That Kleenex in the Wash

October 17th, 2018 by Potato

I’m a big advocate of keeping your portfolio simple and easy to manage. As I was doing laundry and found, yet again, that I’d left a Kleenex in the pocket of a pair of pants and had to pick out little bits of fluff, it got me thinking of this.

It’s so easy to over-estimate our ability to handle a little more complexity, to think that even when you’re busy it’s not big deal. Then you find that Kleenex in the wash. Again. This isn’t even an unforseeable or unavoidable error. It’s happened before, and yet it’ll probably happen again. Probably before the year is out, even.

It’s another reminder to me that we have to arrange things in a way that accounts for the fact that we all have periods of inattention or sleep deprivation, and even at the best of times human error happens. If the plan is to ignore things for a year or to at a time, there’s less room for execution risk.

A simple portfolio is more robust to negligence and human error.

Never Weight — Q3-18 update

October 1st, 2018 by Potato

On August 29th my pants fell down while walking around the living room. So yeah, I’m feeling pretty good about my weight loss this quarter.

After the last update, a few things came together and I finally just did the thing I knew I had to be doing all along (but didn’t because it was hard): I started tracking everything I ate. I used measuring cups and a scale, and put it all into the FitBit app’s calorie tracker function (I had several recommendations for myfitnesspal, but I already had FitBit there to track my steps, and it worked well enough). I started eating a lot more fruit (helped by the fact that Ontario peaches and nectarines were in season so I just bought cases of those) and veggie sandwiches, and tracking, and paying attention especially near the end of the day as I was running out of calories in my budget. I bought just an absolute fuck-tonne of chewing gum, and had light breakfasts and lunches when I wanted to leave the ability to have pizza for dinner. And even on vacation, and even with all-nighters as a grant deadline came up, I stuck to my budget (though on vacation I was aiming for calorie balance for the week rather than a deficit, and with the all-nighters I chewed so much gum the artificial sweetners caused… umm… intestinal distress).

The final score: DOWN 19 lbs BABY. WOO!

I posted 7 days in about how hard it was to fight the cravings, but I stuck it, and it got better. I only have bad cravings every few days (and mostly after about 12:30am), so it’s become routine enough that it doesn’t take a tonne of conscious willpower any more. My habit is to check FitBit — can I eat that? Computer says no. Also, it wasn’t like full intermittent fasting, but I did delay or skip breakfast most days and put a limit on eating after midnight (pretending, as one does, that I was a mogwai), which also helped.

It’s still a total mystery though why I managed to actually do it this time. Yes, I had some extra motivation (a bad score on my cholesterol test, my dad going into the hospital, another quarter where the same-old wasn’t really cutting it), but I don’t think I was all that lacking in motivation before. I did have a bit of a mind-shift internally where I realized how much of my eating was not due to physical hunger, but I really can’t put my finger on how I managed to flip the switch to knowing that chocolate is not an emotion. That’s a bit disappointing because it makes it harder to help other people find that last bit of motivation or mindset or whatever, and also worrisome because I don’t know how easy it will be to stick to better habits for the long run (or re-start the diet after the inevitable future slip-up).

Of course, even this is a relatively minor achievement in the grand scheme of things. I hit my goal for the year, but the loss is still a fairly small change, percentage-wise — few people would notice if I didn’t tell them, and I’m a long way from being described much more charitably than having a “dad bod”. My BMI is still not great, and I have to continue being good for a lifetime to keep it off. And the “never weight” was something I set back in grad school as like a “ok, it would be ridiculous if I got that fat” level. So even losing ~20 lbs from that point still just puts me at about where I was in grad school — and no one was mistaking me for skinny then.

Looking ahead, the final quarter of the year features Thanksgiving, my birthday, Halloween, and Potatomas. I’m going to keep tracking, and the itty bitty candy bars may be a good way to have some treats but not bust the budget — I’ll have to see if I can be trusted, or if total abstinence is the only way to go. Either way, I’m going to take the season into account and adjust my budget & target to be a minor deficit (and I won’t freak if it averages break-even some weeks). I’m less than two pounds off my original goal for the whole year, but if I can make it through to New Year’s holding steady at this weight, I’ll call that a win for the year. My next plan is to get down to the “overweight” range according to my BMI by June next year, which means losing another 15 pounds, more gradually. And then keeping it off for a lifetime.

Anyway, goal reached, so start the countdown: the price of the course is going back up!

One thing that I was amazed with when losing weight is how fast some of my other health issues settled down. FitBit tracks my resting heart rate, and that’s come down almost 10 bpm in just three months. I also used to have heartburn a few times a week, and last month only had it twice (though that is likely less losing weight and more the fact that I’m not eating a bunch of chocolate, chips, and other heartburn-inducing foods right before bed). If I go to a life expectancy calculator, I’ve lost enough weight this year to add a year back to my life (whoops, gotta adjust the savings plan now ;)

Footnote:
I noticed that I started calling it a calorie “budget” and not a “diet” or “allocation”, and that tracking let me immediately see my “funds” left each day. I’m explicitly trying to leverage my ability to be good with money to be good with food, but I needed an easy-to-use electronic tracker to get there. Also, I’m eating a lot of convenience-esque food: almonds that are packaged in small servings, so I know I get 170 cal/serving and don’t have to weigh them, etc. It’s more than double the cost for almonds vs. just buying the big jug, but I think it’s a non-negligible component to success so I’m more than happy to pay for it.

Lemonade Lessons

September 17th, 2018 by Potato

All summer Blueberry has wanted to set up a lemonade stand. We finally got one set up this weekend.

Lots of lessons in setting up a stand. We didn’t get into the cost of goods sold or turning a profit — all the supplies were donated by us. A big one was about expectations: we did go through two pitchers of fresh-squeezed lemonade (~8 lemons), but did not have to worry about a queueing system for the mob. Lots of down time to contemplate being patient, and that our quiet suburban street only had so many potential customers to reach. However, almost everyone tipped her well above the 25 cents she was charging per cup, so she still walked away with a decent amount of money for her efforts.

Totally of her own volition, she choose to donate half the revenue to Answering TTP (which I matched to hit the minimum donation amount).

There were lessons for me, too: it was funny to see people making solid marketing suggestions, like putting colourful signs up around the neighbourhood to direct people to our sleepy street, and to watch as she just didn’t want to do that. And I could so see myself in that, and I don’t think I would have seen that as clearly if I didn’t see it mirrored in her. “Click-baity subject lines work, you’ll get more people opening your emails that way.” “No, I’ll only use descriptive, boring subjects!

So I’m going to have to work on my marketing skills…

Anyway, I suspect this is not the last we have heard from our little entrepreneur.

How to Discuss Uncertainty: Cancer Edition

September 9th, 2018 by Potato

My dad has read Atul Gawande’s Being Mortal, which discusses the suffering that people can experience near the end of their lives — particularly the suffering of medical treatments to extend those lives. There was no question about having surgery to remove his tumour — the cost-benefit there was huge (esp. as it had sent him to emerg). But he explicitly did not want to go through adjuvant chemotherapy, because chemo sucks and he knows that first hand, and he didn’t think it would have much in the way of benefits.

Then we met with the oncologist and found out that the regimen he’d have now would be much less severe than the kind of chemo he had a decade ago, and that the benefits were very real.

But exactly how to convey those benefits is a tricky matter. She told us, roughly speaking, that 50% of people with his kind of cancer would still be alive and cancer-free 5 years out — the surgery alone totally cured them, and taking chemo would be a pain in the rear but not actually help them because they were cured already. 20% of people would have had their disease come back, but not with chemo, while 30% would see their disease come back regardless of chemo. So, a 20 percentage point increase in chances, chemo sounded pretty good.

But it’s hard to frame that in a way that sticks. After hitting the first wall in chemo side effects, “20%” didn’t sound that great any more. So my dad wanted me to explain it to him plainly: he was giving up 6 months of his life (or at least quality of life) to chemo. What was he giving it up for? “How much longer will I live?” And I get it: he wants the benefit expressed in the same units as the cost, which would make decision-making so much easier. But the cancer stats just don’t seem to be expressed that way.

And it’s complicated: it’s not as simple as giving up 6 months, as there are probabilities and uncertainties there, like permanent adverse events, versus the probability of having a recurrence and dying (or having a much harsher round of treatment), or the probability of being cured of cancer for the rest of his life but then having a heart attack or stroke. Even if he was cancer free in 5 or 10 or 15 years, how much longer would he live otherwise? And giving up a year at 69 when he could go golf or enjoy the cottage is perhaps not worth gaining a year at 79 where he might not be having as much fun. These are all hard things to say.

Later, I found a chart that looked basically like this that helped show the survival benefit:

A rough sketch of a survival curve for colorectal cancer patients with and without surgery, where the benefit of adjuvant chemotherapy is about a 20% increase in 5-year disease-free survival.

But even that is lacking, as when choosing whether or not to take chemo the percentage point increase may not be as important as the percentage increase. That is, if you’ve already got a 50% chance of survival, bumping that up to 70% is a 40% improvement in your situation — taking the chemo is better than the “20 percent” figure makes it sound.

So I made a pictograph, which I think may be a better framing for showing the benefit of chemo. The MSKCC nomogram has a similar display.

An infographic with happy faces to visualize the relative survival benefit of adjuvant chemotherapy vs surgery alone.

None of this really helps answer the question in the way my dad wants, with the benefit in the same units as the cost. I started to go down the road of maybe integrating under those survival curves, to try to quantify what the expected increase in lifespan was. I even went into some of the quality-adjusted life years research and found a set of results that I could use as a weighting function — after all, an extra month of good health at 69 is not quite the same as an extra month at 79 or 89. But I stopped because that’s guaranteed to be an exercise in false precision, and I’m not sure giving him what he wants there is the best way (and I’m also doubting myself because no one that I’ve seen in health science presents results in this way to patients — at most such things are used in health economics to talk about big picture costs and programs).

Decisions in Bad Times

September 8th, 2018 by Potato

Following my dad’s surgery for the big C, the standard of care is to give 12 cycles of chemotherapy to kill any cancerous cells that may be out there and help prevent the cancer from spreading or coming back. He had chemo just over a decade ago, and it is not a fun time, so he was a bit apprehensive at the notion before meeting the medical oncologist. But the oncologist laid out the plan and the stats and he said that it made sense and agreed to do it.

About a week after his first cycle the worst of the effects were hitting him hard, and he was done. No more chemo, no thank you. Making life miserable now for a chance at some extra years when you’re like, 80, is a bad deal and why would he have ever agreed to do it?

I went over the next day, made some soup, he started to feel better, and we went through some literature together. He agreed that a declaration that chemo was over may have been hasty, and went back for his second cycle yesterday.

That chemo causes nausea surprises no one. This was a known trade-off going in, but once he was actually experiencing these highly unpleasant side effects he was ready to quit.

You don’t want to be rewriting your plan while your head is in the toilet. On top of just feeling awful, there may be some chemo brain that makes it extra hard to make a good long-term decision.

But even beyond chemo, that’s a generalizable lesson. We’ve seen it often enough in investing: the midst of a market crash is not the time to re-evaluate your risk tolerance — you were aware that there were risks to investing and accepted those risks when deciding on your asset allocation in the first place.

The story also underscores the need to write things down. And not just the result of the plan: we didn’t need to write down that he’d be going to chemo every other week for 12 weeks, we needed to write down how he came to that decision. That there would be nausea, and that it would be temporary, and it would be worth it because the survival stats said so. Because it’s while he’s feeling that moment of doubt and urge to quit that he needs to be reminded of why he’s putting himself through this.