Medical Journal: 8/31/18

After-action report on Ambien:

Image result for new yorker back to the old drawing board

Feeling reasonably sleepy and comfortable, I decided to try to get off without a sleeping potion. So I took my usual bedtime zinc and magnesium (to prevent cramping), and benzonatate (cough suppressant), 1000 mg. of Tylenol, flushed the nasal passages with saline, then used Flonase in hopes of keeping them reasonably dry over night, spayed the throat with phenol and such on a lozenge, turned off the light, and tried to go to sleep. In the back of my mind was the thought that if I wasn’t worried about sleeping –having the Ambien as a back-up –the not-worrying might let me sleep.

No such luck. The throat was a little bit uncomfortable, and (perhaps due to the Flonase) I kept sniffling and swallowing, and sleep was just not a happenin’ thing. So I took one 12.5 mg. zolpidem (Ambien) extended-release tablet, read for a few minutes to let it start working, and turned off the light again. Mistake! Propped up to read, I was fairly comfortable. But as soon as I got horizontal, I felt queasy: not nauseated enough to worry about vomiting, but distinctly uncomfortable. Sitting up all the way brought the queasiness down to a tolerable level, but when I tried to calm myself down with deep, slow breathing –my go-to approach –I found it impossible. It was as if there was something wrong with the diaphragm and the muscles of the chest; I couldn’t expand enough to get a good breath in, and couldn’t contract enough to force the air out. That left me breathing quickly and shallowly just to get enough oxygen. I tried standing and then walking; I think the walking helped a bit, but only a bit.

Now, this is not a problem I have. Back when my back was giving me trouble, I had some New-Agey breath training. So I can –do, when I’m trying to manage my mood –inhale for thirty seconds and then exhale for thirty seconds, sometimes one nostril at a time. So being reduced to about a two-second inhale-and-exhale was pretty seriously scary, and of course I wondered if something was going on with the heart. I even toyed with the notion ofheading in to an ED, but that seemed like an over-redaction and as likely to make things worse as to make them better. I couldn’t really focus enough attention to read, so I just sat in a reclining chair and breathed for a while. (15 minutes? An hour? Time flies when you’re having fun.) At some pointI fell asleep sitting up –as I had two nights earlier –was down for probably a couple of hours, woke up, seemed to be breathing normally, went to bed, slept well, woke up alert at about 10:30. I still can’t do a full thirty-second inhale –the chest muscles just don’t want to cooperate –but otherwise feel no after-effects.

In the meantime, I’m looking for Plan B as a sleeping solution. If anyone is in the market for 29 Ambien XL in mint condition, no reasonable offer will be refused.

***

3:30 pm. Talked to Dr. Weiss. In retrospect, it might have been better to start with half an Ambien. But given the experience, no point trying it again. Will switch to 0.5mg lorezepam (Ativan), which is short-acting. I’ll start with half of that, and take the other half as booster if I wake up in the middle of the night.

Shopping for a Comfortable Coach Airline Seat? Consider the ASSPHIT.

Here’s a travel tip you don’t hear every day: Can you guess how I upgraded all my ticketed airplane seats from basic to premium economy for free? I lost 20 pounds. With two inches taken off my waist, the spacing between me and the arms of my seat has increased to a level I could normally only get by paying for an upgrade. My personal journey of weight loss inspired some research that can benefit any cost-conscious flier, particular those who, like myself, have experienced being “gravitationally challenged.”

Passengers frequently rage at the airlines for restricting seat sizes, and with good reason. Data gathered by former Consumer Reports Travel Letter editor Bill McGee, supplemented by some research I did using Seatguru.com while wedged into seat 47Q, shows that the smallest seat width in coach class across American, Delta, and United Airlines declined around 15% over the past three decades.   

But examining airline seat size decline in isolation understates the march of rear-end pinch. Even if seat size had stayed constant, flying would still feel more uncomfortable because the proportion of Americans who are overweight swelled from 55% in 1989 to about 73% today. Clearly, the nation needs a new statistic to assess the combined impact of smaller seats and bigger (cough) seats. I therefore charted the ratio of minimum coach seat width to the proportion of U.S. adults who are overweight.  At the risk of being cheeky, I label this variable the Airline Seat Size to Passenger Heftiness Index Tracker (ASSPHIT), which reveals a startling 36% decline in posterior comfort over the past three decades. 

The extraordinary ASSPHIT of the first class section is mainly for the corporate traveler; what’s the best coach class choice for the corpulent traveler? Delta Airlines, with minimum ASSPHIT of .23 (and even better ASSPHIT on most of its airplanes) is your best bet among legacy carriers. In contrast, one of the seat configurations of a particular United Airlines narrow body jet offers a minimum coach width of just 16 inches. Even if you have a narrow body yourself, that’s one tight ASSPHIT.

As for my recent success at improving my personal ASSPHIT, the hard fact is that most people who lose weight gain it back again. Given how often I fly, I am hoping to beat those odds. I know I have your good wishes, particularly if you are crammed into the seat next to me.

Hope and the Wish for Certainty: What Alex Kotlowitz’s An American Summer Can Teach Us About Urban Gun Violence


The gun violence that is severely concentrated in poor minority communities in American cities like Chicago has a paradoxical quality. It seems to draw our attention as it repels our reflection. And so, while stories of murder and bloodshed are a regular feature of our news, politics, and urban policy discussions, they rarely encourage us to look beyond the surface of what this kind of violence has done to the people who have experienced it, or to question how it has affected the American body politic.


This is what makes Alex Kotlowitz’s work so important. As he first demonstrated in his 1992 classic There Are No Children Here, Kotlowitz has a unique gift for revealing the humanity that is often forgotten about or ignored in communities that suffer from chronically high rates of racial segregation, poverty, and violent crime.


In his new book, An American Summer, Kotlowitz knits together a collection of true stories about people affected by gun violence in the summer of 2013 in Chicago. Unlike similar kinds of accounts, An American Summer does not try to provide readers with an explanatory theory or a solution. Indeed, it is critical of attempts to do so. But in refusing to participate in this kind of discourse, Kotlowitz’s work can help us examine our assumptions and ask ourselves how should we think and what should we do about the problem of urban gun violence.

About halfway through An American Summer, there’s a short moment that dramatizes one of its most important insights. The chapter in which it appears tells the story of Eddie Bocanegra, a man who has become one of Chicago’s key violence prevention leaders and advocates for peace after serving 14 years in prison for a homicide he committed in his late teens. Kotlowitz writes that after Eddie had served his sentence, an academic asked if he would be on a panel to explore the question whether hope is possible in prison. Eddie has a philosophical disposition and a gift for storytelling. He’d be precisely the kind of person you’d want to hear think about this question. But Eddie quickly realized that the academic wasn’t interested in learning what he thought. It was clear the academic believed he already knew the answer: “that prison sapped one of hope, of any sense of future” and “diminished your sense of self.” Inwardly “agitated,” Eddie “politely but firmly declined the offer.”


The problem, Kotlowitz speculates, wasn’t that Eddie completely disagreed with the academic. Rather, it was the academic’s certainty that angered him. The way the academic presumptuously dismissed the possibility of hope for incarcerated people assumed they could never be more than prisoners of their circumstances, as it also made Eddie incidental to the significance of his own experience. In his certainty, the academic cancelled out something essential about incarcerated people’s humanity. If you lack hope, “you have nothing,” Kotlowitz writes. “It’s about as close to death as one can get without actually dying.” 


It’s not surprising that the academic believed he understood the nature of hope in prison better than Eddie. It’s all too human to feel as if we should be able to understand and master the things that threaten or depress us. You can hear this wish for certainty in the way people often talk about controlling urban gun violence, like in Kotlowitz’s account of former Illinois’ U.S. Senator Mark Kirk’s 2013 proposal to arrest 18,000 members of one of Chicago’s gangs because he believed they were responsible for the city’s murders. Or when one of Chicago’s violence prevention organizations argued in 2016 that a dramatic spike in homicides was caused by decreases in its funding, and that consequently if the organization were fully funded, it could effectively cut the city’s murders in half.  Or when the Superintendent of the Chicago Police Department declared in 2017 that if a proposed law passed to increase the length of prison sentences for a gun-related offense, it would create “a mental culture not to pick up a gun” and reduce gun violence by 50 percent in one year. 


Sometimes these proposals are implausible, the clear product of fanciful thinking or political desperation. Other times they are grounded in empirical observation. But regardless of how they may differ, the more certain people are in plans that aim to control urban gun violence, the more they tend to reduce violence into a kind of mechanistic problem. So conceived, violence will increase when essential inputs in a community are lacking—like a certain program, a policing strategy, economic development, a deterrent threat, or some combination of factors—but it will go down if they are maintained at an appropriate level.


This is a comforting view that we all probably believe or want to believe is true. It makes violence into an operational matter, which we can comprehend and manage. The problem with this conception is that it’s not entirely wrong, but that it never seems to fully satisfy the wish for certainty that usually inspires it. “This is how it often happens in Chicago,” Kotlowitz writes of individual incidents. “One act of violence follows another which follows another and so on. Sometimes there’s a causal relationship between them, and sometime they just happen, almost like an infection being passed along from friend to friend or family member to family member.”  The same kind of dynamic is present at a macro level. Trying to make sense of a 61 percent spike in homicides that occurred between 2015 and 2016, Kotlowitz describes how the University of Chicago’s Crime Lab, the city’s foremost urban violence think tank, examined all of the inputs that experts believe could have caused the increase, but found they couldn’t explain it. Ultimately, the Crime Lab acknowledged, “What caused Chicago’s sudden surge in gun violence . . . remains a puzzle.”


When violence fails to conform to a wish for certainty, it will often produce skeptical resignation, a belief that nothing can be known about how to control gun violence. You can hear this sense of certainty in the voices of commentators who lament they can’t imagine or understand what causes people to engage in gun violence or how people live with it. Or in punditry like The Chicago Tribune’s editorial page which argued in a 2019 piece that “[t]here can’t be a rational explanation [for the city’s gun violence] because Chicago’s plague of urban warfare isn’t logical.”  Behind these expressions of skeptical resignation, there is an assumption that the kind of violence that Chicago’s most disadvantaged communities experience is beyond ordinary comprehension and control because there is something about it that is alien or inhuman.


The fact that some of the most common ways of conceptualizing and addressing urban gun violence can provoke responses that range from confident predictions to skeptical resignation highlights a significant problem in our thinking. The issue here is not with the people who live in communities with high rates of violence, but rather with what a wish for certainty requires of them to work. If we are certain we can master other people’s behavior, we cannot let them be more than the objects of our certainty. To be certain about other people means that we assume we understand their lives better than they do; that their actions are controlled by factors we deem determinative. At its extreme, a wish for certainty is like the academic’s cancellation of hope. It imagines people to be “about as close to death as one can get without actually dying.” This is why public discourse on community violence often devolves into proposals of coercive force, whether in the form of increases in incarceration, aggressive policing, or even military action. It’s because a wish for certainty has already turned the people who would be subjected to these actions into almost dead things.


It is important to keep in mind the deadening assumptions of certainty as you read Kotlowitz’s book, particularly when you consider how he describes his intentions. “Let me tell you what this book isn’t,” Kotlowitz writes at the beginning of An American Summer. “It’s not a policy map or a critique. It’s not about what works and doesn’t work. Anyone who tells you they know is lying . . . . What works? After twenty years of funerals and hospital visits, I don’t feel like I’m much closer to knowing.” This declaration might be misread as an assertion of skeptical resignation. But Kotlowitz grounds his book in a radically different position. Rejecting a wish for certainty—and the lies and untruths that its deadening assumptions engender—he begins with an acknowledgement of his own ignorance, an admission he repeats throughout the book. This admission points to a critical distinction. While believing that nothing can be known closes us off to learning, a knowledge of our ignorance opens us up to possibility and questioning what we can know. A knowledge of ignorance is where the search for wisdom about human beings must always begin.


When we let go of our stubborn wish for certainty, we can learn an important truth from the lives featured in An American Summer about how violence affects our humanity. While we are embodied creatures, our humanity is not reducible to our biological existence. This is why, for example, we believe that even after people die, they retain an aspect of their humanity that seems to demand respect. We can offend the memory of the dead by speaking ill of them, just as we can disrespect corpses if we fail to treat them appropriately. Our biological existence provides the necessary, but not the sufficient set of conditions that enable us to develop and maintain a sense of what our humanity means. Such sufficient conditions lie in the practices and conventions of our community and the concomitant ways in which people treat us as subjects. Thus, when other people treat us violently, they can not only harm our bodies or end our lives, but as the philosopher J.M. Bernstein has argued, they can also injure and even “devastate” our sense of self. This kind of moral injury comes about through the ways in which violence aims to turn people into things or objects, whether by making them into a sign of revenge, a means of obtaining something of value, or a raw expression of rage or a wish for dominance.  As we require others to co-produce our own humanity, violence can fracture the trust we need that others will treat us in ways that reflect the sense that we possess a special kind of dignity because as human beings we are not like mere things or objects, but ends in ourselves.

Acts of physical violence always have a moral aspect that attack a person’s sense of self. But moral violence does not require physical attack to work. Moral violence can be uncoupled from physical attack and used to power our relationships and the conventions and practices that shape how we know ourselves and others. Throughout An American Summer, Kotlowitz shows how such forms of abstracted moral violence pervade the lives and the communities about which he writes. These forms of moral violence draw their strength from the living legacy of white supremacy, which can negatively shape people’s health and life prospects based on their race and the neighborhood in which they grow up. They structure the reductive identities that governmental institutions impose on people, as Kotlowitz shows in the story of Marcelo, a 17-year old who faced an adult criminal charge that would have legally turned him into an adult and branded him for life as a felon. 
They drive conventional wisdom that informs how most people respond to accounts of community violence, which assure us that, as Kotlowitz writes, the victims “must have done something to deserve it; they must have been up to no good.” Such forms of moral violence can even take over strategies to reduce shootings if they treat the people they are trying to help as things—like objects of a wish for certainty—rather than human beings that possess a dignity that we all share. And when that happens, violence reduction efforts can reproduce the moral harm that is interwoven with the physical violence they aim to prevent.


So where does this leave us and the problem of urban gun violence? For Kotlowitz, there are no certain answers that will relieve us from the responsibility to wrestle with this question. While the suffering that Kotlowitz writes about is isolated in poor minority communities in Chicago, its moral harm radiates throughout the American body politic, for we can’t diminish the humanity of others without deadening our own. But if we can acknowledge this essential truth about ourselves, then maybe we can learn the significance of hope, our greatest strength. As we learn from the people in Kotlowitz’s work, hope is the power that enables us to live and love each other even in the face of relentless dehumanizing treatment and sudden violent death. And this is the guiding hope of Kotlowitz’s work: that when we read about the lives featured in his books, we will reflect on our shared humanity, and that through this kind of activity, we can find ways to be more than the worst things that have been done to us or that we have done to others. 



Medical Journal: 8/30/18

Discussed angiogram results with Dr. Weiss:

-No arterial blockage.

-No serious risk of a cardiac event.

-No bar to transplant.

-Possible cardiomyopathy.

He was inclined to wait to start treatment until the radiation sessions were over, but when I said my exercise tolerance was now significantly impaired he agreed that I should start on something now. Identified something he was sure I could take; wanted tocheck with Dr. Bomback about possible kidney risk from ACE inhibitors. Said he’d phone in a prescription, but it didn’t show up at CVS; I left a message at his office.

Wednesday’s lab work came back; creatinine is 5.0, down from 5.9.Apparently creatinine testing is like political polling: enough test-to-test variability to not get excited about a single set of results. Per Dr. Bomback, this doesn’t change his conclusion that I will need a transplant within a year, but it improves the odds that I won’t have to go on dialysis first. Next test scheduled for Tuesday.

Had two very bad nights; as with the last time I had radiation, I have the feeling of something in my throat, and swallowing is slightly uncomfortable. That’s complicated by a persistent stuffed-up nose that’s been with me for a while.

None of this is much of an issue during the day, but it’s enough to keep me from going to sleep. I feel something in the throat, know that I shouldn’t swallow, do swallow, it hurts a little bit, then I’m just worrying and blaming myself for swallowing and worrying without any chance of going to sleep. Worse, I get to sleep, and either the throat discomfort or the stuffed nose is enough to wake me up after an hour or so. Then I feel seriously rotten, with very little chance of getting back to sleep regardless of how tired I feel.

Went to bed about 8pm Tuesday, woke up about 11, never really got back to sleep, and felt miserable. Despite that,I functioned reasonably normally Wednesday. Called Dr. Weiss’s office and left a message, but didn’t hear back.

Wednesday night (last night) I took 1000 mg. of Tylenol just before bed, sprayed the throat with an over-the-counter phenol solution, went to bed, got to sleep, woke up after an hour. I had decided in advance that I couldn’t handle another night like Tuesday, so I took 50 mg. of Tramadol (from an old prescription when I hurt my shoulder).

Tramadol is a weird molecule, with a mix of mu-opioid and serotonin effects, so it functions as a pain-reliever and a mood-brightener. It doesn’t really fit the normal table of milligrams-of-morphine equivalents, but in terms of dosage recommendation 50 mg. replaces about 5 mg. of oxycodone.

It wasn’t so much that I expected it to make the throat hurt less; I hoped it would make me notworry about how the throat felt and get me to sleep. (Truth be told, that’s also true of the pure mu agonists for me; they don’t reduce pain perception so much as they reduce caring about the pain.) So it happenedin this case; it took about 90 minutes for the effects to kick in –a fairly unpleasant 90 minutes –but then I went to bed, dozed right off, woke briefly a couple of times and went right back to sleep, slept through to 11am, got up feeling reasonably normal: still a little bit high from the Tramadol, but fully functional.

So that experiment counted as a (very) partial success. Starting on narcotics in the middle of Week 2 of six weeks of treatment is a clearly losing proposition; with Tramadol in particular, continued administration can have some very nasty side-effects, up to and including seizures. I’ve been on fairly hefty doses of oxycodone (10 mg. every six hours) for weeks at a time, and that’s not the end of the world, but at least at that dosage tolerance builds fairly quickly; within a few days it no longer helps my mood much, and makes me so stupid I can barely read, as a result of which I’m bored out of my skull. I doubt 5 mg. a night for a month would have those effects, but I also doubt it would remain effective, given that the side-effects of radiation are cumulative and I’m still in what was supposed to be the honeymoon period.

So this morning I left an urgent message for Dr. Weiss, and this time he called back fairly promptly. I explained the situation, and we discussed Ambien and the benzos as alternatives. I’d never had Ambien; I’ve had some of the benzos (back then it was mostly Valium) and don’t like them much. They help with sleep, but either it’s not good-quality sleep or they have bad after-effects; I tend to feel groggy the next day. And a month on benzos, given their tolerance/dependence risks, is really pushing your luck. So I was inclined toward the Ambien, which reportedly doesn’t have the grogginess problem and has much less of the tolerance/dependence problem. In particular, there’s an extended-release version that seems ideal for the waking-up-in-the-middle-of-the-night issue.

I hadn’t known about the downside; apparently there’s a significant incidence of sleepwalking and other unconscious behavior (the patient package insert listed “driving” and “having sex” as things I might do without being aware of doing them; I can only hope that no many patients do both at once) or just plain weirdness. Still, given the alternatives, it seemed worth a shot; I’ll take my first dose once I’ve finished writing this. (I went on line and found some patient discussions; apparently the rule is to take the drug in bed and turn off the light, to avoid both unconscious behaviors and the risk of over-shooting the sleep window.)

One option that just occurs to me now is to do Tramadol or another narcotic, Ambien, and one of the benzos in rotation. I’ll ask about that. I bet Ambien and the benzos, both GABA agonists, are cross-tolerant, but as far as I know neither one is cross-tolerant with the mu agonists. Someone should have done that study, but whether it’s actually been done or not I don’t know.Went in for radiation treatment and my weekly meeting with Dr. Sanfilippo. Went 0-for-2: about twenty minutes before I got to the hospital, the power went out and they were on backup emergency generators, and Dr. Sanfilippo wasn’t there so I talked to one of his colleagues. He suggested that I try a lidocaine spray for the throat, but didn’t seem very hopeful that it would work; apparently the pain relief only lasts about 90 minutes, and its primary use is to allow patients to eat and drink. Nonetheless, he phoned in a prescription, but when I got to the pharmacy I was told that my insurance didn’t cover it. I decided to pass for the moment on that option; if the Ambien bombs out I’ll reconsider, and in the meantime I’m going to yell at United Health Group.

Wish me luck on the getting-to-sleep front. I’ll report back tomorrow

RBC Comments Restored!

Some years ago, the RBC site was redesigned and tens of thousands of comments disappeared. Some readers were upset and a few emailed conspiracy theories (e.g., that Mark had deleted them all on purpose for some reason).

But it was just a technical glitch that no one could fix. As everyone can see, the site’s tech has been revamped again. And I just now noticed that all those comments are back with us again.

The world would have survived either way, but reading through some old ones made me realize how many thoughtful, informed, challenging — and sometimes as well very funny — comments have been made on this site over the years and I am glad to have them in the archive again.

Medical Journal: 8/28/18

Having noted the angiogram results below, some notes on the process:

I was instructed to show up for the angiogram at 7:30 a.m. so I could be hydrated intravenously before the procedure, as one way of minimizing the impact on my kidneys. Not very cheerfully, I did so. My cheer factor was not increased by the Lyft driver’s devotion to sports-talk radio; even fifteen minutes of that goes a long way. Arriving on time gave me the opportunity to spend a pleasant hour or so in the lobby before the cath. folks were ready to deal with me.

I got completely undressed, put on a gown, and lay down on a gurney. Then the consent process, EKG, blood pressure (a little bit high, to no one’s surprise), and they started the IV. Apparently someone took blood for lab work at that point, but I don’t think anyone mentioned it to me; a couple hours later someone asked me if I’d had my labs drawn and I said no, leading to what turned out to be a second blood draw (not, alas, through the IV line).

The unit is very heavily staffed; I think ten different people did things to or for me, all ofthem friendly and efficient.

Next step was shaving the two potential sites to insert the catheter: my wrist (in case the cardiologist chose to use the radial artery) and the groin (for the femoral artery). I asked about Brazilian wax, but apparently that’s an out-of-network expense. After the shaving, the groin area was cleaned with alcohol.

At some point in here, black x’s in what looks like Sharpie marker were placed on the tops of my feet and the insides of my ankles: roughly, but not precisely, symmetric. I’ve tried to figure out what that could have been for, but to no avail, and I didn’t notice until I got home.

Finally I met Dr. Feldman; up to this point he’d spoken to Dr. Weiss but never to me, which seemed odd. Like just about every physician I’ve dealt with in New York, he was more than willing to provide as much technical detail as I wanted. In order to minimize the dye load, the procedure took place in a specially equipped “bi-level” operating room that allows two sets of images to be taken simultaneously. Despite the precautions, he estimated my risk of needing dialysis at about 30%, but apparently the typical pattern is a decline over a period of days rather than acute failure. (That’s why Dr. Bomback wanted labs two days and seven days post-procedure.)

We discussed the wrist v. groin question. The wrist option has a lower risk of bleeding, but the groin option uses less contrast. That seemed to me like an easy decision to make. I’d had no food or water since midnight to allow the use of anaesthesia, but that turned out to be entirely optional, simply to help the patient relax rather than because of any pain from the procedure. Normal dosage would be 1mg. of fentanyl (a narcotic) and 10 mg. of Versed (a very short-acting benzo). I voted against it, partly on general principles –those are fairly hefty doses –and partly because I wanted to have all my faculties in a case significant blockage appeared and a decision had to be made about intervention.

The options seemed to be –depending on the degree of disease -a stent (which could be done on the spot), or something more drastic, all the way up to open-heart surgery, which would have to be scheduled separately. Dr. Feldman was agnostic as to what the test would find; apparently my PET results were worrisome but unspectacular. I was pessimistic; my exercise tolerance has dropped markedly over the past few weeks, and walking at full pace for even half a mile is now a strain.

At 11 a.m. –just as I was about to get on a conference call –I was wheeled in to the procedure area, marked by a huge nine-screen array of monitors (which I couldn’t see during the procedure, so I have no idea what they were for). The insertion of the catheter wasn’t entirely painless, but it wasn’t uncomfortable enough to make me regret the decision to go without the narcotic. I’m not sure why –maybe I wasn’t holding sufficiently still –but early on Dr. Feldman suggested that I get 1 mg. of Versed, and I agreed.

I don’t recall feeling it subjectively; I almost asked if it was in yet a couple of minutes after I’d agreed to it. When I mentioned not feeling it, Dr. Feldman said that in fact I’d drowsed off; one of the reasons I don’t like Versed is that it produces a strong prograde amnesia; for example, I have no memory at all of the three hours of back surgery I had in the mid-1980s, and in fact asked with some asperity when we were going to get going, only to find out I was in the recovery room. That was an extremely freaky experience, and I thought then and still think that patients ought to be warned about the possibility that they will lose a block of time before being given Versed. But I’ve never had that warning, and this was no exception.

After some period –maybe an hour, maybe less –Dr. Feldman said, “Good news. Some cardiomyopathy, but no significant arterial blockage.” I asked whether that meant the problem could be managed with medicine rather than surgery, and he said that it could. I suspect the Versed somewhat blunted my emotional response to this, but I did have the distinct sense that I’d just dodged a bullet.

Then back to the room and two hours of bed rest. Finally I was allowed food and water, if a somewhat stale banana muffin counts as “food.” The rest wasn’t very restful, as I had to keep my left leg straight, a significantly uncomfortable position for my back. Moreover, the patient in the next bed –separated from me only by a curtain –found the remote control for his TV and listened to a basketball game at full volume. Why hospitals don’t hand out headsets –as every gym does these days –is utterly beyond me. For admitted patients, I half suspect it’s a way of selling more private rooms, but that didn’t apply here. Fortunately, his sentence expired about half an hour before mine; next time I’m goingto remember to bring earplugs.

At 2:45, I was told that I could get up, and walked up and down the corridor to demonstrate that I was fit to go home. The single milligram of Versed I’d had meant that I had been “under sedation,” which meant that Richard Hahn had to leave work to come to the hospital. In fact, I was led out of the prep/recovery room into the lobby and left there, so I could have escaped without an escort, but since Richard was already on his way I dutifully waited. In the meantime, I had managed to reschedule my radiation treatment –conveniently just across the street from the angiogram –so I went for that, got in right away, and headed home.

As far as I can tell, neither the procedure nor the benzo had any after-effects; I had a good appetite when I got home.

It occurs to me that I haven’t written anything about the mechanics of radiation treatment, but (as some modern Bible translation no doubt phrases it) each day has troubles enough of its own.

Cannabis News Round-Up

Two corporate weed giants are entering New Jersey market. What will that mean for mom-and-pop sellers after legalization? NAACP, Catholic Conference warn of commercialization of marijuana in Illinois. Pot opponents express concerns over safety, commercialization. Support builds for bill to allow banks to assist pot businesses. Without banking bill, federal pot legalization is a three-legged horse until 2021. Wall Street chokes on cannabis bank bill. Michigan Attorney General joins coalition for change to marijuana banking law. Joe Biden supports decriminalization, not legalization. In 1989, Joe Biden believed the difference between marijuana and alcohol is that one can be used responsibly. Cannabis stocks can be a lucrative—but risky—bet.

Efforts to legalize marijuana in New York are at an impasse. Cuomo retreats from legal marijuana promises. New York marijuana: What to know about cannabis jobs, pot college and immigrant weed workers. With recreational pot unlikely, New York medical marijuana program may grow. Columbia County, New York officials to block pot sales if legalized.

Weed smuggling arrests at LAX have surged 166% since marijuana legalization. Illegal marijuana grows in Pacific Northwest declined after legalization. Pot tax revenue welcome in Boulder. Cannabis lounges are coming to Las Vegas.

Vermont legal pot sales doomed this session. New Hampshire Senate committee votes to delay marijuana legalization bill to 2020. Legal pot hearing sure to draw huge crowd in Maine. Maine pot rules must protect kids, problem users. What will marijuana cafes and concerts look like if they become legal in Massachusetts?

Delaware legalization bill announced. Pennsylvania Lieutenant Governor finally brought his listening tour to Pittsburgh—and most want legal weed. New Jersey lawmakers kill the bill, say voters should decide. Despite the doom-and-gloom around New Jersey legal weed efforts, some lobbyists still hold out hope. Booker bill would protect students with drug convictions from losing federal college aid.

Michigan to accelerate decisions on unlicensed pot shops, recreational market. Support for Illinois legal pot thinning. Illinois survey that supposedly shows support for legalization is dwindling actually shows it is rising. Marijuana bill may violate Illinois Constitution, prosecutors say. Growing at home might not be allowed after all under Illinois legalization proposal.

Hundreds march in Fort Worth for Texas legalization of marijuana. Why Kansas cops don’t want to legalize marijuana—medical or otherwise.

Women who love weed: can the industry free itself from stoner-bro culture? Retired NBA player Caron Butler to release documentary on pot industry. State-by-state legalization is a mess.

Canada black market is thriving—even after legalization.St. Kitts and Nevis court rules adults can legally use marijuana in private.

Medical Journal: 8/27/18

Angiogram completed. Further detail to follow, but the bottom line is that the result was unexpectedly favorable: no significant arterial blockage, no need for a stent or a bypass. Some cardiomyopathy; should respond well to medication. The heart is unlikely to be a barrier to transplant surgery when I need it.

The procedure itself was time-consuming but not painful: about as bad, I’d say, as having my teeth cleaned. No narcotic, and only 1 mg. of Versed (which I don’t recall feeling subjectively, but the cardiologist says I drowsed off). Ergo, no after-effects; I left home at 7:20, it’s now 4:45, and I’m back home and feeling normal.

The test was done with only about 20 ml. of contrast, where 100 ml. would be typical for an angiogram. That doesn’t guarantee that the kidneys didn’t take a hit (tests are scheduled for Wednesday and next Tuesday) but the odds are much, much better than they would have been. If you were holding your breath –as I was –you can now exhale.

Meet the Siemens SP260D

Electric motors are taking over from ICEs, for everything.

To make a change from the ongoing TV fantasy drama The Fall of the American Empire, aka The Game of the Throneless, let me introduce you to the Siemens SP260D.

This is an electrical aircraft engine. More details here.

This is only the second of Siemens’ efforts in the line, though they have been making electric motors since the 1890s. (AEG beat them to it, in 1889.) The striking datum is the power-to-weight ratio: 260 kW (footnote) from 50 kg, making 5.2 kW/kg. What should we compare this to?

A table of power-to-weight ratios for a sample of engines on the market today.

References: Siemens, Magnix, Lycoming, Tesla, Honda, Mercedes-AMG)

Continue reading “Meet the Siemens SP260D”

Medical Journal: 8/23/18

Sent a note to Dr. Bomback, the nephrologist. He’s happy with the low-contrast cath, doesn’t think we need to put a dialysis plan in place in advance. That sounds like good news. Wants labs at 2 and 7 days post-cath. Says that the efficacy of n-acetylcysteine as a protective measure wasn’t demonstrated in the studies done on the topic. Agrees that it couldn’t hurt, but says NAC is extremely hard to get; apparently the supply is limited and mostly reserved for cases of acetaminophen poisoning. Recommends hydration before and after the cath; I think that was already the plan.

I’m supposed to get a pre-op call tomorrow.