PMNL

The taiwanese chickenpox vaccine is expected to be available early 2015, the GSK has problem with contamination on their production line and will not be able to supply chickenpox vaccine throughout 2015 as well as the DTap, DTaP IPV, DTaP IPV HIB and well as DTaP IPV HIB and Hep B.

So I don't think it's a 3rd world country's problem really.

http://mobile.in-pharmatechnologist.com/Regulatory-Safety/Chicken-pox-vaccine-shortage-likely-after-problems-at-GSK-plant#.VGh3zYpXec0

everyone has access to government hospitals.

What the poster perhaps meant to day was free access to vaccines at government health facilities.

These may or may not be better supplied, depends on which supplier they use. Govt hospitals in my experience have less flexibility in terms of changing whom they order from than do private, as procurement is centralized and bogged down in bureaucracy.

I have been refused fluvax at the Chiangrai Hospital even on a pay for basis as the people administering the needles say it is only for Thai people. My only complaint about the hospital. Sadly the vaccine they use at the private hospital while not out of life is not the one covering the last few outbreaks as it is nearly a year old.

Not good as I am in a vulnerable group.

The Flu shot at govt hospitals are free Only for those under universal coverage so they won't give it to you though you willing to pay for it. Chiangrai has quite decent private hospital( not to western standard obviously) I doubt it very much if they offer expired flu shot out or old series which also mean expired technically. You can always check on the sticker or label comes with the vaccine. Unless they don't have one for your age group that's another story.

The vaccine is quite easy to get in Thailand, less than 1000 THB.

Have a look at Sipental 400 by Siam pharmaceutical. It is normally a good generic substitution, not equivalent, which work well for claudication. You should talk to your dr about changing over though, there might be condition or medication interact with it.

FYI

Information from the MSD thailand, from the drug representative I know.

Talk to her and give her the right information as much as you can, this is a controllable disease to date and all the new ARV is very effective and much less side effect than decade ago. You can live almost a normal life only have to be very faithfully taking the meds and avoid any bad habit that might reinfected yourself with different strain and avoid bad behavior.

She obviously needs to go see doctor, get all her baseline lab work done like CD4, viral load and if the viral load is high, the genotype testing would also a good idea, initial metabolic

panel will help for future follow up once she on the ARV.

Psychological support and understanding are very important for this diagnosis in my opinion.

I was just in California last week and enquired at a Walgreens. The pharmacist told me their price was $230, and only available without a physician's prescription to those under 60 yo. Younger than 60, they need a prescription.

She also went on to explain that this is a very delicate vaccine. It comes on two components - one is a powder that must be kept frozen at all times, and then carefully mixed with a diluent just before injection. This all sort of makes me wonder whether the bargain price vaccination clinics in Thailand are handling the vaccine properly. Or worse yet, that they are genuine.

There are two components on the vaccine and both should be kept at 4-8 degree Celsius. No freezer required. Surely you can check out http://www.merck.ca/assets/en/pdf/products/ci/ZOSTAVAX_II-CI_E.pdf

I don't know where the pharmacist get the wrong information from.

Well, she was a qualified pharmacist and was the person giving the Zostavax vaccines, so I took what she said as accurate. I dunno, maybe she got her information here, where it says:

To maintain potency, ZOSTAVAX must be stored frozen between -58°F and +5°F (-50°C and -15°C).

Or maybe here, where it says:

Lyophilized zoster vaccine must be kept frozen at -50 to -15°C.¹ (See Storage under Stability.) Reconstitute immediately following removal from the freezer.¹

Surely you can check those as well, and then reply with your own professional judgement.

You are right, and it was instructed on the website, my apologies to you and your pharmacist. Will attached the photo of the instruction on the Zostavax imported by MDS thailand where I have the information from. It says to keep at 2-8 C or colder so I guess colder could be at the temperature mentioned on the Merck website.

I was just in California last week and enquired at a Walgreens. The pharmacist told me their price was $230, and only available without a physician's prescription to those under 60 yo. Younger than 60, they need a prescription.

She also went on to explain that this is a very delicate vaccine. It comes on two components - one is a powder that must be kept frozen at all times, and then carefully mixed with a diluent just before injection. This all sort of makes me wonder whether the bargain price vaccination clinics in Thailand are handling the vaccine properly. Or worse yet, that they are genuine.

There are two components on the vaccine and both should be kept at 4-8 degree Celsius. No freezer required. Surely you can check out http://www.merck.ca/assets/en/pdf/products/ci/ZOSTAVAX_II-CI_E.pdf

I don't know where the pharmacist get the wrong information from.

Yes, I too got it for around $50 (give or take) at a pharmacy in the US, no doctor visit required (this may vary by state though). Penumococcal and I think flu vaccines can be gotten the same way.

Pneumococcal should be given at least 4 weeks apart from the Zostavax.

The Flu is safe to do so.

I bought a manual single auger juicer at the pharmacy near the supermarket in bottom floor Central Airport, i juice carrot, apple, beetroot and greens with no probs, its only 1450baht. i have a twin gear green power $600+ juicer back home and this does the same job

Thanks.

Where do you get your beetroot here in CM? [/quote

MuangMai Market further down from American consulate, walk into the market you will see a small intersection, take right and walk though all the smelly chicken and pickled shops, then you will see one shop on your right selling carrots beetroot, veggies in big bags, go straight to their fridge: Never fail to find the beetroot there and at a good price.

Used to see at Robison not sure if they moved to Ban and Beyond, or look for Hurom on true select. Blender heat up all the veg and Fruits cause so much oxidation by the time you get to drink it. Slow juicer seems a better choice in my opinion.

Always am amused by the "pesticide safe" label in Rimping.

huh?

And now they have Rimping select label with the golden shiny sticker, look marvelous on their products but again means nothing apart from higher price. The pesticide free ones are also meaningless.

Having said that there is a true certified organic products available, very limited choices and quantity.

Yes they do apparently, but what happens if you are international traveller-move around several states / provinces/countries? If you unfortunately need another endoscopist to look at the same issue at different institution? Having your own medical record, at least lab work and imaging, is always do you good in my opinion.

At Ram you get excellent digital copy of the taken pictures as well as print out in good quality. At Rajavej you get a print out unless they have changed lately. English communication is better at Ram >Stiphat> Rajavej if that matters. Equipment Ram=Sripaht > Rajavej. No experience with Bangkok chiangmai yet.

You get an excellent digital copy ? And what use is this to you? Perhaps emailed to friends and family ?

Certain condition like ulcerative colitis , Crohn's disease, tropical sprue, polyps or even diverticulosis needed a frequent follow up colonoscopy thus having a digital copy or a print out pictures is crucial for future comparison to evaluate dr's treatment and so on. Using self experiences to judge others isn't make you a better person I am afraid.

At Ram you get excellent digital copy of the taken pictures as well as print out in good quality. At Rajavej you get a print out unless they have changed lately. English communication is better at Ram >Stiphat> Rajavej if that matters. Equipment Ram=Sripaht > Rajavej. No experience with Bangkok chiangmai yet.

I also can not comment on how sterile the needle was but I can tell you most health care places nowadays use disposable needle syringe and even the blood tubes! So for the safety I personally don't think you are at any risk.

Do not really understand the part pouring blood from one to another vial though, if it was standard blood tube, in which normally contain clotting activator, EDTA, NaF, Citrate, heparin depends on the test needed as Sheeyl mentioned, then it would definitely interfere with the test results. Unless they use substandard recycle or just plain tube/simple glass vial then it's ok to pour from plain tube to the others, as long as it does not clot then.

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

Specialists would mostly be seeing people ALREADY infected, correct?

PrEP is about reaching people NOT YET infected.

A different population.

According to earlier post, it is available here and not particularly expensive. In Bangkok anyway.

What about all over Thailand?

Where is the public information campaign about this option?

Does it exist?

27. TDF 300 mg + FTV 200 mg (Original)

Trade Name: Truvada

Price/Tablet: 70 THB

Price/Bottle: 2,100 THB (30 tab)

28. TDF 300 mg + FTV 200 mg (Generic)

Trade Name: RICOVIR-EM

Price/Tablet: 34 THB

Price/Bottle: 1,020 THB (30 tab)

Government policy?

So government policy is not to pay for Truvada or the Generic?

Why is that?

Is there something wrong with the Generic?

Again, I still suspect Thailand is behind on this issue of PrEP for whatever reason(s).

No, I don't know that for sure, but I don't think you shed much light on this either.

I really would like to understand.

Based on the WHO many infections in the world (and of course Thailand where HIV rates of infection are high in high risk groups) would be prevented with use of PrEP in high risk group people.

If this lack of PrEP for the higher risk population is only about cost savings ... well, treatment of the infected is a lot more expensive.

.......................................................

Don't you think the partner of the infected patients go see doctor too???

They, well, in reality do, not all unfortunately because some of them not being told by the infected partners.

Regarding the government meds,

generic Atripla, which is used for PrEP and costs only over a thousand bath, is not used in the government regimen what so ever! Reason being said too expensive, compared to the local GPOVir family which cost abound 5-600 bath/month, and the national drug committee do not list the meds in any category Of government drug list! So if you have any question you can contact this people and ask them. I am not the one who make a decision what to use what not to use I simply state fact so people know.

As said the meds is not available for public health care what is the point of advertising the options there ? This is killing them doctors inside out knowing there is a better meds but they don't have option to prescribe for their patients being infected or PrEP.

In private section, you pay cash you can access any meds you want so there is always option there. Don't know if there is any campaign normally most of any health campaigns are done by government sectors.

So if you call that 'behind' I would have agreed now.

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

Never knew the T3 is available in thailand. If the pharmacy sell you one and claim it was T3 please check on the package or bottle before leaving their shop! The only T3 available is a pig thyroid extract, which is a combined T3 and T4, called Thyroid S by Sriprasit and Thyroid by greater pharma.

Not available but you can take doxycycline which is available locally instead, Google doxycycline and malaria prevention for more information, CDC is good site.

Available at most private hospital and perhaps internist clinic. Need to see doctor for the prescription as you know it is enoxaparin, blood thinner, Very unlikely to be available as OTC, if any of them chemist dare you sell you one, you should be very skeptical on using their services for anything else.

Zostavax is now available in chiangmai.

Has anyone been treated in Chiang Mai for paroxysmal atrial fibrillation. Would appreciate any feedback. Thanks

Never have even lone AF and obviously never have been treated. Can only advise you who to be seen, Dr. Wanwarang, a lecturer & excellent clinician at CMU. As you know the treatment choice is based on the age group, onset of the AF and any previously failed treatment ? As well as risk of stroke/systemic emboli. I know that the lady cardiologist does have good experience in both pharmacological cardioversion and electrical cardioversion. She is also available at RAM.

Note: if you want excellent cardiologist to take care of your cardio-issue need, look for them from university hospital.

There are two RIA, one is the dirty one as the other poster said which is not a branch of accredited BKK RIA, another is new to town, located at the avenue star on Mahidol road. They are a real brach of the well know accredited BKK RIA.

No idea if they are clean, haven't used them.

The last I heard, a couple of months ago, he doesn't do Sriphat, only Ram.

He is still available at Stiphat only for surgery, not for consultation.