Thursday, May 31, 2007

Charity coin drops

Maybe this is a local thing -- I certainly had enough trouble finding pictures of it online -- but every summer, I find myself infuriated by charity coin drops. This is where some charity, maybe a good one (like funding a fire department) and maybe less good (like funding a school trip) decides that the best way to raise money is to stop traffic on some major artery and practice extortion, all but demanding coins from every passing car.

Well, I appreciate that you really want to earn some cash, but here's the thing. I include at least a thousand dollars a year in my charity donations. I choose very carefully where this money goes, to support causes I want to support and where I think my dollars will go the farthest. I don't give my money to the loudest or most obnoxious people merely because they're in my face -- in fact, I tend to lean away from them, and in favor of those who are quietly using my money primarily to help people, not to pester me for more money while wasting paper and my time.

The fact that you got a permit to inconvenience me and thousands of other people today is not sufficient reason to override all of that. Nor are your puppy-dog eyes or your ineffectual grimace as I pass you by. You think I'm a cold and uncaring person because I choose not to participate in your extortion, but I'm really just choosing more carefully than you are how to allocate my charity.

So give up this intrusive and insulting approach to charity and try something else, please. Because I am not about to start encouraging you.

Wednesday, May 30, 2007

The road to MGBville

Now that we're decided about a gastric bypass surgery, it's good to be working on it. Last Thursday we went to the nutritionist, and today to the doctor, for the first of six pairs of meetings (which must be in consecutive months). Cigna's arbitrary and largely meaningless goal for us is the loss of 5% of weight. My real goal is to get my blood glucose back in control by hook or by crook; if I have to go through this for Cigna I might as well also do something with a very evident need right now.

So, the changes we're making now are as follows. Counting carbs again, and limiting them. Exercising again; for now, just working through it, and soon, getting a physical therapy referral to work on ways to make it less painful and more sustainable. Adding more fruits and vegetables to the diet, which requires us to bite the bullet and go to the supermarket twice a week for just produce. Doubling my metformin dose, starting today.

The exercise part is the linchpin. Exercise keeps my appetite in control, it makes the biggest difference in my during-the-day readings, and it does more to bring my fasting BG down than any single other factor. Finding a way to make it sustainable despite the pain is key.

Getting my BG in order will be a hard struggle, but one that is maybe easier to endure knowing it's very likely that it's for a limited time. (The surgery will not only be very likely to cure my diabetes outright, it'll also make the pain reduce or disappear which also makes everything else fall into place.) Losing 5% of my weight while doing it will be a piece of cake.

Mmm, cake.

Dang, now I have to go exercise.

Tuesday, May 29, 2007

Back from vacation

I wasn't off at the seashore this whole time, that was just three days. But I've been on vacation at home since, some of it hanging around and some of it getting chores done.

Salisbury, Massachusetts was a good getaway... because we really didn't need much other than the ocean. Clearly, this is a town in need of some urban revitalization. The first impression is that most of it is run-down and mostly abandoned buildings. This is a very unfair impression; large stretches of town are actually shiny new and it's clear revitalization is going on with lots of new building. But you don't notice the nice buildings, you take those for granted. What stands out is the run-down old things with signs right out of the 50s. The seaside boardwalk area looked like Atlantic City after Biff stole the Delorean... though I bet it looks less that way during the high season when everything's open.

One thing's for sure, this was not a "touristy" destination, despite the seashore and all the relics of a touristy era. The shops and restaurants were inhabited by locals, and there was a conspicuous absence of the kind of retail presence that touristy areas have. I don't think I saw a single "gift" shop selling tacky crap. Nor did I see many license plates other than MA and NH (Salisbury is so on the border that most of our dining and shopping was over the border in NH).

What really matters, though, is that right outside the hotel room was a small porch which opened onto sand, and the roar of the surf was plainly audible and visible from my bed. There's no sleep so relaxing as sleep lulled by the smell of ocean breezes.

The only interesting dining found in the area was a little Mexican place of no particular significance, clearly catering to locals, but it was good stuff -- well-seasoned, authentic, and tasty. Their baja omelet, full of tender marinated carne asada, was remarkable. Otherwise, the food was serviceable and unexceptional.

Relaxing time at home was also productive. First time I ever did a tuneup on a lawn tractor, using only crappy and incomplete directions in the manual, and everything still went well; the tractor started right up and purred like a kitten. (Well, a very aggressive kitten with 42" cutting blades.)

Back to the daily grind today, but it's not so bad, the rest was nice. Lots more to write about, but that's for another day.

Wednesday, May 16, 2007

Random idea for a roleplaying game element

I can't claim credit for this one, I picked it up on mailing list for Everway years ago, might even be Jonathan Tweet who came up with it. But I've been saving it in my bag of tricks for years and years, waiting for a chance to use it.

Amongst the people of this particular culture has arisen a long-standing tradition that seems very strange to outsiders. People have odd and disturbing names: Poison, Treachery, Despair, Infection, or Bankruptcy, for instance. It turns out that the people here believe these things to be brought by spirits of the same name: if you get poisoned, it is because you were visited by the Poison Spirit. And surely, the Poison Spirit is less likely to harm someone who has been named for him! Children are always named for some malignant spirit which the parents fear might otherwise afflict the child, as a protection against them.

(It might be even more cool if this turns out to be true -- that anyone named Poison is, in fact, immune to poison. Just need to ensure no one can get named Death, or Badness, or something else too vague or potent.)

Tuesday, May 15, 2007

Reticence and reversibility

We were trying to decide between RNY and MGB alternatives for our bariatric surgery, and while we'd heard the arguments for MGB, we hadn't really gotten a fair shake at hearing RNY's side. In all our extensive research, the few RNY doctors we'd heard had only been vague or spoken in anecdotes and speculation; they didn't talk like scientists at all. So we scheduled an appointment with the RNY surgeon, Dr. Spaulding, at Fletcher Allen Health Care in Burlington, in hopes she'd give us her side. After all, we have to choose a surgery before we can seriously begin the process of qualifying for it and getting it.

Between the time we scheduled it and the appointment, they instituted a new program where new arrivals in the bariatric program had a "pre-first-visit visit" in which they sat in front of a dull slideshow that covered the basics, and then got insulted by nurses for a little bit. This is very helpful for most people who, apparently, go to hospitals and doctors without even looking up what their condition means or what the surgery they're considering actually is. Not so helpful for us, as it turns out, since they cancelled our doctor visit in favor of this. We didn't learn anything we didn't know, and weren't able to get any of our questions answered. We wasted half a day of sick leave and several dollars in gas and parking for nothing.

When we complained, they set us up an appointment with Dr. Spaulding for this morning. We went in and got told right off that we'd be seeing a nutritionist and a psychologist to prescreen us for the procedure before we could talk to Dr. Spaulding. It was futile to point out that we weren't on the track for any procedure, we were just trying to get some answers. We were on the conveyor belt and there was no way to get anywhere other than down the assembly line.

So we sat through these post-pre-meeting pre-meetings, which we had to do separately because "that's how we do it", before we could finally talk to Dr. Spaulding. She was friendly and personable, but she also insisted on starting at the beginning, explaining everything in detail except for the bit we said we wanted to talk about: why RNY over MGB? But finally, going into our third hour there (not counting the hour drive each way) we were finally getting to the actual point of the meeting.

Her reasons for RNY over MGB: "Oh, I wouldn't recommend MGB." She added, "I know someone who did those for a while, but he stopped right away." When pressed, she suggested that there wasn't enough data on MGB to determine what its risks were (though she also claimed that they were greater) -- which is not true, they've been doing MGBs for 10+ years and have done thousands of them. Pretty much the same non-answer I have always gotten from RNY doctors which sounds suspiciously like what, in the non-scientific lay world, really means "I am against anything I haven't bothered to learn about yet." You expect that from used car salesmen, but you expect doctors to have a scientist's mindset, to base things on evidence and proof.

I didn't let it rest. We had spent two whole mornings on this and I didn't want to come away without the answer again. I pressed the issue. Her response was that I would have to schedule another appointment, as she had to be moving on.

I can understand that she only has so much time set aside for us and that her next patients don't deserve to be kept waiting. But we explicitly said our whole purpose in coming to see her (both times) was to ask this question. We said it when setting up the appointments, and then first thing when we got there, and first thing when she came in. Now she wants it to be yet another appointment.

And when we talked to the person who schedules appointments, she had no way to do so that wasn't the next step on the assembly line. Merely to come to another appointment would require us to again visit the nutritionist, who would in turn demand detailed day-by-day food logs with calorie counts. It would also be a meeting not with the doctor, but with the nurse who had berated us while providing no answers at our first pre-meeting-meeting. In other words, it would be yet another opportunity to not get answers, while being treated like an interchangeable part.

But in talking more about this, we've come to the conclusion that her answer was all the answer we really need. I don't just mean that the way we were treated is a clear answer that "we will not get a surgery here" -- that goes without saying. I mean that her lack of a good answer, compounded upon all the other lacks of a good answer, and stacked up next to the scientific research we've seen (though I have to read more of that more closely), is an answer.

More to the point, the clincher of the deal is reversibility. RNY is not really reversible -- it's been done, sure, but it's not usually possible and you shouldn't count on it. That means if you get cancer and need chemotherapy, you're screwed. Chemotherapy will make you need more nutrients than your RNY-altered stomach can supply, and you'll starve to death if you go on it, period.

There are other reasons you might need a reversal, but that's the big one. MGB is reversible and also revisable -- if you're losing weight too slow or too fast it can be adjusted, though naturally you don't want an extra surgery if you can help it. But if you need it, the option is there, and that's something the RNY people can't touch.

Settling on MGB also settles the open vs. laparoscopic question since MGBs are only done laparoscopically. It also settles the question of where to have it: the only place that offers them to people my size is High Point Regional Health System in North Carolina. Now we have to work out the logistics of how to get there to do this, for both of us (done at separate times), including followup appointments. We have to start the annoyingly repetitive and unnecessary six-consecutive-month medically supervised weight loss plan Cigna requires.

And, biggest of all, we have to work out how this will get paid for. Getting Cigna to cover a completely medically necessary surgery with an in-plan doctor locally is a challenge. Getting them to cover a surgery they classify (for no reason we can determine) as "experimental", with a doctor in NC who may or may not be considered "in-plan" on our plan, is going to be a bitch. High Point won't bill them, either; we have to get pre-approval and then pay for it ourselves (to the tune of $17,000 each) and hope Cigna comes through after. If it ends up being considered in-plan, and they pay, it'll cover almost all of it (except our travel costs, of course), but if it doesn't, we may have to shoulder 20%, which is more than $10,000 between us. Where I'm going to make that money appear from is a good question.

But at least we have settled finally what direction we're going, so now it's just a matter of overcoming all those obstacles.

Monday, May 14, 2007

Supermarket music

It's been a long time since they played muzak in supermarkets. Or indeed any retail operation, so far as I've seen. Maybe they still do in elevators in office buildings. But apparently someone discovered that actual music is better for sales. And specifically, the music that the primary shopping target market grew up with.

For the last ten years, the music in all the supermarkets I have visited has been mostly light, inoffensive pop music from the 1970s, and gradually it's been working its way forward. Little by little, I'm more comfortable and familiar with the music. And thus, it becomes clear that I am not only an adult now, I am solidly the center of the target market at whom the supermarkets are focusing their marketing machines.

Don't get me wrong. Most of the music I listen to in an average day is not the music I'm hearing in the supermarket (though as time has passed the amount of overlap, though small, has grown). Actually, music composed around and before my birth makes up a larger part of my music collection than the music I actually grew up with, not out of any kind of reluctance to my own generation, but just because it's better music.

But the supermarkets aren't trying to mirror anyone's music collection. They're trying to create a feeling of comfort and nostalgia which, it turns out, inspires more shopping. Maybe it's the feeling of home. For most people it's the stuff you heard while you were in high school. In my case, the stuff that, right now, this year, is the core of the supermarket mix for the first time.

It's almost depressing because, when you get right down to it, the music of my generation was not that great. If you think back to the early 80s and think of music, most of what comes first to mind is superficial fluff that didn't age that well. I do enjoy it, but it's a guilty pleasure, and it sure doesn't make me want to stand up and shout out for my generation.

There was plenty of good music being made at that time. Great music, even. But it was mostly by bands that came before and were still going, and thus are not associated with that period of time nearly as much as bands that arose (and most of the time, vanished) during it. For example, some of Rush's best work was in the early 80s, but no one thinks of them first when you think of "bands of the early 80s".

But that doesn't help when they're playing some A Flock Of Seagulls in the freezer aisle and I find myself singing along, does it?

Wednesday, May 09, 2007

Smokers outside my window

One of the few perks of my job is that I have a window, which I guard jealously. I also retain the ability to open it when, at this time of year, it's beautiful out, but not so hot that I will feel guilty about the air conditioner running more.

The downside is that my window is over one of the two doors out of my building.

Last few years, our office was down to a single remaining smoker, all the others having either quit or... well, quit. And he had an office at the far end of the building, ensuring the other door was far, far more convenient for him to go smoke out of. Thus, I always wondered why he would, time after time, come smoke under my window instead. He had to go out of his way to do it. I complained, and he'd go to the other end for a little while, and then start again, over and over.

This year, we have two new employees, and both of them are smokers. We were so close to nirvana! It's so frustrating. And they're all coming down to my window to smoke. Plus our new cleaning service is one girl who is only here for an hour or two each day, but manages to smoke at least 3 cigarettes outside my window during that time.

All day long I'm opening and closing the window over and over. It's maddening. Maybe I should be more tolerant, but it just gets under my skin that we even have smokers still. Some irrational part of my brain insists on thinking of smoking the way I would about polio or feudalism, as something we used to have but thank goodness we don't anymore. And then they have to bring it to my window.

So here's my question. Get a list of the arguments that smokers use to justify their "right" to smoke in my presence, and for each one, substitute "urinate". The arguments all work just as well, and most of them better, since urination is a natural function necessary to life, and the sterility of urine means it poses no real health danger. So as far as I'm concerned, if you want the right to smoke in front of me, the cost is having to endure people peeing on you, with as gracious a smile as you can put on. Fair deal.

Monday, May 07, 2007

Look, an extraterrestrial!

Like other mammals and, to varying extents, most living things on Earth, humans have a circadian rhythm: a natural, hardwired internal clock that regulates metabolism and other operations of body and mind. When exposed to the cycle of sunlight and dark, this rhythm keeps approximately in time with a day. When humans live in places isolated from these natural cues (for instance, on extended tours of duty on a submarine), they usually, for convenience, create articial rhythms of light and dark on the same 24-hour cycle.

However, when a human is left free of any external cues of light and dark, an interesting thing happens. If he has nothing to calibrate his internal cycle with, it will naturally, and fairly quickly, settle into a rhythm of not 24 hours but 25.

On an apparently unrelated subject, there are a few oddities about how the human musculoskeletal system works, which are often pointed to as evidence that the evolution from quadruped to biped hasn't quite finished. However, some people point out another odd observation: on a planet whose gravity was half of Earth's, our musculoskeletal system would actually work pretty darned good.

Hmmm... we seem to have an innate biological prejudice for low-gravity worlds with 25-hour rotational periods. It's almost as if we come from somewhere else nearby...

Okay, while this is intriguing, I'm by no means serious. This is great fodder for a surrealistic roleplaying game, but certainly not anything real. Though, hmmm...