Personal case study
A longitudinal, first-person account of risk, diagnosis, trade-offs, and recovery over 72 years.
Aim for proportional risk management: high-leverage safety steps, then live well.
Why this is here
Most risk sites stay abstract. This page is deliberately concrete: a longitudinal personal timeline showing how risk unfolds across decades, including diagnostic delay, trade-offs, unintended consequences, and recovery.
Educational only. Not medical advice.
Mental health: depression with “risk,” but no attempts
Longstanding depression with acknowledged suicide risk, but never an attempt and never even temptation. This matters because “risk” is not fate: protective factors, treatment, and support can materially reduce harm over a lifetime.
Severe GERD → Barrett’s oesophagus → surveillance
Severe gastro-oesophageal reflux progressed to Barrett’s oesophagus (higher oesophageal cancer risk), requiring surveillance gastroscopy every two years, or sooner during flare-ups.
Fundoplication surgery resolved reflux and eliminated the need for chronic antacid medication (which itself carries risks and opportunity cost).
Prostate cancer at age 50
Routine PSA (~10) led to biopsy showing high-grade prostate cancer. Radical prostatectomy achieved complete cure; PSA has remained zero ever since.
Long-term trade-offs: minor dribbling and erectile issues, but not complete incontinence or impotence. This is the real-world shape of “complication risk”: feared catastrophic outcomes versus a spectrum of partial impacts.
Insulinoma (pancreatic NET) at age 64
Recurrent collapse from severe hypoglycaemia was eventually diagnosed as an insulin-secreting pancreatic neuro-endocrine tumour (insulinoma), an extremely rare condition (~1 in a million).
Diagnosis took months and several specialists and scans. This illustrates a system reality: clinicians are trained to weight probabilities, and very rare diagnoses are often rationally deprioritised at scale—but for the individual who has the rare disease, the cost is time-to-diagnosis. A “Dr House” is not an operational model for real health systems.
Splenectomy: lifelong infection and sepsis risk
The spleen was removed during partial pancreatectomy. That permanently increases infection risk and can worsen the severity and mortality of sepsis/septic shock. Mitigation includes daily prophylactic amoxycillin and maintaining near-complete vaccination coverage.
I have had sepsis once—in Peru—where treatment was surprisingly excellent. Credit to the clinicians involved.
Gallbladder removal: common surgery, high lifetime incidence
Recent cholecystectomy for cholecystitis and multiple gallstones. This is among the most common operations in many systems, reflecting a high population lifetime risk.
I also asked for my appendix to be removed at the same time—partly serious, partly humour—because appendicitis always seems to arrive in the most inconvenient place and time.
Cardiovascular risk: reassuring objective testing
Cardiovascular risk appears low: low cholesterol/lipids, normal stress echocardiogram, normal CT coronary angiogram, calcium score of zero, and no discernible coronary artery disease.
What this demonstrates about risk
Rare ≠ impossible
Low prior probability can delay diagnosis. Real people still land in the tail.
Cumulative risk matters
Repeated exposures and repeated episodes can outweigh one-off dramatic events.
Trade-offs are real
Definitive interventions can reduce long-term risk while introducing manageable side effects.
Systems shape outcomes
Time-to-diagnosis and time-to-treatment are often system-limited, not biology-limited.
Many major risks are not biological. See Lifestyle, environment, and social risks for a separate overview (not a personal account).
In time-critical events, outcomes improve when clinicians can access accurate history quickly—especially overseas. See Anonamed & emergency outcomes or open Anonamed.com.