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I opened up a piece of snail mail yesterday.  To say I was a little bit shocked is an understatement.  This was the first bill I’ve received after a fairly intense medical procedure five weeks ago.  I’m fine now, things could not have gone better.  But the bill was, let’s say, a little on the high side of my expectations. 

At the very top it had one eye catching line labeled “Total Charges”.  Great, no wading through pages to get to the crux of the matter.  So how much were the total charges?  That three hour surgery and the eight hours I was a guest in their stage one post-op ward resulted in total charges of $249,320.50.  I didn’t mistype that, it was just a few dollars short of two hundred fifty thousand US dollars.  Or stated another way that’s nearly twenty-three thousand dollars per hour!  Man, I’m glad I did not stay overnight.  

That’s a lot of money.  And while I feel its a heck of a bargain in exchange for keeping me alive and kicking, that’s still very nearly a quarter of a million dollars.  And I’m not even sure there won’t be more bills trickling in over time (although I think this is the grand total).  

This is also my first real test of how Medicare and my Medi-Pak supplemental insurance work when facing a major medical expense.  I haven’t had many health scares in my life and the times I did run up a sizable bill I was under my company medical insurance plan.  Obviously I won’t be facing the entire $250K out of my pocket.  But just how much of that is going to have to come out of my retirement nest egg?

The answer was just as surprising as opening the bill, but in a much happier way.  Total out of pocket expense for yours truly was zero.  Zero, nada, zilch.  Not even a single penny.  How wild is that?  No co-pay, no deductible? Not a single penny for this extremely expensive medical care?  The other five pages of the invoice offered an “explanation”.  At this point I was feeling like there had to be a catch and I was afraid I might be facing an unpleasant surprise hidden somewhere in the fine print, so I kept reading.

The bulk of the “Total Charges” showed up on page 3. That was the portion  that was from the hospital surgical center and post-op ward.  Those added up to over $225K.  And of that Medicare applied a “Member Discount” of $215K.  In other words Medicare told the hospital, “Sorry, doesn’t matter what you think it cost, we are only paying you ten thousand.  You can eat the rest, the other two hundred thousand plus dollars.  And by the way, you cannot go after Steveark for any of that, he’s golden.”  Of that $10K that was paid to the hospital, that was split 80-20 between Medicare and the supplemental policy I purchased.  It could not have worked out better for me if Don Corleone had handled the “negotiations” with my provider and made them an offer they couldn’t refuse.

As far as the rest of the costs which included anesthesia, oxygen, robots and my rocket scientist surgeon, they were not as bizarre.  Medicare only disallowed a small part of their fees and they and my supplemental policy paid that with zero out of pocket from me.  

What a great deal for me, I got a little health issue fixed forever and paid nothing.   I know everyone says our system is totally broken compared to the rest of the world, and maybe they are right. But I got first class care where I wanted, when I wanted and with no cost to me.  That doesn’t feel broken.  

I said no cost to me, but that is not entirely correct.  Medicare charges me and my wife premiums, our supplemental policies do also and so does the prescription plan we use.  Those six premiums total up to about $8,000 a year for the two of us.  That isn’t free but it is affordable and only about half of what I paid for private insurance before we hit age 65. 

But something is broken.  I don’t think my procedure cost anywhere near a quarter million dollars.  Pretty sure the hospital made that number up, that it is pure fiction.  But it certainly cost a lot more than Medicare agreed to pay.  So I got a pretty big free ride.  Except, there are no free rides in life.  And that medical center is a for profit business, it is not a charity.  So they have to make a profit or they will shut down, right?  If I didn’t pay for my surgery, who did?  

That’s the question  that points to the where the brokenness lies.  It is you, kind reader, you who are on private insurance, employer provided insurance or health share plans.  They do not have the power of the federal government and while they certainly would have negotiated the total charges down to maybe half of what the hospital asked for, it still would have been a six figure surgery instead of the small fraction they got from Medicare for fixing me.  

I have one additional data point that gives me confidence that I’m right about how this works. I was on a hospital board for a locally owned hospital back in the day.  I remember the CEO explaining how the thing that determined if the hospital made money or lost money was the patient mix.  He used this example.  He said a standard heart surgery at our hospital actually cost about $20,000, that was the amount the hospital needed to recover to break even.  He said if a patient had insurance through their employer or any other kind of private insurance they would get paid $40,000 for the procedure and net a $20,000 profit.  However the same surgery for a Medicare or Medicaid patient would only result in a $10,000 payment resulting in a loss of $10,000 for the hospital.  Therefore you needed one private insurance patient for every two Medicare patients just to break even.  That’s a broken system and that’s a big reason private and employer provided insurance is so expensive.  You are paying a big share of Medicare and Medicaid patient costs.

It is broken on many levels.  But a main one is it sends a perverse signal to the provider.  If they know they are losing money on me as a patient, they have a huge incentive to underserve me, to rush me in and out, to provide the least post operative care possible.  I’m not a opportunity for them to make money, I’m a drag on their profitability.  I’m more like a tax than an income stream.  That’s a terrible business model in a capitalistic economy.  Plus how can the government tell you to operate your business at a loss, how is that moral?  It is like telling a car dealership that they have to give away one third of their new cars for free each month.  What does that do to the price of the cars they don’t give away?  Exactly.  

What is the answer, socialized medicine like our neighbors to the north?  Or just keep things like they are?  I mean it worked great for me, I can’t complain.  I got an incredible bargain even though I could have paid the full quarter million and not seriously impacted my net worth.  I do think any kind of “Medicare for all” is asking for disaster the way things are now because  hospitals generally  cannot make a profit just with Medicare reimbursements. They have to be able to overcharge private insurance companies to offset the low Medicare payments.  At the same time giving wealthy boomers free medical care paid for by the insurance premiums of Gen X, Y and millennial patients feels unsustainable and unfair.  I have no suggestions at all.  How about you?

OK, maybe you stayed at a Holiday Inn Express last night, how would you fix this mess? 

Have you experienced something bizarre in terms of medical bills and insurance?   

Annuities are a polarizing topic.  The FIRE community generally has zero use for them.  But financial advisors, even fee based fiduciary financial advisors, quite often recommend them.  In fact,  a retirement planning expert  I highly admire and respect even included one in the detailed financial plan he did for me and my wife years ago. He doesn’t sell them or get any kind of commission, he just honestly thinks they make since for someone like me, maybe for most people planning retirement.

So what is the truth regarding annuities?  I will lay out the common arguments I am familiar with, pro and con, and let you decide.  First, the case for annuities.  One of the biggest problems with determining if you are truly financially able to stop working is the fact that none of us know how long we will live.  If we knew that it would be fairly straight forward to come up with the amount of investments, savings and/or passive income we would need to quit work and retire. The standard consensus figure that is most commonly thrown around is you need twenty-five times your annual expenses invested to have enough money.  There are a lot of assumptions built into coming up with that.  Its also known as the four percent rule, because if the assumptions hold true in the future, you can safely draw four percent of your investment portfolio out the first year of retirement and then draw that same amount of money, adjusted for inflation, every year after that.  But what about those assumptions?  

And there is the rub.  Those assumptions include that you have a significant exposure to stocks (50% or higher), that’s simple enough.  They also include assuming that all future stock and bond performance will be the same as it was in at least one of the past thirty year historic sequences.  In other words the future will not be different from the past.  Now that is quite an assumption when we have record national debt, new things like crypto currencies and a stock market that is setting records for price to earnings.  It also assumes you are invested in low fee index funds and never panic sell and always faithfully rebalance your allocations. But the biggest assumption of all is that you only need to fund thirty years of retirement.  Now for a guy like me who retired, mostly, at sixty that’s probably about right.  But for many of you, planning to retire well before that age, you will still be pretty young after thirty years has transpired.  What financial planners call that risk, that you’ll outlive your money, is longevity risk.  And it is a real thing.  

And what do we do to control risk?  We buy insurance.  We insure our car because we might hit someone and hurt them and get sued.  We insure our house because the Fed Ex woman might trip on our front step and, yeah, sue us. Or it might catch fire and burn up along with all our stuff.  We even insure our death with a product nonsensically called life insurance, because when we die our income dies with us and we may have people who were depending on us.  So how can you insure against living too long?  That is what an annuity is, it is insurance against out living your money.  The concept makes sense for the same reason those other insurance policies do.  Car insurance is cheap compared to the cost of getting sued for crashing into another car.  Home insurance is pretty cheap compared to rebuilding your house if it burns down.  The reason insurance isn’t super expensive is because most of those bad things you insure against do not happen very often.  So if one person in a thousand has their house burn down the other nine hundred ninety-nine people who never have a claim help pay for rebuilding the house through their insurance premiums.   

An annuity is much the same.  First let me clarify I’m only talking about the type of annuity that pays you a fixed amount of money each month after it starts,  and it never stops paying that fixed amount until you die.  If a vampire bites you and you live to be five hundred years old the insurance company will still be paying you that same monthly check.  And that is how it insures against living too long.  As long as you are still ticking the checks will keep coming, it is the ultimate mailbox money.  Financial planners that favor annuities usually do not try to provide for your entire retirement expenses with an annuity but generally separate out what you need to live a “no frills” dignified life and buy a big enough annuity to cover those costs.  They will usually recommend putting the rest of your investments in conventional things like index funds and bonds and cash and to use that money for emergencies and “frills”.  

It makes sense and should take less money to fund than it would to invest enough of your money in stocks and bonds to provide the same income. Let’s do the one thousand people thing again.  Say one thousand people buy annuities that start paying at the age of 60.  The average life expectancy of those thousand is, let’s say, eighty-eight years.  The fact is some of them will die in their sixties and seventies.  And when they die the insurance company stops writing them checks. So maybe they paid $500,000 to get an annuity that would pay them $2,125 per month( real numbers from TIAA’s annuity calculator).  Well if someone dies at age 61 the insurance company just made a $474,500 profit off that person because they only got back twelve months worth of checks for the half million they spent.  And that money is available to write checks to all the geezers (being a geezer, I’m allowed to say that) that live past their life expectancy.  So the geezers get a wealth transfer from those that die too soon to get their money back.  And that is why a lot of financial advisors like annuities.  They also make a big deal about the fact that annuities are a guaranteed contract, no matter what the stock market does the insurance company has to make those payments to you as long as you live.  That is versus a four percent withdrawal rate that might stop working if the US some day becomes the next Japan with a market going down or sideways for decades.  

What about those who hate annuities, why do they hate them?  Lots of reasons.  First you can usually earn a lot more by investing the money yourself than the insurance company will pay you.  I mean, they have to make a profit and that profit is coming out of the monthly checks they write to you.  And in many cases the fees charged by insurance companies for annuities in the past have been egregious.  I think that competition has greatly improved that but it happened enough that many people permanently wrote all annuities off as over priced.  Next, there is the risk you might die too soon to get your money back. And even if you don’t you still have nothing to hand down to kids or charity because that half a million you spent is gone, its being paid to the old timers who outlived you. 

And that’s generally where the debate ends.  Annuities are a good deal if you outlive all expectations and are pretty terrible if you die too early.  But I think there are a couple more arguments against them that are not made very often, and they are why I have no plans to purchase one.  

First, how good is that guarantee, really?  When you buy index funds you are buying into hundreds, maybe thousands of companies.  As long as they keep making a profit their stock will have some value.  You are diversified, and there is safety in that.  When you buy an annuity you are buying into exactly one company, just one, the insurance company you bought the annuity from.  If they go under, like AIG almost did in September of 2008, they do not have to honor that contract.  And the half a million you gave them, it might have vaporized. Annuity proponents will say, that can’t happen.  That has never happened.  But that does not reassure me much.  Annuities are supposed to be the cure for the fact that the assumptions behind the four percent rule might be flawed.  It is supposed to take care of the risk that past performance may not predict what will happen in the future.  Well you can’t have it both ways.  You cannot say the past is not reliable when it comes to estimating  a safe withdrawal rate and also say the past is completely reliable when it comes to proving annuities are safe. As for me I’ll trust a huge index of domestic and global companies rather than one insurance company. 

The second risk is inflation. Its an much bigger risk in my opinion.   Annuity companies do not sell inflation protected annuities because inflation terrifies them.  That first check they write, in my example at age sixty, stays the same amount even when you are hundred years old.  Again, in my example the insurance company pays you $2,125 each month and you bought that annuity because that was what your minimum expenses were at age sixty.  But using the inflation history I’ve lived through, across a forty year period, that $2,125 check is going to be nearly worthless. After forty years your expenses will have risen to $8,184 because that’s what inflation does.  So how is that good longevity insurance?  You will only have a fourth of what you need to live and you’ll be eating cat food, and not even premium cat food at that.  

So for those reasons, and because my actual withdrawal rate is very low, far below 4%, I do not see annuities as being a fit for me. I am self insuring for longevity risk by having plenty of invested assets.   I have a difficult time seeing them as a good fit for anyone but I’m no financial expert and they might be fine in some situations.  And there are many other types of annuities.  Some pay higher yields when the market goes up while protecting you from market crashes.  Some have life insurance or long term care benefits mixed in.  I’m not talking about those, though I am never buying them either. 

So what say you?  Do any of you have annuities or think you might consider one someday?  

Do you think I’ve treated them fairly in this post or just did a hatchet job on an actually good product?

As always, should the comment box be hiding somewhere you can’t find it, just click on the title of the post. 

It’s Rant Time! I love comments.  I love getting them and I love making them on the blogs I write and the ones I read.  But what I don’t love is the fact that some of my favorite blogs don’t let me comment at all!  Take Humble Dollar, that is a pretty entertaining site but you have to “log in” to comment.  And every attempt I’ve ever made either wants me to log in with credentials that reveal my identity or just fails only providing me some obscure coding reference.  I see others making comments on those sites and feel left out because I can’t figure out how to join in on the fun.  And yes I know when I comment I do provide my email to the site, but it doesn’t attach that to my comment. So I’m only exposed to the person owning the site, and that’s OK with me.

Other sites, lots of them, try to identify me with my WordPress sign in.  And I’m not sure what would happen if I let that go through, but I think it might specifically identify me in the comment.  So I just pass on that when it happens, even if I’ve spent ten minutes making what (to me) was the most insightful comment in modern times.  Also I can’t seem to log in to WordPress directly, I always just log into my Bluehost account and it logs me into WordPress when I access my blog site.   But logging straight into WordPress doesn’t work for me.

Then there are all the sites that don’t allow any comments.  What is with that?  I know some people have restricted comments because they were being trolled by jerks and idiots, like Sherry of Save. Spend. Splurge.  I get that, and I’m not ranting at them, I’d never rant at Sherry.  But there are lots of other sites that just don’t want my opinion.  And I take that personally. I’d insert the meme but I’ve always been afraid of Michael Jordan.

Worst of all there are a handful of sites that tease me into thinking I’m good to go with dispensing my indispensable knowledge in their comments section.  I can fill their little box with my wit and wisdom and put in my email and “name” and website address. But when I hit the “Post Comment” button I don’t get the satisfying sight of my wonderful words  added to their post.  Instead I get a message telling me the site is not accepting comments.  Really?  Now you tell me? 

So what about you other frequent commenters.  Do you experience the frustration of commentus interruptus in your daily life? 

Or am I such an irrelevant Ok, Boomer that I’m simply missing the easy way around the comment barricades.  I’m simply  being culled from the commenters herd by Darwinian selection.  

And because I never want anyone to find it difficult to comment on my posts, if you don’t see a comment box then try clicking on the title of the post up top. That should make it appear.

It is strange how the normal daily routine of life can make a sudden ninety degree turn into the surreal.  That’s how my life has felt the last four weeks surrounding a surgical procedure and the pre-surgical and post surgical restrictions that took almost every one of my favorite activities away from me, for a season.

The casualties were food, drink, running, tennis, fishing, hiking, pickleball, volunteering and travel. The restrictions were pretty simple.  Take it easy, don’t lift over seven pounds and subsist on a mostly liquid diet without any carbonated beverages.  That doesn’t sound bad, I know, but it actually targeted my life in a very insidious and  Machiavellian manner.  

First, I don’t like coffee but I do like caffeine. So in my normal life I have a Diet Mountain Dew every morning.  It gets me that wake up energy with no calories in a form I enjoy, but that’s been disallowed.   I’m a carnivore by nature and meat, nope, not on the menu, nor were fresh veggies.  And every day of the week I’m either playing tennis, pickleball, running, fishing or volunteering.  Sometimes all of those on the same day.  But all of those involve some pretty substantial bouncing around or lifting and therefore, also verboten.  

You might ask “Surely volunteering isn’t on the don’t fly list?”.  And it isn’t per se, but I was only comfortable in loose baggy ultra casual stuff, you know, the work from home wardrobe.  That’s not really appropriate in a college or foundation board room.  Neither was sitting for hours in uncomfortable conference room chairs hashing out organizational governance issues when you are feeling a good bit of physical pain.  And the travel required to get to meeting locations was also unpleasant enough that I just took a pass on everything I could not Zoom in to.  And that left me feeling disconnected from an important part of my life.

I did come up with some work arounds.  I bought a new fly rod, couldn’t find my old one.  And I’ve been a few times to a friend’s pond to catch small panfish.  That stays well below my lifting limit and those little tykes are easy to catch and release.  I also went in slouch clothes to watch my friends play pickle ball, and that was more entertaining than staying home.  Food, well, that was just very boring until the restrictions started to ease up.  And I did get to Zoom into some of the volunteer meetings, just not very many of them. 

And that brings me to this week, I’m halfway through the six week recovery period and life just got a whole lot better.  I was cleared to play pickleball and eat anything I want!  I have to use some self control not to go crazy on the court but since pickle ball is a lower impact sport compared to tennis, I can do that.  And yesterday I brought home a pizza!  It was like a slice of heaven, I had it again for breakfast this morning.  Nothing makes food taste so good as having done without any variety for awhile.  

And I also put on business casual clothes this week for the first time in over a month and drove 5 hours to my former university to mentor five engineering students.  Stayed overnight in a hotel and drove home the next day for three more hours of local college committee and board meetings.  It was a pretty grueling reintroduction to my volunteer life.  But I did fine! It was nice having that face to face social contact again and I really believe in mentoring and in my local college’s mission.  I got all that done without any assistance as my wife is at the beach with one of her old college buddies all this week. 

Today I have to prepare some testimony for my lingering consulting work I can’t quite seem to escape.  But, maybe because it plays to my ego to get paid for being an “expert” I’m even looking forward to that.  Plus it is a favor to my former associates to provide them a local expert.  That saves them the expensive travel costs to bring in a hired gun from the other side of the country.  It is a very simple case and we are taking a noncontroversial position so it should be light duty.  

I think when my wife returns I’ll even cajole her into doing the heavy work of getting our boat from our garage to an area lake and see if we can catch some bass.  And I’ll start hitting tennis balls again next week, not playing singles but just practicing.   That’s pretty light work and I miss being on the court.  All in all,  life is good and it is getting better every day!  I appreciate the positive thoughts and wishes so many readers have expressed in the comments.  Having friends like you means a lot and it is also very powerful medicine.  

What about you?  Have circumstances ever occurred in your life that made a sudden and drastic temporary change in your lifestyle?  How did you handle that?

If you had to give up some of your favorite things for a period of time, did you notice how amazing it was to get them back?  I’m simply in awe of how good pizza tastes!

What is it like to be fully retired?  I think most of the people in the personal finance community can not answer that question because they are still working.  They may be self employed or at a nine to five but they are in the phase of life where their focus is on accumulating the nest egg of investments and passive income they plan to use to fund their lives at some point in the future. As one of the smaller group of us who are actively retired, I’d like to share what full retirement looks like to me.

I became mostly retired when I left my nine to five career five years ago.  I became officially fully retired a few months ago when I stopped my part time hobby job of consulting.   So for the first time in my life my wife and I have no source of income other than our investments and a $300 a month teacher pension my wife receives.  We will not start receiving Social Security for another five years. But for now we are living primarily off our investments.   And how does that feel when you’ve been an earner, a saver and an investor your whole life?   It feels pretty weird.  

When I was actively consulting during the first five years of my retirement I never marketed my services,  I just waited for work to find me.  I did not really think through the fact that just because I decided to stop working, that did not mean work would not continue to come looking for me.  And so it has.  One of my old consulting co-workers called me today and asked if I would do him a favor and testify as an expert witness at an upcoming regulatory proceeding.  It is easy work since his clients aren’t opposing anything in the hearing, so I suspect the parties to the docket will let me slide through cross examination without trying to make me look like an unqualified idiot.   He is in kind of a bind so while I will get paid something for my time I’m not doing it for the money, just for a couple of  friends.  Also because it will force me to study up on the topic, which is good exercise for my brain.

But those are not the only reasons, I have to confess earning the consulting fee I’ll get does give me a little dopamine hit and a sense of satisfaction.  I spent a career becoming an expert on a few obscure topics and getting paid for it sort of closes a circle inside of me, or at least that is how it feels.   So that is one thing I think most retirees will find, particularly the younger ones.   Work will come looking for you, and you will probably agree to do some of it, even if you don’t need the money.  There is just something in the human brain that associates paid work with a feeling of purpose or accomplishment.

While I think work that pays offers more of a reward than unpaid volunteer work, they both do check the “having a purpose” box in your brain.  One of my goals when I stopped consulting was to find a way to mentor to add to the other volunteer work I was doing.  I wasn’t specific about who or in what area but I felt like older people like me who were successful at something could offer some useful life tips to younger people.  When I look back on my life I feel like I was successful in being a dad and husband, financially and in my career.  And coincidentally my university engineering department kicked off a new mentoring program right after I stopped consulting.  This first meeting with our student mentees is coming up in a week and my team of mentors is already meeting to get ready.  It won’t pay a thing, not even expenses, but I think it will be fun and might help a new generation avoid some of the potholes we seasoned engineers learned about the hard way.  

The same week I also have board meetings of the community college trustee board of which I am the chairman.  Prior to the board meeting we also have at least two committee meetings of board subcommittees so there will be several hours of work, not including the preparatory work, to be ready to preside over the meeting.  It can get a little dry, but the mission of the college is something I believe in.  Our students include a lot of nontraditional students, students who only speak English as a second language, first generation college attendees and people living below the poverty line.  I have seen first hand students transform themselves from being poor to becoming millionaires.  That’s not typical but I believe almost every student we serve sees an improvement in their lives.  Education, whether they are studying history or welding, makes a difference.  So while it does not pay anything it scores pretty high on the purpose scale. 

And because, when it rains it pours, my foundation board meets that week too.  I also chair that board  and there will be committee meetings in addition to the board meeting so a few more hours of work will get squeezed into the next few days.  This foundation runs a low income medical clinic, a fitness center that provides scholarships to low income clients and both home hospice and hospice house care for terminally ill patients.  We do a half dozen other things as well but those are the main three areas we serve.  I do not need to explain how good it feels to know you are relieving pain and bringing health to sick people who do not have anywhere else to turn.  It feels amazing to get to serve there as a non-paid volunteer. 

So that is what being retired is like for me.  Perhaps some paid work popping up from time to time but definitely volunteer work in areas I care about.  Plus being on the hunt for opportunities to volunteer a little more.  I spend a lot of time on just plain fun hobbies too, which include running, tennis, pickleball, hiking, off roading, bush whacking, travel and fishing. And while I love all of those (except running) they are not enough in themselves. 

As an aside, my commitments are going to require 14 hours of driving, a couple of nights in hotels and wearing a suit and nice business casual clothes.  Considering I’ve worn nothing but shorts and tee shirts since my surgery and have a few very sensitive surgical incisions this will be a pretty interesting adventure. I will also have to carry my restricted diet food with me and am not allowed to lift more than eight pounds. I’m still trying to figure out how to get my carry on luggage to my room without doing that? My wife would normally volunteer to handle all that for me while I recuperate but she’s headed to the beach that week with her old college pal so I’m on my own. 

What about you, do you volunteer now or do you think you will after you retire? 

Would you accept part time work even if the money didn’t impact your lifestyle? 

Is it crazy to take on these commitments when I’m supposed to be taking it easy and healing up?

Six days ago I had surgery to move some internal organs around and to repair the muscles that  keep them where they are supposed to reside. No, this will never happen to you unless you are one of the lucky 2 in 100,000 people in the world, like me.  It was neither minor surgery nor was it so major that there was a large chance of failure.  And fortunately it seems to have been successful.  I had two goals, one was to fix the problem because it had around a 25% chance of killing me if left unresolved and the second was to possibly free up space for my heart and lungs to perform as designed, giving me a little more stamina on my morning runs and afternoon tennis matches.  

The first goal was achieved, everything is where it should be now, yay me!  The second will be weeks or months in finding out because I’m not allowed to do any extreme physical activity for at least five more weeks.  My diet is restricted to liquids and soft foods but wine is OK again and fish and its infinitely better than the pre-surgery week of clear liquids only! 

By way of warning the rest of this post is going to describe my experiences in perhaps more detail than anyone wants to know, but it is my blog, so be forewarned.  

I have had this condition for eight years or longer and had put off trying to get it fixed because the medical journal articles I had read indicated a fairly high death rate and a high dissatisfaction rate among the patients who had the surgery.  That turned out to be a very smart move on my part.  Over those eight years a very few talented surgeons developed a way to do the procedure laparoscopically instead of cutting patients wide open and that makes a huge difference in terms of recovery time and in terms of reducing the probability of the main thing that kills surgical patients, infections.  

The week before was basically planned starvation.  In order to move my stomach back where it belonged my other organs that had enjoyed occupying the extra space had to make way for a new roommate.   One way to do that is to shrink them.  By eating almost no calories, especially no sugar or carbohydrates my glycogen levels dropped like a rock.  And apparently, according to my surgeon, that shrinks the size of your liver, making it easier to move out of the way.  And you would think drinking broth and eating sugarless jello for a week is no big deal.  To me it felt like a big deal and also like the longest week of my life because at the end of it, wasn’t relief, but fear and uncertainty.  

I went to Denver to get this done and that’s a two day car drive from Arkansas.  The reason was that this is an extremely rare type of a fairly common surgery, so there are not many surgeons who have done it and a precious few who do dozens of them a year.  I had spent some time researching the procedure over the last eight years and there was nobody in Arkansas who had enough experience in my opinion.  In fact, my GI doc here told me it was impossible to do laparoscopic surgery in a case like mine.  I knew otherwise and the fact that a non-expert like me knew more about it than my specialist told me I needed to find someone truly special,  and I did.

 We used to call the super specialized and qualified welders that we would bring in to weld exotic alloys in our chemical complex “brain surgeon” welders because they were so elite in their skill sets.  Well, my surgeon, was a “brain surgeon” surgeon when it came to my problems.  They were routine to him.  And if you have to get anything done medically that is more than simple, do yourself a favor and find a “brain surgeon” doctor to do it. Its as simple as spending some time on the internet.

As the morning of surgery approached I got over my nervousness and just focused on the potential benefits I was going to reap, especially the one about avoiding a 25% chance of sudden death.  I was very calm right up until they rolled me into the operating room.  I’ve had colonoscopies and endoscopies and knee surgery in the past so I was familiar with OR’s, or so I thought I was until my gurney rolled into this one.  This room was surreal, even the lights over the table looked like something out of a science fiction film, like a cross between giant sunflowers and LED’s.  And the eight or nine robotic arms hanging over me were pretty intimidating as well.  Plus there had to be a dozen wide screen computer monitors surrounding me, I felt like I was in the Best Buy TV section.  It was so bright and I think I counted at least eight people on the surgical team.  The thought that kept coming at me was that this must be what its like to be abducted by aliens and probed!

Fortunately that’s all I remember until getting to recovery.  Its not unusual for people to have a partial lung collapse in surgery, at least my CRNA daughter in law says so, and that may have happened to me.  I was stuck in phase one step down for the next eight hours because my blood O2 which has to stay above 90% for a patient to be released, wandered around in the 70’s and 80’s and stubbornly refused to return to normal unless I was fed oxygen.  Eventually they sent me home with some oxygen to get me through the night.  I hung around Denver in the hotel for two days and weaned myself off the O2 after the first day.  And then we came home.  I stopped taking the opioids after the first day even though I had more of the pills.  Tylenol and Ibuprofen were more than enough. 

I started on my new diet, which is pretty much anything soft or liquid, much better than the pre-op and all my internal systems seemed fine.  My O2 levels stayed good, I bought an oximeter thingee at Target that you put on your finger to self monitor.  

I’m walking a mile in one stretch each day outside and doing a lot of internal laps in the house every hour I’m awake.  I have to eat a bite of food every hour to exercise the area that was worked on, but who doesn’t like snacks?  And that’s about all I can think of to say about that.  

I was very pleased by the information given me leading up to surgery, by the hospital’s care and by the surgical team.  I was less pleased with the post-op information we were given, they didn’t expect me to need oxygen and did not help us much in figuring out how to arrange for it or to return the equipment.  They totally changed the post-op diet for the better, which was good, but we had to call the surgeon’s office team several times to figure out the details.  Its not exactly like they dumped us once they had done all the work they were getting paid for, but it felt kind of like that.  I’m guessing as a Medicare patient they saw me as a liability, because Medicare reimbursement rates are not as good as private insurance.  But that’s OK, they did the surgery, and he made some changes on the fly based on what he saw when he got inside me, that put me in a special prized class of patients who have way better than average outcomes.   

So, I’m extremely happy for how things went.  I’m very glad I did the research and got a true expert instead of some generalist who was going to do the best he could with limited experience and knowledge. On a scale of one to ten that’s worth a million. The post surgery kerfuffles were maybe a two, so they don’t matter at all in comparison.  

My takeaways?  In today’s world you can still get world class medical care even if you are on Medicare.  I worry that won’t continue to be the case, but so far you still can.  

It pays to research your condition and who you go to for care.  You can take your car to any mechanic and they’ll say they can fix it, but if you’ve got a Lambo do you really want a shade tree mechanic working on the supercharger?   To me my body is my Lambo, enough said.  

The medical team that took care of me before, during and immediately after surgery were angels, each and every one.   They were compassionate and selfless and so kind.  And I’m nobody special, they did not know me, yet they made me feel like I was important to them.  God bless them, and how in the world can they be so nice when they face an environment of scared and hurting people every day?

Oh, and if anyone ever offers me a another bowl of chicken broth, I’m sorry but I’m going to scream. 

What about you, have you had a health experience that affected your view of the medical community?

Have you ever researched your way into much better care than just staying with a local provider?  

Are you toying with elective surgery, and if so how do you weigh the risks and benefits?  

As usual click on the title of the post if you don’t see a comments box

Three hours of gnarly surgery and eight hours of post op and I’m back in my hotel and doing pretty well! I appreciate all the expressions of concern from this wonderful community!

Thanks to everyone who checked in to offer good wishes, prayers and encouragement!

I’ve got a couple of very unique medical issues that make me a unicorn of sorts, and not in a good way.  These are both conditions where only a handful out of every 100,000 people experience the problem.   One is harmless and the other is pretty dangerous.  One has no known cause or cure and the other has a possible cure but it involves surgery with a significant risk of death.

As to the first, it is called Transient Global Amnesia (TGA).  Only somewhere around 2 to 10 people out of 100,000 ever experience TGA.    And of those few, only about 10-15 % people have a repeat occurrence so that puts me more in the 1 out of 100,000 category since I’ve had two events so far.  Oddly my brother has also had two TGA events, even though it is not thought to be an inherited genetic condition. And I can say this much with confidence, it is one completely bizarre brain malfunction.

 I can describe it two ways, once from what I experience and then a second time from what others around me observe.  This is what my reality was both times.  I’m in a familiar place doing something very normal.  In the first case I was doing a push up in a group fitness class.   In the second I’m sitting in a  lounge talking to a stranger about his job.  What happened next was exactly the same both times.  In the blink of an eye, I’m transported through space and time to somewhere else where a frustrated person is fed up with my behavior.  One was my wife telling me we were going to the medical clinic because I had just asked her the same question for the 15^th time.  The other was a hotel desk clerk, who was unhappy with my uncooperative behavior.  In both cases I lost about one hour of my memory, and never got it back. 

That is what I experienced, my friends who were there have told me what they saw. In exercise class they thought I was just trying out a new routine as the resident class clown. I was doing the exercises poorly and was repeating myself but it was 5:30 AM so nobody was really paying much attention. The second time there weren’t a lot of witnesses I could go back and talk to since I was travelling. But from what I did hear it was pretty much the same story.

One of the stranger things about TGA, as opposed to regular amnesia, is that you do not forget who you are or anything that you knew prior to the event.   You just lose the ability to store anything in your short-term memory.  Nothing, nada, zilch. I was able to do the exercises, sort of, according to my friends in the work out class.  I was able to drive my car home, even though I tried to get in the wrong car.  But you can’t do anything sequential that depends on knowing what you’ve already done.  Because you are truly living in the moment, and you remember nothing of this later.  After it recedes, you start forming new memories though you are kind of loopy and inconsistent and hella confused for an hour or so, and you also are kind of foggy about the events leading up to the TGA.

They don’t know a lot about it because it is so rare and has a short duration and because anyone having an attack is never going to formulate a plan to get to the emergency room. They think they are perfectly fine.  The few times people have made it to medical care before recovering they are generally initially diagnosed as being intoxicated, high on drugs or as having a stroke.  The first time I spent three days getting CAT scanned, MRI scanned and blood tested to rule out a stroke.  A visiting neurosurgeon happened to have had one patient with TGA and he diagnosed me, otherwise I might not have ever known what happened.   This was several years ago, they do now have an MRI test that can find markers of TGA after an event, I believe.  The second time I never went for care, because I knew what it was and that there was no treatment.

The second Gray’s Anatomy weird medical problem I have involves an organ being in the wrong place, I’m not going to get specific because that’s just too much information, in my opinion.  Suffice it to say that 25 out of 100,000 have this same issue and that it is treatable.  I have put off surgery to fix it for about eight years because the mortality rate for the surgery was in the 3% range and because my symptoms were not that bad.  However, it has gotten worse recently and scans show it is probably significantly impacting my heart and lung functions and needs to be fixed.  Also, the mortality rate from surgery is more in the one percent range now. 

The emergency surgery mortality is still around 3% so my odds are far better if I choose my surgeon and do this on a planned basis instead of waiting until it becomes an emergency, maybe when I’m hiking in the middle of nowhere with my wife. So, I’m getting the surgery done at the end of this month.  Wish me luck!

I will have the pleasure of going 7 days on a clear liquid, no sugar, no alcohol diet prior to surgery and a month of only a slightly less restricted diet afterwards.  I also won’t be able to run or play tennis or pickleball for weeks.  On the other hand, if it works out perfectly, I might get some of my endurance back, which is just a shadow of what it used to be.  Even if I only get 5 or 10% more oxygen uptake that would be huge for me in both my running and tennis, so I’m very hopeful.

If I draw that 1% lottery ticket and don’t make it, well, its been fun knowing you folks. But I’ve generally been very lucky in the positive direction so I do not expect that to change this time.  I’m virtually certain I’ll get to post some serious office boy whining about wasting away on soup and Crystal lite in the near future. 

What about you, have you got any of those super rare medical defects that you don’t mind mentioning?

Have you ever had to consider elective surgery that has some risks of not working or of even making things worse?

As always, if you don’t see a comment box just click on the title at the top of this post.

I’m not a touchy person, I am very OK with other people having other opinions than mine.  In fact, about the only time I get sideways with those opinions is when they are uninformed guesses based on stereotypes.  Where I see this the most in the personal finance, financial independence and retire early communities is when it comes to the assumptions younger adults make about “old” people.  

Most of the people who show the most ignorance about aging are in their forties or younger.  This is reasonable because someone like me, in my sixties, fully understands what it is like to be 24, because I’ve been there.  But a 24 year old is abysmally ignorant of life at 65 because they have zero first hand experience of what 65 feels like.  It is something they can only make assumptions about based on older relatives and coworkers and, of course, popular stereotypes.    So they casually dispense common tropes about  people who are in their fifties or older.  And society at large feels like that is OK, even though to do that based on gender, sexual preference, race or religion would be clearly out of bounds. 

This takes a lot of forms, but the most frequent goes something like this.  “I don’t want to work until I’m X years old because I will be too old to enjoy my life, even if I have plenty of money invested.”  And in many cases X is as young as 50 years old.  They state as if it were a fact that they won’t be able to play sports, travel, surf, party, hike, climb, run, backpack, enjoy fine cuisine or handle mentally challenging tasks.  Apparently they base that on the oldest and most decrepit people they’ve ever known. 

Now certainly there will be a day for all of us who survive long enough, when physical and/or mental capability greatly restricts the activities we can participate in.  I’m not arguing that there isn’t a date for each of us when it would be factual to label us as “old”.  That might be based on what percent of the average life span we’ve attained or better based on the amount of physical decline we exhibit.  But what does offend me is the blanket assumption that someone who has reached a certain age, be it 50 or 80, is no longer able to participate in the same activities they enjoyed in their younger days.  

I’m 65 and my wife is 66.  A couple of months ago she ran a marathon with a 40 year old friend. They finished side by side and they both won their age groups, in fact my wife won the over 50’s even though she was sixteen years past fifty.  This last weekend, we both played on 40 and over tennis teams.  Her team won the state tournament and mine didn’t, but we didn’t finish last either. We were competing against much younger opponents and we did this outside in the sun under 110 deg F heat index conditions.   We both get up before 5AM three days a week to run four or five miles.  We both play tennis four or five times a week and some pickle ball in addition to that.  We hike, we bushwhack and we ride rugged off road trails in our side by side ATV.  We fish and take care of home, lawn and vehicle maintenance.  She builds furniture and outbuildings. I run some large nonprofits. 

What’s my point?  Not that we are special, its the opposite of that!  My wife and I are quite typical of the friends we run with.  In fact while our running group has people as young as 40 in it it also has several guys in their 70’s, including our fastest runner.  My point is that I can’t think of a thing I could do in my twenties, thirties or forties that I can’t still do.  Sure, I was faster then, but the amount of deterioration in my physical abilities is still relatively small, and nowhere near enough to prevent me from being competitive at the same sport I competed at in high school.  In fact that high school version of me would get badly beaten on the tennis court by older me if that match were possible.  Much more so for my spouse who has barely lost a step over time. 

We play tennis every week with a couple of guys in their 80’s.  We’ve got one other friend who is 90 who still has game.  Yet I’ve got other friends who have gone sedentary as they’ve gotten older and who would have died if they had tried to exert themselves in the brutal heat of that weekend tennis tournament.  And those are the people that get noticed and give the rest of us much fitter seniors a frail image.  And someday I’ll be in that group as well, but not today.  The thing younger adults don’t get is that when I returned three lightning fast, in my face, net volleys and then jumped high to crush the final overhead to win our third set tiebreaker yesterday it was just as big a thrill as any high school victory or any tournament win in my forties.  Life is not in any way less fun than it was then. This is truly the best time of my life! 

I guess I’m saying that if you fear you’ll only be able to afford to retire when you are an ancient 57 years old, put that fear away.  Happiness does not deteriorate over time, it gets better.  And if you keep moving and working out you’ll likely maintain a very fit body to much older than you think. I think becoming financially independent well before conventional retirement age is smart, because it gives you options.  But assuming you’ll be unable to enjoy life when you retire as fully as you can now, that’s very pessimistic.  And it is something you have a great deal of control over if you do the right things now. Invest in your financial future and your physical future with equal amounts of fervor and discipline.  I certainly  don’t regret any of the twenty-three thousand miles I have ran since starting in my thirties. 

And please, consider giving the older crowd some slack, especially when you consider the older you.  That future you might be a heck of a lot tougher and fitter than you think, and might even pass you in a marathon some day.   

What about it? Am I just a cranky old “Get Off My Lawn!” geriatric or am I right about younger bloggers and commenters constantly throwing older people under the bus? 

Surely you know some people in their 60’s and 70’s that are physical specimens?  If you do give them some love in a comment. 

Why do you think it is OK to use stereotypes for senior adults that would be totally unacceptable if used regarding race, gender, etc. ?

And as always, if you do not see a comment box then click on the title at the top of the post.

I’ve been retired for five years now, even though I used to consult a little it was very part time.  But since it paid all our bills for that period I think it somehow counted as me still having a job.  My wife left the workforce when we started having kids, the youngest of which turns 30 next month, Yikes!  And while I rode out the first five years of retired bliss staying under her radar she finally realized I haven’t been doing my share of the household labor.  It is a dangerous trend that has me worried as I’m very happy to be taken care of.  Something I think I inherited that from my dad. 

It started innocently enough, we began to get a few of those Blue Apron meal kits.  That indoctrinated me into doing some of the cooking, and it was fun.   Then a couple of weeks ago she sprang the trap on me.  She said she thought I should handle all the grocery shopping and cooking the next week.  It sounded like a fun adventure to me so I started looking up recipes and went shopping for supplies.  I did very well, if I do say so myself, making chipotle meatloaf, shrimp pasta and Rachel Rae’s smoky spicy bass filets.  

In fact it was so much of a success that she deftly converted the one week experiment into a new paradigm for our household.  I’m responsible for meals every other week from now on!  So this week it is my time again.  I’ve shopped and gathered the necessary materials for another week of haute cuisine, or at least credible edibles, I hope.  

I’m looking at Jeff’s hot dog chili recipe (allrecipes.com) to go with some purchased frozen tamales and also to make chili dogs with.  Spicy and sweet jalapeño cole slaw(nospoonnecessary.com), crispy beer battered bass filets(iwashyoudry.com), Big Orange cheese dip(dawgnation.com), tortilla chips, broiled broccoli, yellow zucchini,  yellow squash, sesame sugar snap peas(slenderkithchen.com), spaghetti(my own creation), spicy New Orleans shrimp(jocooks.com),red leaf salad with carrots and shallots, pulled pork barbecue sandwiches, baked beans, corn and garlic ciabatta bread.  

Its amazing what you can find on the internet when it comes to recipes.  And it surprised me how much fun it is to cook.  Unless you’ve been doing most all of it for 43 years, like my amazing spouse.  While this is a really interesting new adventure to me I do have some qualms about where it might lead.  I haven’t cut the grass in 43 years either, did I tell you my wife is amazing? 

So what has handling food preparation for two weeks taught me so far?  Well, I have learned that just because someone puts a recipe on a website doesn’t mean it is anything special.  Most of the new ones I’ve tried were good but none of them were quite as good as the author claimed they would be.  Food tastes are just too personal and sometimes too regional to appeal to everyone equally.  

I’ve learned about substitution, there is always something called for I don’t have on hand and don’t discover until the last minute.  I don’t have celery salt but I do have ground celery seeds, no problem.  And I’ve learned that for me and my spouse, double the amount of garlic and cayenne called for in almost any recipe, because we like things spiced up.  

But the main thing I’ve learned, which it shouldn’t have taken 43 years of marriage to figure out, is that there is a tremendous amount of work involved in planning a week of meals, shopping for the necessary ingredients and simultaneously preparing the entree and sides so that everything is ready at the same time. I had no idea how much time and effort my wife had been putting into that for decades.  She is  pro and made it look easy and seamless.  Believe me, it isn’t that easy and there are lots of seams now that I am doing it.  

What about you, have you taken on new household chores in retirement or if you are still working do you split up the food preparation?

Has it changed your perspective on how much work is involved? 

Got any good recipes, I’m only headed for week three and I’m getting desperate!