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Greyhounds Healthcare Holiday Letter Home Remodeling

2021, The year of the snake

This is your boring holiday letter of interest to about 3 people in the whole world. If you’re one of those, press onward. If not, don’t feel bad. This article is a mash-up of this and that.

Year of the snake? Treatment of Dave’s bladder cancer has been the big news of the year. So far, it remains confined to the bladder lining where it is very treatable and is more a nuisance than an existential threat but its treatment has set the rhythm for the year.

Why Year of the Snake?

Dave is a bladder cancer survivor so far. And his bladder is surviving, so far. Bladder cancer is fairly common in men and seems to run in families. Mom had about 12 siblings and 4 of them have had bladder cancer, 2 full brothers, 1 demi-brother, and 1 demi-sister. The half-siblings are just a few years older than Dave. All share a common male ancestor. It appears the family legacy is continuing on into the second generation. I’m the first of the grandchildren to admit to having the disease.

So, I now have a Urologist and we’re best buddies. Urology of Virginia is one of the better practices in the country. Together with my physicians we have been following the bladder cancer standard of care which include regular surveillance by endoscopic inspection and removal and biopsy of the bits that don’t belong.

I’m fortunate to have low grade disease (stage 1 or 2-ish) that involves only the tissue of the bladder liner. My disease presents pretty readily to the practiced eye and the lining can be peeled back to uninvolved tissue pretty easily and reliably. The analogy my urologist uses is “keeping the lawn mowed.”

Keeping the lawn mowed is about a twice a year outpatient procedure under general anesthesia. Using endoscopic tools, the diseased tissue is removed using a heated wire. The procedure takes about an hour and recovery takes about a week. After three weeks, there is a follow up exam to confirm that the tissue healed as was expected.

This years treatment also included a spot of immunotherapy that went well initially but but was suspended when a patch of inflamed bladder liner was discovered on the follow up visual exam. This tissue was just removed and biopsied and found to be benign.

This is why you spring for Medicare Supplement F or G. I pay a little extra for F as it picks up the Medicare B deductible care. I like it that there is only one set of rules to remember and not 2. So far, zero dollars out of pocket for bladder cancer care.

Back Pain is Gone

In spring, I replaced my way too old bedding. Turned out, this was the cause of lots of chronic hip and back pain. Before letting the saw bones work on your back, swap out your bedding. It will be less than your co-pays. Took about 6 months for all the referred pain to clear up.

I mail ordered my mattress following recommendations of our friends at Consumer Reports. They do get some things right. And they are helpful with many others. I usually match CR ratings with fan magazine ratings being careful to avoid the click bait recommendations sites that have taken over the Internet searches.

Lead Sled is almost here

Earlier this year, Dave ordered a Volkswagen ID.4 all wheel drive electric vehicle. The GTI has been a great car but is just a bit tight for an old folk to enter. Hip stabilizers not being as elastic as they once were, I need a bit higher door opening to accommodate old folk boarding technique. So I ordered VW’s most boring family car. At the moment it is going through customs and the port of Baltimore internal processes. Eventually, it will be loaded on a car transporter and shipped to Southern VW for delivery.

Paying for the new sled

Volkswagen-Audi Group has, no doubt, completed a wallet biopsy by now. We’ll see what sort of financing VA Credit offers to get my business. USAA and Navy Federal Credit Union make auto loans on line with no friction.

I looked into leasing. Leasing makes sense if you use the vehicle for business as defined by the infernal revenue code. If so, you can expense the vehicle lease payments against business income. Home owner individuals no longer have access to tax relief for auto loan payments. Whether you lease or borrow, things work out about the same numbers wise. The same time value of money problem is running.

  • There a balloon payment (lease) at the back end or a down payment at the front end. Leasing moves the balloon payment to the end. This can be useful but somebody is financing the entire vehicle cost and passing the bill on to you.
  • The leasing agency owns the vehicle and bills you for insurance and service. With a traditional loan, you have complete control of those costs
  • The leasing company is eligible, maybe, for the EV tax credit. If you’d like the credit to offset the purchase, you’d best buy the vehicle.
  • The leasing company pays the auto taxes and bills you for them. When you buy, you pay them directly.
  • It is likely that leasing and buying have different consumer protections. That’s a matter of state law. Virginia has weak consumer protection law.

Rocky Survives Year 2

Rocky is growing up, finally. But he’s still a mischievous bin-raiding, syrup-stealing puppy at heart. Today at 5.6 years, he nicked the maple syrup jug, bit the top off, and poured himself a serving. I heard it hit the floor but was too late to stop the crime. We had taught him “trade” so he abandoned his prize to collect his loot recovery gratuity. Then he licked up the spill before I could fetch a towel. Just a dog bed cover to wash fortunately. Maple syrup ranks high on the list of substances not to spill.

Rocky is calm enough to go out in public and on walks so we’ve started doing that. Rocky still can’t sit or down on cue but he is learning the important activity of daily living stuff slowly but steadily. This is a much larger body of knowledge than we realize but must be mastered to live in a household. Greyhounds get a late start but they get the essentials down quickly. We’re working on harder stuff like bed sharing and riding in the car, and tolerating tradesmen.

Undercroft Changes at the Manor

Following 2021 summer humidity and out of spec framing moisture levels in the undercroft (crawl space), I engaged a local contractor to upgrade the vapor barrier under the building and to seal the penetrations between the crawl space and conditioned space above. They also installed a dehumidifier and condensate pump to actively dry the air under the house. This was about a $5000 project.

Uninhabited space moisture control is the most important thing you can do to prevent mold and termite problems. Termites like moist wood. They’ll ignore dry wood. Moisture in limits, termites and mold eat at the neighbors.

Several houses in our neighborhood have required crawl space remediation because they were not being properly inspected and maintained in limits. One was so bad that it was taken out of service, floor and sub-floor removed, framing treated with dry ice, and deteriorated joists replaced or paired with new. Then, the interior finish had to be restored.

Needless to say, major expense for the owner and inconvenience for the household. I don’t know if this one was owner occupied or tenant occupied.

Zero Carbon Manor

I’m looking forward a few years to replacement of the Dismal Manor’s Dismal HVAC. Currently, we have a medium efficiency heat pump sized for air conditioning the manor and a gas furnace sized to keep the place toasty on the design basis winter day (-5 F is it?).

Since I bought this kit, the heat pump has provided summer cooling and most heating in April, May, September, and October. The break even temperature is 45 F. Below break even, the heat pump locks out and the furnace picks up the heating load using 2 stage burners and 2 speed variable speed drive fan. This has worked quite well.

Recent developments in heat pump design and drive design allow heat pumps to function down to -20C or -4F. So, using cold climate heat pumps, I can heat the building entirely with air source heat pump heat in most years. Our 99th percentile low temperature is -5F or so.

At design basis, current cold climate heat pumps run with a coefficient of performance of 3. At cooling conditions, the coefficient of performance increases to about 5. This means that the heat pump will deliver 3 times the heat energy to the building relative to the utility energy provided to the machine. I. E., it has a gain of 3 for cold climate heating and 5 for cooling.

I’ll probably keep the current furnace and ducting. If I double the capacity of the heat pumps, that will heat the building down to 20 F with the furnace for backup. This will cover the vast majority of our degree days as temperatures below 20 F are rare. I can do this by adding a Mitsubishi mini-split to cool the great room area you see in most of our photos. A second machine would cool the whole house via the air handler in the stack. It would be lead with the lounge as second.

One thing I learned in my reading is that it does not make sense to replace equipment early to achieve zero-carbon. Rather, replace it late in life or on failure. Eventually, I’ll have to replace my current machine as it will be uneconomical to repair (compressor fails, hx fails). It is designed for refrigerants no longer made. Reclaimed refrigerant is becoming dear.