Recent Medical Check-up

[Isan Farang]

Sheryl would be interested in your opinion

 

On early Nov 2023 i went for a medical checkup at a private hospital - first check in Ubon, my age is 68, on the report it stated detected.

Mild Fatty Liver

Moderate Enlarged Prostate

Impair Kidney Function eGFR(CKD-EPD) 66.42

Suspected BPH (Benign Prostatic Hyperplasia)

PSA was stated as 7.82

The doctor asked if i had a problem to urinate, and i informed her there was no issues. She asked me to take tablet Tamsulosin Uroflow 0.4mg and return back on January for a follow up. I then decided i would cancel the follow up and get a  2nd check up at another hospital

 

This week i went to another private hospital - 2nd check also in Ubon and this was detected

High Blood Sugar - 102

Found high levels of Liver Cancer

Found high levels of Prostate Cancer 

PSA was stated as 12.7

Alpha Fetoprotein 7.1

He told me to come back in April and on the appointment slip is says - Blood Test AFP/PSA

 

I have both reports so if there is any other info you need let me know

[CapraIbex]

I would see an Urologist and a Hepatologist/Gastroenterologist at either Bumrungrad hospital or Bangkok Pattaya hospital.

[SammyJ]

10 minutes ago, CapraIbex said:

I would see an Urologist and a Hepatologist/Gastroenterologist at either Bumrungrad hospital or Bangkok Pattaya hospital.

I agree---those are some alarming test results, having gone thru some of the related medical issues myself, and you need to see a specialist and see how best to address them. 

[Mike Lister]

I'm sure that @Sheryl will be along to comment.

[Sheryl]

First of all, you did not have "high levels of Liver Cancer". You had an elevated AFP, a "tumor marker"  test that is wrongly used by many private hospitals here as screening for liver cancer. In fact (1) AFP can be elevated for many reasons other than liver cancer and is not suitable for mass screening and (2) they  use a much lower cut off for AFP levels in Thailand than is the international norm. The internationally accepted normal range goes up to 10 meaning your 7.1 result would be considrred normal in the West (where the test would not have been performed anyhow, being unsuitable for general screening).   In addition it it sounds like you also had an abdominal ultrasound, which found no mass in the liver, just some fatty liver which is common in people who are overweight. In actual liver cancer AFP values tend to be in the hundreds. 

 

Secondly your blood sugar is not "high" it is borderline, in the range for pre-diabetes but that cannot be diagnosed from a single fasting blood sugar. Just the stress of having blood drawn can raise the blood sugar a bit. You need to get an Hb1Ac test which will show what your blood sugar has been like over the prior 3 months. This will show if you are actually pre-diabetic or not. If you are, treatment is lifestyle modifications (avoid/minimize orocessed carbs and get more exercise) and weight loss.

 

Third -- the eGFR is not a test but rather an estimation calculated based on age  race, and serum creatnine. Considerable error is possible and it can particularly be off in people who are obese. If your serum creatnine was normal, I would pay no attention to the eGFR.

 

Lastly, the PSA. It is important to avoid all sexual activity before a PSA test and also refrain from  riding a bicycle or motorcycle. If this was not done, you should repeat the test. If still elevated, then see a Urologist. 

 

In short: get an Hb1Ac and repeat the PSA after ensuring no sexual activity for 48 hrs and no biking. If still elevated see a Urologist. (If your earlier PSAs were already done under these conditions, skip that and see Urologist now bringing both PSA results with you.

 

You can get these tests at a lab, do not need to go to a hospital. https://uwellness.tech/en/about-us-u-wellness-international/

 

 

 

 

[ezzra]

BTW, with all due respect to our lovely Sheryl, medical check ups results can be looked up on google too where it can you

the upper and lower parameters of any specific tests..

[sungod]

I've had blood sugar anything from 100 to 105 for years now, my Hb1Ac is always way within acceptable limits. Dr is not worried.

[Isan Farang]

8 minutes ago, Sheryl said:

First of all, you did not have "high levels of Liver Cancer". You had an elevated AFP, a "tumor marker"  test that is wrongly used by many private hospitals here as screening for liver cancer. In fact (1) AFP can be elevated for many reasons other than liver cancer and is not suitable for mass screening and (2) they  use a much lower cut off for AFP levels in Thailand than is the international norm. The internationally accepted normal range goes up to 10 meaning your 7.1 result would be considrred normal in the West (where the test would not have been performed anyhow, being unsuitable for general screening).   In addition it it sounds like you also had an abdominal ultrasound, which found no mass in the liver, just some fatty liver which is common in people who are overweight. In actual liver cancer AFP values tend to be in the hundreds. 

 

Secondly your blood sugar is not "high" it is borderline, in the range for pre-diabetes but that cannot be diagnosed from a single fasting blood sugar. Just the stress of having blood drawn can raise the blood sugar a bit. You need to get an Hb1Ac test which will show what your blood sugar has been like over the prior 3 months. This will show if you are actually pre-diabetic or not. If you are, treatment is lifestyle modifications (avoid/minimize orocessed carbs and get more exercise) and weight loss.

 

Third -- the eGFR is not a test but rather an estimation calculated based on age  race, and serum creatnine. Considerable error is possible and it can particularly be off in people who are obese. If your serum creatnine was normal, I would pay no attention to the eGFR.

 

Lastly, the PSA. It is important to avoid all sexual activity before a PSA test and also refrain from  riding a bicycle or motorcycle. If this was not done, you should repeat the test. If still elevated, then see a Urologist. 

 

In short: get an Hb1Ac and repeat the PSA after ensuring no sexual activity for 48 hrs and no biking. If still elevated see a Urologist. (If your earlier PSAs were already done under these conditions, skip that and see Urologist now bringing both PSA results with you.

 

You can get these tests at a lab, do not need to go to a hospital. https://uwellness.tech/en/about-us-u-wellness-international/

 

 

 

 

 

Many thanks for the information, i live in both Ubon & Chiang Rai. Soon i will be heading back to CR can you advise whare to go in CR ?. Do you know of a Urologist in CR, or i can also head to Chiang Mai

Yes a had a Ultrasound check 

If i am correct i need to get a Hb1Ac test and i will repeat the PSA to compare on the two readings i already have. Are these reading all shown by a blood test

 

I just checked both reports and found the following and they have HbA1C

1st check HbA1C = 5.8

2nd check HbA1C = 5.6

[Sheryl]

14 minutes ago, Isan Farang said:

 

Many thanks for the information, i live in both Ubon & Chiang Rai. Soon i will be heading back to CR can you advise whare to go in CR ?. Do you know of a Urologist in CR, or i can also head to Chiang Mai

Yes a had a Ultrasound check 

If i am correct i need to get a Hb1Ac test and i will repeat the PSA to compare on the two readings i already have. Are these reading all shown by a blood test

 

I just checked both reports and found the following and they have HbA1C

1st check HbA1C = 5.8

2nd check HbA1C = 5.6

No need for another Hb1Ac then. Yours are in normal range. You are not pre-diabetic and can safely ignore the fasting blood sugar result.

 

In the 48 hours prior to the 2 PSA tests,  had  you had any sexual activity or ridden a bike or motorcycle? 

 

Are you driving ftom Ubon to CR? As if do might consider overnighting in Khon Jaen and seeing urologust at KKU Hospital.

[Isan Farang]

5 minutes ago, Sheryl said:

No need for another Hb1Ac then. Yours are in normal range. You are not pre-diabetic and can safely ignore the fasting blood sugar result.

 

In the 48 hours prior to the 2 PSA tests,  had  you had any sexual activity or ridden a bike or motorcycle? 

 

Are you driving ftom Ubon to CR? As if do might consider overnighting in Khon Jaen and seeing urologust at KKU Hospital.

 

No sexual activity or ridden a bike or motorcycle, 48h prior to the test?

I have already booked the flights to return to CR

 

I observed there is a Bangkok hospital in CR, just checking on your thoughts if thats worth a shot.

 

 

[Sheryl]

31 minutes ago, Isan Farang said:

 

No sexual activity or ridden a bike or motorcycle, 48h prior to the test?

I have already booked the flights to return to CR

 

I observed there is a Bangkok hospital in CR, just checking on your thoughts if thats worth a shot.

 

 

I take it you are saying that no, you did not gave sexual activity of any kind nor ride a bike/moto in the 48 hours prior to either PSA test?

 

If so do not repeat the test first, go direct to uroligist (though the wide difference between the 2 test results is odd and, together with the unprofessional wording of"results" from the second check up makes me question  the accuracy of their lab).

 

There has been some good feedback on these doctors at Bangkok Hospital CM (not CR)

 

https://www.bangkokhospital-chiangmai.com/en/doctor/dr-supon-sriplakick-m-d/

 

https://www.bangkokhospital-chiangmai.com/en/doctor/dr-wittawat-rawiyotai-m-d/

 

That said, expertise in urology is much better in Bangkok so if it emerges that there is a serious problem should at that point consuder coming there. 

 

[Isan Farang]

15 minutes ago, Sheryl said:

I take it you are saying that no, you did not gave sexual activity of any kind nor ride a bike/moto in the 48 hours prior to either PSA test?

 

If so do not repeat the test first, go direct to uroligist (though the wide difference between the 2 test results is odd and, together with the unprofessional wording of"results" from the second check up makes me question  the accuracy of their lab).

 

There has been some good feedback on these doctors at Bangkok Hospital CM (not CR)

 

https://www.bangkokhospital-chiangmai.com/en/doctor/dr-supon-sriplakick-m-d/

 

https://www.bangkokhospital-chiangmai.com/en/doctor/dr-wittawat-rawiyotai-m-d/

 

That said, expertise in urology is much better in Bangkok so if it emerges that there is a serious problem should at that point consuder coming there. 

 

 

I can confirm there was No sexual activity or ridden a bike or motorcycle, 48h prior to the test

 

I will book an appointment at CM Bangkok hospital and bring the results i obtained in Ubon, will update after the visit.

[Tazmo]

CM Ram also has a good Urologist. 
If your PSA is high most Urologists will want you to have a biopsy, which is an invasive procedure and cannot guarantee they may get a portion of the prostate which has cancer.

I requested and got an MRI Scan, two consecutive years and it is diagnostic for cancer. Negative results.

You can then get tablets to shrink the prostate. It works for some.

High PSA is also known to be genetic, so some people live with a high PSA for most of their lives.

 

 

[TheFishman1]

Yeah, I would be second to recommend Ram Hospital in CM I get yearly check ups there, and I have them checked for almost everything. I get the results the next day for a physical check up, go to the new buildings which is part of Ram hospital.

[jippytum]

33 minutes ago, Tazmo said:

CM Ram also has a good Urologist. 
If your PSA is high most Urologists will want you to have a biopsy, which is an invasive procedure and cannot guarantee they may get a portion of the prostate which has cancer.

I requested and got an MRI Scan, two consecutive years and it is diagnostic for cancer. Negative results.

You can then get tablets to shrink the prostate. It works for some.

High PSA is also known to be genetic, so some people live with a high PSA for most of their lives.

 

Unlike most private hospitals the CM ram do not have a full time urologist. I recall only two days per week in attendance

 

Edited January 26 by jippytum
Correction

[Srikcir]

On 1/25/2024 at 7:54 AM, CapraIbex said:

I would see an Urologist and a Hepatologist/Gastroenterologist at either Bumrungrad hospital or Bangkok Pattaya hospital.

I would add Sumitivej Sukhumvit Hospital for same specialties.

[thailand49]

On 1/25/2024 at 8:48 AM, ezzra said:

BTW, with all due respect to our lovely Sheryl, medical check ups results can be looked up on google too where it can you

the upper and lower parameters of any specific tests..

That might be true but Google isnt going to take personal time to explain it so personal by someone as lovely as Sheryl.🤣

 

[NedR69]

Issan Farang…have you ever been to a doctor on a regular basis?  To have that many significant issues, it seems apparent you never cared enough for your health to have routine visits.  You didn’t list anything in your colon except for your prostate, but if you’ve never had a colonoscopy…maybe get ready for more good news.

[Sheryl]

11 hours ago, NedR69 said:

Issan Farang…have you ever been to a doctor on a regular basis?  To have that many significant issues, it seems apparent you never cared enough for your health to have routine visits.  You didn’t list anything in your colon except for your prostate, but if you’ve never had a colonoscopy…maybe get ready for more good news.

As has been explained he does not have "many significant issues", the report was badly and inaccurately done.

 

His only abnormal result is an elevated PSA, which does need further exploration.

 

We have no way of knowing if he has had a colonoscopy in past ten years but if not, indeed should.