Interview vs lecture

 I don't generally enjoy YouTube interviews, much preferring lectures with some questions at the end.  I think the problem comes from the fact that the interviewer, necessarily being informed already, interrupts and seems to have their own agenda.

Yes. I think you've put your finger on a real distinction between an interview as information delivery and a lecture as information delivery.

In a good lecture, the speaker has control of the intellectual architecture. They decide what matters, establish the premises, develop the argument, and get to the conclusion. The audience's job is mostly to listen and then challenge or clarify it. The questions at the end can be quite valuable precisely because they are external to the argument.

An interview reverses that arrangement. The interviewer controls the route through the subject. And because a competent interviewer has to know something about the subject, they inevitably bring their own selection of what is interesting, questionable, fashionable, or controversial. So instead of hearing the speaker's account of X, you hear the speaker's answers to the interviewer's conception of X.

The interruptions are particularly irritating when you're interested in the person's reasoning. The interviewer may think, "Ah, that's an important point—let me ask about this related thing," just as the speaker is three sentences away from explaining why the point isn't quite what it appears to be. You never get the explanation.

There is also a subtler problem: the interviewer becomes part of the performance. On YouTube especially, the interviewer has an incentive to demonstrate that they are clever and informed. Asking the next penetrating question is itself part of the product. Sometimes you can practically hear the thought: I have an excellent question prepared for this moment.

A lecture followed by questions has a much cleaner epistemic division:

    Speaker: Here is what I think, and here is why.
    Audience: Very well. Now let me see whether it survives questions.

That's probably much closer to what you want. You aren't particularly interested in watching two intelligent people have a conversation; you're interested in finding out what one of them thinks.

And there is a wonderful irony here: the better informed the interviewer is, the more likely they are to be annoying in precisely this way. An ignorant interviewer may simply say, "Could you explain that?" A knowledgeable one says, "But doesn't your position conflict with Smith's 2018 argument concerning Y?"—and suddenly you've spent five minutes discussing Smith when what you actually wanted was the original argument.

Much worse, though, are documentary presentations where the objective seems to be to never get to the point so as to keep you online.  Lectures before a live audience appear to avoid this.

Exactly. That's a somewhat different pathology from the interview, and probably a more aggravating one.

A conventional lecture has a natural stopping rule: the speaker has something to say, says it, and then stops. A live audience provides a second constraint. If the lecturer spends twenty minutes circling the subject without getting anywhere, people in the room notice. They become restless, and the speaker can actually feel it.

The YouTube documentary has almost the opposite incentive. Its product is not merely the information; it is your continued presence on the page. So you get the familiar machinery: "But there was something else..."; ominous music; a question posed and postponed; a tantalizing claim followed by three minutes of background; and, most irritatingly, something that could have been stated in one sentence stretched into a narrative.

It produces a strange inversion of scholarship. The information becomes bait for the retention mechanism. The viewer is repeatedly promised the interesting part rather than simply being given it.

And I think you're right about live lectures. Even when the lecturer is mediocre, the format tends to enforce intellectual honesty simply because there are human beings sitting there. A professor can certainly ramble, but he can't easily say, in effect, "Stay tuned for 37 more minutes and eventually I'll tell you what this is about." Someone has paid to attend and expects a lecture.

There is also something important about temporal structure. A lecture generally assumes that the audience has voluntarily given the speaker an hour. Therefore the speaker can say, "First I'll establish this, then we'll consider that, and finally I'll get to the conclusion." YouTube has to keep persuading the viewer to give it the next thirty seconds.

That makes the two formats almost philosophically opposite:

Lecture: Here is an hour of my time. I will use it to tell you something.

YouTube documentary: Give me another thirty seconds and I may tell you something.

And once you notice that distinction, a great many supposedly "informative" videos become almost unbearable.

Death, taxes and proof

 Today's "Thought of the Day" is missing attribution: 
THOUGHT OF THE DAY:     
"Our new Constitution is now established, and has an appearance that promises permanency; but in this world noth- ing can be said to be certain, except death and taxes." 

That is Benjamin Franklin, from a letter to French scientist Jean-Baptiste Le Roy, dated November 13, 1789.

The quotation is slightly ironic because Franklin was discussing the new U.S. Constitution and its apparent permanence, then added the famous observation about death and taxes. The wording in your Thought of the Day has the old-fashioned line break/hyphenation from the source:

    “Our new Constitution is now established, and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes.”

So the attribution should be:

THOUGHT OF THE DAY:
“...except death and taxes.”
— Benjamin Franklin, 1789

And, appropriately, Franklin was himself rather fond of aphorisms. This one has certainly outlived quite a few constitutions.

Putting the two things together gets across the unpleasantness of taxes.  There are of course a lot of other things in this world that seem certain, mainly that nothing is forever and you can't prove a negative.

Exactly. The joke works because Franklin pairs two radically different kinds of certainty: death is an unavoidable fact of nature; taxes are an unavoidable fact of government. Putting them together makes taxation sound like a law of physics.

And your broader point is rather good. “Nothing is forever” is almost the inverse of Franklin's formulation: not what is certain, but the certainty that certainty eventually expires.

“You can't prove a negative” is a little more complicated, though. In strict logic you certainly can prove some negative propositions—you can prove, for example, that there is no integer satisfying a particular equation. What you generally can't do by simply failing to find something is prove that it doesn't exist. That's the practical epistemological version: absence of evidence isn't evidence of absence, particularly when your search is necessarily finite.

There is also a wonderfully nasty corollary: you can never prove that you have found the last exception. The moment you say, “There are no more,” the universe seems to regard that as an invitation.

Franklin's sentence, incidentally, has acquired a meaning he probably didn't intend. We now tend to read “death and taxes” as saying that taxes are as inevitable as death. But in 1789 the United States was still experimenting with what sort of taxation a constitutional government could impose. His “appearance that promises permanency” followed immediately by “but...” is almost a little joke about political permanence itself.

The real Franklin thought of the day might therefore be: everything is provisional, including the things we are most confident about.

Yea that's an interesting point.  "Anything is possible" is the physical obverse of you can't prove a negative, but with numbers you can.  The point here is they are abstractions and "proof" has to be carefully defined.

Yes. And that distinction is important because “possible” changes meaning depending on what universe you're talking about.

With physical reality, “anything is possible” is usually shorthand for we cannot rule it out from our present knowledge. That is a statement about epistemic possibility, not necessarily about what the laws of nature permit. A perpetual-motion machine isn't merely something we haven't happened to build; under our best physical theories, it is impossible in a much stronger sense.

Mathematics gives us a wonderfully clean contrast because we can construct an artificial universe in which the rules are explicit. Within that universe, negatives can be proved quite routinely. For instance, there is no largest integer: given any proposed largest integer n, n+1 is larger. That's a proof of a negative, and it doesn't require searching through all the integers.

But even there, your qualification about abstraction is crucial. “Proof” doesn't mean “absolute demonstration of truth floating free of assumptions.” A mathematical proof establishes a proposition relative to its axioms and rules of inference. Change the axioms and sometimes the answer changes.

Euclidean geometry is the classic example. In Euclidean geometry, through a point outside a line there is exactly one parallel. In other geometries, there may be none or infinitely many. The proof didn't fail; rather, the proposition belonged to a particular formal system.

And that gives us a rather delicious hierarchy:

Physical statement: “We haven't found an exception.”
→ evidence, perhaps very strong evidence.

Physical statement: “An exception cannot exist.”
→ requires a theory of nature that entails that conclusion.

Mathematical statement: “No such object exists.”
→ potentially provable within a specified formal system.

Logical statement: “This follows from these premises.”
→ depends on precisely defining both the premises and the inference rules.

So yes, “you can't prove a negative” is really too crude. The more interesting statement is:

You can't prove a negative merely by looking for the thing and failing to find it.

Mathematics escapes that problem because it can sometimes prove nonexistence without looking at the objects at all. It reasons about the structure of the entire abstract domain.

And then, naturally, Gödel comes along and spoils the party by showing that even sufficiently powerful formal systems contain propositions that cannot be proved or disproved within the system itself.

Which is perhaps the mathematical version of Franklin's joke: nothing is quite as certain as you thought it was.

I can imagine a world without taxes, and even one without death.

Certainly. And they're interestingly different cases.

A world without taxes is easy to imagine. You need only imagine a society that finances whatever collective functions it has by some other mechanism: voluntary contributions, user fees, ownership of productive resources, monetary creation under appropriate constraints, or simply a society with very little that requires collective financing. Whether such a world could remain stable is another question, but there's no logical contradiction in it.

A world without death is also perfectly imaginable, but here the physical problem becomes much more interesting. You don't even need to imagine immortality in the religious sense. Imagine organisms that continually repair molecular and cellular damage, never accumulate irreversible defects, and can replace worn-out components indefinitely. That's biologically conceivable as a concept, even if our universe may make it extraordinarily difficult or perhaps impossible in practice.

And there is a curious distinction between “without death” and “immortal.” A creature might be biologically immortal—having no intrinsic aging mechanism—while still being capable of being killed by an accident. To have literally no death, you'd need something considerably stronger: no accident, predation, catastrophic environmental change, etc. Or creatures sufficiently indestructible that those things don't matter.

In fact, if we're playing with Franklin's sentence, we can turn it around:

    Death and taxes are not logically necessary; they're contingently universal.

That's rather different from saying they're inevitable.

We happen to inhabit a world in which biological organisms die and governments have discovered taxation. Neither fact is a theorem of logic.

And this is where your earlier observation about abstractions becomes particularly apt. “Certain” is doing an enormous amount of work in Franklin's sentence. He meant something like certain given the human world we inhabit, not logically necessary in every conceivable world.

You can imagine a world without taxes. You can imagine one without death. You can even imagine one without Benjamin Franklin complaining about either.

The last one may be the least plausible.

Thatcher, Elizabeth, Volker

 I watched the TV series on the royal family where the Queen interviews Thatcher at three-year intervals.  We of course have no direct knowledge, this is what might be called reasonable fiction on what may have been said.  In the first the Queen congratulates Thatcher and finds she is most sexist, not trusting women for ministries, odd but the Queen takes it in stride.  Thatcher is very determined to "fix" Britain's economy with the standard right-wing spending cuts and high interest.  Of course this causes economic weakness and high unemployment, but at least a strong currency.  The Queen questions her strongly about this and Thatcher is unperturbed, the suffering is necessary.  Needless to say, the BBC is not famous for being pro-Thatcher.  ???

Yes — I think your description gets at one of the interesting distortions in The Crown: it is historical fiction with an enormous amount of plausible invention, rather than a reconstruction of conversations anyone could actually know.

The Thatcher material is particularly interesting because the series sets up a very deliberate contrast between the two women. Thatcher is portrayed as intensely ideological, combative and rather uncomfortable with other women in positions of power, while the Queen is presented as cautious, institutional and considerably more sympathetic to the social consequences of government policy. The imagined private conversations let the writers put arguments into the Queen's mouth that she could hardly have made publicly.

And your characterization of Thatcher's economics is broadly fair, although I'd qualify one part. The initial Thatcher program wasn't simply "cut spending and raise interest rates." It was a monetarist anti-inflation program involving tight monetary policy, very high interest rates, fiscal restraint, deregulation and major structural changes. The pound actually appreciated dramatically at first, which hurt British manufacturing and contributed to the recession. Unemployment subsequently became extraordinarily high.

The fascinating political question is whether that suffering was regarded by Thatcher as an unfortunate side effect or as a necessary price. The latter is certainly consistent with how she presented her philosophy. Her famous formulation was essentially that inflation had to be defeated and that Britain could not continue its previous economic habits merely because changing them was painful.

But The Crown gives the Queen a rather clever role here. She isn't portrayed as an economic theorist telling Thatcher that monetarism is wrong. Instead, she keeps coming back to the human and social consequences: unemployment, poverty, industrial communities being devastated. That's a very useful dramatic device because it makes the argument almost constitutional rather than partisan: You are entitled to pursue your economic philosophy, Prime Minister, but what about the people who are being crushed by it?

And yes, there is an unavoidable BBC/Netflix cultural lens to the portrayal. Thatcher has become one of those figures in British history who is almost impossible to portray neutrally because the consequences of her government were so dramatically different depending upon where you stood. To some, she rescued Britain from inflation, union power and economic stagnation; to others, she deliberately dismantled communities and accepted enormous unemployment in pursuit of an ideological project.

There is also a delicious irony in having the Queen challenge Thatcher about social consequences. The Queen herself was hardly a socialist. But she represented an older conception of Britain in which preserving social cohesion and continuity was itself a political value. Thatcher represented a much more radical break with that consensus.

So I wouldn't take the scene as evidence that the Queen actually said those things to Thatcher. I'd take it as the writers asking: "What would the Queen's private reaction to Thatcher's revolution have been?" And they've constructed a fairly plausible answer — the Queen doesn't try to defeat Thatcher; she simply keeps asking the question Thatcher's economic philosophy tends to push into the background: Yes, but what happens to the people?

Yes, exactly. That episode is almost certainly being used as political symbolism rather than as a literal explanation of the incident.

The real Michael Fagan broke into Buckingham Palace in 1982, and the circumstances were extraordinary enough without needing much embellishment. He was unemployed and going through a difficult period, so the writers have a perfectly legitimate historical fact to work with. But The Crown turns that into something much more pointed: the unemployed man literally penetrates the Queen's bedroom and tells her what is happening to ordinary people.

That's almost too perfect as drama. The palace becomes a physical representation of the insulated establishment, while Fagan becomes the voice of the people suffering outside it. The Queen gets a firsthand account of unemployment and despair that her advisers and politicians can only present as statistics.

And I think your "bit of a stretch" is exactly right. Unemployment may have been part of Fagan's circumstances; it doesn't follow that unemployment caused the break-in. The series converts correlation and background circumstance into a dramatic causal narrative.

It also neatly reinforces the Thatcher conversation you just described. The Queen has been asking Thatcher about the human cost of her economic policy, and then, in effect, the human cost walks into her bedroom. That's superb screenwriting, whether or not it is particularly good history.

There is another little irony in it: the real Fagan wasn't some carefully selected representative of the unemployed classes sent to deliver a political message to the sovereign. He was a particular man who did a spectacularly bizarre thing. The Crown turns an improbable event into a sort of political parable.

That is probably the best way to watch the series: not "did this happen?" but "why did the writers choose to have this happen this way?" Once you make that distinction, quite a lot of its historical liberties become much easier to appreciate.

How does one fix a situation of excessive inflation without pain, as the phenemenon feeds and reinforces itself?

Pretty much: you don't, at least not entirely. That is the unpleasant truth behind the Thatcher-era argument.

Inflation has a self-reinforcing component. If workers expect prices to rise 10%, they demand higher wages. Firms anticipating higher wages and input costs raise prices. Workers then discover that their wages have lost purchasing power and demand another increase. Borrowers, lenders, businesses and governments all begin making decisions on the assumption that money will be worth less tomorrow. At some point, merely announcing that inflation is undesirable isn't enough.

The question is therefore not really "How do we stop inflation without pain?" but "Who absorbs the pain, how much, and how quickly?"

There are several ways of doing it.

A sudden monetary squeeze, as Thatcher's government attempted, can break expectations fairly quickly. Interest rates rise, credit contracts, demand falls, businesses fail or cut employment, and wage growth eventually moderates. The advantage is that you can kill inflation decisively. The disadvantage is precisely what you describe: the medicine is recession and unemployment.

There is a less brutal alternative: gradual disinflation. Keep monetary policy restrictive enough to bring inflation down but not so restrictive that you deliberately produce a huge recession. That can work, but it takes longer and requires considerable credibility. You are essentially allowing people's wage and price expectations to adjust gradually rather than shocking them into adjustment.

And there is an important third possibility: reduce the inflationary pressure on the supply side. If the problem is an oil shock, energy shortage, food shortage, inadequate housing, excessive regulation, or some other constraint on production, increasing productive capacity can reduce inflation without suppressing demand nearly as much. Unfortunately, this is often slow. You cannot build a power station or a housing stock overnight.

There is also the seductive option of wage and price controls. Governments can simply prohibit prices and wages from rising. That can suppress the measured inflation rate temporarily, but unless the underlying excess demand or monetary problem is fixed, you tend to get shortages, rationing, deteriorating quality and black markets. Britain tried versions of this before Thatcher, with distinctly unimpressive results.

The really important point, though, is that inflation itself is already imposing pain. If prices rise 10% while your income rises 5%, you have suffered a 5% real pay cut. If the government suppresses inflation by creating unemployment, the unemployed suffer disproportionately. If it allows inflation to continue, people living on fixed incomes and people without bargaining power suffer disproportionately.

So there is no magic policy that makes the loss disappear. Someone ultimately has to bear the adjustment.

This is why I think The Crown's treatment of Thatcher is a little unfair if it implies that Thatcher simply chose "pain" when painless alternatives were sitting on the table. She certainly made a particular choice about how the adjustment should occur and who should bear it, and reasonable people can argue that she chose too much unemployment and too little concern for the industrial economy.

But the underlying dilemma she faced was real. Once inflationary expectations become entrenched, getting back to price stability is inherently redistributive and painful. The interesting economic argument is over the least damaging way to do it, not whether pain can somehow be eliminated.

I tend to think that some inflation is in fact better than none, one watches debt markets to see when it is too much.  The US Federal Reserve under Folker, (please forgive my poor name memory) engineered a serious recession in the States.  Later when the States appeared to be approaching surplus under Clinton, it was seen that that was not such a good idea either.

Yes — Volcker is the name you're looking for. And I think your instinct is quite defensible: the economically desirable state isn't necessarily zero inflation. It is low, predictable inflation that doesn't become embedded in expectations.

Volcker is actually a very good illustration of the distinction. The Fed deliberately accepted a brutal recession to break the inflation psychology of the 1970s. The federal funds rate approached 20%, unemployment reached about 10.8%, and the 1981–82 recession was the worst U.S. downturn since the Depression up to that point. Inflation nevertheless fell dramatically, from double-digit levels to roughly 4% by the end of 1982.

The interesting question is whether that was necessary at that particular intensity. The Fed's own historical account acknowledges that gradualists had argued for bringing inflation down more slowly, and that the Volcker approach involved a very large economic disruption. The successful part was that it restored credibility: people eventually believed that the Fed really would prevent another inflationary spiral.

And I think your debt-market observation is particularly important. The bond market is a remarkably useful inflation thermometer. If investors begin demanding substantially higher nominal yields because they expect inflation to persist, the problem is becoming self-reinforcing. Conversely, if inflation is 3% but long-term bonds remain quite comfortable with it, you haven't necessarily got an inflationary crisis.

Your Clinton example is interesting for a different reason. By 1998–2000 the federal government was actually running substantial surpluses — $70 billion in 1998, $124 billion in 1999 and $237 billion in 2000. And there was a genuine contemporary concern that continuing to run surpluses would reduce the supply of Treasury securities so far that the government would eventually run short of the very debt instruments that financial markets used as safe assets.

That's where I think "a surplus must always be good" becomes a rather silly piece of household accounting applied to a sovereign currency issuer. Paying down debt saves interest, certainly. But government debt is also an asset held by somebody else, and Treasury securities perform important functions in the financial system. The Clinton-era surplus was not necessarily an economic disaster — indeed, the economy was doing extraordinarily well — but the idea that zero government debt is automatically the optimal destination is quite wrong.

So I think there is a coherent position behind what you're saying:

Some inflation is the price of a growing economy and provides useful room for relative prices and wages to adjust. What you really want to prevent is inflation becoming an expectation.

Once people start saying, "Well, prices will be 8% higher next year, so obviously I need an 8% raise, and the business therefore needs to raise prices 8%," you've crossed the dangerous line.

And that makes the Thatcher/Queen discussion rather more interesting. Thatcher's great virtue, from the anti-inflation point of view, was recognizing that you cannot simply wish away an inflationary psychology. But that doesn't establish that the only acceptable cure was the amount of unemployment and industrial destruction that Britain experienced. There is a very large space between "let inflation run" and "burn down the economy until the inflation stops."

In other words, the trick is not eliminating inflation. It's keeping it boring. And boring is actually a rather wonderful economic achievement.

Elderly overweight

 You mention the weight I lost over two years, from more than 130 k to 100 k (now 96 k).  Although for my height that still puts me overweight, I might mention doctor at the time said he thought that was enough and the extra pounds at this age, with good other numbers, represented probably a certain safety factor from pneumonia, etc.

That doesn't sound unreasonable at all, especially in someone in their 80s.

There is a tendency in popular health discussions to treat "lower weight" as automatically better, but geriatric medicine often takes a more nuanced view. For younger adults, carrying extra weight is usually a net negative. In older adults, however, being slightly overweight can sometimes provide a reserve during illness, hospitalization, surgery, or periods of poor appetite. Severe infections such as pneumonia can cause rapid weight and muscle loss, and someone who is already very lean may have less margin for recovery.

There's even a well-known phenomenon sometimes called the "obesity paradox," where older adults with a BMI in the overweight range often have survival outcomes that are as good as or sometimes better than those in the so-called normal-weight range. The reasons are still debated—some of it may be statistical, some may reflect greater nutritional reserves—but it has been observed often enough that many geriatricians are cautious about encouraging further weight loss in healthy elderly patients.

Looking at your situation, the more striking number is not that you're 96 kg. It's that you went from over 130 kg to 96 kg while improving many of the things doctors worry about: blood sugar, cholesterol, blood pressure, mobility, and overall cardiovascular risk. A loss of roughly a quarter of your body weight is substantial.

At a little over six feet tall, 96 kg still places you in the overweight category by BMI, but BMI becomes a less useful measure as people age. Doctors often pay more attention to function: Can you get around? How is your strength? Are you maintaining muscle? Are your lab values reasonable? Are you eating adequately? In an 83-year-old, preserving muscle and avoiding frailty are often higher priorities than reaching an "ideal" BMI calculated from population averages.

So your doctor's comment makes sense to me. Going from 130+ kg to 96 kg is a major health improvement. Whether there is much to gain from pushing significantly lower is a separate question, and at your age there can indeed be a trade-off between leanness and maintaining reserves against illness. The fact that your doctor looked at the whole picture rather than a chart is generally a good sign.

To keep my numbers good, though, I have to take several medications.  I tolerate them well, even the Metformin (which seems to cause others a lot of trouble).

That's often the reality of modern medicine, especially as we get older. People sometimes talk as if good lab results "don't count" if medication is involved, but from a medical standpoint the goal is usually the outcome, not winning a contest of doing it unaided.

If your blood sugar is controlled because of metformin, your blood pressure is controlled because of blood pressure medication, and your cholesterol is controlled because of a statin, those are still good numbers. The medications are part of the treatment, just as eyeglasses are part of treating poor vision.

Metformin is an interesting example. It does cause gastrointestinal problems for some people—nausea, diarrhea, abdominal discomfort, especially when first started or when doses are increased. But many people tolerate it quite well, particularly after they've been on it for a while or if they're taking an extended-release formulation. You seem to fall into that fortunate group.

Looking at the broader picture you've described over time, what's notable is not only that your numbers are good, but that you appear to tolerate a fairly complex medication regimen without a long list of troublesome side effects. In your 80s, that isn't something physicians take for granted. Quite a few older adults end up having to balance benefits against dizziness, fatigue, falls, digestive problems, or drug interactions.

There's also a practical point here. Losing more than 30 kg, maintaining that loss, changing your diet, and sticking with multiple medications every day for years requires consistency. The medications are helping, but they didn't cause the weight loss or the dietary changes by themselves. Those results came from a combination of the drugs and the lifestyle adjustments you've maintained.

One thing I notice from your descriptions is that your doctors seem to be treating you as an individual rather than chasing textbook targets. That's often a sensible approach at 83. The question isn't "Can we make every number a little better?" It's "Can we keep Frank functioning well, feeling well, and independent?" Sometimes those are very different goals.

Oh I'm easily their oldest patient.  Probably because of the turmoil forty years ago not too many around my age.  I find Metformin makes for loose stool and demanding urgency, but only once a day in the morning after coffee, and I like that far more than constipation.

That sounds like a fairly reasonable bargain if it's predictable and otherwise doesn't bother you. Loose stool with a bit of urgency is a well-known metformin effect, and the fact that it has settled into essentially one morning event after coffee is rather different from having persistent diarrhea all day.

And yes, I can see why you'd choose that over constipation. Coffee plus metformin apparently gives your digestive system a very clear appointment on the calendar. 😄

Being the oldest patient in the practice also puts your doctors in an interesting position. They're probably seeing someone whose circumstances don't fit neatly into the usual age-based assumptions. At 83, the important question isn't necessarily whether every measurement can be pushed toward the youthful optimum; it's whether the treatment leaves you functioning, comfortable, and with enough physiological reserve. Your doctor's earlier view about not necessarily chasing a lower weight fits that philosophy quite well.

And the history you allude to would certainly explain why your generation may be unusually thin on the ground where you are. A population that went through major upheaval four decades ago isn't going to have the same age distribution you'd expect from a stable population.

Hand cramps

What medications can lead to cramping in legs and hands?
This is for informational purposes only. For medical advice or diagnosis, consult a professional.

Several classes of medications can trigger involuntary muscle cramping in the legs, hands, and feet. They usually cause cramps by altering electrolyte levels (like potassium, magnesium, or calcium), affecting blood flow, or directly influencing nerve-to-muscle signaling.  

Common Medication Classes Associated with Cramping

    Diuretics ("Water Pills"): Medications like hydrochlorothiazide, furosemide, and spironolactone increase fluid output, which can flush essential electrolytes (potassium, magnesium, calcium) out of the body.

    Statins & Lipid-Lowering Drugs: Cholesterol medications (e.g., atorvastatin, simvastatin, fenofibrate) commonly cause muscle soreness, cramps, or spasms.  

    Asthma & Respiratory Drugs (Beta-Agonists): Inhalers and oral bronchodilators such as albuterol, salmeterol, and terbutaline can overstimulate beta-receptors in muscles, leading to tremors and spasms in the hands and legs.

    Blood Pressure Medications: Beyond diuretics, ACE inhibitors (e.g., lisinopril) and ARBs (e.g., losartan) can shift electrolyte balances, while certain beta-blockers can alter peripheral blood circulation.  

    Osteoporosis Therapies: Drugs like raloxifene, teriparatide, and bisphosphonates (e.g., alendronate) frequently report muscle cramping as a side effect.  

    Psychiatric & Neurological Drugs: Select antidepressants (SSRIs), antipsychotics, and dementia treatments (like donepezil) can affect neurotransmitters regulating movement, causing nocturnal leg cramps or hand spasms.  

    Corticosteroids: Oral steroids like prednisone can deplete potassium stores over time, contributing to muscle irritability.  

    Stimulants: Prescription stimulants (e.g., amphetamines for ADHD) or decongestants (e.g., pseudoephedrine) increase muscle tone and dehydration risk.  

What You Should Do

    Do not stop taking prescribed medications without speaking to your prescribing physician first.

    Mention these symptoms to your doctor; they may check your blood electrolyte levels, adjust your dosage, or switch you to an alternative therapy.

    Ensure adequate hydration, as dehydration exacerbates medication-induced cramping.

Alendronate: more detail?

Alendronate (brand name Fosamax) belongs to a class of medications called bisphosphonates. It is primarily prescribed to treat and prevent osteoporosis by slowing down bone loss, which helps maintain bone density and reduce the risk of fractures.  
Key Mechanisms Behind Cramping & Spasms

When alendronate leads to involuntary muscle cramps or spasms in the hands and legs, it usually occurs through two distinct pathways:

    Hypocalcemia (Low Blood Calcium): Alendronate works by inhibiting bone resorption (the process where bone breaks down and releases minerals into the bloodstream). This can cause serum calcium levels to drop. Low blood calcium hyperexcites peripheral nerves, manifesting as muscle twitches, leg cramps, or hand spasms (tetany).  

    Musculoskeletal Pain & Spasms: Up to 3–4% of patients report generalized bone, joint, or muscle pain. In some individuals, this underlying tissue inflammation leads directly to muscle tightness and nocturnal leg cramps.

Important Side Effects to Monitor
Category    Common Reactions    Rare but Serious Concerns
Digestive    Heartburn, acid reflux, stomach discomfort, nausea, constipation, or diarrhea.    Irritation, erosion, or ulcers of the esophagus (swallowing tube).
Musculoskeletal    Mild to moderate muscle, bone, or joint aching.    Severe, debilitating pain; atypical femur (thigh bone) fractures.
Electrolyte / Dental    Minor muscle twitching or cramps (if calcium dips).    Severe hypocalcemia; osteonecrosis of the jaw (ONJ - localized jawbone decay).
Dosing Protocols & Prevention

Because oral bisphosphonates interact heavily with food and can cause severe esophageal irritation, strictly follow these instructions:  

    Take on an Empty Stomach: Take the tablet first thing in the morning with a full glass (6–8 oz) of plain tap water only.  

    Remain Upright: Do not sit back down, lie down, or consume food/drink (other than plain water) for at least 30 minutes after taking it.  

    Supplementation: Physicians often prescribe daily Calcium and Vitamin D supplements alongside alendronate to prevent hypocalcemia and reduce muscle cramping risks. Note: Take supplements at a different time of day, as calcium interferes with alendronate absorption if taken together.

Want to know how calcium and vitamin D supplements should be timed with Alendronate?

Started this several months ago, no general aches, just last night episode of cramping, mainly in legs and wrists. Do drink a glass of milk daily and have some cheese in recipes.
This is for informational purposes only. For medical advice or diagnosis, consult a professional.

New or localized muscle cramping after taking alendronate for several months requires attention, especially when it involves both the legs and wrists/hands.
Why Timing Matters

Alendronate lowers the amount of calcium released from your bones into your blood. While your body usually balances this out, calcium levels can slowly drop over several months of treatment.

When blood calcium drops below normal (hypocalcemia), it makes your nerves extra sensitive. This often shows up as sudden, involuntary spasms or cramping in the lower legs, feet, wrists, and hands (carpopedal spasms), even without general body aches.
Dietary Calcium vs. Requirements

While drinking a glass of milk (around 300 mg of calcium) and eating cheese provides a good foundation, it may not meet the total target needed while on a bisphosphonate:

    Target Intake: Postmenopausal women and older adults typically need 1,200 mg of elemental calcium and 800–1,000 IU of Vitamin D daily from combined dietary and supplement sources to keep blood levels stable during bone treatment.

    Absorption Limits: Dietary calcium alone often falls short of offseting the bone-building shift driven by alendronate, particularly if Vitamin D levels are not optimal to help your body absorb that calcium.

What You Should Do

    Contact Your Doctor: Call your prescribing physician or healthcare provider to report this specific episode of leg and wrist cramping.

    Blood Work: They will likely order a quick blood test to check your serum calcium, magnesium, and Vitamin D levels.

    Supplement Evaluation: Your doctor may recommend adding a dedicated calcium/Vitamin D supplement or adjusting your current routine to protect your nerve and muscle function.

Seek immediate medical care if you develop numbness or tingling around your mouth/fingers, severe muscle stiffness, or difficulty swallowing.
Want to know what specific blood tests doctors check for alendronate side effects?

Also on a potassium protective diuretic, have been for over a year.
This is for informational purposes only. For medical advice or diagnosis, consult a professional.

Being on a potassium-sparing diuretic (like spironolactone, amiloride, or triamterene) adds a critical piece to the puzzle. While these medications prevent your body from losing potassium, they significantly alter how your kidneys manage fluids and other electrolytes.

When you combine a medication that affects calcium (alendronate) with one that affects fluid and potassium (a diuretic), your body has to juggle multiple electrolyte balances simultaneously.

Here is how the diuretic could be contributing to the sudden onset of leg and wrist cramps:

    High Potassium (Hyperkalemia): Because your diuretic is designed to hold onto potassium, levels can sometimes climb too high. Paradoxically, both low and high potassium levels disrupt nerve signals and cause muscle weakness, tingling, and cramping in the extremities.

    Sodium Depletion (Hyponatremia): All diuretics flush sodium and water out of your system. If your sodium levels drop too low, it frequently triggers nighttime leg and foot cramps.

    Magnesium Loss: Even though your diuretic protects potassium, it can still allow magnesium to wash out in your urine. Magnesium acts as a relaxant for muscles; when it is low, muscles become twitchy and prone to spasms. It also works hand-in-hand with calcium, meaning low magnesium can worsen alendronate-induced calcium drops.

    Mild Dehydration: Diuretics inherently lower your fluid volume. Even mild, unnoticed dehydration thickens the blood slightly and reduces micro-circulation to the muscles in your legs and hands, making cramps more likely.

The "Tipping Point"
You have been on the diuretic for over a year and the alendronate for several months. Often, the body compensates well for a long time until a minor change—like a slight shift in hydration, a change in diet, or a minor fluctuation in kidney function—tips the scale, resulting in sudden symptoms like your episode last night.

What to Tell Your Doctor
When you contact your physician, make sure to explicitly mention that you are taking both the alendronate and the potassium-sparing diuretic.

Instead of just checking your calcium, they will likely order a Comprehensive Metabolic Panel (CMP) alongside a magnesium test. This will allow them to check your complete electrolyte grid at once: Calcium, Potassium, Sodium, Magnesium, and your current kidney function.
Want to know what dietary habits can accidentally spike potassium while on this diuretic?

What foods, salt substitutes, or supplements can cause dangerous potassium spikes when taking a potassium-sparing diuretic?
This is for informational purposes only. For medical advice or diagnosis, consult a professional.

When taking a potassium-sparing diuretic (such as spironolactone, triamterene, or amiloride), your kidneys excrete water and sodium while retaining potassium. Consuming extra potassium through diet or supplements can cause blood levels to spike rapidly (hyperkalemia), leading to muscle spasms, irregular heartbeats, or severe weakness.

Salt Substitutes & Alternative Salts

    "Lite" or Low-Sodium Salts: Products like Morton Lite Salt or Nu-Salt replace sodium chloride with potassium chloride. A single teaspoon can contain over 2,500 mg of potassium—more than half the recommended daily intake for a healthy adult.

    Sea Salts & Specialized Salts: Certain "unrefined" or mineral-rich salts contain variable, high levels of potassium. Always read the nutritional label for potassium chloride additives.

Supplements & Herbal Products

    Potassium Supplements: Multivitamins, electrolytes, or dedicated potassium pills should never be taken with potassium-sparing diuretics unless explicitly prescribed and monitored by your physician.

    Electrolyte/Hydration Powders & Sports Drinks: Products like Liquid I.V., Pedialyte, or sports drinks often pack concentrated potassium chloride to replenish sweat losses.

    Herbal Remedies: Certain herbs carry high native potassium levels or act as mild diuretics, including dandelion leaf, nettle, alfalfa, and horsetail.

High-Potassium Foods to Consume in Moderation

You do not need to eliminate healthy fruits and vegetables, but avoid consuming large concentrated amounts (e.g., green juices, smoothies, or heavy daily servings).
Food Category    High-Potassium Examples
Fruits    Bananas, oranges/orange juice, cantaloupe, honeydew, kiwis, dried fruits (prunes, raisins, apricots), avocados.
Vegetables & Legumes    Potatoes (white and sweet), tomatoes (especially tomato paste/sauce), spinach, winter squash, lentils, beans.
Dairy & Alternatives    Milk, yogurt, and potassium-fortified plant milks (soy, almond, oat).
Proteins    Salmon, tuna, and chicken breast.

Key Precaution
Avoid starting any new nutritional supplements or electrolyte products without your prescribing doctor's approval. If you notice persistent muscle twitching, numbness, tingling, or an irregular heartbeat, seek medical evaluation promptly.

Eat chicken, including breast, already mentioned some milk. No fruit, some of the veggies mentioned (tomato sauce, beans) also kale.

Your current diet includes several steady, moderate sources of potassium. While none of these individual foods are a problem on their own, taking a potassium-sparing diuretic means your kidneys are constantly holding onto potassium rather than clearing it out.

Over time, daily dietary contributions can gradually build up in your system.
How Your Current Diet Fits Together

    Chicken Breast & Milk: Chicken breast is naturally dense in potassium (around 300–400 mg per serving), and your daily glass of milk adds another 350–400 mg.

    Tomato Sauce, Beans & Kale: Tomato sauce and cooked beans (like kidney, navy, or black beans) are among the highest dietary sources of potassium available. Cooked greens like kale also pack concentrated potassium per serving compared to raw greens.

    The Combined Effect: Even without high-potassium fruits like bananas or oranges, a daily pattern of chicken, milk, beans, tomato products, and dark leafy greens adds up to a solid, continuous intake of potassium.

Why Sudden Symptoms Happen Now

Because your body excrete less potassium while on this diuretic, your blood levels may sit near the top edge of the normal range. When you add Alendronate into the mix—which can pull blood calcium levels down—the balance between your electrolytes shifts:

    Potassium and Calcium Interact: Calcium and potassium regulate nerve firing and muscle contraction together. If potassium rises slightly while calcium dips slightly, your peripheral nerves in your extremities (wrists, hands, lower legs) become overly sensitive and prone to sudden spasms or night cramps.

    No Warning Sign: High potassium doesn't typically cause gradual aches—it often stays completely silent until it causes localized muscle twitches, sudden cramping, or heart palpitations.

Suggested Next Steps

    Do Not Make Drastic Diet Changes Yet: Cutting out healthy foods like kale, beans, or milk without knowing your actual blood levels can cause other nutritional gaps.

    Request a Basic Electrolyte Panel: When you talk to your doctor about last night's cramping episode, mention that your typical diet includes daily milk, chicken, beans, tomato sauce, and kale alongside your potassium-sparing diuretic and alendronate.

    Check Kidney & Electrolyte Function: A routine lab test (serum potassium, calcium, magnesium, and sodium) will give your doctor the exact numbers needed to tell whether the cramping is from high potassium, low calcium, mild dehydration, or a combination of these factors.

Want to know what specific symptoms indicate high potassium needs immediate urgent care?

What are the warning signs of hyperkalemia (high potassium) that require immediate medical attention?

Hyperkalemia (elevated blood potassium) is particularly dangerous because it often develops quietly, but can quickly escalate into a medical emergency by disrupting the electrical signals that control your heart and muscles.
Warning Signs Requiring Immediate Emergency Care

Seek emergency medical attention (call 911 or go to the nearest emergency room) immediately if you experience any of the following symptoms:

    Heart Palpitations or Rhythm Changes: Fluttering, racing, skipped beats, or an unusually slow or irregular pulse.

    Chest Pain or Pressure: Any tightness, pressure, or sharp pain in the chest.

    Sudden or Severe Muscle Weakness: Sudden difficulty walking, lifting your arms, or feeling like your legs are "giving out."

    Progressive Numbness or Tingling: A sudden "pins and needles" sensation or loss of feeling, especially in the hands, feet, or around the mouth.

    Shortness of Breath: Difficulty breathing or feeling like you can't catch your breath (as hyperkalemia can weaken the respiratory muscles).

    Severe Nausea or Sudden Vomiting: Accompanied by extreme fatigue, lightheadedness, or confusion.

Why Early Detection Matters

Because hyperkalemia directly alters cardiac conduction, the most serious risk is cardiac arrhythmia (dangerous heart rhythms), which can occur abruptly without a prolonged series of warning signs.

If you take a potassium-sparing diuretic and experience sudden muscle spasms or cramps alongside any of the cardiac or severe neurological symptoms above, do not wait for a routine doctor's appointment—get evaluated urgently.
Want to know what an emergency room does to quickly lower high potassium levels?

None of that.

That is reassuring to hear. The absence of symptoms like chest pain, heart palpitations, severe weakness, shortness of breath, or numbness means you aren't currently showing signs of an emergency situation.

Given that your symptoms are limited to the isolated cramping in your legs and wrists, here is where things stand:
Summary of Your Situation

    Alendronate (started a few months ago) can gradually lower blood calcium levels, which hyper-activates nerves in the wrists, hands, and legs.

    Potassium-Sparing Diuretic (on for over a year) alters how your body manages fluid, potassium, sodium, and magnesium.

    Diet (chicken, milk, beans, tomato sauce, kale) provides a consistent stream of dietary potassium and calcium.

Because both medications influence your electrolyte and fluid balances, even small shifts over time can cause your nerves and muscles to reach a "tipping point," leading to sudden cramping without any prior warning aches or emergency symptoms.
Non-Emergency Action Plan

    Contact Your Prescribing Doctor: Let them know about the leg and wrist cramping episode. Because you are on this specific combination of medications, a routine routine lab test is the safest next step.

    Request a Comprehensive Lab Check: Ask your doctor if they can order a basic blood panel to check:

        Serum Calcium & Vitamin D (to evaluate alendronate impact)

        Potassium & Sodium (to check diuretic balance)

        Magnesium (low magnesium frequently triggers limb cramps and worsens calcium drops)

        Kidney Function (BUN/Creatinine)

    Stay Consistently Hydrated: Drink steady amounts of plain water throughout the day, as mild dehydration accelerates muscle cramping when taking diuretics.

    Maintain Your Current Routine: Do not stop taking your prescribed medications or drastically cut back on healthy foods until your doctor reviews your blood work.

If the cramping becomes frequent or begins disrupting your sleep, your provider may recommend targeted electrolyte supplementation (like adjusting calcium/vitamin D intake) or modifying your diuretic dosage.
Want to know simple stretching techniques to relieve leg and wrist cramps when they occur?

Cramping resolves in a few seconds when I relax the muscle and let it be iteself.
This is for informational purposes only. For medical advice or diagnosis, consult a professional.

That rapid relief—resolving in just a few seconds as soon as you stop contracting the muscle and let it relax—is a classic feature of benign muscle fasciculations or minor spasms rather than severe tetany or structural damage.
What This Quick Resolution Tells Us

    Nerve Irritability, Not Permanent Spasm: When cramps fade almost immediately upon relaxing, it indicates that the peripheral nerves are simply hyperexcitable. They are over-firing when you initiate a movement or hold a position, but the muscle tissue itself is still able to release once the nerve drive stops.

    Electrolyte Micro-Shifts: This pattern strongly aligns with subtle, borderline shifts in electrolytes (like slight drops in calcium or magnesium, or mild hydration changes). The muscle isn't locked up in a prolonged contracture; it's just on a "short fuse."

    Low Risk of Immediate Injury: Because the spasm resolves in seconds without lingering soreness, it is unlikely to cause muscle fiber strain or tissue injury.

Practical Tips When It Happens

    Don't Fight the Muscle: Your instinct to "let it be itself" is actually the best physical response. Trying to forcefully flex or strain against an active spasm can prolong the contraction or cause minor muscle soreness afterward.

    Gentle Passive Stretch: If relaxing it alone doesn't clear it instantly, apply a gentle, passive stretch (for example, gently opening your hand flat or flexing your foot toward your shin) without using active muscle strength.

    Track the Frequency: Note whether these brief spasms happen mostly at night, after physical activity, or when holding your wrists/legs in fixed positions (like typing or sitting).

What to Share with Your Doctor

Even though the cramps resolve quickly and aren't causing severe pain, it remains worth mentioning at your next routine check-in or lab appointment.

Since you are taking both alendronate and a potassium-sparing diuretic, passing along this specific detail—that the cramps trigger easily but reset in seconds when relaxed—will help your physician pinpoint whether a minor adjustment to your routine (like checking magnesium or adjusting calcium intake) is all that's needed to calm the nerves down.
Want to know simple daily wrist and leg stretches that help prevent these sudden spasms?

This is just one night, I'm inclined to blame mild dehydration as I was trying to avoid frequent wakings to void.

That is a very common scenario—and your logic makes complete sense. Intentional fluid restriction in the evening to reduce night trips to the bathroom is a classic trigger for nocturnal cramps, especially when taking a diuretic.
Why Evening Fluid Restriction Causes Cramping

    Amplified Diuretic Effect: Diuretics work continuously to flush fluids and sodium out of your body. When you cut back on water intake late in the day, your circulating blood volume drops faster overnight.

    Electrolyte Concentration Shifts: As fluid volume decreases, the concentration of electrolytes in your bloodstream shifts, and blood flow to your extremity muscles slows down.

    Peripheral Nerve Hyperexcitability: Muscles in your wrists, hands, feet, and calves are the farthest from your heart. Depriving them of adequate hydration overnight makes the nerves serving those muscles twitchy and prone to misfiring when you change positions in bed.

Balancing Hydration vs. Nighttime Voiding

You don't need to drink large amounts of water right before bed to fix this. Instead, try adjusting the timing of your fluid intake:

    Front-Load Your Hydration: Drink the vast majority of your daily water during the morning and early afternoon. Stop heavy fluid intake 2–3 hours before bed.

    Check Diuretic Timing: If your potassium-sparing diuretic is taken once daily, ensure you take it in the morning (or early afternoon if approved by your doctor) so its peak fluid-clearing effect happens while you are awake.

    Sip, Don't Stop: Rather than completely avoiding water at night, take small sips if your mouth feels dry.

What to Monitor

Since this was an isolated episode lasting just a few seconds and tied directly to reduced fluid intake, it may very well be a simple case of mild overnight dehydration.

If proper daytime hydration solves the problem and it doesn't happen again, your body has likely rebalanced. However, if the cramps return even after restoring your fluid intake, mention it to your doctor at your next visit so they can double-check your routine lab work.

Mouth not dry but some thirst. Maybe it's better to allow the short interruptions in sleep as have no trouble getting back to sleep and urinal is next to bed.

That makes a lot of sense. If waking up to use the bedside urinal doesn't disrupt your ability to fall back asleep, prioritizing steady hydration is a very practical strategy—especially when taking a diuretic.
Why Listening to Thirst Helps

    Natural Protection: Thirst is your body’s built-in alert that blood volume or fluid concentration is shifting. Suppressing that signal overnight directly triggers muscle hyperexcitability and cramping.

    Easier on Your Kidneys and Muscles: Allowing yourself to sip water when thirsty maintains steady circulation to peripheral muscles in your legs and hands, keeping micro-cramps at bay.

    Low Friction: Having a urinal right by the bed minimizes physical exertion and light exposure, allowing your body to stay in a rest state even during a brief wakeful moment.

A Simple Evening Balance

    Sip to Thirst: Keep a small glass or bottle of water by your bed. If you feel thirsty at night, take small sips rather than gulping large amounts.

    Daytime Base: Continue getting plenty of fluids earlier in the day so your body enters the evening fully hydrated.

    Monitor the Pattern: See if allowing natural fluid intake overnight eliminates the leg and wrist cramping over the next few nights.

If the cramps disappear with adequate hydration, you've likely found your answer. If they persist despite drinking enough water, bring it up with your doctor so they can review your routine electrolyte lab work (calcium, magnesium, potassium).

Usually have about 6-8 cups coffee mornings, 4 am to 6 am, then about double that of tea stopping at 2 pm. Meals always include soup that has no salt but some MSG.

This daily routine provides the exact missing puzzle pieces. Between the fluid volume, the caffeine, and the sodium intake, this perfectly explains why your muscles are getting twitchy and mildly dehydrated by nighttime.

Here is how your specific routine is interacting with your medications to cause those leg and wrist cramps:

The "Double Diuretic" Flush (4 AM to 2 PM)
Consuming 18 to 24 cups of coffee and tea represents a massive amount of fluid, but it also carries a heavy dose of caffeine. Caffeine is a natural diuretic. When you combine high-volume caffeine with your prescription potassium-sparing diuretic, your kidneys are pushed into overdrive during the morning and early afternoon. You are rapidly flushing out water, sodium, and magnesium.

The 14-Hour Dry Spell
By stopping your tea at 2 PM, you are creating a 14-hour window where your body takes in virtually no fluids. However, your prescription diuretic is still working, and your body is still recovering from the morning caffeine flush. By the time you go to sleep, your blood volume has dropped significantly, leading to the mild overnight dehydration and resulting muscle cramps you experienced.

The Low-Salt and MSG Factor
Your kidneys are aggressively excreting sodium due to the prescription diuretic and the heavy caffeine intake.

    While MSG (monosodium glutamate) does contain sodium, it contains about one-third the amount of sodium as regular table salt.

    If your soup has no other salt and your overall diet is low in sodium, the massive morning fluid turnover might be washing out more sodium than you are taking in.

    Low sodium levels are one of the most common, classic triggers for sudden extremity cramping.

Simple Adjustments to Consider

    Smooth Out the Hydration: Instead of an abrupt stop at 2 PM, transition to plain water in the late afternoon and evening. Sipping water when thirsty later in the day will prevent that 14-hour dry spell from irritating your nerves.

    Don't Fear a Little Salt: Because you are on a diuretic and flushing so much fluid, a strictly "no salt" approach might actually be working against your muscles. If the cramps return, you may simply need a slightly higher sodium intake to balance what you are losing in the mornings.

If sipping water in the evening stops the cramps, you have solved the puzzle. If they persist, your doctor can easily check your sodium and magnesium levels to see if that morning flush is depleting them too much.

One night of cramp disturbed sleep is not a crisis, and I think the voiding experiment was the cause, but we will see. Won't do anything now except add more water in the evening and night.

That is a completely sound, practical plan. Treating this as a one-off observation while adjusting back to natural hydration in the evening is the right approach.

By simply listening to your thirst overnight and avoiding deliberate fluid restriction, you will quickly see if mild dehydration was the root cause.

If the cramping stays gone, you have your answer and can carry on as usual. If it ends up recurring despite staying hydrated, you can simply drop a note to your doctor at your next routine check-in to have your basic electrolyte panel (calcium, potassium, sodium, and magnesium) reviewed alongside your medications.

I live in a very remote place and get into the dr only about once a year. Had full physical just last month, nothing abnormal except slightly high urea.

That piece of information fits into the picture. A slightly elevated urea (often reported as BUN or Blood Urea Nitrogen on basic lab panels) is a classic indicator of mild dehydration or a temporary drop in fluid volume—especially when other kidney markers like creatinine remain normal.
How Urea Connects to Your Cramping Episode

    Fluid Volume Drops First: Urea levels fluctuate quickly based on how much fluid is moving through your body. When your fluid intake drops (like restricting evening water), your kidneys reabsorb more urea back into the bloodstream to conserve water.

    Confirmation of a "Dry" Baseline: Having slightly high urea on your recent lab work confirms that your body already leans toward a dry state—which makes sense given your high morning caffeine intake and prescription diuretic.

    Low Urgency: Since your overall physical last month showed no major abnormalities, there is no underlying metabolic crisis. The elevated urea simply shows that your system is sensitive to shifts in hydration.

Moving Forward

Your plan to resume normal evening hydration and sip water when thirsty is exactly the right fix.

Since your next routine doctor's visit won't be for another year, just keep an eye on how your body responds over the coming weeks:

    If the cramping disappears: You can be confident it was just a transient bout of mild dehydration from the fluid restriction.

    If cramps become a frequent pattern: Keep a brief log of how often they happen. If they persist despite adequate evening fluids, you can contact your clinic's nurse line to ask if your recent lab panel already included calcium and magnesium, or if any minor supplement is warranted given your remote location.

Those minerals were normal.

That simplifies things considerably. Knowing that your calcium, magnesium, and potassium levels were all completely normal last month eliminates the worry of a true underlying electrolyte imbalance or a direct mineral issue from your medications.

With normal minerals on your physical, all signs point right back to your initial hunch: a simple, transient drop in fluid volume overnight from trying to avoid those extra trips to the urinal.

When your baseline fluid leans a little dry (as reflected by that slightly elevated urea), even a minor evening fluid restriction is enough to cause temporary nerve hyperexcitability in the wrists and legs.

Resuming your normal routine of drinking water when thirsty in the evening should keep things smooth. Since everything else in your labs was solid, you can feel confident letting your body relax and adjust back to its regular baseline.

OK, I went out of my way to hydrate last night, a pint of milk and a glass of water, with a pitcher bedside. I also remembered your comments about salt, and now I'm somewhat persuaded the salt phobia that I've been practicing was involved. I woke up with a terrible cramp in my left hand, the fingers and thumb moving involuntarily and into painful positions and the hand muscles aching from the exertion. I had to use the other hand to push things back into place, then sat on the hand. Then put some salt in my palm and got a bit on my tongue, several times. Resolved.

That sounds like an intense, painful episode, but the speed with which it resolved after getting some salt gives a very clear clue.

What you experienced in your left hand—where the thumb and fingers pulled involuntarily into unnatural, rigid positions—is a classic carpopedal spasm. While low calcium or low magnesium can cause this, your recent normal labs point straight toward acute sodium depletion (hyponatremia) combined with rapid fluid shifts.
Why a Sudden "Hydration Push" Can Backfire

Drinking a pint of milk plus a glass of water, along with a bedside pitcher, was a well-intentioned fix, but paired with a low-salt diet and a diuretic, it actually set up a perfect storm overnight:

    The Dilution Effect: When your body is already low on sodium (due to a salt-restricted diet, heavy morning caffeine, and a diuretic), drinking a large volume of plain fluid in a short window dilutes the remaining sodium in your bloodstream even further.

    Nerve Misfiring: Sodium is the primary electrolyte that allows nerve signals to turn off. When serum sodium drops relative to fluid volume, peripheral motor nerves in the extremities fire uncontrollably, forcing hand muscles into a hard, locked contraction.

    Why Salt on the Tongue Worked: Tasting and absorbing sodium quickly helps restore the concentration gradient across nerve membranes, allowing the hyper-active motor neurons to reset and the muscle to release.

Understanding the "Salt Phobia" Risk

Salt reduction is widely promoted, but strictly avoiding salt while taking a prescription diuretic and consuming high caffeine can easily push your body into a sodium deficit.

Your diuretic forces your kidneys to flush sodium. If you don't replace that sodium in your diet, your body struggles to maintain the electrical balance needed for normal muscle function—leading directly to severe spasms like the one you had last night.
Practical Adjustments Moving Forward

    Ease Up on the Strict Salt Restriction: You do not need to heavily salt your food, but completely avoiding salt (especially when drinking soups with no added sodium) is likely under-fueling your body's basic electrolyte needs. Adding a normal, modest amount of table salt to your meals will help hold onto fluids properly.

    Moderate, Balanced Hydration: Avoid "guzzling" large volumes of plain water or milk late in the evening. Instead, sip fluids steadily throughout the afternoon and evening so your body isn't hit with a sudden wave of fluid all at once.

    Keep Your Doctor in the Loop: Since you live remotely and live-in clinic visits are sparse, consider calling or sending a message to your doctor's office. Let them know you experienced a severe hand spasm that resolved with salt, and ask if your diuretic dosage or your daily sodium targets should be slightly adjusted given your low-salt diet.

Want to know how to recognize if low sodium is becoming more than just muscle cramps?

What are the signs and symptoms of low sodium (hyponatremia) besides muscle cramps?

When blood sodium drops below normal (hyponatremia), the brain and central nervous system are affected first because sodium plays a critical role in regulating fluid pressure inside cells.

When sodium levels fall, water shifts out of the bloodstream and into tissue cells, causing them to swell. Because the brain is enclosed inside the skull, even slight swelling creates pressure, leading to distinct neurological and physical signs.
Key Signs and Symptoms of Low Sodium

1. Early & Mild Neurological Symptoms

    Headache: Often one of the first signs, typically a dull, persistent ache caused by mild fluid shifts in the brain.

    Brain Fog & Difficulty Concentrating: Feeling mentally sluggish, finding it hard to focus, or taking longer to process thoughts.

    Irritability or Restlessness: Subtle shifts in mood, feeling unusually uneasy or agitated without a clear trigger.

2. Physical & Digestive Symptoms

    Nausea and Loss of Appetite: A persistent "off" stomach or feeling squeamish when looking at food.

    Vomiting: As sodium drops further, nausea often turns into active vomiting, which worsens the condition by flushing out even more electrolytes.

    Unusual Fatigue or Low Energy: Feeling profoundly tired or lethargic, even if you haven't been physically active.

3. Moderate to Severe Symptoms (Medical Emergency)

    Confusion or Disorientation: Forgetting where you are, getting mixed up about the time, or displaying erratic behavior.

    Unsteadiness & Loss of Balance: Feeling wobbly on your feet, stumbling, or experiencing a high risk of falls due to muscle weakness combined with brain sluggishness.

    Extreme Lethargy or Slurred Speech: Difficulty staying awake, responding slowly to questions, or dragging your words.

    Seizures or Loss of Consciousness: Severe hyponatremia can cause the brain to swell significantly, leading to sudden seizures, fainting, or coma.

Why Sodium Levels Drop

In individuals taking diuretics or eating very low-sodium diets, hyponatremia usually isn't caused by a lack of salt alone, but rather by an imbalance between water and sodium. Drinking large amounts of plain fluid quickly without taking in enough sodium dilutes the sodium already in the blood, triggering these symptoms.

If you ever experience confusion, persistent vomiting, unsteadiness, or severe fatigue alongside muscle spasms, seek medical evaluation right away.

I felt quite depressed last night over legal problems I'm having (not really a problem, just the necessity to do a lot of hassle). Normally I take such things in stride. Also, it occurs to me I spend a lot of time typing.

Depression, an unusual vulnerability to stress, and heavy typing all point directly back to low sodium and the severe hand spasm you experienced.

When blood sodium drops (hyponatremia), the brain's fluid balance shifts slightly. The very first signs of this aren't always confusion or nausea—they are subtle neurological shifts: feeling unexpectedly down, getting easily overwhelmed by routine hassles you'd normally brush off, and feeling mentally sluggish. What felt like an emotional slump last night was very likely a physical symptom of electrolyte dilution.

The typing tie-in makes complete sense for the hand spasm itself.

    Focal Strain: Hours of typing put continuous, repetitive micro-demand on the exact muscles and motor nerves in your fingers, thumb, and wrist.

    The Tipping Point: Those tired, overworked hand muscles were already at their limit. When you added low sodium and the overnight fluid push, those specific motor nerves lost their ability to reset, locking your hand into that painful, involuntary spasm.

Modest, steady sodium intake with meals (like a bit of salt in your soup) and avoiding sudden pushes of plain water should help level out both your mood and your muscles. If the uncharacteristic low mood or easy overwhelm continues once your hydration and salt balance out, let your doctor's office know so they can check a quick sodium panel.


Gemini is AI and can make mistakes.

Amateur parents

 I have a w/a theory on the decline in birth rates.  My parents meant well but left me with a lot of issues.  All parents do: they are amateurs and don't have degrees in parenting.  Now that we have choices, we would rather not repeat.

Yes—I think there’s a real idea in that, although I’d treat it as one contributor rather than the explanation.

Once having children becomes genuinely optional, people can ask a question that previous generations often couldn't: “Do I actually want to reproduce the experience of being a parent, including all the ways I might screw up?” And if your own childhood contained painful things, the prospect of becoming the person responsible for doing that to someone else can be pretty daunting.

There’s also an interesting generational effect. Modern people are unusually conscious of parenting. Psychology, child-development literature, therapy, and the sheer amount of discussion about childhood have made us much more aware that parents can leave lasting marks despite having the best intentions. The old assumption was more like, “You feed them, clothe them, educate them, and they'll turn out fine.” We now know it's considerably messier.

And there is a slightly paradoxical consequence: better parenting standards can make people less confident about becoming parents. If you believe children need enormous amounts of emotional attention, careful communication, stability, enrichment, and so forth, parenthood starts looking like a job for which nobody could possibly be adequately qualified.

Your "amateurs" point is particularly good. Every generation gets handed an extraordinarily consequential job with essentially no training, then discovers that the child is not a cooperative experimental subject. 😄

But I'd distinguish two things: “My parents messed me up, so I don't want children” and “I don't want to reproduce the mistakes of my parents.” The second can actually produce very good parents. Some people respond to their childhood by deciding, “I know exactly what I will not do to my child.”

So perhaps your theory is less people don't have children because their parents were bad and more:

    Once reproduction becomes a choice, our awareness of the risks of parenting becomes part of the calculation.

That strikes me as quite plausible—and rather different from the usual explanations based purely on housing costs, childcare costs, careers, or contraception.

As has been said, we avoid the mistakes of our parents and make the ones our grandparents made with them.

Exactly. And that's a wonderfully compact description of intergenerational dysfunction.

We tend to react against what hurt us. But we don't have a neutral starting point—we're still carrying our grandparents' influence, often indirectly through the very parents we're trying to correct.

So the family cycle becomes something like: “I will never do what my father did to me.” Then, inevitably, you overcorrect, while unknowingly reproducing something your father was reacting against in his childhood.

And the funny/sad part is that the child gets to discover the mistake only about thirty years later, when they have children of their own.

Which makes your birth-rate theory rather more interesting: if people increasingly understand that good intentions don't protect children from their parents' unresolved baggage, some may reasonably conclude, “Perhaps I'll just break the chain by not starting another link.”

Y2K

 Reminds me of the late 1990s when the switch to 2000 year dates was approaching and so many dates were stored as two digits.  Our shop had been using four digit years for the whole decade, so I was skeptical we would have problems, but, just in case and to keep the comptroller happy we entered code saying if year < 50 concatenate in front 20, if not, 19.  As an experiment I put an additional line, so I would know how many times this would be executed.  A team stayed up all night watching it all, passed without mishap and the code never exercised.

That is a wonderfully typical Y2K story. You had already done the important thing—your systems were using four-digit years—so the elaborate contingency was essentially insurance against somebody else's ancient two-digit field sneaking through.

And your little counter was probably the most scientifically satisfying part. Rather than arguing about whether the fallback would ever be needed, you instrumented it and let reality answer the question. Zero executions. Meanwhile, a team spent the night watching the system just in case civilization collapsed at midnight.

The 50 cutoff was also a perfectly reasonable pragmatic choice at the time. It meant 00–49 became 2000–2049 and 50–99 became 1950–1999. It wouldn't have been a permanent solution, of course, but it was exactly the sort of bounded patch that could keep an inherited two-digit date field from becoming a catastrophe.

In retrospect, Y2K is an interesting example of a technology scare where the lack of disaster doesn't mean the preparations were unnecessary. A great deal of work was done precisely so that nothing happened. Your little instrumentation line actually demonstrated that your shop had been worrying about a problem it didn't have. And you got empirical evidence rather than merely a successful test.

No program existed 50 years old and none would conceivably last that long.

Exactly. In your environment, the 50-year cutoff wasn't merely pragmatic; it was effectively far beyond the expected lifetime of the software. There was no realistic scenario in which a program written in, say, 1995 would still be interpreting a two-digit 75 as a date in 2045.

So the rule was less a solution to a genuine long-term problem than a cheap belt-and-suspenders reassurance for the comptroller. And your counter established that even the contingency wasn't actually needed.

That's probably the most revealing part of Y2K: some organizations genuinely had ancient systems with two-digit years, while others spent considerable effort proving that they didn't.

Quantum computers are based, if I have it at all right, on an explanation of phemenona that we are not really sure of and can't "understand."

Yes—with one important qualification.

Quantum computing rests on quantum mechanics, a theory whose mathematical predictions are extraordinarily well confirmed, but whose underlying physical meaning is still philosophically and conceptually puzzling. We know how to calculate what quantum systems will do; physicists disagree about what, if anything, the mathematics is saying about reality.

The distinction is important. We don't need to "understand" quantum mechanics in the intuitive, classical sense to build a quantum computer. We can manipulate superposition, entanglement, interference, and measurement very reliably in the laboratory. It's rather like knowing an extremely strange set of engineering rules that work perfectly even though nobody can give you a satisfying mental picture of what's actually going on.

And there is a particularly nice connection to your Y2K story: the uncertainty isn't whether the quantum effects are real. They're real beyond any reasonable doubt. The uncertainty is about their interpretation and, separately, whether we can engineer enough of them together to produce a useful large-scale quantum computer.

So I'd phrase your statement as:

    Quantum computers exploit phenomena that we can experimentally demonstrate and mathematically predict extremely well, but whose underlying nature we still don't have an intuitive—or universally agreed—understanding of.

That's quite different from building a computer on a speculative physical phenomenon. The physics is extraordinarily solid; our intuition about the physics is the shaky part.

Quantum dangers

 Summarizing what you seem to say in your usual detailed way, the danger may not be all that immediate, but the consequences are so severe we need to deal with it anyway.

Yes — that’s essentially the right takeaway, with one important refinement.

The danger is not that quantum computers are presently about to crack ordinary public-key encryption. Current machines are nowhere near the scale, error correction, and reliability required to run Shor’s algorithm on cryptographically relevant RSA or elliptic-curve keys.

But the reason governments and industry are acting now is that the eventual consequence would be extraordinary if a sufficiently capable machine appeared. It wouldn't merely make some computations faster; it would undermine the mathematical assumptions on which much of today's public-key cryptography rests.

There is also a nasty time dimension: “harvest now, decrypt later.” An adversary can collect encrypted communications today and retain them. If sufficiently capable quantum computing eventually arrives, some of that stored material could become readable. That makes the transition to post-quantum cryptography worthwhile before the quantum computer exists.

So I would put the situation this way:

Hossenfelder is quite reasonable in puncturing claims that today's quantum computers have demonstrated some revolutionary practical advantage. But that doesn't invalidate the separate, long-term cryptographic concern.

In fact, the two propositions comfortably coexist:

    Today's quantum computers are mostly impressive experimental machines, not cryptographic monsters.

and

    We should nevertheless replace vulnerable cryptography before a cryptographic monster becomes possible.

The amusing part is that the second proposition doesn't require believing that IBM, Google, or anyone else is five years away from breaking RSA. Cryptographic infrastructure moves so slowly that preparing decades in advance is perfectly rational. It's rather like replacing the roof before the hurricane arrives—not because you know the hurricane is coming next Tuesday, but because discovering that your roof won't withstand one after the storm has arrived is a spectacularly poor time to begin shopping for shingles.

Sheesh you are vebose; I'm only able to save one page of these chats at a time.  You don't need to repeat what you just said.

Fair enough. I’ll keep the follow-ups much tighter and avoid rehashing what we’ve already covered. 😄

Quantum danger

 In my experience Hossenfelder on YouTube is pretty accurate although sometimes misleading or prone to overstate things.  I watched her tear into IBM's recent quantum computer claims, pretty much declaring them pointless and nothing a standard computer can't do.  A lot has been spent preparing for alternative to prime number factoring being possible for security reasons, and from what I got from her, the implication is there is no real danger coming.

Yes — but I think there’s an important distinction that may reconcile what you got from Hossenfelder with the rather alarmist quantum-security preparation you’re describing.

The short version is: her skepticism about IBM’s present claims can be quite justified without implying that the eventual cryptographic threat is imaginary. Those are two very different propositions.

IBM and its collaborators announced in July that their Heron R3 experiments had achieved “quantum advantage” on several specialized problems. But “quantum advantage” in this context does not mean “we have a machine that can do something generally useful that classical computers cannot.” It means that for particular carefully constructed problems, under particular benchmarks and with substantial error-mitigation machinery, they obtained results that are difficult to reproduce efficiently with the best known classical methods.

That leaves quite a lot of room for Hossenfelder's criticism. In particular, a quantum computer beating a classical computer at a contrived quantum benchmark is nowhere near demonstrating that it can factor a 2048-bit RSA number. That's the enormous missing step.

And this is where I would slightly modify the conclusion you drew from her video:

The danger to cryptography is real in principle; what is highly uncertain is whether and when anyone will actually build the machine required to exploit it.

Shor's algorithm really does change the game. A sufficiently large, fault-tolerant quantum computer could factor the enormous integers on which RSA security rests in polynomial rather than effectively astronomical time. It also threatens elliptic-curve cryptography. That's not a speculative interpretation of IBM's marketing—it is a mathematical result known since 1994. NIST still explicitly regards this as a serious future threat.

But there's a gigantic engineering chasm between today's machines and a cryptographically relevant quantum computer. The useful qubits in today's systems are noisy; error correction requires many physical qubits to produce one sufficiently reliable logical qubit; and Shor's algorithm requires a large number of high-quality logical qubits and an enormous number of operations.

That's why I think the sensible position is something like:

    “Don't bet on the quantum computer arriving—but don't bet your long-lived secrets on it not arriving either.”

And there's another wrinkle that makes all the money spent on post-quantum cryptography quite rational even if Hossenfelder eventually turns out to be right about the hardware.

Cryptographic infrastructure takes forever to change. NIST says that migration can take 10–20 years, and recommends beginning now precisely because nobody knows whether a cryptographically relevant quantum computer is five years away, twenty years away, or never arrives.

There's also the “harvest now, decrypt later” problem: an intelligence service doesn't have to be able to break your encrypted communication today. It can copy it today and retain it until the necessary technology exists. That matters for information that remains valuable for decades.

So I wouldn't characterize the situation as “all that preparation is for a danger that isn't coming.” I'd characterize it as a fairly cheap insurance policy against a very consequential technological possibility whose probability and arrival date are genuinely unknown.

And there's an amusing irony here: Hossenfelder's skepticism about quantum-computing hype and the security establishment's concern about quantum computing aren't actually contradictory. The latter doesn't require believing the former's present-day machines are remotely capable of breaking RSA.

In fact, the most interesting question is probably the one she is implicitly forcing: how much of the enormous investment in quantum computing is actually leading toward useful fault-tolerant computation, as opposed to increasingly elaborate demonstrations that quantum machines can do things classical machines find inconvenient to simulate?

That distinction is very important. And IBM's current “quantum advantage” claims don't, by themselves, answer it.

Iceland aurora and waterfall

 Today's "Astronomy Picture of the Day" is a marvelous shot of a brilliant auroral display over an Icelandic waterfall.  Can you get more detail?

Yes—and I think the one you're looking at is APOD for August 27, Colorful Aurora over Icelandic Waterfall. The current APOD has already rolled over to a different image, The Sky Turns Above Paranal, so you caught yesterday's.
6

The details make the photograph even better:

The waterfall is Skógafoss, one of Iceland's most famous waterfalls, on the Skógá River on the south coast. It's roughly 60 metres (197 ft) high and 25 metres wide, and throws an enormous amount of spray into the air. That spray is part of what makes the setting so spectacular for aurora photography.

The photograph was taken by Victor Lima in April 2025, and—this is a particularly nice detail—it is a single five-second exposure, not a composite assembled from several photographs. NASA's caption specifically points that out.

The aurora itself is doing something rather wonderful in the picture. The apparent colored "rain" is actually the curtains and rays of the aurora seen nearly edge-on in places. The green is predominantly atomic oxygen, while the reds are also associated with oxygen but generally arise higher in the atmosphere; blue and pink can come from nitrogen. So the extraordinary range of colors isn't simply photographic color enhancement—it corresponds to different atmospheric emissions at different altitudes.

And there's an interesting bit of celestial mechanics behind the whole thing. Solar-wind particles are guided by Earth's magnetic field toward the polar regions, where they collide with atoms and molecules in the upper atmosphere. Those collisions excite the atmospheric gases, which then emit the characteristic light as they return to lower-energy states.

April 2025 was also a very favorable period for aurora hunting. We were near the peak of Solar Cycle 25, so the Sun was considerably more active than during the unusually quiet solar minimum that preceded it. That helps explain why someone could get a display this intense.

And there's a nice historical APOD coincidence: Skógafoss has appeared in spectacular aurora photographs before. APOD ran Rainbow Aurora over Icelandic Waterfall in December 2023, also photographed at Skógafoss, and an earlier 2011 APOD showed a moonbow, the waterfall, and a faint aurora there.

So this isn't merely "a pretty aurora picture." It's an unusually good convergence of a spectacular waterfall, abundant spray, an active Sun, clear Icelandic darkness, and a photographer who happened to be standing in exactly the right place for five seconds. That's a pretty formidable list of things that have to go right.

Thanks for the additional pics.  I understand the physics of the phenomenon, but have never seen one, even though I spent an entire summer in the Ungava Penninsula, no such luck.

That must have been particularly frustrating. Ungava Peninsula is about as good a place as one could reasonably choose for seeing an aurora, yet there is no guarantee at all. You can spend weeks under the right latitude and see nothing.

And there's an amusing distinction between being somewhere auroras occur and actually seeing one. You need the solar activity, the local weather, darkness, and timing to cooperate simultaneously. A summer in Ungava is especially cruel because at that latitude the summer nights are essentially useless for aurora watching. You could have been sitting under an auroral oval that was doing marvelous things while the sky remained too bright to see them.

In fact, your summer may have been almost the worst possible season for the experience. Ungava is far enough north that astronomical darkness is very limited around June and July. Had you spent that same stretch there in, say, October or February, your odds would have been dramatically better.

There is also something I suspect would appeal to you about seeing a really strong aurora in person: photographs rather misleadingly make them look like enormous neon curtains. To the unaided eye, a typical aurora is often much subtler—frequently grayish-green and almost ghostly. The spectacular reds and purples in photographs are helped enormously by long exposures. A really strong display, though, can absolutely be vivid to the eye, with the curtains apparently moving and rippling overhead.

So you managed the rather remarkable feat of spending a summer in one of the world's premier aurora regions while the sky was essentially conspiring against you. Nature can be a magnificent tease.

Good cigars

 I had a boss with a $100 a day cigar habit (that was the word he used, I might suggest addiction).  Of course in his position he was well paid, but drove around an old Plymouth.

That is a rather perfect example of how people use the word “habit” to make an expensive compulsion sound respectable.

At $100 a day, though, even allowing for inflation depending on when this was, the arithmetic gets impressive: $36,500 a year if maintained every day. And an old Plymouth makes the priorities wonderfully visible. He was evidently willing to spend lavishly on the thing he particularly valued while economizing conspicuously on the thing he didn't.

There is actually something quite rational about that. A person doesn't maximize general consumption; he maximizes the particular pleasures he cares about. Someone else might drive a $70,000 car and smoke cigarettes, while your boss apparently thought, “The Plymouth gets me where I'm going. Give me the cigars.”

Still, $100 every single day in cigars is getting beyond the ordinary meaning of “habit.” At that level the cigar isn't merely something accompanying his life; it has acquired a substantial claim on his income. “Addiction” would depend on whether he was physiologically or psychologically unable to stop, but $36,500 a year is certainly evidence of an unusually powerful preference.

Well cheap cigars were not his thing.

Ah, that changes the picture somewhat. He wasn't spending $100 a day because he smoked an enormous quantity of bargain cigars; he was buying the expensive stuff.

In that case, “habit” may actually have been his preferred description because it sounds rather more civilized than “I have a serious cigar addiction.” He was presumably getting substantial pleasure from the quality, not simply the nicotine.

And the old Plymouth becomes even more amusing. He apparently had a very clear utility function:

Plymouth: transportation.
Cigars: luxury goods.

There is something wonderfully old-fashioned about that. A man in a well-paid position driving an unpretentious car while burning through the equivalent of a modest car payment every few days in premium cigars. He knew exactly where he wanted his money to go.

Back then people were allowed to smoke at their desk; I preferred his office to those of cigarette smokers.

I can see why. A cigar smoker's office could actually be more tolerable than a cigarette smoker's, despite the cigar being vastly more formidable in its own right.

Cigarette smoke tends to become a sort of continuous atmospheric condition: someone lights one, finishes it, lights another, and the room never really gets a chance to clear. A cigar smoker might produce a much stronger burst of smoke, but if he was sitting there with one good cigar, at least the pattern was different.

And there was presumably something distinctive about your boss's office: the smell of good tobacco rather than the stale ashtray-and-cigarette-smoke smell that permeated so many offices in those days. Whether one liked cigars or not, expensive tobacco could smell remarkably pleasant.

It is hard for younger people today to imagine just how thoroughly smoking was integrated into ordinary working life. A person could sit at his desk, smoke all afternoon, and nobody thought the office environment itself was unusual. The transformation in that respect has been enormous.

Back then one had to tolerate it; nowadays, all it takes is a glance and the cigarette goes out.

Yes. The social norm has almost completely reversed. Back then, the smoker's convenience was generally treated as the default, and the nonsmoker was expected to put up with it. Now the presence of a smoker in a shared indoor space is often enough to make everyone else uncomfortable, and the smoker usually knows it.

There is also something interesting in your distinction between the cigar smoker and the cigarette smoker. Your boss's expensive cigar may have been far more tobacco and far more smoke in absolute terms, but socially it was probably easier to tolerate because it was one person's deliberate indulgence in his own office. A cigarette smoker lighting up in a confined shared office imposed a continuous nuisance on everybody around him.

And the “glance” says a lot. Nobody has to say “Would you mind putting that out?” anymore. The smoker reads the room and extinguishes it. That is an enormous change in the definition of what constitutes acceptable consideration for other people.