Sheryl

@Playingthefield I strongly recommend you get a visa. With your history you might be denied Visa Exempt entry. And have a return flight booked. Loner term you should consider getting a retirement extension.

Pay no attention to this link, it bears little to no relation to what government hospitals actually charge. In most cases the base charge (shown as charge for Thais) alone is much lower than in the government hospitals have been charging for years. The pricing in the MoH booklet is utterly unrealistic and has been widely ignored accordingly. The only relevant point -- for those who might assume otherwise -- is that government does officially endorse the idea of charging foreigners more for health care. And only some hospitals bother to create different pricing tiers, for many hospitals it is simply not worth the trouble. You will encounter it mainly in areas where there is a large expat population. (Bangkok, Pattaya, CM etc). In fact some (a few) small upcountry government hospitals won't charge you at all because they so seldom treat anyone not covered by either the universal system of SS that they have not set up procedures to collect fees.

In emergencies yes, often the case But I think it is true that the appearance of government hospitals as well as the crowds and forms, signs etc usually being in Thai only is off-putting for most actual tourists. And very hard for them to navigate the red tape etc. (again, tourists -- expats are a whole other story).

Atenolol is no longer used just for BP but is indicated for heart failure, atrial fibrillation etc. As for adding Manidipine to 25mg Losartan, 25 mg Losartan is sub-therapeutic dose, would be more usual to just increase the losartan does and maybe add clorthiazide. Unless -- and this is possible -- it was because of your decreased renal function. Sounds like the change in lab values and the decrease in losartan happened at same visit? If so, this could be why. However the preferred drug for managing hypertension in people with kidney disease is an ACE inhibitor like enalapril. I very definitely do not recommend going to Sai Noi Hospital, it is a tiny community level facility. Suitable only for things like simple wound care. In Nonthaburi I would suggest Panyananthaphikkhu Chonprathan Medical Center, which is university affiliated. And if possible the "after hours clinic", that way you will see senior doctor and can also ensure same doctor each time. Ask for an acharn in Internal Medicine. It will cost you a frw huindred baht more per visit but be well worth it in the long run. Regarding CKD, staging is based on the estimated GFR which in turn is based on serum creatnine, so presumably your creatnine level significantly increased. Is it possible you were dehydrated when the sample was taken? As if so, would be worth repeating it. If you are making additioanl visits solely for med refills might want to rethink that as =drugs like enalapril are dirt cheap at pharmacies.

Go to the Provincial Labor Dept, bringing your contract with you. They will most definitely follow up, and if it is necessary to go to the labor court (often not, often just a call from them is enough to get employer to act), they will provide the legal representation at no cost to you. This is assuming it is a private company and not a school or non-profit. Labor Dept will not pry into your taxes nor ask to see tax documents. The only issues will be the Employer (private company vs private school etc) , the length of time you were employed and the circumstances of your departure. As others have mentioned, depending on the exact situation the last might entitle you to more than routine severance.

This is pretty much the current system. It isn't working out very well.

It was 500 baht, hasn't been enacted yet and there was conflicting discussion about how the proceeds would be used. Emergency medical costs was one idea floated but AFIK nothing decided.

You won't get "gouged" but costs can still easily exceed 1 million baht at a government hospital in case of catastrophic accident or illness requiring long ICU stay, specialized surgeries etc. Even using just government hospitals, still need either a lot of savings or insurance. Travel policies are not at all expensive (they do, of course, only cover emergencies). Main problem is that many exclude motorcycle accidents (or need a special add-on to cover them, which people may not notice) and pretty much all exclude accidents due to negligence, intoxication, or behavior that violates the law (driving without a valid license, not wearing helmet/seat belt would qualify). A lot of tourist emergencies come under those headings.

Yes. Completely impractical.

I am not clear...are you still taking Losartan 25mg (a sub-therapeutic dose) plus they have added Manidipine? By Zosin do you mean Tamsulosin or Doxazosin? In either case this is given for enlarged prostate but will also have a slight BP lowering effect. It really does not sound like you are being at all well managed. What hospital do you attend?

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.