Hike Report: Romero Canyon Trail to Romero Pools (near Tucson, Arizona)

One of a string of pools

This was a 4.5 mile round-trip on the Romero Canyon Trail to see the Romero Pools, which are about 2.2 miles from the trailhead. I was fortunate to have my daughter with me. Her house is a 30-minute drive from the trailhead. Elevation gain, if memory serves, was 800 or 900 feet.

This is rugged and wild land. I’m sure there are bears and mountain lions here.

There were not many people on the trail when we did this on May 14. At the pools per se were 10-14 folks, including a couple topless women.

My hiking buddy

This trail is difficult due to the rocky footing and steepness. It was a good workout. We never came close to losing the trail, and we never had to scramble over large boulders.

View from first part of the trail

Trail-side flower

My beautiful daughter

I saw about five pools clustered together but there are probably more

Uh Oh: My Knee Hurts

I’ve developed over the last month some bothersome pain in my right knee. It’s not interfered much with my actual hiking, but I pay for it over the subsequent day or two. I’m starting to think this may put the kibosh on my Humphries Peak trek next month.

The pain is mostly anterior (front part of the knee) and is most noticeable after I’ve been sitting for a while with the bent knee, then get up to walk. The pain improves greatly after walking for a minute or less. It also hurts bit when I step up on something using my right leg. If I sit with my knee straight (in full extension), it doesn’t hurt when I get up. The joint is neither unusually warm nor swollen. Ibuprofen doesn’t seem to help it. These pain characteristics seem classic for something, but I don’t know what, yet. Possibilities include degenerative joint disease, chondromalacia patellae, patellar tendonitis, or an internal derangement such as a torn cartilage or meniscus. My twice weekly hikes always include a fair amount of elevation gain. I suspect an over-use syndrome, basically a training error. I plan to take an entire week off from hiking and Bulgarian Split Squats, and taking ibuprofen 600 mg three times a day.

Steve Parker, M.D.

How To Stop Chronic Daily Narcotic Use

Not your typical street-level drug pusher, but a great source of oxycodone

The mainstream news outlets in the U.S. tell us we are in the midst of a narcotic use epidemic. People are dropping like flies from overdose.

Narcotics are also called opioids. I’m talking about oxycodone, hydrocodone, hydromorphone (Dilaudid), morphine, fentanyl, heroin, etc. Not Xanax, Ativan, or Valium.

On average, it takes three weeks of daily narcotic use to get physically dependent on it. This means that when you stop the drug completely and suddenly, your body may crave it and you could have withdrawal symptoms. The severity of withdrawal symptoms varies from person to person. Possible symptoms include anxiety, sweating, nausea, vomiting, diarrhea, hyperactivity, restless legs, weakness, easy fatigue, shaking, suicidal thoughts, insomnia, and muscle pain or cramps.

Good and bad news, bad news first: Narcotic withdrawal can be very uncomfortable but rarely causes medically serious complications. The serious complications are usually in folks with pre-existing heart disease, high blood pressure, low blood pressure, or heart rhythm disturbances.

Here’s how you stop your chronic daily narcotic habit without suffering a withdrawal syndrome (if needed, see the postscript for an example):

  1. Total up your current total daily dose in milligrams
  2. Determine 10% of the amount by dividing the milligrams by 10
  3. Reduce your daily milligram intake by that 10% every week
  4. Nine weeks later you’ll be off narcotics

Congratulations! You’ve done your part to solve America’s opioid use epidemic. You’ve reduced your drug bill, avoided Opiate Use Disorder, and reduced your risk of narcotic overdose death by 100%. And you did it without political meddling or an expensive stay at a detox center.

Be aware that as you taper off your narcotic, you may have a flare of an underlying psychiatric condition such as depression, anxiety, PTSD, bipolar disorder, panic attacks, or psychosis. If so, see a mental health professional posthaste.

Good luck, America!

Steve Parker, M.D.

PS: Take Percocet 10/325 for example. It’s 10 mg of oxycodone and 325 mg of acetaminophen. Say you’re taking Percocet 10/325, four pills at at time, four times a day. That’s a total daily oxydocodone dose of 160 mg (16 pills x 10 mg). 160 mg divided by 10 = 16 mg. We have to round off 16 mg to 15 mg due to the availability of various strengths of Percocet. So starting today, you reduce your daily oxycontin dose by 15 g, which is one-and-a-half pills. After one week, you reduce your daily pill count by another one-and-a-half pills. Etc.

PPS: Let you’re doctor know what you’re doing beforehand. He’ll be overjoyed and ensure it’s safe for you to do this taper.

Mark Rippetoe and Matt Reynolds Talk About Whiskey

As I watched this, I couldn’t help thinking about “wine snobs.” Are these guys whiskey snobs?

Rippetoe is a famous strength trainer. The other gentleman, I don’t know.

They’ve convinced me to try Eagle Rare 10 year old bourbon, Buffalo Trace bourbon, Old Grand Dad 114, and Rittenhouse Bottle and Bond (?) Rye.

I didn’t know it but apparently whiskey has become a thing.

Jamesons Irish Whiskey.
Photo copyright: Steve Parker Parker

Hike Report: The Lookout in McDowell Sonoran Preserve

 

Looking south from The Lookout, you see Thompson Peak in the center. The highest point in the McDowell range is McDowell Peak on the right, about 10 feet higher than Thompson Peak.

This hike is essentially the same as to Tom’s Thumb trail, but instead of taking the short spur going north to the Thumb, you go a tenth of a mile further and take the half mile spur to The Lookout. This last half mile is easy, and rewarded by  excellent view to the south and east.

A prickly pear cactus blossom

My original goal had been to continue walking past this spur, to the west, until I reached a bizarre mountain spring. Bizarre because you’d never expect it in this desert. But after a quarter or half mile, it was getting hot and no one else was on the narrow trail, which was steep and quite rocky. I didn’t know exactly how far it was to the spring. I could see myself getting injured or over-heated, and decided it just wasn’t worth it. I think I’d rather die than call in a rescue party. So I turned around and headed back to The Lookout spur.

Banana yucca

Total distance for this trip was about 6 miles and it took three hours. Loaded with a 10-lb dumbbell and plenty of water, my backpack weighed about 20 lb.

From The Lookout: Phoenix and Scottdale in the distance

I’m impressed with how many young women I see on this trail, either alone or in small groups. I’m glad they feel safe doing it.

Eastern view from The Lookout: Four Peaks on the horizon

I was delighted to see three people on horseback on the trail, too.

Way in the distance is the Fountain Hills, AZ, fountain. It explodes up 300 feet every hour on the hour for 10 minutes.

Did you know that exercise isn’t an effective way to lose fat weight? 90% of weight loss comes from altering your diet. Try one of my diets, like the Advanced Mediterranean Diet.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Thoughts on the Denninger Healthcare Reform Plan

The only way to improve U.S. healthcare while bringing costs down is to introduce serious competition for healthcare dollars.

This post is for U.S. citizens since the federales are going to tinker with our health insurance reform very soon. This would be a great opportunity to make helpful changes  to the system. I have no faith they will do it.

Healthcare in the U.S. consumes one of every five dollars spent in the economy. We are not getting our money’s worth, at least judging from average lifespan.

Karl Dennnger has put a lot of thought into the problem over the last decade, and has a concrete legislative proposal that makes a lot of sense. I endorse it. As you consider the possibilities, you need to keep in mind that the cost of healthcare will drop drastically. Not just by 50%. More like 80% or more. Healthcare will be so cheap you won’t even need insurance to pay for most of it.

How are these price reductions possible? Because the Dennniger plan introduces competition and moves us closer to a free market situation without third-party interference from insurers and government.

Here are the major points:

  • All healthcare providers must publicly post (e.g., on the web) prices which apply to everyone. E.g., not  a price depending on which insurance you have, whether you are paying cash up front, etc.
  • All customers must be billed for actual charges at the same posted prices at the time services or product is rendered. This removes the third party (insurer or government). You file the claim and every one pays the same price. In a way, medical care isn’t too expensive; too often it’s “free,” because someone else is paying. So there’s no comparison shopping. You see posted prices and you pay them yourself when you buy gasoline, groceries, cell phones, computers, TVs, cars, and houses. A valid and collectible bill must be consented to in writing before the service or product is provided. Actual price, no open-ended add-ons.
  • No event caused by or a consequence of treatment can be billed to the customer. (I’m not sure I like this. What about unforeseeable complications like C diff infection after antibiotics, or anaphylactic reactions to drugs? Providers could eventually get insurance to cover those costs, but it would be a brand new insurance market.)
  • True emergency patients who are unable to consent must receive the same price for same service as a person who consents to said service.
  • All medical records belong to the patient and shall be delivered to the patient (customer) at the time of service.
  • Auxiliary services (e.g., x-rays, lab work) may not be required to be purchased at the point of use. Example: an orthopedist wants you to get a knee MRI scan on his machine. You can shop around other places for a cheaper or better-quality MRI scan.
  • All anti-trust and consumer protection laws shall be enforced against all medically-related firms, and any claimed exemptions are hereby deemed void. Stiff penalties and fines for violations. Private lawyers must have access to sue.
  • You are free to purchase any medical test you want if no radiation or drug is required to perform the test. (You can already do this in Arizona, but in many states you need a “doctors order” for the test.)
  • There will be no government payments for care or products when a lifestyle change will provide a substantially equivalent or better benefit, when the customer refuses to implement the lifestyle change. (This point needs some fine-tuning. Who decides when and which lifestyle change would provide an equivalent benefit?])
  • Health insurance companies must sell true insurance, to sell any health-related policy at all. No insurance coverage for an event or condition of which you received treatment over the last 24 months.  If an adverse event occurs, insurance pays for all of it. E.g,, if you get an expensive cancer, the insurance company cannot drop you. The insurance must cover, with a selection of available deductibles, all accidental injuries and true life-threatening emergencies. Medical underwriting is permitted (e.g., insurers can charge higher premiums for smokers, couch potatoes, obese folks, etc. I have long thought that people in the top 25% of fitness, determined by a treadmill exercise test, should get a discount on insurance premiums).
  • All health insurers providers selling true insurance, in whole or in part, must provide within their “true insurance” the ability to replace like with like.” (I don’t know what Karl means by this.)
  • Medicare becomes just another insurance provider. No more Part B (outpatient services).
  • Medicaid is repealed entirely.
  • What about U.S. citizens and “lawful permanent residents” who can’t pay for care but still need attention? For true emergencies, the hospital or Emergency Department bills the U.S. Treasury, who pays within 30 days. For non-emergencies, the provider bills the U.S. Treasury and will be paid within 30 days except no billing for government payment if the condition resulted from a lifestyle decision the patient made. After the Treasury Department pays the provider, Treasury will send an invoice to the customer (patient or taxpayer), which may be settled within 90 days at no penalty. If charges are not paid, they become a tax lien subject to collection from refundable tax credits, tax refunds, other entitlement checks (except Social Security retirement), and windfall amounts (either money or property).
  • Repeal all aspects of Obamacare/PPACA.

You need a break after all that. Almost done. Hang in there!

I don’t recall Karl recommending a specific deductible amount, but often saw mention of $2,000 as a deductible. “Deductible” is what you pay out of pocket before insurance pays anything. I like a high deductible over “first-dollar” coverage, because the high deductible automatically creates 200 million shoppers who are going to check prices for sure before buying healthcare. (Of 320 million people in the U.S., I’m guessing 200 million are adults.)

Karl favors “catastrophic” policies, as do I. Your car needs new tires every few years, oil changes much more often, and periodic repairs, but you don’t expect car insurance to pay for those non-catastrophic costs.

Who would get hurt by this plan? Lobbyists, insurance and healthcare administrators, drug reps, pharmacy benefits managers, and those who refuse to make healthy lifestyle changes.

I don’t recall Karl addressing unreasonable insurance mandates, managed care plans (like Kaiser Permanente in CA), accountable care organizations, liability reform (we need the English Rule), tax parity (businesses buying insurance for employees get a tax break, but private individuals buying their own policies don’t), or much about enforcement. But he may have; Karl’s a very smart guy.

Steve Parker, M.D.

 

Hike Report: Sunrise Trail In Scottsdale, Arizona

…with a side trip to Andrews-Kinsey trail.

This is what 50% of the trail looked like from the trailhead to the peak. Is there a rattler in the shade of that rock?

As you might remember, I’m training to summit Humphreys Peak in June. So I’ve been hiking twice weekly, mostly on Pinnacle Peak Trail and Tom’s Thumb Trail. My longest trek thus far has been seven miles. I plan to walk some longer distances and/or carry more weigh in my backpack in the coming weeks. Lately I’ve added a 10-lb dumbbell to my pack.

Yes, this is the trail. From the trailhead to the peak, 10% of it looked like this. You need good footwear for this.

Yesterday I started at the Sunrise Trailhead, made it to Sunrise Peak in about an hour, then walked over to the Andrews-Kinsey trail and followed for about a mile before turning around and heading back to the car. Total trip was about six miles over three hours. I carried the 10-lb dumbbell in my backpack, plus water.

3/4 of the way to the peak, looking down at the trailhead near houses.

Sunrise Trailhead to the peak is a difficult trail by most standards. Steep, rocky, unrelenting. You gain about 1,1000 feet of elevation. My pace was only 1.8 miles per hour. Approaches from Ringtail Trailhead and 136th Street Trailhead are quite likely less steep, but more miles to the peak.

A view of Scottsdale from Sunrise Peak

The Andrews-Kinsey trail was relatively flat, mostly gravel, and had good views. Didn’t see another soul on it.

From the pictures, you can tell there’s not much shade on this hike. What you cannot see is that the mountains themselves will provide shade for this entire trip if hiked in the late afternoon.

Looking north from Sunrise Peak. These are the McDowell Mountains. Note the trails.

I saw a snake on this trip, just got a brief glimpse of it a foot and a half from me and he was truckin’. It was about 1.5 inches thick, and I’m guessing four feet long. Didn’t look like a rattlesnake. Maybe a bull snake.

I was on the trail at 0740 hrs and was glad to be done three hours later when the temperature was in the upper 80s Farenheit.

I last did this trail in 2013. I didn’t put it in that trip report, but I remember it being particularly grueling, having started at Ringtail trailhead and going to Sunrise trailhead then back to our starting point, a total of 10 miles and 2,000+ vertical feet of elevation.

Let’s Call it KarlCare

Karl Denninger has fleshed out his U.S. healthcare system reform recommendations in a form ready for legislation.

I’ve only read it once and admit I don’t fully understand it. But I can tell already that it would be a major improvement over our current system.

Steve Parker, M.D.