randymarsh

Drinking really only water every day and lots of it - but still dehydrated.  Urine is clear again now after drinking 2 litres earlier.  

Thing is because I had a UTI last year, I know how bad I felt during that infection (albeit only for about 12 hours until I got on antibiotics), could barely walk, had no energy at all.  Today I walked 15km before going back to the room and seeing my brown pee.

There was no pain but I could tell I was dehydrated as not a lot came out, and it was VERY brown.  UTI last year I had bright red urine and later with some clots.  This experience is totally different.

I've had very recent cystoscopy (very good hospital in chiang mai in january this year), and also had abdomen ultrasound last month (unrelated pain under rib) and everything was normal.  I'm pretty relaxed from the UTI side of things.

But I am a bit stumped on this - unless it's exercise.  I will take the antibiotics just in case as WBC in urine suggests I do have an infection but who knows.  

I don't know what the urologist will do either.  I really just want repeat blood / urine tests doing - maybe even go back tomorrow and see what's changed.  

Even after the blood tests, I'm still a little bit concerned it's the start of rhabdomyolysis which can really mess you up / kill you.

I had a UTI last year back in September (blood in urine) which cleared up and had a cystoscopy to check nothing wrong with bladder.  Got all clear.

Today I have very high blood cell counts in urine:

WBC 30-50 /HPF  (normal 0-5)

RBS > 200 /HPF (normal 0-5

Billrubin 1+

Protein 1+

Counts were nowhere near this high last year when had UTI.  And now the thing is this time I'm not sure it's a UTI.  I don't feel the same, I have no symptoms of infection - no fever, normal BP.  

I feel a little bit weak and anxious but I wouldn't even say I feel unwell..  Doctor pushed around on my back / stomach and no pain either.

What I have recently been doing though is exercising.  I've gone from walking less than 1km a day for years to walking on average 20km every day for the past 2 weeks.  I'm doing this every morning when it's still pretty hot.  I am wondering if the shock to my body from doing literally nothing to walking so far each day has affected me?  There seems to be some reference on the internet to blood in urine after exercise but I'm not sure it would cause levels as high as mine.

http://www.livestrong.com/article/383806-what-causes-blood-to-be-in-urine-after-exercising/

"The exact cause of exercised-induced hematuria remains unclear, but there are several potential causes. Trauma to the bladder walls during exercise can cause bruising and bleeding, which could cause blood in your urine. Exercise might also interfere with the process of filtering the urine from the bloodstream, allowing red blood cells to mix with it. During intense exercise, the body can redirect blood flow away from the kidney, causing red blood cells to leak into the urine. The release of hemoglobin -- the protein that gives red blood cells their color -- into your urine during exercise may also cause hematuria."

http://www.everydayhealth.com/urinary-health-specialist/blood-in-urine-from-dehydration.aspx

"Dehydration in and of itself is very unlikely to cause blood in the urine (hematuria). Red blood cells can show up in the urine for a number of different reasons including infection, trauma, bladder tumors, and kidney and bladder stones, as well as other inflammatory conditions of the bladder. There are several ways to detect blood in the urine, and some can create false positives. Visually, blood in the urine appears as a red color. However, there are other chemicals, such as myoglobin, which can be released into the urine due to muscle damage. Myoglobin gives off a dark color and can look similar to blood. This condition is often brought on by extensive prolonged walking, running, or jogging, and is called “march hematuria” as it is sometimes seen in newly enlisted soldiers after prolonged marches."

After exercising this morning, I went to the toilet back in the room and my urine was a very dark brown.  I suspected blood - maybe caused by the exercise - some kind of muscle trauma combined with dehydration.  Immediately went to hospital, did urine test and confirmed blood.

I asked the doctor about rhabdomyolysis and he did a blood test.  CPK level is elevated but not hugely at 270 (normal 28-174).  I've read rhabdomyolysis can cause CPK from 6,000 onwards.  Could it be just the start though?  Should I get blood tested again tomorrow in case it shoots up?

I'm also wondering about the presence of billrubin in urine as this seems to indicate a liver problem.  Doctor did not mention it.

He's given me antibiotics for a suspected UTI (not sure I believe him), and have an appointment with urologist on Friday.  He told me to come back if urine continues to be dark.  It's gone back to clear since drinking water today - but clear urine doesnt mean I'm in the clear.

Any advice appreciated.

Thanks to everyone everyone for the information in this thread.  

I think 2 years of eating pretty much anything in isaan with no regard for whether it was cooked or not puts me at a reasonably high risk so worth a check up.

I think conclusion is:

1. If it's not cooked, don't eat it e.g. koi

2. If it's somtam or any isaan meal that uses pla ra (a lot of the meals use pla ra and you'd never know as they could also have used regular fish sauce), make sure the pla ra used has been cooked (boiled).  If you don't trust the seller e.g. outside food stand, don't buy it.

3. The labelled bottles of pla ra sold in places like tesco have been cooked and are safe 

4. If you've eaten isaan food for a while, get checked as there are very rarely any symptoms until it's too late 

1 hour ago, Moonlover said:

Ok, here goes.

 

The usual fish used in Pla ra, cooked or raw is Snakehead fish or Catfish. Note that both these fish have a smooth, mucas covered skin and, in fact the Catfish is virtually scaleless. Have you ever tried to pick one up? They have evolved that way to facilitate their expeditions across land, which they are both known for.

 

The Liver Fluke's larvae, once it leaves the snail in which it develops seeks a host in the water. Its preferred host is a Cyprinidae. You can look it up if you like, but I'll tell you, it's a large group of fishes that are all scaly. The larvae does not penetrate its host, it slithers under the scales and takes up residence there next to the skin.

 

Because the Catfish and the Snakehead fish, used in Pla ra are smooth skinned, the larvae cannot attach itself to them. Therefore Pla ra is a very unlikely source of liver fluke infection. Do note that the freshwater crabs that you sited. would not be a likely host for the larvae either for similar reasons.

 

The reason why  koi plaa is a threat is because it contains small, uncooked scaly fish, with the larvae still attached to the skin. Cooking the fish first is the recommended way to prevent infection.

 

That's it. It's dinner time and I think Catfish curry is on the menu. Yummy!

You haven't particularly corrected anything about the process of making the pla ra used in tam; just claimed the fish used can't cause flukes.  Evidence suggests it does (if not cooked).

45 minutes ago, randymarsh said:

I'm asking my gf more details now.  Pla ra essentially isn't cooked but if it's fermented properly for the correct amount of time, it can sometimes be safe.  At the end of the process, ideally 12 months later, this is where the optional cooking comes into it (adding actual heat).  At this point, sugar, coffee, or more water is added and heated to make the sauce that is used in som tam.  Generally the heated pla ra is used in som tam, the overall ingredients vary the taste meaning some restaurants are more renowned for their tasty pla ra.... but some Thais still prefer the uncooked stuff in their som tam that still has 6 month old dead fish floating about.  Not safe!!

 

And happy to be corrected on any this because getting info on anything remotely controversial Thai related from my gf is like blood from a stone.  Plus I'm not completely convinced she knows the full process and its timings and variances. 

40 minutes ago, Moonlover said:

I take that as an insult to my wife's intergity, whom I'm quite sure knows a lot more about Thai and Issan food than you do.

 

I'm asking my gf more details now.  Pla ra essentially isn't cooked but if it's fermented properly for the correct amount of time, it can sometimes be safe.  At the end of the process, ideally 12 months later, this is where the optional cooking comes into it (adding actual heat).  At this point, sugar, coffee, or more water is added and heated to make the sauce that is used in som tam.  Generally the heated pla ra is used in som tam, the overall ingredients vary the taste meaning some restaurants are more renowned for their tasty pla ra.... but some Thais still prefer the uncooked stuff in their som tam that still has 6 month old dead fish floating about.  Not safe!!

13 minutes ago, Moonlover said:

You seem to be determined to argue you way into some dreaded disease, no matter what is said. So I'll leave you to get on with it.

 

Good luck.

No worries.  Hopefully your wife has learnt something too. 

Very alarming that even the Thais who have been educated on these risks believe them to be limited to a single dish.

Cheryl can comfirm but definitely a risk from pla ra and my gf has confirmed the same. She no longer buys som tam with the fish floating in.

Not to mention the raw crab in tam pu pla ra which again cause flukes.

Koi pla is just one of many many isaan meals that will cause flukes as it contains raw fish.  

6 minutes ago, peterb17 said:

This is madness- you are consuming food that you think may do you harm. 

The dangers of liver fluke have been known for years- many threads on here. 

 

I personally never ever take any type of drug - it's not some fight against big Pharma ( as many feel)  Obviously if I was really ill I would take the medication. 

 

It reminds me of a friend who constantly took antibiotics ( tetracycline ) - just in case- it's the same here- eat safe food and do not pop pills.

 

Are the from the USA - so many American posters seem obsessed with their 'meds' 

No, I have been consuming food that I did not know was dangerous until very recently.

If left untreated, will cause death in about 20 or 30 years.  So why not self medicate just in case? Lots of Thais do it.  Tell me how exactly it's better to never take any med until it's too late and untreatable?

As far as I know, 2 different types of pla ra, used when making all types of tam.  One is cooked and one isn't.  There is definitely a risk of liver flukes from pla ra used in tam if it isn't fermented properly (for long enough), is not cooked properly, contains raw fish, is not clean...

Some food stands have 2 types of pla ra to choose from, one they claim is cooked and another which has very visible uncooked fish floating in it.  I stay clear of the second option. 

There isn't too much isaan stuff that doesn't use pla ra...

I just went to the biggest facino pharmacy around and they no longer hold praziquantel.  They offered me Albendazole instead which has to be taken for 7 days based on drugs.com although pharmacist told me only to take for 2 days.  Also isn't the drug of choice for flukes

Usual Adult Dose for Clornorchis sinensis (Liver Fluke)

US CDC recommendations: 10 mg/kg/day orally for 7 days

Comments: Recommended as alternative therapy

Any ideas of praziquantel is still available?  Seems crazy that it wouldn't be.

And on the advice to get tested first, I think I will do.  2 days on praziquantel would have been ok but I'm not taking some random pill for 7 days when it might be for nothing. 

So as long as I keep on the cooked stuff and I always ask first, I should be ok?

Thanks.... would.you say it's worth taking it for 'just in case' measures?

Is it generally well tolerated?  

Mentioned in another thread I've been living off pla ra for 2 years in isaan (every type of tam you can imagine, sometimes 2 or 3 a day) without ever googling it to know it kills you.

For the last month I've had pain in gallbladder area, nothing severe but general ache, occasional twisting feeling.  Could be completely unrelated and probably is.  Did have an abdomen ultrasound and nothing found.

However, 2 years of pla ra is making me think as a precaution I should take praziquantel just in case.  

On the dosage, it seems 20mg per kilo of body weight 3 times a day.  I'm 88 kilos, so 1,760mg x 3.  They come in 600mg pills, so this is 9 pills in a day?  Seems a lot and don't want to get this wrong and kill myself.  Some of my gfs family self medicate every 3 months, I assume with praziquantel, and there's no way they take that many in a day...

Final thing and I might be mocked for this by all the farang who dismiss isaan food and have continued to eat only pie and chips since moving to Thailand but it is ingrained in daily life here and has become so for me too.  Is there no hope?  Do I have to stop completely, alienating myself from the entire isaan population and being generally depressed at not being able to eat som tam, and all the other amazing food pla ra is used for.  Or do I just make sure it's properly prepared?  I hear fermented for 12 months minimum is safe and no raw fish floating about.  There is no way to know the history of this stuff, especially from food stands outdoors but can I source clean stuff for home use?  How about the bottles that are sold in places like tesco, although not as tasty, I suppose it's worth a compromise for safety.

Thanks!

41 minutes ago, billd766 said:

 

Stick with being lucky.

 

You do realise that pla ra is banned by the UN as a chemical or biological weapon.

No I thought it was just tasty sauce.  Didn't really think to Google it as who would eat poison every day? Isaan it seems.  

24 minutes ago, tonray said:

It's the liver flukes keeping her BP low.. 

I've been hammering pla ra in isaan for 2 years, eating som tam 2 or 3 times a day plus everything else that uses pla ra... and only found out it kills your liver last week.  The foods so tasty I'm in two minds as to whether to stop completely or try and source stuff that's been prepared properly for 12 months or more... I probably need to make a thread on that too.  I did have an abdomen ultrasound last week for something else and liver was fine and I did read ultrasounds can detect the flukes.  So maybe I got lucky.  Or maybe I need more tests.

Monitor bought.  Did some readings this morning.  Better than at the docs but still not amazing.  Had been out all morning so not completely at rest.

136/80

130/82

127/85

122/91

Maybe a coincidence but the lower my systolic, the higher my diastolic, and also true yesterday at the docs.  To the point where I always have high blood pressure by one or the other or both.  Don't if there's any meaning in that.

Girlfriend showing off with her 100/70, while eating all the pla ra in the world.

Whenever I've been tested at docs/hospital previously, it's usually been about 140/80 so today was a surprise as it was even higher.  Could be white coat but don't know. Will pick up a good monitor tomorrow and start checking over the next few weeks - hopefully without driving myself crazy / becoming obsessive.

I know it's getting worse as 2 or 3 years ago it was 120/60.  But smoking, eating and not moving has taken its toll quite rapidly it seems.  I was probably 8 kilos lighter back then.

Hopefully the regular monitoring will scare me into doing something about it.

Just as long as the home one is accurate but who knows.

Going to buy one tomorrow.

Had my blood pressure taken at hospital this morning and it was high... 156/85.   After I saw the doctor I asked to have it taken again, no more than 10 minutes after the first time and it was 150/99.

That's the first time my diastolic has been so high and it made no sense to have gone up so much in 5 minutes when I'd been sitting in a chair the whole time.

Are these fluctuations normal?  It was done at Pattaya International Hospital so I'd think the equipment was reliable.

I'm only 31 so am worried my blood pressure is so high.  I also know I have high cholesterol from tests back home last year. It was 6.6 and the ratio was bad.

No doctors have ever recommended medication for either my cholesterol or blood pressure.  I don't know whether I should see a specialist for advice or just go with lifestyle changes.  I don't exercise but I eat quite well.  I do feel my cholesterol is naturally high as it was even high in my 20s when I was very active.

Any advice?  Plus thoughts of the fluctuation of two checks in very short space of time.

Thanks 

Thanks for looking into this.  I just know on the test results they gave to me it says gonorrhoea gram stain.  Should i trust this clinic or not?  

I've had sore throat since oral sex with no cold for over a week.  I think i should do the swab to check for any infection, STD or not. 

Clinic Lifecare in Pattaya that i noticed had been recommended a few times on here

http://lifecare.siam2web.com

Curious if the gonorrhoea test was legitimate now as definitely no swab taken so was either by blood, urine, or bullshit!

Anywhere in pattaya to get my throat tested?  I have had good experiences at Pattaya International Hospital Soi 4 before but really wherever will do the specific tests / swabs 

I got checked for STDs today and have a question on the results. Should have asked at the time but got the all clear so only had a quick glance at the results earlier.

On the gonorrhoea test, the testing method was grams stain.  I gave a urine and blood samples.  Will the gram stain have been tested by urine?  I am reading that particular test is usually a swab of the suspected area of infection.  

One comment on the results was gram negative rod in single = few.  I'm guessing few is not a concern ?

Reason I ask is because I have had a sore throat for a week or so and my paranoia is telling me i might have gonorrhoea throat infection.  I'm pretty sure i could still have this and it won't have shown up in the tests.  I did ask for a throat swab but the clinic didn't do it.  Should i go to a hospital and ask for throat swab?  Will hospitals all be able to check for gonorrhoea?

Or does the all clear on these tests mean I'm fine?

Thanks 

I need to get a WiFi dongle which has very strong signal strength to handle skype calls, video calls.

Any advice on the best one to get?  

Guessing shops in Central will sell these.

Needs to be top-up / pay as you go

cheers