Tag Archives: mental-health

Ketamine, Elon, and me

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Elon Musk – a man I admire greatly but not unreservedly – used ketamine. It’s not just a rumor. He wrote about it in a series of posts on what was then Twitter.

Ketamine is a manufactured drug that was originally designed as an anesthetic, and is still used for that purpose. However, it was noticed some years ago that in doses much lower than the anesthetic dose, it produces hallucinations. The effect is similar to that of other hallucinogenic drugs like LSD or naturally-occurring psilocybin (“magic mushrooms”). 

Ketamine, LSD, psilocybin and many other hallucinogens are thought not to be physically addictive (though, like other things that people enjoy, they may be habit-forming and psychologically addictive). In that respect, they are very different than, say, opiates such as heroin and morphine or, for that matter, coffee and alcohol.

Hallucinogens were investigated for years as treatments for emotional disorders such as depression and PTSD. But the “war on drugs” put a chill on that research.

As mind-altering drugs go, ketamine has a much better “brand” than LSD or psilocybin. That might be because letamine came into use as a medical anesthesia, not a street drug, and because a ketamine dose under medical supervision is easily controlled. That contrasts with street LSD and magic mushrooms, both of which are notoriously variable in their potency.

Equally important, a ketamine trip lasts about an hour while an LSD trip lasts more like a day.

Finally, ketamine has a better champion in Elon Musk than LSD had in Timothy Leary. Endorsements are everything, you know.

Given all that, together with some credible clinical studies, the FDA has approved ketamine in inhaler form for so-called “treatment resistant depression.” That’s defined as depression that resists other treatments such as the ubiquitous SSRI drugs.

The biochemical mechanism of ketamine on severe depression is not well understood. In layman’s terms, it seems to have a “resetting” effect similar to electroshock treatment – but without the occasional burn marks.

Ketamine treatment protocols are still evolving. A typical protocol involves half a dozen treatments over the course of several weeks. But sometimes the patient improves with just one or two treatments.  

Like other hallucinogens, ketamine is recognized as something that can be dangerously abused as a recreational drug. 

Elon said his use of ketamine was not for recreation, but was with a prescription under medical supervision to treat depression. (It says something about the sinister nature of depression that the richest person in the world could be afflicted with it.) Elon says he no longer uses it.

I have a personal experience with ketamine. Regular readers are aware that I had open heart surgery a week before Christmas to replace a defective aortic valve.

Due to the particular nature of my valve defect, the preferred method of aortic valve replacement where the valve is installed via a vascular catheter – a procedure something like a transcatheter angiogram – was not feasible for me.

My procedure instead went the old-fashioned route – through the chest. They sliced open my chest, sawed open my sternum lengthwise, pried my chest apart, accessed my beating heart, put me on a heart-lung bypass machine, injected a drug to stop my heart, cut into my heart, carved out my ruined aortic valve, and sewed in a replacement valve made from bovine tissue – from a cow.

They sewed up my heart, took me off the bypass machine, restarted my heart, wired my sternum shut, and sewed up the big wound through my chest.

Surgery took four or five hours, and I was under anesthesia for a total of six or seven. 

My recovery proved problematic. Although the wound healed well and I was up and about in a few days, I soon developed severe heart arrhythmias of various types. The surgical trauma to the heart from open heart surgery often disrupts the electrical pathways that control the beating of the four chambers, such that they don’t beat synchronously.

By then, I was about three months out from my surgery. Mechanically, my heart was doing very well. The new valve fashioned from the heart tissue of a cow was properly seated and functioning. I liked to say that I was doing much better than the cow.

But the electrical system regulating and synchronizing the contractions of my four heart chambers was all messed up. I was like a British sports car – mechanically I was not bad but the electrical system was reliably unreliable.

My random heartbeats not only wore me down, but also interfered with my sleep. Between the arrhythmias themselves and the sleep deprivation they produced, I was fatigued. I was indefatigably fatigued.

Unrelatedly, I had surgery on my forehead that was expected to be routine. That was bad timing. The surgery required a big, deep, star-shaped incision to carve out some skin cancer. I wound up with 19 external stitches plus another 25 dissolving subcutaneous ones. I looked like a hatchet murder victim, but was less active.

Also unrelatedly, my little brother died.

My reliably unreliable cardio-electrical system along with my indefatigable fatigue landed me in the Emergency Room. I was accompanied by a close friend who had helped me through my surgery in the months leading up to and following that.

In the ER, they did what they do in ERs. That is, they decided I was not at risk of dying that day, and they started to send me home.

The attending physician, however, began asking me questions about my situation. He had a ponytail. I liked him anyway, and I told him my recent story.

The doc suggested ketamine. I had never heard of ketamine, but my friend had. She said it killed Mathew Perry, the co-star of “Friends.”

The doc assured us that Perry had taken a huge dose or several doses of street ketamine the day he died, without medical supervision, and died in a swimming pool or hot tub – he might actually have drowned.

In my desperation, and after noting the absence of any swimming pools or hot tubs in this ER, I agreed to try this ketamine stuff. As the nurse was setting up an IV, we asked her whether I would feel anything. She answered that I would feel the pin-prick of the IV when she put it into my arm, but then I would feel nothing.

Maybe I asked the wrong question. After starting the IV, the nurse walked out of the curtained ER cubical, leaving me alone with my friend amid the gentle whirring of the machine slowly infusing ketamine into my vein.

The “disassociation” effect came first. Now I know what they mean by “out of body.”

Then came the hallucinations. They were something like a 70s light show, but crazy-intense and three dimensional – at least. I floated through walls of brilliant lights and gyrating shapes and wild colors.

Nothing had prepared me for this. I have never used recreational drugs. I had never heard of ketamine. The nurse had told me just minutes before that I would not feel anything. So, it was alarming. I whispered something like,

“. . . Oh . . . my . . . God . . .”

I wondered if I’d been given the wrong drug. I wondered if I’d been given an overdose. I wondered if this might be the end of the world, or at least the end of me.

At the same time, the feeling was freeing and exhilarating. I had the sensation of opening up and releasing tension and turbulence. I could see it – or hallucinate it – streaming out of me.

As I flew, I dimly felt that I needed to stay in sight of the ground. I asked my friend if she was still there. She answered yes. I asked her to keep talking. She did. About what, I don’t remember. But her voice reassured me that there was still an Earth, and that I was still on it, even as I floated in the cosmos.

It seemed that the whole treatment lasted no more than a few minutes, but in fact it was about 40 minutes. After the infusion stopped, the hallucinations stopped almost immediately. I was utterly spent.

The doc returned. I told him of my experience. He remarked, “Oh, maybe I should have warned you about that.”

I thought, “Yeah, duh.”

But I later decided that his little surprise was probably part of the treatment. My overall assessment of this physician is that his treatment of me was creative and certainly aggressive, but controlled and safe.

The next day at home, I researched ketamine, and I learned what I’ve written at the outset above.

I was very tired. Events leading up to the ketamine treatment, the sleep deprivation, and then the treatment itself, had physically and emotionally drained me.

But this tiredness was different than the indefatigable fatigue I’d had for months. Within a couple of days, I was much better than before the treatment. Over the ensuing weeks, my heart arrhythmias gradually disappeared. Maybe I’d been “reset.”

Note to readers: Don’t try this at home. Street ketamine can kill you.

Put this on your bucket list: open heart surgery

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“I can hardly wait to see your nine-incher, Glenn!” Those were the words of a dear hiking buddy with whom I’ve had a long platonic friendship.

But I’m getting ahead of myself.

Beginning last summer, I felt less than my usual acerbic, aerobic self, especially when hiking at altitude with my group around Aspen. I finally awoke one morning feeling downright crappy, and a little light-headed. I’m not prone to illness. I haven’t vomited for at least 30 years, and my last cold was over ten years ago. I figured something was wrong.

I drove myself to the local emergency room. Cleverly, or so I thought, I skipped breakfast because I figured they’d want to draw blood for tests.

They did draw blood, and did lots of imaging. They found nothing wrong.

Except I passed out. That alarmed me and everyone else until we figured out it was due to plummeting glucose levels. That’s what happens in early afternoon if you haven’t eaten a thing for 20 hours. So much for my cleverness in skipping breakfast.

Over the next two months, I became a regular in the ER and in the medical offices. Each time was with the same symptoms: Intense fatigue, light-headedness, and now some cognitive and memory issues. Each time, they found nothing wrong.

They did notice my bicuspid aortic valve – a defect that I was born with and have been aware of for many years. The aortic valve is the exit from the heart to the aortic artery. All the blood pumped to your body goes through it. It’s supposed to be three-leafed, but about one percent of the population gets short-changed in the aortic valve line at birth and gets only a two-leafed version.

A bicuspid aortic valve is usually not fatal. Many people never realize they have it. But it’s not as efficient, and it can deteriorate over time.

They saw my bicuspid aortic valve through a routine echocardiogram. They apply an echo transducer to the chest, something like the transducers applied to a woman’s belly to generate an image of a baby in the womb.

The echocardiogram showed that I had “mild regurgitation” through my bicuspid aortic valve, and would need to have it replaced sometime in the next few years. But it was not an emergency and did not account for my symptoms.

I was starting to think my symptoms were imagined, and the docs probably were too.

Almost on a lark, I saw yet another cardiologist. This one was suspicious about the echocardiogram images showing only mild regurgitation at my defective aortic valve. He ordered up a different sort of echocardiogram. For this one, they put me under an anesthetic and put the transducer down my trachea to get a view of the valve from a different angle.  

That angle showed the regurgitation at the bicuspid aortic valve was not mild, but “severe.” The valve had deteriorated to the point that blood was backflowing from the aorta back into the heart. They checked me into the hospital that very day and performed open heart surgery to replace the valve as soon as they could round up a surgical team.

The lead surgeon happened to be a petite blond woman. Her blondness was of no consequence, medically speaking, but I noticed her small, strong fingers that would soon be fishing around in my chest. I thought, “That makes sense – all surgeons should be petite women.”

For the replacement valve, they can use a mechanical prosthesis or a biological one. We chose the biological one. It’s fabricated from natural bovine heart tissue. So, I have a bit of Bessy in me. At least it wasn’t porcine tissue.

Surgery entails a nine-inch incision lengthwise over the sternum (hence the remark by my friend which I quoted above). Then they cut through the sternum, still lengthwise, and pry open the split sternum and chest cavity with a steel prying cage that looks like something from a tire store.

That exposes the beating heart. A vein and an artery are accessed with catheters connected to a heart-lung bypass machine to maintain the oxygenation of the blood. The heart is then stopped with drugs, and remains stopped for an hour or two during the next steps.

The surgeon cuts into the heart to expose the aortic valve, carves it out, takes measurements, and sews in the prosthetic valve of the right size. Then the heart is closed with stiches, the bypass machine is disconnected from its arterial and venous access points, the heart is restarted, the prying cage is closed and removed, the sternum is stapled or wired together, and the skin incision is stitched up. The whole operation usually takes 4-6 hours.

I once had simple knee surgery where they used an epidural to numb me from the hip down. I elected to stay conscious the whole time and observed the surgery on a video monitor.

That was not an option for the heart surgery.

I awoke that evening with a tube down my throat. My first assigned task was to convince them that I was well enough for them to remove it. I succeeded, and they did.

I spent another four nights in the hospital. With encouragement, I was able to walk to the bathroom right away, and each day I walked a bit farther down the hallway. By the last day, I was walking a single flight of the stairwell. It wasn’t exactly the Matterhorn, but you have to start somewhere.

At home, it was tricky to get around without feeling pain in the sternum and thereabouts. After about three months, the direct pain was pretty much gone, except there would be odd bouts of intense pain or cramps in the intercostals between the ribs.

Heart arrhythmias are common after open heart surgery because the surgical incisions cut through established electrical pathways. The body finds alternative pathways that are incorrect and mistimed.

I got the full measure of arrhythmias. Atrial fibrillation was first, where the heart races and flutters. My heart rate would be 64, then 42, then 163, then 81, all in the span of a few seconds.

For that, I underwent the usual treatment of “cardioversion” where the patient is anaesthetized and the heart is shocked with a high-voltage current to reset the proper electrical synchronization. The burn marks left on the chest are usually small and heal quickly.

Then there were the premature ventricular contractions, or PVCs, where the sensation is that the heart is skipping a beat. All people get a few PVCs now and then, and they tend not to be dangerous, but mine would go on for hours or days. They were typically loud enough to keep me awake all night. Eventually, they subsided (I think).

The whole experience is disruptive to one’s metabolism, one’s head, and one’s emotions. I sincerely believe I’m a different person now.

That person is not yet as mentally acute. There’s a name for the symptom of brain fog after heart surgery involving a heart-lung bypass pump. They call it “pump head.” I confess to having a bit of pump head. It often improves over time.

I’m also not as aerobically strong. That, too, may improve – especially now that I have a proper and efficient aortic valve for the first time in my life. I’m not ready to hang up my hiking boots quite yet, or my spurs.

And I’m different in my personality. I’m relearning things, relearning people, and relearning myself. I choose to see it as a blessing. How many people get the chance to reinvent themselves, free of the baggage of who they were?

Meanwhile, I’ve got this nine-incher. Got that going for me.

Like everything else, the debate over alcohol is turning into a bar fight

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Jesus turned water into wine. Modern-day abolitionists want to turn that wine into poison, and modern-day drinkers want to chase them out of town. We’re come a long way baby.

Not.

Let’s start with some facts:

As a long-time drinker, I can say with some authority that alcohol is a toxin. Half a quart of hard liquor in half an hour will probably leave you unconscious. More than that can kill you.

However, people rarely drink that much, that fast. Those who do are probably engaging in many other reckless behaviors, too, that will kill them long before the alcohol does.

The big question is, what about the millions of people who do not drink themselves into oblivion, but just into a mild buzz? And what about people who don’t drink for the buzz at all, but despite it – they’re drinking because they simply like the taste of a beverage, especially with dinner, that happens to contain a small amount of a nuisance toxin?

Most wine drinkers fall into this category, myself included.

As you might expect, the matter has been studied. Most recent studies suggest a strong link between heavy drinking and many different diseases – no surprise – but also a tenuous link between even moderate drinking and some cancers and vascular disease.

(Please don’t rebut these studies with a story about your long-living great aunt who drank every day.)

This link between alcohol and illness is, however, difficult to get a real fix on, because it is confounded by many variables. For example, people who drink moderately tend to be moderate in many of their other habits as well. And moderation is usually a healthy thing.

As for people who don’t drink at all, they tend to be moderate in all things including moderation. That’s why their alcohol consumption is not moderate, but is highly immoderate – it’s zero. These immoderate individuals very often engage in immoderate activities like ultra-marathons and are immoderately ultra-fit.

Comparing the health of a teetotaling ultra-marathoner with a moderate-drinking three-times-a-week treadmill exerciser will produce skewed and misleading results tending to show better health in the former that appears to be, but is not, a result of his teetotalling. Correlation very often does not equal causation.

Here’s another example of a confounding factor. Heavy drinkers tend to die young. People who die young are never included in studies of populations that are not young. Therefore, studies of not-young people will tend to show that drinkers are healthier than they really are, since the unhealthiest drinkers are dead and unincluded in the study.

The Surgeon General last week re-ignited this controversy-for-the-millennia by suggested that warning labels be put on alcohol, much as we’ve done on cigarettes for many years and as we already do on alcohol as it pertains to pregnant women.

As a sign of our times, the reaction was along party lines, but not in the way you might have expected. Strait-laced conservatives were outraged that anyone would dare warn them of the health hazards of getting intoxicated (even if the warning is only a warning and not a ban) while libertine liberals applauded the suggestion.

In reading the commentary, you might think the SG’s suggestion drove conservatives to drink, while it sent liberals onto their wagons.

That partisan reaction seems odd until you realize that the SG is a Democrat. In today’s charged political climate, that means many Democrats will reflexively like whatever he says, while many Republicans will dislike it.

In the mostly-conservative Wall Street Journal, for example, a member of the Editorial Board (with a BA in American Studies – owwwhh!!!) wrote an editorial unburdened by any supporting data announcing that the Surgeon General (a graduate of Yale Medical School) was simply wrong.

Other conservative commentators with similar “qualifications” weighed in with similar sentiments. The common theme was that the SG’s suggestion was yet another example of governmental overreach. It was Democrats trying yet again to control your life by warning you about things that might hurt you.

Well, maybe. But it seems to me that a fine-print warning that alcohol can be unhealthy is not exactly in the same category of, say, a warning that coffee can burn you or water can drown you. This is particularly true in view of widely published studies some years ago suggesting that moderate alcohol consumption is actually good for you – studies that were later debunked as having been confounded by the sort of lifestyle factors mentioned above.

And even if alcohol warnings are indeed in the same category as coffee-can-burn-you warnings and water-can-drown-you warnings, what’s the harm? It seems the protesters doth protest too much. A wee bit defensive, are we?

But that’s the current political world we live in. Messages are judged not by their content or other objective standards, but by the identity of the messenger. In my lifetime, America has never been so tribal. That’s bad.

By the way, I wonder about the position of our current tribal chief, for whom I’ve voted thrice now and whose performance as de facto president is great. (I especially like the idea of annexing Greenland, where we’ve had an early warning Air Force base for many years.) He is a known and admitted teetotaler. (Thank goodness – can you imagine Donald Trump intoxicated?) Wouldn’t the world be turned upside down if he were to side with the Democrat SG?

Along the same lines, I wonder how politically conservative, teetotaling Mormons reacted to the liberal SG’s suggestion.

As for me, from time to time I consider reducing my alcohol consumption, and maybe even ending it. It’s probably not the healthiest of my habits, nor the least expensive. But I hope I’m already knowledgeable enough that a silly new warning label won’t persuade me to stop, and I hope I’m mature enough that it won’t persuade me not to. 

Donald Trump’s anger might not take him any further

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When I was a kid, I had a bad temper. I suppose in today’s psychobabble, they would say I had an “anger-management issue” and perhaps they would give me drugs, a handicapped parking pass, and special privileges. But back in the day, I was just a kid with a temper.

One summer day when I was about 11, when my parents weren’t home, my brother and sister locked me out of the house for reasons I don’t remember (but they were probably good ones).

A back door to the house was sliding glass. This was before modern safety glass or double-pane windows. It was a simple un-tempered sliding glass door.

In a fit of anger, I kicked it. Not just with my toe, but with a big round-house kick. It felt good to see it tremble and shake, so I did it again, harder.

It broke. Sheets of jagged glass fell straight across my extended leg. I was wearing shorts.

I was lucky the glass didn’t cut my leg off. As it was, a big razor-sharp glass sheet penetrated well over an inch into my calf through a four-inch incision. In the gaping wound, I could see the fat layer and, beneath it, the red muscle tissue. I screamed in horror and pain.

My sister grabbed a towel, and we threw it around my leg. She ran across the street to ask a neighbor for help. I limped to his car and he casually chatted as he drove me to the ER. When I emerged from surgery an hour later, the neighbor was white, for he’d been told in the meantime about the severity of my injury.

Fortunately, the glass missed the artery, though there was plenty of blood. It did cut a nerve to my foot and left me without feeling on one side of my foot for a few months. To this day, that side of my foot has a funky sensation.

That evening, my father came home from work as usual.

Father: “I hear your temper got the best of you today.”

Me: “Yeah.”

That was it, and we never spoke of it again. I still lose my cool occasionally – most men do – but that’s the last time I can remember that my anger drove me into doing something dangerously stupid.

Anger is a powerful force. Channeled strategically by high-testosterone men storming the beaches of Normandy, it can save the world. Used less-strategically, it can destroy it – and them.

There’s a place for anger in politics. Like a lot of people today, I’m angry. Like a lot of people today, I want to kick the glass doors of our government, media, universities, and big businesses for their censorship, their racial discrimination, their wokeness, their antisemitism, and their incompetence.

Like a lot of people today, I like a candidate who feels similar anger. That’s why I voted for Donald Trump in 2016, again in 2020, and will again in 2024. He’s angry about the right things for the right reasons.

But anger has its limits. The boys storming Normandy had anger, and they sure as hell kicked in the glass door of Hitler’s house, but they weren’t just kicking a glass door.

Those boys also had a careful plan that was devised over months of thought, analysis and discussion by brilliant professionals like General Dwight D. Eisenhower. There were plans, counterplans, contingency plans, a retreat plan, and even a failure plan. Eisenhower himself drafted a mea culpa taking complete responsibility for the effort in case it failed.

Donald Trump has done a ton of good for America, but his anger is reaching the limits of its effectiveness. On Tuesday, he seemed to be kicking glass doors that weren’t even locked.

That appeals to a lot of people, including me in some circumstances. But it turns off women, who are often frightened by a man’s anger. And it turns off unengaged independent and moderate voters. You may despise such people, but they’re the ones who decide elections.

I’ll vote for Trump again, as I’ve already said. But I don’t expect him to win, and I don’t expect any Eisenhower-type mea culpa from him when he loses. Anger has its limits.