The second one is done. Surgery went smoothly and recovery is going well. The second eye appears to be recovering more quickly than the first. There was less redness and I had usable vision in the eye the next day.
I was amazed at how much colors had changed. The cataracts were filtering blue light. Loosing both of them, colors are consistent across my visual field and I’m amazed at the change in the off-whites in the kitchen back splash, kitchen and bathroom marble, and tile floors. All have lost their lemonade look. Oh, and the stains on the shower enclosure tile are obvious. Field day happened.
Outcomes
Most eye surgery facilities and front of eye surgeons do not make outcomes generally available. There are two outcomes of interest, the complications rate and the percentage of surgeries that achieved or exceeded the surgeon’s target vision quality. Complications are extremely rare, on the order of 1 in 10,000 procedures. Surgeon skill, facility infection control practices, and patient home care compliance determine the complication rate.
Surgeon pre-treatment attention to detail and proper maintenance and use of eye imaging systems before treatment determine the post treatment vision quality. The quality of the pre-treatment eye measurements largely determine the vision outcome. Get the measurements right, correctly pick the prosthetic per measurement guidance, and position it properly when it is implanted and follow home care instructions and a good outcome will happen.
Most facilities and surgeons don’t advertise their outcome statistics. Ask about complication rates. Ask about on target vision outcome rate. Virginia Eye is admits to achieving expected vision quality on 95% of its placements. But they’ll only tell you that if they ask. To put that number in context, you need to ask about national medians and regional medians.
Laser assisted surgery
Because I opted for toric lenses, my surgeon used a femtosecond pulse laser to pulp up the natural lens for removal by suction and cut the access that would be used to remove the old lens and implant the new. The laser procedure relies on the pre-surgery measurements. The better these are, the better the surgery.
The pre-surgery measurements locate retina features that the laser will use to correctly locate the incision. This is all automatic. Machine vision and remote sensing correctly position the laser relative to the patient and steer the laser beam during treatment. The surgeon picks the targets and benchmarks. A laser operator qualified technician does the actual laser operation while the surgeon is working on the previous patient and setting up for the patient in the laser lab.
Yelp?
Most Yelp reviews talk about likability. Did the reviewer like the staff and the experience. Not were patient outcome goals achieved. Take Yelp reviews of healthcare services and providers with a large amount of salt. Nobody is going to like a root canal.
Community Opinion
While in the queue for cataract surgery, I mentioned that I was in the process to my ear, nose, and throat specialist. He asked who my surgeon was and thought well of her and her work. It is best to have your primary care vision practitioner refer you to an eye surgeon and clinic. Review that referral with primary care. They know provider reputations and will wave you off if the referral is to a sub-par provider.
I started this piece in response to an inquiry from younger friend Matt who is considering purchase of a nice audio system. Said friend is a professional software engineer currently at FaceBook, moves with some frequency, who has varied musical interests having played trumpet in high school bands, and guitar and bass off and on, and has fairly eclectic musical interests.
I don’t know if he will trade equipment as frequently as he trades jobs. I’m guessing simplicity is important, durability to withstand moves, durability to withstand loud playback, and non-fatiguing reproduction of the various metal genres. This may mean rolling off the high end in playback processing to loose some of the distortion harmonics.
My financial advisor is also interested, initially as a headphones listener but maybe as a speaker listener. He has a largish home and could probably find a room to use as a listening space. He’s currently an iPhone streaming user who has outgrown ear buds and would like to move up to headphones. He’s married with children so spousal acceptance and resistance to acts of children are factors. The children are at an age where they can be introduced to music listening.
Read on to learn more about building a high performance audio system able to play a broad spectrum of musical genre and styles. The material after the break reflects my experience from 50 years in the hobby, my evolving taste as a music fan, and directions in the modern component audio system industry.
Happy Yuletide. It is time for the yearly Yuletide letter. I rather like the notion of Yule, the pagan winter solstice holiday. Most of the things we enjoy about the Yule season have their roots in Germanic Pagan traditions. Thinking it would be nice to have some music while writing this, I went noodling about in Roon starting with George Winston’s Winter Solstice record. It turns out that George has quite a catalog and that some of it is top shelf.
Roon catalog entry for George Winston’s December
I’d always looked askance at George Winston’s music back in the day because it was in the new age section and and most things in that category were uninteresting. But, this time of year, a good chill tune is appreciated. These are slow straight ahead improvizations. If by another artist like say, Kieth Jarrett, they might be called jazz instead. In fact, George Winston is a noted interpreter of jazz composer and pianist Vince Guaraldi’s music. George’s best records feature Vince’s compositions. As I listen to December, I’m recalling the Lost Songs of St Kilda.
This year I’ve been getting smarter with Twitter. Twitter has lists of user names. Lists can be private or public. Groups use public lists to view the group’s tweet activity. Twitter uses the list to select the posts on display in the view object much like filtering on a user name or set of user names. Really useful for keeping up without having to wade through all the cruft Twitter also serves up.
Muffling retweets
I’ve switched from the Twitter client to the Twitterific client. It has a much better architecture and user experience. I’ve also discovered mute (all tweets by user) and muffle (all retweets by user). @4deerhounds has multiple deer hounds and takes great photos of them at play, rough housing, and lounging about. Several of the portraits are spectacular. 4deerhounds is sharp and speaks passionately about the EU ethos and staunchly defends civil liberties in his own writings. But he can be sucked into twitter squabbles and retweeting of other’s drivel. The muffle option lets me keep the deer hounds and throw out the bath water.
Dog Twitter
Dog twitter is good fun. You don’t need an actual dog to play along but it helps as a post of a photo with a cute tag line has legs. Many people write about dogs past, stuffies, or other critters like birds, cats, etc. There are 2 rules, develop a character and write in character, yes and stay in character (ie. no politics or other worldly stuff your critter wouldn’t experience). Snarky comments about household members are allowed. Complaining about slack wait staff performance is a popular pastime.
A Dog Twitter Handle
The best way to proceed is to have two twitter accounts, one for the fur pals and one for mundane matters. How do you do this without yet another Email address?
Both Gmail and Gsuite Email allow Email addresses of the form string1+string2@domain where the first string is your Google ID or Gsuite user name, the plus sign is a separator, and string2 is the pet handle. For example Missy might be
moocher+missy@retired-moocher-dave.org
Reference 3 describes Google’s rules. Unfortunately, I’ve not tried this with twitter.
Passages
This year, 4 family members and trusty companion Lord Nick passed away. One was in his mid 90’s and one 90-ish. Their age caught up with them. One was in his late 70’s and complications of tobacco use (COPD) took him. Lung, kidney, and heart failure. Another was in his 60’s and complication of alcohol and tobacco use took him.
Living Will Story
One of these had done the living will exercise. He forgot to tell anybody that mattered, like his wife. He goes into respiratory distress. The paramedics are called. He goes off to the ER and begins extended hospitalization on and off a ventilator and back on. All in all, he was in ICU for 6 or so weeks. His wishes were to avoid this sort of extended no hope of recovery ICU care. While settling his affairs, his wife discovered the living will in with the other important documents. The moral of the story is
If you have a potentially fatal chronic condition, prepare a living will
If you are over 78 (median life expectancy), prepare a living will
Ensure your spouse and next of kin are aware that you have a living will and have access to it.
Ensure your primary care physician has your living will on file.
I must confess that I’m not yet delinquent but it is time to begin to think of these things. There are really things to think about. The more important of the two is to define what is a minimum acceptable quality of life for you to help your health care providers decide when the transition to palliative care only is appropriate. With this understanding you can prepare the rest of it more easily than without it. This is also the bit that it is important for your next of kin and spouse to know and to accept.
Nick
Nick left us in December as a result of complications of aging. Nick was a piece of work. He stayed on at the track an extra year to grow up and race. Nick’s sire had a reputation for siring extended-adolescence pups. Just shy of 3 years, his owner decided Nick was a pet. Nick petted out in Feb 2006, went home, and demonstrated that he was a complete arrogant git. Back to Twin River Greyhound adoption kennel.
I adopted Nick on the rebound on April Fools weekend and was willing to put up with his crap. He was such a calm, well mannered hound while the dogs racing that day were preparing to leave for the track holding kennel. Imagine 1000 dogs shouting “take me, take me” and you’ll get the idea of what load out time at the kennel is like. Besides being a bouncy mischievous and playful adolescent, Nick was convinced the world should revolve around him.
The discovery that I had other ideas led to some rather interesting passive aggression. Usually, Nick would mark something associated with me to express his displeasure. He also had some separation anxiety in the beginning. Took about a year to wait all this out and house repairs to pay for the Rhode Island landlord.
Nick grew up
Anyway, the worst of the gittish behavior stopped just before we moved. But he was still a wild and crazy guy charging squirrels and walking the streets head in the trees shouting at squirrels and cats. Major character. It took another couple of years for him to become an adult.
Tleilaxu Eyes
Cataracts caught up with me. One eye done and one to go. I let my surgeon talk me into the optional toric lenses that correct astigmatism. Glad I did as I’m always looking through dirty glasses at the world in addition to clouded eye lenses. The right eye is clear and bright. The left is still yellow and cloudy (you don’t realize until they are replaced). Anyway, one week on, I have better vision with one dodgy eye plus one healing eye than before surgery. Today the recovering eye is working better than the untreated eye.
Medicare and Cataract Surgery
Medicare will pay for complete cataract care implanting regular spherical prosthetic lenses but not the toric prosthetic lenses that correct astigmatism. Medicare will pay for regular hand surgery but not for laser surgery to cut the precise access openings the toric lenses require and or to use the laser prepare the clouded natural lens for removal. I feel this is a bit of a mistake on the part of CMS. The laser procedure is quick and accurate and the recovery is very quick. Thirty six hours post procedure, I had usable vision in the treated eye. One week on, the treated eye is functioning better than the untreated eye. Vision in that eye will improve further for an additional 3 weeks.
Laser incision is also the key to using toric lenses. These implants are elliptical. Because the toric lens has a spherical component that corrects the eye’s focus plus a cylindrical component that corrects your astigmatism, precise orientation of the lens is important to proper implantation. The use of the laser allows the cut to be correct and the lens to be properly placed.
The laser does its work without contact to the patient. The pulses are very short causing the eye to perceive them as green flashes. The laser beam is positioned optically rather than by hand or by stepper motors moving the laser objective lens assembly. The use of electro-optical deflection allows it to do more precise work than is possible by hand.
Focus and depth of field tricks allow the laser to emulsify the lens without damaging the cornea. In the traditional procedure, the surgeon cuts a circumferential incision, inserts an ultrasonic probe into the lens cavity and applies ultrasound energy to emulsify the lens. Both procedures use suction to remove the emulsified lens material.
Technicians actually do the laser work using the orientation information determined by the surgeon. The surgeon removes the mushed up natural lens, inserts the prosthetic lens, and installs a bandage contact lens that protects the new incisions from eye lid blink forces. Friction between the lid and the cornea tends to open the incision prolonging healing.
Toric Lenses
Optometrists and ophthalmologists use toric lenses to correct astigmatic vision. Departure of the cornea, lens, and retina from their proper shapes cause astigmatic vision. Astigmatism may be corrected using toric eyeglass lenses, by modifying the shape of the cornea (LASIK), by use of toric contact lenses, or by use of toric prosthetic lenses in cataract surgery.
Medicare will pay for surgical replacement of a non-functional lens with a regular spherical lens and associated manual surgery to remove the aged lens and implantation of the replacement. Member co-payment is typically $200 per eye.
Medicare will not pay for “corrective” lenses of any sort: no eye glasses, contact lenses, or corrective eye lenses. Medicare also chooses not to pay for laser surgery as the manual variety is quick, safe, and effective. Laser surgery usually allows a quicker return of the treated eye to service but Medicare has chosen not to make its use the standard of care.
Precise eye measurements are essential
Interestingly, spherical and toric lenses have similar manufacturing costs and similar implantation costs. The difference in procedure cost accrues before implantation. The eye measurements required to select and orient toric lenses are much more exacting than those required to select and implant spherical lenses. The amount of astigmatism correction is measured using laser optic scanning. The astigmatism correction orientation is also performed by this procedure and test instrumentation. My treatment required several re-scans to get results that my surgeon was comfortable using for lens selection and surgical laser setup.
First impressions of the new lens
Images in the treated eye are clear and bright. By comparison, the untreated eye shows a blurry, splotchy, dingy yellow world. The treated eye is crisp and clean with whites that are white and a blue sky without an army olive green tint.
Oh, and I can see my “real camera’s” finder. Its a strange feeling to use it without glasses in the way and without field vignetting caused by the eye being away from the eye piece optic.
Dry Eye
It is really important to keep up with dry eye. The tear ducts (about $200 out of pocket) can be cleaned and fish oil supplement keeps tear glands happy. I use a preservative free wetting agent, Refresh Optive, that works well for me. The polypropylene glycol doesn’t work as well for me. The film takes too long to settle down to a uniform thickness causing visual artifacts. Preservative-free Refresh Optive settles in under a minute.
757 Live Music in 2019 and to come in 2020
I’ve been going to the local jazz series at Attucks Theater and Sandler Center and to jazz and symphony concerts at Sandler Center and Chrysler Hall. I was able to hear Justin Kauflin, Ryan Keberle, and Theo Coker, Bela Fleck and Chick Corea, and I’m with Her. Tickets for Jon Batiste in January 2020, Live from Here (the whole show) in May, and Mandolin Orange in May. Plus six VSO classical Sunday matinee at the Sandler.
Since I bought early, I’m in the orchestra pit for three May VAfest shows and row G for Live from Here. Play “Dean Town man.” Can Dean Town be the Free Bird of the decade?
2019 Recorded Music
I’ve subscribed to Tidal and Qobuz and have them integrated with Roon. I can play something I like and Roon will slip into radio mode and play more like what I played. I’ve discovered a whole slew of second tier jazz artists who are great players, composers, and leaders but not marquee names. It was Roon that got me interested in the live music scene. I’d get a promo Email for a coming show, look the artist up in Qobuz and Tidal to see what they are recording, and use that and artist bios to guide ticket purchases.
Theo Coker let out a big secret. When he records, he plays with studio toys because that’s what his label A&R guy wants him to do. If the A&R guy (its always a guy) is unhappy, your record doesn’t get out. When Theo plays out, he leaves the toys home. No synths, effects, etc and plays bebop and straight ahead. And it is way better than his “please the producer” records. Theo writes and plays with the best of today’s trumpet folk.
Unhelpful A&R folks is a recurring theme in today’s music world.
Live from Here
As you can guess from the space given to Live from Here and the number of tweets devoted to Live from Here, I am a big fan of the show.
Four years ago, Garrison Keillor stepped down as A Prairie Home Companion host turning the reins of the show over to Chris Thile, Mac Arthur Genius award winning mandolin player and blue grass singer. In his first career, Chris formed and fronted two newgrass bands: Nickel Creek and Punch Brothers and has teamed up with numerous acoustic music artists for tour programs. Chris appeared on APHC first at age 15, and guest hosted several shows to audition his new career. Chris has been at the helm for 4 seasons as performer and creative direction.
APHC staff, like Garrison, were approaching retirement. If MPR desired to continue the show, it would need new talent, new creative staff, and new support staff. Oh, and new listeners. Chris is the guiding force for renovation of the show moving from a stories with music format to a music and spoken word format.
The Live from Here company performs about half the content for a show with the featured guests performing the other other half. The show floor plan has twelve 10 minute segments. The show typically features 3 musical guests each performing for 10 minutes in first our and for another 10 in second hour plus one or two spoken word segments (comedy, poetry, writers) of about 10 minutes each. The mix is fluid depending on performer availability and actual running time of each segment. Chris and the producers are frequently calling audibles to adjust the material performed.
For its forth season since launch, Chris and crew decided to have a bit more family life so the show is in NYC Town Hall most Saturdays. This is a good thing as NYC is overflowing with musical talent both headlining performers and session players.
LFH is doing 26 or so new shows a year and just closed the 2019 season with a great show. Every home show is simulcast as a YouTube live stream. Links to the most recent video and radio broadcast audio are on the show website just below the masthead. The live show video recording stays up for a week from air date and for the week of a rebroadcast. Radio audio remains available in the show archives like forever.
The video starts 15 minutes before air with a guitar and fiddle tune. Then Chris Thile comes on stage and plays a mandolin tune with more of the band. Then Chris vamps with the audience to practice whatever he plans to have the audience do during the show.
When performing at a venue having a robust Internet connection, Live from Here will live stream the show on YouTube and offer the video on demand for a week following the show. Live from Here always produces video of each show and breaks the take into sets by performer or show segment. Many of these segments are always available on the show YouTube channel. The best segments are collected in several play lists.
I have a public play list of Live from Here favorites that I have collected over the years. This list includes house band, visiting artists, and show prelude and encore segment tracks. All are strong examples of the artists performing and music played during a show.
During each show, I note the guest artists and show band guests and look up their music in All Music database integrated into Roon. Guests come on the show and play their hearts out. I audition their recent wax to find it is muddy sounding and overproduced and unrepresentative of their ability as performing artists.
Nick was an incredibly brave greyhound and tried his best to be Nick to the end but a fall tore the skin over his hip. In an elderly dog, this injury is irreparable so it was time to let Nick go. This is a classic consequence of hip hyper–extension that tears the skin horizontally and can tear the joint capsule. So Nick left us at home on 03 December.
Nick was eating less than his maintenance
Nick was eating his full ration most days. He was a grazer and Missy was a Hoover-hound so I had to take up his leftovers and offer them later which was driving Missy wild.
I was feeding both dogs per the Canidae inactive adult guidelines. Missy is a bit smooth but Nick became increasingly gaunt. Eating most of his ration, Nick was not maintaining weight so I began to look for add-ins that he would eat. I took to feeding him 1/2 cup 3 times a day adding 50 grams of roast beef to one meal and a half-can of canned tuna to a second.
Nick was cleaning his bowl but still loosing weight. I was never successful at stopping this wasting. I’m firmly convinced that his metabolism changed as he aged.
No, they won’t let you know!
Greyhounds will keep on keeping on into overtime. Both Lance and Nick did so. They loose their super powers little by little and also their ability to do activities of daily living little by little. And the progression is one of hills and valleys rather than a steady descent. It was helpful to identify a terminal quality of life but Nick did not approach it linearly. Rather, he’d have good days and bad and good hours and bad. He could appear to be down only to nap for a couple of hours and hop up to follow me around as best he could. It is a myth that they will let you know when it is time.
Some fond memories
I miss my Snarky Puppy. Such a calm dog in kennel, Nick came home an absolute git. He thought the world centered around him and when he discovered that it didn’t, he’d get frustrated and go hose down something he associated with me. Taken to a reunion, he spent the whole time marking and barking at the other greyhounds in attendance. Nick would walk the neighborhood here at Dismal Manor, head in the trees shouting at the squirrels as they laughed at him.
As he completed year 4, Nick managed to shed his sapling ways and become an adult. Just in time for the car trip to Dismal Manor and the motel stay while we awaited our household goods. The marking stopped and a fenced yard let him dissipate some of the energy. Through year 5 and 6 Nick continued to torment squirrels, at first charging them but later stalking to close before the charge. I have a video of him stalking somewhere in the Wayback Machine.
When Missy joined us, Nick gave her one menacing only to be told to play nice. He quickly discovered she was a track fit, track fast 3 while he was nine. Nick would withdraw to the carport when Missy went ripping about the yard. After that one testing of limits, each would take the other’s wing as needed. Sadly, they never played together. But when one called Tally Ho, the other would come running to support. For late night turnout, they’d go together. The first would wait for the second to join.
Missy adjusts
Missy is doing well but she misses Nick’s company and support. She’s needing more play time and more cuddle time (an OK thing). She’s also driving the plan of the day. She raises sand when it is meal time and treat time. I’ve introduced some indoor ball play with the big fuzzy Chuck-It and give her evening treats in a treat puzzle toy.
Another?
Maybe. I’m 71 so my next would be with me into my early 80’s if I adopted a track hound. I also have the option of adopting a displaced hound. Our local rescue is winding down so James River Greyhounds is serving the 757. James River are better prepared to take a group of dogs from the track, house them, and distribute them. They affiliate with Greyt Love Retirement who operates a small kennel, has a hauler, and brings dogs to the area for adoption. James River sorts and places the greyhounds.
Nick’s new shoes arrived Friday afternoon. I unboxed them and fitted them. I was pleased to find that my measurements were good and that they fit nicely. Nick let me put them on and has been up and about some while wearing them. This article covers the initial boot use experience and some issues we discovered. It has grown over several days.
Nick continues to experiment with footwear. In the previous episode, I mentioned that the RuffWear boots I bought 14 years ago were moving around so the slippery part was down. Upon investigation, I discovered that his boots were the old size L(arge. They are a good inch wider than his foot allowing them to roll.
Nick in original RuffWear boots
Since I bought those boots for Nut, RuffWear has redesigned the product line. The new boots are sized in 0.25 inch increments and sizing instructions are to measure foot width and buy the size closest to but smaller than the foot width measurement. Measure all feet to be shod and use the largest size. Nick measures 2.125 inches so he’d wear a 2.0.
So, today I ordered RuffWear Summit boots in bright green.
I’ve been trying to find things that help Nick with his 13.5 year old mobility. Nick had been eating less than maintenance for some months loosing a good bit of hip and shoulder muscle. The muscle loss has impaired his stance and gait. Most commonly, his feet slip outward causing an unplanned split. What might help?
With the advent of iPadOS and development work at Twitter, Inc. the iPad Twitter app has become unstable. As of iPadOS 13.1, multiple users are seeing the following problems.
Each time the app is updated, view mode switches from the most recent to “Home” view. Most users prefer the timeline view.
In both home and timeline views, the app interrupts what you are doing to refresh the view.
The app segfaults at random
The app hangs in the tweet editor
The app segfaults in the tweet editor
In this article, we’ll look at an alternative Twitter app. There are two well regarded apps, Twitteriffic and Tweetbot having similar user interfaces and none of the rude behaviors mentioned above.
The past several months have been up and down and up again as we learned more about Nick’s late in life care. This article is a catch up to November. I never thought he’d make it that far.
Those of you who saw the John Darko interview of Jason Stoddard and Mike Moffat filmed at the 2018 RMAF know that both have a passion for Schitty puns. During this interview, Mike teased a “Schiit Pi” concept. Mike’s idea was to embed an ARM processor in products to pick up additional digital signal processing tasks beyond the abilities of the Burr-Brown parts he had been using.
Jason is adamant that Schiit will not become a “software company”, that is offer IOS and Android apps or make devices having a significant user interface say like Roon Controller or Volumio remote. The ongoing maintenance of these products is simply too costly for the Schiit minimalist value first design esthetic.
A Minimalist Streaming Player
So can we make a minimalist streamer using a hatless Raspberry Pi? If we did, how would it sound? This product is as basic as a Roon Player can get. It turns out to be a very good one. Will Jason put it in the catalog? Probably not. Volumio got there first with more software integrated.
Those not wanting to tinker with hardware and software will find Volumio Primo a good alternative that provides a SBC and DAC supporting AirPlay, Rune, Roon, Spotify, and others but excludes the headphone amplifier. John Darko’s review is excellent and he likes the sound of Primo and the value offered. Primo is comparable, maybe not quite as sweet as the Allo Digi+ Signature. However, the ALLO devices requires you to bring your own DAC.
