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.
Let me set the scene for you. Alex and I are in a classic old Mercedes black sedan I’d describe as “oligarch or drug dealer chic” trying to navigate a steep 700m downhill drive in a tiny Balkan village when the GPS sends the driver (a friend of ours) down a set of stairs.
Confusing signage and incorrect GPS data
We are stuck. The signage pointed confusingly to not enter the other round, the high noon sun meant little to no shadows cast by the small steps, and the GPS insisted this was the way down. Mistakes were made but we learned later we weren’t the only ones who made them.
The village springs into action. Our driver stopped the moment it was clear the directions were wrong and he’d gone down a step. We got out and within moments we have locals trying to bounce this heavy monster into a low rider to get unstuck. This does not work but looks cool and feels very cool.
We are now entering peak male “helping” in which a variety of men, young and old, are watching, commenting and a few are in fact helping contribute to solutions.
Within no more than ten minutes, a couple village guys have shown up with a truck and we are looking at tow options and reverse pressure solutions.
We end up hooked up to the truck as a counter weight with a rope and a block. This is promising. We have half dozen, if not a full dozen dudes helping and watching. A few women watching become women clapping. It worked! We are rolled back.
Young and old come came together to participate in the age old ritual we Twitter types call #DudesRock and got the beautiful old Mercedes safely out. The road is fine too.
How did we get saved? Well a woman who owned a restaurant in the village saw us and sent for some friends. She apologized profusely saying she couldn’t stay as she was opening shop but said don’t worry she will send help.
And she did! And so swiftly. They came ready with a block, a rope, and a truck in no time at all. Alex being a man of action got as dirty as anyone wrangling the solution.
It was like being in a lost episode of Top Gear where a gangster car is stuck in an old village and the wise elders descend with a few able bodies to save Jeremy Clarkson. Some just watch & comment. The car is miraculously running even better at the end. Everyone vows to do more coastal drives along the Adriatic and Ionian seas.
In discussing with our cadre of friends taking time off this week we all realize it had been many varying years where we had multiple days in a row, in the same place, with nothing planned.
For me it’s a playlist and a certain kind of pulpy paperwork. For others it’s a Mexican beer in the sand, another a meandering walk though a hotel property looking at all the options for lounging.
Bouncing from one hotel to another can be a lot of fun then you are driving. A new novelty is over every range and the switch road back slowly brings you to something magical.
Sightseeing and activities have their own merit. I am always asking to see ruins and museums. Some folks are foodies. Others like nightlife.
But we’ve got a few days of staying in the same place ahead of us and any desire to seek novelty is entire up to us. I’d post some pictures from the travel but I prefer to do that afterwards. Just as a precaution even as I share so much.
As we transit desert scrub looming above us in mountain terrain, we are riding high over sea level as we gain and lose altitude. From that vantage we see coastal towns and mountain set backs. From sea to sky on one set of switchbacks.
The car sickness makes an enjoyable roller coaster of views and the focus on the ride helps you avoid the annoyance of slow traffic. A little sick and a little scared and a little excited. A layered set of feelings for going on vacation mode.
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.
The accelerationist types must be feeling smug as the disorientation caused by so much of the world speeding up is a persistent feature of life now.
I’m trying to organize a fairly elaborate vacation that I should have nailed down the details on at least a month ago. I am alas doing it what is functionally last minute and I’m panting at the effort of coordinating preferences, availability, timing and the thousand other logistical details.
We have a range of preferences to accommodate and it’s driving me a little bit nuts and I have no one but myself to blame. I cant manage more than three hours in a sitting position in a car or airplane without hurting. Standing helps but it’s really laying down and relaxing my spine that helps.
The other preferences are more of the one person likes fine dining and Michelin caliber restaurants and another likes delivery and Netflix.
We have to balance intensive activities in hot weather like hiking and sightseeing against the desire to lay out in the sun near a body of water. Really all the classics of different strokes for different folks.
I don’t want to be too ambitious about any of this as I am really just barely out of the woods from July. And I’m being vague about when and where, as I’ll like pretend like we have some amount of operational security. Writing is all about the specific but the best I can do is say it will involve driving and water.
I had a very indoor July which I was not expecting. One of the joys of Montana in the summer is relatively temperate conditions until you hit the end of July and into August.
Obviously freak heat waves come when they come (a lot more than I expected these days) but generally you enjoy low humidity comfortable sixties and seventies temperatures with full sun and the occasional afternoon thunderstorm.
We enjoyed some cabin camping in June but because of my absolutely out of left field emergency surgery for a deep tissue infection I’ve been an indoor cat for the remainder of the summer.
No sweating, no swimming, no excessive movement and lots of rest. Some classes of antibiotics come with very specific warnings for sun exposure as well.
I was meant to be in bed resting and frankly work was almost impossible during some of the worst of the antibiotic transitions as the pain from systemic stress was hard. Which is atypical as I’m almost always able to work through pain.
But as I am almost finished with the last round of antibiotics and I’m seeing good progress on the wound I went outside today and even broke a little bit of a sweat.
I didn’t do anything crazy just some groceries and errands but I walked two miles in the process and I’m doing pretty well. I was feeling so optimistic I bought a sun hat. We’ve got some much needed vacation activities planned and I’d like nothing more than being outside in the shade with my family.
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.
I really feel the weight of month of July today as I am just now getting the sense I am making a recovery. I did not have post surgical wound care for an abscess on my list of “to do’s” for the month but here I am.
Nor did I expect to work through a pathology report on my own while cobbling together the best blend of infection coverage through a globe spanning set of physicians and sub specialties.
I didn’t know what a sub dermal panniculitis was or how to treat an infection where that was a proximate side effect. But I learned and I managed my care to a much better result. I had real consequences from disinterested burned out doctor and I had to step up.
Frankly I’ve spent more time on artificial intelligence projects doing differential diagnostics on myself than I ever conceived was possible. I owner my own data and inputs and I could make inferences while corroborating it with physicians who are more interested in my care.
I am a slow healer and there is a high cost associated with immune suppression biologic drugs for chronic autoimmune conditions. I have no choice but to be active in my own care and tools as simple as a deep search on Perplexity take you so far.
There is a high cost to healthcare in America and it’s not getting any better. That I can now reliably use any number of commercial AIs to break down lab and pathology reports is a huge boon to all of humanity. Real miracles are happening because someone used AI to double check blood work and symptoms.
Healthcare gets rationed by price or by time and we’ve never really known an abundance of trained doctors in my lifetime. But we might have an abundance of intelligence about healthcare in our lifetime.
Part of put quandary with care in America is regulatory capture by organizations like the American Medical Association and others of its ilk. Of course they prioritize what works best for keeping their continued privileged position on care.
I lost a lot of time this month to health but I gained more than I realized. We are seeing changes in a system that has only ever known scarcity. And we know it’s not good enough.
