Sheryl

You probably need an MRI with contrast media. This always costs more and, more importantly, carries a small but serious risk such that I can't recommend doing it outside of a hospital. It would be much cheaper at an imaging center for sure, but at a risk. Also need to consider the caliber of the machine which will not be same as at Bumrungrad and, lastly, the protocol used. Getting a good view of the pituitary on MRI usually requires a special protocol with multiple views. I suggest you read https://radiopaedia.org/articles/pituitary-gland-protocol-mri It is far more complex than a standard MRI of the brain. It would cost less at some other hospitals e.g. less expensive private hospitals like Bangkok Christian or -- least expensive -- a government hospital like Chulabhorn. But you can't just walk in and ask for it, would have to see a Doctor on staff first, bringing all your records with you. And also need to consider whether the radiologists where you go are thoroughly familiar with the special technique. It doesn't matter in the least if the MRI is done at same hospital as your doctor (wherever done you can get it on DVD) but it does matter whether the MRI is done to correct specifications....right machine, right protocol (which does call for some experience on the part of the radiologist and technician). Not all MRIs are the same. If you do decide to get it done elsewhere, first get a detailed written order from your doctor to ensure you get what you need.

This is the same classification as at least 95% of medications bought over the counter in Thailand.

The only place in CM (or for that matter, Thailand) that I can recommend for this is: https://mckean.or.th/dok-kaew-gardens/ I contacted them in October 2021 (concerned for a family member) and received the following info: " McKean is developing a program of multi-tiered age care, so we have four different kinds of services available. The first is a new independent living project called Sunflower Village. These are duplexes set up as a small unit with living room, separate bedroom, kitchenette, master and guest bathroom. These units will include an emergency call system, but other services such as housekeeping, food service, laundry or nurse aide care will have to be arranged and paid for separately. The cost of these units if rented monthly will be 25,000 baht (you can make sure this is accurate with the people organizing the project as there may be long stay discounts etc.) Just around the corner is Dok Kaew Gardens which is the assisted living facility. We offer a complete monthly package which includes an air conditioned private furnished room with private bath, laundry, housekeeping, three meals, utilities, medication management and nurse aide assistance all included. There are two levels of care, one level for people who can do all of their own self-care and do not need regular nurse aide assistance. There is however an call light for 24 hour emergency assistance. The cost of one person per one room is 33,000 baht per month. The rooms are usually too small for two people for anything but a short stay. A better option for a couple is to have two rooms with an internal connecting door. The cost would be for 2 rooms = 66,000 baht. We have one couple who use this configuration and they have one room set up as a bedroom, on the other as a living room. We have also had couples with one spouse in a low care room and one in a high care room. At Dok Kaew we also have a high care wing. This is for people who need more nurse aide assistance. For instance if someone needs help showering, getting dressed, getting to the bathroom etc. The rooms are the same size and services are the same, but because the person needs more assistance, the cost is 46,000 baht per month. I will add that people with dementia should be in the high care wing when their dementia gets to the place where they might wander out, or go out and not be able to find their way back. The high care wing has a security door with a passcode, but the low care rooms are open to an outside walkway. The fourth level of services at McKean is McKean Senior Hospital which acts as a skilled nursing facility" Your friend might, for example, himself rent a duplex in the independent living area while his wife is in the assisted living complex. Like that, he would be in easy walking distance and able to see her daily.

For some bizarre reason, MIMS is now showing some aspirin products as NDD (non-dangerous drug), some as "D" ("dangerous" drug but still OTC, sales limited to first grade pharmacists) and some as S, special controlled drug requiring prescription. No apparent rhyme or reason to it, and many of the aspirin preparations don't have full listing in Mims so I can only check on a few brands. in some cases aspirin by the same company is listed as D for 325mg dose but S for the 81 mg dose. Asatab (T.O. Chemicals) is listed as NDD Aspirin BD 325 mg is listed as D Aspirin BD (British Dispensary) 81 mg is listed as S )special controlled drug) Looks to me like the companies are themselves confused as to how their products should be categorized One can still get aspirin from the various online suppliers (Bangkokdrugstore, Medisafe, Medtide etc)

Again, there is no question but that your OMAD diet is extreme and unhealthy for someone your age and bound to cause periods of low blood sugar, which is likely what you are experiencing. It is also not the best way for someone your age to lose weight as your body will compensate for the prolonged periods of no food by reducing its metabolic rate. Without much increase in total quantity that you eat now (or at least without much increase in total caloric intake - you can safely add in increased quantities of salad, fresh vegetables etc) , try to space out consumption into at least 3 times in the day (the one in the middle can be a light snack) so that your blood sugar does not keep yo-yoing like this, which is definitely unhealthy and places stress on the body. Younger people can get away with this, older people often cannot. I would also suggest that you take a small snack just before bed time to help stabilize blood sugar through the night so that it is not too low when you first get up. To achieve this, what you take needs to be high in protein and also contain some fat (healthy fat) as this slows absorption. Suggestions: small quantity of nuts, a half a peanut bitter or tuna fish sandwich (might use the other half for mid day snack. Make sure the bread is whole wheat).... but anything high in protein and containing healthy fats will work. Note that it is neither necessary nor desirable to be on a low fat diet. Fats are essential nutrients necessary to absorb certain vitamins, and also help slow digestion so that blood sugar levels don't bounce up and down too much. But they need to be healthy fats. Examples being oils from fish and vegetable oils: sunflower oil, canola etc. Do not eat anything made or cooked with palm oil, and minimize animal fats (minimize not 100% eliminate).

Please do not make multiple posts across topics. The other one has been removed.

That's only 3 days. Even courier can sometimes take that long. When I said I had no problems I meant everything came within a week.

OMAD is extreme and will certainly lead to periods of hypoglycemia especially in an older person. So can too much coffee. Plus in this hot weather you may be getting a bit dehydrated or have sn ekectrolyt imbalance. You should start eating either 3 meals a day or 2 with a snack in between. Continue to avoid processed carbs (and processed foods in general) and keep red meats to a minimum (with fat trimmed off) but otherwise eat a good variety of foods. Make this a permanent change from your original diet. If you feel you stilll need to lose more weight do so by keeping the portions small not by going many hours with no food. Also drink plenty of water, reduce the coffee (which dehydrates) and while it is this hot I'd suggest an electrolyte drink once a day -- can use the sachets available in any 7-11 or green coconut water for that. If gor any reason yoy sweat a lot (for example have been out in the sun and/or exercising) take another electrolyte drink.

The ones I know at Samitivej off hand are in specialized area e.g. GYN oncology. I could do some research to come up with others but given your wife's earlier bad experience I prefer to refer her to a doctor I have dealt with personally and know to have a good attitude and manner with patIents. Which is Dr. Petcharat. In addition your wife's current problem is a simple one that does not need special expertise, any GYN can handle it and on cost grounds alone, makes no sense to go to the most expensive hospitals for it. i just mentioned that should not dismiss Samitivej altogether based on one bad doctor because there could come a time in future when you or she face a more complicated issue and the best doctor for it happens to be there.

P.S. I forgot to mention you usually do not need an appointment at St. Louis, it is first come first serve. Call to be sure the doctor will be there as scheduled, then just go. Register on ground floor for patient number. There is less English speaking there than at Samitivej etc but the doctor speaks it and the registration area usually has someone available who can communicate in English. Staff are in general helpful and friendly and if they can't understand you they'll get someone who can.

Oh, I think that particular doctor was way out of line and certainly should be avoided in future. But it is nof a reflection on the entire hospital. There are some excellent doctors at Samtivej as well.

Allow a second opinion (Typo)

I suggest she Consult Dr. PETCHARAT at St. Louis hospital https://saintlouis.or.th/en/FindDoctor A very sincere, nice, down to earth doctor. By the way there are both good and bad doctors everywhere, the negative experiences you report can (and do) occur at times in all hospitals and reflect the individual doctor, not all doctors at that hospital. i think your wife will be quite happy with Dr. Petcharat. And St Louis is a non profit hospital which costs less than Bumrungrad, Samitivej etc.

Do not stop the atorvastatin and do not revert to your old diet!!!! You will have rebound and the bad levels will nto only return but skyrocket. Given how good your numbers now are, you could if you want, try the doctor's suggestion of a reduced dosage, and retest a few months later. However I am doubtful the atorvastatin is the cause of your lightheadedness. It is not a known side effect of the drug. I think the doctor simply had no idea what was causing it so was grasping at straws. What you describe in the morning sounds like either orthostatic hypotension or benign postural vertigo. Are you taking any blood pressure medication? And are the episodes later in the day occcurring after any change in posture or head movement? Feeling queasy/lightheaded could also be due to hypoglycemia, possibly your dietary restrictions now are excessive but I really can't say without knowing more about what you eat and when.

Can be as quick as a day or even a few hours if there is completely unrelieved pressure over a bony prominence. Thinner patients are at highest risk, and those with impaired sensation (coma, paralysis etc) and/or limited ability to move. But can happen to any if there is sustsined pressure for long enough.

I had not realized you were doing this in Hua Hin. Yoh can probably save a bit by having it done in Bkk instead and as that is where you'd need to go for treatment there would be an advantage to having it done by same doctors who might then manage your treatment. Suggest you take all records up to Siriraj and see Prof. Sittiporn. Thus will also slliw a second opinion re utility of another biopsy.

1. Immediately remove all pressure form the area. Do NOT lie on it at all, and get a special mattress (circulating air or waterbed etc) 2. See a doctor, if you have not already, and arrange to have a (real) nurse come in daily to daily for wound cleaning/dressing following doctor recommendations. It is sometimes necessary for doctor to debride the wound to remove dead tissue first. 3. Make sure diet is rich in Vitamin C, zinc and protein. You might consider Redoxan supplement (Vit C + zinc effervescent tablets, available all pharmacies). These are very, very slow to heal under the best of circumstances and need regular (i.e. daily) wound care form a skilled nurse combined with relief of pressure

The thread concerns someone with likely prostate cancer (extremely high probability) and one that may be aggressive at this. I suspect you did nto read all the way through it. For BPH no harm in using these supplements, and they seem to help some, but completely wrong to suggest it as treatment for cancer or in place of biopsy etc.

OP - from the sounds of it you have been managed conservatively and appropriately, striking an appropriate balance between avoiding unnecessary treatment on the one hand and not taking too much risk on the other. I suggest you follow the recommendation to have this third biopsy, especially as you are concerned to avoid surgery if possible. While it is possible that after the results are in treatment will need to go forward, it is also possible that results will still indicate a slow growing tumor allowing continued conservative management. As for your original concerns about "a good pay day at 125, 000 baht", most of that money does not go to the doctor but is rather for the use of the extremely expensive equipment - which costs the hospitals over a million dollars to purchase and which cost has to be recouped within a limited time period. There is profit to the hospital built into that price as well, of course, but far far less than you may assume. The doctor will be paid adequately for his time but is certainly not going to get rich off this procedure. And from how he has managed you so far he is not basing his treatment on profit considerations. That said, costs here are not small and costs of treatment will be even more so. As you still have a house in UK going back is certainly an option. You said you had been registered with a GP. No reason to think you are nto still, but if in doubt why not call and ask? Just call and ask for an appointment explaining that you have been diagnosed with prostate cancer while abroad and see how soon they can slot you in.

That is specific to Pattaya (and perhaps other farang-heavy areas), probably because of customer volume. Elsewhere they use courier.

I hve never had a probpem wirh delivery from Medisafe, Medtide or Bangkokdrugstore. All 3 are very prompt (assuming they have what you need in stock) and all 3 use delivery service (Kerry etc).

Of course. Even from a simple ultrasound, can usually distinguish between a cyst and a tumor. Totally different appearance. A cyst is a fluid filled sac.

You are almost surely in need of treatment at this point but have the biopsy first to be sure. It is not the case that the UK is not an option, it is. Waits for cancer treatment are not excessive as they are for elective procedures. One TV member there right now for this. It does likely depend on which hospital/part of the country you go to as some areas more overloaded than others. If you opt for surgery (as opposed to say brachytherapy) and want it do it here, this doctor and his team at Sriraj do nerve sparing robotic prostatectomy https://www.siphhospital.com/en/medical-services/doctor-biography?id=246

Is the tumor now appearing larger? What have your PSA levels done? There must be a reason why your urologist recommends repeat biopsy.

A tumor and a cyst are 2 different things entirely Kidney cysts are extremely common -- about half the population will have one at some point -- and usually require no treatment . https://www.mayoclinic.org/diseases-conditions/kidney-cysts/diagnosis-treatment/drc-20374138 Kidney tumors on the other hand are cancerous about 80-85% of the time.