Resting Heart Rate — Bradycardia

I went in for some routine medical stuff today, and the blood pressure machine would not shut up—it lit up yellow and bonged because of my low resting heart rate (41 beats per minute). This went on steadily until the triple readings were all done. I suppose my resting heart rate would have been 38 or 39 if I had been lying down (it was 39 a few years ago in a physical when I was in peak condition). The nurse had to shut off the noise.

A low resting heart rate in the AM is a good sign while training hard: this was at 8 AM, and the grueling training load of 107 miles over the prior two days (4100 calories burned) put a load on my system which I could feel as fatigure by evening—and this reading was only about 14 hours later.

For my HR to be at 41 in the morning means good overall recovery/response to the workout, though my legs were clearly short on glycogen today—very hard to replace glycogen stores overnight when also doing a 3000 calorie deficit for those two days, and far more over several weeks*. If I am not well rested, I’ll see my HR in the 48 to 55 range, 60 to 80 if getting sick.

When fit, a very low heart rate is totally normal for me. One year (when younger), I measured it at 31 for over a minute. Recording it for a minute or so while lying down in bed before getting out of bed in the morning is a great way to keep tabs on recovery—patterns will emerge that tell a story about how physical status—recovery, illness, etc.

Medical science doesn’t know much of anything about outliers like me. I’ve had at least 3 experiences in the last year where medical personnel look concerned with my HR in the 41-45 range. They are so used to seeing grotesquely overweight patients I guess (why am I lumped in with such people for health insurance? Grossly unfair). What is “normal” anyway?

So being an outlier, I have a deep skepticism of medical “knowledge”—so much of what was “established science” seems to have been debunked in recent years (in nutrition and health in particular). Then there is the intellectual incompetence and laziness of using BMI, which placed me quite close to “overweight” with 8% body fat for a BMI of 23.8. Applying population statistics to individuals is medical incompetence, except perhaps (and only) as a crude initial screen. But for a doctor seeing someone in person, I say unequivocally that it is incompetence or at least laziness.

* The frequent and extended periods of very cold rain have really “holed” my training schedule but I have still managed to drop 5 pounds of fat in 4 weeks. This is way below my goal, but losing 10 days or so of training makes it tough, especially when I enounctered a box of See’s Candy one day. The box was empty all too soon.

Nutritional Science Studies Start to Look very Non-Sciency

As I understand it, visceral (android) fat acts like an organ all its own with negative health consequences. Only a few weeks into my season, I am already losing fat out of my abdomen, as my ribs/stomach now have a nice drop-off while lying down versus being level prior. A DEXA scan is the best way to see the android/gynoid breakdown.

Emphasis added in places.

Any way you slice it, there’s a lot to say about nutrition studies

For every study that warns against the health perils of coffee, there's another that points to java as the key to longevity.

Really, if you pick any trendy food — wine, kale, chocolate — and search for its health effects, you're bound to find mixed messages.

So what's the deal? Why are nutrition studies so complicated?

The question was debated in a scholarly squabble this past month by nutrition specialist Christopher Gardner, PhD, and John Ioannidis, MD, DSc, who focuses on the accuracy and reliability of scientific studies. The two met to debate a controversial statement: Most studies on the effect of nutrition and diet are false.

...

WIND: sounds about right, and relates to the replication crisis in science.

Still, I’d bet that a BigMac a day is not good for your, or even the fries alone and ditto for sugary drinks. I don’t eat that kind of garbage and most Americans just don’t care anyway.

More Evidence That Nutrition Studies Don’t Always Add Up

A Cornell food scientist’s downfall could reveal a bigger problem in nutrition research.

...

But as news of the scandal reverberated through academic circles, some experts said they feared it was symptomatic of a broader problem in food and health research. While very few scientists are accused of misconduct or misreporting data, critics have long contended that nutrition research is plagued by a credibility problem. They argue that an alarming number of food studies are misleading, unscientific or manipulated to draw dubious conclusions.

...

WIND: don’t even get started on “sin” things like alcohol. With big bucks at stake in the food industry and a government mucking around and subject to influence, one has to wonder what studies if any can be trusted.

What’s Wrong with American Health Care System (everything, but here’s one thing)

One serious but relatively minor crash in terms of total bodily damage = $90468 bill. And that’s not the whole bill—it’s something like another $20K more.

This sort of thing can break someone (most people) financially without insurance. So we all pay far more, since they cannot.

$101.15 for Tylenol, for starters. An MRI for $7900 that is about $400 at Insight Imaging. $13760 for an overnight stay in a secondary facility bed, where the nurse could not manage to produce god-damned Tylenol for two hours while I was in pain, in spite of asking 3 or 4 times. Etcetera.

I’m not sure that this is all of it (the $5500 surgeons’s bill is not listed yet, at the least)—my insurance has stated that I owe $11000 or so, which is a cost for me that displaces all sorts of things, none of which involve niceties.

For many, medical care is an ongoing trauma for a year or so as the bills roll in and what with dueling with the insurance company. In the past, Stanford has billed me up to a year after the fact, so I wonder how this one will roll out.

Update: I called the insurance company. This is ONLY the hospital portion, for which (this is not a typo!) the insurance company paid out about US$64,800 to Stanford Hospital. It does NOT include other expenses (like surgery), for which I am on the hook for over $11,000, pending appeal. I was late on my monthly premium—had I not gurgled out instructions to my wife to pay it the next day (Dec 31), I’d have lost most of my life savings. This is sheer insanity—criminal IMO.

And get this—Stanford Hospital wants their money, but 6 weeks later, they still don’t have all the numerous tests in my medical file—now that’s offensive.

One visit to the Stanford Hospital Emergency Room

How to Deal with Biodiesel with the Mercedes Sprinter

Biodiesel is the kiss of death for a Sprinter diesel, notwithstanding the biodiesel industry-produced propaganda spread all over the internet, and internalized and repeated by every nitwit who reads it.

Mercedes Sprinter Maintenance: Dealing with Biodiesel

Excerpt from 2018 Mercedes Sprinter operating manual

Various Interesting Health Findings in Science Daily

As I understand it, visceral (android) fat acts like an organ all its own with negative health consequences. Only a few weeks into my season, I am already losing fat out of my abdomen, as my ribs/stomach now have a nice drop-off while lying down versus being level prior. A DEXA scan is the best way to see the android/gynoid breakdown.

Emphasis added in places.

Dangers of hidden fat: Exercise is your best defense against deep abdominal fat

What is the most effective way to fight internal, visceral fat that you cannot see or feel? The answer: exercise. Researchers at UT Southwestern Medical Center analyzed two types of interventions -- lifestyle modification (exercise) and pharmacological (medicine) -- to learn how best to defeat fat lying deep in the belly....

The study is published in Mayo Clinic Proceedings. "Visceral fat can affect local organs or the entire body system. Systemically it can affect your heart and liver, as well as abdominal organs," said senior author and cardiologist Dr. Ian J. Neeland, Assistant Professor of Internal Medicine. "When studies use weight or body mass index as a metric, we don't know if the interventions are reducing fat everywhere in the body, or just near the surface."

To find out, the researchers evaluated changes in visceral fat in 3,602 participants over a 6-month period measured by a CT or MRI exam. Both exercise and medicines resulted in less visceral fat, but the reductions were more significant per pound of body weight lost with exercise. "The location and type of fat is important. If you just measure weight or BMI, you can underestimate the benefit to your health of losing weight," said Dr. Neeland, a Dedman Family Scholar in Clinical Care. "Exercise can actually melt visceral fat."

WIND: science finally catches up with my own conclusions based on years of studying myself.

Athletes can rest easy: Extreme exercise does not raise heart disease risk or mortality

Exercise is often cited as the best preventive medicine, but how much is too much for the hearts of middle-aged athletes?

What is coronary calcium scanning and why is it important?

Coronary calcium scanning is an imaging test that helps physicians classify patients without cardiac symptoms as low, intermediate, or high risk for heart attack. It represents how much calcium (and thus cholesterol deposits) has accumulated in the blood vessels that supply the heart. The scan can help physicians determine the need for medication, lifestyle modification, and other risk-reducing measures.

"The question has never been whether exercise is good for you, but whether extreme exercise is bad for you. For the past decade or so, there's been increasing concern that high-volume, high-intensity exercise could injure the heart. We found that high volumes of exercise are safe, even when coronary calcium levels are high," Dr. Levine said.

Coronary calcium is a footprint of atherosclerosis, a disease in which plaque builds up in the arteries and gives rise to heart attack and stroke. When coronary calcium is detected in the heart, the clogging process within the blood vessels has begun. The majority of high-intensity athletes had low levels of coronary calcium, though their odds of having higher levels were 11 percent greater than men who exercised less. Most importantly, the researchers found that higher calcium scores did not raise the high-intensity athletes' risk for cardiovascular or all-cause mortality.

WIND: good news for me: as an extreme athlete, I rank poorly on coronary calcium.

Exercise benefits brains, changes blood flow in older adults, study finds

A new study published by University of Maryland School of Public Health researchers in the Journal of Alzheimer's Disease showed that exercise was associated with improved brain function in a group of adults diagnosed with mild cognitive impairment (MCI) and a decrease in the blood flow in key brain regions.

...

"Our findings provide evidence that exercise can improve brain function in people who already have cognitive decline," Dr. Smith said optimistically. "We have an interest in targeting people who are at increased risk for developing Alzheimer's earlier in the disease process. We are seeing that exercise can impact biomarkers of brain function in a way that might protect people by preventing or postponing the onset of dementia."

WIND: I always feel better the closer I am to 8 to 10% body fat: I feel healthier physically and mentally. At least science catches up to one more of my own personal observation.

Americans concerned about weight, but don't understand link to heart conditions, health

Most Americans (88 percent) understand that there is a connection between a healthy heart and a healthy weight, most aren't doing enough -- or anything -- to combat their own weight issues. The survey found 74 percent are concerned about their weight and 65 percent are worried about getting heart disease due to extra pounds, yet less than half (43 percent) of Americans have tried to make dietary changes to lose weight and 40 percent of those who describe themselves as overweight or obese say they aren't careful about which foods they eat.

Part of the problem may be that Americans aren't sure what to eat for heart health. Nearly one-in-five (18 percent) believe their diet has nothing to do with their heart health, and a mere 14 percent knew that a Mediterranean diet is healthiest for heart health. What's more, nearly half of Americans (46 percent) believe using artificial sweeteners is a healthy way to lose weight despite studies showing they don't promote weight loss.

WIND: it’s time to raise insurance rates for couch potatoes and willful igorance. Why should healthy people pay for those who don’t/won’t take action?

Fasting ramps up human metabolism

Fasting may help people lose weight, but new research suggests going without food may also boost human metabolic activity, generate antioxidants, and help reverse some effects of aging. Scientists at the Okinawa Institute of Science and Technology Graduate University (OIST) and Kyoto University identified 30 previously-unreported substances whose quantity increases during fasting and indicate a variety of health benefits.

WIND: I regularly fast at least 12 hours most days, but while training, it's a serious problem to ride 50 miles a day and eat less than 2000 calories a day (while burning 1500 to 3000 per day).

A new approach to peripheral nerve injury?

In animal models of a totally crushed peripheral nerve, the damaged axons are broken down, allowing healthy ones to regrow. But humans rarely suffer complete axonal damage. Instead, axons tend to be partially damaged, causing neuropathic pain -- a difficult-to-treat, chronic pain associated with nerve trauma, chemotherapy and diabetes. A new study in Cell, led by Michael Costigan, PhD, at Boston Children's Hospital, explore the role of immune cells in breaking down damaged nerves. The findings may change our understanding of neuropathic pain and how to treat it.

WIND: having had neuropathy from the Metronidazole antibiotic, this might still be of interest to me as I age.

Transcranial Direct Current Stimulation (tDCS)

I think that tDCS (Transcranial Direct Current Stimulation) works, based on using the Halo Sport. Scientific types can do their statistical stuff averaging out gains and losses to “doesn’t work”, but I expect they’ll all be proven wrong and the technology will be widely accepted in the medical community within 5 years.

For that matter, I think that PEMF has real effects that will also gain acceptance, and also I disqualify any medical doctor that has not personally had a moderate or severe concussion as unqualified to judge brain function with any insight—zero perspective.

Safety of transcranial Direct Current Stimulation: Evidence Based Update 2016

To date, based on over a total 33,000 sessions and over 1,000 subjects who received repeated tDCS sessions, there is no evidence for irreversible injury produced by conventional tDCS protocols within a wide range of stimulation parameters (≤40 min, ≤4 mA, ≤7.2 C). This analysis consolidates and adds to existing evidence on tDCS safety and facilitates further research of tDCS in human subjects. These conclusions are in agreement with a prior analyses and review focused on single center experiences

Zap: How Electric Therapy Is Curing Navy SEALs of PTSD … And Could Remake Brain Science

What Tony and several other former U.S. Special Operations Forces personnel received Newport Brain Research Laboratory, located at the Center, was a new treatment for brain disorders, one that might just revolutionize brain-based medicine. Though the FDA clinical trials to judge its efficacy and risks are ongoing, the technique could help humanity deal with a constellation of its most common mental disorders — depression, anxiety, aggressiveness, attention deficit, and others—and do so without drugs. And if its underpinning theory proves correct, it could be among the biggest breakthroughs in the treatment of mental health since the invention of the EEG a century ago.

....

For Tony, MeRT’s effects were obvious and immediate. He walked out of the first session to a world made new. “Everything looked different,” he told me. “My bike looked super shiny.” He began to receive MeRT five times a week— each session lasting about an hour, with waiting room time — and quickly noticed a change in his energy. “I was super boosted,” he said. His mood changed as well.

...

Like Cathy, the rest had difficulty sleeping. Even Ted, who had no severe PTSD-related problems, reported that he “slept like crap,” before the treatment began.

All said that they saw big improvements after a course of therapy that ran five days a week for about four weeks. Bill reported that his headaches were gone, as did Cathy, who said her depression and mood disorders had lessened considerably. Jim’s memory and concentration improved so dramatically that he had begun pursuing a second master’s degree and won a spot on his college’s football team. Ted said he was feeling “20 years younger” physically and found himself better able to keep pace with the younger SEALS he was training. All of it, they say, was a result of small, precisely delivered, pops of electricity to the brain. Jim said the lab had also successfully treated back and limb pain by targeting the peripheral nervous system with the same technique.

Choose a Good Oil for Mercedes Sprinter

In Mercedes Sprinter Maintenance: Engine Oil, I discussed various considerations for choosing a good oil for the Mercedes Sprinter. For starters, the Mobil 1 5W-30 oil that Mercedes uses is a terrible oil, but it is an oil that the EPA has browbeaten Mercedes into using oil for an initially better 1% to 2% fuel economy—at a massive cost over the life of the vehicle in increased wear and even potential engine failure. Use it at your peril but if you do, change it every 3500 miles or so.

Diesel engines are much harder on engine oil than gas engines, and combined with fuel accretion that drops the oil viscosity, a diesel engine can wear badly with a 5W-30 oil. The“30” viscosity is a in the context of the dilutiveand viscosity-robbing effects of fuel accretion—pretty much guaranteed to be bad given that very few Sprinter engines will be broken in properly given the wrong oil used from the get-go.

There are multiple factors to consider: ash content, NOACK value, reduced viscosity in the context of fuel accretion, ability to hande soot load, and how much the oil breaks down due to shear.

On that last point, Amsoil has a good point to make in The shear importance of oil :

If the oil loses viscosity due to shear, it can fail to provide the required level of wear protection. Think of the force transferred through the piston, rod and crank to the thin oil film protecting the bearing. There’s not much room for error.

AMSOIL uses naturally shear-resistant base oils combined with top-tier, shear-stable viscosity improvers. AMSOIL synthetic motor oil withstands extreme heat and shearing forces, exceeding industry standards and outperforming competing brands. In fact, it fights viscosity breakdown 46 percent* better than Mobil 1. It stands up to the devastating effects of high-horsepower, modern engines for maximum protection.

Given that I ran until 18K miles until changing the oil on my brand-new Mercedes Sprinter and that there were some punishing conditions during that time (75 mph freeway, steep hills, 105°F Las Vegas, etc), it’s all but certain that my engine has a lot of premature and totally uncessesary wear. Shame on Mercedes for using inferior and inappropriate oil and (this is even worse) stating a service interval of 20K miles (in 2018, Mercedes cut that in half vs 2017!). In this chart, Mobil 1 Annual Protection 5W 30 is a better and more expensive oil than the Mobil 1 5W30 that Mercedes uses. One has to wonder just how poor regular Mobil 1 5W30 performs.

I don’t Amsoil at present because there is a better oil for my operating conditions ranging from 0°F to 100°F. More about engine oil for Mercedes Sprinter.

Amsoil fights viscosity breakdown 46% better than Mobil 1 Annual Protection 5W-30

Followup Early Season 3+ Hour Workout

Given the trauma I suffered only 22 days ago, I’m especially pleased that my body is rewarding me with strong performance only 3 weeks afterwards, and in the 3rd week of January. The fantastic bike fit at 3DBikeFit.com helped substantially.

Two days ago in Promising Early Season ~3 Hour Workout I noted promising results. With heavy rain yesterday, I did not ride, thus resting a day, which I rarely do, but with some gluteus soreness, it was a wise course.

Today, two days after that workout, I set the bar higher by aiming for increased wattage, both overall and in the four repeats. The repeats were slightly increasing in power/watts, power being the only reliable metric (wind and HR vary, plus I had a puncture on interval #3 that dropped rear-tire pressure).

Being able to complete the repeats with slightly increasing power means that the effort level was chosen well (decreasing wattage means the effort was too aggressive). Another sign that I targeted the effort level was perceptual—feeling good but noticeably tired when done—a great way to bump up fitness by enough but not too much physical stress. Goldilocks training. This kind of workout can pay big dividends as quickly as week later, in my years of experience.

My heart rate is running about 15 beats too high for this level of exertion, but that is always true in mid-winter. For 240 watts, I expect a HR of ~135 bpm in cool temperatures (78% of HR max) when in peak condition, but HR is running closer to ~148 bpm. The heart is a muscle and as it gets stronger the stroke volume increases with greater fitness. My functional threshold power (FTP) reached 302W in 2018; I’d estimate that it is currently ~250 watts, and maybe less.

Below, green is power in watt, red is heart rate (bpm). Note the uptrend in wattage and bpm over the four intervals.

Promising early season workout of about 3 hours

Two days prior:

Promising early season workout of about 3 hours

Promising Early Season ~3 Hour Workout

Given the trauma I suffered only 20 days ago, I’m especially pleased that my body is giving me this kind of performance in mid-January. The fantastic bike fit at 3DBikeFit.com helped substantially and it was an awesome 70°F day in mid January—darn hard to beat!

I was able to average ~207 watts for 3 hours steady, and that includes little stops and starts and turn-arounds. Normalized power of 215 watts is a more accurate reflection.

My heart rate is running about 15 beats too high (138 bpm, max ~165 pm) for this level of exertion, but that is always true in mid-winter. For 215 watts, I expect a HR of ~118 bpm (72% of HR max). This same effort in April ought to show a heart rate of ~123 bpm.

Promising early season workout of about 3 hours

Mostly healed outside, clumps of sutures remain inside. They are self-dissolving, but 22 days in there are still some sutures.

20 days of healing

f5 @ 1/1250 sec, ISO 100; 2019-01-19 13:17:30
DSC-RX100 + 28-100mm F1.8-4.9 @ 28mm equiv (10.4mm)

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CBD (Cannabidiol): Oil vs Tincture

I am not a doctor, and none of what follows is medical advice! Consult your own doctor before using CBD.

More about CBD.

I had a discussion with NuLeafNaturals today about CBD oil. CBD oil is CBD in a carrier of hemp oil because delivery of actual CBD would be difficult (tarry consistency). All CBD oil is of this nature.

From NuLeafNaturals:

NuLeaf Naturals CBD
Use code DIGLLOYD20 to save 20%

The human body is water soluble. Alcohol will always absorb faster than oil, however it will not store in your fat cells the same way, so it's long term effectiveness is much less.

Traditionally, cannabinoids are fat soluble. That is why we prefer fat soluble products in high concentrations. Another reason we don't currently provide a water soluble product is because we use a full spectrum CBD extract, which is difficult to formulate into a product that can be water soluble without additives such as corn starch and much more processing.

We believe that full spectrum CBD oils (that contain other constituents such as THC, CBN, CBG, and terpenes) are more effective because these cannabinoids act in synergy with each other, producing the fullest effect - even when existing in trace amounts. Currently, we choose to provide our CBD oil as our only product because we truly believe in our formula containing no additives, just 100% organic hemp in the bottle.

We believe that when you ingest full spectrum CBD oil on a regular basis, it essentially levels out your system. The endocannabinoid system consists of cannabinoid receptors which cannabinoids bind to. Many of the functions that are affected by the endocannabinoid system relate to homeostasis - so these receptors are working to bring balance to your bodily functions on a molecular level. This is why we are happy to provide CBD oil that has one of the highest concentrations of cannabinoids on the market.

CBD (Cannabidiol): Lab Testing for Quality and Freedom from Contamination.

I am not a doctor, and none of what follows is medical advice! Consult your own doctor before using CBD.

More about CBD.

I asked NuLeafNaturals for lab results on their CBD oil. As the lab report is marked with a copyright from the testing laboratory, I cannot republish it here but the figures are found below.

But in a nutshell—for 20 common solvents and six microbial contaminants—non detectable levels of any of them—tap water is nasty stuff by comparison.

NuLeaf Naturals CBD
Use code DIGLLOYD20 to save 20%

Density: 0.93g/ml
Total CBD: 55 mg/ml @ 60.0 mg/g
Total THC: 1.91 mg/ml @ 2.1 mg/g

CBC: 2.2
CBCA: ND
CBD: 55
CBDA: 0.151
CBDV: 0.183
CBDVA: ND
CBG: 1.08
CBGA: ND
CBL: ND
CBLA: ND
CBN: 0.148
CBNA: ND
THC: 1.91
delta-8-THC: 0.157
THCA: ND
THCV: ND
THCVA: ND
TOTAL: 61

ND = not detectable

CBD (Cannabidiol): How to Use/Apply

I am not a doctor, and none of what follows is medical advice! Consult your own doctor before using CBD.

More about CBD.

I had a discussion with NuLeafNaturals today about how to best use CBD, here is a summary. Note that sublingually means under the tongue.

NuLeaf Naturals CBD
Use code DIGLLOYD20 to save 20%

The dosage amount for CBD oil can vary greatly between people. Most people report between 5-10 drops (approx. 12-25mg) once or twice daily as their best regimen, which can be taken at any time, before or after a meal. (For reference, 10 drops is 25mg of CBD). We encourage everyone to research and experiment with serving size to find their best regimen. Some customers report using less, some report using more. Everyone's endocannabinoid system is different, so this is a good starting point to experiment with. I usually recommend starting with 10 drops a day, split throughout the day. Click here for a great article on CBD dosage.

The recommended form of ingestion is sublingually - we recommend dropping your dose under your tongue, and keeping it there for 30 seconds to a minute before swallowing it for the most optimal absorption. We also have customers report that they mix it into a drink/food for a more palatable taste - we encourage everyone to find the method of ingestion that works best for them. Click here for a great article on CBD bioavailability.

Our CBD oil is fully active, so it can be applied topically. When applying topically, you can just drop the desired dosage directly onto the affected area and rub it in. The area will be a little oily for a couple of minutes, and then it will fully absorb. Some customers also report mixing their dosage into their lotion or cream of choice, and applying it that way. Both methods work very well for localized pain. If you would like to apply the oil topically, I usually recommend continuing the daily oral dose and using topical application as an additional dosage.

According to what I’ve read, swallowing CBD reduces the bioavailability significantly because the digestive system and liver break down CBD. So it is best to keep it in the mouth rather than swallowing.

How much CBD?

My daughter who has a chronic health condition swears by 10 drops (25mg cannabinoids), which is the standard dosage. I seem to need somewhat more, 15 to 20 drops. A

See also CBD Oil Dosage: General Tips to Assess How Much CBD to Take.

CBD quality

A key point is that a lab-tested high quality product that consistently offers the same dosage is the only way to be sure of dosing (along with a consistent dosing approach). It is also important to make sure that there are no unwanted chemicals present—ask the vendor for lab analysis result.

CBD applicability to the human body

Happy New Year! (UPDATED: repairing teeth)

Tip for Palo Alto area residents: I keep hearing from various parties that the best place to go for trauma is Stanford Hospital, particularly for potential concussion. I don’t quite know how that works out with insurance just yet (out of network), but that’s where they took me.

I feel blessed because my neck is not broken though it took the ER 20 hours to be sure—just back home out of the ER overnight this afternoon. No nerve damage or signs of it.

Everything hurts and 2 hours of sutures on face and mouth (inside too) is no picnic, but I seem to be A-OK, just sore and very tired. I won’t post any pictures—too gruesome. I am not using narcotics, and Tylenol/Advil are doing the job just fine.

I want to forestall answering many emails, so I’m going to tell the story here, once.

Many thanks to the highly skilled plastic surgeon at Stanford who was on call (how lucky is that?!), who related to me his 25 years of sewing up Marines, and 6 crashes of his own—he no longer rides, which is food for thought. I got to listen to all the shop talk while he and another surgeon sewed things up methodically and efficiently—these guys are total pros and every MD with that level of skill has my deep respect and admiration.

Even with XRays, CAT scans and MRI, an old injury had them sure that I had a broken C3 vertebrae, but it turns out that it was/is a “chronic” thing caused by past injury. I’ve had that awkward spot in my neck for years, but that did not occur to me while lying on the gurney in pain. Fentanyl (once) and hydromorphone (3 times 3 hours apart) work, but I asked that it be minimized as I wanted to remain reasonably alert.

The neck brace worn overnight was torture, digging into my back and making it ache as bad as the injuries. Stone-age technology. This is almost funny—the morning doctor asked if I wanted to take the neck brace home with me for “comfort” (strained neck muscles)! I passed.

Fantastic skilled surgical work—not a person could see a stitch when done: so skillfully did he close the wounds that even the the nurses only half-believed me about the 3/4" hole punched through my upper lip all the way through, and the deep cut on my chin, and the large divot inside. Small chunks of tissue were missing (as per the “shop talk”), and nerve, muscle and skin had to be done in sequence. He kept running out of suture material.

It all looks cleanly done, but until it heals and the swelling drops, I don’t know if I’ll look more rascalish or not. Some teeth need repair and that will probably be the worst part. I am eating smoothies for the time being but the front teeth shifted overnight and I cannot chew—might need orthodontia for the two fronts.

Dumb goof

People ask (already), so I might as well relate what to me is a really bad protocol, combined with bad luck:

I was riding my bike, the 2nd day of what was to be intensive 50 mile/day training for 3 weeks. The wind was strong but I was getting warm so (riding no-handed), I pulled off my wool hoodie. That in itself went fine as it always does. The wind was strong so I decided to stop to tie it around my waist. Accordingly, I half-balled the hoodie against the handlebar, in preparation to stop. That proved disastrous—somehow the wind grabbed a sleeve and threw it into the front wheel, which rotating forward, caught the sleeve and instantly balled-up the entire hoodie, stopping the bike in an instant from 15-20 mph. Newton’s Law took over from there at 19.44 mph.

Post-op

I look a lot better all sewn up and cleaned up (front teeth, not so much, that will be a project). Nor do I feel concussed, which is a miracle of sorts. So I feel lucky and blessed and joyful all at once, really happy to come out so well when it could have been so bad (eyes, arms, legs, back, nose, spine all good). Today on New Year’s Day 32 hours later, I don’t even need Tylenol.

The 2 cm hole which punched all the way through my upper lip was a bit messy when the saline was cleaning things. But it’s all nicely sewn back together. The yellow stuff is lymph fluid which oozes out, not infection, or so I think. The doctor advised to not remove it, and I’ll see an MD tomorrow to check for any signs of infection.

Below, it might look like abrasions, but a 2cm through-hole had existed in my upper lip as well as deep internal gouges and a deep cut in my chin. Repairing nerve, muscle, and skin required at least 90 minutes of stitching by this very skilled plastic surgeon, and a 2nd doctor assisted. I’m guessing at least 100 stitches or so and the surgeon ran out of sutures at least 3 times. The job was so well done with invisible self-dissolving stitches of very fine diameter that even the nursing staff were skeptical that a 2cm through-hole had existed in my upper lip prior. Lots of stitches are inside in lower and upper lips areas too—a big job, expertly done.

f2.2 @ 1/30 sec, ISO 160; 2019-01-01 11:15:06 [altitude 511 ft / 156 m]
iPhone 7 Plus + iPhone 7 Plus 2.9 mm f/2.2

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Update: I picked up my bike from the fire station. I had not seen it since before the crash, but my theory looks to have been spot-on: the sleeve got sucked up and wedged into the front brake. The bike computer showed that I was going 19.44 mph.

f1.8 @ 1/120 sec, ISO 40; 2019-01-01 15:53:04
[altitude 316 ft / 96 m, "bike after crash as picked up at Fire Station"]
iPhone 7 Plus + iPhone 7 Plus 4.0 mm f/1.8

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Repairing the teeth

Periodontist Dan Nelson writes:

I’m a subscriber and I follow your blog and read about your recent bike accident. I’m also a periodontist in Mountain View. As a dental specialist and an owner of a referral based practice, I know a lot of really great dentists and specialists who can help you in your area (if you don’t already have a great dentist). Trauma to your front teeth can involve a lot of different issues and you’re likely to need at least an evaluation by a specialist or two (and endodontist and periodontist come to mind). Please feel free to reach out to me if you need help of any kind. I’m happy to recommend some high quality dentists who can help.

I am grateful to periodontist Dan Nelson DDS in Mountain View for recommending an excellent endodontist and securing a 9 AM appointment for me. In this sort of crash, prompt action can save teeth that might die from the damage, so if you have trauma to teeth, get them looked at without delay. I wasn’t aware of two key risks: (1) death of the nerve into the tooth, and (2) bone growth into the tooth, was if not prevented can cause the tooth to die.

I visited Dr. Keivan Zoufan DDS MDS in Los Altos this morning on a day he had scheduled no patients or staff. We had a short examination and chat and then used his state of the art CT scanner to create a 3D scan of my teeth, as shown below—all in a few minutes. This is incredible stuff—turns out that the broken-off tooth shows no internal damage but the intact tooth can be seen to be wedged out of place along with a broken piece of bone in the surrounding jaw, as seen below. Seems that this particular tooth was “too strong” and instead of breaking itself, disrupted the tissue around it.

Dr. Zoufan’s wife, orthodontist Dr. Mozafari DDS was also in, also with no scheduled patients and thus no staff present. To my utter surprise, Dr. Mozafari along with Dr. Zoufan as assistant (!) installed orthodontia to ease the intact tooth back into its proper place, thus raising the odds of both saving the nerve and avoiding losing the tooth by having bone grow into the tooth, not to mention restoring proper alignment for a proper bite (this takes time of course).

Talk about exceeding expectations! I don't think I've ever had such attention from a doctor for a regular visit, let alone two and the work was quickly and expertly done. I felt very special, and I thank them both profusely for their expert on-the-spot analysis and repair. Highly recommended!

Dr. Zoufan also ground the out-of-place tooth a little to allow chewing with some care, versus a hard stop-click prior which has made any solid food challenging so far. Given a little time the orthodontia should move the tooth back into place.

Tooth pushed out of place with broken bone chip in jaw

Tooth pushed out of place with broken bone chip in jaw

Update Jan 13, 2019

I’m healing up very fast. Biking the past 3 days seems to have accelerated the pace. I also think that the Bemer pulsed electromagnetic therapy has contributed.

14 days of healing

f4 @ 1/30 sec, ISO 80; 2019-01-12 16:35:11
DSC-RX100 + 28-100mm F1.8-4.9 @ 39mm equiv (14.6mm)

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20 days of healing

f5 @ 1/1250 sec, ISO 100; 2019-01-19 13:17:30
DSC-RX100 + 28-100mm F1.8-4.9 @ 28mm equiv (10.4mm)

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Off Topic, Health: CBD (Cannabidiol)—Eliminated My Small Airway Impairment (Asthma)

I am not a doctor, and none of what follows is medical advice! Consult your own doctor before using CBD.

With the New Year about to ring in, another health post seems appropriate—see also my many health posts over at WindInMyFace.com.

My original post follows below. In the past month, I’ve gotten feedback that the NuLeafNaturals organic CBD oil is the real deal. A number of readers ordered it with 100% positive (and unsolicited) testimonials. I was somewhat surprised at the level of interest and the results—if this is the placebo effect it’s an awfully good one (and would be irrelevant).

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I got NuLeafNaturals CBD oil for my daughter who suffers from a medical condition and she tells me that the NuLeafNaturals CBD acts within one minute for her, and eases the chronic aches and pains she has. Use sublingually for fastest absorption.

Use coupon code diglloyd20 for 20% off organic CBD oil at NuLeafNaturals.com. Note that larger bottles are more cost-effective but otherwise all are the same product, differing only in quantity.

My daughter had tried another-brand high quality “full spectrum” hemp oil before (not CBD oil) but it sat unused as it had no benefit she could perceive. CBD is not the same as “full spectrum hemp oil” — real deal CBD oil is high in CBD while also being full spectrum. Real CBD is grown from special variants high in cannabidiol (CBD).

NuLeafNaturals CBD oil is effective for my asthma (more on that below) and general aches and pains—I’m sold, and it’s something I use daily for myself now. Which is why I have taken the rare step of becoming an affiliate: I make a commission with every sal at NuLeafNaturals.com, so I thank you for using my click-through links every time you buy it — bookmark this page.

About CBD (cannabidiol)

Cannabidiol (CBD) is one of dozens of non-psychoactive cannabinoids found in the hemp plant. It is legal in the USA and does not have psychoactive effects. Cannabidiol, and all the other cannabinoids, were patented by the United States Government in 2003 as neuroprotectants and antioxidants (Patent No. 6,630,507).

CBD and other cannabinoids are naturally occurring compounds that appear to have potent anti-inflammatory and pain-relieving properties. They might promote the body’s healthy regulation of the central nervous, immune, and endocannabinoid systems. While there is much research suggesting benefits from CBD, a solid body of research is as yet lacking showing the extent of the benefits, or lack thereof.

CBD applicability to the human body

Last summer’s smoke caused me small airway impairment (asthma) for weeks, in spite of doubled usage of my prescription asthma inhaler—that inhaler did no more than maintain the status quo, meaning continued impairment, no progress. I could not breathe fully, which feels crappy as anyone with asthma knows.

After 2+ weeks of seeing zero progress in small airway impairment, and having read that CBD might be beneficial for asthma, I figured I had nothing to lose, so I obtained a small vial of NuLeafNaturals CBD. Within 24 hours of taking the NuLeafNaturals CBD, my small airway impairment was GONE. This continued in spite of the continuing bad air problems. Later, I ran out of CBD and some impairment returned as I was exposed to smoke again—so I got some more and same result—the CBD cleared up my small airways.

Possibly it was a double coincidence.But continued usage on and off more and more persuades me that something is going on that deals with the inflammatory process.

I’m not a doctor and cannot recommend anything for medical use. I can say that it was either quite a coincidence (twice), or it worked ridiculously better than the big-pharma inhaler. That said, I am not yet fully persuaded, needing some more impairment/cure “OMG” episodes. But so far, CBD appears for me at least to have the potential of being a powerful new non-pharma way to deal with small airway impairment (asthma).

See also: The 17 Most Compelling Studies on CBD from 2017, keeping in mind that until there are half a dozen studies all confirming the same findings that any single study should be read with skepticism.

My doctor scoffed when I related my experience, and perhaps rightly so in general. But is it possible that doctors send patients down poor health paths because of knee jerk reactions and a failure to ask even a single question? In this day and age when so many scientific studies turn out to be non-replicable, I wonder how any doctor can say yeah or nay on the “proven” or unproven with total certainty and without taking a patient’s experience seriously (true anecdote re CBD: doctor: “don’t take this the wrong way, but recently my other patients suggested bear fat”). In this case it was harmless to me, but this was not so with another inattentive doctor emphasizing no risk (when I asked) who gave me nerve damage from double the usual dose for double the usual time of Metronidazole (and never followed up!).

Which CBD?

First of all “hemp oil” is NOT the same thing as CBD, so if you’ve tried hemp oil, you have no basis for judging CBD. Hemp oil might have benefits, but the compounds in full-spectrum CBD are much more potent.

Do not buy cheap CBD, if it is “too good to be true” it is. Including the risk of dangerous synthetics or additives—there is a wild west out there since CBD is not a regulated product. Do your own research and buy only from a reputable company.

High-grade organic CBD is available at NuLeafNaturals.com.

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Jason W writes:

I was just discussing CBD with a friend the other day. He uses it for lower back pain says it works quite well. He also had a theory it helped "modulate anger / stress levels." I suppose this means he felt he had better emotional control with CBD. Any experience that can speak to that?

DIGLLOYD: I’m not ready to say yeah or nay on other benefits, but I think CBD probably helps with pain and has a slight relaxing effect. In general I’d say it is likely a generic mediator/supportive substance and that I sense that is indeed has overall benefits. But between dosing and normal variation due to sleep, diet, stress, etc it’s hard to be persuaded like I was with asthma.

Ferreting out the benefits or lack thereof is going to take science a long time if ever—who’s going to pay for that? It’s not something Big Pharma can make billions on.

It should also be noted that the Placebo Effect is real, and powerful. I try things skeptically, looking for the Real Deal but expecting nothing, but it may be a smarter move to expect it to work—and then it will—the placebo effect can be stronger than real drugs. If CBD does not work at all but taking it does, then it works.

Dr S writes:

Too bad there is a tremendous profit motive in the pharmacology industry that does not put its full resources into cannabinoid research and drug development (at least what is known publicly), but there have been a number of studies that indicate at least an "additive" benefit of the use of cannabinoids in a number of physical issues. A quick survey of the literature and websites (some overlapping) yielded the following:

NIH: Cannabinoids in the management of difficult to treat pain
NIH: Cannabinoids as novel anti-inflammatory drugs
NIH: Cannabinoids in health and disease
Project CBD: Inflammation
The 17 Most Compelling Studies on CBD from 2017

DIGLLOYD: note that THC is the psychoactive part and that CBD is non-psychoactive (some of the studies above involve THC).

Since the profit motive is what has brought us all the Good Stuff in all fields of modern life, I don’t blame Big Pharma—going out of business is not a smart plan. But surely outfits like the Gates Foundation could step in and support research and cost-effective production of CBD (CBD is very expensive), which could ultimately put downard price pressure on regular drugs in areas that CBD is effective. That is, is government can get out of the way for both psycho and non-psychoactive cannabis research. People are dying from bad government policy on drugs.

J.B. writes:

Cannabidiol has been very helpful to reduce my stress in my body. I developed a burnout a year ago and would sometimes wake up with every muscle flexed in my shoulders & neck. A few drops of Cannabidiol would bring relief in 5-10 minutes. Not 100%, but so much more bearable than with regular stress medication. The only thing that works even better is meditation. I’ve been meditating twice a day for 15 minutes since June and hardly notice stress in my body anymore like described above. Just my 2cts.

DIGLLOYD: I’m not read to say this has worked for me too, but I suspect so.

Jim G writes:

Regarding your off-topic CBD post, I wanted to say thanks for the info and also to offer my own experience.

I'm about your age and work as an electrical engineer. I've been a horrible insomniac my entire life, but it has gotten much worse since I hit 50 a few years ago. Entirely by accident (details not forthcoming), I discovered a very effective treatment for my insomnia while on a business trip to Colorado earlier this year. Like you, I don't believe in pseudo-science, nor do I trust coincidences. But the effect sure seemed real enough. I slept like a baby for about a month thereafter.

So then I mail-ordered some CBD oil from a reputable vendor in CO, and after about a month of returning to my normal insomnia, tried it out. And somewhat to my surprise, it worked like magic. I've been using it ever since, taking a small dose an hour before bedtime. I sleep much better than I have in years.

Now I know this is just some random nobody you never heard of making unsubstantiated claims about CBD, but here's the thing. If one or two people say something, it's probably nonsense, but if lots of random folks start saying similar things, there must be something to it.

Also, although I can't get it here in KS, I have learned that CBD oil works even better if it has a small amount of THC, something like 8:1 CBD:THC, and dosing of about 5mg of THC and 40mg of CBD. This is below the psychoactive threshold for most people (though not all), and seems to help make the CBD even more relaxing without causing any intoxication, etc. Just my two cents worth. Keep up the great work.

DIGLLOYD: any measurable amount of THC is illegal I think, but that might change. I can’t speak to THC as I’ve not tried it.

As for “lots of random folks”, I doubt that it is random. I’d subscribe more to the group psychological effects that in turn enhance the placebo effect. Random is surely not so—the bandwagon is rolling. But if relief accrues whether from placebo or hypnosis, it’s way better than an expensive Big-Pharma pill.

Adam S writes (after trying NuLeaf CBD):

OK, the stuff works. It's more potent than Sabaidee, which you would expect given the price delta. The taste is kind of raunchy ("tastes like drugs"), but that's part of being stronger I guess. I'm using it to sleep, and it gets me to 6am or thereabouts before I wake up, just like a triple (!) dose of Sabaidee.

Their customer service is terrific, even given the Black Friday rush.

DIGLLOYD: I’ve come to like the taste, Pavlovian I guess. Very rich, earthy plant-like. Well, CBD-like. Nothing else I’ve tried comes close—it’s like a really rich dense complex wine, though not at all the same taste. It inspires confidence as to potency and makeup.

Cold air still pings my lungs a bit.

Sunset on White Mountain Road

f11 @ 0.3 sec, ISO 64; 2018-11-24 16:45:15
[location “White Mountain Road”, altitude 11400 ft / 3475 m, 32°F / 0°C]
Hasselblad H6D-100C + Hasselblad HC 50mm f/3.5 II @ 33mm equiv (50mm)

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