HinesSight

How my trabeculectomy is doing 7 1/2 weeks after surgery

This is a follow-up to my initial blog post about the trabeculectomy eye surgery I had on March 6, reported on in "My eye surgery went well, though not a load of fun."

As a Johns Hopkins article about trabeculectomy says, this surgery is aimed at controlled eye pressure in people like me with glaucoma, when eye drops or laser surgery either aren't doing a good enough job at lowering eye pressure -- the only viable way of keeping glaucoma from doing more damage to the eye -- or someone can't use those other methods.

In my case, Dr. Young, a Portland glaucoma specialist, felt that I needed this surgery because I'd lost so much peripheral vision in my very nearsighted right eye, while my left eye is only very minimally affected by glaucoma. 

My eye pressure was in the low to mid 20's when I was first diagnosed with glaucoma. Prescription eye drops had lowered the pressure to 10-12 in both eyes,  but Dr. Young wanted to get the pressure in my right eye down to 6-7.

When I asked him why laser surgery wasn't an option for my right eye, Dr. Young told me that given the seriousness of my vision loss, and how slowly glaucoma usually progresses, he didn't want to wait a couple of years to learn how well laser surgery was working -- perhaps because I'm 74, and want to preserve as much vision as possible for the rest of my life.

So I had the surgery. Which then involved five follow-up appointments.

Those weren't convenient for me to get to, since Dr. Young practices in Tualatin, Oregon and I live a ways south of Salem, about a 50 minute drive from Tualatin. But mostly I didn't encounter the dreaded Portland-area freeway traffic, so the Trabeculectomy God must have been smiling upon me.

Dr. Young kept telling me that my eye looked fine, but when he pressed on the trabeculectomy site the pressure in my right eye would drop to zero, or one time 2, which isn't a good thing. In fact, it's a bad thing. 

This meant that while I could stop using an eye shield, and phase down on the post-surgery eye drops I was prescribed, Dr. Young wanted me to keep on not lifting heavy weight. At first the limit was ten pounds. Then twenty pounds. Than thirty pounds. Three weeks ago I was given the OK to lift sixty pounds.

That enabled me to use the weight machines at our athletic club, albeit some of them at a considerably lower weight than I was using before the surgery (120 pounds on four of the eleven machines).

Today, though, I got my trabeculectomy graduation notice, three weeks after my previous visit with Dr. Young where he'd said that my eye wasn't forming scar tissue very quickly. My right eye pressure was six, an excellent pressure and right on what Dr. Young had hoped for.

(Further, Young has told me that there's reason to consider that a low eye pressure following trabeculectomy is a "higher quality" pressure, since it doesn't vary much, whereas lowering pressure via periodic drops in the eye has more ups and downs during the day.)

And, yay!, Dr. Young said I could do away with any weight-lifting restriction -- though I told him that I'd gradually ramp up the weight on the machines where I was using 120 pounds. 

Time will tell whether the trabeculectomy is as successful in preserving the vision in my right eye as it seems to be doing at present.

My next appointment with Dr. Young is in four weeks. I have to wear glasses for the foreseeable future, after quite a few decades of contact lens wearing. I want to ask him when I can wear contacts again. This might relate to when I need cataract surgery, which so far I've avoided.

My bad handwriting makes for interesting grocery checkout discussions

Since I'm 74, I suppose I'd have an excuse for my bad handwriting if I chose to make one up. Like, my hands are shaky due to a neurological condition.

But actually my handwriting has been minimally legible to others for most of my life. Me, I can generally read what I write pretty well, though not always.

On the plus side, my affliction makes for some interesting conversations in the grocery store checkout lane. Here's what the clerk at LifeSource Natural Foods here in Salem, Oregon and I talked about today.

Clerk: The number you wrote on this container can't be right.
Me: (peering to see what was on the label I put on the container) Those are 9's at the end.
Clerk: No, I'm talking about the first number; 599 is bulk dish soap, and that isn't what this is.
Me: Yeah, it's bulk almond butter, 399. But hey, I got two of three numbers written legibly. 
Clerk: Thanks for remembering the number.
Me: Thank you for bringing me back to a memory of first grade. I'm going to go home and practice writing 3's until I can stop them looking like 5's. 
Clerk: Oh, you don't have to do that.
Me: I know, but I want to. Though in my defense, there was quite a crowd around the nut butter area just now, and I was a bit stressed wanting to write the number on the label I'd put on the container as quickly as possible.

Which was kind of true, though it doesn't explain the many other times I've been asked to decipher an item number I'd written on a label. Occasionally I'm even asked if the number is English, or, say, Sanskrit.

Here's a video of me doing Water Boxing (Liu He Ba Fa)

After practicing karate, a hard style martial art, for about 12 years, in 2004 I shifted to learning Tai Chi, a soft style martial art -- albeit one with useful martial applications. 

I've been fortunate to have an instructor here in Salem, Oregon who had a lot of experience in several karate styles before also embracing Tai Chi, which is all that Warren Allen teaches now. So he understands the martial side of Tai Chi.

Warren began learning Tai Chi from a Chinese man who used to live in Hong Kong, where he learned the Water Boxing form, Liu He Ba Fa and taught it to Warren.

Warren has passed on his knowledge of Water Boxing to some of his Tai Chi students interested in this challenging, but engaging, blend of Tai Chi and several other more martial styles, Hsing Yi and Ba Gua.

I've still got a lot to learn about Water Boxing, but decided to make a video of me doing the form yesterday, when April rains stopped for a while and the temperature was pleasant.

Mental health gets talked about at Salem City Club

It's usually good to talk through your mental health problems rather than keeping them bottled up inside of you. Today the Salem City Club did just that, albeit from a policy perspective, in a program called Oregon's Many Mental Health Crises.

The not-so-cheery news is that Oregon ranks 49th out of the 50 states in the prevalence of mental illness and access to care. So for sure, we've got a mental health crisis. 

State Representative Rob Nosse started things off by talking about how the legislature is trying to fix things.

He's chair of the House Joint Committee on Behavioral Health. Until now somehow I didn't understand what "behavioral health" meant. It's mental health plus substance abuse, since you can engage in the behavior of substance abuse without having a mental health problem.

Nosse said that due to the largesse of the federal government, Oregon got $1.3 billion for mental health in the last two years. He said that probably Oregon now ranks as the 46th or 47th worst state for mental health problems and access.

Up from 49, perhaps, but still decidedly pitiful -- especially since we're a blue state with supposedly progressive policies, not one of those backward conservative southern states.

Nosse explained the three levels of mental health care the legislature is trying to improve. The first level is community mental health programs where people are treated on an outpatient basis, often by nonprofits.

The second level is secure residential facilities for those whose care needs are in-between being in the community and in the state hospital. The hope, he said, is that fixing problems with the first two levels will relieve pressure on the third level, the state hospital here in Salem.

Measure 110, which decriminalized drugs like heroin and meth, was needed, Nosse said, since treating drug use as a criminal problem obviously hasn't worked. But he would have preferred to see Measure 110 money for treatment programs ramp up in a first year, with decriminalization happening in the second year, instead of both things occurring at once, as actually happened.

Now that the federal money that was plentiful in 2021 and 2022 has dried up, the legislature is focusing on implementing the programs already started rather than initiating new mental health programs. Nosse said that he's a tax and spend liberal who believes that Oregon needs more investment in mental health.

The next speaker was Ann-Marie Bandfield, a Marion County Health and Human Services Program Manager for many behavioral and mental health areas. She said Marion County has a 24/7 walk-in crisis center. Here's an excerpt from the center's web page.

At least one Qualified Mental Health Professional (QMHP) is on duty at all times to provide face-to-face assessments and crisis counseling. We also provide telephone triage, support, and referral. This service is provided on a first come-first served basis. Most of this work is done at the crisis center itself, but a large number of assessments also occur at the emergency room of Salem Hospital.

The last speaker was Heather Jefferis, Executive Director for the Council for Behavioral Health which helps support behavioral health workers in Oregon. She said it was great that health insurance now has to pay for mental health care. 

However, Medicare rates haven't increased in 18 years. And Jefferis said that Oregon is far below the number of substance abuse and inpatient supportive housing beds that are needed.

In the Q&A part of the program, someone asked the speakers if a universal single payer health care system would help with Oregon's mental health crisis. Each of them said that it would, though Rep. Nosse was skeptical that such a plan is politically feasible in our state. 

I got to ask a question.

I said that when I was diagnosed with a major depressive episode -- meaning I was super depressed, which is much worse than merely being deeply sad -- I contacted every psychiatrist in Salem. None were taking new patients. Some didn't even have a waiting list. I was told that I'd have to wait months to see someone. And I had Medicare Advantage insurance.

But I noted that people in my situation weren't talked about by the speakers today.

I said that people with insurance still have big problems getting mental health care due to a shortage of providers. (Eventually I learned that my Salem Health primary care physician's office had a psychiatric nurse practitioner on the staff, who saw me fairly quickly, prescribed an antidepressant, and saw me every week or two for several months until my depression had lifted.)

Rep. Nosse said my comments were right on, and that the legislature wasn't focused on the plight of insured people like me.

When the program was over I spoke with several people. The program chair told me that in getting background info for his introductory remarks, he learned that half the counties in the United States don't have a psychiatrist. And most psychiatrists don't take Medicare patients because Medicare pays so little for mental health care.

I also spoke with a psychiatric nurse practitioner who said that any doctor can prescribe antidepressants. True. But my wife, a retired psychotherapist, tells me that primary care doctors aren't as knowledgeable about managing psychiatric drugs, which is why she urged me to try to find a psychiatrist when I was depressed.

Bill Maher wrong about transgender athletes and Trump indictment

Bill Maher is a comedian. I like his jokes. It doesn't bother me when some of his one-liners mess with facts in order to get a laugh. That's what comedians often do: exaggerate in order to make a humorous point.

What irritates me about Maher is when his playing loose with facts continues from his opening joke-filled monologue to the mostly serious discussion Maher has with his two panelists.

Last Friday's show (April 14) featured Maher engaging in extended rants about transgender people and Trump's indictment. I didn't like what he said on both subjects.

Maher claimed that transgender women (who transitioned from being a man) were harming the rights of "real" women. I've never heard that from any of the women I know. The main argument presented for this assertion was transgender women competing in women's sports.

OK, this happens. Not often, but sometimes. Maher and the panelists, Katie Porter and Piers Morgan, spent quite a bit of time talking about a transgender woman winning a NCAA championship in swimming.

That was Lia Thomas. 

University of Pennsylvania swimmer Lia Thomas became the first transgender athlete to win an NCAA Division I title after finishing first in the women’s 500-yard freestyle event Thursday evening.

Thomas pulled away in the final 150 yards to win in 4:33.24.

Thomas, who previously swam for the men’s team at Penn, has come to personify the ongoing debate on trans women’s participation in sports and the balance between inclusion and fair play.

This is a worthwhile debate to have. There do need to be rules governing transgender women who want to compete in sports where they may have a competitive advantage. However, Porter made sense when she said this should be left up to the organizations that govern women's sports.

And Morgan was wrong when he said, as I recall, that Thomas won the 500-yard freestyle by 50 seconds over the next fastest woman. Actually it was 1.75 seconds, not exactly a blowout. Plus, Wikipedia says:

In March 2022, she became the first openly transgender athlete to win an NCAA Division I national championship in any sport after winning the women's 500-yard freestyle event. Thomas lost muscle mass and strength through testosterone suppression and hormone replacement therapy. Her time for the 500 freestyle is over 15 seconds slower than her personal bests before medically transitioning. Thomas's winning time of 4:33.24 was 9.18 seconds short of Katie Ledecky's NCAA record of 4:24.06. In other races, Thomas has been beaten by multiple cisgender women as well as by Iszac Henig, a transgender man not on hormones.

Further, the NCAA has instituted a transgender policy that addresses the problem of assuring fair competition between transgender and cisgender women.

At its January 19, 2022 meeting, the NCAA Board of Governors updated the transgender student-athlete participation policy governing college sports. 

The new policy aligns transgender student-athlete participation with the Olympic Movement. The resulting sport-by-sport approach preserves opportunity for transgender student-athletes while balancing fairness, inclusion and safety for all who compete.

So it isn't true that transgender women are trampling on the rights of other women. Maher should educate himself about this before contributing to the transgender hysteria that, as Porter correctly noted, is endangering transgender people, who are subject to physical attacks at a rate much higher than their proportion in the general population.

Regarding Trump's indictment, this is a simpler Maher falsehood to address. First, he wrongly claimed that Democrats were after Trump because he had sex with Stormy Daniels, the adult film actress. That's untrue.

Hardly anyone cares who Trump has sex with, possibly excepting Melania, his wife. And Trump wasn't indicted by Democrats. He was indicted by a Manhattan grand jury that heard extensive testimony about false business records filed by Trump in an attempt to cover up the payment of hush money to Daniels a few weeks before the 2016 presidential election.

Maher blathered on at length about how Democrats were making the same mistake with Trump as Republicans did with Bill Clinton following his affair with Monica Lewinsky. But again, the charge against Trump isn't that he had sex with a woman other than his wife.

He's been indicted because he paid Daniels $130,000 to keep quiet about their affair just before the election where his misogyny was a central focus, and instead of reporting this as a campaign contribution, Trump falsely termed it legal fees.

Bill Maher is a smart guy. So is his staff. So I can't believe that Maher didn't know the facts about Trump's indictment. He knew. Maher just chose to say stuff on his show that was false, in order to take a cheap shot at Democrats.

Just like he took a cheap shot at transgender people.

I try ChatGPT. Asking about myself, I'm impressed.

It took me a while, but after hearing a lot about the marvels of ChatGPT, the online chatbot offered by OpenAI, a company whose goal is A.G.I. -- artificial general intelligence that can do anything a human can do -- I got around to trying out ChatGPT just now.


(All you need to do this is a free account with OpenAI.)

Because I have a significant online presence, and my ego is also significant, my first question for ChatGPT was about myself. I was impressed with the result, which took about five seconds to pop up.

Well, after reading that, I want to be ChatGPT's best friend. Its description of me was a bit over-the-top, but in my decidedly personal opinion, not hugely so.

ChatGPT did provide a profile of me that was kind of one-dimensional, since I'm also proud of my land use and political activism -- though I did ask Chat GPT about Brian Hines the blogger and author, and my Church of the Churchless blog has the largest Internet presence of my three blogs.

ChatGPT rapidly put together a description of me that was well written and accurate. My only minor quibble was that 2004 is 19 years prior to 2023 and ChatGPT said my churchless blog has been operating for "over a decade." But 19 years is over a decade, obviously.

I then tried to learn about Laurel Hines, my wife. But ChatGPT balked, telling me that it couldn't, or wouldn't, provide information on private individuals. I've urged Laurel to sign up with OpenAI herself to see if she has better luck learning about Laurel Hines. It could be that I have enough of a public presence to get a pass on the private person restriction.

Lastly, I recalled that ChatGPT is pretty good at poetry. So my curiosity, and ego, led me to ask it to write a poem about Brian Hines the blogger and author. Here's the result in two screenshots.

OK, this poem is more over-the-top than the prose description of me was. But I love it! Now I not only want ChatGPT to be my best friend, I want it to whisper sweet nothings into my ear about how much ChatGPT adores me. 

After I die, I definitely want ChatGPT to speak at the celebration of life held for me. Unless between now and then, ChatGPT turns sour on me, in which case it can go fuck itself, assuming a chatbot is capable of that.

On a more serious note -- not that I wasn't serious about what I just said -- it was both impressive and a bit creepy to see how well ChatGPT did with my two queries, each of which took only a few seconds.

We're only in the early days of artificial intelligence. There's reason for concern about it, but that's a topic for another blog post. For now, I'm content to bask in the warm glow of what ChatGPT said about me.

Caste is a marvelous book about our racial divisions

I'm kind of embarrassed to admit that I hadn't heard of Isabel Wilkerson's book, Caste: The Origins of Our Discontents, until I read a fairly recent TIME cover story by Wilkerson that provided an overview of Caste.

Somehow I'd missed the publication of the book in 2020. Making up for lost time, I immediately ordered a copy from Amazon. It took me a while to finish Caste.

For even though Wilkerson is a terrific writer with a smooth style that makes reading her a pleasure, her subject matter isn't cheery. So I'd read a short chapter on most days, rather than rushing through her book.

What blew me away in her TIME essay was the brilliant notion that caste, not prejudice, is a better way to understand the 400 year history of discrimination against African Americans in this country. 

Wilkerson makes her case for caste by not only describing how this means of maintaining power by a dominant class has been used in the United States, but also how caste has enforced hierarchies in India (no big surprise) and Nazi Germany.

This book opened my eyes to how caste explains a lot about social power dynamics that go beyond racial discrimination. For example, in a concluding chapter she speaks about a subject dear to my aging heart, how old people are treated in our country.

The challenge for our era is not merely the social construct of black and white but seeing through the many layers of a caste system that has more power than we as humans should permit it to have. Even the most privileged of humans in the Western world will join a tragically disfavored caste if they live long enough.

They will belong to the last caste of the human cycle, that of old age, people who are among the most demeaned of all citizens in the Western world, where youth is worshipped to forestall thoughts of death. A caste system spares no one. 

I'm not capable of doing justice to the book by attempting to summarize it. Others have done that hugely better than I could. Reading Caste, of course, is the #1 way to understand what Wilkerson has to say.

Here's a couple of lesser ways I found by some Googling: a NPR story, 'Caste' Argues Its Most Violent Manifestation is in Treatment of Black Americans, and a 6-minute PBS NewsHour episode on You Tube.

The book contains a lot that is disturbing. But we Americans need to be disturbed by how our homegrown caste system has caused so much pain and suffering and lost opportunity. One of Wilkerson's favorite metaphors, which I've heard her use on several interviews, is of an old house.

Old houses have many problems. She speaks from experience, being the owner of one. The roof may leak. The basement may have standing water. The electrical system may be outmoded. The porch may be rotting.

If a building inspector takes a look at the house and lists what's wrong with it, this doesn't mean that the current owner was responsible for the problems. But the problems are still problems. They don't go away just because someone says "I didn't cause them."

Likewise, those who want us to ignore the problems of caste and racial discrimination in this country -- I'm thinking Ron DeSantis and many other Republicans -- are like a homeowner who turns a blind eye to what's wrong with their house. We don't need to blame ourselves for the past. However, we have to take responsibility for fixing what's wrong with the United States that flows from our history.

Wilkerson ends up on a positive note. Here's how her book ends.

In a world without caste, instead of a false swagger over our own tribe or family or ascribed community, we would look upon all of humanity with wonderment: the lithe beauty of an Ethiopian runner, the bravery of a Swedish girl determined to save the planet, the physics-defying aerobatics of an African-American Olympian, the brilliance of a composer of Puerto Rican descent who can rap the history of the founding of America at 144 words a minute -- all of these should fill us with astonishment at what the species is capable of and gratitude to be alive for this.

In a world without caste, being male or female, light or dark, immigrant or native-born, would have no bearing on what anyone was perceived as being capable of. In a world without caste, we would all be invested in the well-being of others in our species if only for our own survival, and recognize that we are in need of one another more than we have been led to believe.

We would join forces with indigenous people around the world raising the alarm as fires rage and glaciers melt. We would see that, when others suffer, the collective human body is set back from the progression of our species.

A world without caste would set everyone free.