We Want To Be On HGTV Too!

Shiny happy people…

…holding hands.

R.E.M., 1991

I stepped on to the elliptical at the health club, turned on my iTunes, and was about to slip on my headphones when I glanced at the television sets hanging on the front wall. A game show on the left, “The View” on the right, but in the middle–there they were. The damn Property Brothers. Those identical twins, Jonathan and Drew Scott, who buy and remodel homes on HGTV. Along with other HGTV show hosts Chip and Joanna who fix, Tarek and Christina who flip, and Hilary and David who love and list, their faces beam from the TVs in our home morning til night, and if Barb can’t sleep, overnight too. And when no one is remodeling, HGTV has its House Hunters, National and International, looking out for perfect properties. Reality redux.

The programs all have the same basic structure. Introduce a telegenic young pair, plus or minus a few kids, and have the hosts promise to solve some particular housing crisis the couple is facing. Start the project optimistically but run into a hidden obstacle or unexpected expense. Calm the worried homeowner/houseseeker then find an ingenious solution to the problem. Smiles and a champagne toast by the end of the hour. One formula, ten different TV shows!

Now it is OUR turn. I propose a 13 episode HGTV series chronicling The Raff Construction Project. Let’s name the show “Build It or Blow It”. Barb looks great on camera, I look OK on camera, and we can spruce up the general contractor and architect. We’ll use a local couple such as Eric and Cathy for hosts.

Yes, we started the actual project months ago and will have to “recreate” some of the earlier aspects for the camera, but I suspect most HGTV shows use a bit of play acting. We can “enrich” the past, too. All that time spent picking out windows? Let’s spice it up with a visit to a window factory, and toss in an on-screen table saw “incident”. Barb can use her hand therapy experience to perform an emergency thumb re-attachment. Gushing blood and sky-rocketing ratings!

Moving forward, I envision a curmudgeonly pipe smoking plumber with a Yankee accent (fire hazard), a wise-cracking all female painting crew (sexist), and a talented Old World carpenter (expensive). There will be tense scenes when we discover one-coat paint doesn’t cover in one coat and half-gallon toilets do half the job. Imagine the suspense when the village building inspector, tape measure in hand, checks to be sure the electrical outlet is at least the required minimum distance from the bathtub. With the right music on the sound track that one might be good to enough to keep viewers hanging as we go to commercial break.

Our big “do or die” moment in the penultimate episode? It has to be the Home Owners Association deciding our roof shingles are an unsuitable style for the neighborhood. Can we replace them and still stay on budget? Will this send us to the poor house? Don’t worry, it will all be resolved just in time for the grand finale.

So that’s the show. I just have one question. Anyone know anyone who knows anyone at HGTV? If you do, can you talk them into producing “Build It or Blow It”? If not, I’ll settle for one of the Property Brothers’ autographs!

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Getting Serious about a Bad Medicare Recommendation

Frank Zappa and the Mothers
Were at the best place around

In Memory of Frank Zappa

Prostate Cancer Victim

Yes, we got a site permit. Yes, a construction fence is up, though I have not seen it yet, and by the time I get to our lot it may be buried by snow. But that is all the update on the house you are going to get today. It is soapbox time. For those of you who don’t like medical news, cover your eyes or skip to another blog, but this pathologist needs to unload!

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that, you guessed it, runs Medicare. Part of what they do is establish “quality” measures and review bills and electronic medical records to determine how well physicians are following in line with these measures. For the last few years, compliance with these measures has had an effect on how much Medicare pays physicians for patient treatment, and this impact on reimbursement is scheduled to grow over the next few years, with penalties for docs who don’t keep on the straight and narrow. So these measure can have an impact on how doctors practice.

Now you all know I look at a lot of prostate biopsies in my practice, and that my dad died of prostate cancer, and that I run every year to raise money for prostate cancer awareness. So prostate cancer is a big deal to me. Most of the prostate cancers that I diagnose are a result of a man having an increased Prostate Specific Antigen (PSA) blood test in their primary doctors office and being referred to a urologist for evaluation and triage with such newer tests as the PHI test or MRI of the prostate. Sometimes the triage leads to a prostate biopsy. Close to half of the men who have a biopsy sent to us wind up having prostate cancer diagnosed. The goal of all this is to detect men with prostate cancers that are high grade, bad actors that have the ability to spread, cause symptoms, and shorten the patient’s life. We want to see those men treated with therapies such as surgery, radiation, hormones or newer immune therapies in an attempt to improve their lifespan and quality of life. We also detect a lot of men with prostate cancers that look less aggressive and might not have such a significant impact. In the past, most of these low aggression tumor patients also received treatment such as radiation or surgery, but now, with better tools that look into the actual genetic (DNA or RNA) makeup of the tumor, and with better understanding of which tumors are likely to spread, many men are placed on “active surveillance.” They are monitored closely by their urologist, but unless there is evidence that the tumor has changed and become more aggressive, they avoid treatment and any related side effects.

Still following me? Well, in the last few years, there has been review of long term data, much from outside the USA and all of it is from before genetic markers were available and before “active surveillance” was an established treatment plan. The data suggested that PSA testing is a lousy way to detect prostate cancer and leads to too many men having too much treatment. Because of these studies, in 2012 the United States Preventive Services Task Force (whew) recommended AGAINST PSA screening. So fewer men have been getting PSA testing, or have been skipping a few years of testing, and guess what? We now see more men with the nasty acting prostate cancers than we did five or ten year ago. It seems to us here in the lab (and to urologists and pathologists around the country) that less PSA screening=worse outcomes.

Now remember those CMS quality measures we were talking about a few paragraphs above? Well, the CMS has just released a new proposed quality measure. You guessed it. They are proposing that NOT doing PSA testing is better quality. So your doc, or your dad’s doc, or your husband’s doc will get paid more for NOT doing PSA testing on their patients. Yes, I know it is not a perfect test. It is not appropriate in certain age groups. But with logical triage of patients with abnormal PSA results, and then logical treatment or surveillance of men in whom prostate cancer is diagnosed, PSA testing can lead to a strong, positive, impact on the male population. I am a believer. I know that I will keep having my PSA checked–and so should you!

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What Looked Like a Step Forward Becomes a Step Back

I’m fixing a hole…

…were the rain gets in.

The Beatles, 1967

First some clean up from our last blog post. A mea culpa is in order. In this world of instant gratification, I had assumed that since I had ordered my razor blades three weeks ago, they must have arrived already. I assumed that I remembered placing them on the bathroom counter. I was so sure that they had been there, that Barb assumed she had thrown them out by mistake. Well, we all know about what assumed stands for. Yep, that box in the picture is the package that came from Harry’s Razors, not last week, but yesterday. All my shiny new blades. I just have to remember that not everything I order gets delivered the next day. The world is not all Amazon Prime!

And the house cannot be built on an Amazon Prime schedule either. You long time readers of our construction journey may remember all those blog posts about the Bank That Remains Nameless, all the delays in getting the financing settled. You know, the problems I even wrote a song about? Well no, that problem hasn’t recurred. But the ~~Texas~~ Village Two Step has reared its head once again. What is driving me wild today? Permits! Email number one from the village “We will issue the site permit today.” Email number two from the village “No we won’t.” Some minor changes in the plan had been requested by the village engineer. Our architect complied, but the submitted PDF indicating the changes isn’t sufficient for issuing the permit, at least not until 5 hard copies of the revised plan are also received. Grrrr. I feel like slapping on a Pancho Villa Movember mustache, commandeering a bulldozer and screaming “PERMITS? WE DON’T NEED NO STINKING PERMITS.”*

Weather may start to become an issue. Architect/Builder Team assure us that we still have plenty of time to dig a hole and pour concrete before any freeze, and once that is done, neither cold, nor wind, nor snow shall keep them from completion of their appointed rounds. I appreciate the confidence, but Barb and I are not sure we are true believers. How about our loyal readers? Leave us a comment, let us know when you think the house will be “substantially complete.” Maybe we can think of a prize for the reader whose prediction is closest tot he actual date. Remember, the Comment Box may lay below the row of ads. Facebook registration is still required to post comments,,,my apologies!

*with apologies to “The Treasure of the Sierra Madre”, 1948.

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Why a Good Wife is Better than a Pack of Razor Blades

Look through any window…

…what do you see?

The Hollies, 1965

Sunday morning in the Raff home.

Me: I can’t find the new razor blades I ordered on line. I am pretty sure they came last week.

Barb: Where did you look?

Me: Everywhere.

Sunday evening, bed time.

Barb: Why did you order razor blades on line?

Me: I tried a sampler set and they were pretty good. And they are a lot cheaper than the ones I can buy at the drug store, so I can save some money.

Barb: Could they have been in a little brown box on the bathroom counter?

Me: Yea, maybe.

Barb: Oops. I think maybe when I was cleaning last week I threw that box out.

Me: I guess I didn’t save any money then!

So we lost a little cash there. But believe me, Barb more than made up for it earlier in the day. The scene was a north suburban Starbucks after the Bear game, a sit-down with our builder and architect. The construction plans are in to the village for permits, but we had some tweaking to do. Our foursome claimed a large table, spread out a new, clean, copy of the plans, sipped our drinks out of the plain red holiday cups, and got to work. First came the easy part, changing the location of a few light fixtures, moving a ceiling fan, shrinking one window by a few inches and enlarging two others by the same amount. At this stage, changes like that come with the mere flick of the architect’s marking pen. He didn’t agree with every one of our changes, but as we all know, this is going to be OUR house!

Then came the paper work. And paper work at this stage of the game means discussing money. The current issue was the cost of windows. The builder had obtained 3 quotes, all of which were significantly higher than the allowance in the original specifications we signed. Part of the discrepancy was explainable by those pernicious muntins we had added in. They don’t come cheap and were not part of our original discussions, so we understood the added price tag. The rest of the increase in cost seemed more nebulous to us. And Barb was not afraid to say so. It took patience, persistence, and all her power of persuasion, but eventually the builder relented on the rest of the add-on cost and offered a credit to cover it. He may not have been convinced that we were right, but he was convinced he didn’t want to do further battle with Barb over it! Believe me, Barb saved us the cost of a lifetime of razor blades! No need for me to skimp on shaving and grow a Movember beard.

The meeting didn’t end until I had handed over our second payment, but I was prepared for that. It is amazing how much money we have put out, and not even a hole in the ground to show for it. But we are confident (fingers crossed, knock on wood) that things will be progressing smoothly before the Chicago winter hits. Look for a bulldozer, coming soon, to a neighborhood near you!

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First “Doctors without Borders”, Now “Pathologists without Houses”

All in all it’s just…

…another brick in the wall

Pink Floyd–1979

WARNING–PARODY ALERT–WARNING–PARODY ALERT–WARNING

(The following script for a never recorded television advertisement for “Pathologists without Houses” was discovered in a drainage ditch somewhere in Chicagoland.)

Narrator speaking in hushed tones with an upper class British accent:

This is a lot in suburban Chicago. Its measurements and exact location are unimportant. What we observe is that it is empty, save for the grass and wildflowers that grow naturally in this semi-temperate climate. Adjacent to it are homes, roads, a large pond. But whilst the surrounds are teeming with life, this lot lays unimproved, uninhabited, and defenseless as another winter creeps its way into the suburban milieu. Excavation and concrete may be in the future, but for today they are held in abeyance, hostage to permits and licenses and laborers with the skill and desire to exercise their trade in the the hinterlands surrounding the great metropolis.

Narrator continues:

These are the homesteaders, a pathologist, a therapist, who seek to tame this square of Midwest savannah. Their weapons are many, but cause no harm. Stone and Sub-Zero, muntins and Maytag, windows and Wolf. Choices must be made, the totality of the task assessed and each decision correctly fitted into the jigsaw puzzle that will produce order from chaos, a home on this virgin land that was once graced by golf balls and pitching wedges. For this will be their territory, the center point of their life and the spot their brood can return to. To live in harmony with the surrounding tribes, and to defend against the wild animals that roam.

Further Narration:

Not all the beasts are wild though. For the couple has domestic creatures in their household. A canine beast of burden that delivers the news of the day through blinding blizzards and swirling Sirocco. A feline that dedicates her life to preserving the wealth of the clan by spreading her fur across all pieces of furniture large and small, marking them with the family crest. Loyal to the core, these quadrupeds have earned their spot in the home.

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This Blog is Based on True Events–Really!

True colors are beautiful…
…Like a rainbow

Cyndi Lauper–1986

Been to a movie lately? It seems every time Barb and I go to the show, the film has opened with some variation of the “Based on True Events” tag. I interpret the phrase to mean the screenwriter has taken one fact, factoid, or grain of truth (Gary Powers was shot down), hung a lot of window dressing on it and voila, Bridge of Spies. And we see it on TV as well, with the Netlix show Narcos “based on true events” in the battle of the DEA against Colombian drug kingpin Pablo Escobar. It’s not that I don’t believe the story, it’s just that I know life doesn’t have the convenient start, middle and end that makes up a good TV season arc. But it is fun during the closing credits when we see photographs of the real Powers or the real Escobar and say “Wow, Wagner Moura looks just like Pablo!”

Anyway, I assure you that everything (well, almost everything) you read here is based on a true event. The event may have occurred entirely in my own mind, but that doesn’t make it any less real, does it? In real life, it is easy to tell when I am telling tales out of whole cloth since I have a terrible poker face. One look at me and you will know if I have 4 aces or I am bluffing. Or if I am pissed off. I can’t hide my feelings or emotions. Just ask some of my recent tennis partners. On this blog, you will just have to trust that I am telling the truth!

On to house building. The Homeowners Association Representative says “Go for it.” The builder and architect say “Go for it.” So we are going to go for it. With 10 detailed pages of architectural drawings we are submitting our plans to the village for our construction permit. If the village inspectors are quick about it, and the plans pass muster, we may have a hole dug and concrete poured before the ground freezes over. The predicted globally warmed mild winter should help delay the freeze. So we are not quite on schedule, but at least not hideously behind.

Tuesday Barb, the architect and builder visited the window factory. Sounds fun, right? The brand and style of window are now chosen, but no decision yet on window trim color. As to the stone, stucco and roof, I could say we have finalized a palette, but you would know I was lying, wouldn’t you?

A little housekeeping of a different nature. Subscriptions are easy with the box below, and you do want to subscribe so you can always be the first to know of a new blog. But some of you are having trouble leaving comments. Two points on that. First, the Comment Box is usually BELOW the row of ads that appear at the end of the blog (Sorry, I have no control over the ads.) Second, some web filters, such as Barracuda, allow the blog to be read, but don’t allow the Comment Box to be seen. This is a problem particularly for people reading at work (thank you for doing that) where you may be behind corporate IT filters. If that happens and you want to leave a comment, try logging in again from home. Or you can always let me know what you think by email at les.raff@post.com. Or leave your thoughts at the brand new “Downsize, Maybe” Facebook page.

And that is the truth…I swear to it.

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If You are A Parent, or Have Ever Had One–The Forever Plan is for You

And don’t it seem like a long time…

…seem like a long time…

…seem like a long, long time.

Rod Stewart–1971

I am not sure if it quite qualifies as my favorite album, but Mod Rod’s masterpiece is the only recording I have ever bought in both the vinyl and CD versions. The album lays mouldering in a box in the basement (note to self–need to purge basement miscellaneous prior to move), but I still pull out the CD every once in a while. And I believe “Maggie May” may be the most played song on my playlist, just edging out “Sultans of Swing”.

Songs aren’t the only thing that lives forever. This weekend Barb and I upgraded our phones. Sunday night at a family dinner celebrating our anniversary, our 29 year old daughter Laury, an experienced math teacher, living in the city for years, asked if she was still included on our plan. She has taken the phone carrier’s “Family Plan” one step further and created “The Forever Plan.” With the “Forever Plan” some things just go on and on. Here are the features of the “Forever Plan.”

Cell phone charges. The “Forever Plan” state the adult child’s iPhone charges must be paid for on the parent’s cell phone plan long as a potential carrier exists. This does not mean aforementioned child is under obligation to ever call parents.
Health insurance. The Affordable Care Act has made this automatic on parent’s policies until the child hits age 26. With the “Forever Plan” there is no limit. Your adult children can be part of your plan until you hit Medicare age.
Auto Insurance. Your child lives in the city and parks on the street, but under the “Forever Plan” you tell your insurance agent they still live in your suburban home and park in the garage. Lower premiums, but of course they are paid by the parents.
Pet services. Parents must always be available to watch the dog, cat, parakeet or gold fish, no questions asked. Must also be available to respond to “The dog ate the Halloween candy. What do I do?” question at short notice.
Emergency Road Service. Parents must always be available to assist at the site of a dead battery or overheated radiator. At a recent party, two sets of parents were obliged to interrupt there evening to respond to their adult children on this one. We are actually pretty proud that last time that Laury had a dead battery she did NOT call us.
Home Repair Service. Under the “Forever Plan” washing machines are fixed, TV sets installed and toilets plunged. On repairs taking over 3 hours, the parent will bill the child for a large margherita pizza.
Grandchild care. Ok, we would pay for the privilege of this one!

By the way, no insurance agent will sell you the “Forever Plan.” Why do parents do all this? We do it because we love our kids, the adults they have grown into and partnered with, and the choices they have made. If the plan was for sale, the premium would of course be priceless!

Now on to the home building. Barb is visiting a window showroom with the architect today. She will get to see the muntins first hand. For those of you unfamiliar with our muntin situation, here is a look back. Still not in for permits, but we hope to have a hole in the ground before the first frost. Anyone betting against us?

Kudos and Attaboy to buddy Roger, the only reader to correctly identify our Halloween costume. Some of you recognized Barb and I as Paul Stanley and Gene Simmons, but only Roger added in the berets, the striped shirts and the cravats to come up with FRENCH KISS. Now I understand why both Roger and I have been on TV game shows. Our minds are just warped enough.

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Solar Panels–Thumbs Up or Thumbs Down

I’m walking on sunshine…

…and don’t it feel good!

Katrina and the Waves, 1985

Yeah, that song is little poppier than my usual opening. But we need to talk about the sun, and I didn’t think Soundgarden’s “Black Hole Sun” was appropriate. (Love the new Chris Cornell song though.)

Barb and I have never discussed how “green” we want the new house to be. Our builder has told us since the start of this project that instead of regular sheathing and overwrap on the exterior he plans on using something called the “Zip System”. We didn’t pay too much attention. Turns out Zip is a pretty new and hopefully pretty awesome way to build a tighter, better insulated, house. So we get one point for being ecologically correct. But the other day, the architect suggested solar panels. It seems we will have the perfect exposure for it, with a south-facing roof and a big pond on that side of the house. Should get plenty of sunshine, even if it is Chicagoland. But we are not sure if we should go ahead or not. It is quite costly, even with ComEd rebates and future electrical savings. And that wide open southern exposure also happens to be the first thing visitors will see as they drive up the street towards the home. With all the effort Barb is going through to choose the right stone, stucco and roofing combination, are solar panels really the first impression we want the house to make? And since Time Magazine just got done telling me that fusion is the unlimited energy of the almost near future, maybe we don’t have to worry….

I shouldn’t make it sound like I am not concerned about the environment. We actually do a lot of recycling, both at home and in the lab. In my Board of Education days we worked very hard to have the school building be a leader in conservation. But my car, and my driving habits, are on the gas-guzzling side and I do have a bad habit (just ask Barb) of leaving the lights on in every room I have visited, however briefly, during the day. So maybe solar panels are something we can do to help the world–if they aren’t too, too unsightly. What do you think? Worth it to put solar panels in a Chicago home?

There was no sun yesterday for Halloween. Our scoreboard read Super Size Bags of Candy Bought at Target: 2, Trick or Treaters: 0. And if we didn’t already have enough candy laying around the house, Barb and I came home last night with even more as a prize for winning the best costume prize at a Halloween party. A “Kudos” and an “Atta Boy!” in the next post to anyone who can guess exactly what our costume was. Send your guesses to les.raff@post.com

So if Halloween is gone, it must now be Movember. My pledge is to grow absolutely no facial hair. Believe me, it is better this way. But most of you know that prostate cancer is my interest both personally and professionally. Via the SeaBlue Prostate Cancer Awareness Runs I have been fortunate to raise a lot of funds over the past few years. I am also doing a bit of research, so if you or a loved one has had a prostate biopsy, please check out this site.

The sun sets early now, and this blog will go down as well.

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Sucking a Little Less Blood. Is it Trick, or Treat?

We know the fire awaits unbelievers….

…all of the sinners the same.

Unbelievers–Vampire Weekend–2013

Just in time for Halloween, and it’s a bloody mess! The hot shot, Jobsian (think Apple, not Biblical) CEO with the start up venture in California was going to change the way we lab rats did your blood work. No more tourniquets and making fists. No more scary needles and “just one more tube, dear.” She was going to do all your blood work with a little pin prick on the tip of your finger. She had big national pharmacy chains linking up as blood-drawing partners. She had Wall Street falling all over her. She was going to make the world a kinder, gentler, place.

Now, faster than you can say “Enron”, we read about questionable lab practices and not quite right federal inspections. And let me tell you, a few of my pathologist buddies are gloating! But every medical lab has been through those inspections, and we know how capricious and arbitrary the inspectors can be. By which I mean if they find a problem in MY lab, the inspector is capricious and arbitrary. If the problem is with YOUR lab, oh well.

But I wish Ms Entrepreneur and her company well. Change is good. And lots of things have gotten small. You can go to Lending Club and make teeny tiny consumer loans. You can go to PredictIt and make teeny tiny political bets. So why not drive to the drug store and give a teeny tiny drop of blood for your lab work? And maybe someday, replace the drop of blood with a teeny tiny microchip circulating in your blood stream. The chip will send out signals with all your blood counts and chemistries. Drive under the Devon I-Pass Transponder on the Tri-State after the office party and the overhead electronic sign will flash to the world “Driver of Brown Ford Fiesta in the far left lane is anemic. And he has a blood alcohol of .18. Keep your distance!” Gives a whole new meaning to Amber Alerts.

Size IS important, but it is not about big or small, it is about getting it right. Barb and I reviewed the engineering drawings on the new house with our architect the other night, and came across the “impervious surface” limit. The building code says only a certain percentage of the lot can be covered by substances such as asphalt, concrete and roofing. Well, we aced it! One more paving stone on the patio, or one extra inch on the driveway would have set us over the limit and sent alarm bells ringing. But we are perfect. I don’t know if the architect is very, very good, or if we just got lucky! It is a good thing that Barb and I weren’t planning on putting in any playground equipment with an impervious safety mat in the backyard. Got to hope current and future grandkids won’t miss a swing set!

Have a happy and safe Halloween. And remember to read/comment/subscribe. Otherwise the vampires will suck your blood.

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photo credit: Carlee Huttle as Vixen in Dracula via photopin (license)