*

Tuesday, November 28, 2017

Out of 11 Countries Surveyed, U.S. Seniors the Most Likely to be Both Sick and Unable to Afford Care


Despite Medicare coverage, older adults in the United States are sicker than those in other countries and face more financial barriers to health care. Note: When it comes to the problem of high cost preventing access to treatment, Canada rates 6th out of 11 countries surveyed. The U.S. is last by a good margin.

Read more: Commonwealth Fund 2017 International Health Policy Seniors Survey

Monday, November 27, 2017

VW Jetta TDI buyback completed and VW made an I'm-sorry-payment, as well.

It's gone. VW has repurchased my 2011 VW Jetta TDI. Plus, the German automobile maker paid me a cash penalty to make amends for their TDI sins. All in all, I got $16,700. I put it all into the purchase of a 2017 VW Jetta Wolfsburg Edition.

Fuel economy: 5.74 litres/100 kms at 2084 kms.
My new car comes complete with Wolfsburg Edition badges on the sides, a TSI badge on the rear of the trunk lid and a TSI four-cylinder engine under the hood. TSI stands for turbocharged stratified injection. This is a technically sophisticated 1.4 litre turbocharged direct injection engine. VW claims it is state-of-the-art engineering. Hmmm. I recall similar claims when I bought my TDI clean diesel.

So, let's cut to the chase. What was the total out-of-pocket cost to put a Wolfsburg VW in my garage and send the oil-burner packing? The short answer: $2500. That's it. And what will it cost to keep it there? That's a good question. For a start, as a gasoline tends to cost more than diesel in London, I expect my fuel bill to grow. As well, I now have a monthly $139.44 car payment for the next 84 months.

Originally, I had agreed to an interest rate of .99% with a shorter payback period. But, when the deal was finalized the interest rate rate had fallen to zero. I'll decided to keep my money in the bank where it can earn up to 1.9% in a ScotiaBank Momentum account. I can see no advantage in tying up cash to purchase this car.

What are my first impressions of my new Jetta? Good but then I liked my old Jetta. The two cars are very similar. And where there is a difference, often I see little advantage in the new vs. the old. For instance, I can see no great advantage to the keyless door lock system. My old key fob transmitter worked well, in my opinion.  On the other hand, the ignition cylinder was prone to early failure. Maybe this potential problem has been eliminated.

My new radio seems to have possible safety issues as it encourages a driver to play with the touch-control screen rather than paying complete attention to the road. To change the sound system volume, a set of controls can be found on the steering wheel. This encourages more gadget fiddling. If the government thinks cell phones are bad, they should take a look at radios like this one in my new Jetta.

Professor David Strayer, at the University of Utah, found in-vehicle information systems — including SatNav, MP3 players, radios, cellphones and messaging devices — take drivers’ attention off the road for too long to be safe, much like texting.

In the following weeks and months, I'll keep my readers posted as to the total cost to keep my VW Jetta on the road. (If you notice anything amiss, feel free to question my figures. I have made errors. I'm not perfect.)
__________________________________________________
First Add:

Today I got the auto insurance bill for my new car. My annual insurance bill has gone down by $86.00. A nice surprise. This leaves a December bill of $272.50 to pay.

I am now out a total of $2772.50. If you recall, I paid $2500 when picking up the car.
__________________________________________________
Second Add:

Stopped at Costco for a fill-up: $45.01 for 40.583 litre at $1.109 Cdn./litre with 710 kms
I am now out a total of $2817.51 and have used 40.583 litres.
Cost per km:  $3.97 Gasoline alone was .063-cents/km.
Burning 5.716 litres/100 kms
__________________________________________________
Third Add:

Stopped at Costco for fill-up: $45.24 for 40.07 litres at $1.129 Cdn./litre with 1140 kms
I am now out a total of $2862.75 and have used 80.653 litres.
Total cost per km:  $2.51 
Cost for fuel alone: $85.08 or $0 .075/km.
Fuel economy: 7.075 litres/100 kms 
__________________________________________________
Fourth Add:

Stopped at Loblaws for fill-up: $48.97 for 42.001 litres at $1.166 Cdn./litre with 1653 kms
I am now out a total of $2906.55 and have used 122.654 litres.
Total cost per km:  $1.76
Cost for fuel (gasoline) alone: $134.05 or $0.081/km.
Fuel economy: 7.42 litres/100 kms 
Note: I get points worth 2-cents a km when I buy gas at the former Loblaws station, plus I get a 1% credit on all gasoline purchases made using my credit card. These rebates are not factored into the total car costs.
_________________________________________________
Fifth Add:

I noticed my monthly car payment of $139.44 has been withdrawn. 1710 kms on the odometre.
I am now out a total of $3045.99.
Total cost per km:  $1.78
Cost for fuel (gasoline) alone: $134.05 or $0.081/km.
Fuel economy: 7.42 litres/100 kms (at last fill-up)
Note: I get points worth 2-cents a km when I buy gas at the former Loblaws station, plus I get a 1% credit on all gasoline purchases made using my credit card. These rebates are not factored into the total car costs.
_________________________________________________
Fifth Add: January 12/2018

Stopped at Costco for fill-up: $43.28 for 39.023 litres at $1.109 Cdn./litre with 2084 kms
I am now out a total of $3089.27 and have used 119.676 litres.
Total cost per km:  $1.48
Cost for fuel alone: $128.36 or $0 .062/km.
Fuel economy: 5.74 litres/100 kms at 2084 kms.

Note: These figures reflect costs and mileage and gasoline usage at fill-up time. These numbers will be more accurate as time goes by and the kilometers mount.

Saturday, October 21, 2017

CBC Marketplace and Busting Superfoods


Superfood: a term too good to be true? I thought so. I never bought into the hype. But I guess some folks do and CBC Marketplace set out to burst their bubble: Busting Superfoods.

For the most part, it seemed to be a good show but there were statements that I questioned and not because I am a believer in superfoods. For instance, the program presented a Canadian alternative to some superfood. And what was the alternative: the potato.

I was once a big booster of the potato. Hey, the Irish apparently got by quite nicely on potatoes until the potato famine struck. The lesson seemed to be: oodles of potatoes good, no potatoes, or anything else for that matter, bad.

Well, I was wrong. Oodles of potatoes are not good. One should have a balanced diet. No surprise here. But, and here comes the surprise, potatoes do not necessarily make up a large portion of a correctly balanced diet.

Read this article from the Harvard T. H. Chan School of Public Health: The problem with potatoes.

The article, to which I linked, warns "a cup of potatoes has a similar effect on blood sugar as a can of cola or a handful of jelly beans." This is something that I've been told during my visits to various doctors related to my fight against heart disease. Go easy on the potatoes, I'm told.

I'm 70. My body does not need more stress and potatoes, especially a good helping of potatoes without the skins, could put my body under stress as it struggles to cope with the resulting surge in blood sugar level.

So, do I avoid potatoes? No. Potatoes, especially with the skins, are a good source of potassium, vitamin C, fibre and magnesium, plus potatoes are low in fat and inexpensive. Just go lightly on the full fat sour cream and pats of butter. Berkeley Wellness, University of California, has a good article looking at the positive side of the potato debate: Don't Drop the Potato.

CBC Marketplace, like potatoes, not bad, but not super either.

Sunday, September 24, 2017

Does the Watchman LAA closure device offer a new approach to fighting strokes?

Remember, I am just a heart patient sharing his story, plus some info gathered during my recent medical treatment. I am NOT providing medical advice. Talk with your doctor if you find anything here of interest. Cheers! 

When I first posted this, I was slated to have a Watchman left atrial appendage (LAA) closure device implanted. To prepare for this heart procedure, I had a transesophageal echocardiogram (TEE) performed last Friday. The doctors discovered my LAA has already been modified. It has been surgically "obliterated." Clearly, I am no longer a candidate for a Watchman. It is impossible to insert the device into my surgically modified LAA.
I was the first person in Canada to have a leaking mitral valve repaired with the aid of a DaVinci robot. I now know that my surgeon not only repaired my valve but he "obliterated" my LAA as well. This was done in the belief that modifying the LAA would lesson my chances of having a stroke caused by a blood clot originating in the left atrial appendage. Up to 90% of blood clots originating from the heart form in the LAA to be exact..

I was facing LAA closure to lessen my chance of suffering more transient ischemic attacks (TIAs). Over the last few years, I have suffered a lot of TIAs, also known as mini-strokes. I take Pradaxa, an anticoagulant, plus Aspirin, an antiplatelet drug. This dual drug approach has worked wonderfully at preventimg serious blood clot related problems. I must compliment my doctor at the Stroke Prevention & Atherosclerosis Research Centre (SPARC).

So, if my drug therapy is working so well, why implant a Watchman, a foreign object, in my heart? Because I also suffer from cerebral microbleeds (MBs). These are small, bleeding areas in the brain that raise the risk of hemorrhagic stroke. And a hemorrhagic brain event in the presence of an anticoagulant is fatal in many cases. For this reason, all my doctors agree: stopping my anticoagualant therapy must be a goal.

After a lot of consultation among my many specialists, if was decided to put the Watchman Left Atrial Appendage closure device into my heart. A lot of risks and benefits were weighed and everyone was unanimous in approving the Watchman. Now, that route is closed. Here is an interesting link: Summing up the current data, LAA occlusion is a very promising treatment to prevent AF-related strokes due to its safety, cost-effectiveness and therapeutic success.

Discovering that my appendage has been "obliterated" raises a big question: Why am I having so many TIAs if the surgical alteration of my LAA lowered my risk? One answer: my surgical closure may not have been 100% successful. Many now believe that incomplete LAA closure can actually increase the risk of clots forming in the heart, in what remains of the LAA. And how often do surgical closures fail? Answer: In some studies the failure rate has hit 80%. The LAA has proven to be a tough beast to tame. Read: Incomplete surgical ligation of the left atrial appendage—time for a new look at an old problem.

Am I worried? Surprisingly, no. I have gone years suffering numerous TIAs and have not had one full-blown stroke. Maybe the attempted "obliteration" of my LAA has had some beneficial affect. I think it is impossible to say anything for certain. It's Christmas and I'm going to go with an upbeat view.

Problems are the price you pay for progress.”—Wesley Branch Rickey


_______________________________________________________________________

The following is my original post, written before I learned I would have a Watchman implanted and then learned I wouldn't, and couldn't, have one implanted.



I have TIAs. TIA stands for Transient Ischemic Attack. And what, you may ask, is that? Let's just call a TIA a mini-stroke and leave it at that.

My attacks usually last less than five minutes and do not amount to much, at least not individually. But, if one has enough TIAs, the damage can be additive. I have suffered minor memory loss as a result of my numerous mini-strokes. 

Having a TIA can be frightening, and rightly so. One particular attack, called an amaurosis fugax, leaves one or both eyes blind or partially blind for a number of minutes. Although there is usually no permanent brain damage, the blindness is temporary, such an event can be a precursor to a full-blown, life-altering, stroke. I've had close to a dozen of these dramatic, visual events.

TIAs and strokes are often caused by small blood clots, formed in the heart, traveling to the brain and lodging there. These small clots can block the blood flow to the brain. With TIAs the clot is unstable and quickly disintegrates. Blood flow is soon restored. With a brain-damaging stroke, the clot does not break-up and medical attention is needed immediately to prevent permanent brain damage.

Attempting to prevent the formation of these small blood clots is the usual response to frequent TIAs. This can mean taking an anti-coagulant for life. This, of course, comes with its own host of associated risks. 

And ironically, one of the increased risks from taking anti-coagulants can be a type of stroke - a hemorrhagic stroke. A stroke resulting from bleeding in the brain: a hemorrhage.

I take Pradaxa, one of the newer anti-coagulants. Many people rely on warfarin. That's right, the chemical used in rat poison.

I am not an ideal candidate for Pradaxa, or any anticoagulant, as I have micro-bleeding in the brain. I live with threats from both types of strokes mentioned previously. 

Now, there is a new approach to fighting the blood clots that have traveled from my heart to my brain and caused my TIAs. It's a surgical solution but minimally invasive. I learned about this new method of combating TIAs, in cases such as mine, from one of my doctors at the London Health Sciences Centre.

Because I have micro-bleeding in the brain, I am not a great candidate for anti-coagulants. That's why I don't take warfarin, also known as Coumadin. Pradaxa is not as prone to causing a hemorrhagic stroke as warfarin but, that said, there is still an increased risk of bleeding. Not good. And, of the two types of stroke, hemorrhagic strokes are more often fatal and, if one survives, the lasting damage more severe.

Why do some hearts generate clots and not others? Often the answer is atrial fibrillation or AFib. Some hearts, the ones producing clots, often have a quivering, irregular heartbeat. The blood tends to pool and swirl inside the heart before being pumped out to the body. This pooling and swirling in the heart encourages the formation of blood clots.

It is now believe the clots coming from the heart are originating, for the most part, in a small sack on the left side of the heart known as the left atrial appendage (LAA). Blood gets into the small sack and remains trapped there long enough for small but dangerous clots to form. These clots eventually leave the LAA to be pumped out of the heart and to the brain where they may cause a TIA or stroke.

If this theory is right, and there appears to be good reason to believe it is, then preventing blood from collecting in the LAA appears to be a partial answer. 

Some cardiac surgeons are now plugging the LAA with a small closure device. There are a number of competing implants, among them is the Watchman from Boston Scientific Corporation.

This is what the FDA, U.S. Food and Drug Administration, has to say:

The Watchman LAA Closure Device is permanently implanted in the left atrial appendage (LAA) of the heart to prevent LAA blood clots from entering the bloodstream and potentially causing a stroke.

The cardiac-surgeon inserts the delivery catheter into the body through a vein in the leg. The catheter is threaded through the body until it reaches the right atrium of the heart. The physician makes a small hole through the wall between the two upper chambers of the heart (atrial septum) so the catheter can reach the LAA. The physician then pushes the device through the delivery catheter into the LAA where it opens up like an umbrella and is permanently implanted. Once in place, a thin layer of tissue grows over it in about 45 days.

The FDA notes that the device is used in patients who have atrial fibrillation, AFib, that is not related to heart valve disease.

Some time after the insertion of the device,  a patient may be taken off the riskiest anti-coagulants. This action should cut the patient's risk of having a hemorrhagic stroke. I believe this is the big benefit from having an LAA closure device implanted.

I understand that even with the Watchman implanted, taking baby Aspirin, ASA in Canada, may be necessary for the rest of the patient's life. ASA is a far less risky drug than warfarin, Pradaxa, Xarelto and the other common anti-coagulants. And it is far less costly. My Pradaxa therapy is not cheap. Taking sophisticated drugs for life can be awfully expensive.

Will I have a Watchman or similar device inserted in my LAA? I don't know. The idea has been raised and my doctors are in consultation. I would not be surprised to have this new solution to AFib caused TIAs and strokes applied in my case. The Watchman is not a perfect solution. One can still suffer a stroke from a clot originating in another part of the heart. The Watchman only stops the clots coming from the LAA.

As I have made clear, the use of anticoagulants is contraindicated in folk like me. For that reason, the Watchman looks good despite its shortcomings.

I was the first person in Canada to have a failed mitral valve repaired robotically using the da Vinci system, and I was one of the first patients to benefit from the use of the experimental T7 MRI unit at LHSC. I've had good luck with new procedures in the past.

As I learn more, I'll repost or add to this post. Cheers!

Let me end with this final video. If you have AFib but are not an ideal candidate for anticoagulants, for whatever reason, you might find the following video interesting. Talk with you cardiologist.

Remember, I am just a heart patient sharing his story. This is NOT medical advice. Cheers!

Tuesday, September 12, 2017

Bowring goblets may be flawed


This is an add-on. I heard from Bowring and so far my wife and I are the only folk to have encountered problems with these glasses. The local store may have been sent a bad batch. At least, that is the working premise at the moment.
______________________________________________________

Recently, my wife and I bought some glass goblets from the Bowring store in Northwest London, Ontario. Before we had even paid for the ones we had removed from the shelves and carried to the checkout, we discovered three of the glasses had serious and potentially dangerous flaws. The rims were unfinished, jagged, rough and slightly sharp.

Tonight one of the glasses we did buy broke while my wife was drinking from it. She noticed a line near the top of the bowl. When she inspected it, the top lifted free. The wine glass had broken. The break was so sharp, one might have thought it had been done with a glass cutter.

I've written Bowring warning them that one of the wine glass lines they are carrying may be seriously flawed. If I hear back from the Bowring customer service, I will add their response to this post.

Note the shape of the glass, it is made in China and sold at Bowring. Don't buy any. You have been warned.

Monday, July 10, 2017

A murder, followed by an indignity to the body, featured in the Centennial film Helicopter Canada

Misrepresentation at core of opinion piece.
It’s five a.m. and I can’t sleep. Again. It's been a full week and I’m still upset, haunted by the horrifying story brought into my home and into my consciousness by my local paper, The London Free Press

An Indian was murdered, the body desecrated and the local journalist slipped over the nation-shaming incident with a simple mention of crude talk.

Why do I call the incident nation-shaming? Because the incident is a featured vignette in Helicopter Canada, a film made to celebrate Canada's Centennial.

I watched Helicopter Canada and haven’t been able to get it out of my mind. If you’d like to stop here, please do. The following is difficult to write and it will be difficult to read. I am finding it difficult to find a comfortable narrative within which to fit this film into my naive, Canadian psyche. 

At the 40 minute 50 second mark, while a honky-tonk piano plays in the background, the narrator of the film tells us:

The Canadian West is still pretty well strung out but it's held together by legends. (Here a new voice is heard, that of an aged, Western man, possibly a cowboy or an oil man, relating one of the so-called region-binding tales.)


And they started to shoot up ‘round the fort, that is, they were shooting all around the fort and raisin cane there. And at that time they killed an Indian an’ scalped him. They took seven scalps off the one Indian. Now many people think when you talk about a scalp, it’s the whole thing but it’s not. It’s only about the size of a 25-cent piece with a strand of hair. That’s just about the size of it.”


WHAT THE HELL?!
 
I’m numb. Absolutely numb. And my local newspaper headlines a story on this film with “Lights, camera - misrepresentation!” Misrepresentation? We all wish. And the newspaper story talks about the roundabout, crude terms used in the film. Roundabout? A man was killed. Murdered. The body mutilated, desecrated, scalped. And the entire squalid episode was driven by racial bigotry, racial hatred.

I'd like to say the journalist simply didn't view the film But he clearly did. He tells his readers “an old-timer explains that a ‘scalp’ taken from a skull was only about the size of a quarter.” It is the local paper that is unable to address the horror in anything but the most roundabout way.

The writer found the film, Helicopter Canada, now badly dated. When the Globe and Mail revisited the 50-year-old National Film Board production, that newspaper called the film “cringe worthy.” That's it?

Eugene Boyko, the film's editor/cinematographer, delivered a film that on the surface is pretty light fare: a tongue-in-cheek narrative accompanies consistently spectacular film footage shot entirely from a helicopter. But this film is clearly not just high-end visual fluff, it is not, and never was, just a light-hearted look at Canada. 

At its core, this film is subversive. One of the hidden messages slipped past the sponsoring Centennial Commission in 1967 is things are not always what they seem. Here, I could list example after example supporting this contention but please allow me to move on to another clear message: “there are none so blind as those who will not see.”

I am absolutely stunned that so many saw this film on its release and so many more have viewed it over the years but no one, as far as I can tell, has ever gotten passed the honky tonk piano to see, to question, to discuss the horrific way Canada and Canadians treated people of the First Nations.

I'm going to continue digging. Eugene Boyko is simply too good a filmmaker to have included this incident to entertain us. There must be something out there that reveals why this incident is in a film made for Canada's Centennial.

I believe Eugene Boyko is holding a mirror up to Canadians and what that mirror reflects is not always what Canadians want to see. Boyko's film is not ignoble as the opinion writer believes. It is us, us Canadians, who are shown to have an ignoble side.

________________________________________________________________________________


This post could end here but, if it did, it would not be a complete look at the little, aging, documentary film: Helicopter Canada.


Shooting a film entirely from a helicopter is an awesome undertaking, which director-cinematographer Eugene Boyko pulls it off with great skill and style. 

It must be remembered that Boyko worked before most of the technical advances that make shooting something like now easy. 

He pulled it off using big, heavy, Panavision equipment. Many of his images are simply inspiring.

Amazing.

Next, the choice of the little vignettes could be seen as simply veering toward the quirky but I see more. Sadly, what writer Larry Cornies calls “whimsical” is the tone that causes most folk to miss the underlying problems being addressed.

And there are some fine cinematic moments in Helicopter Canada. Moments that slip by journalist-reviewers unnoticed. The little segment featuring the Bluenose is wonderful. The filming and editing is first rate and the music accompanying the episode is provided by The Mountain City Four featuring Kate and Anna McGarrigle. To have included the McGarrigle sisters in a 1967 film was a stroke of genius.





I talked to film buffs about the movie and the criticism of its being dated. Of course, it’s dated, I was told. It’s a visual time capsule. It is meant to grow old. It was a look at Canada “warts and all.” It carried the message “we have problems but we can solve them.”

God, I hope so.



Lastly, I could not believe what I was hearing when the honky tonk piano started and the talk of the casual murder and mutilation of a First Nations man began. I contacted the National Film Board and they sent me their transcript of the soundtrack. I believe the transcript has errors but nevertheless it does contain the murder-mutilation story.


I don't hear the name Grayson. I hear "and raisin' cane there."

Wednesday, March 22, 2017

When will London act on the ReThink promise?

London, Ontario, went through quite a time consuming process called ReThink London. It was an urban planning exercise that invited community participation. ReThink was going to put the large southwest Ontario city on the path to denser future development.

It was, in my opinion, a lot of smoke with very little fire. Despite the claims of massive community involvement, I find the participation numbers questionable. All that aside, what I find most interesting is that the future as envisioned by ReThink is not the future in many places but is simply reality today.

This is a great improvement on the big-box shopping mall.
The posted images are screen grabs from Google Streetviews. The two images from Georgia are not artist's conceptions. These are images of a mixed use development in existence today.

The development, a traditional retail and residential blend, even has a movie theatre as part of the mix.
  
In compact developments, stores front onto streets rather than parking lots.
Mixed use developments, such as this one in Georgia, are springing up throughout the world. London talks the talk but that's where it all stops.

ReThink London promised an end to urban sprawl but unfortunately the ReThink ideas are little more than a gleam in our city planners' eyes.

Lots of parking with a wall separating much of the residential from the commercial.

More than a decade ago, journalist Christine Dirks told readers of The London Free Press about a new urbanist dream development planned for the southwest of London. It would be a first for the city. Talbot Village was the name of the new suburban community. Today the development is nearing completion and the only part of the dream that survived is the name: Talbot Village.

ReThink London. Humbug.

Addendum: And yes, I know the new city plan was not in place when much of Talbot Village was being built. But, mixed use communities are being built not because developers are being forced to build them but because mix use creates sensible developments and profitable ones as well.