u/theorist9

BACKGROUND:
I'm 67 years old, and had a left upper lobe lobectomy a month ago for stage 1 lung cancer. Fortunately the invasive component was only 1.5 cm, and the pathology for the entire remainer of the lobe was clear. Consequently, even though I had the EFGR+ mutation, adjuvant therapy was not indicated.

Prior the lobectomy I was in very good shape (15.5 mets on the accelerated Bruce protocol, which puts me at >90%ile for men aged 20-29). My main aerobic sports are downhill skiing (I'm an expert and like moguls, which are aerobically demanding) and trail running. I've just returned to running, but only for short (~5 min.) intervals interspersed within my walks.

QUESTIONS:
Among those of you of similar fitness who've undergone this, how long did it take before you got to maximum recovery (i.e., before your recovery plateaued)?

Once you got there, how much of your top-end fitness did you feel you lost, both quantitatively and practically?

And was there a change in how you felt when working out intensely? Specifically, even if you lost some top-end performance, were you still able to push yourself hard without anything more than the usual discomfort, or were you no longer able to do that without feeling "off" (e.g., unusual shortness of breath/dizzyness/etc)?

Separately: Did you have any breathing issues within the first month and, if so, how long did they take to resolve? I have a persistent cough and a continuous feeling of restriction in my throat, which my pulmonologist says is unusual. He just ordered me a nebulizer, and expects this should resolve in a couple of weeks.

I was motivated to investigate dictation apps by a recent decision to try my hand at writing fiction, thinking it would be nicer to dictate passages than type them.

You can see that some of the specific tests in my comparison (such as the ability to recognize spoken passages and put quotation marks around them) were included because of my intended use, and thus might not be of general interest.

But I'm sharing what I found anyways in case at least part of what I've done might be helpful to you.

I've divided the apps into two categories: Those I've run locally, and those I've run cloud-based (I say "run" rather than "are", since several are able to do both).

I explored both because I use both a 2019 i9 iMac for my desktop work, and an M1 Pro MacBook Pro for my mobile work

Practically speaking, the iMac can only use cloud–based apps: While models from two of the two best–known packages that are available for local installation (OpenAI's Whisper, and NVIDIA's Parakeet) can be run on an Intel Mac, both transcribe so slowly that neither is practical—though Parakeet V3 (V2 can't run on an Intel Mac, but V3 can) is less egregiously slow than Whisper V3 Turbo.

Thus I focused the cloud-based testing on my iMac. The results should be computer–agnostic, since the dictation is being processed in the cloud.  Indeed, I did test Spokenly's cloud-based implementation with both my iMac and M1 Pro MBP, and found nearly the same results when using the same model.

The one small difference I saw may be due to the microphone, since these programs can be mic-sensitive in subtle ways.* [On my iMac, I used the Anker PowerConfC200 webcam, while on the MBP I used the BOYA CM-40 boom mic.]

*For instance, one of my tests was to see if the program could correctly transcribe the plural possessive in the following sentence: "On many superhero teams, the heroes' costumes are each a different color." On one program, it gave hero's with the mic on my MBP (a mistake), but heroes' with the BOYA boom mic.

And the local testing was mostly done using my M1 MBP.

Overall, I found the cloud-based apps are superior to the locally-installed ones for both speed and capability. One striking difference is that many of the cloud-based apps are able to recognize spoken passages in fiction and thus surround them with quotation marks. By contrast, none of the locally-installed apps are able to do that. In addition, the cloud-based apps generally have much more capability to accept voice commands for formatting and punctuation than the locally-installed apps.

But if you have a much slower internet connection than me (mine is 940 Mbps up/down), and a better-performing computer (mine is only an M1 Pro), you might find the relative speed of local vs. cloud to be flipped from what I found.  But that won't change the relative capabilities of the two categories.

The one feature I really wanted was real-time (text appears as you talk), insert-anywhere dictation, like one gets with Apple Dictation.  Unfortunately, I was only able to find one app that does that: Talk Type (a cloud-based app).  Unfortunately, it is not as capable as the others in its category.

Overall, the best-performing app for me seems to be Aqua Voice, so that's probably the one I'll be purchasing. And its privacy policy says that if you activate its privacy mode, none of the dictation content is retained.  Though while it is certified under both SOC 2 Type II and ISO 27001:2022, I don't know if this privacy policy is specifically enforced/guaranteed, under those certifications, by an external accrediting (so I wrote them to ask; I'll update this post if/when I get an answer).

Finally, this served as a nice reminder that AI is fundamentally dumb: It's not smart enough to understand grammatical rules, since it's been trained on patterns, not what they mean.  For that reason, if a certain compound adjective isn't in its training set as being hyphenated, it's not going to hyphenate it when it transcribes your spoken voice. I dicated much of the above using one of the programs, but then had to go back and manually add most of the hyphens.

These tables summarize my results.  You'll probably need to click on them to made them big enough to read.

CLOUD-BASED PROCESSING (tested mostly with my 2019 i9 iMac)

https://preview.redd.it/iliryku1n37h1.png?width=3750&format=png&auto=webp&s=aa1efac34dfe3e05294ecb4dc5eb51d3391a2306

LOCAL PROCESSING (tested mostly with my M1 Pro MacBook Pro)

https://preview.redd.it/nb1afyhdn37h1.png?width=3824&format=png&auto=webp&s=a2b18810309b3baf0b06cbcd9d7ade525c3ec59f

FYI, here's the internet performance on my iMac, tested using Speedtest's locally-installed app (more accurate than their web browser, which is unsuitable for high internet speeds):

https://preview.redd.it/vkm20loco37h1.png?width=618&format=png&auto=webp&s=bdeb7066cb589175df83ada15fdc6824069bc002

*****
Separately: It occurs to me the killer app that combines privacy and performance would be one that includes both a locally-installed dictation model (like Parakeet) and a locally-installed LLM for polishing. Then you could have the best of both worlds--the privacy of fully-local operation combined with the capabilities and polish of a cloud-based app.

And of course it would also have real-time (text appears as you talk), insert-anywhere dictation 😉.

Alas, a key downside of this approach is that it would only run well on a high-performance machine, like an M5 with a sufficiently large amount of RAM. Though I may have such a machine soon, as I'm hoping to pick up an M5 Max Studio later this year when they're finally released.

As I understand it, here's the standard way ionizatiion is implemented by major brands like Coway and Winix:

The ionization takes place after all the filtration is done. Its purpose is to add anions to the room's air. These anions are expected to attract fine particulates, causing clumping. These clumps then settle out of the air.

This leads to concerns about unintended consequences, such as the formation of potentially toxic compounds from chemical reactions between these highly reactive anions and VOCs in the air

By contrast, Blueair's marketing material seems to indicate that their ionization is used solely within the particle filter, to attract fine particulates to the fillter media, thereby increasing the media's efficiency, and thus does not introduce more anions into the air.

[If this is true, then Blueair does themselves no favors by not making this clearer, instead saying their tech is different based on the semantic distinction that their tech can't be called ionization because it can't be used in purifiers that use ionization only.]

Consistent with this, ionization has little effect on the performance of other purifiers, but is essential to the function of the Blueair purifiers.

Specifically, as shown in Housefresh's review of the Blueair 211+ (https://housefresh.com/blueair-blue-pure-211-review/), while turning off the ionizer had little to no effect on the performances of the Xiaomi 4 Pro, Winix 5500-2, and Coway Airmega Mighty, defeating it in the Blueair 211+ cuts the performance by nearly half (see screenshot).

I'm not sure how this difference in implementation affects ozone generation. Of couse, these purifier are all sold in California, which means they are CARB-certified to emit no more than 50 ppb ozone. So none of them emit much.

I suspect Blueair's "HEPASilent" technology achieves its high CADR:noise by using lower efficiency non-HEPA physical filters (allowing lower fan speeds to achieve the same flow), and thus depends on the ionizer to obtain adequate capture efficiency for small particulates. That's why the Blueair units are so reliant on the ionizer, which in turn explains why they don't allow you to disable it. To check the 211+'s performance without the ionizer, the author of the Housefresh review (Danny Ashton) had to disassemble the unit and cut the wire powering it.

https://preview.redd.it/mnqv6wpjke5h1.png?width=1712&format=png&auto=webp&s=115f1b3ab1d95ded11225ffe8373f572edc6256b

As I understand it, here's the standard way ionizatiion is implemented by major brands like Coway and Winix:

The ionization takes place after all the filtration is done. Its purpose is to add anions to the room's air. These anions are expected to attract fine particulates, causing clumping. These clumps then settle out of the air.

This leads to concerns about unintended consequences, such as the formation of potentially toxic compounds from chemical reactions between these highly reactive anions and VOCs in the air

By contrast, Blueair's marketing material seems to indicate that their ionization is used solely within the particle filter, to attract fine particulates to the fillter media, thereby increasing the media's efficiency, and thus does not introduce more anions into the air.

[If this is true, then Blueair does themselves no favors by not making this clearer, instead saying their tech is different based on the semantic distinction that their tech can't be called ionization because it can't be used in purifiers that use ionization only.]

Consistent with this, ionization has little effect on the performance of other purifiers, but is essential to the function of the Blueair purifiers.

Specifically, as shown in Housefresh's review of the Blueair 211+ (https://housefresh.com/blueair-blue-pure-211-review/), while turning off the ionizer had little to no effect on the performances of the Xiaomi 4 Pro, Winix 5500-2, and Coway Airmega Mighty, defeating it in the Blueair 211+ cuts the performance by nearly half (see screenshot).

I'm not sure how this difference in implementation affects ozone generation. Of couse, these purifier are all sold in California, which means they are CARB-certified to emit no more than 50 ppb ozone. So none of them emit much.

I suspect Blueair's "HEPASilent" technology achieves its high CADR:noise by using lower efficiency non-HEPA physical filters (allowing lower fan speeds to achieve the same flow), and thus depends on the ionizer to obtain adequate capture efficiency for small particulates. That's why the Blueair units are so reliant on the ionizer, which in turn explains why they don't allow you to disable it. To check the 211+'s performance without the ionizer, the author of the Housefresh review (Danny Ashton) had to disassemble the unit and cut the wire powering it.

https://preview.redd.it/mnqv6wpjke5h1.png?width=1712&format=png&auto=webp&s=115f1b3ab1d95ded11225ffe8373f572edc6256b

A week ago I had a lobectomy of the left upper lobe. I was told not to lift objects heavier than 10 pounds for the first four weeks after surgery, because it's important I not tear any of the internal self–dissolving stitches that they placed.

Fair enough, makes sense. But here's what doesn't:

1. I'm sleeping on my back with my torso elevated with a sleeping wedge ( https://www.amazon.com/dp/B0D93BW9SM?ref=ppx_yo2ov_dt_b_fed_asin_title&th=1 ), and it's only comfortable when my butt is right at the bottom of the wedge. To move it there, I have to push down with my arms to raise my butt an inch or so off the bed (sort of a mini-dip motion) so I can scootch it back. I weigh 155 lbs, and when I do that I'm pressing down with at least 50 lbs of force on each arm. I asked the residents about this, and they said "That's fine, we want you to resume moving your body as you normally would as soon as possible, since that's essential to your recovery". Then I asked the NP at the postop clinic, and she said I shouldn't do it. So I'm getting conflicting info.
2. The residents told me sex is OK, even with me on top supporting my body weight. That likewise has to be at least 50 lbs of force on each arm, plus you're moving your hips dynamically, and your arms have to stabilize against, that, so that's effectively a higher load than a mere 100 lbs of static load.
3. The single hardest routine motion I do is getting out of bed. And with the chest tube still inserted it's painful, since step 1 is moving yourself into a seated postion. That requires contracting the muscles on the front of your torso, resulting in a stabbing pain around the tube insertion point. So I came up with my own system: I anchored a TRX strap to some kettlebells at the base of my bed, and then laid the strap out to my side. Now when I need to get up, I grab the strap and work my way up it, which divides the load between my abs and my arms, resulting in no pain! The home care nurse said that was a great solution, but the NP at the thoracic surgery clinic said I shouldn't do it because it counts as "exertion".

So you can't use a force higher than 10 lbs. to move an object outside your body, but when moving your own body with your arms, much higher forces are allowed according to some and not according others.

When I meet with the surgeon on Tuesday I'll ask him to resolve this apparent conflict. What I really need to know is why, given the placement of the stitiches, light lifting of objects (anything >10 lbs) puts those at risk, but much heavier exertions to move your own body do not.

E.g., I know you can't bear down (e.g., you're not supposed to push during bowel movements), but which specific stitch implacements are put at risk with that movement? If I knew what specifically was at risk, I could use my own body sense to limit that risk.

It's interesting that Coway has found the need to be more restrictive with its HEPA13 certification with its latest purifier, the Mighty2, than with its other purifers (including the original Mighty).

Specifically, other Coway purifiers (at least those I've checked) are certified to meet HEPA13 only at fan speed 1 or below, while the Mighty2 (I asssume) doesn't meet HEPA13 at speed 1, and is thus only certified for that standard at sleep mode.

It's possible this is because the Mighty2 has higher airflow/filter area than the other Coways at speed 1.

The one other manufacturer that I've seen acknowledge increased particle penetration (and thus a reduction in filtering performance) at higher flow rates is IQAir, but they don't present that anywhere on their website; instead, this was posted by one of their retailers (Allergy Cosmos). It shows the Atem X's filter decreases from H13 (HEPA13) to E11 (EPA11)* between fan speeds 1 and 8.

[*It's called E11 rather than H11 because the current HEPA standard doesn't extend down to 11, so they need to switch to the US EPA standard, hence E11. But you can think of E11 as what HEPA11 would be if it currently existed.]

I'll note that, since these machines all rely on multiple-pass rather than single-pass filtering, with a sufficiently high ACH they can still provide the needed particle reduction without meeting H13 at all fan speeds.

https://preview.redd.it/bovnr18nj01h1.png?width=1886&format=png&auto=webp&s=9615ef4a55cf8e78d5ad9470c74915dbea379b7f

Just got a pair of Coway Airmega ProX units. I like the design; its size means it moves a lot of air at a relatively low noise level. And its pelleted carbon should be more effective than bonded carbon.

However, the carbon portion of the filters gives off a "chemical" smell. I've run them for a few weeks at top speed (speed 3) in a room with open windows for about 15 hours/day, and they're only now starting to reduce in odor, but it's definitely still there.

Obviously this is not an ideal situation, since the purpose of the carbon is to reduce room VOCs, not introduce them!

I also have a new Winix 5510, which also uses pelleted carbon, and I don't detect any smell from it.

I'll add I also tried and returned the Coway Airmega AP-1512HH Mighty. It has a very strong odor that didn't go away after running it for a week (thogh, IIRC, it was more of a plastic odor, so may have been the housing rather than the filter).