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.
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.
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.
It’s a shame that National Public Radio is going out in a Trump fire as used to regularly produce reporting that I find informative. Look at this old piece of reporting. We have seen a steady rise of disability rolls.
Thanks to their work I was made aware of the disability industrial complex and I was introduced its scope and cost. Even 2013 National Review was singing its praises. And it is staggering that disability has become the fall off program for those who only have unskilled labor to offer. Disability replaced welfare. And it’s not gotten any better.
I think about how easily I could have ended up on disability myself given my health issues if I didn’t work an information economy type of job you can do sitting day.
But I also know there are ranges of accommodations for most of the work I have now. Things could change and that work might be less valuable. I’m sure many Americans are considering this as automation and artificial intelligence threaten knowledge work.
I was somewhat aware of the relationship to welfare burdens being shifted from the federal government to states during the Clinton era for the rise of disability as it is still paid at the federal levels.
Naturally it meant a growth in disability as Washington D.C. has more money than say Washington state. But to realize just how much money disability rolls have grown and how tightly related they are is salient in our current financial and budget situation.
Comparison of lowered welfare rolls to the rise of disability claims. Source: Social Security Administration Credit: Lam Thuy Vo / NPR
A person on welfare costs a state money. That same resident on disability doesn’t cost the state a cent, because the federal government covers the entire bill for people on disability. So states can save money by shifting people from welfare to disability. And there are whole corporations that exist to make that transition seamless.
We are burdened by the unfit to work as manual labor has nowhere else to go but we will find other disabilities and other ways to get around labor if the contribution to rears ratios don’t work out in someone’s favor. After Covid this calculus got a lot worse.
Especially if health insurance continues to skyrocket. Better a live of poverty and healthcare than a live of poverty and no healthcare. But who knows if we choose to tackle this problem and when. If it’s all about getting what you can and we are in the exit scam era of America I am afraid to learn about the privileges of working while disabled.
The good news is that nothing malignant or cancerous is going on. The bad news is that the abscess was a gnarly mix of acute and chronic inflammatory issues that turned from a basic case of folliculitis (albeit 3cm deep so required slicing) to a nasty MSSA case that is resistant to the doxycycline typically prescribed. Yay.
Didn’t know hairs could grow sideways and frack your tissues till they produce a juicy abscess.
A little synopsis of the reports thanks to our favorite LLM Perplexity analyzing the reports with the additional context of my health history, recently bloodwork and current medical regimen.
Pathology Report Review Gross Description • Multiple grey-white tissue fragments, largest 0.6×0.3×0.3cm. • Specimens from the excised lesion. Microscopy • Neutrophilic (PMN) inflammatory exudate on surface, consistent with acute infection. • Proliferative vascular stroma, frequent erythrocytes, and mixed chronic inflammatory infiltrate (suggesting ongoing/recurrent inflammation). • Fibrinous exudate, abscess cavity, active chronic inflammation, granulation tissue: typical of a maturing or organizing abscess. • Panniculitis: inflammation extending into subcutaneous fat. No evidence of malignancy was found. Interpretation: This confirms an abscess with active, mixed (acute-on-chronic) inflammation and granulation, but no neoplastic (cancerous) changes.
Microbiology Report Review Culture • Growth: Staphylococcus aureus (methicillin-sensitive; MSSA) • Sensitive: Erythromycin, fusidic acid, linezolid, teicoplanin, tigecycline, trimethoprim-sulfamethoxazole. • Moderate: Levofloxacin. • Resistant: Tetracycline. Gram Stain • Numerous leukocytes and Gram-positive cocci in clusters, confirmatory of acute bacterial infection and consistent with S. aureus.
So the doxycline and indeed any of the basic tetracycline types I’ve been taking are useless. The extra five days of Augmentin were all for naught after I finished the Cipro. Thank goodness for topical antibiotic I am using is fusidic acid.
I’ll be moving to erythromycin orally and hoping for the best as once I finished the Cipro I started Augmentin which seems to have been functionally useless as a holding pattern antibiotic based on this report.
I’ve had a systemic staph infection before and it’s no fun. I’ve done IV antibiotics and I don’t know if I’d like a repeat. It’s my hope that Erythromycin does the job from here.
I am hanging onto my sanity by a thread as I round the corner of a surgery I did not expect. Well, I’m eight days out from it, so slightly more than a week.
I’m hoping I start to feel gets better soon. It’s my first day without antibiotics and I am already certain I shouldn’t be off them. As horrific as the side effects of Cipro may be, my immune suppression on Bimzelx is leaving me shockingly open to skin infections.
I’m terrified of MRSA at this point. I was taking doxycycline for another skin infection when the cyst went around the bend to “septic fears” on me so I’m a bit twitchy about the entire situation.
The prior IL-17 seemed to strike a fine balance on suppression and capacity to fight off infections. Now my biometrics are better but I’m constantly fighting off chaos with the meiborn gland nonsense and now buried cysts from sideways hairs fracking my dermis.
Maybe I’ll turn a corner and have some better writing ahead of me soon. Until that happens please forgive my poor blogging and missed emails. At this point the singularity could arrive and I’d miss it like a character in Left Behind. I’ll probably miss the rapture at this rate.
I’m a week out from an unexpected “do it immediately, yesterday preferably” surgery on a cyst that went from “watch and wait” advice to hurry before it is a “septic crisis” faster than clearly the first doctor expected.
It’s a long story and if I felt better I’d link up all pieces in the two month saga of failed preventive care that had me flying into surgery to get sliced open. I’m not sure this IL-17 inhibitor is working out for me. Sure my inflammatory numbers look great but I can’t be constantly managing infections that require a scalpel.
I had a week of Cipro and the wound is looking good. I’m still waiting on a pathology report but I’m guessing it’s not arriving today. I am praying that I don’t need a follow up antibiotic but also I’m afraid to not be on one while I still have an open wound knitting back together.
Also I’m hoping for my tendons to remain strong. A fun side effect of Cipro is a much increased risk of tendon injuries for literally months afterwards. No intense workouts for me till the fall.
I took my last dose of Cipro this morning and within a few hours I was losing my lunch. Well my breakfast really. Don’t just eat acidic kiwis after a week of antibiotics folks. I am fairly sure none of the antibiotic came up but who really knows.
I am swinging from dumb medical calamity to stupid medical crisis every other month as I attempt to correct biometrics and optimize different variables. All I achieve is a the occasional small incremental grinding gains for my troubles. Maybe that’s what caused me to be sick to my stomach. Despair makes you nauseous right?
