Adventures with medicine, part XVIII and counting...

 

Regular readers will recall my misadventures with medical bureaucracy in May, and the follow-up (mis)adventures last month.  Yesterday, Tuesday, most of the results came together, with moderately satisfactory results and a certain amount of pain.

My new CT scan images and analysis were ready, and my pain management specialist (who made the necessary arrangements for them) discussed them with me.  There appears to be more going on "over my head" than I'd been made aware . . . it appears possible that the original surgery, twenty-two years ago, might have been - how shall I put this? - sub-standard.  Nobody used the word "malpractice" - perish the thought!  After all, given the passage of time, that probably couldn't be proved.  Nevertheless, it may be one of the reasons why two neurosurgeons, a neurologist and an orthopedic surgeon had all been noticeably reluctant to commit themselves to a potential solution to my problems.  Armed with this (strictly unofficial and off-the-record) information, I'm now in a position to ask very blunt, pointed, direct questions when I see the new neurosurgeon, and apparently he's one of the few doctors who's willing to answer such questions appropriately.  The next couple of months should be interesting . . .

That said, I had my second caudal epidural injection yesterday morning.  The first one (in March) gave me 2+ months of moderate pain relief, so I'm hoping the second one will be at least as useful.  That, plus wearing a back brace for all walking and driving, will hopefully keep me mobile enough to see the new neurosurgeon in Dallas before the end of August, and (with his help) develop a plan for short- to medium-term treatment in preparation for surgery.  It's a slow, painstaking process, but as I've been told repeatedly, spinal surgery is one of those "measure ten times, cut once" solutions that one daren't rush or mess up.

Right now I can't feel anything in my lower back, the result of the anesthetic used to perform the injection into the spinal cavity.  By Wednesday morning I'll be feeling it again, I'm sure.

Peter

When large-scale weather threatens large-scale consequences

 

I'm sure most of us have read news reports about the imminent return of the climate phenomenon known as El Nino, possibly in the form of a so-called "super" El Nino, far stronger than "normal" events of this kind.  There have been all sorts of alarmist forecasts about drought, flooding, and everything in between.  However, the big story may be the effect of this climate phenomenon on global commerce and industry, regardless of whether it's rainy or sunny.  TT Club, a "provider of mutual insurance and related risk management services to the international transport and logistics industry", examines the implications.

El Niño events are part of a naturally occurring climate cycle, but “super” events are characterised by exceptionally high sea surface temperature anomalies, which are far less frequent and significantly more disruptive. Current forecasts are suggesting that a very strong event is increasingly likely, with some indicating increases well above historical norms. The result is not a single point of failure, but rather a synchronised, multi-regional disruption that has potential to affect the interconnected global supply chain.

. . .

Perhaps the most concerning aspect of the current outlook is the convergence of climate and geopolitical risk factors. When overlaid with El Niño-induced climate shocks, the potential for cascading effects increases significantly.

For example: 

• Reduced fertiliser availability may exacerbate the impact of drought on crop yields
• Higher fuel costs may increase the cost of transporting goods
• Trade route disruptions may amplify delays caused by weather-related events
• This interconnected risk landscape highlights the need to view El Niño not as a standalone hazard, but as part of a broader system of interdependent risks.

. . .

The critical point for global businesses is that exposure is rarely limited to the location of the physical hazard. Organisations may face indirect impacts through suppliers, commodity markets, logistics networks, energy systems, insurance costs and customer demand.

Key global vulnerabilities include: 

• Food and commodity price inflation driven by crop losses or supply uncertainty
• Disruption to agricultural, industrial and consumer-goods supply chains
• Transport delays, port disruption and reduced reliability across maritime and inland logistics routes
• Energy market volatility linked to higher demand, reduced hydropower output and infrastructure stress
• Increased insurance, financing and working-capital pressures as businesses respond to greater uncertainty

For internationally exposed organisations, these second-order and third-order effects may prove just as significant as direct physical risks. The practical implication is that El Niño should be assessed not only by geography, but by dependency: where goods are sourced, how they are transported, which inputs are most constrained and where alternative capacity exists.

There's more at the link.

That's an often underestimated factor in many plans:  military, political, business, disaster, whatever.  A factor that is described in geographical terms - like El Nino, often termed the "southern oscillation" of weather patterns - can have effects far outside that geographical area.  I'm sure most US businesses on the East Coast aren't planning for any major disruption due to weather that might affect the West Coast of this country, but that's very short-sighted.  What about Europe, or Asia?  I'm sure many nations on those continents are dismissing El Nino as "someone else's problem", but if, as the article suggests, we define it by dependency on economic activity in the area where it occurs, that dependency reaches into every corner of global markets, both imports and exports.

Even on a small scale, in terms of personal planning for the next year or two, this bears thinking about.  For example:

• Is my employer (and hence my job) likely to be affected by El Nino, positively or negatively?  Could it determine whether or not I have a job at all this time next year?
• What about our household emergency planning?  Are we assuming that certain staple foods and basic necessities will always be both available and affordable, or might the advent of El Nino-related weather patterns affect that?
• Are we planning to travel anywhere over the next year or two?  Will airline flights be affected by El Nino?  Will they become more or less affordable?  What alternatives are there?

Just a few areas where we might all do well to consider what's going on in our atmosphere and our oceans at present.

Peter

Memes that made me laugh 319

 

Gathered from around the Internet over the past week.  Click any image for a larger view.

Sunday morning music

 

A few weeks ago I put up Mike Oldfield's 2008 quasi-classical album "Music Of The Spheres".  In a comment to that post, reader Mauser said "I still need to get a copy of Tubular Bells 3".  I thought I'd save him the trouble, and give the rest of my readers a treat at the same time.  Here, from 1998, is the world premiere of "Tubular Bells III", live (in sometimes pouring rain) at the Horse Guards Parade in London.

Tubular Bells III was less popular than its two previous versions, but I like it very much.  See also "The Millennium Bell" and "Music Of The Spheres" for further development of the musical themes first encountered in earlier Tubular Bells versions.

Peter

So much for the New York City property market...

 

This news is several days old, but it only caught my eye yesterday.

Months before New York City approved a historic two-year rent freeze, Google co-founder Sergey Brin quietly exited a struggling real estate fund at a steep loss.

In December, Brin sold his stake back to A&E Real Estate, the fund's manager, for six cents on the dollar, according to documents obtained by Bloomberg.

The fund holds 5,900 rent-stabilized apartments, with Brin's stake being valued at roughly $79 million, a drop in the bucket when viewed next to his $280 billion net worth.

"A&E bought out one of our long-term investors, who was willing to accept six cents on the dollar on their original equity investment to divest itself from the New York City multifamily sector," a company representative told Bloomberg in a statement.

"The simple and deeply troubling fact for renters is that institutional capital – both equity investors and lenders – are fleeing New York City’s rent-stabilized apartment sector," the A&E representative continued, according to Bloomberg. "They understand New York is in a doom loop."

There's more at the link.

Think about that for a moment.  Working backwards from "Brin's stake being valued at roughly $79 million" at the sale price - i.e. at six cents on the dollar of his original investment - that means he originally invested about $1.3 billion in the real estate fund.  He's lost almost all of that money, thanks to New York City's cratering real estate market, undermined as it is by the socialist communist policies of newly-elected Mayor Mamdami.

If a man as economically savvy as Mr. Brin walks away from a $1.3 billion investment, writing it off as unrecoverable, what are smaller investors to think?  Can they afford to follow his example?  For that matter, can they afford not to follow his example?  Makes you think, doesn't it?

If I were unfortunate enough to live in or near New York City, or have money invested there, after hearing that news I'd be taking steps (rapid ones) to move myself and/or my money somewhere (anywhere!) else . . . before I lost all my investments, too.

Peter