Mortgage Meltdown, Addendum

Here's another idea that seems obvious I forgot to put in the previous article.

It's normal, when a homeowner defaults on a mortgage, that the lender evicts the homeowner and sells the house. Normally, however, there's not a tremendous glut of houses for sale at very high prices, so houses are sitting on the market for very long periods of time. For example, the house at 100 Main Street, the owner gets evicted, and the house sits empty for a year before the bank can get it sold. Say the original mortgage amount was $2400 a month, so the total revenue to the mortgage company was $28,800 for one year. Instead the bank's revenue for that period of time is $0.

Mortgage companies, and especially mortgages backed by FHA, Fanny Mae, and Freddie Mac, instead of evicting homeowners, ought to try to work out a deal that lets the homeowner stay in the house and pay some amount of rent. Suppose the homeowner can pay half the amount they were paying in mortgage payments. If they can pay half, then the lenders' revenue will be $14,400 for the year, instead of $0. They can still try to sell it while it's occupied, but they also have the option of selling it as a rental unit that is already rented.

:typed and edited by Promise Lambert

Mortgage Meltdown

I don't feel like writing a lengthy treatise, but I have to say something about the mortgage crisis, since our political leadership doesn't seem to see what I think is an obvious technique to improve the situation. None of them will see this, probably, but at least I'll get it off my chest.

The Federal Government should pay off 2nd and 3rd mortgages up to 20% of the value of primary residence and take a 25% ownership of the property, if the 1st mortgage is a stable fixed-rate loan and this restructuring will enable the family to keep up with payments after the change. The valuation should be based on the valuation at the time of the last mortgage, not the current valuation.

The Fed is going to pump many billions of dollars into the mortgage crisis somehow. This method allows families to stay in their homes if they can afford it after the deal. They are lightly punished by losing slightly more home value than the percentage of financial assistance they receive. This punishment is appropriate because they bear responsibility for knowing what they could afford long term, and a deal that does not punish them is unfair to those who were more responsible with their finances. Yes, the homeowners were probably deceived by lenders pushing them into houses with payments larger than they could afford in the long term. Criminal charges should be pursued against lenders who misrepresented affordability to home buyers or misrepresented the quality of the loans to mortgage bundlers (for the mortgage resell market). This would minimize foreclosures, which will keep the maximum number of families in their homes and stabilize national home values as much as possible, contributing to a more rapid recovery of housing values than we'll otherwise have.

Thanks to all...

I haven't been keeping up with email, which makes me feel guilty, but I'm probably not going to do better unless and until I can get my pain significantly reduced.  I'm takng a lot less Vicodin than I could in order to avoid getting addicted and to avoid my body becoming so used to it that it doesn't work as well. Unfortunately, that means I hurt more and feel like doing very little, and it makes it hard to sleep until I'm exhausted. That means I've been costing Carla a lot of sleep also.

I've been surprised at how many people have emailed encouragements, even strangers from around the world. Wow. So if I haven't replied to an email from you, please know that I read them all, eventually, and I really do appreciate them.  -- John

FMD Update 4

Well, it was a long, but interesting two weeks, with lots of pain, lots of high blood pressure (measured as high as 195/110) and several new developments.

First, I met with a local interventional radiologist who recommended that he go in and angioplasty my right renal (kidney) artery and look around at all the other arteries in the area, but he wanted to discuss it with my kidney specialist (nephrologist) first. So, I got a call later from an assistant of the radiologist who told me the radiologist talked to the kidney guy, and that the kidney guy wants to see me before the radiology guy does the plasty thing, so I should call the kidney guy right away to get an appointment. So, I call the kidney doctor's office, and they tell me I already have an appointment in 6 weeks. Yes, I explained, but now there's a more urgent matter so I need an appointment right away. Okay, they put me through to the doctor's assistant and I left a voice mail. The next day the assistant called me back and I explained everything, and the assistant said she would talk to the doctor and call me back. That was over a week ago, and they have not called me back. Grrr.

Okay, so the first instance of a major symptom immediately prior to the eventual discovery of FMD was on Sunday, July 13, with lots of abdominal pain, which later localized around my right kidney. I tried to tough it out and went to work as usual on Monday, but the became intolerable and I left after working 7 hours, feeling pretty lame that I couldn't hack just one more lousy hour. Monday night was horrible, and I didn't sleep much, and went to my general practitioner (GP) first thing Tuesday morning, and it didn't take long before she called an ambulance to take me to the hospital. They checked me for kidney stones and gall stones and junk like that, which were all negative. They found a suspicious wedge shaped thing in my right kidney that would need further investigation, and gave me pain meds and sent me home. It wasn't until July 30th that I finally ended up getting an angiogram that revealed FMD in my main right renal artery for sure, and showed a complete blockage in a smaller renal artery that had resulted in the death of 5% of my right kidney, and another partial blockage right next to it. However, no one mentioned the FMD to me, with the possible exception of the radiologist right after the angiogram while I was still stupid from the drugs. Stupider than usual, that is.

Well, this last paragraph is to give you dates, so you can fit this in: In the first week of August, I started noticing a pain in my right shoulder, and it kept getting worse and worse. So I went to my GP about, and was referred to an orthopaedist for a possible tear in my right rotator cuff muscle. Except how could I have torn a muscle? I hadn't been doing anything! Well that led to some big news this week. The ortho doc said all the symptoms fit a tear in the right rotator cuff muscle, gave me a shot in the shoulder and told me to come back in 3 weeks. Did that, and my shoulder was hurting worse, and that wasn't all. The shoulder had only hurt when I moved certain ways. It hurt really bad when I moved it those ways, but when I was a good boy and didn't move it those ways, it didn't hurt. ["Doctor, when I do this, it hurts." "Okay, don't do that."] But in the meantime, my right bicep had started hurting, all the time. So ortho doc sends me for an MRI of my shoulder and I have to wait until yesterday to see her and get the results. And... there's no tear. That's good, right? There's clearly some tendinitis in my shoulder, and some fluid around the joint, and the MRI doesn't show down my arm. The problem is that the tendinitis doesn't explain the severity of the pain.

Now, there's this version of FMD called intimal fibrosis that occurs in less than 10% of FMD cases, but it can cause problems in any artery anywhere, like in a shoulder. I had thought of this a few times, but the odds were really, really tiny. Until I find out I've got no tear. Now those very tiny odds only seemed like tiny odds. The odds my have been tiny, but they were, like, moving in the wrong direction, you know what I mean? So I start thinking too much about it, pondering life without my favorite right arm, and so on. Then I woke up in the middle of the night with a better theory. A much more likely theory. A highly probably theory, that lets me keep my arm solidly attached to the rest of me. Very Tense Muscles. Just hold on, it'll make more sense in a minute.

I went to my GP early this week for a comprehensive review of The State of John, with all the test results, trips to the emergency room with high blood pressure, etc. And as part of the catalog of complaints, the doc noticed my muscles were very tense. I said they had been that way a long while, and I knew it, I just hadn't been able to successfully convince my muscles to relax. It's apparently a reaction to the pain. Or possibly space aliens, but I'm going with pain as the primary culprit. So doc suggests some muscle relaxing drugs. Hey, I'm a basket case, what's one more drug to test? Well, I started taking methocarbamol (generic for Robaxin) "as needed" and pow -- it knocked my blood pressure way down, and reduced my average pain significantly. I hadn't realized just how tense my muscles were!

Now back to the shoulder theory. Tendinitis and tense muscles -- muscles acting like they were constantly doing isometric exercises. What's the treatment for tendinitis? Rest. Don't use the muscles, dummy! Except my muscles were using themselves without permission from the rest of me. So instead of taking the muscle relaxer only when my blood pressure goes high, I'm going to take it regularly for while and wear a sling to remind me not to do anything with my right arm (other than blogging), and I fully expect my right arm to thank me in a week or two. One less source of pain would be a very good thing.

By the way, I had been down to a thyroid medication and pain patches for my feet as my only medications when my kidney blew up. Now I'm on the those, plus 2 blood pressure medications, pain pills, blood thinner, and muscle relaxers. Phooey. By the way, at home, I take the generic version of Vidodin for the pain. They gave a script for Percacet, which is supposed to be stronger, but it does nothing for me. Not only does it not help the pain, it doesn't even give me the intoxicating effect that most people get. Tried it 2 weeks apart, just in case the first time was an anomaly. This, I have no explanation for. Yes, I still have an almost full bottle of Peracet. No, I won't sell it to you. You'll have to get your own malady for that.

For now, it's 11 days and counting until I see Dr. Olin.

FMD Update 3

I haven't mentioned it before, but the reason I'm posting my story of learning about FMD is in the hope that it might help someone else learn about it. Since it's rarely covered on the evening news. And even if it were, people rarely watch the evening news these days.

So, on with the story. I had a duplex Doppler ultrasound of my carotid arteries Friday morning, then Carla dropped me off at the train station and I worked about 4 hours, but on the way home I started hurting a lot worse. On Sunday, my left kidney started hurting, but not as much as on the right side. My blood pressure was bouncing around, going as high as 145/105, even though I'm on a blood pressure medication.

I had an echo cardiogram this morning (Monday), then went to the office, but it didn't turn out well. The train ride increased the pain a bit, and that apparently triggered my blood pressure to go up again. It kept going up despite a double dose of blood pressure medicine. The building I work in has a health clinic, and a nurse there put me in a dark, quiet room and called my doctor. After awhile, my BP stabilized, then went down to about 135/85, which is still too high. Then my family picked me up, and my BP went up again on the way home. After a few hours in bed, it's finally back down to the safe range: 120/80. Unfortunately, I didn't get much work done.

FMD Update 2

Worked all day today for the first time in almost 2 months. I was tired and hurting a bit, but I worked the whole day. Even walked to the train and back home. And I got an appointment with Dr. Jeffrey Olin on October 1st. He's the director of vascular medicine at Mount Sinai School of Medicine at Mount Sinai Medical Center, and has written more about FMD than anyone else. So, I should have a lot of news after that.

FMD Update

Talked to my kidney doctor yesterday and saw my general practitioner today, and they both concur that it's a good idea for me to check with a doc who deals with FMD a lot. I spoke to an assistant for the doc who's written more on the subject than anyone else, and have emailed him my medical history. He's supposed to look it over and his assistant will get back to me regarding one or more appointments. In the meantime, I'm waiting for results of more blood tests, and I have duplex ultrasonography scheduled for my carotid artery and an echo cardiogram just to make sure those things are in good shape. And I now have written permission from my general practitioner that will allow me to go back to work, since my company wouldn't accept a note from my kidney doctor. I still have moderate abdominal pain, but work isn't supposed to make my condition worse, so I'm hoping to last the whole day. Work is good!

Fibromuscular Dysplasia

Well, it turns out I may not have had a kidney infarction after all. There had been continuous confusion amongst the many doctors involved as to whether I had an infarction (from a clot) or an infection (from unknown cause) in my right kidney. The key thing I understood at the beginning was that I had one small kidney artery that was completely blocked, killing 5% of that kidney, and another small artery right next to it that was partially blocked. The blockages were either from a clot of blood or cholesterol or from an infection. An angiogram showed no sign of an existing clot, so if that was the cause, it had dissolved by then. I was put on an antibiotic in case I had an infection, but that didn't change anything. The early prognosis was that I would be fine with such a small loss of kidney tissue, that I would take an anti-coagulant the rest of my life to ward off any more potential blood clots, continue to watch my cholesterol levels, and the pain should be gone in a few weeks.

Except the pain never left. It subsided for awhile, then got worse a while, then better, and so on, but never left. I was out of work that whole time, as the pain was generally more than enough to require medication that interfered with my ability to think, which is what I get paid for. Had I not taken the pain medication, the pain would have been too much to think, so either way, I wasn't much good for working. Last week the pain improved to the point that I thought was ready to resume working and I got a note from my kidney doctor allowing me to return. At that visit, my kidney doctor reviewed with me everything he knew from all the tests. That included something I hadn't been told about before: there were some partial blockages in the main artery feeding my right kidney, and it was determined (by their size, shape, location, etc.) that they were caused by Fibromuscular Dysplasia (FMD). The kidney doctor still didn't know what caused the full and partial blockages in the smaller arteries, as things didn't quite fit the normal characteristics of either infarction or infection.

Then I found out my company and the insurance company require a note from my general practitioner, so I had to wait until next week. Then a couple of nights ago, the pain got really bad again, and my blood pressure went high (around 160/110) and stayed there. Although the pain backed off a little, the BP stayed up, and my kidney doctor called in a prescription for Diovan to bring my BP down. After a day or so of that, my BP is back down. In the meantime, I've been studying FMD.

FMD is a rare disease. Really. There's actually a list of rare diseases, and FMD is one of them. And there's a support site on the Internet run by doctors and patients, and information from FMD doctors indicates that FMD is not well recognized or understood by doctors. Patient stories support the idea that most doctors are not familiar with it.

Basically FMD results in some cells in the walls of arteries growing larger than they should, constricting the flow of blood through the artery, eventually blocking it off altogether. No one knows what causes FMD, though genes and hormones both seems to be factors. There's no cure, but the symptoms can be treated with anti-coagulates and angioplasty. Most people who are familiar with angioplasty have heard of it because they know someone who had it to open up an artery around their heart. That common usage means someone gets an angioplasty once every few years or less often. Some people with FMD get angioplasty several times a year. FMD can effect any artery in the body, with the kidneys being the most common, and the carotid arteries being the second most common.

So, I've come up with a theory, which I wrote up and faxed to my kidney specialist yesterday. He called me late last night to tell me he had been in hospitals all day and had not had time to read the letter yet, so I'm hoping to hear from him next Tuesday. I have an appointment with my general practitioner on Wednesday, and I'll discuss this with her then. My theory is that I had neither an infarction nor an infection, but that both are the results of FMD. There is a form of FMD called intimal fibroplasia that comprises less than 10% of FMD cases, but it appears to me it fits perfectly with the full and partial blockages I have in my smaller kidney arteries. It seems to me to explain everything, including my continuing and fluctuating pain, and I really like understanding things. If I'm right, however, it's bad news, because this form of FMD is the most aggressive.

Well, as Bill Gates famously said, it's good when bad news travels fast. That's because the sooner you learn of something bad, the sooner you can do something about it. So, I have FMD. I may have the most aggressive kind. Since I know, my doctors and I can more aggressively monitor my arteries and intervene with angioplasty as often as necessary. And that could give me months or years more than I might have left if we hadn't figured it out.

Whenever I have more news, and feel like posting, without being to unintelligent due to pain medication, I'll post followups here.

Big Setback

I was sure my next training run of 5k was going to be the first time in over 20 years I'd be able to run that distance without having to stop and walk part of the way. I was just a day or two away.

Then I had a kidney infarction and lost 5% of my right kidney. That was weeks ago, and I haven't stopped hurting yet. Quit doing everything, including eating, and have lost 20 pounds, so I'm down to just over 130 pounds. Haven't weighed that little since high school.

Well, two weeks ago I start walking again, very slow, very short distances. I got to where I can walk to the Metro station again, and took a short test ride. Subway trains are way bumpier than cars, if you didn't know, and the shaking is really tough. Since then I've ridden all the way downtown twice. It made me hurt worse for awhile, but within a day it got back to the same level of hurting it was at before the train ride. I sure am looking forward to running again. And working again. And doing other things again. Especially running.

Running Update

Well, the official results are online for the Race for the Cure, and there were only 7,637 finishers, far fewer than I had been told on race day. I was 517th, with a time of 26 minutes and 23 seconds. I was 23rd out of 222 in my gender/age group.

I ran today, to/from my front door, about 3.1 miles, based on a path I traced with Google Earth. It was 88 degrees, 18% humidity, and rolling hills. I couldn't even run a full 2 miles without stopping to walk this time. It took me 31 minutes & 31 seconds, about a pint of sweat, no known blood loss, and my weak link was breathing (again). For my next race, I may downgrade from a run/walk to a run/walk/stagger.

Rationing Health Care

Heresy! No one in their right mind would support rationing health care. Would they?

Well, since there is a finite amount of health care, and that amount is less than everyone would use if they could, the fact is that health care is rationed now. The current rationing mechanisms are complex, and involve many intertwined interactions between the free-market, public and private health insurance plans, health provider management organizations, volunteers, and other components. It's complex now, it's not going to become simple, and there are ways to improve it and ways to make it worse. In fact, most changes that would make one aspect of health care better will make other aspects of health care worse. So it would be prudent to make changes very carefully, understanding as much of the trade-offs as possible.

But not now. Now, it's national-electioneering time, and most candidates are going to be talking about health care. Lots of them are going to use the phrase universal health care, but what they'll actually talk about will be universal health insurance. It pains me to observe that there are so many people running for office that use "health care" and "health insurance" as synonyms.

The Politics of Health
Most politicians are not morons, so the reason they talk like this is likely that they are simply pandering for votes with sound-bites instead of carefully reasoned positions. I can't help but wonder, though, how many even realize that health care and health insurance are not the same thing. People don't need health insurance, they need health care -- health insurance is just one of several mechanisms to ration health care.

Universal Health Care. Sounds great! But people will never get what many politicians are promising... extending health care to everyone, without compromising quality. Politicians will never fulfill those promises because it's not economically possible for any society to accomplish that. Some of them make know that, but all of them will yammer about it and pass legislation that deals with health care, and they'll claim victory based on such legislation, regardless of the actual results of the legislation.

Ain't Gonna Happen
I'll use two extremes to illustrate why universal health care is not possible. The concepts are the same whether applied to a single nation or the globe, but since we're using the term "universal", I'll use global terms for this example. So let's assume a world population of 6 billion and total global wealth of 1.1 quadrillion dollars. Let's set aside an extremely meager 10% of wealth for food, housing, transportation, and all those other things people seem to like, leaving us with an even 1 quadrillion dollars for health care.

Great Health Care
For the first extreme, suppose researchers develop a vaccine that will make a person immune to all disease, but that the process to manufacture it results in a cost of one billion dollars per dose. (The pill requires a superconducting super-collider to spawn reactions that result in a molecular accrual rate wherein the energy and maintenance costs equal the billion per dose.) While were at it, let's pretend that there are no safety/side-effect concerns.

If we were to spend our 1 quadrillion dollars for health care on this super pill, we could create doses for exactly one million people, or less than two-tenths of one percent of the world's population. Um, that's noticeably less than universal. But, we run the machine because the researchers hope to discover a way to substantially lower the cost, and while they're researching, they create a few hundred of the pills. Who gets them? Who decides who gets them?

Good news! The researchers have discovered how to significantly lower the costs! Unfortunately, it still isn't enough for everyone. So, you chose... do you want the pills to go to the oldest people, the children, or random chance selection? Okay, say we chose the children for the noblest of reasons. Now, at maximum production, we can provide one pill to 80% of all children born. Sorry, there's just not enough wealth to get to 100%. Maybe if we took some of our health care money and used it to improve the economy we could get there, but that would mean we have to create fewer pills now. How could you possibly chose to reduce pill production to cover only 70% of the children now in order to get to 100% some day in the future? Those are hundreds of millions of children you're leaving exposed to deathly disease. Okay, 80% it is. Which 80%?

Great Health Care Equality
Here's the other extreme. All world governments agree to a global health care plan that will be absolutely equal. In order to ensure that it is equal, everyone reluctantly agrees not to allow any health care other than the what is provided by the global health care plan, so the rich people can't have anything better than the poorest person. Yeah! Now that's truly fair to all! Okay, we know we can't afford to give everyone the best of everything, so we have to start from the other direction. We'll come up with a list of health care benefits that can be provided to every person on the planet, adding one item at a time until we reach our 1 quadrillion dollar limit. Now let's see how much we have to spend. One quadrillion divided by 6 billion people equals... $166,666.67!

Wow, jackpot! That's a whole lot of health care for every man, woman, and child on the planet! So, we can allocate for each person for their entire life. Oh, let's say, two boxes of band-aids, two emergency-room visits for broken bones, and we don't have those super-pills under this scenario, so we'll dedicate some funds for vaccines, one-heart attack emergency room visit, a few drugs such as cholesterol and blood-pressure control, and we'll allocate the rest to cancer chemotherapy and radiation. Unfortunately for you, you need a heart transplant, and that didn't make it onto the list.

Well, that's no good, so we'll make the universal health care plan so that everyone gets up to $166,666.67 worth of whatever they need. All right! Oops, it seems that your heart transplant would cost $200,000. Sure, if you sell your house, you can come up with the extra $33,333.33 to throw into the pot, but you're not allowed to. That would be unfair to all the people who don't have any extra money, and a fundamental principle of the universal health care plan is that we absolutely must be fair. No one can get anything extra just because they can afford the extra costs. Besides, we forgot about the time you broke your arm on the playground and had a doctor put a cast on it. Now you're an additional $500 short.

But then you realize that there are a lot of people who are healthy their whole lives and never need any health care at all. The health care money those folks don't use should be made available, equally of course, to all the folks who do need it. And joyously, it turns out to be $33,833.33, so it will cover your heart transplant!

Unfortunately, it took quite a bit of effort to get the world to agree to the universal health care plan, and now its managed by a United Nations bureaucracy, so it may take a little longer to get them to change things than you have left on your old ticker.

Promises, Promises
Okay, so what's my point? The point is that universal health care is what people need, but that universal health care without compromising the maximum quality of health care is not possible, and any political candidate who says otherwise is either woefully ignorant or is lying. So, please don't vote for morons or liars.

2 Months, 2 Minutes

My son David & I completed another 5K yesterday, the Susan Komen Race for the Cure, which raised over $3,000,000 to fight breast cancer. The temperature was about 72 degrees and humidity was about 80 percent at 6:30 AM, but the temperature climbed fast and the humidity went down a bit by the time the race was over.

The race was to start at 8:00 AM, and David and I got to the starting area at 7:20. There were so many thousands of people scheduled to run, I figured it'd be crowded at the starting line by 6:00, and I didn't want to wait there that long even if it meant having to spend as much time running side-to-side to avoid other runners as I spent running forward, so 7:20 is when I planned for us to get there. Much to my surprise, there was only one other person standing at the starting line, though there were at least a hundred on the shoulders of the road nearby.

We took places front-and-center, and I laid down to rest and wait. Normally, I don't recommend that anyone lay down in the middle of the street on Constitution Avenue. Immediately after the starting barriers were removed, about two minutes before the race started, a couple of dozen people pushed their way to the front. You could tell these were the serious runners who wanted to win or place, so I didn't mind giving way to them.

As the race began, I ran my pace, and instead of having to pass other people, other people were passing me. A lot of these folks were those who don't know their pace, so they go real fast to start, then have to walk. I wasn't able to run the whole way, but I ran my pace as long as I could, and I made the first mile in 8 minutes flat, and the second in 8 minutes and 4 seconds. It wasn't long after that, though, that I had to walk a bit, and alternated between walking and running until the last quarter mile or so, when I was actually able to put in a little kick to the finish line. It was so warm, around 2.5 miles, I had started if I would have to walk the rest of the way, but I was able to mush through it.

This race didn't use the sensors attached to shoes, so they had lanes at the finish line. You enter a lane and someone manually writes down your time, in order. Someone else tears off your bar-coded ID from your race bib and puts in on a spindle, in order, so that if it works right, they get a fairly accurate time. Unfortunately, by the time David came through, there were so many people jammed up at the finish line, he had to wait to get counted. That was the case for most of the runners, and there were tens of thousands, so I was told. David still finished in under 40 minutes, though.

I haven't found an estimate by the organizers as to when official times and places will be posted. By my stopwatch, I finished in 26 minutes and 29 seconds, so I shaved a little over 2 minutes off my time from my race in April. This time, I didn't push myself quite as hard, and wasn't completely exhausted afterward. My average speed was 7.02 miles per hour, and my pace was 8 minutes and 33 seconds per mile. Not bad considering this time last year my muscles hurt so badly without knowing the cause that I wasn't sure if I'd be alive this year. My next goal is to be able to run an 8 minute pace without stopping for a full 5 kilometers. Once I can do that again, I haven't decided if my next goal will be speeding up or increasing distance. Isn't that a wonderful dilema?!

After the finish line, I turned right and walked over to the path around the
Smithsonian Museum of Native Americans and scooped up some water to splash on myself while I waited to meet up with David there. Almost everyone else turned left to go onto the National Mall, where the organizers had lots of tents set up. Despite the enormous crowd, only a dozen or so people came over to the museum, so it was a great choice for a meet-up. That museum is such a peaceful place.