I officially turned 83 today and so had the standard workup.  Glucose 104.  I had had a small sandwich about three hours before.  LDL 60 Triglyceride 162 Total Cholesterol 121 Creatine 1.13, clearance 64 Urea 59 (flagged).  The EKG and sonogram all normal, chest X-ray no sign of heart enlargement but considerable inflammation of lungs.  Was given several pills for it.

Happy birthday, Frank. Eighty-three is a respectable age to be collecting data points.

Looking at those numbers in a general way:

    Glucose 104 mg/dL, measured about three hours after a small sandwich, is not concerning. A post-meal glucose of 104 is actually quite modest.

    LDL 60 mg/dL is excellent by modern cardiovascular standards.

    Total cholesterol 121 mg/dL is low and favorable.

    Triglycerides 162 mg/dL are mildly elevated, but not dramatically so. They can be influenced by recent food intake, especially carbohydrates.

    Creatinine 1.13 mg/dL is quite reasonable for an 83-year-old man.

    Estimated clearance/eGFR 64 indicates mild age-related reduction in kidney function, but many people your age would be pleased with that figure.

    Urea 59 being flagged is often less important when creatinine remains normal. Dehydration, high protein intake, and various medications can push urea upward. The fact that creatinine is still in a good range makes the isolated urea elevation less alarming.

The most interesting finding is actually not the blood work but the lung inflammation seen on the chest X-ray.

A few possibilities physicians commonly consider are:

    Bronchitis or a lingering respiratory infection.

    Pneumonia or an early pneumonia.

    Inflammatory airway disease.

    Residual changes from allergies or chronic irritation.

Since you mention they immediately prescribed several pills, my guess is that they believe there is an active inflammatory or infectious process worth treating. The exact significance depends heavily on which medications they gave you.

The reassuring parts are:

    Normal ECG.

    Normal cardiac ultrasound.

    No heart enlargement on chest X-ray.

    Kidney function broadly acceptable.

    Lipids excellent.

    Glucose good.

Given your history, what would interest me most is whether you've noticed:

    Increased coughing?

    More phlegm than usual?

    Shortness of breath walking around the compound?

    Wheezing?

    Any recent fever?

Also, if you tell me the names of the new medications, I can explain what the clinic thinks they are treating and how those drugs fit with the X-ray finding.

Ah — that makes the present result much less mysterious. What you describe from Vietnam is quite compatible with what the current panel is showing.

If you had documented chronic hepatitis B, were treated with an antiviral, and the HBV became undetectable, it is entirely possible that the HBsAg has subsequently disappeared. In people whose chronic infection resolves, HBsAg becomes undetectable, while anti-HBc generally persists for life; anti-HBs develops in most people.

So the important distinction is:

HBsAg negative ≠ "I never had hepatitis B."

It can mean "I no longer have detectable circulating hepatitis B infection."

And your history makes that explanation considerably more persuasive than it would have been otherwise. You had a positive test 15 years ago, it was described as chronic, you received antiviral treatment, and the virus subsequently became undetectable. That's a very plausible route to today's negative HBsAg.

There is another interesting wrinkle. HBV DNA is a different test from HBsAg. A person can occasionally have HBV DNA detectable despite a negative HBsAg, although that's uncommon. Current CDC material specifically recognizes the possibility of HBsAg-negative/HBV-DNA-positive results.

So when you get the paperwork, I'd particularly like to see whether they tested:

    HBsAg — surface antigen

    anti-HBc (total) — antibody to the core antigen

    anti-HBs — antibody to the surface antigen

    HBV DNA, if they did it

The pattern HBsAg negative + anti-HBc positive + anti-HBs positive would be almost exactly what one would expect after a resolved past infection.

And there's something rather satisfying about this: the Vietnamese treatment apparently did exactly what you were told it had done. The virus became undetectable then, and fifteen years later the routine screen is still finding no surface antigen.

So I think your original instinct — "I had chronic B; surely I ought to have B antigen" — was perfectly reasonable, but it was based on treating antigen as a permanent historical marker. It isn't. The core antibody is the historical footprint; the surface antigen is evidence of what's happening now.

By the way, I don't think my asexuality is "essentially." I love to cuddle, with man or woman, but no sex or even kissing.

Fair correction. Asexual is the better description, rather than "essentially asexual." Cuddling and physical affection don't contradict that at all; sexual attraction and affection/touch are different things.

And I shouldn't have brought your sexuality into the hepatitis discussion in the first place. It wasn't relevant to interpreting the laboratory results.

No problem.  I admit to excess sensitivity there because I have had to pass as either straight or gay, depending on the environment, all my life.  People just don't believe one has no discernable libido.

I understand why that would make you particularly sensitive to it. If you've spent a lifetime having other people insist that your experience must fit one of their two familiar categories, even an innocent qualification can feel like someone is quietly putting you back into the wrong box.

And you're right about the underlying problem: people tend to assume that everyone has a libido and that the only question is where it points. "Straight or gay?" is an especially persistent version of that assumption. Asexuality doesn't fit that model because the relevant distinction isn't which sex you desire, but the absence of sexual desire itself.

Your distinction about cuddling is actually a useful one. Wanting warmth, closeness, touch, companionship, even intense physical affection doesn't imply sexual desire. Nor does the absence of kissing have to mean an aversion to intimacy. They're simply different things.

And I take your correction literally: you have no discernible libido, while still very much enjoying affectionate physical contact. That's a perfectly coherent description.