My First Prostate Exam - Advice Please

[JimmyJ]

Personally - I am not a doctor - I think your situation of having to urinate during the night several times is normal, or at least is not cause for concern, and no reason to get the highly questionable PSA test which can lead to suggestions to get highly questionable prostate biopsies due to the PSA number.

 

If you are not having problems with the act of urinating, I also feel there is no need for medication.

If your BPH starts interfering with the ability to urinate, then medication I suppose makes sense.

 

 

 

 

Edited June 30, 2018 by JimmyJ

[KhaoYai]

I have locally advanced, high risk, aggressive prostate cancer and can probably help with your questions.  You will receive all kinds of advice - especially regarding PSA tests.  I visited my GP for a general check up in March 2015 and mentioned I'd been getting up for a pee in the night more than I used to. Blood tests were taken and because of my comments, my doctor included a PSA test. Two days later my doctor phoned me and asked me to come in, when I did I was told that PSA was a massive 189 which sent alarm bells ringing and lead to my final diagnosis a few weeks later. PSA tests are not conclusive, a high PSA does not always mean you have cancer but likewise, a low result does not necessarily mean you don't.  However, at the moment PSA testing is the only way doctors can decide on whether or not to move on to a more definitive test. There is a new type of detailed MRI scan which is said to be better at detecting tumours but PSA testing is still the route most doctors take.  Should either test indicate the possibility of cancer it is most likely that you will be asked to have a biopsy.  Most doctors will carry out a DRE (digital rectal examination) but that is also not reliable.

 

Currently, a biopsy provides the most definitive indication of what's going on in your prostate but it carries a risk of infection.  Samples are taken via a needle which punches through your rectal passage wall into the prostate - hence the risk of infection. Up to 20 samples may be taken although I believe I had 10, split between each of the 2 lobes that form your prostate gland. The biopsy is generally painless - I never felt a thing, but some men report a slight sting as samples are taken.  A high dose antibiotic is taken before and after sampling to reduce the risk of infection.

 

I would recommend all men press their doctor for a PSA test once they reach 50 and repeat that test every year.  Yes, it can lead to unecessary biopsies and worry but I wish to god I'd been tested earlier.  Early stage prostate cancer is very treatable and there are various treatment options which can can and do lead to a cure. As the disease progresses the treatment options become more limited and the chances of a cure are significantly reduced.  For some (too many currently) the diagnosis comes to late and the only treatments available are ones that will slow the disease down.

 

Prostate cancer is often very slow growing disease and in quite a few cases, no treatment is recommended but regular PSA tests are carried out to monitor any cancerous activity.  Although, as I have mentioned above, PSA tests are not 100% definitive initially, they are accurate once the disease is diagnosed.

 

1 in 8 men will get prostate cancer at some point but this rises to 1 in 4 in high risk groups such as Black men and those who have a family history of the disease.  The chances of getting prostate cancer also rises in men over 70 - there is a saying 'you are most likley to die with it, not of it' which, I don't know if its true or not, is supposed to come from autopsy results.

 

The facts are, the disease is very common and left undiagnosed, its a killer. Until a better method of initial testing is developed, doctors will continue to rely on PSA testing.  Many men are scared to even have the test as they think that if they are eventually diagnosed as positive, the treatment will end their sex life.  That is a possibility but for most sufferers, sexual function normally returns in time. Some treaments can also affect urinary function but once again, that usually gets better in time.

 

I've had my treatment which although radical (because the disease was advanced), did not involve surgery. I'm more or less back to normal now and I'm hoping the disease is cured but I know my chances are slim. Please, please, please guys, don't ignore symptoms and get tested regulary. The earlier its detected, the less radical the treatment and the greater the chance of a complete cure.

[KhaoYai]

18 minutes ago, JimmyJ said:

Personally - I am not a doctor - I think your situation of having to urinate during the night several times is normal, or at least is not cause for concern, and no reason to get the highly questionable PSA test which can lead to suggestions to get highly questionable prostate biopsies due to the PSA number.

 

If you are not having problems with the act of urinating, I also feel there is no need for medication.

If your BPH starts interfering with the ability to urinate, then medication I suppose makes sense.

Sorry Jimmy but that is just not good advice. PSA tests are not conclusive but in no way are biopsies questionable.  Please read my post above.  Yes, men may start going for a pee more often as they get older but it should not be brushed aside as normal.  It is only because I regarded it as normal for too long that I am where I am now.

 

It is far better for 10 men to have a false alarm through inconclusive PSA tests than for 1 man not to be tested and die.

Edited June 30, 2018 by KhaoYai

[mokwit]

16 hours ago, tomgreen said:

I have to get up may be two or three times every night to urinate and during the day time I have noticed that when I drink any liquids I seem to want to urinate quicker than in the past.

In a 70 year old man testing for BPH PSA obviously makes sense but don't rule out bacterial infections of bladder or prostate which will generate the symptons described. In Thailand there is a very infectious (can be orally transmitted) strain of NSU that can get into the prostate and cause enlargement through infection inflaming the prostate.If you have a uretheral discharge that would tend to indicate this cause, but note it can be infected with there being no discharge - also may be no discharge with bladder infection. I am not trying to deflect you from the sound advice re BPH/PSA test, just suggesting you consider if this could be a possible cause as opposed to one you could instantly rule out. Note it can occur without sexual contact - I had a very inflamed/enlarged prostate that responded to the right antibiotics. I can only assume it originated with bacteria  from a tooth abscess lodging in the prostate and infecting it (there was no discharge).

Edited June 30, 2018 by mokwit

[Lacessit]

2 hours ago, tomgreen said:

 

Thanks , the part where you say

 

‘’ In the afternoon, I was told that the blood tests didn't show any cancer ‘’

 

is interesting to note that a blood test can show signs of cancer .

 

The urine test part is all so interesting and some thing Ive not seen mentioned so far , so may be along with having a blood test for PSA , a urine test may be of benefit is some way ?

 

 

Tom

 

 

 

 

 

 

Possibly what they meant by "blood tests didn't show any cancer" was the PSA levels were regarded as normal. There are other cancers detectable by blood testing, such as multiple myeloma and leukemia.

Urine tests may be used for STD's, urinary tract infections, or ketosis as a result of diabetes.

Bladder cancer is usually first detectable by blood in urine - painless hematuria.

[Sheryl]

6 hours ago, Jip99 said:

 

 

This is also on my list of jobs to do.

 

 

Sheryl, I am Buriram based but Surin, Korat and Pattaya are all in striking distance. I would appreciate your suggestions. Thank you.

Korat: the  main government hospital is a huge regional level facility and should have an after hours clinic (start around 3:30 - 4 PM) where you can see the more senior doctors at very reasonable price. There will still be long waits but nothing like during the daytime. Ask for a urology acharn.

 

Another good option, also in Korat, is Suranaree University of Technical Hospital http://suth.go.th/webcon/contact.php 

Might be quicker than the main govt hospital

 

If you prefer a private hospital St Mary's is in general the best but I have no specific information re their urologist

 

If there is anything serious or complicated going on, the best care in Issan will be found at Khon Kaen University Hospital (Sringarind).

 

[Sheryl]

9 hours ago, tomgreen said:

 

 

 

 

Thank you , I am based in Pattaya City but in a few days I will be going to stay with an expat friend to assist with his new house building project . So then I will be staying in a village named Tha yiam yai which comes under the province of Nakhonratchasima . I should be there for around 2 – 3 months . So as I would like to get any tests as soon as possible a recommendation for that area would be most welcome. As a pensioner I know getting these test are of great importance but if possible I would prefer to stay away from establishments that may be overly expensive .

 

 

Tom

 

Dear Tom,

 

see my recommendations above for Koart (Nakorn Ratchasima).

 

At your age, if you have not had a complete checkup (blood sugar, lipids, kidney/liver function) in the past year or so, you should. All private hospitals offer packages and you can get PSA as part of it (even if not listed, additional tests can be added on).

 

In Pattaya I suggest doing it at Pattaya city hospital  http://www.pattayacityhospital.go.th/th/promotion

As you can see there is a package that includes PSA for about 5,000 baht but if this is a lot for you get the 1st package (1320 baht) and request PSA to be added on, will still be less than the second tier package.

 

You can then take the results with you when you go to see urologist. In addition to already having your PSA in hand it will be advantageous to know if you have any other issues like early diabetes, liver/kidney problems etc as this can affect choice of medication

 

If, as is likley,m this turns out to be BPH, here is a very good write up on it

https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

You will note in the tretament section that there are several different types of medication that may be used. So if the first drug given doesn't suit, there will be alternatives.

[BritManToo]

7 hours ago, Antonymous said:

Where urine tests are appropriate for peeing problems are if you have a UTI or prostatitis. A sign of UTI is that you would feel a stinging sensation (that can become really painful) when you pee. If you collect a sample in a clear glass you are likely to see it is cloudy with small white particles in it. In this case a urine culture is advised to determine the type of infection. Antibiotics for a few days usually clear that up promptly.

I thought I had prostate problems, weeing often, couldn't finish & just accepted it as old age.

No pain, no cloudy wee, no other symptoms.

 

Then I had a cut that wouldn't heal (road dirt in the cut), and took cipro 500 antibiotics (5 days 2 tabs a day).

Cut healed, and weeing went back to normal, guess it was a UTI and not a prostate problem.

 

Healed 2 birds with 1 antibiotic.

[Sheryl]

3 minutes ago, bkk6060 said:

Some good info on here but I got to say I know at least a dozen guys (including my father) who have had cancer and had it removed and they were left impotent.  Even several years after the surgery.  The " it will come back" comments are mostly being made by Doctor's I bet.  Just like " you will be 100 % after back surgery" which from my experience is mostly never the case.  

For me if I were advanced in age and still was sexually active, I would probably not have P cancer surgery.

Just saying...

 

Please let us stay on topic. No reason to think the OP has cancer.

 

.

[jenny2017]

5 hours ago, JimmyJ said:

Personally - I am not a doctor - I think your situation of having to urinate during the night several times is normal, or at least is not cause for concern, and no reason to get the highly questionable PSA test which can lead to suggestions to get highly questionable prostate biopsies due to the PSA number.

 

If you are not having problems with the act of urinating, I also feel there is no need for medication.

If your BPH starts interfering with the ability to urinate, then medication I suppose makes sense.

 

 

 

 

I've received three different medications with very strange side effects at a time where they knew absolutely nothing what was wrong with me.

 

  OP, please do not take any medication now as that could cause exactly the opposite of what you're trying to achieve. I couldn't urinate sometimes and it took forever to get out a few drops. 

 

But from what I later found out, I was extremely dehydrated, which of course had something to do with it. 

[Sheryl]

Last warning: stay on topic!!!!

 

I do not want to have to close this thread but it is getting hijacked into scare mongering around prostate cancer which is in  no way helpful to the OP, who simply asked about getting a prostate exam.

 

Several off topic posts have been removed.

[KhaoYai]

8 hours ago, tomgreen said:

 

Thanks , the part where you say

 

‘’ In the afternoon, I was told that the blood tests didn't show any cancer ‘’

 

is interesting to note that a blood test can show signs of cancer .

 

The urine test part is all so interesting and some thing Ive not seen mentioned so far , so may be along with having a blood test for PSA , a urine test may be of benefit is some way ?

 

 

Tom

Tom, the blood tests are unlikely to show cancer, what they may do is show a high PSA level which could indicate cancer and will help doctors decide if a prostate biopsy should be carried out.

 

With the symtoms you are reporting a doctor is likley to suspect either prostate or bladder problems both of which can cause traces of blood in the urine - hence the urine test.

 

I had similar symptoms and when tested my PSA was very high and there were traces of blood in my urine. I was eventually diagnosed with prostate cancer.

 

However consider this, you say the symptoms started shortly after you arrived in Thailand. There is a very good chance that you have picked up a urine infection.  The sooner you get tested, the better all round.

 

As for costs - I went to Thailand for a month shortly after diagnosis - it was pre planned and I wasn't letting anything stop me.  I did however come to an agreement with my doctor in the UK - I would have my PSA tested again 2 weeks into my trip, if it had risen significantly, I would go home and commence treatment. If it remained the same or thereabouts, I would continue with my trip as planned.  As it happens, my PSA actually fell a little so all was well.

 

I had my PSA tested at The Bangkok Hospital, Pattaya at a cost of 2200 baht including a semi-consultation.  I say semi because although I explained my position to them, they insisted that I have some form of consultation.  When I actually sat down with the doctor there he understood that I had already been diagnosed and that's probably why the cost was so low.

 

I have no idea what full initial testing and consultation will cost in Thailand but I wouldn't skimp on it.  You can shop around once you've had your diagnosis, any subsequent treatment recommendations and know where you stand.  I wouldn't expect the whole lot to cost much more than 10,000 baht which is not a lot for quality diagnosis and recommendations as to treatmant options if any.

[KhaoYai]

35 minutes ago, Sheryl said:

Last warning: stay on topic!!!!

 

I do not want to have to close this thread but it is getting hijacked into scare mongering around prostate cancer which is in  no way helpful to the OP, who simply asked about getting a prostate exam.

 

Several off topic posts have been removed.

I understand what you are saying but with respect, it is not scaremongering.  If the OP described his symptoms to any Urologist, one of their suspicions would be Prostate Cancer but it is also important to point out that it could also be a simple infection or prostatitis.

 

This horrible disease kills thousands of men needlessly every year.  Early detection could save many of those unfortunates.  Men are well known for mucking about and not going to the doctors as soon as they should with any type of problem. In this case, time is of the essence and procrastination is the worst enemy.  I wish to hell that someone had scared me into going to the doctor earlier, I might not have to worry every time I have a PSA test for the rest of my life.

 

You of course, are the moderator but I don't think censorship is appropriate in this case - there can never be too many warnings about prostate cancer.

Edited June 30, 2018 by KhaoYai

[tomgreen]

Today I went and had a blood test at a private lab  ( 1,100  Baht ) and asked for several readings other than just a PSA , on the test results paperwork I was given the letter ( H ) next to a result was marked in red , looking at the results where the ( H ) is shown I think this indicates a result number that is above the normal result amount and not good.

 

Seeing the ( H ) has sent my mind into a spin and I am now wondering what the next step would be to correct these bad numbers.

The blood test numbers were

Fasting Blood Sugar  104      Normal range 70 – 110mg/dL - I drank and ate nothing after 5pm the previous day

Cholesterol  223   ( H )           Normal range 130 – 200mg/dL

Triglycerides  97                    Normal range 10 – 150mg/dL

HDL Cholesterol   59  ( H )   Normal range Male sex 35 – 55mg/dL

LDL   Cholesterol 137  ( H )   Normal range 0-100mg/dL

PSA  1.20                              Normal range 0-4ng/mL 70-79y N-0 – 6.5

 

The PSA number I thinks looks acceptable , but not 100% sure .


Ive had a quick google on these results but there seems many many different opinions, so if any one can comment on my results I would be very happy

[JimmyJ]

 

The PSA number is great. Over 4.0 is what they're identifying as being above normal.

[JimmyJ]

HDL is the "good cholesterol", being over is fine.

 

Your Cholesterol and LDL "bad cholesterol"  are high.

 

Time for a vegetarian diet! You'll be much healthier and animals will thank you.

If that's inconceivable - cut down on animal fat.

 

 

Edited July 2, 2018 by JimmyJ

[bkk6060]

8 minutes ago, tomgreen said:

Today I went and had a blood test at a private lab  ( 1,100  Baht ) and asked for several readings other than just a PSA , on the test results paperwork I was given the letter ( H ) next to a result was marked in red , looking at the results where the ( H ) is shown I think this indicates a result number that is above the normal result amount and not good.

 

Seeing the ( H ) has sent my mind into a spin and I am now wondering what the next step would be to correct these bad numbers.

The blood test numbers were

Fasting Blood Sugar  104      Normal range 70 – 110mg/dL - I drank and ate nothing after 5pm the previous day

Cholesterol  223   ( H )           Normal range 130 – 200mg/dL

Triglycerides  97                    Normal range 10 – 150mg/dL

HDL Cholesterol   59  ( H )   Normal range Male sex 35 – 55mg/dL

LDL   Cholesterol 137  ( H )   Normal range 0-100mg/dL

PSA  1.20                              Normal range 0-4ng/mL 70-79y N-0 – 6.5

 

The PSA number I thinks looks acceptable , but not 100% sure .


Ive had a quick google on these results but there seems many many different opinions, so if any one can comment on my results I would be very happy

Hey, not bad really.

Your high HDL is much better then low and many ranges are over 60 as being high.

Maybe take Lipitor 10 mg (I do) it will lower your overall cholesterol.

Good luck you are not in bad shape.

Edited July 2, 2018 by bkk6060

[simple1]

19 minutes ago, tomgreen said:

Today I went and had a blood test at a private lab  ( 1,100  Baht ) and asked for several readings other than just a PSA , on the test results paperwork I was given the letter ( H ) next to a result was marked in red , looking at the results where the ( H ) is shown I think this indicates a result number that is above the normal result amount and not good.

 

Seeing the ( H ) has sent my mind into a spin and I am now wondering what the next step would be to correct these bad numbers.

The blood test numbers were

Fasting Blood Sugar  104      Normal range 70 – 110mg/dL - I drank and ate nothing after 5pm the previous day

Cholesterol  223   ( H )           Normal range 130 – 200mg/dL

Triglycerides  97                    Normal range 10 – 150mg/dL

HDL Cholesterol   59  ( H )   Normal range Male sex 35 – 55mg/dL

LDL   Cholesterol 137  ( H )   Normal range 0-100mg/dL

PSA  1.20                              Normal range 0-4ng/mL 70-79y N-0 – 6.5

 

The PSA number I thinks looks acceptable , but not 100% sure .


Ive had a quick google on these results but there seems many many different opinions, so if any one can comment on my results I would be very happy

As said above your PSA count is currently relatively low, but should be monitored. However, Google is not your doctor, to be blunt make a appointment with a trusted doctor for a review, recommended monitoring scheduling and if any medication is required at this time.

 

Take care of yourself...

Peter

Edited July 2, 2018 by simple1

[Sheryl]

1. Your PSA is within normal range, this is positive but does not remove the need for a digital exam, just makes it more likely that any prostate enlargement is benign or at least not due to an aggressive cancer. You should monitor it yearly now that you have this baseline as changes over time are meaningful. I'm sure urologist will so advise.

 

2. Your fasting sugar is in the "pre-diabetic" range (the reference values provided by this lab are outdated).  100 -110 nowadays is considered pre-diabetic and warrants some dietary and lifestyle modications which I'll go through in a bit as they are the same for the lipids.  The next time you have bloods drawn get an Hb1Ac, does not have to be fasting. This also checks for diabetes but is better in that it reflects blood sugars over a period of time as opposed to a single point in time. The stress of the blood draw can, in some people, slightly elevate blood sugar, and what you ate on the days prior can also have an effect. So get an Hb1AC to get a better picture of whether you are pre0-dabetic or even have early diabetes..

 

3. Now on the lipids, this is complicated and as with the sugar some of the "normal" values listed by the lab are outdated.

 

• Total cholesterol level is not important by itself.
• Triglycerides are OK
• HDL is typical value for a male but not optimal. Optimal is to be above 60 as that confers a protective effect on the heart and blood vessels. So you want to raise this, not hard to do with proper diet.
• LDL is in the "borderline high" range. This would not be so concerning if the HDL was higher but it is not.  If you have any cardiac risk factors, the borderline high LDL is of much more concern than if you do not.
• The cholesterol/HDL ratio (total cholesterol divided by HDL) is 3.8. Ideal is 3.5 or less. Raising your HDL will take care of that.
• The Triglyceride/HDL ratio is 1.6. This is fine.

 

So in summary, you are borderline high in terms of blood sugar (unless the Hb1AC comes back at 6.0% or higher) and LDL, and your HDL is not as high as it best should be.  Borderline high LDL is more of a concern if there are any known cardiac risk factors than if not. It would be good to get blood test for CRP (C Reactive Protein, a marker for inflammation) and an Exercise Stress Test in the near future as results would inform whether there is need to be aggressive about the LDL. If these are OK and given the good TG/HDL ratio most doctors would not advice medication at this stage for the  LDL. If the CRP comes back elevated or if EST is positive for ischemic changes then you should consult a good cardiologist.

 

Glucose (sugar), LDL and HDL will usually improve with a combination of improved diet and more exercise. In terms of diet, contrary to what was thought in the past (and what some out of date doctors may still tell you), avoiding fats is not the most important thing, it is avoiding processed foods and refined sugars. This is because glucose and lipid metabolism are closely interconnected.

 

• Minimize intake of anything containing refined sugar
• Minimize intake of processed carbs like white rice, white breads, white pasta
• More fruit and vegetables, nuts, legumes, whole grains
• Protein sources: Lots of fish, less red meat, lean chicken/lean pork.
• As regards fats, try to get in more of the healthy fats and less of the unhealthy ones. Olive oil or safflower/sunflower/canola oil rather than palm oil or butter for frying (note that fried foods sold ready made in Thailand are almost always fried in palm oil, very unhealthy) .
• High fiber - eat as much high fiber as you can, helps reduce LDL as well as other health benefits.. Oatmeal is a good cheap source.

 

Fish oil supplements help boost HDL and are especially good idea if you do not like to eat much fish

 

Losing weight, if you are at all overweight, will also help especially with the sugar

 

If you can do these things and recheck your labs in say 3-6 months, you will likely see an improvement. Given your borderline values 6 monthly checking would be wise.

 

As you seem not to have had check-ups recently before this, remember too that at your age a colonoscopy to screen for colon cancer should be done every 10 years (if you had one within past 10 years that was normal, no problem but if not, should do this when you have a chance).

[mokwit]

Sheryl, would eating high Fructose/high Glycemic load fruit such as (delicious!) sweet mangoes be the same as eating refined sugar (or high fructose corn syrup foods)? On one glycemic load list, sweet mangoes were at the top........................

[tomgreen]

5 hours ago, JimmyJ said:

HDL is the "good cholesterol", being over is fine.

 

Your Cholesterol and LDL "bad cholesterol"  are high.

 

Time for a vegetarian diet! You'll be much healthier and animals will thank you.

If that's inconceivable - cut down on animal fat.

 

 

Thanks , yes I’m going to be looking at my diet in more detail , Ive all ways wondered what living with a vegetarian diet would be like / entail .

 

Tom

[tomgreen]

5 hours ago, bkk6060 said:

Hey, not bad really.

Your high HDL is much better then low and many ranges are over 60 as being high.

Maybe take Lipitor 10 mg (I do) it will lower your overall cholesterol.

Good luck you are not in bad shape.

Thanks for the comment and encouragement.

 

Tom

 

 

 

 

[tomgreen]

5 hours ago, simple1 said:

As said above your PSA count is currently relatively low, but should be monitored. However, Google is not your doctor, to be blunt make a appointment with a trusted doctor for a review, recommended monitoring scheduling and if any medication is required at this time.

 

Take care of yourself...

Peter

Peter thanks for the comment , yes your spot on and I will be seeing a doctor .

 

 

Tom

 

 

 

 

[tomgreen]

5 hours ago, Sheryl said:

1. Your PSA is within normal range, this is positive but does not remove the need for a digital exam, just makes it more likely that any prostate enlargement is benign or at least not due to an aggressive cancer. You should monitor it yearly now that you have this baseline as changes over time are meaningful. I'm sure urologist will so advise.

 

2. Your fasting sugar is in the "pre-diabetic" range (the reference values provided by this lab are outdated).  100 -110 nowadays is considered pre-diabetic and warrants some dietary and lifestyle modications which I'll go through in a bit as they are the same for the lipids.  The next time you have bloods drawn get an Hb1Ac, does not have to be fasting. This also checks for diabetes but is better in that it reflects blood sugars over a period of time as opposed to a single point in time. The stress of the blood draw can, in some people, slightly elevate blood sugar, and what you ate on the days prior can also have an effect. So get an Hb1AC to get a better picture of whether you are pre0-dabetic or even have early diabetes..

 

3. Now on the lipids, this is complicated and as with the sugar some of the "normal" values listed by the lab are outdated.

 

• Total cholesterol level is not important by itself.
• Triglycerides are OK
• HDL is typical value for a male but not optimal. Optimal is to be above 60 as that confers a protective effect on the heart and blood vessels. So you want to raise this, not hard to do with proper diet.
• LDL is in the "borderline high" range. This would not be so concerning if the HDL was higher but it is not.  If you have any cardiac risk factors, the borderline high LDL is of much more concern than if you do not.
• The cholesterol/HDL ratio (total cholesterol divided by HDL) is 3.8. Ideal is 3.5 or less. Raising your HDL will take care of that.
• The Triglyceride/HDL ratio is 1.6. This is fine.

 

So in summary, you are borderline high in terms of blood sugar (unless the Hb1AC comes back at 6.0% or higher) and LDL, and your HDL is not as high as it best should be.  Borderline high LDL is more of a concern if there are any known cardiac risk factors than if not. It would be good to get blood test for CRP (C Reactive Protein, a marker for inflammation) and an Exercise Stress Test in the near future as results would inform whether there is need to be aggressive about the LDL. If these are OK and given the good TG/HDL ratio most doctors would not advice medication at this stage for the  LDL. If the CRP comes back elevated or if EST is positive for ischemic changes then you should consult a good cardiologist.

 

Glucose (sugar), LDL and HDL will usually improve with a combination of improved diet and more exercise. In terms of diet, contrary to what was thought in the past (and what some out of date doctors may still tell you), avoiding fats is not the most important thing, it is avoiding processed foods and refined sugars. This is because glucose and lipid metabolism are closely interconnected.

 

• Minimize intake of anything containing refined sugar
• Minimize intake of processed carbs like white rice, white breads, white pasta
• More fruit and vegetables, nuts, legumes, whole grains
• Protein sources: Lots of fish, less red meat, lean chicken/lean pork.
• As regards fats, try to get in more of the healthy fats and less of the unhealthy ones. Olive oil or safflower/sunflower/canola oil rather than palm oil or butter for frying (note that fried foods sold ready made in Thailand are almost always fried in palm oil, very unhealthy) .
• High fiber - eat as much high fiber as you can, helps reduce LDL as well as other health benefits.. Oatmeal is a good cheap source.

 

Fish oil supplements help boost HDL and are especially good idea if you do not like to eat much fish

 

Losing weight, if you are at all overweight, will also help especially with the sugar

 

If you can do these things and recheck your labs in say 3-6 months, you will likely see an improvement. Given your borderline values 6 monthly checking would be wise.

 

As you seem not to have had check-ups recently before this, remember too that at your age a colonoscopy to screen for colon cancer should be done every 10 years (if you had one within past 10 years that was normal, no problem but if not, should do this when you have a chance).

Thank you very much for the detailed advice and suggestions , which I will now be acting upon .

 

On the subject of a digital exam ( finger up the rectum ) how does that compare to a prostate / rectal ultrasound exam , and would that option be offered in Thailand

 

Tom

 

 

 

 

 

[oldrunner]

I am now 78 yrs young. Took PSA tests on all blood tests. Everything normal except one test show PSA jumping to 27 something. Dr ordered additional tests and cancer was found. Went to Govt  Hosp in BKK and underwent radiation therapy 6 days a week for 8 weeks. PSA normal. No sign of cancer. I have other complications, eg Heart so I continue to see Heart Doctor every two months, get pills, blood tests (including PSA). My life style, drinking/smoking over many years = lucky to be hanging around this long. No smoking or drinking (sugar free tea thank you) past 20 years. Older sister 84, brother 82. I'm the tail end of 11 children, and no we were not farmers but obviously Dad did some serious plowing.

Edited July 2, 2018 by oldrunner
mispelling

[tomgreen]

24 minutes ago, oldrunner said:

I am now 78 yrs young. Took PSA tests on all blood tests. Everything normal except one test show PSA jumping to 27 something. Dr ordered additional tests and cancer was found. Went to Govt  Hosp in BKK and underwent radiation therapy 6 days a week for 8 weeks. PSA normal. No sign of cancer. I have other complications, eg Heart so I continue to see Heart Doctor every two months, get pills, blood tests (including PSA). My life style, drinking/smoking over many years = lucky to be hanging around this long. No smoking or drinking (sugar free tea thank you) past 20 years. Older sister 84, brother 82. I'm the tail end of 11 children, and no we were not farmers but obviously Dad did some serious plowing.

Thanks for posting you story , just a few questions if you don’t mind , did you have any symptoms relating to a prostate problem and thats why you took a PSA test , do you think that possibly your past life style has played a part in your health issues , and do you think that family genetics ( sister 84 / brother 82 ) may be some thing relevant ?

 

Tom

[Antonymous]

1 hour ago, tomgreen said:

 

Thank you very much for the detailed advice and suggestions , which I will now be acting upon .

 

On the subject of a digital exam ( finger up the rectum ) how does that compare to a prostate / rectal ultrasound exam , and would that option be offered in Thailand

 

Tom

 

 

 

 

 

Congratulations on your test results Tom. I wouldn't worry about a thing with those results. Certainly not a bad idea to reduce your LDL, but really not a big deal. If you take the Beta Sitosterols that I recommended, they will help to bring down the LDL. Add krill oil (generally better quality than plain fish oil) at 1000mg a day and your LDL could be under 130 pretty soon. That 'Source Naturals' product actually states on the bottle "Maintains healthy cholesterol levels" and I can testify to their efficacy.

 

The DRE is a blunt instrument compared to an ultrasound (in more ways than one). The finger touches only that part of the gland next to the rectum and cannot feel all around it. From that touch an experienced urologist can give you a rough idea of size compared to normal as in "slightly enlarged" etc. By contrast the ultrasound will give you a precise size such as "55cc" as opposed to the normal size around 35cc. The ultrasound will also give you the dimensions and shape exactly, whereas the finger cannot possibly estimate that. Not all glands are perfectly round 'like a walnut'. The finger may detect rough lumps on the surface it touches and this can indicate the presence of cancer. The ultrasound cannot detect cancer, but will give a good reading of possible lesions, calcification etc that are consistent with BPH.

 

I just booked a lower abdomen ultrasound today. Cost 1,000 baht. Quick and easy to do.

 

Your PSA is in the normal range. Maybe check it again every six months and after three readings you'll have a trend to ponder.

 

Congrats again; now relax.

 

 

 

 

 

[KhaoYai]

Tom, I don't want to take anything away from your good news but you still need to have your symtoms diagnosed. It is entirely possible that its prostatitis or even a urine infection but don't ignore it.  PSA tests can be unreliable but at the moment they are all we have.  A low PSA level does not necessarily mean there's no cancer present just as a high one doesn't always mean there is.

 

You've taken the step of going to a lab but I'm pretty sure that when you do eventually go to a doctor to find out what's wrong, that doctor will ask for some of those tests to be done again.  I don't know about Thailand but in the UK, a doctor will not rely on tests they didn't order themselves.

[tomgreen]

11 minutes ago, KhaoYai said:

Tom, I don't want to take anything away from your good news but you still need to have your symtoms diagnosed. It is entirely possible that its prostatitis or even a urine infection but don't ignore it.  PSA tests can be unreliable but at the moment they are all we have.  A low PSA level does not necessarily mean there's no cancer present just as a high one doesn't always mean there is.

 

You've taken the step of going to a lab but I'm pretty sure that when you do eventually go to a doctor to find out what's wrong, that doctor will ask for some of those tests to be done again.  I don't know about Thailand but in the UK, a doctor will not rely on tests they didn't order themselves.

Yes , although the blood tests results were generally ok , I’m determined to follow things up with a visit to a doctor and see what they have to say , The going to the lab was just to quickly see how things looked . This getting old is a hard pill to swallow ?

 

Tom

[tomgreen]

8 hours ago, Antonymous said:

Congratulations on your test results Tom. I wouldn't worry about a thing with those results. Certainly not a bad idea to reduce your LDL, but really not a big deal. If you take the Beta Sitosterols that I recommended, they will help to bring down the LDL. Add krill oil (generally better quality than plain fish oil) at 1000mg a day and your LDL could be under 130 pretty soon. That 'Source Naturals' product actually states on the bottle "Maintains healthy cholesterol levels" and I can testify to their efficacy.

 

The DRE is a blunt instrument compared to an ultrasound (in more ways than one). The finger touches only that part of the gland next to the rectum and cannot feel all around it. From that touch an experienced urologist can give you a rough idea of size compared to normal as in "slightly enlarged" etc. By contrast the ultrasound will give you a precise size such as "55cc" as opposed to the normal size around 35cc. The ultrasound will also give you the dimensions and shape exactly, whereas the finger cannot possibly estimate that. Not all glands are perfectly round 'like a walnut'. The finger may detect rough lumps on the surface it touches and this can indicate the presence of cancer. The ultrasound cannot detect cancer, but will give a good reading of possible lesions, calcification etc that are consistent with BPH.

 

I just booked a lower abdomen ultrasound today. Cost 1,000 baht. Quick and easy to do.

 

Your PSA is in the normal range. Maybe check it again every six months and after three readings you'll have a trend to ponder.

 

Congrats again; now relax.

 

 

 

 

 

Thanks for the comments and suggestions , the encouragement is much appreciated.

 

Tom