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BANGKOK 19 January 2019 11:16
banK

Peeing dark yellow

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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

 

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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

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40 minutes ago, fertilizer said:

banK - just sent you a PM.

Got it  tks and replied 

 

banK

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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.


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

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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

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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.

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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).

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

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Posted (edited)
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 by ted4647
sp

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

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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  ??????

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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.

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