Twinkle VanWinkle, “List-en Up!” producer
Interview with Bob Bonner, owner of Bonner Piano Service, Carmel, Ind. January 23, 2009
 

Twinkle VanWinkle:
Can I get you to state your name, job, and location?

Bob Bonner:
I’m Bob Bonner, I’m the owner of Bonner Piano Services in Carmel, Ind. I’m a tuner/technician. I’ve been doing this for about 35 years.

TVW:
How about giving us a little information about tuning a piano in general?

Bonner:
The tuner starts in the middle of the keyboard and sets up what’s called a temperament scale. This is a mathematical formula. When the strings are all in tune with themselves to our ears it sounds harmonious or it sounds in tune. That’s what a tuning is. It’s much more detailed than that as you get into the whole process, but that is basically what a tuning is.

TVW:
Why do pianos go out of tune?

Bonner:
Pianos go out of tune for several reasons. The chief reason in this climate and [in] other areas of the country, there are humidity fluctuations that come with the seasonal weather changes. Say in the summer the pitch goes high because the soundboard is wood, it expands as it takes on moisture. When it expands it puts pressure into the strings, so the piano goes high or the piano goes sharp. In most pianos, especially in lower class pianos, the pitch doesn’t change evenly across the whole scale. Sometimes the bass will go high and the rest of the piano stay low or vice versa. The other reason a piano will go out of tune is by heavy playing.  A lot of heavy playing will, of course, put heavy impact on the strings and the piano will go out of tune fairly quickly that way. The third reason is just that it hasn’t been tuned in a long time. The necessity for tuning a piano on a regular basis is critical and it’s the essence of keeping a piano in good condition for the long haul.

TVW:
How often do you tune a piano?

Bonner:
The frequency of piano tunings varies according to how the piano is used. Generally, I would say twice a year would be ideal for a home piano. The piano I’m working on now is a concert quality piano and it’s in a church facility where I average about one tuning a month on this piano. Most homeowners don’t want to put out the money or can’t afford to have a tuning every six months, so at least once a year is the minimum. I would say that when you have a piano tuned each year, have it tuned in the same season so when the piano goes through the weather cycles it comes back to the same level of pitch previously when it was tuned.

TVW:
What tools are involved with tuning?

Bonner:
The basic tool, most people call it the tuning hammer. It’s actually a tuning lever because it levers the tuning pins. It has a special head on it that is tapered and is shaped to fit the taper of the tuning pin. When the tool is put on the tuning pin, you turn the pin right to make the pitch go high and you turn it left to make it go low. Most tuning hammers are heavy built and this is one of the better tools that I have. That’s really the basic tool. The other tool of course is having a tuning standard. A tuning fork has been used forever in tuning instruments. Nowadays most tuners will use electronics. Some people are afraid of the electronic idea because they think if the piano is tuned to the electronics, it’s not going to sound right. Now piano tuning is an art and the ear of the piano tuner is probably a critical tool as well, because it needs to discern between the science of the tuning, which is mathematics, and how to get the piano to sound warm or brilliant, or however the owner of the piano wants it to sound. So the art and the science go together and the ear is a very important tool.

TVW:

Tell us briefly about tuning a piano, the procedures.


Bonner:
When tuning a piano, what I do or what technicians will do is come into the piano, listen to it, check the scale to see if any part of the piano is high or low, and what they do is try to get the whole piano scale equalized so everything is equal and then it has to be done prior to the actual tuning process. If the pitch of the piano is very low, say if the piano hasn’t bee tuned in five, 10, 20 years, sometimes I find the pitch would need to be raised. That can be a process that takes two or three times over all the strings to bring it back up to where the concert pitch would be. Then when everything is equalized, the tuner can go in and tune everything and have it much more stable than if you tried to do the tuning in one pass. It’s like playing a round of golf. If you can get the ball knocked in, in say 30 holes in 30 tries, that’s great. [But], that [probably] won’t happen.

Then the tuner sits down and tunes the temperament scale in the middle of the piano and then he expands out and tunes one string on every key. Once one string is tuned, I go in and take these mutes out from between the strings. Then I can tune the remaining strings to what’s already been tuned. Then at the end of the process, I go through and just check every key, every octave - every pattern that I can think of - just to make sure that piano is in tune when I leave.

TVW:
What is the average cost of tuning a piano?

Bonner:
The average cost of tuning a piano can range from 85 dollars in this area to maybe a little over a hundred. Some other parts of the country, say out west in California, I’ve heard that it’s much higher – possibly around 125 to 150 dollars for a tuning. It just depends on the prevailing rate in your locality.

TVW:
How long have you been tuning pianos and why?

Bonner:
I’ve been tuning pianos for around 35 years. I got into the business as a desire to have my own business. I have a degree in music education. I could be teaching school right now. I chose to go this route of having my own business just because of having the flexibility and having my own standards where I wanted them. I wouldn’t have to be accountable for anyone except the customer who wants the job well done. And I try to make sure that the job is well done. I thought about what I would like to do and I decided that I liked working with my hands. I decided to just try piano tuning as a hobby and then it just began to expand. I was tuning pianos for neighbors, family, friends and it expanded from there.

TVW:
Do you play piano or any other instruments?

Bonner:
I play a little piano, not enough to demonstrate. I am a professional trumpet player part-time, and I play in a couple of orchestras in this area. The Carmel Symphony for one, and another in Indianapolis. Actually, the church here has an orchestra of about 30 pieces that I play in.

TVW:
Is there any maintenance to keep your piano in tune or some things you would like to add?

Bonner:
As a piano gets a lot of wear and age, the felts of the moving parts can compress or wear. The actual touch of the piano can change over the year. And it’s such a gradual process that you don’t realize it. So what I do is I come in and I check the touch of each key and I find out where the action needs to be regulated. There are thousands of parts that need to be working in the correct relationship or ratio with each other. To get the most efficient action response, I come in and adjust several parts of the action and that bring s the keyboard back to a good feel.

People that have pianos that have not been regulated for say 50 years, and I come in and demonstrate in a short section how it can change the touch and the feel are usually very impressed. I can go ahead and do a two or three-hour job after that.

The voicing of the hammers is another aspect with maintenance. That’s something that’s not done very often. It’s a part of the hearing process that maybe the piano owner doesn’t realize. Maybe the piano sounds too bright. Or it may be, in fewer cases, it sounds too dull. There are processes that can be done to the felt of the hammer to increase the brightness if it’s too dull or take out some of the brightness of some of the keys. Right now, I’ve noticed just in working shortly with this piano, there is a few notes right in this section that tend to be a little bright. What I’ll do is take a special tool, which is a voicing tool. Basically, it’s a type of needle that I would insert into certain parts of the hammer to soften certain sections of the hammer to get the desired results that I want.


(Audio as he tuned piano)

Bonner:
I’m going to be inserting the felts, the process prior to the tuning operation. These rubber mutes are situated where the brakes are.  I use a digital tuner because you have to have a standard that you know the pitch is right on where you want to put it. And I’ve checked it and I find that my A and all instruments built in the last 75 years are built to be tuned to A.

When an orchestra tunes before a concert the oboe player sounds the A. It’s the sound that is heard most distinctly through the whole orchestra. Then the other instruments can tune to that. Then of course the piano is built to be tuned at that pitch also. So once my A is set, I can go down and tune the octave below it and match everything to that A.

I tune various intervals in the process. I start with a third and I listen for a very subtle part of the sound, which is a vibration between the notes. The vibration between the notes is a beat pattern that I hear and right here I hear about seven beats every second. Then I go down and tune the E to the A.  I want just a perfect interval there, not quite perfect. And from the E, I go up a half an interval and tune that third. That would be approximately six and a half beats per second. So my ear has learned to hear those subtle beat rates. That’s why when a piano tuner is working he really appreciates having it really quiet in the area where he is working. 

Do you hear the beats? The wah-wah-wah-wah sound?

If I take that pure, it sounds great, but the mathematics of the scale wouldn’t work out. J.S. Bach would have liked this sound. That’s how he would have tuned his instruments. In his case, when he tuned it that way, he could only play in the key in which he tuned. Other keys would not be in tune for him. So we use what is called the equal-tempered scale where there are basically equal distances between the intervals.

I am hearing a click that should not be there.

During the process of tuning, the tuner is listening for other noises, or buzzes or rattles that come in. Sometimes, like in a grand piano, something small will fall on the soundboard. He would have to go in and try to find out where that sound is coming from. And remove whatever object is causing the vibration or the buzz.

Sometimes keys will click and rattle. That’s because the keys themselves are loose and they kind of bump into each other and make some clicking noises while the piano is being played.

The worse thing you can do to a piano is set flowerpots on top or fishbowls or a glass of water or any liquid. You want to keep the piano free from any liquid because liquid getting into a piano can cause serious damage in a short time.

I’m thinking of a Steinway grand that was parked in a school over Christmas break during that time. The only place where the roof leaked was right over the top of the piano. It was about $4,000 damage, just in a few minutes there.

As I am working I am thinking. Where you put the piano is critical because you want to avoid areas where there is moving air. If you put the piano in front of a heat register or where there is moving air around the piano, that moving air has a different temperature and could make the piano go out of tune very quickly. In the long run, it can even damage the soundboard, causing it to crack. Cracks many times will buzz. When that happens, the technician has to come in and do some repairs that are fairly expensive to get that soundboard repaired. So keep your piano in a climate that is as even as possible.

A lot of people have the question or have heard not to put a piano on an outside wall. In the modern homes the walls are insulated and it’s really not a problem. Some technicians say you should really keep the piano 4-6 inches from the wall to have airspace behind the piano so that warm air can get between the wall and the piano.

Yesterday I had a grand piano and the lady said, “There are some sticking keys.” I opened up the front and there were several pencils inside and one pencil was jammed inside between two keys, which caused the keys to stick.

One of the funniest stories I have is about a family who had a very nice grand piano. They called me to tune the piano and I opened it up because some keys were very sluggish. I found that the inside of their piano was covered with their mail. Their three-year-old boy had taken the mail from the mailbox at the house and put it down inside, because he thought it was fun to put his letters in the mailbox. So they had bills that weren’t paid for sometime.

I’m taking the action out. You’ll see that in just a second here. When I’m listening to the voicing. Now you can hear that one. That D stands out as a little brighter, a little more penetrating compared to the notes around it.

So I will pull the action out. And this is the tool that I use for regulating. In this case it’s just one needle. Then I will pull the action. I take the hammer and I do a series of insertions with the needles to try and soften the striking surface a bit.

I don’t want to do too many at first. I like to listen and see where the sound is going before I go too far.

That brought the sound back where I want it.

There is still a little bit of a high buzz in that, but I will still do a few more shallow insertions closer to the striking point.

You can hear that?

Now I hear a bit of that in the C flat, so I can do the same thing there.

In a fine piano, voicing is done more frequently than [in] home pianos.  In home pianos, the quality is not built into the pianos so a piano like that can be voiced, but it’s more of a rough process to get rid of very strident sounds, very brittle sounds.

Now those two notes are blended into the surrounding keys. That is pretty much the voicing process. Although multiplied by the number of hammers, it takes quite a bit of time. And when the voicing is done…I like to have the performer or owner around to get their idea of what a good tone is. It’s a very individualistic aspect of what the piano player wants.

Phone interview on Jan. 12, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and Andrew Pitonyak, an Angie’s List member from Columbus, Ohio.

Jeremy Stacy: Please give me your name and location for the record.

Andrew Pitonyak: My name is Andrew Pitonyak and I'm in Columbus, Ohio.

JS: How often does your family visit a doctor or hospital in a given year?

AP: I would say with two small children, I am at a doctor's [office] more than 12 times a year.

JS: How big is your family?

AP: I have two young children and a wife.

JS: What are important characteristics you look for when selecting a doctor?

AP: I don't like doctors with large egos and having a good rapport, a good bedside manner, is critical. I don't like doctors that appear to me as dishonest, namely a doctor that might order a test because it earns them more money.

JS: Could you expand more on what you mean by not liking doctors with a large ego?

AP: Some doctors are really threatened if you get a second opinion. Having grown up in a family of doctors, that's very annoying to me.

I was on a medication one time and there were problems with the medication. So there I am at a family function, hundreds of miles away from home on a Christmas break, which means my doctor isn't really available. All the doctors in my family get around and say, "We think we should probably do this for you right now."

Well, when I went back and made an appointment to see my regular physician at the time, he was so angry that I had seen another doctor he couldn't even speak. It was just amazing to me. It's like, "Well, what am I going to do? It's Christmas, you're not around and I'm hundreds of miles away and I have a problem. Call 911 and say I can't see another doctor until I call my family doctor?"

But, he was so upset he wouldn't even speak with me.

JS: Did you continue seeing him after this incident?

AP:  I did not. That was a pretty clear indicator to me that maybe I shouldn't deal with him anymore. He stopped seeing patients shortly after that.

JS: Have you had an experience with a dishonest doctor?

AP: I ran into an issue with a dental school where their diagnoses were so outrageous …that I went to see two other dentists. Both dentists agreed that [the diagnoses were] absolutely ludicrous. But, one of [the dentists giving a second opinion] said, “Well, what they’re really looking for is, they are looking for things that are guaranteed benign so that their medical students can do [the procedure].”

They wanted to fill cavities that had been on my dentist’s watch list for years because they weren’t really sure what they were. He said, “I don’t know if that’s a cavity or not.”

And he said, ironically, the one that was more serious, that might have actually led to something, they chose to ignore and only watch because if it turned to something more serious, then the dental student wouldn't get credit for it.

Immediately after seeing a dentist and having him say, "Oh yeah, you're good," and then [another dentist tells you] “Well, I think you're a candidate for periodontal surgery and you have eight fillings you need to fill,” I thought either my regular dentist is just incompetent … but because I was going away to school at the time, my dentist had said, "Well, stop in at the dental school and they can make a bite plate for you."  And they wouldn't make a bite plate without a full checkup. The result of that checkup was just outrageous.

Their motivation was just to find work for their students. Of course, they would have just billed my insurance company for all of it, but quite frankly I considered it fraudulent …

… And, my wife was going to have a baby and the doctor had lost all hospital privileges and she wasn't informing her patients.

JS: What caused her to lose her hospital privileges?

AP:  I don't actually know why she lost her privileges. When we spoke about it at various hospitals while visiting their rooms, the personnel there, all they would say was, "Oh no, you are much better off without that particular doctor."

I don't really know why she lost her privileges, but I considered it a pretty serious breach not to inform your patients and letting them show up at the hospital to actually give birth that, "Hey, your doctor can't come here."

JS: Did that scenario happen to your wife?

AP: One of the doctor's employees, who was on her way out, mentioned it to my wife about a month before [giving birth]. Then when my wife called to confirm, they didn't really want to speak with her about it. What they did was just hand her back to the person who told her that and we were able to find another doctor.

Since then, we have met other people that have used that doctor where that did happen. They showed up at the hospital and the hospital said, "No, that doctor can't come. They have no hospital privileges." By doing that, she was able to continue billing insurance companies and make money.

JS: Do you have a primary care physician now?

AP: I do.

JS: How long have you been with him?

AP: I have known Dr. Douglas Schumacher for quite a few years now and I've known a lot of doctors and I consider him probably one of the best diagnosticians in the Columbus area.

I have seen him accurately diagnose a few people that have gone from doctor to doctor without a successful resolution to their problem. I've seen him just go, "Oh, well it looks like it's this," and now they're well on their way to recovery.

JS: How did you find him?

AP: I actually ran across him when I subjected myself to medical testing because he does medical studies as well as being a family doctor. It was just pure happenstance.

JS: What do you like about him?

AP: He's very personable. He gets along very well with his patients, which means that I have yet to meet someone who has not really enjoyed his bedside manner.

He spends a lot of time listening to and speaking with his patients, which leads to the one negative and that's you may end up waiting. Because, if he's spending a lot of time with his patients … but, the people who work for him say most of his patients say, "That's OK. He spends a lot of time with me."

In fact, today, my wife had an appointment, but it turned out my daughter had croup and he said, "Hey, you're here. Let me listen to her lungs. Let me look in her ears." So we didn't have to make a separate appointment. Very accommodating. Quite frankly, he’s just a very nice guy.

JS: Do your children have a pediatrician?

AP: They do have their own pediatrician. Usually we would take our children to see the pediatrician when they are sick, but when my wife is ill and one of the children happens to be ill, she may just choose to take everyone to see the family doctor. If just a child is sick, we definitely just go to see the pediatrician.

JS: How did you find the pediatrician?

AP: The pediatrician, we found by word-of-mouth. This was before Angie's List offered reviews for doctors. We asked around and we asked people that are in the medical field as well as people that were not. Based on those recommendations, we chose to go to Olentangy Pediatrics.

JS: What do you like about the practice?

AP: They have a wide variety of doctors. Off hand, I'm just going to say they have at least six pediatricians on staff. The nice thing about that is they usually do a very good job of getting you in.

Another thing, which may be good or may be bad, is given that they have so many pediatricians on staff and usually they have a pediatrician that's the on-call guy for that day … it means that sometimes you will get a difference of opinion if you have a particular problem.

They're not going to fight with each other over things, but, for example, my daughter had adenoids that were just huge. Usually you would not treat that until you were 2 years old here in Columbus. With the mix of doctors that we saw, we were actually able to discuss the different treatments available based both on what I call "old school" and "new school."

Some doctors specialize in certain things and based on that, we were given a lot of opinions and then we came to a consensus with the doctors in general that we could do X-rays and determine if something really needed to be done. Based on those X-rays we were referred to a specialist that was able to do surgery on a very young infant.

JS: How much research do you do on your own before you see a doctor?

AP: I usually don't do a lot of research before I go in. I usually will see the doctor and get their opinion before I will go and do my own research.

For example, I have a copy of the Physician's Desktop Reference (PDR) and as a non-doctor myself, I was trying to look up a medication that is prescribed to someone in the family, but I couldn't find it. I couldn't find it first of all because it's a generic name, then after I went from the generic name to the regular name, it turns out it's a medication that is produced by a company that's not in the PDR. I was eventually able to find things out about this, but the point of that is that I don't really have the background or experience to make a lot of diagnoses.

I say that as a research scientist with four college degrees. I'm very good at finding things, but since I go to a doctor that is such a good diagnostician … I mean, after they said, "Hey, your daughter needs her adenoids out, maybe." Well, I'm able to go out and go do research on adenoids. But, I was just absolutely not able to make that determination that that's what the problem was. I didn't know we could do an X-ray and find out.

The doctor said, "I think we should remove the adenoids of this 8 1/2-month-old." Well, after I had the word adenoid, then I was able to go and look it up.

My wife has trouble with migraines sometimes, so we were able to go look up migraines. The doctor had already provided a lot of very good information and then we were able to supplement that with what we found on the Internet. But, a lot of what I read on the Internet, I have to be very careful of the source.

I can tell you about the bio-electrifier that will cause you to lose weight if you're fat and gain weight if you are underweight and it'll cure cancer and HIV and I mean it'll cure everything … if you believe everything that's written about it.

JS: When you go back in to follow-up appointments more educated, how do doctors feel about you asking more questions?

AP: All the doctors that I use do not mind questions in any way. They are usually very good at answering those questions.

I use a bite plate and I remember one time when I mentioned to my dentist, "You know I understand they do a bite plate of such and such type," and without missing a beat he said, "Well, you know some people like to use this type because of this, this and this, and I usually use this type because of this, this and this." He gave me the actual reasons why he chose what he did. That's helpful and he wasn't threatened at all by the fact that I asked him.

JS: Is there any thing else you would like to share?

AP: I am very particular about my doctors. When I met my wife, she had a particular issue and she'd seen many doctors literally in multiple countries, but that's because she was a missionary and had been in multiple countries. They had all misdiagnosed the problem. Dr. Douglas Schumacher nailed it. 

He spoke with her for 10 or 15 minutes and changed her life. She no longer has to deal with pain and problems. He said, "I know exactly what your problem is. It's this. It's not a big deal. Take this pill if you need to and change your diet a little bit." Wow. How could so many doctors have said, "Oh, we think you have some kind of weird worm?" They just got it wrong, which defies me.

I'm also very picky about my dentist. My dentist cleans his teeth himself! Can you believe that? Dr. Curt Ayers, he cleans my teeth. He has a very gentle touch. He is a very kind, gentle man. If you're looking for a dentist that's going to come out and take care of it himself, that's the guy you want to go see. That's almost unheard of and the fact that he's spending time poking around in my mouth means he's very aware. He's not coming in and just doing the follow-up after the fact.

We've had some good experiences and some bad experiences with doctors, but we are very content and happy with the doctors that we currently have.

Typically when I refer someone to a doctor, especially those two that I have mentioned, people go and they stay. Once they go, they say, "We agree with your assessment."

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Phone interview on Jan. 13, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and David Gulbransen, an Angie’s List member from Oak Park, Ill.

Jeremy Stacy: Please give me your name, location and how long you've been a member of Angie's List.

David Gulbransen: My name is David Gulbransen, I'm from Oak Park, Ill., and I've been an Angie's List member for about three years now.

JS: Tell me about your family.

DG: I'm married and my wife and I had our first daughter this fall.

JS: How often does your family visit a doctor or hospital in a given year?

DG: In a given year? Probably a dozen times, maybe not quite that many. With my wife being pregnant last year, it was probably a pretty high year. I would think probably a lot more than that.

JS: What are some important characteristics you look for when selecting a doctor?

DG:  Good bedside manner is really important because you have to be able to trust your doctor. You have to be able to be open with them and feel comfortable when they're giving you medical advice, prescribing drugs and prescribing courses of treatment. Somebody that you have a good relationship with is pretty essential.

I also look at qualifications. Obviously, you want someone who is well-educated at a respectable institution.

JS:  Did your wife have an OB/GYN before she became pregnant?

DG: She did. She had an obstetrician, her OB/GYN from before she got pregnant. But, as luck would have it, we got pregnant and her OB/GYN took a sabbatical for a year. It just worked out that he was gone basically the entire time she was pregnant. He actually came back from his sabbatical the week she was due, but she went into labor a week early, so he wasn't around for most of the process.

JS: How did you find a new doctor to handle the pregnancy?

DG: We stayed within the practice because she really liked the practice and it was on our insurance already. It was very convenient because she had been going to that doctor for several years. We just looked at the other members of the practice and found one who we thought would be a good fit. Sure enough, he was. He was a very good doctor.

JS: What steps did you take to make sure he was a good fit?

DG: All of our doctors at that practice had a website. The practice has a website. It's part of Northwestern University, so they had a website and they have profiles of the doctors with their educational backgrounds and their particular interests in terms of patients and research and that sort of thing.

JS: Do you have a primary care physician?

DG: Yes. I've been with my current primary care physician for about two years.

JS: How did you find him?

DG: When I had gotten my current job, I had just sort of randomly picked a primary care physician just to get one on the record. Then I had met with him and I was not very pleased. I didn't like his bedside manner and we didn't really click.

I started looking at other doctors in the practice and one of my wife's friends who went to that same practice said, "Oh you have to try this doctor. He's fantastic."

And again, because the practice had a website, I went and looked at his credentials and looked at his information about the types of medical research that he does and the things he's interested in. I thought, "Well, he sounds interesting," so I scheduled an appointment with him and met him and I really liked him. We really hit off well and so both my wife and I switched to him as our primary care physician.

JS: Can you expand a little bit more on what you didn't like about your first primary care physician?

DG: The first doctor, it was really a bedside manner issue. If he was prescribing a particular drug and I would ask questions, he would give me cursory answers. He wouldn't really explain things well and sort of had an air that he was the doctor and he knew best. Therefore, my questions weren't particularly important to him and nothing rubs me the wrong way like that, especially from a doctor.

I mean, because these days with so many different prescription medicines out there, I want to know, “Is this really the right prescription medicine, what are the side effects, what things shouldn't I eat or drink, what other drugs should I worry about taking when I'm taking this medicine.”

You know, these days we have a lot of questions about that kind of thing and I think doctors need to be very forthcoming with information and not have the attitude that it's a burden to talk to the patient.

JS: Do you research a problem before you go see a doctor?

DG: Sometimes. Sometimes I just know. Traditionally in the wintertime, inevitably I will get strep throat.  I've gotten it for 10 years. I know what it is. I can look in the mirror, look down my throat and see little white spots and I know that I'm going to go in and I know I'm going to get an antibiotic. I just go in and sure enough, they do a little swab test and confirm it and then I'm good to go and I'm on my way.

But, I always ask a lot of questions about the antibiotics just because we know these days there's a lot of concern about antibiotics being overprescribed. So asking questions about that, you know, “How new is this antibiotic?” that kind of thing.

If I'm going in for something I don't know that much about, I'll do a little research on the web. You know, searching WebMD or some site like that for my symptoms. But again, I don't try to be a doctor.

There are a lot of resources on the web these days where you could look up stuff, but I don't have an M.D. and I'm not a trained medical professional, so I don't try and second-guess their diagnosis.

But, if the doctor says, "OK, it looks like you have X and I'm going to prescribe this drug for it," well, then I'm going to ask a lot of questions about the drug and what are alternate treatments, and what about the efficacy of alternate treatments versus the drug, what are the side effects of the drug, and things like that.

I don't do a lot of research beforehand, but I might do a little bit.

JS: How does your current doctor take to answering your questions compared to your first doctor?

DG: Oh, it's like night and day. He's happy to answer any question that I have and he doesn't look like he's watching the clock or he's in a hurry to get out of the room and on to the next patient. He's happy to answer any questions that I have. Once I start out with a bunch of questions he'll bring other things up like, "Oh, well you may also have questions about this or you may not have thought about that."

He's a lot more forthcoming about information, which I think is really great because I like to be informed. I just like to know as much as possible about drugs that I'm having to take or treatments that I have to go through for whatever illness.

JS: How did you find your daughter's pediatrician?

DG: We found them based on recommendations of other parents in the neighborhood.

JS: Did you talk to more than one pediatrician or did you just go with the first one you saw?

DG: We talked to a couple, but the first one everyone recommended was our final choice. He's fantastic. Everyone in his practice is fantastic. We love them.

JS: What about the practice do you like?

DG: They're very, very informative. They're very friendly. They never make you feel rushed. They never make you feel stupid for asking questions. Especially as first-time parents, we have a lot of questions that are probably stupid.

They never make you feel like you're wasting their time by asking questions. They never make you feel like you're stupid for not knowing the answer to what is probably a simple question. They're just really friendly. Everyone at the practice is just really great.

JS: What are some of your most memorable doctor experiences?

DG: I have a good story and a bad story, both related to the birth of our daughter.
The way that their OB/GYN practice was set up was that you had a primary doctor, but then late in the term of the pregnancy, you would meet with each of the doctors in the practice each week so that you got to know each doctor because when you went into labor, you might get any of those doctors depending on who was on call.

One of the doctors that we met was just awful. He was absolutely awful. Every question that we asked he would say, "Oh that's not really that important," or [he] would answer with one-word answers. He was just absolutely horrible. My wife was livid after we had our appointment with him and swore that if she went into labor when he was on call that she wouldn't go. That was really disconcerting because then we were worried about the other doctors in the practice.

As luck would have it, when she went into labor we were a week early and her doctor was not on call. We had another doctor from the practice who was not her regular doctor and she was absolutely wonderful. She was just a fantastic doctor. She put my wife completely at ease.

She was in the room more than I had ever expected the doctor to be in the room because during the process of labor, which we had never done before, most of it is a lot of nurses. But, this doctor was there for the vast majority of the labor and her bedside manner was just fantastic. She had a great sense of humor. She did an outstanding job and we couldn't have been happier with her. That was pure, random luck of the draw.

JS: Is there anything else that comes to mind in your past doctor experiences?

DG: In my experiences over the years with a bunch of different doctors, the most important thing to me is check out their credentials to make sure they have a good education and that sort of thing.

I've found that if you have a doctor who doesn't seem interested in answering your questions, taking the time to put you at ease, [or] taking the time to listen to your symptoms and to address any concerns that you have … if your doctor isn't willing to do that, get a new doctor because you're not going to get the best treatment.

You can only really get the best treatment when you have an open dialogue with your physician and they're willing to take the time to explain things to you that you might not know.

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Phone interview on Jan. 14, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and Dr. Wendy Byers, a highly rated general internist from Carmel, Ind.

Jeremy Stacy: Please give me your name, location, specialty and how long you've been practicing medicine record.

Dr. Wendy Byers: My name is Wendy Byers and I'm a general internist at Internal Medicine of Carmel, which is in Carmel, Ind. I've been in practice here in Carmel for a little more than 18 years.

JS: Are there certain techniques you use to help patients feel comfortable in the doctor's office?

WB: The thing I do personally and the thing I think a lot of other primary care physicians do is to try and treat the patient like a family member or a friend. Our job is to help you feel comfortable talking to me and sharing things that aren't always so comfortable to talk about. If we can get it down on a level that you feel like you can confide in me like you would your friend or your brother or your sister then I think that helps.

JS: How is patient communication discussed or taught in medical school?

WB: It's been a little while since I've been in medical school, so it's a little different now I think. But, primarily, communication was addressed as a way to collect information.

You're taught interview techniques that are primarily data driven. How long have you had this problem? What things make it better? What things make it worse? Anything else going along with it? Especially at that level in your career, you're focused on getting the information so that you can make some care decisions with that information.

I think now there's a little more focus on patient service, on making people feel more comfortable, on making people have time to express their concerns. Some of the techniques they're doing in medical schools are more … videotaping and critiquing ways that the interviews are taking place. There was a study — I don't know how many years ago, it's been a long time — that says the average patient is interrupted after something like six seconds in the exam room. That's getting a lot of press and a lot of input from both physician groups and from the medical schools.

JS: Do you know of patients who have switched practices because of a doctor's poor bedside manner?

WB: I think you have to be careful about using the words poor bedside manner. I think there are clearly different styles of how we interact and different people need different things and different styles.

My job is to make you feel comfortable, but my job is also to be a teacher and to help you understand the things that are going on in your health. That's where medicine is a little different from other service fields in that what you want isn't always what you need. My job is to help convince you that you get what you need and not necessarily what you want.

A big example of that are antibiotics for upper respiratory infections. There's a lot of press about that. That you have a bad head cold, you've had it for two or three days, you're miserable, you can't sleep, you're clogged up, you just feel terrible. What you want is an antibiotic to make it go away. Well, an antibiotic isn't going to make it go away. So, my job is to convince you that what you need is medicine to help you feel better while your body fights the infection.

As far as patients who switch physicians because of a difference in style, some people may like the friendly, hug you when you come in the room kind of style that some people have. Some people feel like that's not professional enough. "I'm going to a physician, I need to trust that they have a firm command of the medical knowledge base and that I feel better if they're a little more aloof, a little more dogmatic." That style sits better with some people.

The real trick is that you need different styles based on what's wrong with you. When you come in with high blood pressure and diabetes that’s a different style than if you just found your best friend dead in the parking lot dead from a heart attack. What you need from me is very different.

JS: With people being able to more easily research their medical conditions on the Internet, how has that affected the way you treat patients?

WB: I think the way it changes the way I treat patients is that I spend more time on the education piece. My challenge is to make sure that that information is brought to my attention because a lot of times people will go to the Internet and will get a lot of information and I am happy to help sort through that information and I think all of us have to be.

It's hard when you Google fatigue, you're going to come up with a big, long list of all sorts of awful, terrible things that can cause fatigue. It's really hard to sort through where do you go as far as the appropriate workup. As long as I know that you Googled fatigue and I know what your concerns are, then we can deal with them. If I don't know what your concerns are, then it makes my job a lot harder.

It's a matter of prioritizing that information and talking about what are the most common things. What things go along with other symptoms you may have and where we go next as opposed to coming in and just ignoring the fact that that information is out there and saying "OK, here's what I think we need to do." Then you leave my exam room saying, "Gosh, she didn't even talk about what I wanted to talk about."

I think we just have to be more open to that.

JS: How do you handle patients who have inaccurately diagnosed a health problem?

WB: I think most people understand the limits of the Internet. There's a lot of great information out there. There's a lot of bad information out there. Again, my job is to teach, is to point out the data that's clinically relevant and to explain why I disagree with some of that information. There's a lot of gray areas in medicine. That's a hard part to understand.

It's only been in the last, probably 10 or 20 years that we're really getting to be good at evidence-based medicine where when I make a suggestion, I've got data to support it. It's because it's taken time to get the studies, to get the information out to actually know what questions to ask to find answers for. The answer of "Because we've always done it that way" doesn't fly anymore. Now I've got data to support some of my suggestions.

JS:   What are your criteria when making a referral to a specialist?

WB: There are probably two big criteria. One is that the patient needs skills that I don't have. If you're sitting in my office with a ruptured appendix, I can't take your appendix out so you need a surgeon. That's pretty much a no-brainer. You get diagnosed with cancer, I don't do chemotherapy, you need a cancer doctor.

Or, you have a problem I haven't been able to figure out. Something that we've done the first line workup, which is what primary care does, and then I don't know where else to go or do we need something more procedural, then you need a specialist.

That’s kind of the one arm, which I think is kind of a no-brainer. No one would question those referrals.

The other arm, which is a little more of the artistic part of it, is when sometimes patients just want to see a specialist. They feel better if they've gone to that next level of care and have had all of their concerns addressed to the Nth degree.

If someone really wants to see a specialist, I will talk about what I think a specialist is going to do for them and then make that referral.

JS:  Do you take into consideration the patient's and the doctor's personality when making a referral?

WB: Absolutely. You take into consideration how responsive your specialist is to your patients. If I send you to a specialist and when you call them you can't ever get an answer from them, you're not going to be happy with me for making that referral.

I always look at that communication piece. How well does the specialist communicate with patients and how well does the specialist communicate with me? I need to know what's going on. If I get the phone call from you because you've just found out you've got cancer and you've got to start chemo and when you want to talk about it, it really helps me if I know what they talked to you about. Specialists who communicate are probably the most important part.

Technical skill is obviously very critical in some specialties and I think the expectation used to be that if someone was a good surgeon they didn't have to be a good communicator. That's changing with time. I think surgeons still have to be good communicators.

JS: Is there anything else you would like to share.

WB: I think that patients deserve to be comfortable with whomever they're talking to. You shouldn't let inertia keep you from changing doctors if you're not getting what you need from that physician. I think you should do that.

I also think that the communication part isn't just in the exam room. I think the communication part is the rest of the office. What's your staff looking at? Does your staff communicate well with your patients? Does your staff pass on messages back and forth in a timely fashion? Those are all things you need to take into account and need to expect from your physicians … understanding some of the limitations of running an office.

If you call me in the middle of the morning and I'm in the middle of 12 patients, then I may not be able to drop everything and answer that phone call right away. But, there ought to be some way you can get that information communicated back and forth.

*Episode 32 – What’s in your attic?


Phone Interview on Jan. 5, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and Tim Carter, syndicated columnist and owner of the website askthebuilder.com.

Jeremy Stacy: Please give me your name, location and what you do for the record.

Tim Carter: My name is Tim Carter. My company name is askthebuilder.com. I'm based in Meredith, N.H. I write a syndicated newspaper column that runs in about 100 newspapers. Primarily what I do is I publish all that work on my website on askthebuilder.com.

More importantly, I was a hands-on builder for 20-plus years before I wrote my first column and I was picked as one of the top 50 remodelers in the United States in 1993.

JS: What kind of insulation options do consumers have to insulate their attic?

TC: Homeowners have all kinds of options to insulate their attic. They can go with any number of different products such as fiberglass, cellulose, rock wool, vermiculite; there many different types — they could even put straw up there if they wanted to — but what you want to do is use a material that's highly effective and one that's also safe. I say straw because if you've ever slept in a barn before, you know it's a very good insulator, but it's also very unsafe. You drop a match in and your house goes up in flames. People tend to look for insulation products that are not flammable, and fiberglass does not burn. That's why I think when you go to a home center or you see what builders use, they'll use fiberglass typically. You can also use foam. The different spray foams are highly effective insulators as well. And there's a big movement on using spray foam insulation in houses.

JS: What would you say are the top performers for insulation?

TC: Well, I think you have to quantify that question. Does top performance mean which [insulation] gives you the biggest bang for the buck or which insulation has the highest R-value per thickness — per inch — because they're two totally different questions. If you do an analysis, the best bang for your buck might be fiberglass. But, if you have a limited space that you're working in that you need to insulate well, I think your going to find closed-cell foam probably is the best in a given situation. It really depends on your application as to what the best insulation is for you.

JS: Tell me the difference between batt insulation and blown insulation.

TC: Batt insulation is a product that is manufactured in a plant and it comes out in these sheets that are a specific thickness and a specific width. For example, you may buy rolls of insulation for walls that are 15 inches wide and 3 1/2 inches thick or 5 1/2 inches thick or 9 1/2 inches or 12. The reason it's 15 inches wide is because the typical wall studs — when you space typical wall studs 16 inches on center — the actual void space is 14 and a half inches. So by making the insulation 15 inches, it fills up any of the air gaps because it's like a friction fit. That's a batt. The best way to describe what a batt of insulation would be that it looks like a flaky biscuit. That's what a batt looks like because it has layers of fiberglass that are kind of interwoven.

[For] blown fiberglass, they just take regular fiberglass and chunk it up and it goes through a machine that basically pulverizes it into small particles that are as big as a marble — or maybe like a malted milk ball — and it spits out the end of this hose and you just fill an area, much like you would fill the back of a dump truck with dirt or soil. Up in an attic space you can see how that would work really well because with blown-in insulation, instead of spending all that time trying to fit and cut the fiberglass batts around a joists and tresses, you can have somebody up there with a big hose that's just spraying the blown-in insulation. And the blown-in insulation tends to fill in void spaces better in ceilings than with the batt insulation.

JS: What are R-factors and what do they mean?

TC: An R-factor is a unit of measurement and R stands for resistance. It means resistance to heat flow because that's what heat tries to do. You'll notice this if you've ever left a metal spoon in a pot of soup as it was heating up. When you come back five minutes later and grab the end, you burn your hand even though the spoon is not in the fire.

When we heat our homes or when we're trying to cool the homes, we're trying to slow down the heat. Like in the winter, we want to slow the heat from leaving the inside of the house. If you have an insulation that has a high R-value — a number like 20, 30, 40, 50, even 60 — that's good. The higher the number means it's doing a better job of slowing down the movement of the heat from one place to another.

JS: What questions should consumers ask to choose the right contractor to insulate their attic?

TC: We could talk for days about that. The questions they need to ask these contractors are No. 1 : [Get] all the documentation, meaning I would never let anybody in my house to do work if they could not produce a workman's compensation certificate that's accurate and of course a certificate of insurance showing that they are completely insured. No. 2: We want to make sure they are in good standing with the local Better Business Bureau. But then — this is where most consumers fall down — you as the consumer need to go out and get educated about the product or the service before you even make your first phone call. The mistake most people make when they hire a contractor is they place all their decision on hope. Meaning, they hope they're hiring the right guy. If they don't know the right questions to ask the contractors coming in, they're not going to make an informed decision. If you're going to hire a good insulating contractor for your home, you better go and research about insulation yourself, find out what the problems are and the pros and cons. Then when you start to call the contractors and they come to your home, start asking them questions. You already know the answers and you want to see the contractor who gives you the most correct answers. That's who you should probably hire.

JS: How can a homeowner tell if they need additional insulation in their attic?

TC: You can go to the US Department of Energy website. They have some pretty halfway decent guidelines. There are different climate zones here in the United States of America. Obviously the people with respect to heating — the people who live in northern Maine, northern Minnesota — they need more insulation than the people in Florida or Phoenix because it's just not as cold.

When you look at the maps, they give you these recommended R-values you should have in your ceilings and your walls and floors. For example, there are many people who have their homes built on crawl spaces. Well, believe it or not, you need to insulate the floor because it's cold in the crawl space. 

Go to the Department of Energy [website]. Go look at those maps. You can cross-index those maps with information at the different manufacturers' websites. Go look at the people who make fiberglass, the people that make cellulose, the people that make foam and see if there's consistency in what they say you should have as well. That's how I would start that task. Then you just have to go out and measure it.

They'll give you converters — I'm just throwing this number out — 12 inches of batt fiberglass may have an R-factor of 38. Let's just say that you're in an area where the charts you should have an R-38 in your attic. Well, you better have 12 inches of fiberglass up there. If you don't, you've got problems. It means you need to add more [insulation].

JS: Can insulation go bad?

TC:  The answer is yes. Here are ones that typically don't go bad: foam insulation like a closed-cell foam insulation [because of] the way it's made — it can get wet and usually its R-value is not affected. But, many of the common insulations like fiberglass, cellulose, rock wool, vermiculite, things like that — they get their insulating properties by having all this air in the actual product.

If you take a fiberglass batt and it gets wet, it loses much, if not all, of its insulating properties. In that way, it can go bad. Now, will fiberglass insulation on it's own degrade up in an attic for 50 years? No. You can have fiberglass up in your attic — it's still going to be fiberglass. The only way that it might degrade is if somehow gravity or something else compresses it. Because, remember, it gets its insulating value from having a lot of air in it. You want to make sure insulation is fluffed up.

JS: Is there a rule of thumb on how often an attic should be reinsulated?

TC: There's no rule of thumb, it's just that you want to have the highest R-value in your attic or your walls that you can have. There does get to be a point of what I call diminishing returns. Meaning in my attic, when I built my own home, I put in 2 feet of blown-in fiberglass in my attic. At the time, the recommendation was only to have 13 inches. Well, I could afford to put in the 2 feet. I was doing it, it didn't cost me much money and I just thought, "I'm going to get a lot of benefit out of this insulation over the next 20 years."

You always have to kind of judge how long you are going to be there. Let's say you double the recommended thickness. Are you necessarily going to save double the money on your heating bill? The answer is no. You will not. You just have to do some mathematics.

Typically where people are going to save the most money is not so much in insulation as it's actually you want to go around your house and find where all the air leaks are. That's where the real energy robbing is happening. I'd be spending [more of] my time trying to find those air leaks than I would be just trying to add another foot of insulation in my attic.

JS: Can you put new or different insulation on top of old insulation?

TC: You can absolutely layer one type of insulation on top of another. You can mix the insulations back and forth. The only recommendation would be to always check with the manufacturer of the insulations you have and always make sure that they say it's OK.

I can't even imagine in my mind that you'd have some type of chemical reaction where you'd have a problem between the two, but it's always best before you mix two different materials to check with the manufacturer to make sure they say it's OK to do it.

JS: Is there anything else consumers should know about attic insulation?

TC: People should know that insulation is just part of the system. It's not the end all, be all of just trying to put something up in their attic. It's not a good enough thing just to insulate.

You have to couple insulation with fantastic ventilation. Let's say you put in 2 feet of insulation and you live in a hot climate and in the middle of the day your attic temperature soars to 150 degrees. Well, your insulation actually gets hot. Your insulation doesn't stay 70 degrees. If you put a thermometer in your insulation it could be 100 or 120 or 130 degrees. If you have great ventilation with your insulation, you may be actually moving enough air through the attic that you can cool your attic down to maybe 110 degrees. Well, there's a big difference between 110 and 150. And the same thing is true in the wintertime. You want to make sure you have great ventilation in the winter so that you don't have a lot of hot humid air that's seeping through your insulation, which it does, then condenses on your attic space causing the wood to get wet, causing mildew, mold and even to the point where it can actually drip onto the insulation.  Where, as we discussed earlier, if it gets wet, then it doesn't do a good job.

JS: Tell me about your newsletter and how people can subscribe to it.

TC: A lot of these tips I give, I do this for free each week and I have tens of thousands of people on my list. I have this neat personal newsletter that I send out once or twice a week and it's filled with e-mails I get from people with questions just like yours. I answer the questions. I talk about new products. I just talk about all kinds of neat home improvement tips and suggestions and people can get it by just going to my website, askthebuilder.com and right there at the top on the navigation bar you'll see the word “newsletter.” Just click that, sign up and that's all you gotta do. And it's all for free.

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Phone interview on Jan. 5, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and Steve Reisman, owner of Everguard Insulation in Woodland Hills, Calif.

Jeremy Stacy: Please give me your name, your company and your location for the record.

Steve Reisman: My name is Steve Reisman and my company is Everguard Insulation. We're in Woodland Hills, Calif. 

JS: Tell me a little bit about your company.

SR: My grandfather started this company in 1959 and my dad threw me on the truck and had me working in the summer when I was 14 years old. I'm 44 now, so I guess about 30 years of experience. I've been the owner for about eight years and have been doing it full time for probably a good 20 years.

JS: How can consumers tell if it's time to add more insulation to their attic?

SR: That's a great question and I've got to kind of digress for a moment to tell you that insulation is extraordinarily similar to people and their cholesterol. It's something they know they should be concerned about, it's something that's very important, but it's the kind of thing that is very easily and routinely overlooked and relegated into the realm of not being all that important.

It's a very commonly overlooked thing that people have no idea about. Generally they'll look up in their attic and they'll see 2 or 3 or 4 inches of old material and they'll say, "Oh, that is the insulation," and that's it. They're content with figuring that's enough. Very few people realize that you really actually need to attain an R-30 rating, which is your standard building code.

There are two different materials generally out there. There's fiberglass and there's cellulose. The most common material is fiberglass and some of the older products, like mineral wool or rock wool, they have to be about 12 1/2 inches thick to give you an R-30 rating. So you’re looking at over 12 inches — a foot — to get that level. Very few people have that.

With the cellulose, which is much more efficient and effective, you have to have about 8 inches thick to give you an R-30 rating. Generally, the best thing to do is take a look up in the attic and see what you got. If you have, on average, 9 or 10 or 11 inches, you're pretty much in good shape. But most homes don't have nearly that much.

Even a brand new home has rolled in material, generally, and they roll in an R-30. But, the thing is, a rolled-in R-30 only yields about the same performance as a blown-in R-19. Even a brand new home with the rolled material definitely can improve quite a bit by laying thicker information.

JS: What does R-30 mean?

SR: The way insulation works is pretty simple. The insulation's performance level is measured in a resistance level and that's what the R stands for. So the R-value would indicate what the performance level of the insulation would be.

A long time ago they started out with a material that had a standard building code of what they call R-19. Very quickly they realized it wasn't quite enough and they went to R-30. And R-30 has been a standard building code since about 1974. Nowadays though, people who live more inland like the San Fernando Valley, they go with a newer material, which is R-38.

JS: Are there any unique insulation needs in your region of the country?

SR: No, I wouldn't say there's anything unique about it, per se. In the warmer, hotter areas we usually like to go with an R-38 material. Insulation will hold heat in the winter to keep the house warmer and in the summer it actually blocks heat from coming down. It reduces your energy bills and keeps your house more comfortable. You’re looking at a warmer home in the winter and a cooler home in the summer and an all around more energy efficient home.

JS: What factors should consumers consider when deciding between blown and batt insulation?

SR: Batt material is the only material you can use when a new home is under construction and using open framing because you can roll it in. But, once the home is built and the roof is up already there's a huge advantage in that you can use the blown-in material.

The blown application generally takes less time, so there's less labor involved and that means it's a little less expensive. But, more importantly, the blown application allows us to blow the material. When we blow it in, it covers the entire floor of the attic as a solid blanket of insulation. When that is blown in, that matter, as a solid blanket, they call that a monolithic fill. That effectively is 38 percent more efficient than the rolled material.

A rolled in R-30 only yields the equivalent of a blown-in R-19. The flip side of that is if a blown R-19 works as well as a rolled R-30.  Because when you blow it in it just covers over everything as a solid blanket. Plus, when we go with a blown material we can go with a cellulose insulation and cellulose insulation is much more effective, longer lasting and more efficient than the fiberglass material.

JS: What other factors should a homeowner consider when choosing an insulation product?

SR: When we go with a cellulose material, cellulose is only available as blown-in material. Cellulose is such a phenomenally better product than the fiberglass. The cellulose has a lifetime guarantee, it's non-toxic, non-corrosive, even considered hypoallergenic. The cellulose is resistant to insect, termite, rodent, vermin, mildew and fungus. It doesn't itch at all and it's even great for soundproofing.

The fiberglass product is the opposite. It does not have a lifetime guarantee.  Much like the cotton candy that it resembles, it tends to settle and pack over time. Fiberglass is extremely itchy, it has a hazard warning label on it, rats like to nest in it. It's just all around not as good of a material.  

JS: What questions should consumers ask when trying to find a good insulation contractor?

SR: Which material do you use? I very much recommend the cellulose insulation and the reason for that is the fiberglass material, as I mentioned before, resembles cotton candy. In the same manner when you blow fiberglass in it gets extremely fluffed up. Channel 4 did a big exposé on that and they called it the "Insulation Dirty Little Secret."

They call it shorting or fluffing and what it is, when you blow the stuff in, it can get incredibly fluffed up. Not the cellulose. Cellulose is a stabilized product. It does not get fluffed up. Fiberglass, though, does just because it's a bunch of glass fibers, like cotton candy, and it can get very fluffy.

So [unscrupulous insulation contractors] can blow it in and they can fluff it up and they can really cut corners that way. They can use a lot less material and still make the job look half decent. Also, most people will look at a job 8 or 9 inches thick and say "Wow, that's a lot." They don't realize fiberglass has to be 12 1/2 inches thick to get an R-30 out of it. You can give them less material and you can fluff the material when you install it. I would definitely warn people about using fiberglass and I would ask that the installer use cellulose insulation.

Also, use a reputable installer. You really want to avoid these larger companies that actually subcontract the work. That would be air conditioning companies that turn around and subcontract me or other companies like these general construction companies that just do marketing. They don't do anything more than advertise, send out a salesman who has a little price sheet and they basically subcontract the work. All you're doing is spending extra money to work directly with a contractor. I would ask them that, too.

How long you've been licensed and been in business? And do they have the license to do the insulation or are they just a general [contractor] subbing it out? Beyond that, I would also ask them what they charge per square foot.

Most companies, if they're more oriented to sending out a salesmen, they don't want to tell you what they charge per square foot. They'll say, "Oh we want to come out and check out the house," and that sort of thing. The want to turn it into a whole presentation in order to get out there and size you up to get better idea of what they think you would pay. Then they hit you with the price and if you don't take it, they decide to go ahead and lower the price to try and get you to sign up that day. If you don't take that [price], then they call their office and [say,] “Oh gosh, how about that, the general manager just authorized an additional [discount].” Basically, it's just a big game. If they're not willing to tell you over the phone what they'll charge per square foot, then they generally want to play the sales game.

JS: Is there anything else consumers should know about insulation that we haven't covered?

SR: You just want to make sure you get it done by a licensed contractor who has a competent record. You want to make sure they don't close the heat vents off and you want to make sure all the vents remain open and the lights aren't necessarily covered up and it's done by someone who knows what they're doing.

The other thing is there's a gas company rebate nowadays and just this year, they restarted the federal tax credit of 10 percent. So there are a lot of incentives out there.

The tax credit is very similar to giving to charity. All you have to do is let your accountant know that you insulated and they basically process that. Whatever you spend on insulation, 10 percent of that is a tax credit.

As far as the gas company rebate, that's just like a typical rebate where you have to mail in an application along with a bill and they basically send a rebate in the mail.


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Phone interview on Jan. 5, 2009, between Jeremy Stacy, associate podcast producer for Angie’s List “List-en Up!” and Steve Carroll, owner of All Comfort Insulation in Addison, Ill.


Jeremy Stacy: Please give me your name, the name of your company and where you are located for the record.

Steve Carroll: Steve Carroll, All Comfort Insulation, Inc., Addison Ill. — Chicago area. We've been in business for 33 years.

JS: How can consumers tell if it's time to add more insulation to their attic?

SC: There's several ways. If they feel drafts or chilliness through the house, a lot of times that can be a lack of insulation in the attic. The reason being, the cold air is coming down and the warm air is rising and that will give a feeling of drafts through the home. That's one indication. High energy bills, the furnace or air conditioning recycling quite often [are other signs].

Another one is just visual. Go up and take a look in the attic. Different insulations have different R-factors per inch, but our general rule of thumb is you'd probably like to see a minimum of 12 inches of insulation up there. That's a very minimum. R-38 is the Department of Energy recommended minimum, which is roughly a blown-in fiberglass, which is about 14 1/2 or 12 inches of fiberglass batt. The optimum is R-49, which results in 18 1/2 inches of blown-in fiberglass.

JS: What factors should consumers consider when trying to decide between blown and batt insulation?

SC: Blown-in is more economical between the material and ease of installation. Basically it's an investment in your home, so you want to get a better return on your home. Blown in [insulation] works that way. It's costing you less. It's saving you energy so you're going to get a quicker return on it. Blanket insulation is more labor-intensive to put in. Basically what you're buying is R-factor. That's the performance value.

In some attics where it's very accessible, easy to reach everything, batt insulation for the homeowner – do it yourself – would be a good way to do it. If they're handy and careful, they can put that in and all they're paying for is materials. There's quicker return on their investment.

JS: How do you make insulation recommendations to homeowners?

SC: We make an assessment of the insulation they have up there — their R-values — and what we usually do is give them an option. Get it up to the minimum [recommended R-value] or go up to the optimum [R-value]. We leave that up to the homeowner. It depends on what their expenses will allow. We also look at the ventilation, which is just as important when you insulate.

JS: What should consumers consider when deciding between blown cellulose and blown fiberglass?

SC: Fiberglass, like Owens Corning and CertainTeed, are billion dollar corporations. They put a lot into the insulation — research and development — they're high-performing, high-quality materials. Fiberglass is non-combustible, it won't rot, it won't absorb moisture.

On the other hand, cellulose is recycled product — newspaper that's ground up — and about 20 percent of the weight is chemicals. So, more people are thinking green and thinking of not putting chemicals in their home. Most of the higher-end fiberglass have no chemicals in it and most of the major manufacturers of fiberglass are now considered green because they're using anywhere from 35 to 40 percent recycled products.

Hand in hand, they're both green products. Cellulose uses more chemicals to make it rodent and fire retardant. One benefit that cellulose has over fiberglass per inch is it has a higher R-value. Any insulation contractor, we have to sell a product on R-factors.

JS: In terms of blown insulation, do you recommend cellulose or fiberglass?

SC: I recommend the fiberglass. The reason we do it is because most fiberglass manufacturers have a lot of development and research in the product so we feel that's a good insurance behind the product. I feel a lot safer doing it.

Cellulose, they're smaller companies, there's not as much investment into it. They do research and that, but we just feel it's a good insurance policy with the blown in fiberglass. I will lay out on the line the different products and R-factors and I won't twist any arms to let them decide on what I tell them.

JS: Does the Chicago area have any unique insulation needs?

SC: Insulation works year-round. Florida and the sun states during the summer with the air conditioning and electrical use, that's when the highest loads are. Here [in Chicago], we get the hot, humid summers where people are running air conditioners and need insulation then. Then we get the cold winters. Our climate, the way it changes, sometimes it seems hourly, but it's daily, there's a great need ¬¬— one for the insulation and second for the ventilation ¬— we just don't run into one pattern. It's up and down. It's why ventilation is an important part of the way we insulate.

JS: Why is ventilation so important?

SC: Ideally, you want to keep the attic within one degree of the outside temp, which is very hard to do. But, what it does is during the summer when you have ventilation, you're using the natural physics of the air coming in and rising against the deck and pulling out the hot air. Insulation keeps it from penetrating into the house, but if you keep the heat out naturally with the ventilation, it's going to be a less load on the insulation. Then, come winter, insulation is keeping the heat in the home. But, the ventilation, what that does is keep the attic within one degree so you don't have condensation problems and it helps with ice damming. It's a reason why ventilation plays a big part, especially in our region with the climate and how it varies.

JS: Is there anything you can recommend to the consumer about insulation that we haven't talked about?

SC: Have [the insulation] assessed by a qualified contractor and then there's just little things they can do around the home like outlet seals and making sure weather stripping around the doors are properly fitted and sealed.  Just make sure you pick a qualified contractor that’s properly insured. Check, through Angie's List, the Better Business Bureau and make sure if you have any questions or issues it's something the contractor is going to be there and stand behind.

Ask [contractors] about the ventilation, "Is my ventilation fine or what can you do to rectify it?" Make sure they are selling [insulation] in R-factors and that it's stated on the proposal what kind of R-factor they're putting in there. Define what product they're using. Not just blown or fiberglass, but manufacturer and make sure the contractor is fully insured.

I am a transcript not a conscript

Laughter yoga

Twinkle VanWinkle, “List-en Up!” producer
Interview with Linda Batchelor-Ballew January 6, 2009

Twinkle VanWinkle:
Can you state your name, title and location please?

Linda Batchelor-Ballew:
My name is Linda Batchelor-Ballew and I am a certified laughter yoga leader. I’m certified by Dr. Kataria from the School for Laughter Yoga. He is the founder. My location is on the border of Indianapolis and Carmel, in Indiana.

TVW:
Can you give me a brief description of laughter yoga?

LBB:
A medical doctor, Madan Kataria, initially developed laughter yoga in its present form in 1995. He developed it as a way to harness the health benefits of laughter. What we do [in laughter yoga] is lead people into a state of childlike uninhibited laughter for no reason, so to speak. It’s the combined practice of breathing patterns, stretching, rhythmic chanting, movement and laughter exercises. These are the opposite source of laughter to that generated by a joke, or what’s usually called causal laughter. My sessions are usually followed by a relaxation exercise so one gets the full benefit of the chemicals generated in the body.

TVW:
How long have you been involved with laughter yoga?

LBB:
Well, as a nurse in the 1960s I was always in trouble for having fun with patients who wanted to be of appositive mind. Then it was thought that [having fun] was undignified and not the cause of people being well. Then I saw the film Patch Adams and I cried all the way through it because I thought, “There’s my story,” except he had a happy ending or so I thought. Then I saw Jonathan Cleese in what I thought was a comedy sketch, but he was actually interviewing Dr. Kataria as part to of a series. Then I saw it was being practiced at St. Vincent’s Hospital, but I couldn’t get in on the classes. This last year in April someone let me know knowing of my great interest following this there was a class opening. By the beginning of May [2008] I was a certified laughter yoga leader on World Laughter Day.

TVW:
What did you do to get certified?

LBB:
There is a 2-day session. So for upwards of sixteen hours you laugh a lot. You learn the breathing exercises, the movement, the chanting. You learn the clinical theory behind it. You learn how to organize a class. You learn the difference between what we think of as laughter, which is just about always causal. You know as children when we don’t tell a joke the right way, we aren’t allowed to laugh until we tell it the right way. But as very young children, they just laugh - they look at the ceiling or their toes and they laugh. So we learn through the laughter exercises to stimulate that natural laughter. We learn a lot during that weekend.

TVW:
What’s the connection with yoga?

LBB:
There’s been laughter yoga for thousands of years. This is called hasya yoga (or hasja) –spelled h-a-s-y-a or h-a-s-j-a - and it is a form of yoga. There are many forms of yoga. Most people are just familiar with the asayana. That is the positional form of yoga that deals with the body. Then there is prana or pranayama - that is control of breathing yoga. What this is involves the hasya yoga - the laughter. The yogis in the earlier days would just attempt to laugh and their students would just sit and laugh. If you look at YouTube you can see some there that someone has posted from the 1970s. So, that’s what it has to do with the yoga. There are actually 8 different forms of yoga. So we use the breathing and the hasya together to work with each other. If you just laughed heartily nonstop you’d put your blood pressure up. You could have a heart attack. As children you laugh until your sides hurt. That is not a good thing. We combine the pranayana and the hasya yoga together to make laughter yoga - to make it comfortable and fun and beneficial.

TVW:
Can you tell a difference in your health since you have started practicing it?

LBB:
Oh, gosh, amazingly. Initially, I loved it. I felt buoyed up and on a natural high as if you woke up on a perfect day and everything was perfect and everything was great. After I trained and I was practicing everyday my ribs ached. I grew some muscles where I didn’t have them before. So for a few weeks my ribs ached and my waist got smaller. My hips and my waist have continually gotten smaller. I do phone laughter everyday. There is a conference call where anyone in the United States, or anywhere for that matter, can call in and laugh and breathe and laugh and breathe. I was really not doing very well when I started laughter yoga. I had a problem that knocked out my immune system and with in days those things disappeared. I don’t have colds, and my immune system is up. Anything I find that’s a problem is not a problem. It’s not a negative situation. I laugh and it’s not a problem. So my own health and my emotional health, and of course those people that do it with me, has improved. I’m relaxed. I’m refreshed. There are no big problems. Even dire things are no big problems. They are just things to be dealt with. It has really made a difference for me. Of course I have a back and leg injury and when I do the laughter yoga within a few minutes the pain stops. The pain stays away for about two hours. And the more I do it – I do it everyday – the less pain I’m in without painkillers. As a matter of fact, I don’t use them at all now.

TVW:
As an observer, what do think the affects of laughter yoga has been on others in your group or sessions you have led?

LBB:
I can tell you two ways. My personal observation is that people often come in nervous or stressed. If they haven’t been before or they come in with someone else, they may seem skeptical. At the end of the session, they’re refreshed and relaxed and bubbling and saying how they didn’t realize how they needed this before. They say how wonderful it was and talking about their experience. So they are relaxed and energized and feeling really calm. I ask people to fill out feedback forms. From those I have people from information technology or that field and many of those, like this one, “I was skeptical. Afterwards I felt refreshed. I didn’t think it would work. I felt silly at first, but afterwards I felt great and would definitely do it again. I really enjoyed it.” Or this one, “ I am sure I will practice it a lot in the car during traffic jams.”

A lot of people who are professionals feel skeptical and yet most of these people feel refreshed. They use it for relaxation. They found it really enjoyable or they found it embarrassing, but now feel relaxed. There is the same kind of comments on all the feedback. And some found exercises they absolutely loved. So it’s goofy and they’d definitely do it again.

So people during the beginning appear to be skeptic. They think it’s a bit weird or don’t know what to expect, but at the end seem to be very happy and relaxed.  I’ve not had any feedback form that was negative. Ever.

TVW:
Can you tell us why you love it, and anything important you think our listeners should hear?

LBB:
I love it because I have always believed it affected people. One of the things that I looked at, having been a nurse, were studies all the way back to the1960s – Norman Cousins was one who in the 1960s helped heal himself. He had a disease that was not healable. My experience was the scientific stuff that was documented from the 1960s and one from 2,000 years ago by the physician Dalin – but I don’t know if we can actually ask him. But they’re correct. They show laughter stimulates the immune system – the T-cells, they kill viruses. It increases oxytosin (the happiness hormone). It decreases cortisol – the stress hormone (puts weight on your belly too). It produces endorphins, which decrease pain. It oxygenates all parts of the body. So there are all kinds of healing. I love the fact that it is healing, it is wholesome, and it is healthy. With only a few contraindications for health, almost anyone can do it. It’s just my passion to spread it and educate people and give them the opportunity to try it and maybe even find some people who want to train and become leaders like me.

TVW:
When do you meet? When are your sessions?

LBB:
We meet about three times a month in Carmel, usually on a Saturday or Sunday and we try to one week night. If people want to find out when they are, because they do vary, go to meetup.com and search for Laughter Yoga.

TVW:
What does it cost?

LBB:
Oh almost nothing. If someone wants to donate they can donate two dollars a session. Just enough to keep the space we use paid for.

Twinkle VanWinkle, “List-en Up!” producer
Sebastien Gendry Interview
American School of Laughter Yoga
Interview January 7, 2009

Twinkle VanWinkle
Can you tell us your name, title and location?

Sebastien Gendry –
My name is Sebastien Gendry, and I am the Director of the American School of Laughter Yoga, based in Los Angeles, Calif. –

TVW:
What is a basic definition of laughter yoga?

SG:
Laughter yoga is a very simple form of exercise where we combine simulated laughter with gentle breathing techniques and progressively a lot of childlike playfulness.

TVW:
How long have you been involved with laughter yoga?

SG:
I’ve been involved with laughter yoga myself since 2004. I heard about it by chance in a magazine. I went online and was so inspired by everything I found online. So I got on a plane and went to Mumbai, India to find out more from the founder of this amazing technique, Dr. Madan Kataria.

TVW:
What did you do before that? Do you still do the same thing?

SG:
Laughter yoga has changed my life. It’s actually better – it’s changed me. Before getting acquainted with this method I was a serious businessman. Serious businessmen don’t laugh. I was trying to behave like I thought the world was expecting me to behave. As a result of this behavior I was very, very sad. I had everything I wanted to have but something was missing and I had no idea why. When I came across laughter yoga, I came to realize that the way I feel is always my choice. I got to realize my environment has nothing to do with my emotions. The way I feel is always a choice and, as such, it’s changed my life. It’s better. It’s changed me because today I can’t claim I’m not stressed anymore.  I face stress, sadness and anger like most people do I guess, except that now I can’t hide. Meaning I know that when I do get angry, upset or sad, it is my choice and it has nothing to do with it, him, her, or they.

TVW:
Can you tell the difference in your health since you’ve been practicing it?

SG:
Yes, yes indeed! The benefits of laughter yoga are far reaching. Essentially we use laughter as an excuse to breathe deeper. It has everything to do with oxygen – deeper breath – being the fuel that every single cell in the human body needs to function. The better you breathe, the better everything functions.  I haven’t had any symptoms in the past 5 years now, as in cold, flu, headaches. I used to get the flu 2-3 times a year, occasional headaches, but not anymore. Sometimes when I push my system and work more than I should and don’t sleep enough, I sense that a throat infection is coming up. Invariably every time if I laugh for an hour, it goes away. It’s like clockwork. It’s not just me; it’s all the people that are involved with this method. All of the minor symptoms of sickness like cold, chest cold, sore throats, and head colds go away all together. That’s on a physical level. It’s often said that laughter will take you half way home to healing. It’s back to oxygen. When you breathe, when you laugh for twenty, thirty minutes or more, you significantly flush your lungs with fresh oxygen. That is a big kick to your immune system, because it’s a contraction, relaxation, contraction, and relaxation when you laugh. Laughter is a big form of cardiovascular exercise, so physically your immune system is strengthened and you also feel good. So when you feel good physically, your mind has to slow down and feel good. It’s very hard to hang on to past grief, sadness or future worry and feel good in the here and now. It’s very difficult. Actually you can’t. The next outcomes besides the physical benefits are the emotional and spiritual benefits. It brings people back into the here and now. It disconnects you from past and future. It lifts the stress. It lifts depression. Once again, it is real hard to feel good physically and to think of yourself as stressed or depressed or angry. Mind and body have to be in sync at all times.

TVW:
What is something you can say to other people about laughter yoga that would get them interested in it?

SG:
Laughter yoga is extremely simple. Its core concept is one of redefining laughter as exercise. Laughter yoga is body/mind not mind/body. It doesn’t matter who you are, where you come from, or what you’ve done, or what’s been done unto you or where you will be going. It doesn’t even count. You can feel good. You can feel empowered. Happiness is with yourself is here and now. All you have to do is go through the motions.

What we are doing is actually really ancient wisdom. In laughter yoga people learn in a very expansive fashion to let actions impact their emotions and not the reverse, not to be driven by their emotions. Whenever you feel sad or depressed do something. Go for a walk, laugh, or smile. Take a physical action so in time it impacts and changes your emotions.

TVW:
You think laughter is a key element to being healthier?

SG:
We now have a new field in psychology called positive psychology. This field has found out that you need four key things to be happy.  The first thing is that you have some kind of belief system, so when the going gets rough you are not alone. When you laugh, whether or not its exercise, you connect with others, and ultimately the divine, or the higher – the flow. Number two; you need to know you fit in a group somewhere.  Humans are gregarious, they aren’t meant to live on their own. Laughter yoga is done mostly in group settings. When you laugh with other adults for no particular reason, you are forced to drop your ego and connect. It’s a very powerful form of team building as it were because laughter is a very powerful force for democracy. It puts everybody on the same plane. It makes you feel a part of a group. It makes you feel part of the human race. The third key element you need to have is the appropriate amount of intimacy, not just about sex, but being able to share one’s self closely with another person. And the last element is that we need to laugh and play. We do laugh and we do play. There is a beginning and there is an end. Laughter yoga is very much built around childlike playfulness, not childishness or silly or idyllic. It’s not silly; it’s playful.  Who said adults can’t play? It is very important to make the distinction between silly and playful because to define adults playing as silly is positioning yourself within the box of conventions and rules that you accept. Defining it as playful just describes as something happening. It doesn’t put a label or judgment on it. You can’t blame a child for playing, because it is the very nature of the child to play. Likewise, why can’t adults play? Once again, in a safe setting. Laughter yoga is a very powerful way to reconnect with the child within, to break through your own inhibitions. Most people have their issues with happiness because they try to conform to the unspoken rule of society that says you must not, should not, and cannot express intense emotions in public. If you do, you are being irresponsible, out of control, or there’s something wrong with you. What you don’t express, you repress. If you keep feeling something that you don’t express, like you want to cry because you are sad, you want to laugh because you are happy, if you don’t do that it leads to tension. In the context of laughter we allow to relieve all those pent up tensions. We allow the joy of being to express itself – without any rationalizing, without any labels. It makes sense. Adults don’t laugh like we do in laughter yoga. We just play effectively. And it’s exercise. No one is trying to be funny; we just redefine laughter as exercise.

Does that make sense to you?

TVW:
Yes, yes it does.

SG:
Do you want to try?

Yes, here is the thing. Typically when you say in the East, “Laughter is good for you,” usually the reply is, “Great! Show me!”  When in the West when we say, “Laughter is good for you,” the reply is, “Great. Why?”  It is easy to stay in your mind because it’s safe. Humor works really well, humor is very safe because you choose to laugh or not.  Laughter yoga is a bit more challenging because you aren’t trying to make anybody laugh. You have to be willing to laugh in and about yourself.  So you have to be willing to love yourself. You have to be able to accept yourself as who you are. Life is not perfect and humans are not perfect and that’s ok.

So if you want to try a couple of exercises?

TVW:
Well sure!

SG:
OK it is going to start with a question. Do you want laugh now?

TVW:
Yes!

SG:
Ok perfect! Let’s take it!

{LAUGHTER}

SG: Now what usually happens, depending on how you judge is most people would only allow themselves to chuckle. The mind will keep sending out a message to the body saying you can’t do that because it doesn’t fit into the accepted behaviors for who you are.

So you are pushing it one step further in laughter yoga by doing those exercises. You learn in an experiential way, we don’t preach anything. You learn by doing, not by listening. You learn to do, not just try. 95 percent of the world’s population try, 5 percent do. 95 percent of the world will say, “Hey, there’s a wall. I can’t go past it. Can’t you see?” The thing is, they are correct. There is a wall. The thing is, is that there are no mountains, just a small slope. The other 5 percent would actually climb the wall. There is a huge difference between trying and doing. We live in a world of duality.  There is no absolute. There is good and bad. Always has been, always will be. The thing is your perceptions will always validate your belief, and as such if you want to see negativity, you are correct. You will find proof to validate your point. And reversely you can see positivity in the exact same things. And you will find proofs to validate your points. Trying means you don’t really care…. you don’t really want it.

There is nothing harder to pierce than the cloak of simplicity. So it’s one of the main approaches to make breath work more effective. The way you breathe defines the way you are. Now we use laughter to flush our lungs and fill our blood stream with fresh oxygen. And through that relieve stress and through that let go of negative behaviors through time and process.