bubba

24 minutes ago, tideout said:

Some people have doctors or research hospitals. We've got bubba. ????????????

Thanks, Tideout. Having been on the active surveillance route for more than five years, undergone two MRIs, consulted with several different urologists and radiologists and spent a lot of hours researching the subject, I hope I can share some information that is useful. 

1 minute ago, elektrified said:

I may fall into this category. My PSA has been rising for years as high as 13.4. MRI shows a lesion 1 cm X 0.5 cm and 2 biopsies (2nd one was 26 cores) have been negative for PCa. CMU did call and request authorization for additional investigation of the cores from the suspect area and detected "chronic inflammation". The doctor said it is possible there may be a lesion so small and so non-aggressive that in 5 years it hasn't grown or affected surrounding tissue. Or it could be chronic prostatitis. I complete a 30-day course of Levofloxacin and will check PSA again in January.

A few things you might want to consider:

1. Doing an ultrasound guided biopsy is almost like throwing darts. There could be a small lesion, but none of the cores hit it, and especially with a small lesion such as yours. The gold standard now is in-bore MRI biopsy, where the radiologist visualises the lesion real time and has something to aim at. As I mentioned earlier, some radiologists can get what they want with just two cores. I really feel for you having done 26 cores. Did they actually hit the lesion with any of the cores and provide you with a Gleason score?

2. How experienced was the radiologist and how good were the images? Did he/she provide you with a PIRADS score for your lesion? You might want to consider getting a second opinion from a specialist radiologist. It is easy to do, obtaining your images on a DVD, uploading it to something like Dropbox and then the radiologist at the other end downloads them. That's what I did and it saved me from a biopsy, plus I learned a lot in the two hour consultation call. I consulted with Dr. Joe Busch in the USA for this, who is generally considered to be a recognised expert in the area. His fee was US$200 and well worth it. Dr. Busch is very frank and will inform you if he thinks the imaging is of inadequate quality or if he disagrees with your radiologist's assessment. If you are interested in this approach, PM me and I can provide you with more details and contact info.

3. Dr. Busch also considers prostate density in considering high PSAs. Did you get an estimate of prostate volume from your MRI? Have a look at this recent journal article regarding PSA density:

Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer.

Yes, but is that not the point of this thread and the US consular meeting as well? "What about me" is certainly something on many of our minds with the cessation of income verification letters. Yes, there are those of us who are not yet receiving any kind of government pension but still have substantial income from dividends, capital gains and other revenue streams. Verifying those forms of income is a grey area and we need some sort of guidance and clarification soon now that the income verification letters are gone.

11 hours ago, JimmyJ said:

 

I have no signs of it.

I suppose anyone who hasn't taken the PSA test for years could have PCa since you mention there are almost never signs of it until it is too late.

(And some or many who take the test also could have it without the test indicating it based on what I've read).

 

 

I'm interested in treatment options because as I've mentioned previously I feel it would be pointless and counterproductive to take the test if I'm not willing to accept any of the treatments.

 

I last looked into it 11 years ago, and you are well informed on the current state of treatments, so wondering what is new.

 

 

 

 

I think the point is that there are many different treatment options, and those all depend on the diagnosis and nature of the PCa. In some cases, urologists are now recommending active surveillance with no treatment at all for small, low-grade lesions. 

If you do not engage in any kind of PSA screening with follow-up diagnostics, then it is sort of pointless to spend a lot of time researching the many currently available treatments since you will not be diagnosed. As time goes on, more treatment options will no doubt become available. Statistics show that one man in 40 will die of PCa, more than that for men in a high risk group, so just taking your chances with the odds is certainly one approach. 

JimmyJ - a course of treatment recommended by the urologist would of course depend on many factors including the Gleason score grading of the lesion(s), how many lesions, whether the tumour has become extracapsular and the degree, if any, or metastasis. In my father-in-law's case, which was not diagnosed until distant metastases had already occurred, the decision was made because of his age and the metastases to only treat with hormonal therapy. Some tumours are very responsive to that, others become refractory and begin to grow again. In his case, the therapy probably only extended his life for a year or so. 

Just curious – with all your questions regarding treatment options, while deciding against any screening by way of PSA tests, are you interested in treatment options because you suspect you may have PCa?

Form 1099 shows a lump sum, annualised income, correct? So TI would use an average that shows in excess of 65K/month since the 1099 does not show monthly income?

If that is the case, then apparently TI do accept a 12 month average of annualised income.

2 hours ago, JackThompson said:

My suggestion is to keep proceeds out of the country in a "buffer" account, and use that acct to seed the Thai account at or above the minimum required monthly level.  In my case, that means not sending "too much too soon" to retain sufficient funds for "lean" months - so sending money to Thailand is delayed, not accelerated.  In the past, when my business did well, I'd send over a larger chunk, then draw it down over time - not anymore. 

 

This may not be enough, of course, given the income is not from a govt-source with some sort of letter - but it is the best I can do.  Hopefully a year of transfers - or several, if I continue using Non-O-ME Visas (married to a Thai) - will provide a track-record sufficient to satisfy a measly 1-year extension at some point in the future.  I could back this up with the associated university degrees and a CV, if they are worried the business could fail - proving I could easily take a Thai's tech-job here, if I was so inclined (I'm not, unless forced to do this by immigration as a last-resort).

That seems like a good idea, Jack - not keeping 800K tied up in a Thai bank account for three months, with no way to grow it. The problem now is that with the elimination of consulate income verification, it is already too late to show an entire year of 65K monthly income.

As you mentioned, I keep hearing that TI want to see some sort of monthly government pension income. TI really do need to establish guidance regarding income for those of us who have not yet reached pension age.

58 minutes ago, Mark1066 said:

You have no idea if that’s what happened or not. Senior immigration officers have the authority to waive the seasoning requirements.

Do they? Has anyone ever heard of an immigration waiving the seasoning requirement?

28 minutes ago, Thaidream said:

I would agree and the point being that what needs to be 'proved' is that one has 65K per month each month and the stream will  remain  relatively stable for the year.  This can be attained several ways- pensions-  both government and company;  a home rental  generating income;  a  business (not working) investment generating the required income; stocks that  show an ongoing income stream/

 

How one spends their income in Thailand is inconsequential- some rent some buy; some have  cars others use taxis etc.  No one lifestyle fits all. Some will spend much more than 65K per month- others much less. Everyone needs a place to sleep; food; and  transportation and clothing.

 

While I do not have a business or stocks; I would hope that when the dust settles there will be enough in the system to accommodate those who  actually have the income and can  provide documentation showing it and not focus on the type or how they spend it.

That's a good point, Thaidream. Income is income, and not only monthly pension payments. My whole question is: will Immigration interpret the guidance as at least 65K/month each month for a total of 780K PA or will they allow for averaging?

As Sheryl pointed out earlier, dividends are typically paid out quarterly, which could mean big chunks coming in on various months, and perhaps nothing on some months. Same goes for income from asset sales. For a person with income from asset sales and dividend income totalling, say, 5M baht annualised, if a monthly 65K minimum is applied, that person could be denied their extension, while the 70K/month pensioner who is substantially less well off is granted their extension. 

This really is a big deal to many of us who derive our income that way, particularly those of us who have not yet reached pension or social security age. If I have to create 65K/month of income from share sales plus dividends, I do not want to do that, but I can; however, what we need is some clarification on what exactly will be acceptable so that we can do the appropriate planning. None of us wants the unpleasant surprise of being denied our extension next time round.

2 hours ago, rumak said:

and just how would anyone verify that the next day or two you did not reinvest (buy shares) of that or another stock.    ???    very easy to do when you have two seperate trading accounts.   

There is no way anyone could what the proceeds from a share sale are used for, whether reinvestment or spending. It is still income. For a pensioner, is there any way anyone could verify how he/she uses that income, which could be an investment or it could be spending? I see nothing in the retirement extension guidance that stipulates how verifiable income is to be spent. 

2 minutes ago, mfd101 said:

Borrowing & paying it back. The shonky types would be more likely to do that with an averaging system that allows them to borrow & pay back, say, once every 4 months, than with a monthly minimum system (because of the credit costs potentially involved).

Not sure what you mean here with regard to share sales. Do you mean borrowing the funds on margin to buy the shares? That could get very expensive, including the margin interest and the potential for substantial losses.

2 minutes ago, rumak said:

bubba, cmon, dodgy or not what the point that many here on this thread are trying to get across is that

Immigration does not have the time and more importantly the knowledge to interpret the many forms of income that foreigners may have.   heck, even i can't understand the US tax forms !  Last time i did tax it was something like 10 different pages of various forms i had to complete. .  SO...i would say that the many different forms from different countries are NOT easily verifiable.

 

But an investment portfolio transaction statement is quite simple - far simpler than tax returns.

If I sell a share asset, it is in English and looks something like this:

Date: XX/XX/XXXX

Sold: XXX shares at XX per share.

Total proceeds: XXXX

9 minutes ago, mfd101 said:

Most likely a MINIMUM of 65K a month. An averaging system would allow for too many dodgy work-arounds.

Why would it be considered dodgy if you have an investment portfolio and sell off assets such as shares as you need the money? That is easily verifiable and for many, it works out to much more than 65K baht/month. 

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Ditto - as per complex tax-forms - doesn't seem remotely probable.  I think our only hope is that these get a cursory-glance, provided the bank-letter shows the min-income being transferred into Thailand.

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I think the new 'Embassy income letter' will be the 'Bank balances & incoming letter'.

Correct me if I am wrong, but I believe the requirement for income does not require funds being transferred into Thailand. 

17 minutes ago, JimmyJ said:

 

"All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis."

 

The followup article I posted makes some interesting points.

 

In my case, I haven't read of any treatments I am willing to undergo, so it is pointless and counterproductive for me to get the test.

 

 

I suppose that depends on how old you are, what sort of treatments can be considered and whether you consider those to be less desirable to an early, unnecessary and painful death due to metastatic prostate cancer. When PCa is detected early, there are emerging treatments such as focal laser ablation that will spare you from a radical prostatectomy and the potentially associated issues as well as saving your life. 

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.      Concerning proof of income, the Embassy and CM Consulate will be conducting training sessions to explain the various forms of retirement income US retirees depend on, which are quite different from European national pension systems Thai Immigration is used to.

For those of us who are younger than retirement pension age (i.e. American Social Security benefits), I hope they can also explain to immigration other forms of income, such as capital gains and dividend income from investment portfolios.

10 minutes ago, JimmyJ said:

I couldn't find any news confirming that the US medical profession are now again recommending PSA testing.

 

I did find this:

 

"Why I Won't Get a PSA Test for Prostate Cancer"

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

 

I also will not get a PSA test.

 

 

I believe the issue with that opinion article is this:

PSA can indeed be indicative of PCa, but not definitive unless it is very high. A high PSA without consideration for gland size and PSA density can indeed lead to misdiagnosis, unnecessary biopsies and over-diagnosis. What the article did not mention was the recent recognition of multiparametric MRI in differential diagnosis before recommending a biopsy. For example, the article mentions inflammation as a possible cause for elevated PSA. MRI with interpretation by a radiologist experienced with prostate imaging can differentiate between a PCa lesion and inflammation. It is also important to recognise chronic inflammation since that can later lead to PCa, so active surveillance is necessary. Personally, that is where I am at the moment - elevated PSA, large gland with low PSA density, MRI diagnosis of chronic inflammation, with the recommendation for frequent PSAs to watch for a significant increase in PSA velocity and annual MRIs. Without the MRI and my PSA > 7 and sometimes as high as 11, many urologists would have immediately recommended a biopsy. MRI results contravened that.

All that said, if men never have a PSA with no record of PSA velocity, there is no way that PCa can be diagnosed in time for treatment since in many cases there are no symptoms at all, even up to the point of extracapsular tumour growth and metastasis. 

I think you should be happy, Garry. For 56 years old, a 0.59 is definitely at the low end or normal. I don't think any urologist would suggest that you do a PSA bi-annually. Some would suggest that you don't do any at all. Others would suggest an annual PSA to watch PSA velocity. PSA almost always increases with age and inevitable growth of the gland, so what they would look for over time is how fast PSA is increasing and doubling time. That said, there is a small percentage of men with normal or low normal PSA who actually have high grade adenomas, so PSA is not always definitive. 

"The Cambodian port mentioned in the online report is on a concession of land, originally 36,000 hectares when it was signed over to UDG in 2008 for development of “an industrial and commercial coastal project,” according to the C4ADS report. It added that the agreement violated Article 59 of Cambodia's 2001 Land Law, which states "land concession areas shall not be more than 10,000 hectares."

The concession, which is now 45,000 hectares, includes 20 percent of Cambodia's coast, and in September, UDC board Chairman Li Tao announced plans to invest $1.2 billion to build a “Tourism City” on 1,200 hectares."

https://www.voanews.com/a/cambodia-says-beijing-backed-project-will-not-include-chinese-naval-base/4662652.html

It's always just tourism.

17 hours ago, iforget said:

Plain stupidity yet again. There are an estimated 640,000 street dogs in Bangkok. Lock up 8,000 and all you are doing is donating extra food (garbage) to the remaining 560,000.

Well fed dogs breed faster than starving dogs.

Bangkok govt would do better to sort out the garbage stinking up the streets of Bangkok.

This would help to control population growth of street dogs, feral cats and rats.

But for population reduction, sterilisation and vaccination take time but they are the ONLY effective remedy. Anything else is a pointless waste of effort, manpower and funds.

As for impounding the dogs, has no one learned any lessons from earlier this year when 3,000+ dogs were dumped in a pound in Nakhon Phanom?

In a matter of weeks around 2,300 were dead from starvation, disease and injuries in fights. This is humane?

No. It's not.

Even if you loathe street dogs, you have to understand that kneejerk slaughter/impounding WILL NOT WORK.

In a matter of days, weeks or months strays will be back on your street. They'll just be different strays.

Tell the Bangkok authorities to be patient and put serious effort behind sterilsation and vaccination.

Seriously? So where are the resources and what would the timetable be for spaying/neutering 640,000 dogs?

Let's just say there were resources for spaying/neutering 100 dogs/day, which is quite a large number requiring many full-time vets as well as facilities together with systems to track and presumably transport the dogs back to where they came from. That would require more than 17 years to complete and during that time, more would be born each day than could be spay/neutered.

What a a ridiculous suggestion.