I wrote this in 1997 and found it in my old pre-blog Web 1.0 archives. I decided to republish it here because, you know, I could. Some of it may even be relevant today.
Before blogs we did this kind of thing in wysiwyg tools (FrontPage 97 for this piece) and then FTPd to a web server.
The original page is still on the web but it is not known to Google. Astonishingly it's in the Wayback Machine.
Copied from a tweet of mine, a cartoon explanation of our peculiar economic situation.
1. Wealth became extremely concentrated.
2. Returns on labor for 40% of Americans fell below modern standard for economic life.
3. Good investments became hard to find.
Something had to give. COVID broke the dam.
Update Oct 18, 2021: I wrote Trek a paper letter (!) about my experience and they are working on removing any references to trailside Mino Link maintenance. They are also sending me some nice swag for my troubles. (Lastly, yesterday I found the lost Mino Link spacer in the dirt of my driveway. So now I have an extra!)
----
The Trek Mino Link is a feature of the Fuel EX. It lets you raise or lower the bottom bracket depending on whether you prefer fewer pedal strikes or a lower center of gravity. Trek says: "Mino Link lets you quickly and easily make small geometry adjustments to suit your riding style or terrain."
As of Sept 2021 Trek's Mino Link video claims you can even swap your geometry on the trail.
I am here to tell you that you we would be insane to touch the Mino Link over dirt. If you're going to mess with the Mino Link do it over light carpet so you can see what falls out and pick it up -- especially the critical spacer/washer. A sterile environment would be nice.
The 2021 Mino Link is a problematic design. (The YouTube videos I've seen describe an earlier version that the nut and the bolt, I can't speak to that design.) That doesn't mean you should avoid the Fuel EX -- I really like mine. It does mean you should treat the Mino Link cautiously. If you aren't mechanically inclined have your local shop swap it. If you are then do it over that light carpet. Check that it's secure each time you ride (I do before and after).
The problem is the washer:
SUSPENSION PART GENERIC WASHER 10 X 16 X 3.0 Item: 601479594559
Those two black washers fit are supposed to fit on the inside of the bearing race shown below. The race that's scarred up because the washer fell out when I was adjusting the Mino Lake and it took weeks for me to figure out what had happened:
Sunday: CrossFit and family bike ride/Nordic ski, in winter coach special hockeyMonday: CrossFitTuesday: Home CrossFit with Emily and #2 (a relative rest day for me)Wed: Mountain bike (summer) or Fat bike (winter) ride with a friend - can be intenseThur: Inline skating or Mountain bike with #2 (rest day)Fri: CrossFit (plus Hockey in winter)Sat: Road bike ride, Fat bike in winter, sometimes just a rest day
In addition I do my rehab exercises at least 4/week. I've come to love the Romanian Deadlift (RDL). I struggled a few years ago when gyms eliminated the therapeutic back extension machine I was taught to use but my PT signed off on my RDL program and it's worked well.
So far I'm still on the the 30 year plan. In 2014 I figured I'd have to downshift at 65; that sounds about right with another drop at mid-70s and dead at 85.
What's changing? With age I do a better job of relative rest days (2-3 a week of easy activity) but there are still more things I want to do than I have time for. I'm having trouble eating enough to build muscle (also limited by age related stem cell depletion). If/when I retire I will have more time to work on strength development, that's currently hard to fit in. Mountain biking is an odd problem -- it's great exercise, I love doing it -- and I'm getting too good at it. I'm good enough to do trails where a mechanical failure or a personal mistake could lead to serious injury. I should be wearing a full face helmet -- but at my age that's insane. So I have to back off a bit. It's hard to do ...
We've used our Schwinn IC 4 cycle trainer for about 10 months now. It was a pandemic purchase in December of 2020. The same trainer is sold as a Schwinn IC4, a Bowflex and a Nautilus.
We paid $900 from Dicks sporting goods. In September 2021 it's closer to $1000. It may be the only decent trainer left that doesn't require a Peloton-style subscription.
It's worked well for us. The only crappy part was the pedals, but the manufacturer expects those to be replaced. My son likes SPD clips so we use those with an adapter for shoes. The magnetic resistance is easy to adjust and quiet. Unlike trainers that attach to a bicycle it's easy to move and adjust for different heights (in our home 4'11" to 5'11"). There's a mount for iPad and a USB power out.
The trainer connects with Zwift on my son's iPad via Bluetooth and transfers the calculated power output. So if you adjust the magnetic resistance but keep a constant pedaling cadence then the power output goes up. The power output is reflected in Zwift cycling speeds. Unlike more expensive units the resistance doesn't vary based on the Zwift simulated course -- but if you go "uphill" in the simulation your power output converts to slower speeds. So it works.
It comes with a heart monitor that worked when we tested it but we never use it.
It weighs 106 lbs and comes with front wheels that make it easy for me to move. That turned out to be much more important than I expected, we move it around depending on what we're doing in the home gym.
Besides Zwift (my son has a subscription for $15/month) I tested connecting it to a bundled "ExploreTheWorld.app" and "Peloton.app". You can't connect to an Apple Watch. ExploreTheWorld came with 4 free videos ws not very interesting.
Peloton is all classes ... lots and lots of classes. It behaves like a real iOS app with a slick signup. You get 1 month free then it's $14/user. You have to adjust the resistance yourself, the Peloton app can't change it.
Zwift is simulated rides with an avatar and lots and lots of group rides and routes. The UI is pretty crude on an iPad, I think it's made for a giant low res display or maybe a remote monitor. You get 23KM free then it's $15/user/month. We got a Zwift account for my son, the rest of us just watch our iPad or use the trainer for intervals in our family CrossFit workouts.
Representational drift, if validated, tells us that a memory is a set of relationships, not the specific neurons that embody those relationships. This sentence might be rendered in electrons or ink, but it has the same meaning.
Reading an article about this reminded me about an old concern with drugs that aim to treat Alzheimer's by reducing amyloid accumulation in neurons. Drugs like the recently approved (and seemingly minimally effective) monoclonal medication aducanumab. The root problem is that we don't know why neurons accumulate amyloid. There's been a growing suspicion over the past few years that amyloidization might in some way be helpful.
I wrote about one way this might play out in a twitter post which I've revised here:
Representational drift reminds me of a theoretical problem with aducanumab and amyloid therapy for Alzheimer’s dementia. It begins with recognizing that we don’t know why neurons accumulate amyloid.
Many suspect amyloid has a physiological reason to appear in neurons. Suppose, for example, amyloid is the way old crappy neurons are "retired" from forming memory relationships. Amyloidization would then be the brain equivalent of marking a SSD region as unusable.
A system like this would have 2 kinds of bugs. It might be too aggressive or not aggressive enough.
If the retirement mechanism is too aggressive then neurons will be amyloidized prematurely. They could have still formed useful memories, but now they're dead. The brain can only produce so many neurons so it runs out prematurely. Early dementia develops. In this case a drug that cleared amyloid could help -- as long as it wasn't too aggressive. The balance may be fine and hard to get right.
If the retirement mechanism is too permissive then a lot of flaky neurons accumulate without much amyloid. Dementia follows from this too -- but it might look clinically quite different. In this case a drug that cleared amyloid would make the dementia worse! Even more flaky neurons would accumulate.
Even if the balance is just write we do run out of viable neurons. Even a very healthy centenarian has only a fraction of the cognition they once had. Again, in this case, an amyloid clearing drug would make the brain worse.
If this was the way the brain worked then an amyloid reduction drug would make some dementia worse and some better. The net effect would be quite small -- even if the medication worked perfectly and was dosed correctly.
All speculative. Come back in 5 years and see how it turned out.
I'm a physician. Ok, so it's a very part-time practice; I'm mostly a bureaucrat trying to keep civilization together. Still I have the degree and the board status and I listen to The Curbsiders religiously. So I was really annoyed when my left leg swelled up after a modest knee injury and I didn't know why.
It wasn't just me; neither did my physician wife nor my colleagues nor the veteran ER doc I saw nor my CrossFit Physician colleagues. Nobody had an explanation. My rheumatologist had a story though, and I'll get to that one.
Legs swell for several reasons, but the textbook ones I know of are infection, bad veins, bad lymphatics and a backed up/overloaded drainage system (heart failure, kidney failure - usually both sides same). Less common causes are muscle damage (compression syndrome, rhabdomyolysis) and (rarely) tumors. Inactivity, esp sitting, makes most things worse.
My leg wasn't infected. I didn't think my veins had obstructed but I have a family history of clot [1] so I did get an ultrasound -- all good. My muscle, heart and kidneys are all reasonable for age. I didn't think my familial [1] "osteoarthritis" (better called mysterious arthritis) had messed up my lymphatics.
So I was mystified. Why had a knee tweak turned my left (below) leg* into a painless swollen ("edematous") bag with a good half-inch of tough pitting edema over my shin? True, I have an old somewhat arthritic cartilage-depleted knee ill-suited to 150 double-under badly executed rope jumps. True, after the jumps my knee had some kind of meniscal tear and a medial ligament strain. Still, it seemed disproportionate.
I bought a cheap Amazon compression sock that worked better than I expected and I did my usual careful injury care. Meaning I did a lot of mountain and road biking and whatever CrossFit my injured knee could handle. Sitting made the leg swell, sleep and exercise with the compression sock (esp. biking) made it better.
Over the course of about 3-4 weeks the knee improved and the leg swelling mostly resolved. I still didn't know what was going on though. For a while I wondered if I'd ruptured a Baker's cyst (an arthritis thing) doing a heavy squat, but my knee effusion didn't flatten out and the volume seemed too high and persistent.
So I asked my rheumatologist. He claimed I had "reflex sympathetic dystrophy"- see also fpnotebook's great summary. Textbook RSD (now more often called "complex regional pain syndrome") is a badly understood and ill-defined disorder with a dismal prognosis. Patients I've seen with it usually have debilitating chronic pain and often have mental health issues that predate the injury.
I had no pain that I noticed but he claimed this was not unusual in his experience. Reading the online references as a grumpy old seasoned physician I can confidently say we have no idea why things swell in RSD and that the handwaving talk about autonomic dysfunction and inflammation is mostly bullshit. I do believe there's a genetic component [1] and that the articles are correct to recommend exercise and compression. Once again my exercise addition led to a good outcome [2].
So, yeah, I'll go with RSD, which in this case translates as "it swells because you have a (somewhat rare) genetic malfunction in your injury response and the correct treatment is compression and exercise". It didn't show up in the differential of the textbooks I read, but I'll see if my friend Dr. Scott Moses will add it to his fpnotebook article on unilateral edema.
* technically and pedantically the leg is part of the lower limb below the knee but of course we use it to mean lower limb.
[1] All courtesy of my beloved mother who died age 87 of every possible medical condition (she lived on pure wilfullness). I inherited all her bad genes and, yes, she had bad leg edema. My father by contrast had only a bad back and post-90yo dementia but I inherited his back and probably the dementia disposition too. Happily my children are adopted.
[2] My back praises the Romanian deadlift.
Update 11/7/2021, wow, that's one ugly looking photo. I don't know what it was, or why it happened, but I guess I'll go with RSD plus some dubious lymphatics. My knee got better over 8-10 weeks and the edema resolved over 4 to 16 weeks. Sometimes I have trace pre-tibial edema but mostly nothing.
Update 4/12/2023: Never came back. So weird.
My trail bike is a 2010 Cannondale Scalpel I bought used. It was a state-of-the-art racing machine in the 26" era and it's light and fun to ride.
Today I rode a friend's 2018 Trek Fuel EX alloy bike with 27.5" wheels. The Scalpel is lighter and has nicer brake levers -- but in every other way the $2,500 Fuel EX is a much better bike. Faster to climb, faster to descend, faster to cross country, better on the bumps, better shifting over a 1x range.
Huge price drop for better quality in 8 years. That's faster progress than my MacBook.
Then the workout.
Somewhere in my twitter stream mention was made of the "virtual camera" and its advantages for videoconferencing especially as a replacement for screen sharing.
Sounded interesting, so I went looking for more information. I thought it would be an easy google search.
All I could find, in written form, was one quickly written blog post from 2019.
Twenty-five years ago a similar topic would have had a deep technical article in BYTE and a myriad of articles in PC Magazine, Mac User, and the like. Fifteen years ago there would have been hundreds of excellent blog posts. Google would have found them all.
Now Google finds almost nothing.
How is discovery happening in 2021? I'm ancient, so I'm quite ready to believe there are sources I don't know about (and Google, evidently, doesn't care about). What are they? What is the replacement for Google search?
I'm a fairly average sleeper for my age, but this morning I gave up a bit before 4am. With the unexpected time I finished Yuval Harari's 2015 book "Sapiens: A Brief History of Humankind". (The "finishing" part is a bit unusual, I too often lose interest 80% of the way through many books.)
Sapiens was, I've read, quite popular with the Silicon Valley set. So I was prepared to dislike it from the start. In truth, while I can see why the Captains of Industry were fans, it's not a bad book. I'd grade it as very good to excellent.
I didn't learn much new -- I have read many of the same things as Harari. I was reminded, though, of things I'd forgotten -- and he touched on many of my favorite themes. If I'd read this as a young person I might have found it astonishing.
What are the flaws? He has a weird definition of "The Liberal" and he really dislikes whatever he means by that. He has a thing about Hosni Mubarak -- a loathsome person, but an odd choice for chief villain. He is glib, but that's a necessity in a book like this. The glibness is somewhat offset by his habit of critiquing his assumptions at the end of each chapter. He's weakest when he strays into the sciences, particularly biology. Since he wrote this book we’ve seen Trumpism, the rise of Xi, and the slow burn of the Left Behind — events that might cause reconsiderations.
I liked the repeated reminder that non-human animals have paid a terrible price for the rise of humanity. Most books of this kind don't consider them.
In a book of this sort one constantly tries to decipher the author's agenda. What does Harari truly think? He clearly admires Buddhism; I would be surprised if he were not a practitioner of the more intellectual forms of Buddhism. He has a love and admiration for capitalism that outshines his self-critique. On the current American spectrum of political ideology he'd be a techno-optimist libertarian to the right of Obama and me (his characterization of the British Empire is more than slightly incorrect.)
Most of the time the book affirmed my own beliefs and reminded me of things I'd forgotten. Sometimes it annoyed me, but in a way that forced me to examine my priors. It's aged well -- even if some of his 2014 near-future predictions look to be still a decade or two away. I recommend it.
I usually share my blog posts to Pinboard, and from there some creaky old services create tweets and an archive on kateva.org/sh. Not this post though. This post is purely for the search engines. Here I will reveal knowledge lost to humanity. As far as Google can tell, it's not available anywhere but here.
I have been through 3-4 kinds of cross-country ski binding -- 3 pin, something with a post that went straight up (Salomon?) and then bindings I thought of as SNS (in fact they are all SNS Profil, the first version of SNS). I have SNS Profil bindings on 3 "classic" skis all between 25 and 38 years old. All work quite well and, given the limited present and worse future of Nordic skiing I've no reason to replace them. (I'd buy skate ski gear if Minnesota winter were not dying, but I invested in a Kona Wo fat bike instead.)
Which brings me to the point of this post. The bindings work, but after 40 years or so the boots have disintegrated. I needed to either replace the bindings on 3 skis (does anyone even do that on such old gear?) or find SNS boots. Problem is Salomon stopped making SNS boots sometime in the past decade. They are an obsolete proprietary system that was replaced by NNN (and probably more modern proprietary variants too). I might be able to find used boots, but that's a long slow process. Happily, in this one area, Google still works. I found a new pair of Salomon R/Pilot Combi (Combi because they are supposed to work for classic and skating) boots from Boulder Nordic Sport and had them shipped to my home in Minnesota. Despite being marked as US size 10 they were EU 44 -- really US 10.5. Even then they are bit on the generous side, but they fit me well enough. I think Solomon made biggish boots.
They also fit my bindings. They came with a tiny manual that actually describes what ancient discontinued Salomon boot fits which binding types. This is information that can be found nowhere else -- but even this obscure manual is misleading. So here is an enhanced version:
SNS PROFIL boots with 1 bar at toe -> SNS PROFIL bindings
SNS PILOT boots (1 bar at toe, 1 under ball of foot) -> SNS PROFIL bindings and SNS PILOT bindings (in other words, all SNS)
PROLINK boots -> PROLINK or NNN bindings
NNN boots -> PROLINK or NNN bindings
The Salomon's site for my R/Pilot Combi boots says they have 1 rail, but in fact they have two rails. Which fits their name. They do seem to fit my old Profil bindings, just as this old web page says (emphases mine):
... Some of the boots that use the Salomon SNS Profil binding include Salomon, Atomic and Hartjes...
... Salomon also makes SNS Pilot bindings, and while Pilot boots can be used with a normal Profil binding, normal Profil boots cannot be used with Pilot bindings. There’s an extra hinge thingie on the Pilot bindings that attaches to the center of the Pilot boots and there’s no attachment point on the Profil boots...
In short, if you have SNS bindings, the "Pilot" boots should fit them.
PS. More on these old obsolete gear from the "binding confusion" page:
There are two main versions of the SNS Series, the Profil and the Profil Pilot ... the black, extra hinge attachment plate in the middle of the Pilot binding.
... There’s only one cross bar on the SNS Profile and two cross bars on the Pilot. The Pilot system was intended to help stabilize the boot for skaters but I like it better for classic style striding as well.
There is both a manual and automatic version of the SNS Profil. The difference between the two versions is you physically have to open the manual styles by lifting up on the toe piece of the binding and the automatics you can simply step in to attach and use your ski pole to push down the release button on the toe piece to step out of them....
... Salomon also has the Propulse binding, which promises greater kick, but as far as I can tell, it accepts all SNS Profil boots...
This is the last in a short series of post that began on Nov 11, 2020, shortly after Biden won the presidency for the first time. Back then it looked like McConnell would hold the Senate.
In the decades since that post Trump became more insane than usual, a deranged mob of Trump cultists invaded the Capitol building, the Dems took the Senate, and Biden won the presidency for the third or fiftieth time depending how one counts. Truly, I need to finish this series while we still have electricity.
In the first post I wrote about how I think about the Trump voter (and America). I divided the Trump voter up into the religious fundamentalist (sometimes Trump cultist), the despicables (ex: Hawley, Cruz, the WSJ reader), and the Left Behind. The NYT profiled a Left Behind on 11/7/2020 (emphases mine):
... Nick [a] 26-year-old hair stylist ... spent the past few months campaigning for President Trump, taking special satisfaction in offending Biden supporters...
... He did not go to college and prides himself on his independent thinking; he puts himself in the category of street smart, not book smart...
... He had never bothered to register to vote until 2016, when he first heard Mr. Trump debate on television, and saw a political figure who reminded him of himself....
... When Fox News began reporting polls showing Mr. Biden in the lead, Ms. Rocco tried tuning into One America News, the right-wing cable network, which predicted a convincing victory for the president. The Roccos got news from a variety of sources — TikTok, QAnon, the pro-Trump comedian Terrence K. Williams, the YouTube mystic Clif High. “I’m a conspiracy theorist, I guess, if you want to call it that,” Ms. Rocco said...
... he reminded himself what kept him out there all these months: People had disrespected him. The Facebook group manager who had kicked him off. The neighbor who took his yard sign. Teachers who responded to his daughter’s enthusiasm about Mr. Trump with awkward silence.
“People who don’t like Trump, I honestly think they are very soft people,” he said. “That is why the world is becoming so sensitive today. Back in the day, you could throw a snowball at someone at school and everything was fine. Nowadays, a letter gets sent home: Your child is being mean.”
... His older brother, who he describes as the brainy one, took the other path, winning a scholarship to college. (He is the Biden voter.) But Mr. Rocco’s aspirations were staunchly blue-collar; he chose trade school and went to work at 17...
It's unlikely Nick would have done well at a four year college or succeeded as a knowledge worker. He could marry well, or find an inheritance, or show unusual entrepreneurial talent -- but more likely he's going to be the disrespected Left Behind. In today's America if you aren't a knowledge worker you're probably not going to make over $30/hr, and you're not going to make it into the middle class as an individual [2]. Even in countries with effectively free college this non-knowledge worker cohort is about half the population [2].
America can't survive as a democracy with half its citizens Left Behind. We'll have a January 6 every year -- only the mobs will be larger and have better weapons. Of all the threats we face, this is our greatest near term challenge. Even CO2 driven climate change is a lesser threat.
Biden needs to work out a solution for the Left Behind problem. The good news is that for this problem survival and politics align. The Left Behind are the core of Trump's base and the modern GOP, it's tricky for the GOP to block policies to bring the Left Behind into the middle class. And, after Jan 6, 2021, there's intense awareness of the danger posed by the Left Behind (though that will be quickly forgotten).
Most importantly the Left Behind are not only white, they are also Black [3], Hispanic, Asian and any slice you like (though more men than women). Helping the Left Behind crosses political boundaries, unlike reducing college debt.
What policies can be put in place so that most non-knowledge workers can earn over $30 an hour? I've written of a few over the years, here's a partial list:
- fn -
[1] One trade worker and one service worker couple can squeak in it as long as they don't have child care expenses and as long as they stay together.
[2] See also my pre-catastrophe 2015 post on why I was a "fan" (heavy irony) of Trump or a recent post/pre catastrophe retrospective. I've been on this topic for a long time though my thoughts have evolved quite a bit over 17 years.
[3] Deep and pervasive structural racism means there's great potential for increasing four year college participation in Black America. I don't think there's anywhere near that potential for White America.
[4] I think subsidized work has significant political, cultural, economic, psychological, and social advantages over direct cash subsidies -- but I'm not adverse to experimenting.
[5] "Blue collar" is a historic synonym for Left Behind.
I'm on the way to writing about what I think should be Biden's #2 priority (#1 is undoing Trump's executive orders). Three previous in this series include:
Donald Trump is a sign of a healthy democracy. Really.... I’m a fan because Trump appears to be channeling the most important cohort in the modern world — people who are not going to complete the advanced academic track we call college. Canada has the world’s highest “college” graduation rate at 55.8%, but that number is heavily biased by programs that can resemble the senior year of American High School (in Quebec, CEGEP, like mine). If we adjust for that bias, and recognizing that nobody does better than Canada, it’s plausible, even likely, that no more than half of the population of the industrialized world is going to complete the minimum requirements for the “knowledge work” and “creative work” that dominates the modern economy.... This [never-college] cohort, about 40% of the human race, has experienced at least 40 years of declining income and shrinking employment opportunities. We no longer employ millions of clerks to file papers, or harvest crops, or dig ditches, or fill gas tanks or even assemble cars. That work has gone, some to other countries but most to automation. Those jobs aren’t coming back.The future for about half of all Americans, and all humans, looks grim. When Trump talks to his white audience about immigrants taking jobs and betrayal by the elite he is starting a conversation we need to have.It doesn’t matter that Trump is a buffoon, or that restricting immigration won’t make any difference. It matters that the conversation is starting. After all, how far do you think anyone would get telling 40% of America that there is no place for them in current order because they’re not “smart” enough?Yeah, not very far at all.This is how democracy deals with hard conversations. It begins with yelling and ranting and blowhards. Eventually the conversation mutates. Painful thoughts become less painful. Facts are slowly accepted. Solutions begin to emerge.Donald Trump is good for democracy, good for America, and good for the world.
Every three years I have to do a quality improvement project to maintain my family medicine board status. This year I decided to focus on my patients with moderate chronic kidney disease. I have access to a report that identifies the patients of interest so all I need to do for the project is upgrade their care.
To do that I had to put together a list of things to do by reading the short "pocket card" version of the VA/DoD care guidelines (I'm too lazy to read the entire long thing). I then ran it past a friend who is a leading research nephrologist to comment on which of the guideline actions were really valuable.
I liked the result so much I'll share it here. The numbered items are what I took from the guidelines, the comments in () are his corrections, the comments in [] are my later thoughts. I think it's most interesting to read with both, I added emphases:
As of Dec 2020:
1. Measure urine alb/cr ratio yearly (sure in people with diabetes not on ace/arb)
2. Measure Cr yearly (ok- not great evidence) [U/A, micro albumin, Iron]
3. ACE/ARB for all but not both (if htn and/or microalbuminuria – or chf) [so implies measure for microalbuminuria along with yearly Cr]
4. Oral iron therapy (if iron deficient, or starting epo) [so, contra guideline, not routinely, but implies check iron yearly?]
5. If Hgb < 10 consult for erythropoietin (I’d wait till < 9 – no evidence for greater)
6. DM
a. Evaluate metform if CrCl < 40 (ok)
b. SGLT-2 (empagiflozin, etc) inhibitor if stage 1-3 and DM (can go down to egfr of 30)
c. GPL-1 agonist (liraglutide) (no good evidence beyond sglt2) [contra guideline]
7. If GFR < 60 then BP < 140/90 (I think this would be for most people)
8. Do cystatin-C GFR one time (never unless paraplegic or loss of muscle mass – amputation) [contra guideline]
9. If not Diabetic need at least one renal imaging study [I made this one up, but seemed to follow] (sure)
10. Apply Kidney Failure Risk Calculator (Navdeep Tangri, MDCalc) (sure)
11. Stage 3 and above: dietary consult
a. Bicarbonate supplementation if metabolic acidosis (if bicarb < 18)
b. Dietary sodium restrictions (yes – for all those with htn)
c. Protein 0.6-0.8 g/kg/day (skip this one – good evidence – hard to do) [Curbsiders had recent podcast saying same]
12. Stage 3 and above need a PTH measured (never measure pth in ckd unless hypercalcemia) [contra pocket card guideline so many a mistake in that]