I’ve Got Uncomplicated Pancolonic Diverticular Disease
No doctor or anybody else for that matter seems at all bothered.
I did ask Dr. Google, if there was a link between pancolonic diverticular disease and coeliac disease and this paper entitled Prevalance Of Celiac Disease In Subjects With Diverticular Disease Of The Colon was indicated.
This was the conclusion of the researchers.
The results show an inverse relationship between
diverticular disease of the colon and celiac disease. These data
support that the presence of celiac antibodies may have a
preventive role in the development of colon diverticular disease.
The mechanism of the presented finding is still unclear. More
research is needed.
I can accept that conclusion.
Click this link to see what the NHS says about Diverticular Disease and Diverticulitis.
It’s not very helpful, but just a bit frightening.
Could it be, that my strong immune system is protecting me?
I have a few extra thoughts.
Living With Uncomplicated Pancolonic Diverticular Disease
I have now been living with Uncomplicated Pancolonic Diverticular Disease for around six months.
But I don’t feel that much different to say, when I was 18, 50 or 70.
In the mid-1990s, I was diagnosed as a coeliac using the new genetic test, in a couple of days between blood test and letter on the mat. So surely, at fifty, I must have had coeliac antibodies in my blood.
I asked Dr. Google how the standard coeliac test worked and got this reply.
The standard coeliac disease test involves a two-step process: blood tests to detect antibodies, followed by an intestinal biopsy to confirm the diagnosis. The blood test looks for specific antibodies produced when the body reacts to gluten, while the biopsy examines a tissue sample from the small intestine for damage characteristic of coeliac disease.
My excellent now-retired GP, told me, that the antibodies test was usually all that was needed.
So have I had coeliac antibodies in my blood, virtually all my life and have these played a preventive role in the development of colon diverticular disease?
So was I protected from a disease with a long and complicated name, by another disease, I didn’t know that I had?
Using AI To Inveestigate Uncomplicated Pancolonic Diverticular Disease
I have been impressed by th answers Google has given for other things using AI, so I’ve been asking a few questions on uncomplicated pancolonic diverticular disease.
Question: Does Uncomplicated Pancolonic Diverticular Disease Make You Want To Poo?
AI Overview
Yes, uncomplicated pancolonic diverticular disease, also known as Symptomatic Uncomplicated Diverticular Disease (SUDD), can cause a change in bowel habits, which may include a feeling of needing to poo. This change can manifest as constipation or diarrhea, or a pattern of constipation followed by diarrhea.
From personal experience I’ll go along with that.
Question: Does Uncomplicated Pancolonic Diverticular Disease Make You Want To Drink More Fluids?
AI Overview
Yes, individuals with uncomplicated pancolonic diverticular disease are often advised to increase their fluid intake. This is because adequate hydration helps soften stools, which can ease the passage of waste and reduce strain on the inflamed colon. Additionally, when experiencing a flare-up of diverticulitis, it’s common to be placed on a liquid diet to allow the colon to rest and heal, further emphasizing the importance of staying hydrated.
No doctor has told me to drink more fluids or suggested I go on a liquid diet. But I do drink a lot of fluids, including two or three bottles of low-alcohol beer per day.
Question: Is Uncomplicated Pancolonic Diverticular Disease Helped By A Gluten-Free Diet?
AI Overview
A gluten-free diet is not specifically recommended or beneficial for uncomplicated pancolonic diverticular disease. While a high-fiber diet is generally recommended to manage and prevent diverticular disease, there’s no evidence to suggest that eliminating gluten from the diet provides any particular advantage.
As I am coeliac, I’m on a strict gluten-free diet anyway, and have been for the last thirty years.
I’m not particularly on a high fibre diet, but an experienced dietician told me to eat a small can of beans a week to lower my cloresterol levels. And it worked!
But from what I found earlier, it does appear that coeliac disease does help to protect you from uncomplicated pancolonic diverticular disease.
Question: Is Uncomplicated Pancolonic Diverticular Disease Helped By Five Portions Of Fruit And Vegetables Per Day?
AI Overview
Yes, eating five portions of fruits and vegetables per day is generally recommended for individuals with uncomplicated pancolonic diverticular disease, as part of a balanced, high-fiber diet. This dietary approach can help to soften stools, reduce the risk of constipation and straining, and potentially prevent further complications.
I try to stick to a diet like this with a lot of non-alcoholic fluids.
Question: Is Uncomplicated Pancolonic Diverticular Disease Linked To Gallstones?
AI Overview
Yes, there is evidence suggesting a link between diverticular disease of the colon and gallstones, with some studies indicating a higher prevalence of gallstones in individuals with diverticular disease. Specifically, one study found that 45% of patients with diverticular disease had gallstones, compared to 22% in a control group, though this difference was only statistically significant in women.
I had gallstones and I described their removal in Goodbye To My Gallstones.
As the answer mentioned women and coeliac disease is more common, in the female of the species, I wonder if that accounts for the results quoted in the AI Overview.
Application Of Control Engineering Principles To The Calculation Of Pharmaceutical Drug Doses
Today, I was asked by an eminent cardiologist to give my opinion on this scientific paper in the Journal of the American Heart Association, which was entitled Personalized Antihypertensive Treatment Optimization With Smartphone‐Enabled Remote Precision Dosing of Amlodipine During the COVID‐19 Pandemic (PERSONAL‐CovidBP Trial).
This was the background to the study.
The objective of the PERSONAL‐CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID‐19 Pandemic) trial was to assess the efficacy and safety of smartphone‐enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID‐19 pandemic.
These were the methods and the results.
This was an open‐label, remote, dose titration trial using daily home self‐monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5–7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10–12)/7 (95% CI, 6–7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events.
These were the conclusions.
Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App‐assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long‐term care.
About Myself
I am a Graduate Control Engineer, who graduated from the University of Liverpool in 1968.
I then worked at ICI in Runcorn for eighteen months, before moving to ICI Plastics Division, because of the untimely death of my father-in-law.
One of my tasks at Welwyn, was to look at control algorithms for chemical plants. For this I often used a PACE 231-R analogue computer.
Note.
- These computers could solve up to a hundred simultaneous differential equations at one time.
- They were programmed by wiring the various amplifiers and potentiometers together to simulate the equations.
- There were only a few transistors in these powerful machines, as all electronics were thermionic valves.
- Two of these machines wired together, were used to calculate the trajectories of the Apollo missions.
They were the unsung heroes of bringing Jim Lovell and Apollo 13 home safely.
Determining Control Algorithms
In a typical problem, I would model the a section of a chemical plant and the control system around it.
This would then lead to recommendations, as to the design and operation of the plant, so that it performed as required.
It could be argued that the body of an animal, is a very complicated integrated chemical plant, with a sophisticated control system.
For instance, if sensors around the body, say you are slightly low on fluids, your brain determines you should have a drink.
Many control loops on a chemical plant are controlled by proportional–integral–derivative controllers, which are commonly known as three-term controllers.
This is the first two paragraphs of the Wikipedia entry for three-term controllers.
A proportional–integral–derivative controller (PID controller or three-term controller) is a control loop mechanism employing feedback that is widely used in industrial control systems and a variety of other applications requiring continuously modulated control. A PID controller continuously calculates an error value
PID systems automatically apply accurate and responsive correction to a control function. An everyday example is the cruise control on a car, where ascending a hill would lower speed if constant engine power were applied. The controller’s PID algorithm restores the measured speed to the desired speed with minimal delay and overshoot by increasing the power output of the engine in a controlled manner.
I wouldn’t be surprised that the app in the smartphone used in the PERSONAL‐CovidBP Trial contained a form of three-term controller.
These are some points about three-term control algorithms.
Changing Of External Factors
One that was the villain in a problem, I dealt with, also affects my body – the weather.
I was asked to look at the problem of a chemical reaction, that overheated in hot weather. But the plant operators solved it by better insulation and ventilation of the plant and the standard three-term controller adjusted itself automatically to the new conditions.
After my stroke, I am on Warfarin for life. I test my own INR with a Roche meter and I have noticed that atmospheric pressure affects my INR. I change my deose accordingly, using a simple algorithm, of my own design.
The More You Test The More Precise The Control
If you take the cruise control example used by Wikipedia, speed is monitored continuously, as I hope, it would be if you were driving yourself.
But obviously, in many systems, where you are using an input with discrete values to control a system, you can’t be as precise as the data you collect.
When my son was dying from pancreatic cancer, he was fitted with a morphine pump, that he could adjust himself to dull the immense pain he was enduring.
- His nerves and his brain ascertained the pain level.
- He then adjusted the morphine level.
- He could get very precise control of his pain, because he was measuring it continuously.
But he was only using simple one-term control (proportional).
Derivative Control Can Be Difficult To Get Right And Can Even Go Unstable
Derivative control is mainly to stop overshoot, but sometimes you will find that it can go unstable, so two-term(proportional+integral) controllers will be used.
How I Control My INR
As I said earlier, I am on Warfarin for life and test my INR with a Roche meter.
The NHS typically tests patients about once every six weeks, which in my opinion as a Control Engineer is too infrequent.
I usually test myself a couple of times a week.
But every so often, I evaluate what daily dose gives me an equilibrium INR level of 2.5.
For the last three years, I have found a dose of 3.75 mg keeps me more or less on 2.5.
- As Warfarin comes in 1, 3, 5 and 10 mg. tablets, I alternate 3.5 and 4 mg.
- Warfarin tablets are easily cut in half using a sharp knife.
- I record INR and dose in a spreadsheet.
I have been doing this now for over ten years.
Is This A Unique Property Of Warfarin?
In this time, I have had five medical procedures, where surgeons were worried, that as I was on Warfarin, I might bleed too much.
For the first, which was to remove a lump from my mouth, the private surgeon wanted to charge extra for an anaesthetist. In the end, I asked what INR he wanted and he said 2.1 should be OK!
- So I reduced the Warfarin level and tested every day.
- I judged it correctly and had an INR of 2.1 on the day of the operation.
- The operation went incredibly well and I went home on public transport.
- The lump turned out to be benign.
- I’ve not had another lump.
After the operation, I increased the Warfarin level and tested every day, until it regained a level of 2.5.
On analysing my doses through the date of the operation, I found that the total amount of Warfarin, I didn’t take to reduce my INR to 2.1, was the same as I took to bring it back up again to 2.5.
Is this a unique property of Warfarin?
Since then I’ve had two cataract operations performed in a private hospital, where the NHS paid. Interestingly, they wouldn’t trust my own INR readings, so I had to get my GP to take the measurement.
I’ve also had gallstones removed by endoscopy at the local Homerton NHS hospital.
- For cases like mine, the hospital hire in a surgeon from the posh Wellington private hospital for one day a week, who brings the specialist tools needed.
- I wrote about this in Goodbye To My Gallstones.
- As it was a more serious procedure, I reduced my INR to a requested 1.0.
Interestingly, I still have my gall bladder, but the surgeon put it on notice to behave.
Conclusion
I would totally agree with the conclusion given in the PERSONAL‐CovidBP Trial.
Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App‐assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long‐term care.
I would add some conclusions of my own.
- The app used in the PERSONAL‐CovidBP Trial, seems to have had a good algorithm.
- I suspect the app could also be Internet-based.
These are some general conclusions.
- If you are on Warfarin and have access to a Roche meter, it is possible to lower your INR to the value required by a surgeon for an operation or a procedure.
- Since starting to take Warfarin, I have had four operations or procedures, where others would have had anaesthetic or a sedative.
- In those four operations, I was able to go home on public transport. If I still drove a car, I could have driven home afterwards.
- Private hospitals like to use an anesthetist, as it pumps up the bill.
- Avoiding anaesthesia must save hospitals money.
Well designed apps, based on Control Engineering principles, that help the patient take the best dose of a drug will become more common.
Possible Coeliacs Should Get Tested
I was diagnosed as a coeliac by both the quick genetic test and the gold standard of endoscopy.
The genetic test is no more painful than any other blood test, but many people are afraid of endoscopy.
I have had four endoscopies.
- Two to check I had coeliac disease.
- One to investigate a problem in my gut with an ultrasound probe, which turned out to be gallstones.
- One to remove the gallstones, by punching a hold in my gut and then inserting and inflating a balloon to force them out.
Only for the last procedure, did I have any form of sedative. I was game, but the surgeon wasn’t!
Note that gallstones are often associated with coeliacs! As are cataracts, which I’ve also had removed from both eyes.
Yesterday in Liverpool, I had chats with two possible coeliacs, one of whom actually had a coeliac mother and the other a gluten-intolerant daughter.
This page on the NHS web site is an overview about Coeliac Disease.
Under Diagnosis Of Coeliac Disease, this is said.
First-degree relatives of people with coeliac disease should be tested.
My three sons didn’t get tested, despite both my late wife and myself insisting after my diagnosis.
Conclusion
If it’s ever suggested you be tested for coeliac disease, you should get tested.
It’s not a big deal these days.
Homerton Hospital Is Bottom Of The List
In The Times today, there is an article, which is entitled Ambulance List Shows NHS Trust With The Worst Delays.
My local hospital is Homerton and it gets a very honourable mention.
At the other end of the scale, four trusts accepting patients by ambulance reported no delays of more than an hour, led by Homerton University Hospital in east London.
It is interesting that Homerton is down as one of the best.
My GP reckons it has improved greatly in the last few years. He also says, that they seem to have more spare capacity, than the other hospitals in the area.
The hospital removed my gallstones using endoscopy and I walked out to a waiting car. I could have taken the bus, if required.
I also had a knee X-rayed, where the GP gave me a chit and told me to just turn up unannounced in one of two specific three-hour periods. I was in and out in just over ten minutes.
Homerton seem to be thinking hard about their organisation and methods.
Could this be why they are the best on the list?
So what is our South London Mayor doing to improve transport to this much improved hospital?
He’s cutting out, one of the major bus routes to the hospital.
How Celiac Disease May Affect Your Risk for Gallbladder Disease
The title of this post, is the same as that of this article on verywell.health.
I am posting, as I am a coeliac, who has had gallstone problems and want to be able to find the article easily in the future.
Goodbye To My Gallstones
It is now some weeks since I said goodbye to my gallstones.
They were in my bile duct and were discovered by using an ultrasound probe on an endoscopy at Homerton Hospital. I didn’t even put on a hospital gown.
I had that endoscopy, as I did my two previous ones at Addenbrooke’s Hospital in Cambridge to check for coeliac disease without a sedative, as Addenbrooke’s likes to be efficient and cutting out sedatives reduces the manpower required, cuts the need for recovery beds and allows patients to drive home.
After this endoscopy, I came home the way I arrived – on the bus!
I would say that a good endoscopy operator should be able to do the procedure without a sedative. Although in this case, the nurse holding the oxygen tubes up my nose, was stroking my beard to calm me down. Not that I needed it! But it was a nice action!
I had the removal of the gallstones with a sedative, but I only remember the anaesthetist saying something like “Lovely” as he threaded the camera and attachments down my throat.
They broke into my bile duct from the duodenum and then inserted a balloon, which was then inflated to flush the stones back into my duodenum.
I must have dropped off and I woke without any pain or even discomfort.
One complication for me, was that I am on Warfarin, but I dropped my INR to one before the operation, so that there wasn’t blood everywhere.
I have had some after effects.
Where Has My Constipation Gone?
Since I was about sixty, I have suffered from constipation and my GP has prescribed a laxative.
I felt it was a family trait as my father was also a sufferer.
But since the operation, I have only taken one pill, that may not have been necessary.
My Appetite Has Returned
I am certainly eating better and I have not put on any weight.
Conclusion
If you have gallstones and removal is suggested, go for it!
Has Ciprofloxacin Attacked My Tendon?
After my gallstone operation, the hospital gave me a week’s Ciprofloxacin, which is an antibiotic, to take.
I took one tablet on Thursday evening and another on Friday morning. But as I returned from shopping at the Angel, it felt like I had a splinter in the heel of my left foot.
The pain was so bad I could hardly walk this morning.
I have had plantar fasciitis in the past in my left foot, and as someone, who has spent a working life looking for connections in databases, I wondered if the Ciprofloxacin had anything to do with it.
So I looked up the data sheet on MedLinePlus, which is a trusted site, from the US Library of Medicine.
The data sheet starts with this Important Warning.
This is the first paragraph of the warning.
Taking ciprofloxacin increases the risk that you will develop tendinitis (swelling of a fibrous tissue that connects a bone to a muscle) or have a tendon rupture (tearing of a fibrous tissue that connects a bone to a muscle) during your treatment or for up to several months afterward. These problems may affect tendons in your shoulder, your hand, the back of your ankle, or in other parts of your body. Tendinitis or tendon rupture may happen to people of any age, but the risk is highest in people over 60 years of age. Tell your doctor if you have or have ever had a kidney, heart, or lung transplant; kidney disease; a joint or tendon disorder such as rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function); or if you participate in regular physical activity. Tell your doctor and pharmacist if you are taking oral or injectable steroids such as dexamethasone, methylprednisolone (Medrol), or prednisone (Rayos). If you experience any of the following symptoms of tendinitis, stop taking ciprofloxacin, rest, and call your doctor immediately: pain, swelling, tenderness, stiffness, or difficulty in moving a muscle. If you experience any of the following symptoms of tendon rupture, stop taking ciprofloxacin and get emergency medical treatment: hearing or feeling a snap or pop in a tendon area, bruising after an injury to a tendon area, or inability to move or to bear weight on an affected area.
After reading that, I decided the best thing to do was to call a doctor, so I dialled 111 and within three hours I was seeing a young local doctor in his surgery.
He decided to be prudent and changed the antibiotics.
I have since found out from this page on celiac.com, that not all Ciprofloxacin is gluten-free. Mine was from a company called Torrent.
Prioritising Patients
Homerton hospital is hoping to remove my gallstones on Thursday by endoscopy, so it’s just a fairly small procedure.
I do wonder if there is a shortage of nurses, doctors and other staff at the hospital caused by either the Covids or the fuel crisis, if some operations will be cancelled.
At no time, in the diagnostic process was I asked if I was in pain. Which I am not!
Surely, in the Age of Covid-19, where there is great uncertainty about predicting hospital capacity just a few weeks in the future, I should have been asked a few questions, so that urgent cases could be given priority if necessary.
As they must have been there for a few months causing me no trouble, surely a few extra weeks won’t make much difference to me.
The Diagnosis Of My Gallstones
I arrived at Homerton hospital as instructed today for the endoscopy.
Strangely, it was C’s birthday.
The procedure would involve passing an ultrasound probe down my throat and through my stomach to take an ultrasound image of the lump close to my liver.
I’d had two endoscopies before in the late 1990s at Addenbrookes to check for coeliac disease. One was a normal one, but in the second, I was also providing a sample of fluid for a research project at Cambridge University.
I seem to remember at Addenbrookes, I had been instructed to turn up in something like a tee-shirt and shorts, which is what I did. In this case, I took my shirt off and put a hospital gown over my cord trousers.
As I’d had the two endoscopies at Addenbrookes without a sedative, I suggested strongly, that they do the investigation without one this time as well.
The doctor, who was of an age to be very experienced, said he was up for it and we went for it without a sedative.
There was two big differences to the procedure at Addenbrookes.
- There were more staff, than Addenbrooke’s doctor and a technician.
- They were fully gowned up, as opposed to normal clothes.
But, then I got the expression at Addenbrooke’s they were aiming for speed and they were only confirming their earlier diagnosis of coeliac disease. that had been made by a genetic test.
Everything this time, went without a hitch.
- I was laying on my left side.
- I had oxygen tubes up my nose.
- With my right hand I can feel the probe in my stomach.
- To calm me down, a nurse was stroking my beard.
After not a long time, everything was done and I was walked back to recovery area.
Within half an hour, I was informed by the second doctor, that I had got gallstones and they would be taken out by endoscopy on September the 30th. Later they will take out my gall bladder by surgery.
I got the impression, it was the first time, that he’d seen this procedure without a sedative, as he described me as the Star-Of-The-Day. But then I’m a London Mongrel, with more survival genes than a garden full of Japanese knotweed.
I went home the way I came – On the bus!
After Effects
The only after effects were that the air in the theatre had dried me out and my left left arm hurt because I’d been lying on it.
So I vowed to drink a lot of fluids before the operation and do something to improve the strength of my damaged left arm.
The Anonymous Widower 