Breast cancer hospital recommendations

[Onrai]

 

 

We just found out my girl friend has breast cancer. This is not a scam. I sat thru hours of testing-ultra sound of breast and axilla nodes, Fine Needle Biospy, 3-D Mammogram and consultations  with 3 breast surgeons. She has 2 lumps on one breast and 2 nodes are impacted. She can get the procedure done for free in Loei  but the hospital doesn’t  do reconstructive breast surgery. She is 35 and would prefer not  to have a simple mastectomy without reconstruction. We have been to BNH Hospital in Bangkok and have a quote to remove the lump and sentinel lymph nodes for $140,000-170,000 bhat, no chemo, radiation, hormone therapies or follow up visits included. We are trying to determine whether we can do the surgery in Bangkok and have the chemo, radiation and possible hormonal therapies done in Loei for free or substantially reduced cost.

There is antiquated patient/ doctor relationship in Thailand where the patient doesn’t ask any questions and suppose to do exactly what the doctor says. I am from the US and we want to know as much information as possible- stage of breast cancer, tumor receptor type- Estrogen, progestergen, Her2, triple neg, mastectomy vs. lumpectomy, neoadjuvant chem, etc. etc. The doctor will tell us nothing other than she’ll most likely need chemo and radiation.

Anybody know a good, compassionate, reasonably priced breast surgeon? Thanks. 

 

 

[Sheryl]

Moved to the Health Forum.

 

The price aspect is the problem. Price will be reasonable only at a government hospital and even the best doctors in that environment due to the heavy caseload spend little time talking to patients.

 

Assoc.Prof.Dr. Youwanush Kongdan is a top notch breast surgeon specializing in breast cancer.  She has private hours at Bumrungrad, but it is very expensive there.

https://www.bumrungrad.com/doctors/Youwanush-Kongdan

 

She recently (very recently) established  Namarak Hospital which is a small hospital specifically for breast. It is bound to cost less there though how much I cannot say.

https://www.namarak.com/home?lang=en

She is there

Monday-Friday 09.00-13.00

Sunday 09.00-12.00

 

She really is the top person for this. Not as senior as her, but also quite good is Prof. Mawin Vongsaisuwan (male). He is at Bumrungrad, BNH and Bangkok Hospital, all of which are very expensive, but he is also on faculty at Chulalongkorn Hospital  and can be seen rpivately through their after hours clinic on Tuesdays and Saturdays https://chulalongkornhospital.go.th/specialclinics/scheduledoctor1/

https://www.bumrungrad.com/doctors/Mawin-Vongsaisuwon

[Sheryl]

I forgot to mention:

 

1. Breast cancer in a woman her age is often of the aggressive kind so if at any point faced with a choice one if which entails a longer wsit...go for quicker.

 

2. Re Loei the hospital there will not have the capacity to teat this and would refer her. Probably to the Regional Cancer Center in Udon. Treatment still free with letter of referral from Loei. Chemo and hormonal treatment they can certainly do. They can also do radiation but sometimes with upcountry hospitals thd equipment is not state of the art. Chula's is. Discuss with her doctor whether Udon is a viable option for radiation.

 

She could also get free care at Chula IF she can get the Loei hospital to give her a letter of referral but don't know if they would as it is not their normal referral point.

[Onrai]

On 11/10/2019 at 5:30 PM, Sheryl said:

She recently (very recently) established  Namarak Hospital which is a small hospital specifically for breast. It is bound to cost less there though how much I cannot say.

https://www.namarak.com/home?lang=en

She is there

Monday-Friday 09.00-13.00

This a a follow up with checking with Namarak Hospital about breast surgery, specifically a lumpectomy. I am taking all of this with a large grain of salt since I don’t know how anyone can accurately quote a surgery with reviewing biopsy results, mammogram, lymph node ultra sound, etc. In a telephone conversation the nurse at Namarak quoted 200,000 bhat for a lumpectomy. BNH quote was 140,000 bhat for removing the breast lumps and 3 sentinel nodes. So, Namarak is almost 40% higher than BNH. Pretty surprising and am amazed that they are willing to give general quote without looking into the specifics. On the subject of public/govt. run hospitals vs. private. At BNH the doctor made his diagnosis from reviewing a 3-d mammogram. Lumpectomy to remove lumps in breast, removal of sentinel lymph nodes followed by chemo and radiation. No discussion, this is what he would do- take it or leave it. Didn’t explain the procedure and had zero inclination to answer questions. 

We are now at the govt. run hospital Srinagarind Hospital in Khon Kaen, purported to be the best govt. hospital in Isaan. 

The battery of test they are running is astounding: core needle biopsy of lump with 5 core sections taken, Lymph node ultra sound biopsy, bone scan and CT scan as well as reviewing the 3-d mammogram. USA testing protocol suggests running all of these tests as well as genome/genetic testing for the BRCA gene. I am not a doctor but it does seem that the public hospital is taking more care to see if the cancer has metastasized or not. 

Anyway, that is the beginning of our journey through the hospital system in Thailand.

Henry Golobic

 

 

[Sheryl]

I am shocked re Namrak costs, hard to believe. I wionder if the nurse knew what she was talking about and whether that price might have inclued more than just lumpectomy.

 

And surprised re Prof Mawin, as I have found him open to discussion. Maybe caught him on a bad day.

 

KKU is indeed an excellent facility and best in Issan. 

 

It might be possible to get the care there covered under 30 baht scheme if she gets a letter of referral from Loei .

 

Best way to get that is have  the doctors at KKU write a note to Loei Hospital explaining what has been diagnosed and  that they propose to treat her - ask them about it. There is no question about Loei referring,  they'd have to, the only  issue is to where. The main concern hospitals have when referring to other than the official point is flak from the receiving hospital.  If it is clear the receiving hospital is fine with treating the patient then usually not hard to get a referral letter to the desired treatment point  in my experience.

 

Once you get to surgery, chemo and radiation even at a govt hospital the costs doi add up so worth exploring this option.

 

Good luck and keep us posted.