5 Worst States for All-Cause Mortality

Differences between actual mortality and expected mortality range from a drop of about 36%, in Connecticut to an excess of 50%, in one state in the West. The median difference is an excess of 10.5%.

5 Worst States for All-Cause Mortality, Alreadyhttps://www.thinkadvisor.com/2021/12/02/5-worst-states-for-all-cause-mortality-already/

The slideshow for the five states didn’t work for me but the article also contains a data table for all 50 states.

I was surprised Oklahoma was not one of the five worst states.

Need Retirement Income? – (Life Underwriters Need Not Worry)

The total number of life insurance policies sold rose 8% in the first six months of the year and marked the highest such growth since 1983, LIMRA said. And there were other indicators in that same data that pointed to positive signs: Total U.S. life insurance premium increased 21% in the second quarter 2021, the largest year-over-year increase since third quarter 1987; in addition, it was up 18% for the first half of 2021 compared to the prior year.

Life Insurance Sales Are Up, But for How Long? — https://news.ambest.com/articlecontent.aspx?refnum=313837&altsrc=2

I know who you are and I know what you want. If you are looking for ransom, I can tell you I don’t have very much money. But what I do have are a very particular set of skills; skills I have acquired over a very long career. Skills that are currently in short supply. Skills that I can and will take to the highest bidder.

The Supreme Commander

I last posted about my upcoming retirement in More Retirement Income Ahead!

I need to start referring to my upcoming retirement as What Retirement?

More Retirement Income Ahead!

Total individual life insurance policy sales increased 11% in the first quarter, compared with first quarter 2020. This is the highest growth in the number of policies sold in a quarter since 1983. New annualized premium also experienced significant growth, up 15% from prior year, according to LIMRA’s First Quarter U.S. Individual Life Insurance Sales Survey.

LIMRA: First Quarter U.S. Life Insurance Policy Sales Highest Since 1983 — https://www.limra.com/en/newsroom/news-releases/2021/limra-first-quarter-u.s.-life-insurance-policy-sales-highest-since-1983/

I don’t know who you are. I don’t know what you want. If you are looking for ransom, I can tell you I don’t have money. But what I do have are a very particular set of skills; skills I have acquired over a very long career. Skills that make me a nightmare for people like you.

Bryan Mills, played by Liam Neeson in the film Taken

I had my annual wellness visit earlier this week.

5.10 168 130/84 BMI 24.14 O2 sat 98%

CHOLESTEROL 175 mg/dL
TRIGLYCERIDE 69 mg/dL
HDL 65 mg/dL
LDL CALCULATED 96 mg/dL
NON-HDL CHOLESTEROL 110 mg/dL

All of my other labs were normal too.

I have multiple relatives who have lived well into their 90’s. My maternal grandmother lived to 100. I’m going to need another source of retirement income. And for all of my friends and colleagues who never thought I would make it this far…

AST 23 U/L

ALT 7 U/L

GGT 36 U/L (12/2015)

PSA 0.7 (9/2020)

Ten Commandments of Emergency Medicine Revisited

#2 Remember naloxone, glucose, and thiamine (NGT)
Original: Consider or give naloxone, glucose and thiamine
The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.

In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.

Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.

Ten Commandments of Emergency Medicine Revisitedhttps://journalfeed.org/article-a-day/2021/ten-commandments-of-em-revisited

Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.

The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.

So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.

Metformin Should Not Be Used to Treat Prediabetes

Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110–125 vs. 100–109 mg/dL (6.1–6.9 vs. 5.6–6.0 mmol/L) and A1C levels 6.0–6.4% (42–46 mmol/mol) vs. <6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes—i.e., those with FPG concentrations of 110–125 mg/dL (6.1–6.9 mmol/L) or A1C levels of 6.0–6.4% (42–46 mmol/mol) or women with a history of gestational diabetes mellitus—should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.

Metformin Should Not Be Used to Treat Prediabetes — Diabetes Care 2020 Sep; 43(9): 1983-1987. https://doi.org/10.2337/dc19-2221

Anorexia Nervosa – More Dangerous Than You Think

This article is written by an Emergency Medicine doctor for other Emergency Medicine doctors as a quick primer on recognizing and diagnosing anorexia.  While those of us in the life insurance business are not diagnosticians  you will definitely benefit from this short ten minute article on the next case you encounter where Momma Bear is applying for $2,000,000 on her skinny 15 year old daughter who can’t seem to gain weight no matter how much the kid eats.

AN is a common, severe psychiatric illness. It is often present with co-morbid psychiatric illnesses. There is a high mortality rate, 5.6% per decade. It is notoriously difficult to treat with psychotherapy and pharmacotherapy.

Anorexia Nervosa – More Dangerous Than You Think

COVID-19 – Coronavirus Deep Dive

What were the demographics of the forty-one admitted 2019-nCoV patients included in this study?

  • Most were men (30/41 patients; 73%)

  • Median age = 49 years

  • 13/41 patients (32%) had underlying disease (e.g. diabetes, hypertension, cardiovascular disease, COPD, cancer)

What kind of symptoms did the forty-one admitted 2019-nCoV patients included in this study have?

  • Fever (40/41 patients; 98%)

  • Cough (31/41 patients; 76%)

  • Myalgia or Fatigue (18/41 patients; 44%)

  • These three symptoms were the major ones. There were patients who had sputum production, headache, hemoptysis, and diarrhea; however, these symptoms were less common.

  • Dyspnea occurred in 55% later in the course, with mean time to onset of dyspnea at 8 days.

Here’s a nice short summary of a recent study published in Lancet.  The balance of the source article can be found at emDOCs.net

And if you want to maintain your sanity regarding this emerging infectious disease threat avoid social media. 

Social media, for all its many ills and its few redeeming qualities, identifies idiots.

Can we turn serious for a minute? Are you on social media, talking to people that you don’t know about things that you know nothing about? If so, what are you doing? There’s a great big wonderful wide world out there. Why not trying exploring it? Talk to people. See things. Read stuff that is longer than 14 words.

Berry Tramel: Garth Brooks’ Barry Sanders jersey brings out the idiots, thinking he was endorsing Bernie Sanders

 

 

Craft breweries, adaptive reuse, and neighborhood revitalization in: Urban Development Issues Volume 57 Issue 1 (2018)

Source: Craft breweries, adaptive reuse, and neighborhood revitalization in: Urban Development Issues Volume 57 Issue 1 (2018)

The month isn’t over yet the events of the past few weeks already make this a memorable year. My contract with a large insurance company that shall not be named ended. I was with the client for nearly ten years. When I tell people I’ve contracted with a single client for ten years mouths drop open. In the gig economy this is about as rare as rare gets. Who contracts with a single client for ten years? Friday January 10th was my last day. Two days later I was in Lynchburg Virginia. Sometimes life moves quickly. When you get to the same stage and age in life as me you’ll come to appreciate the memories more and more with each passing year. But this trip was special and I want to capture and share these memories before they fade away. For me every day is another opportunity to learn something. Here’s what I learned from five days in Lynchburg.

“Don’t go around saying the world owes you a living. The world owes you nothing. It was here first.” Mark Twain

It’s Nice to Get Out of the House

I’ve been working from home since 2006. Seriously, I don’t get out much and when I do I try to practice my social skills. Working alone at home, or being face down in your smartphone (which makes you dumb), or severe anxiety where you need your benzos, all can erode what little you have left of social interaction skills. The Boss knows this all too well. The last business trip was over 2.5 years ago and placing me in a situation where I have to interact with others can be dicey.

“Be nice.”

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“Be professional. Don’t be yourself.”

“The hardest challenge is to be yourself in a world where everyone is trying to make you be somebody else.”

ee cummings

The Boss knows at the minimum I’ll try to behave. Hopefully I passed the audition.

Staying in a Nice Hotel and Eating Out is Pretty Awesome

I had an excellent stay at the Virginian. The hotel was a block away from my new client’s office and the room was stocked with bottled water from local springs and a Keurig coffee maker. I did what I always do when I arrive in a hotel room with a coffee maker. I check the coffee supply for correctness. As I suspected the K-cup selection was all wrong. I had four servings of DECAF. I immediately went down to the front desk with the K-cups in hand.

“Mr. Lee, is there a problem?”

I handed the coffee to the front desk employee and stated in a low firm voice,

“This is so wrong.”

The very nice young woman at the front desk agreed and allowed me to exchange my four K-cups of DECAF to the real caffeinated kind. I also left a note next to the brewer for housekeeping to restock with only real coffee NO DECAF. The rest of my stay went quite well. The room was comfortable, quiet, and I had plenty of coffee.

Eating Restaurant Food Causes Obesity

I arrived in Lynchburg late on a Sunday evening and the only food available at the hotel was at the rooftop bar. There was local craft beer on tap. I ate there three times during my stay. When you work from home you eat a lot of leftovers. Some days you eat leftover leftovers. By the time Saturday rolls around you simply have to go out to eat. Taking all of my meals outside of the house this week was awesome despite needing to loosen my belt a notch by Wednesday. The team treated me to dinner at The Depot Grille, a renovated old train stop that had nice local craft beer on tap. Before I left town I was introduced to The Water Dog which was more of a Millennial type establishment that had even more nice local beers on tap. After seeing the (beer) menus I thought to myself I could live here.

Despite the proximity of some fine eateries I took most of my meals at the company cafeteria. This company amenity should never be taken for granted. I had plenty of good food, freshly prepared at reasonable prices. When you’re on business expense this is kind of important to avoid any potential criticism of your spending habits when someone else is paying. So the accountants will be happy I found Benny’s.

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I had forgotten how easy it is for me to put the weight back on. Over the years I’ve moved away from the standard American diet (SAD) because it was my diet that was the proximate cause for ballooning up to 370 pounds. It might have been more but I stopped weighing myself at 370 (for obvious reasons). For this trip I relaxed my dietary preferences and ate whatever I wanted to. I haven’t weighed myself since the trip ended but my belt fits again at its usual belt hole. I’m easing back into my usual dietary routine. And I have no regrets about passing on the fried tofu sandwich at The Depot Grille. I didn’t want anyone to think I was a vegan.

“Look for the human connection as you make your journey. Connect us to the people who connected with you.” William Zinsser

There are Really Nice People in Lynchburg

During my week in Lynchburg I met some very nice people. The people you work with are just as important to your happiness as the work itself. I ate lunch at the underwriter table in the company cafeteria all week. I figured I needed as many contacts as possible once I started work in the system and needed guidance. I may work by myself from home but no one ever works alone.

It’s just a job. Grass grows, birds fly, waves pound the sand. I beat people up.

Muhammad Ali

The Boss has told me change is good and my new adventure will be good.  I know she’s right.  And I am thrilled with the opportunity.

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Spike in Death Rates in Young Adults Minnesota

Screenshot_2019-12-05 What’s behind the spike in death rates among young adults in Minnesota MinnPost

That hasn’t escaped the notice of Dan Dahl, of Dahl Funeral Home in East Grand Forks and the former president of the Minnesota Funeral Directors Association.

“The older I get, the younger everyone else gets. I’m 59, and it used to be when I was 35, 35-year-olds didn’t die, it seemed like. It kind of sticks out now the older you get,” he said. “We’re not supposed to be burying our kids, our kids are supposed to be burying us.”

Read the source article at this link.