jimmiejackson

The cheapest way (to avoid unnecessary expensive tests), is ask your doctor/hospital for a blood tests.

2 year ago I was extremely tired, went to a doctor to ask for a blood test, and I was diagnosed with “scrub typhus” (it kills the red blood cells)

https://en.wikipedia.org/wiki/Scrub_typhus

Important: Repeat the blood test after 5 months, to control the disease is totally gone.

I fail to do this, and got it for the 2^nd time in 14 months, while I don’t live in the jungle.

Good Luck.

Thanks for that. I have no issue getting blood tests and usually do so from Bria Labs as they are far cheaper than most hospitals.

The thing is to know what to test for. You could easily spend 10s of thousands of Baht getting tested for everything, so it's important to know what options to select when going in. I guess that's where a Doctor can direct me perhaps. I'm just a little wary of private hospitals here in terms of being over zealous with everything when they make profit on every item and not trusting enough of public ones.

OP,

From the additional information provided (including that you have had a full panel of blood work done thus excluding anemia and diabetes) and given that you have already addressed sleep apnea, I am inclined to agree with those who think this is probably pyschosomatic (and that is certainly what any doctor you go to with these symptoms is likely to think). You do not need any additional physical tests beyond what you already have had. If you want to pursue food allergies, the simplest and best approach is just an elimination diet removing one tye of food at a time and giving it a few weeks to see if it makes a difference.

I would also while you are at it drop the cetrizine as that can certainly cause/worsen fatigue and brain fog. Also if you are taking any nootropics (I didn't see any on your list, but OP mentioned it) drop them as well. I.e. no meds at all other than supplements.

However I disagree with those pointing you in the direction of a pyschiatrist and medications. You have already had experiences with psychotropic meds and to me, what you describe sounds less like an innate chemical imbalance than the extreme fatigue that results from a constant psychic effort to suppress unpleasant emotions, conflicts and memories. Such suppression is natural and even helpful at certain points in ones life (especially childhood) when one does not have the strength and ability to deal with them, but there comes a time when you need to stop and let it gradually out and deal with it. If you do, you will experience a huge surge of pyschic energy. This is not something most people can do on their own, though -- whatever is suppressed is so for a reason i.e. it was painful, scary etc and you did not have the tools to deal with it. So what I suggest is short-term pyschotherapy. See the pinned mental health resource list. http://www.thaivisa.com/forum/topic/90910-mental-health-resource-list/

I can virtually guarantee that if you do this you will find that great stores of psychic energy -- which rather than physical energy, is what you are really lacking -- get freed up.

The relationship with the therapist is key (more important than the specific techniques they employ) and depends a lot on individual chemistry so if the first one you consult doesn't feel right, keep trying until you find one who does. It needs to be someone you feel is empathetic and able to understand you, and of course whom you can come to trust.

How long it will take is variable. Unlike what many people fear, this process does not result in all of a sudden being faced with everything you have tried to suppress. It is more like a slow ooze of pus after inserting a needle into an abscess. It comes out gradually and at a pace you can handle, and what that pace is will determine how long it takes.

The sypmtopms you describe are common for those with food intollerances or allergies.

It is possible to have a test for celiac these days, which is gluten related.

I have many friends who have turned their health around by avoiding gluten. Others have found eggs, peanuts and other foods to cause brain fog, tiredness and similar problems.

It seems that, for some reason, recent populations have developed problems in this area.

You could try a 10 day gluten-free diet, avoiding wheat, oats, rye etc. and see if this changes how you feel. Its a simple test you can do yourself, that eliminates this common malady.

One has to be very careful about noodles and wheat which is hidden in many bought food products.​

The other area of great ​concern is sugar, which can cause a severe reaction.

I have several friends who swear that - just by avoiding gluten and sugar - their lives changed for the better - and I am one of this group.

Thanks for your input.

I am allergic to peanuts and dust/animals (I have a cat so that doesn't help, but these symptoms of brain fog/fatigue were around when I didn't have pets too).

I have tried all kinds of dietary interventions including periods of ketosis (once for 8 weeks and once again for 9) which by their nature are totally gluten free and sugar free (under 30g of effective carbs per day). Felt even tireder than usual.

I seem to be a little sensitive to gluten and I get acid reflux often if I eat any junky foods. Are there any (non quakery based!) tests that would say for sure what I'm allergic to and don't cost a fortune?

well, it won't hurt if i guess. your blood pressure is high, i'm around 100/70 with a HR of 52. but i do sort-of understand your symptoms. i would get a breathe-right strip that you put on your nose when you go to bed. generic ones work well. also get some iron pills, 25 mg. take one, with vitamin C....and ONLY one every few days. stop if poo black. then, drink lots of water (you probably do this) and then go spend time in a MUCH COLDER PLACE. go to elevation....maybe just do an ice bath.

i would also take some exams online to see if you really can or cannot concentrate. EDIT: I do agree depression is possible. But it seem pretty mild now since you can get outside and do things....even if you are sleeping a ton, i would still consider it mild depression. but it's important to consider, yes.

for me, it was a combination of all of these things.....

if none of this works, it might be an allergy. try benedryl.

it won't be fun if you realize you have to go to a different climate.......

Thanks for your input.

For allergies I take cetrizine. Have also used loratidine with no better effects fatigue wise.

For sleeping I use a full face CPAP mask with an auto adjustment CPAP machine, so that's about the best I can do for sleep (I also sleep in a cold room, pitch black, all electronics far away from bed, no screens before bed etc.. I feel like I sleep well, I just never feel very refreshed).

I do take vitamin C regularly as well as activated carbon (sorry, forgot to mention those before), I also take sauna/ice baths at least once a week if I can. As for iron, it can be dangerous so I'd rather know for sure I had a deficiency before taking it. Even saying that, I took it sporadically years ago and noticed no difference.

Symptoms parallel depression.. you've been checked for Hypothyroidism..

You may find value in speaking with a *Psychiatrist who can evaluate you after omitting other possible factors.

This is not a black and white science; the brain releases chemicals (serotonin and norepinephrine) - if your brain is not producing these chemicals in the correct amounts the physical symptoms of Depression may surface...

See a specialist...

In such circumstances much in the same way a diabetic needs insulin someone with depression may see improvements when taking certain medication (SSRI or SNRI).

*Note: Don't mix up Psychiatrist with Psychologist - they are different disciplines (one physical the other mental).

Thanks Richard.

I was diagnosed with depression at around 14 years old and took SSRI (fluoxetine mostly) until around the age of 21. During that time I was depressed much of the time, to the extent of having suicidal tendencies. I felt much happier once I was off the medication as I felt more connected (the medication made me feel numb, as if I was watching my life on a movie screen).

I understand quite well the manifestation of depression and I'm not sure it's that anymore. I'm certainly happier than I've ever been these days and don't feel like I don't want to get out of bed because the world is a deep, dark hole (like I used to feel). Any irritability I have is minor and usually because of my feelings of fatigue.

That being said, I don't discount that brain chemistry is hugely important and I wonder if that's a factor. Would this show in any lab tests?

My mother has bi-polar and after years of misery and ineffective drug treatment is weaning off all pills and seems happier than I remember seeing her, so I remain skeptical (both because of my own experience and hers) but no adverse to anything.

Thanks for your input.

Just dont dwell. There is no magic bullet. If all your labs are normal. No other findings. Just face it and go on. What you dont want to do is make this your hobby if it isnt already. Everyone has crosses to bear. I will say also that if you do dwell and share it constantly with people there will be a lot of busy people in your life and phone calls that are not returned. Good luck.

Thanks for your good wishes.

I would hardly say I've hit it at all angles yet. If it's the case of something easily treatable that I haven't discovered yet, to me it's worth finding out instead of spending a huge proportion of my life in a fog that impacts my ability to do what I want to do (the motivation is always there, the ability to focus and not just want to lie down and do nothing can override it a lot of the time).

The fact that not a single person in my life knows anything about this is testament to the fact that I just put up, shut up and get on with life to such an extent that nobody would even guess for a second that I'm fighting my own private battle. I'm not obsessed about it but I'd certainly love to feel "normal" and be able to do more for myself and my family as a result.

blood test: actual values.

What do you do all the day...just an overview

What vitamins/supplements you take and how much

training details

living conditions

what you eat

only as example: hard training that is OK in cool area, in Thailand + to hot at the recovery time can drain you out.

hard training and you always eat meat but not in the heat you eat fruits but train the same may cause problems

details details details

Sure -

Most days I wake up around 9, gym 3 times a week (strength training and conditioning, about 2 hours total each time - so the "big 3" lifts, Olympic lifts, accessory work and 20 minutes or so HIIT for conditioning). Then various non physical activities (writing, reading, correspondence) for the rest of the day - little other physical activity.

Eat mostly a "paleo" diet, lots of meat and fish, low gluten levels. The occasional pizza or similar "junk" but usually about once a week. Lots of fruit. Was previously obese, haven't been for at least 5 years.

I live in a comfortable home, aircon brand new and regularly cleaned. No signs of mold (at least visual).

Vitamins/supplements - Creatine monohydrate (10g/day dissolved in hot water), B12 (methylcobalamin) 5000mcg, Metyhl Folate (5-methyltetrahydrofolic acid) 800 mcg, Magnesium Malate 425mg, Cetrizine (for allergies) 10mg. I previously have taken all kinds of vitamins and supplements but no longer do as everything was making brain fog worse. Have tried selenium, K2, D3, L-theanine, Noopept, Provigil, Nuvigil, Vitamin A, Vitamin K2, Piracetam, Copper, Iron and probably more I can't remember.

Happy to give more details and thanks for your help!

I'm a little confused. You say it has been like this for as long as you can remember? i.e. all your life??? (hardly makes sense)

and then you say: "normal TSH, Free T3 and T4, T3 but T4 was low". Are you saying the free T4 was normal but the bound T4 low??

Have you had a general physical check up with blood count? (to exclude anemia)

And do you have any muscle aches? Does exercise make you feel better or worse?

And please list exactly all the meds you are taking.

Hi Sheryl,

Thanks for your reply.

I'll try to clarify each point but feel free to ask further questions if you need anything else.

"You say it has been like this for as long as you can remember? i.e. all your life??? (hardly makes sense)" - I was hyperactive as a kid, as a teenager I remember always being quite tired getting up for school but then again I didn't sleep a whole lot and that's probably normal. Between the ages of 17-25ish I was abusing substances daily (mostly very large amounts of cannabis and for a period cocaine) so fatigue and feeling terrible was just a part of that. I remember quitting for short periods a few times and feeling very energetic. Since I have been "clean" I have been feeling like this, gradually worse. It may not have been helped by large periods of time under excessive stress for work and very little sleep (about 3 years total I would say) that I probably never felt recovered from. Stress in my life these days however is minimal.

"and then you say: "normal TSH, Free T3 and T4, T3 but T4 was low". Are you saying the free T4 was normal but the bound T4 low??" - Yes in the test everything came out as "in range" except T4 which was 4.61ug/dl with a reference range of 4.87-11.72. It might be worth noting my mother (who is in her mid 50s) has in the last few years being using replacement thyroid hormone under the direction of her Doctor for hypothyroidism. No other family history I'm aware of.

In case it's relevant the other levels were: T3 104 ng% (ref 58-159), Free T3 3.02 pg/ml (ref 1.71-3.71), Free T4 1.17 ng% (ref 0.70-1.48), TSH 1.93 uIU/ml (ref 0.35-4.94)

Have you had a general physical check up with blood count? (to exclude anemia) - general medical no but my last blood test (in Nov 2014 done off my own back) included CBC, Chemistry, Lipids, Liver Function, Electrolytes, serum iron, testosterone, estrogen and thyroid. The only things that were out of range were: PMN;Neutrophil (low), Lymphocyte (high), Eosinophil (high, HDL cholestorol (low, 55mg/dl, ref was >60), AST (high), T4 (low). Happy to give more specifics if any are particularly relevant.

"And do you have any muscle aches? Does exercise make you feel better or worse?" - I do heavy strength training so being sore is par for the course. I would say exercise while I'm doing it (release of dopamine etc) makes me feel better and afterwards while recovering makes me feel worse.

I know a Doctor would obviously be the best person to talk to regarding my symptoms, however as I have limited funds I would like to try to narrow down the Doctor/tests I should take before I begin if at all possible.

Quick background – in early 30s. History of substance abuse but been clean for about 6 years. Drink alcohol around once a week, not to excess (3-4 beers usually). Very active person, training hard at least 3 times a week. Sleep on average 8+ hours a night. Diet generally “clean” and take various vitamins/supplements/nootropics just hoping I’ll cover the bases or something will magically work. Big guy, lots of muscle and some fat (probably hovering around 20% BF). Blood pressure tends to hover a little high (around 145/80ish).

Since I can remember I’ve felt tired, irritable, had brain fog…what could generally be described as fatigue, kind of a constant drunk/stoned feeling. It seems to be getting progressively worse as time goes on. I do function and am able to hide it from most but it’s a struggle. I spend large portions of all my waking time just completely unable to function properly and get stuff done.

About 6 months ago I paid for a home sleep study which showed an AHI of around 30, so I got a prescriptions from a Doctor here and imported a CPAP machine. I am pretty compliant and my AHI is now around 2-3 most of the time. This has made me wake up feeling less like I’ve been smacked around the face but after 6 months I still don’t feel much better.

I had a thyroid blood test (along with other general bloods/lipids) about a year ago at an independent lab (Bria Labs) and it showed normal TSH, Free T3 and T4, T3 but T4 was low. Never saw a Doctor about it. I tend to research things myself a lot.

I would LOVE to get to the bottom of it.

I just don’t know where to start because I don’t really have the funds to just test everything and see specialists for everything.

I have a BUPA Thailand inpatient insurance that will expire in a month or so, various accident insurances adding up to about 60k in coverage – all with no excess. I also have Cigna Global coverage just started with a $375 excess. I don’t have any kind of OP cover but not necessarily adverse to getting it if it would be financially beneficial before I dive into getting all this checked.

Thanks for any advice you may be able to give me.

Thanks all for the advice! I appreciate it.

Yoga is probably a good idea. Actually I tried yoga for about a year straight before I ever had any chiropractic treatments (couldn't afford it back then) and it worked to an extent, but not so far as to fix the issue.

As for strengthening exercises, I would say my back is pretty strong - I can deadlift well over 400lb. The pain has lessened compared to when I wasn't strength training but it certainly hasn't gone away.

The inversion table sounds interesting but I would need to look into it in more detail.

Thanks for all the offers of help, I'm sure there's many of us that kind find an affinity in the misery of constant back pain!

For the time being, I've booked an appointment with UK trained Osteopath. Phil Hambly at the Osteopath Center (it is near Phayathai) as he said he may be able to assist after I emailed him with details. Who knows? At least he will spend an entire hour with me one on one for the 1700 Baht first consultation so maybe I'll get to learn something if nothing else.

Will report back!

If nothing comes of it then I guess going to a Spine specialist as suggested may the be best next step.

Hi all,

I have back pain which most of the time results in pain in my upper right chest/back (it shifts around) as well as on and off pelvic pain.

There is a vertebrae in my neck on the right side that when it's pushed, I can feel the pain go all the way down to where it hurts in my chest/back, so that seems to be the source of the pain there.

An X Ray a while back revealed I have scoliosis, so it probably originates from my pelvis being misaligned.

Anyway...

I have spent a small fortune on Chiropractors, acupressure, cupping therapy, accupuncture (in Bangkok)....

All it ever does it relieve the problem temporarily, sometimes longer than others but never more than a week or so.

The best results I've gotten is from the Chiros but I'm clued up enough to know that a generic "rack and crack" and some electro/magnetic/laser/ultrasound muscle therapy isn't going to do any long-term good. Plus the prices are just crazy for what you get.

I was considering going to see an Osteopath but I wonder if that will just be more quackery?

There's no point these people giving me generic nutritional or exercise advice, I work in that space and to be honest, I've never received any advice that is more up to date than the Zeitgeist in "alternative health" in the 90s.

I don't mind to spend money to get it fixed ONCE AND FOR ALL but I can't keep spending 2000 Baht a pop for little adjustments for temporary relief.

I'm in Bangkok (upper Sukhumvit to be precise) and any advice would be very welcome!

Ah, very useful. You're correct, that's what I was looking for the correct term for.

Now I have that I will be able to do some further research.

Thanks!

Do not set up a company or partnership of any kind. On the scale of business you are contemplating it simply complicates and adds cost. Do not involve a lawyer they are the source of most grief and tremendous bad business advice. Simply do the business from home. Secure agreements with the people being supplied as to prices, who pays for shipping, customs clearance etc. Also shop around for freight rates. DHL and their kind are fast but expensive. If you can do a 7-10 day delivery lots of much lower cost options open up. Finally, only ship whe ypu have been paid ... even if it's your grandmum on the other end ... place no trust this is a business transaction.

I agree and she will certainly be demanding payment up front (I'll be making sure of that!)

She will need an office and a couple of staff. Nothing fancy, just a small operation. Not possible from home though.

Still trying to work out if anyone knows what this Amphur registered small business thing is and whether there's any point.

Your wife is a personal shopper ?

Nope.

She has friends who live in Europe that want to import a particular product that can be manufactured here.

The reason they want her involved is because otherwise they would send the order to a small Thai factory and hope that that product came out:

On time

On cost

Correctly as per the specifications provided

Shipped correctly labelled and at cost

etc

If they send the orders through her and pay a % markup she will make sure all of the above is done correctly as far as possible.

I'm also exploring this. My understanding (yet to be confirmed) is that if a Thai sets up an export company there are tax and other benefits to be had. The cost of setting up can vary between a couple of hundred dollars and quite a few thousand dollars depending which law firm does the work. All to be confirmed when we talk to the supposedly cheap law firm in the next few weeks.

I have a Thai Limited export only Company. The cost to set up isn't so much (paid less than 100,000 Baht including work permits and various other things I can't remember now) but the running costs to keep everything straight are crazy - notarized contracts, accountant bills, large number of (honestly unnecessary Thai staff) to support work permits, customs inspection on every outgoing shipment etc etc etc. Never ends.

This is why I don't want to mix in my wife's business with mine. What I have is set up and manageable but I can't just decide to export a product casually to someone - I have to jump through a thousand hoops to keep it all on the up and up.

Better she does things separately for her own business but I want to make sure she's keeping it straight as far as necessary.

I am not an expert in this area.

However, I do not see why you would have to do anything extraordinary in this case.

There is nothing wrong with your wife "purchasing" goods made in Thailand and sending them to another country. Unless Thailand has a law stating that exports for the purpose of profit require that a company be formed. I know of no such requirement, but again I am not an expert in this area.

You must be sure that the import duties on the receiving end are properly paid. You need to check if there are any export restrictions or export duties required on the Thailand side of the transaction.

You need to make sure that if she actually make a profit on the transaction that she reports this as income on her tax return.

Simple as that.

Now, if you get serious about things, you will want to setup all of those other structures (company, accounts, etc.), but I do not see why this would be necessary at the very beginning. The only concern would be product liability. For instance, if she is shipping out skin cream, and that cream is burning off peoples' skin or giving them cancer, then she may need some sort of protection. But for simple products, this is not a big concern.

tim

That was my thinking. The product isn't something that would carry any serious liability so I'm not worried about that.

I'm wondering what the difference between her just doing it "off the books" (and obviously declaring her profit 100% honestly just like everyone else...) and having the Amphur issued certificate (I'm really not sure what it is, although I see the certificate in plenty of small businesses) is.

I wonder if it has any tax, banking or liability benefits of any kind.

As for lawyers; I have lawyers and accountants coming out of my ears for my business. I sincerely doubt any of them is going to suggest a method which is essentially free and doesn't require lawyers or accountants. Just like when the advert says "9 out of 10 Dentists recommend Colgate" - you definitely want to stay well clear of Colgate.

Hi all,

Just looking for some advice. This is for my Thai wife but obviously I need to make sure it's done right or I'll end up on the hook one way or another!

She has some friends in Europe that want to import some goods that are made here. They will send my wife the money, my wife will arrange to have the items manufactured by a factory, check they are correct, package and ship them to Europe using an express courier (DHL for example).

Thing is, I don't want to go through the whole rigmarole of her setting up a Thai LTD company (at least until I know it's a big earner) and don't want to get involved mixing my company with her business.

What are her options? I don't really understand what the "Amphur registered" business is. Would this allow a "Company" bank account? How about getting an account with DHL, Fedex etc, and what is her liability in this scenario?

A little confused.

Any advice would be appreciated.

Thanks all. Seems like the best solution currently (after running around all the banks) is for my wife to get "paid" by a real company issuing real payslips and actually putting the money into her bank for 6 months or so at a high enough pay rate for the sum required. Not the hardest thing to arrange.

Only SCB said they would probably take into account the 100k going into her account a month but it's up to the guys at head office and not a sure thing.

Thanks all. Seems like the best solution currently (after running around all the banks) is for my wife to get "paid" by a real company issuing real payslips and actually putting the money into her bank for 6 months or so at a high enough pay rate for the sum required. Not the hardest thing to arrange.

Only SCB said they would probably take into account the 100k going into her account a month but it's up to the guys at head office and not a sure thing.

Better to try get a mortgage on your name/income as well. In some cases foreigners can get a mortgage, however it is limited to 50% of the appreciated value of the property. Don't know about the requirements for such a loan.

Thanks, that seems to be a good way to go although the actual policies of most banks don't appear to allow this.

Does anyone have any recent experience in doing this?

Hi all,

Having read through some posts and been to see the major banks I wonder if anyone has any up to date information.

My Thai wife works for a company with a 20,000 Baht salary which would entitle her to around 1m Baht mortgage over 30 years at most banks.

However we want to mortgage somewhere up to 4m Baht.

I (not Thai) have a declared salary in Thailand of 50,000 Baht a month and have savings here.

I have been putting 100k a month into her bank account each month for the last couple of months hoping this would count towards the total we can borrow. Talking to the banks they don't seem to think this is the case.

Any advice on how to proceed?

Thanks a lot!

Interesting, they must feel there is no need in your case - probably because you aren't selling physical goods locally.

Out of interest are you an export only company or rep office? How does the labor department not want to see your SSF contributions for Thai staff? Or are they (for some unknown reason...) convinced they shouldn't ask?

I am doing this already for 6 years now.

No problems with the labor office and no problems in Penang for the yearly nonB visa.

And no staff on the payroll and no they are not added and removed for the visa and work permit.

And yes i do pay tax and yes Penang needs a valid work permit with at least 8 months validity.

edit: and I know several others who do this. A few for more than 15 years already.

I have a small IT services company.

Work permit is taking care of by my accountant.

Non-B Visa and all the papers needed for it I do myself.

I have no idea why they do not ask about the Thai staff, I only know they do not ask.

I also asked one of my friends who does the work permit papers by herself, if she add not existing staff but she says no.

Also hasn't been asked about it by the labor office.

Out of interest are you an export only company or rep office? How does the labor department not want to see your SSF contributions for Thai staff? Or are they (for some unknown reason...) convinced they shouldn't ask?

I am doing this already for 6 years now.

No problems with the labor office and no problems in Penang for the yearly nonB visa.

And no staff on the payroll and no they are not added and removed for the visa and work permit.

And yes i do pay tax and yes Penang needs a valid work permit with at least 8 months validity.

edit: and I know several others who do this. A few for more than 15 years already.