Stroke care in Thailand

[JESSVANPELT]

Recently I have known of 3 Thai's who have experienced strokes and none were given the medication to reduce the clot. In most countries this medication if given within 4.5 hours of the stroke can dissolve the clot and minimize damage done, thus loss of mobility , speech etc.

 

Does anyone know why these drugs are3 not administered in the country, at least they are not in government hospitals.

 

I appreciate any good information.

I dont need reply like this is Thailand or the like.

please be constructive , we may all reach that age and experience and I'd like to know where to get treated and how

Edited September 12, 2019 by JESSVANPELT
spelling error

[Don Mega]

I had a stroke a few years ago and sat in ER for 6 hours before any treatment as they were waiting on payment confirmation from my insurer.

[scubascuba3]

Good question. I'm going to ensure I don't go to a government hospital for this one and have my credit card ready

[JESSVANPELT]

It may also be the case in the Private hospitals, anyone know.

And if you have a stroke you cant tell the people around you where you want to go, in Pattaya the emergency services folks automatically take you to a government hospital, I dont know about other places....

It would be nice if we could get a reply from Bangkok Hospital

Edited September 12, 2019 by JESSVANPELT
spelling error

[scubascuba3]

I understand there is a specialist stroke care unit in the Pattaya area. A friend was telling me his farang friend had a stoke was sent to this place, he wasn't able to provide insurance or money details (he was unconscious) so he was transferred to Bang Lamung hospital which didn't go too well

[Stocky]

1 hour ago, JESSVANPELT said:

Does anyone know why these drugs are not administered in the country, at least they are not in government hospitals.

My wife's uncle suffered his second stroke recently. They live in a rural area in the mountains near the Burmese border in Prachuap Province. He was given medication and made it through to the hospital in Prachuap Khiri Khan. He's subsequently recovered fairly well, mobility is OK, just a slight droop in the face and speech is a little off. His daughter has since moved him to live with her, closer to medical treatment. I don't think it was a private hospital they used, they're just farmers.

[soalbundy]

If you are in any danger of suffering a stroke in the future I would recommend taking an aspirin before going to bed(blood thinner) and eating plenty of dragon fruit (is good at dispersing blockages in blood vessels)

[uhuh]

Thailand is generally not a good country for speedy interventions (it's not a good country for anything speedy).

Ambulance services are usually too slow, helicopter EMS almost non-existant.

Admission at government hospitals can be very bureaucratic.

Admission at private hospitals can be slow because they wait for the insurer's payment guarantee.

 

That said,  things can move surprisingly fast. It depends a lot on who is on duty, which nurse,  which doctor,  which admin staff. Not really so different from rich countries. 

[zorrow424]

The second level up from basic govt hospitals are good,find out where yours is

[scubascuba3]

I'm surprised no one knows about this.@Sheryl ?

[JESSVANPELT]

Thanks everyone thus far for there comments, unfortunately most are off subject.

Does any one know of an actual hospital that will use these drugs for stroke victims? 

 

Yes we know there are good and bad hospitals, same the world over, and good and bad staff...... 

 

Does anyone see a Doctor for high blood pressure, ask them about this?

 

Does anyone have Ian Corness contact info ask Pattaya Bangkok hospital?

 

PEOPLE!!!!  this is a very important topic, if you or your mates has a stroke and you dont have access to these drugs your basically going to be disabled.

[Speedo1968]

I have had multiple mild and more serious TIA's over the past years and I would strongly recommend that, people who have had or think they may have had these to discuss with a doctor, in either a local clinic or government or private hospital or all.

I live alone and this is another warning that those in a similar situation may find themselves in, try to have someone check on you at least once a day, it could save your life.

 

A couple of years ago during going for a pee early in the morning, I felt strange, sat down on the toilet and was aware that I was going to collapse.     I tried to position myself to help break my fall but passed out.     When I eventually came to I was laying stretched out on the floor unable to move any part of my body.

 

As the house was closed for the night windows were closed but the bathroom door open.

 

I drifted in and out of consciousness for how long I did not know, I heard my phone ring but I was still unable to move.    It was hot in the day and I had no access to water.

Eventually around late morning of the third day a friend who had been away came to my house, got no reply and let themselves in.

They called 1669 and luckily my local govt hospital ( Banphai ) arrived some 15 minutes later.

 

I was taken to hospital and they gave me lifesaving medication by drip without hesitation.   A few hours later I was transferred to my hospital in Khon Kaen.     Had it not been for the rapid response and treatment intervention I would have died.

My condition was that of someone who had been trapped under a building following an earthquake, I had suffered almost total muscle loss throughout the body ( Rhabdomyolysis – creatinine levels of 133,000 ).    I was in ICU for 2 weeks.    The hospital ( and govt hospital ) was aware ( its on my hospital file / in my backpack when out and hanging in clear view in my house ) that I had a DNR request and was allergic to many medications including antibiotics.   Later they suggested dialysis which I turned down due to my preference for alternative therapy.

 

The food in the KK hospital was terrible especially with my being vegan.   I had to try and buy food from outside,

It took me 3 months to walk unaided again.

I can have nothing but praise for the Emergency Response Unit and the understanding of the doctor in the local govt hospital.    The private hospital in KK although my doctor regarding my stroke was excellent in his understanding the doctors treating my kidney failure and other issues could not understand why my recovery was so rapid without added medication ( only drip ) nor why I should want a DNR honoured if it so happened and no dialysis.   They had, it seems, a strict code of practice regarding what works for one works for all.

As an addendum whilst living for a short time in the UK my rented bungalow had an emergency call button, during a bad TIA / mild stroke I pulled the cord; no local hospital, it took nearly 90 minutes for the ambulance to arrive.

 

My message is be prepared yourself, help prepare others with what they can / should do and stay in touch with your local clinic and govt hospital, be prepared for “What if … ?” it helps both sides.

 

Sorry if this still seems off subject

Edited September 15, 2019 by blackcab
Font normalised

[zorrow424]

48 minutes ago, JESSVANPELT said:

Thanks everyone thus far for there comments, unfortunately most are off subject.

Does any one know of an actual hospital that will use these drugs for stroke victims? 

 

Yes we know there are good and bad hospitals, same the world over, and good and bad staff...... 

 

Does anyone see a Doctor for high blood pressure, ask them about this?

 

Does anyone have Ian Corness contact info ask Pattaya Bangkok hospital?

 

PEOPLE!!!!  this is a very important topic, if you or your mates has a stroke and you dont have access to these drugs your basically going to be disabled.

Looks like you are in Pattaya. Chonburi  city govt hospital is a level 2 (or whatever its called) many a stroke victim from surrounding areas are taken there

Bangkok hospital Pattaya will definitely give you a stroke at their pricing regime

Edited September 13, 2019 by zorrow424

[uhuh]

The drugs OP is asking about are called tPA. 

They should be given within 3 hours after onset of symptoms (4.5 hours in certain cases), a CT scan is necessary before they are given. 

 

The number of patients needed to treat for tPA to benefit 1 patient is about 7.

 

tPA is available in many government hospitals and, of course, in places like Bangkok Hospital.

Unfortunately, the schedule given above is unrealistic for most cases in Thailand. This probably explains why OP has never seen it. 

 

[JESSVANPELT]

Yes we can all google this topic and state figures, and the correct figure of success without a stent is 37% but if you dont get the treatment you have 0% chance. All Western world Hospitals give it to the majority of stroke victims

in all three cases none of the patients having a stroke were even given a ct scan, let along in injection of any type.

 

Does anyone know of any hospital that actually does administer the drugs (after the CT scan)?..same question?

 you say its available in many public hospitals and Bangkok Hospital...have you confirmed this? Please tell us how?

 

I have not named hospitals these people were treated in for obvious reasons.

 

Thanks again.

Just trying to get actual facts.

Edited September 13, 2019 by JESSVANPELT
spelling

[uhuh]

A provincial hospital will normally do a CT scan on every patient with suspected stroke.

A district hospital will usually not do a CT scan, because a district hospital usually does not have a CT.

Obviously, a district hospital will not use tPA. Transfer from a district hospital (which is where most patients go first) to the provincial hospital will usually be completed way after 4.5 hours after onset of symptoms. 

 

You're question was "why these drugs are3 not administered in the country, at least they are not in government hospitals." This is wrong.  They are administered in this country, in private and in government hospitals.

I tried to explain the probable reasons why you haven't seen it in 3 cases.

 

BTW your figures 37% and 0% are wrong. 

And no, we cannot all google this topic and expect to become an expert. 

[scubascuba3]

A provincial hospital will normally do a CT scan on every patient with suspected stroke.
A district hospital will usually not do a CT scan, because a district hospital usually does not have a CT.
Obviously, a district hospital will not use tPA. Transfer from a district hospital (which is where most patients go first) to the provincial hospital will usually be completed way after 4.5 hours after onset of symptoms. 
 
You're question was "why these drugs are3 not administered in the country, at least they are not in government hospitals." This is wrong.  They are administered in this country, in private and in government hospitals.
I tried to explain the probable reasons why you haven't seen it in 3 cases.
 
BTW your figures 37% and 0% are wrong. 
And no, we cannot all google this topic and expect to become an expert. 

Provincial and district don't seem to be terms used on this list of hospitals in Thailand.

https://en.m.wikipedia.org/wiki/List_of_hospitals_in_Thailand

[JESSVANPELT]

9 hours ago, uhuh said:

A provincial hospital will normally do a CT scan on every patient with suspected stroke.

A district hospital will usually not do a CT scan, because a district hospital usually does not have a CT.

Obviously, a district hospital will not use tPA. Transfer from a district hospital (which is where most patients go first) to the provincial hospital will usually be completed way after 4.5 hours after onset of symptoms. 

 

You're question was "why these drugs are3 not administered in the country, at least they are not in government hospitals." This is wrong.  They are administered in this country, in private and in government hospitals.

I tried to explain the probable reasons why you haven't seen it in 3 cases.

 

BTW your figures 37% and 0% are wrong. 

And no, we cannot all google this topic and expect to become an expert. 

My figures are from a scientific website, and I admit several websites have higher and lower success rates s depending on the study group, I'm not wrong.

So based on your opinion the are we to assume that those of us that live in Pattaya might only have the opportunity to receive the tPA drug and scan a the Bangkok Pattya hospital? Since all the other hospitals are non provincial?

[uhuh]

9 hours ago, scubascuba3 said:

Provincial and district don't seem to be terms used on this list of hospitals in Thailand.

https://en.m.wikipedia.org/wiki/List_of_hospitals_in_Thailand

If you don't understand the Thai health care system you should read Sheryl's excellent introduction,  not wikipedia. Pinned thread number 9.

[uhuh]

3 hours ago, JESSVANPELT said:

 

So based on your opinion the are we to assume that those of us that live in Pattaya might only have the opportunity to receive the tPA drug and scan a the Bangkok Pattya hospital? Since all the other hospitals are non provincial?

Bangkok Pattaya Hospital is certainly the place where your chance to get tPA is greatest.

 

About the other 2 private hospitals i can only try educated guesses,  so I better don't go into it. 

Banglamung Hospital has upgraded facilities during the last years (new building). But quite recently they did still send patients to BPH for a CT scan. 

[blackcab]

On 9/13/2019 at 2:13 PM, scubascuba3 said:

I'm surprised no one knows about this.@Sheryl ?

 

Sheryl is away for a few days. She will see you tagged her post and she should respond when she gets back.

[spornb]

I have said elsewhere everyone needs their own emergency plan, and to be registered with the chosen hospital, and have a patient number

 

Wife needs to be able to find A&E

 

Get there do not park, go to where the ambulances stop, get patient onto trolley then park

 

We prefer take the risk and drive, you may simply die waiting for the ambulance that never comes

 

I have had two emergency trips in the early hours and each time wound up in the ICU, each time could have been dead without our plan

 

Planning will save a great deal of self inflicted delays

 

THERE IS NO EXCUSE NOT TO HAVE A PLAN

[PPMMUU]

Most Thai hospital has the "FAST TRACK STROKE" protocol. Event in those rural hospital.

 

There are indications and criterion that need to be met before clot lysis drug (tPA) will be given.

 

In a nutshell, those who has too little symptom, too much symptom, too many other risk factors, had symptom for too long, are not eligible for this kind of drug. Whether you are at a public or private hospital is irrelevant.

[Sheryl]

First of all, these drugs are not indicated in all strokes, only in stroked due to a clot as opposed to a hemorrhage. Strokes can be either thrombotic (clot) OR hemorraghic.

 

Not only are the drugs not indicated in stroked of the hemorraghic type but their use in that instance would have catastrophic effects. The drugs can be used only after scans have confirmed a thrombotic stroke and no intracranial bleeding present. If it is not possible to do such a scan, the medications cannot be safely used.

 

Secondly, it is also not safe to give to people who have been on anticoagulant medication, so much so that it is recommended not to give unless it is possible to ascertain with certainty that such drugs have nto been taken. In case of someone unconscious or otherwise unable to give history and no access to information from the patient's doctor or family the medications cannot be administered as the potential  risks outweigh the potential benefits.

 

Thirdly, to be effective the thrombolytic agent needs to be given within 4.5 hours of the start of the stroke.

 

Tertiary level government hospitals (university hospitals and the like) have the capacity to do this, as do the larger private hospitals, but many patients will not meet the criteria mentioned above. Especially given the pace at which things tend to happen at government hospitals.

 

I doubt lower level government hospitals have the capacity.

 

Among the private hospitals I know Bangkok Hospital in Bangkok dose this, they were one of the first to do so i  Thailand, but I do not know re their upcountry affiliates.  Not only would the hospital have to have CT scan capability and the medication but also a doctor trained in the technique...and, in a private hospital, you would have to be being treated by such a doctor or one willing to refer you to one.

 

[PPMMUU]

most provincial hospital can do this (perform CT scan and administer tPA if indicated within 4.5 hr after onset) regularly with little problem

 

problem might arises if you live very far from provincial hospital. in that case, i suggest check with nearest hospital if they can perform CT scan. and if they can't where is the nearest one.

[scubascuba3]

What's the nearest provincial hospital to Pattaya?

[Sheryl]

3 minutes ago, scubascuba3 said:

What's the nearest provincial hospital to Pattaya?

 

 

Chonburi (in Chonburi town). And it is a regional hospital, which is a higher level than provincial.

 

There is also a large Red Cross hospital in Sri Racha town.

[PPMMUU]

My previous comment is irrelevant if you live in Pattaya.

 

I strongly believe that Pattaya City Hospital is almost certainly capable to perform CT and administer tPA if indicated.

 

Please confirm with locals again.

[scubascuba3]

My previous comment is irrelevant if you live in Pattaya.

 

I strongly believe that Pattaya City Hospital is almost certainly capable to perform CT and administer tPA if indicated.

 

Please confirm with locals again.

Pattaya City Hospital seems really basic to me when I've been there.

 

Edit: i wouldn't use their A&E for anything serious, Bang Lamung Hospital was better

 

[PPMMUU]

27 minutes ago, scubascuba3 said:

Pattaya City Hospital seems really basic to me when I've been there.

 

Edit: i wouldn't use their A&E for anything serious, Bang Lamung Hospital was better

 

Thank you for local insight.

 

I checked Pattaya City Hospital website and find that they have CT unit and Internal Medicine specialist, so it is certainly possible to get a CT but I have no information about tPA so I have sent them a query.

 

On the other hand, it is confirmed that Chonburi and Banglamung hospital is capable of administering tPA to indicated patient.

Banglamung hospital is recently capable to do this since October 1, 2018.

A 2019 health index inspection report confirm this
http://203.157.133.41/plan_doc/document_files/20190114-1547472416.pdf