Category Archives: death and dying

Murder on the Subway

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Honestly, I wasn’t going to write about this. I was going to write a post about the obvious fix that is needed to make the JFK Airtrain functional. But it’s insane now to write a post about first-world-problems — getting to and from the airport — while vigilantes are murdering homeless people on the trains.

So short and simple and with some links:

I challenge anyone reading eyewitness  reports of what happened on the train and looking at the photo of the chokehold to say that Neely wasn’t murdered. I’m not saying it was first degree murder, but the chokehold was wreckless, and any REASONABLE PERSON would know that. I say this as someone who is now often frightened on mass transit. The mass shooting in Brooklyn, and the more recent shooting of a single passenger — a man on his way to meet his brother for brunch —  are terrifying. Deaths caused by people pushed onto trains are terrifying. But you don’t react to fear by pouncing on an emotionally disturbed person with no gun, no knife, making no threat because he throws down a jacket, and then putting him a CHOKEHOLD which a reasonable person would know is deadly force. In photos it’s clear the marine was bigger than him and could have subdued him — not his job — without deadly force. Whatever his intent was, he was wreckless, and of course he should be charged.
Updating to add: Just found this, a statement by the alleged murderer’s lawyer: “Daniel never intended to harm Mr. Neely and could not have foreseen his untimely death,” the law firm of Raiser and Kenniff, P.C. said in a statement. “We hope that out of this awful tragedy will come a new commitment by our elected officials to address the mental health crisis on our streets and subways.”
Again, Man A puts man in a chokehold. Man B in chokehold passes out.  Man A continues to choke him.  A reasonable person would have foreseen the victim’s “untimely death.”  And yes, NYC prosecutors if you don’t overcharge, you will find a jury willing to convict on the evidence, and convicting a murderer is your job. Doing your job won’t cost you the election.
Updated to add:  Caught a NYTimes article contrasting the lives of the victim and his assailant. The mental health system (and other systems) failed Jordan Neely before his murder, but some of the failure wasn’t due to money or a need for “stronger” involuntary commitment laws. Some of the failure was simply the failure to track humans within the mental health and law enforcement system. There was a warrant for his arrest because he had left a program that he’d agreed to in court because of charges against him. He could have and should have been arrested and sent back to that program instead of simply being thrown out of the subway by cops — who didn’t check for warrants — weeks before.  Why didn’t the police check for warrants?
That failure will be exploited by his killer’s defense team  (if he’s ever charged) — as it should be because that is the defense team’s job. Ultimately, that failure didn’t cause Neely’s death,  but it is an example of one of many things that could have prevented the encounter from ever happening.
While I don’t think it is the job of NYPD to be psychiatrists or mental health workers, it is certainly their job when called in by mental health workers to CHECK FOR OUTSTANDING WARRANTS.

Earthbound Angels in Need of Decent Wages

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(On my my twitter feed this morning, Pankhearst, an uppity collective of independent women writers, twitted about something on the Bitch Magazine blog. How is it that I had never heard of Bitch Magazine before?  In what Nick Cave have I been living? I checked it out and saw a post about home health workers. This being Bitch, it referenced a 30 Rock episode.  As this is a topic, close to my I heart, I wound up posting an overlong comment. You really should check out Bitch, and Pankhearst while you’re at it, but I’m also re-posting a slightly edited version of my comment below:)

In 2005, after electing not to treat his final bout with cancer, my father was able to get “home hospice” services. Like most elderly in the US who have insurance, he had “managed care.” He was encouraged to have an home health aide (HHA)  in the house to help with daily tasks. He and my mother reluctantly agreed. This was all arranged through the hospice services, which are part of a bigger hospital-affiliated health service. Several HHAs were sent. Some my parents had issues with, including theft. One finally stuck.

Continue reading Earthbound Angels in Need of Decent Wages →

Romney/Ryan to the Elderly, “Drop Dead”

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“Although few of us want to admit it, once we (or our parents) become old and chronically ill, we (or they) will likely end up in a nursing home with care paid for by Medicaid.

— Tom Curry, NBC News national affairs writer

The above quote comes from Tom Curry, NBC News national affairs writer in a blog-post published 8/17/2012 on NBC Politics on Ryan’s plan for releasing Medicaid from federal protections and regulations and turning it over to the states, allowing them to set their own agendas for who qualifies because that’s worked so well for them with voter suppression.

Curry misses the mark on what most people fear or even what’s “likely” to happen to most people.  Dying in a nursing home on Medicaid is not the fate of most people. Many people in the middle-class have worked hard to keep that from being their fate.  My mother worked hard, not only raising her children, but also as a teacher (in the union) and had a decent pension as well as a combination of health insurance from her job and Medicare (managed care).   Her savings and the sale of her home helped pay the rent after my father died and she moved into an apartment in a senior living facility.  That facility wasn’t technically “assisted living” but offered her the services she needed to remain independent.  Facilities like that are private and for the most part fees are not covered by insurance, Medicare or Medicaid. Her managed care helped when she had a fall or other health crisis and needed hospitalization, physical rehabilitation and/or temporary nursing home care.  In a sense she was racing the clock, trying to remain as healthy as she could for as long as she could so that whatever happened would be covered by the managed care she had.  All the rules around what is covered and what isn’t in terms of nursing home care, home attendant services, etc are very complex.  In the current system, the issue is when people’s long-term needs exceed what is covered by managed care.  That’s when savings are needed and after they are depleted or transferred, Medicaid kicks in.

In my mother’s case, her savings paid her “rent” and her “rent” increased when she needed more services that weren’t covered by managed care such as having the facility hand her her meds instead of having her self-manage that.  At the end, she had a stroke and died in the hospital a few days later.  Had she lived, and needed full time, long-term care, I don’t know how much managed care would have covered, and because she still held most of her money, it would have been a while before she would have been eligible for Medicaid. If we imagine a scenario where Medicaid is out or unreliable altogether, then we are imagining a time when people die when they run out of money, period.  In my mother’s case, in addition to life-long thrift, she benefitted enormously from her pure luck in having bought and held onto a home whose value had increased greatly by the time she sold it at the peak of a housing boom.

If she hadn’t had the savings to afford her “rent,” then I’m not sure how we would have coped. She was frail for the last few years of her life, and once my father — who had been the stronger one — passed away, she could not have lived on her own. She would have required family care that would have kept at least one of her adult children or other relatives from working full time for a number of years, as not only would shopping, cooking, cleaning and ferrying her to doctors have been required, but also keeping an eye out to make sure she was safe.  While she would not have needed to be in a nursing home, she would have needed to live somewhere with modifications such as stair-lifts and other safety modifications.

Most people’s fate is not the nuclear meltdown of depleting all their resources, needing Medicaid and dying in a nursing home. People may fear that because under the current system it’s certainly a possibility, but it’s not the most likely one.  Most people fear the erosion of protections for the middle class that would keep all that from happening.  This includes the destruction of unions that help negotiate for decent health care plans, the destruction of things like home mortgage deductions that help make home ownership (the biggest and best investment for most of us) possible, the erosion of Medicare, and the overhaul of the Affordable Care Act which will help us keep the insurance we have and keep the insurance companies from throwing us off plans.  In short, most people (at least in the middle class) fear or have reason to fear, the entire Republican agenda.

This is not to say the current system is perfect. Most people, even in the middle class, are already losing what they had a few years ago.  Benefits, like the ones my mother had, have already been slashed, and the nuclear scenario is still real when long-term care is needed and managed care benefits have been exceeded.  What’s needed isn’t simply keeping Medicaid available, what’s needed is more healthcare reform that will help us with preventative care so more of us will stay healthier longer. What’s needed is more reform, including cost-control, so if long-term care is needed people don’t need to become virtual wards of the state to pay for it.

A Matter of Life and Death

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Email to a friend:

Hi Susan,

Are you in Colorado?  Happy New Year.  Hope the snow is fresh and the crowds are reasonable.   Just wanted to update you on my whacky life.  So last Friday (a week ago), Maizie had a seizure, which I wrote you about. Then the second one the following day which was 12/24, again complete with eye-rolling, collapsing, peeing, and getting up a couple of minutes later and looking around like, “Huh? What? Where’d this puddle come from and why is my backside wet?  Shit. I hope Mommy doesn’t yell at me for this.”

Craig was ready to put her down that day, and if Dr. Dan (the new vet that my nephew works for) had been in, we would have.  But he wasn’t, and we made the appointment for Thursday, as that was the first early morning one we could get, and Craig wanted to go to work afterwards (and not go home and brood).  But Sunday morning, when he took her out, she was all “jaunty” and continuing to want to kill her frenemies, and to want affection, and to get all excited around meal time, and signal to go out to troll, etc.  By Monday, Craig was having doubts.

I just couldn’t take it.  At that point, I still wanted to kill my dog.  I was thinking of my Dad, after his cancer returned and he kept talking about how he just wished a piano would fall on his head.  I was thinking about Craig’s cat, Big Red, and how he waited too long, didn’t even notice how much weight he was losing because he saw him everyday, and finally Craig was supposed to travel for work and I was going to take care of Big Red, but when I went over a few days before Craig left,  I realized he was dying and  we had to put him down sooner.   I was thinking about Maizie’s inevitable decline, and the stoicism of dogs, and how we should just get off this emotional roller coaster, and how it would be me, working from home, more likely to see the next seizure, more likely to be the one taking her in when she finally couldn’t get back up on her hind legs, carrying her to the car.

Craig thought it was my being obsessive, and it was Italy, our planned anniversary trip, coming up in two weeks — the first time we’d be in Europe together, and to a country neither of us had visited.    Maybe something to that, because we both agreed that if we didn’t put her down, leaving her in a kennel for 10 days, even a nice one, was probably not a good idea.

On Tuesday, we went out to dinner with the cousins.  They aren’t fans of the Maize, having a bad impression based on an unfortunate dinner incident.  But Daniel (the smartest man in any room) brought up the seizure thing. Did Craig really want to wait for the third seizure?  The answer was no, but….

The next day, Craig  checked with the airline.  No refund, of course, but $200 to change the dates.  My sister happened to call and I updated her.  I reminded her of my father’s piano line.  She didn’t think it was that simple.  She pointed out how much he’d held on at the end.

“Nobody wants to die,” she said.

She reminded me that even my mother, who was unconscious those last few days, seemed on some level, not willing to let go, although she had said earlier, after her stroke but before she faded away when the subject of a feeding tube was broached, “If I can’t eat ice-cream, what’s the point?”

But Maizie, based on what I was telling her, hadn’t reached that point yet.  And I realized she was right.

Craig cancelled the appointment.  We were still figuring out Italy. We rationalized that before the seizures we’d been planned to board her, and what had really changed?  Yes, she might take a turn while we were away, and we’d feel terrible, but more likely it would be a slow decline, another seizure maybe, maybe two, but not a crisis.

We wouldn’t leave her at the place we usually left her.  They’d screwed up last time, not monitoring her closely or contacting us when she seemed to be reacting badly to the meds she was then on for her Cushing’s.  There was another place we’d taken her a couple of times, swankier, more expensive, less convenient to get to.  We thought we’d try there, but also see if my nephew would consider dog sitting.  He couldn’t.  His workshifts are too long and she’d be alone too much.  My sister had mentioned a son of a friend’s, a musician in need of a day job, raised in an animal loving household as a possibility, but Craig thought given Maizie’s special “behavioral” issues, a stranger who wasn’t a professional might not be a good idea. We called the swanky place.  Before I’d had a chance to explain much, they reacted to the words, “Geriatric” and “frail” and told me straight out that a dog in that condition should never be boarded.

That hit us like a gut-punch.  Not only were we terrible human beings for considering killing our dog, we were terrible human beings for wanting to go away.

We wondered what would happen if there were an emergency and we’d both have to travel.  Or what if Craig got one of those good business gigs to Africa and I could join him after?  The answer to the first case, was we’d leave her at the vets, for as short  a time as possible.  In the second case, I’d stay home

Today, Craig reported Maizie seemed a little out of it on their walk.  She’s sleeping now.  She sleeps mostly.  Italy is probably off the table for a while, unless she takes a turn for the worst in the next few days.  We might ask the musician if he’s interested in the gig, not for Italy, but generally, if she lives a while, and come spring we want to use those tickets.

This is it.  There aren’t a lot of choices.  Putting down an animal is never easy.  But it probably helps if it’s already too late, if their suffering is obvious. In some dispassionate way, I don’t think it would be a big deal to deprive her of continuing a journey that is almost at its end, and may involve a steep uphill slog.  That’s in the abstract.  In reality, I couldn’t see getting her into the car, which often signals trouble but sometimes signals fun, driving her to Dr. Dan’s, where she’ll greet my nephew like a friend and then look at it me like I’ve betrayed her when she remembers it’s a doctor’s office. I couldn’t imagine my husband, lifting a now shaking dog onto the table as Dr. Dan gets the needle ready, and feeling for the rest of our lives that we deprived her of something, even though I’m not exactly sure what.

UPDATE:  1/12/12: We canceled Italy. The good news is I may go to see a show on Saturday, have tickets to see Al Green, Lin-Manual Miranda and POTUS at the Apollo on 1/19, and the better half and I will be taking some time off to celebrate doing New Yorky things.  Maizie seems to be doing better.  We went to the vet just to check in and because she was licking herself a lot.  He said it was a probably just an irritation from lying all day on a hard spot.  He said she looked great for a dog her age, even for one who doesn’t have cushings.  No seizures since the ones that almost caused her executions. We decided not to put our lives on hold and called up a bunch of kennels.  We found that some wanted to put her in a “special care” doggy nursing home where she would be tended to way more than she would ever want.   We now have two potential reasonably priced places that we think will work and will check both of them out.  Maizie will definitely do a test run of two days to make sure she can tolerate the boarding.

Maizie is Still Not Dead

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(Originally posted: 10/30/2011 — See update at end)

Just wanted to follow up on the October 1 post, Whose Dog Life Is It Anyway, as I’m still getting occasional responses.

I’m writing the follow-up because dogs like humans are now living longer, but as with humans, extended life is not necessarily quality time, and may involve living with chronic debilitating conditions that require extensive and expensive treatment.  More owners of geriatric pets are faced with a dilemma.  Is it better to treat or to let nature take its course, and at what point is euthanasia the best option? So I’m going to review Maizie’s treatment, its outcome, and lessons learned, in case this is useful for other people with geriatric dogs diagnosed with Cushing’s, who come across this in their web travels.

Maize, a Jack Russell mix, is (probably) 15 years old.  While she had abnormal liver enzymes indicative of Cushing’s disease, she was asymptomatic until July when she began to drink excessive amounts of water and urinate all over the house.  She also could no longer hold her urine while sleeping or lying down and would wake up wet.

Testing revealed it was indeed Cushings. The two most effective treatments are either Lysoderm or Vetoryl.  Lysoderm is the older treatment.  The medication itself is less expensive than Vetoryl, but dosing can be tricky.  Both drugs require frequent and very expensive monitoring in the form of invasive tests. The little research I did, led me to think Vetoryl would be a better choice.  The vet started Maizie on 60 mg a day, based on the Dercha’s (the manufacturer’s) recommendation for her weight.  Had I been paying more attention to the very helpful Canine Cushing’s forum,, I would have insisted they start her on less.  As one of the more experienced consumers later told me, despite Dercha’s recommendations, there’s “no rhyme or reason” to how dogs react to Vetoryl.  A big dog may do well on 10 mg a day, while a Chihuahua might need 30.  Within ten days the polydypsia and polyuria had abated.  Her first ACTH test showed that her cortisol level had come down.  A more experienced vet, might have noticed it came down too much and too quickly.  She didn’t and neither did we. The vet, at our insistence also started her on something for the incontinence that was still ongoing when she was sleeping. The medicine was called Pro-in.  This was another one I wish I’d researched more on the net.  Pro-in is the same formula as the old formula for Dexatrim, an OTC diet-pill for humans.  The formula was banned for causing strokes in humans.  Anecdotally, at least, the same problem is seen in dogs.  Maizie seemed to lose her appetite almost immediately upon starting it.  We lowered the dose and then stopped it within a couple of days.  In retrospect, the reaction may have been a coincidence, though who knows?  In any case, she was going downhill.  Her cortisol had crashed, and she was in an Addisonian crisis.  After prednisone, IV fluids, and an overnight at the vets, she came home, tapered off the pred and was once again symptomatic for Cushing’s.  More tests and she was restarted at 30 mg a day of Vetoryl and DES for the incontinence. (Yes, that DES). She crashed again. The second time was so bad that we couldn’t get her to take the prednisone and she had entirely stopped eating.  A two-day stay at the vets with more fluids, and more prednisone got her eating again.  The bill was astronomical.

She came home.  Again we had to taper her off the pred.  The vet wanted us to bring her back for an expensive test to see if she was permanently Addisonian.  We declined.  Clearly she wasn’t.  Her thirst, appetite and peeing were back.  She still had the Cushings.  Rather than start her on an even lower dose of Vetoryl, we made another decision.  I bought Wee-Wee Pads.  As we couldn’t live with the polyuria and were heading toward euthanasia,  this was a kind of a “hail-Mary pass.”  To our astonishment, she figured out what we wanted her to do with them within two days.  All it took was putting the pads over the areas where she was most likely to urinate, praising her when she went on the pads, and scolding her when she didn’t.  Suddenly, we weren’t slipping in urine puddles.  We weren’t upset.  She wasn’t nervous.  She still signals when she has to move her bowels or just wants the opportunity to troll the buffet that is Amsterdam Avenue.   We still walk her several times a day.

I wouldn’t have thought we could live with the pads, but here’s the thing — her urine is so dilute it doesn’t smell and the pads really do absorb ten times their weight in fluids. It’s easier than dealing with cat litter.

At this point the only medication she’s on is the DES, which is still working the way it’s supposed to and keeping her from wetting herself in her sleep. What she can’t do is hold out very long when she’s awake.

We are also giving her melatonin as a supplement, which may or may not be doing anything, but is touted by some as a natural alternative, and may slow down tumor growth.  We’ve also started her on wet food only.  This also may or may not make a difference, but she’s old and she likes it.

The take away for us is:  If we had known that the Vetoryl would bring her so close to death, and how expensive treatment would wind up being — not only because of the required ACTH tests, but because of the iatrogenic Addison’s, then we would not have started to treat her.  While Cushing’s is progressive, treatment probably does not extend life in geriatric dogs, and the high cortisol levels actually help alleviate symptoms of other age-related conditions like arthritis.  If we’d known how easy it would be to train her to use the pads, that’s what we probably would have done in the first place.

Because every case is different, I’m hesitant to give advice, but if your geriatric dog is diagnosed with Cushing’s, here’s what I would recommend:

1. Read the forum. The people there are consumers not vets, but some of them may be more knowledgeable  than your vet regarding treatments and side effects.  While I had looked at the forum, I didn’t realize how helpful it could be.  The people there will ask you to give them your lab results.  Give them the information and take their advice.  Ask them questions before making decisions.

2. Both Lysoderm and Vetoryl have some pretty severe side effects, including permanent Addison’s.  You might be better off finding out which medication the vet has more experience with and going with that. Also if your vet does not have extensive experience with Cushings, find one who does.

3. If the vet is using Vetoryl, insist they start at a much lower dose than Dercha recommends. They started Maizie at 60 mg.  If she’d weighed a couple of pounds less, it would have been half that.  I wish they had started her at 10mg.   Treatment protocols call for testing after 10 days, so if the low dose doesn’t work they can gradually raise it.  That does mean you’ll be living with the symptoms longer, but the cost to you and your dog will be less.

4.  Consider NOT treating.  Most people begin treatment only when the polyuria becomes a problem.  Treated or not, most dogs with Cushing’s are dead within two years.  The Cushings may be masking other problem like arthritis, especially in geriatric dogs, and per the earlier information the medications can be pretty nasty.  If your dog is NOT symptomatic and Cushings is only suspected because of tests, consider starting some safe alternative treatments like melotonin and/or flax seed oil.  Melotonin may slow the growth of the tumors that causes the cortisol to rise, delaying your dog’s becoming symptomatic. If your dog is symptomatic, consider whether or not these are symptoms that you and/or the dog can live with. In Maizie’s case the main symptoms are excessive urination and excessive drinking. The drinking isn’t all that excessive. That is, she doesn’t seem to be dying of thirst, just drinking about two or three times as much as she used to.  The urination was making us all nuts until she learned to use the pads. We are all happy now.

5.  If you aren’t blessed with a house in the country that features a doggie door, buy Wee-Wee pads.  Even without Cushings, as your dog ages, she or he may need more walks than you can reasonably supply.  They are far superior to paper, and as stated earlier, training and clean up are simple.

——-

Update: 7/15/13 — Maizie crossed the rainbow bridge on Saturday, July 14, 2013. Euthanasia was a tough decision as there was no one “This is it” moment. She’d been having gastrointestinal issues for a while and losing weight. It finally reached the point where medication wasn’t helping to stimulate her appetite, and her sense of smell and taste were diminished to where she would reject anything that wasn’t loaded with sodium. Basically, her last week, she was eating only Chinese take-out duck, and chicken-shack rotisserie chicken, and even those reluctantly, with coaxing, and not enough. (Yes, we tried healthier alternatives including homemade foods.) At the same time, she seemed hungry, and we knew that must have been torturous.

She died of age-related conditions, that weren’t related to Cushings. Again, this is only our story, but I would urge anyone whose dog has been diagnosed to learn everything you can, find a vet you can trust (We changed vets after we decided to take her off Vetoryl) and consider both the age and temperament of your dog. In Maizie’s case, the stress level of frequent vet trips for the testing the medications require would have killed her even if the drugs themselves didn’t. We hope we gave her the best possible quality of life in the two years since her diagnosis, and are sure we made the right choice in taking her off the anti-Cushings meds.