Sheryl

Eli Lilly has taken Cymbalta off market in many locations including Thailand. However some places may still have stock remaining. They have it at Medtide https://medtide.com/product/duloxetine-cymbalta-30-mg-28-tablets-box/ (you may have to create an account to view it) You should also check with https://medisafepharma.com/ (Use the Messenger function to ask) Since it is off market, resupply will eventually become impossible so, subject of course to expiration date consideratiopns, may be worth stocking up a bit

It doesn't usually have this effect. With the Oestrogel, should use the smallest amount that controls symptoms. This will usually be less than full applicator. That also helps to prevent much buildup of the endometrium. There are several different schedules that can be used: Continuous (Oestrigel + utrogestan) every day, all the time Oestrogel every day, adding Utrogestan for just last 10-14 days of the month Oestrogel for 25 days of the month, adding Utrogestan for the last 10-15 days Of these approaches the last one is most likely to produce some spotting but even that, in only some women. The first is probably least likely to cause any bleeding but will also be more costly (the Utrogestan is not cheap!). So if she is troubled by spotting with one regimen can modify it. All that said, no need to take systemic HRT at all unless she is significantly bothered by symptoms such as hot flashes and mood swings. Vaginal estrogen, on the other hand, pretty much all women need.

Have you tried melatonon? A fast dissolve version, undre the tongue when you awaken too early. Early morning wakening in older people is directly linked to low melatonin levels many older people find that a daily nap (1-2 hours) is the answer, as it does get harder to sleep for long at a stretch as you age.

Suggest https://www.phukethospital.com/doctor/perapun-jareoncharsri/ If he can't sort it out then see one of the Oral & Maxillofacial Surgery specialists in the Dental center there https://www.phukethospital.com/center/dental-center/#doctors or at one of the dental clinics.

Laparoscopy is still a hysterectomy, just a less invasive (but more costly/technically difficult) approach. While fibroids make it a bit harder, a skillful surgeon would usually be able to do laparoscopic hysterectomy with 2 medium sized fibroids in the uterus. I say "usually" as they don't know until they try and it can sometimes happen that they have tyo switch to open approach after first trying laparoscopically. Doctors would not usually mention laparoscopy as an option separate from hysterectomy, since it is a hysterectomy. The issue of laparoscopic vs open approach comes into play only if the patient has decided on hysterectomy. Re GYNs, depends on what you most want. I find this doctor at St Louis to be a very good communicator, unpretentious, frank and personable: https://saintlouis.or.th/doctor/dr.petcharat--pitahongnun/8ec97b6a-7666-4fa5-8561-fbbaac15ba7b However, as of last time I saw her (admittedly some years ago), she herself did not do laparoscopic surgery though has no issue referring to someone who does. So if what you mainly want right now is explanation and discussion of options she would be a good first choice. At St Louis it is first come, first serve so I'd suggest a Wednesday or Thursday as apt to be less crowded which means more time possible with the doctor.

Give it a week or so then if persists see a doctor. Start with an ENT. If no success then a dentist speciaizing in jaw problems. As this sort of thing can be from either ear issue or jaw/TMJ issue. Where are you located? Might also try chewing gum and intentional yawning as these can help reset pressure in the Eudtachian tubes.

P.S. while your post talks only sbout fibroids, title mentions also menopause.. please clarify. If she also needs treatment for menopausal symptoms (e.g. hot flashes, mood swings) then (1) all the more reason to have hysteretomy if fibroid related symotoms are intolerable, as medical management of fibroids will often worsen menopausal symptoms. (2) unlike fibroids, which any GYN can handle, there is much more limited range of doctors skilled in HRT so please specify.

Agree, reasonable way to proceed. If antifungal seems to work continue it for at least a week past full disappearance of the rash.

Please stop bickering. Psoriasis is an autoimmune condition. SOME sufferers find that certain foods trigger or worsen symptoms. Which foods exactly is highly individual and for some people diet has no effect at all.

Of course I can recommend various doctors but I do not think it will achieve your desired aim of avoiding surgery. With fibroids, no treatment is needed if the symptoms are tolerable. That is, obviously, a subjective assessment. I do find though that Thai women tend to be unduly worried by menstrual irregularities and also to fear (incorrectly) that fibroids may turn cancerous. If her problem is more this (fear/worry) than that the symptoms are physically intolerable, simple reassurance may suffice,. If the symptoms are not tolerable, then first line of treatment is hormone therapy. The hormones least likely to cause significant side effects (e.g. birth control medications) have already been tried in your case. Next approach would be either surgery or classes of drugs known as Gonadotropin-releasing hormone (GnRH) agonists and Gonadotropin-releasing hormone (GnRH) antagonists. These drugs have significant side effects including loss of bone mass which is especially undesirable in women nearing menopause age, and hot flashes. Unless there is a desire to have children, most doctors at this point would advise a simple hysterectomy instead for a woman her age. There is a drug called Ulipristal which some places here are using, but it has been linked to serious liver damage in some women and is thus not approved for use in Europe except in women with a medical contraindication to surgery and intolerable symptoms from fibroids. I am not clear what you mean by "everyday extra bleeding started more or less depending on the period cyclus". If you mean she is now having spotting (light bleeding) on most days, or between periods, this could also just be because she is nearing menopause, irregular periods are normal during that time. Even iuf she were to revert back to DMPA injections, might still have soem menstrual irregularity for this reason . In short, continuing to try non-surgical treatments at this point -- given that the safest/simplest ones have already been tried and failed -- may cause more (and more serious) problems than just having the hysterectomy, assuming she cannot simply tolerate the symptoms. The latter would be best if possible, as at age 52 the fibroids are likely to shrink on their own soon as she enters menopause (though if she then needs to use HRT, that can sometimes cause the fibroids to not shrink or shrink more slowly). I don't think any Gyn is likrly to give different advice than this given her age and experience with hormone therapy to date. May I ask why the determination to avoid hysterectomy? For fibroids it would be removal of only the uterus, a very simple procedure which can often be done laparoscopically or even sometimes vaginally with minimal or no abdominal incision.

I use it. Of course, like anywhere, varies somewhat with the doctor. I have gone there for some 20 years, only one dentist there I did not care for, all the rest were fine. And they offer all specialties. you will find mixed reviews for everyplace, unless the place itself has somehow rigged the reviews. And people are always more likely to recount or post a negative experience than a positive or neutral one.

Please give the names of the creams/lotions already tried.

This place can arrange everything, including paperwork with your Embassy (important if you have any assets or entitlements in your home country, or relatives who might every need to prove you are dead for any reason) and you can prepay for it. While the site talks about funerals, they can and will arrange no frills local cremation without funeral. (though if your wife is still living she might be more conmfortable having at least basic Buddhist ceremony). https://www.amarinternational.com/pre-planning-funeral.html

Hydroxyzine is not physically addictive. Neither is doxylamine, another available OTC sleep med in Thailand in the antihistamine family (brand name Sominar) BUT both of these can cause grogginess next day and this class of drug (first generation antihistamine) is not recommended for regular, sustained use (e.g. every night) especially in the elderly. In the elderly, may cause or worsen confusion and cognitive decline especially if taken regulalry. Though as with all side effects, individual response may vary.

Puritan Pride is my preferred brand. And personally, I take a full 10mg. But YMMV. There have been some anecdotal reports from people buying on Lazada (unspecified which seller) that product seemed fake. So please update if it works for you and, if so, specify the seller. (Lazada is just a platform not a merchant, so quite possible to get different quality products using it depending on the store/seller).

iHerb is easy to order from and totally reliable https://www.iherb.com/c/melatonin

Prof. Watchara Boonsawat Besides KKU Srinagarind Hospital he can also be seen once a week on Wednesdays at Ratchapruek Hospital in KK https://rph.co.th/en/doctor/watchara-boonsawat-md/

Places that as of 2 weeks ago had the JN.1 vaccine (newest one that is available at this time): https://www.thaitravelclinic.com/cost.html note that there is a doctor add-on fee of 200-500 baht depending on when you go https://www.medconsultasia.com/ (does not show on their website, but they have it, I got it there myself about 2 weeks ago) https://www.bnhhospital.com/ https://www.vibhavadi.com/en/package/covid-19-vaccine-strain-jn1 There may be others, my impression was that hospitals had just started to order it in.

@carlyai do you mean mean this doctor? (Nappaporn not Natapong) https://bangkokpattayahospital.com/doctor/napaporn-ketvatanawes-m/?srsltid=AfmBOoowJZ5zQqiw7FO2owfRFW8gp05hSi3skp7n0vzxyQYGDYeueZz0 @TimBKKGoing to BPH will cost quite a bit vs free care through the government system for what may be an extremely common problem. It is the most expensive private hospital in the area. Personally, I would at least start in the government system. She can use the "after hours" channel top see a senior doctor directly for a small extra fee. If things prove to be more complicated than expected, then could always switch to private. Note that fibroids do not require treatment unless the symptoms are intolerable or interfering with desired fertility. Diagnosis made by ultrasound (which she may have already had). First line treatment, if not desiring pregnancy at this time, would be hormones (and these, only if symptoms are bothersome - the majority of women develop fibroids sooner or later and most never need to be treated).

There is no such thing as H. Pylori of the lungs. You must be thinking of something else. Are you perhaps confusing this with GERD?

This is not correct. The most recent estimste (2021) is a prevalence of 21% among symptomatic Thai people. Prevalence in overall population would likely be a bit less. https://pmc.ncbi.nlm.nih.gov/articles/PMC10290267/#jgh312916-bib-0009 H. Pylori us a major risk factor for gastric cancer as well as peptic ulcers and should be aggressively treated for this reason. Thailand is not considered to be a developing nation. It is classified as a newly industrialized nation.

Moved to insurance forum. Note that for OA visa, only specific companies are accepted. All are Thai and some will not enroll over age 65. All will exvclude pre-existing conditions. Premiums rise sharply with age and some fldo not guarantee lifetime renewal so examine closely.

She can get this done for free at the government hospital where she is registered under the universal ("30 baht") or SS scheme. This is an extremely common problem which any Gyn can handle

A post conta9ining ony AI text has been removed. Please do not post AI search results. They are not accurate.

that would have been the stool antigen test, not the (more accurate) breath test