403: forbidden

I was expecting this to happen eventually, but not soon.

I spent February in the UK with my sweetheart. ~80% positive experience even though I spent most of it either sick or grotty from asthma. It also served as early warning to update my passport (3yrs early), when the border guard got a colleague to double check that my face matched my photo ID.

At the same time, my interactions with officials on both sides of the international border—as well as occasional service professionals across the pond—were uncomfortably gendered. There wasn't any moment of hesitation to select a pronoun or honorific, as people had towards me in many U.S. contexts since the post-COVID reopening. It's about as dysphoria-inducing as being consistently "ma'm"d when other's default perceptions of me were feminine.

I still feel vastly better with my sex hormones balanced towards testosterone, but damn if I like the side effects.

We just might know how antidepressants work, now. As it turns out, both SSRIs and ketamine bind to a receptor for Brain-Derived Neurotrophic Factor, TrkB (free article). If you just want the high points, there's a graphical abstract on the front page of the PDF version.

Now, this right here? This made my day. :D



It also offers some new leads to understanding why entire categories of antidepressants don't work for some people. Subtle differences among TrkB alleles and expression frequencies might have big effects on what fits into that molecular pocket and how strong an effect it has. After all, we already know that one particular allele seems to confer a 2.2x risk of suicide attempts in depressed people.

On a more basic research level, we might also be able to develop model animals with cued brain-only overexpression of TrkB (where a gene promoter is added, and operates IFF some exogenous chemical cue is present) to determine what effects it has, and whether it's worthwhile to consider tinkering with the expression rate as a treatment method.

This is far too important a subject to languish behind a paywall. Original article here: https://www.nytimes.com/2021/01/02/health/coronavirus-smell-taste.html

tl;dr: Scent is intimately tied to physical and emotional well-being. If you can't smell sulfur dioxide, you can't tell that the kitchen is filling with gas from the oven or stove. If you can't smell food, you're at a real loss for determining whether it's gone off, and even when nothing's wrong with it, most people say that the pleasure of eating is gone. And people with damage to their sense of smell tend to become socially isolated--because face-to-face interactions are no longer enjoyable.


( Full text inside. )


Addendum:
My immediate thought after reading this was, 'What if the Western plague of anomie is down to our cultures' insistence that smelling like oneself is unacceptable?' It's such a simple, pervasive thing. If scent is up there with touch in its ability to create feelings of interpersonal connection and warmth, then what effect does its absence have on political polarization? On a societies' degree of individualism vs. collectivism? On America's basic civil society, which has been crumbling for generations?

After learning in mid-March that my liver was markedly unhappy after six-ish months of danazol, I decided to give the Mirena IUD a try. ( Cut for medical content. )

Being poked and prodded for the ultrasound has ratcheted my pain level up to the point where OTC medications are not adequate, and it's lingering.

All I wanted when this saga started was to experience less pain, goddamnit.

As of yesterday afternoon, I have a "transition" refill of sleep-hack medication. W00t!

I'm still all kinds of tired, from the time on half-rations. That will take a little while to resolve. Appointment with sleep specialist to get things properly moved over to new health insurance is tomorrow morning.

Due to doctors' offices not being able to get their shit together enough to transfer my records (even after I did the voodoo dance to get them to actually talk to one another!) in a timely manner, the window of opportunity in which I could have a doc-appointment and get all the insurance garbage out of the way in time for a refill of my sleep-hack medication to ship to me before I ran out has closed. Launch postponed. Houston, we're screwed.

I'm stretching the amount I've got left by rationing it at one dose per night rather than the usual two. Which is why I've been up for nearly two hours and have only 5h of sleep behind me. Unmedicated, my sleep is located at random times throughout the day, in intervals of 2-4h, and has around 50% of full efficiency. (So to feel similarly alert during the times when I am awake, I now expect to need somewhere between 10 and 12h. My normal requirement is 7.5h.)

Took today as a mental health day; not doing appreciably better at the end of it. Just going to have to hope that tomorrow is magically better somehow.

I've been on the new OC for 27 days, now, with no break for dummy pills. There's enough else going on that it's not yet evidence of anything, but experience suggests that'd be the prime suspect.

Oh, right. I fed them to PubMed and the NCBI digital bookshelf because being mobility impaired is keeping me from doing most useful things. I'm restless and frustrated as a result.

It's difficult to keep myself reined in and not go back to normal activities where I'd risk re-injury in the attempt. Last night I tried to put away my own groceries and my body forcefully informed me that bending my left knee that much was not going to happen.

One more week until X-rays and check-in.

Today I got poked and prodded and X-ray'd some more. The doc I saw this time was more informative than the ER staff, probably due to not juggling a dozen or more patients at once.

The specific problem is that I have a vertical fracture through the head of my fibula. It's "minimally displaced", which is good. Doc is optimistic that it will turn out to be stable without further intervention, but still wants me to go back tomorrow (11h from now) to see the sports-medicine surgeon who's in a couple mornings each week. Between them, they'll decide whether I need the broken bit surgically reattached to the rest of the bone to make it hold still and heal.

Today's exam has left me quite sore. 9h after getting home, I'm still needing extra painkillers to do anything besides lie here and hurt. So I'm not really looking forwards to the next one, even if the result is likely to be good.

All this has got me thinking about how I'm never sure how much pain one is expected to be able to tolerate. If we're going for functionality targets, there's a pretty big difference between what I need in order to reach 'able to do most basic self-maintenance if provided with ample distractions in between', vs. 'able to produce in-depth analysis of X.' - The latter being my bread and butter; the former being where I'm at right now. (Aside from which, it's disturbing to be left clinging to a rock rather than swimming in the ocean of data that I call home. Am I beyond the low-tide line? Will there be a hospitable tide pool to limp to if I am?)

At any rate, I have to get up early for that appointment. Goodnight, Dreamwidth.

I keep meaning to update, but then before I'm done composing a post, more stuff happens. Going to change strategies and just hit the most important high points.

* Around the beginning of summer, I was diagnosed with narcolepsy. Suddenly the excessive difficulty of the last two-ish years made sense.

* I'm trying out a medication for it - so far, so good. Still feeling tired all the time, but it's an order of magnitude less than before. I can do stuff, now, and I'm actually interested in doing it.

* In line with that last bit, if all goes well I should be getting my B.Sci in May. Finally!

So yes, there's a thing. Hi again, everyone.