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Dientamoeba Redux

I’m publishing this with the goal of perhaps helping someone else who runs into a similarly unsettling and baffling issue.

See Apparently Infection After All (Dientamoeba) and On Flagyl (Metronidazole), Dientamoeba Killed (not).

It was so nice to feel normal again (for 11 days). No growly stomach, completely regular elimination, no pain in my right side, etc.

But the Dientamoeba fragilis seems to be back, all at once and all of a sudden, starting November 30: identical symptoms—growly stomach, moderate bloating, disrupted elimination schedule, minor fatigue.

The night of Nov 30 I knew something was up because my body was hot all night, apparently running a mild fever. The next day, back to square one (symptoms of past 5 months). Then a fever again on Dec 4, so it’s oscillating, clearly there is level of immune system response. And it’s draining my energy—not in a major way but enough to be very discouraging and certainly to preclude full performance on the bike.

So what does this mean? Did the bug survive 2 weeks of Flagyl/Metronidazole, thus becoming a resistant strain that took ~11 days to multiply up again? (nasty thought) Or was I somehow reinfected via an unknown vector? (perhaps more nasty, what is it?)

It’s discouraging. Another stool test to confirm presence/absence of Dientamoeba will take at least 2 weeks.

Infection with D. fragilis, called dientamoebiasis, is associated variously with symptoms of abdominal pain, diarrhea, weight loss, and fever.

In one study, D. fragilis was identified in 0.9% of patients observed. Its coincidence with enterobiasis has been reported

As for symptoms, abdominal pain and low-grade fever are a match, but no weight loss and never any diarrhea. But what else could it be? All other parasitic stool tests were negative (giardia, salmonella, shigella, campylobacter, endolimxa nana).

Thanks to ObamaCare (“vicious” is too kind), I’ve lost all my doctors, my rates have tripled and the doctors I can see in-plan take days to respond and are backed up for weeks. All independent doctors are out of plan, or will be soon, being forced out by laborer-level reimbursement by “Covered California” plans.

On Flagyl (Metronidazole), Dientamoeba Killed (not)

I’m publishing this with the goal of perhaps helping someone else who runs into a similarly unsettling and baffling issue.

See Apparently Infection After All (Dientamoeba).

After a two week course of Metronidazole (brand name Flagyl), my gut is feeling like normal again, so I think that means the Dientameoba has been wiped out.

UPDATE It was so nice to feel normal again (for 11 days), but the damned Dientameobe seems to be back, all at once and all of a sudden.

Metronidazole was not an antibiotic I’d prefer to take again: no alchohol is just an annoyance, but overall, Metronidazole made me feel heavy and uncomfortable in general; nothing overt but something for sure.

“Burnt” toes

On Day 11.5 on Metronidazole, toes on both feet turned warm and itchy. Completely symmetric in reaction, so perfectly so that one might suspect a neurological side effect, above and beyond an allergic type reaction, since one of the rest of my body was affected. Very odd indeed.

By Day 12, my toes felt almost blistered (but no fluid): red and angry looking, and itchy. This persisted through Days 13 and 14, 14 being the last pill day and three days later, 72 hours after the last pill. My toes 3 days later (Day 17) were intensely itchy and irritated after my bike ride, so I called to set up an appointment with a dermatologist, but all were gone that Friday, so the date was set for Tuesday.

Since 72 hours is the recommended period before alcohol is to be consumed after taking Metronidazole, I did the only sensible thing: looked for a cure in a bottle. So I uncorked a bottle of red wine and over the course of evening to night, I drank and enjoyed while I worked.

Fancy that. The next morning, the itchiness was gone, all inflammation was gone, and the only remaining sign were some purply blotches where the skin had been particularly irritated. I’d say the red wine cured it, and heartily recommend my “red wine itchy toe cure” to anyone. Never in all my life has any medicine tasted so good and worked so well.


The whole 5-month discomforting experience (from infection to cure) reinforced this with me: be aggressive with your own medical issues. With doctors, it’s not so common to see keen insight or to have them push for action, or even perhaps to probe with precision. In my experience, many find it difficult to say “I don’t know”, which is part and parcel of the problem.

At least that’s the way it felt to me with both my primary care doctor and the gastroenterologist. I don’t recall having been asked a question of “how well do I do” (in whatever words it might be). But I see it as a “how can I raise my game” issue for them, or any profession.

I have some professional criticism for the gastroenterologist. My initial “are there any risks to Metronidazole” question was met point blank with “no”. No elaboration, no willingmess to engage, or so it felt to me. This seemed odd at the time, and I knew it to be suspect (all drugs have potential issues). Indeed, the very first person I met to whom I mentioned the antibiotic (a nurse in another context) immediately told me of all the issues her son had had with Flagyl. That same gastroenterologist took 30 hours to get back to me (via a nurse) on my concern about my toes. 30 hours and no doctor call with a nurse as an intermediary going both ways is not high quality care IMO. Can it be any wonder doctors get sued?

A Chance Meeting While Riding Leads to Major Improvement on Bike Fit for One Rider

Out riding one day, I happened to engage in conversation with a rider I was passing. He mentioned injury and pain (sit bones) and I communicated my satisfaction with the work of Kevin Bailey at 3DBikeFit.

So if you’re having pain and want it to stop, get a bike fit NOW. Winter training by dint of less volume and less hard gives the body time to adjust to a new fit—before the muscles have grown “summer strong” and thus can exert more force on the joints. Even small changes cause different forces on joints, so adaptation over time is wise—and when a bike fit is right, you’ll want to overdo it because it will feel so good!

Frank writes:

My name is Frank. We met on Canada Road just a couple of weeks ago. I am the 62 year old with sit bone pain. YOU have SAVED my CYCLING and I want to thank you. I followed your advice and booked a 6 hour refit with Kevin at 3D. I told him you sent me and how kind you were to me. Last Tuesday I was with him from 11 AM until 7 PM. He is a genius and ALSO very nice. In ONE DAY he eliminated my sit bone pain.

I now have a wider saddle for greater stability, my crank arms are shorter and more appropriate to my build, the balance of my pedals was offset by 7 mm so(like you) I was limited in my ability to rotate my pelvis forward, my handlebars were too narrow limiting extension , my seat height was way too low and with at least two years of imbalanced riding I have some adjusting to do with strength and position. But I am on my way now!

Your kindness on the road has truly saved me and I wanted to thank you from the bottom of my heart! I hope I can run into you again to shake your hand, buy you a cup of coffee or a meal to appropriately show my appreciation for directing me to Kevin. The first time I went out this week on my new fit, I felt more power than ever although 8 months of lost training is evident. However, I felt like I was “HOME” on the bike again. It made me cry happy tears!

Thank you for your kindness and road friendliness and THANK YOU for the direction to Kevin. I feel truly blessed!

WIND: wonderful story, and satisfying to have helped someone.


Winter Tires: for Tubulars, One Great Choice, the Veloflex Roubaix

Which tires to use during winter, where glass and sticks and general debris show up on the road shoulder?

I ride only tubulars, and for winter I recommend the Veloflex Roubaix on the rear, with another Roubaix on the front. The Veloflex Criterium is also a good choice but the Roubaix is the most robust, so for winter it’s my first choice. Several thousand miles on the Roubaix have me picking it as my #1 choice for a robust tubular.

BTW, Veloflex tubulars are certainly the best tubulars on the market today: ride quality, grip, handling and removable valve cores for side-of-the-road insertion of Stan’s NoTubes in case of a puncture.

Veloflex Roubaix 700 X 25C tubular tire
Veloflex Roubaix 700 X 25C tubular tire
Veloflex tire construction
Veloflex tire construction

Exercise Has More Than Physical Benefits

For many years I’ve felt “off” if somehow my exercise drops off: general feeling of wellness, mood, etc—and the more intense the exercise the more long lasting the effects.

So I was intrigued to see new science emerging that backs up this idea. Science News in Mighty muscles may stave off depression reports:

A powerful body can protect the brain, a new study suggests. Toned muscles filter a toxin from the brain and keep depression at bay, researchers report in the Sept. 25 Cell.

“This paper really emphasizes ‘strong body, strong mind.’” ... Researchers have known that in response to a good workout, muscles produce a compound called PGC-1 alpha 1, which is a general do-gooder around the body. The compound prompts the body to make more blood vessels and mitochondria, for instance. The new study, which includes tests involving a small number of people, shows that PGC-1 alpha 1’s rejuvenating effects extend to the brain.

Winter Means Clothing that Works

Check out Warm Gear for Cold Weather Riding.

Moots MootoX YBB deep in the White Mountains, Nov 5, 2011 Leica M9 + 21mm f/3.4 Super-Elmar-M ASPH
Moots MootoX YBB deep in the White Mountains, Nov 5, 2011
Leica M9 + 21mm f/3.4 Super-Elmar-M ASPH

Bloating/Fatigue Issue from Last Spring: Apparently Infection After All (Dientamoeba)

I’m publishing this with the goal of perhaps helping someone else who runs into a similarly unsettling and baffling issue.

I had a terrible time starting several weeks after March 22 Solvang Spring Double; something hit me hard with bloating and fatigue, and the effects went on for at least 5 months, slowing getting better but not quite resolving.

Now it looks like the answer might be at hand: Dientamoebe Fragilis and possibly endolimax nana.

Dientamoeba fragilis is a single-celled parasite found in the gastrointestinal tract of some humans, pigs and gorillas. It causes gastrointestinal upset in some people, but not in others.[1] It is an important cause of travellers diarrhoea, chronic diarrhoea, fatigue and, in children, failure to thrive.

Endolimax is a genus of amoebozoa[1] that are found in the intestines of various animals, including the species E. nana found in humans. Originally thought to be non-pathogenic, studies suggest it can cause intermittent or chronic diarrhea.[2][3] Additionally, it is very significant in medicine because it can provide false positives for other tests, notably the similar species Entamoeba histolytica, the pathogen responsible for amoebic dysentery, and because its presence indicates the host has consumed fecal material.

DientAmeobe Fragilis is transmitted by stool (feces), according to the doctor. But aparently the transmission vectors are not well understood. Personally I suspect contamination of water during the Solvang Spring Double event, but that might be completely erroneous—no way to say.

Either way, I’m quite annoyed that the vector must have involved someone not washing their hands after pooping who prepared food or drink that I consumed. Bad luck, as I rarely (very rarely) eat out, though I did so once in Solvang after the double century. And I ate and drank at the rest stops with some dubious water supply pipes and hoses. And the onset of symptoms (~2 weeks after) is consistent with the timing of the Solvang trip.


The cure

Oh joy, a 2-week course of an antibiotic that gives 30-40% of patients nausea: metronidazole. Its chemical structure is similar to a drug for alcoholics, to make them vomit if even a little alcohol is consumed. So no wine for two weeks.

Metronidazole is an antibiotic. It fights bacteria in your body.

Metronidazole is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.

Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

Winter Almost Here, and Winter is the Ideal Time for a Bike Fit

Get a bike fit NOW so that winter training (lighter and easer) gives the body time to adjust to the new fit—before the muscles have grown “summer strong” and thus can exert more force on the joints. Even small changes cause different forces on joints, so adaptation over time is wise.

Ditto for anyone considering a custom bike frame.

I’m really happy with where I stand on my fit. Although my twisted hips took time to untwist (because of 12,000 miles with a skewed crank offset prior to the 3DBikeFit), things are working great now, and I’m really glad to have made the change. My skewed pre-fit condition was atypical, and at this point I can ride at any power level, any slope (climb) and not have any pain or back fatigue, etc—excellent results.

See also Saddle Position and Tilt for Power and Comfort and Strong Again. I’m really pleased with how well I can put out power now that I can rotate my pelvis: I can almost lie flat on the back when I wish (without arcing my back so the gluteus stays engaged), very helpful into the wind.


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