Blog Archives - Polaris Underwriting

4/28/2020 0 Comments

Clear as mud? The Complexities of the Cardiac System!

Is everyone clear on the cardiac system?? If not, read on! My intent is to simplify the cardiac system and the impairments that are commonly seen in Life Settlements. In an effort to simplify the anatomy and function, I am going to compare the heart to a car! Think of the heart muscle or myocardium (myo=muscle) as the car. The coronary arteries feed the muscle and are like the fuel lines, if they become clogged, the car will not operate properly. This is called coronary artery disease (CAD), and if severe, may cause a heart attack. Procedures to open the lines include the very invasive coronary artery bypass (CABG) or if the lines are not clogged too badly, a percutaneous angioplasty (PCI or PTCA) with or without stents. The car can also get dents, dings, fender benders or more serious damage, and possibly still drive. The cardiac muscle injury is called cardiomyopathy and can occur from toxic medications, chronic uncontrolled HTN, chronic uncontrolled atrial fib, valve problems, sarcoidosis, or amyloidosis (and others), and still function, but not as well. The ejection fraction (EF) measures function or loss of function in the heart. Medications can improve the function just like body work on a car…to a point. If the frame is bent, the car will limp along and if the myocardium is seriously diseased, the individual will be significantly impaired.

Inside the car are four “seats”, R and L atria and ventricles (the drivers side is the on the right). The seats pass the blood from R front to back, then to the lungs, like the drive thru for carryout (oxygen) and from L front to back (then to the rest of the body with the oxygenated blood). The seats are separated by valves and gaskets. Just like in a car, if there is trouble with a valve, such as leaking, the function of the car will not be optimal. Shortness of breath (SOB) is a common symptom of severe valve leak. Procedures to repair the valves include a full replacement which requires pulling the “engine” or a trans-catheter repair or replacement. These procedures are highly effective at eradicating the valve leaks. Instead of the blood flowing through the seats, the front and back seats can also develop blood clots (not good). If a clot develops in the drivers’ side, as often happens in the case of atrial fibrillation, the clot may break off and lodge in the one or both lungs as a pulmonary emboli (PE). Passenger side clots can disengage and reach the legs causing deep vein thrombosis (PE, DVT) or the brain causing a stroke (CVA). This is why atrial fib is treated with a blood thinner, an anticoagulant, to prevent the clots from forming.

There are times when cars simply wear out, like heart failure. The heart is not able to pump strongly enough to move the blood to the lungs for oxygen or to the rest of the body. If the failure occurs on the driver’s side (diastolic), there will not be enough blood going to the lungs; fluid will build up in the lungs and cause shortness of breath. If the failure is on the passenger side, called systolic heart failure or congestive heart failure (CHF), fluids can build up in the legs (edema). When the car is not damaged too badly, it may be drivable. Same with the heart, medications can be used to enhance the heart pump and promote diuresis (urination), thereby decreasing symptoms and restoring function.

In other words, many cardiac problems are very treatable, including a transplant when necessary. The takeaway: treatment effectiveness and transplant candidacy hinge on age, response to treatment and comorbidity.

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4/22/2020 0 Comments

Take care of yourselves! The Effect of Diabetes on Longevity

Most people today are aware of what diabetes is and how it is treated. The formal name is diabetes mellitus, now commonly called diabetes (sugar diabetes in the dark ages). Diabetes occurs when the amount of glucose in the blood exceeds the amount of insulin produced by the pancreas. Insulin is a hormone responsible for assisting the glucose into the cells to be used as fuel. Type I insulin is also referred to as juvenile or insulin dependent diabetes; the pancreas no longer produces insulin. Type II is more common and easier to treat; the pancreas is not producing enough insulin.

Awareness and improved medications (including insulins) have made living with diabetes much easier. Insulin administration and glucose testing have also drastically improved; the insulin pump and continuous glucose monitors simplify the lives of Type I diabetics. The problem often lies with persons not embracing a restrictive diet or improved exercise regimen. When diabetes is not controlled, complications result. Diabetes affects the basement membrane in cells. Poorly controlled diabetes can deteriorate the vascular system (vasculopathy), eyes (retinopathy), renal function (nephropathy) and nerve receptors (neuropathy). Ultimately complications may cause blindness, renal failure, and even gait disorder, due to advanced neuropathies. Vasculopathy complications will negatively impact a heart that is already impaired with coronary artery disease. This shows why the combination of diabetes and previously existing vascular disease will increase the mortality multiplier. As poorly controlled diabetes continues to affect quality of life, the life expectancy will continue to deviate from standard.

Mortality of both type I and II diabetes has steadily improved since 1980. Of course, the most important information when underwriting diabetes is the control of the glucose and the affect complications are having on ADLs (activities of daily living). Levels of glucose control in the past simply revolved around lab analysis of the glucose level; for accurate levels, the person tested had to be fasting. In the 1980s, testing advanced to include hemoglobin A1c (A1c for short) which gave the average glucose level for the past 2-3 months. This was especially important because a single glucose level would be impacted by that days dietary intake only, but an average level gave a very real representation of what the actual glucose levels were. The control will affect the complications and the complications will affect the aging process and therefore longevity.

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4/1/2020 0 Comments

Working from home…Are we having fun yet?

Hello, everyone! You may have already learned that the changes in work environment due to the quarantine probably require more flexibility and open-mindedness than originally expected! Having spent many years successfully working from home, I thought I could offer a few tips and tricks I learned the hard way!

First things first, GET DRESSED!! You wouldn’t go into the office in your pajamas, would you?? Get dressed! That doesn’t mean you have to be in a suit or wearing pantyhose, but it does mean you should be presentable if someone should see you. Plan your work and work your plan. Sounds simple, and yet…! We are all tempted to sneak off and watch Netflix or engage in some other distraction. Plan your work with breaks, just like you would at the office. Coffee break at 10? Instead of using the opportunity to veg in front of the TV or play mindless games on some other device, take a walk. If you see your neighbor, they may admire your wearing apparel as you take that walk through the neighborhood. It is a good chance to connect to another living soul while practicing social distancing.
I have a love-hate relationship with my petulant printer / sinister scanner, and don’t even get me started about the fax. Funny thing, swearing or conversely begging and beseeching gets me absolutely no-where. All my ministrations and pleadings fall on deaf ears. Same thing with idle threats. I know those of us who are married, can relate. Take my husband for instance. He is the rock solid, analytical type (love truly is blind). In fact, I have never seen my husband launch a printer off the back deck!! When I do that, he looks at me like I have three heads! He tells me I must “lighten up” (GRRR). Don’t tell him this, and I will call you a liar if you repeat this, but I secretly know he is right. If I want to successfully work from home, I actually have to act like an adult and not scream at the printer “I hate you!” (sadly, a true story). It helps me to focus on breathing AND focus my attention on something else, by taking walks or at least staring out the window…stare at anything but electronics. Remember, in the place formerly known as the office, we had human interaction (be that as it may). Get to know the birds, and even your neighbors, as long as you keep social distance with both.

As the days progress to weeks and the weeks to months, the added stress will decrease longevity and increase OUR mortality if we are not careful! Not good. It is important to remember our track record as an industry, proves we are a resilient bunch. We survived and thrived the AIDS epidemic. Our industry was there to help finance continued treatment for insureds. Science in time solved the problem, and the impact today from a formerly fatal disease is minimal. We survived the 9/11 uncertainty, again, offering hope to many. We survived the financial reversals of 2008, liquefying assets to help those in need. Phil and I survived our dilemma in 2013, like now, surrounded by love and support from the industry. This too shall pass, but we must hunker down, stay positive and keep supporting those in need…and wash your hands!

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