All of Duddon… Broughton Mills, Esdale and Woodland are great… less tourists than the rest of the Lakes, relatively low car numbers, friendly… 🙂

please feel free to come and pick up rubbish – or just enjoy yourselves any time… I’m lucky enough to be a resident!

looked to be up Walna scar from Duddon to the stone wall, south through the quarries the down ‘netty bridge’ descent over the watershed. Options then for traverse round to long mire and down to the pub or stephens ground and back to Duddon.  The other descent was Wallbarrow, so up the road to the pub, then into hard knot forest over the small humpback bridge, at Birks and up….

it’s all good, MTB, Gravel or road…

welcome & enjoy….

Though in truth that’s the amnesic properties… not that you were actually asleep… I have regular ‘discussions’ explaining to patients that last time they were not actually asleep… it just feels that way.

I have provided sedation (for dentistry), for more than 25 yrs and the techniques used for endoscopy are very similar / copied from those originally developed by our profession for the nasty stuff we end up having to do.

Both propofol and midazolam can be used as anaesthetic agents or for sedation, though the margin of safety for sedation is greater for midazolam than propofol, at least for an ‘operator sedationist’ model of care. I.e. it’s easier to inadvertently give you too much using propofol than it is with midazolam. Knocking you out is a BAD thing in this context, so if using propofol you need someone just for the sedation and a second operator for the procedure. With midazolam it can safely be performed by a single operator with nursing support.

In an outpatient context midazolam is probably a better option for most cases. Propofol requires a higher level of training for the sedationist, more kit (infusion pumps), and whilst recovery is slightly faster (discharge is not), amnesiac and anxiety reduction are about the same. Adding in additional opioids increases the complexity of the procedure and the risk of complications such as respiratory depression. It’s also unnecessary as single agent midazolam work just as well and is safer.

What really matters in terms of safety and ‘the experience’ is how well the team have been trained and how how carefully you are monitored in recovery. Either will provide anxiety reduction and and amnesia in about 80%.

Assos baselayer are really nice….

Have a look at four4ths as well. U.K. not as sophisticated as exposure, but I have had good service from my scorpion (?6-7yrs), and I have 2 scorch units. The extra / replaceable batteries are a useful back up.

Duddon Valley – it’s at the other end for the lakes but all the main routes / descents are rideable year round, and in the wet.
Natty bridge, park head road and wallowbarrow descent. Wouldn’t bother with Walna scar.

Read the SMC guide
On Skye the routes are much less obvious – the rock is fragmented and you require a higher level of navigation skill – especially as the compass isn’t always reliable. It’s the pinnacle of U.K. mountaineering and a step up from lakes or rest of Scotland.
I also take a helmet if climbing / descending any of the stone shoots / screes.
The are also guides you can hire….

I have 2 gradients – I bought a custom geometry frame, which my wife appropriated (shiny, purples and fits), I then replaced what was my’n with a stock frame (and coped with the spacers – I need a 185mm head tube to be comfortable).

I have been very pleased with the ride, and it works well round here in the lakes.

Unfortunately not ridden the Escape, but if I was buying from scratch I would make a trip and demo, also both companies will do some lovely anodising finish’s and I’m sure you will get a better more personal service, after all it’s one for life so…..?

View it as a weekend, or two away.

Peter F Hamilton the nights dawn trilogy
The commonwealth saga
The Great North Road was also good as a stand alone

Glen brittle campsite +/- car park
The walk to the end of the peninsula, ruined Brock, view across to Rum. Flat if in places a touch damp. Sit of end of cliff, watch for whales, seals and dolphins
Corrie Lagan busier but definitely WOW

Or to be virtually crowd free, follow the path to the southern end of the ridge, then climb up to the last peak. Walk back along the narrow grassy ridge, and eventually into the Corrie. Requires scramble out, but for all the world looks like Mordor…

USE as well….

I tried this with my gravel bike, in order of preference UK made, UK designed, everything else you need.

Frame – take your pick, lots designed in UK, far less are made here, but they are out there
Fork – designed yes – made? Much harder
USE seat post, bars, stem, bottles
Hopetech rear cassette, brake callipers, discs, hubs, BB, headset and seat clamp
Saddle fabric
Wheels built in UK but DT Swiss rims and spokes
Bike build at LBS
Lights Four4ths

Yes it’s got an Easton crankset, and a Shimano Ultegra hydro / XTDi2 combo

Bar tape ? Fabric

https://photos.app.goo.gl/whsqu7wBAJQ7ybbk6

I have been very pleased with my gradient, buying a second one for my partner this month. Build up with di2 1×11 hope tech cassette and USE components it’s 8.8kg without pedals, about 9.1kg as ridden.

Re breakages…. my frame came with a lifetime guarantee.

I was in exactly the same position last year. I wanted a Ti, UK made, gravel type frame. I went for a custom Reilly Gradient – the stock sizes are made elsewhere, but the custom frames are made in UK. The waiting list was / is currently 6 months. The custom geometry was +£350 a year ago.

Its a lovely bike to ride, so nice that I’m currently buying another one (a stock gradient frame this time with custom anodising), as my custom just got expropriated by my partner. The welds are as lovely as the ride. Everything I wanted to ride on the roads up here in Cumbria. If you can wait ….. I would certainly recommend one. It was also loads of fun sourcing as much other parts from the UK Hopetech, USE, Four4ths… then UK designed Fabric etc. You cannot quite manage everything of cause …. but it’s great fun!

Be ask your friends and work colleagues, get a recommendation, or call into a local practice, explain the problem and ask. If they don’t provide a service they will know who does.

Best of luck!

Your not exactly alone – around 40% would describe themselves as anxious, with about 12% of the population meeting the criteria of phobic. The best advice, echoing what already been said I’d ask for recommendations – some of us treat more anxious patients than others, usually because we like the challenge, and then develop skills in this area. Hypnosis can work for some , so can cognitive behavioural therapy, others benefit from sedation (which comes in a variety of types). This is still available via the NHS but only usually via referral to specialist services. Other practices / teams will offer it privately. The regulations and training requirements are quite strict, which is why it’s not as widely available as it used to be, though this means the teams left tend to do more of it, regularly.

The main specialist society is SAAD,

If the tooth has fractured and can be repaired with a filling -unlikely to be a problem

Root canal treatment should be possible, may be with a lower threshold for prescription of some prophylactic antibiotics.

Extraction if required, still possible – and if needed sooner better, but will carry the potential for increased risk of complications.

General rule of thumb, stabilise the problem by the least invasive means.

Yes I’m a dentist, and a tier 2 surgery provider (half way between general practice and hospital). Ideally sight of current blood tests, and a chat with oncology would be best prior to an extraction.

Petrol

To echo a previous comment…. Duddon Valley. It’s 40min from J36, it’s beautiful, quiet and everyone’s polite (if you are). Accommodation, cafes, pubs and shop in Broughton… It was done as classic ride a few magazines back. They did not quite get it all right…(you can incorporate the netty bridge descent and loupe into long mire – which is dry – and not loose height for the main high kiln cross descent.. And do the stone star descent from almost the top of great Stickle ). Just done bother with Walna scar it’s not worth it…. It’s relatively low level, doesn’t involve much hike a bike and is quite possible whatever the weather…. It’s also still fun in the rain. Multiple classic Lakes rocky descents, high kiln cross to the pub (conviently placed at the base of the biggest descent, or on only a slight detour if you do the extended loupe), grass guards to wallabarrow traverse has excellent views, and the descent has a different, but still engaging character to high kiln cross. Stone star, Netty bridge (use the fireroad in the forest to get to the top).

Nice that they thought to put the ‘start’ in the wrong place on the map, and left out all the ‘extra’ extension up to Great Stickle, to help discourage tourists.

As a Duddon resident, it was very considerate…..

I’m a dentist …

So providing you have no medical reason why not…(asthma, stomach problems..), a combination of 1 g paracetamol and 400 – 600mg ibuprofen taken 8 hourly will give you the best pain relief. Opioid work differently and are rarely useful for toothache.

If the wait is an issue, your own dentist could open the tooth and ‘extirpate’ remove the dying nerve. It’s the initial stage of endodontic treatment (aka root canal treatment, aka microsurgery…), and would not prevent the specialist from completing the treatment.

Like medicine, dentistry has specialities, of which endodontics is one. We are all trained to undertake the procedure, and most of us do so on a regular basis, but a GDC registered specialist will have a MSc (about three yrs of additional study), and access to an operating microscope. These make halo bikes look cheap. (The few hundred grand in study fees, and lost of income to get the qualifications just being the start….). My 3.5x top of the line loupes and coaxial light are around £5000, and Zeiss or Global microscope would be about £25,000 – £30,000…… But provide up to x20. Root canal treatment is basically undertaking microsurgery (instruments down to the diameter of a couple of human hairs), though a small dark hole, at the back of a larger, moving hole…..in the region of the human body the highest density of neurons outside the brain. To an accuracy of less than a mm. Simple? Err… It may appear so, but that’s because the person doing it is really really good at what they do.

Cost…. Well the NHS contract fees are actually the same for an extraction (20-30 mins), or root treatment (60-120minutes depending on which tooth), which then requires a whole load of expensive tech (an apex locator is about £1000, add as much again for the specialist micro motor, and then same again for the thermal GP to fill the canal…), and NiTi files (the ones which go in the drill are about £20-35 each and single use, you need anything from 1 to 5, plus 3 or 4 other instruments), so if you want to do a good job, with the correct upto date kit, and take enough time to do it correctly…. And expect it in the NHS (3 UDAs are worth about £70 on average….), you are relying on your dentist to do the right thing, and essentially take a loss. Which we do.

I would say about £250-450, is a reasonable fee for a non specialist. The specialist I refer to would cost £500-650. 90% success rate … Which will be better than my’n on the same tooth. If it’s a molar, you will usually need a crown as well. This makes a statistically significant difference in the long term, as it makes fractures less likely.

Hope you get sorted out…

Sinus pain is generally a dull continuous ache, made worse by (weirdly), sticking your head between your legs, nipping your nose and trying to blow your nose… This increases the pressure in your nose and sinus. Generally patients are aware of being stuffed up, or having a post nasal drip.

Over the counter decongestants, olbas oil etc are effective (it’s almost always viral, so antibiotics rarely appropriate unless it’s a chronic / anatomical problem). Problem is, if present it can make other symptoms worse as some of the nerves exit the upper back teeth, then run into the sinus, nd can then be affected by inflammation present ‘on the way’, so to speak.

I am a dentist, but haven’t examined you, so…..

There are a number of options, and frankly it can be very difficult to diagnosis a symptom that comes / goes, varies in intensity. Sometimes you end up starting with the least invasive option, eliminating it,mans then moving on. Which is to be far exactly what your practice have been doing….

One of the issues may be the cause may be multi factorial I.e. You may have a sensitive tooth (dentine sensitivity), plus some sinus congestion which exacerbates it. You could also have a molar tooth which is in the process of ‘dying’. Sometimes as these teeth have multiple roots one is compromised (and resulting in sympts), which these others remain vital… Making pinning down the problem tough. It’s also possible to have cracks within the tooth structure which are invisible on examination or xray, but only become detectable when you take the filling out and investigate.

Neuralgia is when the nerves which supply an area are damaged (trauma, viral infections, and other causes), so the pain is real, but it’s coming from the wiring, not he teeth. Also very tricky to diagnose, only way is to exclude every other cause, then maybe they show up on an MRI, though usually the diagnosis is made on clinical history plus improvement with some quite powerful medications.

HOWEVER

Common things occur commonly, go back and see your dentist. Your doctor will not be able to help.

I suggest you use interdental brushes….pipe cleaner things with a handle, Wakerpiks are very rarely useful. You are trying to achieve the same effect in between your teeth as you do with a brush on the easier to reach surfaces. So why try anything other than a brush?

The purpose is to disrupt the biofilm. Mechanical means win hands down. Which is why mouthwash is minimally effective. Yes there is some circumstances where we may suggest an antiseptic oral rinse…. Chlorhexidine for example. But it is not a substitute for effective mechanical cleaning. Oh and listerine has some evidence, but less than CHX. If you have ++++ decay a fluoride rinse at a different time to when you brush may be helpful.

A dentist. And yes I ride a Santa Cruz.

Ok …so speaking as dentist and a tier 2 oral surgery provider to the NHS (I’ll probably have wisdom teeth to remove on my list tomorrow), …..

A dry socket is exactly what is sounds like. It basically means the clot which did form initially, has broken down (usually due to food debris becoming lodged), and the bone is exposed / becoming inflamed. It’s painful but it DOES NOT NEED antibiotics. They are not the answer to everything, and do not relieve pain! This is the most common reason for increasing discomfort (usually initially better, then gets worse after 2-3 days), post op. It can happen with any extraction, but more common with surgical removed wisdom teeth.

Treatment is to have the debris removed, usually achieved but irrigating the socket with saline, or an antiseptic mouthwash (I use either one containing hydrogen peroxide or one with chlorhexidine). Depending on how it then looks, degree of closure etc it may or may not be worth popping in a pack – these all delay healing, but may make it feel better, and / or reduce further debris packing. So go back to your surgeon or your general dentist.

A post op infection (a situation which may need antibiotics to manage), is relatively uncommon at around 1-5%. The main characteristic being the presence of PUS, a raised temperature, and swelling associated with the pus. Treatment is to achieve drainage (get rid of the pus), antibiotics may be needed after drainage, but not always.

Pain relief…. Unless there are reasons to avoid (asthma, stomach problems etc… Check with your dentist), I normally suggest paracetamol + ibuprofen taken together (1g paracetamol + 400mg ibuprofen at 8hourly intervals).

Rinse carefully after every meal with saline or an antiseptic oral rinse for 7-10 days post op.

Wisdom teeth are used to research the effectiveness of different analgesics, so yes it’s unpleasant, but it will improve. If in doubt, reattend for advice.

YEP posts. I have been running one for 3 years, no need yet for a service, or even having to add more air!

The head doctor / star screw aluminium adjustment screw had snapped, so they needed to remove this (scary hammer!), then replaced the component, and the spacers with new hope components. Took about 45 minutes…

Having just spent 4hours riding the trails I recommended, in the lakes, at the end of half term, in beautiful, blazing sunshine, 26degrees C….
I met two walkers, two horses, and two guys on riding. One of whom was down from Keswick…. ! Massive day out to be riding Park head road!

For (shorter), lakes descents that you can also ride to the top of, I would suggest the Duddon Valley area, just don’t both with Walna scar. They are all rocky and a fun test, just not as committing as those listed above, but all rideable mans you don’t have to carry up!. They also have the advantage that even on a bank holiday it’s quiet, and relatively walker free. Nice bakery / shops / cafes in Broughton, and a very convenient pub…….
Park head road (high kiln cross down to the pub), stone star but start up by the tri (just keep going up!), the natty bridge descent into the top end of Broughton mills (use the fire road to get to the top after traversing around stevensons / hartleys ground), wallabarrow, and Black Combe (just possible to climb up via the Bootle bridleway, then descent south). You can loupe this via the Corney fell bridleway but be very careful with the washed out middle section, it’s lethal at present – deep wheel trapping gullies….

http://four4th.co.uk/products/lights/scorpion/

Brighter (should you want it to be) than a very bright thing

The mount is metal, adjustable and has a screw in, back up tether

Does not seem to fall out even if mountain biking in the lakes

Just need to remember to keep it charged

You do need to see a dentist as they vary in severity, some superficial and some affecting a greater thickness of enamel. Depending on whether the hardness of the enamel surface has been affected (hypo mineralisation), some treatment may be advisable. It can also affect the first adult molar teeth which erupt at about the same time, as a general rule the glossier the surface the less problem it is, if it looks ‘chalky’ or starts to look more yellow, the more it will benefit from intervention. If it affects the molars as well, intervention is much more likely to be needed.
The pictures above show the range of appearances characterised as ‘fluorosis’ though they may not in fact be anything to do with fluoride per se. The cells responsible for laying down enamel as some of the most specialised in your entire body (they are basically making glass), and therefore the most susceptible to minor fluctuations in your homeostasis, anything from minor rises in temperature, infections etc can trigger problems with the process. Think formula one cars, bloody fast, but also very prone to breaking down.
The white lesions basically represent a disruption in the crystalline structure of the enamel prisms (think of it as a very carefully tiled floor, where some one plonked some crazy paving in the middle), which affects it’s optical properties – not a problem, but if severe enough leaves gaps to allow in staining ( changes colour), and if badly enough disrupted makes it weak (chalky appearance). At the (less common, but not unusual), end of the spectrum it leaves the teeth more suspectible to wear, acid damage and sensitivity, but if identified early it’s possible to maximise the potential to harden up (some of the mineral is acquired once the tooth has erupted and under matured enamel has the potential to harden up a bit more once erupted), the outer layer using something like GC MI paste plus( your dentist should be able to supply this if needed, it’s not available OTC). It’s also possible to use some techniques to make the white spots (or yellow / brown patches), less obvious or to seal the surface with resin inflitrations such as ICON from DMG.
In the worse affected cases white fillings may be needed to repair of masks these areas, but very rarely are things like veneers needed now, certainly not in children.
All of this makes it more important to make sure your children has a healthy (tooth healthy as well as generally so), diet, and you can get more info either googling ‘oral health toolkit’ from the uk department of health, or have a look at http://www.sign.ac.uk or smiles4life. Acid erosion is atleast if not more damaging than just sugar in these cases….

Yup I’m and dentist, and to reinforce the stereotype i ride, you guessed it, Santa Cruz…….

YEP no issues what so ever after 2 yrs use in the Lakes. Prefer it to the reverb on the newer bike.

Best and lightest are http://www.phdesigns.co.uk custom made, if needed, you can even specific shell ….. But not cheap. Just value for money? And uk made.

Have a read of the http://www.phdesigns.co.uk/ site, they make the best bags in the world… In the UK.

Apologies ….. Decided I needed to wait till dark and refresh my memory with a ride!

For what it’s worth the scorch works well solo mounted on a helmet, but you need to run it at full power 1400 lumens if your off road. Probably not quite powerful enough / not wide enough beam for sole use on the bars. I bought it more to have in the pack, than a devoted ride all night light and it is good for this. If your going to ride on a regular basis at night, best with bar mounted and a separate (narrower beam), helmet light, but if it’s occasional only ….this is fine.

In terms of build etc, it’s good. I have not had any issues, and I am happy with the value for money.

I have a scorch (1400lumen), and their rear light ( which is ridiculously bright

You may find it worth checking out

http://four4th.co.uk/

U.K. Made, nice kit.

I have a bronson, and rode this bike as a demo a month ago. It was great, and appeared very nearly as capable as a bronson, on anything less than ultra rocky trails. It climbs better as well. Yes there are changes to the linkages, and the sizing has been changed on the new model, as well as a few other changes. I am sure it ‘better’, but ask yourself this, are you good enough to actually notice? If you can size up, then swap out the 70->50 stem….. You would be very close.

You could try Broughton in Furness in South Lakes. The natural riding around Duddon and Broughton Mills is good, (don’t bother with Walna Scar), there’s access to Grizedale if needed, and the village is well endowed with pubs, cafe’s, butcher, bakers and a micro brewery…..