Saturday, May 11, 2019

My exercise program towards the end of year 60

Current exercise guidelines are more demanding that the “12 minutes a day, 3 times a week” standard of my youth ...

For substantial health benefits, adults should do at least 150 minutes ... to 300 minutes ... a week of moderate-intensity, or 75 minutes ... to 150 minutes ... a week of vigorous-intensity aerobic physical activity...

… Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week.

… Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week

I’ll be 60 in 10 weeks. This is how, as a genetically ungifted athlete, I approach those recommendations between May and October

Sunday: 3-4 hour road bike ride, not counting lunch. If weather is bad then CrossFit St Paul. I’ve been enjoying CFSP for more than 6 years now. Often 9 holes of walking golf with #1 son.

Monday: CrossFit, usually with my teen daughter, followed by sets of sit-ups and dubs (120 and 80+)

Tuesday:  Mountain biking 1 hr at Battle Creek, River Bottoms, Leb or CarverSt Paul JCC with Emily and #2 son, weights and running — whatever I’m not doing at CrossFit. Usually Bench, SLR, and working on components of a Bar Muscle Up.

Wednesday: CrossFit, with the daughter, sit-ups and dubs.

Thursday: CrossFit (daughter) and the J with Emily and #2 son. Some light weights and sauna.

Friday: CrossFit, sit-ups and dubs.

Saturday: Rest day! Nothing scheduled but often kinetic anyway.

From October-April I do JMS Hockey on Friday nights, CrossFit on Sunday, and Nordic skiing when conditions allow. This year I’m planning to add winter mountain bike trail rides.

Because I once had a quite bad back I do a set of 9 stretches every morning and 20 weighted roman chair reps each night — but those go fast. I do dumbbell curls during phone meetings and before bed because of that muscle-up project.

I’d love to be able to also bike commute to work, but my current job is a remarkably bad fit for bike commuting.

On a good week I do at least 600 minutes of moderate to high intensity exercise. It keeps me more or less balanced and able to work. I didn’t start out doing 600 minutes a week, it just built gradually over the years. The older I get the more important exercise is, and the more time I need to spend on it. It helps that I’m quite good at amateur injury rehab.

Current medical wisdom is that exercise won’t control weight, but I think that depends on how much exercise one does. In the winter I am more careful, but in the summer I sometimes need to add extra food to maintain my weight.

Saturday, May 04, 2019

Gordon's platform 2020

It is my privilege to announce that I will running for the Presidency of the United States of America.

I understand that, as a foreign born dual citizen of the United States and Canada I am technically not eligible for the Presidency. On the other hand, America elected Donald Trump. Compared to him I’m eminently qualified.

My Presidential Platform is achievable and focuses on our core challenges as a nation and wannabe world leader ...

  1. Free community college. This was, I think, part of HRC’s platform. Didn’t get much media coverage but just makes sense. Unlike free college, which is dumb. Quebec basically does this and it has worked very well for them. A lot of health care workers can be trained in 3 years of community college.
  2. Restore ACA, including the individual tax penalties for non-participation, with a public option that leverages experience from Canada and Veterans Health Administration. Incorporate broad support for physical activity (aka exercise) in health care system. Attack agricultural subsidies for unhealthy foods and subsidize healthy foods. Move the dial on obesity and lifestyle diseases.
  3. Restore Obama’s carbon control framework, not including a carbon tax. I love the idea of a carbon tax, but I’ve seen my fellow citizens. Some costs are better buried.
  4. Increase employment income of the non-college. Reduce taxation incentives that favor automation (it will happen anyway, but slower is better). Create plug-and-play packages for small businesses that employ non-college. Provide subsidies for training in skills accessible to non-college. Extend the framework used for disabled employment to subsidize and support non-college work including public sector employment. Subsidize minimum wage. Tax breaks to employers that promote employment. This will be a core pillar of my administration.
  5. Strong antitrust; promote competition among corporations and consumer choice. May include breaking up several MegaCorp.
  6. Transit, bikes, walkability, parks, attractive infrastructure. Make car ownership optional. Require new motor vehicles to incorporate technology that makes pedestrians and cyclists safer. Require autonomous vehicles to meet strict standards for safety of the non-armored.
  7. Taxes. Of course. VAT. Restore the "death tax”. Various forms of wealth tax. Tax soda and the like. Fund my platform, start to beat back dysfunctional wealth concentration.
  8. Attack political corruption, particularly post-political employment, at every level. Public funding for elections including mandated free media time.

There’s more, but you get the idea.

Vote for me. 

Whatever my name is.

Sunday, April 21, 2019

Healthcare reform 2020: Public option based on the VA healthcare model

Medicare for All won’t work in 2020. We have an insurmountable path dependency problem.

We can, however, implement the ACA public option. It should be based on the VA model for healthcare delivery, which is basically the American version of the UK’s NHS. It’s not luxurious, but it’s more than good enough healthcare.

Tuesday, February 26, 2019

Primary care 2019 vs. 1989

There’s been at least a 200-300% increase in care complexity between when I started medical practice and today. Many new classes of medications for fairly common disorders, many more specialty interventions that may be considered.

At the same time computer based clinical decision support systems have been a surprising failure. (Emily uses Epic, I use VistA/CPRS). In the 90s we expected far more than we actually got.

We are asking a lot of the modern primary care physician.

Monday, February 18, 2019

Greenlight card for "kids" - early impressions

I ordered the Greenlight cards for our children. Only one is a minor (and she uses a regular debit card) but two are special needs adults who are more vulnerable to financial scams or misjudgments. I also got one for a sibling with some similar issues though that is certainly not the Greenlight market.

So far it’s been a mixed experience. The Greenlight site has suprisingly poor documentation — basically some simplistic FAQs. They don’t document where the cards don’t work but from customer support I got:

Since our cards are meant for children, there are certain places that our cards will not work. Liquor stores, gambling websites or establishments, money orders, MoneySend and wire transfers are some examples of things that our cards will not work for. Since we are a prepaid debit card, we have also had families experience some trouble when attempting to use our cards to pay bills. We recommend not transferring funds to the Greenlight card that need to be used for utilities or other bills.

That seems reasonably, but it’s not the complete list. They don’t work for Patreon for example — my son wanted to donate there. Greenlight won’t provide a full list.

There’s also a problem with Greenlight.app behavior on one child’s phone. Again, this is undocumented, but I think there are two paths it should follow on launch. One path should enable access to card balance, the other is for requesting a card. On his phone it goes down the wrong path. Hard to sort out since, again, there’s no documentation.

The vibe I get from Greenlight is that is a venture funded effort that didn’t scale quickly enough …

Saturday, February 16, 2019

CrossFit for Olds - years to build ligaments and tendons

My son bought me a slim book on rock climbing techniques. Rock climbing was my brother Brian’s gig, but I could see doing it when my knees knock me out of CrossFit. It’s something I did in college back when we belayed using ropes wrapped around our body (no belay hardware).

The book talks about single finger pinch holds. Specifically, it says not to try them until at least two years of building up tendons and ligaments.

Two years is a fair amount of time. I’ve not seen that mentioned in any clinical references I read. I suspect it’s right though; it’s obvious muscles can develop much faster than tendons.

I think we should be more aware of this in CrossFit training. Young muscles develop fast, but ligaments and tendons take time. To lift heavy things safely we need connective tissue to be at least as strong as muscles (ideally stronger).

In my 60th year I lift significantly heavier things than I did when I was younger-Old. Probably heavier than I could have done in my mid 30s. My muscles are somewhat stronger, but I think a lot of that is connective tissue development, and that took years. More than two years for Olds I think.

Saturday, February 09, 2019

The curious psychiatric state of Robert F Kennedy Jr

Robert F Kennedy Jr showed up in a scrum of pro-measles whackos recently. It  me wonder how he got so nuts.

There’s an extensive wikipedia page for him, starting with a time I remember:

He was 9 years old when his uncle, President John F. Kennedy, was assassinated during a political trip to Dallas, and 14 years old when his father was assassinated…

Despite childhood tragedy he was a successful academic and he’s done some decent work legally and for the environment. He seems to have started off the rails in the 80s:

In 1983, at age 29, Kennedy was arrested in a Rapid City, South Dakota airport for heroin possession after a search of his carry-on bag uncovered the drug, following a near overdose in flight.

By 1989 he’d started on vaccines — but not with autism … 

His son Conor suffers from anaphylaxis peanut allergies. Kennedy wrote the foreword to The Peanut Allergy Epidemic, in which he and the authors link increasing food allergies in children to certain vaccines that were approved beginning in 1989

By 2000s he’d jumped from immunizations causing his son’s anaphylactic disorder to immunization causing autism. He became "chairman of “World Mercury Project” (WMP), an advocacy group that focuses on the perceived issue of mercury, in industry and medicine, especially the ethylmercury compound thimerosal in vaccines”. It was a downward spiral from there.

Despite his vaccine delusions and troubled marriages he seems to have maintained a fairly active wealthy person life. He’s said to be a good whitewater kayaker.

Psychiatrically it’s curious. He combines fixed irrational beliefs (the definition of delusions) with relatively high functioning in other domains. He reminds me of L Ron Hubbard, founder of Scientology

We need to keep him far from the political world.

Saturday, February 02, 2019

Against superhuman AI

I am a strong-AI pessimist. I think by 2100 we’ll be in range of sentient AIs that vastly exceed human cognitive abilities (“skynet”). Superhuman-AI has long been my favorite answer to the Fermi Paradox (see also); an inevitable product of all technological civilizations that ends interest in touring the galaxy.

I periodically read essays claiming superhuman-AI is silly, but the justifications are typically nonsensical or theological (soul-equivalents needed).

So I tried to come up with some valid reasons to be reassured. Here’s my list:

  1. We’ve hit the physical limits of our processing architecture. The “Moore-era” is over — no more doubling every 12-18 months. Now we slowly add cores and tweak hardware. The new MacBook Air isn’t much faster than my 2015 Air. So the raw power driver isn’t there.
  2. Our processing architecture is energy inefficient. Human brains vastly exceed our computing capabilities and they run on a meager supply of glucose and oxygen. Our energy-output curve is wrong.
  3. Autonomous vehicles are stuck. They aren’t even as good as the average human driver, and the average human driver is obviously incompetent. They can’t handle bicycles, pedestrians, weather, or map variations. They could be 20 years away, they could be 100 years away. They aren’t 5 years away. Our algorithms are limited.
  4. Quantum computers aren’t that exciting. They are wonderful physics platforms, but quantum supremacy may be quite narrow.
  5. Remember when organic neural networks were going to be fused into silicon platforms? Obviously that went nowhere since we no longer hear about it. (I checked, it appears Thomas DeMarse is still with us. Apparently.)

My list doesn’t make superhuman-AI impossible of course, it just means we might be a bit further away, closer to 300 years than 80 years. Long enough that my children might escape.

Sunday, December 30, 2018

Why the crisis of 2016 will continue for decades to come

I haven’t written recently about why Crisis 2016, sometimes called Crisis-T, happened. For that matter, why Brexit. My last takes were in 2016 …

  • In defense of Donald Trump - July 2016. In which I identified the cause of the crisis, but assumed we’d dodge the bullet and HRC would tend to the crisis of the white working class.
  • Trumpism: a transition function to the world of mass disability - Aug 2016. “How does a culture transition from memes of independence and southern Christian-capitalist marketarianism to a world where government deeply biases the economy towards low-education employment?"
  • After Trump: reflections on mass disability in a sleepless night - Nov 11, 2016. "Extreme cultural transformation. Demographics. China. The AI era and mass disability. I haven’t even mentioned that pre-AI technologies wiped out traditional media and enabled the growth of Facebook-fueled mass deception alt-media … We should not be surprised that the wheels have come off the train.”
  • Crisis-T: What’s special about rural? - Nov 16, 2016: "The globalization and automation that disabled 40% of working age Americans isn’t unique to rural areas, but those areas have been ailing for a long time. They’ve been impacted by automation ever since the railroad killed the Erie canal, and the harvester eliminated most farm workers. Once we thought the Internet would provide a lifeline to rural communities, but instead it made Dakka as close as Escanaba.”

How has my thinking changed two years later? Now I’d add a couple of tweaks, especially the way quirks of America’s constitution amplified the crisis. Today’s breakdown:

  • 65% the collapse of the white non-college “working class” — as best measured by fentanyl deaths and non-college household income over the past 40 years. Driven by globalization and IT both separately and synergistically including remonopolization (megacorp). This is going to get worse.
  • 15% the way peculiarities of the American constitution empower rural states and rural regions that are most impacted by the collapse of the white working class due to demographics and out-migration of the educated. This is why the crisis is worse here than in Canada. This will continue.
  • 15% the long fall of patriarchy. This will continue for a time, but eventually it hits the ground. Another 20 years for the US?
  • 5% Rupert Murdoch. Seriously. In the US Fox and the WSJ, but also his media in Australia and the UK. When historians make their list of villains of the 21st century he’ll be on there. He’s broken and dying now, but he’s still scary enough that his name is rarely mentioned by anyone of consequence.
  • 1% Facebook, social media, Putin and the like. This will get better.

That 1% for Facebook et all is pretty small — but the election of 2016 was on the knife’s edge. That 1% was historically important.

Rupert Murdoch will finally die, though his malignant empire will grind on for a time. Patriarchy can’t fall forever, eventually that process is done. We now understand the risks of Facebook and its like and those will be managed. So there’s hope.

But the crisis of the white non-college will continue and our constitution will continue to amplify that bloc’s political power in rural areas. Even if civilization wins in 2020 the crisis of 2016 will continue. It will test human societies for decades to come.

Thursday, December 27, 2018

Life goal #2 - The CrossFit Kipping Bar Muscle-Up

In 2018 I met one of my two CrossFit Life Goals (tm) - 10 consecutive dubs (hit 42 in a wild fluke the other day). Only took me five times as long as anyone else I know.

The other goal is the Kipping Bar Muscle-Up. So that’s on the list for 2019. I’m also planning an IMBA “Epic” mountain bike trek — the Maah Daah Hey, but that’s mostly about showing up and moving my feet. The Bar Muscle-Up may be impossible, so it’s more interesting. (Watching Paoli video I should be able to do it now [1], but that’s now what I’m feeling!)

I’m putting my training notes and references on this page.

Examples

Movement notes

Some of the best tips came from a post in the CrossFit Physicians Facebook group.

  • Hands a bit wider than shoulder, but narrower than bench
  • From beneath the bar jump up and back to a big arch then fall forward into extension position — gets good start there
  • Drive hips to bar from top of “hollow” position, while “push down on bar with straight arms”. There should be a bend at hips so can “pop” the hips and pull, row bar into chest/navel (pop/pull is the trick - need timing). The pull should be very hard and fast
  • Grip. Begin with the end in mind. You want to think about the position the hands and wrists need to be in when you're on top of the bar and doing the dip portion of the BMU. A lot of people struggle because they grab the bar from directly underneath and don't really wrap their hands over the bar. Instead of doing that, wrap your hands as far over the bar as possible. It's basically a 'false grip' maneuver that you've probably seen on the rings, just on the bar. The idea is to have to turn your hands/wrists over as little as possible. The-two word actionable cue for this is "meaty grip".
  • In the kip swing, think about getting your body as loooooong as possible in as you move in front of the bar into the extreme of the arch position. Maximize the full range of motion of your shoulders, keep knees as straight as possible, and point your toes. Your body is a sling shot. Two word cue: "get long". 
  • For the pull up & over the bar. Pick a spot on the floor in front of you. Your goal is to stare at that spot all through the first part of the kip and the initiation of the transition into the hollow position & first part of the pull. At some point, as you pull your hips up to the bar, you're going to lose that spot from your vision (it's unavoidable - the head tilts backwards), but your goal is to see that spot again as soon as possible. The instant you don't see the spot anymore, your sole focus is to find it again. This will help you with the speed necessary to execute the transition. Actionable cue: "find the spot". 

Training programs

Some of these are for the (ring) muscle-up, the bar muscle-up is considered to be harder

Training exercises

  • Strict pull-up
  • Kipping chest-to-bar with elbows behind the back
  • Lat Pull-downs
  • Use gym machine with pulley’s ropes to emulate the curious straight arm downward push-pull (see still below).
  • Back extension and arching
  • Shoulder range of motion, esp. internal rotation
  • Band-assist Muscle-Up with gradually diminishing bands
  • Box jump muscle-up with gradually smaller box
  • The glide kip drill - stand on 1-2 bench, bar a bit above eyes, arms and back in line with hip flex to big hollow, hop up, glide out with feet just above bench and extend to small hollow, then reverse on return.
  • Paradiso progression
    • 3 sets of 5 high back kip swings
    • Hip to bar pull up (20 repeat 1 rep) - kip swing with hip snap
    • Transition (atop box, etc) - 20 to 30 reps of jumping box muc
  • Hip-to-bar progression with a slight arm-pull, hip drive from the hollow (I can’t get my hips to the bar yet), note in this still from Paoli video his elbows are bent, but he’s mostly pushing the bar down towards his hips and lower abdomen. Feet are below hips. Trapezius muscle here. I have to figure out how to build something like this.
    Screen Shot 2018 12 27 at 4 27 15 PM
    and note he’s actually hitting bar around navel at this point (not hips), feet are still in front as he transitions.
    Screen Shot 2018 12 27 at 4 32 13 PM

[1] Well, not now exactly. My left biceps is strained, so I have to rehab that first.

Saturday, December 15, 2018

Old doctor pet peeve - disease descriptions were better in Osler's day.

I didn’t know Sir William personally, but I think he’d be appalled by the descriptions of patient-disorders in our medical textbooks.

We typically present a collection of findings, sometimes organized by ‘history’ or ‘physical’ or ‘lab’, but the sequencing and relationships are all lost.

We should have textbooks that describe a disease or disorder with 3-8 case histories that span a reasonable spectrum of presentations. So not x% have red eyes and y% have chest ache, but a case called “common” that might be “8 yo both with cough, then red eyes for day and a swollen lymph node, then a day later some red palms …” and another case called “often”, and 2-3 called “unusual1”, “unusual2”, and so on.

Ok, it’s not just my Oldness. I’ve been grumpy about this for roughly 25 years, even when I was only old in spirit. It annoys me a great deal.

Now I’ve said it.

Saturday, December 01, 2018

Quicken for Mac -- why vendors are going to screw-up subscription pricing for software services

We’ve been using Quicken for Mac for the past year. I’m satisfied with the software, but I no longer trust their pricing and renewal.

We paid $60 for Quicken for Mac 2015 on 7/31/2015.  On 1/8/2017 we paid $48.41, presumably for 1 year of subscription service. On 12/31/2017 we paid $32.35; we probably switched from a “deluxe” plan to a basic plan.

Today I received an email requesting renewal:

Your Quicken membership will expire on 12/31/2018. In order to continue enjoying all of the benefits of Quicken, including connected services such as bank downloads, stock price updates, account sync, and free phone support, please click here to renew your plan.

The link goes, however, to Quicken for Windows where we are shown as “deluxe” plan for $50.

Ok, so that’s presumably a mistake — albeit a bad mistake. When I go to https://www.quicken.com/mac/compare I can see the Mac plans - Starter at $35 (so probably a 15% price hike from last year) and “most popular” Deluxe for $50. I can’t compare to last year but it looks like most of the features added in the past year or so require the “deluxe” option now.

Which leads me to reconsider my previously relatively positive attitude towards software subscriptions.

I’ve been generally in favor of subscription pricing for software. I think Microsoft has done a great job with Office 365. It does, however, come with temptations for vendors. Subscription pricing makes it too easy to hide price increases and game features. It promotes “information asymmetry”.

I think Quicken has fallen for that trap.

I don’t trust them now.

We are evaluating options.

 

 

Saturday, November 03, 2018

Amazon reviews now unreliable - negative reviews filtered (Anker example)

Amazon reviews have long been helpful to me, and were once a big part of Amazon’s value proposition.

That is no longer true. Amazon is filtering out negative reviews.

I learned this after attempting to review Anker bluetooth earbuds I bought for Emily’s birthday. The power switch was defective. That wasn’t a complete surprise, I have a similar pair and I often have to push 2 or 3 times. Anker should have spent another 10 cents on that part.

Amazon made the return easy, but when I tried to write a review I got this notice:

Screen Shot 2018 11 02 at 10 12 04 PM

“Sorry we are unable to accept reviews for this product …”

I then switched to Emily’s account. There I was at able to start a review, and even able to give in a two star overall rating. When I clicked 1 star for material quality however the “unable to accept reviews” notification appeared:

Screen Shot 2018 11 03 at 12 18 40 PM

This is, of course, worse than if Amazon removed all product reviews. They are promoting systemic bias in their closed world. The Fox model is catching on elsewhere, Apple is doing something similar with the Mac App store.

On certainty

A week ago, in a Facebook group for CrossFit physicians, I read a post blaming poor parenting (i.e., poor mothering) for childhood obesity.

There and elsewhere I read confident statements on nutrition. I read confident statements about market movements (usually retrospective) and white men.

I always imagine these confident people are young, but I believe that is not always true.

There are likely things. There is entropy and death (but also the inexplicably low entropy of the early universe, and it is possible for an Old person to be stronger than they were in middle age).

Most things though, they are … complicated. They are some of this and some of that.  If you cannot imagine a worse outcome than an obese child you have not opened your eyes enough, or lived long enough for the world to pin your eyelids back and burn reality into your retina.

Look for the Old of any age. Some have something that might be wisdom. Ask them about certainty.

Sunday, October 21, 2018

Nasty flaw in Minnesota mail ballot process

There’s a nasty flaw in Minnesota’s vote by mail process.

When you apply for a mail ballot you are asked to provider either a SSN last 4 or License number or State ID number.

When you complete the ballot you are asked to provider either a SSN last 4 or License number or State ID number.

The two numbers have to match or the ballot will be rejected.

Hope you remember if you used your MN License number or your SSN Last 4 on the ballot application.

I tried testing for the identifier I used by querying my absentee ballot status, but it found the same status regardless of which identifier I used.