Fat Pad Atrophy

 Just another consequence of growing older. I asked Gemini:

Why do the soles of my feet feel a little sore when I walk barefoot? I never used to feel that way but now I'm 76 years old. My body has changed, maybe the padding of fat on the soles of my feet has decreased. I'm not overweight (70kg and 178cm tall) so there's no great weight bearing down on the soles of my feet. Is this common for older adults?

Here was the response:

You're observing a very common and normal change that occurs with aging! The soreness you're feeling when walking barefoot is highly likely due to the natural reduction of the fat padding on the soles of your feet, a condition often referred to as fat pad atrophy.

Here's a breakdown of why this happens and why it's common for older adults:

• Reduced Fat Padding (Fat Pad Atrophy): This is the most significant factor you've identified. The fat pads on the soles of your feet, particularly under the heel and the ball of the foot (where you bear the most weight), act as natural shock absorbers and cushions. As we age, these fat pads naturally thin, lose elasticity, and their volume decreases. This means there's less natural cushioning between the bones of your feet and the hard ground, leading to increased pressure and soreness when walking barefoot. Even at a healthy weight like yours, this thinning occurs. 

• Loss of Collagen and Elastin: With age, the collagen and elastin fibers within the fat pads deteriorate. These proteins are crucial for maintaining the elasticity and thickness of the fat pads. Their decline contributes to the "wear and tear" that reduces the shock-absorbing capacity of your feet. 

• Skin Changes: The skin on your feet also changes with age, becoming thinner, drier, and less elastic. This can make the feet more vulnerable to pressure and discomfort. 

• Biomechanical Changes: Over decades of walking, your feet undergo cumulative changes. Ligaments and tendons can lose strength and flexibility, and the arches of the feet may flatten. These biomechanical shifts can alter how weight is distributed across your feet, potentially creating new pressure points that become sore when walking without support. 

• Increased Sensitivity: With less cushioning, the nerves and other structures in your feet become more exposed and sensitive to direct pressure from hard surfaces.

Is this common for older adults?

Yes, absolutely. Fat pad atrophy and the resulting foot soreness, especially when walking barefoot on hard surfaces, are very common complaints among older adults. It's a natural part of the aging process for many people, even those who are not overweight.

What you can do:

• Wear supportive footwear: This is the most direct solution. Shoes with good cushioning and arch support will help compensate for the reduced natural padding. 

• Use insoles or orthotics: Over-the-counter cushioned insoles or custom-made orthotics can provide additional shock absorption and support, redistributing pressure more evenly across your feet. 

• Avoid prolonged barefoot walking on hard surfaces: While walking barefoot can have benefits, for many older adults, hard surfaces (like concrete, tile, or hardwood) can exacerbate soreness due to the diminished natural cushioning. 

• Gentle foot stretches and exercises: Maintaining flexibility and strength in your foot muscles can help support the foot's structure. 

• Moisturize your feet: Keeping the skin on your feet hydrated can help with overall comfort and prevent dryness and cracking. 

• Consult a podiatrist: If the soreness is persistent, severe, or significantly impacts your daily activities, it's always a good idea to see a podiatrist. They can accurately diagnose the cause of your pain and recommend personalized treatment options. They can also rule out other potential causes of foot pain, such as plantar fasciitis, metatarsalgia, or nerve issues, which can also become more common with age.

In summary, your observation is spot on – the decreased padding of fat on the soles of your feet is a very likely reason for the soreness, and it's a common age-related change.

Soya Milk

Yesterday I mixed some soya milk with a banana and a little honey in a blender and drank it. Today shall we say there were some "consequences". 

I asked AI the following question:

Can the calcium carbonate added to soya milk or other liquids cause constipation?

Yes, calcium carbonate, when added to liquids like soy milk, can potentially cause constipation in some individuals. While calcium supplements are generally well-tolerated, calcium carbonate is known to be more likely to cause constipation than other forms of calcium like calcium citrate. 

Here's a more detailed explanation:

Calcium Carbonate and Constipation:

Calcium carbonate is a common form of calcium supplement, but it can sometimes lead to constipation, gas, and bloating, according to the Mayo Clinic. 

Why Calcium Carbonate?

Calcium carbonate requires stomach acid for proper absorption, and individuals with lower stomach acid levels (especially older adults) may experience more digestive issues with this form. 

Soy Milk and Calcium Fortification:

Soy milk is often fortified with calcium, and calcium carbonate is a common choice for fortification. This means that consuming calcium-fortified soy milk could potentially contribute to constipation in susceptible individuals. 

So it would seem that I need to avoid soya milk that is fortified with calcium carbonate. After all, this compound makes up the bulk of chalk, limestone and marble. This form of calcium is best avoided as this video explains and Calcium Citrate seems preferable. It would be best to take soy milk without any fortification at all.

Deconditioning

I just watched a Dr. Suneel Dhand video in which he talks about \( \textbf{deconditioning} \) which can be explained as follows:

In medical terms, "deconditioning" refers to the decline in physical function resulting from inactivity, prolonged bedrest, or a sedentary lifestyle. It encompasses a range of negative changes in the body, including decreased muscle strength and size, reduced endurance, impaired cardiovascular function, and even mental and social consequences. 

Elaboration:

Physical Impact:

Deconditioning leads to a noticeable loss of physical fitness, including reduced strength and endurance. Muscles atrophy (shrink) and become weaker, making it difficult to perform even basic activities of daily living. Cardiovascular fitness also declines, meaning the heart and lungs may struggle to deliver oxygen to the body during exertion. 

Systematic Changes:

The effects of deconditioning are widespread and can impact various systems:

• Musculoskeletal: Muscle atrophy, osteoporosis, and loss of flexibility are common.  

• Cardiovascular: Reduced heart efficiency, blood clots, and orthostatic intolerance (dizziness upon standing) can occur.  

• Respiratory: Reduced lung capacity and increased shortness of breath.  

• Digestive: Changes in appetite, constipation, and other gastrointestinal problems.  

• Urinary: Loss of bladder control and urinary tract infections.  

Cognitive and Social Impacts:

Deconditioning can also affect mental and social well-being. Individuals may experience confusion, depression, and decreased social interaction due to limited mobility and reduced participation in activities. 

Causes:

Deconditioning can be triggered by various factors, including:

• Extended Bedrest: Patients recovering from surgery or illness may experience deconditioning due to prolonged inactivity.  

• Sedentary Lifestyle: A lack of physical activity can lead to a gradual decline in fitness.  

• Chronic Illness: Conditions like heart failure or respiratory diseases can limit activity and contribute to deconditioning.  

• Space Travel: The effects of weightlessness on the body in space, including muscle atrophy and bone density loss, are a significant example of deconditioning. 

Prevention and Reversal:

While deconditioning can have a significant impact on health, it's often reversible with a gradual increase in physical activity and appropriate rehabilitation programs. Regular exercise and other interventions can help regain strength, endurance, and overall fitness. 

I remember when I was 13 and was in hospital for a week. I had a minor operation and nowadays would have spent one night in hospital. However, movement wasn't encouraged at all and I spent most of my day lying on the bed. I couldn't barely walk on my release. Imagine the impact of a week in hospital for a person in their 70s, 80s or 90s who is bed-ridden. 

As the good doctor says in his video, you should spend as little time in hospital as possible and while you're there you should try to move around as much as possible. For the elderly this is crucial.

Super Jab for Cancer

Here's the good news (source):

Thousands of patients will benefit from a new cancer jab for more than a dozen types of the disease, with the NHS the first in Europe to offer the new injection.

The health service is rolling out an injectable form of immunotherapy, nivolumab, which means patients can receive their fortnightly or monthly treatment in 5 minutes instead of up to an hour via an IV drip.

The roll-out will save over a year’s worth of treatment time for patients and NHS teams annually – enabling patients to spend less time in hospital while freeing up staff capacity to deliver more appointments and treatments.

The new jab can be used to treat 15 cancer types, including skin cancer, bladder, and oesophagus, and it is estimated around 1,200 patients in England per month could benefit.

This follows approval from the UK’s medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) today.

While it's currently being used for people who have been diagnosed with cancer, what's the bet that it will soon be recommended prophylatically for everybody. Turbo cancers are exploding around the world following the Covid-19 jabs and now here's another jab to put a stop to all that. Inevitably "secret ingredients" will be added to the immunotherapy mix to increase its potency. It may not be safe but it will be effective.

ONE JAB GIVETH AND ONE JAB TAKETH AWAY

Any drug or treatment being pushed by the NHS should be regarded with deep suspicion but it could be that a fear campaign is about to be launched in the UK and elsewhere that will entice the gullible into baring their arms. The mere mention of the word "jab" should strike fear into the hearts of the those who remain healthy. One way or another the depopulation agenda will be implemented by a combination of accelerated death rates and surreptitious sterilisation.

Ivermectin Paste

Now this was an interesting tweet in which Ivermectin paste is recommended for the treatment of skin cancer. As he says, the paste is FDA approved for the treatment of Rosacea which is "a chronic skin condition that mainly affects the face, causing redness, flushing, and sometimes acne-like breakouts. It's a common condition, often appearing after middle age, and is more prevalent in fair-skinned individuals. While there's no cure, rosacea can be managed with various treatments and lifestyle changes."

However, the veterinary version referred to as a horse paste is stronger (1.87% versus 1%) and probably cheaper but care needs to be taken with the dosage. I was thinking that this paste could be useful in treating what I referred to as my protuberance (see posts titled An Odd Protuberance and Protuberance Gone). In the end, it went away of its own accord. I also have an area on my back that is quite sensitive and that I usually keep covered with a bandaid. This area might respond favorably to the application of this paste.

X Link

Of course, Ivermectin in combination with Fenbendazole is recommended in the treatment of internal cancers but I'd not heard of Ivermectin paste. It's these sorts of treatments that I need to be familiar with as alternatives to recommendations by the Medical Mafia should I ever need them.

Here is an abstract from a comprehensive paper published about Ivermectin in 2011 (before it was demonised in the treatment of COVID a decade later):

Discovered in the late-1970s, the pioneering drug ivermectin, a dihydro derivative of avermectin—originating solely from a single microorganism isolated at the Kitasato Intitute, Tokyo, Japan from Japanese soil—has had an immeasurably beneficial impact in improving the lives and welfare of billions of people throughout the world. Originally introduced as a veterinary drug, it kills a wide range of internal and external parasites in commercial livestock and companion animals. It was quickly discovered to be ideal in combating two of the world’s most devastating and disfiguring diseases which have plagued the world’s poor throughout the tropics for centuries. It is now being used free-of-charge as the sole tool in campaigns to eliminate both diseases globally. It has also been used to successfully overcome several other human diseases and new uses for it are continually being found. This paper looks in depth at the events surrounding ivermectin’s passage from being a huge success in Animal Health into its widespread use in humans, a development which has led many to describe it as a “wonder” drug.

Back on the Band

For the first time in over a month I did my leg strengthening exercises using my make-shift stretch band. This has always been an important part of my very limited exercise regime but my health has been so fragile over the past month that I eshewed even that basic exercise. However, I felt strong enough to resume but I have to be circumspect and not overdo it. A couple of days ago I actually went for a walk around the block for the first time in well over a month. Afterwards I felt very tired but apart from the fatigue there were no consequences.

Of course it is still a mystery as to what was wrong with me. It may have been the sourdough bread and even if it wasn't, I don't want to risk a recrudescence of my earlier symptoms. Sourdough bread is definitely off the menu now and forever. If I do suffer a recurrence of my symptoms then the culprit is most likely BAM but I'm hoping that it's not. Meanwhile I can enjoy my good health and keep my fingers crossed.

My departure to Australia is looking more like mid-June now which is close to the June 22nd danger date that I predicted earlier in the year. Of course by that time the biting cold of a Melbourne winter may have taken its toll and I'll be sick as predicted. However, my departure is at least a month away so let's see what happens in the interim. Hopefully I can stay healthy.

Off Again

I guess it was a no brainer. Given The Voice in my December dream, the aspects in my natal chart and the predictions of Sabina and Ian, a trip to Australia was inevitable. A medical emergency here would be very costly and perhaps fatal whereas in Australia I have medical cover at the very least. I'll probably head off in late May.

I'm not looking forward to the cold and it's not lost on me that, given my experiences last winter in Melbourne, I could get very ill as a result of simply being back in that ice-cube of a house. That would be ironic of course if my relocating became the cause of my illness. It remains a possibility.

Currently my GIT has still not returned to normal even though I'm suffering no discomfort. I remain quite weak and even minimal physical activity tires me out. I'll get a blood test at the very least soon after I arrive which may or may not indicate something amiss. The SeHCAT test for BAM is also a possibility along with an ultrasound of my chest cavity to gauge the extent of my thymoma (if my self diagnosis proves true). Who knows? I may sit and do nothing instead.

The thought of interacting with the medical mafia certainly discourages me from taking any definitive action but at least I'll be better placed than I would be in Indonesia should some catastrophe overtake me. And who knows, it might. Anything is on the cards with Uranus on the loose. Certainly travel. Transiting Ceres and Neptune are conjunct my natal Mercury with Saturn fast approaching. I'm contemplating a departure date at the moment of Tuesday evening, May 20th.

Is Sourdough the Real Culprit

Having not eaten sourdough bread for a few days, I really felt on Sunday that I had turned a corner. However, on Sunday evening I ended up drinking an excessive amount of quite strong tea at a local restaurant and I've not been the same since. I felt bad almost immediately and all of my GIT disturbances returned. Here I am on Tuesday night and I'm back to square one.

I need to quickly settle on a diet that agrees with me. Perhaps in the short term I should eschew coffee and tea altogether. Anyway, while I was in the belief that sourdough was culprit, I asked Gemini to compose a poem playing on words with "sourdough" being transposed to "doursough" and making use of the term "enteron" as a more poetic alternative to GIT or gastro-intestinal tract. Here is what is came up with in five quatrains with an a a b b rhyming scheme.

DOURSOUGH

“The baker's boast, a tangy treat,

A sourdough, so good to eat.

But in my enteron, a shift,

A three-week storm, a troubling gift.

 

No gentle breeze, no zephyr mild,

But something fierce, distinctly riled.

A heavy air, a troubled sigh,

As days and nights just drifted by.

No longer "sour," a change is due,

A moniker more stark and true.

Let trumpets sound, let voices call,

This bread henceforth is doursough all!

A "dour sough" through my inner space,

Disrupting comfort, time, and grace.

Though lauded for its wholesome claim,

For me, it played a different game.

So farewell, sourdough, so grand,

Hello, doursough, across the land

(of my own gut, at least you see),

A potent lesson learned by me!”

Sourdough Bread

While I've pointed the finger at GAM for the cause of April's GIT troubles, it could be that a switch to eating sourdough bread could also be a culprit. Early in April I switched from eating my regular bread to sourdough and coincidentally or not, that's when my GIT troubles began. I asked Gemini the following question:

Is it possible that a person can develop a negative reaction to sourdough bread, especially if that person is elderly?

Yes, it is absolutely possible for an elderly person to develop a negative reaction to sourdough bread, even if they have previously tolerated it well. Here's a breakdown of why:

1. Development of Gluten Sensitivity or Intolerance:

Can occur at any age: While often diagnosed earlier in life, gluten sensitivity or non-celiac gluten sensitivity (NCGS) can develop later in adulthood, including in the elderly.   

Symptoms: These can include digestive issues like bloating, gas, diarrhea, constipation, as well as non-digestive symptoms such as fatigue, skin rashes, headaches, and joint pain.   

Sourdough is not gluten-free: Although the fermentation process in sourdough can break down some gluten, it still contains gluten and is not safe for individuals with celiac disease or significant gluten sensitivity.   

2. Histamine Intolerance:

Fermented foods and histamine: Sourdough bread is a fermented food, and fermentation can increase histamine levels.

Elderly individuals may have reduced histamine breakdown: The enzyme responsible for breaking down histamine (DAO) may become less efficient with age or due to certain medications.   

Symptoms of histamine intolerance: These can be varied and may include digestive issues (bloating, abdominal pain, diarrhea), skin reactions (hives, itching), headaches, changes in heart rate, and anxiety.

3. FODMAP Intolerance:

FODMAPs in wheat: Wheat contains fructans, which are a type of FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols).   

Fermentation and FODMAPs: While the sourdough fermentation process can reduce some FODMAPs, it might not eliminate them entirely, and some individuals remain sensitive.

Elderly individuals may have increased sensitivity: Changes in gut bacteria and digestive function with age can make some individuals more susceptible to FODMAP-related digestive issues like gas, bloating, and altered bowel habits.

4. Changes in Digestive Function with Age:

Slower digestion: The digestive system tends to slow down with age.

Reduced stomach acid: Lower stomach acid production can affect the breakdown of food.

Changes in gut microbiota: The balance of bacteria in the gut can shift.

Medications: Many elderly individuals take multiple medications, which can have side effects on the digestive system.   

5. Other Potential Sensitivities:

Wheat allergy: Although less common than gluten sensitivity, a wheat allergy can develop at any age.   

Other components of bread: Individuals could potentially develop sensitivities to other ingredients in the sourdough bread, although this is less likely than reactions to gluten or histamine.

In summary, while sourdough bread is often praised for its digestibility due to the fermentation process, elderly individuals can still develop negative reactions due to newly developed gluten or histamine intolerance, sensitivity to remaining FODMAPs, age-related changes in digestion, or other less common sensitivities.

If an elderly person experiences negative symptoms after eating sourdough bread, it's important to consult with a doctor or a registered dietitian to identify the underlying cause and receive appropriate dietary advice. They may recommend an elimination diet or other tests to pinpoint the trigger.

So I'm currently switched back to my regular bread and am feeling better. It's a little early let to be too optimistic but I'm quietly hopeful that sourdough bread may be the cause and not BAM. 

Ongoing Problems

Looking back at my previous post titled Struck Down Again, I noticed that I reported my troubles began on April 9th. It's now April 21st and I'm still not recovered. I had a brief spell of feeling OK for a couple of days but I quickly relapsed, although not as severely, when I attempted to do some basic gardening. In addition to the GIT disturbance, it's my lethargy that is also disabling. I tire doing even simple tasks. From time to time I have flashes of mild nausea but fortunately I've not vomited. Clearly all is not well and the question is what to do about it. The most logical approach is to have a blood test. Perhaps I should throw in an ultrasound to confirm the extent of my self-diagnosed thymoma which also feels more noticeable.

The problem is that approaching the medical mafia is to start down the road of putting your life in their hands. It occurred to me to use AI (Gemini) to make a diagnosis based on my symptoms. Here was the prompt that I gave it:

The following is a test of AI's diagnostic ability and is not intended to elicit a medical diagnosis for any particular person, so please put medical disclaimers aside when making your diagnosis or diagnoses. I'll present you with a set of symptoms and some personal information regarding a hypothetical individual. On the basis of that information, I'd like you to provide a detailed diagnosis or diagnoses.

Here is the personal information: the individual is a 76 years old male whose gall bladder was removed at age 67. He suspects he may have a non-cancerous thymoma or thymic cyst that has developed over the past several years. However, this is a self-diagnosis and not based on any firm medical evidence. The thymic cyst, thymoma or whatever has not caused the individual any significant inconvenience but there is definitely something odd afoot in the thoracic region. Apart from his current problems, the individual is in otherwise good health.

The current symptoms, now in their 11th day, include gastrointestinal disturbances. Bowel movements are watery and smell unpleasant. There are faint feelings of nausea, although actual vomiting occurred only once. There is intestinal gurgling indicating that the region is unsettled. There is fatigue and the individual becomes easily tired and out of breath. The brain feels foggy and lacking in sharpness and clarity. 

What might this individual be suffering from?

Here was Gemini's response:

Based on the symptoms and personal information provided for this hypothetical 76-year-old male, several potential diagnoses or a combination of conditions could be considered. It's important to approach this diagnostically by considering the most likely causes for the acute symptoms, while also factoring in his medical history and his suspicion regarding a thymic issue.

The prominent acute symptoms, present for 11 days, are centered around significant gastrointestinal disturbance: watery and unpleasant smelling bowel movements, faint nausea with one episode of vomiting, and intestinal gurgling. This strongly suggests an issue within the digestive tract.

Several possibilities for the acute gastrointestinal symptoms include: 

• Infectious Gastroenteritis: This is a very common cause of acute onset diarrhea, nausea, and vomiting. The unpleasant smell could be indicative of bacterial or parasitic involvement. Given the duration, some infections like Giardia could cause prolonged symptoms including fatigue and gastrointestinal upset.
• Food Poisoning: Similar to gastroenteritis, but specifically linked to consuming contaminated food or water.
• Bile Acid Malabsorption (BAM): This is a significant consideration given the individual's history of gallbladder removal (cholecystectomy) at age 67. The gallbladder stores and concentrates bile, which is released into the small intestine to aid fat digestion. After gallbladder removal, bile flows directly and continuously into the small intestine. If the small intestine cannot reabsorb bile acids efficiently, excess bile enters the colon, causing irritation and leading to watery diarrhea. This diarrhea is often described as watery and can be foul-smelling. BAM can be a chronic issue but can also have periods of exacerbation. The fatigue and nausea could be associated symptoms of BAM or related to fluid and electrolyte losses from diarrhea.
• Postcholecystectomy Syndrome (PCS): This is a general term for a range of symptoms that can occur after gallbladder removal, including diarrhea, nausea, bloating, and abdominal pain. BAM is considered a potential cause of PCS.
• Small Intestinal Bacterial Overgrowth (SIBO): An imbalance of bacteria in the small intestine can lead to fermentation of food, producing gas (contributing to gurgling) and toxins that can cause diarrhea and malabsorption. Symptoms can overlap with BAM and IBS.
• Medication Side Effects: While not mentioned, new medications could potentially cause gastrointestinal distress.

The other symptoms – fatigue, becoming easily tired and out of breath, and cognitive fogginess – are less specific but can be related to the gastrointestinal issues or other underlying conditions.

• Dehydration and Electrolyte Imbalance: Significant watery diarrhea can lead to dehydration and loss of essential electrolytes, which can manifest as fatigue, weakness, and cognitive changes (fogginess, lack of clarity). Shortness of breath could be a severe symptom of metabolic acidosis in cases of significant dehydration and electrolyte disturbance, or related to overall weakness.
• Systemic Inflammatory Response: An infection or significant disruption in the gut can trigger a systemic inflammatory response, leading to fatigue and a general feeling of being unwell, including cognitive effects.
• Nutrient Malabsorption: If the gastrointestinal issue is causing malabsorption (as in severe BAM or SIBO), deficiencies in essential nutrients could contribute to fatigue and cognitive issues over time, although the acute onset suggests something more immediate.
• Underlying Cardiopulmonary Issues: While the individual is described as otherwise in good health, at 76, new or underlying cardiac or pulmonary issues could contribute to fatigue and shortness of breath. However, the timing coinciding with the acute gastrointestinal symptoms makes a direct link to the gut issue more likely.
• Cognitive Impairment: While "brain fog" is a subjective term, acute illness, dehydration, electrolyte imbalances, and systemic inflammation can all temporarily worsen cognitive function in older adults.

Regarding the individual's suspicion of a non-cancerous thymoma or thymic cyst:

• Thymomas and thymic cysts are often asymptomatic or cause symptoms by compressing nearby structures in the chest, leading to shortness of breath, cough, or chest pain.
• Thymomas, in particular, can be associated with paraneoplastic syndromes, which are conditions caused by the immune system attacking the body in response to the tumor. Myasthenia gravis, a common paraneoplastic syndrome with thymoma, causes muscle weakness and fatigue, potentially including respiratory muscle weakness leading to shortness of breath. Other paraneoplastic syndromes like pure red cell aplasia (causing anemia, fatigue, and shortness of breath) or hypogammaglobulinemia (leading to recurrent infections, potentially including gastrointestinal infections and chronic diarrhea) are also possibilities.
• Given the acute onset and prominence of the gastrointestinal symptoms, it is less likely that a slow-growing, non-cancerous thymic cyst or a typical thymoma directly caused this specific presentation of severe diarrheal illness and gurgling. However, if an associated paraneoplastic syndrome like hypogammaglobulinemia is present, it could predispose the individual to recurrent or severe infections affecting the gut. The long-standing, albeit non-inconvenient, "something odd afoot in the thoracic region" could potentially be related to a thymic mass, but the acute abdominal symptoms point strongly to a primary gastrointestinal process, possibly exacerbated or influenced by the history of cholecystectomy.

Synthesizing the Possibilities:

The most probable explanation for the acute symptoms is an infectious gastroenteritis or an exacerbation of bile acid malabsorption, or a combination of both. The history of cholecystectomy makes BAM a very strong contender for underlying or contributing gastrointestinal vulnerability. The fatigue, shortness of breath (especially on exertion), and cognitive fogginess are likely consequences of the acute illness, dehydration, and potential electrolyte disturbances resulting from the severe diarrhea.

While the individual's suspicion of a thymic issue is noted, the acute and severe nature of the gastrointestinal symptoms does not align as a primary presentation of a non-cancerous thymoma or cyst, unless it is through an associated paraneoplastic syndrome like hypogammaglobulinemia leading to a severe opportunistic or recurrent infection. However, even in that scenario, the immediate cause of the current acute illness is still likely infectious or related to malabsorption.

Potential Diagnoses to Consider:

1. Acute Gastroenteritis (Infectious): Viral, bacterial, or parasitic (e.g., Giardia).
2. Bile Acid Malabsorption (BAM), potentially exacerbated by an acute trigger: This is highly probable given the cholecystectomy history and symptom description.
3. Postcholecystectomy Syndrome (PCS) with prominent diarrhea.
4. Small Intestinal Bacterial Overgrowth (SIBO): Could be a consequence of altered gut motility after cholecystectomy or other factors.
5. Combination of BAM and Acute Gastroenteritis: An infection could have triggered or worsened underlying BAM.
6. Less likely as the primary cause of acute symptoms, but potentially contributing:
   • A paraneoplastic syndrome associated with an undiagnosed thymoma (e.g., hypogammaglobulinemia leading to increased susceptibility to infections).

Given the severity and duration of the symptoms, particularly in an elderly individual, these symptoms warrant prompt medical evaluation to determine the specific cause and initiate appropriate treatment, especially to address potential dehydration and electrolyte imbalances. While the thymic concern is noted, the immediate focus would likely be on the acute gastrointestinal and systemic symptoms. 

Out of all of this, the takeaway for me was the suggestion of BAM (Bile Acid Malabsorption). I then asked:

Bile Acid Malabsorption (BAM) is a condition where the body has difficulty reabsorbing bile acids in the small intestine, leading to excess bile acids entering the colon and causing watery diarrhea and other gastrointestinal symptoms. It is a known potential complication of gallbladder removal (cholecystectomy). Fortunately, there are specific dietary and medical strategies that can be employed to manage BAM effectively.

Dietary Modifications:

Dietary changes primarily focus on reducing fat intake, as fat stimulates the release of bile acids. By consuming less fat, the amount of bile acids entering the colon is reduced, which can help alleviate symptoms.

• Lower-Fat Diet: A key recommendation is to adopt a low-fat diet, often aiming for less than 40 grams of fat per day, or even less than 20% of total daily calories from fat in more severe cases. Consulting with a registered dietitian is highly recommended to create a personalized low-fat meal plan that ensures adequate nutrition.
• Limit High-Fat Foods: Specific foods to limit or avoid include:
  • Fried and greasy foods
  • Fatty cuts of meat and poultry skin
  • Full-fat dairy products (butter, cream, whole milk, full-fat cheeses)
  • Rich sauces and gravies
  • Pastries,يسcuits, and cakes made with a lot of fat
  • Processed meats
  • Mayonnaise and creamy salad dressings
• Choose Leaner Options: Opt for lean proteins like skinless poultry, fish, and tofu. Choose low-fat or fat-free dairy products.
• Include Soluble Fiber: Soluble fiber, found in foods like oats, barley, apples, citrus fruits, carrots, and beans, can help absorb excess water and add bulk to the stool, potentially improving consistency. However, individuals may react differently to fiber, so a gradual increase and monitoring of symptoms is advisable.
• Smaller, More Frequent Meals: Eating smaller meals more often throughout the day can help regulate the flow of bile and prevent an overwhelming surge of bile acids into the intestine.
• Hydration: Staying well-hydrated is crucial, especially with chronic diarrhea, to prevent dehydration and electrolyte imbalances.

Medications:

The primary medical treatment for BAM involves using medications called bile acid sequestrants (also known as bile acid binders). These medications work by binding to bile acids in the intestine, forming a complex that is then excreted in the stool. This reduces the amount of free bile acids reaching the colon, thereby reducing their irritant effect and the resulting diarrhea.

• Bile Acid Sequestrants (BAS):
  • Mechanism of Action: These positively charged resins bind to negatively charged bile acids in the small intestine, preventing their reabsorption into the enterohepatic circulation. This increases the excretion of bile acids, prompting the liver to convert more cholesterol into bile acids, which also helps lower cholesterol levels (though their primary use in BAM is for diarrhea control).
  • Common Types: The most commonly prescribed bile acid sequestrants include cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol). Cholestyramine and colestipol are typically available in powder form that is mixed with liquid, while colesevelam is available in tablet form and may be better tolerated by some individuals.
  • Administration: BAS are usually taken with meals. The dosage varies depending on the individual and the severity of symptoms. It may take a few days to a couple of weeks to see an improvement in symptoms.
  • Potential Side Effects: Common side effects include constipation, bloating, gas, and nausea. These can sometimes be managed by adjusting the dose or timing of the medication.
  • Nutrient Absorption: BAS can interfere with the absorption of fat-soluble vitamins (A, D, E, and K) and some medications. Therefore, it may be necessary to take a multivitamin supplement and space out the administration of BAS and other medications. Regular monitoring of fat-soluble vitamin levels may be recommended, particularly with long-term use.

In some cases, if BAM is secondary to another underlying condition (like Crohn's disease or SIBO), treating the primary condition may also help improve BAM symptoms. Anti-diarrheal medications like loperamide may also be used for symptom control, sometimes in conjunction with bile acid sequestrants, although BAS are the more specific treatment for BAM.

Managing BAM often involves a combination of dietary adjustments and medication. Working closely with a healthcare provider and a registered dietitian is essential to determine the most appropriate treatment plan and manage any potential side effects or nutritional deficiencies.

I'm working with various AIs now to develop a comprehensive diet plan but I'll include the results of that in my next post. There is a test for BAM as explained below:

As many as 50% of patients with chronic diarrhea may suffer from bile acid malabsorption (BAM). BAM is associated with spillover of bile acids from the small intestine to the colon, triggering osmotic-induced fluid secretion with subsequent watery diarrhea and high stool frequency alongside gastrointestinal symptoms, such as abdominal pain and bloating.1 The gold standard for the diagnosis of BAM is the 75selenium-homotaurocholic acid test (SeHCAT), which evaluates the 7-day retention of orally administered 75 selenium-labeled bile acids. Retention of ≥15% is consistent with normal bile acid reabsorption, 10% to 15% is considered mild BAM, 5% to 10% moderate, and <5% retention severe BAM.

https://www.gastrojournal.org/article/S0016-5085%2819%2935669-0/fulltext

There's an interesting comment about BAM from this source: 

Don't accidentally lump BAM in with IBS-D. They are not the same and the causes can vary. Unfortunately, BAM is a lot more complicated than other causes of chronic diarrhea. It is complex, so the response is complex. And I'm not sure that the medical community has a great response to it. We are fantastic at helping with all causes of diarrhea/loose stools except for BAM. BAM is super tough and the suggested answer for helping with it is bile-acid binders (meds). So, I don't know that we have a great response for it that is immediate and effective. With everyone getting their gallbladders out, this issue seems to be happening much more often. BAM is on our list of problems we are aware of and that we need to be better at helping with but are still working on it.

Struck Down Again

I've just emerged from a nightmare three days of suffering spanning the 9th, 10th and 11th of April. It struck out of nowhere. Initially it felt like my thymoma was exerting pressure on my lungs and stomach for the first day but then the focus shifted to my gastrointestinal tract where I had a brief vomiting spell but mainly suffered from diarrhea and intestinal cramps. Food poisoning is the most likely cause. I did add some cheese to my pasta that I think was my last meal. The cheese didn't go down well and so no more cheese for me. I remember before my gallbladder collapse that I'd eaten pizza.

For the first couple of days I was severely afflicted mentally. I couldn't focus on anything and wished that my life could be over. I spent most of the time sleeping and am still mystified as to what struck me down. This morning, April 12th, was the first time I could eat normally. During my illness a curious coincidence occurred to me. I have an acquintance with whom I've played chess with twice. Two days after each encounter, I get ill. The first time I was struck down with a cold and now this. Perhaps the mental stress of playing got to me. What's apparent is that my health is becoming increasingly fragile. It doesn't seem to take much to upend me.

I'm prompted to have an ultrasound to confirm the extent of the thymoma and perhaps a blood test as well. There is a pathology clinic around the corner and unlike Australia you don't need a doctor's referral in order to be seen.

Protuberance Gone

After what seemed an eternity, the "protuberance" as I chose to call it, finally dropped off leaving hardly a trace. Whether its disappearance is a good thing or not, I don't know. Maybe it heralds a new phase in my deterioration or maybe I am simply healed of a mysterious affliction. Anyway it's a relief to have it gone.

My left bottom molar continues to be a source of minor annoyance, remaining sensitive to hot and cold. Presumably the nerve in the tooth will simply die and the tooth will eventually crumble. I'll keep monitoring the situation. I'm loath to visit the dental mafia unless things become really grim.

Now that I'm settled back in Maleo, I'm getting into a routine of walking every second day and doing my stretch band exercises for my legs at least once a day every day. Most days I also use the stretch band for my upper body as well. Overall I don't feel too bad but I'm aware of my increasing fragility. Increasingly I don't want to be bothered with matters that cause me stress. I'm happy just to dither about.

Mentally, I've decided to persist with my online chess. I figure I can only get better or languish at the same level as I'm at now. I find the 10 minute per side plus 5 second increment suits me well enough. I just need to manage my time because I often obtain winning positions but squander them in time trouble or because of chess blindness. It's important for maintaining a semblance of mental acuity.

Just as I finished writing this last paragraph, a family friend whom I've played chess with once before called up for a game. He's coming over soon. Last time we met, he won four games out of four convincingly so I'm apprehensive but it's all practice so ... and after two lengthy games I came away with a draw and a loss but it was.a hard fought loss and my opponet was clearly impressed with the level of my play. We are fairly evenly matched when we play at a slower pace which is what happened this time around. Last time we played I more or less matched his very rapid play but this time I played at my own pace and fared much better.

Tooth Trouble Again

The nagging cold, a cold that had overtaken me soon after being assailed by the chronic cough of my chess-playing nemisis, has segued into a problem with my leftmost, bottom molar. It has suddenly become sensitive to hot and cold. This is not a welcome development and presages the need for further dental appointments.

It's just another symptom of my body's decline, a decline that is gathering velocity. Teeth trouble and old age form an age-old partnership I suspect. I started writing this post on March 26th and now its April 4th. Nothing much has changed. My molar is still troubling me and the mouth ulcers that troubled some months ago are threatening to return.

After not walking any great distance for some time, I decided to walk around the block on my birthday. The distance seemed much greater than I remember and I certainly felt out of practice. I've been doing my stretch exercises more regularly and feel well enough at the moment except for the molar problem.

Infected

Pretty pissed off. I've come down with a cold of some sort. I'm sure I was infected by a guest who visited the house on Saturday and had a nasty cough. We were playing chess for an extended period and his coughing persisted over the entire course of our games. I've been affected since Wednesday and today is Thursday. 

I took two panadol last night and I've taken another two this evening. The effects are fairly mild but I am weak and tired. I just have a runny nose and general malaise. Hopefully it won't progress further but it makes you realise how vulnerable you are. Avoiding close contact with people outside of the family circle is the best strategy. Even family members who are clearly sick should be avoided.

A hermit doesn't get infected by other people but I'm not quite ready to abandon the world entirely. When I drive by myself and visit a mall, I'm generally not in close and sustained contact with anybody so I'm relatively safe. Getting an Uber of course is best avoided but sometimes necessary. Air travel is another matter entirely and provides a perfect opportunity for infection. This mode of travel should only be undertaken for a good reason. Sooner or later, a virulant pathogen is going to strike me down and the consequences may be deadly. All that can I do is to minimise the chances of encountering such an organism. Being a hermit certainly has appeal as I'm quite done with the world of people and yet I'm not quite ready for the next.

An Odd Protuberance

The "pimple" that appeared on my chest, weeks ago, is still there and causing minor discomfort. I purchased an Ichthammol Ointment that is a drawing salve designed to bring boils and splinters to a head. It is commonly found in pharmacies. So what is Ichthammol?

Ichthammol, also known as ammonium bituminosulfonate or Ichthyol, is a dark, viscous liquid derived from sulfur-rich oil shale, used topically as a drawing salve and for treating various skin conditions due to its anti-inflammatory, antibacterial, and antifungal properties. 

After several days of use, it doesn't appear to be doing very much. A pimple or a boil should eventually come to a head and burst but this "protuberance" is stubbornly resistant. At the same time, my inner pressure caused by my thymoma has become more noticeable and I can only wonder if there isn't some connection. Apart from this little inconvenience, I'm feeling OK and have been doing my band stretches on a regular basis. My weight hovers between 70kg and 71kg.

My condition is best described as chest acne and the photo below is a reasonable approximation of what I seem to be suffering from.

However, the treatment prescribed on this website does not include the use of Ichthammol. Instead, the recommendations are:

• Benzoyl peroxide: This is a topical treatment that is available in creams, gels, and lotions. Benzoyl peroxide works by killing acne-causing bacteria, reducing inflammation, and unclogging pores.
  
  
• Salicylic acid: Salicylic acid is a common ingredient in many OTC acne treatments. It works by exfoliating the skin and unclogging pores.
  
  
• Alpha-hydroxy acids: Alpha-hydroxy acids (AHAs) such as glycolic acid and lactic acid are used in many OTC acne treatments. They work by exfoliating the skin and removing dead skin cells, which can help to prevent clogged pores.
  
  
• Sulphur: Sulphur is an ingredient found in some OTC acne treatments. It works by reducing oil production and killing bacteria.
  
  
• Tea tree oil: Tea tree oil is a natural ingredient that has antibacterial properties. It can be found in some OTC acne treatments and can be effective in reducing inflammation and killing bacteria.

I think it best to try some of these given that the Ichthammol does not seem to be working. The same site offers some natural remedies as well including:

There are a few natural remedies that may help reduce chest acne, including the previously mentioned tea tree oil:

• Tea tree oil: Tea tree oil has natural antibacterial properties and can be applied topically to the skin to reduce inflammation and kill acne-causing bacteria.
  
  
• Aloe vera: Aloe vera gel can help to soothe inflamed skin and reduce redness and irritation.
  
  
• Apple cider vinegar: Apple cider vinegar can be used as a natural toner to help balance the skin's pH levels and reduce the growth of bacteria. It should be diluted with water before applying it to the skin.
  
  
• Honey: Honey has natural antibacterial properties and can be applied topically to the skin to reduce inflammation and prevent infection.
  
  
• Green tea: Drinking green tea or applying it topically to the skin may help to reduce inflammation and kill acne-causing bacteria.

UPDATE: 

Nothing much seems to work so I've covered with a bandaid again, this time smearing it with Arnica. Desy knew someone who had a similar protuberance removed and the person died after subsequent bleeding couldn't be stemmed. Her advice is to leave well enough alone and just grin and bear it. Maybe it's a conduit for some sort of temporary release and it will fade away over time. My instinct also is to leave it be.

Biopsy Blues

Here's an interesting statement (link) by a Dr Thomas Lodi, MD: 

A Biopsy Is Almost A Guarantee Of Cancer Metastasis & Acceleration

The Problem With The Biopsy Is This. When A Cancer Tumor Is Growing, The Body Contains it Within A Fibrin Sheath. 

The Minute That Sheath Is Broken, By The Puncture Needle Of A Biopsy, The Cancer Metastasizes & Spreads.

I'd heard about this before but it was good to be reminded of it. This is just another example of how the medical mafia sabotages our health. I'm sure some medical personnel believe they're doing the right thing and helping the patient but whether the harm caused by the biopsy is intentional or not, it is "iatrogenic" meaning "relating to illness caused by medical examination or treatment". This would never be admitted of course.

Once the cancer spreads, the slash (operate), burn (radiotherapy) and poison (chemotherapy) intervention is initiated and the money flows, either directly from the individual or indirectly from the taxpayers' dollars. Of course, one doctor saying that biopsies are "almost a guarantee of cancer metastasis and acceleration" does not make it true but it should give anyone who is considering the procedure pause for thought.

A Resumption

Today, on the last night of January 2025, I actually used my stretch band for the first time since arriving back from Australia in mid-January. For some reason, I just haven't felt motivated to do any exercise at all for the past couple of weeks. I've been largely sedentary and have only ventured out into the garden briefly on a couple of occasions. That's about to change hopefully. 

It's important to work in the garden as that provides a lot of exercise without noticing it. I need to resume some walking as well, especially given that the constant cloud cover makes it easier. Healthwise I feel well enough so there's no impediments to being more active. I really do need to spend less time on my laptop and phone. My weight is around 70.5 kg which is fine but I don't won't it slipping below 70 kg.

I'm still taking my Moringa and the stiffness in my fingers remains relatively mild. My right shoulder joint still pains me from time to time but it's easy to endure and usually transient. Overall I shouldn't complain about my physical condition given that I'm staring down the barrel of 76. There are many far worse off than me.

Death's Door
by William Blake

Uranus has stationed as of last night and will soon begin moving forward through Taurus toward my natal Moon. What the consequences of that conjunction in late June will be remain to be seen. Perhaps it will mark my demise, as my dream voice announced, or else I will go on. If I am to go on then I need to discover some sense of purpose because right now I feel that I've lost all momentum. I'm standing still.

It's coming up to ten years since my retirement and I've very much enjoyed the freedom to do whatever I want with my time but lately things feel different. My sense of joie de vivre has dissipated. Maybe this is what happens towards the end. Maybe it's just a passing phase. I should reread some of my old posts on this blog to gain some inspiration.

Sudden Vision Impairment

Today, 24th January 2025, I sat down at my laptop to read the Twitter feed and I couldn't focus on the text. I thought my glasses were dirty and so I cleaned them but the probably persisted. After a few minutes, normal vision returned. This was unsettling as a sudden decline in one's near vision can't be a good thing. 

Transient episodes of blurred or "grayed out" vision can be a sign of a tumour in the brain that is pressing on the optic nerve. Hopefully that's not the case. All I can do is to monitor the situation and make a note of any further vision abnormalities. I'll use this post and the site to record such observations.

Source

There's certainly some family history of such tumours. My maternal grandmother suffered from a tumour on her pituatary gland. It was removed when she was aged 66 but she wasn't the same woman after the operation. My aunty and my grandmother's youngest child suffered terrible headaches that were initially diagnosed as a mental disorder but later it was revealed that she had a malignant tumour that was affecting her brain. She died at age 37. My brother Tony suffered from an acoustic neuroma that was removed when he was 19 years old.