ProThaiExpat

Grace Clinic receives raves from most who don't mind paying a little more for world class dental work.  They do it all and I have been a patient there for 12 years and decry the day I try to save money and go elsewhere.

Clearly de facto your marriage is, however in Thailand where there is no same sex marriage recognized in law,  it would not be de jure or in law. In your home country  it is legal or de jure.

Proof of identity is a major issue for many expats dealing with their governments.  I recently was required to prove my identity to obtain a certified copy of a marriage certificate from the County Assessor in San Francisco.  The US Consulate in Chiang Mai will execute a proof of identity document by a consular officer by appointment for $50. If you have the document, the consular officer will have you swear who you are even with your passport and then so attest to it with appropriate seals and stamps on the proof of identity document from any government.

I became ill a couple of years ago and so didn't feel like drinking my usual two cups of wake up strong coffee.  Since I got headaches every prior time I tried to get off coffee I felt like I was truly addicted and that time was a good one to De-caffinate.

I have not knowingly injested any caffeine since.  Upon arising, I drink a moderate size glass of fresh orange juice with pulp and the fructose in orange juice gives me the same wake up boost I used to get from coffee, without the caffeine jitters and stomach false hunger pangs I used to get when drinking coffee.

Clearly ones blood sugar markedly goes down during sleep and raising that blood sugar upon arising would act as a boost. I have known people who have a mug of coffee in their hand during the entire work day and they must have terrible withdrawal symptoms if they ever tried to decaffeinate.

In searching for US bound airfares last week, I was surprised to find that round trip tickets on the airline websites are cheaper than one way.

I suggest you try the airline websites and price both options. After all, you don't need to use the round trip ticket if it is cheaper than one way.

Yes, I get an eye injection every ten weeks. The OCT machine shows an accumulation of blood in my macula at about that interval and I do see visual acuity start to deteriorate about that time. I detect visual acuity loss by covering my other eye and look at a straight line, pole, edge of wall or pipe and if it starts to undulate or waiver in its straight line I know it is time to have an injection. We confirm the build up of blood with the OCT machine.

If you are in Singapore, I cannot give you much help as my experience has been in Thailand and Australia.

I would be surprised if your doctor didn't give you an option of Avastin as an alternative medication.

My doctor has patients who have had to have an injection monthly for two years before it stabilized. Your husband needs to get his mind around a shot every month until his vision returns. I certainly would explore Avastin since the cost of Lucenta medication is astronomical if shots are needed every month. If you have health insurance, the Doctor may have felt there was no economic motivation to use Avastin. You definitely need to go back to a macular specialist and show him no improvement from the Lucenta shot and be guided by his advice.

If your doctor did not do an OCT examination of your husband, he clearly is not using the latest diagnostic tools available. Your husband may have to wait two weeks to detect any improvement depending on how bad his vision was when he received the first shot. He may not see improvement before a few shots. You need to be talking to your doctor about what to do next.

Choonpoon: Read my post more carefully. I am totally symptom free, perfect vision in the affected eye after the first shot of Avastin. Perhaps you could tell me more about where you are and who is managing your treatment. Does your husband have wet or dry ARMD. You can send me private message if you wish. If you are in Thailand, I am surprised you are receiving Lucenta injections as they must be very costly.

The only post so far describes an eye problem that is not ARMD (Age Related Macular Degeneration)

Speaking only from my own experience and internet research, ARMD occurs when the tiny blood vessels in the very center of the macula of the eye bleed thus causing central vision blindness. There are two types of ARMD Dry and Wet. The dry version may not involve bleeding.

In my case the first symptom of wet ARMD was when a large black ball obscured my vision in the center of my eye. I could see around the edges of the black ball and many untreated ARMD people learn to live with that limited vision. but I don't see how.

I sought medical treatment with a general ophthalmologist who quickly referred me to a macular specialist. The most advanced diagnostic machine available at Sripat Hospital in Chiang Mai is called an OCT and was made in Germany. It uses sound waves to map the bleed in the macula and displays pictures of the amount of bleed on its computer for the doctor to evaluate.

The only treatment for the wet form of ARMD is an injection of a drop of one of two medicines that originated in the treatment of bleeding in female reproductive organs. Avastin manufactured by Genentech costs about $75 worldwide while the other one costs $2000 per injection from the same drug company and is called Lucenta (sic). Tests last year found them to be nearly identical in chemical makeup and equally effective. Genentech justifies the higher cost of Lucenta as it is US FDA approved while Avastin is not an Genentech paid for the FDA approval and must recover their costs. Last year Medicare in the US paid out more that 2 billion dollars for Lucenta treatments from Ophthalmologists maintain it is a better treatment even at the higher cost. I need not get into the issue of drug companies incentive to doctors to use certain of their products.

With my first injection of Avastin, my vision cleared right up and I have not had any decrease in vision for over two years. However, I do need an injection at Sripat every ten weeks to alleviate the bleed that causes the blindness. I had one injection a month for three months until my condition was considered stabilized and I went on the one shot every ten weeks, the need for the injection is measured by the OCT machine.

ARMD is a fairly common condition and there is an abundance of ophthalmologists in most major cities around the world who regularly treat patients for the condition. There are three such ophthalmologists at Ram in Chiang Mai where I started my treatment regimen but migrated to Sripat as that is where the OCT machine is.

I have no knowledge if any or what the treatment for dry ARMD, which is the most prevalent form of ARMD. I did get the impression that treatment for Dry ARMD is less sucessfull than that for the wet variety.

OP you should seek evaluation of your ARMD if you have symptoms but you probably already have or you would not be able to ask the question contained in your OP correctly.

May you be as lucky as I have been in finding excellent results from treatment.

SCB no longer will permit in bank ATM withdrawals and insist you use ATM outside the branch. Don the newsletter guy confirms that a manager told him the denial is done so fees are earned with each ATM withdrawal.

Fortunately by stateside bank reimburses three ATM fees per month so I rarely suffer from such ATM fees. There have been no reports that other banks have followed this policy but I doubt this will continue if SCB gets away with it long term.

I become a believer when I hear someone has actually received paid for care from an insurance carrier or state plan in Thailand!!!!

"Mr Perry said he did not know whether the widely-discredited therapy worked, but then claimed gay people had the ability to avoid their “lifestyle”.

As Mr. Perry has the "ability to avoid his "lifestyle". And I thought Texas prided itself on being the home of the "free". I frankly think Carl Rove got the radical right to believe the fallacious concept that if you tell a lie often enough, people will believe it.

I think many politicians advocate what appeals to their base in public to get or stay elected but that advocacy has nothing to do with their true belief or orientation.

Take Dick Cheny who became a same sex believer magically after leaving office. There are so many examples.

Accordingly, political rhetoric is just that, not to be believed and certainly not a window into the politicians soul.

I would like to hear from those that have taken advantage of the offer and are now subscribers of True Visions Group.

Did they change your subscriber number?.

When I was last overseas, they changed my subscriber number without telling me, so payments piled up in old account number and old company name. Took a visit to a true office to show ID to move the money from the old account number to the new account number as the company name and organization changed and a new bank reference number was required.

Are we going to go through the same procedure again. If the company name and registration changes then the money payed into the old company must be transferred to the new company and steps are required. Anyone move from PLC to Group and not have had a account number change.

It maybe too early for anyone to have experienced the billing issues involved but it is a major issue to resolve with the call center when you have them move you over from PLC to Group. Certainly an different company even though the owners may be the same.

If you pay through your bank, check carefully as to the company name at the bank and your account number from the Group bill to see if they are changed.

I do not know what "grade c" insurance is. However, both of my cars are over five years old and have never suffered any damage. In the west that coverage is called "collision coverage" and can be excluded at substantial savings. Likewise, if you have good medical insurance or are self insured, you can drop the medical coverage and save a great deal more.

My two cars have million baht liability coverage, (covers damage to others and their property) and nothing else and I now pay one third of my previous premiums for what many refer to as "grade A" coverage from one of the grade A companies.

If I drove a motorcye I certainly would get the most insurance coverage possible as accident risk is substantially higher on that vehicle, especially medical.

I don't know the actual figure, but retail sales are largely made during the end of the year season. I think it is over 60% of annual sales.. And yes that is the tourist season as well.

There are gems of truth in many of the foregoing posts such as three new malls opening in one year and certainly more than doubling the retail space.

I often wondered how the old Central on Huay Kaew ever made money as almost always when I went in the store it was not busy while the mall area was very busy.

I would like to know also.

Wrong places. Most Thai barber shops who cater to locals charge under 100Baht per cut, but expect electric clippers. They are good cutters for short hair wearers.

The state tax issue mentioned is very important. Some states lik California are very aggresive about imposing state taxes.

I had not been back to the US for six year and not back in California for 9 years when the Franchise Tax Board filed a tax lien of $4500 on me. I only learned it this last month when a credit report was generated for me by an online service.

After a few telephone calls, I found out that in 2008 FTB decided that since I had a Real Estae Brokers License and had not filed a state income tax form for five years, I must have been earning income with the Brokers License and estimated what my income would be and filed the tax lien in court.

Talk about being flabergasted!!!! When I explained the reality to the state tax agent on the phone, she said if you fax me a copy of your annual social security income statement to support your contention that you are retired, I will have the lien expunged. I did and only time will tell if she did it.

Tax liens destroy your credit and prevent you from buying a home through mortgage etc. How is that for agressive tax collection!!!!

Thanks for the comments ProThaiExpat.

Bit confused as to the pricing.....I think my friend.....rather a special man.....may be getting treated as a special deal by the female doc at Ram.......however the price of the drug itself certainly went up multifold.

I am meeting my friend at Ram Thursday afternoon ( I often go along as he has bad hearing, well worse than mine! and speaks with a gravelly voice so I'm a sort of communication aide both ways.....the period waiting for the a aesthetic to work gives us chance for a chat). I shall check the doc and pricing details.

Not heard of OCT machine we normally see the retina on a screen as the doc checks it and takes photos for the record.....she does her best to explain any latest developments or hopefully non developments in the retina.

Again thanks for you interest.

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Your friends condition might be such that an OCT evaluation as to the amount of bleed present and if enough to justify an injection may not be applicable in his case. I was required to visit Sripat to get the OCT exam before Dr. Pardee would give me an injection, even while seeing her at RAM. Thus made sense to move to Sripat.

However, the Doctor may feel your friends age and his ability to wait up to two hours to see the doctor might be too much for him so she keeps treating him at RAM. Also, there may be a tacit agreement between RAM and Scripat doctors that patients are not moved to Sripat unless the patient specifically insists on it, as I did. I have also moved to Sripat with my kidney doctor who has a clinic at RAM once a week in the evening but works full time at the University Hospital where Sripat is the private department of that government hospital.

I would certainly bring up your friends financial condition with Dr. Paradee at the next appointment, assuming he is seeing her and ask if it would not save him money by moving to Sripat. I have an appointment with her this evening so will inquire in general terms if she ever does an injection without at OCT before and under what conditions is that done. I, of course, would like to know for my own knowledge and if relevent, I will pass on that information here.

I would not assume he would be excluded. Once you get the police clearance docmument, submit it with a declaration under penalty of perjury explaing in detail the circumstances surrounding his arrest in the most favorable terms. My guess is you have included your pregnancy issue adequately in your other paperwork.

He should be prepared to respond in a positive way if he gets an interview as my guess he would be questioned about the arrest even if there is a declaration in the paperwork explaining it.

Only if he gets a rejection based on the criminal record would I go the special waiver route.

I have been receiving Avastin injections every ten weeks for two years now both at Ram and at Sripat. Sheryl is right as usual as Sripat is quite a bit cheaper.

I would be interested in his Doctor at Ram since I was referred to a Sripat Doctor that had a clinic at Ram twice a week. Since she is full time at Sripat I moved over to Sripat and know how much price differential there is. I was told that Dr. Paradee is the macular specialist at Ram and she is full time at Sripat.

Your friend should be getting OCT examinations prior to any determination if a shot is required. At the time I moved from RAM they did not have an OCT machine, only Sripat did. If Ram got an OCT machine, they are very expensive and my guess is he is paying alot just for that exam.

Comparing prices, I would say that the operating room fee for the injection is half the cost at Sripat, the Avastin cost two months ago at Sripat was 2200 baht, Doctor fee for injection 2000 baht, Ram it was 3500 last year. Sripat pharmacy costs are much cheaper than Ram.

Total cost for my last Avastin injection at Sripat was about 7000 baht. It has been as low as 5000 baht when I had the procedure on a different day than the office visit with the doctor and the OCT.

My operating room fee at Sripat was as low as 400 baht until my Dr. was clued in and now it runs about 1000 baht. Ram it was 1500 last year.

Years ago I had bad flu symptoms about once a month for many months that had major work ups. It was finally resolved when a urologist did a urethera look up and found a small pocket that collected bacteria and the mild infection gave me flu like symptoms of muscular aches and pains.

The fact that you have a very sore throat every time your "flu" comes on suggests you may have a recurring infecton somewhere in your nasal or throat passages that cause the flu like symptoms.

As Sheryl suggest, get a good ENT to do a full work up as there are many pasages in your head and throat that could be the breeding ground for an infection. Sinus drainage can cause sore throats as you know and the sore throat could be an mild infection that your body thows off after a few days.

Jingthing: I would submit that your thread title could be edited to just say male vs. gay male. Objectiying female beauty has long been a problem with straight men.

Maybe its a human trait that males generally objectify the object of their desire.