Coincidences

Ian Fleming, the creator of James Bond, wrote in one of the Bond novels that “Once is happenstance. Twice is coincidence. Three times is enemy action.” I think the “enemy action” one is  more a function of the spy business than real life, but my life has been filled with coincidences, regular, recurring, frequent coincidences. So many, in fact, that it can not really be considered as coincidence any more. It’s got to be intentional. I have a charmed life and yes, damn it, you’d think that WOULD include the lottery, but …

And it’s been this way most of my life. When I was in college they instituted the draft lottery system, to make it more equitable to find human fodder to send to Vietnam and my lottery number was 10, so low that companies wouldn’t even schedule interviews with me – there was no point. So the Navy sent me a letter telling me about a program they had that would keep me far out to sea away from Vietnam, would get me promoted faster, and potentially trained in something useful for the future. Coincidence maybe, but it worked.

When I finally finished the Navy and got a Master’s and moved back to Nashville, I had all the interviewing skills and personality of a cross between Al Gore and a wooden indian. Despite having the highest recommendations possible from the CEO of Hospital Corporation of America, I blew four or five excellent interviews there and eventually got a job by testing highly on openings at the state, where they had to pick the highest rated people period. My future wife and the love of my life worked there. Coincidence, I don’t think so.

This job changed over time and I became a grant officer, helping establish programs for the disadvantaged across the state. We had a “special” sort of funding and we were encouraged to experiment with things that were a little out there. So we funded a program for displaced homemakers, women who had ben out of the job market taking care of children and were suddenly needing to earn a living, usually because their husbands had found someone younger. The twist this program put on the process was that they purchased a video camera and a monitor. They’d video the women in mock interview situations and then analyze what the cameras saw in the interview – body language, hesitations, etc.

One day I was talking with the director of the program and mentioned I was thinking about trying to get into industry and out of government, because the pay was so much better. She suggested we spend a weekend in front of her video camera. One thing led to another and the next thing I knew I was working in aerospace with a 60% raise. Not a coincidence.

Aerospace pays well but one reason it does is that it is highly dependent on government budgets for fighter and bomber budgets. When they end, so do the aerospace jobs so two years later I found myself unemployed and headed back into a state office building looking for a job. I was walking down a lower hallway in the Cordell Hull building when suddenly a woman came out of a stairwell and around a corner right in front of me. We both went flying, landing on our rears. It was an old friend I had known years before at the state. She asked what I was doing there, I told her and she immediately said “I have a friend who needs someone just like you.” Not a coincidence.

Within a week or so I had a decent job, paying nearly what I’d made in aerospace and a few weeks later, my new boss got promoted and reorganized her department, making me a director with another 50% raise. Because I had a Master’s in Economics, I was in charge of the budget as well as writing our annual plans. I created separate Excel spreadsheets on a 512K Mac, one for each of 16 departments, and a summary one that added up the individual categories and let me do reporting faster than our accounting department could.

Plus we were working with the local Apple reps on trying to negotiate a deal for Tennessee schools. I upgraded my 512K to a Mac Plus (I still have the motherboard) and I did some freelance design work for the Apple sales people, getting paid in software (they’d given up paying off in hardware by this time). I got a program called PageMaker, Illustrator 88 and a beta of some image editing program called Photoshop. Each one came on a 300K single-sided diskette. By now it could no longer be coincidence, it was fate.

I  used to Pagemaker to design the impending annual planning document. This was required by Federal regulations to get the money (several hundred million smackers) and tended (in other states and in Tennessee in the past) to be dense beyond measure and approved by the State Board of Education only because Federal law required it in order for us to get the money. But when I looked at what it really needed to say and started rewriting it to be simpler and more straight-forward, it became more useful and truly understandable. It also became a lot smaller document. I used the data from my spreadsheets to show what we’d done in past years and how that was to change in the future to meet (as best as possible) real demand in the local school systems. The State Board of Education called it the simplest and easiest to read state plan for Vocational Education they’d ever seen. Not a coincidence.

Then a new administration came in and, since I was a director-level person, I was considered a political appointee and I was replaced fairly quickly. I used my writing skills to find a position with an accounting firm that was moving its computer center from Manhattan to Nashville as a cost savings and I started supervising writers doing system documentation manuals. Unfortunately, all we had were writers so there was nobody to create the hundreds of forms necessary for all the systems or design the page layouts or create cover art. Some forms had already been created as nightmarish pages of form fields, broken up by hash marks for each character, and some forms had yet to be created. I learned that creating a paper form is something anyone can do, but making it usable is another thing altogether. I made them usable.

While I’d been looking for work, my wife had landed a job at Saturn as a visual designer working in their training department. They had more work than she could complete in even 60 hours a week, despite having eventually hired a dozed remarkable artists and designers, so I began helping her do her work here and there until we were working almost 50-50 on some of her projects, earning money like crazy, and becoming a better and better designer.

So once I started at the accounting company, I started doing the design work as well as supervising the writers because there was no one else to do designing. After a year or so, our team merged with another writing team and I became the lead designer, after having taught myself how to design using magazines like Step-by-Step and it’s co-publication Step-by-Step Electronic Design. Because everything was still print then, using Illustrator and FreeHand were preferable for design because of things called trapping, chokes and holds and CMYK separations, arcane aspects of design lore from the inky abyss of print.

This was fun and we were getting paid to do it. I went to Seybold annually, a magical conference at the intersection of print and the electronic future where everything in the industry premiered and where I was by now a second tier player, having trained with Jeff Schewe, Bert Monroy, Sueki Woodward, Kai Krause, and others at the top of the game. I’m not sure there were ever coincidences involved

We started creating interfaces, electronic transaction and interaction kiosks, primarily supporting in-house IT functions and meetings, complete with everything from conference displays with session and room information and 3D directions (including carpeting and wall coverings mapped to the 3D environment) displayed on screen. The first few interfaces were horrible, but the learning from them was incredible. Then we began to create interfaces for internal Lotus Notes databases, creating dozens of custom looks and applications. As part go that process we learned how insanely impossible it could be to get “leaders” to decide what the users really needed and wanted (or what look they liked for any current project).

By then, the web started to take off in the late 90s. Nobody wanted the responsibility for the company’s website but our partner saw the value and realized that there was also a need for an internal version of a website as well, an intranet. Wild dreams back then. Our writers became part-time content specialists and our designers became part-time interface designers. From our first experiments in Lotus Notes until we had a full user experience team with researchers, testers, designers, and multiple managers, It took fifteen years of effort to get beyond the leadership and the subject matter experts to the real users, but we did it.

We built a usability team, laid half the team off under a development-oriented CIO, and rebuilt it a few years later into an exceptionally talented group of 20 individuals around the world, thanks in large part to a new Chief Information Officer who lived and breathed the user experience as intently as we did, simply because it made sense. Sadly, in time he was made the global CIO and was replaced at the national level by someone who thought that he, like Steve Jobs, knew what the users really needed without having to ask. He destroyed the team there a second time.

But none of this was really coincidence. Haphazard at times, perhaps, especially the three times I was laid off, but it all built to a crescendo of a wonderful life focused on making things easier to read and use. That’s a story that never ends.

 

Healthcare Customer Experience

Change is difficult for people. We prefer the comfort of the familiar over the strange. Despite that, the world around us and how we interact with it is changing incessantly. Being aware of how your customers perceive the experience you are providing them is becoming good business. It’s critical in healthcare, particular when the illnesses are life-threatening.

I have cancer, hylar colangiocarcinoma. It’s a very rare (1,000+ per year) cancer of the bile ducts in the liver, and it’s mean. It doesn’t respond much to chemo or radiation treatments, just cutting it out. Even with successful surgery, there’s a really high rate of recurrence (58%). People who get this cancer will die from it sooner or later. There is no permanent cure. There is living a few years more or living less than a year.

My experience at receiving the same basic recommendation and prognosis from two different oncologists illustrates the current divide that exists still in medicine. This divide needs to end.

The Doctor Knows Best, Just Trust Him Method

When I was diagnosed, I had several physicians who instantly recommended a local doctor. “He’s the best there is here.” and “If I needed surgery, he’s the one.” were what we heard over and over, so that’s who we went to see. He gave us no statistics.

After he looked at the CT scan images, he came in to meet with us. He explained where the tumor was located and told us it had affected the right half of my liver and the right bile duct already. They had to come out. 

Then he told us that the CT scan wasn’t clear enough to determine if the left bile duct (there are two) was clear or not. He’d have to see once he got in there whether it was affected or not. He wanted to do a second CT scan to see if it would tell us something different, but it looked like it would be a close call as to whether the surgery could be done at all, much less be successful.

We asked him if he felt comfortable doing this sort of surgery or if there was another facility that did more of them we should go to. He responded “I do liver surgeries, I don’t sell them.” We told hime we just emanated to make sure he felt comfortable doing the surgery and he responded “Yes, I can do it.” He gave us no statistics.

He then took a few minutes to show us the CT scan onscreen, pointing out where the right duct suddenly closed off and where he said the left one was iffy. CT scans are splotches of gray and black on a screen. It takes a trained eye to understand what you’re seeing. He turned us over to the scheduler, who set up the second CT scan and the operation itself. It was to take 190 minutes.

We left the office unconvinced about how much experience he had with this specific cancer. He had offered us no data, no percentages, nothing concrete except his faith in his own abilities.

Afterwards we accidentally ran into our primary care physician who asked how things had gone. After we told her, she asked if we wanted a second opinion and we said we did. She told us she’d do some research to see which cancer centers we should call and would get back with us tomorrow morning. She recommended two, Mayo and Sloan Kettering. We called Mayo first but they had more demand than supply and couldn’t handle us. So we called Sloan in New York.

The Patients Are People Too Method

Cancer centers have toll-free appointment numbers. When you dial in you’re usually presented with a phone routing system. At Sloan, I was asked to state the kind of cancer I had. Then it asked me if I wanted a clinical or a surgical oncologist. Since surgery is the only path to survival, I picked that. I then was told “Connecting you with colangiocarcinoma.” Even the phone system specializes in my disease. I got an appointment for Christmas Eve.

We were called back to an exam room and a doctor came in almost immediately. He was an associate of our surgeon. He told us he wanted to get preliminary medical history information while the doctor was looking at the scans we had brought up. He said the doctor would be in not long after we finished the history. He then proceeded to take my complete medical history, asking questions for about five minutes. By the time he was ready to step out, he had already spent as much time with us as the local surgeon.

The lead surgeon came into the room with his entire team of nurses, two other doctors, and his physician’s assistant. He introduced the team to us and then asked what we knew about the cancer so far. Once we finished, he took up a diagram and proceeded to show us where the tumor was and what else in that area was potentially affected. He also discussed the risks of the surgery, including my dying during the operation. (Nationwide the rate is 10% for this operation, according to the American Cancer Society.) He told us that the rate at Sloan was 4%. He also talked at length about the things they didn’t know yet and the complications that would arise from them – what could keep the surgery from succeeding. Then he told us what would take place during the surgery.

The CT scan we brought up with us from home only covered the right half of my abdomen, which he indicated was unusual and didn’t provide him information they needed to make a decision critical to the operation. He needed to be able to determine as closely as possible how much liver he could leave behind – it had to be sufficient to sustain my life, and the CT scan did not show that. Nor did it show whether the left bile duct was affected. He also suggested an ultrasound that could give more information on the left bile duct.

He discussed what he was looking to determine with each test. Also, since I had other medical issues in the past, he also wanted to make sure he clearly and completely understood the state of my health, so they were going to schedule appointments with a physician and a cardiologist. Once they had time to talk to the physicians and look at the test results, he wanted to meet with me again on New Year’s Eve.

He then asked what we planned to do for Christmas Eve since we were away from home and family. We had talked about finding a nice Italian restaurant, and that’s what we told him. He said they would go get us a list of Italian restaurants in the area and have the staff make some recommendations on which ones were the best. In a few minutes, we had a five page list of Italian restaurants in Midtown Manhattan, and four or five recommendations for specific ones.

Over the next week, I had two ultrasounds, a CT scan, and appointments with other physicians. The day after Christmas, the doctor called me to let me know that the results of the CT scan and the ultrasound showed the left bile duct was not yet affected, nor was the artery leading to the liver. He was very encouraged by this and felt the surgery had a much likelier prospect for success. He had set aside an operating room and set a date for surgery.

By New Year’s Eve when we saw him the second time, I had been scanned and poked and prodded everywhere, plus they had discovered a blood clot behind my left knee that they were treating prior to surgery. The first thing he wanted to know was what we’d done for dinner on Christmas Eve and whether we had enjoyed Christmas in Manhattan. Then he went into detail about the surgery again and his remaining concern – the vein that feeds from the liver. It was the only thing they didn’t know. It hides behind the bile duct and they couldn’t determine if the tumor had reached it. The tumor had not affected the left bile duct or the artery. We discussed the surgery and it’s aftermath on me. The surgery would take anywhere from six to seven hours. Then we talked about how long the recuperation period would be and what I should expect day-by-day in the hospital after surgery.

Both physicians told us the same basic information – surgery was necessary and there were unknowns, so it might not be successful.

One took the extra time and effort to explain everything about the disease, and the treatment and did days worth of additional testing to try to find out everything possible about whether the surgery could be successful first and whether we understood all the possibilities and risks. He felt he could get the cancer and return me to my baseline health status for several years.

The other scheduled surgery.

Which would you have picked?

 

Oh, crap, part 2: The glimmer of hope edition

Well, the CT scan isn’t conclusive one way or another (so they’re going to do an MRI this week) but it’s possible that the left bile duct isn’t affected. Which is great news. They can whack off the right part of the liver and I’ll do just fine without it, but it’s just possible at this point, not definite.

If the MRI shows more detail one way or another, then the oncologist will have a better idea of whether the surgery is worth it or not. If it doesn’t show the left duct any better, that means opening me up and finding out afterwards whether the left bile duct isn’t affected (or can be resected). Or is too affected or not resectable. After.

It would be better obviously to know or at least have a better indication of if, or to what extent, the left duct has been affected by the tumor, but the line in the sand is that operating is definitely a risk but not doing it is waiting to die.

If they can’t get it all, once I recover from the surgery (6-8 weeks to get back to 70% or so of where I was before surgery), I’ll probably have maybe a year left.

We’ve heard from multiple authoritative sources that the oncologist is the best liver guy in Nashville, but we’ve also reached out to Mayo and Sloan Kettering for second opinions. Mayo was a no – they have more demand for help than specialists to give it. We’re waiting on Sloan. Waiting is the worst part of waiting.

Oh, crap. That’s not good.

When you hear someone in a white lab coat say, “it’s malignant.” or “it’s cancer.” you’d expect the reactions to be dramatic and you’re wrong. But you actually have a good indication before hand. Doctors have seen cancer before and it not only is abnormal cell behavior, but it also looks abnormal and, well, bad. And they’ll tell you that “they’re sending samples off for pathology to look at” but “it doesn’t look good.” So you know, but it’s “unofficial.”

Well, it’s official. I have hilar cholangiocarcinoma, a form of bile duct cancer. (Don’t look it up on wikipedia. Trust me on this. That’s depressingly worse than WebMD by a long shot, which is saying something.) If you try to send that information to someone on your phone, autocorrect changes “hilar” to “hilarious” and “bile”  to “bike duct” cancer, which is just funny as all get out in a gallows humor sort of way. And not. Both. It’s kind of a “My plan was to live forever. So far, so good. Oops.” kind of situation.

What that means in terms of treatment differs a lot. I’ve read it does and doesn’t respond to radiation or chemotherapy, that it requires surgery, but sometimes it’s inoperable, and that you can and can’t get a liver transplant. All pretty mixed news. But the survival rates really suck. Only 29% make it two years (only 91% make it through surgery anyway) and 17% make it to five years.

Mostly treatment is up in the air because we don’t see the bile cancer oncology specialist until later in the week. There are lots of unknowns and the websites are generally less than specific because it all depends. (As a user experience professional who uses that phrase a lot in his work, the irony isn’t lost on me.)

Like real estate, cancer is all location, location, location. Can they cut it all out (as in every little bit) and replumb the bile ductwork successfully? We don’t know that and it will probably take some other sort of operative intrusion into my innards to figure out.

Nashville has huge medical complexes and it’s home to lots of hospital organizations. They also have a really good bile cancer oncologist we see Thursday. That’s our first step. We’ll keep you up to date.

Mockup Tools (Sketch)

Introduction

If there was a list of all the design tools I’ve tried over the years, it would be pretty long. The first one I had was Illustrator 88 on a 300K diskette, partial payment for design work I did for Apple as my first freelance project. Over the years, I’ve seen and tried almost every one that’s come along, up until about a half-dozen years ago. That’s when the team I was on settled on Fireworks as our standard.

I have more familiarity with standard vector-based drawing tools, like Illustrator and FreeHand, and with Photoshop because I was a visual designer, but Fireworks can be a great tool for teams, particularly if you want to standardize what you do. Its Library feature has great potential for creating and dispensing standard components.

I had one team member create vector versions of every standard form and application element we currently used. Each element was created using styles as a wireframe element, as a fully rendered, brand-compliant element, and in inactive, active, selected, and deselected states, as appropriate. We then used an ActionScript-based add-on panel for corporate styles. Selecting an element (or a screen full of them) and selecting the right radio button could change every element from wireframes to fully-rendered mockups while you went for coffee. A huge timesaver.

All a designer had to do was drag an element onto the file from the library and modify the size and labels to meet the application needs. It included tables, standard form elements, text boxes (complete with content), complete banners for intranet sites with brand, search, personalization links, etc., everything we used on a regular basis. The screens still needed to be designed, but the components all looked as they should and no matter who the designer was, there was consistent appearance and behavior built in to the system.

Adobe never had a handle on what a web-oriented design application should be. For print, designers had to use a vector app for illustrations, logos and visuals (Illustrator or FreeHand), exported as .eps files, Photoshop for imagery, exported as tiff or .eps, and then put it all together in yet another application (Pagemaker or Quark, at first, then InDesign). They wanted the same thing to happen in the web world (Illustrator/FH, Photoshop, into Dreamweaver) but the designers at that time didn’t want to code HTML in Dreamweaver. They just wanted to design stuff and let someone less purist convert it into prosaic HTML. Now they’ve decided to stop supporting Fireworks and let it die, just as the other products they bought from Macromedia have also died.

When I’d try out a new design application, I had a process for it. I’d install the application and use it for one of my projects with an impending deadline. Yes, no training, no manual, just dive in and see if it’s shallow water. Thats what I’m planning to do with the current tests (although I’ve only done one so far). For the first tool, I decided to create a full set of the Teehan-Lax iPhone PSD files as the test. T-L had just released them and I hadn’t looked at them yet (not having a project to use them on). There was no deadline, but it would be a test involving standard mobile UI components, small, highly detailed images, and it would be a file with lots and lots of elements to create.

Sketch: Rating — workable, but not perfect

Advantages:

  • inexpensive
  • easy to use
  • good at drawing things from scratch if you can draw
  • If all you need are standard shapes, that’s easy to do
  • lets you specify pixel dimensions of objects for pixel perfect positioning
  • fully rendered looks and feel with gradients, filters, and effects are easy to do
  • lets you create styles for objects
  • once you create your screen, you can export the CSS (but not HTML)

Limitations:

  • no library of items means redrawing everything or finding that one file with that thing you need
  • limited number of objects you can have in one file
  • Mac only. No file sharing with corporate PC types

As you can see from the results, creating iOS7 files using Sketch is obviously possible. I was able to create each and every UI element in Sketch. I made a jpg of the PSD file, dropped it into the bottom layer of Sketch, locked it, and started drawing. However, after starting with the individual UI element portion of the PSD file, I ran into a snag and it was a big one.

As I work, I organize things. It’s a learned skill from trying to pick up work others have done and make changes. I group things into folders (or grouped elements) so they stay together and I can figure out what line goes where. So when I create a keyboard, for example, I’ll do each row of keys and collect them into a folder and I’ll have each row of letters in its own folder with letters in the folder in left-to-right order and the key shape layer right below the letter it goes with and the background for that keyboard at the bottom. Organized.

In addition to all the elements that make up a component, that adds complexity and more things to the files, but it’s great for six months down the road. Once I had created the individual UI components and started working on some of the dialogs and screens, Sketch stopped letting me add objects. I apparently hit the upper limit on the number of objects I could create in one file.

Most of the projects I’ve worked on are corporate applications. Internal and external applications with heavy data usage and lots of things ending up on the screens. Having limits on the number of objects I can create in one file doesn’t work well in those situations. No matter how I tried to restructure the file, it was obvious I wasn’t going to get it all in there. When you also consider that a simple drop-down picker requires a rectangle, a square, a downward pointing arrow, a label, and content text, items multiply faster than you’d think. This is a crippling feature for large applications. Combined with the lack of a library for reuse and storage, it’s less than I want for screen mockup purposes. It’s a good application for sketching but that’s not what I’m looking for.

 

More Than You Thought You Needed to Know About Hearing Aids

Some time back I heard an interesting NPR Report on hearing loss (with sound examples) that can give you a good foundation of understanding what it is like to be hearing impaired or be around someone who is. Hearing loss isn’t linear or across the board. I hear low tones pretty well but as the frequency climbs and the pitch rises, I hear less and less of it. That’s typical nerve damage-related hearing loss. Working around loud machinery, too much loud rock and roll through headphones, and similar noisy environments can do real damage. Usually, the greater loss comes in the higher portion of the hearing spectrum. People begin to have difficulty hearing consonants more than vowels.

Technology:

Analog: boosts the volume of sound coming into your ear – like tiny loudspeakers. Boosts the level of everything with limited filtering, some targeted help. Lesser cost (which in hearing aids is a hugely relative term. You can spend $7,000 or more for a pair of high-end digital hearing aids). To be honest, this may now be a historical category. I don’t know if they are still made.

Digital – the latest in very expensive, very tiny sound processing equipment using digital sound processing technology to make things sound clearer, less distorted and LOUDER, while trying to filter out background noises. Offers noise reduction and almost no feedback. If you’ve never had hearing aids, feedback is like a kid with a loud whistle hiding inside your ear. It’s usually caused by poor fit. It is guaranteed to make you wince and grab madly for your ear in public. Newer technologies can take sounds at a certain spectrum of frequencies and short them to a slightly different part of the spectrum. If you hear very poorly in one section of the hearing spectrum, those sounds get shifted to another part of the spectrum where you hear a bit better.

Analog programmable – a hybrid of the two with some programming capabilities.

Note: The technology in hearing aids changes almost as often as does other modern technology, like laptops and phones. This is up to date as of when I wrote it and thus, completely out of date.

Types: (Note that size and price are not linearly related to each other. If anything, they’re inversely related.)

Barely visible at all – fits inside the ear canal (and called ITC – in the canal) and has a nearly invisible flexible stalk with a little ball on the end you use to grab it and remove it. Least noticeable of all hearing aids and appealing to your vanity. They offer cosmetic advantages (harder to see by others) but their small size limits the amount of technology inside them. Uses the smallest batteries and thus has the smallest battery life.

In the ear – called ITE. Capable of handling digitally programmable technology that allows for several advantages. The audiologist can set break points in the audio boost to better tailor what gets amplified to match your actual hearing loss patterns. Can have both a volume switch and a tiny push switch you trigger with a fingertip to change the audio boost for certain types of environments (such as in a noisy restaurant with hard walls and ceilings which echo like crazy, or a concert/tv setting). Custom environment settings can make a difference between understanding the conversation at your table and impossibly trying to pick sounds out of the whole restaurant to hear and understand.

Behind the ear – (called BTE, you seeing the pattern?). These come in tiny versions (which can be thought of as training wheels for hearing aids) which can provide a nice boost to hearing for people who don’t yet need a significant jump in decibels. The smallest BTE aids can be perfect for small children and adults new to hearing aids with lower levels of hearing loss. They have a small clear tube that runs from the hearing aid to the (usually) flexible earpiece. They can be hard to notice if you aren’t looking for them.

When you think of the hearing aid your grandfather or great-grandfather wore, this is what you think of. These days, with technology, the huge ones like grandpa had are dinosaurs. The modern ones are much smaller (a quarter the size) and much more powerful. They can be unobtrusive. Bigger size can also mean more room for high-tech gadgetry including directional microphones to help you hear what the person in front of you is saying. (Hearing aids make everything a little louder, so you can hear things being said at restaurant tables two and three tables away almost as easily as hearing your dinner partner.) Keeping your hearing focused where you want it can be a trial to learn. This type of hearing aid usually has a larger clear plastic tube that runs from the hearing aid, over the top of the ear and into the ear. The less technology-savvy versions of the BTEs can be in the $500 each range, which is great if they work for you. You don’t want to know the top end.

The earpiece itself frequently has an open fitting which is a central dome inside an open, vented tip. This open type lets air get in your ears and reduces sweating that would take place if the ear was completely filled with a hearing aid. Hearing aids that fill your ear can make you feel as if your ears are plugged (Surprise! They are.) They have holes that run from the outside of the hearing aid through to the inside, called vents, that help. Vented tips don’t feel as intrusive and can be more comfortable.

There’s also a kind of BTE that actually has a small speaker on the tip that fits in your ears. Somewhat akin to magic. Some BTE’s come with remotes. Why would you want a remote? In a word, bluetooth. The remote can link your hearing aids and your smartphone together so that when you get a call you tap the remote and the call is fed right to your ears through the hearing aid. This is serious magic.

Remember when I mentioned the little buttons that you use to change the settings when you go in that trendy restaurant with the brick walls and tin ceiling?  Well, the buttons are on the outside of your hearing aid where you can easily tap them. When you stick your smartphone up to your hearing aid it can hit those same little buttons. As the button changes a setting, it tells you with a set of beeps or a voice that things just changed. You’re having a conversation (or trying to) and suddenly you hear the conversion punctuated with beep, beep, beep or a voice saying Three, One, Two as  you accidentally tap the buttons with your phone. The person on the other end won’t know it is happening. They’ll keep talking even though you can’t keep up.

Also, have you see those commercials for those headphones that can make the TV sound louder? the remote can work the same way. Set it in front of the TV and turn it on and the TV is piped straight into your ears.

Other things to know:

Hearing aids don’t fix your hearing problems. The most common damage is from nerve damage. Those nerves won’t heal. You will still have difficulty figuring out what the sounds are and what words those sounds are creating. (That NPR clip is an excellent example.) Most hearing loss is from nerve damage caused by exposure to loud noises. If you have a good degree of nerve damage, people will mumble louder once you have hearing aids. Mental sound processing will still be required, particularly if you are really hearing impaired. Nerve damage-based hearing loss is the most common and that loss makes it harder to hear consonants in spoken words. Write a sentence down on a white board and then erase the consonants. If you hadn’t written it down yourself, would you be able to figure out what it used to say? Begin to see the problems.

You have two ears. Had you noticed? Your mind processes the sound input from both ears to generate how you understand what you hear. If you need hearing aids, unless you had only one ear suffering from hearing loss somehow, you will also probably need two hearing aids. It’s a binaural world out there.

Using them with phones

Features you want to have in a hearing aid: Telecoil – means the hearing aid can sense that you have a phone next to your ear and it turns the hearing aid off. You want this because having something up against your ear usually creates feedback. Feedback hurts and prevents you from paying attention to anything else in the world at that moment. If you have a house phone or a standard office phone at work, this can be important.

If you have a VOIP (internet-based phone) at work or home that plugs into a USB port, you need a headset that has a cushion to keep the ear pieces off your ears. The earpieces provide space – not too much so the telecoils work as they should, but not so close that the headphones trigger any mode-changing buttons on your hearing aids. If you like to listen to music on your phone or iPod, you’ll probably need a similar type of earphone with them. One that stands off your ears and lets you switch from music playing to answering the phone will be difficult to find, but not impossible.

Cellphones are available that work with hearing aids. They are specifically labeled as hearing aid compatible. (HAC is the acronym you look for.) If you are not near the end of your contract, changing phones could be a cost to deal with in addition to the hearing aid costs. Remember, you’re going to have thingies in your ears. You can’t put ear buds in there too.

Most cell phone sales locations don’t display hearing aid compatibility information but the sales people can be beaten into confessing which models work. You can also search for accessibility at the vendor’s site as well. The Bluetooth gadgets you wear over one ear may not work with your hearing aids but you can use a hands-free bluetooth gadget in your car.

Other useful info

Hearing aids are expensive. They may fit in your pocket easily but you could also use that money to buy a used Mazda Miata. Add them to your homeowner’s insurance so they are covered. See if your employer’s insurance will cover some of the purchase cost. My employer at the time covered ½ the purchase price, but they would only do that once in my lifetime. I waited to use that benefit until I got the fancy digital ones and told my audiologist I wanted ones that would last me forever. They didn’t but I happened to change insurance carriers to one that covers the whole cost. By the way, if you are approaching Medicare age, have insurance coverage for hearing aids and need them, go ahead and get them. Medicare doesn’t cover the cost.

So how do you decide which hearing aid is right for you and how do you sort through the manufacturers? That’s where your audiologist comes into it. You have to find a good one that you can trust. You can ask doctors (like an ear, nose and throat specialist) for a recommendation, that works sometimes. The audiologist may be friends with the doctor (you’ll sometimes find an audiologist working in-house with an ENT practice) or there may be an undisclosed financial connection (happened to me).

Also, some audiologists are virtually a sole source vendor for one manufacturer. That sort of exclusive deal can get them special pricing but not necessarily the best product for you. This is about you, not them. Manufacturers can also compel audiologists to buy certain quantities of certain models on a regular basis, which is an incentive to prescribe what they have on hand instead of what’s going to be better for you in the long run.

You can try Angie’s List or a Google search, but word of mouth works the best. There’s probably someone you work with or know or see in church or the grocery that wears hearing aids. Ask them who they use and if they’d recommend them. I started with one recommended by a friend. I was tested and she recommended ITE hearing aids. They worked excellently but I wasn’t accustomed to them. Everything was so loud. I’d gotten used to having the world on mute and had a hard time adjusting. I returned the hearing aids within the 30 day period. I went with an audiologist recommended by an ENT physician. He fitted me with small BTE hearing aids that boosted the volume and were tiny. I became accustomed to hearing better with them on and a few years later moved back to the ITC types. I also moved back to the first audiologist. The second audiologist said some things that didn’t jibe with what I’d been told by the first one and I trusted the first one more. You have to go with trust. She eventually sold her practice to someone that treated customers poorly. Another friend then recommended my current audiologist and I’ve done business with him for a decade.

iPhone 7 Sketch Files

As part of trying to figure out what I’ll move to now that Adobe is ending support to Fireworks, I’m looking at alternatives. First up was Sketch, partly because lots of people use it and like it, so I decided to try it out. From past lives, I’ve found the best way to learn a new application is to grab a project, set a deadline and try to make it happen in the new software. This can be painful. Since I didn’t have a personal project to toss at it, I decided I’d just create something.

Slice 1I took a JPG export of the Teehan+Lax iPhone OS7 template, dropped it into the background, and off I went. (Those people, by the way, are significantly amazing. I’ve used their iPhone templates for as long as they’ve been making them. I’d convert them into Fireworks files and jigger them around to create what I needed. I have a lot of respect for what they’ve done. If you use Photoshop or Fireworks, use their stuff.)

My goal was to completely recreate that file in its entirety all as vectors. No bits were mapped in the making of this project. Every icon, gadget, and everything else are either vector images or Sketch objects. (Do not try to deconstruct the settings gears icons, I’m letting you know ahead of time, that one’s a pill.) As a result, you won’t see shiny iPhone cases and dreamy space scenes as background images, but nobody really uses them when designing applications anyway. You also won’t see perfectly constructed icons, either, but they do have usable ones. If you use them, your mom won’t be embarrassed for you.

What I discovered as I finished all the screen components, the Apple application screen samples, the two iPhones, the AirDrop, table views, new message screens, and then started in on creating the underlying home screen they had as an image under the control center, is that Sketch seems to have a limit on the number of objects one file can handle without repeatedly crashing and burning. It just stopped letting me make objects, period. They aren’t huge files. It happens.

As a result, I broke out the components into one file, and kept working. Then it stopped a second time and I couldn’t add anything else. As a result, I have three sketch files, the screen components, the screens sets within the applications, and a third file with the two phones, the home screen and the Control Center overlays.

What these do also include that T+L didn’t include (and I don’t blame them. That was a pain.) a fully rendered vector version of the home screen, including all the icons but not the space background image.

What these files do not include: The lock screens. They’re nice looking, but I don’t create lock screens when I design applications. It also doesn’t include the two notification screens for the same reason. (Oh, and I’m tired as well. There were five of these screens.)

Link to the archive

Urban living

After having been living in the East Dallas area for a couple of months, it’s becoming obvious to me that there are distinct advantages to living inside the city. Everything is closer. My  employer is only a few miles away and it takes less than 15 minutes to get there. Grocery stores and shopping areas are nearby a well. I filled up the gas tank on my car at the end of January. I’ve driven everywhere I needed to go since then and didn’t have to fill the tank until the 9th of March. That’s seven weeks. Amazing.

And walking to places is easier in the urban area, well, if you pick the right places to live. in some cities. I’ve got a grocery, a hardware, two coffee shops, two Tex-Mex, one Chinese, one Italian, and one Mediterranean restaurant, all within walking distance. I’m really getting accustomed to this urban lifestyle thing, Once this contract job is done, I’ll probably move back home and we’ll try to downsize our stuff, and our lives.

Daylight Savings Time

A couple of years ago I put aside my single-purpose things like watches. Although I love the look and feel of a beautifully designed watch, I can’t see a lot of sense in something that dedicated (unless it’s a hand tool, of course. Guys never get rid of good hand tool).

As a result, I’ve only got one clock to reset and that’s the bedside clock radio. It’s one of those clock radios that’s designed to automatically jump itself forward or backwards as the calendar requires. Unfortunately, I bought the clock radio in the earlier part of this century when we sprang and fell at different months than we do now. So I’m still setting and resetting clocks, this time four times a year. I just have a hard time getting rid of an otherwise perfectly good $8 clock radio.

It seems so wasteful – after all, it still works just fine. EIther that, or I’m an idiot.

Living in Dallas

Everyone we meet who finds out we are new to Dallas is warmly receptive and you always hear a “Welcome to Dallas” from them but I’ve started noticing some things. I saw it once before and it didn’t strike me but today I had a repetition and it was striking.

I’d gone to Walmart and was getting ready to leave. The super center is located less than five or so miles away and reasonably convenient to get to and like most Walmart stores, the parking lots are frequently packed. Today was no exception. After I finished shopping I started the car and made my way to the end of the row to turn left into the stream of cars leaving Walmart and I had to wait while the line cleared some and for people to make their way out from in front of me.

In the row adjacent to me, a young man and girl in a pickup took the opportunity the pedestrians provided to jump out into the line. They didn’t go much more than a dozen feet and they didn’t endanger anyone, but the Dallas policeman there (there’s always at least one at this Walmart) stepped in front of the truck, motioned for the young man to stop and then put his left hand on the hood. He began to tell the young man that he shouldn’t have pulled out, should have been in less of a hurry, etc. He was being a little pushy about it in a cop sort of way and it wasn’t a question of the young man breaking the law. He hadn’t. He was a bit impatient, but that’s not against the law. The policeman was using his badge to try to push a little “courtesy training” so to speak on someone who won’t be all that receptive. Then I noticed the officer’s right hand.

The Dallas PD, like most police departments have standardized on recommended pistols their officers can carry and they carry a Glock semi-auto pistol. It is light weight and has its safety is built-in to the trigger which makes it faster to take off the safety and fire. Most pistols have a separate safety lever that must be manually moved to take the gun off safety, but the Glock people developed an alternative and it’s built into the center of the trigger. You put your figure on the trigger and the safety is off, pure and simple.  In 9 mm caliber, the Glock can accommodate at least 15 rounds. Recall the scenario. It’s a minor traffic situation in a parking lot, an act more of discourtesy than lawbreaking. The truck stopped smoothly and quickly and no one was endangered. The police officer’s right hand never left the pistol the entire time. He had it in his holster, but it was ready to pull out in a second. He was fully ready to start a gun battle right then on the spot. In a confrontation with a police officer, there is no situation where the officer is forcibly using heavy duty intimidation than this, without pulling the weapon from his holster. I’ve heard the comment before that you don’t want to get on the bad side of the DPD. Now I understand. It was inexcusable bullying.