Personal .... health


  [black-on-black personal]
 
 
 

some data . . .

Adrenal mass

On 31 October 2016, a chest+abdomen+pelvis CT scan looking for prostate cancer metatstases accidentally discovered a right adrenal mass 2cm x 3.3 cm (report). Two years later a follow-up CT scan on 04 September 2018 shows no increase in size, suggesting a high likelihood that it is a benign adenoma (report).    

Shingles

In Late July 2017 I developed intermittent pains in one place on the left side of my chest. The pains continued to occur from time to time, until on the evening of 3 August I noticed an itchiness develop in the area of the sore spot, with a couple of red areas marking the itchy places. I saw Dr L the next day (couldn't get an appointment with Dr M) and she diagnosed shingles. I started a course of famciclovir that day (250 mg tablets, taken three times / day for 7 days). By 8 August the rash had spread only a little (photo), and the pains were still present but not too troubling.   

Foot sensation

In late 2015 I developed tingling sensations on the plantar surface of both feet, especially the left. In February 2017 as it had not improved, I asked Dr M about this. He ordered a blood test for vitamin B12. Result: serum B12 (measured on 24 February 2017): 529 (ng/L). Conclusion: No vitamin B12 deficiency. Dr M then referred me to a neurologist - perhaps for nerve conduction studies. I can see where this is headed - "idiopathic neuropathy" with no treatment. I made an appointment, but then cancelled it. I don't have the time, the money, or the hope that it would go anywhere useful. 

Bowel

I developed frequent diarrhoea in mid-2016. I subsequently had lots of distractions from this issue with the discovery of coronary artery disease and prostate cancer leading to fasting, bowel wash-out for surgery and days of only taking clear fluids. However, when the condition was still persisting in January 2017 I saw a GP (Dr M).  He ordered pathology tests of my faeces to look for pathogenic bacteria and parasites and for signs of bleeding (pathology report shows nothing abnormal). He then decided we'd better look at other possible issues. He ordered a full blood count and measurement of Ferritin, CRP, Coeliac serology, and TSH. Nothing especially revealing, so he referred me to a gastroenterologist. Not the one I saw back in March 2008, Dr G, but a new one (Dr N) who was recommended by my urological surgeon, Dr K. Dr N recommended a colonoscopy and an endoscopy. He did these on 10 May 2017. His reports indicate that he found nothing sinister: endoscopy, colonoscopyfollow-up biopsy result and letter to GP. The diarrhoea continued to occur. In mid-2019 the diarrhoea was still continuing so I decided to try the low FODMAP diet, designed for people with irritable bowel syndrome. Minimising FODMAPs fixed the problem - and then when I re-introduced each FODMAP component the diarrhoea didn't return! However I did eventually find a convincing link between the diarrhoea and soy - specifically tofu, textured vegetable protein, and perhaps to a lesser extent soy icecream. Total abstinence from soy definitely cures the problem. Small amounts (e.g. soy flour in baked goods) seem to be tolerable.


Heart & cardiovascular system

On 15 September 2016 I saw cardiologist Dr James W in relation to my elevated Troponin level with normal ECG  found in August 2016.  They did a stress-echo test: they used ultrasound to look at heart function (how well the chambers move, whether they're the right dimensions etc), then got me to exercise on a treadmill for 7.5 minutes with gradually increasing speed and grade, terminating when it was still only a fast walk. Then very quickly did another ultrasound scan of the heart to see how it was performing under the stress of just-completed exercise. Full ECG was also being measured throughout, along with periodic blood pressure measurements. Conclusion: Some minor changes on ECG but no significant abnormality. Dr W then sent me for a coronary artery CT angiogram and coronary artery calcium scoring (CACS) at the Sydney Adventist Hospital. Results:

I visited Dr W again on 23 September to discuss the results and he prescribed rosuvastatin, atenolol, and aspirin. 

Follow-up tests arranged by Dr S on 10 November 2016: 

On a follow-up visit to Dr James W on 23 December 2016, he decided I didn't need to keep taking the beta blocker, atenolol, and I didn't need to see him for two years, and he wasn't sure why my troponin level stayed high for so long. 

Follow-up tests arranged by Dr M to check on effect of rosuvastatin:

Routine follow-up by Dr M in September 2020:
After an episode of syncope while running on 26 September 2020, a couple of weeks later I consulted my GP, Dr S., who arranged for an ECG to be done.
I then saw a cardiologist, Dr Gregory N, who thought the syncope was unlikely to be of cardiac origin, but nonetheless he arranged for a 24 hour Holter monitor (result) and stress-echo test (result).


Prostate

From 17 August 2016 to November 2016 I saw urologist, Dr K, in relation to the high PSA value 'accidentally' discovered by Dr S. Dr K did a digital rectal examination - result was a "small, soft" gland, otherwise unremarkable. Dr K ordered, in sequence:

He then arranged for a radical robotic prostatectomy on 23 November 2016 at the Sydney Adventist Hospital

4 weeks post-op follow-up tests 21 December 2016:

11 weeks post-op follow-up tests 10 February 2017:


9 months post-op follow-up tests 23 August 2017:


15 months post-op follow-up tests 15 February 2018:


18 months post-op follow-up tests 04 June 2018:


21 months post-op follow-up tests 03 September 2018:


27 months post-op follow-up tests 01 March 2019:

33 months post-op follow-up tests 16 September 2019:

39 months post-op follow-up tests 10 March 2020:

45 months post-op follow-up tests 07 September 2020:


Hearing

About 30 years ago I noticed a hearing deficit in my left ear - I couldn't hear my watch ticking on that side. I have inviestigations, including a head CT scan looking for an 8th nerve tumour, but no significant disease was found. I perhaps had some loud noise damage on that side. I keep intermittent track of my hearing, however, in case the left side hearing problem is one which is progressing. Here are test results: 2007 audiogram, 2018 audiogram and report


Temporo-mandibular joints

Episodes of left TMJ pain led to Xray imaging in 1973 and 1995 (X-ray reports from 1973 and 1995). In 1973 molars were ground to achieve better occlusion. In 1995 treatment with 200 mg sustained release ketoprofen. After two weeks pain stopped, but movement abnormality still felt for another two weeks. In July 1996 left TMJ was sore during chewing for about 2 weeks. Dr S prescribed ketoprofen again, but pain stopped before commencing. In January 2001 had a few weeks of intermittent right TMJ pain. No treatment needed. (Detailed notes 1973-2001: p1, p2, p3, p4, p5). Right TMJ pain occurred again in June 2020 - no specific action taken but see Rheumatoid Arthritis section.


Rheumatoid Arthritis

In 2020 I developed pain in: right hip, right sternoclavicular joint, left hip, left knee (with swelling), right knee, right temporomandibular joint, left and right carpometacarpal joints, left and right shoulders, left tarsometatarsal joint, and left and right elbows. On 17 June 2020 Dr M did some blood tests for inflammation markers and PSA (results: page1 - haematology, CRP, biochemistry; page 2 - iron, PSA (not detected), cyclic citrullinated peptide antibodies, rheumatoid factor, antinuclear antibodies). Results (raised ESR, CRP and rheumatoid factor, nil ANA) suggest a diagnosis of Rheumatoid Arthritis. Dr M sent me to a rheumatologist, Associate Professor S who started me on 15mg prednisone while he waited for  a whole batch of tests for various conditions that might cause polyarthritis (results page1, results page2). Results tend to confirm the RA diagnosis, so A/Prof S started me on methotrexate (20 mg / week) + folic acid (5 mg / week), with gradually decreasing  prednisone dose. On 24 August 2020 I wasn't improving much, so A/Prof S added hydroxychloroquine 200 mg and recommenced prednisone (7.5 mg). Regular blood tests are done to detect liver damage, kidney damage, bone marrow suppression, lymphoma, etc  induced  by methotrexate, and evaluate the degree of inflammation (ESR, CRP):





Timeline of miscellaneous issues

April 27, 2021.  First dose of AstraZeneca COVID-19 vaccine

February 2021.  Soreness around right nipple found to be associated with a lump. Chest X-ray and ultrasound showed evidence of gynaecomastia. No evidence of malignancy.

November 2020.  Fell on Friday 20 November (for a second time in this location on Pacific Highway near Campbell Street) while running (see Heart for first instance on 25/9/20), hitting left side of head on concrete. Vague recollection of some sort of trip. Instant numbness in distribution of Infra-Orbital nerve ("V2"). Saw Dr Alex B at GP practice on Monday 23 November. He arranged a brain and facial bones CT scan which showed a zygomaticomaxillary complex fracture (report page 1, page 2). I was briefly admitted to RNSH via Emergency on Monday afternoon, and then re-admitted on Wednesday 25 November 2020 for Gillies Lift surgery (Dr Alice C). No fixation done but no chewing allowed for 6 weeks. Numbness likely to continue till second half of 2021. 

May 2020. I'm still not running due to right hip problem from January 2020, but in early May my left knee became sore (behind the knee) and I couldn't fully flex it. After a period of being flexed, it was then hard to extend. A few days later the left knee became quite swollen, then a few days after that the left ankle became swollen and the left calf was tender all over. The knee swelling decreased. To confirm his telephone-consultation diagnosis (Baker's cyst) and to check for DVT, Dr M sent me for Doppler ultrasound and a knee X-ray. The X-ray and ultrasound report confirmed a burst Baker's cyst as the diagnosis. Probable initial cause of knee swelling was degenerative meniscus tear. About a week later the right knee is also sore behind the knee, is hard to flex (both knees limited to not much more that 90 degrees), and the right ankle is swollen. Presumably this is another burst Baker's cyst, most likely due to degenerative meniscus tear. In June 2020 the right ankle was still swollen and the calf very sore. Dr M thought we'd better check for DVT. Ultrasound showed no DVT, and confirmed the Baker's cyst - and suggested that it was likely there had been a bleed into the cyst cavity. (Right calf ultrasound and right knee Xray report). See Rheumatoid Arthritis section for further findings.

In January 2020 I developed right hip (mostly groin) pain that was much worse than previous. Also right knee pain (referred from hip?). This occurred after  a few days in which I tried increasing my step lengths in walking and running. Initially pain improved with ibuprofen (2.4 g /day) but then got worse and kept me awake at night. On February 12 I Saw Dr M who suggested X-ray imaging of right hip and knee (Hip and knee X-ray report). Based on the X-ray report Dr M suggested: standard ibuprofen (1.2 g / day), plus paracetamol for greater pain relief (e.g. night), and esomeprazole (a proton pump inhibitor to reduce stomach acid and decrease the risk of ulcers). Dr M pointed out that ibuprofen does carry an increased risk of heart attack and stroke. So, rather than add another drug (esomeprazole) with more side effects, my strategy will  be to minimise my intake of ibuprofen. I tried stopping ibuprofen, but pain at night was too troubling. Maybe the hip will get better? I wonder if the problem is actually iliopsoas bursitis. It did improve very gradually over the next few months.See Rheumatoid Arthritis section for later relevant findings.

In September 2019, after a previous discussion of abnormal liver enzymes seen in March 2019 prostate tests we re-tested liver enzymes. On my  suggestion, we also measured B12. Results measured on 16/09/19 - first day after marathon with additional Serum Protein Electrophoresis (EPG) ; then re-tested four weeks later: Results from 4 weeks after marathon

In May 2019 I saw Dr M about a pain in my neck which I'd experienced for a few months. We agreed that arthritis was the most likely cause. I thought it might be the left C5/C6 zygapophyseal (facet) joint to blame. Because of my history of prostate cancer he suggested that if the pain continued we  should have an X-ray done to rule out a sinister cause. So in July 2019 I had a cervical spine X-ray done. The report confirms that nothing sinister is evident (i.e. no signs of cancer metastases). There are signs of degeneration in the C3/C4 and C4/C5 zygapophyseal joints (my lateral view radiograph) (but X-rays are notorious for their lack of validity in identifying a cause of spinal pain).  

In June 2018 I saw Dr M about my bone mineral density. Because I am still in the osteoporotic range, we agreed to start on 70 mg alendronate / week. He also checked on a few other issues and ordered a check on my urine protein content to make sure my kidneys are working ok. Result - good. He offered shingles vaccination (no thanks), and influenza vaccination (no thanks).

In May 2018 I saw Dr M about a pigmented lesion on my forehead and one on my back. He referred me to Dr Nita, who was sufficiently suspicious of the forehead lesion to take a couple of biopsies. Result - Pathologist declares Seborrhoeic keratosis

In April 2018 I saw Dr M about some thoraco-lumbar & ribcage pain. He thought these symptoms were not a sign of anything sinister (i.e. not prostatic metastases), but he suggested it was time for a re-measurement of my bone mineral density. I have been treating the osteoporosis by weight gain, high impact exercise, and calcium supplements. Results:

Conclusion: Spine now improved compared with  2016 data. But continues to be osteoporotic. To be discussed with Dr M. He will want to start me on alendronate, I expect.  

In August 2016 I saw Dr S about my thoracic back pain. Test results:

On 22 June 2016 I finally had enough improvement in my proximal hamstring tendinopathy that I could start running again. I gradually increased the distance and frequency, but on 29 June 2016 while running to work I developed a strong pain in my thoracic spine. I stopped all running for three weeks and the pain was almost gone. I started running again on 22 July 2016. I ran quite happily for a week or so, until the thoracic spine pain recurred during my run on 02 August. Given the absence of a major trauma, my background of marginal bone density, and history of rib fractures, I presume this pain is due to osteoporosis-induced compression fracture of one (or more?) vertebra. Looks like I have another disability to live with. I will go and see Dr S and have a chat about it. A visit to her costs me nothing! Maybe this issue will stop me ever running again?

In December 2015 I developed pain in the lateral shoulder region on abduction of my left arm. In May 2016 I thought the shoulder was getting worse so I saw a sport and exercise oriented doctor about it - Dr Etinenne. He did a thorough physical examination and a quick ultrasound scan of the tendons. He concluded that it was a muscle strength & control problem causing impingement of the head of humerus on the under side of the acromion process, inducing sub-acromial bursitis. Dr E wanted me to have an X-ray (here is the report) and full ultrasound scan. He suggested I see a physiotherapist for a series of exercises and go back to him for review in a couple of months. He also suggested an injection of cortisone into the bursa. After having the radiograph done I concluded that I really couldn't afford to pay for the full ultrasound, or the visits to the physiotherapist, or the return visit to Dr Etienne. And I didn't want an injection of steroids into my shoulder. It's now August 2016 as I write this, and the shoulder is no better - or worse - so it looks like this will be a permanent disability that I just have to live with.

In August 2015 while training for the Sydney Marathon I developed proximal hamstring tendinopathy (read the full story here) which forced me to stop running - and worse than that, to stop walking too.

In September 2014 I had a recurrence of my (presumed) gout, which first presented in April 2011 (see below). This time the main focus seemed to be the joint between the cuboid and the 5th metatarsal on the right foot. The pain developed at night to very strong levels, but responded well to ibuprofen (or improved on its own) over the next few hours. The location was immediately adjacent to a long-standing lump on my foot (pain location arrowed on this picture - lump is just proximal to point of pain). It is apparent that the lump is most likely to be a tophus. I continued to take 2.4g ibuprofen per day but minor soreness also occurred in the right 1st MTP joint, and the left 5th MTP joint.  Issue continues (17/09/2014).

In April 2014 I had an eye test for new glasses and to check my eye health. Here are the results

In June 2012 I had a 5 month history of hip adductor tendon soreness (proximal end, mostly left side), rectus abdominis tendon soreness (left side, inferior end), and buttock soreness  (mostly left). It was getting worse despite not running for two months, so I saw Dr S who arranged for a pelvis/hip Xray and some blood tests. My diagnosis was osteitis pubis, but Dr S reckons it's hip joint osteoarthritis. April 2013 update: I have become convinced Dr S was correct, although it's most likely that both conditions were contributing to the problem, the osteoarthritis now remains. Both left and right hip regions are now sore from time to time, with the left side initially worse that the right, but in late 2013 the right became much worse and the left pain-free. In February 2014 the pain in these tendon areas became such that I had to stop running altogether. In September 2014 I gradually started running again, and aim to perhaps be running 20 km / week by Christmas 2014. 

 
In April 2011 I had left mid-foot pain with a rapid onset and no history of trauma. It was fixed with one 50 mg dose of indomethacin. Gout is the presumed cause, but there's no proof in the blood tests done at the time.

 

In March 2008 Dr Vicki referred me to a gastroenterologist, Dr G. He also ordered some blood tests:

 

In January 2008 I had suffered what I believed were multiple rib fractures with minimal trauma. I also felt that I had abdominal distension. I went to see Dr Vicki, mostly about the rib fractures, to make sure there wasn't any underlying problem. She organised a bunch of tests, and here are all the results:

 

In September 2005 I saw Dr S about abdominal distension & urinary symptoms. She ordered some blood & urine tests:

 

Regular Faecal Immunochemical Test / Faecal Occult Blood Test results (done by Enterix Australia Pty Ltd except where noted)

Date

 

Result

April 2020


negative

^^23 September 2019

 

negative

14 February 2019

 

negative

18 January 2018

 

negative

12 January 2017

 

negative

#10 January 2017

 

negative

May 2016

 

negative

April 2015

 

negative

April 2014

 

negative

^December 2013

 

negative

April 2013

 

negative

April 2012

 

negative

April 2011

 

negative

September 2009

 

negative

September 2008

 

negative

June 2006

 

negative

March 2006

 

negative

*September 2005

 

negative

August 2005

 

negative

* St Vincents Hospital Bowel Cancer Screening Unit

^ National Bowel Cancer Screening Program - Dorevitch Pathology

^^  National Bowel Cancer Screening Program - Sonic Healthcare

# Douglass Hanly Moir

 

 


Copyright 2021
updated  28 april 2021