It has not been an easy year for me or my family. The struggle to find a path to a sustainable place of health feels harder than ever.
I am living in some type of thermodynamic hell. Everything I try comes with equally forceful reactions and I wish I could say more of them were positive.
Even when results look positive they have high costs that make me reconsider if I should have done it at all. Switching my immune suppression drug put my inflammatory markers in the best place we’ve seen them in years.
Alas it is so effective that I’ve had four major skin infections in 2025 of which four required going under the knife. And the fourth was caused by a small incision that was considered so safe and routine we almost didn’t consider antibiotics at all.
I just so badly want something to work in a way that doesn’t come with staggeringly high costs. Normally I’d link around to all the relevant posts but I just need a break so I’ll leave it as an exercise.
But can you imagine anything more depressing than having an infection on your ass? I sure can’t. I am stuck trying to keep pressure off of it while working on all the various projects of life and I am a slow healer.
I don’t even get to see if the HBOT is doing anything for my main concerns, as if it is we are only going to see it when I clear this crazy infection.
I suppose the good news is that one of the best treatments for high risk wound care is actually hyperbaric oxygen therapy so the positive and the negative are at least balanced.
My inner child finds the idea asking if “you want to see something gross” to be funny. Of course, I want to see.
Gore and violence don’t get this reaction from me. I dislike it in movies and in the real world. But to see gross and the weird in the real world. I get it. Maybe lots of humans thinks seeing gross things are cool.
I think it is a bit sweet. It is as a very human reaction go “ewww cool” when faced with non lethal wounds. Maybe it’s truer with boys than girls, but if a kid said “do you want to see something gross?!” in Colorado when I was a tween the answer was a rousing yaah! Gross things are cool.
Maybe it’s a type of survival mechanisms where if we can learn more about what is lethal, and lethal injuries look like, it then improves our Darwinian fitness. We judge risk more accurately.
Flesh wounds need proper care and do turn out absolutely fine. And boy have we improved on the science of wound care since I was a kid. We have evolved past the bandaid.
But even in a hard situation like a fire burn or the dermis getting sliced open, I still had a bit of that bravery of a little girl. That is cool! The bravado of a human who believes we can fix it
If you enjoy a story of plucky Rocky Mountain woman learning to do emergency care for herself and her community I’m glad we shared this time together.
Hopefully you never need these emergency skills. We take learn the risks and practice for them so we may never experience them.
So if you don’t feel this way, I’m giving you your ticket out of here. Stop reading now. But if you want to see something gross stay on.
This is my wound on Wednesday morning after I had the procedure. It’s much bigger a slice than I’d expected but first time practitioners (I asked for the experiment) and while the treatment is safe across most vectors, I was a nervous immune compromised patient who prepared for the worse.
So this a real 10/10 “let’s see how it goes from here” experiment especially if the returns it delivers are real. I hope for the energy, pain tolerance and healing benefits the average patient sees
So I am using a 90 minute full 2 atmosphere protocol already as I go went this treatment. I had also begun testing the GLOW stack from a peptide spot where I trust the owner. I’m helping him test. And this is the recommended stack for recovery.
.01 of the GLOW stack which is a regenerative peptide therapy with three peptides—BPC‑157, TB‑500, and GHK‑Cu—it was made to promote healing, tissue regeneration, and collagen production,
So I am absolutely throwing the gold care package at this. I am taking collagen and biotin, we’ve got the local food and the lack of seed oils, we’ve got the best current standard for peptides on injury and surgical recovery.
And somehow I am still scared. I never heal well or easily. I bruise easily and badly. I was so slow this summer to heal from an abscess surgery. I took a risk and I worried.
But I woke up this morning and my open wound has closed and the bruising has retreated in just five days to this. I’ll be in the scar mitigation territory in no time, and soon it won’t even be visible to the naked eye.
Day 5 of recovery from testosterone pellets
Progressively, the wound has moved from acute bruising and erythema toward decreased inflammation and resorption of bruising, with steady wound closure. Monitoring should continue, but the pattern suggests healthy tissue repair
So I hope you enjoyed seeing something gross. As it is keeping less and less gross by the minute.
We spent a long time at the doctor’s yesterday as Alex and I gutted it out with our excellent physician (with AI assists) through a myriad of different tests. We were attempting to figure out why he keeps getting respiratory infections and why I’m such a tasty treat to skin bacteria.
What I don’t seem to be able to improve is my low testosterone and the flavors of migraine headache that come with the roller coaster of my luteal phase. Which is presumably a clue and we are following it.
Astonishingly my lady hormones are in tip top shape. Though the “you should have no trouble getting pregnant if we can get off the medicines that stabilize you” remarks remains a heads trip. Yes I asked.
It is not a head trip that makes one’s husband enthusiastic about the prospect. Which is fair, as we have no family support, no backup plans for me regressing physically, and the family that does support us can’t get to America. So one can see why a CEO husband with sick investor wife who would have to give up work, plus potentially messed up baby, isn’t super appealing. Anyways! TFR is a fun topic.
I started with basic supplements in the precursor category like DHEA and STRO about a year ago when my testosterone came in at a 2 nanograms per deciliter (ng/dL) when it should be somewhere between 9 to 55 nanograms per deciliter (ng/dL). For context, adult men typically have levels in the 240–950 ng/dL.
The one sticky widget is that my testosterone remains stubbornly low. You wouldn’t think such a raging “see you next Tuesday” such as myself would be overburdened with the feminine hormones and lacking in ball buster hormones but I am.
For the past 8 weeks I’ve been using a testosterone cream that clicks up your dose and you rub it between your thighs. I know it’s gross. So I was curious to see where I might land. And praise the Lord I am now at 15 ng/dL. From 2 to 5 to 15 is some excellent progress but still below where we’d like me to hit. So we are going to run another test and try out the tiny pellets they slice into your skin. Since I’m already used to scalpels and antibiotics I figure why not?
I slept rather poorly last night. I get anxious before medical appointments. Interfacing with America’s medical system can range from merely uncomfortable to actively hostile so I suppose some heightened vigilance isn’t irrational.
I really yearn for an uptick in qualitative metrics I associate with higher quality of life like energy for my favorite physical activities (weightlifting and hiking). The fatigue and stress from the pain, and downstream side effects are constant reminders of poor health.
So I am looking for improvements in basic markers like my CRP and Sed Rate as those inflammatory markers should coincide with the qualitative improvements.
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.
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 now forty eight hours post operative and I feel like shit. I was warned but I am not enjoying how the very intense antibiotics make my brain feel.
The first five to ten hours after surgery when the local anesthetic hasn’t fully worn off and your adrenaline is still pumping are the easiest. I was smiling and happy to walk myself to the hotel and I was snapping pictures of the Turkish Cipro in amusement. How cool was all of this?
It didn’t stay cool. The first 24 hours are weird as you are still gooy and gushy so it’s tons of clean up and hand done hygiene. You aren’t allowed to shower yet, so it’s just a liminal state of grossness as you wait for swelling to abate and antibiotics to work.
Well, I’ve passed hour forty eight and I’m brain dead. I can’t think straight. The work I was excited to do in bed as I stared out over the Bosphorus was probably a fantasy.
I’m tired. I’m swollen in very tender areas. The idea of showering is simultaneously appealing and too exhausting to even contemplate. I am staring at the lovely bathtub I can’t use. Suddenly all the sources of water submersion are a threat instead of a joy.
We don’t have a bathtub at home so I only get to relax and soak a tub when a hotel and here is a beautiful one that I cannot use
Right about now as I contemplate my banishment from the pool, the beach and the bathtub I think about how much I’d enjoy the healing waters of a mineral hydrotherapy spa.
As I slowly walked myself out of surgery yesterday, I thought to myself “I actually feel much better!” And I genuinely did.
If you have a gentle stomach, maybe stop reading here. I’m fine. I’m on my way to well. And this will be graphic.
I do feel dramatically better having had the “slouching towards septic” abscess drained of infection as well as removal of the initial pearl style irritant (a 3mm deep entirely horizontal hair growing not up but sideways like an underground fracking tube).
But post operative care is hard? I’m a mess. I’m exhausted, loopy, and the hotel’s guest services are concerned enough that they are doing me such kindnesses like sending up tea and maxipads. Turkish hospitality comes from a place of genuine kindness and I need that right now.
It’s been a long journey of stupid to end up in Istanbul to get a smart fix. Going from a squishy movable almond sized lump without any pain six weeks ago to a hard plum sized lump was disconcerting enough. Especially having done my damned preventive care visits with the useless Dr Oetkin in Montana.
Have had two days of prodding, poking, squeezing, moving and ultrasounding done in the Mediterranean, I was swollen, feverish, and all hurt to the touch. I was afraid.
How did I get here? How had my next generation IL-17 managed to cause me so many negative side effects even as I was doing better across all biometrics and across quality of life metrics?
No wonder the doctor in Istanbul was so concerned. All the previous doctors had done was make my situation worse though inaction and delay m, and then the action they took made it worse.
Now I have recovery ahead of me. Last night as I went to pee, I realized why they had padded the upper areas of my underwear with maxi pads. I’ve got no discharge downstairs but on the upper bikini area there was no such luck.
I only needed one stitch to close up thanks to the careful work of the doctor, but a lot of goo came out during the surgery drainage and I was warned there was still more to come, though it would taper off.
I gently washed the area with a cloth and antiseptic soap before application of antibiotic cream (my third type of antibiotic). I gasped as I saw the first lightly red sticky watery fluid gush out rapidly around the stitch. It was so fast and there was so damn much. Bodies are disgusting what else can be said?
I mopped up with a clean moist towel and applied a thick layer of antibiotic cream, but I had learned the deflation of the abscess wasn’t quite done. The swelling, I was told, would take a week or more to full abate.
I’ll be sleeping this off for the day but if you are in Montana with an autoimmune disease and need a dermatologist I’d recommend you stay away from Dr. Tara Oetken at SkincareMT. Without her hasty heuristics and lack of conviction I wouldn’t be in this mess.
I’m waiting on the lab work for the culture and pathology but from what I saw come out of the abscess it can’t be anything good as the doctor prescribed multiple antibiotics including Cipro while we wait for results.
Bimzelx has some gnarly side effects and I don’t know how much more slicing up infections I can manage for an immune suppressant biologic. My biometrics are better but 2 eye infections and one abscess surgery that almost went septic isn’t making me feel great about the balance of value on the drug.
A lovely interpreter and patient advocate was with me the entire time. The physician was so empathic. She was astonishingly effective in technique and her whole being moved with an efficient alacrity that was admirable given she was in a floral print silk sundress, high heels and pearls.
Imagine being so good at your job you can squeeze infected goo out of another human that you do it in white silk? I was impressed.
She on the other hand was not impressed by the care I received in America.
“They knew you were immunocompromised and did not insist on an ultrasound and immediate treatment?
What do you mean they said wait and see?”
“I don’t believe the other doctor thought it was a swollen lymph node given the clear folliculitis literature warnings for your biological drug.”
I was headed straight to sepsis and in her mind having multiple doctors leave a high risk patient to “put a compress on it and wait and see” when it was easily 3mm below the skin was malpractice to her.
Quite the big abscess eh? And look at that irritating side ways hair in there so deeply buried
And indeed I am on the kinds of antibiotics you’d expect someone close to septic shock might be on. I am amazed to be doing as well as I am. But I am frankly furious.
I tried to be responsible with preventative care and was ignored. I just kept on going until the small lump became a large lump. Then it rapidly became so swollen and infected it couldn’t be ignored. What a metaphor for the American healthcare share. You try to be responsible and are shown the door till it’s a crisis. And then they can’t even fix the crisis.
On the bright side I’m in a lovely hotel next to the hospital receiving excellent care. I could afford to fly in and get it taken care of without any worries (for the curious this was $2,000 for surgery and follow up care). I was in a very space age room after being in surgery and all my intense antibiotics were hand delivered to me. Now we wait to see what the labs say.
I’m a mess and somewhat scared. This abcess saga has grown from dismissive preventative care visit (which I did did out of an abundance precaution) and ended with me meeting a general surgeon at a Turkish medical tourism hospital tomorrow to discuss labs and my ultrasound. It’s my second time this year so that’s quite an endorsement as a revealed preference.
I was afraid she would be a box checking paper pusher afraid to give an opinion. But maybe younger doctors are afraid to treat that way given our system. I needed to know is it worth getting a clearer diagnosis before it is a crisis? Is imaging necessary? I have a set of drugs I take with these specific side effects. Given that risk profile and nuance at hand needed the interpersonal relationship that would guide me.
I do endorse SkincareMT’s cosmetic practice, and Addison in particular is fantastic, but their healthcare wing is clearly designed to extract maximum Medicare dollars from Montana seniors.
My failure to get an ounce of prevention means I’m flown to Istanbul to attempt to get a pound of cure. Don’t worry I was already in the Mediterranean. Not in the way way some think though.
Yesterday we found out by pulling teeth that I had a problem. It’s clear I need this excised and quickly. The ultrasound is gnarly. Drainage, removal of the foreign object, and potential curratage to make sure the walls of the cyst are removed forever are what is needed.
The sprawling medical tourism complex in Istanbul is amazing and I trust them more than any other system or talent pool on the planet right now. What they have built is an incredible achievement and in challenging conditions.
Doctors who listen, who educate you on your options, and most importantly are up to date on current research and global innovations so don’t give you glassy eyed stares when you mention a new medication like a next generation IL-17 inhibitor it’s exotic side effects. American doctors like that are rare and their hands are often tied by our horrific mess of state failure and lack of market innovation.
I’m relieved to have choices like “general surgeon or gynecological surgeon” and texting discussions with my case lead (a full time liaison for you and your family on the entire case) on how we will handle excision and culture pathology.
It does feel like I’ll have good choices. But it also seems like I booked less time than is necessary and I don’t know how I feel about that. A week of waiting on labs in a hotel while in pain is scary. Sure I can work and be productive and maybe even do some tourism but I just want this shit sliced out, an IV of the right antibiotic that will work and some sleep.
I’ve been doing some crazy bi-phasic sleeping as the Mediterranean is hot as hell from noon to 10pm. So I’ve been doing a bit of staying up late and sleeping in to avoid the heat. It’s not clear how much it’s messing with me yet because I’ve got all these odd infection fever doctor nonsense. A quick surgery and some answers can’t come fast. Thankfully I’m at the crossroads of empires.
