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.
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 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.
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?
