voyagerUSA

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

Thank you for this very informative reply. The urologist treating me never mentioned testing prostate fluid, each flare up he just keeps testing my urine or penis swab including multiplex PCR for STI, culture and a very expensive test called "16S rRNA bacterial identification" - all negative. I found out about prostate fluid testing from my own research, not sure if maybe he is just not comfortable doing this for cultural reasons or maybe because my symptoms are only urethral (I don't have prostate pain or difficulty/urgency peeing, thankfully). A week of doxycycline clears up my symptoms completely but then they come back in 1-3 months. So for now I decided to try 1 month of doxycycline based on my own research and see if it works better than the standard 1 week course Ive been prescribed several times before. I guess if this does not work I will try to find a urologist who can do the prostate massage thing and see if can catch the bacteria (if any) this way. If you don't mind do you have reference for the professors who finally fixed your issue? I travel a fair amount so is not necessarily a problem if they are outside of Thailand.

Thanks. Actually the urologist currently treating me is on this list. He thinks the problem is an infection because I respond well to an antibiotic and referred me to infectious disease specialist who said he doesnt know what it is and refer me back to urology. I guess I will try another urologist on your list :(

I'm aware of the non bacterial prostatitis. However every time I get symptoms my urine shows white blood cells, they prescribe me antibiotic and in one week the symptoms go away completely. Then in a few months the exact same symptoms come back...

I am looking for a specialist on difficult to diagnose urethritis/prostatitis. Extensive and repeated urine testing negative for any sort of bacteria. It seems that many urologists here are primarily surgeons and not that interested or experienced in treating non-surgical issue like this. So I am trying to find a urologist or maybe infectious disease specialist who specifically has experience with this sort of thing. I am located in Bangkok. Thank you in advance.