Peeing dark yellow

[banK]

Around 3 days ago noticed that the colour of my pee was markedly above the normal pale yellow.

I initially thought that I was dehydrated, (the week before went up north with the family and did not drink much water, just coffee and only occasionally water. I have had no alcohol since the back end of 2015).

 

I also thought that I had contracted a slight dose of food poisoning initially, normal stools one day and the next a bit runny but then back to normal the following day.

Despite taking on plenty of water the colour remained dark yellow - I still thought that it was dehydration because I had a dry mouth and throat despite drinking adequate water, perhaps I was missing essential minerals.

 

Yesterday evening I thought that I had a tinge of yellow in the eyes and body, more striking this morning.

 

I went to Bangkok Khon Kaen hospital today to find out what was going on.

 

It seems to be a revisitation of the back end of 2015, only this time its to do with the liver - not the lung cancer and AAA episodes.

I saw a Dr. Apichat Sangchan (asst. Prof.)

 

He recommended I have a kidney and Liver function test, I also suggested to have a CBC. After that an ultra sound of the abdomen.

 

The results: Kidney all ok

                  Liver - not ok.

                  CBC ok

 

I had an annual Kidney, liver and PSA check done about 6 weeks ago where all appeared to be normal.

 

This time there was an 8 test for the liver

Total Protein   7.9    g/dl     (6.6-8.7)

Albumin          4.4   g/dl     (3.5-5.2)

Globulin          3.5   g/dl

Total Bilirubin  7.1 H mg/dl  (0.0-1.2)

Direct Bilirubin 6.3 H mg/dl (0.0-0.3)

SGOT (AST)     265 H U/L    (0-40)

SGPT (AST)     423 H U/L     (0-41)

ALP (alkaline Phosphatase)  401 H U/L    (40-130)

 

In November all that was tested was SGOT  which was  17 U/L   (0-41)  and  SGOT which was 20 U/L  (0-40).

Was not able to query with the Dr. as I only noticed it when I got home. But that's water under the bridge now.

Maybe worth noting that the LFT should consist of the 8 tests above.

 

I have to revisit tomorrow as the Dr. recommended to have MRI with contrast + MRCP. Unable to have them today as I had something to eat between the tests and the results today.

 

ULTRASOUND UPPER ABDOMEN FINDINGS - The study reveals mark inhomogenous increase echogenicity of liver with increase periductal echo; parenchymatous changed of liver or infiltrating tumor could not be excluded. No detectable liver mass is found.

 

   - Dilation of IHD in both lobes liver and dilatation of CBD (about 0.92cm in diameter) which could not demonstrate cause of obstruction due to much of bowel gas artifact.

 

  -  The thin-wall gallbladder is markly distended (about 11cm in length); hydrop gallbladder is suggested. No detectable gallstone is noted.

 

  -  The rest is about the Kidneys what all was ok.

 

IMPRESSION:

  -  Dilatation of IHD in both lobes liver and dilatation of CBD which could not demonstrate cause of obstruction due to much of bowel gas artifact.

 

  -  Mark inhomogenous increase echogenicity of liver with increase periductal echo; parenchymatous 

changed of liver or infiltrating tumor could not be excluded. Please correlate tumor marker and MRI + MRCP could be helpful.

 

  -  Hydrop gallbladder is suggested.

 

  -  Suspected renal stone at lower pole of right kidney (about 0.6cm) without hydronephrosis.

 

  -  Simple renal cortical cyst at lower pole of left kidney, about 2.85x3.06 cm.

 

The Dr. suggested that the obstruction is not a stone as there is no pain so the only other thing will be a tumor.

I asked what remedy is there is it is indeed  a tumor - he said surgery.

 

As far as I understand the obstruction is in the bile duct inside of the liver and not outside. Is it possible that surgery could be done?

 

Having read a bit about it, it seems to be a rare and aggressive type of cancer (if that is what I have).

 

As the ALP indicates the obstruction, if its a tumor can it grow that fast (6 weeks)? Even though ALP was not tested in November, the SGOT was which I understand is the inflammation marker so I would expect them to go hand in hand i.e. SGOT normal in November I would expect that ALP would have been normal then.  Now SGOT elevated and also ALP.

 

Also - would a PET scan be definitive more so than the MRI + MRCP, although I will be having these tomorrow anyway.

 

I would feel more comfortable if I were to be operated on in the Bangkok Bangkok hospital as I was in 2016 - more facilities, equipment including PET scanner and wide ranging physicians.

 

Sheryl - Could you comment on my post and any suggestions re doctors/professors in the Bkk Bkk hospital.

 

I am insured with Cigna Global - That's one ray of sunshine!!

 

banK

 

[Sheryl]

When you see the doctor tomorrow ask about blood test for AFP (a tumor marker, will be elevated in about 40% cases of liver cancer - but can also have other causes of elevation) and hepatitis panel.

 

The MRI should shed more light on what this is. As to PET, wait and see what is recommended after the MRI and MRCP.

 

Lack of pain makes stone less likely but does not completely rule it out. Anyhow the scans should clarify if one is present.

 

At Bangkok Hospital:

 

Prof.  RATHA-KORN VILAICHONE

or

Prof. VAROCHA MAHACHAI

 

These are GI/liver specialists but not surgeons so they may refer you onward but it is a good starting point.

 

 

 

 

[banK]

18 minutes ago, Sheryl said:

When you see the doctor tomorrow ask about blood test for AFP (a tumor marker, will be elevated in about 40% cases of liver cancer - but can also have other causes of elevation) and hepatitis panel.

 

The MRI should shed more light on what this is. As to PET, wait and see what is recommended after the MRI and MRCP.

 

Lack of pain makes stone less likely but does not completely rule it out. Anyhow the scans should clarify if one is present.

 

At Bangkok Hospital:

 

Prof.  RATHA-KORN VILAICHONE

or

Prof. VAROCHA MAHACHAI

 

These are GI/liver specialists but not surgeons so they may refer you onward but it is a good starting point.

 

 

 

 

Thanks for that information.

 

The Dr., when I asked about speed of the obstruction becoming apparent, said that it could be a slow growing tumor, if in fact it is the cause. Wouldn't it have shown up with an elevated number in November, even though only SGOT and SGPT were tested.

 

One crucial question - How urgent is it to have any surgery done - hours/days/weeks?

 

One curiosity - the only symptoms are a tinge of yellow and yellower pee, no itching  of the hands  etc.

 

banK

[fertilizer]

banK - just sent you a PM.

[banK]

40 minutes ago, fertilizer said:

banK - just sent you a PM.

Got it  tks and replied 

 

banK

[Sheryl]

Thanks for that information.
 
The Dr., when I asked about speed of the obstruction becoming apparent, said that it could be a slow growing tumor, if in fact it is the cause. Wouldn't it have shown up with an elevated number in November, even though only SGOT and SGPT were tested.
 
One crucial question - How urgent is it to have any surgery done - hours/days/weeks?
 
One curiosity - the only symptoms are a tinge of yellow and yellower pee, no itching  of the hands  etc.
 
banK

If it is a tumor then time is of the essence (as in days not weeks). I suggest you plan on gettng to Bangkok early in the coming week if the scans indicate a tumor.

Dark urine is an early sign and results from the body trying to eliminate the excess bilirubin. Other signs like itching come later if bilirubin levels rise high enough.


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[banK]

56 minutes ago, Sheryl said:

If it is a tumor then time is of the essence (as in days not weeks). I suggest you plan on gettng to Bangkok early in the coming week if the scans indicate a tumor.

Dark urine is an early sign and results from the body trying to eliminate the excess bilirubin. Other signs like itching come later if bilirubin levels rise high enough.


Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thanks - I'll get my skates on tomorrow!

 

banK

[banK]

Just spoke to Cigna- explained the situation and they couldn't have more helpful. From hereon in they will be picking up the tab after the first thousand pound deductible is paid by me, they will direct bill the hospital. Cancer and scans are part of the inpatient deal.

They also have an 'advisory medical program' free of charge whereby one can speak to a doctor at any time for advice or opinion. They phone you after you request a time/date.

 

A bit of insurance info.

 

bank

[Formaleins]

12 hours ago, banK said:

Thanks for that information.

 

The Dr., when I asked about speed of the obstruction becoming apparent, said that it could be a slow growing tumor, if in fact it is the cause. Wouldn't it have shown up with an elevated number in November, even though only SGOT and SGPT were tested.

 

One crucial question - How urgent is it to have any surgery done - hours/days/weeks?

 

One curiosity - the only symptoms are a tinge of yellow and yellower pee, no itching  of the hands  etc.

 

banK

Pancreas check out OK? worth a look to make sure. I have problems there and it isn't pleasant.

[simon43]

Bank, I wish you all the best of luck with your prognosis and treatment. 

 

This post is simply to compliment you on having the common sense to take out medical insurance for use in times of need such as this.  I hope uninsured forum posters will take heed....

[Sheryl]

Bank, I wish you all the best of luck with your prognosis and treatment. 
 
This post is simply to compliment you on having the common sense to take out medical insurance for use in times of need such as this.  I hope uninsured forum posters will take heed....

Indeed. And all those "insurance is a scam, they never pay claims" folk should note that OP had a claim in excess of 3 million a few years back for issues that included cancer and cardiovascular problem. Paid without issue and no problem with subsequent renewal and company is now prepared to pay out for new cancer treatment if required.

(Sorry for the digression BanK and good luck today, let me know what the scans show).

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[ted4647]

2 hours ago, simon43 said:

Bank, I wish you all the best of luck with your prognosis and treatment. 

 

This post is simply to compliment you on having the common sense to take out medical insurance for use in times of need such as this.  I hope uninsured forum posters will take heed....

indeed have taken heed..at the moment receiving excellent treatment at govt hospital at a mere fraction of what an elderly insured/private hospital patient pays.

  Reading the posters prognosis /treatment I would say it is elective and selective,so no need for insurance if choice is a factor,agree accident insurance is ideal tho and just how much are his premiums ,beside the upfront "thousand of pounds".

  The poster a while back who went to India for 5 stents,private room etc. I would say is the way to go ,all in at 8000US.

   However which ever way to look at it do the insurance cover end of life treatment?  that will be a requirement for all or

 

 

Edited January 5, 2019 by ted4647
sp

[Sheryl]

I realize I contributed to the digression but please, let's stay on topic. the OP has a very serious health concern.

[murraynz]

5 hours ago, Sheryl said:

I realize I contributed to the digression but please, let's stay on topic. the OP has a very serious health concern.

are you a doctor or an insurance agent  ??????

[banK]

15 hours ago, Formaleins said:

Pancreas check out OK? worth a look to make sure. I have problems there and it isn't pleasant.

checked out nothing seen.

[banK]

15 hours ago, Formaleins said:

Pancreas check out OK? worth a look to make sure. I have problems there and it isn't pleasant.

 

15 hours ago, simon43 said:

Bank, I wish you all the best of luck with your prognosis and treatment. 

 

This post is simply to compliment you on having the common sense to take out medical insurance for use in times of need such as this.  I hope uninsured forum posters will take heed....

 

13 hours ago, Sheryl said:

Indeed. And all those "insurance is a scam, they never pay claims" folk should note that OP had a claim in excess of 3 million a few years back for issues that included cancer and cardiovascular problem. Paid without issue and no problem with subsequent renewal and company is now prepared to pay out for new cancer treatment if required.

(Sorry for the digression BanK and good luck today, let me know what the scans show).

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Long day at the  hospital today. Had the mri and ct scans done. MRI + contrast took about an hour, a bit like being buried alive - no possibility of movement - close eyes and follow the instuctions given over the headphones, then a quick CT scan.

 

The results in precis - no tumors on pancreas and liver seen.

There is a stricture where the bile duct meets the head of the  pancreas. Indicator is that  the stricture is more on the  bile duct side. Probably not a stone due to no pain despite prodding. More likely small tumor, but unsure. To that end the Doctor recommends an endoscopic ultra sound that will take biopsy samples. The recommended Doctor at the  Bkk medical  centre is Dr. Aroon.He doesn't work Saturdays so will  arrange an  appt. tomorrow.

 

The longest part of the day was taken up by me talking with the third party admin insurance dept ln Bkk hospital to arrange the line of communications with Cigna. The hospital were asking for a Gop of Cigna and Cigna saying they were waiting for paperwork from the hospital! It very confusing for all concerned.

 

I was in the middle speaking with  Cigna one my mobile  in one ear and hospital landline with Bkk insurance dept. ln the  other! Like some comedy sketch! after half an hour I thought I was successful.

 

Left hospital got home  (80km from hospital ). To then receive a phone  call from a doctor from the UK attached to a new service from Cigna (medical advice service). You can request a doctor call you -a free of charge service provided by Cigna. Because of the urgency of my problem I thought it best to try to streamline the gops via phone calls to enable quick decisions. Questioned by this  doctor so she had all the information and she agreed quickness was essential and she said she would tell Cigna this.

She asked me to phone cigna to say I would be making an appointment tomorrow to attend Bkk Bkk hospital. So  I phoned them only for them to say that nothing could proceed because they have not received the referral letter. 

I was assured by the hospital before I left that all the info. would be supplied to Cigna......

I had a copy of this referral letter and Cigna asked me to scan and send it to them - panic over!

 

Cigna has been extremely  helpful, very personable admin staff. They are available 24/7. In the dark hours in the UK the far east office takes over -Hong Kong or Singapore, not sure which - same level of service.

 

Insurance wise the  proof is in the pudding - I've tasted it and I like it and it works.

 

I turn 71 in May, I have not been discriminated on age or claims - to the contrary unbelievable service.

 

banK 

[banK]

Update.

This morning got confirmation of GOP for the Endoscopic Ultra sound procedure  from Cigna by email .

 

Booked an appt, with Dr. Aroon in the Bkk medical centre tomorrow. Flying to Bkk this afternoon for the appt.

 

Cigna says any further treatment could proceed once the hospital recommendation is received.

 

At the moment - looking good!

 

banK

[Sheryl]

An insensitive and unhelpful post has been removed. ????

 

There will be zero tolerance of that here.

 

BanK, good news so far. As you no doubt realize the big concern given your prior history would be a metastatic tumor in the liver or pancreas.  So far no clear indication of that, which is good, but of course final diagnosis still pending.  Fingers crossed and keep us informed.

[banK]

Yep - wait and see

 

banK

[banK]

Had the Endoscopic Ultra Sound done.

Result.

1. Not a stone - a tumor - impression of Dr. is that is malignant.

2. The tumor (2.5cm) was pressing on the bile duct causing the obstruction.

3. No other lesions/tumors on the liver/pancreas. 

4. No lymph nodes on the pancreas. Location is not near any main artery - spread limited.

5. Biopsy samples will be analysed results in 7 days.

6. If it is malignant then the surgery is "The Whittle Procedure". 5 or 6 hour complex operation. 

   The surgeon that will carry out the procedure, the doctor said, is the most experienced in the hospital       for this type of procedure, He told me his name but can't recall.

 

The invoice estimation not included:- 

1. Medical supplies

2. Expenses for Medical clearance/IPD Doctor visit

3. Expenses special consultation and home medication

4. Investigation, Pathology.

 

Estimation  for one day stay - 181,000 Baht

                       two day stay - 222,000 Baht

 

In here till tomorrow, then back home until the result of biopsy then probably back here for the op.

 

banK 

 

 

 

 

 

Quote

 

 

[Sheryl]

Sorry to hear this, BanK,  but it is encouraging that it sounds contained.

 

Did the doctor indicate if he thinks this is a metastasis form the lung vs an altogether new tumor? It would be unusual for lung Ca to spread to pancreas but not involve liver, and sounds like your liver is clear. They'll know more when they get the path result.

 

If it is a new tumor of the pancreas you are actually very fortunate that it is located where it is and caused the obstruction it did, as most pancreatic tumors are not symptomatic or detected before it is too late for surgical removal, this is why pancreatic Ca usually has such a bad prognosis.  Sounds like yours is still pretty small  so, to the extent that a person with cancer of the pancreas can be considered lucky, you are.

 

That's Whipple procedure they mean. You can read about it here

 

https://www.pancan.org/facing-pancreatic-cancer/treatment/treatment-types/surgery/whipple-procedure-pancreaticoduodenectomy/

 

 

[banK]

Hi Sheryl

Thanks for the reply.

The bit about whether it had come from the Lung - I asked that same question and he replied that it will become apparent after pathology.

 

I realise how important it is that the tumor had developed in the place it did, it most likely is my Savior (at least for the time being). Shame it wasn't actually in the bile duct and not the pancreas head - although, thinking about it, I don't think it will have made much odds, they would still have to do a "whipple" to whip it out! He said that it had probably been growing from nothing to 2.5cm during the past 6 months to a year.

Had a LFT, (although not all 8 tests for some reason), only in November - 6 weeks or so ago and all was normal. Yes indeed lucky - if you can call it that!!

 

Yes - I've looked it up on the internet - a nasty bit of an operation!.   Asked the Dr. whether a laparoscopic robotic surgery would be possible - He said not available for this type of operation in this hospital although they have a robotic unit for other simpler procedures. I think he also said not available in Thailand, but in Hua Hin in 2009 one was carried out - so not sure on that one.

 

Right time to sleep

 

More info. as and when.

banK

 

[faraday]

Bank, thank you for this thread, I also have dark urine at times which isn't connected with what I eat or drink.

 

However, your experiences have encouraged me to go & get a blood test.

 

I am sorry to hear about the Tumour, but at least it's been discovered before it became inoperable, & as Sheryl says, it's pretty small.

 

I know that when dealing with such a vital subject, 'words' can sounds distant - if you know what I mean, but mine are sincere, & I hope they will give you, a little bit more power.

 

[MalandLee]

Hi Bank,

I wish you the VERY best outcome possible and I hope you can try at least, not to worry too much. The advice here is really good as is the support of fellow members.

 

I do not know you and can offer nothing other than my sincere best wishes, for the BEST possible outcome.

 

By your selfless posting(s) you have already prompted at least one member (Faraday) to seek advice, there may indeed be others that benefit, in other ways, e.g.. from the peripheral components such as insurance, etc..

 

Once again - Good luck mate..

Mal

[banK]

3 hours ago, faraday said:

Bank, thank you for this thread, I also have dark urine at times which isn't connected with what I eat or drink.

 

However, your experiences have encouraged me to go & get a blood test.

 

I am sorry to hear about the Tumour, but at least it's been discovered before it became inoperable, & as Sheryl says, it's pretty small.

 

I know that when dealing with such a vital subject, 'words' can sounds distant - if you know what I mean, but mine are sincere, & I hope they will give you, a little bit more power.

 

 

2 hours ago, MalandLee said:

Hi Bank,

I wish you the VERY best outcome possible and I hope you can try at least, not to worry too much. The advice here is really good as is the support of fellow members.

 

I do not know you and can offer nothing other than my sincere best wishes, for the BEST possible outcome.

 

By your selfless posting(s) you have already prompted at least one member (Faraday) to seek advice, there may indeed be others that benefit, in other ways, e.g.. from the peripheral components such as insurance, etc..

 

Once again - Good luck mate..

Mal

Thanks for the best wishes.

This morning the surgeon who will carry out the operation, (Professor Dr. TANAPHON MAIPANG),  came by and explained the operation. He said that the glove inserted for the AAA done in 2016 is quite close to the site of proposed excision, and due to the risks involved he will have a cardiac surgeon on hand for the operation. He also said that he had done hundreds of this procedure and hasn't lost a patient yet, hopefully that continues!!

A PET scan tomorrow, back home in Khon Kaen area tomorrow and then come back for pre-op tests Saturday/Sunday and have the operation next Monday.  I hope everything falls in line as per the plan.

 

Faraday - Yes best check out kidneys and liver function test (LFT) 8 tests - good luck!

 

As for the insurance - I took out mine with Cigna when I was 66 - so it's not too late to apply.

I opted for their Gold Plan with a 1000gbp deductable and at the time (about 5 years ago) the cost was 2500gbp and was at the last renewal, last March, 3800gbp. I have had approx. 3.6 million Baht paid out by them. Now I would guess that this next procedure would be between a million and 1.5 million. I haven't been told yet. Last years renewal was 300gbp less than the previous year. So not all insurance companies are scammers.

banK

 

[banK]

PET CT scan tomorrow.

 

Cost 63,000 baht picked up by Cigna.

 

banK

[banK]

Back from Bkk after having the PET scan. No cancer anywhere else so surgeon will operate.

 

Booking into hotel Bkk Medical Centre Sunday morning and having the operation 8.30am Monday morning.

Expected stay 10 - 11 days. The operation is called a Whipple procedure, takes out various bits and pieces and reattach the pipework. Don't like to dwell on it too much!!

 

Cost of operation 1.2 - 1.4 Million.

 

Will update as and when.

 

banK

 

[faraday]

10/11 days in hospital; that'll be fun.....

Yup, surgeons love cutting bits off us, taking things out, re-attaching part #a to part #b, but fortunately our bodies have alot of spare capacity....

 

Thanks for the updates.

 

Edited January 10, 2019 by faraday
too many biscuits....

[Sheryl]

13 hours ago, banK said:

Back from Bkk after having the PET scan. No cancer anywhere else so surgeon will operate.

 

Booking into hotel Bkk Medical Centre Sunday morning and having the operation 8.30am Monday morning.

Expected stay 10 - 11 days. The operation is called a Whipple procedure, takes out various bits and pieces and reattach the pipework. Don't like to dwell on it too much!!

 

Cost of operation 1.2 - 1.4 Million.

 

Will update as and when.

 

banK

 

Thanks for the update.

 

I'm sure you are apprehensive about things, but take comfort that the PET scan showed nothing else, that is good news.

 

Have you gotten the biopsy results yet?

[banK]

Pathology results Sunday

 

bank