Post-Transplant thoughts #mycousindave

My cousin Dave and I email frequently. Usually sending each other random Seinfeld trivia questions, discussing recent movies or television shows, or music. He was the first one to really introduce me to the Beatles when I was about 10. He put late-1970’s giant headphones on me and put on “Revolution 9” from the White Album and he and his brother went in the corner and giggled as my 10-year-old brain was exposed to an onslaught of the trippiest weirdest Beatles song ever recorded.

Dave hit me, rather out of the blue, with a somewhat serious question about my recent experience of getting a liver transplant and the months leading up to it. Here’s my response (please feel free to listen to Revolution 9 while you read…it’s a fairly good audio accompaniment to how I felt during the crazy of the last year.

Cousin Dave: “In all your dealings with the Liver situation John, What period was THE MOST painful of the entire ordeal so far?”

Physically painful?  Definitely the first time trying to stand up out of bed post surgery. They made me do that on day 2. It took two nurses plus my sister Cara to get me on my feet. It HURT. My entire core, many of the muscles in my abdomen had been severed. After standing for a minute, I was spent. The post-surgery pain was significant and I was on pain medications for a couple weeks post-surgery.

Getting pumped with lots of stuff!

Pre-surgery the worst physical pain were the paracentesis/thoracentesis procedures, where they poked a needle into my abdomen or my upper back and sucked out extra fluid that had built up. Those were not fun and had many gallons of excess fluid drained over the course of many months.

In the ICU after my first episode of hepatic encephalopathy

But more than the physical pain, I’d say the metal pain was much more difficult. Dealing with the daily roller coaster of emotions of my mortality, dealing with the ups and downs of my health…one day I could be fine and then a few hours later be rushed to the hospital in an ambulance. The frustration of feeling helpless and hopeless, that I couldn’t trust my own brain to tell me when I was not thinking clearly (I feel like I can empathize with people suffering with Alzheimer’s much more now) but mostly the burden of the fear and pain I knew my family and friends were going through. All of that weighed heavily and still does.

Cousin Dave: And also, What period was THE Most Joyful of the whole thing?

How how so many people reached out, even people I barely knew who would tell me how I had made an impression on them. Like one girl I was facebook friends with (who I honestly don’t remember meeting), told me that she met me in a bar and we started chatting and I mentioned I played piano. And she said she had always wanted to play but never learned and she regretted that. I told her that it’s never too late to learn. And apparently she got home and started taking lessons and thanked me. You never know how little things you do and say can affect other people’s lives.

Or another girl name Gabriella, again a Facebook acquaintance, who had read when I posted that I was afraid I was going to miss a show. I had tickets to see Patton Oswalt at the Hard Rock live but I was still in the hospital the morning of the show. Thanks to the hustle of a very caring and resourceful nurse, she wrangled all my doctors on the phone on a Saturday and was able to get me discharged, but I didn’t have a chance to post until after the show that I made it just in time. After I got home I had a message from Patton Oswalt himself in my inbox because Gabriella had messaged him a told him I was sick.

There were so many moments like that, like the Patton Oswalt video, friends sending me funny messages or videos, everyone coming to a dinner at my favorite restaurant…like the week before the Covid lockdown began…the many friends who visited me, brought me groceries or tasty home cooked meals.

And I cherish how much closer I have gotten with my family who were all there the whole time. I had really come to grips that this might be the end and so I began to cherish every moment and opportunity that I had with every friend and loved one I could. I made amends with many former friends, forged new ones, I found a newly optimistic outlook on life. I really feel like I almost got to
experience my own funeral in many ways, and now I get a whole second chance at life.

Cousin Dave: Was that photo actually you at Doc’s\Transplant Place today?

Yes, that is a selfie I took in the waiting room of my transplant clinic this morning. Received all thumbs up from my doctor. Reduced more of my meds and it was my last visit with my transplant surgeon. Next visit I go back to my pre-transplant doctor.

Orange County #Florida ICU Bed Data 7/20/2020 #covid19 #orlando #orangecountyfl

ICU Bed Capacity across Orange County has increased since 7/8, but so have the number of occupied beds.

Orange County FL Adult ICU Hospital Data 7/8 – 7/20
Orange County FL Pediatric ICU Hospital Data 7/8 – 7/20

Data Source: Florida Agency for Healthcare Administration Hospital Bed Census Data

Living in Fear of COVID-19

Am I afraid? Yes.

I’ll admit it…I do live in fear. But I don’t think it’s the same kind fear as what the anti-mask crowd is calling “living in fear.”

I am afraid that if anyone I love or care about falls ill because of COVID-19 (or any highly communicable disease for that manner), that I won’t be able to be with them when they need comfort the most.

Having spent more time than I imagined in a hospital from March-May while waiting for a life-saving liver transplant, I know all too well how much having visitors helped keep my spirits up. Social media certainly helps, but there is nothing like being able to hold someone’s hand or hug them or just simply watch a movie together. To have someone bring me a McDonald’s Shamrock Shake or a Smoothie, drop off some comic books, some Twizzlers, Dinner from Maxines’s, play some guitar for me…anything from the outside world… helped.

The sterile environment of a hospital room can be a very lonely place.

And it’s a very scary place, especially because you’re there because you’re sick and not because you want to be. And despite having the best care and the most wonderful doctors and nurses, they can’t replace your friends and family.

When I first went to the hospital there were no limitations to who could visit me or even when. If someone didn’t get off work until 2am they could come see me in the middle of the night. I could have 4 people visit at the same time…the only limit was how many people could fit in the room and how many I had the energy for in any given day.

But as Covid-19 appeared, restrictions started happening. Visiting hours became limited as did the number of visitors. At one point it came down to one approved visitor per day and so I literally had to choose. But at least I still had a choice.

COVID patients don’t even have that luxury. They are prevented from having ANY visitors. Their interactions are limited to FaceTime or Zoom meetings or maybe a live visit through a glass window. They are at possibly the most vulnerable, helpless time of their life…possibly the end…and yet can not even find a tiny bit of comfort from the presence of the people they love.

That’s my fear. And any time I hear someone who mocks that fear by saying that we are acting out of “media-induced fear-mongering” or that “Covid is a hoax” or anything like that it just makes me sad. Because I know that they must not have ever experienced true loss or felt love. Theirs is a much more deep-rooted fear that I don’t and will never fully understand. Wear a damn mask!

23andMe Data Suggests Blood Type a Factor for COVID-19

The DNA testing company 23 and Me has been using their massive data sets to assist scientists with analysis in how COVID-19 spreads and if genetic factors play a role in determining how likely someone is to get infected and how severe the infection will be.

While not definitive, some of their early data seems to confirm that blood type may be a factor in transmission and immunity.

“In percentages, in the entire population, individuals with blood group O were 9-18% less likely to test positive when compared to other groups. “Exposed” individuals with blood group O were 13-26% less likely to test positive.”

Read more: Large Study Suggests Blood Type O May Be a Protective Factor Against COVID-19

Orange County #Florida ICU Bed Data 7/8/2020 #covid19 #orlando

Here are the latest numbers for ICU Hospital Beds in Orange County, Florida as of 7/8/2020.

Orange County Hospital Data 7/8/2020Adult ICU CensusAvailable Adult ICUAvailable Adult ICU%Total Adult ICU CapacityPediatric ICU CensusAvailable Pediatric ICUAvailable Pediatric ICU%Total Pediatric ICU Capacity
ADVENTHEALTH APOPKA1200.00%12000
ADVENTHEALTH EAST ORLANDO2100.00%21000
ADVENTHEALTH ORLANDO1464523.56%191262650.00%52
ADVENTHEALTH WINTER PARK10323.08%13000
ARNOLD PALMER MEDICAL CENTER2360.00%52839.68%31
ASPIRE HEALTH PARTNERS000000
CENTRAL FLORIDA BEHAVIORAL HOSPITAL000000
LA AMISTAD RESIDENTIAL TREATMENT CENTER000000
NEMOURS CHILDREN’S HOSPITAL00020623.08%26
ORLANDO HEALTH – HEALTH CENTRAL HOSPITAL1400.00%14000
ORLANDO HEALTH DR P PHILLIPS HOSPITAL11321.43%14000
ORLANDO HEALTH – ORMC6500.00%65000
SELECT SPECIALTY HOSPITAL ORLANDO NORTH000000
SELECT SPECIALTY HOSPITAL ORLANDO SOUTH000000
UNIVERSITY BEHAVIORAL CENTER000000
Total2815416.12%335743532.11%109
Source: https://bi.ahca.myflorida.com/t/ABICC/views/Public/ICUBedsHospital?%3AshowAppBanner=false&%3Adisplay_count=n&%3AshowVizHome=n&%3Aorigin=viz_share_link&%3AisGuestRedirectFromVizportal=y&%3Aembed=y&fbclid=IwAR38HDFnczinuXk9-X4s2NVw2p-4ZicuzOubdJhdOxcFqJ4X8lsL0jallsc
Image of Data

Here’s to one year of Sobriety!

Remember that year when you quit drinking, went to Burning Man, was diagnosed with end-stage liver disease, spent months in and out of the hospital, saw Australia burn, the President get impeached, watched a global pandemic kill more than 400,000 people, giant locus swarms in Africa, survived a liver transplant operation, Saharan dust clouds, protests, civil unrest, riots and violence in cities around the globe, and Kanye West announced he was running for President with support from the guy who both designed your car and helped return America to manned Spaceflight? Here’s to one year of sobriety!

My Cousin Dave’s Guide to Why Your Stupid Smart TV Sounds Damn Crappy #mycousindave

My Cousin Dave recently sent me an email:

Cousin Dave

Why does the sound on everything stink today? TV’s, Tablets, computers, cells.
(Corporate greed! Oh, buy this special sound component.) My Stupid Samsung Smart TV, brand new, on 100, the highest it goes,
is just audible on some channels.
And my hearing is perfectly normal.

Well, Dave, there are several factors. But it basically boils down to two: audio compression and format.

Almost all recorded audio today is compressed. CD-quality was established as an audio standard when CDs were first released. The quality is crystal clear and typically mixed to be presented as stereo sound with 2 channels (Left and Right). The problem is that the data files are really big and you can only fit about 80 minutes of music or 700mb. That’s about 35mb for a 3 minute song.

Then the Internet became a thing and people very quickly realized that downloading a song took FOREVER. So one guy said, hey, since humans can’t really hear EVERY frequency why don’t we remove some of that “extra data”? And so he set to chopping out the bits (compressing) HE deemed weren’t important. So now we have a whole generation of kids that only grew up hearing compressed audio (MP3’s) and don’t know any better.

This same compressed audio is used in streaming movies and television today because of the same logic. Some stations and streaming platforms compress the fuck out of the audio and/or picture. The only way to get really really good quality picture and sound is to buy the Blu-Ray versions and play them on a really good home theater system.

That’s the first thing: compression. The second thing is audio format.

Unless you have your smart TV connected to a fancy home theater audio system, you’re likely hearing plain old (compressed) stereo sound. If the source of that audio was originally mixed for stereo, it probably sounds fine. But if it was mixed for more than 2 speakers… such as Dolby 5.1 Surround, you are likely not hearing some of the mix.

5.1 refers to the number of speakers that an audio track is mixed to. In a typical 5.1 set up you would have Front L and R, Front Center, Side L and R, and a subwoofer. The Front Center would typically have the majority of dialogue where the sides and subwoofer would have music/Sfx and so on. This is how they create that “surround sound”.

The problem is, if you don’t have that center speaker, you’re probably missing much of the dialog audio. Most smart TVs attempt to compensate for this with some audio trickery but it is inconsistent because there are so many different ways the original audio can be formatted. It’s like if someone were to listen to early Beatles with all the treble down and all the bass up…it would totally sound fucked up.

Your smart TV likely has a few different audio settings (check your manual or look at your remote). You may try switching to a different format that sounds better to you for whatever you are watching at the time. Or you can start investing in a home theater system and spend thousands of dollars and thousands of hours learning the finer points of audio engineering.

Or just get some damn headphones ya deaf bastard!

Enjoyed #Devs on #Hulu? Yes..but is it real?

I recently watched the FX-produced “limited series” Devs on Hulu. It stars Nick Offerman (aka Ron Swanson from “Parks & Recreation“) as the “mad genius” and Sonoya Mizuno as the protagonist trying to uncover the secret behind her boyfriend’s sudden and inexplicable disappearance. I might add that Sonoya Mizuno may very well be my new favorite actress. If you’re not familiar with her work, watch this: The Rise of Sonoya Mizuno

The roughly 8 hour show (broken into 8 segments) is the brainchild of writer/director Alex Garland, who also wrote and directed Annihilation and Ex-Machina and wrote 28 Days Later. Garland has been on my radar for several years and has brought some of the most intriguing science fiction to both the big and little screens in recent years. Here’s what I wrote on Facebook after seeing Annihilation a couple years ago:

After being a little late to the game on Devs, and despite the fact that I had seen the name pop up as recommended by several friends…I never went digging enough to find it. I saw it once on Apple TV+ but it wanted me to buy it…then I realized it was on Hulu for free! So I binged all 8 episodes in about 2 Covid quarantine days.

The story goes like this: A russian-born software security developer working for a Silicon Valley tech giant gets recruited by the company’s Founder/CEO, Forest (Offerman), to join an elite team within the company called “Devs”. Shortly after he joins Devs, he disappears and his girlfriend, Lily (Mizuno) suspects foul play, leading her on a journey that weaves international espionage, high-tech, quantum computing, determinism and the concept of a multiverse.

Lily and Forest in Devs

The Multiverse theory is a very real theory that has its roots in ancient Greek philosophy and basically postulates the multiverse is a hypothetical group of multiple universes. Together, these universes comprise everything that exists: the entirety of spacetimematterenergyinformation, and the physical laws and constants that describe them. The different universes within the multiverse are called “parallel universes,” “other universes,” “alternate universes,” or “many worlds.”. The ideas of a Multiverse have been debated by physicists and philosophers alike, and has been the subject of many modern science fiction works, including the Marvel Cinematic Universe, Star Trek, Family Guy, Hitchhiker’s Guide to the Galaxy, Chronicles of Narnia…and many, many more.

In Devs, the multiverse is explored as a predictive tool. If every action has a cause, say you drop a pen, the pen will fall to the floor. It’s predictable and quantifiable. Devs takes it a step further by saying that if the pen is already on the floor, you can calculate how it got there, essentially peering back in time to the initial drop. Once you can visualize it being dropped, in theory, you can continue predicting backwards (and forwards) further and further, using massive computing power to predict all possible scenarios and accurately visualize the most likely outcomes.

It very quickly gets sticky and mired in the ethics of this technology…and the concepts of “free will”, determinism and quantum physics are all blended nicely in the Devs Universe. Forest is driven to build this technology due to a great loss he suffered and hopes to use it to recapture what he lost. Lily works for the same company and uncovers the mystery of her boyfriend’s disappearance and the truth behind Devs but begins to question her own thoughts and reality along the way.

Trailer for Devs

The series is visually stunning, filled with religious imagery and themes of death and rebirth. The Devs soundtrack is fantastic as well, with one notable episode starting and ending with a song called Congregation by Low. Every episode starts and ends with a unique song. It’s quite a fun watch, and I highly recommend it. But…could it happen for real??? Some physicists say perhaps.

Excerpts from the article “Physicists Have Reversed Time on The Smallest Scale Using a Quantum Computer

“It’s easy to take time’s arrow for granted – but the gears of physics actually work just as smoothly in reverse. Maybe that time machine is possible after all?

“An experiment from 2019 shows just how much wiggle room we can expect when it comes to distinguishing the past from the future, at least on a quantum scale. It might not allow us to relive the 1960s, but it could help us better understand why not.”

“The second law of thermodynamics is less a hard rule and more of a guiding principle for the Universe. It says hot things get colder over time as energy transforms and spreads out from areas where it’s most intense.

“It’s a principle that explains why your coffee won’t stay hot in a cold room, why it’s easier to scramble an egg than unscramble it, and why nobody will ever let you patent a perpetual motion machine.

“It’s also the closest we can get to a rule that tells us why we can remember what we had for dinner last night, but have no memory of next Christmas.

“That law is closely related to the notion of the arrow of time that posits the one-way direction of time from the past to the future,” said quantum physicist Gordey Lesovik from the Moscow Institute of Physics and Technology.

“Virtually every other rule in physics can be flipped and still make sense. For example, you could zoom in on a game of pool, and a single collision between any two balls won’t look weird if you happened to see it in reverse.

“On the other hand, if you watched balls roll out of pockets and reform the starting pyramid, it would be a sobering experience. That’s the second law at work for you.

“On the macro scale of omelettes and games of pool, we shouldn’t expect a lot of give in the laws of thermodynamics. But as we focus in on the tiny gears of reality – in this case, solitary electrons – loopholes appear.

“Electrons aren’t like tiny billiard balls, they’re more akin to information that occupies a space. Their details are defined by something called the Schrödinger equation, which represents the possibilities of an electron’s characteristics as a wave of chance.

Read more here: Physicists Have Reversed Time on The Smallest Scale Using a Quantum Computer

Growing New Livers in a Lab #livertransplant

Assembly and Function of a Bioengineered Human Liver for Transplantation Generated Solely from
Induced Pluripotent Stem Cells

That’s the fancy title of a new report by Kazuki Takeishi and other scientists who have successfully created miniature human livers from stem cells and put them into mice. I won’t get into the details, mostly because I don’t understand them, but here’s a picture:

A picture is worth a 1000 liver transplants.

You can read the very technical research paper here on Cell.com: Growing Mini Livers

About 17,000 people are currently waiting for a liver transplant in the United States. This number greatly exceeds the amount of available, donated by deceased donors. Meanwhile, organ transplants can be prohibitively expensive. In 2017, patients receiving a liver transplant were billed an estimated $812,500. That includes pre and post-op care as well as immunosuppressant drugs to keep people’s bodies from rejecting the transplanted organ.

I am one of those liver transplant recipients. My donor passed away on May 12th 2020, and in the early hours of May 13th, my dying liver was removed and replaced with the donor’s healthy liver in an operation that lasted about 4 hours. That was exactly three weeks ago, but I could have been much more unlucky. Each year an estimated 2000 people die while on the national transplant list…there are just not enough donated livers to keep up with demand. And you can’t live without a functioning liver…it is one of the most important organs and supports over 500 key body functions.

While the science isn’t quite ready for prime-time, scientists expect that within 10 years, liver donations will be a thing of the past.

You can read a much less science-y version of the story here: Lab Grown Human Mini Livers