voyagerUSA

Just something to keep in mind - studies show that in case of stable heart disease stents do not improve survival as compared to medical treatment. They only seem to improve survival when done during a heart attack. It is probably best to think of stents as a palliative measure that helps improveunpleasant symptoms such as chest pain, but they dont seem to prevent heart attacks unfortunately, at least this is my understanding...

Yeah I was quoted 23k including prep work by my current place, but sounded a bit high and also the crown they did before lasted only 9 years which is on the low end from what I understand so I am inclined to shop around. There are several places with fancy english language websites but perhaps a more local oriented place would do as good a job but at lower cost? Or is it just that the cost of the crown itself so high that they cant discount much?

Looks like I may need to have a crown replaced soon. What should be the price range for a porcelain crown and what is a good place to do it in Bangkok? The one I have now lasted only about 10yrs and is now leaking apparently, I am hoping for something that will last longer.

Im mid-50s and do heavy powerlifting 3x per week plus cardio.. but I've been doing some form of resistance training for a long time and my body is used to it. Either your body is just not used to such exercise and you need to get into it slowly scaling up gradually or you have some medical issue. 50s is not yet the time to slow down unless you have specific medical problems. Maintaining muscle mass an strength is important and just gentle stuff like yoga (which I do as well) is not enough

Yes I know my specific issue hard to find a good specialist anywhere, but is not the only issue I have or will have in the future so information about good general health options outside of thailand I think is useful to me and to others.

Yes, I've used Gleneagles outpatient services before and is pretty good

The problem is not known, lower urinary tract symptoms, but cause unknown, doctors so far suggested everything from bacterial prostate infection to cancer, though more likely the former I hope!

My specific problem at the moment is in urology (though is probably not cancer), but I also want a place that is generally excellent so I have a go to place with my records etc.

Yeah fortunately my insurance only excludes USA so Switzerland is an option. USA is completely off the charts when it comes to costs, it can be financially tough even if you are a $$ millionaire

Thank you Sheryl. I like how they have detailed profile for every specialist so you can find the one with the right subspecialty and interests

I realize also for a lot of readers here their natural fallback option would be their home country because of public health benefits and general comfort.

Yes I realize is somewhat problem dependent but lets say you are looking for a go to place that is broadly excellent, for all your health care issues where you want to go a step above what is available in Bangkok, so you looking at a place that is tops in research etc. For example I know in USA this would be places like Cleveland Clinic, Mayo Clinic etc, but I am less clear what are the centers of excellence outside USA. And assume you are not looking for cheapest, as you have insurance or the means to pay.

So if you had a complicated or hard to diagnose issue and you felt that what is available in Bangkok is not sufficient, and you could travel and had health global insurance where would you go (Excluding USA). Singapore? Hong Kong? Germany? and which hospital?

Another surprising thing about medication prescriptions here is doctors most often dont ask what other medications you are on to check for interactions or redundancies. I got into the habit of bringing a written list with me to every appointment, because only when seeing it in front of them in writing do they pay some attention to that.

Fluoroquinolone antibiotics do have that black box warning but the actual rate of serious side effects I think is very low. Still doxycycline or minocycline are safer, if they work.

For minocycline it is almost impossible to get here in Thailand but may be able to order it from India for example For the other more exotic antibiotics you may need to see an infectious disease specialist at one of the top private hospitals, see if they can import it for you somehow. Alternatively you may need to travel outside thailand for treatment. Like this guy might be able to help you - but it will be expensive https://www.medparkhospital.com/en/doctor/assist-prof-dr-thanomsak-anekthananon

For those interested about prices, here is what I was quoted for colonoscopy+gastroscopy with sedation: Bangkok Hospital 43,400 baht Samitivej Hospital 41,700 baht Bumrungrad 38,000 *plus* 15,000 for anesthesia (this anesthesia charge was added on estimated cost after I went there for consultation it is not shown upfront when you ask the package price)

Sheryl I PM you with details

The reason I am asking is that I had a strange experience with GI specialist at Bumrungrad. I went to see him to arrange the colonoscopy+gastroscopy (just screening no symptoms other than common acid reflux stuff that so many people have) and brought the results of my previous screening from several years ago done at Bangkok Hospital (which was 100% normal according to the report) . I expected it to be a routine conversation but instead he started talking about how technology they use at Bumrungrad is superior and how he can see from my gastroscopy report that I likely have some sort of pre-cancerous condition which would be detected by this "NBI" technology but which doctor at Bangkok hospital could not see. This made me very uncomfortable. First of all it is bad bedside matter for doctor to make the patient anxious unnecessarily before the test is even done. Secondly he is sort of talking down the other hospital or doctor before he even has test results to show they been wrong. Not sure if this is standard Bumrungrad marketing tactic or this young doctor is just showing off, but now considering changing doctor/hospital as a result. Of course I could always go back to my old doctor at Bangkok hospital but now I am not certain who is right ????

Just want to know who is recommended to do the best most thorough job on this procedure and with best equipment (this is for screening purposes). Cost is not a big concern as covered by insurance. Location is Bangkok. Thank you in advance

This is interesting because my symptoms are also 100% in urethra, I have no pain in prostate or anywhere else. Perhaps the difference is I also get high white blood cells in my urine whenever I get a flare up which made her think is more likely an infection. I deliberately did not try to influence her diagnosis, just described my symptoms and showed my labs, and she was the one to bring in possibility of prostate infection, among other possible explanations, including cancer (not the best bedside manner, I know...)

Just some feedback for those interested in this issue I saw both Dr Suntchai at BNH and Dr Umaphorn at Bumrungrad (she is also at Sukhumvit Hospital I think) for consultation. They both seemed fairly knowledgeable about prostatitis/urethritis issues and understand the nuances of this difficult to diagnose and treat problem. They are both easy to talk to, explain their thinking well, and patient about listening to my lengthy disease history, especially Dr Suntchai. However their recommendations on further testing and treatment were different. One suggested MRI of the prostate the other cytoscopy for example, and their thinking on antibiotics was not the same either. Dr Umaphorn seems a bit more up to date, she knew very well about fosphomycin and suggested it as the next thing to try should my current treatment fail. Dr Suntchai seems a bit more "old school" but he seems very open and willing to discuss and research alternative treatments if you point him in the right direction. For anyone who has this sort of problem either of these doctors are probably among the best that we can do here in Thailand. Please note I have not actually started treatment with either of these doctors yet, these are my impressions from a single consultation.

Incidentally I am planning to consult Dr Damrongpan, urologist at Bangkok hospital. Anyone here had experience with him?

Fosfomysin is quite commonly used for treating acute UTI in women so is widely available. Its use for treating chronic prostate issues in men is somewhat new but there is good data that it works well (provided your problem is actually caused by a bacteria and not something else).

Another question: if you had good response to some antibiotic followed by a relapse after you stopped it have you tried just using a small dose of antibiotic long term as a sort of prophylaxis against a relapse (provided the antibiotic didnt have intolerable side effects)? Since doxycycline seems to work for me, and doesnt produce any side effects I have considered, as a backup plan, just taking a small dose of it permanently as a way to prevent recurrence, but I cant find any research on this approach.. except for treating skin issues