Chest Infection or something else

[4MyEgo]

It appears that since I move here 2.6 years ago, I get a chest infection every year, my symptoms are coughing, shortness of breath and phlegm which varies in colour depending on the day, light brown in the morning, white with some green spots in it, then white and the spider web type at times if that makes sense.

 

Last year I saw the doctor who gave me antibiotics, went back a week later, wasn't feeling good at all, sent me to the hospital for a chest x-ray, all clear, hospital put me a face mask over my mouth/nose and gave me oxygen for about 45 minutes, I felt better, as I was treated in the emergency ward as the hospital was closed in the evening, they released me and gave me a metered dose inhaler Aerotamol 100 MCG, Salbutamol sulphate and it helped to open my airways when I felt a bit tight in the chest, the infection cleared up with some more antibiotics, which I try to avoid best I can.

 

The same thing has come back this year, although I did try to fight it for about 3 weeks but to no avail, so back to the doctor, anitbiotics again, but those white coloured ones she gives me from her own batch didn't work this time, she also gave me some pink ones and some antihistamine which I won't take as they make me feel like crap, so back I went and she gave me new generation antibiotics, (her words) Azithrin, each tablet contains azithromycin 250 if I can read the small print correctly and have been on them for two days, and as she continued to prescribe me with those pink tablets which I told her make me cough and bring up phlegm all day, i.e. Bronchoitath, as written on the plastic bag, 1 tablet every 6 hours, I stopped taking them because they would make me cough all day, and as I am usually bringing up phlegm anyway, there is so only so much you can cough in one day, and since the new generation antibiotics, I have managed to get two nights sleep with limited coughing, thankfully.

 

I have a wheezing sound when my chest is tight, but not now, i.e. short of breath, but once I take the inhaler, I feel better, and I try to avoid taking it to often, no fever or aches and pains, and am assuming that when this dose of antibiotics is done and dusted I will be better ?

 

I gave up smoking 18 years ago and was a smoker for about 25 years,, I am 57 years of age, relatively healthy, not overly overweight for my age and height, 89kg 183cm and have read some stuff on Google am trying to work out if I have something else like COPD, Chronic Bronchitis, or Asthma, and am wondering if anyone else has had the same symptoms and whether I should get checked out with one of those breathing machines for how much air I can inhale and exhale quickly when tested, i.e. a diagnostic test for COPD if they have them here or when I return to Sydney in 4 months.

 

Just wanting to sort this because if its going to be an annual event, I want to be able to be prepared best to combat it.

 

Appreciate the feedback and Sheryl, your wealth of knowledge is always welcome.

Edited June 22, 2018 by 4MyEgo

[Sheryl]

You indeed do need to be examined by a proper pulmonary specialist. That you experience shortness of breath, tightness in the chest and get relief from an inhaler all suggest possible asthma or early COPD.

 

Where in Thailand are you?

[4MyEgo]

12 hours ago, Sheryl said:

You indeed do need to be examined by a proper pulmonary specialist. That you experience shortness of breath, tightness in the chest and get relief from an inhaler all suggest possible asthma or early COPD.

 

Where in Thailand are you?

Hi Sheryl

 

I am an hours drive to Udon Thani or Sakon Nakhon, the closest town to us is Sawang Daen Din which has a big hospital, i.e. Crown Prince Hospital, but I don't know if they are equipped for such a test, however I did drive to Khon Kaen which is about a 2 hour drive once to have a Basel Carcinoma removed by a plastic surgeon which was on my right cheek, thanks to your assistance.

 

Having a car means I can travel, so either Udon Thani, Sakon Nakhon or Khon Kaen for the test is no problem for me.

[chubby]

COPD is by definition emphysema (your FEV1 test- forced expiratory volume in 1 sec - generally not an advanced test to my knowledge),  with chronic bronchitis, which I believe has to do with volume of phlegm any color  expectorated on a regular basis.

 

colors indicate infection, unfortunately COPD is progressive, and your probably at risk based on your history of PPD packs/day ; and higher risk for pneumonias and upper tract infection because the mucosa are probably damaged that move the phlegm

 

so if your going to have exacerbations  and live a good distance from a hospital, it's good you have the nebulizer, maybe some   Azithromycin, and even  oral steroids on hand .... if you start having > 2-3  exacerbations  / year  (which may be another way of diagnosis of the COPD); maybe even a finger O2 saturation checker, though COPD is really a problem of CO2 getting trapped   from the obstruction

Edited June 23, 2018 by chubby
a

[Sheryl]

Go to KKU hospital after hours clinic and ask to see  Prof. Watchara Boonsawat

[4MyEgo]

27 minutes ago, Sheryl said:

Go to KKU hospital after hours clinic and ask to see  Prof. Watchara Boonsawat

Thanks Sheryl

 

Will see if we can make some enquiries before we head out, as it's about a 2 hours drive each way and will have to make arrangements for the kids to be picked up from school, or come with us.

[4MyEgo]

On 6/23/2018 at 3:47 PM, Sheryl said:

Go to KKU hospital after hours clinic and ask to see  Prof. Watchara Boonsawat

Just a update on this, I ended up having some sort of anxiety attack on Sunday at about 5pm after I couldn't breath, i.e. short breaths only, so I took a blast of an inhaler which I later found out was faulty, (just my luck) as is wasn't really letting out enough of the stuff, so I was doubling up, then a few glucose jelly beans and a small bottle of lemonade to get my sugar level up, borderline diabetic, my wife preparing us for the hour journey to the private hospital at Udon Thani, however I asked her to contact the local doctors office to see if they were open at Sawang Daen Din which is a 15 minute drive, which they were, so we went there as I didn't want to be draggin 4 kids along coming onto dinner time and then school tomorrow.

 

After checking me at about 6pm, she said it appears the new generation antibiotics sorted the chest infection, but as I had this persistent cough and continued wheezing, she sent me to the public hospital for a chest xray and some oxygen.

 

I had the chest x ray done, come to think of it, I also had one done there from the same issue back in September last year, plus oxygen. Results, chest all clear, she also asked the hospital to book me in for a COPD test as they have it there at the hospital, but only once a month, fortunately for me it was open the next day on Monday, so we went as this would save me having to travel to Khon Kaen (2 hours).

 

I did a Spirometry test and based on my age, height and weight, I should have scored 730 but scored 605 (% prediction) 121%, now I am not sure if it was supposed to be the other way around, e.g. 605 vs 730, but was given an inhaler to inhale and then went back 15 minutes later to repeat the test, same results.

 

Then I saw the doctor, who said the chest x ray last night showed that my chest was clear, mild wheezing, and the reading on the spirometer was normal for someone of my age who gave up smoking 18 years ago, so I do not have Emphysema and if I did get it later in life it would be mild, that said, he said that it was normal for me to be coughing and exerting phlegm for a 4-8 weeks plus after the chest infection and that there was no further need for more tests.

 

We then went and handing in our paperwork to the nurse who said, you could have mild asthma and be allergic to cigarette smoke, dust, other forms of smoke, pollution etc etc, that said, based on my own research I would think the nurse is correct, however I would say that I have Chronic Bronchitis which usually lasts up to 3 months and the humidity doesn't help, however when in Sydney in October I will discuss this with my doctor further, but in the meantime will email him for a Pulmonologist's contact details to book in do the actual test, because no one here is talking Bronchitis in any shape or form, maybe Asthma is there way of describing it ?   

 

This cough is still here, but the Phlegm is clearing, and turning on my IQAir Purifier last night did help, and is on, beside me know while I type, that said, one is still seeking an accurate prognosis which will arrive eventually, I hope 555

 

 

[VocalNeal]

^ Do you walk at least 2k everyday or at least 2000 steps?

[giddyup]

2 hours ago, 4MyEgo said:

 This cough is still here, but the Phlegm is clearing, and turning on my IQAir Purifier last night did help, and is on, beside me know while I type, that said, one is still seeking an accurate prognosis which will arrive eventually, I hope 555

Does the air purifier help? The reason I ask is that I have similar symptoms as yourself. I was a long time packet a day smoker but gave up about 6 years ago, however I'm sure my lungs have suffered damage as I still have what I would call a smokers cough, some clear flem, a little wheezy at times and use an inhaler on occasions. I have had regular x rays that show some dark spots, but the specialist said it's not serious. Wondering if investing in an air purifier might help?

[4MyEgo]

5 hours ago, giddyup said:

Does the air purifier help? The reason I ask is that I have similar symptoms as yourself. I was a long time packet a day smoker but gave up about 6 years ago, however I'm sure my lungs have suffered damage as I still have what I would call a smokers cough, some clear flem, a little wheezy at times and use an inhaler on occasions. I have had regular x rays that show some dark spots, but the specialist said it's not serious. Wondering if investing in an air purifier might help?

Check you mailbox

[giddyup]

5 minutes ago, 4MyEgo said:

Check you mailbox

Cheers.

[xylophone]

5 hours ago, giddyup said:

The reason I ask is that I have similar symptoms as yourself

As do I on occasion here and all of the tests show nothing untoward and I put it down to an allergy of some sorts, either from a particular pollen (cos it used to happen over a couple of particular months) or other allergen??

 

If I take an anti-histamine at the first signs, then after about 5-7 days I can come off them and feel ok. I also bought an air purifier which MAY have helped.

 

A friend suffers similarly and insists on taking antibiotics but they do no good, so he fights his way through it and an inhaler helps him.

[4MyEgo]

8 hours ago, VocalNeal said:

^ Do you walk at least 2k everyday or at least 2000 steps?

Prior to getting sick, I used to go on the treadmill for 45 minutes at least 5 days a week.

 

I am now much better (90%) as the 2nd course of different antibiotics finished yesterday, and the inhaler I purchased a week ago wasn't really firing the usual dosage, so I think it was faulty as it wasn't also wasn't the usual brand I buy, that said, the new one since yesterday morning, (my usual brand) has helped me as it fired up brilliantly, and I have to say the IQAir purifier that I have, which has been on since last night, has literally been pumping me with pure air, if you can believe that, with my coughing passing, and me feeling much better.

 

So my hypercondriac analysis of all this is that I had a chest infection which was exacerbated by me not taking antibiotics thinking it was a cold/flu which I could manage with my (shot) immune system, not going onto antibiotics for at least 4-5 weeks, the 1st batch failing, with the 2nd different batch doing its job and finishing on Monday, the new inhaler and the IQAir purifer all bringing me back to life !!!

 

The above said, at least I know from the Xray on Sunday night that my chest is clear, and the reading on the Spirometry test was 730 for my age 58, height 183 cm and weight 89kg, which isn't too bad considering I gave up smoking 18 years ago, however when I get to Sydney I will see a Pulmonologist to get a proper test to see what he/she thinks, as there could be something else, like Asthma, Bronchitis or COPD, but as I am usually fit, hope not.

Edited June 26, 2018 by 4MyEgo

[4MyEgo]

22 minutes ago, xylophone said:

As do I on occasion here and all of the tests show nothing untoward and I put it down to an allergy of some sorts, either from a particular pollen (cos it used to happen over a couple of particular months) or other allergen??

 

If I take an anti-histamine at the first signs, then after about 5-7 days I can come off them and feel ok. I also bought an air purifier which MAY have helped.

 

A friend suffers similarly and insists on taking antibiotics but they do no good, so he fights his way through it and an inhaler helps him.

In my case, the antibiotics got rid of the chest infection, the inhaler assisted with opening up the airways, but at the tail end, I have to say the air purifier has worked wonders, so might be an allergy or pollen of some type as you say.

[Sheryl]

10 hours ago, 4MyEgo said:

 no one here is talking Bronchitis in any shape or form, maybe Asthma is there way of describing it ?   
 

 

 

 

 

 

They are different conditions and correct differentiation is important to management.

 

Chronic bronchitis and asthma are both obstructive lung diseases but chronic bronchitis will not open up with bronchodilators the way asthma will.

[4MyEgo]

1 minute ago, Sheryl said:

 

 

 

They are different conditions and correct differentiation is important to management.

 

Chronic bronchitis and asthma are both obstructive lung diseases but chronic bronchitis will not open up with bronchodilators the way asthma will.

Now that makes a lot of sense, because I have found the bronchodilators (inhaler) to open my airways, so probably some form of Asthma caused by an allergy, pollen ?

[Sheryl]

35 minutes ago, 4MyEgo said:

Now that makes a lot of sense, because I have found the bronchodilators (inhaler) to open my airways, so probably some form of Asthma caused by an allergy, pollen ?

yes, except that if I read correctly your spirometry readings did not improve after treatment...?

 

[4MyEgo]

9 hours ago, Sheryl said:

yes, except that if I read correctly your spirometry readings did not improve after treatment...?

 

Correct, 1st reading was 730 and the 2nd reading after having the inhaler was the same, strangest thing is when I take the inhaler my airways feel as if they have opened up and the coughing stops.

 

To add to that, I just can't put my finger on this, yesterday was a great day after having the IQAir purifier on all day, and the night before, there was no coughing, or very very limited coughing, with no phlegm, but get this, as soon as I went to bed, no purifier on, I was having coughing attacks, so I turned it on, didn't help, so I turned it and the fan that was on, off, I was coughing most of the night, with some hours breaks, the phlegm was light yellow.

 

I took the inhaler at 11pm and woke up at 12.30am with a coughing attack, I woke up again with another coughing attack at 3.00am, so I took the inhaler and managed to get some good sleep till 6.00am this morning.

 

It has slowed down now, still have the wheezing and the occasional cough, if this persists, I might go for some antihistamines as someone said it helped them after 5-7 days that helped them.

 

They had the same symptoms, and after having the same tests with negative results, but the antihistamines sorted it.

Edited June 26, 2018 by 4MyEgo

[xylophone]

2 hours ago, 4MyEgo said:

Correct, 1st reading was 730 and the 2nd reading after having the inhaler was the same, strangest thing is when I take the inhaler my airways feel as if they have opened up and the coughing stops.

 

To add to that, I just can't put my finger on this, yesterday was a great day after having the IQAir purifier on all day, and the night before, there was no coughing, or very very limited coughing, with no phlegm, but get this, as soon as I went to bed, no purifier on, I was having coughing attacks, so I turned it on, didn't help, so I turned it and the fan that was on, off, I was coughing most of the night, with some hours breaks, the phlegm was light yellow.

 

I took the inhaler at 11pm and woke up at 12.30am with a coughing attack, I woke up again with another coughing attack at 3.00am, so I took the inhaler and managed to get some good sleep till 6.00am this morning.

 

It has slowed down now, still have the wheezing and the occasional cough, if this persists, I might go for some antihistamines as someone said it helped them after 5-7 days that helped them.

 

They had the same symptoms, and after having the same tests with negative results, but the antihistamines sorted it.

Just out of left field here...………..are you on statins for high cholesterol?? Simvastatin can cause inflammation of the airways and an associated cough. Happened to a friend but it was more a nagging cough, however the constant cough caused more inflammation which in turn led to a chest infection.....and this cycle was repeated for years until he changed statins.

Edited June 27, 2018 by xylophone

[4MyEgo]

4 hours ago, xylophone said:

Just out of left field here...………..are you on statins for high cholesterol?? Simvastatin can cause inflammation of the airways and an associated cough. Happened to a friend but it was more a nagging cough, however the constant cough caused more inflammation which in turn led to a chest infection.....and this cycle was repeated for years until he changed statins.

Actually I take Atorvastatin 40mg once a night before I go to bed for Cholesterol, been on these for as long as I can, originally on Lipitor, but changed to the generic brand as the chemists advised Lipitor was out of stock and one even said there was an issue with them, so they pulled them off the shelves, now I don't know who to believe, but I have been taking the above for years.

 

I had a stent put into my left arterial artery descending due to a clot, and suffered a mild heart attach. 

 

Are you suggesting I come off them for a little while then ? This I could discuss with my Cardiologist.

 

My recent blood check showed all was in order with my Cholesterol etc etc

 

This is very interesting.

 

My coughing subsided after 9am this morning, and so far so good, but who knows what tonight may bring.

[xylophone]

 

2 hours ago, 4MyEgo said:

Are you suggesting I come off them for a little while then

No certainly not without discussing it with your cardiologist, and he may suggest a change of statin...…..see below re Arvostatin side effects:- 

 

If you develop any muscle cramps or pains, particularly if they are in your legs and you also feel unwell or have a high temperature (fever). If you feel short of breath or develop an unexplained cough. This is because (in very rare cases), atorvastatin may cause a disease called interstitial lung disease.

[Sheryl]

Best to see a pulmonary specialist as previously advised. Bring all records with you and be sure to mention being on a statin.

[4MyEgo]

7 minutes ago, xylophone said:

 

No certainly not without discussing it with your cardiologist, and he may suggest a change of statin...…..see below re Arvostatin side effects:- 

 

If you develop any muscle cramps or pains, particularly if they are in your legs and you also feel unwell or have a high temperature (fever). If you feel short of breath or develop an unexplained cough. This is because (in very rare cases), atorvastatin may cause a disease called interstitial lung disease.

I will keep it simple/stupid as the saying goes

 

No muscle cramps or pains (tick),  

 

Don;t feel unwell or have a high temperature (tick),

 

Short of breath (sometimes). unexplained cough (no), was sick with cold or flu at 1st, then the coughing came afterwards because I though my immune system could fight it off.

 

Antibiotics, 1st didn't work, 2nd course probably didn't work also because it might be a virus and if its a virus, the body has to fight it alone, so I read, if its bacterial, then antibiotics should clear it.

 

Time will tell, although from what I have read, tests done, etc, etc, and being a smoker for 25 years, having given up 18 years ago, and living in a climate with high humidity, I will stick with Chronic or some type of Bronchitis for now

[xylophone]

3 hours ago, 4MyEgo said:

I will stick with Chronic or some type of Bronchitis for now

Or possibly an allergy...……...and very true about antibiotics and viruses, although Drs here will give them out willy nilly.

 

Hope you find the cause and cure/treatment.

[impulse]

4 hours ago, 4MyEgo said:

I will keep it simple/stupid as the saying goes

 

No muscle cramps or pains (tick),  

 

Don;t feel unwell or have a high temperature (tick),

 

Short of breath (sometimes). unexplained cough (no), was sick with cold or flu at 1st, then the coughing came afterwards because I though my immune system could fight it off.

 

Antibiotics, 1st didn't work, 2nd course probably didn't work also because it might be a virus and if its a virus, the body has to fight it alone, so I read, if its bacterial, then antibiotics should clear it.

 

Time will tell, although from what I have read, tests done, etc, etc, and being a smoker for 25 years, having given up 18 years ago, and living in a climate with high humidity, I will stick with Chronic or some type of Bronchitis for now

 

One of the things that disturbs me on threads like this -and this is based on my own experience in the Thai healthcare system- is ticking off a bunch of test results and filing them away as if they are definitively true.  I had symptoms similar to the OP, and went through a plethora of hospital visits over a couple of years to determine the cause of my cough and shortness of breath.

 

Long story short, my Thai cardiologist (famous, foreign focused hospital) had for 3 years been missing the fact that one of my arteries was blocked 100% and one was blocked 95%.  This despite 3 consecutive years of annual treadmill tests and quarterly EKG's.  The ENT and allergy guys never even looked there since that possibility had already been investigated and (erroneously) ruled out. 

 

In 7 years of working in BKK, I also had 6 co-workers who had similar horror stories with missed diagnosis in the "best" hospitals in Bangkok.  And our company lost an expat employee before I arrived because of a missed diagnosis in a well known, foreign focused BKK hospital.

 

I can't recommend a solution, because that's not my area of expertise.  But I do suggest you take all test results with a grain of salt and confirm them with a second opinion from an independent facility before ticking them off on any differential diagnostic process.

 

Edited June 27, 2018 by impulse

[4MyEgo]

9 hours ago, xylophone said:

Or possibly an allergy...……...and very true about antibiotics and viruses, although Drs here will give them out willy nilly.

 

Hope you find the cause and cure/treatment.

Thanks, ad yes about the antibiotics, hence the reason I delayed going to the doctors for 4 weeks and then holding off another week on taking them, well two of them because the antihistamines (3rd tablet) I don't like as it literally knocks me out and I don't like the feeling, 2nd visit a week later, different type of antibiotics and the Bronchi ones I took before, but told her I wasn't going to take them as they made me bring up further phlegm and I was bringing up enough without aggravating my cough, "up to you" was the reply.

 

That said, chest X-ray clear, Spirometry reading ok, so I am told, and no need for further tests required, i.e. its normal to bring up phlegm for at least 8-12 weeks after being sick, as advised, unfortunately  that doesn't cut the mustard for me, as I am used to, well you have tried this and that and all appears normal, so what we are going to do is refer you to a specialist for further tests, but not here, e.g. my job is done.

 

At least a check to see if its an allergy or something else, and as you and Sheryl suggested, tell them you are on statins which I did, that said, I came of the evening one last night, and not having the morning one, best night sleep since I got this, i.e. no coughing, so I am going to take them every 2nd day for a week to see if I stop coughing, as you say, they might be aggravating the symptoms, who knows and when back in Sydney come late October will see a Pulmonologist 2nd one after I see one here in Khon Kaen, and my Cardiologist to discuss either coming off the statins or reducing the daily intake, because the long term effects can be a little frightening.

[4MyEgo]

9 hours ago, impulse said:

 

One of the things that disturbs me on threads like this -and this is based on my own experience in the Thai healthcare system- is ticking off a bunch of test results and filing them away as if they are definitively true.  I had symptoms similar to the OP, and went through a plethora of hospital visits over a couple of years to determine the cause of my cough and shortness of breath.

 

Long story short, my Thai cardiologist (famous, foreign focused hospital) had for 3 years been missing the fact that one of my arteries was blocked 100% and one was blocked 95%.  This despite 3 consecutive years of annual treadmill tests and quarterly EKG's.  The ENT and allergy guys never even looked there since that possibility had already been investigated and (erroneously) ruled out. 

 

In 7 years of working in BKK, I also had 6 co-workers who had similar horror stories with missed diagnosis in the "best" hospitals in Bangkok.  And our company lost an expat employee before I arrived because of a missed diagnosis in a well known, foreign focused BKK hospital.

 

I can't recommend a solution, because that's not my area of expertise.  But I do suggest you take all test results with a grain of salt and confirm them with a second opinion from an independent facility before ticking them off on any differential diagnostic process.

 

That is appalling, glad your still with us to share your story.

 

Did you have chest pain with your blockage ?

 

I know that in 2008 when they found that I had a blocked artery (90%), I had a crushing chest pain which lasted for about 5 minutes.

 

As for check ups regarding my condition etc etc, I will go as far as I can here, and then will check it out when I am in Sydney in late October, but for now, am travelling well, hoping its the tail end of it, but its something I want to get to the bottom of, because I had it in September as well, but not to this extent, but my wife believes I saw the doctor in the first week back then because of the shortness of breath and was fine after antibiotics, that said, could have been a different scenario i.e. bacterial vs viral ?

 

We soldier on......and when I do find out what it is/was I will update things here, at least I have been provided with a few options to look at, outside the square.

[xylophone]

2 hours ago, 4MyEgo said:

Thanks, ad yes about the antibiotics, hence the reason I delayed going to the doctors for 4 weeks and then holding off another week on taking them, well two of them because the antihistamines (3rd tablet) I don't like as it literally knocks me out and I don't like the feeling, 2nd visit a week later, different type of antibiotics and the Bronchi ones I took before, but told her I wasn't going to take them as they made me bring up further phlegm and I was bringing up enough without aggravating my cough, "up to you" was the reply.

The friend I mentioned in a previous post had several episodes like this and every time he would go to the doctor and they would prescribe him Augmentin and on one occasion, it did work as he probably did have a bacterial infection, but on the others it didn't and I was extremely concerned when I went round to see him one day and he was laying on the sofa feeling not well at all.

 

He had just gone out to buy some more Augmentin and had already been on a three-week course with no improvement whatsoever, so I advised him to stop taking them, but, he said I'm still coughing up phlegm!

 

Very often that is a reaction to inflamed airways and not always an infection. Anyway he stopped the antibiotics and just used a bronchial dilator for a while and seemed to get better, but he did have a persistent cough and when it got bad, this whole set of symptoms would start up again. When he went back to the UK and saw his Dr that's when the link between the statin and this cough was established. So he's changed that to another one and has been free of this never-ending cycle for about four years now.

 

As regards another poster and second opinions, I fully subscribe to that here especially as I've had experience with that myself where one doctor kept prescribing antibiotics after antibiotic for what he considered was a minor UTI and he wouldn't culture the specimen, even after I asked many times. This esp as I was feeling very sick indeed.

 

Eventually I saw another doctor and E. coli ESBL (resistant to most antibiotics) was established and I had to go on daily intravenous injections of a rare and expensive antibiotic for 14 days.

 

As it turns out the original Dr had a bit of a history of this as another acquaintance told me......... he had been having some bladder problems and this Dr looked inside with a cystoscope and suggested there was cancer present and that he may have to remove his bladder.

 

This guy immediately went back to Australia to see his own doctor and the specialist there diagnosed a small lesion in his bladder which was treated successfully (radiotherapy I think) and a couple of years later everything is fine.

 

Anyway we compared notes on this Dr and decided that his name should be, "Dr death" after both of our experiences – – not only that I found out that other patients had similar experiences, and even some of the nurses used to raise their eyebrows at the mention of his name.

 

Basically, a second opinion is always worthwhile, especially over here, and quite possibly so in other countries as well.

 

PS. So pleased that you managed to get a good nights sleep when off the statin...….and as for antihistamines, the latest generation ones are less inclined to give that "spaced out/tired" feeling, and just in case I take them before I go to bed!

[impulse]

25 minutes ago, xylophone said:

Anyway we compared notes on this Dr and decided that his name should be, "Dr death" after both of our experiences – – not only that I found out that other patients had similar experiences, and even some of the nurses used to raise their eyebrows at the mention of his name.

 

Basically, a second opinion is always worthwhile, especially over here, and quite possibly so in other countries as well.

 

Immediately after my bypass (quadruple), I just chalked my experience up to "one of those things".  That is, until I started to compare war stories with some of the guys I worked with, both co-workers and contractors.

 

I was gobsmacked at the percentage of them who had similar stories of diagnostic incompetence, in spite of the fact that most of us had only spent a small minority of our lives inside the Thai health care system.

 

Compounding the problem seems to be a tendency for the Thai doctors and nurses to cover for their colleagues within the same hospital.  I suspect that's a career preservation thing, though someone with more insight could probably eclipse my tiny pinhead of knowledge about that culture. 

 

I can only go by my limited experiences, and anecdotes from dozens of expat colleagues.  Back home, we only got second opinions when the news was bad and the insurance companies balked.  Here, I suggest a second opinion even if the news is good.  Better yet, go back home for your second opinion if you can afford it.

 

Edit:  To be fair, once they identified the problem, the care I received was first rate.  But to this day, I believe I may have gotten by with stents instead of a bypass had they diagnosed the problem 2-3 years earlier when I first presented with the shortness of breath.  Instead, my cardio guy blamed it on BKK heat and me being out of shape.  Live and learn.

 

Edited June 28, 2018 by impulse

[Sheryl]

EKG would not show blockage until/unless heart attack occurred. (For which reason their routine inclusion in check up packages makes little sense and may even do harm by giving people a false sense of security.).

 

Exercise Stress Test is the first line screening test for coronary artery disease. It has the advantage of being non-invasive, inexpensive and entails very little risk.  It will, however, detect at best just 85% of cases i.e. at least 15% of people with CAD will have normal EST.  Any cardiologist knows (or should know) this. 

 

The definitive test for CAD is a coronary angiogram. This is invasive, expensive and carries significant risks so is not suitable for mass screening. It is done when the EST indicates likely CAD. It should also be done in people with negative EST if they have clinical signs suggestive of CAD for which no other cause is identifiable.

 

I think one problem -- and it is not limited to Thai doctors, though may be worse with them - is a tendency not to give much credence to patients' subjective complaints. And to be fair, many patients are very unreliable and inconsistent in their reports, it can be very difficult to figure out what actually is being experienced and how severe it is. The exact same pain that one person will call excrutiating, another will call mild, etc. Some people will use different words to describe what they are feeling than most people do, etc. Hence the tendency to rely much more heavily on objective test results and clinical findings (symptoms visible to the doctor).

 

This is where  GP/primary care physician based systems do best, because it allows a doctor to get to know patients on an individual basis, get used to their personal way of describing things and a feel for whether, relative to most people, they tend to over or understate the severity of symptoms.  We don't have this in Thailand, unfortunately. 

 

I'm going through something similar myself right now. I have cellulitis due to a hand injury but pain and loss of function way beyond what the cellulitis can explain. I know this, but the doctors just assume that it is only cellulitis and that my complaints of "severe pain" are just an exaggerated response to the mild/moderate pain that can accompany cellulitis. I can even understand why they think this, but it is not the case. I have in fact an extremely high pain threshold. But they don't know this.

 

Sometimes all you can do is trust your gut instincts and persevere, getting more opinions etc. (Does not apply to those with "somatization disordert" AKA hypochondriacs - and you know who you are! )