Category: March 2025

My title sounds like an overly hyped, unrealistic self-help book. How is it possible to be able to dance but not walk? I actually can walk, but slowly, with a certain amount of pain and limping. Weirdly, I’m not impacted out on the dance floor. How is that possible?

Is it because I just stand out there and maybe sway a bit like a tree in the breeze? Uh, no, I’m definitely an energetic dancer. Or maybe I’m so into the music that I don’t even notice my foot killing me? No, not that either, although it sounds almost plausible.

I actually had to put some thought to this. For starters, what exactly hurts? According to pictures on the internet, the problem seems to be my first metatarsophalangeal joint. Say that three times fast!

The MTP joint is down at the base of the big toe, over the balls of the foot, not out in front where you see the big toe. And it only hurts when I’m flexing it, not when I’m just putting weight on it. Which is why I don’t think the problem is in the metatarsal bones.

Here’s a fun experiment. Start by standing up, bending your knees and shifting your weight from one foot to the other. You’re not standing up, are you? It’s such a nuisance to get up out of your chair, I know. Ah, there now we have a couple of you standing up.

Start by bending your knees a little bit. Next, move first one, then the other foot around a little bit, tap the floor with your heel or toe while leaving most of your weight on your planted foot. Pretend you’re playing hokey-pokey! Put that right foot out and shake it all about. Now wiggle your butt back and forth, swing your arms a bit, do a shoulder roll or two and you, my friend, are dancing. Note which joints you’re using. It’s likely that you’re primarily using ankle, knee and hip joints, as well as elbow, shoulder and neck, maybe even wrist and finger joints. But very possibly not your first metatarsophalangeal!

For our next experiment (stay standing, we’re not done yet, don’t worry, this one is easier). Just walk forward a couple steps. That’s it! Take a couple of steps forward. Now what’s bending? Hip, knees, ankle…and most definitely your metatarsophalangeal joint! It’s nearly impossible to walk in a forward gait while keeping your foot flat. But ironically, it’s completely possible to dance!

At home I’ve been wearing a splint that braces my toe all the way back to the arch of my foot. This definitely slows me down and creates a limping gate. When I’m out, I wear stiff boots, which keep my foot from flexing too much while walking. However, it’s March and it’s soon going to be too hot for stiff boots! Now that I better understand what is aggravating my foot, I hope to get better soon.

Laura’s friend Emily took this brief video of Laura and I dancing the other night at my friend Rebecca’s retirement party. It was a great party, and a great visit from Laura and her friend!

To send me a comment, email turning51bykristina@gmail.com.

I don’t usually do reposts, but I found this recent finance and tax article from The Atlantic to be interesting.

Titled, “Buy, Borrow, Die” by Atlantic staff writer, Rogé Karma

America’s superrich have always found ways to avoid paying taxes, but in recent years, they’ve discovered what might be the mother of all loopholes. It’s a three-step process called “Buy, Borrow, Die,” and it allows people to amass a huge fortune, spend as much of it as they want, and pass the rest—untaxed—on to their heirs. The technique is so cleverly designed that the standard wish list of progressive tax reforms would leave it completely intact. Step one: buy. The average American derives most of their disposable income from the wages they earn working a job, but the superrich are different. They amass their fortune by buying and owning assets that appreciate. Elon Musk hasn’t taken a traditional salary as CEO of Tesla since 2019; Warren Buffett, the chair of Berkshire Hathaway, has famously kept his salary at $100,000 for more than 40 years. Their wealth consists almost entirely of stock in the companies they’ve built or invested in. The tax-law scholars Edward Fox and Zachary Liscow found that even when you exclude the 400 wealthiest individuals in America, the remaining members of the top 1 percent hold $23 trillion in assets. Unlike wages, which are taxed the moment they are earned, assets are taxed only at the moment they are sold—or, in tax terms, “realized.” The justification for this approach is that unrealized assets exist only on paper; you can’t pay for a private jet or buy a company with stocks, even if they have appreciated by billions of dollars. In theory, the rich will eventually need to sell their assets for cash, at which point they will pay taxes on their increase in wealth. That theory would be much closer to reality if not for step two: borrow. Instead of selling their assets to make major purchases, the superrich can use them as collateral to secure loans, which, because they must eventually be repaid, are also not considered taxable income. Larry Ellison, a co-founder of Oracle and America’s fourth-richest person, has pledged more than $30 billion of his company’s stock as collateral in order to fund his lavish lifestyle, which includes building a $270 million yacht, buying a $300 million island, and purchasing an $80 million mansion. A Forbes analysis found that, as of April 2022, Musk had pledged Tesla shares worth more than $94 billion, which “serve as an evergreen credit facility, giving Musk access to cash when he needs it.”

This strategy isn’t as common among the merely very rich, who may not have the expensive tastes that Ellison and Musk do, but it isn’t rare either. Liscow and Fox calculated that the top 1 percent of wealth-holders, excluding the richest 400 Americans, borrowed more than $1 trillion in 2022. And the approach appears to be gaining momentum. Last year, The Economist reported that, at Morgan Stanley and Bank of America alone, the value of “securities-backed loans” increased from $80 billion in 2018 to almost $150 billion in 2022. “The real question is: Why would you not borrow hundreds of millions, even billions, to fund the lifestyle you want to live?” Tom Anderson, a wealth-management consultant and former banker who specializes in these loans, told me. “This is such an easy tool to use. And the tax benefits are massive.” You might think this couldn’t possibly go on forever. Eventually, the rich will need to sell off some of their assets to pay back the loan. That brings us to step three: die. According to a provision of the tax code known as “stepped-up basis”—or, more evocatively, the “angel of death” loophole—when an individual dies, the value that their assets gained during their lifetime becomes immune to taxation. Those assets can then be sold by the billionaire’s heirs to pay off any outstanding loans without them having to worry about taxes. The justification for the stepped-up-basis rule is that the United States already levies a 40 percent inheritance tax on fortunes larger than $14 million, and it would be unfair to tax assets twice. In practice, however, a seemingly infinite number of loopholes allow the rich to avoid paying this tax, many of which involve placing assets in byzantine legal trusts that enable them to be passed seamlessly from one generation to the next. “Only morons pay the estate tax,” Gary Cohn, a former Goldman Sachs executive and the then–chief economic adviser to Donald Trump, memorably remarked in 2017. “All of this is completely, perfectly legal,” Edward McCaffery, the scholar who coined the term Buy, Borrow, Die, told me. But, he said, the strategy “has basically killed the entire concept of an income tax for the wealthiest individuals.” The tax economist Daniel Reck, who has spent his career documenting the various ways the rich evade taxation, told me that Buy, Borrow, Die is “the most important tax-avoidance strategy today.” The result is a two-tiered tax system: one for the many, who earn their income through wages and pay taxes, and another for the few, who accumulate wealth through paper assets and largely do not pay taxes. Much of the debate around American tax policy focuses on the income-tax rate paid by the very wealthiest Americans. But the bulk of those people’s fortunes doesn’t qualify as income in the first place. A 2021 ProPublica investigation of the private tax records of America’s 25 richest individuals found that they collectively paid an effective tax rate of just 3.4 percent on their total wealth gain from 2014 to 2018. Musk paid 3.3 percent, Jeff Bezos 1 percent, and Buffett—who has famously argued for imposing higher income-tax rates on the superrich—just 0.1 percent. The same dynamic exists, in slightly less egregious form, further down the wealth distribution. A 2021 White House study found that the 400 richest American households paid an effective tax rate of 8.2 percent on their total wealth gains from 2010 to 2018. Liscow and Fox found that, excluding the top 400, the rest of the 0.1 percent richest individuals paid an effective rate of 12 percent from 2004 to 2022. (Twelve percent is the income-tax rate paid by individuals who make $11,601 to $47,150 a year.) One solution to this basic unfairness would be to tax unrealized assets. In 2022, the Biden administration proposed a “billionaire minimum tax” that would have placed a new annual levy of up to 20 percent on the appreciation of even unsold assets for households with more than $100 million in wealth. Experts have vehemently debated the substantive merits of such a policy; the real problem, however, is political. According to a survey conducted by Liscow and Fox, most Americans oppose a tax on unrealized gains even when applied only to the richest individuals. The Joe Biden proposal, perhaps unsurprisingly, went nowhere in Congress. Making matters more complicated, even if such a policy did pass, the Supreme Court would very likely rule it unconstitutional. A second idea would be to address the “borrow” step. Last year, Liscow and Fox published a proposal to tax the borrowing of households worth more than $100 million, which they estimated would raise about $10 billion a year. The limitation of that solution, as the authors acknowledge, is that it would not address the larger pool of rich Americans who don’t borrow heavily against their assets but do take advantage of stepped-up basis. That leaves the “die” step. Tax experts from across the political spectrum generally support eliminating the “stepped-up basis” rule, allowing unrealized assets to be taxed at death. This would be far more politically palatable than the dead-on-arrival billionaire’s minimum tax: In the same survey in which respondents overwhelmingly opposed broad taxes on unrealized assets during life, Liscow and Fox also found that nearly two-thirds of them supported taxing unrealized assets at death. Even a change this widely supported, however, would run up against the iron law of democratic politics: Policies with concentrated benefits and distributed costs are very hard to overturn. That’s especially true when the benefits just so happen to be concentrated among the richest, most powerful people in the country. In fact, the Biden administration did propose eliminating stepped-up basis as part of its Build Back Better legislation. The move prompted an intense backlash from special-interest groups and their allied politicians, with opponents portraying the provision as an assault on rural America that would destroy family farms and businesses. These claims were completely unfounded—the bill had specific exemptions for family businesses and applied only to assets greater than $2.5 million—but the effort succeeded at riling up enough Democratic opposition to kill the idea. The one guarantee of any tax regime is that, eventually, the rich and powerful will learn how to game it. In theory, a democratic system, operating on behalf of the majority, should be able to respond by making adjustments that force the rich to pay their fair share. But in a world where money readily translates to political power, voice, and influence, the superrich have virtually endless resources at their disposal to make sure that doesn’t happen. To make society more equal, you need to tax the rich. But to tax the rich, it helps for society to be more equal.

To send me a comment, email turning51bykristina@gmail.com.

When driving to my follow-up appointment with my oncologist a week after my clean CT scan, I did not happen to notice what I had playing on Spotify. I currently have 662 “liked” songs in my primary playlist, (as well as over two dozen more specific, smaller playlists). I was busy trying to find a parking place and wondering whether I was early or late.

As I only later noticed, Spotify happened to be playing a cover by a local Tucson band I like, an old R&B song that had originally been released during the month and year of my birth, and then made popular by Ray Charles a couple of months later. This little piece of trivia will become relevant three hours later, when the same song, queued up and waiting patiently for my return to the car, burst into the quiet of the cancer parking lot when my phone got back within bluetooth distance.

But first, I had three hours at the cancer center. The cancer center’s scheduling system is messed up. A portion of the multitude of alerts, texts, emails, and automated appointment reminders that bombard us patients give the actual time of the appointment, while another portion of the message reminders add anywhere between 10 minutes to 60 minutes of lead time in order to get you there early for prep that you may or may not need.

For example, my CT scan instructions include 60 minutes of prep time that doesn’t apply to me, and yet, they invariably have me come in 60 minutes early anyway. Their system is not nuanced enough to sort out whether you need contrast solution or not, and if so, whether it is going to be taken orally or by IV. I take mine in an IV, which is much faster than drinking it. Therefore, all the many, many automated appointment reminders sending me to the center a full hour early are completely wrong.

Adding to the complication, sometimes they need to do bloodwork first, and sometimes they don’t. It becomes quite a guessing game, and I guessed wrong. After getting my bloodwork done I had two hours to sit around at the cancer center before seeing my doctor. Cancer centers are not my ideal spot for spending a couple of hours. Everyone is suffering and scared. Cancer centers are very, very sad places.

Adding to my impatience was that I already had the (very happy) news that my scan was fine. I could see the report online. So why did I even need to be there to have the doctor tell me that? Well, for starters, I had bloodwork to do. And I needed to check in with the doctor to see if he wanted me to change any of my meds and supplements. And I needed to know when he wanted me to schedule my next set of bloodwork and my next scan.

The standard surveillance for recurrence for most types of cancers is 5 years, and I hit 5 years on March 1 (Yay!!!). But you probably remember how I have always said that in my case, I have to monitor for cancer recurrence for seven years, instead of the typical five years. That is because my kind of cancer is fairly slow to develop and it can take longer to reoccur.

For colon cancer there is a 6% recurrence rate between 5 and 10 years out. That is for stages I-III; I’m not sure the number specifically for stage 3. The likelihood of recurrence is much higher in stage 3 than in stage 1 in general, but on the other hand, it’s likely to happen sooner. So who knows. The point being, I’ve been thinking 2 more years of surveillance.

When I asked my doctor when my next scan was, he said, “You’re done.” I gaped at him, and he said, “Congratulations, you made it 5 years cancer free, and we don’t need to scan anymore.” I protested, being sure it was 7 years. Then I realized that it had to have been some other doctor had told me that, either in Boston where I got my surgery done, or Albuquerque where I did my chemo. This doctor reassured me that the protocol is still five years, not seven, even though, yes, my tumor was moderately differentiated…bla-bla-bla…and yes, the cancer had spread to a node…bla-bla-bla…my ears were buzzing.

I stood up and said, “I’ll take it!” and I burst into tears – the happy, relieved, I’m-not-dying kind of tears that happen all too infrequently at cancer centers. I hugged the doctor (and I am not a hugger) and I thanked him profusely for the work he did “saving lives” and left in a daze, still weeping.

As I exited, concerned staff and fellow patients looked up and made sympathetic noises, this poor women, sobbing as she leaves her doctor’s appointment – she must have gotten horrible news. So I announced my astoundingly good news, “The doctor says I’m ok now! I’m done and I don’t have to come back for scans anymore! He says I’m done!” There were congratulations and prayers and “bless you’s” as everyone there experienced this moment of joy that we all dream of, this moment that proves we don’t all die, that some of us survive and walk out that damn door in a flood of grateful tears.

I cried all the way to my car. As I got in my car, the song started back up again, right where it left off, still playing “I Don’t Need No Doctor”. And I don’t need my oncologist anymore!

I played the song on repeat and cried all the way home. I was such a blubbery mess that I called Laura from the car to tell her that everything was ok. She’s at my house visiting this week, and I figured if I walked in from my oncologist appointment with tears streaming down my face she’d have a heart attack. Which would have been entirely unnecessary.

To send me a comment, email turning51bykristina@gmail.com

Hi everyone, I just wanted to let you know that I got a clean CT scan this week! We are celebrating! I still have some more routine surveillance tests to do in the next few weeks, but this scan is always a big deal for me. Such a relief to be continuing with no signs of cancer reoccurrence.

Here is a photo of John and I in Hawaii recently:

We’ve been having a good winter! Hope to write more soon.

To send me a comment, email turning51bykristina@gmail.com.