about 5 weeks ago had a really bad dizzy spell and had to go to the local hospitol in Khaosuankwang

[n210mp]

Had BP of 155/105/150 was seen by a young Doctor who gave me EKG  together with the advice that he did not know what was wrong because the EKG looked ok  but  to go home and come back in a week if I didn't improve  (This was a Sunday and the hospitol was very obviously short of staff)

 

I went home and was still ill and uncomfortable so the next day Monday I went together with my Thai lady wife to see a more mature Doctor in the village at his clinic who also worked at the same hospitol who  on seeing my BP much the same as the day before rang the hospitol and sent me there again where I had another EKG and was sen by a young lady Doctor who advised me that she would give me some drugs and that if my BP and Pulse rate did not come down in 1 hour they would admit me and possibly refer me to an hospitol in Khon Kaen .

 

In the event the BP and pulse rate did come down and she then advised me that due to the covic situation in KK she would make me an appointment for one month at the local hospitol and  later  she would hopefully be able to refer me to a cardiologist at an hospitol in KK

 

The appointment is for the 18th of this month and I am looking for any advice that I can get about my particular heart problem .

 

My wife and I are in Khaosuankwan looking after her dying Dad, we are looking to move here permanently normally living in Pattaya  but Papa who looked as though he was dying when we arrived is now very seriously ill and obviously on his last legs but this situation could go on for a very long time .

 

Edit I am 76 years old and normally fairly fit and healthy  but this last few months of high stress and constant driving up to KK from Pattaya has maybe been responsible for my heart condition 

Edited May 11, 2021 by n210mp

[BigStar]

Impossible to know exactly what's going on with your heart based on that limited info. Your appt is only 7 days away. If the meds are working and you feel OK, then simply wait patiently for the further tests and professional diagnosis to come. Millions of people exist on BP meds, so no safety concern there. Suggest not doing any stressful exercise but at least do a daily walk if you can.

[Sheryl]

What heart problem exactly do you refer to, your post does nto give any diagnosis. Or do you just mean hypertension?

 

Are you monitoring your BP had home? (Should do). If so has it come down?

 

What meds are you on?

 

Any more dizzy spells?

 

With dizziness one thing that has to be considered, especially at  your age, is a cardiac arrythmia which will  not always show up on EKG, sometimes needs at least 24 hour monitoring of the heart rhythm to detect (because the arrythmia may come and go) .

 

It would be helpful  to feel your pulse while you are having these dizzy spells and note whether  it is regular or if it feels like there are skipped beats

[n210mp]

24 minutes ago, Sheryl said:

What heart problem exactly do you refer to, your post does nto give any diagnosis. Or do you just mean hypertension?

 

Are you monitoring your BP had home? (Should do). If so has it come down?

 

What meds are you on?

 

Any more dizzy spells?

 

With dizziness one thing that has to be considered, especially at  your age, is a cardiac arrythmia which will  not always show up on EKG, sometimes needs at least 24 hour monitoring of the heart rhythm to detect (because the arrythmia may come and go) .

 

It would be helpful  to feel your pulse while you are having these dizzy spells and note whether  it is regular or if it feels like there are skipped beats

 

Thanks for your replies Bigstar and Sheryl, I will try to give more information 

 

I had a very severe dizzy spell and thought I was going to fall over and so I checked my BP&P

 

I was suffering from high BP, tachycardia and irregular almost fluttery  heart beats, my initial readings were consistantly in the 155/105/150 area

 

The second  Doctor  visited on my second visit to KSK hospitol  prescribed 2 x 40mg  Propranolol  which after two days seemed to be too much because my BP&P was down maybe a little too much and I didn't have any "energy" to leave the couch and so I managed to contact the Doctor and reduced the dosage to 20mg of the drug before breakfast and 20 mg before sleep. This dosage seems to be ok.

 

I have been keeping a  record of my BP&P readings since the 12th of April checking 4 times a day

This was the first day after the first tablets'

 

 

                                                          1^st                                       2^nd                        3^rd                        readings

Date                     Time                        S     D     P                        S   D   P                S  D  P   

12/04/21             0530                    162/120/145                                   

“                           0700                    116/99/145

‘’                           0740                    112/94/144

‘’                           1020                    128/97/145

“                           1200                    108/82/140

“                           1300                    150/92/95                 

“                           1539                    96/74/137                  

‘’                           1820                    153/132/106

‘’                           1920                    105/81/147

 

This is this last 2 days

 

 

09/05/21           0845                112/63/72       119/65/59

“                      1545                124/71/108     99/69/106       107/76/79

“                      1923                118/80/100     106/67/80       114/72/98

“                      1350                108/76/109     139/82/49       111/75/101

“                      1930                118/79/109     110/75/96       115/78/93

11/05/21         0630                129//87/73      126/76/75      

I do notice by "feel" that my pulse is not regular and sometimes the Omrom MT-110 BP monitor  drops out due I think to the pulse not being consistent.

 

I hope that I have answered some of the points raised .

 

The reason the Doctor gave me for not referring me to a cardiologist at the time of the second visit to the hospital was that in KK the covic situation had stopped all such referrals 

 

Edited May 11, 2021 by n210mp

[Sheryl]

Did the doctor mention what type of heart arrythmia you have? From the sound of it, either atrial fibrillation, atrial flutter or paroxysmal atrial tachycardia.

 

i am not too comfortable with the delay in your seeing a cardiologist. I suggest you go to either Khon Kaen Ram or Ratchapruek Hospital in KK and see this US trained cardiologist who is also on the faculty at KKU Hospital (Srinagarind):

 

http://www.khonkaenram.com/en/doctors/3

https://rph.co.th/en/doctor/orathai-pachirat-md/

 

 

[Cake Monster]

2 hours ago, BigStar said:

Impossible to know exactly what's going on with your heart based on that limited info. Your appt is only 7 days away. If the meds are working and you feel OK, then simply wait patiently for the further tests and professional diagnosis to come. Millions of people exist on BP meds, so no safety concern there. Suggest not doing any stressful exercise but at least do a daily walk if you can.

And stop or greatly reduce the number of trips you are driving from Pattaya to KK and back.

Very stressful

[n210mp]

19 minutes ago, Sheryl said:

Did the doctor mention what type of heart arrythmia you have? From the sound of it, either atrial fibrillation, atrial flutter or paroxysmal atrial tachycardia.

 

i am not too comfortable with the delay in your seeing a cardiologist. I suggest you go to either Khon Kaen Ram or Ratchapruek Hospital in KK and see this US trained cardiologist who is also on the faculty at KKU Hospital (Srinagarind):

 

http://www.khonkaenram.com/en/doctors/3

https://rph.co.th/en/doctor/orathai-pachirat-md/

 

 

 

I think that Atrial fibrillation was mentioned Sheryl but due to problematic communication couldn't be sure.

 

I feel that I also need to see a cardiologist  ASAP too but didn't want to go over the head of the local Doctor.

 

l also need to go the cheapest way as I do not have medical insurance  so your advice on the most practical approach would be appreciated .

 

Is it "done" to approach these specialists directly and not through referral?

 

I have not opened your link yet in anticipation of your answer

 

Thank you for your help

[n210mp]

48 minutes ago, Cake Monster said:

And stop or greatly reduce the number of trips you are driving from Pattaya to KK and back.

Very stressful

 

After the 29th of December 2020 when we came to KK to take care of Papa (At the drop of a hat) with nothing other than small bits of personal stuff because Papa was on his death bed .We were logically Thinking we would only be away long enough for the funeral.

 

But Wan in her fantastic love for her dad not only brought him back from an obvious death (when we first saw Papa we thought he would be gone within 24 hours)  but Wan  also made his life better by feeding him  good food and loving care to the extent that now we are taking care of an incontinent, helpless poor old soul who has no quality of life , this is wearing Wan out who hasn't had a break in the 24 hour x 7 day routine since we came here.

 

Personally I am very fond of the old boy  and will continue to support my Lady wife for as long as it takes , we are the only "family" that is able to physically take care of him, other younger members of the family are in Australia and cannot leave there to help.

older family members are just to old to help .

 

Up to coming to KK I was reasonably fit riding my bike 2/3 times a week, walking and playing walked up golf.

 

The complete disruption in our lives caused by our sudden emergency move  has I think caused my heart problem maybe to erupt a bit earlier that it normally would .

Made worse by having to return to Pattaya  three times to collect much needed stuff and also take care of our other  business there.  But yes in answer to your post I will not be going back there for a while 

 

 

Edited May 11, 2021 by n210mp

[Sheryl]

1 hour ago, n210mp said:

 

I think that Atrial fibrillation was mentioned Sheryl but due to problematic communication couldn't be sure.

 

I feel that I also need to see a cardiologist  ASAP too but didn't want to go over the head of the local Doctor.

 

l also need to go the cheapest way as I do not have medical insurance  so your advice on the most practical approach would be appreciated .

 

Is it "done" to approach these specialists directly and not through referral?

 

I have not opened your link yet in anticipation of your answer

 

Thank you for your help

You do not need a referral to see a specialist at a private hospital. It is quite normal and usual to book directly yourself.

 

The doctor I am recommending is also at the government university hospital in KK (which is hopefully where the local doctor planned to refer you, if not, it should be -- sometimes they follow the referral; route required of Thai patients not realizing that it doesn't matter for you as you have to pay anyway. For Thai patients whose care, is free the referrals have to be in a specific order and to specific facilities).

 

I am sure the local doctor would not object to your doing this and indeed, be glad you got seen. It is a perfectly common thing to do and should not be viewed as going over someone's head, especially since you are not covered by the Thai government health scheme and thus paying privately.

 

Consulting a doctor at a private hospital is not the cheapest way, but it is the only way if the government hospitals are not taking referrals due to COVID.  Before doing it, you might like to call KKU hospital just to see if that is in fact the case...the Heart Center number is 043 232 700.  If they are seeing patients as usual (most government hospitals these days are) then go there.  You do not need a referral to see a cardiologist at KKU Heart Center, again because as a non-Thai your care is not free anyhow; you can book directly through their after hours clinic.  However you should bring your medical records with you. Go through the after hours clinic and ask for the doctor I listed above is possible or other acharn.

 

If KKU Hospital is really not accepting consultations then a private hospital is your only option. Even those of us with medical insurance do not usually have cover for outpatient care, almost everyone pays that out of pocket. .Consultation will cost probably 500- 1,000 baht plus any tests done. Don't buy medications from the hospital pharmacy,there is a mark-up, get the name and dosage from the doctor and buy at an outside pharmacy.

[n210mp]

44 minutes ago, Sheryl said:

You do not need a referral to see a specialist at a private hospital. It is quite normal and usual to book directly yourself.

 

The doctor I am recommending is also at the government university hospital in KK (which is hopefully where the local doctor planned to refer you, if not, it should be -- sometimes they follow the referral; route required of Thai patients not realizing that it doesn't matter for you as you have to pay anyway. For Thai patients whose care, is free the referrals have to be in a specific order and to specific facilities).

 

I am sure the local doctor would not object to your doing this and indeed, be glad you got seen. It is a perfectly common thing to do and should not be viewed as going over someone's head, especially since you are not covered by the Thai government health scheme and thus paying privately.

 

Consulting a doctor at a private hospital is not the cheapest way, but it is the only way if the government hospitals are not taking referrals due to COVID.  Before doing it, you might like to call KKU hospital just to see if that is in fact the case...the Heart Center number is 043 232 700.  If they are seeing patients as usual (most government hospitals these days are) then go there.  You do not need a referral to see a cardiologist at KKU Heart Center, again because as a non-Thai your care is not free anyhow; you can book directly through their after hours clinic.  However you should bring your medical records with you. Go through the after hours clinic and ask for the doctor I listed above is possible or other acharn.

 

If KKU Hospital is really not accepting consultations then a private hospital is your only option. Even those of us with medical insurance do not usually have cover for outpatient care, almost everyone pays that out of pocket. .Consultation will cost probably 500- 1,000 baht plus any tests done. Don't buy medications from the hospital pharmacy,there is a mark-up, get the name and dosage from the doctor and buy at an outside pharmacy.

 

Thank you for your invaluable advice Sheryl.

 

I will telephone the KKU tomorrow and enquire about making an appointment.

 

In the meantime I want to say "thanks" and  mention yourself and also  Ubonjoe who sometimes whilst  not  directly have resolved issues that if  were  not caught in their infancy could have led to major issues  for many of us just reading the forum.

 

In a  nutshell you have just by your posts on my OP have  taken a heck of a lot of stress off me  regarding the way forward to do  what I need to do to and make some headway with my problem.

[Sheryl]

Glad to help.

 

Before going you might like to read up on cardioversion and ablation as these are  ipossible treatment option given you are otherwise in good health.

 

Also - and very important! - be aware that if you remain in atrial, fibrillation you need to be on blood thinners as AF carries with it a risk of blood clots. That alone is one reason to perhaps try ablation procedure if the cardiologist thinks you are a candidate.

 

https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630

 

[n210mp]

8 hours ago, Sheryl said:

Glad to help.

 

Before going you might like to read up on cardioversion and ablation as these are  ipossible treatment option given you are otherwise in good health.

 

Also - and very important! - be aware that if you remain in atrial, fibrillation you need to be on blood thinners as AF carries with it a risk of blood clots. That alone is one reason to perhaps try ablation procedure if the cardiologist thinks you are a candidate.

 

https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630

 

 

Oh Sheryl I had  just written this post  before I read your above "quoted"  but have decided to still post it on the basis that really nothing has changed !

I have researched intensely but fear too much knowledge for my limited understanding capability is also  inherently a risk I do not wish to take .

 

So I will take a chance on you and other wise folk giving me some feedback on my situation. If it sounds overly dramatic or the ravings of a crank I do not care as desperate situations sometimes need desperate solutions. 

 

Thankyou once again for your kind attention.  hereunder is the post I wrote without checking if there had been any other replies since yesterday, incidentally I started writing this post at 2 30 am  on the 12th of the 5th 21

 

 

"Sheryl this post is mainly directed at you but hopefully there may be people like yourself who on reading this post may well be able to come up with ideas or indeed a practical solution however temporary to my present circumstances!

I feel I must “put my cards on the table”

I am in a hard place where there seems to be “no winners or simple answers”

I will of course follow your excellent advice and make contact with the US trained cardiologist in KKU and make an appointment with him or her for the tests on my heart that will hopefully gain me an insight into my ageing cardio vascular system.

 

However going to KK and attending the initial interview with the Doctor gives me problems that I may not be able to overcome so easily.

You see my wife cannot leave the side of her chronically ill and infirm Papa who needs 24 hr x 7 days a week care to accompany me to my appointment with the Doctor and therein makes for another set of problems.

On the basis that there maybe also “problems”  in getting a consultations  with the Doctor or any other Cardiologist in the area because of the covic situation prompts me to “burn some  midnight oil” in coming up with some temporary solutions or indeed self treatments until the situation gets back (if it ever does” l to some kind of normality.

Another major issue for me is that the simple act of going into a hospital environment at this moment in time is fraught with high risks of being infected with the covic virus and then the massive consequences this would have on my home environment if indeed I contacted the virus

Personally and if no one else was involved this would not be a major problem for me but bearing in mind that maybe contacting the virus in my visit to KK and then bringing it back to my home environment with stimulate a set of circumstances where all those in contact with me on a daily basis would be then whisked off and separated in isolation to God knows where!

It seems that I have few “options”

One option I have though is that of temporary self treatment and medication.

I have friendly a local Pharmacist whom I can communicate with in English and maybe get Blood thinner type drugs apart from the “warfarin “based ones

Being reasonably fit and leading a healthy and less than sedentary lifestyle in the past has kept me able to maintain some level of mental and physical fitness that is perhaps better than the average 76 year old, however there is a problem in that I always loved good food including more than my fair share of biscuits crisps and good whisky.

This over indulgence may well be the cause of my current health problem with a buildup of “plaque” in my ageing arteries causing “Arteriosclerosis” that was accelerated to a now “Acute’ situation  due to high levels of mental, physical  stress levels in the last 6 months or so.

Summary

On the basis that I cannot overcome the many problems associated with  simply seeing a cardiologist  or  indeed in just  getting away for a consultation or  treatment  on  an outpatient basis are there any suggestions of a minimal drug treatment that I could self administer  until my situation normalizes itself or bluntly Papa leaves this mortal coil?"

 

edit  BP&P  at rest last night and this morning

 

11/05/21         0630                129//87/73      126/76/75

“                          2020                110/68/102     123/84/100    

12/05/21         0400                142/87/74       133/90/71       128/83/73

 

 

Edited May 11, 2021 by n210mp

[Sheryl]

Do NOT try to self treat this.

 

You need to see a skilled, experienced cardiologist.

 

Your wife's difficulties will be many times magnified if you end up hospitalized, incapacitated by a stroke, or dead.

 

There are precautions in place to keep suspected COVID cases well apart from other patients at hospitals and the risks of going to a hospital are not as great as people seem to assume. The risks to you of not getting  medical care are, on the ither hand, significant.

 

If really worried about it then see doctor at a private hospital, these are very uncrowded.  You can always switch over to public if treatments or investigations that cost more than you can afford are advised. The doctor I recommended is at both 2 private hospitals and KKU so this is easily done. 

[n210mp]

26 minutes ago, Sheryl said:

Do NOT try to self treat this.

 

You need to see a skilled, experienced cardiologist.

 

Your wife's difficulties will be many times magnified if you end up hospitalized, incapacitated by a stroke, or dead.

 

There are precautions in place to keep suspected COVID cases well apart from other patients at hospitals and the risks of going to a hospital are not as great as people seem to assume. The risks to you of not getting  medical care are, on the ither hand, significant.

 

If really worried about it then see doctor at a private hospital, these are very uncrowded.  You can always switch over to public if treatments or investigations that cost more than you can afford are advised. The doctor I recommended is at both 2 private hospitals and KKU so this is easily done. 

 

 

Thanks Sheryl of course you are right, maybe brain not quite working correctly at this time 

[greenmonkey]

Hi OP. I concur with the advice given - book yourself to see a specialist in a private hospital (you don't need to get a referral here). The second thing (not so easy) is to try not to worry about it as it causes more stress. I had a similar experience a few years back. My heart rate was all over the place and almost certainly caused by stress. Was prescribed some pills that slowed down the pace of my hearbeat and after a few months I stopped taking the pills and was back to normal again. It all coincided with my financial situation being pretty bad and then improving so almost certainly stress caused my problem. Best of Luck!

[cooked]

Just anecdotally, I was having dizzy spells, not as bad as yours, until I started to take additional salt to my food and went Keto. 

Same thing with my wife, her dizzy spells disappeared. She also had high blood pressure, now solved by going onto a Keto diet. 

I'm glad I changed my diet before letting myself in for a never ending and ever increasing series of medicaments, but up to you of course.

[Sheryl]

2 hours ago, cooked said:

Just anecdotally, I was having dizzy spells, not as bad as yours, until I started to take additional salt to my food and went Keto. 

Same thing with my wife, her dizzy spells disappeared. She also had high blood pressure, now solved by going onto a Keto diet. 

I'm glad I changed my diet before letting myself in for a never ending and ever increasing series of medicaments, but up to you of course.

From his posts he had serious hypertension and is also in atrial fibrillation with a rapid ventricular response. 

 

Diet is nto going to fix that. And additional salt could be dangerous.

 

 

[cooked]

17 hours ago, Sheryl said:

From his posts he had serious hypertension and is also in atrial fibrillation with a rapid ventricular response. 

 

Diet is nto going to fix that. And additional salt could be dangerous.

 

 

As I was careful to write, this is anecdotal. Both my wife and I fixed the dizziness problem with a minimal increase in salt intake (1 teaspoon a day). Diet is the most important aspect of a healthy life style and is usually the most neglected.