Sheryl

When there are problems in multiple different joints this can suggest an autoimmune issue for which you would need a rheumatologist. I don't find any listed in the private hospitals in Udon (but their websites ardn't very detailed). There should be one at the main government hospital in town which is a large regional level facility, though maybe not every day, and it should be possible to see him through the after hours clinic. It is also possible that your shoulder pains are due to a problem in your cervical spine unrelated to the elbow issues before. For that you'd need an orthopedic surgeon specializing in spine, there are none in Udon as far as I know. I suggest ruling out an autoimmune problem first. Go to the government hospital around 3 PM on a weekday or else on Saturday morning, register for a patient number and tell them you want to see an acharn in the after hours clinic specializing in rheumatology. (Show them that term written down). If no luck doing that in Udon there are some very good, Western trained, rheumatologists in Bangkok As well as spine specialists.

Exactly what I was going to suggest

I already replied to your PM before seeing this thread. Please do not both post and send PM with same question. That said, from the added information you provide here, I am not sure if a neurologisf is what you need. Please clarify what you mean by losing energy. Do you mean a decline in muscle strength, or more like overall fatigue? Have you had a recent blood count done? What medications are you on?

Sorry typo. Meant to say dnd para

No long acting forms of it here AFAIK. 100 mg is available but certainly not what would usually be needed or prescribed. I also react very badly to Tramadol but find that if I must take it (rare situation) the 37.5mg in Ultracet works as well as any larger dose and with fewer (though not nil) adverse effects.

Make that used to do in America. They have gone completely over to the opposite extreme there now. Which is also unfortunate.

First of all - Tramadol 100mg is a huge dose. A single tab of Ultracet , by comparison, has only 37.5mg of tramadol in it. Might be worth a try. Para plus codeine is certainly better but you can only get it from a hospital or clinic and Thai doctors are hesitant to give for chronic pain. Have you tried an NSAID? (Ibuprofen/diclofenac/celebrex/arcoxia etc)? Do you have any contraindications to them? Have you tried drugs in the gabapentin/pregbalin family? (Anti-seizure med often used for nerve pain). There is actually a new generation drug in that class which is much more specific to, and efficient for, nerve pain and has fewer side effects. Brand name Tarlige, but only available from hospitals and only really up to date specialists have it (see below). Most important: 1. Have you seen a really good spine specialist? (Only a handful such in Thailand, all in Bangkok). I have/had L5-S1 issues too, but opted for a permanent solution and am now pain free. Not all people's problems warrant surgical intervention, and not all patients are good surgical candidates, of course. But I find there are a lot of people in Thailand with conditions that can only be addressed surgically and who have never been properly evaluated/diagnosed. 2. Have you ever had an epidural steroid injection? Related to #1 above, of course, as needs both a spine specialist and good pain specialist to know (a) if it will help and (b) if so, where exactly to inject.

100 mg is a very large dose. 50-75 mg would likelyy have also helped the pain with fewer adverse effects. That said, tramadol does have some nasty side effects, as I mentioned in my prior post. Affects some people more than others.

That particular brand is not here but there are brands of paracetmol + codeine that are. Most have just 15 mg of codeine, plus either 300 or 500mg of para, Strictly controlled, have to get from a hospital or clinic.

https://www.footcare.co.th/about Dr. Cherdpong Hanasuta You probably don't need permanent nail removal - just need effective topical treatment, which means having the nail mechanically filed down first (it's painless) before application of the medication. The problem with self-application of topical meds is that they just don't penetrate the nail enough. I had this treatment with Dr. Cherdpong years back, I forget exactly but I think it took something like 3 sessions. Full cure and problem never returned...but in part because I learned to avoid the causes (see below) Both during and after treatment is it very important to avoid conditions that help fungus grow, namely dark damp ones. Wear only open toed shoes (sandals) without socks. Encasing your toes in socks and closed shoes in this climate makes an ideal situation for fungi. If you absolutely must do this for some reason, e.g. athletics, keep the intervals as short as you can... Carry a pair of sandals with you to switch into as soon as possible e.g. after the game or whatever is over, don't keep your toes enclosed any longer than essential. And try to thoroughly wash your feet before and after (or as soon after as is practical) followed by a vinegar soak. Also, if you have not had a recent checkup that included an HB1Ac (preferrable) or at least a fasting glucose, you should as diabetes is a big risk factor for this problem and fungal infections in general. If you are known diabetic, keep your glucose as well controlled as possible.

Thank you so much for the update. I am very happy to hear you got a benign result. The surgeon chose well in opting to remove only the 1 lobe of the thyroid rather than the whole thing. Usually the remaining lobe is able to take over avoiding the need for lifelong thyroid replacement - or if any replacement is needed it will be at a lower dose and without the major hormonal ups & downs that in initially occur after complete removal. It was a bit if a gamble in that, had it been malignant, depending on the exact biopsy results (how well encapsulated etc), might have then needed a second operation to take out the rest. But worked out very well in your case. Likely the doctor felt confident from the ultrasound that even if malignant, it was of an encapsulated/ noninvasive type. She opted to be conservative in approach (many doctors here would not) and it paid off. Incidentally, had you opted to go through the government system, while you would have saved some 70K, odds are that right now she'd still be on a waiting list for surgery -- if not still awaiting parts of the diagnostic work-up - with al the mental stress that goes with it.

It is in fact OTC in Thailand. Brand names Tonolyte (locally made) Tidar (locally made) Tizan (Indian generic, Sun Pharma) Sirdalud (import) It is a serious drug, mainly used in conditions like multiple sclerosis and spinal cord injuries where there is severe muscle spasm,not prescribed for your average stiff back. It has some very serious potential side effects, contraindications and drug interactions so research carefully before using.

Ultracet is Tramadol plus codeine. Both are sold OTC but only in pharmacies with "real" pharmacist always on duty and willing to keep the required records. Some people (me included) experience a severe "dysphoria" (generalized icky/weird feeling ) from it as well as nausea and constipation. I get all 3 so have to be in serious pain without other recourse to take the stuff. But others do fine with it, some people even like it and get somewhat addicted to it.

OP and others in similar situation (no insurance, or SS insurance) might like to consider getting a Personal Accident policy. They are pretty inexpensive and while medical cover limits are low, the better policies would likely suffice for a few days at a private hospital. Accident is of course not the only thing that might have you brought unconscious to a hospital but in Thailand it is not an uncommon scenario, PA policies cover both in and outpatient and extend to things like dog bites as well. Last time I investigated best deal for older people was Bangkok Insurance which will enroll up to age 75 and renew for life, and offers 200K medical expense cover per event https://www.bangkokinsurance.com/en/product/accident

Ultracet and/or an NSAID (Ibuprofen, celebrex etc - which is best depends on medical history and age) If the issue is muslce spasms, I suggest travelling with a heating pad

Essential hypertension (high blood pressure) refers to elevated pressure in the peripheral arteries. Pretty common. Pulmonary hypertension is elevated pressure in the blood vessels of the lung, usually secondary to heart disease. It is a serious condition mainly encountered in patients in intensive care units. Everyone experiences momentary surges in blood pressure when exerting themselves or coughing/sneezing etc. This is completely normal and will not cause a problem in someone with a healthy cardiovascular system.

It is not recommended/approved for use in treating essential hypertension. It is used in treatment of pulmonary hypertension, but that is a different condition.

More unhelpful posts have been removed

the main difference is that a government hospital (and also some nonprofits) will often have a social service office that may help negotiate a solution (i.e. a repayment contract). At a private hospital, have to do it on your own and at a fairly high level i.e. Hospital Management.

Above is best option. They will not discharge or transfer him until he has either paid his bill or signed a repayment contract. Meanwhile, charges will continue to mount. Getting them to agree to a repayment contract will not be easy but if he holds firm that he simply does not have the money, they eventually will. Meanwhile he should insist on a detailed bill and have someone who knows what they are looking at, go through it with a fine tooth comb as the amount seems high if he has nto yet had surgery. He should also file an accident report and see about getting the 30K he can get from that fund -- even though a drop in the bucket, it is something.

What you refer to is the Social Security cover. Actually enforcement of the "72 hour emergency care" policy at privarte hospitals is difficult even for Thais. And Thais are often pressured to pay out of pocket. Do note, it is valid only for up to 72 hours maximum, the idea being that within that time it would usually be possible to stabilize an emergency case and transfer them to their registered hospital. Actually the more likely scenario in a case you describe (brought to a private hospital unconscious and no one available who knows your insurance status) is being denied admission or given only very, very limited treatment. Ber sure to have emergency contact information prominently displayed in your wallet and that these people know you are covered under SS, and which is your registered hospital.

OK so you were referring to your total cholesterol, which is not a meaningful metric. What was your LDL cholesterol before starting the statin?

Many internationally issued hospitalization-only policies include outpatient cancer care, as well as outpatient dialysis. One of the things to look for when selecting a policy, since both of these can be quite costly.

I don't see why not since you fully reported the event.

Doesn't have to be deep diving. Just head underwater far enough to put some pressure on the ear. I've known people to do it in fairly shallow water.