Spinal Specialist in Chiang Mai

[ThaiPauly]

An MRI has revealed that my wife has some severe problems with the disks at the top of her spine and is in great pain at the moment apart from the mornings. The pain gets worse as the day progresses

After initially being diagnosed with Fybromyalga by her doctor at Klaimore Hospital where she was admitted for 3 days, it would appear that after a consultation with a spine specialist  Dr Sutiphas ( that is my wife's interpretation of his name from Thai- I think it could be Suttipat) at Sriphat hospital this morning that she really needs an operation to insert some new titanium disks in her neck. She has a pinched nerve which is giving her radiated pain down into her hand , legs and feet. It has taken months to get this far with some kind of diagnosis, though we can't think why her doctor at Klaimore did not pick up on it, he was the first to see the MRI, and we have got to this doctor by chance, he wanted her to see a pain specialist at Nakorn Ping. I wanted her to see Dr Pasakorn at Sriphat as he had helped me many years ago. He said there was nothing he could do and passed us on to this doctor.

 

My question is does anyone know of any other spine specialists in CM

 

It's not that we don't like him , I certainly think he is more than capable, he is also the orthopedic doctor at Bangkok Hospital.

 

 

Anyway, as it is such a serious operation  we would like a second opinion,  and/or an endorsement of this doctor from anyone that might have had any interaction with him.

 

Cost is not the issue, He is quoting 200,000-300,000. I don't know if that is cheap or expensive but (as he says) the operation is quite serious

but not dangerous as I was concerned that if he made a mistake she would never be able to walk again. He assures me that is not the case.

Although I was quite alarmed when he said that the operation requires an entry incision in the neck to do the job. I am no doctor but I thought you would enter through the back. He also says he will need to take some bone from her back. Not sure why? We did not get that far in the half an hour we spent with him which is much longer than most people get.

 

Going to Bangkok is not out of the question so any recommendations from there would also be useful.

 

Thanks you for taking the time to read this

 

TP.

[Sheryl]

If willing to go to Bangkok, can't beat Dr. Wicharn

 

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

 

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

 

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

 

The surgery will cost less at BCH than at BNH

 

From what you describe it does not sound like there is a plan to put "titanium disks" in her spine but rather do a fusion which entails some titanium screws.

 

 

[meechai]

So sorry to hear this & hope things get better.

 

If I may suggest an alternative to you it would be Mungkala clinic in ChiangMai

 

It is something that you could try & see what your wife thinks. Both Mr & Mrs Pawaradhisan are long time acupuncture practitioners

 

 

 

 

Edited November 3, 2019 by meechai

[ThaiPauly]

Yes, we plan to do acupuncture for the next two weeks

 

Do you happen to have a phone number?

 

Thank you

[uhuh]

I cannot help about CM.

 

1. It is unusual to have pain in arm AND leg/feet from a pinched nerve in the neck. Reconsider diagnosis.

 

2. I would rather go to Bangkok 

 

Before an operation, i would try 

- physical therapy. It should be manual therapy,  not ultrasound,  not laser, not traction by machine, not Thai massage

- medication: tolperisone, oral steroids under medical supervision, maybe NSAID

- consider epidural steroid injection under fluoroscopy (Dr Nut in Bumrungrad, Dr Pisit in Bangkok Pattaya Hospital) IF the diagnosis is correct

- consider facet joints as the reason for the symptoms (talk to Dr Marvin, Bangkok Hospital)

- get a second opinion from another surgeon

- ask, whether an artificial disc is indicated ( it's not titanium) or just screws and plates

 

The operation is serious. 

It is usually done from the front of the neck. 

NB 200,000 to 300,000 is not expensive. 

 

Edited November 3, 2019 by uhuh

[saengd]

I've had lower back disc problems for over thirty years and have refused a discectomy twice, the outcome is just not reliable, chiropractics can work but you need to be careful in your choice of chiropractor - I personally would not consult with one in Thailand under any circumstances. Most recently I had an MRI and saw a consultant orthopedic surgeon at the John Radcliffe in Oxford, despite severe numbness in the thighs and toes, tripping and an inability to sit comfortably for more than fifteen minutes, he declared there was no neurological deficit, to say otherwise would mean disk fusion and as he put it, it's the devil you know versus the one you don't. He told me they would entertain disc fusion in the case of severe and constant pain but only after physical therapy, medication, traction, injections and anything else they could think of had failed. Just remember, if you have that op., you can't reverse it.

[meechai]

1 hour ago, ThaiPauly said:

Yes, we plan to do acupuncture for the next two weeks

 

Do you happen to have a phone number?

 

Thank you

Hi yes

053 278 494

 

I believe they open at 9am everyday except Sunday

[ThaiPauly]

1 hour ago, saengd said:

I've had lower back disc problems for over thirty years and have refused a discectomy twice, the outcome is just not reliable, chiropractics can work but you need to be careful in your choice of chiropractor - I personally would not consult with one in Thailand under any circumstances. Most recently I had an MRI and saw a consultant orthopedic surgeon at the John Radcliffe in Oxford, despite severe numbness in the thighs and toes, tripping and an inability to sit comfortably for more than fifteen minutes, he declared there was no neurological deficit, to say otherwise would mean disk fusion and as he put it, it's the devil you know versus the one you don't. He told me they would entertain disc fusion in the case of severe and constant pain but only after physical therapy, medication, traction, injections and anything else they could think of had failed. Just remember, if you have that op., you can't reverse it.

I here you, 2 of my kids were born at The John Radcliffe. If we lived in the UK that's where we would be going. It's a fantastic hospital. My kids still live in the Witney region and I still have two properties there. Love Witney. But as far as medical problems are concerned and my wife being Thai right now, we are stuck in Chiang Mai.

[ThaiPauly]

1 hour ago, saengd said:

I've had lower back disc problems for over thirty years and have refused a discectomy twice, the outcome is just not reliable, chiropractics can work but you need to be careful in your choice of chiropractor - I personally would not consult with one in Thailand under any circumstances. Most recently I had an MRI and saw a consultant orthopedic surgeon at the John Radcliffe in Oxford, despite severe numbness in the thighs and toes, tripping and an inability to sit comfortably for more than fifteen minutes, he declared there was no neurological deficit, to say otherwise would mean disk fusion and as he put it, it's the devil you know versus the one you don't. He told me they would entertain disc fusion in the case of severe and constant pain but only after physical therapy, medication, traction, injections and anything else they could think of had failed. Just remember, if you have that op., you can't reverse it.

That's a scary post. But I appreciate your honesty. Truth often hurts

 

Have tried physical therapy..they havegiven up and said they can do no more

Have tried a chiropractor. The best from the UK who has a clinic in CM and visits a few times a year

He says he cannot help and we would be wasting our money having him try more.

Have tried injections...of course they work when they pump you full of steroids or Tramadol but only for a short time, then it's back to constant pain . She had an injection that consisted of 3 different drugs at 11am. It's now 6pm and they have all worn off and she is in a lot of pain again

Have tried Acupuncture. Outcome of that was positive and we will continue that for longer and see what happens, but I won't be holding my breath. Another poster has recommended another one and we shall try to get the best we can

Edited November 3, 2019 by ThaiPauly

[Sheryl]

2 hours ago, uhuh said:

I cannot help about CM.

 

1. It is unusual to have pain in arm AND leg/feet from a pinched nerve in the neck. Reconsider diagnosis.

 

 

True but from what he says surgery was recommended only for cervical spine.

 

 

[ThaiPauly]

I have been studying a website dedicated to spine health and there maybe a couple of alternatives to the full  operation.

Cervical Epidural Injection

Cervical Selective Nerve Root Block.

 

Has anyone got any knowledge of these procedures and know if either are a credible alternative to surgery?

 

My wife is scared to death by some horrible stories she has heard from friends about back operations going wrong.

Many thanks

[uhuh]

I refer to your last post,  to Sheryl's last post and to your original post and repeat:

It is very unusual to have pain in legs AND arms from cervical spine problems. It is also difficult to imagine how doctors confuse cervical radiculopathy with fibromyalgia. Before considering any treatment you need to have a definite diagnosis. 

 

A doctor who could help you figure out if the pain is muscular pain and has not much to do with the spine is Dr Urairat, Bumrungrad.

 

IF the diagnosis is cervical radiculopathy (pain, numbness resulting from irritation of the nerve root, by compression by a herniated disc or a narrowing of the neuroforamen) - without muscle weakness! - 

 epidural steroid injection should be tried before any operation. 

 

Epidural steroid injection should be done under fluoroscopy.

It is not risk-free and there are doctors in Thailand who would not recommend this procedure in Thailand at all. Doctors who perform this procedure include Dr Phisit at Bangkok Pattaya Hospital (cost 30,000, for Thais considerably cheaper) and Dr Nut at Bumrungrad. 

Epidural steroid injection is not a simple fix. It may be necessary to repeat it. Dr Phisit will not do it more often than 2 times, other doctors will do it up to 6 times. The intervals between the injections vary from doctor to doctor. Altogether this may go on for 6-9 months. 

Most important: the patient needs a lot of active physiotherapy and training, otherwise all treatment options are useless (operations included). Besides training of the neck and back muscles, treatment of cervical spine consists of 3 pillars: posture, posture, and posture.

The reason for cervical spine problems is often bad posture. The patient needs to tackle this underlying problem.  No more smartphones, you understand?

 

Root blocks are a wider field.  As I mentioned above,  medial root blocks can help if the diagnosis is facet syndrome (not the same as narrowing of neuroforamen). The diagnostic test is an injection of anesthetics. Dr Marvin at Bangkok Hospital does this under ultrasound guidance. His therapy is then radioablation, which in most cases results in a painfree time of about 6 months, with luck longer, can be repeated (costs about 90,000). He uses an anterior approach, other doctors use lateral approaches or block other nerves, some use CT-guidance or no guidance at all (not recommended).

All these procedures are not risk-free.

 

Many patients understandably try to avoid cervical spine operations and try all other options first. Read the post about the Radcliffe Hospital, I quite agree with them.

Is it possible to wait too long? Yes, definitely: if there is increasing muscle weakness from stenosis of the cervical spine,  operation is necessary and urgent. Otherwise, you can lose the function of arms and hands if you wait too long.

But as long as the problem is only pain and the pain is chronic already, operation is not urgent, and should be avoided if possible. 

 

 

 

 

Edited November 4, 2019 by uhuh

[Sheryl]

3 hours ago, ThaiPauly said:

I have been studying a website dedicated to spine health and there maybe a couple of alternatives to the full  operation.

Cervical Epidural Injection

Cervical Selective Nerve Root Block.

 

Has anyone got any knowledge of these procedures and know if either are a credible alternative to surgery?

 

My wife is scared to death by some horrible stories she has heard from friends about back operations going wrong.

Many thanks

Neither of these are curative they just temporatily reduce or relieve pain.

 

If there is nerve compression in the cervical spine the next question is the cause as some can improve with time while others will not. If the compression is due to insufficient space for the nerve root to exit then surgery is inevitable. If on the other hand it is due to pressure from a bulging disk this may retract with time and conservative measures may suffice.

 

She has been given conflocting and unclear diagnoses and I think it is premature to talk about trreatments. She needs to see a good spine specialist to determine whether the cause is in the spine and if so from what exactly.

 

I have given you the name of a top jotch spinal specialist. Take her MRI, Xrays etc and consult him.

[ThaiPauly]

We have been dragging our feet a bit over the last couple of days as we want to exhaust all options in CM before going down to Bangkok to stay until we get somewhere with Doctors down there.

I had a quote for the same operation from Bumrungrad Spinal Centre as in Shriphat Chiang Mai and they are quoting about the same amount as you would pay in a hospital in the US, around 720-750,000 baht.

Shriphat wanted 200,00-300,000, but I have the money saved so can afford any amount, I just want the best outcome for her.

 

We are going to try acupuncture, she received one session from a Doctor at Shriphat and it helped for a short while  could this help long term? Chinese Acupuncture Specialists reckon you need about 20 sessions with long needles to have any effect, but they claim they can get results in helping the problem. We have an an initial consultation with them tomorrow. A poster on here on this thread recommended them.

 

If we get nowhere on this front we will go to BCH as Sheryl recommends and will stay down in Bangkok until we get a resolution to the problem. If we don't get answers there Uhuh has recommended many more.

 

Uhuh are you a doctor? You seem to have a fantastic grasp of our situation, for which I am very grateful to hear your suggestions and observations, some of which are a bit hard to understand but I am getting there. I have never had to delve into spinal problems before, but spending 6 hours a day on-line I am learning.

 

Thank you for your help people

[Sheryl]

Whether accupuncture will help depends entirely on the cause of the problem whuch remains unknown.

 

In my opinion your focus at this stage  should be on diagnosis not trial and error treatments.

[Sheryl]

P.S. as you ate reluctant to hoto Bangkok suggest you bring her along with MRI and Xray to see Prof Torphong Bunmaprasert at either Sripat or CM Ram.

 

One thing to be aware of is that IF there is serious nerve compression delay in treatment could result in permanent nerve damage. Surgery in that case can relieve pain and prevent future nerve damage but cannot undo damage that has already occurred.  If she has noticeable weakness in the affected arm then should move quickly.

[ThaiPauly]

Thanks Sheryl,

 

I am not reluctant to go to Bangkok. My son and Grandson live there so it is easy for us to be there.

I only got the diagnosis on Sunday so I am trying to get as much info as I can before traveling down there.

 

I have told my wife to contact BCH today to try to get an appointment with the doctor you rate so highly.

 

[ThaiPauly]

On 11/3/2019 at 3:29 PM, Sheryl said:

If willing to go to Bangkok, can't beat Dr. Wicharn

 

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

 

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

 

 

 

 

Sheryl, Prof Wicharn does not appear to be at BCH any longer, my wife just called to try to get an appointment, so we will go to BNH to see him there.

[meechai]

4 hours ago, ThaiPauly said:

We are going to try acupuncture, she received one session from a Doctor at Shriphat and it helped for a short while  could this help long term? Chinese Acupuncture Specialists reckon you need about 20 sessions with long needles to have any effect, but they claim they can get results in helping the problem. We have an an initial consultation with them tomorrow. A poster on here on this thread recommended them.

 

As others have said of course it will depend on root cause but.........I would fully give it a fair try.

In my life I have had some terrible problems due to motorsport accidents & also work related & have had long term excellent results with acupuncture from the couple mentioned earlier in Chiang Mai.

 

Previously when treated over the years by both accu & chiro in the United States I had relief but no long term repair. When I moved to Chiang Mai I used the place I mentioned earlier in this thread & after 8 weeks treatments & years later I have never since needed any further treatments. Really still amazed myself

 

I hope your wife may also find relief

Edited November 5, 2019 by meechai

[ThaiPauly]

26 minutes ago, meechai said:

 

As others have said of course it will depend on root cause but.........I would fully give it a fair try.

In my life I have had some terrible problems due to motorsport accidents & also work related & have had long term excellent results with acupuncture from the couple mentioned earlier in Chiang Mai.

 

Previously when treated over the years by both accu & chiro in the United States I had relief but no long term repair. When I moved to Chiang Mai I used the place I mentioned earlier in this thread & after 8 weeks treatments & years later I have never since needed any further treatments. Really still amazed myself

 

I hope your wife may also find relief

Very thoughtful post Meechai.

 

The problem is that the problem won't wait. We have a diagnosis and have to move along with traditional medicine

I wish it were different.

I did initially make an appointment to go there after reading your post but after reading more on here and on spinal forums I think we have to take more immediate action that can promote cure faster than acupuncture can.

Ironically when I rang to cancel my appointment they could not find my booking which was for 4pm tomorrow, which is strange, we would have got there and not been able to see anybody as they are super busy.

[joealx]

5 hours ago, ThaiPauly said:

Sheryl, Prof Wicharn does not appear to be at BCH any longer, my wife just called to try to get an appointment, so we will go to BNH to see him there.

See Bumrungrad at Spine Center.

[ThaiPauly]

On 11/5/2019 at 7:52 AM, Sheryl said:

P.S. as you ate reluctant to hoto Bangkok suggest you bring her along with MRI and Xray to see Prof Torphong Bunmaprasert at either Sripat or CM Ram.

 

One thing to be aware of is that IF there is serious nerve compression delay in treatment could result in permanent nerve damage. Surgery in that case can relieve pain and prevent future nerve damage but cannot undo damage that has already occurred.  If she has noticeable weakness in the affected arm then should move quickly.

Very impressed with the professor Sheryl, he is without doubt seems the most competant we have seen.

 

We will go back to his clinic tomorrow to give him the go-ahead for the operation which he said he will squeeze in somehow before he goes off to America at the weekend for 2 weeks. My only concern with this is that he won't be around post-op. But if she waits until he gets back then the nerve damage could get worse, she is in a world of pain and I think another 2 weeks of this would be very bad for her,it needs doing now

 

Do you think that after this kind of op my wife would be better off recovering at somewhere like the McKean Rehabilitation Centre in CM? There will only be me to look after her. Her family have all been down this weekend trying to convince her to go back to Surat with them, but they have no ideas about doctors or any understanding of what is wrong with her and would have to start from scratch. She trusts me to deal with everything so has sent them all away, very disgruntled.

 

 

[Sheryl]

Re post-op, he has a pretty good team that works with him. The most important period is the 1st 24-48 hours and with luck maybe that can be before he leaves.

 

There usually isn't much by way of post op care needed, she should be fully ambulatory by discharge, but see what the doctor thinks. My sister had the same Op and just came home with me afterwards and I do not recall it taking much of anything in the way of after care.

 

Yes, if there is nerve  root impingement - which it sounds like Prof. Wicharn confirmed  -- the surgery should be soon as possible to avoid permanent nerve damage.

 

 

 

 

[Mapguy]

PM me if you wish a recommendation for a highly competent spinal surgeon and special hospital unit for spinal surgery in Bangkok.

 

[ThaiPauly]

The Professor did the operation on Monday afternoon and apart from the pain from the surgery sites there is no more nerve pain.

Tomorrow she will stand  and Thursday she will walk. Friday she can come home.

Thank you so much for the recommendation Sheryl. If not for you we would not have found this excellent spinal specialist.

 

I was reading on the another thread about insurance. The hospital she is registered at in CM could not perform this operation as they do not have the qualified doctors or the equipment in theatres. 

Is there any chance of claiming some or all of the cost through her insurance coverage which is the basic 440 ,Baht a month?

[Sheryl]

4 minutes ago, ThaiPauly said:

The Professor did the operation on Monday afternoon and apart from the pain from the surgery sites there is no more nerve pain.

Tomorrow she will stand  and Thursday she will walk. Friday she can come home.

Thank you so much for the recommendation Sheryl. If not for you we would not have found this excellent spinal specialist.

 

I was reading on the another thread about insurance. The hospital she is registered at in CM could not perform this operation as they do not have the qualified doctors or the equipment in theatres. 

Is there any chance of claiming some or all of the cost through her insurance coverage which is the basic 440 ,Baht a month?

 

I assume by the 440 baht you mean she is covered under Social Security.

 

To be covered elsewhere, he hospital would have had to have given her a letter of referral and the receiving hospital would have to accept SS which BNH does not.   her own hospital's point of referral would have been Maharaj. . So no, I am afrraid you can't get it covered under SS. I know it was expensive (out of curiosity  how much exactly?) but sounds like she got the desired outcome.

 

My sister was the same - as soon as she awake in the recover room the unremitting pain she had been in, was gone.

[ThaiPauly]

Not sure of the price yet Sheryl but was quoted 450-500k when we arrived yesterday.

 

There will be a 20pc discount for hospital costs but not Doctors fees

[meechai]

1 hour ago, ThaiPauly said:

The Professor did the operation on Monday afternoon and apart from the pain from the surgery sites there is no more nerve pain.

Tomorrow she will stand  and Thursday she will walk. Friday she can come home.

Thank you so much for the recommendation Sheryl. If not for you we would not have found this excellent spinal specialist.

So very nice to read this good news!

 

Very happy she found relief & I am sure your feeling much better also Pauly.

 

 

 

Edited November 12, 2019 by meechai

[ThaiPauly]

On 11/12/2019 at 7:44 PM, ThaiPauly said:

Not sure of the price yet Sheryl but was quoted 450-500k when we arrived yesterday.

 

There will be a 20pc discount for hospital costs but not Doctors fees

Final was 370,000 baht.

She is recovering well at home although in pain, but not the same pain

as she had before the operation. She was on morphine in hospital, but now she is on a standard pain killer and muscle relaxant.

So far so good, although she moves very slowly, I suppose this is to be expected after major surgery?

[Sheryl]

Yes. As the incision heals she will naturally move better.

 

That price is more what I would have expected than your initial quote. I suppose they prefer to quote high

 

Did she get an artificial disk or have a fusion?