daniels, who claims to have had a sexual encounter with Trump about a decade ago. It could have been difficult for Cohen to convince that judge to put Daniels’ case on hold while Cohen continued to press civil suits in other federal courts…



The American Legion In NY Requests Assistance On Behalf Of A Vet Who Fought On Guadalcanal!

Sorry to big foot TaMara’s post, but I wanted to get this up as quickly as I could.

I’m working my Marine Corps connections, as well as my contacts in the chaplaincy to see if they can do anything, but the farther and wider we can spread this, the more likely it is to get a hit.

Open thread!








Afternoon Open Thread: The Duckies Are Alright

I heartily approve.  Senator Duckworth is an inspiration every day.

Open thread.








Back, and to the left…

A depressing thought occurred to me recently. Those of us who experienced the 2016 election as a national and personal trauma could be forever doomed to live with the mysteries and what-ifs associated with it, in the same way my parents’ generation is still haunted by the Kennedy assassination and the horrors that unfolded from that.

Am I being a drama llama to compare the two events — an assassination and a fucked-up election? Possibly. In 1963, a sitting president was murdered — a shockingly violent act. The violence associated with the 2016 election has thus far been indirect and mostly out of sight: people dying of treatable diseases, hurricane victims left to fend for themselves, people brutalized by emboldened rogue cops, folks murdered by re-energized white supremacists, etc.

In the future, the 2016 election’s body count may very well be increased by women who die from back alley abortions, children silently poisoned by polluted water and air, cities drowned by rising seas, a higher suicide rate among LBGTQ youth and victims of a war John Bolton is itching to start. Horrific results are already here, and more definitely await us; only the magnitude is in question.

James Comey’s current halo-polishing tour inspired this depressing line of thought, specifically his struggle to explain his decision to insert himself into the election at critical inflection points, which arguably set the current nightmare into motion.

Among Comey’s rationales was his perceived need to counter Russian bullshit about Loretta Lynch controlling himself and the FBI on Clinton’s behalf. So, Comey was the biggest fly by far caught in the “fake news” web Putin’s operatives spun. We’ll live with the consequences of that, one way or another, for the rest of our days.

Maybe that’s why I’ve felt compelled to watch the bastard’s “aw shucks, I’m just a big ol’ Boy Scout” book tour. It’s horrifying and fascinating to watch him explain why he did what he did — kinda like watching the Zapruder film. You know the outcome is catastrophic. But you watch it anyway, wondering how things might have turned out differently, marveling that so much turned on such insignificant things, like one man’s massive ego.

Eh, fuck it — let’s watch something more pleasant, like these birds on my hanging feeder. They’re house finches, maybe?

That feeder hangs from a tree and is located about four feet from the window where my my workstation is. When we have high winds like we did the other day, I take the feeder down because I’m afraid it will start swinging hard enough to bust through my window — possibly with squirrels attached to it, which would obviously result in chaos.

Anyhoo, open thread?



Prognosis is hard

Predicting death on an individual basis is hard.  It is uncertain and it is a dynamically looping system.  MedPac publishes an annual report on Medicare and there is a table in the Hospice chapter that shows how it is tough to predict death.

To qualify for the Medicare hospice benefit, a Medicare beneficiary needs their personal doctor and the hospice medical director to state that the believe that the individual has less than 180 days to live.  This is a prospective prognosis estimate that determines eligibility.  And most of the time the docs are right.  But not always, and their misses are fairly frequent depending on diagnosis, care setting and a few other factors.

 

Most categories of the 90th percentile are misses.  Neurological conditions have very long tails because the disease has a very noisy and jumpy staging.  Cancer on the other hand is a well staged disease with reasonably good predictions.

There are confounding factors.  Some regions of the country are suspected to use hospice as a cobbled together long term care benefit. But the quick take-away from this table is that prognosis is tough to do even when there is a hard decision that acts as a gate to a different flow of resources are on the table.








Lily- Update- No Real Info Yet

Just got off the phone with the hospital a few minutes ago, and she is doing well. Her platelet and red blood cell counts have increased, and she ate a little, but the nurse doesn’t really have a whole lot of information for me yet. They are going to fast her so they can do some tests, and the doctor is supposed to call between 11-4 to give me a consultation.