Sheryl

This is a small community hospital. It will not have a cardiologist. The doctors will be young, recent graduates without specialty training and (as amply demonstrated by the stopping of hte aspirin) are not adequately trained to manage your cardiac issues and related measures. There might be a cardiologist available at Surin Provincial Hospital and will definitely be one at Maharat Hospital in Korat town (main government hospital, a regional facility and much larger than Surin). Unless you have free health care through your wife being a civil servant, you do NOT need a referral to go to one of these places and see a specialist. The best approach is through the "after hours" clinic, as that way you can directly see a senior consultant; through the public channel it will take longer and you may only see a resident in training. The after hours clinic in an upcountry government hospital will cost a couple of hundred baht more than the public channel (250 vs 50 baht out where I am, but it does vary) but well worth it if you can manage it...especially when having to travel a bit to the hospital to begin with. Typically the after hours clinics begin around 4 PM, should try to get in queue before that.

"Heartburn" is a lay term without precise medical meaning. People commonly use it to describe discomfort due to reflux but may also use it to describe discomfort/pain from gastritis.

No. Omperazole is a PPI. Systemic effects. Gaviscon is an antacid containing aluminum hydroxide and magnesium carbonate. There is minimal systemic absorption, the effect is mainly direct on the stomach contents. Antacids such as thsi are the preferred first line treatment for heartburn, with PPIs reserved for more severe cases. Main disadvantage of Gaviscon etc is short duration of action.

Pharmacies are not banned from selling aspirin. Just required to have a full fledged pharmacist in hand at all times if selling it (rarer than one might think) and also to keep records of sales. Some do not meet that criteria or want to bother. It is easily gotten from online pharmacies such as Medisafe and https://bangkokdrugstore.com/?s=aspirin if hard to get at the pharmacies near you. When used to prevent reduce the risk of stroke in cases like yours aspirin dose needs to be daily, not every other day. Aspirin does not cause GERD but it can cause gastritis. Clopigrel is an alternative drug in cases like yours if the aspirin is too irritating to the stomach. (You would know that by symptoms other than reflux, aspirin does not cause reflux). Which government hospital do you attend/where are you located? Small community hospitals and even some provinicial hospitals will not have cardiologists but you do nto need a referral to go to a higher level government hospital which does.

This is not going to do anything for aches. It is helpful for certain types of skin problems. Urea is a byproduct of protein metabolism. Urine contains it (hence its name) and so do other things (including fertilizers).

Sorry to hear about all your troubles - and glad you beat the odds! But I must correct one point: an operation is not usually indicated to resolve GERD. It would be indicated only if the cause was a severe hiatal hernia (which was presumably the cause in your case). There are many other causes. Age itself is one of them. When combined with obesity and a tendency to lie down on a full stomach, so much the worse. Coffee and other caffeine is also a big culprit and more likely to cause problems as one ages since its effect on the lower esophageal sphincter (LES) is augmented by the natural LES weakening that occurs from age. Another cause can be bacterial or fungal overgrowth in the small intestine, leading to gas build up. Often the reflux is actually accompanying a small upward passage of gas which may nto be readily noticeable, but explains why the LES opened. This may also happen in the absence of bacterial of fungal overgrowth due to ingestion of foods apt to cause gas. As one ages, this is more prevalent. One should certainly nto allow regular reflux to take place, but there are risks to long term use of drugs like omeprazole. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372031/ Best approach is tofirst try to reduce the need for omeprazole by lifestyle modifications as previously advised.

History of heart attacks, valvular disease and angina: You do have a need for ongoing, periodic supervision by a cardiologist, and most importantly. you should not go off aspirin unless advised by a cardiologist familiar with your history that it is safe to do so or (likely best option) given an alternative medication such as clopigrel. Your GERD is not likely caused by any of the meds you are one. Are you overweight? Do you drink coffee? Tend to eat close to bedtime?

These are all not-for-profit private hospitals.

It should nto be given before 3 months have past. If necessary second dose can be a bit later but a 6 month interval is pushing it and there is no data on that. Is it not possible to get it where you are going?

It is impossible to comment without knowing the reason for both prescribing and then stopping the aspirin and also whether an anticoagulant of some type was prescribed when the aspirin was stopped. @Dario can you be more specific as to your cardiac history? And are you under the care of a cardiologist? What other medications are you on? It is standard to give omeprazole when someone is on aspirin. This is not done to prevent reflux but rather to prevent irritation of the stomach lining (gastritis) and ulcers. When going off drugs of this type, there is often a rebound increase in acidity; it can be very difficult to stop these medications and one sometimes needs to do it gradually, for example (if already on one tablet a day) taking every other day first for a while. If you have reflux then naturally you will feel it more once off omeprazole. It is important to understand that omeprazole does not in any way stop reflux. It only makes it less painful by lowering the acidity of the stomach contents. Measures that will help reduce or stop reflux include: - avoid or minimize caffeine (coffee, chocolate, tea etc. - don't smoke/stop smoking - lose weight if at all overweight -avoid eating too much at one time; several small meals are better than fewer large ones - do not eat for 2 hours before lying down - elevate the head of the bed. This can be done by special pillows or by bricks/concrete blocks under the bed. -avoid any particular foods that seem to trigger this. This is highly individual. - consider whether you take any medications that may be causing this or worsening it

Got it, thanks!

These fielda are a new addition. I think not required. Have you tried submitting without these attachments? Be sure you are using https://www.evisa.gov.kh/

I don't follow. If I atrach these wires to the fitting how can I also attach the power wires?

Thanks. Probably the best option as not only would rewiring all the lights be a huge job, it would be very hard to find a competent electrician. From exhaustive past experience there are none in my area and ones in Bangkok aren't willing to come out for what is (from their point of view) a small job. How exactly does one wire these in? And what do you mean by "just connect L-N"? Connect the wires where and to what? (I will have to instruct handyman). They are cheap enough certainly. How long do they last?

No it's a big house and the various lights are on on many different breakers. So this isn't something that can just be fixed at the switch? Need to redo the wiring from the breaker on out, or what? And aside from the glowing what orger effects does this have? Does it increase electric consumption? Pose any dangers?

Yes, with switch off I get neon on the top wire and nothing on the bottom. With switch on I get nothing at either wire This is by testing at the screw

Surgery is rarely used for a broken thumb and would be rerserved for cases with unusually sever features. Normally they would just splint it. I really do not think you need to be concerned about being pushed to have unnecessary surgery for this. Bangkok Christina Hospital (Silom), St Louis Hospital (Sathorn), Camellian Hospital (Thonglor) and Mission Hospital (near Rachadamri) are all nonprofit hospitals and an ortho at any of these would be a find choice.

When did you get the first shot?

He is referring to urine.

@Crossy to be clear do I need to detach the wires to the switch to test this or can I do bu just testing at the screws? Just did it in bedroom and testing the screws, nothing lights up. (With switch on)

No sputtering and the wiring for the heater was all done by Stiebl technician so I think to standard. Flickering stopped when I changed the light bulb so I think just bad bulb. Stores near me sell now only LED and mostly cr*p brands.

Making Thailand less than the best place for them.....! Yet HomePro et al have decided to carry nothing but. The HomePro near me also carries only junk brands to boot. Just now, finally, they have Lamptan. Otherwise it is a shelf full of no-names and the like. Expensive enough but, in my experience at least, very short-lived. Al least with my wiring and power supply.

If you find a urologist willing to perform the procedure for you at an affordable price, I really would not worry much about "no scalpel" vs scalpel. The latter is nowhere near as bad as it may sound. Very quick and simple minor surgical procedure.

Yoy are confusing different reports pertaining to different issues and different time periods. The 4,100 cases mentioned in the Washington Post occurred between 2020 - 2022 and included outright overdoses (consumption of many fold the safe dose) and muxture with other drugs. No reference to the salmonella cases. Citing potential risks and need for product regulation is not "anti-drug", it is common sense. None of these sites are advocating a ban. Just highlighting the risks when a pharmacoactive substance is not regulated as such.

It is not so much a matter of being annoyed - the only one that could cause annoyance is the bedroom and I wear eye shades anyhow to avoid being awoken by the rising sun. The issue is that I worry it might signify something that needs fixing. Though if it does, hasn't done me nay real harm in almost 30 years, knock on wood, other than possibly adding to my electric bill a bit?