Sheryl

Who is the surgeon at Vibharam?

Assuming you are now in Thailand, your local hospital will not have it. Since there is no yellow fever in Thailand, the vaccine is not widely available here. Where in Thailand do you live? The Mahidol Thai travel clinic or MedConsult Clinic, both in Bangkok, are best options.

No flouting of the rules involved: Tramadol and Pregbalin are both, by law, available without prescription in Thailand. Codeine, on the other hand is strictly controlled and not only needs a prescription but can only be gotten at a hospital or clinic. (In addition, there is no Nurofen Plus or equivalent registered for use in Thailand.)

10 day course is normal duration for antibiotic treatment. As to the need for it at all, see my prior reply. If in Thailand now, or if in Thailand in future and problome has nto resolved, this is the best doctor to see https://www.bumrungrad.com/en/doctors/mason-porramatikul

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I have had no problems with getting meds delivered from them (though have not specifically ordered Ozempic). Use the Line app to communicate with them, do not try to order online via web. They reply quickly and will be able to tell you if they have currently in stock etc.

Try Bria labs https://www.brianet.com/ Make sure to avoid all sexual activity and motorcycle/bicylce riding and vigorous exercise for 48 hours before the test

I am having trouble following this. Do you already have these medications and need a written prescription to show doctors in the UK? Or do you have the medications but not enough to last you until you can refill prescription in the UK? If this is the case, yo ucan simply buy what you need at a pharmacy. Both tramadol and pregbalin are available over the counter in Thailand, though many smaller pharmacies will refuse to sell tramadol or sell it only in combination with paracetemol (Ultraset). Suggest Fascino's.

https://www.bumrungrad.com/en/doctors/chairat-burusapat

There are 2 issues: one is possible infection from the injection procedure (see post above) and the other is that steroids can worsen a pre-existing infectious process if there was one. Both concerns suggest possible provider side issues (techinique and diagnosis, respectively). For now, follow the doctor's advise. If any future issue see an ortho specifically specializing in shoulder issues. Where in Thailand are you located?

No need to attach films, I am not proficient in reading them anyhow. From the report, there is a very large mass on the kidney with features that suggest it is not just a simple cyst. Could be a complicated cyst, could be a benign tumor, could be cancer. Hence the recommendation for further imaging. I am a bit surprised MRI was recommended, as usually it would be a special type of CT with contrast. This has to be done at a hospital and involves a special protocol which a regular imaging center would not be able to offer (plus, as previously mentioned, receiving contrast media outside of a hospital setting is risky). Going forward it is important to be under the care of a urologist with expertise in diagnosis and treatment of kidney tumors. The most expertise in this is at Ramathibodi Hospital (though the top doctors there also have hours at various private hospitals). Your wife could go there through the public channel explaining she has a mass on her kidney, or she could consult one of their top doctors privately as follows: https://www.phyathai.com/en/doctor/dr-kittinut-kijvikai Not only the CT/MRI but possibly also subsequent treatment (depending on final diagnosis) could be costly. Is your wife a Thai citizen? If so, at what hospital is she registered under the universal health scheme?

I am completely confused. Your OP stated there was a mass on the kidney for which an MRI was advised. The US report you list, is for the breast. And the films you attach are of the uterus and ovaries. ?????? For what area of the biody was she recommended to have an MRI? Please attach the relevant US report.

Sorry, no.

The document must be in Thai, you will want an English translation as well. Most hospitals have their own forms that they want used so ask about that.. But still make your own since cannot be sure you won't at some point end up in a different hospital. Even more important than the living will is to give someone a HealthCare Power of Attorney. Make sure it is someone who understands your wishes and is on board with them, and willing to be assertive about it. This is what my Living Will says: " I, XXXX, a citizen of XXX , currently holding an X Passport with the number XXX expiring on XXX having my permanent address at XXXX , being of sound mind and currently 64 years of age, would like to make known the wishes in this Living Will and Health Care Declaration (hereinafter referred to as the “Declaration”). I direct that my family, physician, health care provider, and all others follow the directions I am writing down in this Declaration. If the time comes when I can no longer take part in decisions for my own future, let this Declaration stand as the testament to my wishes. I understand that this Declaration will only be valid and enforceable if I am not able to speak for myself. 1. Choice Not to Prolong Life I do not want my life to be prolonged with life sustaining treatment if (a) I am permanently unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness; (b) I have an incurable or irreversible condition which is terminal, or (c) I have irreversible brain damage and will never regain the ability to make decisions and express my wishes. Life sustaining treatment shall include, without limitation, intubation, use of ventilator, B-PAP or other breathing devices, tube feeding or parenteral nutrition, dialysis or any other measure that would keep me alive but would not cure me. Permanent unconsciousness is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that within a reasonable degree of medical certainty I can no longer think, feel, move, or be aware of being alive. Terminal condition is when my physician and another physician are of the expert, considered opinion, after full examination of my case, that I have a condition that is incurable and irreversible and will result in my death within a relatively short time. 2. My Directions In circumstances such as those mentioned above, I shall not be subjected to any medical intervention or life sustaining treatment aimed at prolonging my life. I hereby direct that all such orders be placed in my medical record. Any distressing symptoms occurring in the aforementioned circumstances shall be fully and aggressively controlled by appropriate palliative care, ordinary nursing care, analgesic or other treatments, even though some of these treatments may have secondary effect of shortening my life. Giving intensive care to me is to be allowed only on the condition that reliable reasons exist for the possibility that such treatment will have a better result than merely short prolongation of life. In the event that a treatment with prospect of recovery has been started but proves to be futile, it has to be discontinued immediately. 3. Health Care Proxy I hereby appoint the following person as my health care proxy: XXX" I had this drawn up and notarized by Thai legal firm.

Management of metastatic breast cancer has improved in recent years. It is still an ultimately fatal prognosis but some women can have years of productive life first. To know if this is true of your friend's wife, additional scans and likely blood tests for genetic and other markers would be needed. Posisbly the latter has already been done>? I would suggest she and her husband have a consultation with an oncologist either in a private hospital or through the after hours channel of the government oncology hospital to discuss in more depth than is going to be possible through the public channel.

Contrast agent is only needed for some things. Where the issue is orthopedic, usually not. When looking at (or for) a tumor or blood vessels, usually is. "Radioactive" is nto an issue but adverse/allergic reaction to the contrast material is. Affects only a minority of people but can be life-threatening and needs immediate emergency measures. Hence my recommendation not to have scan with contrast media outside of a hospital.

The imaging center will provide the scan on DVD, allowing specialist in other hospital to interpret it. Anywhere in Thailand, the radiology reports are of limited use and most specialists won't eve4n read it, just call up the scan on the computer and read it themselves. That said, it is risky to have a scan with contrast media outside of a hospital. A minority of people have severe, life-threatening reactions.

Your problem in UK will be really long waits for MRi etc. Getting the tests here then returning to UK with test results in hand (if they show need for intervention) might expedite things.

No idea what you mean bt T2. But ruling out small vascular disease and tumors would usually require injection of contrast media.

I'm afraid I have not heard of EWST being done for this purpose anywhere in Thailand as yer.

With or without contrast?

Many (but not all) government hospitals require that you fiirst see a junior doctor (in fact this is often actually a medical student) who functions as a sort of gate keeper deciding if and which specialist you need. Theydo not function as GPs/family doctors in the Western sense. If you are certain of what you need it may be possible to bypass this step. Some hospitals use nurses for initial screeming/triage and referral. In private hospitsls you can always go directly to a specialist but if you are unsure of what you need they will send you to an internal medecine doctor.

Only the tertiary government hospitals have MRIs and there is usually quite a wait list -- so much so that many government hospital patients go to private imaging centers instead. The larger issue here s whether the MRI is really needed, and that depends on exactly what the ultrasound showed.

That place is fine and many use it. HOWEVER it is inadvisable to get MRI or CT with contrast outside of a hospital setting. For a mass contrast media is often needed, and from the price quoted this is what was planned. I sssume this was found on abdominal ultrasound which many Thai checkup packages include despite not being recommended for general screening by any public health authority. These frequently pick up liver and kidney cysts of no real significance . Can you post here the exact ultrasound finding? In particular the size and appearance of the mass.

Npthing to do with Anutin. it is up to hospitals whether or not they want to charge foreigners more or not. Some were doing so long before Anutin and some still do not. Siriraj levies a 20 or 25% (forget which) surcharge.