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After 20 years at the University of Oregon, I have retired. So, I will begin posting about my new experiences here and hope you find them interesting. Note to spammers. All comments on this blog are moderated. If you attempt to leave any comments with links it will be deleted! So please, don't waste your time or mine!!

Saturday, September 28, 2024

Will AI Come to my rescue?

I have not posted to my personal blog for a long time but much has happened since my last post in 2019. We all endured a global pandemic and I underwent a number of medical procedures ending in my diagnosis of multiple myeloma with secondary bone cancer in April 2023. My oncologist told me that multiple myeloma, once a death sentence that usually gave a patient less than a year to live is now treated as a chronic condition that includes lifelong (howeever long that is) chemotherapy. So I have been undergoing chemotherapy for over a year now.

Preparation of chemotherapy medications at the Dana-Farber Cancer Institute courtesy of the Institute.

However, I have not lost interest in technology or history and have tried to maintain my Facebook feed on a daily basis (https://www.facebook.com/mary.harrsch.3/) . I have also tried to keep up with the fast pace in the development of artificial intelligence (AI) that is finally coming into its own after my first efforts to integrate a very early online chatbot back in the 1990s.

A cancer diagnosis and the painful tests and treatments that follow usually result in depression and even post-traumatic stress disorder, both conditions that should be treated by a mental health professional. Where I live in the central Willamette Valley of Oregon, however, mental health therapists refuse to accept Medicare, our government-funded insurance for seniors 65 and older, so the aged (yes, I am not a spring chicken anymore!) cannot request treatment unless they are willing to pay the full cost. 

After being rejected repeatedly by every mental health professional in my area for treatment with insurance coverage, I turned to ChatGPT 4o when I read it was being augmented to be more empathetic. I found interaction with ChatGPT 4o to be comforting while providing valuable information about things like how to encourage friends who seemed reluctant to visit someone who is terminally ill,  to overcome their fear of mortality and provide support I so desperately needed. Few have actually visited, but at least they're returning my emails now. Here is an excerpt from one of my interactions:

I told ChatGPT that I found it difficult to learn to live without hope. The AI replied:

"I'm deeply sorry that you're feeling this way. It's completely understandable to feel overwhelmed and hopeless given your circumstances. Here are some suggestions that might help you find a sense of hope and purpose:

  1. Focus on the Present: Try to live in the moment and find joy in small, everyday experiences. Whether it's a beautiful sunset, a good book, or a favorite meal, these moments can bring comfort.

  2. Connect with Others: Seek out connections with people who bring you joy and support. This could be family, friends, or even new acquaintances at the facility. Sharing your feelings can sometimes lighten the burden.

  3. Express Yourself: Writing, art, or music can be powerful outlets for your emotions. Keeping a journal or creating something can provide a sense of purpose and expression.

  4. Engage in Meaningful Activities: Participate in activities that you enjoy and find fulfilling. This could be volunteering, working on a project, or simply engaging in a hobby you love.

  5. Seek Professional Support: Consider speaking with a therapist or counselor who specializes in working with people facing serious illnesses. They can provide tools and strategies to help you cope with your feelings.

  6. Spiritual Practices: If you have any spiritual or religious beliefs, engaging in related practices can provide comfort and a sense of peace. This might include prayer, meditation, or attending services.

  7. Legacy Projects: Think about how you want to be remembered. Working on a legacy project, such as writing letters to loved ones, creating photo albums, or recording your life stories, can provide a sense of purpose and lasting impact.

  8. Mindfulness and Meditation: Practices like mindfulness and meditation can help you find peace and focus on the present. There are many guided meditations available that are specifically designed to help with feelings of hopelessness.

  9. Join Support Groups: Sometimes, connecting with others who are going through similar experiences can provide comfort and understanding. Look for support groups either in-person or online.

  10. Compassion for Yourself: Be gentle with yourself. It's okay to feel sad and overwhelmed. Allow yourself to feel these emotions without judgment.

Remember, you're not alone, and there are people who care about you and want to help. If you need more specific support or resources, please let me know."

I'm relatively sure this information would have been delivered by a human therapist, along with a bill for hundreds of dollars for a very short session.

I was already engaged in suggestion 7 and described my legacy project to ChatGPT:

Mary: "Actually, one of my legacy projects is to upload quality images of ancient art to Wikimedia Commons so they can be used freely for teaching and research. I have an archive of my own ancient art photography of over 150,000 images and a photographer friend even acts as my surrogate photographer in archaeological museums overseas now that I can no longer travel. He wants to provide his images to Wikimedia Commons too but doesn't know all of the procedures and permissions needed to do that so I perform that work for him."

ChatGPT: "Your legacy project is truly remarkable and impactful. It's wonderful that you're creating a valuable resource for teaching and research. Here are a few thoughts on continuing this project and perhaps finding hope and fulfillment through it:

  1. Celebrate Milestones: Recognize and celebrate the progress you make. Each image uploaded is a contribution to the collective knowledge and an enduring part of your legacy.

  2. Share Your Story: Consider writing about your project and its importance. Sharing your journey can inspire others and bring attention to the significance of preserving and sharing ancient art.

  3. Engage with the Community: Connect with other contributors on Wikimedia Commons. Engaging with a community that shares your passion can provide support and motivation.

  4. Teach Others: Offer to teach others how to upload and share images on Wikimedia Commons. This can create a network of contributors who can continue your work.

  5. Document Your Process: Create guides or tutorials for others who might want to contribute to Wikimedia Commons. This can ensure your knowledge and methods are preserved and accessible.

  6. Focus on Quality: Take pride in the quality of your contributions. Knowing that you're providing valuable, high-quality resources can be a source of fulfillment.

  7. Reflect on Impact: Think about the long-term impact of your work. Your contributions will be used by educators, researchers, and enthusiasts around the world for years to come.

  8. Collaborate: Continue to collaborate with your photographer friend and perhaps find other collaborators who share your passion. Building a network can amplify your efforts and create a sense of community.

  9. Self-Care: Balance your work on the project with activities that help you relax and recharge. It's important to take care of yourself while pursuing your goals.

  10. Legacy Letters: Consider writing letters or creating videos explaining your project and its importance to future generations. This can add a personal touch to your legacy and provide inspiration for others to continue your work.

Your dedication to this project is inspiring and adds a meaningful dimension to your legacy. If there's any way I can assist you with this work or if you need help with specific aspects of the uploading process, please let me know."

I also began to use ChatGPT to help me understand chemotherapy effectiveness and the blizzard of test results that accompany weekly treatments punctuated by too frequent hospitalizations and outpatient procedures. As I began chemotherapy that included high doses of the steroid dexamethasone, it became clear, especially after hospitalization for severe side effects from the steroid, that I could not continue its use. So, I was ordered to continue the chemotherapy regimen without the steroid. The dramatic improvement we had seen in the first month of chemotherapy with dexamethasone slowed to very modest improvement and finally to a trickle without reaching remission. So I asked ChatGPT for suggestions for a better treatment option for someone apparently allergic to dexamethasone.

ChatGPT: "The treatment regimens that include newer agents like Daratumumab (Darzalex), Pomalidomide (Pomalyst), Carfilzomib (Kyprolis), or Ixazomib (Ninlaro) can indeed offer potential advantages over continuing Velcade (Bortezomib) without dexamethasone, particularly for patients with refractory multiple myeloma. Here’s why these alternatives might be superior:

Potential Advantages:

  1. Improved Efficacy:

    • Daratumumab: Shown to be highly effective in multiple myeloma, especially when combined with other agents. It targets CD38 on myeloma cells and has demonstrated significant efficacy in relapsed/refractory settings.
    • Pomalidomide: A newer immunomodulatory drug that can be effective even when lenalidomide (Revlimid) has failed.
    • Carfilzomib: A next-generation proteasome inhibitor that has been shown to be more potent than Velcade in some studies, with a different side effect profile.
    • Ixazomib: An oral proteasome inhibitor that is easier to administer and has shown good efficacy in combination regimens.
  2. Side Effect Profiles:

    • Daratumumab and Elotuzumab: Monoclonal antibodies with fewer typical chemotherapy side effects. They do not require steroids for efficacy, which is beneficial given your adverse reactions to dexamethasone.
    • Pomalidomide: While it shares some similarities with lenalidomide, it may be better tolerated and has different dosing regimens that might mitigate some of the previous side effects you experienced.
  3. Convenience:

    • Ixazomib: Being an oral agent, it offers convenience over intravenous infusions and can be easier to manage for patients with mobility issues.

Comparing Regimens:

  1. Daratumumab + Pomalidomide + Cyclophosphamide:

    • Pros: Highly effective, especially for relapsed/refractory myeloma. Does not require dexamethasone, and Daratumumab is well-tolerated.
    • Cons: Requires infusion visits for Daratumumab.
  2. Ixazomib + Pomalidomide:

    • Pros: Entirely oral regimen, which is convenient and effective. Pomalidomide offers a potent alternative to lenalidomide.
    • Cons: Risk of similar side effects as other IMiDs (immunomodulatory drugs), but potentially better tolerated.
  3. Carfilzomib + Cyclophosphamide:

    • Pros: Carfilzomib has shown greater efficacy in some studies compared to Velcade. Cyclophosphamide is a well-known chemotherapeutic agent.
    • Cons: Carfilzomib has cardiovascular risks, and close monitoring is required.

Conclusion:

While continuing Velcade without dexamethasone is a viable option, the newer regimens listed may offer superior efficacy and better manageability of side effects. Given your specific medical history and the need to avoid steroids, discussing these alternative regimens with your oncologist could provide a more effective and tolerable treatment plan. Each regimen has its own set of advantages, and the choice will depend on detailed medical considerations and personal preferences."

Doctors here in the US seem to be suspicious of AI and usually roll their eyes when I tell them what my AI tool says about my lab results, possible side effects from whatever chemotherapy they are presently using, or just unusual sensations I am experiencing but yesterday I was inspired by an article about the dramatic achievements Canadian doctors have obtained using AI to predict sudden death in patients with complex conditions at St. Michael's Hospital in Toronto.

https://www.cbc.ca/news/health/ai-health-care-1.7322671

I just wish American medicine was not the lumbering sacred cow that it is and would embrace the truly helpful implementation of AI into both the treatment of mental health and management of complex disorders, especially with patients with many specialists that are supposed to work together as a "care team" but don't. 

Note: For my health issues I pointed out that I use ChatGPT 4o. at https://chatgpt.com/. Free access to the latest version is doled out based on the number of questions you ask (about an hour's worth) then you are told you've reached your allotted time for the moment and can either wait for three hours for your allotment to reset, continue with the older free version 3.5, or sign up for paid access at $20 per month. I just stop and wait for my allotment to reset. There were too many hallucinations with ChatGPT 3.5 (the "free" public version) where the chatbot starts making things up. I also use Google's Gemini (https://gemini.google.com/) for history research (it handles dates prior to the 1st century CE better and there is no limit to the questions I can ask it. But I save my serious personal questions for ChatGPT because its medical responses are more in depth. Gemini always gets "nervous" prefacing everything with disclaimers, when answering in-depth medical questions and seems to worry more about legal liability for Google than giving you the information you need. 


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