==== prostate cancer marker
Prostate cancer is the least dangerous and most treatable among all cancers. Detection is highly sensitive — low false negative, but with false positive.

— enlarge.. benign enlargment as of Jan 2024. (Normal for men above 45.) Some enlargements cause discomfort[frequent urination] and may require treatment.

For my Jan 2023 screening, Dr He said mine was normal size, smaller than before, and one of the smaller ones among his patients.

In the future, let’s prefer ultrasound rather than finger probe.

I have had at lest 3 episodes since my early 20s, when I had a biopsy done at National Skin Centre.

Cold press may help relieve the inflamation such as ice pack … for 5 to 10 minutes!

— #1 precaution: scratch .. can damage the skin

• shorten all fingernails and /file/ any sharp edges
• use palm, fingertip, knuckle etc to rub an itch
• any itch not related to the condition can be scratched as usual

— On 14 Sep 2024, Dr Sonia of RMG Toa Payoh examined my skin condition and told me

• Very likely an allergy
• Even a single insect bite (in this case near the neck) can cause this inflation over a large area. It can spread to many parts … including wrists as seen today.
• stress could have exacerbated the condition. I told her stress could be the primary trigger in this episode.
• heat can exacerbate the condition
• can last 2 to 3 weeks

The 13 Sep 2024 doctor said insect contact without bite can also trigger this condition.

Take The Prediabetes Risk Test | DoIHavePrediabetes.org has a visual step-by-step questionnaire to assess prediabetes risk without a blood test.

risk to kidney.. if and only if diebetes is poorly managed, then kidney can be damanged, according to Dr Cindy of RMG

— aging calls for diet adjustment .. As our organs (like pancreas) age, t2dm (Type2 Diabetes mellitus) risk increases, so it’s wise to adjust diet habits early in your life
* Tier 1 important factors for me .. cakes/sugary-desserts/chocolates; sweet fruits;
* Tier 2 factors for me .. (refined) starch; belly fat
** Obvious but Tier 2 factors for me .. sugary drinks; visible sugars

Avoid or reduce

• white rice , yellow noodle
• fruit juice .. esp. at airplanes or parties. These are seldom real juice.
• milk chocolates, chocolate-flavored <whatever> (always too sugary)
• grapes, sweet mangos, sweet oranges, durain,
• all fruit-flavored foods .. flavor invariably comes from added sugar, never real fruits

If I can’t reduce to “two fruits a day”, then I will go for less sweet fruits like pear, kiwi, variouis berries,

— compare the three diagnostics
CDC_Diabetes_Social_Ad_Concept_A2_Facebook.png (1080×1080) is a visual chart comparing all three

Some overseas publications (esp. from U.S.) say Hba1c is more accurate than FPG, though Singapore MOH approved FPG before hbA1c. For future blood tests, include both. OGTT (most time-consuming) is the gold standard diagnostic, and is used in uncertain cases.

Dr Cindy of RMG said that a clean OGTT means that 5.9% Hba1c is not a real concern. You can retest OGTT annually iFF Hba1c is 5.7% or higher.

I told Dr Lau that my hbA1c may remain in 5.6 ~.5.9. Still, she felt it doesn’t mean I’m prediabetic.

Dr Lau said OGTT level 120 is what she looks for, though 140 is official diagnosis for prediabetes.

( for FPG 100 mg/dL is the cutoff. Am 90.)

Hui Mei said usually the FPG will detect pre-diabetic earlier, even when hba1c is still normal. I think that is logical — Hba1c is slower to change and shows less fluctuation.

Q: some sites (CDC and Mayo clinic) classify Hba1c 5.7% as prediatetic, but presumably most patients will skip OGTT and live with the assumption for decades?
A: ….

— hb A1c history

• 5.6% 20 Feb 2025
• 5.5% 5 Nov 2024
• 5.4% 4 Apr 2024, big improvement.
• 5.9% 3 Jan 2024 ICON

— Prediabetes .. reversible, but t2dm is probably not. Reversal requires lifestyle improvements. I think that’s  the rationale of the “prediabetes” designation, diagnosis, public education, public funding,,

Compared to other countries, U.S. researchers, healthcare providers, governments and publications emphasize pre-diabetes.

HuiMei said U.S. cutoff (5.7%) is for U.S. population, with its own ethnic makeup. Indeed hbA1c is race-specific. Still I find 5.7% an important reminder for me to improve diet habits and maintain the (shrinking) buffer zone from prediabetes.

— prevalancce of diabetes .. Age-adjusted prevalence calculation factors in the strong pattern that older people are more likely to develop t2dm. https://www.moh.gov.sg/news-highlights/details/result-from-government%27s-five-year-war-against-diabetes-effort shows 8% among Singaporeans.

Many people are predisposed due to genetics and adopted lifestyle of family and community. My CAD condition makes me more vulnerable to t2dm than most people. I may not be predisposed, but am still high-risk.

See ##deeper green

My dad has no hypertension even at age 88. My mom developed hypertension at age 60 exactly and has been on medication since…

— suitable target for my condition
On 25 Apr 2025, during my post-angiogram review, Dr Leow mentioned 140, 180 etc as thresholds for hypertension medications. (I forgot his diastolic numbers.)

Dr Leow knew my family history and had first-hand insight into my current condition.

Q: my blood pressure is around 120. Can it worsen with age? Yes
A: above 140/90 for a short while would not need medication. The 140/90 threshould applies regardless of age

Personally, I still aim to avoid consistently_above_130_80 … a personal green zone, not a medical recommendation.

— measurement noise
Night time is often lower, as seen in my overnight stay after angiogram.

[u=unattended measurement, which tend to be lower than manual measurements]

Standard procedures often involve repeated readings.

Both feet on flat ground; heart at same height as the elbow.

— history
“usually below 120/80” … is a difficult target for me.
“not consistently above 120” is an easier target for me since my systolic has hovered over 110 ~ 130 for years.

• [u] 124/87 @3 Feb 2025 in RMG
• 110/70 @Oct 2024 in DJDJ self-measured
• 110/70 @Jun 2024, Dr Leow also recorded HR 50 and explained that standing/walking HR of 80 is normal for me.
• 100/60@May 2024 RMG. I asked Dr Cindy “Is this accurate, given I’m usually 120+? Does it vary so much?” She said yes and was not unsure. Actually not too different from the 107 in 2nd treadmill. I am fixated on high outliers like 130+ but dismiss low outliers like this. I better keep this record.
• 111~131/86 @Apr 2024 Healthway repeated results
• [u] 125 evening ; night 105 @16 Apr 2024 after angiogram
• [u] 107/73 @Apr 2024 second treadmill
• 117/75 @Jan 2024 Icon
• 118/70 @Jan 2023 Arcade
• 130/77 @June 2022 Icon
• 130/71 @Jul 2021 Icon
• [u] 137/86 @May 2021 first treadmill though Dr Leow said my treadmill was excellent
• 130/77 @Aug 2020 Icon
• 100/70 @Sep 2019 Steffy

k_CAD

1. Biggest blockage is D1, but it supplies a smaller territory than the LAD artery, as Dr Leow explained
2. 2nd biggest blockage is LAD, below 50%.
3. The right side … around 10% blockage. The “below 50%” from CT is overestimate, according to Dr Leow.

Q: Is my D1 big enough for stenting when needed? Fortunately yes

Q: when the wire passed through the narrow sites, was it possibly rubbing off the plaque?
AA: Yes for some patients. In my case, the plaque is calcified (hardened), and protects the artery wall against wire robbing.

Overall, need to bring LDL under 80, with two new drugs to replace lipitor.

— CTCA (CT coronary angiogram) ^ invasive angiogram
https://modernheartandvascular.com/differences-between-cardiac-ct-scan-and-angiogram/
https://www.circlecvi.com/resources/cardiac-ct-scan-vs-angiogram-what-s-the-difference

For abnormal CT angiography findings, such as blockage or narrowing of one or more blood vessels, the patient may need a standard angiography as a follow-up. This is typical when doctors consider surgery to treat the narrowing or obstruction.

FFR is even more reliable. See https://www.uptodate.com/contents/clinical-use-of-coronary-artery-pressure-flow-measurements

CT has (better sensitivity, therefore good for rule-out) poorer specificity, therefore inferior for ruling in i.e. diagnosing a borderline case like me.

Low specificity means high probability of mis-fire (false positive). Such diagnostic tests need a follow-up (more identifying) test with better specificity. See my bpost on specificity^sensitivity

k_CAD

“My heart is not damaged but it is at high risk of heart attack.”

你姥姥76岁时得心梗，住院45天，好了。（当时没有支架的治疗方法）。78岁时有复发了，医生惊讶地问：老太太还活着呢？，82岁时由于你的三姨病逝，她悲痛过度，5分钟猝死！

— fitness vs risk .. In 2021 I told doctor that

• I was expecting that my fitness is better than average.
• But my risk of heart problems was unknown to me.

Based on the treadmill + echocardiogram in 2021, doctor concluded that no further tests were needed at the moment.

Doctor said I was very fit. It confirmed my expectation. My own assessment is based on my workout. Doctor’s assessment was based on tests.

Note by then I had already shown my cholesterol results, and told doctor about my stories — 2016 in Macq, boxing, stent,,, Later I showed Dr Leow the referral letter from Raffles Medical about the Jan 2021 fainting experience in office. (He said it’s known that some people can experience that due to an extremely unpleasant experience.) So until now, I have perceived my overall heart risk as higher than average, in spite of my fitness.

The notion of fitness is confusing, distracting and counter-productive to me. This heart screening is actually risk profiling, though it used a treadmill which is a stress test that resembles a fitness test.

With the treadmill stress test the real focus is not fitness but heart risk.

 

— gastritis .. relatively mild so Dr Wee felt no need to see me again unless conditions worsen.

Q: how do we know if the medications are helpful or unnecessary?
AA: You can follow your gut feelings. If no symptom at all, then technically no way to check until the next scope. “We have to accept that.”

Q: when I see a GP for other ailments, is there anything to check on a regular basis?
AA: Nothing. The only way to monitor is another scope. (Some patients may need annual re-check.) Dr Wee said 5Y recheck, but I insisted 3Y recheck.

Dr Wee predicted that if I don’t treat my gastritis, i will definitely get stomach problem down the road. Dr Wee was not wrong to warn me of stomach cancer even though I’m the anxious type. Without his warning, I would not take gastritis seriously.

Q: How do I monitor my condition? No way. You will feel pain if it gets worse

Q: What stomach sensations to watch? empty-stomach sensation is fine

— breakfast .. Some healthy adults can safely skip breakfast, but I told Dr Wee that I no longer counted myself as one of them. He said 3 meals are good for me.

.. Is intermittent fasting safe for me or “risky by default”? not medically proven and Not recommended for me. eat regularly to reduce gastritis. Lunch-skip is possibly less unsafe, but not breakfast-skip

 

Dr Lau (not a gastroentereologist) said that for most people, 3 meals a day is recommended.  In my case, she recomends

• small piece of bread, better than biscuits
• milk
• oatmeal
• fruits in empty stomach not recommened, but Dr Wee said okay