Monday, October 21, 2013

Stone, Surgery and Recovery

This tale starts in late June with extreme abdominal pain that, for at least four hours, I was convinced was just severe gas pain.  I was sweating and shaking and curled up in a ball, and eventually asked Jen to get me to the emergency room.  Well, x-rays, urine samples, and a contrast CAT scan later, and I was told that I had a Kidney stone descending into my bladder.  That was 4mmx2mm, and too small for them to try to do anything specifically for.  They gave me some really effective pain medication, and told me to follow-up with their Urology clinic.  Jen and I left the ER around 7AM, and I missed a day of work.  Within a day, the stone had passed, and I was feeling much better.

I tried to get to the Urology clinic that the hospital had suggested, and I couldn't get anyone on the phone (Jen also tried), so I was a bit stuck.  Jen went into the annual best doctor's issue of New York magazine, and found a doc who works out of Mt Sinai.  I ended up with an appointment at the beginning of September.  I asked the local hospital to forward my medical records, and waited.

During this time, I read up on Kidney Stones, and adjusted the things in my diet that are safe to adjust without knowing which of the seven types of Kidney Stones I was having  (my blood pressure is lower, now).  During this time, I had a few other instances of kidney stones passing (one, even, on the right side).

When I arrived at the doctor's office, the local hospital had never forwarded my records, and time had passed, so the doc had to basically start over, and ordered a new CAT Scan.  I went back the following Wednesday (to another part of Mt. Sinai) and got the new Scan, and then, after another two weeks, I was finally able to see the Doctor (I was fit in, but didn't have an actual appointment time).

The Doctor's appointment on the 25th of September was very interesting.  They showed me a 25mm (and inch wide) Staghorn (meaning grown into the various valleys of my kidney) Kidney Stone, and said it had probably been growing there for several years.  And... the local hospital E.R. had clearly missed it.  The Doctor tentatively scheduled me in for the 8th of October to have it removed, and sent me off for a different doctor, to get a pre-surgical clearance.  I was able to get in there on the 27th, got some chest X-rays to verify that my heart was ticking proper, and then I waited to find out about the firmness of that date.  I didn't find out for certain about the surgery on the 8th until they called me on the 7th.

The surgery itself was slow to get started, but eventually happened.  I was VERY nervous about this, being my first time under general anesthesia, but ... I did wake up.  The entire surgery was done through a single tube inserted from my left flank into my kidney (this part was done about an hour before the surgery, and under just a local anesthetic.  The estimate was that I'd be in the operating room for 1 hour, and instead it took 2 hours and 15 minutes.  The Doctor said to Jen, "chasing bits of stone into all sorts of nooks and crannies", or something near that.  I'm repeating it third hand, at least.  Which suggests to me that this thing was even more spread out than the CAT scan had showed.  Anyway, when I woke up my first thought was, "Oh, I guess I am going to survive this."

I stayed in the Hospital overnight, and got two morphine shots; though, I only remember the second one.  By morning, I was feeling better.  I had two catheters, one was the tube that had been put in to support the surgery itself, directly into my kidney, I went home with this one.  The other was removed fairly early on Wednesday (in front of an audience of 8 nursing students), I was too groggy to even feel embarrassed.  By that evening, I had done the required walking, and they sent me home, with an appointment to have the tube (and bag) removed the following Monday (14th).

Walking around with a tube sticking out of my side, and carrying a bag of urine is a surreal state of being.  I was tired and if I walked for more than about a block, my muscles would cramp up around where the tube was sticking out of me.  I was also worried about people bumping into it.  So, I ended up staying home a lot.  There are pictures, but I'm not planning on grossing anybody out with them.

On 14 October, I went in to have the tube removed.  So the tube that was in me was a catheter. That is, it went from inside my kidney to outside of my body, and handily hooked up to a bag. This means that when my kidney finished with liquids, and ejected urine it would go through this catheter. From my right kidney, everything continued to work as normal, kidney, bladder, urethra, toilet.

I had joked with some people that, by the description of the doc, they would clip a tether, pull the tube out of me, and send me home...

...I had that wrong. They did put two very thin pieces of gauze over the hole and taped it on before sending me home. The implications of this should not have been surprising, but they took me a bit off guard. Pardon, but this is gross, and I can't really help it.

Knowing that there would be "a little leakage" (my dumb head was just thinking bloody discharge), I smartly asked Jen to buy us some Chux. I mean, it seems crazy that they would send me for an 1 plus hour ride home with two strips of gause if my kidney is still pumping out 1.8 liters of urine per day (as measured from the bag over a week). But this, they did, and to suggest that the gauze and the Chux were insufficient, would be a nice way of putting it. Remind me to get the car steam cleaned.

Over two nights, Jen and I tried some different things to hold the deluge, and each failed in its own interesting way resulting me waking up cold, scared and wet.  We eventually settled on Pampers taped to my side, which were the most effective but still not 100%.

Some time before 11AM on Wednesday, the hole in my kidney finally healed enough for me to unstrap from the diaper. Also, there was an immediate flood of pain as (and I was warned about this part) surgical detritus flushed towards my bladder. It was not "all better" for me quite yet, but with a dry back, sanity begins to return, and I would be able to get the much needed post surgery rest that I'd been lacking up until that point.

Since Wednesday the 16th, I've been feeling progressively better each day, until today, when I am finally well enough to return to work.

The fallout of this is that I have Uric Acid type kidney stones.  This means, I get coffee back, but it also means that I cannot have more than six ounces of "animal protein" per day.  Chicken, Pork, Beef, Fish, even eggs are high in these chemicals called Purines.

Wednesday, July 3, 2013

NSA and Security, Again

Or: What I knew, what I thought I knew, and what I really didn't know.

I have, since at least 1999, worked with companies that are internationally distributed.  This means, I regularly have correspondence with people in Australia, China, France, Germany, India, Israel, Poland, Singapore and the United Kingdom.  Some of these folks, I have become friends with, so I have had personal correspondence with people in these countries, both paper and electronic.

I have known about the existence of the NSA since the 80s.  They are, of course, prominently featured in political dramas (Tom Clancy's works, for example).  The technology suggested in such entertainment has long been "accelerated technology", but I never for a moment assumed that it was all fiction.

That is, I have long known that the NSA knows who I am.  There's a huge amount of the population, of course, that has to correspond with people in foreign countries, but it is a small percentage of people in comparison to the whole US population.  Domestically, the USA is not in the NSA charter, but in talking with another country, I figured that I would be fair game in the context of those conversations, on a technicality.

Of course, then 2001 happened, and everything went haywire.  Homeland security, the merger of the intelligence services, a new era of inter-agency cooperation, all in the name of security.

In 2002, it turned out that the FISA court had found out that the FBI was breaching the provisions of the Fourth Amendment of the Constitution, by lying to the court, and they issued a rare public opinion, to try to stop it.

In December of 2005, the New York Times broke a story that the Bush Administration had unilaterally authorized spying on US citizens' phone calls without any court oversight at all.  I wrote a blog entry in direct reaction to that at the time.

Well, it's 8 years later, the NSA has actually vastly expanded the project that was started in 2002, and seems to have no shame about it.  Probably because nobody cared in 2005, or because nobody noticed, and this time the FISA court seems to issue ever renewing blanket warrants for everything.

The revelations that have come out of this have been deeply surprising in some ways, and sad.  Mostly sad.  I could point you to resources, but if you haven't looked it up yet, I highly doubt my blog will convince you.  I will, though, leave you with a quote from one of the US founding fathers.

They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.
 -- Benjamin Franklin

Tuesday, July 2, 2013

Fourth Amendment to the United States Constitution

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

The right of the people to be secure in their persons, houses, and effects, against unreasonable seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation the persons or things to be seized.

Friday, February 22, 2013

No Project Without A Tweet

You should be able to describe your business project in 140 characters or less. I don't have more time than that.
  -- @GAVollink

I've been following along with a pilot training program that was recently launched where I work.  One section of it is on a project definition framework.  I have never liked this framework, and only today - while responding to the trainer on another inquiry, did I finally understand why.  At the same time, I realized that I shouldn't dislike the framework at all...

I started implementing projects 18 years ago.  I started defining projects 12 years ago.  I started advocating projects from other peoples ideas almost 10 years ago.  Over the last 8 years, sometimes, I am the decision maker.  In all this time, I have never seen a project accepted by a decision maker for implementation because of how carefully documented it is.  Quite the opposite.  The project that can be described in two sentences - basically, twitter format - is most likely to get that person's attention.  The project that can get someone's attention an ALSO has a 30 second elevator pitch as a follow-up is rarely passed by.

That said, mounds of research and careful documentation is absolutely useful, essential even, about 20 minutes after the idea has been successfully pitched.  At the point it has been pitched, it will be a project, ready or not, so the details need to be ready too.  That's not the point.  What I've come to realize is that if someone has not thought through the project carefully enough to be able to isolate it to an introductory sound bite, and a follow-up paragraph, then the project probably is not ready to be done.

In some cases, it is a project that is supposed to be solving too many problems at once.  Something that is trying to fix everything is likely to be like a porcupine walking backwards through a silk shop.  In some cases, it is a project that would be best served as an add-on to a different project entirely.  In most cases, it is a project that is going to be waylaid by someone else's description of a problem.

When the project that can't be simply explained is swimming in a decision makers head, and someone else describes a problem, suddenly - because the project is not understood in the first place - the project and the problem are arbitrarily married.  The misguided ah-ha moment, "That must be what that project is for."

Coming back to the framework though, if there isn't a full project framework in place to back up that sound byte and elevator pitch, any technical person who is supposed to support that project going forward is going to expect that mound of research, the proof that this was really thought through.  Not having a well thought out plan for an idea that was already bought by a decision maker, will grow enemies quickly.  So my dislike for the framework is not about the framework, but the lack of the step where a sound byte and elevator pitch are distilled from that framework.

So, now I think of it this way; If I can't tweet a project description that makes sense, I'm not ready to pitch the project.  If I can't come up with a 30 second elevator speech to back up the tweet, then, I'm not ready to pitch the project.  If I don't follow the framework, too, then I don't even have a project to pitch.