Please suggest me a good neurologist.

[Shohag Hasan]

I am planning to visit Thailand with my mom to see a neurologist asap. Last MRI report shows there is a mild compression on her C5, C6, C7 bilateral existing nerve roots. Also. Xray report shows small osteophytes are seen in L3 - L5 vertical bodies. Sometimes she suffers pain and not able to move her leg. We belive, neurologist who has expertise on nerve is the best person to see in this regard. Can you please suggest?

[Sheryl]

You should see a spinal specialist, these can be either neurosurgeons or orthopedic surgeon. The one I recommend is the latter, Asso. Prof. Dr. Wicharn Yingsakmongkol.

 

He is at BNH Hospital most evenings and also at Bangkok Christian Hospital once a week only. Bangkok Christian is cheaper than BNH but of course the less frequent schedule can be a problem. If you to Bangkok Christian come early to register and get in the queue as it is first come, first serve.

 

https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

 

At BNH should make appointment, which yo ucan do online.

 

The Bangkok Christian Hospital website is in Thai only. Prof. Wicharn is there on Saturdays, he comes at 2 PM but as mentioned should get there long before. No appointment needed but call to make sure he will be there.

 

https://www.bch.in.th/find-doctor/

 

Both hospitals are in the Silom area, lots of inexpensive hotels and guesthouses around.

 

good luck.

 

 

 

 

[Shohag Hasan]

Thanks Sheryl,

 

Definitely I will try to make appointment with him. Also, I will go for a second opinion. Any recommendation for that?

 

In case they ask me to go for one more MRI, can you recommend me any good place for MRI? how much it might cost me? 

 

Regards

[Sheryl]

For MRI, here:

 

http://www.mrithailand.com/en/

 

I think about 12,000-14,000 for either cervical or lumbar spine, if both (whole spine) maybe 20,000.

 

If the MRI is not recent and if they are cheaper in your country you might like to get it done there instead. MRIs and CTs are comparatively expensive in Thailand.

 

Dr. Wicharn is the one I suggest people wanting a second opinion to see, he is really the best in the country. But if you want another opinion I suggest Prof. Areesak Chotivichit or one of his associates at Siriraj

http://www.siphhospital.com/en/home

 

 

 

[mike787]

Bumrungrad hospital is amazing.  try their as well.  good luck.

[uhuh]

Spinal problems ideally need a cooperation of an orthopedic doctor (preferably one who is not just an orthopedic surgeon, but who also uses conservative treatment) for initial assessment (and to rule out other, unrelated causes of the symptoms), a doctor for rehabilitation (and a physical therapist) to try non-invasive treatment options, a radiologist (who sees the MRI), a neurologist (who checks for nerve damage and the the necessity of surgery) and finally a neurosurgeon. (If surgery is necessary the neurosurgeon is usually the one who does it best.)

 

You will be surprised how different they will see things. 

(You may also be surprised how poorly they often cooperate)

The leading private hospitals here all have "spine centers" with "spine specialists", where they try to put all this under one roof. 

The results are very mixed. I personally have not seen good results from spine specialists in Thailand. Quite the opposite. Physical therapy in Thailand lets much to be desired,  and doctors tend to operate to soon.

 

BTW for cervical spine a 3 Tesla MRI (or a Siemens Sola 1.5 T MRI) would be preferable,  i don't think mrithailand has that,  not sure though. 

 

[Sheryl]

I personally have seen excellent results in spinal surgery in Thsiland, many times. I have also seen bad results both from surgery and from failure to do surgery or doing it after undue delay.

It all depends on the surgeon. Both for operative technique and, equally important, appropriate patient selection (who requires surgery vs who can be managed conservatively; correctly identifying the cause of the pain. Disk problems seen on MRI can be incidental findings and not necessarily be the reason for the pain being experienced in which case surgical correction may not yield expected results).

Mistakes in patient selection/recommendation for surgery can go in either direction and it is not always best to manage conservatively. If there is major nerve compression permanent damage can result. When surgery is eventually performed it will relieve pain but it cannot undo nerve damage that has already occurred. My brother in US and his dovtors made this mistake and he was left with a permanent limp as a result of surgery too long delayed.

I disagree that neurosurgeons are best for this, especially in Thailand my experience is the opposite. But the ortho surgeon needs to be a spinal specialist with advanced training in spinal surgery and extensive experience.

With a well qualified orthopedic surgeon specializing in spine the involvement of a neuroligist is usually not necessary though depending on the case he might seek a consult. Nerve conduction studies are often helpful pre-op to ensure that the source of the pain has been accurately pin pointed and surgery will produce the expected relief. These are done by technicians and a skilled orthopedic spinal specialist can interpret them.

Rehab services may or may not be necessary, depends on the patient. Many need no more than simple post op instructions. Someone whose pre-op condition was one of impaired mobility and very frail patients are obviously different.

Within my immediate family and household 5 spinal surgeries in Thailand. 4 of the 5 went very well. 1 (done in govt hospital with I suspect inadequately supervised residents operating) did not and required re-operation which then went OK.








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[snowballthecat]

Hi, 

The thread is a bit confusing...

Spine specialist? neurosurgeon? neurologist?

I fall down my own stairs a month ago and hit badly the back part of my head. Run to the local government hospital A&E, was given a CT scan (clear), medicines and told if "neurological symptoms" appear, come back here. (Vachira, Phuket).

In the CT scan report, a mention of Hydrocephalus appear (pre-existing?). No one word from the doctor. 

I don't know what is a neurological symptom, never had one before.

Or yes....

 

Now I feel dizzy daily and have headaches in different part of the scalp. Light and brightness annoys me  a lot. 

Yesterday went back to the A&E, they send me away saying I should see a neurosurgeon. 

Can anyone confirm this is the specialist I should see now? and if it is, who can you recomend in Phuket? I don't mind to travel to Chiang Mai, if I can visit a good doctor there.

 

My insurance is only inpatient and covers A&E, yesterday one guy at Vachira said that the follow up of emergency is covered as well? Started to worry about the costs, as it is "head" and 'brain" it may involve many scans, investigations, etc. 

 

Any input will be highly appreciated, Sheryl's one in  particolar....Thanks in advance!

 

[blackcab]

5 hours ago, snowballthecat said:

Any input will be highly appreciated, Sheryl's one in  particolar

 

@Sheryl is away for a few days. I have tagged this post so she will be able to see it and reply on her return.

[uhuh]

Your symptoms may be considered "neurological symptoms" and you should see a neurologist or a neurosurgeon. You don't need a spine specialist.

Among Thailand's best neurosurgeons are Dr Nantasak (Bangkok Hospital) and Dr Yot (Chulalongkorn Hospital,  Bumrungrad, Bangkok Hospital), both in Bangkok. If a difficult operation is necessary i would prefer them. 

In your case,  I would see a Neurosurgeon in Phuket first, e.g. Dr Lersak at Bangkok Hospital in Phuket

[Sheryl]

On 9/19/2019 at 3:16 PM, snowballthecat said:

Hi, 

The thread is a bit confusing...

Spine specialist? neurosurgeon? neurologist?

I fall down my own stairs a month ago and hit badly the back part of my head. Run to the local government hospital A&E, was given a CT scan (clear), medicines and told if "neurological symptoms" appear, come back here. (Vachira, Phuket).

In the CT scan report, a mention of Hydrocephalus appear (pre-existing?). No one word from the doctor. 

I don't know what is a neurological symptom, never had one before.

Or yes....

 

Now I feel dizzy daily and have headaches in different part of the scalp. Light and brightness annoys me  a lot. 

Yesterday went back to the A&E, they send me away saying I should see a neurosurgeon. 

Can anyone confirm this is the specialist I should see now? and if it is, who can you recomend in Phuket? I don't mind to travel to Chiang Mai, if I can visit a good doctor there.

 

My insurance is only inpatient and covers A&E, yesterday one guy at Vachira said that the follow up of emergency is covered as well? Started to worry about the costs, as it is "head" and 'brain" it may involve many scans, investigations, etc. 

 

Any input will be highly appreciated, Sheryl's one in  particolar....Thanks in advance!

 

 

What you describe are neurological symptoms.

 

You should see a neurosurgeon and right away. You probably need to have a repeat CT.

 

I can't say re your insurance as it depends on the policy. Check your policy documents.

 

Phuket is not the greatest place for medical care. But there are 3 neuorsurgeons at Bangkok Phuket hospital and probably (not certain) at least 1 at Mission Hospital. I would also have thought surely there would be at least 1, likely more, at Vachira?

 

if you can quickly come to CM then Sripat.

 

[PPMMUU]

Totally agree with Sheryl that you need to see a neurosurgeon right away

 

If you cannot find a neurosurgeon, go to Vajira Phuket, because you have a previous CT there. Comparison of medical imaging with previous one is beneficial.

[snowballthecat]

Thanks to all input on this thread!

I have seen Dr Lersak in Vachira. He is a neurosurgeon. I do recommend him, although it is better to go to Bangkok Hospital, Vachira is collapsed with people!

Arrived 8;30 am only to be seen at 13;30.....

Doctor didn't stop for lunch either....

Phuket is not exactly the right place to see a doctor. 

Anyway, done. He said the vertigo may last a few months....so NFA, 

Forget to ask: can I fly with such a vertigo? Can compression have an effect on my brain? Anyone knows?

 

[Sheryl]

You really need to ask the neurosurgeon this as I have no way of knowing what the nature of the injury is. Was a repeat CT done?

 

[snowballthecat]

no repeat CT scan....As I found out later, my insurance follows up emergencies only within 15 days of the first episode. 

If I need further investigation, I have to pay myself. (inpatient plus emergency is covered up to 5 million per condition).

He just told me it can last a few months....then told me to take medication -Mertigo 12 mgx 3 times a day-

And stress it: do not spend time in front of any screen. Reduce time with gadgets and screens, rest as much as you can. 

Then he went to explain how the pixels send signals to our brain....etc, etc. One more reason to go into 'real life"!!

All patients out there seem to love him, for his dedication. After so many hours sitting together spoke to many of them....My God, so many conditions and scary symptoms....

i did not ask any question about hydrocephalus, scared to death! about this one. Nobody mentioned it....me either. 

Anyway, will stop doing any movement  and "shaking" including driving and flying, and will do what he said to do. Will take it from there, afterwords. Maybe will go to Shripat or BKK if it lasts. 

Thanks, Sheryl!