Hepatic Adenomas and Hepatic Adenomatosis and Birth Control Pills: Some Thoughts

 Don't ask how or why, but I've had to learn about every form of hormonal birth control on the planet in detail over the last several years, and lately that's caused me to revisit what was offered to me once they diagnosed the hepatic adenomatosis.

Initially, they insisted I needed a hysterectomy. I was...skeptical. There's just so little research about what causes hepatic adenomas and there is a patient community where I could see how often the tumors do NOT shrink once birth control pills are discontinued. I had a lot of doubts.

I pushed back and negotiated for a uterine ablation since my cycles are essentially stabbed-by-a-serial- killer level arterial bleeds without hormonal birth control. The one time I tried to not use the pill, I bled enough to be cold and light headed and meet the definition of emergency bleeding. Something needed to be done. I couldn't just go hormonal commando. It was just a question of what to do and I wasn't sold on the hysterectomy.

Since they planned to do an MRI every year to monitor the tumors and most of my tumors are small, they accepted my proposal to do an uterine ablation and we'd pivot if the MRIs showed the need for it. Aside from another tumor that tried to be a problem after my hepatic resection (which got as far as the tumor board but resolved on its own) all my tumors are generally stable. They do drop kick me every so often but-- so far and touch wood--the drama, while making me nervous, has always ended well.

But I ended up circling back around recently and questioning why I couldn't have taken a progesterone only pill. Not only was it not offered to me, I myself was concerned about the risk even though these tumors are supposedly more estrogen sensitive. HOWEVER, if you talk to patients, you will observe mixed outcomes. Some absolutely can't take any hormones at all because everything causes their tumors to grow, others are fine on a progesterone only pill. It's a mixed bag. Just like some see their tumors shrink after stopping birth control pills and some don't. Mine don't care about the hormones, and in fact, the tumor that tried to hemorrhage after my resection, I hadn't been on the pill for six months or more.

My tumors were small enough that I could have risked a progesterone only pill. In hindsight, I look back and realize that. I wish I had realized that at the time, but oh well. I was flying blind and the doctors were at Defcon 5. At least I resisted the hysterectomy...rightfully so it turned out.

Anyway, if anyone is ever googling this, I hope they find this post. There's a huge amount of variability in patient outcomes with hepatic adenomas and hepatic adenomatosis, outcomes that don't match the literature well, which is a strong signal that we need more research buuuuuut we're not going to get it because this is considered to be so rare and a lot of docs think all the science is settled soooo patients are on their own. 

Personally, I feel that way too many patients are on their own just in general. I doubt I'll see it improve in my lifetime, but I hope medicine sorts some of their bullshit out at some point.

When it comes to hepatic adenomas and adenomatosis patients really need second even third or fourth opinions...if the tumors will give you that time. And talk to all the patients you can find. That will help you decide the best course of action for your case more than any one doctor.  If your tumors are small, you can take more educated risks and these tumors are something where sometimes it's worth doing it. Less is more in terms of quality of life with this in my experience. The care options have pretty big impacts so dodge as much as you can...tumors willing.

And yes, my life continues to be a flaming dumpster fire...not of my making. I am too overwhelmed to go into any detail. I don't want to talk about it. Just be grateful it's me and not you. 

The only thing I'll say is the second, literally the SECOND, your aging parent is paranoid or behaving in any kind of extreme, that's the time to be on high alert. That's the sign there's issues brewing. 

I had trouble recognizing it because the first blush of paranoia was directed at me personally...which, you'd think I could have noticed, but I was so under attack and being verbally abused and my parent is a difficult personality just in general that I couldn't get past the immediate moment to think bigger. That turned out to be an absolutely HUGE missed opportunity.

Lots of hindsight going on over here theses days. Coulda woulda shoulda. Sigh.

Everything Is Worse Everywhere

 You know, there really needs to be a documentary or reality show about all this aging parents shit. We need to get some of these dynamics out in the open so people have a fucking fighting chance.

My parent pretty much lost everything to a lonely heart scammer.

Had an epic addict meltdown.

Plus, has been wandering around naked in public while losing control of their bladder. More than once.

Yes, that's right, class. Please welcome Felony Charges.

Oh look! They brought their friend, Divorce. 

My parent will be forced to divorce their spouse of 30 years courtesy of spouse's family. 

And they can't accept that any of what I just wrote is true.

So our discussions go round and round. 

You have no money for an attorney. 

I have money. 

No you don't. 

Yes, I do. Spouse has it.

Spouse is under their sibling's POA now. That money is no longer available.

What do you mean? I have the POA.

No, you don't. Where is your money? The money in your name?

My fiancee has it. 

You don't have a fiance. 

Yes I do. Get into my Facebook and message them. I have investments with them and they've been doing really well. We're getting married in September.

There are no messages from anyone by your finace's name in your messages. They don't exist. You're not getting married. There is no one to marry.

You're stupid. Get your sibling to do it. They're smarter.

Every day they call me and refuse to listen. Every day I spend hours and hours navigating this mess. 

I'm so tired. Emotionally exhausted. 

How do you get through to someone who's in the middle of detoxing and clearly not functioning well? Who never listens and can sit there in jail and tell me they know better than everyone, including the police...when they can't even remember what the fuck happened? How?

I need to know what I can sell. I need them to release their property to me so I can get the car out of impound and maybe sell it.

It took a few days to find me, but I have POA. I can take unilateral action, but I'm trying to work with my parent so they can tell me what they need, what protects their interests.

But they can't do it.

Yes, clearly incompetent, but the criminal charges are moving faster than everything else. Because there's no money. We may never have a chance to establish the incompetency in any meaningful way.

We'll see. 

But wouldn't you like to watch a show navigating that kind of a situation? Because I sure would. 

Will my parent end up in a nursing home or rehab or prison? Stay tuned because none of us know what the fuck will happen next either.

I politely told the APS supervisor their entire office sucked. They've caused material harm to my parents despite dozens of phone calls from several people. We tried and tried and tried and omg tried. They barely lifted a finger. May their parents drag them through a similar experience...

Did you know...at least where I'm at, there's no way to make an official complaint about the APS office?I sincerely believe they're incompetent and negligent. That they are actively harming people beyond just my parents. I'd like to alert someone to that. But there's no mechanism to do so. At all. 

For comparison, the social worker for my district...they're the one helping me. They have no official role--my parents aren't their jurisdiction--but out of the kindness of their heart, through the connection of community, they have spent several hours on the phone explaining guardianship to me. 

I literally just teared up. I'm so grateful to that social worker. Someone actually tried to help. They can't do much because the mess isn't in their district, but I'm much better oriented on the guardianship piece.

Enough to realize the lawyer that answered the phone was going to make me do all the legwork and take $5,000 to file paperwork (that they made me put together) for $200.

Bitch, please. I can file that shit myself.

Worse, I asked them a question on information I didn't have and they couldn't answer it*. Let me get this straight...I pay $5k just to for them to file my paperwork (again, that I set up) and they don't even know how to help me problem solve?

Brilliant. APS must be ignoring this scam extra hard.

But guardianship doesn't matter much right now. Parent is still in jail. No criminal defense attorney in sight. We're still trying to find money. 

The goal is to plea down the felony. You can't get into most nursing homes with a felony on your record so that's kind of important. 

We are hoping my parent is sentenced to a correctional rehab program. My parent, of course, has a different agenda.

I don't think they can give up their addiction. I really don't. I think they'll be sober while they're in custody and then go right back to using. I fully expect, if not now, then later they will end up in prison for the end of their life.

I hope they prove me wrong, but it's bad. It's really bad. I don't see them overcoming it and there's just not enough money to endlessly defend them from their stupidity. Their lonely heart scammer saw to that.

We are just lucky stepparent has just enough left to squeak by. They should be okay. So long as my parent doesn't get into their money ever again. It also helps that stepparent is too passive and unfocused now to chase their addiction. They're not going to fight being cut off. 

So. Anyway.

Meanwhile...teen...we've been to some doctors. It's going slow. Options so far suck. No diagnosis still. Some doctors have really let us down.

I've come to realize they give up on you if they can't figure it out. My sense is they tell themselves there's nothing wrong...they don't recognize they're unable to diagnose. Bite your tongue depressor and shove a stethoscope up your ass, they would never miss a diagnosis! No, it's always the patient who's the problem.

Medicine is stupid. I've just seen them miss too much and then get snotty about it. It's dumb.

Meanwhile, the patient community has some leads for us. So that's good. 

I just wish it wasn't always such a battle when a body isn't being obvious. Bodies don't read textbooks. If there are objective problems and a doctor gives up...yeesh. Please quit your day job. You suck. Especially in peds.

As for me...my foot was doing okay but then I almost fell and caught myself with my full weight on my foot so... It's burning. Otherwise, it's the same old same old. Hip hurts yadda yadda. 

Mostly I'm just really stressed though. I stopped eating, realized it, and have been trying to make sure I'm eating. I'm just really really stressed and very very busy chasing all the things.

Work? What's work? I haven't touched work. No time. And yes, that could cost me.

*For the record, there's a certain amount of sleuthing in these situations. You have to track down a lot of people connected to your parent to file for guardianship. I was going through my parent's house like Nancy Drew. Craziness.

What a Party

My main purpose today appears to be serving as that person who makes you grateful for your life because at least you're not me.

First, the good news. The only good news. My foot pain, which was pretty minimal anyway, is greatly reduced. My hip has decided to accept that it's a beast of burden and get over itself and thus, my pain there is better now.

So. The shit show. 

Parent was due to be charged by police with one thing.

Then got arrested for something else and is in jail as I type. Yes, they kept going after the last post. 

In three days, they had three citations or charges or arrests with the police. One a day.

Hello, Bottom. How are you?

There are eight of us in my family working on this. Eight people. 

Funny how everyone ends up in the side car for an addict's trip to Bottomsville, isn't it?

At least we're all pulling together pretty well and delegating the work halfway decently. We don't suck. We could do group projects in college and get As.

Ultimately this is good, but in the most awful way. Now that the fire has actually flamed instead of throwing occasional sparks, maybe we can DO something about it.

But of course, it's never that easy.

We were thinking there'd be a DUI type charge, the typical addict stuff, but that was naive. My parent, ever the overachiever, managed to do worse (but didn't hurt or kill anyone which is good).

The legalities are extra advanced now.  (Although I think the medical exam is probably going to find some things going on. I suspect this isn't all addiction, or if it is, it's reached the stage where it's seriously damaged organs and they'll probably be released or plea bargained out due to their medical state and age.)

Also, there's bomb threats and violence by the jail, which is complicating everything. Court isn't in session. Things are on Zoom. Nothing's moving efficiently. Good luck bailing anyone out.

We don't want to bail them out actually--this is not our first addiction rodeo--but there are some legal advantages to that and health concerns at the moment so...

But good luck getting through the absolute chaos around the jail system though.

APS continues to not answer their phone. Lawyers don't answer their phones either. 

You know how you're supposed to call around and find the best expert? Ha. That's dead. Now the best lawyer or whatever expert is the one who answers the damn phone.

I've picked up my parents' dog and hoping my other dogs will accept them. My stepparent still recognizes them so I'm trying to make it possible for the dog to visit them in memory care. The dog seems sweet so I hope it works out.

Meanwhile ALSO trying to coordinate the next step now that medication #13 is failing the teen. Got a same day emergency appointment squeezed in between spurts of chaos. They actually gave us an urgent referral which resulted in a next day appointment with yet another (omg) specialist. The next specialist was on it. Called us immediately.  We've got the referral to the out-of-state specialty clinic as well. Different specialties because this is one that can span multiple specialists. 

Oh, and we're back knocking on genetics door. This also needs to be screened for genes apparently.

And then I was getting calls on my last imaging thing in between all the above. The hinky thing will need a 6 month follow up ultrasound and I was told to see someone else for the grapefruit because they don't think it's related to the body parts their specialty looks at.

So now I gotta bounce to PCP because I don't actually know what the next specialty is. So it's a displaced sign of a problem in another spot. Or my doctors are bad. Or I need an MRI because that's trending for me a lot anymore. I don't know. Maybe it's my hip??? Like, that whole side is swollen around the whole joint, but grapefruit is a grapefruit...it's large and weird and elsewhere. I don't know, man. I just don't even know anymore.

OMFG. The medical stuff is an perpetual motion hydra. Every time I turn around, there's fifteen new heads.

And then work. Which, I screwed up a whole thing while all the above was spinning. Not a huge deal. Fixable. But public and annoying.

Rights sale meet went well. I'm going to get an offer. Not sure if I'll take it. Need to see the money. (Although at this point, I can't be picky because I have to give lawyers all my money now.) 

The whole time I was talking to them, I was getting phone calls and texts about my parents. The whole time. God. That was stressful.

Probably hundreds of texts today. Dozens of phone calls.

I'm going to spend the rest of what's left of the day (obv this is posting in the am but I wrote it day of time of) disassociating online and probably eat too much sugar. I'm not much of an emotional eater--normally I am a stress cleaner--but I can't walk, and for this shit ball of stress...oh yeah. I'll feed it some sugar. 

WTAF.

A Shower and a Wheelchair

The asthma is back in the box. For today anyway. Here's hoping it lasts a long time.

My hip is super angry. It's worse than my sliced and diced foot. Sigh.

It woke me up at 4 am and that's it, I'm done sleeping. 

All hell has broken loose since I had surgery...

My parent has had 3 run ins with the law. Boom boom boom. They've managed to make the last one a jaw-dropping doozy. And that's before we even get into the lonely heart scammer that's sunk their claws into my parent.

I have to go for guardianship of one or both now. Have to. Not sure how that's going to work out. APS did get my stepparent into memory care. Hey look! APS finally did something! If they'd acted sooner, when we all told them shit would go down if they didn't, maybe things wouldn't be such a mess now...

Honestly, 80% of my life is dealing with the fallout and bullshit from people with power who are incapable of problem solving and/or won't do their fucking jobs. 

As a result, I've got relatives calling and texting me left and right and it's just chaos. Everyone is in different stages of processing and accepting reality. Several of the older folks are confronted by their own mortality because of what's going on and struggling with that and then displacing that emotional energy onto my parents' situation. People seem to want things to happen that they would want done for them...they're not responding to the actual situation.

And then I'm coordinating with my siblings, who are much younger than me and this is a harder hit for them as a result. This is their first family clusterfuck festival. Do you want to be guardian? It doesn't have to be me. It can be one of you. I'll help you with the medical stuff. Or I can do it, set it up, and hand it off later because with my health, I may not be the right person to do this. Who's taking the dog? Where is the dog? Has anyone seen the dog?

That's a long way of saying I'm doing a lot of hand holding and nudging. It's taken up 4-5 hours a day and all my energy the last three days. Full crisis mode.

My siblings and I continue to be on the same page though, which is helpful. That has been my main goal, to not let our parents trash our relationships with their trauma drama. We're the ones who will still be standing at the end of this. We're the ones who have to go on. It'd be good if we didn't have bad feelings.

I've seen how divisive these situations can be, how siblings turn on each other, how one selfish person can ruin generations of relationships in a family. I've tried to keep open communication so we know what we're all thinking, to check in with them about the agenda. So far, it's working out?

I'm tired though. People are exhausting. We're all sad. My parents are sucking a lot of people dry right now. 

So. 

You know, several years ago, I woke up in the middle of the night with the phrase 'slow motion suicide' in relation to my parent playing through my head. I do not normally wake up with dark catch phrases blaring through my mind, but that night I did and the power of it was 1000x. It had an intensity that I couldn't ignore.

At the time, the phrase didn't exist. I googled, certain that someone somewhere had thought it up, that I'd heard it before, and I think there was like, one obscure thing. Now? There's more. It's in the zeitgeist. Interesting.

Anyway, the whole thing was weird. BUT the point of sharing that is that was the moment I began to process my parent's behavior and understand it was terminal. They weren't going to survive themselves.

I wish I could say that brought me some peace. No. Understanding isn't the same as peace, but I have been more grounded, more centered, less shocked than other family members. I wish I could say that made me more useful, but no. My health makes it hard for me to be as useful as I could be. Not to mention that if you're the only one who sees it, you're just an asshole to everyone else when you bring it up. Especially if it's a sensitive topic.

Anyway, in terms of my health, right now the practical problem is I can't walk well enough to go see the memory care director to discuss my parents and the reports they've made to APS. I tried calling to ask if they had wheelchairs for visitors, but fun fact, no one ever answers the phone at nursing homes. 

Hand to God, I'm getting a fucking wheelchair. And knee scooter while we're at it because why the hell not. That's my plan for today--a shower and a full stable of mobility aids. I need something that can give me a fighting chance to keep up. 

Dictator on Wheels

Asthma is still pissy. Pain is fine. Already tired of limping. Hip is unhappy. Support leg is decently swollen from hip to knee. Can't find anything to really entertain myself with. Usually I'm pretty good at that, but I'm in go mode. 

Spring has infected me. I want to be outside. I want to be active. Plant flowers. Fill raised beds. Weed. Spray. Fertilize. Dig holes. I don't want to be stuck on my ass with screens. Not in this weather with that sunshine. So I'm antsy and having a hard time keeping myself occupied.

I am trying to convince everyone we should get a wheelchair so they can wheel me to the garden and I can tell them what to do.

Surprisingly, interest in that is low lol.

So I've switched to asking them to bring the riding lawn mower up to the door and I'll drive to the garden and tell them what to do.

Surprisingly, no buyers for that idea either.

Ha. Nobody wants a garden dictator on wheels. Their loss.

And dear asthma, shut up. I don't need wheels to tell you what to do. You're boring and no one likes you. Go away.

Chairs I Got

Doing good over here. Pain is minimal. I'm mostly taking stuff to help with inflammation more so than pain at this point. (Which I have Toradol. Didn't even attempt an opiate for this one.)

I'm sleeping pretty good too. Finally. I think some of what's going on is the last of Covid is finally leaving the building...at least on this front. It's a mega sleep disruptor for me so I'm guessing this is a sign I'm finally past that.

But it's not all roses and sunshine. The dogs are super petulant about not being allowed up in bed with me. Currently my chocolate rescue is in my spot in bed and giving me a baleful look I translate as 'bitch, you'd better not make me move.' I am ruining their lives lol. They pace the bed super anxious about coming up with us and instead they get kicked out where they cry and huff at the door.

They also don't like it when they're in my chair and I make them move. And I won't let them lick my toes. They really want to lick my toes. Normally they don't care about my toes and we're not telling them no on much of anything so they are super insulted right now. Little princess babies lol.

I'm trying to walk as little as possible until I can fully bear my weight. I don't want to overload the other foot/knee/hip fuckery and trigger more issues and medical stuff immediately after this. Healing is dynamic and can cause secondary problems same as an injury if you're not careful.

To wit: We had a black lab (best dog ever RIP) who blew a knee. We replaced the joint and when that was done healing, she immediately blew the other one. The stress of hobbling ate up her other knee. I'm already not 100 going in so I'm trying to be extra careful and not make anything worse. 

And I want a break! And I want to have a fun summer! And I wan to work, really work, not piece meal around all the stupid medical shit! (Oh hey, I've said this before. Ha. At least I'm consistent.) So treating things like they're fragile is my attempt to achieve that. However, I am doing leg lifts so I don't completely turn into jello over here or make my hips hurt. Always gotta be busting moves to keep the hips in place...

 

My big adventure today is a shower with my little bamboo shaving stool and a cast cover. They were so funny at discharge about not standing in the shower and needing a chair and cast cover. They were shocked when I told them I had it all already. They literally stopped talking to just process for a second. I guess they'd never had anyone who already had the set up???

But like, I'm a planner. I work ahead and I pay attention. But also, this neuroma made me buy a shower chair (but like, cute) and a cushy foot pad months ago. I haven't been able to walk or stand barefoot on hard floors or put all my weight on one foot to shave for over a year. I had to problem solve.

So chairs I got. What I don't have is a faster runway to diagnostic imaging for earlier diagnoses which is what would really improve my outcomes...

The dogs are petulant about being displaced by my surgery, I will forever be petulant about the harm done to me by the anti imaging bias in the medicine decision tree that I can't overcome even with my multiple growths, multiple surgeries for growths history.

Where's the Dial? Is It in the Room with Us Now?

I've had a good run. All the inflammation in my body disappeared a few days ago. Poof. Gone. I felt fucking fabulous.

My body refused to be agitated. I hit asthma triggers (smoke, dust) and nothing. The lungs were not interested. It was amazing.

So naturally, I fucked my shit up with some surgery.

Surgery went well. Apparently the neuroma was fairly large once they finally cut to see it, but my inflammation was so low that the surgeon couldn't elicit any pain when palpating it prior to surgery. I could tell it was still there, but whatever switch got flipped in my body this past week turned everything down to 1 instead of up to 1000. 

And yes, I know I had a mega dose of prednisone recently but we're past that window. Something got turned OFF. Maybe triggered by the prednisone, I can't tell, but it's not just prednisone at this point.

I went from multiple charley horses in my foot all night long to just ONE in a WEEK. Whatever happened, it was crazy awesome. 

(Gosh. I wish I knew how that happened so I could do more of it. How do I get control of that fucking dial????)

Post operative pain seems fine, but I'm reserving judgement before I make a final ruling as it's still early days of recovery. Asthma is a bit triggered but I think I'll be able to get it back in the box with just inhalers.

My eyes are kind of fucked up. Whatever they did dried me out like they were trying to make a mummy. My mouth finally started salivating again last night, but my eyes are struggling to make tears and something is under my eyelid making it feel like I'm sanding my eyeball every time I blink. I'm using Visine as a stop gap and hoping it resolves on its own soon.

I did see what I assume is covid related dysautonomia in my blood pressure, heart rate, and oxygen levels on the monitors. I've spent a lot of time staring at those numbers when I've been too sick to do anything else (when the asthma is bad, I can't focus on much). I have a pretty good handle on what my pre covid pattern was. This shit ain't it. 

My BP is wildly low and high in weird patterns, one number will be funky low while the other is strangely high. Oxygen is bouncing like a rubber ball. Up down up down. It's actually going below the line into abnormal territory but it bounces right back up. Same for heart rate. Everything is bouncy so once it hits normal, that's what they record and call it good. They just wait for the ball to hit the sweet spot.

Overall, I'm fiercely positive right now. I want more of what I just had. My self talk goes something like 'okay foot, your problem is gone, now shape the fuck up and quit your bullshit, we've got summer swimming coming and a new swimsuit and we are going to have a great time, including good sleep, or die trying. I will amputate you if you can't get it together. I know where the hubby's table saw is...'

My ultrasound for the grapefruit came back with...something. What exactly is unknown. Something hinky, but the degree and exact kind of hinkiness is up in the air. I need follow up of some kind. Waiting to hear on that, however doc is out of state right now so... It never ends...

One Day

I feel good. I'm in a good mood. My pathologies are all behaving at the same time. I almost wish I could postpone surgery so I could fully enjoy this freak occurrence. 

It's not that I can hike the way I want to, I'm not healed, but mostly my foot is contained. I can feel it, but it's chill, refusing to fuel fires. I'm getting a great long tail on the MRI steroids. And as much as I miss going for walks, right now I'm so busy in the garden, walking isn't even possibly anyway. So I'm not mad.

My biggest issue is my sleep is a hot mess for several different reasons. This time of year, I wake up with the birds. I love listening to them, even though it's not really enough sleep. And my routine is all messed up from covid still and now the pre-surgery stuff too. Can't take this. Can't take that. Blah blah blah. No melatonin for meeeee.

I've been in the garden every day for the past week, working for hours. I'm racing the clock. We're due for rain. I'm due to be out of commission. 

Despite the massive increase in activity--things like literally throwing bricks and softball sized stones and then loading them up and dragging them back to storage--still haven't lost weight lol. 

You'd think there'd be a change just from the sweat.

Whatever.

Anyway, I'm pleased to see that I'm finally developing some skills and informed judgement on the gardening. I'm making progress on strategies and systems too. I'm learning! I'm getting there!

I'd say gardening is as complicated as medicine. Or right up there. Close. There's so much marketing hype and so many people trying to monetize gardening...good information is very hard to find. And there's chemistry and science, health and disease, and fifty different opinions on what to do. There's even surgery! 

I'm slowly getting to where I can see the bullshit.

I say slowly because I love gardening, but I'm bad at it. It doesn't come naturally to me. Mostly I kill things. It doesn't make sense to me. 

But it's a killer workout. Wow. I love it. The longer I go being unable to control my ability to exercise, the less interested I am in aerobics classes. Just exercise itself isn't enough now. I'm all about functional and productive fitness. Like gardening or working out specifically so gardening doesn't kill me. Or fun things like swimming or dancing. 

I want to have a good time and/or I want to have something to show for it beyond exercise. I don't get to keep any fitness I achieve or build on it because I'm constantly deconditioning due to illness, so I want some other payoff anymore or else I can't motivate myself.

Before my spine cyst threw a fit, I'd planned to hand build a cottage stone wall around our acreage. I figured it'd be a productive project for cold weather and it would take a long time to finish so I'd have something to work on for years. I gave up on it because of my spine, but if I can feel as good as I do right now for any reliable amount of time maybe I'll go back to that...

But aside from that, I have gardening. It has some ability to accommodate limitations. You can sit for some of it or do a little bit here and there. It's natural HIIT. But also pretty adaptive to a variety of needs and limitations. There are tools to make work easier and it's still HIIT. It's fairly neuroma friendly too (for me at least). 

It also builds strength like crazy and the strength lasts better than if I were lifting weights alone. (Digging holes is the best workout I've ever seen.)

At the rate I'm figuring it out, we should be self sufficient sometime in the next 1000 years. I'm going to need some of that immortality the headlines keep yapping about...

Also, acreage sounds fancy. We bought a dump of a farmhouse. We're not rich. Just frugal and handy with friends in the trades. Don't worry. Eventually medical stuff will bankrupt us. Maybe I'll do a post on that sometime...

Circling back to AI and geopolitics...

Did you notice the headlines are starting to peg some of what's happening as a BRICS thing? Hell, even TikTok has videos from just regular people talking about it now. That started a few weeks ago (maybe it's propaganda?). I'm also seeing more financial headlines talk about the 'attack' on the dollar. Part of this war is economic. I hope someone somewhere knows wtf we are doing. 

The public discourse on this tends to be very 'sides' driven as if a world run by BRICS is going to be some kind of improvement for the little guy. People are naive if they think that. BRICS will be worse than the West (which is no saint), but everyone's so anti-West they'd rather work against their own self interests. I especially raise my eyebrows at the part where different nations with little power are singing BRICS' praises as if they aren't going to be under a boot heel same as they are with the West. 

Different boot heel, more war, more dead, more environmental damage, more human potential lost, same shit. Humans just refuse to evolve here.

There aren't really any good guys in this. It's just do you want a world with dictators who have nukes or do you want a world with some churn in the power structure where no is an actual thing you can say to leaders without getting a surprise polonium tea enema? Meanwhile, wealth concentration, inequality, and corporate hegemony will continue unabated either way...

As for AI...I continue to pay attention and research and learn, learn, learn. Stuff is weird. I'm reading a book about AI and robots that's eight years old right now...The Rise of the Robots. Usually I don't like outdated info, but this time it's very interesting. Tech moves so fast, eight years is essentially a century so seeing the ancient history (as it were) provides an excellent foil.

For instance, so many AI companies were trying to make AI happen at scale and...nothing. It didn't land. I'm not sure why. But a few of the companies are still in business (I Googled), doing very niche small scale stuff, going nowhere fast, no longer the 'It Girl' of the tech industry. Not sure the latest advances in AI are going to change things.

They could've scaled before now and didn't. Why? 

Technically, you and I could have house robots already. Why don't we?

I don't know. I keep running into weirdness. Lots of overselling. Grandiose claims. Strange narratives. It's just...off.

Also, I didn't realize the origin of UBI went so far back. It was Martin Luther King who started talking about the impact of automation and the need for UBI. The problem is the tech moved much more slowly than the alarm, so the alarm went nowhere, and now that every day is a hockey stick on the growth chart, when tech is actually moving at a speed that requires a response, there's no energy for it among those who have the authority to do anything about it. It's passe. There's a mismatch of urgency.

And you can make a good argument than the wage stagflation and the income inequality destroying the 99% is because of rising automation. Companies have been keeping the profits of automation this whole time much like they've been predatory about prices and profits during Covid. (At this point, I've decided they're raising capital to implement AI and robots buuut I don't think it'll be so easily done.)

This interview with the 'Grandfather of AI' gets really weird the longer I think about it.

For one, you have a scientist who ostensibly is so concerned about his work being militarized that he moves to Canada (one of the US' big military allies) to avoid US Dept of Defense funding and then materially contributes to AI that is being militarized...by the US Dept of Defense...and everyone else. 

Like, how did he not know? Why could he not extrapolate?

And he's concerned about autonomous weapons (which have actually already been used in warfare) and keeps developing the science anyway. 

If he was so concerned, why was he doing that? Why does no one ask that question? 

You know, billionaires aren't heroes, they're hoarders. It's not normal to hoard money you'll never live long enough to spend.

Now I'm starting to wonder about the psychology of scientists. I don't use my training and skill sets to create things that will destabilize the world. I could. In this era of misinformation, I absolutely could. But I don't. However, scientists like this guy do. Often at scale.

Why are scientists so intent on setting the world on fire? They know they're doing it with AI. They're not blind. Why are they so hellbent on releasing AI that has no respect for anyone's intellectual property, little ability to fact check, and a propensity to make shit up?

Do they just want to be the next big money hoarder? Is that it? Do they think it's going to save us from ourselves in the long run and it doesn't matter who pays the price for that? Solve climate change? Cure cancer? What?

How do they reconcile the harm it can cause? Why unleash it now when they don't have all the problems resolved? Why aren't we resolving the problems before we release this tech? Why isn't it still in the sandbox? What was the decision tree on that?

I don't know. Maybe he was edited poorly. But there just a lot of WTF things in what he said. 

This piece from 60 Minutes shows how the robots are doing. They are single use technology still. They can only do one thing, but are getting better about moving across different planes of motion. Maybe as ChatGPT evolves we'll get robots that can use that movement in a variety of ways per our unique directions.

Here's how CBS blurbs the interview which I think is telling: "Competitive pressure among tech giants is propelling society into the future of artificial intelligence, ready or not."

This talk from the same folks who made The Social Dilemma is a great academic overview and offers an architecture for thinking about AI and its challenges/risks. Probably one of the best things I've seen on AI to date. And, of course, because it's the sane voice in the discourse, it's getting almost no attention.

Things I still don't see talked about enough...

-Protecting human intellectual property and copyright. No one cares about this outside the actual artists and creators who were used to train the AI.

But data scraping is so vital to AI's development that Reddit is planning to charge for access to its API to monetize AI training while offering nothing to the users who make Reddit such an AI hot spot. The inequality of how data is monetized gets no attention from AI thought leaders.

You know, the ethos used to be different. In the mid 2000s users were paid for the content they generated. I made five figures off royalty sharing and ad revenue splits on different sites. It's not like it's never been done. It's more that they realized if they don't pay, no one can do anything about it.

-Actually questioning the premise of whether these scientists unleashing all this chaos are operating ethically and in our best interests. Instead we laud and celebrate them...it's fucked up.

-When are we going to have fact checking in AI? There's some ability to request fact checking and ask for sources, but it's not automatic. In the CBS piece I linked above, AI generated a list of non fiction books that didn't exist. It shouldn't be doing that. Why isn't this technology oriented to reality?

-Still no conversation of loophole/process hacking expertise. They're just assuming everything humans do will be replaced by AI. But how will AI create financial systems to offshore money a la the Pandora Papers without creating a digital trail the IRS can download?

-Privacy. This does come up here and there but not in detail. It's ignored more often than not. However, you can't run a company off open access AI without making all your proprietary intel public. Self hosted AI is coming, but until then, companies can't fully implement it. 

-Power. No one talks about power. We have an electrical grid in the US that already doesn't work well. How much power will all this AI need and where are we going to get a reliable supply? Plus how much will it cost and who will pay for it? The cost of the power may be where we find some spots where humans are cheaper. (Or they'll triple residential electric costs to cover the grid updates and turn off  power to keep the AI moving when it suits them.)

Again, our species constantly creates undersupplied systems and then wonders why there are problems like it's an unsolvable mystery. 

Sidebar: Yo. Forget AI, there's 8 billion people now. We need to allocate more resources to things just in general anyway. (Did you know? What should be a 5 minute commute in Lagos, Nigeria--on track to be the largest city in the world--is taking 2-3 hours now? There's been a massive influx of population and it's destroyed the efficacy of their infrastructure. This is the scale of the problem in terms of resource demand. Too many people want the same things x 8 billion.)

-Cost. Anyone remember the Concorde? The plane that could fly to destinations in half the time? And how it went out of business? It was too expensive to run even with all the extra efficiency. Here we are decades later with no improvement in the tech to make it affordable either.

Same with healthcare. We have hospitals closing down all over the place, not because there's no demand, but because the economics don't work.

Can we afford to have AI do all the things? Will that even be cost efficient once you start factoring in all the costs of running AI? 

There is some talk about having levels of capability in AI. You'll have a top level with all the bells and whistles and then a worker bee level that follows patterns the top level figured out. But will that be economical enough? Can tech dumb down enough to cut costs and still be effective?

We couldn't make flying places in half the time work. We can't make healthcare work. You can actually reach a point where efficiency is too expensive. 

Once innovation is expensive, it stalls out. 

There are already problems with the economies of scale with AI. We don't have the electric grid for this and it will be expensive to build it up. We'll need a lot more servers and a lot more water and buildings for them. The costs will all be passed on and it's quite possible the vast majority of the world will be priced out of using AI as a result.

If it's costing a ~million dollars a day now and it's been implemented at, let's say 1% to make the math easy, the other 99% (unless we find some cost efficiencies at certain points, which is possible) means it will potentially cost somewhere around $100 million dollars a day to operate. I believe that will make AI the most expensive enterprise in history unless we get some major innovation on power and infrastructure that lowers costs. 

-Bias. How are we going to eliminate bias? AI is still only as good as its inputs. Which, when I look at medicine, my stomach sinks. There are a lot of biased inputs with medicine. A lot. They're embedded in the text books. Language itself is infused with bias...actual word choice and sentence structures can be heavily racist or sexist and people don't even realize it.

-War. How does a world with AI that doesn't fact check, that is full of bias go to war? And what does an AI arms race look like? (There's a part of me that wonders if Russia made their move now because of the uncertainty of AI's impact on geopolitics and power. The top levels have known about ChatGpt long before you and I ever saw it.)

-Same as we have a right to repair, we have a right to know if something was generated by AI. Where's that movement?

-I suspect we're going to see some kind of fundie religious radicalization around AI. As a preacher's kid, the first thing I thought of was the Tower of Babel, but no one seems to have leaned into it yet.  A Google search shows it has been mentioned here and there in conjunction with AI, but it hasn't gained critical mass.

It's quite possible some religious sects/demographics are going to have an Amish moment where they eschew this new technology and devote themselves to a faith driven lifestyle without it.

It's not just a Christian thing either which is why I wrote 'fundie religious'. There are actually similar stories in other major world religions just waiting to be leveraged. 

This Will Be Boring

I'm in a good mood. The weather is gorgeous. I got to garden, and despite a solemn vow to never, ever eat again while in the dark throes of power puking (some people power walk, some power lift, apparently my workout options are different lol), I am hungry and eating. 

I did over 2 1/2 hours of gardening yesterday and have already done about 45 minutes today, so in this body, that means I won't lose weight, but with Ozempic in the mix, I won't gain either.

Yes. For real. Despite the puking and the not eating around that combined with some heavy duty gardening, I have lost nothing. Not an ounce. I don't usually weigh myself much, but I've been hopping on and off the last few days waiting for my stomach turning inside out to make a difference. Nothing. Yeesh.

I eat and I don't lose. I starve and I don't lose. I starve and exercise and I don't lose. I get Covid last year and I lose 10 lbs in 6 days. What?

You can see why I'm not typically obsessed with the scale. Mostly it never moves.

Anyway, the eventual goal is to get back to low carb and I was on track to do that before I was derailed by my new cross fit puking routine. I've proven, through a lot of fun carb testing, that while I won't gain, I'm not going to lose more than a few pounds unless I combine Ozempic with low carb. I still have to do more to control my insulin on my end. Calories aren't enough. It matters what the calories are. (Zero stars. Not a fan.)

And I'll note, I'm still growing new skin tags despite a normal A1c and Ozempic on board. Which is annoying. (I have grown skin tags since I was ten supposedly due to insulin resistance but who knows anymore.)

Did the Ozempic cause this latest bout? I don't think so. It's hard to be certain, but usually I have to fuck up and eat too much sugar for Ozempic to make me nauseated. I was eating properly, everything was balanced. In fact, I hadn't eaten enough that day and had to find something more to eat to avoid being under 1000 calories. I assume it has more to do with the MRI contrast side effects/allergy or Covid than anything else. I was puking roughly around this mark after that first round of Covid.

Aside from all that, I'm gearing up for my surgery date by trying to get all my gardening work done in a tenth of the time it usually takes without making the various things wrong with me worse. 

The strawberries did take a hit, but they are there. We are essentially where we started last spring instead of having a full crop coming, but that's okay. It's survivable. I spent about an hour digging up and transplanting wayward strawberries into the raised beds to help compensate for what was lost. I don't think we'll have to buy any new plants.

The garlic is a disappointment. I planted about 50 bulbs in pots and only 10 are growing. Hopefully more come up.

The row of rhubarb is happy as fuck. I wish I liked it more. Murphy's Law of Gardening: The stuff you like the least will defy all odds, never die, and produce like free money. Like, I don't love zucchini, and it knows it. I grew enough from one plant once to be the next Jesus teaching men to fish. I don't plant it anymore... I don't want to be zucchini Jesus.

I harvested the last of the lemons from our dwarf lemon tree, which I've named Pandora because the marketing makes it sound easy to grow lemons when it's actually a lot of fussy clusterfuckery. We got about 15 lemons from her after 2 1/2 years of work and now she's trying to die. I'm doing my best to save her, but eh...

I will say, I have confirmed, firsthand, the advice to not compost citrus because it really does take forever to breakdown. The hard green baby lemons that fell off and that I buried in the pot to decompose instead ripened and are probably edible six months later. I dug them out and disposed of them elsewhere in case they were bothering Pandora.

I've got lettuce, poblano peppers, valerian, lavender, and cilantro seeds into pots. Some outside, some inside. Hopefully the family will water them when I can't walk.

In the cold frame, I have some random freebie flowers that were sent with some other order, broccoli, and peas. The seeds are old and I planted the broccoli late and it's getting really hot really early here so it's probably not going to go well, but I tried. I'm still not accomplishing much with the cold frame, but hopefully some day it'll click. Hubby just scavenged some old lab equipment that can make a second cold frame. It'd be good to figure this technique out.

And I'm working on the flower bed off the main porch. It's a little early to sow the seeds, but I think I'm going to risk it. I've got seeds saved from my calendula, marigolds, and the neighbor's snapdragons. The goal this year is to buy no landscaping flowers except for this hill we have where we want to do creeping thyme and phlox--that'll be gorgeous if it works. But I am zucchini Jesus, not creeping thyme and phlox Jesus so let's keep expectations low.

Next up, fertilizing all the fruit and nut trees, proactive pest control on the asparagus, sow flower seeds in the other flower bed,  add compost to plants that need it, coffee grinds to others, distribute some animal safe rodent repellant, general gardening clean up, and getting the potatoes out and chitting. I won't be able to plant them, but I can get it all set up so it's turnkey for everyone.

On the work front, I have some business paperwork to wrap up and some other tasks to work ahead on. I don't expect to be down for more than a few days but I'm still trying to avoid hard deadlines since you never know how surgery or recovery will go. I have a potential deal going with a company to buy rights to some stuff (woot!) and a payday coming from the one business (yay!) and am planning out how those funds will be used. 

(For the sale of rights thing...why does this stuff always hit when I'm in the middle of medical shit? Is it that I'm sick that often? I've had to delay some of the meetings for the surgery. Annoying. Hopefully the timing isn't too sensitive. You never know on deals like this though. A day can cost you everything.)

Also I need crutches and a shower cast cover thingie. Need to get those ordered/picked up. Oh, and the ultrasound for the latest lump. Shit. Not sure I can get that going fast enough...