HinesSight

Be sure to take Plenvu rather than Gavilyte for your colonoscopy prep

I've had four or five colonoscopies, can't remember exactly.

Started when I was fifty, then, because unlucky me always has benign polyps, I'm scheduled for another colonoscopy 4-5 years later, while my more fortunate wife gets away with a 10 year repeat (she can even have the test for colon cancer that doesn't require a colonoscopy).

Tomorrow I'm having another one. So today was the preparation day: no solid food, with the colon cleansing prep starting at 4 pm, with a repeat at 11 pm, a couple of hours from now. 

I'm looking forward to the colonoscopy itself tomorrow morning, since that's the easiest part. I'm a fan of propofol that I've been getting for anesthesia.

When I wake up (or regain my memory, I'm not sure which) my first reaction always is disappointment, since the propofol puts me in such a peaceful, blissful state of consciousness -- which argues for me not remembering the procedure, rather than being unconscious.

Drinking the prep stuff, not a fan. But there's better and worse colon cleansing approaches. At first I was prescribed Gavilyte by Salem Gastro, even though the Colonoscopy Preparation Instructions I was given referred to Plenvu.

I learned about the switch only after my pharmacy said that the prep was ready to be picked up. I noticed that the container was really large, but didn't think much about this until I got home and realized that I'd gotten Gavilyte, on the right in the photo below.

When I phoned Salem Gastro to find out what happened, they said that Regence MedAdvantage, my insurance company, wouldn't pay for Plenvu, which uses the much smaller bottle on the left for two split doses. 

I told them that I'd pay out of pocket for Plenvu, since Gavilyte requires drinking 4 liters, or 135 ounces, of water mixed with the prep solution, while Plenvu requires only 32 ounces of water mixed with the prep solution, 16 ounces in two split doses. You're also supposed to drink another 16 ounces of additional clear liquids of your choice after each dose.

Fortunately, my pharmacist told me that Plenvu had a discounted price for people like me whose insurance company won't cover the cost of it. So I ended up paying $50, I think it was, for the Plenvu. The cost was worth it, since I would have add to drink over four times more prep solution with Gavilyte. 

Keep this in mind if you're scheduled for a colonoscopy. The colon cleansing process isn't pleasant, given that you have to stay near a toilet after taking any prep solution. But drinking 32 ounces of the stuff is way better than drinking 135 ounces of it.

Lastly, my even more important advice is to not put off getting a colonoscopy if your doctor says it's time for one. As unfun a colonoscopy is, it's hugely preferable to dealing with colon cancer. 

The Psilocybin Center is open in Salem for psychedelic transformation

Thanks to a story in the Statesman Journal, I learned that Salem's first psilocybin service center has opened on State Street. It's aptly named The Psilocybin Center. 

Husband and wife Sammy Kahuk and Dina Odeh have opened Salem’s first psilocybin service center, and a second location is being licensed.

The Psilocybin Center at 2585 State St. offers personalized “psychedelic mushrooms” sessions to anyone over the age of 21 for behavioral or physical health conditions or for spiritual or recreational purposes.

It took me a while to find the web site for The Psilocybin Center, but once I did, I was impressed. 

So much so, this afternoon I made an appointment to talk with Sammy Kahuk next Tuesday via an online video chat that takes fifteen minutes. I'm assuming he'll ask me some questions, and I can ask some of my own. 

Like, how much the sessions cost, information that I didn't notice on their web site. My leaning is to go with the middle Moderate-High Dose option below. Microdosing seems too little for me; a Hero Dose session seems a bit too much for me at the moment.

I say "at the moment," because like many people my age (I'm 75, a baby boomer), I had quite a few psychedelic experiences during some of my college years -- 1967-68 -- with LSD, mescaline, and, yes, psilocybin. 

Some of those, most of them, really, were in the "Hero Dose" range, especially when I took LSD. Walls would melt and shimmer with color. Reality was transformed into a magical mystery tour, to not coin a phrase. 

But I'm kind of wary of jumping into a really intense psychedelic experience right off the bat, since doing this at my age could be considerably different from doing it at 19 and 20.

My primary motivation now is what Michael Pollan in his book How to Change Your Mind refers to as shaking up the snow globe. My mind has fallen into some senior citizen habits that I'd like aid in revising, which psychedelics are great at. In college, everything was fresh and new, so my psychedelic experiences just added fuel to that already flexible fire.

The Google reviews for the center are all highly positive. Here's a sampling.

 

Elon Musk has become an annoying genius

There's no doubt that Elon Musk is a brilliant guy, arguably a genius, who deserves a lot of credit for his accomplishments with Tesla, Space X, and other business pursuits.

I've been a happy Starlink customer (a Space X offering) since it's early beta days, and it's enabled us to trade our crappy 7 Mbps copper phone line DSL for a snappy 250 Mbps satellite broadband here in rural south Salem, Oregon.

But Elon Musk has gone from being fascinating to annoying.

Not to everybody, because a big cause of my annoyance with Musk is what he's done with Twitter after buying the company and renaming it X. Though X is still a social media platform that I use and enjoy numerous times a day, under Musk it has become much more of a haven for right-wing crazies. 

Fortunately, X still allows users to only see posts from people and organizations that they follow. That walls my X account off from extremists and conspiracy theorists. But I follow Elon Musk, so I'm "treated" to his frequent posts about politics, which are decidedly in accord with the wacko wing of the Republican Party.

This is a dumb move given that liberals and Democrats have been much more likely to buy Teslas that conservatives and Republicans. Now, surveys have found that this group is turned off by Musk's right-wing antics, which hurts Tesla sales.

Another thing that's going to hurt Tesla is Musk's temper tantrum that led to him firing the entire staff of the department in charge of the vaunted Supercharger network, which has been a key reason to buy a Tesla rather than a different electric vehicle. 

Today I came across a Reuters story that describes how the firing happened. Here's excerpts from "The inside story of Elon Musk's mass firing of Tesla Supercharger staff." 

The day before Elon Musk fired virtually all of Tesla’s electric-vehicle charging division last month, they had high hopes as charging chief Rebecca Tinucci went to meet with Musk about the network’s future, four former charging-network staffers told Reuters.

 

After Tinucci had cut between 15% and 20% of staffers two weeks earlier, part of much wider layoffs, they believed Musk would affirm plans for a massive charging-network expansion.

 

The meeting could not have gone worse. Musk, the employees said, was not pleased with Tinucci’s presentation and wanted more layoffs. When she balked, saying deeper cuts would undermine charging-business fundamentals, he responded by firing her and her entire 500-member team.

 

The departures have upended a network widely viewed as a signature Tesla achievement and a key driver of its EV sales. Tesla Superchargers account for more than 60% of U.S. high-speed charging ports, federal statistics show, and the company has been the biggest winner so far of $5 billion in federal funding for new chargers.

 

The charging-team layoffs mark the latest drama in a tumultuous year for Tesla as Musk has shut down or delayed several core efforts meant to drive the rapid EV sales growth that investors have expected. Instead, Musk now says Tesla will shift its main focus to self-driving cars, a fiercely competitive and riskier business that could take years to develop.

 

The company posted its first decline in auto sales since 2020 in the first quarter amid fierce competition from Chinese electric-vehicle makers and sagging worldwide EV demand. Reuters reported in April that Tesla had scrapped plans for a long-awaited affordable car known as the Model 2. That has thrown into doubt Tesla’s plans for new factories in Mexico and India, where Musk had been expected to travel last month to meet Prime Minister Narendra Modi, before canceling at the last minute. And a host of executives have departed amid deep companywide layoffs.

I'm disappointed about Tesla's decision not to offer a lower cost, and smaller, electric car.

My last three cars have been subcompacts: a Mini Cooper S, a VW GTI, and a Subaru Crosstrek. I much prefer that size car over larger sizes. A Tesla "hot hatch" priced around $25,000 to $35,000 would be very popular both in the United States and elsewhere. 

But Elon Musk appears to have scrapped the Model 2, choosing to instead build updated versions of the Model 3 and Y, both of which have been around for quite a while and look similar. His intention to focus on self-driving cars/taxis strikes me as a mistake, though maybe it will pay off in the end.

After all, like I said, Musk is both annoying and a genius. I just wish he manifested more of the latter quality and less of the former. 

After five months, I finally get medical treatment for my severe sciatica

If you've ever had severe sciatica pain, you'll find this blog post a heck of a lot more interesting than if you haven't. Usually that nerve pain is produced by problems with the spine, either degenerative or following an injury. 

I wrote about my current bout with sciatica back on March 23 in "If you're wondering about my absence, the answer is sciatica." An excerpt:

It can be an extremely annoying pain. My worse moments have been in the middle in the night when I need to use the bathroom, or when I get up after sleeping. A few times I was almost unable to move from my bed. When I tried, the pain was so intense I'd cry out uncontrollably, and needed help from my wife to just put my pants and shoes on.

Now I can do that on my own, though I use a single crutch to hobble into the bathroom, the pain is so bad. When I'm asked to rate the pain on a scale from 1-10, I say that at its worst, it's a 10. 

Given the occasional high intensity of that pain, which otherwise is just really annoying (though I'm doing better now, perhaps thanks to acupuncture), I've been highly motivated to get the health care system moving as quickly as possible toward treatment for the sciatica. 

However, aside from physical therapy, which I got after only a 5-week wait, and acupuncture, which I got on my own with less than a week's wait, it took me a bit over five months from when I first contacted my primary care doctor about the increased discomfort from the sciatica that I've been dealing with since 2020, until today, when I got two epidural steroid injections. 

In pain time, it felt a lot more than five months. But in health care system time, this is all too typical. Maybe even better than typical, since I have a Medicare MedAdvantage plan that is fairly generous and pretty responsive to referral requests.

Still, there are annoying hoops to jump through all along the way. For example, my wife has had three epidural injections that have helped her sciatica pain a lot. For me to get one, my primary care provider said that I needed a Lumbar Spine MRI. And in order to get the MRI, I needed six weeks of physical therapy, a Lumbar Spine X-ray, and something else that I've forgotten.

After that, of course, it took more time to be seen by several specialists. Some of them were clearly understaffed and overworked. In one case, I was shocked when I was told that it would take a week and a half to two weeks to schedule an appointment. Not to be seen at an appointment, just to schedule an appointment. That was a first for me. 

And our health care system isn't under the stress of Covid as it used to be. When I first got severe sciatica in 2020, I could understand why it wasn't possible to schedule a lumbar spine MRI, given that so many resources were going to care for Covid patients.

Now, though, the health care system seems to be under "normal" continual stress. My aging baby boomer generation must be partly to blame, given our increased medical needs. But my wife and I are both finding that now it takes much longer to get doctor appointments. Something is stressing the health care system, and i'm not sure what it is.

Here's my chronology.

December 8, 2023. I ask via MyChart for a referral from my primary care provider to Salem Health Rehabilitation Center, saying:

Dr. Gyuricska, sorry to hear that you're leaving Salem Health soon. I'll miss you. Wish you the best for your new course in life. I'm messaging you because I'd like a repeat referral to Salem Health Rehab Center for my right leg problem. The sciatica continues. What concerns me now is a different sensation in the right leg, some transitory unsteadiness/weakness after sleeping or sitting in a soft chair. Sort of weirdly, the sciatica pain is a bit less. The new problem might go away soon, but with the holidays upon us I figured that a physical therapy referral now would mean I could be seen after the first of the year. If I wait until January, naturally the wait to see a physical therapist, hopefully the same one I saw before, would be even longer.

December 11, 2023. Referred to Salem Health Rehabilitation Center for physical therapy.

January 5, 2024. Medicare wellness exam. Got advice to use BioFreeze to reduce stronger sciatica pain, which, sadly, isn't "going away soon" as I'd hoped on December 8.

January 15, 2024. Had first physical therapy session.

February 23, 2024. Primary care appointment about sciatica. Referred for Lumbar Spine X-ray which I got on same day.

March 9, 2024. Had Lumbar Spine MRI. Numerous problems found, including spinal stenosis. 

March 12, 2024. Referred to Salem Health Spine Center by primary care provider.

March 13, 2024. Had last of six physical therapy sessions.

March 14, 2024. Notified by Salem Health Spine Center to make appointment with Capital Neurosurgery Specialists neurosurgeon.

March 14, 2024. Referred to Salem Pain and Spine Specialists by primary care provider. 

March 18, 2024. Had scoliosis X-ray at request of neurosurgeon. 

March 26, 2024. Had appointment with neurosurgeon. Epidural steroid injections at two spine locations were recommended as first therapeutic step, which also would have diagnostic value.

April 8, 2024. At my request, referred by primary care provider to Portland doctor who performs MILD (Minimally Invasive Lumbar Decompression) for consultation about this possibility.

April 10, 2024. Had appointment with Physician Assistant at Salem Pain and Spine Specialists. It was agreed that I should get epidural steroid injections.

April 16, 2024. Had appointment with Portland doctor's Physician Assistant. 

April 29, 2024. Had first acupuncture treatment, which I chose to do.

May 9, 2024. Had second acupuncture treatment.

May 13, 2024. Had two epidural steroid injections at Salem Pain and Spine Specialists.

July 1, 2024. Follow-up appointment scheduled with neurosurgeon. 

Stormy Daniels, porn star, is more moral than Donald Trump, ex-president

We live in strange times.

Sure, all times are strange in their own way, but 2024 in the United States is shaping up to be among the strangest years, politically speaking, in my more than a half century of following political issues closely.

No cameras are allowed in the courtroom, so we have to rely on sketch artists

Yesterday and today the news was full of how Stormy Daniels, porn star/adult film actress, testified for the prosecution at the criminal trial of Donald Trump, ex-president. That in itself is damn strange. 

For it's the first time an ex-president has had to defend himself in court against criminal accusations. In this case, that he falsified business records in furtherance of a deception that a $130,000 "hush money" payment to Daniels was for legal expenses rather than a contribution to Trump's presidential campaign -- since if news about his affair with Daniels had come out just before the 2016 election, this could have tanked his chances given the uproar over the Access Hollywood tape where he bragged about "grabbing women by the pussy."

The reason for the payment was that in 2006 60 year-old Trump had sex with 27-year-old Daniels. It creeped Daniels out, but she climbed into bed with Trump anyway, in part (or in whole) she says because of the power imbalance between a rich guy with a bodyguard standing outside the hotel suite and a female porn star.

This was four months after Trump's wife, Melania, gave birth to their son, Barron. By contrast, apparently Daniels was in between marriages in 2006, given what this Daily Beast article says:

Daniels has been married four times. Her first marriage was in 2003 to Pat Myne, a fellow adult-film star, just as her career in the industry was taking off. The couple divorced after two years, and Daniels quickly remarried to Mike Moz, an art director, in 2007.

So that's one reason I consider Stormy Daniels to be more moral than Donald Trump. (In truth, I consider almost everyone to be more moral than Trump.)

Another reason is that despite the best effort of one of Trump's attorneys to undermine Daniels' testimony via cross-examination, her story of their sexual encounter held up well. Sure, there were some minor differences between the way Daniels described this over the years, but 2006 was 18 years ago. It makes sense that her memory would fade some with time.

But not to such a degree that Daniels would confuse not having sex with Trump, with having sex with Trump. This is the sort of thing that would be hard to forget. Yet Trump has denied they had sex. Not in court, though, because that would open him up to a perjury indictment.

Daniels had to go into considerable detail about the hotel suite where she met Trump and other descriptions of that evening because his defense team is strongly implying, though not explicitly saying, that the sexual encounter never happened.

This is another reason why Daniels is more moral than Trump.

By no means is she a perfect person (who is?). However, she comes across as someone who is doing her best to speak the truth, while every day Trump speaks to reporters with lies cascading from his mouth. Something he is practiced at, since he lied incessantly during the four years of his presidency, just as he is doing at every campaign event in his hopefully quixotic attempt to be re-elected in November.