Chemotherapy begins.

Sep 11 2020

Mom had her first round of chemotherapy last Tuesday.  Early that morning I drove her to the Hillman Cancer Center at UPMC, got her checked in, and had to leave as they took her back because, due to the pandemic and generally immunosuppressed state of the other patients in the office I posed a contamination risk.  I spent most of the day puttering around the house, fixing stuff up, cleaning, and getting a bit of dayjob work done after dropping her off.  Mom spent most of the day hooked up to one IV line or another.  Unsurprisingly, it took some time to get the actual procedure started: Mediports can be used for drawing blood samples as well as administering medications.  However, while it was possible to flush her mediport with saline the doctors weren't able to draw any blood samples through it and they couldn't proceed until they were able to.  As I understand the situation, it required three heparin flushes to un-fuck the catheter, which took roughly 90 minutes.

Mom's oncologist says that each run of chemo has to be compounded specifically to the patient's current blood stats, height, and weight, which is why vitals and blood samples need to be taken every time.  Seems like it's pretty tricky stuff to get right and it gets mixed up immediately prior to administration.  Thing is, if the blood sample takes a while to get, the compounding process takes a while, and and and... this is why cancer patients normally bring lunch and things to occupy their time while they're in the office hooked up.  Once they got things going, though, they started the process off with a prophylactic IV antibiotic (probably to minimize the risk of something already in her system getting any ideas while her immune system is suppressed), IV benadryl (because hypersensitivity to chemotheraputic drugs is a known problem), and an IV dose of an anti-nausea drug before the actual chemo drugs went in.

Another eventful couple of weeks.

Aug 30 2020

CW: Stuff about medicine, post-surgical care, and cancer.  Feel free to close the tab if you need to.

It's been a couple of weeks since my last update.  I was working on a different post in my spare time but I'm not entirely pleased with how it's turning out, plus I think it needs a lot more work, so I thought it'd be easier to write about the last week and change.  By "easier," I mean "easier to write," not "easier to handle."

A little over a week ago, on the 21st of August, I was killing time with mom rewatching Twin Peaks (she didn't know there was a third season so of course we had to rewatch the first two beforehand).  Nothing fancy, just the television and me hacking around a bit on a project.  Partway through the episode, around 2230 local time, she said in that quiet voice that in my family means that something is terribly wrong, that she was having trouble breathing and that I needed to call 911.  I'm sorry to say that I was expecting that something like this would occur so I kept my phone within arm's reach and had a go-bag packed and standing by, so it was the work of a few seconds to dial emergency services, give a situation report, request an ambulance, and get my stuff together.  There isn't much to say about the process of paramedics showing up, gathering data, loading my mom onto a stretcher, and heading to the hospital.  There wasn't any room in the ambulance, unfortunately, so I had to call in a favor from a neighbor to follow.

Update from the homestead.

Aug 02 2020

CW: Stuff about medicine, post-surgical care, and wounds.  Feel free to close the tab if you need to.

This won't be easy for me to write, mostly because I'm tired, scatterbrained, and trying to put everything in some kind of order.  I'm pretty stressed out and my allergies aren't helping, either.  It's also been difficult to find ideas to put together right now.

Cancer is a nasty adversary.  It runs you down, robs you of your strength, and tries to steal away your dignity.  The overall supply of dignity in the world right now is starting to run low and I don't want to contribute to that.  I'd be lying if I said that I knew, really knew, what mom was going through right now.  I don't, and I can't.  I can imagine what it's like from being here and watching and helping as best I can but that's not the same thing.  Cancer can also throw you curveballs in the same way that an entire team of pissed off baseball pitchers could.  When there are rogue immortal cells gobbling up the body's resources faster than they can be replenished it really wipes you out.

I mentioned a couple of days ago that my mom was diagnosed with cervical cancer and I flew back to Pittsburgh to help take care of her.  Since that time it's been a whirlwind of activity around the old homestead, picking up, cleaning, throwing things out, fixing stuff, ordering parts and tools, and generally trying to get the house ready for her to come home.  It's been a pretty big job, involving more driving in a day than I've done during the entire covid-19 lockdown (that's not saying much, I don't drive all that much back home) and finding myself on a first-name basis with the staff of our friendly neighborhood chain hardware store because they've been helping me track down the stuff I needed.  Closer to mom's discharge date I had to call in assistance with the house because it just got to be too much for one body to handle, and as of when I write this we've been able to make some pretty serious changes for the better.

An in-depth discussion of tear gas.

Jun 07 2020

Before I repost this Twitter thread in toto, I'd like to say a few things.  First, Zander is an old friend of mine (pushing 20 years at this point).  Second, while he might bill himself as "an amateur chemist," his scientific expertise has been helpful to me numerous times over the years, so I feel that I can vouch for his knowledge as well as his assessment of the situation.  I asked him if I could repost this research earlier and he gave his permission.  For clarity I've made minor edits to add punctuation.  I've also reposted the images he used and gotten hold of copies of his references.  I feel that, right now being able to verify the provenance of information is very important because information sabotage is an effective tactic.

Take it away, Zander.

- - - - -

I’ve been seeing a lot of conflicting information about tear gas online and wanted to make a guide about what tear gas is, how it’s used and how to treat exposure to it. I have a background in experimental methodology and research, and am an amateur chemist.

Special thanks to @3liza for this thread that gave me inroads to the literature, @taliabear for proofreading this and my professional chemist friend who wishes to remain anonymous for reviewing this.

So the first thing to really drive home: Tear gas isn’t just one thing. There’s nearly a dozen different compounds that are used as riot control agents across the world. I’ll be focusing on the USA because that’s where I live.

A little preparation is not a bad thing: Getting Narcan.

Apr 11 2020

Obligatory disclaimer: I AM NOT A MEDICAL DOCTOR.  SEEK PROFESSIONAL ADVICE AND TRAINING.

There's really no good way to start an article about the epidemic of opiate overdoses and deaths in the United States.  It's a terrible thing.  Unlike a lot of articles out there and stereotyping that happens, a nontrivial number of opioid deaths are due to accidental overdoses of painkillers taken by folks who are trying to manage chronic pain.  I say this as someone whose dental health history reads like Hellraiser fanfic.  If you're in so much pain that you can't even think straight most of the time, especially for years on end, it's really, really easy to make a mistake.  Case in point, the death of Art Bell in 2018 due to an accidental overdose of multiple painkillers.  Many times over the years Bell had complained on the air about his back, and a couple of times his nightly shows were cancelled because he was in too much pain to go on the air.  I've never had to use opiates in such a manner in my life, but I can definitely look at it from the outside and understand at least some of it.

Anyway, I wanted to do a quick writeup about how to get hold of the drug naloxone (local mirror, 20200411), usually sold under the trade name Narcan.  It's an opioid antagonist, which means it shoves molecules of opiate compounds out of their receptor sites and takes their place to arrest and reverse the effects of an overdose.  It can be injected intravenously either by a trained medical professional with a syringe or an autoinjector in the same way as epinepherine if one is deathly allergic to certain foods or insect stings.  Narcan is also available to civilians in the United States in a single-use, single dose nasal spray.  The idea is, you rip the packaging open, flip the little cap off, shove the end of the sprayer up the patient's nose and squeeze the device so that a mist of naloxone squirts into their sinuses to be absorbed.  It doesn't take much training to use one effectively though I do recommend getting training as part of a regular first aid certification.

Not too long ago I set about acquiring a couple of doses of Narcan to carry around with me as part of my field kit, because you never know what's going to happen.  The page on drugabuse.gov I linked to above says the following about getting naloxone:

Naloxone is a prescription drug. You can buy naloxone in many pharmacies,
in some cases without bringing in a prescription from a physician. The
major pharmacy chains CVS and Walgreens now make naloxone available
without a personal prescription in all stores in the U.S. and the District
of Columbia.

What I did was basically Google 'narcan' and the first hit was how to get Narcan.  Just to be on the safe side I downloaded a copy of the Narcan prescription aid PDF file (local copy), printed it out and brought it with me the next time I went to the pharmacy to pick up my prescriptions.  I just asked for it, handed over the hardcopy of the request, and unfortunately found out that the pharmacist on duty at that moment had never filled such a request before so it wound up not happening.  The next time I went in to get a prescription filled they had it waiting for me along with everything else: A little box of two Narcan nasal sprayers, each with 4mg ready to go.

The instructions on the box: CALL 911.  SPRAY CONTENTS OF ONE SPRAYER (0.1ML) INTO ONE NOSTRIL.  REPEAT IN 2-3 MINUTES IF SYMPTOMS OF OPIOID EMERGENCY PERSIST, ALTERNATE NOSTRILS.

To be fair, it could just as easily have been the other pharmacist at that store who was on duty, and there would not have been a week's wait and happy surprise on my next trip.  You will probably not run into that particular setback.  Total cost after insurance: $25us.

Do I need to have Narcan in the house? No. None of us use opiates. Do I feel better having it around in case somebody nearby need it?  Yes.  Do I feel better having it in my field kit, just in case? Yes, I do.

Go be safe, people.  And maybe help someone in need.

Please Try This At Home: Dr. Mixael Laufer

Sep 28 2019

In September of 2019 a conference called Please Try This At Home was held in Pittsburgh, PA.  One of the talks was given by Dr. Mixael Laufer on the topic of how to acquire pharmaceuticals such as mifepristone (local mirror) and misoprostol (local mirror) for emergency personal use.  I spoke with Dr. Laufer and the person who made this recording, and they both agreed to let me post it for download and archival as long as I sent them the links to it.  So, here it is.

Drug-resistent yeast, synthetic synapses on the nano scale, and memristor research.

Jul 04 2016

For the last decade or so, bacteria that are immune to the effects of antibiotics have been a persistent and growing threat in medicine. Ultimately, the problem goes back to the antibiotic not being administered long enough to kill off the entire colony. The few survivors that managed to make it through the increasing toxicity of their environment because they either had a gene which rendered them immune (and the toxins released when the other bacteria died weren't enough to poison them) or assembled one and survived long enough to breed and pass the gene along to other bacteria. This means that the pharmaceutical industry has been scrambling to find new antibiotics that won't harm the patient any more than they absolutely have to... except that now we're seeing antibiotic resistant yeasts in the wild, also. A strain of the yeast candida auris was discovered in 2009.ev in Japan that is resistent to every commonly used drug used to treat fungal infections, including caspofungin, amphotericin B, and fluconazole. Since that time, the dangerous strain of c.auris has spread to the United States, India, South Africa, Pakistan, Kuwait, South Korea, Colombia, the UK, and Venezuela. The fungus is known to invade the body through open wounds in an opportunistic fashion and take up residence in the bloodstream, where it subsequently causes organ failure. It is also known to infect the lungs to some degree, as evidenced by having been extracted and cultured from same. The US Center for Disease Control published a bulletin on 24 June 2016 describes the outbreak in more detail, including the risk factors for contracting the infection (diabetes, recent surgery and antibiotic use (both of which impact the integrity of the body overall), and the presence of large venous catheters). Unfortunately, c.auris is difficult to differentiate from several other less-critical fungal species without extensive testing so it can be misdiagnosed until it is too late; the CDC advises the use of MALDI-TOF mass spectrometry or DNA sequencing (analyzing the D1-D2 region of the 28s rDNA) to confirm infection.