Monica

Oh phooey -- we ate that yesterday, "possibly" exposing us to listeria monocytogenes (warning: I cringed while reading this). But kudos to Giant Eagle for calling and telling me; store affinity cards do bring privacy issues, but it's nice to know that the tracking of purchases can produce good outcomes too. Unless it were to make the news somewhat prominently, I might not have known otherwise. (Specifically, I might have heard "River Ranch" and not connected it to "Farmer's Market", the local branding.)

Tomorrow morning I'll ask what my doctor recommends.

At the Giant Eagle pharmacy:

Me: Here's a prescription, and a gift card from Big Pharma that will pay for three months' worth. If I mail-order it I can get three months' worth at once; can you do that for me?

Her: I don't know; I'm just the front-desk flunky. Do you want to leave it and we'll give you as much as we're allowed to?

Me: Sure.

After I did my grocery shopping I returned.

Her: Sorry, we're only allowed to do one fill-up at a time.

Me: I understand. Have we completed this transaction, then?

Her: Um, yes?

Me: Will you take as given that I walked out through that exit and then came back in, or do I need to actually do it?

Her: Nice try, but you have to wait a month.

Oh well. I have until the end of the year to use the gift card.

---

Dani: So you can read on Shabbat; can you use a Kindle?

Me: No, because you have to manipulate the controls. It's like changing the channels on TV; technically you can watch it if it's on but you can't change the channel or volume. (Pause.) I suppose if, before Shabbat, you set in motion a smooth scroll at a readable pace, that would be like programming the lights. But it seems unworkable.

Dani: What about software that tracks your eye movements and turns the page at the right time?

Me: Seems like manipulation to me. Next you'll be bringing up sentient lightbulbs again.

Dani: How good does the programming have to be before your software qualifies as a servant?

I have no answer to that. Halacha geeks?

This is the weirdest cold (?) I can remember. It started with a mild cough Saturday night (after I'd performed, fortunately). That continued Sunday, and I applied tea, ginger root, and steamed milk (not concurrently). Nothing productive -- just the motions of a cough. Sunday night I started to get a mild runny nose (non-productive, i.e. the output didn't have any icky bits or colors). I took a 24-hour Sudafed before bed. Today at times I sounded a little hoarse, though my throat feels fine. Nose and cough action unchanged; took another Sudafed tonight. At no point have I had anything resembling a fever, which I understand I would have if I had either flu.

Isn't the runny nose supposed to come before the cough? I mean, the latter is usually caused by the former, right? I discounted the cough as possibly some sort of environmental reaction (dry air?) when it showed up because it was out of order.

Weird.

(I don't particularly like taking Sudafed, but I also don't like getting up every 3-4 hours at night to take more cough medicine, and I can't take most over-the-counter decongestants. And I figured if there's stuff in there, better to deal with it while it's still in my head, right?)

My doctor says that my "bad cholesterol" is a smidge high (good's fine) and I should cut down on dairy and red meat. I eat very little red meat (really not much meat at all, though lots of fish), but I did bump up the dairy intake a bit in pursuit of calcium after learning of some family medical history this summer. Ok, fine, I'm perfectly willing to take calcium/D supplements instead, go back to soy milk instead of yogurt for breakfast, etc, but it does raise a question for me.

Presumably it is possible to find the right combination of nutrients in nature, without taking supplements. Sure, our understanding of "right" has changed over time, but for at least several decades I gather that we've grokked the importance of basic vitamins and minerals, and I don't remember supplements being nearly so prevalent a few decades ago as they are now. So how does one get enough good stuff (calcium, protein, vitamins) without getting too much bad stuff (cholesterol, sugar, excess calories), without supplements? What is the canonical modern (wo)man supposed to eat? (The last time I looked at the food pyramid it wasn't very helpful for gleaning details. It also assumed 2000+ calories/day, which a sendentary blob like me shouldn't eat.)

In the comments here we were talking about health care in the US. The current system is broken in many ways, but the "nuke it and start over with some nationalized program" proposals are scary too. What incremental improvements are possible? I have to believe that there are some.

One idea I'm interested in is what would happen if we separated paying for routine care from paying for catastrophic care. What would happen if people could be on their own for the former but could buy a policy to cover hospitalizations, major illnesses, and the like? How effective would that be and what would it tend to cost? What would having that in play do to the over-the-counter (uninsured) price of routine care? (Yes, I know that not everyone can afford to pay for routine care out of pocket. I'm exploring a suite of options, not choosing a single one.)

On the flip side, would medical practices or insurance companies be willing to sell affordable plans that cover all your routine care (only), if they were not on the hook for catastrophic losses? Could that get things down to the point where the average family could afford regular checkups, preventative care, and routine tests (which helps prevent some catastrophic issues)? Such plans exist now in niches (vision and dental, most commonly in my experience), but I haven't heard of one for general medical care. Why not? (Am I totally misunderstanding where the profit centers are in the insurance business?)

Both angles are important. What I'm labelling catastrophic incidents are (as the label implies) financially devastating if you don't have sufficient coverage. Outside of elder-care issues I'm not sure how common they are, but it's the sort of thing I wouldn't want to take a chance on. I insure my car and house, after all -- how much the moreso should I insure my health?

What I suspect has a bigger impact on the poor, though, is the routine care. If you don't have insurance, you're looking at a three-digit number to walk into your doctor's office. Throw in some kids and you're in trouble. (This is why I asked what would happen to those costs if catastrophic care were a separate factor.) Could plans that just cover routine care be made affordable enough for most people? This doesn't solve the other problem, but neither does the current system -- we rely on hospitals' obligations to treat (which is a legitimate public demand while they pay no taxes), or medicaid/medicare/SSI in some cases, to get through those. Remember, incremental improvement.

I'd also like to explore the effects of reducing drug regulation, letting people buy from anywhere that's selling and reducing barriers to getting things onto the market. I know the standard argument against this (those high prices pay for R&D), but I'm not sure how much I believe that. What are the other considerations?

Where else could we look for incremental improvements?

(In case you haven't figured it out, I am not a medical professional, an economist, nor part of the insurance industry.)

An article in my local dead-tree news reported on something I'd been wondering about for a while: are allergies and asthma more prevalent than they used to be (versus just being diagnosed more), and, if so, is it because of lifestyle changes? Yes and yes, apparently; research shows that more sterile environments mean our immune systems don't have as much to do, so they go off and find other ways to keep busy. (I couldn't find the local article online; Google found me this one from half a year ago.) I'm glad my parents let me play in the great outdoors and eat anything, and that we had pets, when I was growing up; I do have some allergies (environmental, not food), but they're mild. I feel sorry for one of my in-laws: his parents are hyper-paranoid about food allergies and are attempting to build a shield around him. They didn't come to our wedding because we couldn't guarantee that none of a long list of foods had never passed through the hall's kitchen. That kid is going to be a mess when he grows up, and he's probably going to think this is normal when he has kids of his own. Ugh.

Via Slashdot: daylight "saving" time actually increases energy usage. ("Saving" is a misnomer; we should call it "daylight shifting time", which is all it accomplishes. There are not, after all, storehouses in which we collect excess sunlight for use during lean times; nothing is saved.) The researchers were handed a great data-collection opportunity: they did their work in Indiana, where until recently some counties did DST and others did not. So they not only had before-and-after data, but also a control group nearby to factor out weather and the like.

A few days ago a house in Plum (near Pittsburgh) exploded, apparently from a gas leak. (I actually saw this on national news before I saw the local news.) This made me wonder whether it's possible to build a detector (other than the human nose) for household use. We have smoke detectors and carbon-monoxide detectors; why have I never heard of a gas-buildup detector? Granted that such incidents are extremely rare, but they are potentially much more devastating than fires and CO buildup, so if an inexpensive household gadget could provide some potential warning, that'd be great.

In lighter news:

You know that "who do you want to answer the phone at 3AM?" ad the Clinton campaign is running? The little girl in the ad was stock footage; she's now an adult and working on the Obama campaign (via insomnia).

Headline of the day, from thnidu: Skywalkers in Korea Cross Han Solo.

A couple days ago, while changing the needle before giving Erik his fluids, I accidentally jabbed myself with the used needle. I called my vet to ask if the kind of hepatitis that Erik (likely) has can be transmitted to humans. She said she didn't think so but I should consult my doctor. (She said that he doesn't have the human strains, like B or C.)

So I called my doctor, and he said he didn't know but he would check. I gave him my vet's name and phone number so he could get anything he needed from Erik's medical records. I kind of figured that he and my vet would talk in medspeak not meaningful to ordinary humans, or something.

He called back the next day and said that he'd gone on the internet and he didn't think there would be a problem, but if I saw $symptoms I should give him a call. Err, ok, I could have done that -- and did, but found nothing conclusive. I think he was trying to be reassuring ("you can find anything on the internet"), whereas I see "going on the internet" as, at best, comparable to "going to the library". (It might also be "going to the local bar and trading gossip", of course.) If you went to the Johns Hopkins medical library, you probably got good information -- but you could have gone to the children's section of some backwater library for all I know, and been reassured that the Cat in the Hat would have said something if that were possible. I trust my doctor (if I didn't he wouldn't be my doctor), and I'm confident that he found reputable information, but his way of presenting that was not as helpful as he thought it would be. :-)

I saw my opthamologist for my regular checkup today and was surprised to learn that medicine's understanding of glaucoma has changed since it was last explained to me. I guess I think of glaucoma as an old, well-understood disease that doesn't change much.

For the first time ever, while my eyes were numb anyway they applied a second gadget. After the round of "heywaitaminute, tell me what you're doing before you do it", I learned that this gadget measures the thickness of the cornea. (The technician doing it didn't know the mechanism and I haven't gone looking yet. I wonder if it's sound-based; how else would you measure the thickness of something like that?) She noted that my corneas are thicker than normal but would not pronounce that good or bad.

My opthamologist pronounced it good. Well, not good in absolute terms, but it turns out that people with thicker corneas tend to measure higher for eye pressure, which is what the glaucoma test measures. So my pressure might not be as high as they think it is. Hey, I said, my pressure has always been borderline anyway; is high pressure the sole detector for this disease and do I really have it?

She said that contrary to what I was told when I got the diagnosis (and several times since), high pressure isn't the definition of glaucoma. That's just high pressure. Glaucoma is a condition of the optic nerve usually caused by high pressure, though there exist people who have low pressure and the optic-nerve condition (and people with high pressure without effects). I do have damage to my optic nerve, though she hasn't noted it getting worse (which is both good and expected).

I should have asked her to describe what the medicines I take do, just to satisfy my own curiosity. (And, well, my co-pays just went up again...) My impression is that one is about lowering the amount of ocular fluid produced and another is about venting it, and I'm not sure what the third is. Oh well; I can ask next time. She said that she is not going to change the treatment at this time based on the cornea thing because that's speculative, which sounds right to me. There's plenty of time to ask later if I'm actually taking the right mix of drugs; it sounds like, at worst, I'm taking something ineffective. I'd rather not waste money on something known to be useless, but when in doubt, my eyes are a heck of a lot more important than saving some money.

She also suggested that it may be time to get pictures of my optic nerves taken. I gather that the philosophy is similar to that of the mammogram: at a certain point you start looking and from there on you're looking for changes. She described the process for the eyes as "sort of like a CAT scan but without radiation", which doesn't tell me directly (I don't know from CAT scans) but I can apply Google. She said it can wait until summer, when I'm next due for a visual-field test, and they can do 'em together. Ok, whatever.

I'll be interested to compare notes with my father, from whom I inherited the glaucoma, to see what his doctor has been doing lately.

Tidbit picked up in passing: my opthamologist has been practicing for 13 years. I've been seeing her for about 8; I hadn't realized she was so new when I started going to her. When choosing a doctor there's an interesting trade-off between recency (more up-to-date education) and decades of experience (seen more "in the wild"); I'm pretty happy with her, though I got her semi-randomly so that's just luck.

I'm allergic to Pennsic. (Well, to dust and grass and pollen and weeds and...) So I take Allegra for about three weeks each year to deal with that, but don't take it the rest of the year. (I don't want to develop a resistance to it like I did to all previous allergy drugs save one [1].)

This year I started taking it on Saturday, and then went to Cooper's Lake Sunday for setup. I was fine yesterday, but today I've been congested all day. Mid-day I added Sudafed to the mix; I hope that wasn't bad but I really needed to treat the symptoms. (I take the Allegra once a day and had taken it this morning.) It took about four hours for the Sudafed to produce results.

I think this must have happened in the past, because there's Sudafed in with my use-only-at-Pennsic stuff. Now that I think about it, I remember once calling my doctor from Pennsic to ask if taking Sudafed while taking Allegra would kill me and he said it wouldn't.

I don't know if starting the Allegra earlier would help; how long does it have to be coursing through your veins to lay down a basic barrier against the nasty little allergens? With luck, writing this entry will help me remember next year to start earlier. (I'm sort of assuming that I should be taking allergy drugs (Allegra) and not cold drugs (Sudafed) as a baeline. I don't have a cold; I just have some of the symptoms.)

I should remember to ask my doctor if he can improve on this for me.

[1] Seldane. It worked gloriously, better than Allegra I think, so naturally the FDA eventually decided I couldn't have it.

Ok, you. Out of my brain! Now!

We got email this morning from a recent houseguest whose family turned up with head lice the day after they visited. Oh joy. From our interactions with the affected individuals, and their interactions with our furniture and our subsequent interactions with said furniture in the next 24 hours, we're probably fine. But now I itch.

When I got home from work I vacuumed all the relevant furniture and then took a flea comb to my hair. (Hey, having cats can be handy -- it's a much finer comb than anything I have that's designed for my hair.) Nothing. I had Dani do his and he turned up empty. (I was concerned that lice might be small enough that I wouldn't be able to see them.) It's been 24 hours, and we're avoiding the living-room furniture tonight just in case. So really, we should be fine.

So could my brain please stop with the sympathetic or psychosomatic itching, darnit? This is getting old.

I saw a news story today about how US life expectancy is at an all-time high. The article doesn't give enough data to be really useful (it's just the popular press, after all), but I found on reading it that I'm not really interested in life-expectancy figures any more. I'm much more interested in the much-harder-to-compute health expectancy.

In other words, at what age do the statistics say the average person will be last able to live independently with a functioning mind and body? (Yes, of course I recognize that this is hard to characterize precisely.) I don't care if life expectancy goes up to 120 if the last 20 years of it are spent lying in a bed no longer able to recognize anyone. That's where we face our challenges today. Keeping people alive is easy; keeping lives worth living all the way to the end is harder.

Guess-the-anonymous-poster update: One outstanding guess (paging aliza250), one where I had to be told (eclectic_1), all others identified. That was fun.

The stereotype is that smart people (including anyone whose job title implies serious analytical skills) don't get picked for juries, but I'm beginning to wonder. I've been called three times and picked twice, and our engineering director is currently away from work because he's on a jury. Do they just sometimes miss in the screening, or are the lawyers not really screening for this sort of thing after all?

A Texas judge has ordered that a person convicted of animal cruetly must post pictures of the animals she starved in her jail cell. Good for the judge! This is similar to the local story some months back of the hit-and-run driver who is required to carry a photo of the person he killed in his wallet during his probation. Such orders do no harm (it's hardly "cruel and unusual") and serve to put a human (or animal, in the one case) face on the damage done by these people. More, please. (And remember, we're talking about people convicted of criminal charges; I am not advocating haunting those who accidentally cause harm and don't try to hide it with such sentences.)

Do spammers really think that people still open messages with the subject line "URGENT"? Or that most of us think we even might know a sender named Brittany? Ah well; it doesn't fool the filters.

At my most recent physical my doctor called for a routine test that kicks in for women at age 40. (Am I being sufficiently delicate?) No surprises there; the surprise came when I called to schedule and the person said "oh, and no caffeine for two days before". After I moved from incoherent blubbering to actual words, I explained that this posed a difficulty and she relented. It turned out to be advice, not medical necessity. Don't scare me like that!

Shavuot was good. More about that later.

One of the other people on that cantors'/etc list turns out to be worship chair at her own congregation and a year ahead of me in the Sh'liach K'hilah program. It's been interesting to compare notes with her, and she's given me some good information about the SK program. Last year's class was 17 people, she said; this year's is bigger, though she doesn't know how big. So it sounds like a fairly intimate experience, which I like.

She also warned me that the air conditioning in the classrooms is set for "arctic", and there is no internet access in the dorm but there is in the library. That's managable.

I got an information packet from the program in the mail a couple days ago, including a class schedule. Sounds like good stuff. I will assume that the word "chugim", which appears daily, corresponds to "SIG" or "BOF" -- subgroups on specialized topics. (I can imagine four ways to spell "chug" in Hebrew, and I'm too lazy to try them all in the dictionary.)

My professional world is getting a little bit smaller: two past coworkers will be joining my company soon. Nifty.

I heard an ad today from Subway for "low-fat" and "Atkins-friendly" sandwiches. I presume this represents union, not intersection. I'm not sure what the options are for fulfilling both criteria in a sandwich/salad context. My dentist, in whose office I heard this, didn't know either.

A man is suing the Atkins people for his heart problems, saying he needed angioplasty to clear his arteries -- and is asking for $15,000. Usually these suits ask for a heck of a lot more than that; it makes me wonder what the figure is based on.

I've been needing a new pair of non-casual shoes for a while. ("Non-casual": shoes you can wear with skirts, like for Shabbat.) I went to the higher-end store in Squirrel Hill a while back and ended up buying something I ought not have (I went looking for flats and let the clerk talk me into a slight heel). Today I noticed a PayLess in the same mall as my dentist's office, and I believe I've solved my problem for $12.99. I know what I'm doing in the future... (I try to support independent businesses over chains when I can, but they've got to work with me here.)

I watched the season finale of Enterprise. I thought they had promised a complete story in one season. Technically they might have, but I'll bet they address this ending next season...

Off to the annual congregational meeting and, technically, the end of my board tenure.