Confused about Monoclonal Antibody Treatments? So was I.

A lot of people have asked, and since I have done some amount of personal research on this here’s what I’ve learned about the various monoclonal antibody treatments.

Due to a close-contact Covid exposure before Christmas, my transplant team recommended I get a monoclonal treatment. They sent me to the Florida State-run free monoclonal infusion website and I made an appointment and went last Wednesday and got the Regen-Cov infusion.

Currently in the US (as of 1/5/2022), there are four different approved monoclonal antibody infusions:

  • Regeneron – REGEN-COV (Casirivimab and Imdevimab) – 4 injections, each arm and 2 in stomach
  • Eli Lily – (Bamlanivimab and Etesevimab) – Administered via IV.
  • GlaxoSmithKlein – (Sotrovimab) – Administered via IV
  • AstraZeneca – Evusheld (Tixagevimab/Cilgavimab) – 2 intramuscular injections

As of last week, Florida was only distributing Regeneron and the Eli Lily brands. The GSK one is the version that data points to being the most effective against Omicron, but you can’t just assume you know which variant you have or been exposed to. Unless you’re doing some fancy test that the rest of us don’t have access to, the particular flavor of Covid anyone has is an unknown. While Omicron is the most common out there at the moment, there is still plenty of Delta around.

The AstraZeneca one isn’t recommended for people who have Covid or been exposed, but as a preventative for immunocompromised people who for whatever reason can’t do vaccines.

Like I said, I got the Regeneron 4 shot injection. After the injections I waited in the waiting area for about 30 minutes for observation before I was told I could leave. I didn’t notice any side effects at all.

Hope this info helps someone!

Florida Monoclonal Antibody Website

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!