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FOR SALE: LOOK 595 Ultra frameset

The LOOK 595 Ultra is a fantastic bike— see my review of the LOOK 595 Ultra including build details and image gallery.

This is the 'Ultra' which is more stiff than the regular version, but actually a more comfortable ride due to the carbon used for the frame—highly recommended versus monocoque “dead wood” carbon frames.

The 595 Ultra was a spare bike, and I find that I just always ride my Moots Vamoots RSL. In fact this bike is all but brand-new. It has a minor scratch on the frame (as it did when I bought). Of course, never crashed or abused in any way.

The bike has about 1500 miles on it. Seriously— I keep detailed records for every ride and that’s what it adds up to.

  • Size large (see chart below).
  • Includes ZIPP 404 rear tubular wheel with DuraAce cassette (no front wheel).
  • Includes DuraAce brakes front and rear.
  • Includes brand-new Shimano DuraAce 53 X 39 crank (10 speed).
  • Wired for 10-speed DuraAce Di2 electronic shifting (external). This can be stripped if you wish to run mechanical, but you'd need mechanical shifters.
  • Includes Shimano Vibe Pro handlebar and with nice fresh double bar wrap installed with stem as shown).
  • Serious local buyers welcome to come see the bike.

As described above: $1200 (bargain price considering all the extra on it).
Frame only: $900
With front and rear Di2 derailleurs, battery and charger: $1700

See the build notes for build details, though it now has the Shimano Vibe Pro handlebar on it.

This is a superb ride in superb condition. Low mileage (lightly used spare bike), never crashed, never abused.

Contact me to inquire. Asking $3300.

FOR SALE: Look 595 Ultra size large
FOR SALE: Look 595 Ultra size large
FOR SALE: Look 595 Ultra size large, size chart
FOR SALE: Look 595 Ultra size large, size chart

As I had built it below(NOT for sale this way).

FOR SALE: Look 595 Ultra size large, size charge
FOR SALE: Look 595 Ultra size large

Fresh Food is Best: Additives to Keep Food Fresh May Disrupt the Gut Biome

Science new reports in Additives that keep foods fresh may sour in the gut; These compounds can disrupt intestinal bacteria, cause inflammation, mouse study suggests:

Food additives may keep snacks fresh and tasty looking, but they can wreak havoc on the gut. These additives disrupt the intestine’s protection from bacteria and boost inflammation in mice, scientists report online February 25 in Nature.

The new research “underscores the fact that a lot of things we eat … may not be as safe as we think they are,” says Eugene Chang, a gastroenterologist at the University of Chicago.

Additives called emulsifiers help many foods, including ice cream, salad dressing, pasta sauce, bread and cookies, stay fresh on supermarket shelves. To see whether the additives play a role in inflammatory conditions, researchers fed emulsifiers to mice for 12 weeks.

The mice put on weight and made proteins that signal inflammation. More inflammation-causing microbes also showed up in the bacterial communities in the mice’s guts.

...

The jury is out on this one. But why eat processed food with preservatives when so many fresh foods are available?

Details in Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome.

... in mice, relatively low concentrations of two commonly used emulsifiers, namely carboxymethylcellulose and polysorbate-80, induced low-grade inflammation and obesity/metabolic syndrome in wild-type hosts and promoted robust colitis in mice predisposed to this disorder.

Emulsifier-induced metabolic syndrome was associated with microbiota encroachment, altered species composition and increased pro-inflammatory potential. These results suggest that the broad use of emulsifying agents might be contributing to an increased societal incidence of obesity/metabolic syndrome and other chronic inflammatory diseases

Anti-Oxidants Might be Counterproductive for Athletes

Science new reports in For athletes, antioxidant pills may not help performance; Some supplements can blunt the positive effects of exercise training:

...the American College of Sports Medicine estimates that around half of elite athletes take vitamins in hopes of keeping their bodies fit and boosting endurance.

... It’s that American mentality,” says Jay Williams, a professor in the department of human nutrition, foods and exercise at Virginia Tech in Blacksburg. “If some is good, more is better.”

Except when it might be worse. In a scientific reboot, many newer, more rigorous studies are contradicting decades of previous thinking, finding little support for — if not outright harm from — antioxidant supplements for athletes. Although antioxidants obtained from food appear to do a body good, the colossal doses in supplements may disrupt a cell’s built-in system for coping with oxidative stress. And it appears that muscles under exertion may need a certain level of oxidative beating to adapt and strengthen over time. If the recent research holds up, it means one of the very things athletes commonly do to help their bodies could not only waste money but may even undermine the benefit from those hours of dedication.

Be sure to read the entire article. At best, the research suggest little harm; at worst it suggests a substantial negative.

A healthy diet surely needs little supplementation. Special cases for special reasons always exist, but it makes little sense that carefully chosen foods are somehow inadequate, especially since the body is adaptable an frugal when necessary.

Aggressive Start to 2015: Two March Double Centuries Planned, Maybe 3

I’m planning an aggressive training year, because I wish to beat my best effort in the 2012 Everest Challenge. And because the peripheral neuropathy still comes and goes, and it has degraded my ability to work at the computer. So getting on the bike makes it go away within 45 minutes, and it stays better for some days. But the P.N. still has my toes weirded out and a little uncomfortable.

Lean and strong for peak condition means 9 months of training for EC. Body weight is trending to 174-175 pounds (lost ~5 pounds of fat in ~2 months), and aerobic condition is already at very high levels (see graph below).

A couple of double centuries should bump up condition to 2012 levels by April. Hopefully 2015 won’t deliver bad luck as did 2013 (surgery) and 2014 (gut problem all year).

So I’ve signed up for the Southern Inyo Double Century on March 7, followed by the Solvang Spring Double on March 22. Possibly if the timing works and the conditions are favorable, I’ll insert the Joshua Tree Double Century on March 14. Then in April there is the grueling Devil Mountain Double, followed by Alta Alpine 8-Pass Challenge in June.

Preparing For a Double Century (Dry Run / Pre-Test)

Extensive endurance workout at 70-75% of max heart rate (fully aerobic), recovery ride

Fitness Pre-test for a Double Century

I did this 6-hour ride in late February, having signed up for an early March double century with a similar amount of climbing, but twice the distance.

I also wanted a good “shock to the body” by doing this ride to force a bump up in fitness. The distance and power levels and feel of the legs post-ride suggest a likely 5-day recovery period which should result in a bump up in fitness. Past experience suggests that to get to the “next level” of fitness requires periodic shocks odf this kind. Double centuries are good for that, which is why I have two scheduled for March.

Preparing For a Double Century (Dry Run / Pre-Test)

Extensive endurance workout at 70-75% of max heart rate (fully aerobic), recovery ride

How to lose ~1 Pound of Body Fat in a Single Day

I discuss how a great deal of fat can be “burned” off in a single day.

Lose a Pound of Fat in ONE Day: Century Fat Burner

See also Fat Loss vs Weight Loss and Muscle Loss.

Extensive endurance workout at 70-75% of max heart rate (fully aerobic), recovery ride

Extensive Endurance Workouts: Three Examples

I discuss three endurance workouts that I performed within the past 5 days, showing how I train for the Everest Challenge and for double centuries and similar.

Extensive and Intensive Endurance Workouts, 3 Examples

Extensive endurance workout at 70-75% of max heart rate (fully aerobic), recovery ride

Custom Orthotic Foot bed for Cyclists at 3DBikeFit: Fixing the Power Transfer Kinetic Chain

For the first time in forever, my the big metatarsal (big toe joint) in my right foot now plants my foot firmly as it ought to be, just like the left foot.

This foot placement issue has dogged as long as I can remember (forever I think), but a custom orthotic by 3DBikeFit.com has finally made my right foot placement symmetric with my left, fixing the weakness in the kinetic chain.

Read more...

Kevin Bailey of 3DBikeFit.com making a custom orthotic (shaping phase)

Training and Fitness: Why and How to Track Morning Resting Heart Rate (MRHR)

I should have been tracking this at the start of training season, but hadn’t. So I’ve just started again. So far, there are only three data points shown below, the first being the day after two very hard training days (4 hour ride and 3 hour ride on two weekend days). So the 44 figure is on another moderate day (2 hours); the 42 bpm follows an easier day, and the 41 bpm figure follows a 1/2 of baseline workout (600 kilojoules).

It's only a few beats drop, but the resting heart rate can be seen to decline a bit over the course of the week as recovery progresses from the hard ride on 16 Feb, in spite of a 6 day rolling average workout energy of 1952 kilojoules per day (1866 kilocalories/day).

3248, 2296, 1391, 667, 2541, 1573 = 1952/1866 kilojoules/kilocalories / day
(first figure 6 days old, last figure newest)

The workouts following the hardest and longest 32348 kj workout (on a Saturday) were designed as disciplined extensive endurance workouts so as to stress only the aerobic system, not muscle strength. The strategy clearly was effective.

Fully rested (taking 2 days off), I expect something around 38 (to be confirmed, but I have observed figures as low as 32 in the past).

Morning resting heart rate (bpm), start of data gathering (5 days/mornings)

Tracking Morning Resting Heart Rate (MRHR)

Tracking MRHR gives clues as to recovery or illness and other factors:

  • MRHR will be relatively high the day after a hard workout (5 to 10 beats, depending on a variety of factors).
  • MRHR will be up by 5 to 25 beats in the case of illness. Skip training if illness seems apparent; it’s a red flag.
  • MRHR can do odd things if overtrained; any significant variation from typical is cause for some thought at least. Recording heart rate overnight against a “known well rested” baseline adds a lot more insight than just a morning check.
  • Hydration and stress and medications can affect MRHR.
  • MRHR drops steadily as fitness increases, thus it is an excellent long-term tracker of fitness gains (provided one allows for full recovery).
  • MRHR is generally lower with age, at least for fit people (maximum heart rate drops by about 1 beat per year, but minimum heart rate also declines a bit).
  • Heart rate is a personal measure; don’t bother comparing your own heart rate to someone else’s; there is no real “normal”, only a very wide range of physiological normals. Do not confuse statistics of populations with your own personal physiology. This is why tracking your own normal is important.

How I measure MRHR

  1. Before rising in the morning, strap on heart rate band*.
  2. Lie flat on back, relax completely, record a multi-minute interval at rest.

Any movement (even raising an arm) can push HR up a few beats, so be consistent in position and lie still. Take the *average* (mean) heart rate over the lowest 2-minute interval. If the device does not record, observe the heart rate on the device; use the consistently lowest reading (not necessarily the lowest number).

* Counting heart beats by sensing one’s own pulse introduces error by a few beats because some muscle activation is generally required to to do (at complete rest on one’s back, even a little muscle activation can introduce 10% error, e.g., 4 beats on top of 40). But as long as done consistently each day, this is fine for the purpose of trends (but the true MRHR may be a few beats lower).

Shown below is a 3+ minute recording at rest averaging 41 beats (bpm).

Morning resting heart rate (bpm) recorded for nearly 4 minutes

To Clot or Not to Clot: Aging Athletes and Blood Clot Prevention vs Injury/Crash

A fellow cyclist described to me a health episode involving a blood clot.

In a nutshell, he had gone for a ride and come home and then suffered through two days of intense pain in his chest/back area. Heading to urgent care when it became intense, it turned out to be a blood clot lodged in the lung, likely formed and then dislodged from a large vein in the lower body (perhaps hip area).

Clots that form in the lower body in veins travel upwards with the blood to be oxygenated and this is why they lodge in the lungs (barring a congenital heart defect). So there is little chance of such a type of clot reaching the brain; those types of strokes are caused by other factors. It is thought that small clots (1-2mm) in the lungs are fairly common, and that the body assimilates them.

Aspirin and clotting: dual edged-sword

Legal disclaimer: Since we are not doctors, never follow anything based on health-related or training topics on this or related sites without first consulting with your doctor or other trusted health professional.

Being of similar age, the foregoing piqued my interest: as aging athletes, what might be the role of aspirin? Aspirin has anti-clotting properties, which is a dual-edged sword. Low-dose aspirin is used by many as a prophylactic.

Another speculative point is that highly trained aging athletes might be susceptible to blood clots while sleeping and similar because of a very low resting heart rate (venous “flushing”, my own made-up term to articulate the idea). I am researching this point.

When, how much and whether to take? (see updated notes that follow)

  • If aspirin is to be taken at all, it seems to make the most sense to take it after the effort, so as to have maximum anti-clotting effect were a clot imminent (from the effort), and yet the aspirin would have mostly dissipated prior to the next-day ride. How much to take?
  • Taking aspirin before or during a ride could be risky: if a crash were to result in a bleeding cut or laceration, aspirin could cause excessive and perhaps even dangerous bleeding.
  • If a crash results in no external bleeding but does result in impact, might immediately consuming aspirin be called for (how much?), so as to minimize the risk of a blood clot from the trauma? But this too could be risky, due to the risk of internal bleeding, say in a badly bruised area. The situation here is not at all clear-cut.

The above is speculative thinking and not advice—check with your own doctor. Hard and fast answers might prove elusive, but it’s worth pondering.

UPDATE after talking to a heart surgeon

I spoke with a heart surgeon with 35 years experience (these guys have to know clotting). What follows is my rendition of what I learned.

Aspirin works by “poisoning” the clotting receptors on platelets (drugs such as coumadin work by blocking the chemical chain for clotting, very different and much more dangerous if bleeding starts). Aspirin is thus a permanent change to platelets, regardless of when taken. But toxic doses of aspirin would have to be consumed in order to inactivate all the platelets (think 'moles' in the chemistry sense).

New platelets are constantly being created by the body; this is why surgeons ask patients to be off aspirin for a 7-10 days prior to surgery—to let the body release new platelets not previously inactivated by aspirin. Finally, about 20% of the population is non-responsive to aspirin in its platelet clotting factor inactivation (but still respond to analgesic effects).

Bottom line: barring a medical issue (bleeding gastric ulcers, sickle cell, surgery, etc—see your doctor), aspirin taken daily may be helpful and is unlikely to be harmful. And it won’t matter when taken—once platelets are inactivated, they stay that way in terms of clotting ability.

Other notes:

  • Dehydration can be a factor in clotting; stay hydrated.
  • Fixed body positions, particularly those that stress the body can cause clots (e.g. those viciously small airline seats). Such as sitting on one’s folded leg, which appears to have been the precipitating cause of the clot in the fellow cyclist narrative that starts this post (clot was in femoral vain in knee area according to an ultrasound, sat on leg folded for several hours, thus crimping the femoral vein for a long period).

Science News: “Signs of sleep debt found in the blood”

Science News reports that Signs of sleep debt found in the blood (emphasis added):

A drop in certain fats and acids in the blood may reveal whether a person is critically sleep deprived, scientists report online February 9 in Proceedings of the National Academy of Sciences. When people and rats skimp on slumber, two compounds involved in metabolism become depleted.

A reliable marker of sleep debt could be used to test whether pilots, truck drivers and other people who hold jobs with long hours are sufficiently well rested, says coauthor Amita Sehgal, a neuroscientist at the University of Pennsylvania.

WIND: the emphasis is on risky professions, but might this not be a wonderful tool for athletes in the emerging age of personalized digital medicine?

Recovering from Donating Blood? Mitigating, and perhaps a Really Bad Idea for Competing Athletes

Science News reports that Bouncing back from giving blood can take months (emphasis added):

People who donate blood can take months to recoup their stores of iron, a new study shows. But the process moves much faster if they take iron supplements afterward, scientists from the National Heart, Lung and Blood Institute and elsewhere report in the Feb. 10 JAMA.

The findings help to explain why up to one-third of regular blood donors develop iron deficiency, which can cause fatigue, irritability and other symptoms.

In the United States, healthy people are permitted to donate blood every eight weeks. The Food and Drug Administration is weighing whether this interval should be longer, the researchers note.
...
IRON REBOUND Levels of the protein ferritin, which stores iron in cells, recover faster in blood donors taking daily iron pills afterward — regardless of whether they start with low or high iron levels in their blood.

WIND: Not spoken to in the above is the rapid degradation of red blood cells by athletes (physical degradation), which might entail similar risks of iron deficiency, an idea that rings a bell for me—speculating—sometimes my hematocrit has been low after some months of hard training, which always seemed odd to me. OTOH, I have always rapidly acclimatized to altitude. What does it mean? Higher hematocrit can be a huge advantage when racing, which is why I raise my hematocrit prior to the Everest Challenge the natural way: acclimatizing.

Legal disclaimer: Since we are not doctors, never follow anything based on health-related or training topics on this or related sites without first consulting with your doctor or other trusted health professional.

I’m not jumping to any conclusions, but the issue of adequate iron is one I’m pondering consciously now. Excessive iron supplementation can be dangerous to kidneys, but once or twice a week might be OK, and especially since those iron-rich dark leafy greens don’t make it onto my plate as often as I’d like (and bison ribeye steaks are a distant memory!).

BMI (Body Mass Index): Junk Science

See also Screw Up Your Gut Biome with Artificial Sweeteners?

Beware “experts” (particularly doctors) who are so smart they’ve never even tried (or considered) an issue you might raise—because they know less than they think they know, or simplify to the point of ridiculousness, or think an individual’s specific circumstances are amenable to statistics (a fundamental cognitive error), or find it hard to say “I don’t know”.

A doctor with integrity unwilling to explore just says “dunno” (acceptable); a really good one probes and asks and then gives a considered answer (in my experience, this is rare).

As a very basic example, the whole BMI measure of body composition drives me crazy (BMI junk science). Evan at the 0th percentile for body fat (8% lean), I was/am classified by BMI as close to overweight, all the while being physically fit for my age to about 1 in 10,000 or better.

This morning, I was weighed in at the doctor’s office at 188 pounds this morning: with a bunch of heavy stuff in my pockets, fully clothed, shoes on, pockets full, etc—at least 10 pounds of stuff in total including 2 liters of fluid (4+ pounds) I had consumed not long before (I weigh myself on a medical grade scale every morning, 178.5 this morning). Idiots. Why do they bother with this charade? Better to ask the patient to undress and just look. I also carry my body fat as mainly “baby fat” (mostly subcutaneous under the skin, with less than 1 pound of visceral fat when I’m in race condition). Again, BMI is 100% blind to the type of fat (critical factor), as well as bone density, or even a woman with very long hair (which all all adds in).

Damage Your Gut Biome with Artificial Sweeteners? (make yourself more prone to diabetes)

Saccharin, sucralose, or aspartame = glucose intolerance?

Sugar (sucrose) quite likely is better for you than artificial sweeteners. This is not to say that excessive sugar is ever good. Or that no sugar is good. Or that all sugars are the same. And, yes, a Mountain Dew is very good 10 hours into a double century, proven in actual usage, repeatedly. It all depends.

Artificial sweeteners

Artificial sweeteners induce glucose intolerance by altering the gut microbiota

Sugar Substitutes, Gut Bacteria, and Glucose Intolerance

Non-caloric sweeteners can spur glucose intolerance in mice and some people, according to a study published today (September 17) in Nature. Researchers from the Weizmann Institute of Science in Israel and their colleagues have uncovered “the unexpected effect that artificial sweeteners drive changes in the [gut] microbiota, which promote glucose intolerance,” said University of Chicago pathologist Cathryn Nagler, who studies how the microbiota regulate allergic responses to food and penned an editorial accompanying the study.

Although the human data provide some evidence that artificial sweeteners may have a detrimental effect on glucose metabolism in a subset of people, the authors cautioned that additional studies are needed to understand who is susceptible to the potential negative effects of artificial sweeteners and to further elucidate the mechanism by which gut microbes may drive metabolic changes.

In other words, the food industry has an enormous financial incentive to keep pushing products that may in fact be pushing entire generations towards diabetes.

The gut microbiota. So incredibly complex, yet so little study until recently. And why is there an epidemic of obesity and diabetes when untold millions have been drinking diet drinks? If diet drinks really did the trick, shouldn’t we see a correlated drop in diabetes?

The human body is very complex. It’s not just our cells, it’s a huge micro biome living inside our gut and everywhere else in our bodies. Yet we have a huge industry looking to sell us processed food, and when the financial incentive is there to sell Sugar Plus Wheat**, guess what doesn’t get funded?

* Don’t get me wrong: I just love some processed garbage, under the right circumstances. And maybe once a year.

** Wheaties (this is for you Dad): tons of sugar plus fiber plus some table sugar on top plus milk (more sugar). Have some cereal with your sugar. But at least it’s not aspartame!

To be clear: all science needs multiple repeatable confirmation to be considered solid.

Then again, we now know that idiotic advice promulgated for decades* is often bogus (eggs are bad for you, trans fats are better than butter, butter is just plain evil, high fat is bad, high fat is good, high protein is good, high carbohydrates are good**, salt raises blood pressure, and similar BS upon BS used and abused by the food industry). FUD and more FUD. A lie repeated often enough becomes believed. The bigger the lie, the more believed.

Heck, drinking pure water can kill you (hyponatremia). What’s defined as bad often depends on who’s making money on it, and that includes (at times) organic food. Food pimps. (I prefer organic as it’s often higher quality, but anyone insisting on 100% organic is irrational and irrelevant to a reasoned discussion, ditto for a blanket anti-GMO approach). But if in doubt, avoid the unproven.

* The government (which you can never trust about anything) food pyramid continues to embody stupidity in some details of its recommendations. It’s a political document in good measure.

** How do you fatten cows for hugely marbled fatty meat? Feed them a high carbohydrate diet like corn. Then the meat is rated even higher (and tastes disgusting to me). For the beef I eat, I eat only grass fed beef (preferably hard to get bison), and only lean cuts.

Natural food or products consisting essentially of natural food is the only sensible way to go, and only in moderate amounts that respond to nutritional needs. Free of growth hormones, antibiotics, excessive marbled fat (beef), pesticides, etc. Organic is good, but not the only possibility.

See also

When bacteria-killing viruses take over, it’s bad news for the gut

NYT: “A Prescription for Youth”

Dovetails exactly with my feeling about day in and day out cycling as I age.

A Prescription for Youth (New York Times, Jan 13, 2015)

Active older people resemble much younger people physiologically, according to a new study of the effects of exercise on aging. The findings suggest that many of our expectations about the inevitability of physical decline with advancing years may be incorrect and that how we age is, to a large degree, up to us.

The Joy of 50 Years: Neuropathy, Gut Ache, Gallbladder Polyps

Update 2014-02-02: right side pain has been gone for 10 days. Polyps can stay for now, will recheck in 6-9 months for stability. Neuropathy healing.

In spite of the nerve damage (Metronidazole (Flagyl) antitiotic reaction (autonomic neuropathy), I had an exceptionally strong training week around the last week of the year. A full week of very strong 2+ hour rides felt great. The Bad makes the Good even more delicious.

I had hoped that given a few weeks my body would steadily heal the nerve damage. But while the initial symptoms abated, it now seems to be regressing: no overt tingling but low level pinprick sensations in hands, a feeling of weakness in forearms, odd little sharp pains in wrists and forearms as far as the elbow, gritty feeling toes that have blotchy discolored purple areas. Not so pleasant, but all pales in comparison to the prospect of no improvement, or the disheartening prospect of worsening symptoms, or a propensity to further damage by unknown future agents.

Blood sugar

Equallly worrisome is that my blood sugar which for 12 years tested (fasting) in the low 80's to 90's historically, was tested in late December at a whopping 120 (14 hour fasting), then retested in January at 111 as a 3-month average (blood test for average glucose based on red blood cells).

I seem to be a statistical data point in a case-plot band to doctors, who seemingly consider a radical outlier (in standard deviation terms) as “normal”, because it falls just short of diabetic. Perhaps damage from the Metronidazole might not be limited to neurological effects. Or it could be something else. But my glucose was normal (85) in May 2014 in the midst of the right side gut ache issue, so that suggests some other precipitating cause. Like the neuropathy, the future prospects look uncertain. And I have felt like I’ve been carrying extra fluid for some months now; this might be related to blood sugar.

12 year of blood glucose tests (fasting)

Right side gut ache / bloating vs gallbladder

The right-side gut ache (now a 9 month ordeal) for which I took the damned antibiotic is back with a vengeance for over a week now along with uncomfortable bloating and an enervating energy drain. So while I’ve continued training, my power meter reading say it lops off 10-15%. I've had to cut back, but that isn’t solving anything—I just feel marginal when I don’t get exercise. Recovery is also impaired; whatever the root cause, that right side gut ache and bloating is exacting a significant “energy tax”.

Because the right side pain increased to a level that could not be ignored for long, I went in for an ultrasound for the gut. As an “incidental finding”, 3mm polyps were found in my gall bladder. All doctors I consulted indicate that that gall bladder ought to come out, even forgetting other symptoms. And all agree that it might have nothing to do with the right side ache / bloating symptoms, or that it might be the root cause. No one can say.

“There are multiple gallbladder polyps measuring up to 3mm. No gallstones or sludge. No gallbladder wall thickening or pericholecystic fluid to suggest cholecystitis”.

So next up is Laparoscopic Gallbladder Removal (Cholecystectomy). I’m going to find a very experienced surgeon, as I don’t want the common bile duct damaged or bruised.

Another possibility

Besides the gallbladder, another possibility for the right-side ache could be sphincter of ODDI disfunction.

Individuals with sphincter of Oddi dysfunction present with abdominal pain resembling that of structural or inflammatory disorders of the gallbladder, biliary tree or pancreas. Among other characteristics, the pain is typically in the upper part of the abdomen or in the right upper quadrant of the abdomen, lasts 30 minutes or longer, and is not associated with a structural abnormality that could lead to these symptoms.

Functional disorders of the gallbladder, bile duct and pancreas have been defined and classified by the Rome criteria for functional gastrointestinal disorders.[2] The criteria outline three variants of functional disorders of the gallbladder, bile duct and pancreas, termed functional gallbladder disorder, functional biliary sphincter of Oddi disorder and functional pancreatic sphincter of Oddi disorder. All of the following criteria need to be met for as part of the definition of a functional disorder of the gallbladder:[2]

  • the pain must be located in the upper part of the abdomen and/or the right upper quadrant of the abdomen
  • episodes of pain must last at least 30 minutes
  • the symptoms must be recurrent, and occur at differing intervals
  • the pain must incrementally increase to a "steady level"
  • the pain must be severe enough the patient's daily activities are affected, or that the patient must attend the emergency department
  • the pain must not be relieved by any of bowel movements, change in posture, or antacids; and,
  • other structural disorders that could explain the symptoms must be excluded.
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