guru

I thought the same Scuba but then again I leave for indoors work during the week with the only sun exposure being when I walk to lunch. I thought I was getting enough sun by being outside at the weekends but obviously not. I go to the 24km airport bike lane at the weekend which is completely exposed to the sun but I put factor 50+ sunscreen on which is maybe part of the problem? After prior years of reckless sunbathing and sunburn I had a mole go strange two years ago which concerned the doctor. Biopsy was thankfully ok. Maybe it’s psychological on my part now and I’ve been more cautious of the sun since the biopsy and hence that’s when the low Vitamin D problems started.

Thank you Sheryl for your detailed response. I just went to see an endocrinologist at samitivej and pointed out my high uric acid/glucose levels and low vit d levels and asked her about ordering a parathyroid test. She disagreed after asking me a list of symptoms all of which I didn’t have. She said she didn’t think it was necessary nor could she justify ordering a parathyroid function test if using my insurance. She said abnormal parathyroid level results in abnormal calcium levels and she read me a list of symptoms of which I had none. She also said the low vit D could cause a false positive parathyroid result. She suggested taking the 100,000 vit D units per week for 4 months which she estimates will put me up to about 36 which is in the normal range. She said I could then ask for a parathyroid test which would be more reliable. This samitivej endocrinologist disagreed with the samitivej cardiologist that I saw last week regarding calcium supplements. Even though my vit D is low at 25 today’s doctor says I do not need calcium supplements as I will get enough calcium through diet. She also said she doesn’t think it’s necessary to get a calcium and phosphate blood test today but to reevaluate in 4 months after next appointment and blood test. I am overweight and she obviously told me to reduce weight, by 10%. I’m 89kg. I’m hopeful to get that goal achieved this coming year. I could have not used my insurance and she would order every test I wanted but she said she still didn’t think any were necessary. The parathyroid test was 2400 baht. Calcium was 300 baht and phosphate I think was 400 baht. I have the choice of now waiting to reevaluate at next blood test in 4 months or go somewhere cheaper and pay by myself for the tests. However, I guess the problem is if the parathyroid comes back abnormal, is it a false positive due to my low vit D as warned about today. In response to your questions: My only current medication are statins and Vit D. I have never suffered from gout or any effects of high uric acid so no medication. Family history of gout is only in maternal grandfather. Don’t think I’ve got any bone problems. My age - coming up to 50. Alcohol: did not drink for 6 weeks before last week’s blood test to see if that would have any significant results on uric acid. It did go down from 9.4 to 8.6. Is that significant? When I did not stop drinking before the blood test last year it went down from 9.5 to 7.5. On average I drink about half a dozen bottles of beer on some Friday nights after work but not every week of the year. Finally, she said the high cholesterol and high uric acid could be genetic.

Yes scuba thats’s the goal. I’m on statins three times a week now and will have had blood work done three times by this time next year. I’m hopeful I’ll be off them by then. I’m also hopeful that blood sugar will mirror this and decrease for the same reasons. I know from past experience that Vit D will increase with the 20k unit supplements so not worried there. I do not feel confident that I’m in control of my uric acid though. Doc said reduce alcohol so I didn’t drink for 6 weeks before last blood test but still didn’t reach the window. Will have to do some more research to see what other foods I eat are high in purines. I know about chicken so will reduce that further.

I’m not much of a squatter myself but I just tried and no, there was no pain. I go to the gym every other day and do the usual treadmill, stepper etc and also go cycling around the 24km bike lane at SV airport and no pain at all.

Yes the consumption of junk food was probably the root cause of it all. Reduced junk food after first blood test but I still couldn’t manage to get cholesterol down just by this. Started statins and further reduced junk food to a pizza etc on Saturdays. Now all cholesterol has been normal this year but I don’t know how much of this normality is from my further reduction of junk food and how much is from the three times a week Atozet 10mg/10mg.

Hello yellowtail and thanks for the reply. I’m beginning to think I need to see a nutritionist. I thought I was doing myself a favour by eating chicken, tuna and asparagus but maybe that’s my uric acid downfall. Looking at a range of food on different websites, it’s quite confusing to know what to eat if I want to lower cholesterol, uric acid and glucose.

Hello tropic and thanks for your reply. Oh goodness I hope I can get my uric acid levels down so it doesn’t develop to gout later. I remember my grandad suffered from gout so it’s interesting that you say your high uric acid was hereditary.

No unfortunately body weight not always healthy. It used to be but then I tore my ACL and meniscus playing football. I took far too long to pluck up the courage to get down to see Dr Panya at Bumrungrad to have the knee operation. During that time I gained too much weight, not exercising and not eating healthily. After recovery things got better but the trigger for starting blood work was last year when a friend of the same age dropped dead from a heart attack with no prior warning signs. I booked myself in for a health check up and started to self reflect on my lifestyle. All the bad cholesterol numbers were high. I tried diet first but it did not lower significantly so the doc suggested statins. She initially said I would be on them for life but I don’t want that, so since last year she’s gradually took me down from daily to 3 times a week on the lowest dose. She said if I stop cold turkey it would probably rebound to high levels so she said the best way is to gradually reduce the dosage and frequency to try and get off them. I’ve now managed to lose weight, exercise more and eat more healthily. I’m still not where I want to be with my weight but it’s slowly going in the right direction.

Hello Mike and thanks for your reply. TSH 2.284 Free T4 1.00 Total T4 8.77

Hello scuba and thanks for your reply. Age - approaching 50 Exercise - gym every other day Weekday sun exposure low - limited by work. Weekend - no limit but don’t sunbathe anymore. Weekday lunch- e.g. tuna/egg/salad wholewheat sandwiches. Bread probably doesn’t help glucose levels. Week day evenings - e.g. meat/fish/vegetables. Weekends - eat at wife’s family house or out. Usually end up with rice/noodles in some form. Need to get on top of that.

Hello. I have blood work done at samitivej Sukhumvit every 4 months or so since 2022 and having trouble with my Vitamin D levels and uric acid levels. I obviously get advice from the doc but I’ve come here for any extra tips. Uric acid: their normal range is quoted as 3.5-7.2. I started at 9.5 and it got down to 7.4 and remained stable for a while but then went back up to 9.4 and now it’s back down to 8.6. No matter how much I reduce my alcohol and chicken consumption I haven’t reached the window and don’t know why it’s fluctuating. Not on any medication and no symptoms at all e.g. gout. Vitamin D: their normal range is 30-100. I started at 18 in mid 2022 and she put me on 20,000 units of vit D three times a week and a calcium supplement. 6 months later vit D was still only 25 so she increased the dose to 20k units four times a week. It then rose steadily reaching 35 in August and I was in the window. She then reduced the dosage slightly and said no need to take calcium daily now but just whenever I wanted to as a supplement but I never took any. I’m now back out of the window and down to 25 so she has now increased dosage to 20k five times a week and put me back on calcium. I understand that calcium needs vit D for absorption so it makes sense that when my vit D is low she prescribes a calcium supplement but does it also work the other way round because the only thing I did differently was not take calcium. I can’t find any google literature on this but she said could be. No noticeable symptoms but just been reading the BBC website where they have reported a link between low vit D levels and early onset dementia. I know about sunlight but my work involves being indoors during the day. I do get out at the weekends though but still cautious. After a reckless sun bathing youth, a recent skin cancer scare on a mole on my back came back negative from the biopsy. Cholesterol: this seems to be doing well and my goal is to get off statins eventually. I was on 20mg daily in 2022 but shes gradually decreased dosage and I’m now down to Atozet 10mg/10mg three times per week. Hopefully next visit gets this decreased further. Glucose: HbA1c hasn’t budged from 5.7 which she says is just in the prediabetes window. I blame the rice/noodles everywhere when all I want is meat/fish and vegetables. Not sure what meat I can eat though because red meat affects cholesterol and chicken affects my uric acid. Anyway I need to get in control of this by myself. One last thing, when I had the exercise stress test false positive last year, the CT scan gave 0% calcium in the arteries. Will all these calcium supplements make their way into my arteries and change my clean record? Samitivej Doc says no but Dr Google suggests otherwise.

I had my meniscus repaired and ACL reconstructed by Dr Panya at Bumrungrad. He did a good job.

If you decide to have the exercise stress test, don’t automatically panic like I did if the doc says your results are abnormal. I had an exercise stress test as part of my annual medical at Samitivej Sukhumvit and doc said abnormal. She said it could be a false positive but to cease all exercise until I had a CT scan at 25k and one just happened to be available that evening. Only way to rule out this false positive was this CT scan. I was as scared as anything and in my mind, I had no choice. Scan came back normal with 0% calcium in my arteries and the exercise stress test abnormality was ruled a false positive. My mate had the same false positive stress test and same clear CT scan result at an annual check up in a different hospital. Good luck with your check up and I hope all goes well.

Just got an sms from Bangchak with log in details for their phone app and successfully gained entry. The app is all in Thai so can’t read a word of it except my name at the top but ever so excited about the imminent arrival of my member card. Oh and the wife found her member card in the car yesterday so I didn’t have to do any of this.

Maybe I should have started on a 2mg dose to see if that worked rather than leaping straight to 5mg. Anyway, the 5mg definitely does help me fall asleep quicker. I take it about 10pm and I’m usually out within 30 minutes.

So after exploring the Bangchak website I downloaded the app which was in Thai except an English sentence saying “foreign customers call 1651 and press 4”. That led nowhere so I kept on pressing random numbers until a human spoke. She told me to add Bangchak on the line app and start a chat. So I did and told them about the Bangkok Sukhumvit Soi 62 foreigner rejection and they apologized, asked for my details and will send me one by mail. Haven’t been this excited in years and my new life goal is to get a 100 baht discount at the Sukhumvit Soi 62 station from the manager who rejected me as a foreigner.

Well these last 10 days have been a bit of a rollercoaster but educational. We arrived at Namarak today and saw a lovely, gentle female Doctor. She read the Sukhumvit Hospital Doctor’s report and Radiologist’s report, looked at the mammogram and ultra sound images. She said the ultrasound was not clear enough so ordered another. So into see the Namarak radiologist who said she was sure it was a liquid cyst as she was performing the ultrasound. Back into the Doctor who agreed with her breast specialist radiologist who downgraded Sukhumvit Hospital’s Birads 4a to Birads 3 with less than 2% malignancy risk. According to the Doctor, Birads classification is down to radiologist’s interpretation and experience. She then said she can do a fine needle aspiration today. We said the Sukhumvit Hospital Doctor already tried that but said it was solid. However, she was not confident he went down far enough and thus misinterpreted. Furthermore, he was a general Doctor and didn’t use ultrasound to guide his needle. Anyway the Namarak Doctor did the fine needle aspiration using a local anaesthetic (Sukhumvit hospital didn’t offer any local anaesthetic - hence my wife’s pain last week). No pain today and a full syringe of liquid was extracted which looked normal to the Doctor who said no need for biopsy. Back in 6 months to Namarak for next check up. If we had listened to Sukhumvit Hospital, she would have had an unnecessary 89k surgical excision biopsy under general anesthetic with the associated risks and scar. Today was 6k as classed as out-patient so AIA only paid 1500 baht. If we had waited a week for insurance to pre-approve the cashier said we could have probably got away with it being classed as an in-patient procedure and AIA would have paid in full but we wanted a conclusion today. Thank you Sheryl for recommending Namarak. It truly is a gentle, relaxing, professional set up and we thoroughly recommend it. My wife also says thank you and if she ever meets you she says she’s buying you dinner.

Having taken my first tablet from the new supply last night (this new vendor I’m using has one of those preferred Shopee badges which the old vendor didn’t), it seemed to feel harder in my mouth and took longer to dissolve than the initial softer tablets with a missing expiry date. Slept longer without waking up too. I did go to the gym yesterday so not really a fair test though. Both tablets look and taste identical and both gave off a cloud of strawberry volcanic ash when opening the container and removing the cotton wool. Instead of being fake, had the initial container had an old expired sample containing melatonin that had degraded over time with the expiry date somehow removed from the container?

That’s the problem circa02, I had to turn to Shopee because Boots, Watson’s and other pharmacies don’t sell any Natrol melatonin 5mg and only sell a different brand which has far less quantity for a similar price and only in 2mg. My eyesight is very good close up and there’s no evidence of any fading with the lot number/expiry date space being completely blank. I’ve only had the container 89 days.

So at the request of the nurse at Namarak we finally got the doctor’s report from Sukhumvit hospital which took 6 days. My wife phoned Namarak back saying we have the doctor’s report and imaging dvd in hand as requested so we would now like to schedule an appointment. The nurse now said that the earliest doctor available tomorrow insists she re-does a mammogram and ultrasound with Namarak. Eh? If that’s the case then why ask for her records in hand before scheduling an appointment. It was only last Wednesday she had it done at Sukhumvit Hospital and my wife says the mammogram was quite painful and would prefer not to redo if not absolutely necessary. The nurse then said there’s a different doctor available later in the day who isn’t insisting it’s redone and will look at what we’ve got before making a decision so she chose that one. That’s exactly what the nurse told us on the phone last week. Anyway we are going to Namarak tomorrow in any case.

They only seem to sell 2mg melatonin in Bangkok pharmacies so I bought some 5mg Natrol melatonin (extra strength fast dissolve strawberry flavor) from a vendor via shopee. Before buying, I always check there’s been a lot of sales and good reviews which their were. The 90 tablets have run out so I went to order again but this vendor no longer sells it so I bought from another vendor which arrived today. I compared the two containers and they were identical including the bar codes. However, the first one I bought does not have anything written in the Lot/Exp: space which is not normal and I didn’t notice before. Today’s new arrival has a lot number and an expiry date of Dec 31 24 which is more pleasing. So with a missing expiry date, I’m now concerned about the authenticity and what I’ve actually been ingesting. I do seem to fall asleep quicker but have I just been taking strawberry candy which has had a placebo effect or some melatonin that expired years ago.

I used to have a member card for Bangchak in the wife’s name but lost it. Wife works so as I was refilling today at the petrol station we got it from, I asked for a replacement. Original Thai ID card required as expected. I asked for a new one in my name and presented my Thai driving license and pink ID card. The pump attendant took them to his manager in the kiosk but returned saying only for Thais. I thought I was offered one a while ago by a Bangchak attendant and was wondering if it was today’s petrol station manager being lazy or not up to date with the rules. It’s the massive station next to Bangchak BTS in Bangkok Anyone manage to get one in their name?

Yes we agree with you Sheryl and will use Namarak. Ideally we wanted to go down this weekend but the hold up is Sukhumvit Hospital and her doctor records. She went on Thursday and they gave the imaging dvd straight away but no records. She called again yesterday and they said still not ready and it takes 5-7 days. I don’t quite understand why it takes so long and Namarak don’t want to schedule an appointment until we have the records in our hands.

Thanks butty. I don’t suppose you know if they have this vacuum assisted biopsy equipment there? My wife would ideally like to avoid surgical excision biopsy and hopefully namarak or elsewhere will be able to obtain a biopsy sample using this vacuum assisted needle method suggested by Sheryl. The syringe needle method attempted at Sukhumvit hospital could not obtain a sample.

They may well pay and fingers crossed they do but I fear the plan she has via her company is basic and does not have very high coverage. For the imaging and aborted biopsy sample attempt, we had to pay Sukhumvit Hospital the majority of the bill in excess of what AIA covered.