Bad back better

Fifteen months ago my insurance paid out over $1000 for about $10 worth of meds so I could stand up and ride home on the floor of a van.

It makes for a good family story, but really nobody was very happy with me. After a nearly 30 year run my strategy of ignoring my back pain wasn't working. I'd gotten pretty good with ice packs, advil, canes and early inline skating, but I'd advanced from an every 8 months problem lasting 3-5 days to every 4 months lasting 14-21 days.

Every doc knows where that story goes. So I bit the bullet, and I saw a doctor (other than myself and my wife that is). Specifically, I signed up with the marines of back rehab - Minnesota's Physicians Back and Neck Clinic (PNBC).

It worked. My back is better now than it's been for at least twenty years. That was probably the last time I went this long without a 'stuck to the floor' acute exacerbation.

It's been long enough now that I know they did right by me. My doc was a bit crispy after decades of doing bad back work, and I was a bit surprised he didn't even bother with a plain film (these guys do very little imaging), but the program he and his buddies established worked. I did about 2 months of PT driven core muscle training and eternal daily stretching routines. I'm still religious about the 10 minute daily stretching regimen. As per my colleague BF's husband, I do them before I get out of bed.

I haven't been as diligent with the maintenance Roman Chair back extensions they prescribe, so I know what I'll have to change if my pain returns. That's my problem though, not a problem with the PBNC program.

Yeah, it's n of 1, but these guys are pretty much smack in the center of evidence-based back pain management -- they're just meaner about it. For n of 2 I'll mention that my buddy ZH was facing grim cervical spine surgery when he went there. They fixed him good - no surgery, full activity, he's a fan.

It's perhaps not for everyone, but if you're in MN, and you've got a really bad back or neck problem, chronic or acute, this is the team to see. Just remember when they want 10 more reps - "Pain is weakness leaving the body".

See also:

• Back pain: an untreatable condition? 2/2004. I have to disagree.

Update 11/21/09: Something I'd forgotten when I wrote this post. For the first few months after treatment began my back often ached. I felt as though I'd spread the severe pain over time, as though the total had not changed but the distribution had improved. I was fine with that, it didn't stop me doing anything. It is only now that I realize that my tolerable legacy symptoms, slowly and without my notice, went away.

Update 7/3/2013 - six years after my summer 2007 injury

Around 2010 I had another episode of reasonably severe back pain and I returned to PNBC for another rehab session. In retrospect that was probably unnecessary, but it proved I'd done a bad job of maintaining my muscle tone.

I have been utterly reliable at my morning stretching exercises, which I credit for 60% of my prolonged remission. The rest is core muscle; I've done better at maintaining that, but it is possible to have too much of a good thing.  In June of 2013, while engaged in an arguably insane level of physical activity for non-elite 54 yo at CrossFit St Paul, I injured my back when I lost form doing my 16th front squat with a 120+ pound bar. (More on CrossFit in a 2013 post I think). Clean and jerk and squats likely voided my PNBC warranty. That pain resolved in about 24 hours, and 48 hours later the discomfort is mild.

It must be noted PNBC's aggressive strengthening program doesn't make one completely invulnerable. (That's a joke.) I'll go easy for the next six weeks, then keep my free weights under 90lbs for the next six months and focus on reps.

After 2009 PNBC was acquired by a local healthcare enterprise; I suspect it's lost a bit of the old intensity. Sadly, their 2009 approach to managing back pain is still radical.

Update 12/24/2015 - 8+ years later.

Over the past 4 years I've had 2-3 back strains related to pushing the envelope while weight lifting, most recently on the dead lift. I don't think one can complain about this sort of thing! So far they've all resolved fairly quickly with nothing like the severe pain I once new. So far :-).

Further notes:

• Acute back strain management - one anecdote 6/2013, I noted this in the last update, since then it's been a template I've followed 1-2 times.
• Bad backs: not necessarily hopeless 6/2014
• Growing old grudgingly: The CrossFit Inversion

How business stories are made - the inside scoop

Dan Lyons, writing as his alter ego "fake steve jobs", tells us how big glossy business magazine stories are made. It's a story everyone should know. (The "filthy hack" is Dan Lyons of course, and he's getting some revenge served cold ...)

The Secret Diary of Steve Jobs: Exclusive Story Opportunity...

...One of the filthiest hacks on the beat has been trying to curry favor with Katie, and she's playing along, pretending to be his friend, hoping we can maybe use him for something at some point. Katie calls this her "back pocket strategy," meaning it's always good to keep a few of these frigtards in your back pocket in case you need them someday....

...If you want to see the full version of the pitch letter you can find it here. I didn't want to fill up this post with the whole thing because it's pretty long. But it's also pretty hilarious reading, especially if you've ever wondered how those big features on giant companies end up in your magazine.

Little hint: The companies think them up themselves, and put together a complete package, with charts and statistics, phone numbers for analysts and "independent observers" (all of them fully prepped and totally on message) -- and then, when they've got the whole thing wrapped up with ribbons and bows, they go looking for a hack to write it up for them.

What makes this case especially ridiculous is that the hack who passed us this pitch has had a somewhat rocky relationship with the Original Borg. In fact, this hack was once on an O.B. blacklist...

Another time the two top flacks at IBM actually met with the top two editors at this hack's publication and demanded that the editors remove this hack from the IBM beat. Another times, an O.B. exec and his minions orchestrated letter-writing campaigns against this hack, bombarding the hack's publications with letters denouncing him. The O.B. exec wrote his own letters to the publication, too, and in his he demanded that the hack should be terminated...

Now they want a favor. Funny how that shit comes around, isn't it?

IBM won't be trying pitches to Lyons for a while. Must have been someone who didn't know the back story.

I gave up on business magazines decades ago. I haven't noticed their absence. Incidentally, Microsoft's effective ownership of the 1980s and 90s industry trade magazines was much more important than is remembered now.

--
My Google Reader Shared items (feed)

Death by rosary bead - poisonous plants

I love the web.

When my science kid asked me about the deadliest plant, I asked Google. Google sent me to the "five most poisonous plants". Plant #3 was used to make Rosaries. I have a strong suspicion that the rosary my mother had 40 years ago was made with this seed ...

HowStuffWorks "Rosary Pea"

.... rosary pea seeds contain the poison abrin. The seeds are only dangerous when the coating is broken -- swallowed whole, the rosary pea doesn't present any danger. But if the seed is scratched or damaged, it's deadly. The rosary pea poses greater danger to the jewelry maker than to the wearer. There are many reported cases of death when jewelry makers prick a finger while handling the rosary pea...

Wikipedia has more on abrin, which, unlike its cousin ricin, has not been weaponized. It's impressive how many of these very poisonous plants are fairly common.

Great material for one of those medical mystery TV shows.

Note mushrooms are fungi, not plants. So they didn't make the list.

--
My Google Reader Shared items (feed)

Why are automotive web sites so ugly and disorganized?

We need to replace our decrepit 12 yo Subaru Legacy wagon. It's done well -- geeky, plain, does the job. It'd be perfect but for the cup holders (problem with manual trans) and the mileage.

It's not easy. I can't find anything like it on the market today (all wheel drive wagon); if the 2005 Outback were still sold I'd buy it immediately (the 2010 model is awful).

So we've been visiting lots of automotive web sites, like Toyota's. As a rule, they're remarkably lousy in a remarkable number of ways. Aesthetically, they're ugly. Poor layout, weak icons, muddy fonts, garish colors, clashing boxes -- the web equivalent of geek clothing. Functionally they're mostly missing the kind of information we're looking for, and few have useful imaging (ex: would need to include human forms to provide scale information).

Why is this? The auto industry may be troubled, but it's a trillion dollar worldwide business. Surely they could afford a few million to hunt down the people who do Apple's web site* and hire them away.

Most large traded companies make very odd choices. Apple is the bizarre exception, probably because Jobs is a force of nature.

* Heck, they could just point someone at the site for the latest iMac, steal everything and paste in some auto images and text.

Update: In a weird bit of synchronicity, within hours of writing this, Daring Fireball linked to an explanation of why American Airlines web site design sucks. It's exactly what I imagine is true of most corporate web sites -- huge teams, lots of hands, lots of politics, lots of executives deciding aesthetics.

--
My Google Reader Shared items (feed)

Eye Glasses and other iPhone health care related apps

I was sure someone would do this (blogged about it) but missed it was out ..

Medical Apps for the iPhone - Pogue’s Posts

... Eye Glasses. As an over-40-year-old, I’ve become addicted to this app. It simply turns the iPhone 3GS into a magnifying glass. Hold it in front of some tiny type—on a menu, a receipt, a ticket, a medicine bottle—and Eyeglasses, after a moment of autofocusing, shows you a magnified version of it on the screen. Keeping your hand steady is tough, and the 6X and 8X images sort of fall apart—but the 2X and 4X views have saved me more than once. ($3)...

I'll buy a copy for the fun factor alone. Nice job.

Pogue tells us there are 7,000 health care related apps, but he didn't find much of interest. The "Anatomy Lab" app might be worth some med school nostalgia points. (Update: Looking at the reviews it's nowhere near the level med students are tortured at.)

--
My Google Reader Shared items (feed)

The magical bomb detecting wand saves Iraqi police

When you read this story, there are 3 things to keep in mind.

The first is that US money, directly or indirectly, pays for these “wands”.

The second is that policemen who discover explosives have a high risk of sudden death.

The third is that Iraqis don’t, by and large, like dogs.

Emphases mine.

Iraq Swears by Bomb Detector U.S. Sees as Useless – Rod Nordland - NYTimes.com

BAGHDAD — … Iraq’s security forces have been relying on a device to detect bombs and weapons that the United States military and technical experts say is useless.

The small hand-held wand, with a telescopic antenna on a swivel, is being used at hundreds of checkpoints in Iraq…

… the Iraqi government has purchased more than 1,500 of the devices, known as the ADE 651, at costs from $16,500 to $60,000 each. Nearly every police checkpoint, and many Iraqi military checkpoints, have one of the devices, which are now normally used in place of physical inspections of vehicles…

… The Iraqis, however, believe passionately in them. “Whether it’s magic or scientific, what I care about is it detects bombs,” said Maj. Gen. Jehad al-Jabiri, head of the Ministry of the Interior’s General Directorate for Combating Explosives…

… Aqeel al-Turaihi, the inspector general for the Ministry of the Interior, reported that the ministry bought 800 of the devices from a company called ATSC (UK) Ltd. for $32 million in 2008, and an unspecified larger quantity for $53 million. Mr. Turaihi said Iraqi officials paid up to $60,000 apiece, when the wands could be purchased for as little as $18,500. He said he had begun an investigation into the no-bid contracts with ATSC.

Jim McCormick, the head of ATSC, based in London, did not return calls for comment.

The Baghdad Operations Command announced Tuesday that it had purchased an additional 100 detection devices, but General Rowe said five to eight bomb-sniffing dogs could be purchased for $60,000, with provable results.

Checking cars with dogs, however, is a slow process, whereas the wands take only a few seconds per vehicle. “Can you imagine dogs at all 400 checkpoints in Baghdad?” General Jabiri said. “The city would be a zoo.”..

… ATSC’s promotional material claims that its device can find guns, ammunition, drugs, truffles, human bodies and even contraband ivory at distances up to a kilometer, underground, through walls, underwater or even from airplanes three miles high. The device works on “electrostatic magnetic ion attraction,” ATSC says.

To detect materials, the operator puts an array of plastic-coated cardboard cards with bar codes into a holder connected to the wand by a cable.

… the operator must walk in place a few moments to “charge” the device, since it has no battery or other power source, and walk with the wand at right angles to the body. If there are explosives or drugs to the operator’s left, the wand is supposed to swivel to the operator’s left and point at them.

If, as often happens, no explosives or weapons are found, the police may blame a false positive on other things found in the car, like perfume, air fresheners or gold fillings in the driver’s teeth…

Effective dog teams: $60,000. Plastic wands: $60,000,000. A thousand fold cost difference, and the wands, of course, do nothing.

It is very likely that good portion of that $60 million sits in the bank accounts of “Maj. Gen. Jehad al-Jabiri” and other Iraqi decision makers. Assuming the wands cost $100 each to make (probably much less) ASTC’s owners must also be rather wealthy now.

On the other hand, use of these wands must have reduced the death rate of Iraqi police over the past year or two. The police may not be as gullible as one might think.

The worst is that this is probably not the worst.

Update: The Onion's monument to human stupidity.

The Abyss. Averted?

A must see graph: The story so far, in one picture - Paul Krugman.

Team Obama deserves our sincere gratitude Alas, it's far from over.
--
My Google Reader Shared items (feed)

Marcia Angell on the corruption of physician expertise

I missed this Jan 2009 quote when it came out. I tracked it down after reading a post Jacob Reider shared (emphases mine, I remember that she was the Editor in NEJM's glory days) ...

Drug Companies & Doctors: A Story of Corruption - The New York Review of Books - Marcia Angell

... The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.

One result of the pervasive bias is that physicians learn to practice a very drug-intensive style of medicine. Even when changes in lifestyle would be more effective, doctors and their patients often believe that for every ailment and discontent there is a drug. Physicians are also led to believe that the newest, most expensive brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect because sponsors do not usually compare their drugs with older drugs at equivalent doses. In addition, physicians, swayed by prestigious medical school faculty, learn to prescribe drugs for off-label uses without good evidence of effectiveness...

I've been long away from the world of practice, but my recollection is that there were very good thinkers on groups like the US Preventive Services Task Force. On the other hand, confident experts ruled the big panels, and they were as predicted, often confidently wrong. (The American Cancer Society was infamous for this, but lately they've surprised.)

Angell may be too harsh, but the reversals of the past ten years (estrogen therapy being only one) should humble all physicians. I'd suggest starting with humility and seeing where we go.

See also:

• Drug reps and their whores - the commercialization of medicine
• Crooked judges and the powerful emergence of corruption

--
My Google Reader Shared items (feed)

The hero of the marketarians ...

Any Rand is the heroine of the marketarians ...

Two biographies of Ayn Rand. - By Johann Hari - Slate Magazine

... In her 70s Rand found herself dying of lung cancer, after insisting that her followers smoke because it symbolized "man's victory over fire" and the studies showing it caused lung cancer were Communist propaganda. By then she had driven almost everyone away. In 1982, she died alone in her apartment with only a hired nurse at her side...

I can see why.
--
My Google Reader Shared items (feed)

My son destroys 2010 Outback sales

My son singlehandedly destroyed 2010 Subaru Outback sales.

It was a considerable accomplishment. Until late 2009 the Outback had been selling relatively well.

That was before my 100 lb son, climbing out of the back seat of a show room Outback, stepped on the protruding black running board beneath the rear door.

And it popped off.

It's not a running board, it's lightweight plastic door trim held on by a few plastic clips. He's not the first person to pop the door trim.

Wow. A manufacturer who'd do something that stupid could do ... anything.

I don't think we're buying a Subara ...

--
My Google Reader Shared items (feed)

Curious world and Google Wave

For some time I've been (Google Reader) following a man named Thomas. Some months ago he liked something I liked (say that three times fast), so I visited his shares and I liked those too.

He lives in Chiang Mai, Thailand. I knew the place a thousand years ago, and knew some people who might live there yet. It was a quiet town then. Now Chiang Mai is a sprawling city.

Today I received a Google Wave invitation. From Thomas, with whom I've never directly corresponded.

Thank you Thomas, I'm looking forward to exploring GW.

Curious world.
--
My Google Reader Shared items (feed)

Reading my writing translated

I have knacks, but not for language. I still remember a bit of the old country however. Which is why it's neat to try to read a blog post - in French (see the drop down on the right side of this page to translate)

Some of it reads sensibly, other bits less so. Some of the word choices seem exotic.

I expect there's a knack to writing for translation. One would author a post, then do a round trip translation. Identify the parts that, on back translation, don't quite work. Do this a couple of times with your target language. Once the back translation is acceptable, you can be reasonably sure the initial translation works.

This would be fairly easy to automate. I'd like to give it a try if the tools were in place. I'm excited about machine translation, even if it's so far had less of an impact than I'd expected.

See also:

• Google reader: now with translation services

--
My Google Reader Shared items (feed)

Wanted: email redirect to google reader note shares

I'm not so keen on Twitter, but I do like Google Reader. Lately, I'm particularly keen on GRs shared posts, notes and microblogging features.

There are just a few more things we need.

For example, the latest version of the NYT iPhone app supports shares to Twitter and Facebook. Alas, not GR shared notes, even though there's an API for creating Google Reader Shared Notes. Maybe this will come to a future app, but these days lots of companies fear Google. The NYT may not want to add this particular link.

Happily, there's always email. It's the lowest common interface; the means to bridge unwilling vendors.

So we need Google to provide a way to post to the GR Notes stream via email or SMS (for email at least they can use the Blogger post secret address approach). Or we need some 3rd party to setup an email gateway that would call the API for creating Google Reader Shared Notes. Mail to a secret address, add to the GR read stream that extends my older memory managers.

This ought to be of interest to people like ping.fm.

Update: I tried sharing this on the (once) official Google Reader Product Ideas site, but it's now rejecting submissions with an error message. So I created a getSatisfaction request.

See also:

• What my blogs are for: memory management and the Google-Gordon geek-mind fusion
• Fewer posts, more shared items – Google Reader changes my memory management
• Strange loops: Google custom and customized search - and a memory blog
• Google's confusing social graph strategy: Google reader friends via Google Chat
• Google reader micro-blogging and changes to Gordon Notes
• Loving Google Reader - Shared post feed
• Share anything in your Google Reader Share feed
• Ping.FM: a router for status updates ... with just one small problem.

Update: Via Louisgray.com I came across an app that syncs Twitter and Reader. It's not well documented, but if it posts Tweets to reader then I can use Twitter as a Notes poster.

Update: Nope, reader2twitter didn't seem to work, and it felt too rough for the likes of me. I tried pointing TwitterFeed to my Reader Shared Item feed, but Twitter output has misplaced URL encoding. It's not the answer, and, really, I'd prefer to use Twitter as a way to post items to my Google Reader shares -- not the other way around.

Facebook has the eBay disease - the Farmville story

eBay went downhill because they made money off scams.

They didn't run the scams, but they didn't fight them that hard either. eBay's execs wanted the revenue, and they didn't worry too much about where it was coming from. Later, when eBay's reputation was about shot, new management started fighting the scams. Maybe too late.

It's hard for a publicly traded company to be virtuous. It's easy to separate revenue from sources. I give Google credit for avoiding this trap.

I think, however, that Facebook is deep in it ...

Slashdot Games Story | Scams and Social Gaming

... The article asserts that Facebook and MySpace themselves are complicit in this, failing to crack down on the abuses they see because they make so much money from advertising for the most popular games...

In Facebook you can hide people, or you hide individual apps, but you can't hide large classes of apps. On the iPhone FB app you can't hide apps at all. If you're annoyed by the social propagation of annoying apps you have to defriend the person -- who may be a family member.

Facebook gets a lot of money from apps. They don't get much money from direct ads (when was the last time you clicked on one or even remember seeing one?).

Facebook is at risk for the eBay disease. It might be too late for them already ...

Update 11/1/09: I was wrong. Facebook hasn't caught the eBay disease. In their case, it was congenital disorder. Wow. So FB's revenue stream is significantly based on getting cell phone numbers to promote phone fraud? Apparently I'm not the only one to ignore the ads.

By comparison, Google really isn't Evil.

Update 11/7/09: More on the effective conspiracy between shady apps and facebook.

Update 11/8/09: The NYT completely blows the story and Dan Lyons nails them for it. Old media fails. Lyons also recaps the story with links to all the Arrington/Tech Crunch coverage:

• Scamville: The Social Gaming Ecosystem Of Hell (play on Farmville)
• How To Spam Facebook Like A Pro: An Insider’s Confession
• Offerpal Tries Out A New CEO. Shukla, Queen Of Scams, Is Out.
• Zynga CEO Mark Pincus: “I Did Every Horrible Thing In The Book Just To Get Revenues” - such as getting users to download spyware
• “Horrible Things” Slink Back Into ZyngaScamville: Zynga Says 1/3 Of Revenue Comes From Lead Gen And Other Offers - "lead gen scams" explained. These trick users into paying for worthless recurring expenses like "learning CDs" and shady mobile phone subscriptions.
• Zynga’s FishVille Sleeps With The Fishes For Ad Violations: Farmville and other Zynga apps running scams make up 10-20% of Facebook's total revenue. Talk about a conflict of interest.

Bad genes, bad people and a crisis of punishment?

If every there was a slippery slope, it began the day we allowed that a two year old who'd pocketed some candy should not be sent to the penitentiary.

The rest was inevitable. We allowed that someone who didn't know wrong from the sparkly fairies whispering in their ear might not get much from the rack. Maybe it didn't make sense to judge someone who couldn't learn to read as harshly as a wall street banker*.

So now we have bad genes mitigating murder or perhaps driving violations.

Where will it all stop? Will we decide that nobody can be guilty of anything? Will we think that a fine IQ might be offset by lousy judgment, or that a miserable upbringing and an odd personality might equal the diminished responsibility of active schizophrenia?

Why if we walked this all the way back, who could we punish?! We'd only be able to treat and manage!

Unthinkable.

See also

• Diminished responsibility: the next cultural battleground
• Changing attitudes about mind and responsibility: Patricia Hearst
• Addiction and disease: My comments on the TIME Science blog
• Free Will RIP - The Economist on preemptive punishment
• How common are false convictions?
• Special needs criminals
• Using electric shocks to manage the behavior of special needs children and adults

*ok, so we're working on that one.

--
My Google Reader Shared items (feed)