Clean Living Survey

Keeping an eye on consumer spending is a natural part of being a marketeer. So when i found this custom-designed survey in ESM Magazine (European Supermarket Magazine), i went for it.

https://go.numerator.com/rs/567-EJP-123/images/Numerator%20-%20Consumer%20Trends%20in%20Clean%20Living%20.pdf?version=0&mkt_tok=NTY3LUVKUC0xMjMAAAGbZZyYhFM1H9tAdbk9n_r11t-iQcHDb5jJZvN_v7Hy38nQu0wmjdX4qneowSm9XpjzSb4pxR7O8_BkySYhHt7SGp8UsV2X2g_qH1atp__FK7xO

SNOW!

10:56 a.m.

5:15 a.m.

7:20 a.m.

10:00 a.m.

Still Coming Down!!!

A murder!

Front

Two FITs...a 2008 & 2015. Never, EVER choose cars based on brother-in-law's opinion. I still can't believe we got the 2nd one.

2:48 p.m.

Living Room

Il Barbiere Di Seviglia

 Warsaw Chamber Opera

Figaro begins his famous song of self aggrandizement at 18:52

Angina Attack!

We were collaborating; the idea was pasta w marinara. We make our own marinara with tomato paste and seasonings.

Pain got so bad I had to lie down and put my feet up.

We hadn't had a selfie in a while.

Feet up.

The pathos!!!

We took several.

Michelle's mom's last Paramour crafted the cabinets to my left. He died about 10 years ago. She died 10 years ago.

The triage Nurse told me to get back onto my oxygen. That meant walking from the kitchen to the bedroom. 40 feet never seemed so long.

Update Sunday.25.Jan. - 7 days later

It was a tad past 4:30 a.m. when, after several anti-angina pills and a swig of morphine had had no effect, that I called the office. The on-call Nurse said he was coming to do an assessment.

When he arrived 20 minutes later I was writhing. I've been poked so many times over the years the mere mention makes my arms hurt; I've specified no more needles. So, after consulting with the attending physician, he slapped on all three of my 25-microgram fentanyl patches and 20 minutes later I had an inkling I might actually live and was able to whisper, "We beat it." I came close to pulling the plug, though.

It's taken a week to regain the energy to write it up. I've stayed with the 50-mcg increase in fentanyl. It's meant I'm sleeping more. They gave me 4mg tablets of hydromorphone (dilaudid, another form of morphine) for breakout pain; I've taken it a few times.

Jessica, my poet-nurse, is caring for her 94-year old aunt. She said Theresa came out from her bedroom the other day and announced, "I'M NOT DEAD YET!" They, Jessica, Jessica's daughter and Jessica's granddaughter, didn't know what to think.

I can't speak for Theresa, but my feeling is she wanted some reassurance that they hadn't gotten fed up with caring for her. I felt kinduh guilty about bringing someone out at 5 a.m.

I've always thought it'd be the pain that would motivate me to use the MAID (medical aid in dying), but this brought out some psychological perturbations around being a burden.

I encouraged Jessica to give Theresa a hug & tell her she loves her. Fortunately, it's true.

Phoebe Leaving

I set the price, $1,000.00, based on her not being drivable. All she needed was the clutch adjusted. The young man climbed under and...

Bob's yer uncle. 

I went to The Martz & got a jack & stands to try & adjust the clutch myself. Just going & getting the stuff wore me out so badly I didn't wanna think about getting under her.

She might've brought $5k or more if I'd spent the $300.00 - $500.00 to get the interior spruced up, but I'm past the point. 

They got a great deal. That's always nice. Now I can get the $82.00 back for the jack & stands.

Dinitrate Dosing

A ChatGPT conversation:

QUESTION:

I'm currently taking 90mg of isosorbide dinitrate every 4.5 hours for angina (450+ mg/day). The maximum recommended dosage is 240 mg/day. I'm thinking of increasing my dosage to 120mg hoping to extend its effects. How long would it need to be effective in order to justify the additional 30mg.

ChatGPT ANSWER

I need to be very careful here, because this involves cardiac medication at a very high dose, and changing it on your own could be dangerous.

Short answer (important)

Increasing isosorbide dinitrate from 90 mg to 120 mg is very unlikely to meaningfully extend its duration of action, and it significantly increases the risk of side effects (low blood pressure, dizziness, syncope, reflex tachycardia). Dose escalation does not reliably overcome nitrate tolerance, which is usually the limiting factor—not insufficient milligrams.

You should not change this dose without your cardiologist’s explicit guidance.

Why a higher dose usually doesn’t “last longer”

1. Pharmacokinetics

• Oral isosorbide dinitrate:
  
• Onset: ~15–30 minutes
• Peak effect: ~1–2 hours
• Typical anti-anginal effect: 3–6 hours
• Increasing the dose raises peak concentration, not duration in a linear way.

Once hepatic metabolism and vasodilatory pathways are saturated, extra drug mostly increases side effects, not therapeutic time.

2. Nitrate tolerance is the key issue

When nitrates are given frequently or continuously, the body rapidly becomes tolerant:

• Tolerance can develop within 24–48 hours
• The effect shortens even if the dose is increased
• Increasing dose accelerates tolerance

That’s why standard nitrate regimens include a daily nitrate-free interval of 10–14 hours.

Your schedule of every 4.5 hours suggests tolerance may already be playing a role.

What would “justify” an extra 30 mg — in theory

From a pharmacologic standpoint, an additional 30 mg would only be justified if it:

• Extended symptom relief by at least 1–2 additional hours, without
• Causing hypotension, headaches, or tachycardia

In practice, studies and clinical experience show:

• Duration rarely extends meaningfully
• Side effects increase disproportionately
• Anti-anginal benefit plateaus

Specific risks at 120 mg per dose

At that level, concerns include:

• Orthostatic hypotension
• Syncope (especially at night or on standing)
• Reflex tachycardia (which can worsen angina)
• Severe headaches
• Dangerous interactions (especially if any PDE-5 inhibitors are involved)

What cardiologists usually consider instead

If angina control is inadequate at high-dose dinitrate, clinicians typically consider:

• Switching to isosorbide mononitrate ER (more predictable kinetics)
• Re-structuring dosing to restore a nitrate-free interval
• Adding or optimizing:
  
• Beta-blocker
• Calcium channel blocker
• Ranolazine
• 
  
• Reassessing ischemic burden (stress testing, imaging)

Please don’t adjust this alone

Given the dose and frequency you’re already on, this is well beyond a “minor tweak.”

The right next step is a cardiology discussion, not a self-trial.

If you want, I can help you:

• Frame a clear question for your cardiologist
• Compare dinitrate vs mononitrate regimens
• Understand how tolerance might be affecting your symptoms

Just tell me how you’d like to proceed.

Just Security Litigation Tracker

Strolling through the warrens, i came upon Just Security, a website that includes the lawsuits against the Trump administration. 

Image is a link to Litigation Tracker

The 1st lawsuit is from the Ntl Assoc of the Deaf seeking reinstatement of American Sign Language interpreters for all presidential speeches, announcements etc. It describes several cases from among the 48 million deaf Americans for whom closed-captioning is insufficient.

The 2nd lawsuit is from the Perkins Coie law firm, a large firm established in 1912 that now employs over 2,500 people. Pages 45-46 describe half the people as business professionals and half as attorneys. 

The filing, in response to an executive order from President Trump, provides details of the president's depth of enmity and revenge-based attitude.

Here is Just Security's Trump Administration Litigation Tracker page...

https://www.justsecurity.org/107087/tracker-litigation-legal-challenges-trump-administration/

Here is the Coie lawsuit's "Amended Complaint" (a pdf)...

https://storage.courtlistener.com/recap/gov.uscourts.dcd.278290/gov.uscourts.dcd.278290.176.0_1.pdf

It is disheartening, to say the least, to see presidential power be used for punitive purposes, but even more so for such petty reasons that require expenditure of time and tax dollars.