Middle Ages Medical Hacks

How about an update on my medical condition? This might be sort of cathartic for me. Note - I'm writing this while under the effects of extreme irritability. Kor referred to it as being "aggressive" months ago.

I agree now that confirmation bias was at the root of my insistence that I had a CSF leak, which was causing the symptoms that onset last November. In my own defense, when something very strange happens to you suddenly, and you think that modern science, particularly a neurologist, should have some answers.. and they look at you like you're patient zero of some new and exotic condition, that might cause an inquisitive, and rather desperate, person to try and figure it out themselves.

Because I had been pretty damn healthy for 45 years, I had always assumed that while physicians may not be able to treat every condition, they know what the conditions are. That's not true. It was my unfortunate luck that I was referred to a neurologist who seems to enjoy treating patients that he has a good understanding of the problem, but when it comes to something less obvious, has pretty much zero intellectual curiosity. I thought that every single neurologist in the US was trained to be inquisitive, curious, and excited when presented a case that didn't fit into the easy diagnostic buckets. I was wrong. From the beginning, it seemed like Dr.  X was not particularly interested in finding out what was wrong with me and treating it. His very first (and I mean this - it happened in the first visit with him) treatment suggestion was to simply address the symptoms with medication under the assumption that the condition would simply resolve itself. It didn't.

Yes, he did review the results of the tests my PCP ordered, which included blood work and an MRI/MRA of my brain. Those tests, apparently, did not point to anything obviously wrong. I never really mentioned on my blog what meds I was put on because there is a societal stigma associated with them. My big mistake is that I just took them under the assumption that they would be helpful. My PCP put me on Zoloft, which is an anti-depressant. She said she was prescribing it for "diagnostic reasons" - whatever that means. After she referred me to the neurologist, she was done with me. Any correspondence I sent to her was met with "ask Dr. X". I suppose she did not want to interfere with how he was treating me, without knowing that he wasn't actually treating me but rather just trying to make me feel better without solving the problem. I can't tell you how many times he told me that in the science of neurology, about half the time they have no idea what causes the condition. I'm serious... said "half the time". Not an exaggeration.

Dr. X put me on Nortriptaline, which is another anti-depressant which also has an analgesic (pain reliever) effect. The purpose of that med was to treat the constant headache I had. Again, instead of figuring out why I had the headache (and tinnitus) he just wrote a script to make it so I didn't feel the result of the medical problem I had. The third med I was put on was Valium. This is a benzodiazepine drug. It was prescribed to bring down the intensity of the ringing in my ears. Again - no real work was done to find out why my ears were ringing, but rather just try and make it less intense in the hope that it would just go away on its own. The Valium was at a low enough dosage (2m/g 3xday) that it did not cause the addiction that benzos are known for. They are as evil as heroin at high dosages.

I fucked up so badly that I can't believe myself. I'm usually neurotic in the extreme to know exactly what is going on with myself. I did not do the study required to become an expert on these drugs, which is very unlike myself. In my defense, I was just desperate to have the symptoms resolve. In the first couple of months after onset, I was pretty much a mess. John can attest to that. The doctors refer to it as "emotional liability", which is kind of a nice way of saying that I went mega emo. Again, there is social stigmas associated with that (which is the whole point of my blog being anonymous except to people who actually know me). Even though it's not a character flaw to lose your mind when you have a freight train running circles in your head 24/7, I still like to think I can handle every situation. That might not always be the case.

I had just assumed that a neurologist would be hyper inquisitive, and prefer having patients that are a challenge. When I work, I never give "I don't know" responses to problems given to me. I figure it out. I take that personally. Dr. X a seems only interesting in turning around the easy cases, and those that are difficult, he gives the impression he doesn't want to deal with it. He's not inquisitive enough to embrace the unknown and do the work that it takes to figure it out.

Early in my treatment, he was already talking about referring me to another neurologist - ya.. he wanted to pawn me off on somebody else so he didn't have to deal with the engineer who was not willing to accept "I don't know" as an answer. I had just assumed that those that are at the pinnacle in the medical professional weren't the Walmart types. I assumed every unknown would keep them up at night. He didn't even order any tests for me until 6 months after I had first seen him, and the way that happened was quite illuminating.

The visit I had with him in May, the growing frustration was more difficult for me to conceal, and I think he realized that my attitude was that he was a shitty physician.. one of those types that just want to run as many patients through his office as he could so he could bill as much as possible. The next day, he called me and said that he thought he wasn't giving me the best care he could - seriously, that's what he said - and asked me to get a spinal tap done. I did.

Apparently the results of the test did not make the diagnosis of my problem obvious, and so he asked me to do 30 days of steroids. I did. They helped quite a bit, but after the course of treatment was over, the tinnitus got worse again. I haven't been back to him since, even though I think I've actually figured out my problem this time. But hey.. I'm just a guy that is desperate to find a solution, and my track record for diagnosing myself is not that good.

Every single week since then (it's been 4 months or so), I keep telling myself I need to make an appointment to talk to him, and each time I dread going to see him because he's going to blow me off. I keep telling myself I need to see him one more time before I try to find somebody who is going to take my situation seriously. I'm willing to have every test imaginable done. I have the money to pay for whatever it takes. I'll go wherever I need to.. but part of my problem is that my natural procrastination seems to be amplified, even though I desperately want to find a solution to my problem.

Anyway, because the symptoms are less severe after the steroids, I decided I didn't want to be on the meds anymore. Yes, I know.. simply discontinuing meds without talking to the doctor is not a smart idea, but when talking to the doctor is an exercise in futility.. well.. I just did it. I stopped the Nortriptaline first. Because it's very similar to Zoloft, I didn't experience any issues with that. Then I stopped the Valium, and since that was a low dosage, I didn't have a problem with that either, other than the intensity of the tinnitus went up. I found my own solution to that problem, which I'll describe in a bit.

Finally, I cut the Zoloft dosage in half for a couple weeks, and then stopped it entirely. Stupid me did not go read about the implications of that... and there are rather severe implications. What happens when you start taking an anti-depressant is that your brain adapts itself to the chemical changes. You experience some temporary weirdness as your brain literally re-wires itself, but then it feels fine. Coming off them is an entirely different animal. Your brain needs to re-wire itself again. You can feel your brain doing it. Seriously.. most people have never had the sensation of actually feeling their brain, but when you come off an SSRI, you do.

I'm having the typical symptoms of "brain zaps". It's like having a mild electroconvulsive treatment while awake. It's a very short dizziness, with a electric zap in your brain that you feel, and for me actually makes a sound.. or the sensation of a sound anyway. It's highly unpleasant. It is the process of the brain rewiring itself in the absence of the SSRI. I feel shitty, to say the least... and I don't know how long this will last. I can't find anything definitive about the duration on the net, but I did find a mountain of information from other people experiencing the same thing.

One thing I'm pretty good at, though, is keeping my shit together while bad things are going on. I've not had a day off work during this whole shitstorm, and I haven't beat anyone to death. Realizing what is going on helps in working through why I don't feel like myself. I know it's just severe chemical changes going on in my brain, and hopefully it'll sort itself out soon. I want to get to the point where all I'm left with is the tinnitus and then work that out without re-wiring my brain.

What I don't want to do is start taking Zoloft again because I can't tough it out through the withdrawal. I don't have major depression. I shouldn't be treated for it when I don't. By the way.. I've had 3 brain zaps so far while writing this.

So, finally, what I think is the actual cause of my problem;  Adrenal insufficiency.

Logically, it makes sense. I had a very positive relief of symptoms while taking steroids. When I finished the steroids, the problems came back. The obvious answer is that it is just tissue inflammation that is causing the problem.

I have other areas of my body that are also affected by inflammation. I started using albuterol and advair (which is a steroid) for asthma about 10 years ago. I did some reading, and I don't think it's actually asthma that causes the lungs to tighten up. I sometimes cough up some mucus-like substance. From what I've read about that, the mucus is a response to inflammation in the lung tissue, and it clogs the breathing passages resulting in the sensation of being short of breath - or an asthmatic episode. So, then it's not at all surprising that while I was taking the steroids last May, my breathing was better than it had been in years. My lungs were clear as a bell and it was amazingly good. The steroids fixed the inflammation in my lungs, so there was no more production of the mucus.

There are a couple other soft tissue areas in my body that were irritable, but felt just fine when on the steroids. While reading about the steroid I was on, prednisone, I learned why the dosage is titrated, or reduced gradually. It's because when you are taking a steroid, the adrenal glands stop producing the body's natural steroid. The adrenal gland is supposed to keep the steroid in balance, and so when you're taking a drug to replace the natural steroid, the adrenal gland stops producing steroids. In order to get the adrenal gland to start producing them again, the dosage is reduced gradually.. and in my case, it seems like the adrenal gland is simply not producing enough steroids to repair the inflamed tissue.

If the adrenal gland is, in fact, producing the amount of steroid that it should, then it would follow that there is some other chemical process that is causing soft tissue inflammation. Either way, that seems to me to be a reasonable cause-effect. I either have an adrenal insufficiency problem, or there is something causing tissue inflammation.

What I did to verify this hypothesis was to start taking a non-steroidal anti-inflammation drug (NSAID). It's an over-the-counter med. I started taking it after I had stopped the Nortriptaline and Valium, and the results are that the tinnitus intensity is about the same as when I was taking the Valium. I don't have much in the way of headaches either.

The NSAID is helping control some of the inflammation, including in my lungs, but it's not strong enough to completely solve the problem. If I do have an adrenal insufficiency, this would likely mean that I'd have to take some sort of steroid for life. That would suck. Steroids make me feel like I've had 1000 cups of coffee.

When I started the treatment in May, I went for days either without sleeping at all, or only for a couple of hours. There may be a way to control that.. I'm not sure. So.. I've known about this for 2 months and have not made an appointment with Dr. X, because I dread explaining this to him, and I dread the "stop being a wikipedia doctor" attitude I'm going to get from him. I need to do something though. I have to make the appointment, and I think about it every day, and every day I don't do it. I want to fix this problem.. but I don't want my doctor to contribute to my problem by making me feel like a burden.

Gah.. two more brain zaps..

I've met my insurance deductible quite a while back this year, and so if I'm going to have any other testing done, I should do it ASAP so I don't incur the deductible again. I'll try my best to make an appointment on Monday, but I'm sure I'll be able to find a reason not to. If I do see him, I'll have to tell him I stopped the meds without talking to him first, which is not something a patient should do. Hopefully I don't get shamed for doing it. I had no business being on those meds in the first place.

Nice Hat

I still can't believe that millions of people treat these drag queens seriously.

Video of the Day

As far as an interest in politics go.. that had me rolling so hard the back of my neck hurt.

Govmint Work

I used to joke quite a bit about how cush my gig is with the fed.  Well, it is pretty sweet, but I still have to do some difficult work fairly regularly.  However, new contractor hires for the fed do have the best gig in the world, bar none.

Get this...

Our group needed another developer to keep up with the growing demands for output, mostly related to the conversion of the ICD-9 coding system (medical terms map to a number, etc.) to ICD-10.  It's such a big job that the Health and Human Services secretary recently pushed back implementation one full year.  It's not just a VA thing, but affects every aspect of medical record keeping and billing in the US.

So.. the company that won the contract to provide warm bodies to the VA needed to hire to fill the jobs.  One of the jobs that was needed was a developer.  Last January, I sat in on the interviews to provide subject matter expertise and we picked a guy.  He turned down the job, so we picked the other guy.  That's right.. there were only 2 guys applying for a 100k/year job.  I thought that was pretty crazy.. but really isn't the point of the story.

The second guy accepted the offer.. and it wasn't like he is less skilled than the guy that turned down the job, but rather his verbal skills weren't as strong.  One thing I've learned over the last 10 years is that you have to have exceptional verbal skills in order to break through the din of a distributed office environment.  The guy who got the job is shy.. older, and has a mouth full of marbles.  He does seem technically proficient  however, and that's all I really care about.  He'll be able to get things done when he's on the job.

This is where it gets ridiculous.

The guy who got the job quit his former job, and started with the new company as a contractor to the VA.  Everyone who comes on board has to get a security clearance with the federal government, and that means a background investigation and all that.  It is now 9 months later and he still hasn't got his security clearance.  That means he's had no access to do any work at all.  He's basically done nothing but read email for 9 months and get paid for it.

In retrospect, I'll bet he regrets quitting his former job.  He could have done both jobs and had a hell of a year.

There is a massive amount of government waste.  That doesn't mean that what the government does is not vital, it just means that the bureaucratic process eats a vast amount of resources without providing any tangible benefit.  The people who actually do work are a tiny subset in a system packed with people who do nothing but slow everything down.  Sure, there are necessary safeguards to ensure that no one person can make a mistake that has serious implications, but the balance point is whacked right now.

If the OPM needs more investigators to do the security clearance work, they should get them.  Instead, they pack the staff with people who don't actually do the work, but rather manage the process.  Government has truly become all about process, and much less about the work product.  That's where the waste in government is, but since the people that make the decisions are huge part of the waste, it's not going to change.

The guy that's been sitting around doing nothing for a year doesn't cost taxpayers 100k.  That's his take.  The Process must be fed, and its share is mammoth.  My health insurance plan costs $15,000 on its own.

I recently needed to deliver a release candidate for a major package of updates in a short amount of time.  The people that drive The Process had very urgent meetings about prioritizing the work and setting very rigid schedules that needed to be met.  This was done with the utmost seriousness.

I finished the release candidate and had it installed in the test environments of 3 hospitals about a month and a half ago.  The regulations require that the testing scripts be completed and signed off on by the hospitals, and then we request permission to install the RC in the 3 hospital's production environment.  It's been nearly 2 months since we requested the authorization for production install.  We cannot release the software without production installs in our 3 test sites for 2 weeks duration, therefore we cannot release the package that was so important to The Process that the highest Lords of the Govmint that they put me on the hook, or the chopping block, or the dead-and-we-mean-dead-line, and then turned around and are basically ignoring the paperwork needed to get it released.

Keep in mind, these people add no value to the software.  They are part of the Govmint machine that wastes vast amounts of money.

Government doesn't need to be "smaller".  It needs to be less dominated by personalities.  These personalities only know that they need to make money and don't have any real skills at all in creating something meaningful or usable.  They expand The Process as a means to keep themselves employed.

It is the concept of;

Deep Thoughts

If you're gay, don't use the phrase "man cave".

fini

Asshat Quote of the Day

I think he needs to reboot by embracing Bowles-Simpson in its entirety (but he's far too timid to do that and he fumbled the moment when he really could have done it) and challenging Romney on his big Pentagon spending. - Andrew Sullivan

Most Americans (probably 95%+) have no idea what Bowles-Simpson is, but Sullivan really really wants it to pass because that'll put old people in parks.  Sullivan really thinks that Obama backing something that nobody knows what the hell it is, is going to make a difference?  What a joke.

Most Americans think that reducing the deficit during a deep demand crises is sound economics.  That's simply another reason why Americans deserve to end up living in parks.

Sullivan is in full pearl clutching mode as the polls show Romney essentially tied in the campaign, with momentum on his side.  Romney has managed to do this by lying with impunity.  That's why Americans deserve him.  Ultimately, Romey is about 90% identical to Obama, so it doesn't much matter.

But what most everyone is missing is that Obama really doesn't want to win.  The only thing he controls is his own debate performance, and it was so bad there's no way his plan could have been otherwise.  In the next debate, Obama will make an effort to appear at least somewhat interested, but he'll lose again because that's what he wants.

The only reason I can see that Obama winning would be a good thing is that it would piss off the Loon Brigade.  That's really the only interest I have in politics anymore.  I like seeing the crazy people lose their fucking minds.  The rest of it is unimportant because it's all rigged.  All the national politicians are pretty much exactly the same.  There is only one who is actually different, and that's Dennis Kucinich. But then, he's been labeled "crazy" and thus doesn't matter.

R&R Hall of Shame

Shocking.. Rush has been nominated for this year's Rock and Roll Hall of Fame induction.  They will obviously be inducted.  The question is.. will they show up for the ceremony?  My guess is that they will, since they aren't the spiteful types.

That doesn't mean that the list of current members isn't a joke.

Bitch Slapped!

How is Obama's closing statement so fucking sad, confused and lame? He choked. He lost. He may even have lost the election tonight. - Andrew Sullivan

One can only hope (and not change).

I've been fairly accommodating to the theory that Obama really doesn't want to win the election. Tanking the debates is a good way to do that. It's not as if Romney's recent drop in the polls had anything to do with Obama, but rather the dumb things that Romney's said.

Why would he want to win the election? It's not like a 200k a year job is worth the pressure and schedule. Obama could lose, and go on to make a whole lot of money without appearing to age 5 years for every 1 in office. I wasn't kidding when I said I wanted Romney to win.. or rather for Obama to lose. Obama has been far to the right of George Bush on issues that I care about. Of course, Romney will likely be worse, but so what? You can't reward bad behavior just because you think the alternative is worse.

Americans always get what they deserve, and they deserve a magic underwear wearing lunatic. Obama was so bad in the debate, it had to be intentional.

Video of the Day

Quote of the Day

"Here's the recipe for getting your ass kicked, all right: 2 for 13 on third down. That's 15 percent. Four turnovers. A blocked punt when they rush one guy. And giving up 245 yards rushing. How's that for a recipe?" - Rex "hey baby, nice feet" Ryan

I watched that game.. it was ugly.  SF has a really good team.  I like to think they represent Teh Gay in the NFL.  I'm sure the Tebowits will be growing in volume.  I don't want to bash a player for his crazy, but when they drag their crazy out onto the playing field, I root for them to fail spectacularly.

NBC has a pretty cool online player for NFL games.  The new teevee season has kicked off, and we actually have 3 programs already recording in HD so I'm watching Giants/Shegals online.

How ironic is it that the Packers had a touchdown scored against them where the officials (the non-scab ones) missed the offensive pass interference?  I can tell you from my years of officiating high school football that you tend to focus like a laser on the main action (the catching of the pass) and miss the little things that look obvious to everyone else watching on teevee.  I once worked the back judge position in a varsity game where a pass was intercepted and on the run-back, the DB fumbled and the offensive team player picked up the ball and was running for a touchdown.. and I blew my whistle when the fumble happened.  It looked to me like the DB was tackled but I wasn't watching the ball close enough to notice it wasn't in his hands when he hit the ground.

Then.... you have to explain that to the white hat, and he has to go over and explain that to the head coach of the team that got robbed of a touchdown.  The good part about the back judge spot is that you are in the middle of the field and aren't on the side line near the coach where they will give you a hard time for screwing up that bad.  There is a big difference though.  In HS football in Arizona, a varsity crew is 5 officials, and in the NFL it's 7.  That's a big difference.  The back judge has a lot more to watch in a high school game than in the NFL... plus, back then, I was affected by the cataracts in my eyes.. so ya.. when they yelled the ref was blind, it was sort of true.

On a completely unrelated topic, I think I know why my ears are ringing.  I have to admit I was wrong about the CSF leak that I was fixated on for so many months.  When something is slowly driving you insane, you tend to grasp at straws when the doctor is clueless.  I'll write more about that later, but I need to make an appointment with the neurologist. The good news is that it might be treatable, but the bad news is that it's probably not curable.  John F. Kennedy had the same condition.

... the end of the Falcon's game was pretty lol.

Quote of the Day

Dear Emmett C. Burns Jr.,

I find it inconceivable that you are an elected official of Maryland's state government. Your vitriolic hatred and bigotry make me ashamed and disgusted to think that you are in any way responsible for shaping policy at any level. The views you espouse neglect to consider several fundamental key points, which I will outline in great detail (you may want to hire an intern to help you with the longer words):

1. As I suspect you have not read the Constitution, I would like to remind you that the very first, the VERY FIRST Amendment in this founding document deals with the freedom of speech, particularly the abridgment of said freedom. By using your position as an elected official (when referring to your constituents so as to implicitly threaten the Ravens organization) to state that the Ravens should "inhibit such expressions from your employees," more specifically Brendon Ayanbadejo, not only are you clearly violating the First Amendment, you also come across as a narcissistic fromunda stain. What on earth would possess you to be so mind-boggingly stupid? It baffles me that a man such as yourself, a man who relies on that same First Amendment to pursue your own religious studies without fear of persecution from the state, could somehow justify stifling another person's right to speech. To call that hypocritical would be to do a disservice to the word. Mindfucking obscenely hypocritical starts to approach it a little bit.

2. "Many of your fans are opposed to such a view and feel it has no place in a sport that is strictly for pride, entertainment, and excitement." Holy fucking shitballs. Did you seriously just say that, as someone who's "deeply involved in government task forces on the legacy of slavery in Maryland"? Have you not heard of Kenny Washington? Jackie Robinson? As recently as 1962 the NFL still had segregation, which was only done away with by brave athletes and coaches daring to speak their mind and do the right thing, and you're going to say that political views have "no place in a sport"? I can't even begin to fathom the cognitive dissonance that must be coursing through your rapidly addled mind right now; the mental gymnastics your brain has to tortuously contort itself through to make such a preposterous statement are surely worthy of an Olympic gold medal (the Russian judge gives you a 10 for "beautiful oppressionism").

3. This is more a personal quibble of mine, but why do you hate freedom? Why do you hate the fact that other people want a chance to live their lives and be happy, even though they may believe in something different than you, or act different than you? How does gay marriage, in any way shape or form, affect your life? If gay marriage becomes legal, are you worried that all of a sudden you'll start thinking about penis? "Oh shit. Gay marriage just passed. Gotta get me some of that hot dong action!" Will all of your friends suddenly turn gay and refuse to come to your Sunday Ticket grill-outs? (Unlikely, since gay people enjoy watching football too.)

I can assure you that gay people getting married will have zero effect on your life. They won't come into your house and steal your children. They won't magically turn you into a lustful cockmonster. They won't even overthrow the government in an orgy of hedonistic debauchery because all of a sudden they have the same legal rights as the other 90 percent of our population-rights like Social Security benefits, child care tax credits, Family and Medical Leave to take care of loved ones, and COBRA healthcare for spouses and children. You know what having these rights will make gays? Full-fledged American citizens just like everyone else, with the freedom to pursue happiness and all that entails. Do the civil-rights struggles of the past 200 years mean absolutely nothing to you?

In closing, I would like to say that I hope this letter, in some small way, causes you to reflect upon the magnitude of the colossal foot in mouth clusterfuck you so brazenly unleashed on a man whose only crime was speaking out for something he believed in. Best of luck in the next election; I'm fairly certain you might need it.

Sincerely, Chris "my new favorite NFL player" Kluwe

P.S. I've also been vocal as hell about the issue of gay marriage so you can take your "I know of no other NFL player who has done what Mr. Ayanbadejo is doing" and shove it in your close-minded, totally lacking in empathy piehole and choke on it. Asshole.

Blah

So ya.. nothing much to say, so obviously you are not entertained.

I did happen to catch Bubba's speech on youtube earlier today, and caught the end of Obama's speech earlier tonight. Clinton was quite good. I don't think it matters much if Obama was any good or not.

It looks like Obama is going to win the election, rather easily I would imagine. It doesn't much matter either way, other than it's funny to see the Loon Brigade frothing on and on.

My ears are still ringing. I keep meaning to make an appointment with the neurologist, and I keep not doing it. I'll bet I sleep about 12 hours a day now.

One Little Victory

Just a headline;

Meet Brig. Gen. Tammy Smith, the US’s first openly gay general

The comments to the yahoo news article are as you would expect. There are so many scumbags in this world, it's hard to fathom sometimes.

It does give me an appreciation for the straight people I consider friends.

Geeks Gone Wild

I watched the live feed from NASA. Yes, I'm a geek as well, and think that type of project is incredibly cool.

The way they landed the rover on the planet is remarkable. The future of NASA was riding on it working, and it did. I'm really happy for them. It's always good when ridiculously smart people make something amazing work.

Talk about having a good job..

Over Complicating

I've had another wide-ish gap in posting. I don't think I've had anything to say. I think I should change the name of my blog to "The Grumpy Old Man" because the only urge I get to blog now is when something annoys me.

So, today's annoyance is at work. We get new sets of codes used for medical billing once a quarter. The process involves 4 people. Person #1 gets the data from 3M and puts it out on an FTP. Person #2 (me) validates the integrity of the data, and then loads it into the database which exists only to do this process. Person #3 builds the patch, and Person #4 is SQA, which reviews everything and makes sure we didn't miss any of the details. Person #1 coordinates the testing of the patch at a few of our test sites, which are hospitals. Once that's done, the patch is released to all hospitals.

I got an email from a new manager that is involved with our group. I had sent her an over view of how this process is done. It contains 10 steps. She turned it into a "mind map" and wants an hour of my time to discuss it. A "mind map" is... oh fuck it, I'll just show you what she sent me.

First, this was my 10 step process list.


With all quarterly update we have the following process:

1. Validate the data that we receive from the SDO
2. Load the data into the Lexicon and coding systems files
3. Validate the Lexicon content and relationships
4. Internal test by STS analysts
5. Build patch
6. Load patch into second account (different to where patch was developed)
7. Internal tests by STS analysts in second account
8. Send patch to SQA
9. Once given the OK by SQA send the patch to the test sites
10. At the same time as the patch is sent to the test site send the quarterly update reports to Austin

This is the mind map. You can click it if you really want to see what it looks like, but it's not that important.



This is an example of what happens when you put somebody who recently got an MBA into the mix. They over think a straight forward process, the steps of which can easily be documented. You end up with diagrams of things which are useless.

Essentially, we assembly line the patch, and worker bees on the assembly line don't need bubbles to describe what we do. The least important person in the entire process is the one that gets paid the most.. that is.. the person that makes bubbles.

There has probably been 500 Dilbert comics done about this sort of thing.