Categories
economics Me

Inflation

July is the time of year when I do the budget for the coming year for my businesses. That’s the main reason why I didn’t post yesterday. Busy with business. From an inflation standpoint, things are actually looking more dire than they were last year. My property taxes are up 10%, my landscaping costs are up 15%, insurance costs up 21%, and interest (in dollars) on the mortgage is up 18% year over year.

In December, I posted about the increasing popularity of rent control. It turns out that Florida’s constitution and state laws make rent control a difficult prospect at best. So the communists in the blue counties are looking at other ways to make financial war on landlords. Miami-Dade is looking at requiring that tenants be provided government funded attorneys in landlord/tenant disputes. That also increases both the expense and risk for landlords. If that catches on, then there will be even more increases.

I predicted that landlords would find other ways to increase income without increasing rent. Things like fees for lawn maintenance, rental fees for appliances like washers and dryers, forcing maintenance costs like pressure washing on to the tenants.

It seems like I called it, because that is exactly what is happening. Landlords are passing these “extras” on to tenants, adding all sorts of fees on to the lease. These are costs that are associated with a rental property that tenants just don’t think about. Here is a complaint:

“Usually these increased costs do not come with increased services or amenities,” Rabin said. “They are often used as a way to deprive people.”

Take washers and dryers. Once common in rentals across Florida, now, many tenants rent not just their apartments and homes, but the appliances within it.

I don’t see how making you rent a washer and dryer is a way to deprive a tenant. A washer and dryer is an unnecessary convenience item that costs the landlord to both purchase and maintain. Many tenants destroy these appliances because, well, they just have no respect for the property of others.

The cost of buying and maintaining property is increasing. That includes opportunity cost. Let’s say that I bought a house for $200K. I can rent it out, or I can sell it. The only way that I would (and do) choose to rent is if I can get a better return on that investment by renting than by selling it. As housing prices rise, so do rent costs.

The same goes for appliances. Washers, dryers, kitchen appliances, they all cost money. In the past two years, I have had to replace a range, repair a refrigerator and a central air conditioner, and replace a dryer. That costs money that must be recouped. As appliance prices increase, so do my costs. As the cost of lawn maintenance and appliance repairs increase, so do my costs. That means higher fees and rent.

So far, I limit the fees on my rental property. I charge an application fee for each adult who will live at the property. That covers my cost to do the background and credit check. I provide a washer, dryer, and lawn maintenance. I pay HOA fees. The tenant provides for electric, water, and trash service. They also have to pay for cable TV and Internet service, if they so desire.

So how rents are priced is actually pretty straightforward: the amount that it costs me to maintain and rent the property is my base. That includes maintenance expenses, insurance, taxes, landscaping, administrative overhead, and legal expenses. To that, I add my expected return on investment. Since there is more risk than previous years, my expected return is around 8 percent. If I get much less, it is more profitable to sell. The resulting number is my rent.

What all of this means is that my rents this year will be increasing to reflect those added costs and risks. Last year, I increased rent on my rental property by 8%. This year, the increase will likely have to be around 9 or 10 percent.

Categories
Blog News Me

July 11, 2007

This blog is fifteen years old today. It wasn’t always here at AreaOcho. This blog began over at blogger those fifteen years ago as a way for me to vent about things from my job as a fire medic. The first post was about one of my patients getting his penis stuck on a keyring. In the past fifteen years, there have been more than 4,500 posts, over 10,000 comments on those posts, and I don’t know how many people have read what I have written over the years because I didn’t count them for the first decade or so. There have been nearly a million views in the past year, so there is that.

So many things have changed for me in the past fifteen years. When I started this blog, the death of my father was still fresh on my mind. Since that time I have been married, divorced, and then married again. Employed, retired, then employed again. I declared bankruptcy and then became a millionaire. The last decade and a half have been busy:
In 2008 I got married.
In 2009 the bottom dropped out of the housing market, my pay was cut by 30% and, faced with a depreciating asset, I declared bankruptcy with the intent of giving my house back to the bank.
In 2010 My bankruptcy was discharged.

Before the bank could get the paperwork done to repossess the house, they were caught lying to the court. It turns out that they lied in court and hadn’t been the mortgage holder of my house for years. They were forced to pay me nearly $10,000 in damages.

A year later, they tried to repossess the house again and their lawyer was caught forging mortgage paperwork in my case and several dozen others. Their lawyer was disbarred and the bank had to pay me more than $25,000 in damages. He disappeared with a pile of his clients’ money and I have no idea where he went.

The FTC stepped in and filed a class action against the same bank, and I got paid another $4,000 as my part of the settlement.

In 2011 My wife announced to me (during the week of my birthday, no less) that she wanted a divorce. That divorce became final in June. In November, I retired from my career as a firemedic and began school to be a physician assistant.
In 2012 I decided to leave school, moved back to Florida, and began teaching adult education while remaining mostly retired.
In 2014, I met my current wife. I also applied for my teacher’s license and became a high school science teacher.

In the spring of 2015, my daughter made me a grandfather.

In the spring of 2016, my daughter made me a grandfather for the second time. By the end of that year, I was married again.

In 2017, my new bride and I took a 51 day road trip across the nation, spending two weeks in Alaska in the process.
In 2018, I finally had a net worth of over a million dollars. Not bad for being insolvent less than a decade earlier. We celebrated by spending the summer in Europe.

Of course we all know what happened in 2020, and this led to me leaving the teaching profession and returning to medical work in 2021.

My son, the man I thought would be a committed bachelor until the day he died, got married in 2021.

Fifteen years is a long time, especially for a blog. I wonder what the next few years will bring.

Categories
Me Medical Medical News

Airplane Medical Kit

Because of the comments to the post about the doctor on the airplane, I wanted to do a follow up. So let’s first talk about what is in the medical kit on a commercial aircraft. The FAA requires an AED, and a medical kit that contains the following items:

The most common inflight medical events are:

  • Gastrointestinal/Nausea (31%)
  • Neurological, such as fainting or seizures (26%)
  • Respiratory (7%)
  • Cardiovascular (5%)
  • Dermatological (5%)

My wife was on an aircraft flying from JFK to Heathrow where there was a death in flight. The flight attendants cleared out the back row of the plane and put the body on the seats, covering him with a blanket. That is where he stayed for the remainder of the flight.

I myself have been on two flights were there were medical issues. In both cases, the flight crew called for medical personnel. I wasn’t going to volunteer, but no one else did, so I raised my hand. The FA brought me a radio headset that was connected to the airline’s on call doctor, who consulted with me and we agreed upon a course of action.

The first was a moderate allergic reaction (urticaria, wheezes, pruritus) on a flight from Orlando to Boston. The passenger got himself 50mg of IV diphenhydramine and some inhaled albuterol. He was fine and slept the rest of the flight.

The second was on a flight from Las Vegas to Orlando. It was a guy who was having himself an anxiety attack. He was hyperventilating and complaining of shortness of breath, chest pain, along with numbness and tingling to his fingers and lips.

The reason for it was hilarious. He had gotten married to his fiancé (a white woman) while in Vegas. He was Puerto Rican, and was dreading his mother’s reaction when he told her that he had married a woman (who wasn’t Puerto Rican) that his mother hadn’t even met yet. If you know anything about Puerto Rican mothers, you would know that they are much like Italian mothers. He had every right to be afraid.

Anyway, I told the doctor that his vitals looked good and I felt like it was an anxiety attack. The doctor agreed. I traded seats with his wife for about half an hour and talked him down. Once he felt better, I went back to my seat. An hour later, his wife came and got me a second time. During that second visit, his wife told mine that I was a very patient and nice man.

That’s it for my aircraft stories.

Categories
Me

Insurance

I lost the genetic lottery. Let me explain.

  • My father was a type 2 diabetic. He died 18 years ago at 63 years old.
  • My grandmother was a type 2 diabetic. She died 50 years ago at 63 years old.
  • My grandfather died at 56 years old in 1948. It could have been diabetes, but there was no real testing for that back then.
  • You can trace it back. My great-grandfather died at 47 years old, his mother died at 57 years old.
  • My sister has diabetes. My brother does not.

So genetics are working against me here. I was diagnosed with diabetes about 12 years ago, while I was in my mid 40s. I went on a diet and lost 90 pounds. That was good enough to manage my diabetes for the next 6 years.

As you may or may not know, diabetes is a progressive disease. Those with it know that it will progress eventually, and I am medically knowledgeable enough to know that it will likely be what kills me at some point. I am just committed to making that date as far in the future as I can. So I watched what I ate, stayed active, and kept up doctor visits.

At any rate, it was about six years ago that my blood sugar began climbing. My A1C was right around 8. So the doctor put me on Metformin. The doses slowly increased, another drug was added. Still, my A1C stayed pretty good, wavering between 6.5 and 7.5.

My levels slowly have been increasing. Last September, my A1C was up to 7.8. Then in April, my A1C was as high as it ever has been: 10.0. The doctor tested my blood to see if I was still making my own insulin, and I am. So we talked about a few options.

One option is to stay the course. That is the worst of the choices and, considering my family history, will lead to a death within a few years. Not a good choice.

The second option is insulin, meaning that I would have to inject myself at least once per day. There are a lot of drawbacks to that plan, and isn’t much better than option one. I’ve seen for myself that type 2 diabetics don’t do well or last very long once they go on insulin.

The third option was to try one of the new drugs: Trulicity, Ozempic, Rybelsus. The one we decided on is Trulicity. The catch? The drug costs $800 to $1,000 a month. None of the others are any cheaper. My insurance company says that they won’t cover it unless I can prove that I am a diabetic who has tried other, cheaper options, and those options don’t work. The Dr wrote the prescription.

Of course the insurance company kicked it back and demanded more documentation. We provided it. According to their own website, I fit the criteria.

The doctor just called me. The insurance company denied it anyway.

I have some calls to make to try and take care of this. I don’t think that I have any legal recourse, so I have to review my options. It is stuff like this that makes me believe that insurance companies should be liable for malpractice.

Categories
Blog News Me

Yesterday

About yesterday’s post. It’s been a trying week. At work in the ED, I had a guy with a serious heart attack (STEMI alert), some COVID patients, and more. The one that took the cake was the woman who was a mother of 3 kids. She was in the middle of a miscarriage and was bleeding to death. Her pulse was 120, her blood pressure was 72/42 and a MAP of 52. Her ER bad looked like a movie murder scene. Watching her fight to save her own life as well as the life of her unborn child, while at the same time watching other people literally fight to kill others. It made for a tough day at work. Emotionally draining.

On top of that, I am trying to complete my CEN certification while at the same time completing my BSN, all while working PRN in the emergency department. This will mean completing my 6th college degree. Lots going on that was physically tiring. Oh, did I mention that I am on the HOA board, my wife is dealing with some (minor) health issues, and I also had to do some minor repairs on the rental?

There are times when the cup is empty, when you are simply out of the energy that you need to do all of the things, and yesterday was one of them.

Today will be better, once I am done with today’s scheduled 3 hour class. I expect to be back to my usual opinionated self this afternoon. Thanks for listening to my venting.

Categories
COVID Me

Again

I haven’t posted in a couple of days. After managing to make it two years without COVID, I have managed to catch it twice in as many months. The odd part is that the two episodes have differed in symptoms.

The first time consisted of large amounts of congestion and coughing that lasted eleven days. I had no fever and COVID tests came up negative, but I lost my sense of taste and smell.

This latest bout had me with a mild stuffy nose and cough, no fever, and only lasted four days. I was so tired, I couldn’t stay awake. I wasn’t sure that I had COVID until my wife got sick, took a test, and it was positive. So I took one too, and what do you know, it was positive. Then yesterday morning, I woke up without a sense of smell or taste. This second bout with COVID has been MUCH milder than the first. The only other symptom is copious amounts of sweating.

I have no idea how we caught it. With my wife being a teacher and me working in a busy emergency room with daily contact with COVID patients, who knows?

Categories
Glory Days

Signal 7

To help in understanding the Disney rules, I want to take a minute to explain how Florida works when it comes to EMS and dead people. Florida’s EMS system requires that all prehospital services (like EMS) have to be supervised by a doctor. That doctor is called a medical director, and that medical director sets the rules under which all of the EMT’s and Paramedics that he supervises must operate. The rules are referred to as protocols.

Some medical directors don’t trust their underlings very much, and keep them on a very short leash by making protocols restrictive. Other medical directors allow their medics latitude to make more clinical decisions than others. There are all kinds of protocols.

My first medical director here in Florida was one of the strict kinds. We were not allowed to declare someone dead. Ever. Every single person got transported, and the doctor in the ED had to make the call. We once transported a person whose head was severed from his body. The ED doctors were pissed.

If you decide that the patient is dead on scene, the radio call used to be “Signal 7.” Then the 911 commission came along, and we were no longer allowed to use codes. From that point on, the radio call became: “No code, no vitals.”

Reedy Creek is, for all practical purposes, a government that is owned by a private company. Their medical director is VERY strict, and the protocols that they operate under are anachronistic. They wrote their protocols IMO with a lawyer and PR department in mind, but not a doctor, and certainly not the patient, in mind. One of the rules that Disney operates under is that all medical patients need to be transported to the hospital, even if they are dead. The majority of them go to Advent Hospital in Celebration, where the doctor then declares them dead. Since Celebration Hospital is not on Disney property, the person didn’t die at Disney. They died in the Hospital.

Categories
Me

Plumbing Problems, Part 4

This is my only post of the day today because of my plumbing issue, complicated by the fact that I was scheduled to work in the emergency room 9-9 today, until my boss called me at 8 o’clock and rescheduled me to work 1 pm to 1 am today.

For six years running, we have had a plumbing problem. I have been suspecting it was a vent problem. It rears its head every fall and spring. We have had three different plumbers out, and I swear it has cost us thousands of dollars, and no solution has been found. The problem corrects itself after a day or two, so by the time a plumber gets here, they never find anything, but are happy to bill us between $100 and $500 to tell us nothing is wrong. Assholes.

The last plumber to come out (4 months ago) thought I was nuts when I asked him to check the vents. He found two large frogs living in one of the vents. That cost me $200. Other than that, nothing has ever been found. They even put a camera through my pipes two years ago. Nothing was found, but they still billed me $500.

Let me describe the drains in my house: There are two vents in the house: one over the laundry, which shares a drain line with the kitchen. The second vent is over the guest bathroom and shares a drain line with the master bathroom. There are three undersink vents that are covered by air admittance valves.

We are planning on moving next year and converting this house into a rental. If this plumbing issue keeps up, I may just sell it, even though the wife doesn’t want to.

Anyhow, time to get ready for work. I am not looking forward to getting off at 1 am.

Categories
economics Glory Days Me

Paramedic

One question I get all of the time is “What is it like to be a paramedic?” There are a few places that you can work as a paramedic in the peninsula of Florida. I have heard that things are different in other places, but this is how it is here. I described it 9 years ago, if you want to compare.

Most new paramedics want to work flight. The glamour of riding around in a helicopter is pretty alluring, but due to weight restrictions on helicopters, they generally won’t let you be a flight medic if you weigh more than 150 pounds. Flight medics typically have at least 5 years of experience with a 911 service to even be considered for the job.

The next best thing is running with a 911 service. Running with a 911 service is not as boring or routine as other jobs, so that is where nearly all paramedics want to work. The catch is that nearly all 911 EMS on the Florida peninsula is run by fire departments. The pay is pretty good with 911 service, so the competition is fierce. There will be 200 or more applicants for each position, so getting hired for one of these jobs is difficult. Starting pay for a dual (fire, paramedic) certification paramedic is currently about $50,000 per year.

Then there are hospitals and doctors’ offices. They are largely avoided by paramedics because nurses have managed to get employers to prohibit paramedics from giving medications. The reason is that nurses don’t want to be replaced by paramedics making less money. Hospital paramedics are also prohibited from inserting endotracheal tubes, because doctors make several hundred dollars for doing them. They aren’t going to let an hourly employee perform a procedure that a doctor can do for the price of a Lexus payment. So many medics (especially new ones who want the excitement) don’t take these as full time jobs. What winds up happening is the paramedic gets to do all of the things the nurse doesn’t want to do. You start IV lines, draw blood, bathe patients, change adult diapers, collect stool and urine samples, run ECGs, fetch drinks for patients, and other gopher work. A medic in a busy emergency room can expect to walk 20,000 steps (over 8 miles) per day. Starting pay for a hospital medic is around $36,000 a year with no experience.

There are also the theme parks. Most of the work there is simple first aid, with a few emergencies, and a bit of employee health. There are the big ones: Disney, Sea World, Universal, and Busch Gardens. There are smaller ones like Lego Land, Cypress Gardens, and even water parks like the now defunct Water Mania or Wet N’ Wild. Starting pay at these places can be odd, because some require experience, and quite a few only hire part time paramedics who already work elsewhere. Starting pay is between $18 and $23 an hour.

The paramedics who get the least pay and respect in this area are the ones working on non emergency transport ambulances. The pay is low and the working conditions are poor. Shifts are long, normally 12-14 hours each. You do not get a station to sit in on those times where you wait for your next call. You sit in the truck and wait. No reading, eating, sleeping, watching movies on your electronic devices, no texting, no phone use, and no drinking of anything except water. (Not even coffee) These jobs are easy to get, but turnover is high, and most people don’t stay for long, using this place to get experience and move on. These positions are where many medics who can’t get a job elsewhere wind up. Most medics work one of these jobs at some point in their career, but strive to get away from as soon as possible. If you work at one of these for more than 2-3 years or so, most employers will assume that there is a reason why you can’t get a better job and will avoid hiring you out of general principle.

One manager at a private ambulance company told me that his crews were not allowed to eat during shift, because he doesn’t pay them to eat, he pays them to haul patients so he can make money. Expect no meal breaks for the entire 12 hour shift. Another told me that patient care is secondary to keeping the customer (nursing home, hospital, etc) happy, and that the patient was just cargo, and no one cares what cargo thinks. One of my former EMT students was told by an employer when he complained about working conditions, that for every EMT that was working there, there were 7 more looking for a job, and if he didn’t like it, he could be replaced tomorrow. Starting pay for a transport medic averages $32,000 a year. In contrast, a kid right out of high school can get a job at a fast food place for $25,000. Delivery drivers for places like Sysco are making $50,000 a year.

A person aspiring to be a paramedic who isn’t a firefighter is better off going to nursing school. An RN has the same amount of schooling as a paramedic, but makes about double the pay.

That and burnout mean that only half of all paramedics are still working as paramedics five years later. The half of paramedics that leave generally eventually become nurses or respiratory therapists, the rest usually leave for other professions. I know one that became an ice cream man.

Even becoming a firefighter paramedic is a tough road. About half of the people who spend two years becoming paramedics and another six months becoming firefighters never get hired by a fire department. They wind up either moving on to other careers or taking jobs like non emergency ambulance jobs as they wait for the big break that never comes.

I got lucky. I spent two decades running 911 calls with fire departments. I have worked in all of the settings above (except flight- I am too heavy): three hospitals, four different fire departments, two doctor’s offices, three different theme parks, and two different ambulance companies. Each had its plusses and minuses. The biggest minus for most is pay, closely followed by poor working conditions.

In Florida, a nurse can challenge the paramedic exam and become a paramedic, but a paramedic can’t challenge the nursing exam. I can say with all honesty that nursing school doesn’t teach you anything that you didn’t already know as a paramedic. Even so, nurses who began their careers as paramedics make better nurses, especially if you are working in the ED.

Categories
COVID Me

It Took Two Years

But the coof finally caught up to me. It started on Day 1 with some post nasal drip, mild fatigue, and a sore throat. No big deal, but I knew I was coming down with something.

Day 2, and I woke up to discover that I had a stuffy nose and my throat hurt so bad I couldn’t swallow. After some cold water and Ibuprofen, it eased up enough that I figured it was a mild cold.

Day 3 was more fatigue, congestion, and a mild cough. Dayquil worked fine. I took a home COVID test and it was negative. I was tired and fatigued, so I spent a good bit of the day napping before going to bed early with a dose of Nyquil.

Day 4: I went to work and pulled a 12 hour shift. I felt slightly under the weather, but still not too bad. I have had far worse. Symptoms to this point were mild fatigue, a runny nose, and a mild, non-productive cough. I went to bed at midnight with Nyquil and Robitussin. I didn’t sleep well.

I woke early on Day 5 (at 0430) because I couldn’t breathe. I sat up in a chair, eating Vick’s cough drops like candy. That and some extra strength Robitussin DM seemed to work. A second at home COVID test of a different brand also showed negative. I slept on the couch for a good bit of the afternoon before getting up to take a shower. I was shaving when I realized that I couldn’t smell the Vick’s shower tablet. Then I realized I couldn’t smell anything- not my soap, shaving cream, nothing.

My wife and I did some experimenting. I couldn’t even smell Vick’s Vaporub when it was rubbed on my upper lip. The only thing that I could smell (very faintly) was vinegar. That’s when I knew. COVID.

It’s now day nine, and I have spent the last few days sleeping in the recliner, coughing up large amounts of mucous. It feels like I am breathing through a straw. That and fatigue are the only remaining symptoms. Even my senses of taste and smell came back after two days.

My wife doesn’t think that it is COVID, mostly because the home tests say that it isn’t. I don’t want to take an official test, because my job would require me to quarantine for 14 days. Regardless, my wife woke up with a sore throat this morning, so now it appears as though she has it.