Psychiatric issues plus too much water can be deadly in summer heat

[atyclb]

19 minutes ago, KiwiKiwi said:

That seems like an awful lot of folk. I suppose one has to take into account the usual incompetence of Thai doctors, and guess that a goodly percentage of those people have been mis-diagnosed.

 

I have a small elective surgery schedule for 2 weeks, if the pallava I had to go through to make a simple appointment is any indication, I should probably cancel. Mind you, the comedy of errors a friend of mine went through at Samitivej would have been hilarious if it wasn't so tragic.

 

the level of competency is not uniform thus mistakes can be caused by anyone making up the chain.

 

have noticed big variation in nurse competency at a leading bkk hospital

[KiwiKiwi]

13 minutes ago, atyclb said:

 

the level of competency is not uniform thus mistakes can be caused by anyone making up the chain.

 

have noticed big variation in nurse competency at a leading bkk hospital

 

I have noticed a huge level of complete incompetence at the level of nurses and the clinical level of doctors. I seems to be ubiquitous, even making a simple appointment usually results in phone calls to confirm a completely erroneous date despite specifying it 2 or 3 times.

 

How can we explain and understand such an overweaning level of stupidity and incompetence? What might have caused it? If the Thais did anything with the penetration and effectiveness with which they achieve their usual level of incompetence, it would be regarded as a miracle of management.

 

So, what on God's earth went wrong with these people?

Edited May 21, 2018 by KiwiKiwi

[hkt83100]

On 5/14/2018 at 1:16 PM, overherebc said:

I know that distilled water and reverse osmosis produced water is not good for you as it pulls salts etc out of your system if you drink a lot of it.

The only two persons in my household drinking distilled water are my PCX and my Toyota. Both got batteries which love it! I usually prefer other recipes of distilling liquids.

[atyclb]

16 minutes ago, KiwiKiwi said:

the clinical level of doctors.

can you cite specific examples?

[KiwiKiwi]

30 minutes ago, atyclb said:

can you cite specific examples?

Sure, a doctor at Samitivej  who saw a close friend of mine who was having spontaneous and persistent arrhythmias. The doctor 'suggested' 15000 THB of tests, and then said he did not know what was causing it. Just like that, 'I don't know, goodbye'. On his way out, my friend was intercepted by the same doctor who wanted to do 'just 1 more blood test', which proved positive for hyperthyroid. Given the symptoms profile as reported, that should have been the first test, Then, he prescribed a medication for the hyperthyroid and another for the arrhythmia (a beta blocker), which were contraindicated so the doctor had to recall the prescription and medicines and re-prescribe a different thyroid medication.

 

This is almost the very definition of incompetent - incompetent for not understanding the symptoms, incompetent for thrashing around for tests (some of which apparently involved a brand-new ultrasound viewer for his heart, incompetent for not understanding the first test should have been for hyperthyroid (particularly common among Thais as I now understand), incompetent for prescribing contra-indicated medications. The man should not be qualified and should not be practicing but there are no avenues for complaint in Thailand, complaints are ignored, as many will tell you.

 

I, as a layman, when I heard about his symptoms for the first time advised him to him to get his thyroid function checked (a simple blood test costing about 200THB).

 

And this from one of the self-described  'best hospitals in Thailand' and one of the best-qualified (USA) doctors in Thailand.

 

It's just keystone kops with these people, and this is not atypical, it's pretty normal. and accords precisely with an examination (routine health-check) I had with one of the 'county's top USA-qualified doc at Param 9. It was a balls-up from start to finish and at the end, having mis-diagnosed 3 things and completely ballsing up a prostate examination, calmly presented me with an invoice for 13,000THB. No shame and no dignity. Money only.

 

It's just horrible. I'm not of the view that I or my firiend were singled out for special treatment, I have to conclude this is at least a common ocurrence.

Edited May 21, 2018 by KiwiKiwi

[atyclb]

18 minutes ago, KiwiKiwi said:

48 minutes ago, atyclb said:

 can you cite specific examples?

Sure, a doctor at Samitivej  who saw a close friend of mine who was having spontaneous and persistent arrhythmias. The doctor 'suggested' 15000 THB of tests, and then said he did not know what was causing it. Just like that, 'I don't know, goodbye'. On his way out, my friend was intercepted by the same doctor who wanted to do 'just 1 more blood test', which proved positive for hyperthyroid. Given the symptoms profile as reported, that should have been the first test, Then, he prescribed a medication for the hyperthyroid and another for the arrhythmia (a beta blocker), which were contraindicated so the doctor had to recall the prescription and medicines and re-prescribe a different thyroid medication.

what was name of arrhythmia?

 

was friend having it while at hospital?

 

some arrhythmias are associated with hyperthyroidism but many are not

 

if 12 lead ekg is ok then usually a holter monitor is done to record what is wrong and when

 

thyroid is easy cheap test but not all hyperthyroid people have the same arrhythmia as some can have other or in addition to abnormalities.

 

an echocardiogram(sono) is not such a bad test in addition to simpler ones especially in aging people.

 

profit factor is very strong at private hospitals.   cannot say profit factor is weak at usa hospitals either as studies show the well insured get the most tests.

 

also anyone that trained in usa learns to do defensive practice though not cost effective.

 

 

18 minutes ago, KiwiKiwi said:

 

This is almost the very definition of incompetent - incompetent for not understanding the symptoms, incompetent for thrashing around for tests (some of which apparently involved a brand-new ultrasound viewer for his heart, incompetent for not understanding the first test should have been for hyperthyroid (particularly common among Thais as I now understand), incompetent for prescribing contra-indicated medications. The man should not be qualified and should not be practicing but there are no avenues for complaint in Thailand, complaints are ignored, as many will tell you.

 

I, as a layman, when I heard about his symptoms for the first time advised him to him to get his thyroid function checked (a simple blood test costing about 200THB).

 

And this from one of the self-described  'best hospitals in Thailand' and one of the best-qualified (USA) doctors in Thailand.

 

It's just keystone kops with these people, and this is not atypical, it's pretty normal. and accords precisely with an examination (routine health-check) I had with one of the 'county's top USA-qualified doc at Param 9. It was a balls-up from start to finish and at the end, having mis-diagnosed 3 things and completely ballsing up a prostate examination, calmly presented me with an invoice for 13,000THB. No shame and no dignity. Money only.

 

It's just horrible. I'm not of the view that I or my firiend were singled out for special treatment, I have to conclude this is at least a common ocurrence.

 

[KiwiKiwi]

5 minutes ago, atyclb said:

what was name of arrhythmia?

 

was friend having it while at hospital?

 

some arrhythmias are associated with hyperthyroidism but many are not

 

if 12 lead ekg is ok then usually a holter monitor is done to record what is wrong and when

 

thyroid is easy cheap test but not all hyperthyroid people have the same arrhythmia as some can have other or in addition to abnormalities.

 

an echocardiogram(sono) is not such a bad test in addition to simpler ones especially in aging people.

 

profit factor is very strong at private hospitals.   cannot say profit factor is weak at usa hospitals either as studies show the well insured get the most tests.

 

also anyone that trained in usa learns to do defensive practice though not cost effective.

 

 

 

Well, thanks for the comments anyway. I'm not a medically trained professional but I would have done better than this clown. Yes, there are other causes of arrythmias, but in Thailand, hyperthyroid should have been the first suspect after questioning ref other symptoms and incidence. Should certainly not have been an afterthought as my friend was on his way out having been parted from his money.

 

I never said my friend was ageing, as it happens he was in his 50's and a former athlete. Strong as an ox

 

"Profit factor is very strong". Nice euphemism for venal.

[overherebc]

1 hour ago, hkt83100 said:

The only two persons in my household drinking distilled water are my PCX and my Toyota. Both got batteries which love it! I usually prefer other recipes of distilling liquids.

??

Can't remember where I heard/read it but reverse osmosis water is virtually the same as distilled water. Maybe yes maybe no.

[atyclb]

16 minutes ago, KiwiKiwi said:

Well, thanks for the comments anyway. I'm not a medically trained professional but I would have done better than this clown. Yes, there are other causes of arrythmias, but in Thailand, hyperthyroid should have been the first suspect after questioning ref other symptoms and incidence. Should certainly not have been an afterthought as my friend was on his way out having been parted from his money.

 

I never said my friend was ageing, as it happens he was in his 50's and a former athlete. Strong as an ox

 

"Profit factor is very strong". Nice euphemism for venal.

 

 

i looked current therapy and it would appear beta blockers can be used for faster symptomatic relief until the thyroid medicine brings function to normal levels

 

Treatment of hyperthyroidism includes symptom relief, as well as therapy with antithyroid medications, radioactive iodine-131 (¹³¹I), or thyroidectomy. Symptomatic treatment is as follows:

• Oral rehydration for dehydrated patients

• Beta-blockers for relief of neurologic and cardiovascular symptoms

• For mild ophthalmopathy, saline eye drops as needed and tight-fitting sunglasses for outdoors

• For vision-threatening ophthalmopathy, high-dose glucocorticoids, with consideration for orbital decompression surgery and ocular radiation therap

  https://www.medscape.com/answers/121865-25161/what-are-the-treatment-options-for-hyperthyroidism

   

   

  Use of beta-adrenoceptor blocking drugs in hyperthyroidism.

  Feely J, Peden N.

  Abstract

  There is an increasing use and variety of beta-adrenoceptor blocking agents (beta-blockers) available for the treatment of hyperthyroidism. Recent comparative studies suggest that atenolol (200mg daily), metoprolol (200mg daily); acebutolol (400mg daily), oxprenolol ( 160mg daily), nadolol ( 80mg daily) and timolol (20mg daily) produce a beneficial clinical response equal to that seen with propranolol ( 160mg daily). Most beta-blockers reduce resting heart rate by approximately 25 to 30 beats/min, although a lesser reduction is seen with those possessing intrinsic sympathomimetic activity such as oxprenolol and pindolol. While earlier studies employing large doses of intravenous propranolol concluded that beta-blockade reduced myocardial contractility, more recent non-invasive studies suggest that the predominant cardiac effect is on heart rate. In patients with cardiac failure, beta-blockers may, however, produce a profound fall in cardiac output. Nevertheless, in combination with digoxin they may be useful in controlling the atrial fibrillation of thyrocardiac disease. beta-Blockers improve nervousness and tremor (although to a lesser extent with cardioselective agents) and severe myopathy, and they also reduce the frequency of paralysis in patients with thyrotoxic periodic paralysis. There is often subjective improvement in sweating but usually no major effect on eye signs. Recent studies show a 10% reduction in oxygen consumption/basal metabolic rate with long term oral use of selective or nonselective beta-blockers. In addition, many agents (propranolol, metoprolol, nadolol and sotalol but not acebutolol, atenolol or oxprenolol) reduce circulating tri-iodothyronine (T3) concentration by between 10 and 40%, although the clinical significance of this effect (if any) is not established. beta-Blockers may also have endocrinological effects on gastrin, cyclic AMP, catecholamines and other hormone levels. Given in adequate dosage, propranolol has been shown to control thyrotoxic hypercalcaemia. Minor side effects (nausea, headaches, tiredness, etc.) are quite common but overall beta-blockers are well tolerated by the thyrotoxic patient. The major use of these drugs is in symptomatic control while awaiting definitive diagnosis or treatment. As an adjunct to antithyroid drugs or radioactive iodine, beta-blockers will produce a satisfactory clinical response in the weeks to months before these forms of therapy produce a euthyroid state. beta-Blockers are more convenient than antithyroid drugs in the control of patients receiving therapeutic radioiodine, in that continuous therapy and assessment of biochemical response is possible.(ABSTRACT TRUNCATED AT 400 WORDS).

  PMID:

   

  6144501

  [Indexed for MEDLINE]

   

 

---

 

 

 

 

Edited May 21, 2018 by atyclb

[KiwiKiwi]

13 minutes ago, atyclb said:

 

 

i looked current therapy and it would appear beta blockers can be used for faster symptomatic relief until the thyroid medicine brings function to normal levels

 

Treatment of hyperthyroidism includes symptom relief, as well as therapy with antithyroid medications, radioactive iodine-131 (¹³¹I), or thyroidectomy. Symptomatic treatment is as follows:

• Oral rehydration for dehydrated patients

• Beta-blockers for relief of neurologic and cardiovascular symptoms

• For mild ophthalmopathy, saline eye drops as needed and tight-fitting sunglasses for outdoors

• For vision-threatening ophthalmopathy, high-dose glucocorticoids, with consideration for orbital decompression surgery and ocular radiation therap

  https://www.medscape.com/answers/121865-25161/what-are-the-treatment-options-for-hyperthyroidism

   

   

  Use of beta-adrenoceptor blocking drugs in hyperthyroidism.

  Feely J, Peden N.

  Abstract

  There is an increasing use and variety of beta-adrenoceptor blocking agents (beta-blockers) available for the treatment of hyperthyroidism. Recent comparative studies suggest that atenolol (200mg daily), metoprolol (200mg daily); acebutolol (400mg daily), oxprenolol ( 160mg daily), nadolol ( 80mg daily) and timolol (20mg daily) produce a beneficial clinical response equal to that seen with propranolol ( 160mg daily). Most beta-blockers reduce resting heart rate by approximately 25 to 30 beats/min, although a lesser reduction is seen with those possessing intrinsic sympathomimetic activity such as oxprenolol and pindolol. While earlier studies employing large doses of intravenous propranolol concluded that beta-blockade reduced myocardial contractility, more recent non-invasive studies suggest that the predominant cardiac effect is on heart rate. In patients with cardiac failure, beta-blockers may, however, produce a profound fall in cardiac output. Nevertheless, in combination with digoxin they may be useful in controlling the atrial fibrillation of thyrocardiac disease. beta-Blockers improve nervousness and tremor (although to a lesser extent with cardioselective agents) and severe myopathy, and they also reduce the frequency of paralysis in patients with thyrotoxic periodic paralysis. There is often subjective improvement in sweating but usually no major effect on eye signs. Recent studies show a 10% reduction in oxygen consumption/basal metabolic rate with long term oral use of selective or nonselective beta-blockers. In addition, many agents (propranolol, metoprolol, nadolol and sotalol but not acebutolol, atenolol or oxprenolol) reduce circulating tri-iodothyronine (T3) concentration by between 10 and 40%, although the clinical significance of this effect (if any) is not established. beta-Blockers may also have endocrinological effects on gastrin, cyclic AMP, catecholamines and other hormone levels. Given in adequate dosage, propranolol has been shown to control thyrotoxic hypercalcaemia. Minor side effects (nausea, headaches, tiredness, etc.) are quite common but overall beta-blockers are well tolerated by the thyrotoxic patient. The major use of these drugs is in symptomatic control while awaiting definitive diagnosis or treatment. As an adjunct to antithyroid drugs or radioactive iodine, beta-blockers will produce a satisfactory clinical response in the weeks to months before these forms of therapy produce a euthyroid state. beta-Blockers are more convenient than antithyroid drugs in the control of patients receiving therapeutic radioiodine, in that continuous therapy and assessment of biochemical response is possible.(ABSTRACT TRUNCATED AT 400 WORDS).

  PMID:

   

  6144501

  [Indexed for MEDLINE]

 

You're right, The accepted treatment for hyperthyroidism in the first instance, would be an anti-hyperthyroid drug, supported by a beta blocker in the event that arrythmias are involved (which as you know ought not to be allowe to continue long-term). The point is that some beta blockers are contra-indicated for some hyperthyroid medications. That's the point - he didn't know and he should have known, or looked it up before prescribing.

 

Anyway, it has drifted off-topic. The guy was incompetent, end of insofar as I am concerned. Were incompetence the exception in Thailand rather than the rule, one could take another approach, but we both know what Thailand is and what Thais are, and frankly speaking, making excuses for this guy isn't going to help.

 

End of issue for me.

Edited May 21, 2018 by KiwiKiwi

[Artisi]

15 minutes ago, KiwiKiwi said:

You're right, The accepted treatment for hyperthyroidism in the first instance, would be an anti-hyperthyroid drug, supported by a beta blocker in the event that arrythmias are involved (which as you know ought not to be allowe to continue long-term). The point is that some beta blockers are contra-indicated for some hyperthyroid medications. That's the point - he didn't know and he should have known, or looked it up before prescribing.

 

Anyway, it has drifted off-topic. The guy was incompetent, end of insofar as I am concerned. Were incompetence the exception in Thailand rather than the rule, one could take another approach, but we both know what Thailand is and what Thais are, and frankly speaking, making excuses for this guy isn't going to help.

 

End of issue for me.

seems incompetence is not confined to Thailand

https://besthealth.com.au/drugs-and-medical-errors-killing-one-of-every-five-australians/  

 

And Kiwi's

[KiwiKiwi]

20 minutes ago, Artisi said:

seems incompetence is not confined to Thailand

https://besthealth.com.au/drugs-and-medical-errors-killing-one-of-every-five-australians/  

 

And Kiwi's

 

Sure, incompetence is a part of the human condition, it's a statistical exercise, I know this, and you should not be making excuses for Thais on the flimsy grounds that other nations have stupid people as well, that's just ingenuous.

 

But where others bear with incompetence, Thais excel at it, and it seems much more widespread in Thailand than certainly I have ever seen before.

 

And that really is my last word on the matter.

Edited May 21, 2018 by KiwiKiwi

[terminatorchiangmai]

15 hours ago, atyclb said:

 

60% of 2.6 million = . 1,560,000 .    or 1.56 million on schizo meds

 

1.56 million .out of  59 million(population)  =  2.26% .   approx .  1 out of every 44 people

 

 

https://www.researchgate.net/publication/45659223_Schizophrenia_in_Thailand_Prevalence_and_burden_of_disease

Population in Thailand is 68.000.000 and growing!

 You need to get out your cave more often instead of posting non helpful remarks on Thaivisa all day.

Sorry that i was off a few persons , but i think most readers got the point.

[atyclb]

1 hour ago, terminatorchiangmai said:

17 hours ago, atyclb said:

 

60% of 2.6 million = . 1,560,000 .    or 1.56 million on schizo meds

 

1.56 million .out of  59 million(population)  =  2.26% .   approx .  1 out of every 44 people

 

 

https://www.researchgate.net/publication/45659223_Schizophrenia_in_Thailand_Prevalence_and_burden_of_disease

Population in Thailand is 68.000.000 and growing!

 You need to get out your cave more often instead of posting non helpful remarks on Thaivisa all day.

Sorry that i was off a few persons , but i think most readers got the point.

 

 

the reason i wondered was not due to your math but due to search "prevalence of schizophrenia in thailand"

 

correct 68 million

 

my cave is very comfortable complete with 2 swimming pools, well equipped gym, etc etc.

 

 

The prevalence of schizophrenia at ages 15-59 in the Thai population was 8.8 per 1,000 (95% CI: 7.2, 10.6) with a male-to-female ratio of 1.1-to-1. 

 

 

would seem 0.88 per 100 people or 0.88 % that seems markedly lower than the 1:60 or 1:40 ratio

 

helpful vs non helpful remarks about epidemiology are  subjective 

Edited May 22, 2018 by atyclb

[Speedo1968]

On 5/15/2018 at 4:13 PM, overherebc said:

Dead sea salt is black. Maybe not clear in my post. ?

Didn't realise that.

I use Himalaya or Lava salt, some are black others black and pink.