Sheryl

Are you referring to peritoneal dialysis or hemodialysis? And us this for yourself or for a Thai National? If the latter are they already receiving dialysis in the government system?

Hospital is not the issue. The issue is, does your problem have a surgical solution (I would not assume this) and, if so, who is the best surgeon to do it. I recommend you come to Bangkok and consult Prof. Songklot at St Louis Hospital https://saintlouis.or.th/th/index Or (same doctor) at Bangkok Hospital https://www.bangkokhospital.com/en/doctor/dr-songklot-aeumjaturapat

+1 for Dr Roy at Rutnin. Excellent choice.

Moved to the Health Forum. 1. The fact that she has detectable cataracts does not necessarily mean she needs cataract surgery now. Cataracts should be removed only when they have begin to seriously affect day to day activities. This can be many, many years - even decades -- after they first develop. Although it is very much not good medical practice, I have come across some doctors in Thailand pushing for cataract surgery well before it was necessary. So we cannot assume that she needs cataract surgery at this time let alone in both eyes (often one eye needs it before the other). 2. What you were told re "correct her vision" is at best questionable. Cataract surgery will remove the cloudiness in vision that cataracts can cause. The lens that is then implanted usually ensures 20/20 distance vision but most people still need glasses for reading/near vision. There are special lens types that are supposed to avoid this but they do not work well for a lot of people....and they cost a great deal more. Other than when to have cataracts removed, the type of lens that will be implanted is the biggest decision and warrants some thought and research on your part. From the cost estimate the doctor may have been proposing the so-called multifocal lenses. If so, this should have been clearly explained along with the risks/downsides which include haloes/glares, difficulty with night vision, 2-3 month adjustment period (and some people apparently never do adjust well),less precise visual correction (such that some people still end up needing glasses) etc etc. See https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003169.pub4/full An alternative to multifocal lens is monovision whereby one eye is intentionally left (or made) a little myopic (near-sighted). This avoids the cost and other disadvantages of "multifocal" lens and works well for some people but not for all, so if thinking of doing this it is a good idea to first try out monovision using contact lenses or glasses designed to create same effect. If there is any astigmatism, then that has to be factored into the selection of the artifical lens as well. 3. If in fact both eyes need immediate cataract removed (a definite "if", as per #1) it would be usual to do one eye at a time, and this is essential if opting to go for monovision. Normally the second eye would be done after vision in the first eye has stabilized which may take a month or more. in terms of cost, with standard lens implants a Bangkok private hospital would nowadays run about 65-85k per eye all in. What I suggest you do is consult this US trained and very good doctor at Rutnin eye Hospital for (1) second opinion as to whether cataract surgery is needed now in both eyes and (2) in depth discussion of lens options. https://www.rutnin.com/en/doctor/resume.36.1_Medical_history_0_0.html

Impossible to say re reversability given lack of clear diagnosis. But it does not sound severe nor like you are very limited by the problem at present? While CT scan etc may shed more light they are nor likely to smalter management. The vaccines had nothing to do with it. The COVID and your smoking history likely do.

You mean Pattaya City Hospital and she should not go there. Chonburi Regional Hospital (in Chonburi town) is best option in terms of government hospitals. But for free care she will need referral ftom whatever hospital she is registered at under either the universal health care system or SS as applicable. Nowadays endoscopy is usual means of diagnosis and besides identifying HH if present this will also detect ulcers, gastritis and h. Pylori infection (common csuse of the last 2 things).

As aboive, the results -- if they can be relied upon -- suggest mild obstructive lung condition but would need to be interpreted together with your clinical picture and history (which, if memory serves, includes a long bout of COVID?) It has been my experience that these tests are often poorly administered in Thailand )(incorrect/inadequate instructions etc) leading to results often being not so reliable. If you are really troubled by persistant or worsening respiratory symptoms you should invest in a trip up to Siriraj, Hua Hin is not the place to try to investigate this

I am nowhere near Chiang Mai and in any event, no place I can recommend for this there. Khon Kaen would be a better option. This doctor there (US trained) http://www.khonkaenram.com/en/doctors/2 He can also be seen at Srinagarinbd (KKU Hospital) Otherwise, come to the govt Derm institute in Bangkok as previously advised, unless doing this back in your country is an option.

Prof. Permsak Paholpak at KKU Hospital But if surgery is contemplated -- or results of conservative treatment are unsatisfactory -- you should come to Bangkok. There are only a handful of spinal surgeons in Thailand I can recommend and they are all in Bangkok.

Experience with skin cancers is extremely limited in Thailand. Thsi applies to both dermatologists and pathologists (who interpret the biopsies) Best advice I can give for Bangkok is to go to the government derm institute https://www.iod.go.th/en/ But retain a healthy degree of scepticism and if the lesion does nto resolve consider seeking care in your home country

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Yes, neither needs a prescription in Thailand. Readily available in cheap local generic brands. Though the HTCZ will need a larger pharmacy.

I think you are confusing Biotox with fillers. Fillers do last up to a ear. Botox, never. 3-5 months is usual. Typically shorter interval when you first start using it and gradually lengthens. I've been using it for decades and mine now lasts 5 months but it lasted only 3 when i first started. I mostly use allergan but I think last 2 times were xeomin and it seemed to work OK.

Losartan is in the same drug class but is not a generic equivalent to valsartan and certainly not to the combo of valsartan/amlodipine which he is taking.

You do nto bneed a prescription. There is no locally made generic for the single pill combo of amlodopine+valsdartan, only brands are Amval and is Exforge, both imported. You can get Exfordge online from: https://bangkokdrugstore.com/product/exforge-5160-mg-14s/ https://bangkokdrugstore.com/product/exforge-10160-mg-14s/ Under 1,000 baht for 28 tabs Might also ask here, use their Messenger function https://medisafepharma.com/ Both are very reliable pharmacies that deliver. If you want to save even more money ask your doctor if you can switch to Losartan (same drug class as valsartan) and amlodipine and take them separately. Both come in very, very cheap local brands. 80 mg of valsartan is equivalent to 50 mg losartan.

I get my Botox at Medconsultasia https://www.medconsultasia.com/services/botox/ Don't try to book on the website (cdoes nto work well). Call, email or use LineApp Yanhee as a hospital is fine for eyelift procedure but main issue is to choose best doctor. This one has gotten good reviews https://www.yanhee.net/doctors/dr-pramote-manurangsee/

You are fine. No need for statins or any other change.

Great! Have you gotten the direct LDL result yet?

If there is no cardiac reason for taking this then you should discuss stopping it with your doctor (rather than adjust the other BP meds). Beta blockers are no longer recommended for hypertension alone plus your BP is fine and will probably stay fine without it. But, this class of drugs needs to be tapered off slowly. So discuss with your doctor how to stop it.

Prescribed for what condition? This is a beta blocker. Use as an anti-hypertensive is obsolete, but it still has uses for heart failure, atrial fibrillation etc. Hence my question. You are on 3 medications all with the effect of lowering BP.

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That is 2 BP meds (Losartan and Kerdica) as well as a beta blocker (Cardeloc) which also has the effect of lowering BP. Your Losartan dosage is already low but the Kerdica dosage is at the upper end (range is 10-20 mg) so might perhaps be lowered. Discuss with your doctor. Why are you on the Cardeloc?

110/60 is not extremely low. It is normal range. Whether ior nto to adjust your BOP meds depends on what yo uare takinbg buyt the adjustment would nto be to every other day as these merds do nto have that long an action. More likely a reduction in daily dosage. What exactly are your meds? (list all not just BP meds as some others can reduce BO as a side effect)

Depends on your age and your diet Dietary protein needs increase in old age at the same time that people are often taking less in

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