Sheryl

Absolutely. Needed to be especially wary during the first months of the academic year (May - July) as at that point many of the "doctors" were still in medical school just a few months back and have almost nil experience. I have a family member who underwent complex spinal surgery at a government university hospital. Turns out the senior doctor in charge did not even enter the OR, the interns and residents were left totally on their own (I later found out he was altogether out of town). The result was excessive blood loss (needing multiple transfusions afterwards) and a hematoma pressing on the spinal cord which nearly paralyzed her for life. Further, the staff lied about her condition and kept telling the senior doc by phone (and writing in the chart) that everything was fine when in fact she was numb from the waist down and could not stand up. I had to stage a virtual sit-in at the nurses' station two days in a row to finally get the senior doctor to come in (he hopped a plane in Chiang Mai once he knew the actual condition of the patient) following which he operated himself, luckily in time to avoid permanent paralysis. There is a work-around for this issue, which is to utilize the "after hours" clinics that most government hospitals have. There, for anywhere from 250 - 500 baht extra, you can directly see a senior doctor.

I agree that using private facilities is a choice. And that government facilities are far, far less expensive (excluding opportunity costs and, for some people, travel costs). But I doubt any expats opt for private because of "marble fountains in the foyer and the 42 inch flat screen" ! (And there are private hospitals without anything like this e.g. the various no-frills non-profits). It is unfair to imply this. Those who opt for private facilities usually do so because of things like (in no particular order): - Ability to choose the doctor and availability of doctor credentials online - Ability to make online appointment in advance - English speaking - Speed of service (which can be a difference of days, if needing to see a specialist) - Convenience (e.g. less red tape, ease of navigating the place) - Less crowding - air con waiting areas with plenty of places to sit (in some government hospitals it is standing room only, non -a/c, packed like sardines and waiting for hours...) - direct payment arrangements with insurers -if being admitted: much better nurse-patient ratio; possible to stay without a friend/relative always accompanying; more comfortable patient rooms Now whether these factors are worth the cost, rather depends on the individual and their financial circumstances. Also on whether one has a lot of time to spend getting medical care -- for some people, time is in shorter supply than money, or effectively is money. Lastly, the medical quality of both government and private options -- and the range of specialists available in each -- varies enormously depending on where one lives. I almost always use private, mainly because to I live 3 hours each way from Bangkok and the added cost in travel and hotels to use the large government hospitals more than outweighs the savings for most outpatient care (one whole trip just to make the appointment, at least one more another for the visit etc etc), and I have insurance for inpatient which will reimburse private, but not government, hospitals directly . However if I lived in Bangkok, I would be much more inclined to use the after hours clinic at Chula and other major government hospitals for outpatient care because at that point the savings is meaningful. But I have used more local government facilities for some uncomplicated things, especially ones where I could go straight to the emergency room e.g. like animal bites etc.

And accidents. Some exception regrading motor vehicle accidents as there is another compulsory insurance scheme for that. But certainly all other accidents.

Rather difficult to enforce mandatory insurance when so many tourists enter Visa Exempt. For visa yes, could be done. But for VE? Would be a nightmare at the airport.

Medical services are free to citizens only in government facilities (or, i nthe case of people covered by Thai SS, private facilities that choose to opt in to the system). Majority of Thais are covered by the "universal" (AKA "30 baht" or "gold card") system. This is totally subsidized by the government. For those who re covered by SS, this is funded through employee and employer contributions. Foreigners are eligible for this as well as Thais, if formally employed (private schools excepted). At private facilities charges are not just actual cost, how can they be? A private establishment needs to not just cover costs, but make a profit. (And many private hospitals make a substantial one). At government facilities the price for those paying out of pocket (which can include some Thais who choose to go to other than their registered hospital) is typically less full cost of the services. Government hospitals perpetually operate at a considerable loss. However, in the case of the few government hospitals who practice 2 tier pricing, sometimes the official price for foreigners exceeds actual cost of the servcies (overall they are still running t a loss though - government subsidies are way too low).

You can buy inexpensive stands that will both raise the height and also tilt the screen in a useful way...like these https://www.amazon.com/s?k=laptop+stand&crid=3F400QX06UJIG&sprefix=laptop%2Caps%2C307&ref=nb_sb_ss_ts-doa-p_2_6 I have one and also put something under it (reams of printer paper, or books, work well). Very easy to increase font size on a Mac...Command +

Very good to know, but I wonder if this varies by location/province?

Manidipine is for high blood pressure, not diabetes. Swollen legs & feet is a common side effect if this class of drug (calcium channel blockers). Common, and inexpensive, alternatives are ACE inhibitors (e.g enalapril) and ARBs (eg losartan) Hydrochlorthiazide is a diuretic that also reduces blood pressure, though for most people this alone will not suffice and it rather needs to be taken along with abother drugs such as those mentioned above. How high is your BP?

There is no specific rule, but some Imm Officers take a dim view of people spending more than 180 days per year in Thailand, and many will at least question a back to back entry. Basically they have been instructed ti be on the lookout for people who are actually living fulltime in Thailand without appropriate visa i.e. using sequential tourist visas or vi=sa exempt entries etc to live here. In typical Thai government fashion this instruction came with no specific criteria so each IO makes up their own interpretation of what would suggest someone lives here. Zeal of enforcement also varies btoh by individual IO and over time. What you propose to do, 60 days here, 2 months away, another 60 here, should be fine.

Locking in the moisture that otherwise seeps out the pores is exactly the point of using it. But best nto to have it on 24/7. As it is also messy to use at night (smears the pillows) I usually suggest just day time use.

Went low was after significantly increasing dose and then using new vial. Pretty clear to me that it was the old vials - based on which he upped his dose - that were the problem. Decreased efficacy, likely due to heart exposure which could happen in transit to the hospital or through a on-off staff error in the pharmacy. For that matter might even have happened at home, for example if power went out at night while asleep, or during day while not at home, you might now realize it, Moral of the story is if you have been stable on an insulin dosage for some time and then start getting high BS readings, try a different vial batch before changing dosage.,

It is not. It is an offshoot of Allison Monkhouse, an Australian funeral agency with an excellent reputation which branched out into handling deaths abroad about 30 years ago. Has been awarded for its free relief work, e.g. during the Asian Tsunami. Head office remains in Australia. But large regional office in Bangkok has been operational for at least 20 years, maybe more., originally under the name Allison Monkhouse Co, Ltd. (Thailand). I have dealt with them directly and also referred people there, consistently good results snd very reasonable costs.

With US Embassy, in case of death of a US citizen, you can call 24/7 and get through to the Duty Officer, it is one of the most common tasks a Duty Officer has. You'll have to go through the general switchboard first, key thing to say are if it is after hours is "need to speak with the Duty Officer to report death of a US citizen". During working hours would just ask for American Citizen Services. Besides providing various lists, the Embassy will facilitate contacting next of kin in the US if needed, and also if needed facilitate communication with local authorities for family based out of country, of family in country who need help (translation etc). - has to give the green light for release of the body (which they will only do upon instructions from the Next of Kin. )There is form for identification of Next of Kin which can be downloaded on Embassy website. - will issue a "Consular Report of Death Abroad" which serves in lieu of a death certificate in the US. A Thai death certificate, even with notarized translation, will usually ot be accepted by US financial institutions and authorities so this document is critical. Even if there are absolutely no assets in the US, one would want this to claim the Social Security lump sum death benefit and (if applicable) survivor benefits. See https://th.usembassy.gov/u-s-citizen-services/death-of-a-u-s-citizen/

They are Thai based. Office in Bangkok and excellent, sensitive staff. Asia Division – Bangkok Office Bio House Tower, 3rd Floor 55 Soi Phrompong, Sukhumvit 39 Klongtan Nua, Wattana Bangkok 10110 Thailand Office: +66 (0)2 258 5946 Mobile: +66(0) 92 859 5616

I would add to the above that, although it is listed as a peer-reviewed journal, the qualifications and affiliations of the authors are less than clear to me. They seem to belong to the "Nagoya City University and Institute for Consumer Science and Human Life" which despite its name seems based at Kinjo Gakuin University, a small private women's college. I can find no information on this Institute other than other articles written by the same people in online journals (all of them of similar bent). Website for Nagoya University does not mention this Institute under any of its faculties that I can see. From the article, the authors have expertise in pharmacology but not epidemiology and many of their hypotheses simply do not fit what we see happening in the real world, epidemiologically. There ave been innumerable long term prospective studies related to coronary artery disease and if in fact stain use increased its prevalence or severity this would have been apparent by now. The journal this appears in is one of pharmacology not epidemiology or cardiology. Which is not to say statins are totally benign or should be used indiscriminately. But the propositions in this article are far fetched to say the least. Between an in vitro lab finding and actual impact on living organisms there are many steps and factors. The Co-Enzyme Q10 depletion mentioned is well known. Use of Q10 supplementation for patients on statins has been proposed and is routine in Japan, but several random controlled studies have failed to show any effect from it. These however focused on muscle pain and muscle related changes, not coronary effects. Nonetheless no harm in taking a Q10 supplement and personally, I put a family member with CAD who requires statins on it.

Would your insurance cover the 190K at Medpark Hospital? Note too that when there is an issue with insurance typically it gets resolved in negotiations between the hospital 3rd party payment opffice and the insurer. Often the hospital ends up reducing a charge or "repackaging" the breakdwon. I would not expect that from an upcountry private hospital (those are usually best avoided for a number of reasons) -- especially one that came up with such seemingly odd cost estimates to you -- but big hospitals in Bangkok, yes.

It is. And it is the OR charge that should be dramatically different between laparoscopic and open since no need to use endoscope for the latter

These quotes are quite high, and difference in price between open and lap should be much greater (typically at least 50K). Even the laparoscopic is less expensive at top hospitals in Bangkok e.g.190K at Medpark https://www.medparkhospital.com/en-US/packages/laparoscopic-hernioplasty and 219k at Bumrungrad https://www.bumrungrad.com/en/packages/laparoscopic-inguinal-hernia-repair-1-side Open is not listed but would be usually around 150k or less And of course government university hospital would be less still

I can't recall specifically for hernia but there are AN members who have used hospitals in India. You need to research both the hospital and the specific surgeon carefully as in India, like anywhere else, quality varies greatly. The price you were quoted could not have been for open or laparoscopic as the 2 have very different costs. I expect it was for laparoscopic. It is not routine to require a CT scan first unless there is doubt about the diagnosis which is not usually the case. If I were you I'd consider going to Khon Kaen University Hospital, quality is good and cost will likely be similar ti going to India once you take into account airfare etc. Not that should not fly for at least 48 hours after laparoscopic surgery and a full 10 days after open surgery. And sometimes even when laparoscopic is planned they have to switch to open during the procedure (especially likely to happen in patients who have had prior abdominal surgery or re obese). In other words you might ave to stay longer than planned in India afterwards.

I meant that use by people who do NOT have coronary artery disease is of less clear benefit. You DO have CAD and there is no question but that you should continue the prescribed statins. The source is a peer-reviewed journal. However the authors repeatedly stress that this is a hypothesis of what may be the case. It is a controversial article.

They have the same action. Atorvastatin is somewhat more effective but also also has a higher incidence of side effects. https://academic.oup.com/qjmed/article/92/7/387/1696923 https://pubmed.ncbi.nlm.nih.gov/10687671/ Simvastatin can not be given at a "high intensity" dose while atorvastatin can so for people needing very high statin doses atorvastatin is preferred. If your atorvastatin dosage is 20 mg or less, and you have good results on that, then discuss with your doctor if Simvastatin could be taken instead. Note that there is a 2:1 dosage equivalency i.e. 20 mg Atorvastatin = 40 mg Simvastatin; 10 mg atorvastatin = 20 mg Simvastatin.

Atorvin (made by Unison) Chlovas (made by Millimed) Lipostat (made by Siam Bheasach) Will run about 500 baht for 30 tabs

1. Use a very mild soap like Pears 2. Apply vaseline to the dry areas, it is by far the best thing for dry skin though a bit messy. Are you sure it is dry skin and not some other skin condition?

And the "they" that come are fully trained and equipped EMTs. Who will provide immediate stabilization right on the scene as wel las in the ambulance while in transit. Not the case here.

Moved to the Health forum. You have gotten some suggestions for psych but I would also suggest you see this doctor at Sripat https://sriphat.med.cmu.ac.th/en/doctor/detail/26 what you describe sounds much like fibromylagia. Most Thai doctors are not familiar with it, and the "must be stress" is a default response when they can't find a cause familiar to them The above doctor is familiar with fibromyalgia. See what he thinks. Anxiety can do a lot but is unlikely to cause the sort of widesprerad nerve pain you describe.