FBN

This sounds like a thrombosed prolapsed (external) hemorrhoid; these can be managed without surgery but may take up to 6 weeks to resolve. Use Proctosedyl or Anusol suppositories as the ointment does not treat it effectively. Important to keep the area clean as dry as possible to avoid itching.

Decongestant should be the last resort; usually with kids this age it is an adenoid problem. Get her checked out by an ENT. If she has enlarged tonsils, which is easy to see, it is an indication that the adenoids are enlarged as well.

Decongestants has severe side effects for kids this age and may even lead to an increased susceptibility to upper respiratory tract infections as it changes the nasal lining which is the most important first line of defense against viral infections.

Good advice from Sheryl and I want to emphasise Japanese B encephalitis shots (jungle trekking; rainy season) as well as Rabies.

Dengue also a risk but there is no vaccine for it so mosquito repellants are important.

The kids probably have RAD (Reactive Airways Disease); there is some good info here: http://www.drugs.com/cg/reactive-airways-disease.html

This condition is becoming more common in countries with significant air pollution and is similar to asthma but there usually is no audible wheezing. Brought on by multitude of factors and management is difficult but antibiotics should be used as a last resort only when there are clear signs of infection such as fever or a productive cough.

Useful to get a little device called a "peak flow meter" which should be readily and cheaply available in pharmacies. Kid blows as hard as he/she can into the device and it measures the maximum airflow which is a measure of how "open" the airways are. Even without audible wheezing, this is a very sensitive test to detect any airway narrowing due to swelling.

Sometimes these chronic coughing is relieved by using a mild bronchodilator such as Ventolin inhaler.

This condition is known as CSOM (Chronic Suppurative Otitis Media) and the treatment is usually first a cleaning of all the debris from the ear canal, followed by examination and bacterial sampling from the inner ear and then appropriate treatment which usually is a local antibiotic and not systemic. Cultures taken from just the ear canal usually shows mixed infection with pneumococcus and pseudomonas most common. Infection becomes chronic when an acute otitis media causes a rupture of the ear drum if it is inadequately managed; the perforation in the eardrum then gets blocked by the thick secretions and the infection starts up again in the middle ear until it drains again.

For this reason, grommet tubes (or T-tubes) are inserted to keep the inner ear drained; the infection clears up with local antibiotic drops, the drum heals and the tube falls out. (Ideally)

Systemic antibiotics orally or IV in acute infections usually reserved for when there are signs of mastoiditis (infection of the bony sinus behind the ear.

She needs ENT specialist examination and treatment..

Spraying the areas prone to blistering with surgical alcohol will toughen the skin over time and make it more resistant to friction. Once blisters are there, try and keep them from popping for a few days to allow the underlying skin to thicken; makes it less prone to "weeping" after it pops. Applying some merthiolate will dry them quickly if you can stand the significant discomfort from applying alcohol to exposed nerve endings!!

Ideally, any fracture that requires surgery should be done within 10 days or so otherwise healing starts and surgery is much more difficult.

The wounds should be managed in a hospital environment under the supervision of the orthopedic surgeon that will do the operation as only he will determine when surgery can safely be performed without or limited risk of infection.

Chonburi may not be the best option at this time and you may need to consider coming to Bangkok perhaps to Chulalungkorn university hospital if funds are a problem. You need admission, the ankle needs 24h elevation, the wounds need professional attention and regular dressing changes; this you are unlikely to be able to manage effectively on your own.

An ankle is a weight bearing joint and is extremely important to have managed properly or you may have a lifetime of discomfort..

On just another note; if you buy at any of the street stalls that crowd lower Sukhumvit road, you may actually, apart from exposing yourself to a shakedown by the BiB, be buying not only fake but potentially toxic substances. These little packages of Kamagra are exposed to around 35+ deg C all day and every day and will degrade; so will all forms of "medication" sold that way..

The problem with all opiate and related drugs is that the "therapeutic index" changes with higher and more frequent doses. This means that the desired effect (painkilling or inducing sleep as with barbiturates) reduces with increased doses taken on a regular basis while the side effect profile, including depression of breathing etc, does not. This is the basis of many fatal ODs on these drugs.

Best to try a combination of drug but this is also not without danger; if both is broken down in the liver, for instance, that may have the same impact as a higher dose of the single drug.

The trend of prescribing for and managing chronic pain has moved away from just analgesics to more multifaceted approaches and methods. It remains a difficult matter nevertheless.

The way the OP seems to be using this drug is just about optimal; except for the episode that prompted this post, of course!

May be worthwhile to check with International SOS for a quote anyway (02 205 7777); likely to be expensive but what you would get is the correct recommendations for escorts and in-flight support such as the need for Oxygen etc based on a medical report from the treating physician. These recommendations will comply with international commercial airline requirements and avoid a situation where the individual is refused boarding if the needed documentation (fit to fly medical certificate) is not in order.

Mitral valve prolapse may lead to heart failure which may have a very slow onset and fit in with all of your symptoms which may even include some weight gain which may be due to fluid retention; best to have this checked out. It is also associated with pulmonary hypertension, the main complication, and the value of the echocardiogram is an assessment of this rather than the ejection fraction.

Any eye problem associated with this much pain will be associated with some visual disturbance.

Likely to be a frontal sinus blockage so a visit to an ENT is more likely to be of benefit. Sinus X-rays may show a thickening of the lining in case of a chronic problem. The pain is as a result of negative pressure in the sinus that happens when the drainage is blocked; the air in the sinus gets absorbed by the mucosal lining and this creates the negative pressure which results in this much pain.

Try a decongestant and perhaps a saline nasal rinse as well in the meantime.

Agree with Sheryl here..

In any situation like this, ask the hospital to transfer you by ambulance with an escort if you are stable enough in the treating doctor's opinion. Hospitals outside of BKK generally have no objection to arrange this; especially hospitals within the same group as with the Bangkok group of hospitals.

From original post it appeared, and still does to me, that this person would not be able to travel by commercial means even if able to leave hospital. Is this wrong? All this talk of leaving; but OP painted a picture of a dying old man "It's doubtful he'll ever be well enough to survive the rigors of transport to Bangkok and IDC". It that is true there is no way he could safely travel around the world in his condition and I believe it would be better to use his pension to pay hospital and last stage care providers than overstay charges or plane fares for a flight he could not take. Immigration is not interested in making his life more difficult and hospital obviously is taking a humanitarian stand. There are times when 'legalization' has limitations and perhaps should not be the priority.

Agree with Lop here. With all due respect to the OP's good intentions, it may result in this poor chap ending up in a far worse situation he is in now. Frankly, it does not appear that there is a problem right now; the hospital seems to be fine with the situation and he has a pension that could be applied to any medical costs. An airline would require a medical clearance if a passenger travels from a hospital admission and, if they do require a medical escort, this is clearly out of the question. The problem is once this process is initiated it won't be possible to stop.

Unfortunately the 2 steam options you mentioned above will not do the trick. Hot showers not always useful as it may increase body temp to an uncomfortable level before you had enough steam. Boiling pots are OK for kids but an adult needs substantially more over a longer period of time. May be worthwhile investing in a "facial sauna" as used by some beauty therapists for skin pore treatment or a conventional steam room in a gym. Being a "natural" remedy, it takes patience and persistance but it will work.

It sounds like a "Reactive Airways" problem in response to an allergic stimulus. Seasonal may mean it is something in the environment and probably plant/pollen related.

It may be useful to combine the inhalant with an antihistamine or even use a steroid based inhaler in combination.

Inhaling steam is very useful and can combine that with an aromatherapy solution. Any inflammation in the airways (the narrowing causes the wheezing) disrupts the normal mucous production and steaming aids this; prevents thick secretions getting stuck in the airways and become infected.

This is most likely just a sprain of a costo-chondral joint. This is where the bone of the rib joins the cartilage part of it. Not serious but most annoying as it can be painful for a number of weeks. Most annoying when in bed and turning..

You can usually pinpoint the exact spot/rib joint. Some anti inflammatory drug may help initially.

Best to avoid pressure on the same area while the pain persists.

The most important aspect of this remains clinical examination by a competent physician. These tumours tend to be very small when still at a treatable stage and an MRI etc is not sensitive enough.

^^ Seriously ... worthy of a new topic.

By my Member name you can approximate my age ... way to young for a DVT ... but it happened.

And yes ... I did have a pulmonary embolism ... only discovered when I went through that big donut shaped thing.

Warming suggesting starting a thread about it as that,

1/ we don't hijack the OP's initial meaning of his question ... just a common courtesy ... and

2/ with the proper title, you might get some more members opening up and sharing their story.

Agreed!!

Such filters on jugs will probably only filter out particulate matter and not as useful as an in-line system. The manufacturer should be able to provide filter efficiency data.

The mg indicated on the pack will always refer to the amount in a single tablet not the whole pack.

Due to the number and very superficial structure of blood vessels on the nose (the face and scalp generally) any lesion in this area bleeds more than normal compared to other areas.

Aspirin will slow down clotting time (as it is supposed to do) but bleeding should stop with pressure. Adding an infected lesion will cause prolonged bleeding as well.

Excellent suggestion by Lop above; cancerous, or pre-cancerous lesions (acantinic keratosis) will bleed a significant amount more and also longer. Not serious but worth a checkout by a dermatologist and easily treated if so.

True indeed and what is more disturbing is a remark in the same article: "..at the moment there is no drug to replace it.. (artemesin).."

For the resistant strain to spread to Africa, it would require a carrier of the resistant strain to travel to a malaria endemic country in Africa and be exposed to the mosquito vector there. Given that it is happening in mostly poor, rural areas on Thai/Cambodian/Burmese borders, international travel for these populations are not a major issue now but, eventually, spread of resistance is inevitable. This will most likely be due to Artemesin becoming available through illegal production and distribution to the populations at risk, the same way is has happened here.

The spermatic cord which is cut during a vasectomy procedure lies in a bundle that contains a nerve, 2 small veins as well as a small artery. These can fairly easily get damaged during the procedure in inexperienced hands but, although bleeding is a known complication, it does not occur that frequently.

Important to stay on your back for 2h or so in the clinic or hospital to give the incision time to settle, wear tight fitting underpants immediately after and don't walk too much or climb stairs..

Lots of discussions previously in this forum on the subject..

Looks more like a contact dermatitis.. May be unrelated to the injury.