lsemprini

Thanks! Yes odd no other responses to a topic that has historically been popular on this forum.

My long-diagnosed herniated disks (lumbar, L5/S1) are getting way worse and I need a new MRI and investigation. Quite likely surgery, hopefully the minimally invasive type (laminectomy as opposed to ACDF/Fusion or worse). Can someone recommend a doctor/surgeon they've had actual good experience with in Chiang Mai? Ideally someone who doesn't immediately jump to assume surgery is the best but who also has well-researched knowledge about the likely long-term effectiveness of more conservative treatments. Thanks.

Ok, well one more datapoint. I finally tried some Sumigran. I can say that it worked, but clearly it is somehow chemically different from the expensive Imigran/Imitrex even though both pills are supposed to be the same 50mg sumatriptan. I had some mild headaches over a week and used 6 doses, 50mg a day. The headaches did go away, but seemingly a little bit less quickly than with 50mg Imitrex and, more to the point, I didn't get the same distinct "nasal passages opening" feeling that I get 100% of the time with Imitrex when the medicine is finally working and the pain is receding. While possible, it seems unlikely that the difference in "nasal passages opening" feeling is due to differences in the non-active ingredients between the brands. This leads me to wonder if the Sumigran really has 50mg sumatriptan, or any sumatriptan at all, or if Imitrex has something extra. If Sumigran has some other substance, I wonder what substance. Wish there was an easy way to test the contents, or an FDA that we could trust to test for us. Eventually I will try it for more severe headaches to see.

By the way, a little off-topic but sharing with this group of migraineurs. I recently received some advice on meds to use for migraines from a Harvard Medical emergency doctor friend of mine. These are the treatments he used for his patients and also his migraneur wife. I ran these by another friend who is a neurologist and she says this is sound advice (with the only caveat being that some migraineurs are not so much struggling with how to abort their current headache, which the advice below focuses on, but rather have the problem of headaches coming back in subsequent days in a cycle, which the meds below do not address but also do not make any worse). I have not tried any of these (other than sumatriptan) and don't know which are available in Thailand, but thought the advice might be useful to this group. Be sure to do your research before trying any. ----------------------------------- BEGINNING OF QUOTE: On the migraines, yep, avoid caffeine, except that it can be an effective abortifacient. Here are the tools you should have in your medicine cabinet. All can be taken simultaneously with no safety risk. You should use injectable or nasal sumatriptan at the earliest sign of a migraine. Injectable sumatriptan is far more effective than the oral form. The nasal form is not as effective as the injectable form, but is much more effective than the oral form. So efficacy is injectable > nasal >>> oral. (Those are “greater than” signs.) Prochlorperazine (Compazine) is a fabulous migraine abortifacient. It can cause some people to feel jittery or have a weird cramp in some part of their body...this is NOT dangerous but can be frightening...this side effect is easily treated with diphenhydramine (Benadryl) [though it is NOT an allergy], so, often, we just go ahead and presumptively give a Benadryl tablet or ½ a tablet when we administer prochlorperazine. Take prochlorperazine 10 mg (perhaps with a half or whole tablet of Benadryl) at the earliest sign of a migraine. [Those of larger physical size e.g. 100kg] may need to take 20 mg of the prochlorperazine, and that’s fine, so don’t hesitate to repeat the 10 mg dose after 20-30 minutes if no effect. Metoclopramide (Reglan) is another fabulous abortifacient. The aforementioned side effects can occur as with prochlorperazine, though somewhat less commonly. Dosing is the same, and this medicine is so safe that it doesn’t even matter if you take both together. For clarity, it’s okay to take sumatriptan + prochlorperazine 20 mg + metoclopramide 20 mg + Benadryl, all at the same time. Of course you should figure out the lowest possible number of medications and the lowest possible doses, because we always want to avoid these chemicals, but I just want to be clear that I’d rather you take the above than have to go to the hospital and face that horror show. Caffeine and NSAIDs are very effective abortifacients, but you face the risk of rebound. For some people who get migraines infrequently, some caffeine and a couple Aleve tablets does the trick. When my wife feels a migraine coming on, I give her 10 mg of metoclopramide and 1-2 Aleve tablets, together with a diet coke if it’s not bedtime, and this is almost always curative...almost instantaneously...usually after 10-20 minutes. It is okay to take caffeine and NSAIDs together with all the other medicines (sumatriptan, prochlorperazine, metoclopramide, and diphenhydramine). It’s a rare migraine that doesn’t get crushed by this combination, though usually just one or two of these meds is needed.

Interesting...to be clear though, does your other half also feel that original sumatriptan (Imigran/Imitrex) does not work? In other words, is the objection against sumatriptan in general or the generics Sumigran/Siagran specifically?

Interesting points, but even for motorbikes, surely there are things a technically knowledgeable person could check for that could benefit a non-technical client? For example, when purchasing a used motorbike it seems the biggest ticket item would be when the engine needs to be rebuilt with new seals (often costing 5000-10000B, which might be near the purchase price of the motorbike)...surely there must be some tests a mechanic could run that can predict how close this event is more precisely than just smelling for smoke when you turn the motorbike on? I've seen several bikes that had no visible/smellable smoke on purchase but that required engine rebuilds within 6 months of purchase....avoiding that would be a valuable service potentially worth thousands of baht.

That's the problem---for someone who is not familiar with the technical details of auto maintenance, they have no idea what that list would contain, and they have no way to tell which mechanics have experience with their vehicle type. This is exactly the dilemma for non-technical people who want to evaluate a potential purchase. If they already knew those things, they wouldn't need to hire a third party inspector (at most they'd need to visit a shop and order up specific tests they already know about). And yes as gamb00ler said, it's not only about being ripped off, but also a question of finding a mechanic with vaguely the same standard of what is acceptable wear and tear vs. what is a red flag that should dissuade one from purchasing. If some entrepreneur takes up this role and establishes themselves with positive reviews from non-technical used vehicle owners who are happy with their purchase even in the long-term, then that entrepreneur would make a lot of money. Especially if they can offer the service in English and meet the needs of farang vehicle owners.

For people who are thinking of buying a used motorbike/car but who are not auto mechanics experts, is there some kind of trustable service in Chiang Mai that will give an unbiased (meaning not in cahoots with the seller) evaluation of a car/motorbike for a fixed fee? Something similar to the AAA vehicle inspection service in the US. Ideally the service provider would have access to equipment needed to make a good inspection that goes beyond superficial things like looking for smoke coming out the exhaust pipe. Where to find such a service and how much? One good location would be near the large secondhand vehicle markets in Chiang Mai. My friend is looking now and I've seen people ask about this multiple times before...clearly there is a market for something like this. But so hard to know who is competent and actually unbiased...

I found Sumigran at a chain called Fascino in Chiang Mai; looks like they have 3 Fascino in Pattaya too.

No need to import; Lorry was just being helpful by seeing if sumatriptan is available from reputable producers in other countries at that price. Sounds like 15B is actually the market price, not the 150B we've all been paying GlaxoSmithKline even 13 years after their patent expired.

Mostly safety concerns (contaminated meds for example) since I don't know the producer and want to hear from others before swallowing their product. Apparently different types of med have very differing difficulty to produce and different ease of accidentally introducing contaminants or producing the wrong molecule, so even if a producer "gets it right" for some meds, it doesn't necessarily translate to their ability to produce sumatriptan. I have no idea where sumatriptan falls in that spectrum. Second concern would be fake pills that don't have any active ingredient. The price made me suspect that, but sounds like 15B/50mg might be the actual market price (finally seen, 13 years after patent expires).

Thanks! My doc is in the US, so I'm on my own for evaluating Rx Chumchon. So far I've just learned it's a Thai pharma factory put together by a bunch of independent Thai pharmacies. One Thai pharmacist who used to work for Pfizer says he's not surprised about the price difference given Big Pharma gouging, but then again he sold Sumigran.

What went wrong?

Has anyone ACTUALLY tried the new Thai Sumigran sumatriptan migrane abortive for a reasonable period of time and what can you report? Does it work? Does anyone know anything about the Thai maker, Rx Chumchon aka "Community Pharmacy Public Company Limited" ? I have been purchasing GlaxoSmithKline's pricey Imigran/Imitrex sumatriptan migraine abortive for decades and very interested to see there is now a Thai version. The price is insanely lower, 10x. One headache (50mg pill) of Imigran/Imitrex is approximately 150B whereas 1 headache (50mg film-coated tablet) of Sumigran is approximately 15B. Both are supposed to be 50mg sumatriptan succinate with no other ingredients. The price difference could be due to the insane markups of Big Pharma, or it could be due to corner-cutting and fakery. Glaxo's patent on sumatriptan expired way back in 2009, so either industry collusion kept the price high until now, or there's something dodgy about the local brand.

For future reference, out of the ~20 shops I called/visited, the only one that even has Waves in their fleet is the very nice people at Yayee rental on soi 88 https://maps.app.goo.gl/h8W8F4KkyRy89nCw5 but their bike was out when I was looking (and one of the owners was using the other one!). Seems like a business opportunity for rental places.