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.

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.

Cracked Rib and Other Ailments

Leaning into a garbage bin to retrieve a rock that had tumbled in along with the garden refuse that I was discarding, resulted in a pronounced crunch that left me feeling that my one or more of my lower ribs had cracked. I don't know for sure if it has but the area remains very tender and I have difficulty in moving from various positions.

A couple of weeks earlier I was suffered for a couple of days with discomfort in the right unguinal area after a lot of up and down movement in the garden. I didn't have any herniation but the sudden onset of symptoms was a bit of a shock. The decrease in the strength of my leg muscles is disturbing. Today I was bending over repeatedly and putting all the weight on my right leg as I plucked out grass shots from the wood chip in the garden. I soon found that the leg was becoming fatigued.

Gardening has the benefit of making one realise where the weaknesses are in ones body. The unguinal discomfort and today's rapid onset of fatigue in the leg muscles remind me that I need to do a lot more strengthening exercises for my legs. I have started doing some regular isometric exercises for my upper body and a little for my legs. 

As I do so, other problems emerge such as discomfort in the bony protuberances on my hands and elbows. The latter is termed the medial epicondyle (the bony bump on the inner side of the elbow) joint while the former is the pisiform bone. To quote: 

Pain and tenderness on the palmar and ulnar aspects of the wrist in the area of the pisiform bone is fairly common. Chronic pain in the pisiform area may be due to tendinitis of the insertion of the flexor carpi ulnaris, bony fractures or osteoarthrosis of pisotriquetral joint which is the second most common degenerative arthritis in wrist after the scaphotrapezial osteoarthrosis. Source.

My right shoulder continues to bother me, especially when lying horizontal in bed. If I raise my upper body a little using two pillows, the pain subsides. The discomfort from my thymoma is ongoing but only manifests when getting out of bed or doing stretching movements. This and these other disabilities don't encourage exercise but I need to persevere nonetheless or I'm to find myself increasingly incapacitated.

A few days ago I weighed in at 70.8 kilograms and in fact over these past months I've been hovering around 71 kilograms. If I drop below 70 kilograms, it will assuredly be due to sarcopenia so I must strive to maintain muscle mass.

Source

Just as I track the properties of the number associated with my diurnal age EVERYDAY, I should be equally diligent in tracking all exercises and activities associated with my physical health. Should it be a physical diary or an electronic one? What do I track? 

... to be continued.

Recrudescence

A recrudescence is defined as the recurrence of an undesirable condition and that's certainly a word that applies to me at the moment. For a while there, I thought that my stiff fingers, weak wrists and dodgy left ankle were on the mend and that the discomfort caused by my thymoma was largely in abeyance. However, the last few days have seen a rise in finger stiffness and a noticeable uptick in thymoma-related discomfort. My ankle remains tender but then again I've been walking fairly regularly of a morning so that's to be unexpected. Overall, my mobility and ease of movement have declined and I tend to dodder about the house being particularly careful when negotiating any stairs.

While on a walk, I can generally stride about as I did in the old days but with the constant awareness that all is not right with my left ankle. Apart from the morning walks, I'm engaging in very little physical activity around the house. I found my old resistance band that was fashioned from pantyhose but have yet to make use of it. One can only speculate on the cause of this decline and what the dire consequences might be if I were I to suffer another fall. I've spent no time at all on introspection designed to discover what remedial action is necessary on my part to stem and perhaps reverse this decline.

I've adhered to my a significant reduction in my intake of fried foods, assisted by use of an air fryer. This is a healthy choice of course but I don't whether it's sufficient in itself to turn things around. I need to look deeper into the underlying causes, both physical and psychological. To this end, I decided to take another Etorvel (Etoricoxib) tablet. I still had four tablets left following my tooth extraction. It was 2:30am at the time of ingestion and this gave me about four hours before my morning walk to monitor the changes in my physical condition.

If there's a noticeable reduction in my finger stiffness, ankle soreness and general restricted mobility, then my problem is definitely of an inflammatory origin. The body is attacking itself. I've written about the effects of this drug in my recent post titled Tooth Extraction. As I said in that post, it's not a drug that you'd want to take in the long term given its side effects but this one off experiment should prove useful. So how is the experiment progressing?

• After about half an hour, the physical effects are quite noticeable. I feel quite flushed and I'm sure my blood pressure is elevated. My brain is not working all that well. I don't feel like concentrating on anything too taxing. I have an inclination to listen to some music which I'm doing. My fingers still feel stiff so not much change there.
  
  
• After about an hour, there is a noticeable reduction in finger stiffness and wrist weakness and overall a general feeling of well-being. I'm continuing to enjoy the music.
  
  
• After about an hour and a half, the flushed feeling has subsided and my mental faculties have returned. The general improvement in my fingers and wrists remain but has far from disappeared entirely. I'm definitely moving more freely and am feeling far less stiff as I walk about.
  
  
• About three and a half hours later, I went for my morning walk and felt particularly strong with my ankle giving me very little trouble. It would be good if I always felt like this but I have the drug to thank in part this time.

What conclusions are we draw then from this little experiment? It would seem that the drug is working as it's supposed to:

Etoricoxib works by selectively inhibiting an enzyme called cyclooxygenase-2 (COX-2). COX-2 plays a role in the production of prostaglandins, which contribute to pain, inflammation, and fever. By blocking COX-2, Etoricoxib helps reduce these symptoms.

The question is why is my body continuing to produce prostaglandins that cause pain and inflammation. As Google's Gemini explained:

Prostaglandins are major contributors to the inflammatory response. They trigger processes like: 

• Increased blood flow to the injured area
• Increased permeability of blood vessels, allowing white blood cells to migrate and fight infection
• Pain perception by sensitizing nerve endings

 This process is what led to my DOMS but the problem is that the process never stopped.

ADDENDUM:

A day later and I'm still feeling very good. I have very little stiffness, my ankle is not troubling me and even the discomfort from my thymoma is greatly reduced. It will be interesting to see how long this feeling of well-being will last. Doubtless, the production of prostaglandins is still being inhibited by the Etoricoxib. 

The Big Freeze

Arriving in Melbourne in the depth of its winter and during a particularly cold snap has not proved good for my health. While I did do some walking upon arrival, I found that the cold was affecting my chest and so I've abandoned all forms of exercise. I definitely function better in the tropics and I'm looking forward to returning there.

This is the worst shape I've been in since my affliction emerged toward the end of 2018. Even moving about the city proved too much for me yesterday and I was struggling to make it back home. Since then I've spent most the time sleeping. The fact that I breathe through my mouth exacerbates the problem as the cold air enters my lungs directly whereas via the nose the air has a chance to warm up a little. When I consciously breathe through my nose, I find things are better.

There's so little information available about my condition and I'm not really sure what my condition is. My research leans toward thymoma or thymic cyst but most probably the latter as I have a long history of cysts on head and, as I only learned in 2015, cysts on my liver. "14% of patients with thymic cysts also had hepatic cysts" (see earlier post titled Thymoma or Thymic Cyst) and so there is clearly a correlation between the two. 

Hopefully, the temperatures will be warmer in Sydney in a week's time when we visit and on our return to Melbourne five days later. If this sees an improvement in my condition, then it will be strong evidence that low temperatures exacerbate my condition and are best avoided in the future. On an unrelated note, I weighed in yesterday at 74.7kg. This is the first time that I've weighed myself in a while and this weight isn't too bad considering my recent lack of exercise.

The Morning After

Oh dear. 15 posts to this blog for 2022 compared to 100 for my mathematics blog. It's clear where my priorities are. Nearly all my days are sober nowadays but on New Year's Eve I did cut loose and downed about one and half bottles of wine/champagne. The next morning I felt fine physically but not psychologically. For about three days afterwards, I didn't feel myself psychologically. 

Perhaps my astral body had been knocked out of alignment with its physical counterpart. I didn't feel all that comfortable in my physical body. It was only yesterday, January 4th, that I felt more or less my old self. It wasn't a comfortable experience and I'll think twice before I indulge in the demon drink again anytime soon. Perhaps the link between my astral and physical bodies is more fragile than it used to be in my youth and more easily disrupted.

I do know that I need to be more attentive to my body and more protective of it. To this end I've made my leg strengthening exercises a more or less daily routine along with some full squats and hand grip exercises. I regularly keep my neck flexible by use of appropriate stretches and rotations. I keep busy around the house, going up and down the many steps within it, which proves a good source of exercise in itself. There's a lot more I could do of course but then again any excess on my part is quickly punished. If I do expand my exercise regime, I need to do it by small increments.

My thymoma is quiescent but always present, its effects being felt whenever I put any stress on the area surrounding the solar plexus. When I was heading off to attend a twenty year reunion at a school I used to teach at, I was feeling a little nervous and had an attack of gastric reflux which was unusual for me. This might or might not have been related to the thymoma. Sometimes I forget about it altogether, for a day or two at least.

I keep clipping health articles that I come across to Pocket. I should review some of the articles here while I'm at it. Here's one that caught my attention (link):

Minute-long bursts of vigorous exercise during daily tasks linked with lower risk of death: study

“A few very short bouts totalling three to four minutes a day could go a long way, and there are many daily activities that can be tweaked to raise your heart rate for a minute or so.”

I've long believed this to be true but still fail to practise it because of an ingrained belief that I have to embark on an "exercise session" which I habitually procrastinate about undertaking. If only I could regularly undertake a brief burst of activity whenever the idea of doing so came to mind. 

This site is useful in providing specific burst activities and helpful diagrammatic summaries:

Some exercises, involving bending over, are not suitable for me. When I do this, I really feel the effects of the thymoma putting pressure on things. I'm lucky that the house I live in has so many steps, as this means that even normal movement around the house involves exercise.

Six Weeks of Indolence

After six weeks of holidays, I've eventually returned home and my weight was disappointing but not surprising. In shorts only, I weighed 74.5 kg. I say not surprising because I did very little exercise, even neglecting my leg strengthening exercises with the stretch band. I'm basically back to zero so anything I do from this point on will be of benefit.

Just before heading back home, I had the opportunity to have a brief session with my psychic healer who said that my lungs and heart were not in synch, meaning that my rate of breathing and my heart rate were out of synch. He recommended that I consume three sachets of SuperGoat per day. I was somewhat surprised at this prescription, after all drinking goat's milk sweetened with palm sugar isn't exactly my style. See Figure 1.

However, I have faith in his healing and have been dutifully consuming my three sachets daily for some days now. I can say that I've noticed some definite improvement in my condition since beginning the regime and I'm motivated to continue. My condition, as I've diagnosed it, is a thymoma or thymic cyst but my healer made no mention of kelanjar  or gland this time as he'd done on a previous occasion. 

Figure 1

Meanwhile I need to get my body back into some kind of shape, slowly of course. The goat's milk has provided me with a little more energy to embark on this enterprise. Before I was feeling too lethargic to even begin. At this point in my life, the goal is to simply hold on. Sooner or later, something will carry me off but hopefully it will be quick and, in the interim, I would like to maintain an acceptable level of physical health and cognitive functioning.

HOLD ON

Weight Gain

Oh dear. The hotel room in which I'm staying has a set of scales and for the first time in weeks I stepped onto them. Butt naked, I came in at a shocking 75.8 kg, the most I've weighed since my precipitous weight loss in the second half of 2015. Figure 1 does not show my feet, nor the transparent glass scales on which I stood, but it serves as a visual reminder of my slide toward obesity.

Figure 1

How did it come to this? Well, two weeks in Bali marked a decisive break from my normal routine at home. Meals become irregular and there's a tendency to eat more than one should. I have been walking but clearly not enough. The time has come of course to embrace some dietary discipline, reverse the weight gain and head back toward an ideal weight of between 71 kg. and 72 kg.

As for my thymoma, I've discovered in the process of palpation that I have a small area of my sternum that is sensitive to pressure. I hadn't noticed this before. There is a general feeling of discomfort when I move about while lying down but it's hardly debilitating. I've did bring my "elastic band" for leg exercises but haven't used it much at all. Whenever I have lengthy lapses like this, I find that the affected muscles lose their tone quite quickly and it takes some time to bring them back to full strength. The moral is to not allow such lapses. However, sometimes I feel quite weary and use that as an excuse.

My eyes have been giving some trouble and there is a growth on my left eye that is somewhat annoying. It's benign and has been around for a while but has slowly increased in size over the years. See Figure 2.

Figure 2

It shouldn't be too big a deal to have it removed, by laser surgery I would suppose. It's disturbing to see how far my eyes have sunk into their sockets, the inevitable consequences of old age. Along with diminishing eyesight, my mental acuity seems to be in decline although its hard to quantify to what degree. I try to keep mentally active.

Thymoma Update

There's nowhere to hide with a thymoma inside you. Yes, I'm back with another of my infrequent posts to this blog. I try to avoid thinking about my inner companion, hoping that it will just go away or at least stop growing. But growing it is and the pressure on my inner organs is being felt. Figure 1 shows an image from Wikipedia of a typical thymoma.

Figure 1

I hasten to add that this is my own diagnosis but there's not anything else that it could be really. The Wikipedia article adds that:

A third of all people with a thymoma have symptoms caused by compression of the surrounding organs by an expansive mass ... Once diagnosed, thymomas may be removed surgically. 

There are various stages described by the Masaoka Staging System:

I: Completely encapsulated

IIA: Microscopic invasion through the capsule into surrounding fatty tissue

IIB: Macroscopic invasion into capsule

III: Macroscopic invasion into adjacent organs

IVA: Pleural or pericardial implants

IVB: Lymphogenous or hematogenous metastasis to distant (extrathoracic) sites 

One hopes of course that the thymoma is completely encapsulated. I can't really ignore the reality anymore as it's starting to effect my daily functioning. Sneezes really hurt and I have to careful when I move about not to induce discomfort. Deep breathing is also met with discomfort. I need to seek medical help sooner rather than later.

Figure 2 shows how large these thymomas can grow:

Figure 2

My thymoma is a little on the right side of my sternum as shown in Figure 3 (marked with a red circle).

Figure 3

Hidden Hazards

Yesterday morning I tested out my mini-trampoline for about half an hour. I was basically just stepping up and down on it, and certainly not bouncing. The exercise seemed innocuous enough. However, I seem to have paid a price. Yesterday evening, I skipped my evening meal because my appetite was gone. During the night I felt somewhat nauseous and didn't even feel like breakfast this morning, although I did eat some toast later.

I think what happened was that the continuous up and down motion aggravated my thymoma. The motion of stepping up and down on the trampoline is quite different to that of walking. It would seem that my thymoma, probably an encapsulated cyst-like object located directly above my stomach, was bobbing about and pushing and pulling against things in a more extreme fashion than normal.

Despite my exercise routine being slow and sedate, it was enough to cause me serious concern. My reaction emphasises how fragile my body has become and how cautious I need to be when beginning any new exercises. My chest still feels sensitive and I have a general malaise.

Weighty Problems

First post of the year 2022 to my most neglected blog. Let's compare the number of posts for 2021 against the tallies for my other blogs:

• Mathematical Meanderings: 101 posts
• Alternative Media: 38 posts
• Pedagogical Posturing: 27 posts
• Astrology: 13 posts
• Astrowatch: 10 posts
• Staying Healthy: 7 posts

This meagre tally for Staying Healthy is odd since I spend a lot of time thinking about "staying healthy". I was shocked a few days ago when I climbed on the electronic scales and found my weight to be a hefty 73.3 kg. This morning however, I weighed myself and came in at 72.4 kg. It might be best to weigh myself at the same time each day: just after arising and before consuming breakfast. I don't want to regain the weight that I was before retiring, which was in excess of 77 kg and sometimes nearing 80 kg. I'm happy to be a little about 70 kg.

For this morning's weigh in, the result from this source indicates:

Height: 178 cm

Weight: 72.4 kg

BMI: 22.9 

This indicates your weight is in the normal category for adults of your height. For your height, a normal weight range would be from 58.6 kg ≡ BMI of 18.5 to 78.9 kilograms ≡ BMI of 24.9.

In the bad old (working) days, I was thus nudging this upper limit of 24.9 but soon after retiring my weight plummeted to a little above 63 kg at its lowest. Even this was far too thin and at 58.6 kg, with a BMI of 18.5, I would have looked skeletal. A weight of around 72 kg is ideal for me.

My resting pulse rate is a little above 60, usually 61-62, which seems fine. I haven't had my blood pressure measured for a while but that's never been a cause for concern. Figure 1 shows where I stand in the heart beats per minute game:

Figure 1: source

Exercise-wise I go for a brisk 20 minute walk with my granddaughter most mornings. I complete a sequence of 4 x 40 repetitions of leg exercises with my "elastic" band (which is actually just a piece of pantyhose that continues to stand the test of time). My reasoning is that it's important to keep the base strong in order to support the rest of the "structure".

Most days I also do around 300 partial sit-ups in which I lie on my back and attempt to sit up but don't actually go through with the manoeuvre, instead I just tense (and thus strengthen) my abdominal muscles. I sometimes do a set of 10 full squats but I've been neglecting this of late. I certainly do a lot of neck stretching and rotations in an attempt to maintain flexibility against the encroachments of ossification.

My thymoma, now of three years duration, doesn't cause me too much bother. I'm back to drinking a cup of coffee in the morning and sometimes another cup if I go out during the day. I don't drink tea at all now. I'm careful not to put too much stress on my upper body for fear of exacerbating the discomfort in my sternum. My granddaughter has been doing some psychic healing of the area and this has proven very effective.

Hopefully I will post more frequently to this blog during the coming year.

Thymoma or Thymic Cyst

 I was reading a medical journal article this evening and here is its introduction:

The normal thymus evolves over the course of a lifetime, with involution and gradual fatty replacement beginning around puberty. The thymus originates from 3 embryonic germ-cell layers and thus has the potential to transform along a number of neoplastic cell lines. On computed tomography (CT), the normal thymus appears as a triangular-shaped structure in the anterior mediastinum (see Figure 1). Variations in the morphology of the normal thymus gland, along with its association with a diverse range of pathologic processes, can make the thymus an imaging enigma and diagnostic challenge for clinicians.

Figure 1: source 

An abnormal appearance of the thymus can be attributable to either diffuse enlargement of the gland or a discrete mass. Benign thymic hyperplasia and lymphoma can both cause diffuse enlargement of the thymus. Many lesions—including thymoma, thymic carcinoma, and thymic carcinoids—as well as benign lesions—such as thymolipomas and cysts—can present with a focal thymic mass. This is often an incidental finding in an asymptomatic patient undergoing imaging for unrelated reasons. Clinical presentation can play a role in the evaluation of patients with thymic masses. One study found that more than 75% of asymptomatic patients with mediastinal masses had benign lesions, whereas almost two-thirds of symptomatic patients with mediastinal masses had malignant lesions. It has been suggested that expectant management can be considered for observation of asymptomatic patients with diffuse thymic enlargement. For symptomatic patients, biopsy or, at times, resection may be appropriate.

At present, CT remains the imaging modality of choice for the evaluation of mediastinal masses. Magnetic resonance imaging and positron emission tomography (PET) are useful adjuncts. While there is overlap in the features of many thymic lesions on imaging, some lesions have a characteristic appearance on CT. Thymolipoma, an uncommon benign thymic neoplasm, typically manifests on CT as a large anterior mediastinal mass containing fat intermingled with areas of soft-tissue attenuation, which may conform to the shape of other mediastinal structures. On CT, idiopathic multilocular thymic cyst, an acquired benign thymic lesion, cannot be reliably distinguished from the cystic components of malignant thymic lesions, including thymomas, Hodgkin lymphoma, and mediastinal germ-cell tumors. The appearances of thymomas on imaging can vary according to their staging and histologic subtype; lobulated contours, calcifications, and heterogeneous attenuation are associated with more-advanced, rather than early stage, thymoma.

Figure 2: source

The increasing use of CT has led to more-frequent identification of incidental lesions in the anterior mediastinum, and with recent advances in minimally invasive surgical techniques, an increasing number of thymic lesions are referred for surgical evaluation. Consequently, some patients may undergo invasive procedures for ultimately benign disease. If the benignity of a thymic lesion could be determined on imaging with a reasonable level of confidence, then the need for invasive procedures may potentially be obviated for a number of cases. The purpose of this study is to identify imaging features that help distinguish benign thymic lesions from early stage malignant thymic neoplasms.

From this study, we learn that "14% of patients with thymic cysts also had hepatic cysts" and:

A thymic cyst is a benign mediastinal disease which has been reported to be the second most common type of primary mediastinal cyst. Thymic cysts are rare, and the majority are believed to be congenital in origin. Approximately 60% of patients with a thymic cyst were asymptomatic, and the most common symptoms were cough, dyspnea, and chest pain, according to the literature (1,4). However, there were no specific symptoms for thymic cysts. 

Given that an ultrasound revealed that I had one or more cysts on my liver back in 2009, then the possibility increases that I might have a thymic cyst rather than a thymoma. It might be self limiting and not cause any severe problems. Up to this point, I've just assumed that what I had was a thymoma but that may not be the case. As the study says, it's often not possible, using CT, to determine the exact nature of an abnormality in the anterior mediastinum. Surgery may be carried out when it is not necessary. 

What struck me, when looking at the diagram in Figure 1 and similar depictions, is that there's not a lot of room in there and this means trouble when neoplasms or cysts develop. Lately I've been feeling quite tired during the day and fatigue is one of the symptoms of thymoma. For the moment, let's wait and see if my condition worsens or not.

Magnetic Healing

It was interesting to read that a thymoma is considered a relatively indolent neoplasia. In my case, it does seem to have an indolent quality and is certainly slow moving or perhaps it's stopped growing. Maybe it's self-limiting. In saner times, I might have sought an ultrasound to probe its extent but any contact with hospitals nowadays is best avoided. 

I asked my inner physician today what could be done to treat it and the answer that came back was magnetism. That was interesting. I decided to do a little research. I was surprised to learn that magnetism is used as a therapy in mainstream medicine. See Figure 1.

Figure 1: source

Figure 1 shows that magnetic fields (pulsed and static) and ultrasound (high intensity focused ultrasound and low intensity focused ultrasound) can be used to treat cancers. Hyperthermia, DNA damage and apoptosis (the death of cells which occurs as a normal and controlled part of an organism's growth or development) are some of the effects of the magnetic fields. 

However, given that I don't think my thymoma is carcinogenic and that I'm actively avoiding hospitals, any therapy that is carried out will be with my own magnets at home. So what's the news on magnetic healing at home? This site has the following to say:

Magnetic field therapy uses different kinds of magnets on the body to help boost your overall health. It may also help treat certain conditions.

There are several types, including:

Static magnetic field therapy: In this, you touch a magnet to your skin somehow. You might wear a magnetic bracelet or other magnetized jewelry. It could be a bandage with a magnet in it, or you may wear a magnet as a shoe insole. You could also sleep on a special mattress pad with a magnet in it.

Electrically charged magnetic therapy (electromagnetic therapy): The magnets you use here have an electric charge. Treatment with electromagnetic therapy usually comes through an electric pulse.

Magnetic therapy with acupuncture: Magnets go on the same sections of your skin that an acupuncturist would probably focus on in an acupuncture session. You may hear these areas called your energy pathways or channels.

How It Works

Your body naturally has magnetic and electric fields. All your molecules have a small amount of magnetic energy in them. The thought behind magnetic field therapy is that certain problems happen because your magnetic fields are out of balance. If you put a magnetic field near your body, it's believed things will go back to normal.

Does It Work? 

There haven’t been many studies on magnetic field therapy. The ones that have been done don’t have enough data to draw solid conclusions. Though some clinical trials have shown potential for magnetic field therapy as a treatment for back pain, for the most part, there's no clear proof that it can treat any condition.

The site is very much mainstream medicine so there's not likely to be much support for this type of therapy. Here is an abstract from an article on another site discussing the uses of neodymium magnets:

The strong magnetic field properties of magnets have led to their use in many modern technologies, as well as in the fields of medicine and dentistry. Neodymium magnets are a powerful type of magnet that has been the subject of recent research. This review provides a brief explanation of the definition, history, and characteristics of rare earth magnets. In addition, a broad overview of results obtained in studies performed to date on the effects of magnets, and neodymium magnets in particular, on body systems, tissues, organs, diseases, and treatment is provided. Though they are used in the health sector in various diagnostic devices and as therapeutic tools, there is some potential for harmful effects, as well as the risk of accident. The research is still insufficient; however, neodymium magnets appear to hold great promise for both diagnostic and therapeutic purposes.

These magnets can be bought easily online (see Figure 2):

Figure 2: source

There's no reason not to purchase one and try it out. The 40mm x 20mm size costs Rp218,400 which is about A$20. I should check first with my psychic healer in Medan who is overseeing the handling of my physical condition. If he approves, then I'll go ahead with it.

I don't know what's happened to my quoted text in this post. 

It's ended up italicised and enlarged for no reason that I can discern.