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bubba
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Posts posted by bubba
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I was just there two weeks ago and it is absolutely safe. I never even thought of any concern walking around at night.
The seafood places along the beach near BP Samila can be kind of a ripoff sometimes - just watch what you order. Another suggestion if you want a great meal and don't want to spend a lot of money on it: try the corner shop on the roundabout next to BP Samila. Very tasty with cheap fish and seafood dishes. It's been there for ages and there are always locals eating there.
I didn't check any out, but there is a new string of restaurants and night spots along the beach road to the right (facing the sea) of BP Samila. Some of them look sort of upscale.
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1 minute ago, elektrified said:
That is for "Free PSA" test. Doesn't matter for "Total PSA" test. For "Free PSA" tests, no sex or riding a bicycle for 48 hours.
I believe you will find that the recommendation is for total PSA. Free PSA (e.g. not bound to serum proteins) is a component of total PSA and it all comes from the same place for the same reasons.
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@bkk6060: I know of another one to add to the list: bicycle riding. I have a friend who showed a PSA of 7.5. He is an avid cyclist (62 years old), riding distances every day. His doctor told him to get off the bike for a month and come back for another PSA. That one was 4.5. He has since installed a special seat for prostate issues and will go back in another three months for another one. That was a dramatic decrease in just one month and his urologist is sure it was the cycling.
@xylophone: the general guidance for abstinence is to abstain for 48 hours before your PSA draw. I was even given printed instructions that specified that at one hospital. However, from what I have read, that really might only increase the PSA by a few tenths.
I might add that my prostate radiologist specialist advised me to "keep the pipes clean" as he said by keeping hydrated and also with...ahem...ejaculations as frequently as you might feel inclined to have. If that is not enough, then he advised engaging an able assistant if one does have one. No really, that is what he said. He then went on to cite some studies where frequency of ejaculation (or the lack thereof) can relate to PCa occurrence and inflammation.
I believe BKK6060 mentioned that the above is part of his prostate health regimen.
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That's interesting, Xylophone. I have read that many antibiotics also have a mild anti-inflammatory effect, and our lowering of PSA levels following treatment may indeed be the result of that rather than an antibiotic effect.
Have you ever had a culture done of prostatic fluid? I have had three: in two of them, they did culture bacteria (different in each case). If they do culture bacteria, the doc can better target the pathogen by selecting the best antibiotic against it.
The radiologist I referred to told me that at least in my case of prostatitis, he felt there was no way we would ever find the root cause and I would just have to live with it. That is sort of like your "medical wasteland" comment. It is interesting that you have never had elevated PSA, as in most cases of prostatitis as clinically significant as yours, elevated PSA is almost always a result.
Have you considered curcumin? There have been many anectdotal accounts of that providing some relief, presumably due to its anti-inflammatory properties. There have also been some studies showing that COX-2 inhibitors (which are anti-inflammatories) such as Celebrex and Arcoxia can provide some relief for prostatitis. You may want to ask your urologist about that. These are available over the counter in Thailand, but there are certain predisposing health considerations to be considered before prescribing them, so I think consultation with a physician would be a good idea before you try self-medicating with those.
COX-2 has also been shown to play a role in PCa. You can learn more with some googling.
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Now I realise that Dr Sumeth Onwandee, head of the Urban Institute for Disease Prevention in the northern Thai capital, prefaces his name with a 'Dr', but is he actually a physician? Look at this statement:
He said that foreigners tend not to have resistance to the legionella bacteria that causes the condition.But he added that Thais thankfully have a natural resistance to the bacteria.By "resistance" I assume he means immunity. Humans are not born with a "natural" immunity to a pathogenic bacterium, depending upon the national border within which they were born. Immunity is acquired by exposure to the pathogen with subsequent development of cells and processes that present an immune reponse specific to that pathogen.-
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On 6/11/2018 at 12:32 PM, lkn said:
The check-in staff are not agents of Thai Immigration so I sincerely doubt they’d prevent you from flying to Thailand just because they *think* that you may not be granted entry, they have no way of knowing this, and they are not liable for passengers who do not get entry.
Though as a courtesy/service, they will ask if you have proper VISA to stay in Thailand, etc. Has happened to me many times that they asked about my VISA situation and if I was aware I could not stay more than 60 days on my tourist VISA (before I had a PE) etc.
I would tend to disagree that asking about a visa is a courtesy. With every flight back to Thailand for at least the last five years, each and every airline check-in agent has noticed that I did not have an outbound flight and asked about my visa. I travel a lot and have a passport full of stamps, so they often need help in finding it. I have asked about this several times and they told me no outbound ticket, and no visa = no boarding the flight. Most recently, I have noticed that several agents (Asiana was the last) actually entered my visa details into the record at their terminal.
In your case, it appears you did have a visa, so no outbound ticket is required. If you were planning to enter on visa waiver, without a visa, you would be required to have an outbound ticket.
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Suggestion to the moderator: Since we are really talking about PSAs, MRI and the associated diagnoses anywhere in Thailand, might it be a good idea to move this from the Chiang Mai local category to the general Health and Medicine category?
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16 hours ago, elektrified said:Any recent experiences on prostate MRI's?
I had planned on going to Pitsanuvej to get the 3T MRI but was hesitant based on Dante's experience. I spoke to my doctor the other day about it and he did not seem interested in an MRI from anywhere other than CMU or 3 locations in Bangkok. He said it is more important to have the T-1.5 technology performed by experienced radiology technicians and interpreted by qualified radiologists (like his colleagues at CMU) than new technology interpreted by radiologists he has never heard of before. That makes sense. He didn't even know Pitsanuvej had 3T MRI.
I inquired today at both Sriphat and Suan Dok which share the same equipment and same radiologists and technicians. Sriphat is 25,500 Baht and Suan Dok is only 2-3 thousand Baht less but with a 3-4 month queue. I believe that is with contrast dye.
I did overhear one technician say that Bangkok C.M. Medical Center offers prostate MRI (T-1.5). Has anyone had a prostate MRI there? If so, how was the experience and what was the cost?
Thanks.
At the risk of getting a bit lengthy, I do have some experience with prostate MRIs.
For several years, I have had significantly fluctuating PSAs. That is, as high as 11 and then back down to 5.2. I was treated a couple of times with antibiotics (a month of Cipro) and PSA would go down some, and then back up and then back down. Another time, Cipro didn't push it down much. My urologist had a gut feeling that this was a case of non-specific prostatitis and didn't think it was a cause to suspect prostate cancer,(PCa) so we just kept watching PSA every three months. After almost two years of that, he referred me for an endorectal coil 1.5T MRI with contrast. The radiologist said no suspect lesions...completely clear with no areas of concern. But...the PSA kept swinging up and down. My urologist still didn't want to do a biopsy, but sort of seemed puzzled and told me to go get a second opinion. I did that at another hospital and this urologist seemed puzzled as well. I do have a large gland, at around 100 cc, and one thing I have learned over literally years of my own research is that a larger gland means you produce more PSA. Being 18 months after the initial MRI, I asked that urologist about whether I should do another MRI and what might that tell us. I was astounded as I sat in his office and he literally went to his PC and started googling prostate MRI and PIRADS scores (more on that later) and he didn't really have an answer. So, cancel that urologist and I decided to take things into my own hands. Through my own research, I learned that 1.5T MRI does not render the resolution necessary to clearly render a small lesion and allow for a reliable PIRADS score. Fortunately, I have an academic background that includes biochemistry, so I was in a slightly better position to understand the literature than some, but admittedly not to the level of a urologist or radiologist.
PIRADS is an acronym for Prostate Imaging and Reporting System. PIRADS has a set of rules that standardises the way a radiologist assesses a lesion that he/she observes in MRI images. The scale runs from 1 to 5, with 1 being very low with clinically significant cancer highly unlikely, to 5 for which clinically significant cancer is highly likely.
I then phoned all the larger hospitals in Bangkok and spoke with techs in their radiology department. I did find a 3T MRI and they could do prostate imaging with contrast, but I did not find their level of expertise to be all that encouraging. As I had a business trip coming up to Honolulu, I decided to enquire there, found a hospital that seemed experienced and competent with 3T MRI for prostate and elected to self-pay for one there at a cost of US$1100. The report came back with a lesion identified by the radiologist as PIRADS 4 – clinically significant cancer is likely to be present.
Now as part of all the reading I have done over the last two years regarding prostate MRI, I have learned:
- 1.5T MRI is not currently considered to be adequate for identifying or ruling out lesions with a high degree of confidence.
- Even with 3T MRI, some instruments produce superior resolution. Also, the good news is that an endorectal coil is not necessary with the better instruments. What a relief that is.
- The skill of the techs in producing the images is very important. In other words, the best MRI with techs that do not know how to use it can result in a marginally useful set of images.
- Very importantly, interpreting these contrast images is very complicated and the radiologist may or may not have the skill set and experience to do a superior interpretation. No radiologist is a jack of all trades, the same as a surgeon.
So, I was given a PIRADS 4 and nearly any urologist would immediately go to a biopsy. Damn. But....and again from doing a lot of reading, I realised that a second opinion is necessary because I had no idea of that radiologist's expertise in prostate MRIs. I came across the name together with numerous publications and references to a radiologist in the USA who had devoted the last decade of his practice to prostate imaging, and he did second options. He has performed more than 5000 prostate MRIs and just completed his 1000th in-bore MRI biopsy (more on that later as well) I obtained all the imaging data on a CD from the hospital in Honolulu, uploaded it to Dropbox and obtained a second opinion from him. I then had a one hour Skype call with him and he reviewed the images with me as well as the original radiology report in great detail.
His findings:
- The instrument used was a superior, high resolution instrument and yielded very good high resolution images. His opinion of 1.5 MRI was that it is not very useful for PCa assessment with a high degree of confidence.
- The techs were not great at what they did, but the images they produced were adequate.
- And the best part: he revised my PIRADS score to 2. His opinion was that the radiologist had misdiagnosed an area of chronic inflammation as PCa. He said he had commonly seen this and in his words "that radiologist just didn't know what he was looking at". A bit surprising to hear that from one physician being so critical of another physician. He also told me that this had likely been present for years and the 1.5T MRI that I received in Bangkok had completely missed it.
- He did not recommend a biopsy at this point and told me he would not even do one for me if I asked him to do so. (I liked that degree of confidence).
- But...this sort of chronic inflammation is still cause for concern, since after some time it can result in a malignant lesion, he had seen this happen, and I would have to live with active surveillance for the rest of my life.
- His recommendation: continue PSA testing every four months for the next year. If I see each PSA getting higher, get back in for another MRI. If I do not, follow up in one year with another MRI and keep up with the PSAs as an indicator.
- My current PSA is 6.5, which he said is completely normal for a prostate of 100 cc, or about twice the average volume for a man of my age. His words: 'nobody should be using a one size fits all PSA to indicate risk, because we must take into account the size of the prostate – a bigger prostate makes more PSA".
He referred me to a New England Journal of Medicine publication from March of this year stating that MRIs should be performed before making the decision for a biopsy. This can prevent unnecessary biopsies (which do carry risks as well as over-diagnosis and over-treatment, including unnecessary radical prostatectomies ) and if PCa is detected, the suspicious area is highly localised to better target a biopsy. He also told me that the real gold standard for biopsies now is an in-bore biopsy, where the patient is biopsied while in the MRI tube in order to get a very accurate area for the biopsy. This can mean fewer needles (he sometimes only does 2 - 3 rather than the usual 12 - 18) and knowing where to shoot them means better certainty of actually hitting a PCa lesion.
I have omitted some details including names and hospitals in the above. If I can help you with any ideas or further details, please send me an IM and I would be happy to talk with you about my experiences.
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Here's a nice summary of the air quality situation, from a talk given at the Informal Northern Thai Group:
"Chiang Mai Burning Season: What new data can (and can’t) tell us about the problem”.
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5 hours ago, EricTh said:
I've been looking for those soya sauce without MSG for quite some time. Most do have MSG.
Where can I buy this Megachef?
I buy it at Rimping.
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59 minutes ago, Rimbuman said:
Pretty much all of the soy and oyster sauce that is being used contains MSG, so even if they say it's not in the food, it will be in the food anyway. Hardly anyThai/Asian food without soy or oyster sauce, although there could be a difference between naturally occurring MSG and the processed MSG crystalline stuff.
Most soy sauce also contains wheat, which of course is not good for people who require a gluten-free diet.
Fortunately, there is one company in Thailand that makes gluten-free soy sauce that contains no MSG as well:
Their fish sauce also contains no MSG.
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10 minutes ago, lordblackader said:
Well, being able to spell Promenada properly would be a start ?
A map is irrelevant - you type "Promenada" into the app, it gives you "Promenada," you tap "Promenada" and magic - you've told it where you are going. It's not rocket science and it's certainly not the app.And for the record - I've been back and forward from Promenada plenty of times using Grab with ZERO issues. Maybe I'm a secret rocket scientist? ?
Respecting that you are a potential "secret rocket scientist" and may succumb to auto-spelling, I do appreciate your pedantic reply; however, the point that many are making here is that compared to Uber, the Grab app is extremely lacking in a complete POI database. When the POI is not there, the user must manually select the destination point from the map and that is not an effective and user-friendly feature for those who are not already familiar with the city.
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20 hours ago, lordblackader said:
1. you can contact them to add a specific condo - I know, I had them add mine.
2. if you can't get Grab to find Promenada the problem isn't the app ?
When you first arrived in Chiang Mai, could you find Promenade on a map?
What about a tourist who wants to go to Promenade?
Yes, the app is the problem.
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16 hours ago, Kohsamida said:
Ive had issues with BOTH pick up and destination. Today I tried to book for a pick up at Maya. The Grab app put my pickup point about almost 0.5 km east on Huay Kaew, and on the westbound side when my destination was in the Old City, with no way to adjust pickup point. Needless to say, the driver couldn't find me as he was looking for me down around Bikky Bike rentals!
The Grab App is complete trash, and of course, Grab Support staff act like this is all news to them. Really have an intense dislike for big-company attitudes towards their customers! All I can say is Google Maps is the way to go.
Another tip though: Be sure you shut down the Grab App before using Google Map, otherwise Grab will not accept info from Google Maps correctly. That's how I got screwed at Maya!
Just an interesting fact: Uber spent millions of dollars developing their app and mapping system. They even paid for special satellite usage for ultra-precise positioning. The way they integrated Google Maps' database into their own destination look-up feature was outstanding. You'd think if Grab has bought out Uber/Asia they would utilize all of this. Maybe, in time.
Well you could have dashed across the superhighway so you the driver could find you, and even better if it was raining! But seriously, this is not only an issue of convenience, but also one of safety when riders cannot even select the correct pickup location and must dash across traffic to be at the point that Grab selected for them.
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I am having the same experience as many others have noted here regarding pickup and destination locations. Note that there was already a thread in the Chiang Mai section regarding Grab experiences:
https://www.thaivisa.com/forum/topic/1035678-grab-in-chiang-mai/
It's not just riders, I am hearing the frustrations of drivers who have converted from Uber who cannot find their pickups. They are becoming increasingly frustrated with wasting time driving around looking for their pickup, since the app has selected an incorrect location. Many do not have to English language skills to speak with the rider concerning pickup and destinations, which was one of the big advantages with Uber. If a tourist wants to go to, say, Promenade, they type that search in English and Grab doesn't find it, how are they supposed to find it and pin it on a map if they have no idea where it is? I have heard former Uber Grab drivers say that the app is so ineffective and they are wasting so much time with locating pickups and requested destinations, they are seriously considering giving up on it.
Here are some other comments I posted in the earlier thread:
- Unlike Uber, Grab did not plot the route to my destination, so you have no way of knowing whether the driver is taking the most direct or correct route.
- My position on the map while enroute did not update, but lagged by as much as several minutes.
- You don't get all those interesting driver details like Uber did, but we can live without that.
- Yes, Grab was far more expensive compared to Uber for the same trip, by about 35%, but it's still relatively cheap.
- The emailed receipt details from Grab were in Thai (too bad if you do not read Thai) and didn't show the route taken, as Uber's receipts did.
- I didn't have a driver route problem, but after my ride just to check out the app, I looked into how to obtain a fare refund or adjustment for a driver taking a poor route. That was simple with Uber and they always promptly responded with a resolution. Tapping "Report a Past Issue" you get taken through a series of Help Centre pages in broken English only to find out that there is no apparent way to make such a request. In fact they seem to admonish the rider by saying "In every ride, we advise you to drop your preferred route in NOTE TO DRIVER so driver can follow your request". Sure, and what if you are not a local and have no idea what the route should be? Keep in mind that the route is not plotted on the rider's map so you have no idea where you are or which route the driver is taking.
- Popup adverts...why? I am already paying to use this service.
I have yet to receive a discount promotion from Grab, while I used to get them once or twice per month from Uber. The Grab driver I had told me he used to drive for Uber but now on Grab he gets a fraction of the rides he used to get on Uber and was reconsidering driving for Grab at all. He said he found the Grab app not as easy to use and found it more difficult to locate his pickups, probably because the mapping and locations database are both inferior to Uber's.
If Grab wants to keep or grow both riders and drivers alike, they need to devote some serious attention to fixing their app. I have a car but often used Uber for convenience when going to places where parking would be difficult. I think I will be doing more of my own driving now.
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2 hours ago, CMsojourner said:
While it’s not an app, according to the RTC FaceBook page you can still see the Route 3 bus stops (including the next bus’ current whereabouts) on a desktop computer -or -on a mobile browser with a data plan: http://chiangmai.yusai.asia/app/#/app/map
Thanks for searching that up and it works fine even on an iOS device...who needs an app!
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Was just looking for the CM Transit app that Nancy mentioned and it appears that the app is Android only and does not have an iOS version.
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I just tried Grab yesterday for the first time, having used Uber a lot previously. Compared to Uber:
- The Grab map location database contains only a fraction of what Uber's contained. That means you will often have to find your own pickup and drop-off locations on the map.
- Unlike Uber, Grab did not plot the route to my destination, so you have no way of knowing whether the driver is taking the most direct or correct route.
- My position on the map while enroute did not update, but lagged by as much as several minutes.
- You don't get all those interesting driver details like Uber did, but we can live without that.
- Yes, Grab was far more expensive compared to Uber for the same trip, by about 35%, but it's still relatively cheap.
- The emailed receipt details from Grab were in Thai (too bad if you do not read Thai) and didn't show the route taken, as Uber's receipts did.
- I didn't have a driver route problem, but after my ride just to check out the app, I looked into how to obtain a fare refund or adjustment for a driver taking a poor route. That was simple with Uber and they always promptly responded with a resolution. Tapping "Report a Past Issue" you get taken through a series of Help Centre pages in broken English only to find out that there is no apparent way to make such a request. In fact they seem to admonish the rider by saying "In every ride, we advise you to drop your preferred route in NOTE TO DRIVER so driver can follow your request". Sure, and what if you are not a local and have no idea what the route should be? Keep in mind that the route is not plotted on the rider's map so you have no idea where you are or which route the driver is taking.
I have yet to receive a discount promotion from Grab, while I used to get them once or twice per month from Uber. The Grab driver I had told me he used to drive for Uber but now on Grab he gets a fraction of the rides he used to get on Uber and was reconsidering driving for Grab at all. He said he found the Grab app not as easy to use and found it more difficult to locate his pickups, probably because the mapping and locations database are both inferior to Uber's.
I have a car but often used Uber for convenience when going to places where parking would be difficult. I think I will be doing more of my own driving now.
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So I found a book listing on Amazon by someone called Ken Albertsen :
About the Author
Ken moved to Thailand from California in 1998 with no prior connections. His sense that making friends there would be easy was borne out, and he plans to stay for the long term.
When bored, he goes out solo to one of the surrounding cliff faces to 'free climb.' Besides writing, he's developing a homestead on rural property north of Chiang Rai. A previous title is "Metaphysical and Paranormal Hocus Pocus" subtitled; why people embellish reality with myths."
The book is entitled "Lali's Passage".
Novel based on true some true memoirs - revolving around Lali, an entrancing young Burmese lady. Lee helps her escape from servitude at a Thai massage parlor, they travel to Europe and on to California where he loses track of her.
Sort of ironic, isn't it?
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Just now, edwardandtubs said:
Not scared of needles but as I've never needed to in the past in spite of multiple claims on Thai Visa that it's necessary, I see no reason to start doing it now.
Ok, that's good.
So now you have a "claim on Thai visa" that the blood test was necessary. I have no reason to misrepresent that. I am only offering my experience in the hope that it might be helpful to others who may be headed to the same office where I do my WP, where I was told it was necessary.
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2 minutes ago, ubonjoe said:
I cannot find that info here. http://www.mfa.go.th/main/en/services/4908/15388-Non-Immigrant-Visa-"B"-(for-Business-and.html
I only mentions a work permit is required.
I believe those are the the requirements from the Ministry of Foreign Affairs for a non-imm B visa.
A work permit is an entirely different application under the authority of the Ministry of Labour. They are the ones that require a medical certificate for their work permit application.
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31 minutes ago, edwardandtubs said:
Clearly the customer facing people at One Stop don't actually makes decisions about whether to accept or reject an application. I've never heard of anyone who has been rejected in Bangkok with a medical certificate with all six diseases. It depends how strongly you feel about giving blood for no reason.
Really? You know of someone with all six diseases on their medical certificate and they didn't get rejected? I am surprised that the applicant was able to make it up to the counter.
Your statement "clearly the customer facing people at One Stop don't actually makes decisions about whether to accept or reject an application" is not exactly accurate. I am assuming you have done visa extensions and work permits a few time, as I have for 19 years. For most of those years, no medical certificate was required at all. So when you have done yours, did you notice how carefully they scrutinise every piece of paper and tick off each of the required ones? I do not know whether they are in a position to reject an application, but they are clearly in a position to not accept the application due to incorrect or insufficient paperwork. All I can say is that the last time I did mine (August last year), I asked the officer if the blood test was really required and she said yes it was. That was at One Stop Chamchuri and I have no experience elsewhere.
As for "giving blood", no I do not have a problem with a 5 cc blood draw if it will ensure that my application is not turned away, which would result in wasting another day getting the test done and going back to Chamchuree. Are you scared of needles?
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53 minutes ago, edwardandtubs said:
People have been saying the same thing for years ever since syphilis was added to the list. All I can say is I never had a problem with a form that included syphilis but not the blood test results.
Anyway, I'm sure Bumrungrad know what they're doing so I would just go there and accept their expertise.
But requiring a blood test for syphilis has nothing to do with Bumrungrad and their "expertise". It is all about the Employment Department officer looking at your paperwork, his/her interpretation of the requirement and whether they will accept your medical form without the blood test. As I mentioned earlier, the officer at Chamchuri One Stop told me it was required. I would rather just go ahead and get the damned blood test rather than risk being turned away and having to waste another day going for the blood test and then queuing again at One Stop.
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14 minutes ago, edwardandtubs said:
The whole thing about requiring a blood test for syphilis is based on a misunderstanding of medicine. The rules very clearly state third stage syphilis and there is no blood test for that distinct from stages 1 and 2. The third stage of syphilis is the final stage before death where you would be showing obvious symptoms like loss of balance and insanity. The last time I got a work permit I brought in a blank medical form with those six diseases to a clinic. The old doctor knew straight away what he had to do to test for third stage syphilis. He asked me to look up and down, stand up, walk to the door and walk back. Anyone with third stage syphilis would be stumbling about all over the place. This doctor was actually very thorough, carefully doing his best to establish that I was in fact free of those six diseases. It cost 80 baht and was accepted by the work permit office. This was a couple of years ago.
However, I did go into two other clinics and they refused to fill in the form I gave them, instead insisting they do their own form which included an overpriced syphilis test.
This was all in Bangkok. It's obvious that in some provinces you definitely need a blood test.
A few years ago I went to Bumrungrad Hospital and the doctors there are knowledgeable enough to know there is no blood test for third stage syphilis so they will give you a physical examination and a form that certifies you free of all six diseases. It cost about 800 baht but if I had to get a work permit in Bangkok right now, that is what I would do.
I know exactly what you are saying and I even brought it up with the clinic doctor. He assured me that the blood test was required (this was almost two years ago) although it had not been previously, so I did it. Later, I asked about that from the officer at One Stop Centre in BKK and she confirmed the blood test was required, although she may have said that because I asked. I did the blood test again the new renewal, just because it would be a real PITA if they refused to process my renewal without it.
Who knows what the requirement is at other locations or how it is interpreted.
Trip to songhkla
in Southern Thailand
Posted
Agree with the recommendation for Mermaid over BP Samila. It's newer and nicer I think, but you need your own car if you stay there since there are no restaurants or shops within easy walking distance. If you do stay there, ask for an upper floor room and you will at least have a partial sea view.