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.
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.
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.
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’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?
In the first article of this series, I outlined Nick’s initial presentation of low back pain and the therapy he is receiving from his regular vet and his late in life care vet, Hampton Roads Veterinary Hospice. This practice specializes in late in life palliative care to maintain an elderly pet’s comfort and function late in life.
This practice offers selected Chinese therapy including acupuncture and herbal therapy in addition to cold laser and message therapy. They care for Nick in home and a significant portion of the visit is spent interviewing me about how Nick’s condition is changing, a thorough leg hip and back exam, and some coaching while the acupuncture session completes. I recommend this style of care for late in life care. This is the first time I’ve not felt alone with a geriatric hound.
How he’s doing
Nick is facing two problems, gradual deterioration of his hips and lower spine resulting from aging and slow wasting from loss of appetite resulting from pain and possible age-related metabolism changes that cause him to extract less energy from his ration.
Over the summer, Nick has stopped running the fence line and vaulting the porch steps to enter the house. He’s also been doing his toilet along the street fence rather than the customary area behind the shed that is a 100 foot walk so he’s consciously minimizing the distance walked. Over August and September he stopped doing a late night garden prowl with Missy.
His bowls are mostly regular with an occasional poo in an i’ve fallen and can’t get up context and the occasional spontaneous emission while sleeping. He remains in good bladder control.
I’ve taught him to walk up the steps and he has it mostly down but needs some support to compensate for imperfect control of his aft end. The Ruff Wear Webmaster harness has been a good thing for both of us. I can tailor the assistance provided to his needs of the moment allowing him to maintain strength and confidence. Without the harness, I’d have to carry him like a puppy risking injury to both of us in the event of a misstep and fall.
Nick continues to experience slow wasting, mostly as a result of eating less than maintenance on the average. Nick is receiving a high quality grain free food with most of its protein from animal sources, usually salmon or duck flesh and meal plus menhaden meal. Legumes and sweet potatoes provide carbohydrates and fiber without added beet or tomato pomace. Food macronutrient ratios conform to industry standards. Nick is supplementing pot roast which he eats eagerly and packet tuna which he eats eagerly. He receives either cream cheese spread or peanut butter as a pilling aid.
Nick and Missy are eating the same diet and the same amounts roughly. Missy is chubby while Nick is distinctly under weight. Some of Nick’s weight loss is a result of him leaving a small amount of kibble at each feeding but some may result from metabolic changes associated with aging. I try to intercept Nick’s leftovers and offer them later in the evening between meals. This was a matter of teaching Missy some restraint and having a treat for her when Nick was receiving his later feedings.
Nick is a grazer so I have to feed him when he wants to eat even if that is 2300. So I offer about 1/3 of his food in the morning around 9 AM, 1/3 at 5 PM and 1/3 around 8-9 PM with pot roast at 5 and tuna at 8. This has improved his eating. I give his medications at 9 and 9 with the gabapentin at bedtime around 10 to give him the best mobility during the day.
Nick continues to receive 3 primary medications for pain management, carprofen, gabapentin, and Hindquarters Weakness. He also receives PhyCox supplement and GlycoFlex supplement mostly for added glucosamine and chondroitin but each has a different system of anti-inflammatories that is supposed to help maintain hindquarters comfort.
Hindquarters Weakness is a traditional Chinese Veterinary Medicine believed over centuries of experience to be effective at managing hindquarters pain in Chinese draft animals. The formulation Nick receives is from a US supplier that runs an FDA style quality program to verify the purity and potency of China-sourced leaves and roots from which the product is prepared. The Chinese herbs have proved much more effective than the glucosamine and chondroitin supplements. I suspect this is because his food has adequate glucosamine and chondroitin while the Chinese herbs found only in Hindquarters Weakness have a robust anti-inflammatory action.
We started the gabapentin first followed by the Hindquarters Weakness. When we started 2 a day gabapentin, Nick became sedated and showed reduced rear leg control as indicated by a drunken gait with slouching hindquarters.
He’d improve at random. Invariably, each good day was preceded by a missed round of medication remaining in his pillbox, usually the bedtime dose. This suggested that one of Nick’s medications had slow removal kinematics in Nick.
We tested the Hindquarters Weakness first by reducing the dosage from 2 and 2 to 1 and 2. I started with it because I knew none of the ingredients had been FDA trialed to determine kinematics and that greyhounds have slow liver function relative to other breeds.
The dosage change produced no change in sedation and slouching. So I returned to 2 and 2 and reduced the gabapentin to one tablet at bedtime and stuck with it. Nick showed an immediate improvement in alertness, appetite, and walking posture.
At hospice vet’s suggesting, I increased Nick’s Hindquarters Weakness to 3 in morning and 2 in evening. This appears to have improved his mobility. We’ve been on this protocol for about 2 weeks. In that period, Nick has been much more alert during the day, is sleeping through the night, and is waking around 9. He can be a bit rubber-legged in the morning but this walks off in 10 minutes or so.
Since starting added pot roast, both dogs have shown reduced flatulence. It appears that adding some additional meat has shifted gut bacteria and less fermentation is happening in the back end. Of both dogs.
When I first wrote about HomePod on March 26, I wrote about the out of the box experience. Since then, I’ve had a chance to live with HomePod as a day to day device and to form a more detailed impression of its sound. Originally, I found that HomePod was very revealing and embarrassed poorly mastered material and lossy compression. Those impressions still hold.
I stopped by the Apple Store on the way home from church, always an expensive detour. This Sunday was no exception. I auditioned the HomePod and was suitably impressed. In the noisy way-too-big Apple Store hall, it sounded creditable in the near field. My impressions after a day at home follow. Most of the reviews focus on Siri when the focus should be on the killer app of the “smart speaker”, music reproduction. I’ll talk about music reproduction.
Back in the winter, I kept a friend’s greyhound while she was on holiday. Crash joined Nick and Missy as their guest. Crash was a perfect gentleman with impeccable manners in the house, in the garden, and on lead. After all, he’s a US racing greyhound and they’re indeed special.
Crash enjoyed his stay with us. He and Missy had several epic chase sessions in the back garden. Missy was overjoyed to have a bouncy boy about her own age for play. Nick, he’s 11 and acting positively senior.
Recently, a friend asked her social media peeps for camera recommendations for a first camera that is not a point and shoot. Her expected uses are garden macrophotography, the occasional photo of the moon, and urban/country trekking photography, including wildlife photography (BellaBob?). And of course, photographing her photogenic dogs when a phone camera just won’t do.
Since I was last in the marketplace, the players have changed somewhat. Several have introduced innovative product lines and new product types. Several manufacturers now make mirrorless advanced cameras. Some are styled to mimic the rangefinder cameras of old and others to mimic single lens reflex cameras. All have an eye to camera view finder. Two things distinguish an enthusiast camera from a point and shoot, the view finder, and the shutter lag.
Rather than try to survey the market, this article will inform you of important camera design considerations and the way in which they influence a purchasing decision. After reading this article, considering how you might use an advanced camera, and consideration of personal characteristics such as hand size, vision, and fiscal health, you can venture forth into the market place. I suggest that you handle each camera and take some snapshots with it on a memory card that you bring along. This will give you a feeling for the view finder, menus, and control layout that you won’t get from reading Amazon reviews. And keep your friendly shop keeper in business by buying local rather than ordering.
I kept putting off writing the year end newsletter. I couldn’t think of anything to write about. Once I got started, I couldn’t believe how long it had become. Anyway, 2016, that was the year that was.
Last summer, niece Alison Kiehl and Sarah married. This summer, they came to the beach to celebrate their union with Alison’s Virginia Beach friends and family. They rented a nice beach house, held a reenactment of their wedding ceremony, and held a reception for family and friends.
Sadly, three friends since high school days, Dar, Elmer, and Fred Kiehl passed away. Fred was a high school classmate overcome by advanced lung cancer. Fred’s parents, Dar and Elmer lived to 88 and 90 respectively. Both were good friends and gracious hosts for summer holiday when I lived up north and were the center of Kiehl extended family life, as much a result of their charm, wit, and patience with offspring as their oceanfront address in Virginia Beach.
We live in interesting times
My countrymen surprised me by electing Donald Trump president. I’m hoping for the best but fearing the worst.
Donald Trump, in his election eve speech, said some hopeful things but I fear his darker nature will keep them from happening.
In my old age, I’m a pragmatist desiring a competent government that works to create a future worth living rather than struggling to prevent futures we fear. In my life, I’ve watched our fear-motivated policies squander so many opportunities to make a better world for all to enjoy.
This year’s home projects were all small potatoes. A local contractor replaced the carport columns and front porch rails and my fencing contractor installed the bits I deferred until the carport was repaired. The perimeter fence and carport fence make a nice playground for my greyhounds.
As part of last year’s renovation, a landscaper sodded the side yard, installed paver walks for carport access and wheelie bin storage, and constructed a small bed with flowering shrubs and ground cover at the new porch. This year’s strange weather resulted in a wet fall and spring that caused significant fungus loss in the new sod and the jasmine developed root rot and croaked. I also lost one of the two spreading rosemary plants in that bed. Feeling brave, I planted Encore Azaleas to replace the jasmine that I lost. I’m watching them nervously. A dry October and November followed a hellishly wet August and September. Mild weather is keeping shrubs active longer than normal.
Oh no, Mr. Nick!
This was Nick’s year for minor injuries. First, he skinned up his forelegs belly flopping in the hurricane Matthew flooded street. Just recovered from the street encounter, he cut a pad hooning in the garden. Probably while trolling passers-by at the fence with Missy.
Life with 3 is interesting. Krash is a perfect gentlemen, about 5 years of age and a year off the track. Krash visited while his mum toured the Biltmore Estate for 2 days. So I had to figure out how to do routine with 3. Three dinners. Walks for 3. Play for 3. The dynamic was interesting. The youngsters played while Nick chaperoned. Every time Missy and Krash began to hoon, Nick would break things up. Finally, I kept Nick in and let the 2 young ones have a go. They played some serious chase tossing a prey stuffy back and forth. After 2 minutes they were spent and settled for the evening.
Krash liked his ration wet with canned food. So I fixed his wet and the resident’s rations dry. Mine turned their noses. up at their dry rations. Finally, I had to feed them all wet and share the canned food for three. I continued feeding my two wet food which completely fixed their fussy eating. A few ounces of warm water and the ration goes down immediately. No picking at it. And Nick cleans his plate. No more food thieving, Missy.
It was really funny watching him the first evening. Judy slipped out to join her trip mates without a visit so Krash was a bit unsettled. He looked for Judy for a while and paced for a while more. After 2 hours of this, he settled until bed time. Come bed time, he had no idea what to do. Who sleeps where? Where do I sleep? Nick took a bed in my bedroom. Missy took a bed in my study. Krash finally settled on the second bed in my room. All made it through the night without issue. Nobody stepped on. Nobody chomped. The second day, you’d think he’d always been here.
Each year stuff wears out and needs change so I keep tinkering with the household technology. This year, I changed the video stuff around to add a Roku set top box, nVidia Shield Android TV, and a Google Chromecast Audio gadget. I also figured out how to get Adobe Lightroom CC to earn its keep.
Clarkson, Hammond, and May move to Amazon Video after Jeremy slugged one of his assistant producers. Being a fan of the show, I had to change things up to see the new program. Apple and Amazon are competitors as music and book distributors so Amazon keeps its original programs away. No Amazon Video for Apple TV. But Amazon Video is on Android TV (Amazon Fire) and Roku. I bought a Roku box because all the distributors play with Roku. It works decently well but doesn’t have that nice Apple look and feel.
I’ve been wanting to move the music serving chores off my Mac Mini so I could log it out when not needed. It looks like I can actually do this. I added MacOS Server to MacOS. This program sets up and administers file sharing and other services present in MacOS. I was able to export my iTunes library and should be able to mount it on an nVidia Shield (coming). nVidia Shield includes a PLEX player and PLEX server as part of the standard software load out. I can also add Kobi to it making it a flexible media player. More on this when it happens in a week or so.
I also have a Google Chromecast Audio device. I use it as an alternative destination for PLEX which has chrome cast built in. Although Google doesn’t make a big deal of it and most reviewers fail to mention it, Chromecast Audio has a TOSlink optical interface built in to the 3.5 MM connector in addition to the normal stereo TRS socket. This lets me pass the pristine bit stream on to my Parasound Halo P5 preamp. It’s a bit fussier to get going than AirPlay but once going, you can’t tell the difference. And the Chromecast puck is all of $35.
Apple’s tinkering with Photos has pretty much abandoned the hobby photographer. Photos is fine if you take snapshot and want them automatically organized. It is lacking if you want to render them. So, about a year ago, I subscribed to Adobe Lightroom CC which includes Camera Raw and Photoshop CC. This summer, I downloaded Lightroom Mobile and figured out how to set it up. I now have it rigged to post photos from my iPhone and iPad to CC and from there to Lightroom CC. Apple convenient but with Adobe rendering muscle. The images appearing here are all original images
Institute for Learning in Retirement
‘m Communications and Technology committee chair for Institute for Learning in Retirement, a local seniors club. ILR is a life long learning institute affiliated with the Road Scholar network. Other Institute is a similar organization. Both promote senior’s life long learning by running local institutes and Road Scholar offers senior’s “adventure” travel overseas. Outdoor Adventure Travel offers similar programs. Both organizations aim for local culture immersion rather than a posh travel experience.
Back office automation
Last year, the board tasked CTC to find a replacement for our home brew registration system using MS Access and MS Excel. The system was single user and amateur developed (lacking input validation, etc). Our registration workload had grown too large for a single operator to process it in the time available. After a market search, we settled on ProClass, a software as service operation with 1500 clients that included many life long learning clubs like ILR. We’re part way through the transition with both systems operating in parallel. We expect to shift to the new system in 2017 and hope to offer on-line registration later that year.
ILR Website Rebuild
I’m also our webmaster. Our current website is an Open Academy Drupal 7 based site that replaced a legacy MS FrontPage site that was becoming seriously out of date. Our new site uses the Drupal 7 content management system that separates editorial content from presentation much like WordPress does for this blog. The site is relatively easy to maintain with a built-in menu system and document rendering that is responsive to screen size and shape. It automatically does layout for phones, tablets, and desktop displays.
Drupal 8 is replacing Drupal 7. Our Open Academy environment is last in a sequence of open source projects that must be revised for Drupal 8 which picked up many of the capabilities of the middleware packages in Open Academy as built in Drupal 8 capabilities including the page by page paned layout engine. But Drupal 8 does things differently. So it is not a matter of removing the redundant package. The client bits must be rewritten to use the new Drupal 8 native implementations of the capabilities added to the core. This is not happening quickly, and given that small consultancies wrote these modules for their own purposes, it may not happen if the shop’s business has taken a different direction.
For this reason and to expand our volunteer author and editor pools to a size greater than one (me), we’re moving the site to WordPress at our current host later this year. We need a custom hosting service (Pantheon) because the ILR site requires an added module or 2 for things we want to do. WordPress hosting restricts us to pre-packaged versions of WordPress and curated fixed plug-ins. To add an event manager, we need custom hosting. To restrict content by user roles, we need a custom host. So ILR will be staying with Pantheon.
I’m an ILR Presenter
This winter, I gave my first ILR presentation on electric power with an emphasis on the history of electric power, understanding of the utility business characteristics influencing utility decisions, and the challenges posed by renewable generation. It was a bit too much material for 2 hours but nobody threw produce.
And, ILR invited me back. This spring, I’m planning a new presentation on nuclear power. This presentation will focus on the early history of reactors, Alvin Weinberg, and the emerging molten salt reactors with emphasis on their safety and operational advantages over the expedient light water reactor technology in use today.
The trials and tribulations of the retired moocher lifestyle