Sheryl

1.1 is actually not too large. Large enough to not pass on its own, but well within the size that lithotripsy might be able to break up. Sounds like many, perhaps even most, of the other stones are small enough to pass on your own (i.e. without needing to be btoken up by shock wave first), has conservative management been tried (e.g. hydration plus pain meds and an alpha blocker?) I do not see any indication on the estimate to suggest that there would need to be multiple admissions at that price, are you sure that is the plan? I cannot understand why it would be. Of course if the litho does not work, might have to then have surgery, that is always a possibility (not a certainty. A back up plan if the litho does not work). The larger issue is why so much stone formation. Do you maintain adequate hydration? Do you have an enlarged prostate causing urinary retention? Have you been evaluated for parathyroid issue? I continue to urge you to go to Bangkok and consult the recommended doctor for a comprehensive treatment plan. Bring a CD with the Xrays and ultrasound images on it.

P.S. Who told you that you have 20 kidney stones, that is pretty much unheard of. Or was that a typo? And how large is the largest stone?

would not be usual to need a CT for this. See my previous post.

Lithotripsy (shockwave therapy to break up stones) is not surgery. It is a non-invasive procedure. In fact sometimes done as a day procedure without overnight stay. While any large hospital will have CT, not all can do lithotripsy as this requires specialized equipment and expertise. Note that lithotripsy is not always successful, and skill of the doctor is paramount, not just in doing it but in deciding if it makes sense to do in the first place. Given how many stones you have, might or might not. I am not sure why CT needed, usually stones can be visualized by ultrasound (and sounds like they already have been)?? If they are going to have to operate to remove a stone that is too large for lithotripsy (a point you should perhaps get another opinion on before proceeding) via what I assume will be either Percutaneous Nephrolithotomy or Uteroscopy (laparoscopic approach through the urethra) I don't see why they would not remove the other stones at same time? In fact, if at least one stone is too large to remove otherwise, might make most sense to just go for a single operative procedure to remove all of them, the procedures just described can be done at same time on both kidneys....and might give the best chance of success. The whole thing as you describe it, does not seem to make sense. I think you need another opinion on treatment plan altogether. As for lithotripsy costs, 99k here https://phyathai2international.com/programs-and-promotions/Extracorporeal+Shock+Wave+Lithotripsy+(ESWL)/695/en However, the cost would likley be more for large number of stones. I strongly suggest you come to Bangkok (bringing CD of ultrasounds and all other medical records with you) and consult this senior doctor at Siriraj https://www.siphhospital.com/en/medical-services/doctor-biography?id=249 As there is a good chance you can be treated with a single procedure or surgery at a far lower cost. The treatment plan you describe seems odd to say the least. Most private hospitals in Thailand offer only private rooms, but with a range to choose from, which you select at time of admission or reservation. Unless you opt for one of the most costly VIP rooms, the room cost will be a very small factor in the total cost -- even though you may feel the room is unnecessarily nice or large.

Is the CT you require with or without contrast? What type of surgeries are these? Cost should not be sole consideration. Won't do you any good to have surgery done badly, or the wrong type of procedure -- both quite possible outcomes if surgeon not selected with care. Depending on what this is, you might be better advised to come to Bangkok. While other hospitals may cost less than BPH the diffetence is likely to be fairly small unless you to a government hospital. At these, wait fof CT is often very long hence my question about contrast. If no contrast media, CT at a stand alone imaging center eould be an option. I am frankly puzxled by refeence to 240k for "each Op". Rare for a surgery to cost that little at a private hospitsl these days, but again, I have no idea what exactly this is. BTW Pattaya Memirial, like most hospitals, does have CT. https://www.pattayamemorial.com/departments/radiology

Have you tried at all 3 places and found him not available at all? St Louis is ususlly jjust first come first serve. This sort of scheduling us typical of the best doctors. It refers only to their outpatient consultation hours, not their vompleye availability (for procedures etc). Not a good idea to select doctor based on convenience of scheduling, that usually gives poor results.

Above is a reasonable approach.

Certainly you should not undergo more surgery until/unless the cause of the problem is clearly identified. I suggest you consult this doctor in Bangkok: https://saintlouis.or.th/doctor/dr.aree-tanavalee/d39d763d-0ca2-4b2d-b865-967c61a380e2 https://www.medparkhospital.com/en-US/doctors/prof-dr-aree-tanavalee https://www.bumrungrad.com/en/doctors/aree-tanavalee Same doctor, different hospitals. listed in ascending order of cost. It might also be possible to see him at Chulalongkorn after hours clinic but as it is a government hospital, long waits and red tape so maybe not so practical for someone not living in Bangkok. If possible bring Xray films and any (post operative) scans with you

Certainly water diverted to the GI tract (as in diarrhea) will reduce the smount of excess water in the body and hence urine amount.

Do you mean Rivarox made by GM Pharma? Where did you buy it exactly? Does not seem to be registered in Thailand.

Government hospitals will have rivarobaxan. I can't say re 10mg dose since locally made versions currently are only in 20 mg dose. Tertiary govt hospitals will likely have imported 20mg but Xatelto brand will still be expensive. Indeed, if at one of the government hospitals which apply a foreigner surcharge, could be more expensive than if bought at a pharmacy (note that this does not require prescription in Thailand). People covered by SS do not pay anything for medications at their nominated hospital . Whether that hospital will have 10mg rivarobaxan depends on the hospital. The only way a retiree can be covered under SS is if they were employed in Thailand for over a year and enrolled under the SS scheme through such employment. In which case they must elect to continue the SS coverage on self pay basis within 6 months of stopping work.

They are film coated tabs, not scored.

Where in Thailand are you located?

First of all, forget "Dr. Google" and whst yoh have read online. Neither Google nor AI at at all suitable for medical diagnosis. Secondly, do not rush into expensive tests like MRI or CT. Such testing should be based on a differential diagnosis. Please describe exactly where the pain is, in your own words, and what it is like (e.g. sharp, cramping, burning, achy or what) and what if anything seems to make it better or worse. Also clarify if the pain seems to radiate to leg or thigh, and whether there is any numbness, weakness or tingling in the legs. And give your age and location in Thailand. Then I will suggest a doctor.

Does this policy have a stipulation that it only covers emergencies? Because if not, then problem was that paperwork submitted did not provide adequate medical justification to establish why surgery, rather than conservative management, was proposed. . Either that, or the surgery really is not medically essential i.e. the injury may heal without it. If so then conservative management would be better. As mentioned this surgery is not always successful. Overall, studies show outcomes with it not to be better than with conservative management https://pubmed.ncbi.nlm.nih.gov/33419401/ Though in specific individual cases there may be more reason gor surgical intervention than in others. I have no idea if this applies to you. Do not have this in Udon Thani. If you go elsewhere, go to Bangkok. In fact even using government hospital, Bangkok is far better choice e.g. Chulalongkorn or Siriraj. Continue to recommend consultation with Prof. Mason to get clear handle on what can be expected with and without surgical intervention. No

Sorry, I overlooked the dosage issue. The 2 locally made brands here ( Rivoxam and Roxaban) do nto come in 10 mg dose. So that would leave only Rivaxored as alternative to Xarelto. Quality would probably be OK but I agree, not as certain as for Bayer.

If you are set on Xarelto brand you are not likely to get this for much less, since it is an import. There are locally made generic equivalents that would be less e.g. Rivoxan Roxaban

Research on new antibiotics is ongoing and new antibiotics are developed all the time. As this thread does seem to have an actual point and is attracting the usual nonsense agendas, it is closed.

An iff-topic trollling post has been removed

A flaming/unhelpful post has been removed

Careful if your insurance requires pre-approval. Most do, at least above a certain cost threshold, and have significant penalties if not obtained. Is this travel insurance or regular insurance that you have? Travel policies indeed will only pay for emergency/urgent care, not elective procedures. A regular insurance policy would not / cannot disallow a procedure just because it is elective, provided it is still medically necessary. Can you clarify type of insurance, and share the exact wording of the disallowal notification? If it is regular health insurance (not a travel policy or otherwise limited to emergency care) then I would suspect that the hospital failed to provide sufficient information/justification, which would not surprise me. In which case a re-submission by a different hospital, providing more complete information and medical justification, might do the trick. Keep in mind the expertise of the surgeon is of paramount importance, this is not a simple procedure and it not always successful, either. Likelihood of success is very much dependent on the choice of surgeon. Cost aside, I would hesitate to do this outside of Bangkok, to be frank. You will certainly nto be able to get this for less than 350k at a private hospital. Vachira is a government hospital but has a private channel and I assume that is where your quote came from. You might investigate whether it can be done through regular public channel, but if so there may be a wait list and again, need to consider the skill and experience of hte doctor -- whom you might not be able to choose if using the public channel. There is no better shoulder surgeon in Thailand than Prof. Mason at Bumrungrad. You might try consulting him and having that hospital try to get the insurance approval, explaining the need for detailed medical justification (assuming he concurs that surgery is unavoidable). https://www.bumrungrad.com/en/doctors/mason-porramatikul

Aranyaprathet/Poipet is open today but absolutely mobbed. Lots of people were stuck on both sides ovetnight due to sudden closure yesterday without advancd notice. Unclrar if it will be open tomorrow or if today's opening was just to address that immediate situation.

Indeed, if she had had prior mammograms to compare to, biopsy now could likely be skipped.

The Thai side shut the border (main crosding, Aranyaprathet) at 3:30 today without any advance notice. Many people stranded there unable to cross.

They just closed the border.