Actinomycsis

 Enterococcus Faecalis is a gram-positive bacterium that can cause a variety of nosocomial infections, and urinary tract infections are the most common. These infections can be exceptionally difficult to treat, because of drug resistance.  Despite their troublesome nature, little is known about the host or bacterial factors necessary for E. faecalis to cause disease in the urinary tract.

Enterococcus faecalis is a tenacious species of bacteria that is growing increasingly resistant to antibiotics. The bacterium is capable of forming "microbial communities," in which it attaches to other microbial cells to form what's known as a biofilm. These biofilms are especially resistant to antibiotic therapy.2

 The ability of Enterococcus Faecalis  to cause disease in the kidney is well established by its tropism. The diagnosis of upper versus lower urinary tract infection caused by enterococci, as with gram-negative bacilli, is generally based on signs and symptoms. Thus the presence of fever and flank pain, with or without lower tract symptoms of dysuria, frequency, and urgency suggest upper tract infection.

Histologic examination of bladder and kidney tissues demonstrated that E. faecalis induced an inflammatory response in the kidney but not in the bladder. 

E. faecalis-mediated urinary tract infection appears to occur via a strikingly different mechanism than E. coli-mediated urinary tract infection.  In a typical E. coli urinary tract infection, the bacteria invade the superficial umbrella cells and replicate to high levels, forming intracellular biofilms, a process that induces a TLR4-mediated cytokine response that recruits neutrophils to the site of infection. In enterococcal urinary tract infection, there is little to no inflammation in the bladder 
Furthermore, neutrophils represented only a minority of the inflammatory cells targeted to the site of infection, which typically is in the kidney. We found that TLR2, which is hypothesized to play a similar role in the innate response to gram-positives as TLR4 does for gram-negative pathogens,  does not play a substantial role in the innate response to E. faecalis in the urinary tract

Since facultative anaerobes are able to grow in both the presence and absence of oxygen, they can survive in many different environments, adapt easily to changing conditions, and have a selective advantage over other bacteria.  As a result most life-threatening pathogens are facultative anaerobes^.

The ability of facultative anaerobic pathogens to survive without oxygen is important, since their infection is shown to reduce oxygen levels in their host's gut tissue. Moreover the ability of facultative anaerobes to limit oxygen levels at infection sites is beneficial to them and other bacteria, as dioxygen can form reactive oxygen species (ROS). These species are toxic to bacteria and can damage their DNA among other constituents.

Actinomycosis is an infrequent invasive bacterial disease, that has been recognized for over a century. Actinomyces spp. are filamentous Gram-positive bacilli mainly belonging to the human commensal flora of the oropharynx, gastrointestinal tract, and urogenital tract. To date multiple different clinical features of actinomycosis have been described as various anatomical sites, such as face, bone and joint, respiratory tract, genitourinary tract, digestive tract, central nervous system, skin, and soft tissue structures. 

Actinomyces are often isolated with other normal commensals such as Aggregatibacter Actinomycetemcomitans, Eikenella Corrodens, Capnocytophaga, Fusobacteria, Bacteroides, Staphylococci, Streptococci, or Enterobacteriaceae depending on the site of infection.

It is difficult to discriminate colonization of mucosa-contaminating samples and infection due to Actinomyces, except when the culture is pure and associated with the presence of polynuclear neutrophils.

Actinomyces infections could be polymicrobial and associated with other bacteria named “companion microbes,” which contribute to initiation and development of infection by inhibiting host defenses or reducing oxygen tension.

The multimicrobial nature of infection is well described in animal models and in human cervicofacial actinomycosis.

Isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

Because of the microaerophilic or strict anaerobic character of Actinomyces, strict anaerobic processing (rapid transport to the laboratory and/or transport in an anaerobic transport medium) and anaerobic growth conditions should be used for primary isolation.

The most appropriate clinical specimens are tissue from surgical biopsy or pus; swabs must be avoided.

The identification of Actinomyces in mucosa, where these bacteria are normal inhabitants, is of little significance in the absence of sulfur granules.

A Gram stain of the specimen is usually more sensitive than culture, especially if the patient had received antibiotics. Actinomyces are non-spore-forming Gram-positive rods. Except for A. meyeri, which is small and non-branching, all the other species are branching filamentous rods.

 Growth of Actinomyces is slow; it appears within at least 5 days and may take up to 15–20 days. Thus incubation of at least 10 days is required before conclusion of a negative culture. Most Actinomyces spp. are facultative anaerobes, but some relevant species (such as A. meyeri) are strictly anaerobic. Cultures must be incubated in an anaerobic atmosphere.

 Penicillin G or amoxicillin are considered drugs of choice for the treatment of actinomycosis.  Third-generation cephalosporins are less frequently used even if they are considered to be active on A. israelii; It is important to note that some species are resistant to ceftriaxone (Actinomyces europaeus and Actinomyces graevenitzii).  Piperacillin–tazobactam, imipenem, and meropenem are considered to be active, but the use of these broad-spectrum antibiotics should be limited to avoid acquisition of resistant flora. Oxacillin, cloxacillin, and cephalexin, a first-generation cephalosporin, are not considered to be active. Metronidazole and aminoglycosides have no in vitro activity against Actinomyces. Fluoroquinolones (Ciprofloxacin and Moxifloxacin) are usually considered to be inactive, but data is limited and controversial.  Doxycycline is considered to have a poor activity on Actinomyces spp., but clinical successes have been reported with this drug.  Macrolides and Clindamycin have been used successfully as alternatives.  As Actinomyces spp. do not produce beta-lactamases, it is not useful to combine amoxicillin with beta-lactam inhibitors such as clavulanic acid, except if co-pathogens such as Enterobacteriaceae are involved in the disease

 

Enterococcus faecalis  formerly classified as part of the group D Streptococcus system, is a Gram-positive commensal bacterium inhabiting the gastrointestinal tracts of humans^]. Like other species in the genus Enterococcus,  E. faecalis is found in healthy humans and can be used as a probiotic.  As an opportunistic pathogen E. faecalis can cause life-threatening infections especially in the nosocomial (hospital) environment, where naturally high levels of antibiotic resistance found in E. faecalis contribute to its pathogenicity.  E. faecalis has been frequently found in reinfected root canal-treated teeth in prevalence values ranging from 30% to 90% of cases Re-infected root canal-treated teeth are nine times more likely to harbor E. faecalis than cases of primary infections.

Physiopathological pathways of cervicofacial actinomycosis explain that predisposing conditions include poor oral hygiene and oral mucosa trauma by dental extraction,  Other predisposing factors include male sex, immunosuppression, alcoholism, and malnutrition. 

Although cervicofacial actinomycosis is the most frequent form of actinomycosis with bone involvement, Actinomyces spp. could also be involved in extra-facial bone and joint infection. Various clinical forms of extra-facial bone and joint actinomycosis have been described: hematogenous spread of localized actinomycosis; contiguous spread of pulmonary actinomycosis to the spine; and polymicrobial bone and joint infection following bone exposition.

Concerning hematogenous spread of localized actinomycosis, Brown  reported a case of hematogenous infection of total hip arthroplasty 9 months after a noninvasive dental procedure with Actinomyces spp. in intraoperative specimen cultures.   Zaman  reported a case of chronic hematogenous infection due to Actinomyces spp. of prosthetic joint in an intravenous drug user.  Concerning the contiguous spread of pulmonary actinomycosis to the spine, case 2  had contiguous spread to the spine with thoracic spondylitis of the T3 vertebral body associated with anterior paravertebral abscess).

Genitourinary tract actinomycosis is the second most frequent clinical form of actinomycosis. The main clinical feature of genitourinary tract actinomycosis is pelvic actinomycosis in women using an intrauterine device (IUD).  Other clinical presentations have been described, such as primary bladder actinomycosis and testicular actinomycosis.

Primary bladder actinomycosis can mimic bladder carcinoma, with macroscopic hematuria associated with thickening of the bladder wall.

Symptoms are unspecific, and patients frequently experience focal weakness, sensory losses, and seizures.

Primary skin and soft-tissue actinomycosis is poorly described. Skin disruption may facilitate invasion of Actinomyces spp.

A granuloma is a focal aggregate of immune cells which forms in response to a persistent inflammatory stimulus. It characteristically demonstrates the compact organization of mature macrophages which may or may not be associated with other inflammatory cell types. Granulomas are evolutionarily ancient structures found throughout both vertebrate and invertebrate species and are likely to have evolved as a protective mechanism to destroy or encapsulate foreign material.  They were first identified and described as "tubercules" in the lungs of tuberculosis sufferers as early as 1679. 

Granuloma formation begins with an inflammatory trigger, such as an infectious pathogen or a foreign body. Macrophages are recruited to the site of inflammation and activated as part of the innate immune response. If the recruited and activated macrophage is unable to remove the inflammatory stimulus efficiently, a further immune response may be triggered, orchestrated by dendritic cells and major histocompatibility complex II. Additional macrophages are recruited to the site, and a chronic inflammatory reaction develops. The macrophages form a tight aggregate around the inflammatory stimulus and may become surrounded by a peripheral cuff of lymphocytes. This inflammatory focus is known as a granuloma.

 

 

 

 

Rail Monopolies

It was not good news how SCOTUS ruled on gerrymandered voting districts in South Carolina.  North Carolina is stuck with gerrymandered voting districts after several appeals and a ruling by SCOTUS.  The Supreme Court is moving to the right, and while they are hedging on a decision about Donald Trump's candidacy, you can feel the ball rolling into his court.  I have given up.  I will not see America turn around in my lifetime, so I have stopped diligently reading the news.  It is all inflammatory, bad, or propaganda.  It makes life that much more difficult living inside your own self-created bubble of morality.  So many things are against us it seems unbearable at times.  I don't think commercial jets should be able to fly so low over urban areas where people reside, and that includes Skibo Road, Cross Creek Mall, and downtown Fayetteville.  It is obvious the airlines' opinions of the Fayetteville citizenry.  They could care less.  The homeless, indigent, drug-addicted folks roaming the streets don't take the Red Eye to Charlotte demanding fast WiFi.  The elite few get the good treatment.  The poor struggling people further are persecuted.  They kick you when you are down.  Commercial aircraft never flew this route before, and Piedmont's new direct to Charlotte set the precedent.  Who will notice if they strafe your neighborhood at five in the morning?  Then six, then seven, and then eight.  By that time all the air has been sucked out and turned into carbon emission.  That is to what we wake up, the refuse of the important.  They shit on us.  No one shits on us more than Wabtec.  One only has to watch their professional promotional video about Locotrol to understand.  The only thing they care about is moving more freight faster to increase revenue.  Finally I have discovered that the communication platforms on these freight locomotives are what are so disruptive to everyday life.  They have WiFi.  They have Cell.  They have every imaginable kind of radio transmission available on a locomotive.  Why does a train engine need to be communication central?  There is an uplink.  There are engine diagnostics.  There is distributed power.  What they don't realize is that all of this freight operates in the back yards of America's citizens.  It would seem we are not important.  Their example is hauling long trains through winding passes, not the Eastern Seaboard from Florida to new Jersey.  The protocol is the same.  Twenty thousand locomotives equipped with remote control.  They can put a 4400 horsepower locomotive anywhere in the train with no engineer.  Less employees, more profit.  There is no mention of radiation, emissions, or adverse consequences to human health.  Finally I realized why my television reception falters and my WiFi is intermittent.  It is because these locomotives have all of these capabilities to control their trains, and they switch from one to another at liberty.  Their IGBTs and high voltage electrical processing could power a small city, and no one bats an eye that amount of power rumbling down the tracks.  North of Washington they use electric.  We, the South, are the rust belt where diesel is king.  There is no oversight, no government regulation, and no holds barred.  Freight rail is a nemesis. 

New Leadership in Fayetteville

It's time to talk about the reality of Fayettenam.  The war dynamic always has been a part of Fayetteville fabric.  Although surreal in certain ways considering the preparation for killing only is a few miles away in the field, never did it overtake mainstream Fayetteville.  Always there was an elite social class who frequented Highland Country Club, filled the prestigious historical churches, and demanded a higher quality of life than war.  As this generation of older money began to die out, and BRAC brought Ground Forces Command to Fort Bragg, things changed.  9/11 ushered in a new American dynamic of domestic terrorism.  The Patriot Act was born, the NSA began monitoring our communication, and slowly we have succumbed to the military industrial complex.  The southern Eastern seaboard, Virginia to Florida, has become the military industrial complex.  It is not just North Carolina anymore.  (although probably it never was)  Norfolk, Charleston, Jacksonville, and much of Florida are hosts of the military.  The booming artillery of the Marines firing their guns at Fort Liberty only is a small part.  The breadth of aerial training is massive, and one only has to look at one of several free websites that monitor air traffic.  The most surprising (and it may be Robin Sage) is when four low-flying C-17's followed by four C-130 Hercules fly in circles around North Carolina.  An aerial brigade did deploy recently, so they must get their training.  The onslaught of Apache attack helicopters that flew four at a time through the night has waned.  None of this seems to be related to what has happened to Fayetteville.  Separately what is left of the city of Fayetteville is not dissimilar to the south side of Chicago, Watts, or any other barrio in a large city that has succumbed to poverty and crime.  If there are no trained workers who will work for less than minimum wage, then that faction lives on the street.  Covid dealt a stark blow to brick and mortar retail stores and restaurants.  The GOP does not champion small businesses.  Large corporate monopolies often owned by wealthy hedge funds have consumed America.  Now we are a big money entity, but most people can't survive.  There are the elite rich, and there are the poor, and a once active middle class has deteriorated.  Teachers once were a crucial part of the middle class.  It is simple and easy to understand this devolution.  We no longer champion public education.  Poor people are forced to live on the streets.  Shopping for groceries and home items has been invaded by indigent people.  They are using commercial real estate for their homes.  Private businesses are hosts for parasites, and the businesses are suffering.  This is wrong for many reasons, but laws are vague and indigents often wander free.  Fayetteville has not solved its homeless problem even with a brand new day center downtown.  The soup kitchens have closed.  What are these people supposed to do?  They create their own society, and it is recreational drug use, panhandling, and prostitution.  They are grifters, and it is a huge bumpy rash on the streets of Fayetteville.  I have not been threatened,  and I understand this subculture.  There are times when reason and sanity disappear, and chaotic mayhem ensues.  I was at McDonald's recently and ordered a No. 7, Medium.  (There used to be two choices)  I was charged for seven medium fries at a cost of $23.00.  I could not through their intercom explain I wanted a fish sandwich meal.  The line in the drive through was long, and I did not have the energy to engage.  I drove off in disgust and patroned Burger King.  Insanity it would seem has infiltrated mainstream America.  It is in politics.  There are no police.  With no cruisers,  street people push the envelope of decent living.  Leadership in Fayetteville is the problem; there are examples.  There is a lack of police.  We have a mostly unused minor league baseball stadium, and it is a view for expensive condos.  They are proposing a one hundred and fifty million dollar performing arts center in the middle of downtown, homeless central.  There is an unfinished professional tennis compound.  The paving work on Bragg Boulevard is a joke.  Streets in Fayetteville need attention, and there are pot holes and patches.  The Joe Biden infrastructure money is sitting in the bank, and it is being used for the wrong things.  The city and its patrons are being ignored, and a clandestine group of Fayetteville insiders are raiding the coffers.  It is time for new leadership. 

Real Estate or Gentrification?

 I should write a novel, because the reality of America today is too bizarre to believe.  It's not, but it has been a long time since this kind of personal strife has beset America.  At sixty-one I am lucky to have lived a mostly peaceful life.  When I am forced to look back (which I don't do often), it is a mine field littered with my suffering.  As an adult we find ways through, continue to grow, and discard negativity.  Our personal happiness (as is often said), mostly is our choice.  "You're about as happy as you choose to be."  Sometimes, like now, your community or environment won't allow you to be  happy.  Their misery is to intense and widespread.  To stay abreast of reality one must be open to this dynamic, experience it, try to understand it, and then formulate a plan to move forward.  This last week has been exactly that, and it took me most of that time to figure out it was not me.  It is the people around you.  As a Christian I am empathetic, but to survive one cannot be pulled into the abyss.  You must resist.  Last week (in a novel) should be called, "The Stealth Assault of Robin Sage."  Last Sunday was Mother's Day, and we enjoyed an afternoon tea at The Carolina Inn.  Come Monday a post-holiday depression ensued, and it must be associated with the Robin Sage exercise at Fort Liberty.  I now will call it, "Trying to increase your pay by getting the Green Beret."  Because we do not have boots on the ground, I have mixed feelings about the American fighting force.  I did not support a war in Afghanistan, because the ultimate goal was minerals in their mountains and a lucrative poppy crop.  (Poppy Cock!)  America is over thirty trillions dollars in debt, we have no grass roots economy, because we outsourced our manufacturing, agriculture, and everything else to cheaper foreign labor markets, and we became addicted to wireless technology.  This shift, streaming music and video, managing our homes, families, and businesses online, and receiving acquiring medical care has proven a pitfall.  Over the long term America's existing and fastidiously-created systems were more efficient and reliable.  The "wired" network of communication is superior.  You cannot harvest all electrical signals from their insulated conduits and release them into the air.  It is ludicrous and belies the laws of physics.  That campaign, the campaign of a wireless economy based upon previously prohibited microwave frequencies, has proven detrimental to America.  Its "green" campaign continues, but Americans are starting to understand.  We are unhealthy, and there are reasons.  It's called the "time card." The time card is weaker people forgetting or not paying attention over time.  The Monday after Mother's Day a bleak vacuum emerged.  In stark contrast to normal Fort Liberty training (noisy aircraft, booming artillery, and rumbling fright trains), last week was the most challenging.  I call it "Major Suckage," major suckage because of the huge enveloping vacuum, and Major Suckage, the Army officer who oversees freight operations at the Honeycutt Marshalling Yard.  When they assemble military trains at Fort Liberty and CSX pulls them into Fort Junction, life in Fayettenam is a pittance.  The telltale sign of this military activity is a common moniker of Fayettenam.  The heat and humidity of Fayetteville, North Carolina (which has receded somewhat in recent years), is caused by Military Ocean Terminal Sunny Point.  A deep water military port sitting at the mouth of the Cape Fear River south of Wilmington, when trains are loaded at Fort Liberty, traverse the CSX tracks through Pembroke to the large sorting yard at Leeland, here they are shunted to Sunny Point to be loaded onto waiting cargo ships.  A huge vacuum envelopes the entire Carolina coast.  Why does this happen?  Weak people will object, because we now live in a culture of fantasy in cyber space.  There is no pollution here, and because of the neglect of our mother Earth, the human population has become endangered.  Internal combustion engines burn air and fuel.  They breathe air from the environment for free and replace it with carbon.  To say comtrails are not harmful to people is lunacy.  While the white ribbons in the sky may contain water vapor, what comes out of a jet or diesel engine is not copacetic to human health.  It is harmful.  What happens to me in the wee hours of the morning when a freight train passes or a jet strafes our house covers the Cape Fear River Valley.  The breathable naturally-created oxygen humans need to survive is sucked out, burned for propulsion, and replaced with carbon emissions, heat, vibration, electricity, magnetism, and intense barometric pressure.  This is not a formula for survival, and this is one reason why we sick  When the core necessities of human survival are compromised for transit, then we are in crisis.  If we kill off humans, who will use these commodities?  Who will travel?  Who will consume energy?  I don't think AI ever will replace human beings, but I am beginning to think a small group of sociopaths are using it to thin down the population.  The proliferation of wireless airborne technology has reached an uncontrolled state of seeming domestic terrorism.  This operation seems to be cooperating punishing and controlling specific undesirable cross sections of the population.  The NSA via the Patriot Act has gone rogue and assumed the identity of an American Schutzstaffel.  We are being surveilled and manipulated by wireless technology, because this technology makes it easier, the same way living in cyber space is easier and more idyllic than living in Earth's reality.  No one has thought to question the Star Link satellite network, a low orbit band of snooping transmitters.  What I am describing is dystopian, but it is real.  Maybe we are on the cusp of this trend.  With AI in the forefront it would be easy to imagine a surveillance network which would influence your life with subtle changes to your daily challenges.  It could make things easier, or it could make things harder.  It could provide positive reinforcement or provide negative reinforcement.  If you think to much or outside the box of prescribed American life, it could make your life hell.  In most likelihood always this has been the case, but it occurred within human society through social class.  Say and do the right things, you move up the ladder.  Say or do the wrong things, and you get blacklisted.  Not that long ago it was Communist activity which elicited this ire, and it was correct for America to be proactive about this treasonous behavior.  Perhaps it became a snipe hunt and went off the rails like this onslaught of wireless technology.  I know for real that someone is watching and listening to every single thing I do.  When a home is supposed to provide you financial security and mental refuge, this mechanism can be put into play to force you out.  Selectively they can target you, a chosen malcontent, and push you out.  It's called Real Estate. 

Transparancy of the Military

This is a historic time in America, and it is not good.  Politicians actively suggesting and condoning insurrection as strategy to win political office is extreme.  It should be illegal.  Freedom of Speech, like many other tenets of the U.S. Constitution, should be debated.  Traditionally this occurred in institutions of higher learning, perhaps even in junior and high school.  I remember debating scenarios in The Governor's School of North Carolina that were similar.  They made you think through certain situations and decide if it was a favorable or unfavorable outcome.  The freedom to challenge other constitutional tenets vocally as intimidation or antagonism in an upcoming election is objectionable.  A party announcing they will not accept election results in 2024 is a thesis perspectus of anarchy.  While it is just talk at the moment, the powers at be should take note.  This leads us to the United States military.  I live in close proximity to the world's largest military base.  In the past there was a clear delineation between military life and civilian life.  The city had not become militarized.  With a newer less educated generation suffering from obstacles not encountered in decades, this line becomes gray.  With Donald Trump's gaslighting, campaign of false information, and utter deviance truth and liberty have become challenged.  I no longer trust the United States military.  General Mark Milley retired as the Chairman of the Joints Chiefs of Staff.  He had a clear grasp of Trump's wrongdoing and upheld the ideals of freedom and democracy.  Never would he allow the United States military to be turned upon the people.  If you look at other dictatorships worldwide, you see their military as a core component of authoritarianism.  Eventually the established national military is turned upon the people.  The once open borders of Fort Bragg have been replaced with check points, tighter security, and a sense of separation.  What caused this change?  The answer is 9/11.  So many things that have been bad for the country came about in response to 9/11.  The Patriot Act.  The Department of Homeland Security.  The buttoning up of Fort Bragg.  With an ailing Secretary of Defense not capable of overseeing the Pentagon, and a new Chairman of the Joints Chief, and promotions hanging in limbo from one senator, the United States military no longer is transparent.  We need able capable leaders in Washington, and we have old men, stooges, and extremists.  It is so disturbing and overwhelming, most Americans choose to tune out.  We see no favorable end to our plight.  I see nothing but the loss of democracy to bully Confederates.  How serious should we take the threats of the GOP?  The gun lobby will not relent on the sale of assault weapons, although they have murdered hundreds of thousands of innocent citizens.  Some suggest this mass murder is the result of mental illness or criminal behavior.  Finally I realize the reason why we won't outlaw assault weapons again, is because we are afraid of being attacked by our own military.  If an able and prepared military have this potential and capability, and they are led astray by a zealot leader like Donald Trump, how could a population protect their freedoms?  The influence of the military is insurmountable for many reasons.  When a force actively is training for war in the name of national security, we must trust the leaders of the military to instill in their charges allegiance to the American people.  It is for the populace they are fighting.  It is not themselves.  I see a blurring of this line and a reverence to their own cause, as military members are brainwashed into submission.  They are tempted with expensive homes, vehicles, and benefits, just like average Americans.  No one is candid to say their salaries are provided by the tax payers.  They work for the tax payers.  I'm not sure that one guy at Fort Liberty sees clearly.  

Dr. Scarymelagos

 Sitting in that little room waiting for the doctor is the litmus test for sanity.  Many doctors leverage that scenario into their financial favor.  Like any sideshow snake oil salesman, the bad doctors have no moral code.  The medical establishment has succumbed.  Enter Dr. Scarymelagos with no medical license in North Carolina.  A professed urologist, he is not a neurologist or any other type of specialist.  He told me so in his opening prologue.  When he asked me, and I told him about my symptoms, I should have realized I had the wrong doctor.  Peripheral neuropathy, mucous in the urine, and high blood pressure, all tell tale signs of a kidney infection.  He was not interested.  He denied I had blood in my urine before the test results arrived.  Profusely he patronized me.  With his digit fully inserted in my anus he said, "No cancer."  Why did he suggest a prostate biopsy?  Why did he want to look inside my bladder?  The answer is simple.  While touted as surgically superior urologists like to practice, whether you need the procedure or not.  He did not order a urine culture.  He did not check my blood for infection.  He did not prescribe pain medication for a kidney stone.  He did nothing to help me, except order an eight thousand dollar MRI, of which Lasthealth charged me without a blink of the eye.  A year later I am suffering from the same undiagnosed illness, but we are going to get to the bottom of it.  After I tried to file a complaint about Dr. Scarymelagos, I discovered he had no active license in North Carolina.  He had dropped the ball in almost every conceivable way.  It verged on malpractice.  I good place to start is a hundred urologists at the bottom of the ocean. 

A Fraught Liquid

 It is time to write again; I can't feel my soul.  I am depressed, and it is Sunday.  When I can't discern my soul, I struggle.  Motivation is my daily routine.  I am motivated to produce.  When I feel bad, I sit down and reflect and engage the affective.  Lack of feeling causes depression.  If your brain does not release, you don't feel.  If you create physical pleasure, you feel hedonistic.  Enlightened medical circles teach masturbation for older men for the prostate.  This is unspoken, and with woke society it will be a miracle if humanity survives.  The meek may inherit the earth, but the meek shouldn't be confused with the inability to understand or make decisions.  Not discerning one's own gender is the beginning of this tirade.  The adage, "Jazz is anything," is appropriate.  Jazz isn't "anything," and a connotation that suggests this gaslights its significance in American history.  It is counterculture (a cop out), and an excuse for refusing to learn and grow.  Those who expect to be given to, because they deserve it, will not inherit the earth.  The meek will not be confused with those who can't understand.  We seek to be educated and enlightened and eat a slice of daily humble pie.  Pride is not a sin.  The human race wouldn't  have evolved.  Accomplishment creates serenity.  If you completed your work, you rest and enjoy.  Sitting back and doing nothing should not be confused with the meek.  Meek is manners and a recognized ability to keep stay silent.  My brain will not provide a list of things to do.  It is awash in the rubbish of the neighborhood; I spend time trying to figure out why I am inhibited.  I browse to the the Washington Post, and their front page stark.  Totalitarian Autocracy.  Militarization.  Limited Cultural Rights.  Vladimir Putin's ideals are anti-Jazz.  Jazz, the real jazz, the empowerment of the human mind and soul, and its emotional expression through music is Putin's enemy.  My chosen vocation, expressive musical language and identity, are the enemy of the second most powerful man.  It is crucial for the most powerful nation to take a stand.  Is it possible the nation that created Jazz doesn't understand?  Is it racism?  I have lost touch with America.  For the first time in my life I feel the perspective of an ex-patriot.  It would not be better abroad.  Like a home in a neighborhood that doesn't swing, I am trapped in a selfabsorbant, ignorant, and antagonistic nation.  My depression is oppression.  I feel no support with my involvement in jazz music.  I feel resistance.  When I play, abruptly I feel the cold deaf ears of those who do not understand.  You do not have to understand, but you have to feel.  You must feel, and in America it is perilous.  You are vulnerable.  You are exposed, and your are weak.  To be human you must feel.  My ninety-two year old mother does not like it when I feel, because my feelings are different than hers.  When she is happy,  I am malcontent.  If I am happy, she is not.  Family blood is a fraught liquid.