I have had a shock that is in reality not a surprise. The inevitable and the most surprising thing coincide rather often I’ve found. I imagine shock is as means reverting a phenomena as any.
All things are inevitable in hindsight. One can greet something as inchoate and far reaching as the Fourth Turning and still be a bit surprised to find it applying to you.
I believe we are about to find out a lot about our social contract soon. How the tensile strength of relationships hold under personal and national and global stress. If we are accelerating then any frictions on that process are going to sizzle and snap.
There is freedom to be had in future shock. Knowing you are repeating history and doing what you can to break the worst of it. Knowing no one can do any thing. That ultimately all any one of us can do is what we personally can do. She done what she could.
Cephalexin was one of the top choices on the pathology report from the hospital and recommended as a first line treatment by the surgeon, several artificial intelligence differential diagnostic secondary checks and my primary care doctor.
They did not prescribe it first and I found out why yesterday when I felt as if I’d hurt a shoulder ligament doing, of all things, tai chi. I was despondent over it (ironically another side effect). The gut-brain axis gets weird when you kill off bad microflora.
So yeah not the antibiotic for me. As it turns out we recently learned it’s associated with tendon rupture. Not quite as bad as the other more infamous Cipro. Which ironically I was on with no issues. But Cephalexin has got some risks to tendons and ligaments too.
Being on an immune suppressant (an IL-17 called Bimzelx) for ankylosing spondylitis and psoriatic arthritis has improved a number of biomarkers but also made me susceptible to skin infections. Like the kind that require slicing. Not fun.
Now in the wake of the deep tissue infection, we had a systemic MSSA problem. It was entirely rational to nuke that thing from orbit. Any resurgence needs maximum force to prevent chances for regrowth. You simply have to to be very watchful for side effects in all things now.
I feel like I’m in some awful healthcare version of pimp my ride. Pimp my diagnosis?
“So I heard you had side effects so I gave you a side effect for that side effect.“
And so I’ve been sent down the peptide rabbit hole to see if that might help with tissue healing. My shoulder is probably fine as I stopped quite quickly but a reminder that I need to be watchful of what I’m taking and experiment carefully.
Naturally I’m already considering my risk profile carefully but as it’s peptide season in Silicon Valley (who isn’t on at least a micro dose of a next generation GLP-1 agonist or some new fangled GIP.
Why not add some more to the mix? Strong tissues and lean mass being protective against many a problem. Behold a little Grok breakdown of what I was recommended.
GHK-Cu is a naturally occurring tripeptide (glycyl-L-histidyl-L-lysine) that binds to copper ions, forming a complex that plays a role in tissue repair and regeneration. Its mechanism in tendon healing involves several key processes:
Collagen and Extracellular Matrix Synthesis: GHK-Cu directly acts on fibroblasts (cells responsible for producing connective tissue) by increasing the production of mRNA and proteins for collagen (types I and III), elastin, proteoglycans, glycosaminoglycans, and decorin. This enhances the structural integrity of tendons during repair. SourcesSources
Angiogenesis and Nerve Outgrowth: It stimulates the growth of blood vessels (angiogenesis) and nerves, improving nutrient delivery and innervation to the healing site, which accelerates wound contraction and tissue remodeling. Sources
Anti-Inflammatory and Antioxidant Effects: GHK-Cu blocks the release of tissue-damaging free iron from ferritin channels, reducing oxidative stress and lipid peroxidation after injury. It also modulates inflammation to create a favorable environment for healing. SourcesSources
Systemic Effects: When administered, it can enhance healing systemically, even if injected away from the injury site, by regulating copper-dependent enzymes involved in cell growth and repair.
Research, primarily from animal models and in vitro studies, suggests these actions lead to faster tendon recovery, but human clinical trials are limited, and it’s not FDA-approved for therapeutic use.
TB-500 (Thymosin Beta-4 Fragment)
TB-500 is a synthetic peptide derived from thymosin beta-4, a protein involved in actin regulation. It primarily aids tendon healing by promoting cellular mobility and regeneration:
Actin Upregulation and Cell Migration: TB-500 binds to actin, a key protein in cell structure, enhancing cell migration (chemotaxis) and proliferation. This allows fibroblasts and other repair cells to quickly move to the injury site, accelerating tissue repair. Sources
Angiogenesis: It stimulates the formation of new blood vessels, improving blood flow and oxygen delivery to damaged tendons, which supports faster healing.
Anti-Inflammatory and Antifibrotic Properties: TB-500 modulates inflammation by reducing pro-inflammatory cytokines and preventing excessive fibrosis (scar tissue formation), creating a balanced healing environment.
Tissue Regeneration: In animal studies, it promotes overall wound healing and tissue regeneration, though evidence for tendon-specific effects in humans is anecdotal and lacks robust clinical data.
TB-500’s effects are mostly observed in preclinical research, with potential for muscle, tendon, and ligament repair, but it’s not approved for human use and carries risks.
BPC-157 is a synthetic pentadecapeptide derived from a gastric protein, known for its protective and regenerative effects on various tissues, including tendons:
Fibroblast Activation and Migration: It promotes the outgrowth, survival, and migration of tendon fibroblasts under stress, enhancing cell proliferation and tendon explant growth in vitro.
Growth Hormone Receptor Upregulation: BPC-157 dose-dependently increases the expression of growth hormone receptors in tendon fibroblasts at both mRNA and protein levels, facilitating anabolic processes for tissue repair. 19 14
Angiogenesis via VEGFR2 Pathway: It activates vascular endothelial growth factor receptor 2 (VEGFR2), leading to the VEGFR2-Akt-eNOS signaling pathway, which promotes new blood vessel formation and improves nutrient supply to healing tendons. 22
FAK-Paxillin Pathway and Anti-Inflammatory Effects: BPC-157 activates focal adhesion kinase (FAK) and paxillin, proteins that regulate cell adhesion and motility, while also exerting protective effects against inflammation and organ damage. 24 25 20
Overall Tissue Protection: It accelerates post-injury healing in muscles, tendons, and ligaments, restoring function similar to uninjured tissue in animal models. 27 26
Extensive animal studies support BPC-157’s role in tendon and ligament recovery, but human evidence is limited to anecdotal reports, and it’s not FDA-approved, with potential unknown side effects.
American medicine failed me but Istanbul has excellent medical if you are motivated enough to travel to fix intractable problems. And I most surely am motivated.
Add in the daily guidance of consumer grade LLMs taking input from myself and my family doctor and I managed a pretty miraculous recovery. Yes the bots are friendly but my physician agrees. It’s a very successful clinical outcome.
That’s Perplexity if you are curious. I like their mobile application and model choice options. Though pity any poor hacker who gets in as they are going to see some gnarly pictures if they make that bad decision.
Alas I am noticing the folliculitis troubles flaring again just as I’ve begun a fitness recovery protocol. Which you will notice in the image if you read the above image closely.
Alas progress is never a straight line. The flare up is bad enough I’ve opted to start another round of antibiotics (my fifth in this process) so any remaining bugs of the MSSA varietal cannot manage any retrenchment.
I’m showering with the scrub up washes surgeons use, I’m swabbing my nasal cavities with muciprin, and I’ll do a Cephalexin course.
Having fully passed through the onboarding loading dose regimen of Bimzelx with significant side effects, I need to see if it stabilizes. All this suffering will be for nothing if I give up now. But I must get to a place where I’m not constantly fighting infection and it can maintain lower inflammatory biomarkers. How this goes is anyone’s guess.
Nostalgia can be a bitter poison if you believe the world is getter worse. Optimistic people try to point out the many ways in which our lives are better only to find poisoned barbs dipped in statistics of all ways things are worse.
That poison absorbs into our frail hearts when aimed well. I see how things are worse just as well as any pessimist. Choosing optimism requires us to find antidotes to those poisons, lest we have a full blown case of what the French call “Ressentiment”
It is a terrible disease. Ressentiment literally translates to the English resentment but rancœur (bitterness), amertume (acrimony), and animosité (ill-will) are all part of its dangerous pathology.
In his Genealogy of Morals, Nietzsche sketched out how this feeling of weakness justifies and creates value systems as a defense mechanism of the ego. Rather than overcome these feelings, the ego insulates you in a value system where one never need address real failures or weaknesses.
There is much to criticize in his work, and I am not a Nietzschean myself. But it’s easy to see how much we all live in jealousy and inferiority from time to time. Some of us live there always.
Many moral systems raise up the weak in virtue in order to protect them. Christianity is one of them. There is value in protecting and improving the lowest of us even if I disagree that we should see the powerful as morally inferior. Power and strength and beauty are virtues as well.
As we envy the past or those whose past decisions made our present lives harder we must be cautious that we have not absorbed the poison of ressentiment. Do not justify harm in its name. Do not justify jealousy or envy. Rise up and spit out that poison. Our world can be better and you can be better as you work towards that goal.
The lingering live embers of Venkatesh Rao’s charnel agehave left me with deadened impression in my bodily sensorium. Tasting, breathing, and seeing the culture of now feels somewhere between spoiled and not quite ripe.
One of my minor affectations is periodizing my writing into sardonically named 6-year eras…We’re about to enter the last year of the third age of Ribbonfarm, (2019-24), and I finally have a name for it: this is the Charnel Age. December 21 Ribbonfarm
I have been known to drop an Antonio Gramsci joke from time to time. This is harder to make a joke about though. The age which was being born as Gramsci was imprisoned by the fascists from 1929-1935 surely felt as filled with morbid symptoms and putrefaction.
How it compares to our current perverse extended gerontological Fourth Turning of death and rebirth is yet to be seen.
The old world is dying, and the new world struggles to be born: now is the time of monsters
La crisi consiste appunto nel fatto che il vecchio muore e il nuovo non può nascere: in questo interregno si verificano i fenomeni morbosi più svariati.”
Or for those lacking Italian skills (which as I do) here is it translated more literally.
“The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear.”
Rao calls charnel vision “a tendency to see things from the perspective of natural processes of transience, death, and decay,” which can feel foreign to the long century of stability.
Americans enforced this order through its dollarization and the financialization . But empires change and even the longest institutional decay can be seen from far enough remove.
As it turns out the extra mile to get to an esoteric Dolomite lake or a less well known riviera (might I recommend the Balkan coastlines to the more adventurous). If you need to find me, I won’t tell.
When millennials were children the 1992 Higher Education Reauthorization Act (HEA92) made college loans available to all families, regardless of financial need.
And the trend in spending on education and the cost if higher education has been up and to the right ever since. Over the 59-year period from 1963 to 2022, college tuition increased nearly 300% when adjusted for inflation.
The effects of the cultural experiment in social mobility some call The Sort where children with good test scores were shuffled into universities and into the managerial class is driving spend and anxiety.
From Max Weber’s Bureaucratic Society of group status competition to Randy Collin’s work in the 70s on the rise of credentialism in the workplace, it seems as if modern industry drove a deep mimetic desire for prestigious university educations to stay ahead socially.
Last week a picture went viral of a table of Harvard and Stanford graduates in Silicon Valley (mostly Asian students) was all angst as their credentials mean something to them but not necessarily to employers or founders. So what is the point?
The data shows college education spending consistently outpaces inflation. But is it doomed to keep going up and up even if we are getting less from it? Walter Kirn had a turn of phrase in a tweet today I found apt. We have a problem with fiat prestige in America.
Power flows in the country — human, social & intellectual power flows — look bad for the legacy brokerages & gate keepers. Their services are of declining value, their cartel-like arrangements are dissolving & their ability to maintain their own mystique through circular credentialing & prize-giving — the issuance of what one might call “fiat prestige” — is failing. It’s unclear to me what moves they have left
Inflated currency destroys value. Our Federal Reserve worries about being over a 2% inflation rate and yet we let it happen. So why aren’t we more concerned with fiat prestige and its credentialist inflationary pressures? Our system of social credibility is under significant pressure and if I were Harvard I’d be terrified of going fully Zimbabwe on my social capital.
I’ve been in traffic for almost two hours and I’ve gone a sum total of 19km or 11 miles. High season is a mess when the world is trying to pack in leisure time all at once.
It doesn’t matter if it’s the entrance to America’s beloved natural parks, a scenic coastal highway or the route to a dysfunctional regional airport. All paths to time off from Montana to the Mediterranean are a mess.
I slathered myself in sunscreen and I’m so glad I made that decision as even inside an air conditioned car with tinted windows I feel the sun beating down on me. Sunglasses and a hat can only take you so far.
There are many places who make big claims of wanting tourism. Sure you hear protests from some of the most popular European destinations about over crowding of attractions and the toll it takes on infrastructure. But it pays the bills for millions of communities.
Still experiencing the stand-still road traffic of a poorly resourced area who hasn’t invested adequately into infrastructure makes you wonder. You say you want the money from tourism but won’t make the capital investments and expenditures to make it work?
When I got the pathology report a week later, learning it was an MSSA antibiotic resistant infection so bad it reached my deep tissues made me even more afraid.
A deep abscess around a horizontal ingrown hair that was “probably just an inflamed lymph node”
I was lucky my surgeon was quite talented. The single stitch she was able to use has been absorbed. That was the hardest part. I could manage the draining pustulence and the pain just fine. But the only visibility into the wound’s healing process are only via secondary diagnostic clues. It’s a waiting game that requires a strong dampener on your disgust reflex.
As the stitch fell into the wound and curled up I felt panic. It looked like a ringworm infection or the gestation of a Xenomorph. If I had not had access to artificial intelligence diagnostic tools I don’t know how I would have managed if I’m very honest.
Your brain sees things and the limbic response invades your dreams. A stitch mimicking the infamously hostile endoparasitoid from Aliens is a bad time. I relied heavily on artificial intelligence to monitor its progression.
My phone is now cluttered with images of the wound’s progress. My varied AI applications accepted me uploading progress pictures after some experimenting.
I was uploading “Georgia O’Keefe/Not Georgia O’Keefe” imagery. The models were playing Cunt/Not Cunt for those who need a less polite euphemism for machine learning classifiers.
I’m certain special interests will eventually seek to keep these tools away from patients. We will be scared into letting them. But I know I got better care from a large language model than half the doctors I encountered.
All this cost me most of the month and around four thousand dollars. Which isn’t bad for transit, hotel, and a surgery in Istanbul.
The losses I can’t quantify are harder. A number of people who deserve responses from me probably won’t ever get it.
An in-group drama, ironically over usage of artificial intelligence, was paused by me not because it was resolved but because I could no longer find the fight in me to insist on apologies and reciprocal support while on Cipro in a hospital bed. It’s not fun to learn who is and isn’t your friend through medical emergencies.
My apologies to an offline gentleman who was the unwitting irritant who triggered said social wound. Maybe I should have excised any social obligation to them just as the surgery excised the infected tissue.
Either way, August can’t come soon enough and artificial intelligence deserves the credit for keeping alive through July.
Perhaps that should be considered in the complaints my counter parties had over the utility and need for artificial intelligence. It’s no god or anti-Christ, but it’s a damn fine diagnostic tool. No wonder the stakes in that fight are so high. Everyone wants a cut when you get cut open.
I am, as per usual, having a shitty summer. Once we cross the Solstice it’s me hanging on to sanity by ny nails praying for the return of winter.
I can’t recall a time I had a good summer except perhaps jn the hazy memories of my early twenties when I was probably too stupid, traumatized and physically healthy to know one way or another.
Now I’m smarter, sicker and I’ve done enough emotional work to actually feel it all. Don’t knock that desensitized disassociation kids you may miss it when it’s gone.
Maybe it’s simpler than that. Back in the aughts & the briefly booming Obama ZIRP teens, our global climate weirding just had not hit New York City hard enough for me to have really bad summers.
I always had a window air conditioner and enough cash to run it. Either way, a summer where I wasn’t miserable isn’t a memory I cant access now. It’s sealed off under the pain of the now. The past being a foreign country and all.
I’ve certainly not had a good summer in the last decade. I’ve got daily tracking data from the last six years of my life and the summer is just an unending torment of bad biometrics, pain, cabin fever and seasonal affective disorder. Bet you didn’t know it has a summer variant did you?
I’m always sicker when it’s hot. So it’s just bile and spleen for now. Almost enough to make me want to toss the entire daily logging project till the torment lifts. Since I won’t do that I’ll pour the misery on page.
I can’t wait to see what August has in store for me. My cold comfort is knowing I will be enjoying a long week of financial news. At least that you can do indoors locked up under the air conditioning.
We are entering an era where technology is liable to be the scapegoat for a number of problems that are all too human. Seeing state failures and institutional failures and deciding to blame something new rather than human nature is very much human nature
We are looking for someone or something to blame for human nature and the thing that makes the current world different from the hazy memories of childhood are an easy place to start.
The rate of change fights with the basic realities of being evolved apes. And the social dynamics of our ancestors are pretty gnarly so I don’t blame religion for wanting to obfuscate the evidence of our base nature. We have to believe we can be better.
The trade offs involved in providing communal protection has meant submissions to various forms of power and hierarchy and yet we still have social scandals over genes, jeans, semiotics and the perversion of our biology. It’s not a day to discus sex and advertising online.
I look at this chronology of my life and have pride in its daily discipline even as I know being myself online is a risk. I see day 1669 and want to make a nice joke. I believe in the commons and my freedoms within it.
It’s just getting more dangerous to be online. I am considering how I bring myself to a world where I’ve always be extremely present online under my own identity. I want to train the intelligences we develop on top of our digital commons and feel the pull of that responsibility.
Then I see another grid failure. I see a plane crash. We have terrifying realizations that we can’t rely on the systems of the past for where our future is headed.
In American and Western Europe we are already seeing daily examples of anarcho-tyranny. The state can hurt you but not help you. Communal needs we once enabled the state to run and provide can’t be counted on in water, energy, and infrastructure. You have to build systems for yourself where and when you can while you still can.
