Paramedics Membership

I paid $60 last week for a Paramedics Membership with the City of Orange. When I first moved here in 2009, there was no additional charge for paramedic services. Then suddenly one year, the option to include $2 per month was included in our water/sewer bill to opt-in. That then became a $48 one-time fee payable only by check, and now it is $60.

This is basically insurance for paramedic calls. It covers all services for everyone in your household (up to ten people) anywhere in Orange and covers visitors to your house. My problem with this setup is that local emergency services is a monopoly. When you call 911 for a medical emergency, the call is routed to the fire department. You cannot choose another provider. Knowing that it is a captive market, the fire department refuses to participate in any insurance networks, so they will always be out-of-network and can charge astronomical fees.

I experienced this fucked-up system twice while I was on dialysis. The first time was when I had severe hypoglycemia. I woke up in the morning delirious and my parents called 911. The paramedics game me a glucose/dextrose IV and took me to the St. Joseph hospital ER. Even though I enrolled in the program, the fire department still tried to bill me about $2,000. The billing office claimed that someone else lives at my house, so I was not covered. It took over three months to clear that up. I also got a 30-second ride from the dialysis clinic to the ER due to a likely panic attack. I remember the fire department sending a similar bill to insurance, but that was somehow paid by insurance, and I did not have to pay.

Why are paramedics not covered by my property tax? Police and remaining fire department services are included. I think it is because you can use fear to motivate residents who are old or in poor health to sign up. If they do not, then the fire department can charge thousands of dollars for services. I really want to see if they are making money on this program and what the justification is to increase the fees from $24 to $48 then $60 in just a few years.

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I have lived in three other cities, five if you include my immediate family, in Orange County. No other city charges separately for providing basic emergency service for residents. The City of Orange also forces you to get a business license and pay fees if you claim business expenses on your taxes. I used to incur some travel expenses when I helped my friend with his company in China. This was not an issue when I lived in Brea or Costa Mesa. However, as soon as I moved to Orange, I got a notice demanding I get a license that costs a minimum of $65 each year. The city provides absolutely zero services, but they want their pound of flesh. Fucking assholes.

COVID-19 Cases – November 2022

During my video call with UCLA Transplant Center, the doctor said that I should continue to wear a mask indoors since flu season is upon us again. I did get a flu shot in late September, and I just got the latest bivalent booster from Moderna last week. Since case count has been very low, I think I have been lulled into complacency, and have not been too rigorous in wearing a mask at work. Now, I am receiving emails from county health agencies warning that the number of new cases is increasing again.

Here is recent new case count for Los Angeles County:

Orange County:

It is hard to see any trends in the Orange County chart since the scale is messed up by last year’s Omicron spike. Here is the last 90 days from another source:

There does seem to be a slight increase, but it is hard to tell if it is just noise, or the start of another winter spike in cases. In any case, I am scheduled for another Evusheld injection in early December. Hopefully, that and the last booster shot will prevent another infection.

Omada Health

My online pharmacy offered this free program to help me manage my health, so I signed up. They send you a wireless scale and assigned you a health counselor. I was assigned to Alicia.

I just set up the scale today. You basically open the box, insert four AA batteries (they were Duracell), and step on the scale. I was expecting to have to connect the scale to my Wi-Fi network, but after my weigh-in, the scale blinked a bit, and sent my weight somewhere. I looked online and the scale connects over either AT&T or T-Mobile’s cellular network to send data. I did not know it was possible without a SIM card. Omada also must have pre-configured the scale, so they know to associate the weight data to my account.

Initially, I thought the program was just collecting weight data and sending me information. However, it appears that I need to track food intake and activity in addition to tracking weight. There is also homework and likely chat sessions with Alicia. It is definitely more work but I need accountability to start the weight loss process.

Multiple Neuropathy Attacks

This has been a bad week for my peripheral neuropathy. I mentioned earlier that I had an attack early Tuesday morning. It prevented me from driving to work, and I blocked off all afternoon for naps. Fortunately, that attack subsided in the afternoon, but my left big toe started hurting again that evening. By Wednesday morning, it subsided enough that I was able to drive to work after Tesla service replaced the 12V battery in my car.

After that, I thought the worst was over. I have never had two attacks in 24-hours and I was hoping I get a long break. Well, that was wishful thinking. I can feel an0other attack starting. It is in my left foot again, and this time it is between the first two toes and higher up on the foot. That is three major attacks in four days.

Kill me now.

WFH Neuropathy

A massive peripheral neuropathy attack just started on the outside of my left big toe. This is an uncontrollable scream-out-loud attack. Luckily, I am working from home today due to the bad 12V battery in my Tesla. I tried to massage the sore spot since it appears only skin deep, but like before, it did not have any effect.

I managed to clear my calendar for the rest of the afternoon. I did take two Tylenol capsules, but so far, the pain has not subsided. I wanted to try and sleep it off, but it is too painful now to try and sleep. I am hoping the pain will subside a bit later so I can get some work done. Otherwise, I may need to take a sick day since I have been very unproductive so far.

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Luckily, the pain went away at around 5:00 pm. I did not get to sleep since the pain was keeping me up, but I watched a mediocre movie called Bloodshot starring Vin Diesel. A solid 5/10 for me. Now I have to get back online and do some work for the next few hours.

COVID Update 10/15/2022

With the prevalence of the various Omicron variants and many people contracting COVID, there seems to be less media focus on the pandemic. Just from my anecdotal observations, mask use has gone down at work and locally in Orange County. I know I am less careful now that I have had COVID and received a bebtelovimab injection.

This is also visible from the case count history. Here is the past twelve months in Los Angeles County:

*https://www.google.com/search?q=covid+la&oq=covid+la&aqs=chrome..69i57.1132j0j4&sourceid=chrome&ie=UTF-8*

The January 2022 spike was the original Omicron variant. The long low bump is likely the BA.4/BA.5 variant finally hitting the US after spreading in Europe first. Does this mean the pandemic is almost over? There are more spikes in the worldwide case chart, but new cases have also flattened out to about 450k cases daily. For now, I am still going into the office only two days per week. If the numbers continue to drop, will work revoke my medical exemption to work from home?

Lower Leg Cramps

When I was on hemodialysis the first time, I would get a lot of cramps in both my upper and lower legs. This was usually due to removing too much fluid during the dialysis session. Things would be better during the six months of peritoneal dialysis as leg cramping became rare. Likewise, when I was back on hemodialysis the second time, there were occasional cramps, but nothing like the frequency or intensity before.

For about a year after transplant, I would still get occasional cramps, but more often in my ankles rather than legs. This subsided about six months ago, so I was quite surprised to have both calf muscles cramp hard early yesterday morning. My right leg cramped so hard that my calf muscle was sore for the entire day. Thankfully, the cramps did not return this morning and things are fine again.

My lab results were mostly normal, so it is not due to low sodium, potassium, or phosphorus. I have been peeing a lot recently, so I am not dehydrated either. Strange.

Old Fistula

My fistula surgery was in early 2020 so I have had it for about two and a half years. There are a few photos in earlier posts when it was in use, but I have not used it since the transplant surgery twenty months ago. This is what it looks like now:

The bumps disappeared quickly, and all that is visible is some discoloration at the three needle insertion points. The fistula is still working fine as you can still hear and feel the high-pressure blood rushing through the vein.

There have been some changes recently, however. I often feel a slight burning sensation in my forearm near the fistula. At the same time, I also feel an increased numbness in my right hand. I often feel cold or numb in my right hand while using the fistula since it diverts a portion of the arterial blood flow into the surface vein, bypassing the hand. This is the first time it has been noticeable post-transplant.

*https://www.saintlukeskc.org/health-library/arteriovenous-av-fistula-dialysis*

Zero Communications

I recently switched from using test strips to a continuous glucose monitor to measure my blood sugar. The first order included a reader and seven sensors. I am on my last sensor, which is expiring in two days. The manufacturer, Abbott, is very stingy with the sensor life. You cannot read from the sensor if you are one second past the expiration time of 14 days. Knowing this, I placed a refill order two weeks ago with Edgepark, a durable medical equipment (DME) supplier. They are the worst.

I know online reviews are not that reliable but 2.2 stars!? My experience so far has been about two stars as well. When i called to sign up and get my first order filled, the CSR was rude. It is always confusing when you have two medical insurance providers, but the CSR was impatient and gave me lots of attitude. On my refill order, I entered it online, but Edgewater still wanted me to call them. The call took only a few minutes, and I did not provide any additional information that was not already in my account. I also asked twice if my order was complete and both times the CSR (different one) said it was shipping soon. So, after two weeks, I did not receive anything. I looked at my account online and my order was cancelled. Sigh. I called them again and they said that I need to see my endocrinologist again for a refill. That is all fine, but I did not receive any notification from Edgepark nor my doctor’s office. Luckily, this is just a glucose meter. What if it was my anti-rejection medication? Terrible.

I guess I need to see my endocrinologist soon. In the meantime, I am back to pricking my fingers and using the old test strips.

Nephrologist Visit – September 2022

I finally saw my nephrologist today after five months. I was supposed to see her every two months. The appointment was scheduled for early July, after our Europe trip. However, due to COVID, I had to cancel all my appointments and I am catching up now.

There was not much change. We went over my labs and talked about how after two and a half years, there is still a lot of confusion about COVID prevention and treatment. She has patients from many different transplant centers, and each has different guidelines on vaccinations and preventative antibodies treatments. In my case, we are going to wait a few months, check my antibodies levels, and get either the bivalent vaccine or Evusheld again.

Here are some important test results:

Creatinine	1.46 mg/dL
EGFR	57 mL/min/1.73m2
Urea Nitrogen (BUN)	34
Potassium	4.7 mmol/L
Phosphate	3.3 mg/dL
Calcium (two different tests)	10.1 mg/dL or 10.9 mg/dL
PTH	207 pg/mL
Hemoglobin	17.6 g/dL
Hematocrit	51.4%

Bold items are out of range. Most of them have been borderline high since the transplant so my nephrologist was not worried. She is holding off on having me take Sensipar for the high calcium, but she did increase my Losartan dosage from 25 mg to 50 mg to deal with the high hemoglobin. My blood pressure is a bit higher too so more Losartan will help.

Next step is to schedule an appointment with UCLA transplant center since I have not talked to them since February. They were okay with six to twelve months between appointments so no I should be okay.

Bivalent Booster Shot

My work is once again offering vaccine shots. This time, the shot given are bivalent boosters, and we can choose which company’s product we want. I contacted my nephrologist to see if I should get the booster, and the answer was a definite “yes, but wait.”

Similar to the reason given when I was rejected for Evusheld shots, I should have enough immunity from my COVID infection, and any antigens produced will be neutralized by my immune system. The recommendation is to wait 4-6 months before getting the booster post COVID infection.

I have a lab draw Friday morning, so I was going to drive in to work afterwards for the booster shot. Now I think I will wait a few more months instead.

Today, the U.S. Food and Drug Administration amended the emergency use authorizations (EUAs) of the Moderna COVID-19 Vaccine and the Pfizer-BioNTech COVID-19 Vaccine to authorize bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines, which we will also refer to as “updated boosters,” contain two messenger RNA (mRNA) components of SARS-CoV-2 virus, one of the original strain of SARS-CoV-2 and the other one in common between the BA.4 and BA.5 lineages of the omicron variant of SARS-CoV-2.

The Moderna COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 18 years of age and older. The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 12 years of age and older.

The monovalent COVID-19 vaccines that are authorized or approved by the FDA and have been administered to millions of people in the United States since December 2020 contain a component from the original strain of SARS-CoV-2.
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use

No Evusheld For You!

So, it was not really like that. Nobody yelled at me. The nurse was actually very nice and apologetic that the hospital would not give me the shots.

This is my second time getting Evusheld. The cancer infusion center, where the antibody shots are administered, scheduled today’s appointment for me. Their logic was that since I got COVID, and received additional monoclonal antibodies at the hospital, I do not need the Evusheld shots again. I am unsure if this is just for this six-month period, or if I have immunity for a longer period.

I wasted two hours this morning driving to the infusion center, waiting to check-in, and waiting for them to reject my appointment. It also cost me $2 for parking.

Strange Blood Sugar Readings

These are my blood sugar readings for the past two and a half days. I have a continuous glucose monitor (CGM), although I do not know the sample interval. I worked from home on Monday and my blood sugar was consistently high. I do not remember eating anything that should have kept it high all day. There was a spike Tuesday morning, but I did not eat anything after dinner. I probably took an insulin shot to get the levels down to normal. Yesterday (Tuesday), I ate lunch around 1:00 pm. It was the last bit of leftovers consisting of some rice, tofu, and beef slices with onion. My blood sugar rose and fell but spiked at 5:00 pm when I got a cup of coffee from a machine at work. It did not taste sweet, but I guess I need to avoid it from now on. I did take a shot around 8:00 pm and ate some dinner but fell asleep soon after. I woke at around midnight feeling like crap, and my blood sugar had dropped to 78. It was very unclear why that is the case, so I took one glucose tablet and had a bowl of cereal and milk. My blood sugar stabilized but rose again at 7:00 am for no apparent reason. I slept the entire time without any food or drink intake. What the hell is going on!?

The CGM is nice since it gives me a continuous blood sugar readings. However, it is causing a lot of confusion as I cannot match the readings with food intake or activity. The readings do correspond with food most of the time, but there are many instances where the readings were really high or really low, and all I was doing was sleeping.

COVID Exposure Notification

During the initial COVID outbreak, I remember my iPhone kept asking me to approve Exposure Notifications. I imagine this was using the iPhone network to track close contacts and to provide a notification if one of them tested positive for COVID. This was released with iOS 13.7 in early September 2020.

So after almost two years, I finally got a notification tonight.

A couple of issues. First, the notification is for a 48-hour period. Is the by design? I am sure Apple knows the exact moment of the proximity contact; at lease give us a narrower window. Second, there is no location. For this notification, it was for Wednesday and Thursday. This means it is 99% likely that it was a work contact since I did not see anyone outside of work. If you visited a lot of places during the 48-hours, this notification would not give you any useful information other than to get tested for COVID. Finally, I assume that the notification is two days late is because the contact only tested positive today?

I guess I will wait until tomorrow morning to do another rapid test.

Low Blood Sugar at Raising Canes

As part of my Amazon/Kohl’s return adventure last night, I got dinner at Raising Canes. I believe I got there around 8:30 pm and the was a medium line. The problem was that I took an insulin shot before I left the house 30+ minutes prior. My blood sugar has been high most of the day, so even when I measured a 120 before leaving the house, I shot 12 units of insulin thinking I would get the food quickly.

While driving from Kohl’s to Canes, I could already feel signs of hypoglycemia (slight dizziness and cold sweat). I popped a glucose pill but felt about the same. After placing my order in the drive-thru, I took another pill but felt more or less the same. Fortunately, I got my order (just six chicken fingers) after only about 10 minutes, and quickly ate two chicken fingers. When I got home, I tapped the reader to my CGM sensor and it appears my blood sugar got down to the 50’s. That is way too low for me. Good thing I have 5 mg glucose tablets stashed everywhere.

Next time, I will just carry the insulin pen with me instead of injecting early and trying to time my food intake.

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I downloaded the glucose data from the Libre 2 scanner. My blood sugar got down to about 75 yesterday. That is not super low, but since I have diabetes, anything below 90 feels terrible for me.

COVID Test History

So after two plus weeks, I am finally over my COVID infection. The positive indicator was very faint on Thursday, and totally not there last night. I still have a slight cough and itchy throat, but I often have those symptoms for no real reason way before COVID.

The question now is what variant did I get? Based on the new cases history for France above (the curve for Italy is similar), I think it was the BA.4/BA.5 variant.You can see the massive spike in cases for the first Omicron variant (BA.1) in January, then the smaller bump for BA.2. I was feeling pretty good about our trip to Europe since we left during the low in early June, but a month later, we can see the effect of BA.4/BA.5. I read that the BA.5 variant appears to have a R0 of > 18. That is higher than measles and puts it as the most infectious virus ever.

Here is the same chart for Los Angeles County. This is my main area of concern as I decide whether to return to the office or continue to work from home. The timing of each spike is different, but the original Omicron spike is evident. Looking at the slow increase of the past few months, is it due to BA.2 or BA.4/BA.5? I had fairly mild symptoms during the past two weeks, but if I get reinfected, will I have similar symptoms or maybe something a lot worse?

It seems that after two and a half years of COVID, we know much more about the virus but there is still a lot of questions.

Italy and France COVID Cases – Post-trip Review

The day before leaving for our Europe trip, I posted about COVID cases in Italy and France. At that time, it appeared that the case count in each country was trending downwards. I did not continue checking during our trip. After testing positive for COVID upon our return from Paris, I just updated the case data.

Coincidentally, the COVID case count started to increase just as we left for our trip on June 5th. I am unsure whether I would have changed anything if I had this data available, since I am unsure where I contracted the virus. Perhaps be more careful and wear a mask on the flights back from Paris?

For LA County, the case count was stable to slightly decreasing. It does seem that the US lags European trends by a few months so maybe the count will decrease then spike up again?

This is important because my work wants everyone to return to the office. I thought I had an exemption due to taking immunosuppressive medication, but HR said I now need a doctor’s note. This is after spending over a decade as part of company management.

Bebtelovimab

Today has been one of the worst health days since getting my kidney transplant. Why post-transplant? Because dialysis sucks so bad that anything is better than having to do dialysis.

I mentioned in a prior post that my sister’s family all tested positive for COVID yesterday. I initially tested negative, but the results came back positive on today’s retest.

Ugh. I then spent the entire morning calling all my doctors for instructions or to move upcoming appointments. My nephrologist recommended that I go to the ER and get a monoclonal antibodies infusion to help prevent worsening symptoms.

I drove to the ER at 11:20 am and was put in ER room #27 after an hour. I have been to St. Joseph hospital so often that it is like a second home. I then waited for another hour to see a doctor, then one more hour for the pharmacy to prepare the medication. Finally, a nurse came to insert an IV, and infuse the antibodies. The procedure took about a minute, but including the 60 post-infusion observation period, I was there for four hours. While waiting, I was on my work phone rescheduling several meetings scheduled for this afternoon.

The drug they administered was called bebtelovimab, which has to be the worst named medication ever. The nurse could not pronounce it. After leaving the ER, i went home and made some more work calls, then decided to take a nap. I had turned on the AC and a fan, and I was getting some chills under the cover. At some point, I fall asleep and the AC compressor stops working. This happens occasionally at our house. I then woke up with what felt like the worst fever ever. I tried to measure my temperature with my cheap Chinese made infrared thermometer and it gives me 98.4. Since that cannot be correct, i found a under-the-tongue thermometer and it said 99.9. Ugh again. I then go downstairs and continue to nap on the sofa, finally waking up at 9:00 pm. Having noticed the AC problem, I reset the brakers and everything is fine. I also noticed my fever is gone, and my worsening cough reverted to what it ws this morning.

What happened? Did I just have the shortest fever session? Was I delirious? Did the medication kick in even though it was supposed to take 24 hours¿ Right now it is 10:00 pm and I feel ok, whereas I felt like death at 7:30 pm. Super strange.

Back From Trip

I am back from my 16-day Europe trip. The trip went mostly well except for one “day from Hell” where we could not get a taxi or van to our Eiffel Tower tour, and we missed our Louvre tour since the tour agency changed the meeting place without notifying us. We also had to walk forty minutes back to our hotel at midnight after a night tour since all the taxis were full during that time.

The food in Italy was great, but we ate a lot of pasta and pizza. We did not eat any French food since our schedule was so packed, and most French restaurants near our hotel were expensive and had non-children-friendly menus. We did eat dinners at a Japanese and a Vietnamese restaurant; prices were like what we have here in Orange County.

We also walked a lot. Some of it was due to the many walking tours, but there was also walking in airports, train stations, and just in general since we did not have our cars. Here is the log from Apple Health app.

On WFH days, there is not much walking since I am in my house all day. Starting June 5th, you can see a significant increase in the daily number of steps. The 17,688 day was the night walking tour and having to walk from Notre Dame to the Louvre (hotel area) at night.

On the health side, I was mostly okay except for two medium intensity neuropathy attacks. We did spend $1,500 on travel insurance, but it was worth the peace of mind. My sister’s entire family tested positive for COVID this morning (day after trip), but I tested negative so far. I still need to test for a few more days, and self-quarantine due to close-contact or exposure to COVID infected persons.

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One other health related item. I packed the wrong medication before the trip, so I had way too much Rosuvastatin and no Metoprolol. Since i did bring Losartan, it was not a big deal to miss the medication for two weeks.

Italy and France COVID Cases 6/4/2022

Since the EU case rate map is a live link, it will show the same data as the previous post. If you look at the COVID data on Google/NYT, the number of cases in both countries continues to drop.

Italy

France

Like the previous charts I snipped for both countries, Italy’s case count is still decreasing while France is holding flat. Again, for comparison, here is the case count for Los Angeles County.

Since our work is asking people to return to the office, this trend is positive as well. I have a medical exemption to work from home, but I still feel more effective if I am onsite so I will likely go back in the office two or three times a week when I return from Europe.