Keep the memory alive.

On Monday, she called Jay and I over to her desk and said “check this out.” She proceeded to take low quality, blurry photo, and drastically improve the level of detail.

I am blogging “remotely” right now, so I can’t do screen shots and show you what I’m talking about, but I promise it will make sense. I will also try to get back here later to edit this post to include some “pics” so you can see what I’m talking about.

Ok -
So over in your layers area, duplicate your background layer (whatever layer the image is currently on).

Next, go up to ‘Filter’, then to ‘other’, then to ‘high pass’.

With the high pass filter enabled, move the ’slider’ from left to right until you see only the lines of the image showing through.
Click ‘ok’.

Finally, in your layers area, select the new layer, and in the filter options, set it to ‘overlay’.

If done correctly, you will see all of the edges in the photograph improve in detail.

Of course now that I’m sitting here reading through this, it all seems to be wrong. Everything you’ve just read might be totally incorrect - my apologies. I will check later though, and edit this as necessary.
Really, this is more of an exercise in writing for me, than it is an exercise in Photoshop for you.

Sorry Google Adsense, please accept my apologies, and my support for your candidacy in ‘08.

So… After much deliberation and heartache, my life has taken about 42 amazing and thrilling turns since we last saw each other.

I am no longer working at BrightStores - which some of you are probably saying “bright huh?”.

Ok… lemme backup.
About a year ago I left Chris Finger Pianos to try my hand at professional web development. I took a job with a small company called “BrightStores” under the pretense that I would be working from home. This was a great move at first, what with my busy dialysis schedule and all. After several months though the owner of the company began looking for office space, yearning for the cohesion that comes from everyone sitting around checking sports scores and instant messaging their friends in the same building. He decided ultimately to get office space in Evergreen after telling me several times “Don’t worry - I’m never going to require you to be in an office 5 days a week.” Of course after about a week in the new office he decided that he did in fact want me there full time. Furthermore, if I was unable to be there full time, I should consider going either contract, or part time (this of course made sense given the number of hours I would miss due to treatment). I actually moved my schedule all around to try and make it work for a couple of weeks, but in the end decided I should go contract. Keep in mind, I made this decision thinking that my job would stay much the same it was, but that I would now have the freedom to work from home again not being a full time employee.
Nope…
I think I racked up between 5 and 7 billable hours of work after going contract.
Anyway - needless to say, I had to think quick and find some other way to make ends meet.
We’re still in that phase I guess, but a few exciting things have happened. I will try to enumerate upon these things in the coming days.

1) Anna and I began (and completed) training to do home-hemodialysis, allowing us to now schedule dialysis around our lives, rather than the other way around. We absolutely love it, and I am much healthier for it - not to mention I get to spend more time at home with the wife, cat, and puppy.

2) My friends over at the iO Group were kind enough to take me on as a contract employee there, helping me to fill in some empty hours with web development work. This was truly a God send, and I’m hoping it will continue to blossom and grow as a source of work for me.

3) I have started my own business venture. I have been a piano technician for more than 12 years now, and very much enjoy some aspects of my work. I have for a long time been wondering how else I can, with my current skill set, find meaningful work - how can I make a difference? After much deliberation I have decided to begin teaching piano. First off, it puts me at the piano which is where I want to be, and second it allows me to become a better student myself. I’ve begun practicing again, and am starting to crank through some new music which is fun.
I’m also toying with the idea of doing some recording and seeing if anyone might like to listen to my “music”.

Anyway - time for me to go to bed after finishing up yet another daily dialysis treatment - but things are wonderful and I am content.

Soon going to tollidee.com will simply bring you here, and this will become the meat of the operation.
I’m done trying to inspire dialysis patients with my trials and tribulations - rather, I will begin writing whatever I feel like writing. Some of it (much of it I’m sure) will be dialysis related, but much of it will also be related to whatever flotsam is wedged into the conduits of my brain.
I hope to jettison much onto you willing participants.

… Until then …

I recently started a new job as a web designer, and find that I don’t spend a lot of time with the upkeep of this site now. My intentions are pure I assure you, but I’ve just not had time with the new job to come “over here” and take care of things.

My apologies, as I know this has been apparent in the forums, and on the blog - with the complete lack of any fresh content.

As always, after a long hiatus, I will return with several fast posts in a blitzkrieg of literary mediocrity.

Yes, I’m enjoying the new job immensely, and even get to work from home - which turns out to be a huge plus for the dialysis patient.

I don’t know this man’s story, but he showed up here just last week. I can guess that he has just started dialysis, due to his chest cath, and seemingly minimal amount of experience with the procedure.
This poor man has been uncomfortable every treatment he has been here - visibly uncomfortable. Every few minutes he expresses his displeasure with being here, and tries to stand up to leave. To be clear, he’s not grumpy, or angry - just discontent with being here. I’m not sure he completely understands what’s going on here, or why he has to sit still for 4 hours. He’s obviously suffering either from some degree of senility, or dementia, as he seems to forget sometimes that he is hooked to the machine.

He tries to laugh with the techs and the staff, and when I asked a tech to give him some popcorn last week, he looked at me dead in the eye and told me I was “right on” in my assumption that he might like some too.
He’s either being treated like a 2 year old (last week miss squeaky-voice tech was talking to him like a toddler), or being neglected all together.
No family - not one person has come in to visit this man who almost certainly has stories to end all stories.

My question though is: why?
Why is he here?
Why would you be put in a place like this to waste away what little time you have left here? I would understand if his family was trying to maximize their time with him - but he is transported to and from here by ambulance (no family) and receives no - absolutely no - visitors.
It’s disgusting.
He obviously doesn’t want to be here, and obviously isn’t being heard.
What can someone like me do though? I’m in the same situation - bound and chained to the chair.

He’s on the other side of the room now (and last treatment) but if he ends up over here again I’m going to try and strike up a conversation with him and see if there’s something to be learned on my end.

09.14.2006 The Amgen Rip-off (6 comments ) READ MORE: 2006, Washington Post, George W. Bush
Medicare spends more money on Amgen’s Epogen than any other drug in its medicine chest — $1.75 billion in 2005. Virtually all of it went to patients on dialysis. (The agency also pays for the same protein for cancer treatments, but those are sold under the brand names Aranesp by Amgen and Procrit by Johnson & Johnson.)

Given that level of spending, you’d think there would be pretty good evidence that this drug, which raises the red blood cell count, is delivering positive results for the unfortunates suffering from what the government and physicians euphamistically call “End Stage Renal Disease” (ESRD). The euphamism refers to the fact that the average life expectancy of a person who enters dialysis after their kidneys fail is about five years.
You’d think that but you’d be wrong. In fact, the evidence suggests just the opposite. Of course, treating the anemia associated with kidney failure was a godsend when Epogen first came on the market in 1987. It ended the need for blood transfusions, and allowed dialysis patients to have red blood cell counts (hematocrits) near normal.
However, the Food and Drug Administration’s initial approval for Epogen called for raising hematocrits to about 15 percent below normal. While most patients don’t notice the difference, Amgen, through a series of studies it funded, attempted to show that higher hematocrits were better for patients. Their measuring sticks? “More energy” and “greater alertness.” Through intense lobbying, they used those studies to browbeat Medicare into reimbursing dialysis clinics to raise hematocrits to slightly below normal. Not surprisingly, in the wake of that 1997 decision, Medicare spending on Epogen soared.
But what were the medical results of that policy? In a paper published in 2004 in the Journal of Clinical Epidemiology, Dennis Cotter of the Medical Technology and Practice Patterns Institute and his colleagues at Johns Hopkins and the Boston VA showed that attempts to reach normal hematocrits, which required LOTS more Epogen, did not correlate with increased longevity for people on dialysis. In fact, they showed that raising ESRD patients’ hematocrits to normal levels actually resulted in shorter lifespans because it increases the incidence of heart attacks, strokes and other cardiovascular events.
Gee. You mean thickening the blood in people who have severe microvascular distress from a lifetime of untreated hypertension and diabetes (which are the primary causes of kidney failure) causes heart attacks? To quote that famous line in Casablanca, I’m shocked.
Now, Cotter and colleagues are back in the latest issue of Health Affairs (subscription required), bringing us up to date on the Bush administration’s policy on Medicare spending for Epogen. In a move that NO ONE in the mainstream press covered (Hey, another half billion dollars in drug spending? Who cares?), CMS this past April gave dialysis clinics the okay to raise patients’ hematocrits to 39, which is normal for women and a shade under normal for men.
If Cotter’s earlier paper is correct, the end result of this policy will be shorter lifespans for many dialysis patients, but greater sales and higher profits for Amgen. To use the dry language of the Health Affairs study, “CMS has tacitly implemented a policy that does not appear to confer additional proven benefit to its beneficiaries.”
What would Cotter do about it? First, improve the evidence for drugs Medicare buys. Payment decisions should no longer be based on surrogate markers like the relationship between higher hematocrits and a subjective measure like “more energy.”
Second, the agency should require randomized clinical trials, systematic reviews and meta-analyses to prove that a drug it pays for results in better outcomes for patients. In addition, since the companies selling the drugs have a stake in the outcome, those trials, reviews and analyses should be conducted by physicians without conflicts of interest.
Finally, if CMS doesn’t have that kind of evidence generated in independent studies, it shouldn’t pay for any drug that has not been prescribed for an FDA-approved use and at an FDA-recommended dosage.
This past week, Bernadine Healey, the former head of the National Institutes of Health, launched a wrong-headed attack against evidence-based medicine in U.S. News and World Report. (For a good blog entry attacking her article, see Gavin Yamey’s latest posting on the PLoS Medicine website.) The Amgen-Epogen-dialysis saga is a perfect example of how ignoring the evidence is costing taxpayers a bundle.
Meanwhile, economic pundits like Robert Samuelson (see today’s Washington Post) rail against increased Medicare spending (even though its costs are rising at a much lower rate than overall health care spending, a fact I wish he had mentioned in today’s column).
But I agreed with his larger point, which is that uncontrolled health care spending (not just Medicare) will bankrupt the rest of the economy if left unchecked. But how should we rein it in? But cutting benefits and raising first-dollar coverage so people will simply stop going to the doctor for minor ailments and preventive care?
That would be a tragedy. What we need now are reporters in the mainstream media willing to go after companies like Amgen that rip off Medicare. Of course, we also need courageous editors willing to ignore the fact that the drug industry’s full page ads are a major prop in their shrinking bottom lines.
But that’s another story.

gleaned from the dialysis_support list (thanks Kim!)

What an eye opening article, and so objective! :)

Yeah, Epogen sure is a ripoff - nobody notices small increases in oxygen carrying capacity of red blood cells - that’s why so many cyclists utilize it to gain increases in their hemadocrits - because people can’t tell the difference.

Where this article fails (aside from its blatant bias) is in assuming that patient longevity is the sole purpose of dialysis. Just because Epogen isn’t prolonging life doesn’t mean it is a ripoff. In fact, I don’t think its use is for extending life, rather for improving quality of life, particularly for those dialysis patients still active in their lives.
For most of us, End Stage Renal Disease does not refer to our last stage of life, but our last stage of renal function. Most of do in fact notice a large increase in energy and alertness (I won’t use quotes the way the article does to suggest that these attributes are fictitious) with the use of EPO.
I think the real issue here, is not that Amgen is ripping off Medicare, but that Medicare is ripping off dialysis providers, and the providers are combating their losses by prescribing more epogen. Why not after all, Medicare is paying for more EPO, when it won’t pay more for dialysis treatments.

It takes less than two minutes.

Medicare is not just for seniors, it’s used by many people in different age groups and demographics - and for many it is their only access to life saving health care. Take me for example: I’m 29 years old, and un-insurable privately. That makes it really difficult to receive the life giving dialysis treatment I so desperately need.

Medicare pays for 80% of my dialysis treatment - that is - 80% of a number that is nowhere near what dialysis is worth.
Right now I think that number is somewhere around $130.00 per treatment.
The actual cost of treatment to the provider is several hundred dollars more.
That number isn’t made up - it’s based on actual costs to keep the provider running as a viable business.
Medicare though, has not changed its rate of compensation for something like 30 years, which is why the Kidney Care Quality Improvement Act is so important.
This act simply makes it possible for Medicare to pay dialysis providers more. Not more than they’re worth, but enough to actually keep up a decent standard of care.
You see, when the dialysis clinic has a bunch of patients with Medicare as their primary insurance, they lose money. In fact, they lose between $5 and $10 per patient per treatment. The obvious move for the business would be to disallow Medicare patients - but they can’t do that (thankfully). They do need fair compensation though. The result of this loss is the hiring of less staff members (we’re already well below what should be an appropriate staff/patient ratio). Also, the staff we do get are paid less, and as such are less likely to really be proud to be making the difference in lives that they are.
“Big deal” you say.
Well, every time I write about staff not changing gloves, or sticking a patient poorly, or doing some other inappropriate thing - someone’s life is honestly and truly on the line. Not changing gloves can EASILY lead to an infection. I don’t know if you know this, but the odds of leaving the hospital healthy after entering with an infection aren’t that great.
Bad sticking affects our accesses. These are quite literally our life lines, and even one bad stick can lead to clotting, and eventual loss of an access. I have been fortunate, but many who infiltrate end up with constant problems resulting in the loss of that access. We only have so many arms and legs, and after that it’s onto catheters - which have a very high infection rate.
See where I’m going with this?
What staff shrug off as a bad stick, or “just forgetting to change gloves” is really incompetence. It can only be addressed through better education, higher standards, and hiring people who understand the importance of their job.
The best way to do that right now, is to allow Medicare to pay dialysis providers what it should for treatment. This brings much needed care to many, like me, who fearfully go to the dialysis clinic, hoping that this treatment isn’t our unlucky treatment.

Please go and make your voice heard

For the most part I think Tom’s an OK guy. He tries to help people out, and I think in many cases does. He’s also right on in a lot of what he says - but sometimes I just don’t get him.

Take today for example. He’s asking people “what makes you crazy?”, and putting them on the air. One person complains about how people drive, and another about the legal system. Then some woman comes on because what makes her crazy is … now get this … that people were donating “too much” money to the victims of Hurricane Katrina, and not enough to some wildlife refuge in Colorado. That’s right, this woman was in tears over the fact that the general populous valued troubled and underprivileged humans, over troubled and underprivileged animals.
Now don’t get me wrong. I’m an advocate for animals. I love em, they’re cute, and they’re hilarious entertainment after a couple of vodka tonics. I don’t however see how any sane person can value the life of an animal in need over the life of a human in need.

In the movie Equilibrium there is a scene where the bad guys are ordered by their leader to kill a bunch of dogs that they’ve found (in this future place dogs and all other sources of emotion are outlawed). The movie makes a point not to show the “ratta-tat-tat” mow down of the helpless puppies, and rather shows the face of the main character while you hear the assault taking place in the background. It’s a very powerful display, and makes its point very well.
In numerous other parts of the movie however, our fearless main character mows down humans left and right not only with his high-tech pistols (and his high-tech way of wielding them), but also with the butts of his guns, and anything else he happens to get his hands on.
We as a movie going audience have no problem watching these “bad guys” get annihilated in the most violent ways. In fact we have a sense of justice seeing these puppy killers get taken out in such violent fashion.
No puppy violence though please - that’s too much.

So after this woman describes how this refuge is going under (which is really disheartening), Tom Martino goes off on this rant wherein he not only agrees with her, but puts forth that too much money was sent to Katrina victims - who were losers in the first place, and who are still losers now.
Tom and I would probably agree that many irresponsible people received very generous donations from people trying to do right by their fellow man.
We would disagree however, that because these people are irresponsible their potential value to society is now less than that of a large cat.

Perhaps Tom can divert some of the advertising money he gets pushing reverse mortgages on the elderly into this cherished refuge - or maybe we’ll just have some large albino tigers roaming the front range experiencing “survival of the fittest” first hand.