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Blood in urine - Help


randymarsh

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I had a UTI last year back in September (blood in urine) which cleared up and had a cystoscopy to check nothing wrong with bladder.  Got all clear.

 

Today I have very high blood cell counts in urine:

 

WBC 30-50 /HPF  (normal 0-5)

RBS > 200 /HPF (normal 0-5

Billrubin 1+

Protein 1+

 

Counts were nowhere near this high last year when had UTI.  And now the thing is this time I'm not sure it's a UTI.  I don't feel the same, I have no symptoms of infection - no fever, normal BP.  

 

I feel a little bit weak and anxious but I wouldn't even say I feel unwell..  Doctor pushed around on my back / stomach and no pain either.

 

What I have recently been doing though is exercising.  I've gone from walking less than 1km a day for years to walking on average 20km every day for the past 2 weeks.  I'm doing this every morning when it's still pretty hot.  I am wondering if the shock to my body from doing literally nothing to walking so far each day has affected me?  There seems to be some reference on the internet to blood in urine after exercise but I'm not sure it would cause levels as high as mine.

 

http://www.livestrong.com/article/383806-what-causes-blood-to-be-in-urine-after-exercising/

"The exact cause of exercised-induced hematuria remains unclear, but there are several potential causes. Trauma to the bladder walls during exercise can cause bruising and bleeding, which could cause blood in your urine. Exercise might also interfere with the process of filtering the urine from the bloodstream, allowing red blood cells to mix with it. During intense exercise, the body can redirect blood flow away from the kidney, causing red blood cells to leak into the urine. The release of hemoglobin -- the protein that gives red blood cells their color -- into your urine during exercise may also cause hematuria."

 

http://www.everydayhealth.com/urinary-health-specialist/blood-in-urine-from-dehydration.aspx

"Dehydration in and of itself is very unlikely to cause blood in the urine (hematuria). Red blood cells can show up in the urine for a number of different reasons including infection, trauma, bladder tumors, and kidney and bladder stones, as well as other inflammatory conditions of the bladder. There are several ways to detect blood in the urine, and some can create false positives. Visually, blood in the urine appears as a red color. However, there are other chemicals, such as myoglobin, which can be released into the urine due to muscle damage. Myoglobin gives off a dark color and can look similar to blood. This condition is often brought on by extensive prolonged walking, running, or jogging, and is called “march hematuria” as it is sometimes seen in newly enlisted soldiers after prolonged marches."

 

After exercising this morning, I went to the toilet back in the room and my urine was a very dark brown.  I suspected blood - maybe caused by the exercise - some kind of muscle trauma combined with dehydration.  Immediately went to hospital, did urine test and confirmed blood.

 

I asked the doctor about rhabdomyolysis and he did a blood test.  CPK level is elevated but not hugely at 270 (normal 28-174).  I've read rhabdomyolysis can cause CPK from 6,000 onwards.  Could it be just the start though?  Should I get blood tested again tomorrow in case it shoots up?

 

I'm also wondering about the presence of billrubin in urine as this seems to indicate a liver problem.  Doctor did not mention it.

 

He's given me antibiotics for a suspected UTI (not sure I believe him), and have an appointment with urologist on Friday.  He told me to come back if urine continues to be dark.  It's gone back to clear since drinking water today - but clear urine doesnt mean I'm in the clear.

 

Any advice appreciated.

Edited by randymarsh
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my sole advice would be...do not listen to any acquaintances, friends improvising doctors....only consult and take advice from regular doctors and nobody else!!...similar symptoms can have diametrically different causes from one individual to another, so act with caution. all the best.

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Your doing the right things. An antibiotic will clear up any kidney infection (which is why he pounded on your back) suspected. The urologist can do an ultrasound of kidneys if necessary to look for any suspicious growth.Liver enzyme levels tested cannot hurt and will rule out liver involvement.

 

Hang in there....many years ago had blood in urine, everyone scared the hell out me with warnings of prostate and kidney cancer...no cause ever found and 9 years later still here without obvious signs of any major illness.

Edited by tonray
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Not sure if this is help or not but will mention anyways.

Do you have pain associated with the urine in blood?

Is there pain trying to void?

  The reason I ask this is these are symptoms I had before my bladder just quit working .

 But reading your post I feel you are way out of shape and the exercise is giving you blood. in urine.But you also had blood before exercise so makes it questionable.

 I would go to urologist and get fully check out. Once your bladder goes it is hell.

  But to be honest urologists some times are stumped too. In my case I had blood and pain. They checked and gave me antiobiotics. for infection. This stopped the bleeding.but this   was repeated 2 years later,then 1 year,then 6 months,then 3 months then oh sorry your bladder does not work you need to catheter the rest of your life 4 or 5 times a day.

 So what I am saying is go urologist and get it checked out thoroughly. I had ultra sound,MRI,scopes through everywhere  you name it they scoped it nothing found. No prostrate problem,no cancer nothing. I was put in hospital twice and monitored and probed for 2 weeks each time nothing was solved..

  So no easy answer but do not let it slide. Also get many opinions.

  

 

  

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Thing is because I had a UTI last year, I know how bad I felt during that infection (albeit only for about 12 hours until I got on antibiotics), could barely walk, had no energy at all.  Today I walked 15km before going back to the room and seeing my brown pee.

 

There was no pain but I could tell I was dehydrated as not a lot came out, and it was VERY brown.  UTI last year I had bright red urine and later with some clots.  This experience is totally different.

 

I've had very recent cystoscopy (very good hospital in chiang mai in january this year), and also had abdomen ultrasound last month (unrelated pain under rib) and everything was normal.  I'm pretty relaxed from the UTI side of things.

 

But I am a bit stumped on this - unless it's exercise.  I will take the antibiotics just in case as WBC in urine suggests I do have an infection but who knows.  

 

I don't know what the urologist will do either.  I really just want repeat blood / urine tests doing - maybe even go back tomorrow and see what's changed.  

 

Even after the blood tests, I'm still a little bit concerned it's the start of rhabdomyolysis which can really mess you up / kill you.

Edited by randymarsh
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10 minutes ago, randymarsh said:

Thing is because I had a UTI last year, I know how bad I felt during that infection (albeit only for about 12 hours until I got on antibiotics), could barely walk, had no energy at all.  Today I walked 15km before going back to the room and seeing my brown pee.

 

There was no pain but I could tell I was dehydrated as not a lot came out, and it was VERY brown.  UTI last year I had bright red urine and later with some clots.  This experience is totally different.

 

I've had very recent cystoscopy (very good hospital in chiang mai in january this year), and also had abdomen ultrasound last month (unrelated pain under rib) and everything was normal.  I'm pretty relaxed from the UTI side of things.

 

But I am a bit stumped on this - unless it's exercise.  I will take the antibiotics just in case as WBC in urine suggests I do have an infection but who knows.  

 

I don't know what the urologist will do either.  I really just want repeat blood / urine tests doing - maybe even go back tomorrow and see what's changed.  

o

Even after the blood tests, I'm still a little bit concerned it's the start of rhabdomyolysis which can really mess you up / kill you.

You should not allow yourself to get dehydrated especially with Urinary tract concerns. Just being dehydrated can turn urine deep yellow. Stay hydrated and see if color returns to normal. Any dietary changes ? Drinking beetroot juice ? Eating red dragonfruit ?

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Do see the urologist but it could well be your new exercise (that is a huge change) as you have found in internet search - but best to check again to make sure as that was what I suspected a year ago and it turned out to be bladder cancer so best to not take any chance (but do not believe this is your problem as mine was found in ultrasound and follow up cystoscopy) so be sure to have those test results with you - it might be required again.

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Treatment for UTI is reasonable given the findings of blood, WBCs and protein in the urine, but is not enough as there is also the question of the bilirubin in your urine (which is where the dark color is coming from), which a UTI will not cause.

 

At a minimum you should have liver enzymes, serum biliribin, BUN and creatnine tested. Can get a repeat CK while you are at it - rhabdo is unlikely (and also does not explain the bilirubin) but not impossible, and since other labs are needed anyhow can easily recheck the CK then. In the unlikjley event it is rhabdo it will have risen significantly.

 

Lower urinary tract infections can be asymoptomatic. The one you had previously where yo ufelt so bad, may have been because it had spread to the kidneys. Anyhow virtually any doctor would give antibiotics for presumptive UTI with these urinalyiss findings but would also do the  other investigations as I mentioned.

 

Bilrubin in the urine usually means a liver problem.

 

I am surprised the doctor did not investigate this. What type of doctor is this, a urologist or other?

 

And where do you live? As I might advise you to see a different doctor.

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Pattaya International Hospital Soi 4.  Was just a regular doctor i think, but seeing urologist on Friday.

 

Will go back tomorrow for the tests you've mentioned, plus repeat urine test.  And will ask them on the bilrubin.

 

Also my urine has been completely clear all day since the brown sample I gave at the hospital.  No visible blood or funny colours.  I know the urine was dark because bilrubin?  But also a lot of it was just dehydration from exercising without drinking enough...  Maybe they weren't concerned on the bilrubin levels, considering how high the RBC was?

 

Thanks

 

 

Edited by randymarsh
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They should have been concerned about the bilirubin. Actually more worrisome than the blood, the latter might simply be due to UTI.

 

When you are dehydrated, your urine will be more concentrated so the relative amounts of various things will be higher.  Better hydrated = urine more dilute. So you may still have some bilirubin in it, just not noticeable now.

 

However there should not be any bilirubin in the urine if the liver is working properly and there are no blockages in the biliary tract.

 

If your liver enzymes and serum bili come back normal and there are no further episodes then =chalk it up to possible lab error or false positive (can happen if they used simple dipstick  to test).

 

If your liver enzymes come back elevated then more investigations e.g. hepatitis panel will be needed. Up to you if you prefer to just get that done all at same time, but it is more costly than the other tests, hence we usually reserve it for patients with elevated liver enzymes.

 

As long as you are at it, get a CBC (blood count) as this will help indicate if you have a bacterial infection.

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Blood and urine tests this morning

 

Urine:

Bilirubin Negative

Protein Negative

WBC 1-2

RBC 5-10   - compared to > 200 yesterday

 

Bloods were all within normal levels.

 

BUN 9  (8-25)

Creatinine 1.25 (0.7-1.5)

Total Bilirubin 1.0 (0.2-1.2)

Direct Bilirubin 0.2 (0.1-0.5)

CPK 259 (down from 270 yesterday)

WBC 6,750 (5,000-10,000)

Only one that was high was Totla Protein at 8.3 but only just outside normal (6.0-8.0)

I don't know which ones specifically relate to liver enzymes but nothing else outside of range.

 

 

 

I think my theory on exercise might be right, and doctor didn't rule it out.  The shock to my body of going from 500 meters a day to 15 kilometers may have damaged my bladder.  I didn't mention yesterday I had a pee when I woke up and it was fine, it was only after walking 15km and peeing again that my pee had turned brown and bloody.  I think I damaged my insides during that walk.

 

I also think because my urine was so heavily concentrated with blood yesterday and I was so dehydrated, the bilirubin came back positive just because there was so much blood in the sample?  Anyway, it's ok today, and my eyes are still white.

 

I think the RBC in urine still came back positive because I'm still healing inside - bladder damage?  I said I'd go back in a week and test only urine.

 

Cheryl - thoughts on antibiotics?  I don't think I have an infection.  Doctor said to take them anyway but I haven't started them.  He also gave me a questionable antibiotic for a UTI - cefdinir.  I have cephalexin and would much prefer to take that if I'm to take anything as cephalexin was highly recommended by top urologist in Chiang Mai and has worked for me in the past.  I don't believe I have a UTI anyway though so should I take anything or not?

 

Also on risk of my exercise theory being completely off.  I had a cystoscopy in January.  How likely is it that something serious has developed between then and now which would cause such excessive bleeding?  Mentioned I also had an abdomen ultrasound a month ago.  To me all signs point to exercise and shock to my body.

 

Thanks

 

 

 

 

 

Edited by randymarsh
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AFAIK blood in the urine cannot account for the presence of bilirubin.

 

You do not seem to have had liver enzymes checked, these would be called either ALT and AST or SGPT and SGOT.

 

Extreme exertion can cause hematuria (blood in the urine) but not the WBCs, bilirubin and protein seen on the first result, though the urine can easily look "brown" from nothing more than dehydration.

 

The reported urinalysis results just 1 day apart are so different that I frankly suspect lab error. These are more common than people realize.  Can occur due to specimens or result reports from 2 different people being mixed up, due to mistakes in lab technique, or due to the use of less sensitive testing methods with a comparatively high rate of false positives. In this instance where the 1st day findings had multiple abnormalities I would tend to suspect a lab mix-up of specimens or reports between 2 different patients. (In which case someone with some serious medical issues was wrongly given a normal result).

 

Since you feel well with no urinary or other symptoms, and the 2nd day results are internally consistent (i.e. blood test and urine test are consistent with each other) I think most likely the prior day was lab error and today's results correct. Based on today's result there is nothing to suggest a UTI so no reason to take antibiotics. Cefidnir, BTW, is a cephalosporin just as cephalexin is, and can be used in UTI, in fact may be effective in patients who have developed resistance to other cephalosporins. So no issue with that, and based on yesterday's labs it made sense to treat for UTI. But not based on today's.

 

if you want to be extra sure, repeat just the urinalysis (which is pretty inexpensive) in say a week.  And of course, stay hydrated and make your work-outs more gradual.

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The SGOT SGPT tests I actually had done both days.  Both days identical results 16 (<37) and 24 (<40)

 

You'll have to stick with me on the exercise theory because I'm ruling out bladder tumour (cystoscopy), kidney or liver damage, UTI...

 

I'm not sure they would have mixed up the tests for one main reason:  the hospital is so quiet.  I'm always in and out within an hour with full blood and urine results and consultation.  I really doubt any other urine tests were done in the 20 minutes it took them to test my urine.  Even if 1 other test was done, they wouldn't mix up 2 tests; you'd be looking at 100s of tests a day before a mix up surely?  Plus my urine was so insanely brown and bizarre looking, it wouldn't have been mixed up...  

 

I actually think there is little precedent for the urine test I took yesterday with the very high RBC.   Assuming exercise related, it's like testing the urine of a marathon runner just after they've finished a marathon and pee blood.  How often is that done and wouldnt you expect some surprising results considering the exertion / dehydration?  Runners know to expect some blood so would not be too worried / get tested.  In a similar way, I'd just walked 15km, was dehydrated, gave the darkest brown/purple urine sample with no transparency.  Maybe a sample such as this can just give surprising results as its not your classic UTI sample.  Does it explain the bilirubin, protein, WBC?  It sounds like it doesn't.  But how often is urine tested in these circumstances?  Compare that to todays clear yellow sample - yes it looks like a completely different person but I was hydrated and haven't exercised (moved) at all since yesterday morning.  So I really doubt a mix up of urine during the testing, but I wouldn't rule out false positives on things like the bilirubin.  

 

Anyway, thanks a lot for your input.  I will do another urine test next week and hopefully RBC will be normal.  

 

And I'll keep those overpriced hospital pills in case I ever need them.

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eGFR calculations can be unreliable in body builders/people with unusual muscle mass and people taking creatnine supplements or large quantities of protein supplements, would you fit either of those?

 

If not, and assuming you are under the age of 70,   possibly this is of concern given that you also had what seems to have been (assuming no lab error, from what you say doesn't seem likely you got someone else's result) an isolated episode of hematuria accompanied by  +1 proteinuria and bilirubinuria. and that you have a history of a severe UTI (which from your description may have gone up to the kidneys).

 

However, it could also just be down to physical over-exertion. The eGFR is estimated based on your serum creatnine, age, race and sex.  Serum creatnine will be higher than its normal level in an individual after extreme physical exertion, because it causes muscles to  release creatnine .

 

Your creatnine level is actually a little high by most standards, BTW. The upper limit for males is usually not more than 1.2. For some reason the lab where you had this done uses an unusually wide reference range.

 

I would suggest giving yourself a week or two of more moderate levels of activity (i.e. no over-exertion but you don't have to totally rest - just keep the exercise moderate, should not approach anything that puts a strain on your body), keeping well hydrated,  and then repeating the creatnine and eGFR, and recheck the urine while you are at it with specifical request for  a urine protein/creatnine ratio along with it. I would also suggest doing this at a better lab than this hospital seems to have. A number of TV members have used the Pattaya Clinic Laboratory http://www.pattaya-lab.com/

 

In addition ot hopefully more precision, you will find tests there also much less expensive than at the hospital

 

If after allowing your body to recoup from the over-exertion and being adequately hydrated every day you still have a low eGFR better see a good urologist.

 

BTW are you taking any regular medications that might affect kidney function? NSAIDs? PPIs? etc?

 

 

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Thanks Cheryl

 

I noticed I got my creatinine and eGFR levels tested.on both days.  On the first day of lots of blood, it was higher:  1.33 creatinine and eGFR 70.23

 

So even a day of rest / hydration improved the results by a bit.

 

Will include blood tests next week and hopefully see more improvement.

 

And I thought exercise was meant to help me LOL 

 

Not taking any meds

Edited by randymarsh
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Quote

I've gone from walking less than 1km a day for years to walking on average 20km every day for the past 2 weeks.

Perhaps I (we) misread above as meaning you went from 1km to 20km in a two week period?  That would seem extreme - but perhaps your meaning is only that for last two weeks average has been 20km but that increase was over a much longer period of time?  In any case 20km seems rather extreme to my old bones.

Edited by lopburi3
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14 minutes ago, lopburi3 said:

Perhaps I (we) misread above as meaning you went from 1km to 20km in a two week period?  That would seem extreme - but perhaps your meaning is only that for last two weeks average has been 20km but that increase was over a much longer period of time?  In any case 20km seems rather extreme to my old bones.

 

No I literally went from doing no exercise at all, to walking 20km a day starting 2 weeks ago... with no gradual build up.  Thought I was drinking enough water but clearly not.

 

And I was feeling happier and healthier for all of that time until incident 3 days ago, which has pushed me back as now I'm apprehensive to exercise at all.  Also I'm off alcohol so with no exercise and no trips to the bars, some long slow days ahead. 

 

I'm 32 btw.  I didn't think I was overexerting myself, but I think I did, along with probably dehydration.  I did lose some weight also but not as much as I thought I would exercising every day, I went from 89.5 kilos to 87.  I'm 6ft1 so not really overweight either. 

Edited by randymarsh
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20 km walking in a day is quite extreme. Even more so when started suddenly, but extreme in any case.

 

There is no need to be afraid to get exercise but there is a difference between normal healthy exercise and the sort of extreme you went to -- especially in a hot, humid climate like this.

 

Make your walks more like  2-5 km a day, taking care to avoid overheating and to stay well hydrated while you do.   In addition to dehydration you may well have had some degree of heat exhaustion. That can cause  myoglobin in the urine, which will give both a brown color and also show up on urine tests that are done with dipstick as blood (the dipstick tests cannot differentiate between RBCs and myoglobin ).

 

One good trick is to pop into every 7-11 you pass, spend a good 5 minutes in the a/c there, buy a bottle of water, then sit outside if there is a bench and slowly drink it before you continue on. There is no need to do the whole walk unbroken, period rests to rehydrate and cool off are wise. You can also get rehydration sachets in the 7-11.

 

 

 

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Thanks for the advice Cheryl.

 

On staying hydrated, how much water a day is sensible in this climate?  With an hour or twos exercise, I'm thinking 5 litres a day spread as evenly as I can might be ok.  And I was drinking nowhere near that now I think back, I was probably averaging 2 litres a day.  I know there's a risk from too much water but very unlikely so rather drink too much than too little.  I've had 3.5 litres already today and only been to the toilet 3 or 4 times.

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It depends entirely on how much you are sweating. If you are mostly  indoors in air conditioning, 2 liters will likely be fine. If you are out in this heat, need more, and if working out/sweating a lot, still more.

 

Be guided by your urine, drink enough to keep it  very light in color.

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I have had some very bad and incorrect doctors opinions that missed things like cancer, I had blood in my stools and told one hospital many times and was told do not worry, no problem, I have had MRI AND Ct scans the results were not properly interpreted

 

Having said the bad bit I have learnt a lot, and had the other extreme as well, competent and loving care

 

Success very much depends on your consultant

 

You are a young man 32 I believe, and also posted on liver flukes, and your life style appears a little extreme like eating uncooked food in Issan, and what about what you have not volunteered, no criticism meant 

 

Initial consultations even at the top hospitals are generally not expensive, like well less than 1500bhatt

 

Follow Sheryls advice and get her help to identify a top urologist, even if it means going to Bangkok for tests

 

Please do this it is important

 

Personally I rate the Chulalongkorn in BKK very highly

 

Identify the problem

 

Then find an affordable way to fix it, do you have medical insurance, where do you come from, maybe you need a trip home, if UK Hospital of Tropical medicine in London is highly recommended

 

(One time i went there and they diagnosed shingella a type of dysentry I believe, in the UK and a notifiable disease, so young Doctor comes to the house wanting to investigate all the places I had eaten at recently, I asked if the NHS paid all her travel expenses, why she asked, I said you need to go to India, she smiled and left)

 

This is your body it has, hopefully a long life ahead, you must look after it

 

Remember a stitch in time saves nine

 

Be lucky, (but you make some of it, so have the checks )

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Week later and had follow up urine and blood tests at the clinic you recommended, Sheryl.  I think these results are ok but welcome any comments.

 

Urine test:

 

RBC 0, WBC 0, Protein negative, Glucose negative, Ketone negative.

 

One thing on the pH...   My dark brown urine had a pH of 5.  The following day, it was 7.  Today's sample has a pH of 8, which is just on the limit.  The last week I've concentrated on keeping hydrated.  Been drinking only 3 things: water, green tea (no added sugar), coconut water (no added sugar).  No alcohol at all.   Any reason why it's so alkaline and whether to be concerned?  Could be sign of UTI...  or have I just been drinking so much water that that explains it?

 

 

On the blood tests

 

BUN has gone from 9 to 18 (normal range 8-25).   So has increased but still within normal range, and I have read 18 is closer to the optimal levels (based on this link optimal BUN is 16 - although don't know how accurate this site is http://www.stat.unc.edu/visitors/temp/Health/Thyroid/blood_test_results.htm)  

 

Creatinine has gone down from 1.33 (brown pee day) to 1.25 (following day) to 1.07 (today).   This clinic uses a different formula for eGFR but using the formula from the hospital, this puts my eGFR at 91 which i think is better.    I think it's clear my kidneys were struggling with my new routine, but seem to be ok now.

 

Total protein is 8.1 (6.0-8.0) so still just high, although the Pattaya clinic puts the normal protein range at up to 8.5 (as it considers globulin ok up to 3.5) so going by that, I am in normal range.  .  Albumin high now at 5.2 (3.5-5.0) despite trying to keep hydrated.  Globulin 2.9 (2.5-3.0).   A/G ratio is 1.79.   Previous tests were protein 8.3:  albumin was previously ok at 4.6 and globulin 3.7 (high) giving A/G ratio 1.24.     Hard to know exactly what the A/G ratio should be despite googling for 10 minutes, but this site (http://www.ndhealthfacts.org/wiki/Albumin/Globulin_Ratio) seems to think optimal is 1.5-2.0 so I'm going to say my results are better today than they were last week .... 

 

Total and direct bilirubin levels normal (and lower than last week)

 

 

Edited by randymarsh
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On ‎19‎/‎06‎/‎2017 at 3:38 PM, observer90210 said:

my sole advice would be...do not listen to any acquaintances, friends improvising doctors....only consult and take advice from regular doctors and nobody else!!...similar symptoms can have diametrically different causes from one individual to another, so act with caution. all the best.

First answer to OP is the best.  Can't believe people would take serious medical advice from strangers on Thai Visa than from qualified doctors! 

 

 

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2 minutes ago, jak2002003 said:

First answer to OP is the best.  Can't believe people would take serious medical advice from strangers on Thai Visa than from qualified doctors! 

 

 

 

I have done exactly that.  The first thing I did was go to hospital, within about 10 minutes of seeing my urine.  However, Sheryl is so knowledgeable, I do like some input and reassurance on the results to check I am doing the right things.  I don't value the rest of you to be honest.  

 

Doctors here can be good but they can also be very light on communication / explanation of results, and recommendations for improvement. 

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On ‎21‎/‎06‎/‎2017 at 3:15 PM, randymarsh said:

Thanks for the advice Cheryl.

 

On staying hydrated, how much water a day is sensible in this climate?  With an hour or twos exercise, I'm thinking 5 litres a day spread as evenly as I can might be ok.  And I was drinking nowhere near that now I think back, I was probably averaging 2 litres a day.  I know there's a risk from too much water but very unlikely so rather drink too much than too little.  I've had 3.5 litres already today and only been to the toilet 3 or 4 times.

OP.. Sorry don't want to be mean.. but you are sounding like a serious hypochondriac.  Your other thread was very similar.

 

Drink when you are thirsty.  Drink alcohol in moderation... stay off your raw shrimps and other raw foods, get moderate exercise, don't overeat, eat plenty of veg and less processed foods.... you will be good.  No need to weigh and calculate every amount of things you eat or drink.. just use common sense. 

 

 

Edited by jak2002003
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7 minutes ago, jak2002003 said:

OP.. Sorry don't want to be mean.. but you are sounding like a serious hypochondriac.  Your other thread was very similar.

 

Drink when you are thirsty.  Drink alcohol in moderation... stay off your raw shrimps and other raw foods, get moderate exercise, don't overeat, eat plenty of veg and less processed foods.... you will be good.  No need to weigh and calculate every amount of things you eat or drink.. just use common sense. 

 

 

 

I probably worry too much, yes.  But you try having a brown/purple pee with RBC count >200 (a reading so high, they don't even bother counting) and not being concerned.  Only natural that since that event, I've been more focused on keeping hydrated - because I thought I was keeping hydrated during all the exercise, but clearly not.

Edited by randymarsh
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