Recommended Inoculations

On a visit to the allergist last month she asked whether I had a flu shot yet.
No, I'm having a physical in January and I'll get one then.
That's great, she said. Meanwhile, you might want to ask him about these others. She brandished a report by the CDC:

Vaccines Recommended for Older Adults

Influenza vaccine, which protects against seasonal flu (for all adults every year)

Td vaccine, which protects against tetanus (for all adults every 10 years)

Tdap vaccine, which protects against tetanus, diphtheria, and pertussis (also known as whooping cough) (for all adults once instead of Td vaccine)

Pneumococcal vaccine, which protects against pneumococcal diseases that cause infections in the lungs, blood, brain and ear (for all adults over 65 years old, and for adults younger than 65 years who have certain chronic health conditions like heart disease, diabetes, lung disease, or who smoke)

Zoster vaccine, which protects against shingles (for adults 60 years or older)

There may be other vaccines to consider because your health, job, or lifestyle may put you at higher risk for certain diseases. For example, people with diabetes are recommended to also get the Hepatitis B vaccine.

I wish that I had been made aware of these recommendations in 2012, before I came down with the shingles that put me out of commission for over a month.

Any one of the other maladies will put a crimp in achieving ambitions for 2014. Recommended inoculations: another item on the to-do list for January. © 2014 Stephen Yuen

Not Going With the Flow

The technician tapped my left arm, searching for a vein. She inserted the needle. It was a dry hole. Her second attempt on the right wrist was successful, and the sample vials were filled in short order. The visit was more pleasant than average, however, with three or four tries being the norm.

Lab technicians have explained the multiple pricks and prods (and bandages) as being due to my veins being narrow and difficult to locate. I'm a wuss for admitting it, but the unpleasantness of the experience has caused me recently to forego donating blood (5-10 years ago the technicians seemed more skilled).

It's unfortunate that the blood banks aren't integrated with the labs, because I'd be perfectly willing to donate a pint once they take the relatively small amount needed for testing. After I've made the trip to the laboratory, filled out the paperwork, and incurred the discomfort of getting the flow going, the marginal cost of extracting a pint is minimal. There's probably a bureaucratic reason why blood donation and testing can't be done at the same time, but it escapes me.

New Year's "W"-esolutions

Every year we try and only partially succeed, if not fail. This time we really mean it! (right?)

This 17-year-old didn't need
to lose any weight.

Weight loss: This is the number one New Year's resolution for Americans. I resolve to lose 1½ pounds per month---an 18-pound weight loss should get the doc off my back. Exercise and diet will be the means of achieving this goal.

Wealth: I resolve to pay more attention to investments. Buy-it-and-forget-it is not an option, and neither is too much concentration in one stock or one sector.

Work: This one seems to be related to wealth, but it's really not. Whether doing something for pay or for love, I resolve to accept tasks sparingly and finish the ones that I do undertake.

Wisdom: I resolve to take 80 hours of continuing education and restore my CPA license to active status. Also, I will read at least one non-business book each month. Excluding work and education, I will limit online time to two hours daily.

The above may not seem overly ambitious, dear reader, but rest assured, they are. © 2014 Stephen Yuen

Life Lessons

Two diagrammatic answers to the question, "What has life taught you?", from Quora.

The Venn diagram displays how difficult it is to hit the sweet spot of careers. Very few individuals are able to make a lot of money while both doing what they love and what they're good at. Top-tier athletes and entertainers are on the list, as well as billionaire entrepreneurs. Most of us, if we're lucky, become good at something that pays well. Love? that's for retirement and/or second careers.

The Project Triangle is a favorite way of picturing the difficulty of achieving three conflicting goals. Achieving two is difficult, and accomplishing all three is nearly impossible. Students usually strive for good grades and social life, with sleep coming in last. However, that would be a mistake, as sleep is more important to performance than most people think. Well, maybe in our lifetime, science will come up with a pill, not to help insomniacs sleep but to safely get by without it. © 2013 Stephen Yuen

Medical Bypass

A family member was referred to a San Mateo ear-nose-throat doctor and was treated promptly and effectively. What was unusual about this story is that the doctor didn't accept insurance or even credit cards. Payment is via cash or check only.

By avoiding the elaborate medical payments bureaucracy Dr. Kelly charges a fraction of what other doctors bill (a good portion of which the insurance companies disallow anyway). He's literally old school, that is, he's eligible for full retirement under Social Security and his nurse-administrator uses a typewriter.

Opponents of the Patient Protection and Affordable Care Act should not fall into the trap of defending the pre-2009 system that has multiple middlemen coming between the doctor and patient. Obamacare may or may not be repealed, but we will not go back to the old system either.

Dr. Kelly's clean, simple, and very old-fashioned method of handling payments won't work in most cases today, but what about tomorrow? Changes in everything, not just health care, are happening more often and more quickly. The one surprise is that people are still surprised when the unexpected happens.

BTW, Dr. Kelly's Yelp rating is five stars. © 2013 Stephen Yuen

Losing the Narrative

Over the last half century the non-STEM academy has embraced postmodernism, which has as one of its premises the lack of an objective "truth", that is, everyone has his or her own equally valid experiences, truths, and stories to tell. This philosophy, plus our embedded preference to listen to stories over other styles of communicating, is one reason why we are inundated with people telling their tales throughout the day. Narratives are fine for entertainment, but they're often a lousy way to set public policy. Nevertheless, that's the world we live in and the way decisions get made.

Over the past 20 years the debate over health care has raged, primarily driven by (true) stories about the rapacious behavior of insurance companies, and to a lesser extent drug companies and heartless hospitals. In 2009 the Democratic Party, which controlled the legislative and executive branches of government, birthed the Patient Protection and Affordable Care Act, aka "Obamacare," under which the Federal Government took control of the health care sector of the economy. No, the government does not technically "own" the health care sector, but through a combination of massive regulation, spending, and taxation the government controls it.

Now the horror stories are going the other way. They are so compelling that the Administration and its Obamacare supporters are finding it impossible to control the narrative. One example: stage-4 cancer patient Edie Sundby's story of insurance cancellation because of Obamacare regulations:

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market.

The narrative is lost, and in the postmodern world probably the battle is, too. © 2013 Stephen Yuen

"Politically where are we right now, at this moment?"

Peggy Noonan, WSJ editorial page:

It’s as if it’s 1964 and the administration has just passed landmark civil rights legislation and the bill goes into effect, and....It doesn’t help minority groups – it makes their lives harder and less free! And it does real, present and intimate damage to the majority.

It’s as if it’s 1937 and they launched Social Security, only rich coupon-clippers on Park Avenue immediately started getting small monthly checks, and 67-year-old dust bowlers in tarpaper shacks started getting monthly bills.

In other words, "ObamaCare is a practical, policy and political disaster, a parlay of poisonous P’s."

We can also play the "P" game. Critics of ObamaCare opposed it on the grounds of

principle: government takeover of a major sector of the economy,

privacy: as in loss of, especially since the IRS would administer it,

practicality: the government is not able to run something this big without turning it into the post office or DMV,

price: cost estimates were low-balled by hundreds of $billions.

All the criticisms made sense, but the one that resonated the strongest was the practical: I just didn't see how they were going to make it work. From July, 2009:

the current [healthcare] system is deeply flawed, yet, based on the government's recent performance in the comparatively simpler task of reviving the economy, have no confidence that the cure will be better than the disease.

© 2013 Stephen Yuen

It's Free at Last

Four years after the last one (the gastroenterologist recommended a three-year interval),  I scheduled a colonoscopy for December. Since we're staying with our current insurance carrier, there's little point in waiting until next year in the hopes of getting a better deal.

Obamacare does promise to save some money on colonoscopies, versus private plans:

In 2014, insurance providers will be forced to (1) cover a screening colonoscopy at 100% and (2) classify the colonoscopy as screening even if polyps are found.

As the article points out, however, many aspects of colonoscopy reimbursements are unclear, like the liquids I'm not supposed to drink 24 hours before. This year I know what I'll be paying, and I know what services I'm getting, so I may as well get it over with.

Preparation for the procedure involves drinking a prescription medicine that "cleans your colon by causing you to have diarrhea" (the drug company didn't run the instructions past marketing, obviously). Hey, another untouted benefit of Obamacare: the diarrhea is free. © 2013 Stephen Yuen

There's Always Next Year

Blue Shield Silver is the closest to what we have now,
and the net cost through Covered California will be half
of what we will pay next year.

The open enrollment period on my retiree health plan expires today, October 25th, when I have to decide whether to re-up for 2014 or take my chances on the California Obamacare exchange, Covered California. If we do choose Obamacare, however, we can't go back to our old retiree plan...ever.

On the one hand I can pay over $1,000 per month--my share of the cost, with my former employer kicking in a smaller amount--or pay a lot less through Covered California, provided I am willing to do or believe the following:

1) Manage our household income to be below four times the poverty rate (in our case that means capping it at slightly less than $79,000). This will enable us to a) limit the premiums to 9.5% (or less) of our income and b) receive a tax subsidy.

2) The extensive personal data that we will be entering into Covered California is secure.

3) The benefits and costs from the insurance company that we select are as described on the website.

The decision isn't close. We will stay on the insurance plan that we know, though we will pay thousands of dollars more. It's a matter of risk, but most of all it's a matter of trust---the fact that we trust health insurance companies more than the government to deliver on promises is a terrible indictment of our current system.

And there's always next year to change our mind. I'll be happy to be proven wrong. © 2013 Stephen Yuen

The Endless Loop

Two weeks should have been enough time to correct startup glitches, so I decided to check out the Covered California website, reputedly one of the most reliable of the Obamacare exchanges.

Coveredca.com: an attractive home page...on to "getting covered"

Getting covered: let's try the "Shop and Compare Tool" links.

Oh-oh, we're back here again.

You are in a maze of twisty little passages, all alike.

Kidding aside, some links do work and it is possible to get to the Shop and Compare Tool.

Whew! and to think that almost three years ago I was a worry-wart.

A Crisis That Isn't

Sooner or later one of these governance "crises" will have dire consequences, but your humble observer doubts that the impending October 1st shutdown of the Federal government will have different results from the sequester, the 2012 debt limit kerfuffle, or the 2012 U.S. Treasury downgrade. Some people, such as government employees, will be affected, but the rest of the country will probably just shake its collective head and hope that the stalemate does not go on too long.

While there has been no government shutdown since 1996, there were 17 separate events in the previous 20 years so clearly the markets would not be too inconvenienced by a brief hiatus. Analysis by Rabobank found that the previous events had very little impact on bond yields. The famous 1995 shutdown did not make a dent in a roaring equity bull market.

Undoubtedly the House Republicans will take most of the blame for the shutdown, but I can't fault them too much for their desperate and seemingly futile attempt to stem the tide of big government. Increased government control over medical care, education, and banking seems to have made the problems in those areas worse; the proposed solutions always involve more spending, prosecuting the "crimes" of the people working in those sectors, and more regulation and more laws.

Someday lenders will stop lending, taxpayers will stop paying taxes, and government services will be shut down in earnest, but the good news is that it won't be this October 1st. © 2013 Stephen Yuen

It's Now Respectable

I did a double-take when I passed by Costco's new display of hemp oil.

Hemp, as every child of the Sixties knows, has many uses, some illegal but enjoyable.

Not to worry, parents, hemp oil is a health food and is not the same as hemp juice. As the label says, it's organic, and if it's organic it must be good for you, nicht wahr?

Perchance We'll Dream

Where the monitoring occurs

At 8:30 we showed up at the sleep center. Over a dozen electrodes were taped to the head and chest. The technician explained that there were three primary causes of sleep apnea. Aging, weight, and genetics all could restrict breathing during the night, and with the patient at least two factors are in play. Getting enough oxygen to the brain during sleep is vital for physical wellbeing, mental alertness, longevity, job performance, and a host of other reasons.

We'll meet with the doctor in a few weeks to discuss the findings. She'll likely prescribe a CPAP machine. It will take some getting used to, but putting the mask on every night is preferable to mouth or throat surgery. © 2013 Stephen Yuen

The Straight Poop

Writer Kate Kershner begins to answer the question on everyone's mind: Are courtesy flushes useful -- or healthy?

What is a courtesy flush? Per Yahoo! Answers: "more people need to learn this.... after you drop a #2 you flush the toilet as to not stink up the restroom, as a courtesy to the next person, then proceed to wipe and flush again."

Kate Kershner's conclusion: it might achieve the objective of reducing odor at the cost of using more water and, perhaps of greater concern, "you might be coating your hindquarters with a fine mist of bacteria."

You won't find such useful information in Emily Post.

From September, 2011: #1 has its own forms of etiquette.

21st Century Marketing

How to update an old product through the use of marketing wordsmithing: use antigravity to imply that cutting-edge science is at work.

Also, add braid, which had been primarily used in traditional "women's topics," because braid has secondary meanings in math and space science when accompanied by a noun or adjective.

"Antigravity".....when wicking won't do. © 2013 Stephen Yuen

A Cuspidor Bites the Dust

The spit bowl, aka dental cuspidor

When I sat down in the dentist's chair, the spit bowl was gone. The technician explained that a heavy patient had broken it when he used it as support rising from the chair.

I expectorated into the proferred suction hose while Stan explained that the $4,000(!) replacement cost of the spit bowl would be better allocated to newer technology.

Of course, I agreed.....as I always do with the man who held a sharp instrument in my mouth.

Too much information? the full panel

He took a full panel of X-rays. With the money saved from not replacing the cuspidor Stan was able to buy a late-model X-ray system, which emits much less radiation than machines of yore. Okay, despite fond childhood memories of the water going round and round, I don't miss the spit bowl that much.

The technician said that I had good bones and gums. Not the highest compliment I've ever received, but these days you take them whenever you can get them. © 2013 Stephen Yuen

The Cost of Marriage Equality

Now that same-sex marriage will become legal in Minnesota, the Mayo Clinic is requiring that Minnesota employees who receive benefits in same-sex partnerships get married. This is the same rule that the Mayo Clinic and other employers apply to opposite-sex pairings [bold added]:

"Mayo has long had a policy providing same-sex domestic partner benefits because those affected were not allowed to be married. That policy notes that marriage would be required if same-sex marriage became legal in the state where the couple lives," [spokesman Bryan] Anderson said in a statement.

There are a few voices in favor of retaining special treatment. Paul Guequierre of the Human Rights campaign:

"We have heard companies consider doing this. We have not heard of any companies that have actually done this and from our perspective it is a bad idea to require them to marry," he said.

Sleepless in San Francisco

Fitful sleep has been our constant companion for the past 40 years due to the usual culprits: work-related stress, lack of physical activity, and a two-cup-a-day coffee habit. After early retirement and a welcome change in career, I'm making progress on the stress and exercise but have been unwilling to cut the caffeine...until this week when I switched to decaf.

Quitting cold turkey was tough for a couple of days; the morning headaches made it difficult to concentrate, and by the late afternoon the craving for a nap became nearly overwhelming. However, I'm now sleeping through the night, and problem-solving during the workday seems a little sharper (measured from a low starting point, to be sure).

According to the American Psychiatric Association,

To be diagnosed with caffeine withdrawal, a patient must experience at least three of five symptoms within 24 hours of stopping or reducing caffeine intake: headache, fatigue or drowsiness, depressed mood or irritability, difficulty concentrating, and flulike symptoms such as nausea or muscle pain.

With three withdrawal symptoms checked, your humble observer sure looks like he was/is "addicted" to caffeine, but he's content to leave that final judgment to the professionals.

Plastic Rapped

At last week's dinner the kitchen volunteer covered the vegetables with plastic wrap before she put it in the microwave oven.

"Are you sure that's okay? I always use waxed paper or parchment," I interrupted helpfully. She pointed to the "microwave safe" label that I hadn't seen on the box. Sheepishly, I nodded assent. Being perceived as a busybody is a necessary price when one is at least partially responsible for the welfare of others.

Which raises the question anyway---just how dangerous is heated plastic when preparing food? (I learned to avoid using plastic wrap and plastic containers before today's young adults were born. Perhaps that rule no longer applies.) Per Tuesday's WSJ:

Plastic is ubiquitous but there are two chemicals in it to watch out for when it comes to what your body ingests.

Phthalates, the chemicals that make a PVC container flexible, .....can leach into food, resulting in hormone imbalances and birth defects—although no one knows at what level those effects are triggered. [snip]

Bisphenol A, or BPA, is a potentially worse offender. Once tested for possible use as an estrogen replacement, BPA was found to be of better use in the mass production of polycarbonate plastic. It's used in everything from the lining of metal soup cans to receipt paper. The FDA banned the use of BPA in baby bottles in July 2012, because of growing consumer concerns over its link to developmental delays.

One big no-no:

reheating foods heavy in cream and butter in plastic is always a bad idea. "Fatty foods absorb more of these harmful chemicals when heated," [Dr. Rolf Halden of Arizona State University] says.

Despite assurances that plastics are now safe to be used in cooking, we'll be taking a few extra seconds to pour the leftovers into a glass or ceramic bowl and cover the same with parchment paper before reheating. Just because the wisdom is old doesn't mean it's not true. © 2013 Stephen Yuen

First Day of Spring

Spring is really when the new year seems to start. For farmers [bold added],

"Spring is an exciting time for us, because you're just starting the work, and there's something new as the ground is being turned over," says Jennifer Scheer, executive director of the Santa Clara County Farm Bureau. "Any losses or frustrations that you had last year are washed away and you're in a new place, starting fresh."

For lovers, science tells us the stirrings are from more than sunshine and extended daylight hours:

A circadian rhythm section of experts has declared spring a peak period for skyrocketing sperm counts in men and ovulation overdrive in women. No wonder spring is the leading season for unplanned pregnancies.

And for this allergy sufferer, a maintenance (an injection once every 28 days) level of immunotherapy has finally been attained. I'm still sniffling and sneezing, but much less than I ever have. Everything's looking brighter today. © 2013 Stephen Yuen

The neighborhood is taking a tern for the better.