Bodies are weird, episode 26

My right wrist hurt the other day. A sudden sharp annoying pain. Maybe a tendon, maybe my arthritis acting up.

So I did my usual amateur self-therapy. I avoided the sharp ouch, but I moved with weights and resistance through a proximal path that was sometimes achy but not ouchy. I had lots of opportunities to load the wrist with weights, I am obliged to do CrossFit six times a week [3].

After about 4 or 5 days of this I noticed the wrist was pretty good. No more sharp pains.

It seemed … familiar. Eventually I remembered it happened before, back in Oct 2015, a bit before my formal Dec 2015 arthritis diagnosis. Resistance work was the fix then too.

This isn’t what we were taught in the medieval medical school of my youth. We were taught to rest sore joints, not to put them under painless load. We weren’t taught that running might make knee cartilage better.

Bodies are weird. Back in 2015 my knees were quite sore. I figured my CrossFit days were numbered; I even tried underwater hockey.

But then the knees got better. I continued my back squats and lunges and all the CrossFit rest. Maybe it was the exercise, maybe it was the hydroxychloroquine my atypical rheumatologist prescribed [2] maybe it was both.

Over the next four years I sometimes had knee and wrist effusions, sometimes not. Lots of things came and went. My hands got beat up, but they didn't bother me much.

Then this past summer came around. I felt weaker. My back was fragile in late July. I developed “pseudo-claudication” (look it up). I lost a bet with my daughter when I missed my birthday Bar Muscle Up. I figured age had caught up.

But then it turned out I had the pseudo-claudication was pseudo-pseudo. Probably a protruding disc. It got 80% better after 6-8 weeks of modified exercise and 100% better after 8-10 weeks. (Discs do that — it’s even in the textbooks.) I hit new lifetime best lifts in clean & jerk and back and front squat. Equaled some others. Got even closer to that elusive bar muscle up.

It’s not like I’ve stopped aging. I look a few years older than my age. I feel pretty old. Everything could fall apart tomorrow. So I’m not expecting to carry on like this. I’m just saying bodies are weird and “osteoarthritis” / “idiopathic arthropathy” [2] is weird. We do not understand. We might as well keep moving.

- fn -

[1] The process likely began with some rogue antibodies before 2010 and a single acutely inflamed distal finger joint in 2012.

[2] The one study I’ve seen on HCQ and OA says it doesn’t work. OTOH, I think “osteoarthritis” should be renamed “idiopathic osteopathy” to underscore our ignorance of what’s likely many different conditions with similar appearances. My mother did relatively well on it FWIW — before she went full RA.

[3] I leave it as an exercise for the reader to imagine why a sane person would actually need to go 6 times a week, even foregoing my ice hockey. It’s not for (my) health or training!

The killer application for Apple's AR glasses will be driving

Sucks to get old. At 60 my night vision is probably half of what it was at 25. I drive slowly at night to reduce the risk of missing a pedestrian.

What I need are AR glasses that receive input from forward facing light sensitive sensors and that enhance what I see as I drive. Draw circles around pedestrians. Turn night into day. With the usual corrective lenses of course.

I’d pay a few thousand for something like that.

Seems quite doable.

Carbon sequestration

It’s the year 2,500. Civilization has long recovered from the chaos years following the Trump regime.

Alas, even that catastrophe only transiently slowed CO2 accumulation. It continued for decades near the 2020 height of approximately 4*10^13 kg (40 gT) of CO2 a year.

Happily in 2,500 post-AI solar powered nanotech can extract atmospheric carbon and produce diamond sheets and glues. It’s possible to build a diamond wall to hold back the Atlantic and restore the lost cities of Manhattan and Miami.

How much CO2 would that take out of the atmosphere?

Diamond has a density of 3.5 gm/m or 3,500 kg/m3. If the wall is 1000km long by 50m high by 10m wide it will consume about 1.75*10^12 kg of carbon.

So we only have to build 22 such walls to undo a single year of CO2 emissions.

Update 9/24/2019

I put the numbers into a Google Sheet. Since the wall only required a few weeks of carbon output I decided to try the diamond base of a floating city modeled as a disc with a radius of 50km and a depth of 200m. That did the job!

A single floating city absorbed 145 years of 2018 carbon production.

It would be easier, of course, to build something attached to a landmass, but where’s the romance in that?

Clark Goble 1967-2019

Clark and I had different opinions on the future of ISIS. This was years ago, when we conversed often on app.net/ADN. He under his own name, me, less boldly, using my John Gordon pseudonym. (Clark knew I was John Faughnan, we corresponded by email too.)

Clark was a slippery fellow in a debate so I suggested a wager based on the state of ISIS in a year or so. I forget what I wagered, but Clark offered to pay off in Amano artisan chocolate. His company’s chocolate that is.

Some time later, a bit prematurely I thought, Clark decided I was right and he shipped me a wonderful supply of some of the finest chocolate I’ve ever had. I tried to stretch out the supply but I’m bad with chocolate. I ate it too quickly.

I was in Clark’s debt after that. I thought I’d have a way to pay it back, but I didn’t expect that to be a donation to his posthumous gofundme account. He died 9/6/2019 of a ruptured cerebral aneurysm. He was 52yo, married, with five children.

My wife’s mother died the same way at the same age. I remember, from medical school days, a young woman dying suddenly the same way. It’s like being hit by lightning. Here one day, gone the next.

I never met Clark in person. We chatted for years on app.net, then continued on Twitter. We had some things in common. We both loved the outdoors - mountain biking and, in his case, mountaineering. We enjoyed science and especially physics — though he was the real thing and I am just a hobbyist. Both of us were happy fathers; Clark's youngest child was about a year old when he died. 

We were both born in Canada. We both liked travel, he wrote often of his mission work in Louisiana.

Politically and spiritually we were pretty different. Clark took his faith and Mormon theology seriously, I’m a functional atheist. Clark was a Western old school Republican, I’m an Obama-Democrat. Many of our discussions were on politics — he loved the ins and outs of democracy.

I miss Clark's voice. I’m sad I’ll never get to drop in for chocolate. I mourn for his family and all who loved him.

• David Clark Goble Obituary - Visitation & Funeral Information
• Remembering Clark Goble | Times & Seasons 
• Clark's Tech Blog | Trying to figure it all out a post at a time
• Clark and my last twitter conversation - Aug 27, 2019

Bicycling North Dakota's Maah Daah Hey trail with Western Spirit

Last week I bicycled most of North Dakota’s Maah Daah Hey trail. The New York Times’ John O'Connor described it in 2018 (emphases mine) ...

… One moment I was bouncing along, knee-deep in sagebrush, mind reeling from all the natural beauty zipping by, and the next I’d caught a wheel on a rock and gone sailing into that familiar somersault: butt rising from the saddle, shoulders twisting violently, hips lurching up-and-over, heels actually clicking midair, sunglasses and water bottle and half-eaten Clif Bar hurtling into the trees, the ground closing in...

… it had been my idea to cycle the Maah Daah Hey Trail, the longest and arguably most grueling single-track mountain biking route in the United States...

… I was an unlikely candidate for the trip: I had never ridden a mountain bike before, or even camped much….

I read that introduction before the ride and I scoffed. How would O'Connor  know about going OTB (over the bars) if he’d never ridden a mountain bike? And wasn’t riding a “grueling" single-track absurd for someone with no prior experience?

So of course I went OTB on my first day on the trail. Damn water break bumps, I really didn’t know how to ride them at speed. I learned.

Anyway, after doing that trail outfitter glamping style I gotta admit that while O'Connor doesn’t have the best judgment, he is pretty tough. 

I could write a lot about the experience. The crew I rode with were each worth a story of their own! Alas, I don’t have the time or talent to do that justice. Instead, since I’ll share some things I wish I’d know before the trip. 

Western Spirit

There are two full service outfitters that supply guides, food and water, and gear transportation. I used Western Spirit, but I’m told the competition is also excellent. Dakota Cyclery will do gear transportation but no longer does guiding, I think it works with both outfitters.

This was my first experience with an adventure cycling outfitter. Some things I didn’t know:

• Our guides were superb. They were also extreme athletes, so they have different attitudes towards “steep” and “exposure” then civilians.
• The foot is amazing — quality, quantity, variety. Our guides really knew how to cook. Probably 4000-5000 calories a day plus gel packs, snacks, bars, etc. I neither gained nor lost weight and I ate a lot.
• I drank 4-5 Liters on a hot day and I was still behind. Have a big hydration pack and make sure you fill it. The guides expect you to know to do that.
• Guides supply gel packs and sunscreen, but to be safe you should carry your own as well.
• Bring your own derailleur hanger. They don’t have those for every bike. Also a replacement chain link in case the join link brakes.
• You are expected to tip. I’m not sure how much, but on a $1200 tour 15% is about $200. The ideal is one rider collects funds and presents them as a single gift. Have cash with you.
• One guide rides sweep and one rides truck. Unless you’re dead last you may be well ahead of the guide. Some days I had a lot of time alone on the trail.
• You can bring a four person / family tent, it doesn’t have to be a backpacking tent.
• We didn’t do the whole trail. We started at a camp site about 16 miles south of the Northern CCC terminus, so south of China Wall (never saw it). They did a Friday ride on a different but really excellent trail that was basically a sub for that segment.
• My companions were older than I’d expected and they were all more skillful than me. Of our group of 7 four were over 60 including our best descender. I think mountain bikers do the Maah Daah Hey when they’ve done everything else many times and are looking for something different.

Maah Daah Hey notes

• The trail doesn’t seem technical compared to Sedona or Moab, but it has its own challenges. There are a lot of steep climbs with marginal traction — only the super-strong and skilled can nail every one. There is exposure on loose surface tight off-camber downhill hairpin turns. There are deep ruts that suddenly appear along the trail that you don’t want to hit at speed. The working trail itself is effectively narrow, a tire worn 8” dirt path with grass alongside. You need a smooth pedal stroke and good control to avoid hitting the grass ledge along the trail.
• Unless you’re really good you can’t look around and ride, you need to stop to take in the scenery.
• Everyone in my group had a modern XC/Trail bike — dropper post, 1x12, tubeless, full suspension, 29” wheels, slack geometry. Everyone … except me. My bike was out of the mists of time. If you don’t have "that bike" I recommend renting from your outfitter or Dakota Cyclery.
• Flats or Clips? Most do Clips, I did Flats because I was willing to sacrifice some climbing power for faster exits. Clips make for smoother pedaling though, and make it easier to stay on the narrow trails.
• If it rains you are screwed. The trail has been getting more rain the past few years … which makes the landscape surprisingly green but the trail unrideable. The Bentonite soil turns to cement, only a very strong rider with lots of frame clearance can get anywhere. Rain is the achilles heel of the Maah Daah Hey. We were lucky to have only one rainy day and 2-3 h of hike-a-bike. If rain persists outfitters bail to hikes and gravel rides. It’s a risk.
• In September there were almost no bugs at our campsites!
• You don’t see bison. This is ranch land, bison are not welcome. You see lots of very healthy and powerful looking cows and maybe some gazelle. We heard lots of coyotes but didn’t see any.
• We met 2-3 people total on the MDH trail over 4 days. There were hunters at the campsites; they campsites are all reachable by road.
• We crossed the Little Missouri twice carrying our bikes, there are multiple stream crossings. Don’t try to ride across, you’ll get mud everywhere.
• You can get lost. The trail is well marked until it isn’t. It’s good to have guides. There are one or two spots that could kill someone moving fast in the wrong direction.
• The landscape is more diverse than I’d expected. Badlands, grasslands, even some thin forest. It really is beautiful to ride across, not least through the wide grasslands.
• I bought inexpensive sun sleeves and a weird geeky neck/ear sun cover that fit under my bike helmet. They were great.

More updates and revisions to some … if time allows ...

Sorrow for the Long Tail - the memory machine I will never see

There are several software products I want nobody will build.

For example, I want a “screen saver” that will randomly select from a collection of video and still images and display them across multiple screens.

Pretty much like Apple’s annoying [1] screen saver, but for video it would randomly select a xx second file segment and play that without sound.

I don’t think anyone will ever build this. It’s too hard to do [2] and there’s no money in it. Only a small number of people would pay, say, $20 for this. Maybe 1 in a 1000. After expenses and marketing it would be hard to earn even a few thousand dollars.

Which reminds us of the false promise of The Long Tail. Those were the days that Netflix had a huge catalogue of barely viewed movies [3] that were often very fine. We thought there would be business for the interests of the 0.1%. That didn’t happen.

This is why I’ve given up on trying to predict the future ...

--

[1] Whenever macOS cannot connect to the folder hosted on my NAS it reverts to the default collection. I need to restore my share and I’ve never been able to find an automated way to do that. On iOS things are much worse. Speaking of products I want, I’d pay $20 for a macOS utility that that simply reset my screen saver to my preferred share.

[2] We never thought software development would keep getting harder. We used to think there would be a set of composable tools we could all use (OpenDoc, AppleScript, etc). We expected a much more advanced version of what we had on DOS or Unix in the 80s or the early 90s web. Instead we got AngularJS.

[3] In the mailer days our kids movies were unplayable due to disc damage about half the time. Finally gave up on that.

Rough personal notes on review of management of degenerative lumbar spondylolisthesis with lumbar spinal stenosis and pseudoclaudiation

Every so often I review a medical topic and stick my notes into Simplenote for later reference. The reviews are quite messy since it’s just for my use. For what it’s worth, some hasty notes on this topic.

IMAGING

Initial Plain film: spondylolysis/listhesis. Standing flexion/extension lateral plain film, oblique (for pars interarticularis), AP for severity. (or just lateral, oblique and AP). See https://emedicine.medscape.com/article/2179163-workup

Considering surgery: MRI (neurosurgeon will have preferences)

---------------

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270383/
Degenerative spondylolisthesis - European perspective - 2008

“Symptoms of neurogenic claudication that cause the patient to stop and sit after less than two blocks of walking usually correspond to the time, when the patient consents to surgery …

…. The plain radiographic features include the essential finding on a lateral view of forward displacement of L4 on L5 or, more rarely, L5 on S1 or L3 on L4 in the presence of an intact neural arch. Defect of pars interarticularis (which has the appearance of a Scottie dog with a collar) that can be seen on lateral or bilateral oblique views helps to distinguish between DS and isthmic spondylolisthesis …

… Only 10–15% of patients seeking treatment eventually will have surgery…

… The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. LBP improved following a decrease in the total intervertebral space size. The development of osteoarthritic spurs, hypertrophy and ossification of the intervertebral ligaments, and facet arthrosis may lead to secondary stabilization that prevents slip progression…

Indications for surgery:
1. Persistent or recurrent back and/or leg pain or neurogenic claudication, with significant reduction of quality of life, despite a reasonable trial of non-operative treatment (a minimum of 3 months).
2. Progressive neurological deficit.
3. Bladder or bowel symptoms.

--------------

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357993/ (2019 review, neurosurgery)
A systematic review of the literature has shown that delaying surgery for a period of conservative management is not associated with a worse surgical outcome and that surgery is more effective than continued conservative treatment when conservative options have failed for a period of three to six months…
… minimally invasive surgical approaches that preserve stabilizing paraspinal musculature …

————————
Some other odds and ends:

- We suggest that the angular instability of the intervertebral disc may play a more important role than neurological compression in the pathogenesis of disability in degenerative lumbar spondylolisthesis (this was weird — from MRI study of axial loading)

- Vanderbilt neurosurgery study from 2014 claimed medical management didn’t work but it looked like a horrible study

- BMJ review of 2016 was down on non-surgical treatment but not super keen on surgical. Consistent with trying conservative management for some time before trying surgery.

Warmer climate on the earth may be due to more carbon dioxide in the air. 1956.

Originally published in the NYT Oct 28, 1956 by Waldemar Kaempffert. Reprinted as Climate Science in 1956 and 2015 | HuffPost:

The general warming of the climate that has occurred in the last 60 years has been variously explained. Among the explanations are fluctuations in the amount of energy received from the sun, changes in the amount of volcanic dust in the atmosphere and variations in the average elevation of the continents.

According to a theory which was held half a century ago, variations in the atmosphere’s carbon dioxide can account for climatic change. The theory was generally dismissed as inadequate. Dr. Gilbert Plass re-examines it in a paper which he publishes in the American Scientist and in which he summarizes conclusions that he reached after a study made with the support of the Office of Naval Research. To him the carbon dioxide theory stands up, though it may take another century of observation and measurement of temperature to confirm it….

…. The atmosphere acts like the glass of a greenhouse. Solar radiation passes through to the earth readily enough, but the heat radiated by the earth is at least partly held back. That is why the earth’s surface is relatively warm. Carbon dioxide, water vapor and ozone all check radiation of heat.

Of the three gases that check radiation, carbon dioxide is especially important even though the atmosphere contains only 0.03 percent of it by volume. As the amount of carbon dioxide increases, the earth’s heat is more effectively trapped, so that the temperature rises.

... According to Dr. Plass, the latest calculations indicate that if the carbon dioxide content of the earth were doubled the surface temperature would rise 3.6° C and that if the amount were reduced by half the surface temperature would fall 3.8° C...

...Despite nature’s way of maintaining the balance of gases the amount of carbon dioxide in the atmosphere is being artificially increased as we burn coal, oil and wood for industrial purposes. This was first pointed out by Dr. G. S. Callendar about seven years ago. Dr. Plass develops the implications….

… Today more carbon dioxide is being generated by man’s technological processes than by volcanoes, geysers and hot springs. Every century man is increasing the carbon dioxide content of the atmosphere by 30 percent — that is, at the rate of 1.1° C in a century. It may be chance coincidence that the average temperature of the world since 1900 has risen by about this rate. But the possibility that man had a hand in the rise cannot be ignored.

Whenever the cause of the warming of the earth may be there is no doubt in Dr. Plass’ mind that we must reckon with more and more industrially generated carbon dioxide. “In a few centuries,” he warns, “the amount of carbon dioxide released into the atmosphere will be so large that it will have a profound effect on our climate.”

Even if our coal and oil reserves will be used up in 1,000 years, seventeen times the present amount of carbon dioxide in the atmosphere must be reckoned with. The introduction of nuclear energy will not make much difference. Coal and oil are still plentiful and cheap in many parts of the world, and there’s every reason to believe that both will be consumed by industry as long as it pays to do so.

I believe current predictions are on the order of 2C with doubling CO2 with longer term higher secondary increases. So bit less than 1956 model, but on the other hand the effects on climate have been obvious sooner than expected.

Overall, holds up quite well.

The rules change

On the 9th of August 2009 I wrote a post on at the start of my 51st year. It included an estimate that I was at "70% lifetime strength”. That was an improvement over June of 2008.

I figured it was downhill from there.

I was wrong though. Four years later, in April of 2013, I started doing CrossFit. It’s enlightening to look back at what I wrote then:

… I now do CrossFit twice a week; that's about as much as I have been able to safely handle. I currently need 3 days to heal between each session. Between sessions I do my usual 2 hours of bike commuting one day a week...

...After five months, despite my back strain injury, St Paul CrossFit has worked well for me. I haven't developed much visible muscle, but I'm significantly stronger and I can handle more exertion. My weight didn't decrease until about month 4, since then I dropped 8 lbs and am close to my optimal weight.

The net effect is that physically I perform and feel more like I did at 44 than at 54. That's a big difference; if I feel at 62 the way I was at 52 I'll be content.

I'm not as keen on CrossFit as some but I enjoy the people, the exercise, and the game of staying within my limits … I'll probably go to three times a week when ice and snow stop my bicycle commute...

… At 54 I'm into managed-decline rather than improvement, but at 34 I'd have been tempted. CrossFit workouts are intense -- and I'm not sure five or even four workouts a week makes sense for most 35+ bodies…

Six years later I would frequently do CrossFit five times a week, and I usually managed four times a week. At age 59, six years after starting, I amazed myself by surviving a 300 lb deadlift. That’s warmup weight for a strong middle-aged man, but it was a lot for me.

I got my dubs last year.

I've had several weight lifting and gymnastic personal records in the past two years. “Managed decline” didn’t happen at 54 after all -- despite being hit by the familial arthritis train at age 56. In retrospect, while my physiologic maximums had been declining for decades, there was more head room than I’d expected. I just started living closer to that maximum performance level.

But we know how the story ends. We know what 85 looks like. There’s a steep descent ahead.

I think I’ve started that run. Over the past few months I’ve been more fragile, prone to old injury patterns, healing more slowly. I didn’t make my 8/1/ Bar Muscle Up goal (still training though).

My peak performance has met my downward trending physiologic limit.

They probably met in May of 2019 - 3 months ago, but I only got the message last week when a minor back strain passed all my usual fitness tests — and got suddenly worse on a warmup lift. The rules changed.

I greeted this understanding with the mature wisdom of an Old person.

Hah, hah. Not really. I wanted to cry. I was crying on the inside. For a day or two anyway.

Now I have to figure out the new rules. I’m off CrossFit until after my early September Maah Daah Hey mountain bike trail ride — I need to be as rehabbed as possible until I’ve done that trip. So I’m doing my training rides, my rehab weight lifting (my strict pull-ups are 50% improved, also working on a new bench PR!), started swimming again, picking up more inline skating.

I’m studying my Supple Leopard book.

When I return to CrossFit (9/9/2019 is the plan) I can max on the cardio and the body weight reps and I can keep training for my maybe-never-bar-muscle-up, but it will be months before I let myself do serious weights. I have to figure out the new rules.

Maybe next year I’ll do my first triathlon.

Update 12/6/2019

So this week I set new lifetime best weight lifts in clean & snatch, front squat (17 lb increase!) and back squat. More than I’ve ever done before. I was also just 5lbs short of my PR for bench press. Aced every 1 rep max test over 5 consecutive days.

The back? After 6 weeks it was 80% better, after 10 weeks 100%. I think it was a posterior L5/S1 disk — that resolved.

The bar muscle up? No, not quite. But today I was agonizingly close. If I’d piked forward I’d have made it. By far the best ever.

I do not understand all this.

Update 2/3/202

I got my bar muscle up.

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 Carver. St 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.

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.

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.

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.

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 …

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.