Monday, February 27, 2017

Knee injury

This is to post about a new small injury I just had on my left knee but before that, I would briefly talk about another knee injury that I never documented, for what it may help.

In few sentences... One day snowboarding I felt on my face and let my board hit my butt. Basically one foot went straight to my butt, but the other, as tight by the board, swung to the side of my hip and sprain my MCL (yeah, I wasn't very flexible). The thing was not recovering for 6 months although I was not doing anything to it (no medicine...). Then I thought about applying heat. I did, for a weekend, and it got totally recovered in just that!

Anyhow, that was a hint, as I said, in case it may help somebody... Now I got my knee hurting. I don't remember doing anything special to it when I felt the pain. Basically went down the car and felt it was hurting. Got a standing meeting with somebody for an hour, and it just got worse and worse.

The only thing I can think of is the following. Since the episode above, I try to stretch the MCL in the knees. Usually I kneel down, separate a bit the fit and then just sit between them. I am at the point where I can sit comfortably... Another stretch I do is squatting, trying to stretch my calfs (remember my issue). I always do these and I am fine (I just bring them in for the record as it still may happen that one day, one of them hurts you and I just don't know). Nevertheless, over the last week I introduced a 3rd one to stretch my gracilis and adductor lungus (and the groin area). Usually I do this by squatting in one leg while stretching the other to the side. But this time, besides that, I did one where in the squatt position you open your knees and place your elbows between them, while your hands are in the floor, in front of you. By pushing with your elbows out, you can feel the groin stretching. To put more force I leaned forward, on my tip toes, while the elbows push open on the knees. Anyhow, while doing all these, I felt a tiny sharp pain inside, behind the knee, a bit centered to the left (on my left knee). See Note 1 below. Very fine but I decided not to run for few days (also because of the calf issue) although I kept stretching this way at the gym. And after about a week, the car incident happen... 

Now, 3 days later, after applying 2 or 3 times ice and taking maybe a total of 600 mg of Ibuprofen (I know, that is little), I still feel I haven't improved much. Haven't been standing a lot but still normal life...

The pain is not behind the leg (where I felt the sharp pain) but feel more on top, under the kneecap. This also reminds me to some pain I used to have if I took off running without warming up. Now, after I regularly run, this does not happen anymore, but this time the pain is similar to that. On those cases, after 3 days I was fine. Doctor said once it may be a tendinitis. But this time, as I said, still not good...

Looking around squatting position type injuries, I found this article which mentions this type of injury may be due to pressure to the patellofemoral. This I guess can be many things. There is a book which seems very complete on a chronic problem, which is not my case (it just happen suddenly and hopefully won't stay long). Unfortunately only a partial intro is displayed and you got to pay for the rest. The references at the bottom of the page may be interesting, though.

Note 1: that is a point close to where the soleus reaches the knee. I wonder if it has anything to do with the calf sprains...

Note 2: reading this, I realized that they have something like that for teenagers. I did suffer a similar pain in both knees when I was a kid. Finally I pinpoint the reason to sliding forward on the seat of my class desk all the way till the knees hit the front legs. They were bearing the pressure and things got worse over time, for weeks till the point I couldn't run. One day I finally realized the cause and stopping that position went away (yeah, tell me about it!).

Note 3: Also, he mentions that running is good for your joints, which is what I have been saying that happened to me...

Update: By Monday (4 days after the injury), pain seems to be gone. I don't want to squat or test it on any way, so, can't be 100% sure, but the icing worked out pretty well. Tip: I didn't use ice per-se, just put the Sac-Gel bag in the refrigerator (not the freezer) which allows me to "recharge" faster. Used it like 5 times over a Sunday and did the deal. Won't come back to this post unless I get injured again @@

For the next, in case I need it, an old paper which seems pretty complete.

Wednesday, February 22, 2017

How jobs will do in US from 2017 and later?

I am realizing these days that you don't have to think in finances... Well, that is a bit of an exaggeration, but if you look hard enough, you can find somebody who spent a lot of time researching the question you are trying to answer, finding the angle that you are looking for, refuting one or other idea that you question, etc... As an example, yesterday I found out that people have been tracking the number of times that the word "optimism" shows up across all the CEO's earning reports to see how economy is going to do in the future. Geez!! They look for every indicator possible! This other article questions the pick-up in stock prices (reflecting technically a good economy) while commodities have not moved (which should be the result of increased demand for goods).

Anyhow, continuing with my analysis of US jobs that I did here, today I learnt:
  1. That you don't need to try to speculate what jobs will do... The congressional budge office will do the Labor Market Projections for you :). By the way, if you are interested to know, they predict that basically all the slack left on the labor market to deal with future job openings will run out in the next 2 years. "Everybody" will be employed with wages going up...
  2. Also learnt what the Beveridge curve is. Basically a plot of job openings rate vs unemployment rate. Very interested to anticipate where the economy is heading. 
  3. The #2 link gives the curve in 2012 and predicts that things are just going to get really good in the next 4 years. We all know they nailed it. For an updated Beveridge curve these days, check out this very recent (2/17) and nice article from the Bureau of Labor Statistics. It includes also other graphs like number of unemployed persons per job opening. 
Cheers!

Saturday, February 18, 2017

PAD: peripheral artery disease or SIntrom / Warfarina

I'll jump straight to the answer now that I know, but will leave all the other rambling below (which is what I was digging before I found out the answer).

It is not the point of this write up to explain what PAD is. Plenty of basic intros out there. But try to dive down as a family member seemed to be getting tired legs when walking... He had had surgery few months before and during the surgery had an arrhythmia so they put him on sintrom (a blood thinner also called warfarina). As such, our first suspect was that, but I couldn't find any relation (see below... I was not that smart). Doctor checked and said that he seemed to have weaker pulse in one of the legs, so, he said, he had a mild case of PAD. But over the months he was getting worse and worse. One year later (after many monthly checks of the sintrom dose in blood) he went for the annual check, and the doctor wonder how he could be so pale. Then he discovered it had a huge anemia and rush him to the ER where they transfuse him 5 bags of blood!! Bottom line, he was bleeding to death over all that time. All the checks so far have been unable to find where he was bleeding from. But hey, if you get tired after taking warfarina / sintrom, check your blood levels! After the transfusion, he can now walk like the first day!! DUH!!! Big round of applause for those morons that didn't listen...

I'll put it in Spanish in case somebody searches for it: si el paciente se cansa de las piernas cuando camina hasta el punto que se tiene que parar y esta tomando sintrom, puede que no sea enfermedad arterial periférica (EAP), sino una anemia/perdida de sangre interna! Un simple analisis lo deberia decir.

If you want to see some paper on the topic, check here

Cheers!

PS.: Here is all the other stuff...

The first line of treatment for PAD is daily exercise and a healthy diet
ankle-brachial-index, or ABI << Test he got? The procedure is really well explained here and should be doable by a layman except that one may have to use stethoscope or ultrasound Doppler. 

One suspicious is sintrom, But a first read doesn't seem to point clearly on that direction. Below some of the stuff I found. One important thing would be to simply ask the doctor to change medication or stop it for a short period of time. 
http://sdesalud.es/recomendaciones-para-para-pacientes-con-anticoagulantes-orales-sintrom/
http://www.medschat.com/wiki/Warfarin/
Nice site on several blood thinner. Example
Vitamin K antagonist

It is hard to find side effects on tired with sintrom when looking in English. It may be because in US they use warfarina. Nevertheless, I found this link when looking under Spanish. People complaining about sintrom/tired legs

Alternativos: Dabigratran, Rivaroxaban, Apixaban, Aldocumar (warfarina)

Medications are also often used, including a statin to lower cholesterol, blood thinners, blood-pressure medications and a drug called Pletal that helps expand arteries and relieve leg pain.
angioplasty with stents

from here
i can help you with stabilizing your inr. i know how to do it. first of all you have to buy your own COAGU CHECK aparatus,from roche germany. find it on google,order it,pay it and have it. then learn to measure your inr youself. not difficult at all. aparatus i have cost me around 800 euro,and for measuring little films,i dont know how else to call them,every farmacy have them. they cost about 4 euros each. not expensive. then you are your own master re your inr. after that you can eat what you want. and measure your inr once in a forthnight. in the meanwhile,have in mind that on whatever day you ate more green stuff,find on google lists of content of vitamin k in foods,on such a day you should take one fourth of a sintrom tablet more than on days when you did not eat much of such foods that are full of vitamin k. as general rule,green leafy vegetables like lettuce and spinach parsley etc have much vitamin k in them. it is not a good idea that you stop eating these foods cos they contain folic acid that is nesessary for health. and omega 3. the one fourth of sintrom tabblet more on days you ate more green foods,and less on days you did not eat much of these foods,is my rule. for me it works. but you will say,who will decide how much sintrom daily i will have to take after having measured my inr. you will decide it. ill tell you how i do it. lets say my todays measurement of inr was 2,75. its a good finding. then ill decide to take three thirds or one whole tablet every day. we dont all react to the same dose equally. so in the beginning you will have to measure your inr more often so as to see how you react at one tablet or at three thirds. but you will have only you,only one patient to follow,while your doctor has many. one more thing. it makes sense to take sintrom in the evenings,cos in a public laboratory or you doctor they measure it in the morning lets say at nine o clock. so,nine in the evening is half time,12 hours in between.

Tuesday, February 14, 2017

Health care and retirement coverage in Spain

This post is mostly looking into the situation of Spaniards living abroad but eventually planning to go back to Spain.

For healthcare covered by taxpayer pocket, the governing law is really wide and covers almost everybody. Some that fall outside could be a resident that makes more than 100k Euros but doesn't pay Social Security (which includes Health Care). Or a Spaniard that is not resident. Nevertheless, if the Spaniard is visiting, he is still covered as long as nothing else does:

  • "Los trabajadores por cuenta ajena españoles de origen que no residan en Estados miembros de la Unión Europea, ni en Estados parte del Acuerdo sobre el Espacio Económico Europeo ni en Suiza que se desplacen temporalmente a España tendrán derecho a la asistencia sanitaria en España, con cargo a fondos públicos, a través del Sistema Nacional de Salud cuando, de acuerdo con las disposiciones de Seguridad Social española, las del Estado de procedencia o las normas o Convenios internacionales de Seguridad Social establecidos al efecto, no tuvieran prevista esta cobertura."

I guess that integrates de-facto such a Spaniard in the coverage, although there is a doubt about treating not urgent cases ("go back home and take care of it there").

How about retirement?
Wikipedia, as usual, is a good reference but I think only shows the old regime (which somehow you can choose, if you want?). In the new regulations, it seems that to compute the base of what you get paid you use the last 25 years of data. The formula is tricky and it never gives 100% of your pay (you divide by 350, but there are only 300 months in 25 years). But you can actually start getting paid after paying only 15 years. The kick is that then you get only 50% of the base. The percent increases by 0.19% every month, the first 248 months and then by 0.18% the rest, to cap at 100% after 300 months (25 years). Notice that if you only worked 15 out of 25 years, the first 10 are included on the base but at much lower rate (not zero, though, but minimum salary type stuff). So, if it was zero it would be 50% of 15/25 = 30%, but it'll be a bit higher (as again, it is not zero...) on one side, but lower as you actually owe to compute the base by dividing by 350, not 300 (25 years).

I guess I can decide soon if it is worth... How much is the payment?
A friend suggested to sign up as self-employee (autonomo). To compute how much you would pay, you would choose your salary from a range (between 893 and 3642), and then apply a rate (29.8%). So, say that you want to have the maximum salary at retirement but start paying when you are 52 (15 years before the 67 years of retirement age). You would pick the 3642x29.8%=1085 Euro/month. Nevertheless, you have to make sure you are paying that by the time you reach 47 or otherwise the maximum is limited to 1900. Anyhow, if I am thinking this right, notice that you pay about 1/3 of what you claim to make (which becomes the base eventually). So, when you start getting paid back (after retirement) you actually make about the same per month (in the scenario where you only paid for 15 years). Looks a bit like a break even deal (as you don't know if you are going to live past 67+15=82 years).

The kicker is that my friend was considering doing that while he was actually working on a foreign country (non-EU) so, probably was not legal (?).

Cheers!

Sunday, February 5, 2017

Has the economy in US really recovered for everybody during the Obama administration?

Frequently I hear folks on both sides either praise or complain about the employment figures in US. The argument from the anti-Obama folks is that the figures do not reflect the reality. It is also an argument of why Trump was elected. So, I try to figure what is really happening. Did folks recover from the recession or are there certainly groups that are worse than they were pre-recession?

We should probably start by looking at how the government measures unemployment. Their last number was 4.8% seasonally adjusted as of January 2017, which is 7.6M out of 159.7M (labor force) out of 254M (civilian non-institutional population) our of 325M (US population). Note: The difference between the last two is the addition of folks in institutions (penal, mental facilities, homes for the aged), folks who are not on active duty in the Armed Forces, and of course, folks less than 16 (22M).

The critics of this index point to the fact that the government does not count as unemployed in the official figures: 
  1. Discouraged workers: a subset of persons marginally attached to the labor force. The marginally attached are those persons not in the labor force who want and are available for work, and who have looked for a job sometime in the prior 12 months, but were not counted as unemployed because they had not searched for work in the 4 weeks preceding the survey. Among the marginally attached, discouraged workers were not currently looking for work specifically because they believed no jobs were available for them or there were none for which they would qualify. It is also important to say that to be accounted as discouraged worker, one should have tried to actively find a job in the previous 12 months. Planning what to do or browsing through ads doesn't count. This trend can partially be extracted from the labor force participation rate (labor force to total population older than 16) and from the employment population ratio (employed to total population older than 16). Interesting enough the government does track this too! Check U5 here. Including those, rate goes up to 5.8%, again, seasonally adjusted as of January 2017.
  2. People that partially work a tiny bit (>15 hours) of the week when the survey was done are counted as employed. So, sure, they worked, but how much money did they really make? Government also tracks part time workers (+ discouraged). See U6 here again. In this case, we are at 9.4% seasonally adjusted as of January 2017.
Note: Just not to rely entirely on the survey which yields the above numbers, the government itself reports also the number of nonfarm payrolls. This stands at 145.55M (slightly lower than the 159.7-7.6 = 152.1). That is actually higher than pre-recession levels (138M).

We could look at those too, but let's look first at some other interesting links. Wikipedia (as usual) has a nice explanation/graph showing what happened:


Somehow, with the crisis, the percentage of employees respect to the full population dropped by about 4.5%. Similarly, the unemployment rate went up by about 5%. During this time, the first nevertheless has barely improved 1%, while the second (the statistics used by the government) is actually back to pre-crisis levels. So, there may be some truth to it.

The other point to look at is the complain that although people may have work, pay is actually lower than used to be. Again on the same Wikipedia link we can see that being the case:

I am not sure how the wages and salaries are obtained (got to go back to this) but overall, there seems to be some truth to the statement that although for many the crisis is behind and they are thriving (they may have never been hit, actually), there is a segment of the population that didn't recover and are actually worse than pre-crisis levels. In fact, it is probably this inequality who accentuates social unrest and could trigger even more dangerous consequences.

Cheers!

PS.: I did a follow up on future job trends here.