Sheryl

They insert the tiny tube through area chosen because if is free of major blood vessels ect Endoscopic approach has excellent safety record. Since your nodule is asymptomatic, the only reason to remove it at this time is if it is cancer. Benign thyroid nodules can sometimes go away on their own but this is rare, usually they either stay the same or increase in size. CBD won't affect it. If a benign module keeps increasing in size it will eventually cause sympyoms requiring removal. If it stays the same, you can live with it indefinitely-- IF it is benign. A cancerous nodule must come out and the sooner the better, delay is inadvisable. I don't think waiting will change biopsy results. What would is getting the sample tested by Afirma GEC. And possibly better technique by doctor doing it and/or more skill by pathologist who reads it. I would trust Dr. Jun's judgment as to whether there is any point in a repeat biopsy. While I understand your need to prepare emotionally, imagine how you will feel if the surgery finds it is cancer and it has has spread. Requiring more extensive surgery etc. You will always wonder if that could have been prevented by acting sooner ... and maybe it coild have. And emotionally you will be much worse off. he delsy u

This actually is the norm worldwide.. But it is true that based insurers have a comparatively poor record and many of them engage in practices that would be unthinkable (and unallowable) elsewhere. Some of the negativity one hears from expat community here is from people whose only frame of reference are Thai policies.

There are certainly treatment options, both government run and Buddhist affiliated. Also expensive private ones. And Thai speaking chapters of Narcotics Anonymous (free,). See However NONE of these are going to help in the least unless he himself is strongly motivated to get off drugs. Which does not sound like the case at all. Better to just try to support your wife on setting limits and detaching a bit emotionally. Above all she needs to understand that she cannot solve his problems or change him...only he can do that, and he probably won't. There is a small government psych hospital in Pitsanoluk town. I don't know what if anything it offers by way of counselling but she can try. It can certainly help with treatment or referral for treatment for the son but I am doubtful he would agree. Can't hurt for her to try talking with them though. https://mapcarta.com/W577455331

Not available yet in Thailand.

If by "Thai indurance" you mean insurance issued by a Thai company, they will usually not issue a new policy beyond age 75 bug many will allow renewal well past that age. There are internationally based expat insurance policies that are newly available past age 75 and will cover you kin Thailand. Internationally issued policy ls preferrable in at any age anyhow...more reliable and better regulated. The big barrier is not age per se but that by age 70 or so, most people have some chronic health conditions which may make it difficult or impossible to get a policy.

If the money was sent (as opposed to claim approved... actually already transferred out by their finance people,) then should not take more than a couple of working days.

Moderna booster dose is a standard 0.25 ml. As long as the place giving it knows it is booster, that is what they will administer. This is one reason why they ask your vaccine history. When you said "half dose" they likely did not know what you meant and perhaps thought you for some reason wanted just half the normal booster dose. which of course makes no sense. The correct term is "booster dose". It is only given IM. You do not need to tell a nurse how to administer an injection and it is rather insulting to try. By the way aspiration is done not to ascertain depth of injection but as a precaution against the (rare) risk of sccidental injection into a blood vessel. It is an automatic part of IM injection technique regardless of the drug. Even a first year student nurse not only knows to do this but does it reflexively. Leave the injection technique to them. You can if you want double check at the stage of injection that it is "booster dose".

1. No. The single 3 Gm dose of amoxicillin is a preventive measure before invasive procedures that might introduce bacteria into the blood stream. It us not how you would treat an actual infection of any kind. Treat any actual infections exactly as indicated based on type of infection and underlying cause. Just be prompt about it. You are overthinking this. Risk is when infections get into the blood stream. Most infections are localized. Many people go their whole lives without ever having a systematic infection. You do need to take precautions before dental work and any invasive medical procedures. Beyond that just manage illnesses and injuries as you normally would. Just don't be negligent in treating infections. 2. Bait and switch indeed. Wonder if quote you had in Phuket included the implant.

Probably sebaceous then but if concerned see a dermatologist.

An oncology dept deals only with confirmed cancers, especially those requiring chemo or radiation. It is not where one goes to find out initially if one had cancer. For that one goes to the appropriate specialty, in this instance dermatology. The problem is that few dermatologists in Thailand have much experience with, or interest in, skin cancer. Dr. Anna was/is one of a kind. Besides her own skill she was careful about what pathologist she used as pathologist experience is also very important.

She has for many years worked only at BPH. Also been threatening for years to retire.

She still shows on the hospital website as 3 times a week. Has anyone called hospital to confirm? .

However using government hospitals is time consuming which is a real issue for someone not now living here.. He'd need to plan on staying here a month or more at least. There are often long wait lists for surgery especially since COVID. And they won't do a procedure just based on recommendation from his home doctors. He will have to start at the very beginning with initial consultations, batteries of tests etc. I am also not sure this type of surgery is even being done for COPD in government hospital and, if it is, likely just in major university hospitals (none in Pattaya area, he'd have to try in Bsngkok). Criteria are likely to be quite specific and restrictive. (Would help to know exactly what procedure was recommended). Frankly I think it very, very unlikely he would end up getting this specialized surgery - if at all -- any sooner than if he just waited his turn in Ireland. Probably take longer and there's a chance he wouldn,'t get at all. (This is all referring to using a government hospital). Now at a private hospital waits would be minimal and good chance he would get the procedure but it will be costly. Likely over 500k baht (if no complications) but again, could tell more if I knew exactly what procedure has been recommended. Other important considerations are: 1. Travel risks. Flying with COPD severe enough that he was recommended for surgery may be contraindicated, especially a long flight. In fact it is advised not to fly for 6 weeks after a COPD exacerbation. Then there is the COVID angle. I don't know the situation for airport he would use but can tell you first hand that Heathrow is a veritable petri dish for COVID transmission as I just learned the hard way. Needless to say COVID is especially dangerous for people with COPD. 2. Insurance aspect: unless he already has good insurance that will cover him in Thailand ,(including related to his COPD) or is very wealhy he is taking a big gamble as he could end up needing hospitalization for more than just the elective surgery he seeks. With COPD he is at elevated risk of heart problems, pneumonia etc etc. especially after a long flight. Every chance of ending up in an ICU with bills in the millions of baht. Since he moved back to Ireland because of his COPD I am guessing he is neither extremely wealthy nor privately insured. In which case this seems a very bad idea indeed. At an absolute minimum he should: 1. get the exact medical name of the recommended surgery 2. Verify its availability and cost in Thailnd and don't even consider coming unless/until he is sure he can get what he needs at a price he can afford. 3. Discuss with his doctor whether it is safe for him to fly in his present state of health. Coming to Thailand for say a catarct removal in order to avoid delays back home is one thing. Your friend's situation is altogether different.

Could be a sebaceous cyst. These are harmless. They are filled with a sort of cheesy substance and may spontansously rupture. They also often recur. Synovial cyst, also known as ganglion cyst, seems unlikely given location as they usually occur over a joint. (And they too are harmless,). They also feel a bit different on palpation as they are filled with fluid though as it is on your back may be hard for you to tell. Pilonodal cysts are usually located right at the tailbone immediatrly above where the buttock crack begins. They easily get infected and require treatment when they do. They do sometimes spontaneously rupture so if the location fits this too might be what you had especially since it sounds like new lump is in same place as the old, and pilonodal cysts do often recur. Other posssibility is lipoma. But these do not tend to rupture as you report it having done the first time. So sebaceous or pilonidal cyst are the most probable and if you can be more specific as to location that would tend to narrow it down. You can google pix of pilonodal cyst to see what I mean about location. Palpate the crack between your buttocks and move straight up, if the lump is immediately at or just above the start of the crack then pilonodal cyst is more likely. If further up the back sebaceous cyst more likely. These aren't absolutely rules just probabilities.

Again, I recommend Dr. Pichai at Bumrungrad for any needed medication - he is one of only a few doctors in Thailand specifically trained in addiction psychiatry. If as I suspect the doctor he saw was not, there is chance what was prescribed might be counterproductive. Aldo strongly recommend he see a (Western) counsellor with experience with addiction disorders. There are several in Bangkok and links already given Just seeing random Thai psychiatrists is a bad idea and could well make matters worse.

A "hot" nodule is one the secretes thyroid hormones causing you to be hyperthroid. Nothing to do with feeling hot. Your blood thyroid panel tests would show this. Since you do not mention abnormal blood test of thyroid function you probably do not have a "hot" nodule. And I see you also do not mention any problem speaking or swallowing (as one would expect since the nodule is still not that big) If I am correct in all this then you have an asymptomatic nodule. (the various symptoms you mentioned are likely stress related not physically caused by the nodule). The only reason for surgery with an asymptomatic nodule is if they are cancerous. Cancerous nodules need to be removed and the sooner the better as delay can lead to metastasis requiring more extensive treatment and in some cases (especially with certain less common types of thyroid cancer that are unusually aggresdive) even death. Your dilemma is that, with an indetetminate biopsy result, you do not know if it is cancerous or not much less (if it is) what type of cancer. I strongly urge against delaying this until September. If it is cancer that would increase the chances of it spreading into lymph nodes or even other organs requiring much more extensive surgery and other treatments. See Dr. Jun as soon as possible. Having not been happy with 1 doctor in a hospital in no way means you will be unhappy with another. Doctors vary greatly not just in their competence but also in their communication and interpersonal skills. I think you will find a big difference with Dr. Jun. Ask her specifically: 1. Would it help, in terms of getting clearer diagnosis, to get a repeat FNA? FNA depends a lot on the doctor sampling the right parts of the nodule and getting enough tissue -- and on the skill of the pathologist who reads the sample. Knowing that you had a prior indeterminate result, she might be able to get better/more extensive samples and/or direct them to a particularly good pathologist. No guarantee but worth discussing with her. 2. Is there any way to access Afirma Gene Expression Classifation (if necessary, by sending sample abroad?). This can help decide if a sample is malignant or not, through genetic markers. If you can get a more definite biopsy result through either of the above approaches that would end the dilemma. A benign result would mean no surgery. A malignant result would mean surery is unavoidable. Either way you have a clear answer and know what to do. The doctors at Ramathibodhi also work at other hospitals including Bumrungrad. The equipment there is not better than in the large private hospitals and sometimes indeed the opposite. If for financial reasons you had to use a government hospital then, for thyroid surgery, Ramathibodhi would be a good choice but makes no sense if you can afford to be treated by the same doctors at a private hospital, especially since you do not live in Thailand and presumably speak no Thai. It is very difficult and time consuming to access care in a government hospital. You usually have to go in person just to make appointment and there will often be long wait to get it. Then long wait on day of appointment. Not unusual for it to be canceled without you being told in advance. Any tests etc needed will usually require additional trips. All in all, what you could do in a single day in a private hospital will take weeks in a government one -- especially impractical for someone not living in Thailand. Lots of complicated bureacracy that can be hard to figure out. Language barriers are considerable -- senior doctors will speak English but not admin and nursing staff. This makes it very hard to navigate the system for a non-Thai speaker. And can make for a pretty scary experience as an inpatient (imagine being prepped for surgery, and cared for post op, by people you can't communicate with). While it is certainly worth trying to get a more definitive diagnosis, should that prove impossible-- or should you get one but with result of cancer - you should not be unduly fearful as risks are much smaller than you seem to think. Risk of permanent damage to the laryngeal nerve (affecting speech) is well under 1% in an endoscopic lobctomy. More like 0.1%. (One in one thousand,) I have recently discovered thyroid nodules myself and just went through the ultrasound and FNA process so I can relate to what you are feeling. During the wait for results I had plenty of time to consider what I would do and to extensively research options and complication rates. There was no question in my mind that I would get surgery ss soon as possible -' preferably just a lobectomy, and done endoscopically-- if the nodule proved malignant. Which does not mean I wouldn't be apprehensive/scared and dread it...just that I knew it was by far the safest, wisest course. Sometimes we have to compartmentalize our feelings for our own good as emotions are not good decisions makers. Luckily for me I got a clear benign result, big relief. But during the 3 days wait (which felt like 3 years!) for the result my mind went through all the possible scenarios in vivid detail...so I do understand your feelings. But for your own sake don't make an emotion based decision or put things off.

Vans and buses to the border at Mor Chit.

And HIV. And Hepatitis. Unprotected sex eith strangers is a thoroughly bad idea at any age. But protection (i.e. condoms) while very important will not prevent monkey pox as any skin to skin contact with lesions can spread it. Stick to partners you actually know or at leadt have had a thorough look at in good lighting. Might also like to avoid crowded dance floors/mosh pit type settings.

The hospital does not matter much. It is the skill of the surgeon. Which hospital fo you mean by Rama? Ramathibodhi? It is a government hospital so not as easy to use and likely to have wait lists. If you have surgery you will need to be followed by endocrinologists after as well so it is a advantageous (though not absolutely essential) to hsve surgery as same hospital where your endocrine specialist is. What are your symptoms currently? Is it a "hot" nodule (one that secretes thyroid hormone) or causing pressure on your neck for swallowing etc? In some cases -- especially for benign "hot" nodules -- use of radioactive iodine is an option. But not usually when there is a suspicion of cancer. Your problem Is that cancer cannot be ruled out, there is 20-30% chance you have cancer. If you do, surgery is unavoidable and better not delayed. When you see Dr. Jun you can ask about whether a repeat FNA might help or if they have access to Afirma Gene expression testing. (To see if you can get a more definitive result).

Definitely not needed at this time unless in a highrisk group. Don't have sex or other close physical contact with anyone who has visible sores or in settings where you don't get a good look at your partner. The latter (orgy like gatherings with very dim lighting and often a lot of intoxicant use) has accounted for many, even most, of the clusters in US and Europe.

True but there is indeed a big difference between Thai companies and intetnational ones and Thai companies -- some mucn more than others -- do have a poorer reputation for paying claims for reasons unrelated to policy terms and frankly sometimes very dubious/far fetched. And, the regulatory framework for health insurance in Thailand is weak and allows things not permitted in westetn countries. I think OP may have Cigna Global. If so they are international company based in UK and under UK insurance regs. If not I would suggest he look at changing to an international insurer while still young enough and without any chronic conditions.

Dropping add ons like this will certainly lower your premium as would adding or increasing deductible and/or copay. Just make sure whatever changes you make are ones you can live with permanently. Because the guarantee of lifetime renewal does not include being able to upgrade coverage, only to continue it. You can always downgrade (drop additional add-ons or increase deductible etc) but they can refuse to let you upgrade, or exclude certain things from the upgrade.

I would add to that PSI. https://www.psiadmin.com Ben Weinstein there is especially recommended but I don't know if accepting new patients at this time. If he has need of medication (addiction often stems from self medication for underlying anxiety or depression, hence the high rate of relapse) this excellent US trained psychiatrist specializes in addiction psychiatry https://www.bumrungrad.com/en/doctors/Pichai-Saengcharnchai

Usually no need for blood test. Just treat promptly if it looks like a bacterial infection. Be especially quick and aggressive to treat if any signs of cellulitis (red area increasing in size and warm to the touch).

I see no harm in trying saw palmetto. Some people also report benefit from stinging nettle.