Category: Making

Projects that make or build something.

Post #1620: Musings on putting together a bug-out bag

 

This is a lengthy set of ramblings.  There's a conclusions section at the bottom if you just want the bottom line.

I continue in my quest to Get Rid of Stuff, a.k.a., Swedish Death Cleaning.  At present I’m wondering what to do with four decades’ worth of camping gear.  Most of it is lightweight gear for backpacking.  My answer is to repurpose it into a couple of bug-out bags (or SHTF bags).

For those unfamiliar with the term, a bug-out bag is set of emergency supplies packaged so you can easily pick it up and carry it away.  Typically, it’s a backpack full of stuff.

Many responsible entities suggest that every citizen have one of these on hand.  You can get guidance on what ought to be in a typical bug-out bag from, among others, FEMA, the CDC, the Red Cross, the U.S. Army, the Commonwealth of Virginia, and Fairfax County, VA.  I’m emphasizing that because having a bug-out-bag or emergency kit isn’t something you should associate with end-times preppers.  It’s a completely prudent thing to have and maintain.

Though I have to admit that all the loose talk about nuclear war and dirty bombs does not exactly reduce my anxiety level, given that we live about 15 miles from the Pentagon.  Plus, all the anti-democracy craziness at play in the coming elections suggests a non-negligible chance I might end up on the wrong side of a armed mob.  And then there’s always the odds of the next Carrington Event.  Which, while maybe not quite as destructive as an electromagnetic pulse (EMP) from a high-altitude nuclear explosion, could wreck the power grid, with all that implies for ensuing long-term lack of water, food, fuel, and commerce in general.  But let’s keep it mainstream.  Think blizzard, hurricane, or similar natural disaster.

To be clear, for almost any conceivable emergency, I’m going to shelter in place.  We’re never going to get hurricane-force winds this far inland.  I’m never going to have to go on the lam to avoid arrest.  And in the event of nuclear war, the last place I want to be is in a multi-day traffic jam on I-66.  I’m going to stay where I have a comfortable bed and flush toilets.

At-home preparedness really isn’t the issue.  Almost everyone who lives in a big suburban house pretty much has that covered.  E.g., every person with a standard hot water heater is already storing 50 gallons of potable water.  For us, with a modern wood stove and a car that serves as an electrical generator (see Post #1020), we’ve got heat and light.  We’d suffer no hardships to speak of in (e.g.) a prolonged winter power outage.

When you step back from it, the question isn’t what to put in a bug-out bag. You can get lists of suggestions anywhere.  Heck, you can buy them ready-made on Amazon.  The basics are pretty obvious:  Water, food, shelter, light, sanitation, medicines.  And batteries.  Lots and lots of batteries.  It’s just another version of going camping.

The key question is why have a bug-out bag?  Given that I have all the basics of existence covered at home, why would I even want something I can pick up and carry off?

Let me defer an answer to that for the moment.  Because if you carry through on that thinking, you will immediately arrive at an even more basic question for which — around here at least — there is absolutely one correct answer. To get oriented, all I really need to ask myself is this:  What am I most likely to be facing, if I’m picking up those bug-out bags and heading out of town?

Around here, the answer is obvious.

Scenario 1:  Three-day traffic jam.

Northern Virginia is pretty much one big traffic jam on the best of weekdays.  If there is some general reason to evacuate this area, by far the most likely result will be a multi-day traffic jam.  Similar to — possibly worse than — the Houston evacuation prior to hurricane Rita, or the Florida state-wide traffic jam for the evacuation for hurricane Irma.

Once I started looking into that, it seems that more-or-less every modern mass evacuation in the U.S. has generated horrific traffic jams. So an epic traffic jam isn’t just likely, it’s more-or-less guaranteed in any large-scale emergency evacuation situation in the U.S.  No matter what the underlying reason, if a lot of people around here suddenly decide to go elsewhere, a massive traffic jam will be the inevitable result.

In addition, recall the earlier this year, a snowstorm broke I-95 in central Virginia, leaving people trapped in their cars, in the middle of nowhere, in the snow, in central Virginia, for more than 24 hours (reference).  My point being that you don’t necessarily even need a mass evacuation to find yourself trapped in your car for a day or more.

Accordingly, the first thing I really ought to prepare for, in a set of bug-out-bags, is spending a few days in the car.

A typical evacuation traffic jam.

Traffic jam, Florida, Hurricane Irma.  Source:  Accuweather (AP Photo/Gerald Herbert).

Let me briefly see what I can learn from recent U.S. hurricane evacuation experiences.

Here’s one first-hand account.  Some takeaways:

  • Stores were still open, so if traffic was stopped, you could hop out and use the restroom at local commercial establishments.  Plausibly, you may or may not need a porta-potty or urinal in the car, depending on whether traffic is literally stopped.
  • Once the traffic jam got started, it snowballed due to people running out of gas.
  • That then littered the road and shoulder with stopped cars, which made access for emergency equipment far more difficult.

Here’s a good scholarly article on traffic and hurricane evacuations.

  • Basically, nobody does anything to manage or stage the traffic load.  In most modern instances, while evacuation routes are identified ahead of time, once the evacuation starts, it’s just every man for himself, with the resulting chaos.
  • Roads rapidly fill past the optimum point on the K-Q curve  — the point of greatest throughput — and that throttles down the number of vehicles able to leave an area.
  • This due, in large part, because everybody waits until the last possible moment.
    • Elected officials, hoping that (e.g.) the hurricane will go elsewhere.
    • Residents, ditto
  • If I get one takeaway from that, it’s that if you are going to evacuate, do it as early as possible.

One other takeaway from that one is that people spend a lot of time farting around as they prepare to evacuate.  That adds to the chaos and further slows traffic.  They don’t have a plan, they need to hit the stores for supplies and so on.  They don’t even have a preferred route.  That strongly suggests having a preferred evacuation route in mind, and having your supplies ready to go.

Here’s a weird little tidbit, from this analysis of Florida evacuations for hurricane Irma.  So many people chose Orlando as their destination that you didn’t just have traffic jams on the gulf coast, you ended up with massive traffic jams around Orlando.  The authors described the results as “catastrophic traffic jams throughout the state”.   The clear takeaway there is to avoid what you believe will be the most common destination for people leaving your area.  In fact, the Irma evacuation caused massive traffic jams in Atlanta, Georgia.  I can only guess that was mostly people who couldn’t get a hotel room in Orlando.

This scholarly analysis adds another helpful hint.  When everybody in an area goes out to gas up the car and pick up bottled water, hey, guess what happens?  Gas and water get scarce.  The clear implication there is that you should consider keeping supplies of both water and gasoline on hand.  If nothing else, you won’t be adding to the chaos in the run-up to the evacuation.  (Although, admittedly, stockpiling a bit of gasoline involves some risks and difficulties.)

For my part, given that the Prius Prime has a 640-mile range at the stated EPA mileage, and that traffic jams actually increase your mileage, my guess is that all I would need is a full tank.  I can’t imagine the scenario where I’d have to run more than 700 miles.  I mean, I’m only 400 miles from Niagara Falls, so that range gets me well up into Canada.  So I shouldn’t need to take gas cans in the car.  Just have enough on hand to be sure to be able to fill the tank.

It almost goes without saying that you are unlikely to be able to obtain a hotel room during a mass-evacuation scenario.  Just to put some numbers on that, in all of Florida, there are under 500,000 hotel rooms (reference).  On any given day, two-thirds of them are already occupied (same reference).  On a good day, for the entire state, you might have 150,000 empty rooms.  The Irma evacuation in Florida involved an estimated 4 million vehicles (reference).  In round numbers, for the entire state of Florida, there was at best one empty hotel room for every 25 evacuating vehicles.  So I’d say, plan for some alternative accommodation is good advice.  Barring that, book well in advance.

Floridadisaster.org puts it a bit more mildly:  ” … hotels and other sheltering options in most inland metropolitan areas are likely to be filled very quickly …”   So, in addition to urging you to leave sooner rather than later, they suggest that you identify someplace safe nearby, ” … minimize the distance over which you must travel in order to reach your intended shelter location. ”  All of that seems like sound advice.

The most important takeaway from that is the idea that you will have already identified your intended shelter location.  If you do it right, you aren’t just evacuating the area, you’re evacuating to a chosen destination.

I have not seen any advice or empirical evidence on whether or not it would be better to use secondary routes rather than interstates or primary highways.  In some places — and Florida comes to mind there — the only through roads are the primary highways and interstates.  But in other areas, you might have a fairly well-developed network of secondary routes.

So what I really need is an instant #vanlife kit?

Yeah, pretty much.  That’s my conclusion, anyway.  No matter what the emergency, if there’s a mass evacuation in this area, we’re all going to be living in our cars for a day or two.

In addition to what you’d put in a normal bug-out bag (water, food, light source, and so on), I should ideally have three more things on hand, ready to go, in case of an emergency evacuation.

Source:  Clipart library.com

First, pre-select a handful of potential destinations, at various distances, and store that list in the car.  Apparently, during many of out recent hurricane-driven evacuations, a lot of people wasted a lot of time trying to figure out where they could go.  This hesitation pretty much guarantees getting stuck in the worst of traffic. Even if you’ve picked a (one) place, there’s going to be a pretty good chance that there will be (e.g.) no hotel rooms or camping spots left.  So pick several.

As I would almost certainly be driving west, and have no relatives living west of me, that would almost certainly be a list of hotels and campgrounds along the interstate and primary highways leading west of here.  Write it down and keep that list in the car.

Source:  Amazon.com

Second, keep some gasoline on hand.  A second clear lesson is that any situation that would generate a mass evacuation will also generate panic-buying of gasoline.  And if there’s anything we learned from COVID, it’s that panic buying can clear out the local inventories in a flash.  In my case, I’d want enough to ensure that I could fill the tank of my wife’s car — about ten gallons.

This is a lot tougher to do well, because gas goes “stale” in a relatively short amount of time, perhaps as little as three months.  This is due largely to the loss of the most volatile components.  As they evaporate, it raises the flash point of what’s left and makes it harder for a spark plug to ignite it.

The upshot is that you have to rotate your stock.  You can’t just put some filled gas cans on a shelf and be done with it.  You need to transfer that stored gas to your car periodically and re-fill you gas cans with fresh gas.

Maintaining adequate gasoline turnover is already a minor issue for some PHEV owners.  If you do almost all your driving on battery, you might keep the same gas in your tank for a prolonged period.  That said, car fuel systems are sealed, so there’s relatively little evaporation.  I believe Toyota recommends at least half a tank of fresh gas every year.

Just by chance, I actually have the right equipment for storing modest amounts of gasoline.  That’s a gasketed metal jerry can, as pictured above.  Those have no vent, and they seal completely when closed, slowing the rate at which the gas goes bad.  I can’t recall exactly how I came to own mine, but I’m sure they can no longer be sold in CARB-compliant areas such as the DC metro area.

I’m undecided as to whether I’m going to store a can or two of gas.  The decision to store gasoline is a commit to the effort it takes to keep it fresh.  I’m not sure it’s worth the effort.

At this point, I think I have the inputs for this process down pat. 

My final concern is for outputs.

What are your alternatives if you’re stuck in the car and can’t get access to a bathroom?  I realize you can stop the car, run into the woods, and take care of business in some fashion.  The interesting question is, what can you do without getting out of the car?

And, in the modern era, well, of course there are multiple websites that will tell you just exactly how to poop and pee in the car.  Typically with some variety of D-I-Y receptacle.  And numerous vendors of commercial products for the same purpose.   And the inevitable YouTube videos.

After working through a considerable amount of that, I’ve decided to do two things.

One, I’m going to buy a pack of the “Travel Jane” brand disposable urinals above.  These contain a polymer that gels more-or-less instantly when it comes in contact with urine.  Apparently the shape is more-or-less female-friendly (but guys can use it too.)

Enough said about #1.

And then there are the various contraptions for an in-car #2.  Of which, none of them look like they’ll work for a fat guy in a Prius.  (And a standard steel bedpan won’t work, because it slopes the wrong way to be used in an already-sloping car seat.)  Instead, I’ll be cutting down a five-gallon-bucket-style emergency toilet, to match the dimensions needed to work with a car seat (3″ front, 5″ rear).

Then buying a box of disposable liners.

Then hope like hell I never have to use the thing.  And that’s that.

Some commentary on disaster kit checklists

There’s no point in my offering you a list of stuff to go into your own bug-out bag or disaster kit.  There’s no shortage of experts who will tell you what to keep on hand for disaster preparedness.  By and large, they all say the same things.  And those are pretty obvious:  Water, food, shelter, sanitation supplies, and so on.  I listed some references at the start of this post.

I will add just four refinements that you may not read elsewhere.  These are all about maintaining that emergency kit once you have put it together.

First, never leave the batteries in your devices.  Take them out, and put them in a plastic bag taped to the device.  Although battery corrosion is far less of a problem now than it was decades ago, alkaline batteries will eventually corrode.  And you’ll only find out that the device is ruined when it ceases to function.

Two, invest in a cheap battery tester.  Five dollars will get you a perfectly adequate tester on Amazon.  That will pay you back in terms of batteries that you don’t have to throw away, because they remain within spec even after sitting around for a few years.

Three, separate out all the items that need to be replaced periodically, and put them all in their own bag.  Food, medications, batteries, and so on.  Anything that has an expiration date.  If not, you’ll have to go rooting around in your kit, every year, to check for expired items.  Which means you won’t bother to do it.  Which means that when you go to use your bug-out bag, it will be full of expired items.

Four, use a sharpie to mark the purchase date of every food item.  And every other item that is in your bag of expire-ables.  This takes almost no time, and saves you having to squint at the various packages when checking the contents of your bug-out bag.

In terms of the standard lists of items, oddly, almost all of these lists not only have the same items, they have the same handful of items that I consider to be decades out-of-date.

Some common bits of bad advice

Surely the most out-of-date recommendation found on every list is to carry some travelers’ checks.  Travelers’ Checks?  Do they even make those any more?  (Answer:  Yes, American Express still offers Travelers’ Checks.)  I cannot imagine the situation in which cash would not be superior to Travelers’ Checks.

In the same vein, there’s a suggestion that you carry some change, in addition to paper money.  Maybe there are still vending machines that don’t require electricity and don’t take bills.  I can’t recall having seen one for a long time.  My guess is, that’s a recommendation that dates back to the era of pay phones.  Otherwise, if I’m in a situation, the last thing on my mind will be worrying about having to round up to the next whole dollar.

Arguably, the second most out-of-date recommendation is to carry matches in a waterproof container.  Don’t.  Carry a Bic lighter.  (What the heck, go crazy, carry two.)  Backpackers made that switch decades ago.  Bic advertises 3000 lights from its full-sized model, and most people seem to get a lot more than that.  And it’s inherently waterproof.  I can’t even imagine carrying 3000 matches.

Third worst recommendation is to include a bottle of bleach.  This was to be used to sanitize clear (non-cloudy) water for drinking.  But that’s a bad recommendation for a couple of reasons.

First, household bleach degrades rapidly.  Unless you are prepared to replace that every couple of years (or annually, per most sources), you’ll have no idea what strength the bleach is.  Standard household bleach is either 6% or 8.5% sodium hypochlorite.  Accordingly, use 8 or 6 drops of bleach per gallon of clean, pre-filtered water.  This, per the U.S. EPA.  In round numbers, to be safe, that’s a quarter-tablespoon per gallon of clear water.  Stir and let stand 30 minutes.

But that’s also a bad recommendation for drinking water purification because the technology has improved.  Back in the day, you had your pick of awkward ways to disinfect water.  Boil the water for one minute, or use water purification tablets (foul tasting and only partially effective), or use bleach (merely foul tasting).  There were also systems set up around the use of iodine rather than chlorine.

These days you have many better options.  There are microfiltration systems, such as the Lifestraw or higher-volume units that use (more-or-less) dialysis filtration material to filter pathogens out of the water.  There are systems that use salt and electricity to create chlorine for water disinfection.  There are systems that use battery-powered UV-C lights to disinfect water.  And so on.

For my part, I’m tossing one of the little Sawyer micro-filtration water filters into each bug-out bag.  Plus a handful of coffee filters for pre-treatment.  If I ever get to the point where I’ve run out of potable water, that’s going to be a lot more reliable than whatever happens to be left in an N-year-old bottle of household bleach.

Some good advice that I wouldn’t have thought of.

By contrast, here are some things I wouldn’t have thought to add:

A lot of lists recommend keeping a complete change of clothes in your emergency kit.  I guess, in the back of my mind, I figured I’d also pack a suitcase.  But if this really is for an emergency getaway, maybe a change of clothes in the bug-out bag is a good idea.  Particularly if you are making some sort of kit to reside in your car.

I would not have thought to include maps of my area.  But that makes perfect sense, as you could easily imagine a situation in which the cell towers are out.  Of course, if I’m traveling by car, I’ll have a set of maps already.

A final general item that I would not have included on my own is a selection of standard over-the-counter medications.  Things like antacids, anti-diarrhea medications, and so on.  I could see where (e.g.) a bad case of acid reflux or heartburn could be a real hindrance if you couldn’t get your hands on some antacids.

Otherwise, those lists are pretty much all the same.  And pretty much common sense if you have any camping experience.

A brief diversion on the space blanket.

Source:  Walmart

Everybody tells you to pack a space blanket.  Few people have ever tried (e.g.) camping with just a space blanket, nothing else.  (I have, and it doesn’t do much to keep you warm.)  Virtually nobody understands how space blankets actually work.  Yet that lack of understanding does not keep people from offering advice on how to use them.  As a result, much of the advice you will get about space blankets is wrong.

A space blanket is, first and foremost, a radiant barrier.  Without even attempting to get into the physics of it, I’m just going to tell you the rules.  It only stops radiant heat if there’s at least a 1″ air gap on at least one side.  It doesn’t matter which side — which kind of belies the use of the word “reflect”.  All that matters is that at least one side faces at least a 1″ air gap.

Ignore that rule, and it’s just a cheap, thin piece of plastic.

If you put one of these under your sleeping bag, it does nothing to reflect heat.  If you drape a regular blanket over it, it does next-to-nothing to reflect heat.  (It only reflects heat in the spots where there’s an air space under it.)

If you’re going to use one of these, put on whatever insulation you are going to use — warm clothes, blankets, and so on — and drape the space blanket over that.  So that that the entire top surface of the space blanket is open to the air.

Think of it as the (shiny) icing on the cake.  That’s how to use it properly.

Now you know.

Conclusions

It has been a long strange trip from “what do I do with my old backpacking gear?” to “how, exactly, does one poop in a car?”.  Let me summarize.

Every U.S. entity that is responsible for emergency management suggests that you maintain some emergency supplies, including but not limited to some form of a bug-out bag.  Something so that, no matter what the chaos is surrounding some unexpected evacuation, you’ll have some basic elements of water, food, light and shelter with you.

Practically speaking, if you are part of some mass evacuation in the U.S., you will be driving your car or other vehicle.  Along with absolutely everybody else.  In a major evacuation the odds appear overwhelming that you are going to be caught in a massive traffic jam.  You will likely end up spending 24 hours or so — maybe more — in your car.  That’s not some one-off mistake.  That’s not some rare occurrence.  That’s seems to happen, like clockwork, with each major American evacuation event.  And if history is any guide, nobody is going to be doing anything to (e.g.) make that go more smoothly, enforce traffic laws, and similar.  Chaos appears to be more the rule than the exception in U.S. evacuation traffic jams.

Plan accordingly.

First, decided on your likely destinations ahead of time.  Have a paper-copy list with (e.g.) address and phone of hotels and campgrounds along your likely evacuation route.  The less time you spend dithering, the earlier you get on the road, and the more likely you can escape the worst of the traffic.  The absolute standard advice is that if you think you may need to evacuate, leave as soon as possible.  The less time spent gathering supplies and pondering your destination, the better.

A lesson from Hurricane Irma in Florida is:  Don’t choose the same destination as everybody else.  If there’s an obvious place to get a hotel room (e.g., in Florida, Orlando), go somewhere else.  Otherwise you get caught in a second major traffic jam at your destination.

Second, don’t assume that you’ll be able to get a hotel room.  Even in tourist-rich Florida, evacuees outnumbered available hotel rooms about 25-to-1.  That surely requires having several potential destinations in mind, and booking early.

Third, keep some gasoline on hand, if you can.  Because gas and bottled water are the first two things to run out when an evacuation is declared.  Gas, in particular, is tricky, because it goes bad.  You need to store it in an unvented container and you need to replace it periodically.

Fourth, include some way to take care of all your needs in the car.  Inputs and outputs.  From shopping Amazon, it’s clear that there are many effective and moderately-priced products that will handle urine.  But poop seems to be a different story entirely.  Most of the devices sold for that would either require a lot of empty floor space in your vehicle, or would require you to stop and get out of your car. A standard bedpan is the wrong shape for use in a car seat — tall at the front, short at the back.  For my part, I’m going to cobble up something from a five-gallon-bucket-style emergency toilet, and then hope that I never have to use it.

Beyond that, you can get reasonably good lists of what to include or not in a bug-out bag from any number of sources.  Or simply buy a ready-made kit from Amazon.  I have nothing to add to those other than the handful of minor refinements listed above.

In summary, the real eye-opener to me was the auto-centric focus you need for your personal planning.  If you’re not going to shelter in place, and you live in the typical urban American setting, then evacuation means getting to your shelter by car.  For most of us, any evacuation event means that we’re going to get a brief taste of #vanlife.  And I judge that most advice for constructing your bug-out bag pays little to no attention to that basic fact.

Post #1853, autopsy of a Mint 5200 battery pack failure.

 

This is more of a note-to-self than a posting for the public.  But come along for the ride if you care to.

This is about getting fed up with short-lived rechargeable battery packs for a home device.  And deciding to Do Something About It!

I don’t actually make the repair in this post — I need to get my hands on some parts.  But I outline my proposed solution. Continue reading Post #1853, autopsy of a Mint 5200 battery pack failure.

Post G22-059, first summary of this year’s gardening season.

 

I tried a number of new plants and techniques in this year’s vegetable garden.  As we move into September, it’s time to start sorting out what worked and what didn’t.

Drip irrigation (Post G22-026, Post G22-027, Post G22-037).  A huge success.  For a bit over $100 in parts, and maybe two hours of labor, I can now water my entire garden either by hooking up to my rain barrels, or by using water from the spigot.  I can reconfigure it and add to it at will.  Key takeaway:  Use 1/2″ drip line.

Portable electric fence as a deer deterrent (Post G22-018).  A winner.  This is another project that took almost no time and a bit over $100 to set up.  Push in some cheap plastic posts, run the “wire” (more like metallized twine) through them, pound in a grounding rod, and hook up a small fence charger.  With deer deterrents, it’s hard to tell whether they worked or you just got lucky.  But I’ve had essentially zero deer damage since this went up.  I suspect the deer really don’t much like it.  (And, having tested it on myself, I concur.)  Key takeaway:  The technology has changed to make these easy, cheap, and flexible.  If you only need a small fence, you only need a small, cheap fence charger.

Sprawl technique for tomatoes (Post G22-035).  Thumbs down.  This year, I tried letting one bed of tomatoes grow un-staked and un-caged.  Just let them sprawl.  It’s by far the easiest way to grow them, but I’m not going to do that again.  They grow just fine.  I didn’t see (e.g.) any higher levels of leaf diseases and such.  This bed is now a mat of interwoven vines.  It’s hard to see the ripe tomatoes, and I’m losing more tomatoes to garden pests than I would if I had staked them.  Key takeaway:  The problem isn’t growing them, it’s getting a good harvest after allowing the vines to sprawl in the garden bed.

Cold-tolerant (early season) tomatoes (Post G22-025, Ripe Tomatoes in June).  A big winner.  This worked out quite well.  Not only did I have tomatoes by the end of June, those plants are still producing a decent yield of salad-sized tomatoes.  They slowed down in the heat of the summer, but it looks like they’re picking up steam as the cooler weather sets in.  I also learned a lot about what “days to maturity” really means.  Key takeaway:  Pick the right varieties, and you can have tomatoes in June without having a hothouse.

Growing large seedlings in paper lunch bags (Post G22-012, Post G22-017).  Works well.  This year, my butternut squash and pumpkin seedlings outgrew the paper cups I started them in before I was ready to transplant them to the garden. I moved them to doubled-up paper lunch bags filled with potting mix.  The idea was to give them room to grow and to avoid transplant shock by planting them bag and all.  Coincidence or not, I’m having my best butternut squash year ever.  Key takeway:  Double up the bags, and handle them gently when it’s time to plant.

More to come.

Post G22-018, Sprawl method for tomatoes.

 

End-of-season edit:  When all is said and done, I won’t be doing the sprawl method again with full-sized tomatoes.  Maybe I planted these too closely, but I ended up with a tangled mass of vines, weighted down by the fruit.  A lot of tomatoes ended up rotting.  Either you can’t see them, or you can’t get to them, or they end up on the ground.  It’s a lot less effort to grow them, compared to staking them up, but you don’t get much in the end. 

Everything else here:  Cold-tolerant tomatoes, and electric fence as deer deterrent, gets two thumbs up.  I now plan on growing cold-tolerant (short-season) tomatoes every year.

I’m now in Phase III of my four-part tomato strategy for 2022.  I outlined that in  my first garden post of 2022 (G22-001).  It’s time for an update.  I’m posting it because otherwise I’ll never be able to recall how things went this season. Continue reading Post G22-018, Sprawl method for tomatoes.

Post #1412: A simple heated outdoor faucet (tap, spigot, sillcock, hose bib) cover.

 

This post shows you how to take a few off-the-shelf parts from your local hardware store and make a plug-in heated cover for an outdoor faucet.   This will take you about two minutes to assemble, and, depending on how much heat you think you need, will cost you either about $6 (using a cheap night-light), up to maybe $17 (using a proper candelabra-base light fitting), including some spare light bulbs.  The only tool you need is a knife.

It’s not rocket science:  Add a candelabra-bulb socket or a cheap night-light to a standard foam faucet cover.  Screw in a night-light or similar incandescent bulb.  Attach that foam faucet cover to the faucet, and snug it up against the wall.  Plug it in.  Turn it on.  You’re done.

The only value added I’m bringing to this, other than pointing out the obvious, is that I’ve tried three wattages and recorded the results.  Having tested it, you can be assured that you’re not going to end up with a flaming piece of Styrofoam attached to your house.  In fact, the 4 watt bulb is barely warm to the touch.

Pick the wattage that meets your needs:

  • 15 watt incandescent:  60+ degrees F over ambient temperature
  • 7 watt incandescent: 40 degrees F over ambient temperature
  • 4 watt incandescent: 28 degrees F over ambient temperature.

E.g., if I’m expecting a low of 6 F in my neighborhood, a four watt bulb should keep the inside of that foam cover at a toasty (6 + 28 =) 34F.  These temperature increases were measured with the Home Depot foam cover (referenced below) snugged up against a brick wall.  You might get somewhat better or worse results depending on your siding (e.g., wood or aluminum).

The only warning is that you must use an old-fashioned incandescent bulb.  You’re using them for the waste heat, not for the light.  Do not use an LED night-light bulb.  They won’t put out enough heat.  I think that seven-watt incandescent night-light bulbs are available at every hardware store in the country.

The nicest thing about this setup is that is starts with a standard foam faucet cover.  I put these on my faucets at the start of winter, with the cord bundled up, out of the way.  Most of the winter, they just sit on the faucets like a normal foam faucet covers.  When extreme low temperatures are predicted, I unroll the cord and plug them in.  At that point, they’re heated faucet covers.

If you just want some ideas for a temporary fix, to be used for a few days in an emergency situation, read the “Cobbling something up” section below, in addition to the main post.

Parts, tools, and assembly, high-wattage model.

Parts, left to right:

Home depot reference: , $4.

 

Pick one:

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Ace hardware typical reference., $6 for four.

 

Home depot reference, $7.  (Edit 1/12/2024:  I see HD no longer carries these in stores, but Lowes (reference Lowes.com) has the equivalent for $8. 

If you can’t find this part, and a night-light won’t do (next section), see the section “Cobbling something up” below).

Instructions:  Use the serrated knife to cut a small (1/8″ wide) notch in the bottom of the Styrofoam faucet protector.  Bend the metal fitting that comes with the candelabra socket to spread it out a bit.  Press the cord for the candelabra socket into that notch.  Snug the bottom of the socket up against the foam.  Screw in the bulb.

What you see below is the inside of the faucet protector, fully assembled and lit.  Attach this to your faucet, and draw it up firmly against the wall.

One clear drawback is the need to run an extension cord out to the faucet cover.  But, with a power draw so low, the cheapest, flimsiest outdoor extension cord will do.  Optionally, wrap any junctions (e.g., where the extension cord and lamp cord meet, or where the switch is on the lamp cord) with electrician’s tape or other waterproofing material, depending on how exposed they are.

I call this the high-wattage model because that $7 light fixture from Home Depot can easily handle a 15-watt bulb.  And the feet on the fitting keep that bulb well away from the Styrofoam.  But that’s also the most expensive part.  And you need to buy bulbs separately.

There is a cheaper way, if you don’t need 15 watts of heat.  Below.

Much cheaper, low-wattage model:  Use a night-light.

In the original version, I went with a candelabra base fitting because I thought I might need 15 watts of heating.  Turns out, 15 watts was overkill, for me.  And so, you can make this cheaper by substituting a night light for the candelabra base, as long as you keep the wattage down.

The instructions are identical to those above, you just cut a wider notch into the faucet protector.  Take the plastic shade off the night-light.  Stuff the night-light fitting into into place.  (See pictures below).  You’re done.

Originally, I cut back the foam a bit, to clear the bulb.  Not a bad idea, but not really necessary.  A four-watt night light bulb barely gets warm to the touch.

In any case, because the night-lights come with bulbs, you can make this for about $6.  I used a manual night-light, with an on-off switch.  You can use an automatic one, just tape over the sensor so the night-light thinks it’s in the dark.

I would NOT put a 15-watt bulb in one of those ultra-cheapo night light fixtures.  There ain’t a lot of metal in them.  Most of the night-lights I’ve found were rated for seven watts.  One (by GE) was only rated for four watts.  In any case, don’t exceed the rated wattage of the night-light fitting.

Note:  There are heavy-duty 15-watt night lights, sold as plug-in wax warmers or plug-in fragrance warmers.  I have no idea how hard it would be to tear one down to just the socket and switch, for use as an outdoor faucet warmer.  And they cost as much as the high-wattage fitting used in the first section above.  So may guess is, if you’re going to the night-light route, stick with a cheap night light, and low wattage.

Be sure you are getting a night-light that uses an old-fashioned incandescent bulb.  Do not try this with an LED night light.  They don’t generate enough heat.

One final caveat:  Your night light might be rated for seven watts, but that doesn’t mean it comes with a seven-watt bulb.  Here’s a $1.33 model from Menards that specifically says 7 watts for the included bulb (reference).  Here’s a Home Depot reference, 2 for $2.50, rated for 7 watts, definitely sold with 4 watt bulbs.  (reference).

So, if you go this route, pay attention to the bulb.  Otherwise, if you need 7 watts of heat, but ended up with 4 watt bulbs, you’re going to pay more for replacement bulbs than the night-light cost.

 

Cobbling something up:  A few suggestions if you are desperate and need a temporary fix.

The whole point of using these candelabra-base night-light-sized bulbs is that they’ll fit easily into a standard foam faucet cover, with room to spare.  This gives you a good chance of buying a few parts off the shelf and having it fit  your particular faucet, and gives you something you can leave up all winter.

But suppose you’re in a hurry, and just need a temporary fix, and you can’t lay your hands on the parts that I used.  What are some plausible alternatives?   It’s not like light bulb + insulation is somehow difficult to achieve.

I have to warn you that I haven’t tried all of these.  But based on making the ones above, these seem to have the highest chance of working, with minimal risk.

1:  Same idea, different socket and bulb.  Here’s the link to a guy on YouTube doing his version of this, using a 25 watt incandescent bulb (link).  He feeds the electrical cord through the end of the foam cover, rather than cutting a slot in the foam cover.  But it’s basically the same notion as what I’ve presented above.

2:  Make up a candelabra-base fitting from parts.  Let’s say you can’t lay your hands on the candelabra-base fitting that I used.  But you want to use more wattage than a night-light can handle.  Substitute a standard two-wire extension cord plus a socket-to-light adapter plus a medium-base-to-candelabra base adapter.  At my local Home Depot, those two adapters are available as this part, and this part, for a total of about $5.50 for the two of them.  That way you can still put a small night-light-sized bulb inside the foam faucet cover.   Instead of cutting a small hole, for night-light, as above, cut a hole, for the end 1″ wide end of the candelabra-base adapter.  Then proceed as with the original model above.

 

3:  Cheap trouble light, “60 watt” CFL bulb, and a cotton towel:  30 degrees F of heating.  By “trouble light”, I mean a plug-in 120-volt socket with a cage surrounding the bulb, and a hook for hanging it.   Like this, $9 (no cord, Walmart) and $16 (with cord, Lowes), respectively.

The point of the cage is to keep stuff from contacting the hot bulb.  Put in a moderate-wattage bulb, hang it on your faucet with the open side of the cage facing the wall, and then insulate it however you can, taking care that nothing touches the bulb.

Above is an example I tested using a towel, a plastic grocery bag, and a “60 watt” compact fluorescent, which actually draws 13 watts.  (And the world’s cheapest plastic-cage trouble light.)  Poke the lamp cord and the handle of the trouble light through the bottom of the bag.  Arrange some towels around the light, being careful not to touch the bulb.  Hang the light on the faucet, pull up the grocery bag, arrange the towels for best coverage, and tie the handles of the grocery bag on top of the faucet.

If you do this, be sure to come back and check it to make sure nothing is burning.  And, obviously, don’t leave this out in the rain.  (But if it’s raining, presumably you aren’t worried about your pipes freezing.)

As shown — “60 watt” (actual 13 watt)  CFL bulb, one bath towel — this produced at least 30F of heating above ambient temperature.  Obviously, YMMV.  If you have a kitchen thermometer, nothing will stop you from measuring how well yours does, before you trust it to keep your spigot from freezing.

If all you can get your hands on is an LED light bulb, bear in mind that a “60 watt” LED bulb only uses about 7 watts.  So you’re only going to get as much heat out of that as you would out of a 7-watt night-light bulb.  With this setup, I wouldn’t count on more than about 20F of heating, maybe less, with a “60 watt” LED bulb.

If all you can get is an incandescent bulb, I would not use more than a 25-watt incandescent bulb here.  Maybe not even that much.  It’s just going to get too hot.  You’ll risk (e.g.) melting something inside your cheap trouble light, or setting setting the plastic grocery bag on fire.

4:  A completely different approach:  Use a string of miniature Christmas lights, towels, grocery bag, and duct tape.  I’ve seen this one mentioned on the internet, and it seems like it should work, given the wattage involved.  You just need to have some reasonable wattage of lights, something between (say) 5 and 20 watts.  Wrap a string of miniature Christmas lights (either mini-incandescents or LEDs) around the exposed pipe of the outdoor faucet.

The rest is as shown above. Wrap some towels on top of that, for insulation.  Put a plastic trash or grocery bag on top for waterproofing.  Maybe duct-tape the entire thing.  Maybe just tie the bag on, as shown above.

As with the trouble light, check it after it’s been on for a while to make sure nothing is burning.  I would not do this with full-sized (C7 or C9) incandescent Christmas lights.  Those bulbs get hot — they run about 6 watts each — so even a short string of those can run to more than 100 watts.  That’s a LOT of heat in a very small space, and suggests a pretty significant fire risk, to me.  A string of (say) a dozen such bulbs emits vastly more heat than I would consider safe in these circumstances.

Some totally unnecessary background.

I guess the target audience for this post is people like me:  Southerners, facing a few bitterly cold nights a year, who would rather not mess with trying to winterize their outdoor faucets the proper way.  I’d rather run an extension cord to the faucet than hope that the 60-year-old sillcock shutoff — that hasn’t been used in at least 30 years — will work without leaking.

In my case, I was motivated to install one of these by a recent 11F night, after which water would only trickle out of my outdoor faucet, suggesting it was very nearly frozen solid.  This, despite using a standard foam faucet cover.  Given the damage that a burst pipe can cause, adding some heat to that seemed like a cheap bit of insurance.

I looked around for something I could buy, but came up empty.   Sure, there are heater tapes sold to keep pipes warm.  But those come in (e.g.) 30-foot lengths, and consume hundreds of watts. Overkill for a single outdoor faucet.

Near as I could tell, there doesn’t seem to be any product made to provide electric heat to a single outdoor faucet.  I assume that’s because you’re supposed to winterize these by draining them.  It’s only people who don’t want to do the right thing — shut off and drain that outdoor fitting — that would need something like this.

Which is how I ended up making these for my outdoor faucets.  For me, this is the simpler solution, for a few days of cold weather a year.

One final extras-for-experts: Post #1666.  Sure this works in practice, but does it work in theory?  The answer is yes.  In that post, I do the math.  Starting with the R-values for Styrofoam and brick, the dimensions of the faucet cover, and the heat output of a 4W light bulb, I calculate a steady-state 28F temperature difference between the inside and outside of the cover.  Which is, purely by chance, exactly what I measured.

Post #G21-052: Starting to wrap up the garden year.

 

Last year, I put in some raised beds and made a serious effort to grow some vegetables.  Mostly, it was to have something to do during the pandemic.  If nothing else, during all that isolation, it was cheering to look out my back window and see a patch of giant sunflowers.

Now it’s year two of the pandemic and of my garden.  I’m done with planting for the year, and I’m focused on winding things down, and on the likely first frost date for Vienna, VA.

It seems like a good time to summarize what did and did not go well this year.  Mostly as a reminder to myself, but also in case anyone else might benefit from reading it.

After a brief note on first frost dates, I’ll go through methods and techniques I tried this year, and maybe finish up with some notes on individual vegetables, if there is anything notable to say.  Click the links to go to the relevant sections.  Click the links below to see those sections, click the “back” link to return here.
 Continue reading Post #G21-052: Starting to wrap up the garden year.

Post #G21-051: Adding to my deer deterrent arsenal.

I have an un-fenced vegetable garden in Vienna, VA.  Which means that I have a problem with deer.

We all know that deer can read.  Otherwise, how would then know where to cross the highway?  But for some reason, they scoff at my no-deer-allowed signs.

This post is a summary of everything I think I know about deterring deer from eating my garden.  And an introduction to my latest deer-deterrent device, wireless deer fence.

Edit on 3/9/2024:  A year after I wrote this, I ended up buying an electric fence.  Those are a) surprisingly cheap, b) surprisingly easy to set up and take down, and c) effective against deer.  So far.  I use an electric fence to define the outer perimeter of my garden, and run a couple of motion-activated sprinklers (“Yard Defender” and similar) inside the perimeter.  That combination has turned out to be effective.  So far.    See (e.g.) Post G22-063, to see what one looks like.  If you don’t have little kids or pets to worry about, I’d say that a small, portable electric fence setup should be the backbone of your deer deterrence.  So much so that I planned my new garden layout with an electric fence in mind.  Take it down in the fall, put it back up when you have something worth defending, in the spring.

Why it’s so hard to separate fact from fiction regarding deer repellents

Much has been written on deer deterrents, some of which might even be true.  But it has taken some sifting and sorting to try to separate what I believe to be true, from what I believe to be false.

The first problem with evaluating deer deterrents it that deer damage is sporadic.  The deer will come by, mow down a row of (say) beans, and move on.  They might be back tomorrow, they might be back next month.  You might have one herd of deer frequenting your garden.  You might have several distinct herds.  I’ve had long stretches where I’ve seen no evidence of deer.  I have had stretches where I’ve seen them daily.

As a result, absent a serious large-scale controlled trial, all tests of deer deterrents are one-way tests.  If you see continued deer damage, you know they are not working.  But if you see no damage, well, you just don’t know whether the deer deterrent worked, or whether you just got lucky for a spell.  There is a real element of people mistaking luck for effectiveness.

The second problem with evaluating deer deterrents is that deer differ, conditions differ, and the attractiveness of your plantings (compared to other nearby forage) will differ.  People swear that deer love hostas.  We have hostas all over our yard, and the deer have never touched them.  Others will swear that deer won’t eat tomato plants.  Yet that doesn’t stop my deer from chowing down on mine from time to time, at least when the plants are young.

This generates a true “path of least resistance” effect.  Deer manage their risk/return tradeoff depending on what’s available.  Deterrents that might work on some plants, in some circumstances, will not work in others.  If you’re growing something that deer find merely edible, but there is better forage nearby, maybe a simple folklore-style deterrent (Irish Spring soap) will convince them to go elsewhere.  But if you’re growing something that deer really like (e.g., sunflowers), and there’s little for them to browse elsewhere, you’re going to have to seek a stronger solution if you’re going to keep the deer off those plants.

As a result, the available information is a mix of:

  • Proper controlled tests run by (e.g.) state extension services.  These focus almost exclusively on commercially-available products that would be of use to (say) farms, orchards, and the like, to the exclusion of things you might use in your back yard.
  • Claims/testimonials from manufacturers.  Who, of course, are not going to tout any of the negative reviews.
  • Self-reports from people who have tried some deer deterrent.  This is everything from thoughtful advice from individuals who lots of experience, to anecdotes from people who tried something and the deer went away, to classic friend-of-a-friend urban-legend style stories where the person doing the writing isn’t the person with the actual deer problem.

And in each case, the solutions that some people will swear by may or may not work in your circumstances.  Just as the plants that some will swear are “deer proof” may or may not be, depending on just how hungry the deer are.  And the same for plants that are thought to attract deer.

The facts, as I believe them to be.

I’m not giving citation as to source here.  This is just a summary of my impression of what’s true about deterring deer, based on extensive reading of internet sources.

  • Deer do prefer certain plants, and not others.  You can find lists all over the internet.  But if they are motivated enough, they’ll eat almost anything.
  • The only 100%-sure fixed deer deterrent is a physical barrier such as a tall fence, a properly configured electric fence, caging or netting.
  • A properly-trained dog, allowed to roam, is also said to be 100% effective in keeping deer out of your yard.
  • Deer get more aggressive as fall approaches.  Deterrents that worked earlier in the year may not work then, or you have to ramp them up (e.g., increase the concentrations of odor-based deterrents).
  • Deer will get used to any fixed device meant to scare them.  They actively test the limits of your deer deterrents and stay just beyond those limits, or figure ways to work around them.

If I had it to do all over again.

I use several different deer deterrents.  Mostly, I only started gardening seriously last year, and I wasn’t sure what would work or not.  So, I tried a range of them, to hedge my bets.

If I had to start from scratch, knowing what I now know, I believe I’d invest a few hundred dollars in several Yard Enforcer motion-activated sprinklers, and the associated hoses.  I’d set up double coverage of every bit of garden beds that I have.  And I’d leave them on the “night” setting, so that I’d never forget to turn them back on after I’ve been working in the garden.

This would be a somewhat expensive solution.  The hoses would eventually sun-rot from being left out continuously, and would need to be replaced.  You’d probably cut one with the mower now and then.  And I’d guess that I would not expect to get more than five years’ reliable service from the motion-activated sprinkler.

That said, absent leaks, or freezing weather, I think this would solve my problem with minimal effort on my part.  As far as I can tell, the deer have never gotten used to the Yard Enforcer that I have.  I’m not sure if that’s luck, or whether it really does annoy them enough to keep them away in the long run.  But so far, when I remember to turn it on, for the area that it covers, it seems to keep the deer at bay.  This clearly would not work if you need to protect plants when temperatures drop below freezing.

What I have actually used, so far.

Bobbex deer repellent.  This has an excellent reputation, and really does seem to work in my situation.  I couldn’t really say if it’s any better or worse than any other name-brand odor-based repellent.

It has some drawbacks.  It stinks, so it’s kind of nasty to mix up and apply (you use a spray bottle).  You have to re-apply it at two-week or one-week intervals.  You can’t spray it directly on fruits or vegetables (it taints the taste of them).  And you have to amp it up as fall approaches, according to the directions, because the deer get more aggressive.

Of all that, the biggest drawback for me is that you have to remember to mix it up and use it every week, during peak deer season.  I’m just not that regular in my gardening habits.  (And, clearly, it’s not going to work if you take an extended vacation).

Yard Enforcer motion-activated sprinkler.  The deer don’t seem to get used to this one.  As long as I remember to turn it on, it seems to provide complete protection to the area it covers.

The hose connection on mine leaked, but a ten-cent rubber hose washer fixed the problem.  You do have to change the batteries every once in a while.  And I get a lot of false triggers in bright sunlight.

I have taken to leaving it set on “night”.  On that setting, it’s only active in the dark.  That way, I don’t have to turn it on and off as I go into and out of the garden.  (Or, more likely, turn it off and forget that I’ve done that).  And that avoids the false triggers in bright sunlight.

Home-made motion-activated radio (Post #G07).  I left this one in the shed this year.  It works, but it requires having an extension cord running across the lawn.  Not only will that eventually sun-rot, but there’s no convenient way to turn it off.  As a consequence, I was always triggering this as I went out into the garden.  (Don’t know if it scares the deer, but it never failed to scare the pee out of me.)  I think this would work well in an area that you didn’t routinely walk through.  But in an area where you do some sort of activity almost daily, this was less than ideal.

Blood meal, Irish spring soap, and other similar folklore-based repellents.  These had no appreciable effect that I could see.  Doesn’t mean that they don’t work in some circumstances.  Just didn’t seem to keep the deer away in mine.

New for this fall:  Wireless Deer Fence.

As fall sets in, the deer get larger, hungrier, and more aggressive.  It gets increasingly hard to keep them out of the garden.  And, frankly, I get tired of spraying stinking solutions every week, trying to keep them out.  And I’ll forget to turn on the Yard Enforcer after I’ve been working in the garden.

I looked over what was commercially available, and settled on “wireless deer fence“, three units for $60.  That’s probably not quite enough for the size of my garden, but these will work in conjunction with everything else.

The wireless deer fence consists of roughly one-foot-tall plastic stakes that hold a deer-attracting scent-based lure.  They hold that lure in the middle of four high-voltage metal tines, running off a couple of AA batteries in the base.  If the deer touches nose or tongue to the tines, it gets a nasty shock.  And, ideally, this trains the deer to go elsewhere.  Place one wherever you note deer damage.

Of course I tried it on myself.  (If this turned out to be really horrific, I wasn’t going to use it.)  I did not have the moxie to lick it, deer-style.  Instead, I tapped it on my wet skin.  It hurts, but not too badly.  Felt about the same as brushing up against an electric fence.  Unpleasant and startling, but not hugely painful.  And no lingering pain once you lose contact with the high-voltage metal.  Once you break contact, you’re fine.

Based on the company’s write-up, one shock is enough to train any one deer to stay away.  In the grand scheme of things — no damage, no lasting pain, one shock, and trying it out on myself first — this did not seem like an excessively cruel deer deterrent to me.  Others could reasonably disagree.

And so, you place these where you see deer damage.  Maybe move them from time to time, just so the deer don’t know how to avoid them.

So far, they seem to work.  But, as noted above, there’s really no way for the backyard user to separate cause-and-effect from sheer luck, when it comes to deer deterrents.

Conclusion.

Now you know everything about this topic that I think I know.  A tall fence was not practical for my garden.  I’m fairly sure that an electric fence would be illegal in my area.  I don’t own a dog.  So I’m left with a mix of second-best solutions.

Edit, 3/9/2024:  Turns out, only barbed wire fencing is explicitly illegal in my area (Fairfax County VA).  County code does not address electric fences.  Not sure whether that’s on purpose, or because they never thought any back-yard gardener would be crazy enough to install an electric fence.  In any case, there is no legal ban on electric fences where I live.

This year, I planted my most deer-attractive plants right next to the Yard Enforcer.  I put things that deer don’t like — potatoes, for example — on the edges of the garden.  That, by itself, worked fairly well.

I’ve kept up with the Bobbex from time to time.  And I’ve now installed three wireless deer fence devices.

I still get some deer damage.  Mostly when I forget.  Forget to spray, forget to turn the Yard Enforcer back on.  But I’ve managed to keep it to a tolerable level.  As long as the deer are here and hungry, that’s about the best I can hope for.

Post #1158: High-volume knee replacement surgeons in DC, MD, VA

EDIT:  The downloadable file for this post ended up with several Excel-related glitches.  It is in the process of being replaced with a corrected file (with, I think, no Excel problems) using a newer year (2019) of Medicare data.  The revised version of this will be posted shortly.

 

If you’re thinking of having knee replacement surgery and live in DC, MD, or VA, you may want to download and have a look at this Excel (.xlsx) file:

High volume knee replacement surgeons DC-MD-VA
Size: 0,2 MB
Download surgical volume Excel workbook
398 Downloads

 

The workbook linked above contains a list of orthopedic surgeons in DC, MD, or VA who performed knee replacements on traditional Medicare enrollees in 2018.  It shows the volume of each surgeon’s Medicare-paid total knee replacements, partial replacements, and repairs (revisions) of replacements. A second sheet in the workbook provides counts of fee-for-service Medicare inpatient knee and hip replacements by hospital for the same three states.

Why should you care about how many knee replacements a surgeon has done?  In a phrase, practice makes perfect.  This is true of most complex surgical procedures such as joint replacements, and is particularly true of partial knee replacements.  To quote one carefully-done large scale study out of Great Britain:

Caseload had a profound effect on implant survival. Low-volume surgeons had a high revision rate ... and therefore should consider either stopping or doing more UKR procedures. High-volume surgeons ... demonstrated a 10-year survival rate of 97.5%, which was similar to that reported in registries for the best-performing TKRs.

(N.B., UKR = partial knee replacement, TKR = total knee replacement, revision = repair or replacement).

Why care about Medicare-paid surgeries?  Mainly, that’s the only data you can get that shows the number of procedures performed by individual surgeons.  The data and methods are public information (accessible at this link).  That raw information is impossible for most people to use, so I created the workbook above.  As importantly, Medicare is a big piece of this market.  In these three states, in 2018, the traditional (fee-for-service) Medicare program paid for roughly half of all knee replacement surgeries (documented below).  And so, while this Medicare-based workbook only shows part of each physician’s practice, in most cases it shows a large part of it.

Think of this as a place to start as you decide upon a surgeon and hospital for your knee replacement.  Volume of surgery alone is not a direct measure of a physician’s quality or competence.  But if you’re going to have a knee joint replaced, you probably want a surgeon who replaces a lot of them.   You’ll obviously want to look at more than just surgical volume before choosing a surgeon.  But surgical volume is one reasonable criterion.  This is one of the few places were you can find orthopedic surgeons known to do a high volume of knee replacement surgery.

For now, you only need to know a few things to use the data. 

  • There are no warranties or guaranties about the accuracy of this information.  Use it at your own risk.
  • This is a snapshot of 2018.  Things change, people move around.
  • These are based on claims (bills) submitted by these surgeons and paid by Medicare.  There may be occasional errors, such as the inclusion of a mix of surgery and assistant-at-surgery services for an individual surgeon.
  • This is restricted to self-designated orthopedic surgeons.  This may omit the occasional legitimate knee surgeon who (e.g.) self-designates as a sports medicine physician or other sub-specialty.
  • An orthopedic surgeon had to be paid for at least eleven knee surgeries of a given type in order to be listed.  (A “type” in this case is an AMA Current Procedural Terminology (r) code.)  A blank entry in this file should best be interpreted as “fewer than eleven surgeries”.
  • An orthopedic surgeon practicing in this geographic area might have been correctly omitted from this file because a) they moved here after 2018, or b) the address of their main practice is listed as being in some other state, or c) they did fewer than eleven of every type of knee surgery on traditional Medicare enrollees in 2018.

This workbook also contains a crude ZIP-code based distance measure.  You can use a standard Excel method (“filtering”) to find orthopedic surgeons near you.  For example, you can easily reduce the list to orthopedic surgeons within 30 miles of a given ZIP code, who did at least 100 Medicare-paid knee replacements in 2018.  The README sheet in the workbook briefly explains how to filter the data.

Absolutely nothing about this file is perfect.  The counts are incomplete, the distance measure is crude, and so on.  But for most users, it’s probably good enough to be useful.   If you’ve ever tried to find a specialist, used an on-line website, and been faced with a list of hundreds of names, you’ll understand the utility of having some systematic approach to whittling down the choices.  At the very least, if you’ve gotten recommendations for a surgeon, you can now look them up and see whether or not they appear to do a lot of knee replacements.  And, as discussed below, you can often use the Medicare Compare website to identify hospitals to which that surgeon admits patients.

The rest of this post talks a bit more about the underlying data source, documents the estimate of traditional Medicare’s share of the market in these three states, and rambles a bit about about why I put this together.

 

The data, and fee-for-service Medicare’s share of the local knee replacement market.

The Excel workbook above is based on Medicare claims (medical bill) data.  In this section, I describe the relevant parts of the Medicare program, and show that for the three states in question (DC, MD, VA), in total, traditional fee-for-service Medicare paid for about half of all knee replacements in 2018.  Throughout, I ignore Medicare Part D (drug) coverage.

Roughly 60 million Americans are insured via Medicare, our federal health insurance for the aged and disabled. You can find a concise summary of enrollment statistics at this link.

Of those, just over one-third are actually enrolled in private health care plans, termed “Medicare Advantage” or “Medicare Part C” plans.  For those beneficiaries, Medicare simply pays monthly premiums to those plans, just like any other health insurance coverage.  With limited exceptions, the Medicare program itself never sees bills (claims) for services provided to those individuals.  They are (almost by definition) excluded from the counts in the Excel workbook provided here.

Roughly two-thirds remain in the traditional “fee-for-service” Medicare program.  For those individuals, Medicare hires contractors to process and pay their covered health care bills.  For those individuals, the Medicare program gets an electronic copy of every bill that was paid.  One way or the other, each bill shows what service was provided, and how much Medicare paid for it. Those are the counts that make up the data for the workbook above.

There is a small factor that also must be considered, which is that Medicare covers inpatient facility care (Part A) separately from payment for professional and outpatient services, such as payment to a surgeon (Part B).   An increasingly large share of enrollees in traditional Medicare have Part A coverage (which is free) but not Part B coverage (which is merely heavily subsidized, not completely free).  (This does not happen in Medicare Advantage, because (with rare exception) you must have both Part A and Part B coverage to be able to enroll in a Medicare Advantage plan.) Working from these enrollment statistics, about five million Medicare beneficiaries have Part A but not Part B.  Because these are by definition concentrated solely in the fee-for-service portion of Medicare, this means that currently about 12.5 percent of Medicare fee-for-service beneficiaries have Part A (hospital inpatient bill) coverage, but not Part B (surgeon’s bills) coverage.  These individuals tend to be relatively low users of care.  But to the extent that such an individual would get an inpatient knee replacement, Medicare would see a bill from the hospital, but not from the surgeon.

For the U.S. as a whole, we can use a reference inpatient database (the AHRQ HCUP database) to estimate the fraction of all inpatient knee replacements paid by any part of Medicare.  This will include both traditional fee-for-service Medicare and Medicare Advantage plans.  As of 2018, Medicare paid for 57% of all inpatient knee replacements.

But that would include not only traditional Medicare, but Medicare Advantage as well.  To parse those apart, I relied on an old analysis that I had done for clients back when I worked in this area.  (That analysis required separating out Medicare fee-for-service discharges from records for Medicare Advantage discharges.)  Based on that analysis, for knee surgery, for DC+MD+VA combined, traditional Medicare accounted for 90 percent of inpatient knee replacements in 2017.  (For the U.S. as a whole, it was more like 70%).

So fee-for-service (traditional) Medicare’s share of inpatient knee replacements, for DC+MD+VA, would amount to 90% of 57%, or 51%.

Finally, I have to guess what fraction of those with Medicare fee-for-service inpatient knee replacement had Part A but not Part B.  This is a lot harder, because those without Part B tend to have a much lower rate of service use for elective surgery such as knee replacement.  As a reasonable guess, based on years of looking at this question for other procedures, I’d guess that 6 percent of those knee replacement patients had Part A but not Part B.

So fee-for-service (traditional) Medicare’s share of surgeon’s bills, for knee replacements, for DC+MD+VA, would amount to 94% of 51%, or 48%.

The upshot of all of that is that, if I’m looking at fee-for-service knee replacement claims paid by Medicare Part B, in DC+MD+VA, in 2018, I’m looking at just under half of all knee replacements done in this geographic area.

The actual public-use data file is Medicare’s summary of the individual claims (bills).  Medicare summarized the file by physician identifier, place of service (inpatient or outpatient), and procedure (AMA Common Procedural Terminology (r) Code).  As a privacy protection measure, Medicare blanks the data any time that leads to a count of fewer than 11 total services.

Because of that summary-and-redaction process, I will lose some counts of knee replacements every time a surgeon does fewer than 11 of any one particular type of knee surgery.  But that factor is more-or-less irrelevant if the task is to find high-volume surgeons.  It might might drop a lot of volume out of the file in total, but it should leave the counts for high-volume surgeons more-or-less unaffected.

I did considerable post-processing of the Medicare file, to achieve two things.  First, I edited out aberrant-looking lines, mostly trying to get rid of claims for assistance-at-surgery.  (Assistance-at-surgery is exactly what it sounds like — it’s the service of assisting the main surgeon who performs the surgery.  Unfortunately, assistance-at-surgery is billed using the same codes as the surgery itself, with a separate “modifier” indicating assistance.  Medicare just summarizes all the bills, regardless of modifier.)  Second, I added the counts for the range of surgical codes to generate the categories you see labeled on the spreadsheet.

As a validation, I found that after all my edits, and all the CMS redactions of cells with fewer than 11 surgeries, I ended up with 93% of the “benchmark” count of U.S. total knee replacements.  (The benchmark is based on the Medicare Part B National Summary file, excluding assistance-at-surgery (80s) claims.)

Why did I put this together.

I worked more than 30 years as a health economist, and spent most of that time analyzing Medicare claims data.  After three decades, I was both good and quick at doing that sort of analysis.

During my career, I was repeated floored by how hard it was for the lay person to get an answer to even the simplest questions about health care, based on Medicare’s experience.  If somebody in the Medicare program had not tabulated exactly what you wanted, just by chance, then you were out of luck.  In most cases, for most questions, my sole option was to work up an analysis, from scratch, directly from the large public-use or limited versions of the Medicare claims and enrollment data files.

Absent that data access and analytical firepower, I could not get answers to obvious and simple questions.  And it wasn’t so much that Medicare didn’t occasionally try to provide summary data that could answer some questions.  It’s more that most questions you’d like to see answered require just a little bit of analysis that is specific to that question.

And so it is with these counts of surgeries.  Medicare makes the raw summary file available, and even has an interactive on-line query system.  And even with that, I’d bet that the average American would find it impossible to use that system to produce any sort of meaningful information.  You have to know just a little bit — about the codes used to represent the surgeries, about assistance-at-surgery claims — to convert the raw data to a useful listing.

And, since I spent 30 years developing those skills, I figured I should put them to some use.

This is actually the second time I’ve done this analysis.  The first time was years ago, when a friend’s wife was facing a replacement of a failing partial (unicoldylar) knee.  Her knee was not done correctly the first time, it had worn prematurely, and replacements are much harder than initial implants.  She really wanted to find the best of the best for her surgery.  And so I did essentially this analysis, and in fact came across the surgeon who literally wrote the textbook on revisions of uni knees.

That story then had a happy ending.  But without access to information like this, it’s hard to pick a surgeon.  You are reduced to asking friends for suggestions, or soliciting suggestions from social media.  Both of which can work, but neither of which is very systematic.

The second time I did this analysis was two weeks ago, when a question about surgery for a uni knee revision was posted on NextDoor.  I figured, I might as well dust off the old analysis and see what it said now.  And it actually turned up the same national expert on uni knees, at the top of the listing.

Otherwise, finding and choosing a surgery is just a hard task.  You scrape together whatever information you can find from various sources.  Maybe you solicit recommendations from your family physician, friends, or via social media.  And you try to synthesize all of that.

What I have found is that on-line physician finder sites give you an overwhelming number of choices.  And when it comes to surgeons, it seems like all of them get top ratings.  They are great for showing you all of your options.  They are not much good when it comes to narrowing your options.

And that’s why I like practice-makes-perfect as a guide.  It’s not merely that you should avoid surgeons with low volumes of the particular surgery you need.  It’s that you will find that, particularly with anything out-of-the-ordinary, surgeons with high volumes got that way because they had a reputation for being the local expert.  A surgeon doesn’t get to do (say) 80 partial knee revisions per year unless that surgeon has the reputation as the go-to person for that particular surgery.

So there you have it.  It’s not perfect, slick, or pretty, but it makes that Medicare data available to people who might want to use it.  Now that I’ve worked out the kinks for doing this from public-use data, there’s no barrier to doing a national version of this file, and there are only small barriers to doing this for other common surgeries where the practice-makes-perfect effect is known to be important.  As a final note, Medicare updates the underlying data annually in November, so if I’m still in this business at that time, I should be able to update this using newer data then.

Post #1153: The dance of data destruction

For about 20 years, I was self-employed as a health economist.  In the course of that, I used terabytes of “sensitive data” in the form of health care claims (bills), all of which, at some point, had to be destroyed.

I started in the era of reel-to-reel magnetic tape.  You’ll still see those big reel-to-reel tape drives in the backround of cheesy science-fiction movies.  At some point, those open reels morphed into tape cartridges, the same magnetic medium in a more convenient and higher-storage-density package.

In either case, destroying data on magnetic tape was easy.  All you had to do was pass a big purpose-made electromagnet over the tapes, and they were rendered unreadable.  Bulk tape erasers were cheap, fast, and effective.

Then, for a while, I got most of my data on optical media such as DVDs.  Those actually had some entertainment value when they were due to be discarded.  I’d toss them on the gravel pad in my back yard and invite my kids to stomp on them.   They seemed to have a good time, and I guarantee the results made the discs unreadable.  It was an occasional family ritual we referred to as the dance of data destruction.

But what I mostly have now are disk drives.  Boxes and boxes of high-capacity disk drives.

As my career progressed, drive manufacturers were great about increasing drive capacity.  I started out using 30 and 60 megabyte drives.  (Yes, megabyte).  Large files had to be split across multiple drives.  But as time went on, files that I used to have to split across multiple drives now easily fit on modern multi-terabyte drives.  The sizes of the files that were made available for distribution increased accordingly.

Drive manufacturers did a great job of increasing capacity, but speed of access did not increase in proportion.  As a result, it takes hours upon hours to overwrite the data on a modern multi-terabyte drive.  I even bought a device dedicated to erasing drives.  This device absolutely works at as fast a rate as the drive can handle.  And for multi-terabyte drives, it takes the better part of a day to do even one pass over the entire drive surface.

And so, as much as I hate to do it, I’ve decided to destroy the drive hardware rather than just wiping the drives and giving them away.  Once you figure out how to get into the drives and extract the platters (disks), this is orders-of-magnitude faster than overwriting the data and keeping the drive intact.

This bothers me, because these drives still work.  But it only bothers me a little.   Disk drives with rotating magnetic media are dinosaurs, being replaced by solid-state drives in just about every conceivable situation.

So my lovely multi-terabyte hard drives are, in a sense, just the reel-to-reel tapes of the 2020s.  They work, but they are in the process of becoming obsolete.

I found several YouTube videos on how to take apart hard drives, but none of them seemed particularly good.  So I made my own.  If you’ve ever wondered what the inside of a hard drive looks like, check out my three-minute YouTube video on how to disassemble a hard drive and extract the platters.