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.
I have been writing every single day for seventeen hundred days. 1700 days is approximately 4.66 years or 4 years and 7ish months. Not bad right?
This is quite a bit longer than I anticipated when I first began writing daily with the relatively modest ambition to write once a day for a month.
I had done daily journaling in private for ten days and was interested in seeing if I could write in public every day for some period.
I wanted to create to synthesize what I consumed across the media landscape as I tried to make sense of a world deep in the throes of Covid.
This experiment was my second sustained blogging project as I had kept a WordPress blog in the glory years of 2005-2008 or so. Other social media was easier but I’d always liked the format of public long form writing.
I had a secret silent ambition to take the daily habit to one year. It seemed doable. I fantasized about making it to 1000 days, even from the start, but that seemed bigger and more likely to fail. But if Scheherazade could make it to One Thousand and One Nights maybe I could as well?
I set out with realistic expectations but big ambitions. And now here on a random August Wednesday I am deep into the depths of a daily habit that shows no sign of stopping.
I nurtured my early ambition by saying I’d take it one day at a time, while never pressuring myself into achieving it. A journey of a thousand miles (or in my case days) starts with a single step.
I don’t care for pressure. I never have. I believe those who are truly ambitious about themselves set their own standards. You make your own life.
I will do things in my own time and at my own pace. I have never been a quitter so it’s never been a problem that I go at my own pace. Life is about results not effort.
My tenacity remains a force in my life because I am comfortable tending to my will daily. We only make progress by nurturing the seed of a thing.
Not every day is a good day. We don’t always win. I have many days where I lose. But as Allen Iverson said “it’s practice” and you never miss practice. And practice adds up. I’ve done amazing things in the last almost half decade.
I hope that this aspect of my character is as clear to others as it is to me. If I sent out on a journey I will do what I can to make it. If I fail (and I might) it is because I couldn’t.
Maybe the timing isn’t always right or my mind or body isn’t right or the market isn’t right or I am not right. Full stop. But I’ll never let myself fail because I didn’t make an honest effort. And you make the effort every single day.
We often talk about solving “pain points” when doing product development and market fit work for startups. We have popular metaphors in this vein. Start a company that sells painkillers not vitamins is so ubiquitous a piece of advice I can’t even locate its original source.
I’ve been thinking a lot about how much I personally apply this motto to the pain I’ve experienced in my own life. I’ve had personal pain points (travel and miniatures cosmetics sounded small but the market proved itself out) and now I am working on a medical spa concept as a side project in our barn in Montana.
The two growth areas in America, and soon I imagine the world, is artificial intelligence and healthcare for aging populations. I’ve been particularly interested in complex chronic diseases and the holistic approach required to treat them as I myself suffer from one.
If I experience a problem my instinct is to solve it for everyone. So I figure if the data coming from Jackson Hole is to be believed I should find a way to integrate what I know well (technology and complex disease management) and use that experience help our elders age with less pain. Literally painkillers perhaps in some cases.
I found this listicle in some dreck of an SEO bot optimized website so apologies to any original bloggers but it’s a decent list of how to think through why we like this metaphor. Skip if you just want my human written personal content. I’m just experimenting with including extra content from AI for my own recording keeping.
The Reality Test: Do users actively seek solutions, or do you need to educate them?
• The Money Test: Does budget appear instantly, or do they “need to think about it”?
• The Urgency Test: Do they want it this month, or is it “maybe next quarter”?
• The Solution Test: Are they actively looking for alternatives?
• The Decision Test: Do deals close in 1-2 calls?
• The Value Test: Can they quantify the cost of the problem?
• The Team Test: Does the whole team being sold on it want it?
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.
Reports that say that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tends to be the difficult ones.Donald Rumsfeld
Much hay was made over how ridiculous this sounded at the time. It was the title of an Errol Morris documentary. Naturally the origins of this phrase are more complicated than a soundbite from a politician.
I find it to be a pretty useful framework. I have to imagine the Lockheed folks are irked that their clever coinage has come to be associated decades later with Rumsfeld and the Neo-conservative boondoggle of the war on terror.
I feel as if I’m in a persistent state of unknown unknowns these days. It’s not a new feeling either. I know what I don’t know and how vast a space is contained therein.
I know precious little and find that I know less as I get older (maturity being a helpful tutor in that manner). Which admittedly sucks.
Being uncertain of what I don’t know is just the natural state of being. Yet I’m regularly trying to add more to the small set of known knowns in my life. I hate not knowing how to have less pain and poor health in my life.
The experimentation I do on my body is part of my attempts to shave off a few more of unk-unks by trying to add more knowledge. And I just wish I could feel even a little bit physically better. But that seems to be in the unknown unknowns these days.
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.
I’ve been using it for a week now as I needed a recovery plan for the fitness losses that came with a month of bed rest recovery after my surgery in July.
Not to suggest I was in terrific shape before the surgery as it discovered a deep tissue infection that went so deep and so rogue I’d likely been suffering from it for sometime despite my attempts at preventative care.
It’s upsetting seeing your resting heart rate go from mid 80s to mid 60s. Realizing your high resting heart rate isn’t because you are a lazy fattybombalatty who doesn’t do enough cardio (real thing a physical therapist has said to me) but because you have a chronic deep tissue antibiotic resistant bacterial infection. Ain’t chronic disease a trip?
Anyways, I’m healing and trying not to overdo things in the process as I’m a bit stupid when it comes to wellness. More is always better has been my mental orientation for much of my life and it’s a hard habit to kick.
Workaholics Anonymous needs a subgroup for those of us who can find ways to over do literally everything. And I do mean everything. I did a stretching and mobility routine last night that had my heart rate at 150BPM doing seated spinal twists. Did I stop? Nope. I finished the 30 minute program. My adaptive training programs response?
Complete rest – no negotiations
And who am I to negotiate with an AI who has no emotions involved in the process of putting together a recovery training regimen. It’s not going to moralize at me.
One of my Twitter mutuals recently published an artificial intelligence prompt for making an adaptive fitness coach which works inside any of the major large models.
Being failed rather regularly by doctors over a decade of chronic illnesses has made me skeptical of the institutions in American medicine. But having one doctor (a dermatologist) miss a glaringly obvious differential really shook me.
Her dismissal of the details and particulars wasn’t malice, but a function of the systemic inability to put enough attention on the details of the person in front of her. Attention really was all she needed ironically.
I’m sure she didn’t set out to be that kind of doctor, I’d bet she hates that it’s all 90 second visits and Medicare coding and making money for the private equity group who owns the clinic. I feel for her. She surely wants to get back to doctoring.
No one can spot every detail and retain the complexities of every case. Especially one like mine. But a computer has a much better shot at mimicking Dr House than I do at finding a Dr House for myself. And it certainly has a better chance than someone who let the system dominate them into breezing over the details.
So I am using my mutual’s prompt to see if I can outsource a very slow and adaptive return to fitness after my month off from exercise to recover from surgery. I like what I’m seeing from all models that I’ve tried it on but I imagine I’ll have all the same “me” problems with overdoing it and pushing too hard. But who knows, maybe this aspect of wellness is better handled by machine than by me.
One of the most unsettling aspects of having a deep tissue infection surgically removed is watching the hole fill itself back in from the bottom up. It doesn’t look like normal tissue as it regrows.
When deep tissue wounds heal from the bottom up, the new dermal tissue appears white because it consists of immature collagen fibers and lacks proper vascularization during the initial stages of repair. Via Perplexity
I happen to take a collagen supplement which is looks like tiny little white balls in a capsule. Collagen is a hot aesthetic supplement for making your hair and nails grow but it benefits your fascia as well. It’s a popular supplement with biotin for overall health of one’s tissues.
I am aware of a number trends in the space to generate and promote the growth of collagen as I happen to follow the arc of Korean plastic surgery as it led to many successful cosmetic products. Collegen became popular in America through aesthetic practices and social media.
And yet with working in cosmetics and taking it as a supplement I hadn’t ever experienced a chunk of tissue growing back personally. It’s all been, well, literally cosmetics. And now it’s growing back and it’s really anything but attractive.
I am also concurrently bringing a hyperbaric chamber to Montana so we can do hyperbaric oxygen therapy protocols for ourselves and for the community. I am interested in their benefits for chronic issues but they have also proven themselves in the treatments of skincare wounds in diabetic and burn patients.
Ironic that I should have immature collagen fibers lacking vascularization at this moment and will soon have access to state of the art treatment for it but I have to heal this one the old fashioned way.
It’s my hope that we are going to improve our treatments for chronic issues in the future but in the here and now my acute issue is being handled the old fashioned way with lots of care and research and rest.
We just wrapped up a week long “coastal convalescence” tour otherwise known as Alex and Julie’s European Vacation tour. Typically we take time off during shoulder season which is the off peak months for a destination.
Not being bound by school vacations or particular holiday schedules, shoulder season works better for many reasons from fewer guests to lower prices.
Mostly it’s because I struggle with high season summer heat and we live in one of the most in-demand areas for vacationing in America. Why go to Greece when I can go to Yellowstone? Why go to St Moritz when I can go to Big Sky?
And yet somehow between the Istanbul surgery incident and a general “why not” attitude we decided to be like the masses, head to Europe and enjoy the Ionian and Adriatic coastlines in high season. No we didn’t go to Sicily or Italy or France. We went to the Balkans.
Ksamil at sunset where you can see Greece. High above the Mediterranean
If you pay attention you may have noticed a fondness for Albania which sounds odd but isn’t as unusual as you might imagine. Many older military families served in the Balkan campaigns and recognized the beauty of Albania, Croatia, Bosnia and Herzegovina as well as Serbia and Kosovo.
The Ionian Sea is quite clear
Our Congressional representative Ryan Zinke served there as well many other Montanans. Heck, a guy I went to college with studied Balkan languages with the goal of being deployed there for peacekeeping operations with NATO in order to avoid being deployed to “the sandbox” during the war on terror years.
I wonder if this closeness to America has contributed to the country’s troubles in managing an ascension to the European Union despite being country you could easily mistake for Italy in climate, culture, scenery and history. It’s closer to Italy by boat than Helsinki is to Tallinn.
High above Vlore which is so close to Italy you can almost see it and can cross over by ferry
And yet they are treated as if they aren’t Europeans at all by dint of being on the wrong side of the Iron Curtain. Which you’d think Germans would appreciate.
Alas Albanians prefer the good ol’ USA to Brussels and this is a problem. That Europe let in less European countries than Albania into both the EU and Schengen feels unfair.
And it sucks for them as their passports are some of the worst in the world despite producing superstars from Dua Lipa to Mira Murati. Don’t give me guff about corruption or timelines either. If Romania and Hungary are part of the bloc then surely they can hurry up and let a NATO ally in during this time of crisis for the continent.
In my opinion, Albania is in every way superior to Italy from the kindness of its people to the beauty of its countryside and the quality of its food. Even the Italian luxury houses have exported most of their leather goods and clothing manufacturing to the country but that’s meant to be secret.
So if you want to experience the mysteries of antiquity from Thucydides to the birth of Rome to its empire years don’t look simply to Greece or Italy but to the Balkans. Delphic temples, Melian cities, even a Roman emperor are from this region.
If you enjoy Positano style sea vistas and clear blue Ionian waters go to Albania. And then please tell Brussels to let them into the European Union.
