Saturday, April 9, 2016

Take a deep breath

As a insulin-dependent diabetic (Type 2), a primary challenge has always been to figure out the right amount of Insulin to take, and deal with the fact that injected insulin, despite being referred to as “rapid”, has a 4-hour absorption curve. That means that if I had a meal but didn’t take enough insulin, I’d be stuck with the elevated blood-glucose level for another 4 hours. As this happens to me fairly often, this is quite detrimental to my health, long-term.

A few months ago, an amazing company by the name of Mannkind released the perfect solution – Affreza…inhalable insulin with a super-rapid acting time of less than an hour. Finally, I can take an insulin correction and have it take effect within minutes rather than hours. In addition, this gets rid of the need to tear holes into my flesh (not to mention worrying about sterility, disposing of used needles, and finding a place to perform the injections while out of the house without freaking people out).

So, if you’re a diabetic and never heard of Afrezza, go ask your endocrinologist about it…it WILL change your life! However, when I first tried Afrezza, I ran into an unpleasant and detrimental side effect…coughing. Afrezza comes as a powder that you inhale deeply, and my body’s defenses against foreign bodies flared up, causing me a severe cough that led to the Afrezza powder being coughed-out before it had the chance to do its work. Today I want to share not only the news about Afrezza, but also my way of handling the challenge.

After speaking with Mannkind and other Afrezza users, I learned that a cough is not uncommon, and most people get used to the powder and stop coughing within a few weeks of continued use…so if you’re coughing, don’t give up on it…fight though it and you should get used to it pretty fast. If not, however (like me), I did figure out two tricks.

The 1st trick is that drinking some liquid after inhaling seems to suppress the cough. This can be water, juice or anything you like drinking. The only trick is to be able to hold the cough for a few seconds until you can get a sip in. Using this method, I was able to avoid coughing 90% of the time.

A few weeks later, though, I found an even more effective way. As it turns out, my cough-defense can actually be fooled into “thinking” I’m OK by simply coughing AHEAD of taking the medicine. By intentionally coughing once or twice before inhaling the Afrezza I was able to get myself to be “coughed out” enough so that when I did inhale the drug, I wouldn’t cough at all! I’ve been using the 2nd work-around for months now, with great satisfaction. Now Afrezza works for me 100% of the time, and as a result, I’m very close to 100% balanced, with a super low HBA1C values (probably even better than most pump users).

Hope you find Afrezza to be useful, and the above tips useful as well!

Sunday, March 27, 2016

Washington democratic Caucusing 101

This entry is a little late for the 2016 elections, but having gone through it recently, I feel this info might be useful next time around and worthy of noting down for future voters.

Why caucus? Well, if you have to ask that, you might have come to the wrong place, but generally, the answer is that it’s a way to be much more influential in the election process. In the general elections, a person’s vote is one out of hundreds of millions, but in a caucus, it’s relative strength is much stronger and therefore, a better use of one’s time.

If you are outside Washington State, keep in mind that the process is somewhat different in different states, so the info below may not be accurate for your region. Same goes if you’re a republican, as the Republican Party has a different process.

The Democratic Party splits the country into several levels, starting with the top (national), through the State, congressional district, county, legislative district and finally, precincts. At the precinct level, anyone can attend, and if they are of legal voting age (or will be at the actual elections), they can vote as well. It is recommended to pre-register on the Washington democratic website (, but not required – you can also do this at the event itself, but you should at least use the site to figure out where your precinct’s caucuses are held (typically somewhere in your neighborhood, like a school or other public venue).

Caucuses are typically held on Saturday, usually starting at 10am. Depending on how busy and active your town is, crowding might be a challenge, so I recommend arriving 30-60 minutes ahead, especially if you’re arriving by car and need parking.

Once you arrive, you will have the chance to register and sign-up if you haven’t done so online yet. This includes either signing up to be a voter generally, or signing up to the caucus itself (or both, of course), so if you’re legally allowed to vote but haven’t registered yet, this is a good place to do it.

The caucus, also referred to as a “convention”, things will typically start with a 30 minute introduction, where a local volunteer will read out the precinct names and provide some other high-level info, and then ask the people present to move-off to their precinct tables. This varies by location, but precincts are typically around 50 people each, so the location would typically have many tables setup, sometimes all in one big room, and sometimes in several rooms. Rarely any place has actual tables that can seat 50 people, so some people will have to stand up (if you can’t due to personal limitations, I’m fairly sure someone at the table will give you his or her seat…we are all friends at the caucus!).

Each precinct must have a chair-person, which requires some training, so it typically will be someone from the organization assigned to your precinct. The chair-person can be anyone, really, so don’t expect anyone too formal – it could easily be your neighbor’s 17 year old son or his grandmother. There’s no dress code to the entire thing either, so most people just show up in their daily jeans and t-shirt, including the chair-person.

The chair-person will have an envelope with forms and a “script” to go through the process, and will start by collecting the registration forms. These are supposed to have your full details, as well as the name of the candidate you support, and whether you are willing to be a higher-level delegate for your precinct. In the 2016 caucus, the online forms many people used actually told us NOT to fill this section, which was a mistake that led to some contention. If this happens again later, make sure you DO fill out those details.

What does being a higher-level delegate entail? This is typically a second caucus, a few weeks later, with selected few delegates from each precinct representing and voting for their candidate at the legislative-district convention. What starts out as millions of voters at the precinct level slowly thins out to be less and less people at the higher levels, until reaching the national level, which is about 5000 delegates total. If you continue to step-up and get elected, you might end up going to the nationals (typically somewhere on the east coast) and that’s pretty much the epitome of being involved in the process.

The chair-person will collect the forms, and ask for someone to volunteer to be a secretary and take notes of the caucus, as well as a tally-person who will help count forms and numbers for everything. Once the forms are collected, the tally-person will count how many votes each candidate has, as well as how many people volunteered to be delegates to the next level. Often times, there are at least a few people who are yet undecided (“uncommitted”), and the chairperson would then offer the people at the table an option to say something generally or specifically to the undecided. This is the real meaning and purpose of the caucus, and while time is usually limited, there should be at least 20-30 minutes available to discuss and deliberate.

Different precincts have different numbers of delegates, and for each delegate, there must be an alternate (in case the delegate can’t make it for any reason). Depending on the vote count, the number of delegates for each candidate varies. For example, if your precinct has 50 voters, and assigned 6 delegates, then if one candidate has 33 votes and the other has 17, the 1st candidate will have 4 delegates and the other 2. The Chair person’s packet includes information on how to calculate the number of candidates, of course.

If the number of delegate volunteers isn’t sufficient to cover the required number of delegates and alternates, the chairperson will ask the table for more volunteers, though it’s often the other way around – there are more volunteers than needed delegates. In such a case, the chairperson would ask the table participants to vote on the candidates. If you feel your precinct might be in such a situation, and you really want to be a delegate, the common practice is to talk to your own neighbors (who are in your precinct) ahead of time to find those who support you and/or your position, and might show up to vote for you to be delegate.

Once all the delegates and alternates have been selected, the chairperson would hand out certificates to each, noting their precinct, name and role (primary or alternate), and the caucus should be concluded. Later on, as the democratic org website is updated, more information would be provided about the next level, and it’s up to each delegate to find out where and when that is, and show up to continue the process.

At my caucus this week, I was selected as delegate, and I will blog about that experience afterward as well, on April 17th or a little later.

Wednesday, February 10, 2016

Land of opportunity

Land of opportunity
As an immigrant who has integrated well into 21st century America, many friends ask me about living here, usually as part of their own quest or aspiration to immigrate to the USA. To help future friends and colleagues get the right info, rather than relying on them asking the right questions (and me, remembering all the details) every time, I’ve decided to put it all down in writing. Here goes…
Where to live
When moving to the US, pretty much everyone sets their eye on either New York or Los Angeles. Other prime targets are Boston, San Francisco, Florida, Washington DC and Las Vegas. These are the most populous and well-known cities in the country, and therefore sound to many like “the” place to be. One thing to remember is that the high demand leads to a major competition for resources. Residents compete for every job, every parking spot, every house, every lane on the street, etc. Businesses compete for every customer and every dollar. The result is a dog-eat-dog society and the proverbial “rat race”. This is even worse for new immigrants, who have to deal with learning a new culture, geography and language. Truth be told that while costs are higher in the more popular cities, wages are higher too. However, in the big cities, the delta between the costs and income is smaller, leading to an overall lower quality of life.
In other words, I strongly recommend against taking up residence in those cities and focus your attention on the lesser known and less populous regions. Texas, for example, is a great target to consider. It has plenty of work, open spaces, decent prices, and the only downside is the heat (which can actually be an attraction for Israeli and Indian immigrants, who might be used to the heat). Another great option is North Carolina, which also offers plenty of opportunities but without so much competition. Other than those two, the US has over 40 other excellent states with thousands of cities that, despite not being ‘the big apple’, still offer every possible modern convenience. Even if you have to wait a couple of years for Justin Bieber to sing in your city, isn’t getting a nicer house and spending less time in traffic worth it? I think so, and this is why I picked Seattle.
Housing in America
America is a big country, and so generally speaking, land is abundant and cheap for most of the country. The exceptions to this are the high-demand cities New York and San Francisco. Like anywhere else, residence is cheaper the farther you go from the city center, but still, the primary form of residence in the US is in houses (as opposed to apartments). Apartments do exist, but most Americans live in houses, many of which are over 200 square meters (2150 square feet). The costs vary in different regions, but the general average is that in major cities and their suburbs, you can rent a small apartment for around $1000 a month, and a sizeable house for around $2500. As you go farther away and into the “middle” (states like Montana, Wyoming, Utah etc), prices drop significantly, and a similar house would cost only around $1500. Then again, in good old San Francisco, you can expect to pay upwards of $6,000 for the same exact thing. Another common form of residence is the “town-house”, which is a small-footprint house that goes upwards. This format allows sizeable houses to be built in areas that are in high demand, like major cities. The cost is typically a little less than a regular house, and these places typically have a tiny yard, or no yard at all.
The residence rental market is highly developed in America, with millions of families who live as renters throughout their entire life. To cater to this market, house owners use management companies to manage their property. These companies collect the process the rent and taxes, maintains the property, and basically isolate the owner from the tenants…for a fee that’s around 10% of the monthly rent. Also, there are many real estate companies who build housing complexes that they rent out individually. Such companies have an office for the complex-manager and his team, who do all the management and maintenance. All this leads to a very streamlined experience for the renter, which makes it easy and convenient to live as renter for many years.
For those who prefer to buy a residence, things are trickier. Unless you have the cash in hand, getting a mortgage in the US requires a “credit rating”, which new immigrants don’t have (it takes time to build…more about that later), as well as a down payment of at least 10% (preferably 20%) of the house’s cost. Another challenge with buying a house in the US is that when getting a mortgage, the mortgage company will examine your finances very thoroughly (to protect themselves from fraudulent buyers who can’t really afford what they are buying). This can come back to bite you, as you will have to explain in detail not only your income, but also the money you have for the down-payment. If you got that as a gift from your parents overseas, you’ll need to get some tedious paperwork to prove that.
Being a home owner carries the advantage that you can get a tax-refund on the interest you might pay for your mortgage, but the disadvantage of having to pay homeowners tax (usually around 0.1% of the houses’ cost per month), homeowners insurance (typically around $1000 a year), and of course, whatever maintenance expenses show-up along the way. Another thing to keep in mind about houses is that maintaining one is a lot different than maintaining an apartment, and there’s no single and simple way to learn how-to. For example, how to deal with a woodpecker that has decided to hammer the wall on the other side of your bed, or what to do if your gutters get clogged up (they do every year or so) or how to continue living when you have a power outage for 6 days (not uncommon in many parts of the country). My advice for any new immigrant is to NOT rush into buying a house. Instead, I recommend living at least a year in a rental apartment or house, which will give you a chance to learn more about how this country works, as well as traffic patterns which might steer your house selection and may not be obvious at first.
Earning and working in America.
Salaries are usually listed yearly in America, and before-tax, so it’s not always easy to understand what kind of money you’ll be ending up with. Also, many places pay salaries twice a month instead of once (this can affect your cash-flow, positively or negatively). The taxes you pay on your income vary by state, county and city, so some areas have very low rates (as in, just Federal income tax) like Washington and Alaska while others have much higher rates, like California and Oregon. In addition, most state have a ‘sales’ tax (comparable to the V.A.T that many countries have), which can be up to 9.45%. This is still low compared to countries like Israel, which charge almost 20%, but then again, some states like Alaska and Oregon has none at all.
As you probably know, America requires all citizens to file an annual tax report. This means that citizens can elect to not pay income tax during the year, and just pay the total sum annually. This also means that a significant number of residents get a tax refund after they file, and many others have to pay additional sums at that time. The American IRS also requires everyone to report about assets held outside the US, so immigrants who have houses or large bank accounts overseas are required to report, and sometimes pay taxes on that money.
The world-famous American “capitalism” has made the US great in many ways, but it also means that the law is frequently on the side of the business, and not the employee. If you come from a European or otherwise socialist country, the realities of this might seem harsh. For example, in many states, you can get fired from your job for ANY reason…or for no reason at all, and most states you’re not entitled to a notification period or for severance pay. Likewise, an employer has very little requirements related to employee benefits (for example, an employer doesn’t have to give you paid time off, or even sick-days). Then again, if you open up your own business and hire employees, the same laws will protect you as an employer, and help you screw your employees and make more money. Hopefully, you will choose not to exploit them too much. The US is world-famous for have better work-life balance than many countries, though it pails compares to some European and south-American countries. Things are actually pretty bad for people in the retail industry. While corporate employees often get as much as 7 weeks of paid vacation and a 40 hour work-week, retailers often work 10+ hours days and 7-day workweeks, with little options other than be patient until they move up the ranks or get some other corporate desk-job. From watching TV, you might get the impression that Americans are very laced-up, square and strict in the workplace, but that’s not always true. There are many friendships established at work, and it’s not unusual for someone to mutter a “fuck” or “shit” at work, even in meetings or presentations. Still, there are many places with harsher conduct code or policies where you would have to call others “Sir” and “Ma’am” and wear a suit-and-tie all the time.
Life expenses
In America, materials are cheap, and man-power is expensive. This means that the stuff you buy is affordable (TVs, computers, food and other stuff), but getting work done by human beings is very expensive. For example, a plumber or carpenter often charges upwards of $100 per hour. If you come from a country where getting an interior car-wash is simple and common, you’d be surprised to find it can costs hundreds of dollars in the US. This is also why medical services and education cost huge amounts of money here.
If you’re curious about routine expenses and costs, here are some general examples. Keep in mind that they vary from area to area (for example, heating is hardly needed in California, but is a major thing in Alaska, obviously).
  • Internet. Typically $50-90, depending on speed and service type (DSL, Cable, Dish, fiber etc)
  • Cellphone. Typically $30-50 per line, depending on smaller to larger providers
  • Home phone. Typically $30 a month. Can be cheaper if bundled with internet and cable TV.
  • Alarm system. Typically $20 per month
  • Trash. Typically $30 per month
  • Electricity. Typically $80-100 a month, depending on season and regional climate.
  • Gas. Not used anywhere. Can reach $300 in harsh winters if used for heating
  • Water. Between $70 to $160. Higher end is for those with yards or gardens that need watering.
  • Sewer. Usually separate than water, around $65 per month
  • Cable TV. Starts around $20 and can reach over $100 for a wide range of channels. Can be cheaper if bundled with internet and phone.
  • Gardening. Depends on your area, usually around $80-100 a month. Can reach hundreds for large homes.
  • House cleaning. Typically 70-90$ per visit.
  • Baby Sitting. Typically $12 per hour.
Other regular costs are day-care for young kids and private-school for older kids (many prefer that, as its higher quality education than public schools). This is typically $1300-1800 per month, which can be very hard if you have more than one kid. Public schools (free) are from age 6, and in some places, from age 5. Many parents who want child care as early as a few months old have to figure out a way to pay for it.
A major expense to most families is health insurance. News article sometime makes it seem like health in America is terrible, but the reality is that for most people, it’s actually very good. The health industry is huge and very rich, so for those who do have health insurance, things are usually very good. There are certain people who can’t get health insurance for various reasons, but those are a small minority. Health insurance pays for almost everything, even bariatric surgery and psychotherapy, and although there are situations where the insurance may refuse to cover something, this is also a fairly rare situation for most people. One thing to keep in mind is that the best health insurance is given to employees by their employer (some even give it for free) and those who are unemployed or self-employed may be in a tougher spot. Typically health insurance starts off at around $200 per month per person, and high-end plans can cost upwards of $600 per person. For low income families with many kids, even the low-end insurances can be a major burden, of course. Most people pay around $350 per person. All insurance plans have a deductible, just like a Car insurance has, and this means that healthcare does cost money above the monthly costs. Usually, the out-of-pocket is capped so that you don’t end up with huge debt, but the caps are typically a few thousands per year for a family. This means that if several medical events happen all at once, you might find yourself paying a lot.
Food is relatively cheap in America, especially with chains like Costco, Sam’s club and Cash-and-carry, which sell stuff in large boxes, suitable for long-term purchasing or large households. “outside” food, especially fast food is so cheap that it’s often even cheaper than cooking your own food (for the cost of veggies for a large soup, you can typically buy 5-7 meals at McDonalds, for example). Costo operates a prepared-food counter in each branch which sells food at incredible prices (for example, $10 gets you a huge pizza that can easily feed 6 people).
In some circles, Americans have a reputation for being unfriendly and cold, but that’s not very true. Some of them are, but that depends mostly on where they are rather than some ingrained cultural thing or genetic makeup of the population. If you choose to live in an area where there’s less competition for resources (as mentioned earlier, as farther from the high-demand cities of NY, LA etc), you would find that people are friendly, outgoing, caring and fun. Another reputation is that Americans’ are ‘square’, but that’s also not the case, and a lot of them are fun-loving and open. Another major factor in is how open YOU are to assimilating in your new environments. Being an immigrant is tough and scary to many, and a lot of people deal with it by retreating to what they know. Many immigrants socialize almost exclusively with their own race/culture, and spend most of their energy and time on replicating the environment they are used to (TV, movies, literature, food and other commodities of their home country). Many don’t bother learning English properly, not to mention refining their accent or exploring American culture, and all this often leads to poor assimilation and an increasing feeling of loneliness. My advice is to go against your instincts and do the opposite. Keep your food and a handful of close friends, but try to meet and develop relationship with the locals (not necessarily people from work) and explore the local culture as much as you can, from reading the news in English (not your native language) to getting used to watching TV and movies without subtitles.
Marriage and family
Immigration is often a huge blow to marriage. At first, everything is exciting and new, and people are overwhelmed by the abundance of material luxury. However, this rarely lasts more than a few months. Many immigrant families have only one working parent, with the other typically unable to work due to Visa limitations and/or language and culture barriers. The non-working parent often becomes a stay at home mom or dad, and that’s also fun at first. You get to spend time with the kids, rest more and build a nice home. However, usually within a year, this gets old and tensions start to build. Home-life becomes boring and repetitive, and the stay-at-homer often starts to feel lonely and depressed (the other parent being successful and happy at work only makes things worse), and oftentimes develops strong nostalgia for home (where everything was so ‘great’…). With that, the home parent starts to develop a desire to go back to the home country, which is rarely met positively by the working parent. This kind of situation often leads to a break up, or to artificial (and usually false) means of bolstering the marriage such as moving to different residence, or having more kids. Needless to say that this rarely works out. One way to prevent that is to make sure that both parents work, even if the work is only volunteer-based or part time (sometimes developing an art-form is a good substitute). Good emotional intelligence and open communications is also key to preventing tension and false pretense build-up.
Similar issues can develop with kids. Kids above the age of 6 typically have active social life, and aren’t happy about starting fresh. Often times, parents deal with that by presenting the move as temporary, which often puts the kids in a problematic place. They don’t want to bond to their environment, and instead, spend their time and energy waiting for the move back (sometimes pushing and nagging their parents to go already). This can also be detrimental to the success of the relocation, as well as to the marriage. My advice is to set clear and correct expectations, and don’t define the move as temporary unless you have a very specific return plan (many immigrants have a rough idea on the length of their stay, but later on find it very hard to actually start the move-back process, and end up staying much longer, and even forever).
This is pretty much it. I could probably write much more on the topic (and someday, I might expand this), but this is the basic stuff that should be kept in mind. Some of it is positive, and some not so much, but if I wasn’t clear – if you make the right choices, living in the US is a LOT of fun, and has a quality of life much higher than most countries in the world (even those who are higher on various ‘quality’ charts that papers like to print). If you do right by your family and actively work to take a full part of the country and the culture, you too can live like a king!