Hematologist in case of TTS

[Sheryl]

2 hours ago, Captor said:

Dear Sherry,

You seem to know a lot about Thai health care. Do you think the Ratchaphiphat Hospital in Bang Khae would be OK for rthis type of side effect?

At the ICU there (if there is that).

We have never been there only seen it in far distance. It looks not so big.

 

No. Very small hospital run by BMA.

 

In Bang Khae area I would head for Siriraj or Thonburi Hospitals (probably Thonburi as Siriraj is pretty overwhelmed with COVID)

[Sheryl]

1 hour ago, Liebemein said:

It's 400-bed hospital. Not sure if it's possible for check all labs especially D-dimer. However if it's emergency, they would do best and can refer later if they need specific treatments and investigation.

It is 102 beds only and definitely not where to go with a major problem, especially given the much better options within 20 minutes or so.

[Liebemein]

21 minutes ago, Sheryl said:

It is 102 beds only and definitely not where to go with a major problem, especially given the much better options within 20 minutes or so.

This wrote it was a plan to set up beds from 135 to 400 in 2017. Could they make it?

http://www.msdbangkok.go.th/news 090457.html

[Captor]

6 hours ago, Sheryl said:

It is 102 beds only and definitely not where to go with a major problem, especially given the much better options within 20 minutes or so.

Thank you very much, Sheryl. Just the information I am looking for. Plan for the worst and hope for the best ????

[Captor]

6 hours ago, Liebemein said:

This wrote it was a plan to set up beds from 135 to 400 in 2017. Could they make it?

http://www.msdbangkok.go.th/news 090457.html

Thank you Liebeman, Better plan for one of the big. Better safe than sorry ????

[Captor]

7 hours ago, Sheryl said:

 

No. Very small hospital run by BMA.

 

In Bang Khae area I would head for Siriraj or Thonburi Hospitals (probably Thonburi as Siriraj is pretty overwhelmed with COVID)

If she not want go to Thanburi but to Siriraj that is government, can she go there directly without going to Ratchaphiphat before were she is signed? My wife says she must go to the signed hospital first and if they can't treat her they send her to another hospital. Sounds time consuming. That is under the 30-bath treatment.

 

Also she says there is a section of Siriraj that is more like a private hospital were she can pay and getting more fast treatment. Is that correct? Do they have an ICU there as well?

 

I think in this case if something happen About TTS then better go to the private Thonburi in order to not lose time. Or the private section of Siriraj if not owerwhelmed with covid.

[Sheryl]

1 hour ago, Captor said:

If she not want go to Thanburi but to Siriraj that is government, can she go there directly without going to Ratchaphiphat before were she is signed? My wife says she must go to the signed hospital first and if they can't treat her they send her to another hospital. Sounds time consuming. That is under the 30-bath treatment.

 

Also she says there is a section of Siriraj that is more like a private hospital were she can pay and getting more fast treatment. Is that correct? Do they have an ICU there as well?

 

I think in this case if something happen About TTS then better go to the private Thonburi in order to not lose time. Or the private section of Siriraj if not owerwhelmed with covid.

1. The need for referral letter is only for Thais and only in order to get it financed under the 30 baht scheme. Foreigners, since they have to pay for care anyway, do nto need to be referred. (Thais can also go without referral but would have to pay).

 

There is indeed a private wing of Siriraj see here    https://www.siphhospital.com/en/home

I am not sure if it has its own ICU or uses that of Siriraj

 

But I suspect it is also pretty overwhelmed hence the rec to use Thonburi

 

Many of the top doctors at Siriraj have hours at Thonburi Hiosop

[Captor]

12 hours ago, Sheryl said:

1. The need for referral letter is only for Thais and only in order to get it financed under the 30 baht scheme. Foreigners, since they have to pay for care anyway, do nto need to be referred. (Thais can also go without referral but would have to pay).

 

There is indeed a private wing of Siriraj see here    https://www.siphhospital.com/en/home

I am not sure if it has its own ICU or uses that of Siriraj

 

But I suspect it is also pretty overwhelmed hence the rec to use Thonburi

 

Many of the top doctors at Siriraj have hours at Thonburi Hiosop

Thanks Sheryl, my wife is Thai so the normal way should be the hospital were signed. And then if they can not take care of it then they send her along.  In the 30-bath scheme it is.

What i am wondering is if the condition is severe, for example heart or brain problem. Would it not be better for her to go to the bigger hospitals ER right away instead for loosing time by a detour to the smaller signed hospital? In this case not losing time is important and that is what she would do when going to the small hospital.

If she would go by ambulance to the bigger ones would they close the door in the face there and demand her to go to the smaller signed hospital first?

 

Edited August 6, 2021 by Captor

[edwardandtubs]

35 minutes ago, Captor said:

Thanks Sheryl, my wife is Thai so the normal way should be the hospital were signed. And then if they can not take care of it then they send her along.  In the 30-bath scheme it is.

What i am wondering is if the condition is severe, for example heart or brain problem. Would it not be better for her to go to the bigger hospitals ER right away instead for loosing time by a detour to the smaller signed hospital? In this case not losing time is important and that is what she would do when going to the small hospital.

If she would go by ambulance to the bigger ones would they close the door in the face there and demand her to go to the smaller signed hospital first?

 

I recall reading that any medical costs arising from severe vaccination side effects will be paid by the Thai government so if I were you I would just go straight to the biggest and best hospital and don't worry about cost.

[Sheryl]

4 hours ago, Captor said:

Thanks Sheryl, my wife is Thai so the normal way should be the hospital were signed. And then if they can not take care of it then they send her along.  In the 30-bath scheme it is.

What i am wondering is if the condition is severe, for example heart or brain problem. Would it not be better for her to go to the bigger hospitals ER right away instead for loosing time by a detour to the smaller signed hospital? In this case not losing time is important and that is what she would do when going to the small hospital.

If she would go by ambulance to the bigger ones would they close the door in the face there and demand her to go to the smaller signed hospital first?

 

 

That never happens. The issue is not being refused care but rather, being billed for it afterwards.

 

In an emergency, there is not supposed to be a charge for treatment at any government hospital for the first 72 hours (for a Thai) but in practice ,the cashiers will present you with a bill and you will have to call the NHSO to straighten it out and this can take some time and effort.   https://www.nhso.go.th/

 

You would have to use your judgement - getting sent onward with referral is usually pretty fast in a true emergency but if it looks to you like every second counts then yes, go straight to a higher level facility, call the NHSO and explain where she is and that it was an emergency.

 

 

 

 

[Captor]

2 hours ago, Sheryl said:

 

That never happens. The issue is not being refused care but rather, being billed for it afterwards.

 

In an emergency, there is not supposed to be a charge for treatment at any government hospital for the first 72 hours (for a Thai) but in practice ,the cashiers will present you with a bill and you will have to call the NHSO to straighten it out and this can take some time and effort.   https://www.nhso.go.th/

 

You would have to use your judgement - getting sent onward with referral is usually pretty fast in a true emergency but if it looks to you like every second counts then yes, go straight to a higher level facility, call the NHSO and explain where she is and that it was an emergency.

 

 

 

 

Thanks, Sheryl

I am just curious and who know what might happen down the line. it is always a good idea to be well informed how to act in these different situations. Hopefully I will never need to make the choice.

[Captor]

5 hours ago, edwardandtubs said:

I recall reading that any medical costs arising from severe vaccination side effects will be paid by the Thai government so if I were you I would just go straight to the biggest and best hospital and don't worry about cost.

Right! Sounds reasonable. Thanks.

[Captor]

6 hours ago, edwardandtubs said:

I recall reading that any medical costs arising from severe vaccination side effects will be paid by the Thai government so if I were you I would just go straight to the biggest and best hospital and don't worry about cost.

Is that for private hospitals as well that the government is paying?

[edwardandtubs]

23 minutes ago, Liebemein said:

Some information for you to observe symptoms.

https://vaxpain.us/

That appears to be an anti-vaxx website rather than a useful source of reliable information. No need for that when the websites of government health authorities have plenty of reliable information on this condition.

[Sheryl]

Posts with antivax quackery/misinformation and links to questionable sources have been removed.

 

There are plenty of reliable sources of information on vaccine side effects, including:

 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html

(for Moderna, Pfizer and J&J)

 

https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-benefits-risks-context

Astra Zenica

 

It is important to understand that most reported deaths/serious events after vaccination are not related to the vaccine. A small number are, but most are not. In order to avoid missing anything serious, medical professionals and the public are instructed to report all adverse events following vaccination. These are then investigated and more often than not prove to be unrelated. Beware of reports of "X number of people dies after being vaccinated". X number die after not being vaccinated, too. with hundreds of millions of people being vaccinated, there will naturally be deaths among them.  It is nto the case that every single thing that happens after a person is vaccinated, is due to the vaccine.

 

 

[Captor]

48 minutes ago, Sheryl said:

Posts with antivax quackery/misinformation and links to questionable sources have been removed.

 

There are plenty of reliable sources of information on vaccine side effects, including:

 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html

(for Moderna, Pfizer and J&J)

 

https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-benefits-risks-context

Astra Zenica

 

It is important to understand that most reported deaths/serious events after vaccination are not related to the vaccine. A small number are, but most are not. In order to avoid missing anything serious, medical professionals and the public are instructed to report all adverse events following vaccination. These are then investigated and more often than not prove to be unrelated. Beware of reports of "X number of people dies after being vaccinated". X number die after not being vaccinated, too. with hundreds of millions of people being vaccinated, there will naturally be deaths among them.  It is nto the case that every single thing that happens after a person is vaccinated, is due to the vaccine.

 

 

Right! Thanks.

[Captor]

On 8/6/2021 at 5:13 PM, Sheryl said:

 

That never happens. The issue is not being refused care but rather, being billed for it afterwards.

 

In an emergency, there is not supposed to be a charge for treatment at any government hospital for the first 72 hours (for a Thai) but in practice ,the cashiers will present you with a bill and you will have to call the NHSO to straighten it out and this can take some time and effort.   https://www.nhso.go.th/

 

You would have to use your judgement - getting sent onward with referral is usually pretty fast in a true emergency but if it looks to you like every second counts then yes, go straight to a higher level facility, call the NHSO and explain where she is and that it was an emergency.

 

 

 

 

Sheryl,

I still not understand about private hospitals for a Thai citizen. What if she chose the private Thonburi as you recommend and what then with payment? She is alone in Bangkok and maybe can´t pay that second because of unconscious or very sick and can not communicate. What then when coming to the ER at the hospital? Will they refuse to take care of her and send her away? Or can she pay later within 72 hour same as government hospitals?

She don´t have any private health insurance so I guess she need to show some $$$ before they even take the temperature?

 

She has some covid insurance but I guess that is useless when it comes to the truth. And I guess that is for covid and not for failed vaccine treatment.

 

Also I wonder about ambulances. I understand that there are many different ambulances to call? Not one central and they will connect to the closest like in my home country. Which one to call when want to go to Thonburi and Siriraj?

[Sheryl]

14 hours ago, Captor said:

Sheryl,

I still not understand about private hospitals for a Thai citizen. What if she chose the private Thonburi as you recommend and what then with payment? She is alone in Bangkok and maybe can´t pay that second because of unconscious or very sick and can not communicate. What then when coming to the ER at the hospital? Will they refuse to take care of her and send her away? Or can she pay later within 72 hour same as government hospitals?

She don´t have any private health insurance so I guess she need to show some $$$ before they even take the temperature?

 

She has some covid insurance but I guess that is useless when it comes to the truth. And I guess that is for covid and not for failed vaccine treatment.

 

Also I wonder about ambulances. I understand that there are many different ambulances to call? Not one central and they will connect to the closest like in my home country. Which one to call when want to go to Thonburi and Siriraj?

 

If she chooses to go to a private hospital for reasons of her own she has to pay full price.

It is only when there is no alternative  but a private hospital and a true medical  emergency that the 30 baht system covers emergency care for first 72 hours. If she was unconscious and that is where ambulance brought her, for example --  and even then will usually have to call on NHSO to intervene. Choosing to go to a private hospital, you must pay. Whether or not they would insist on payment upfront or treat first varies with the hospital and the situation.

 

That said, care for vaccine related side effects is supposed to be free for Thai citizens no matter where it is provided. But the odds of needing hospitalization for a vaccine-related problem is astronomically low.

 

The number for public ambulance is 1669.  However unless there is some impediment or contraindication to moving the person (eg suspected spial i njury, broken bones etc) it is usually best to just use private transport or a taxi as that will be quicker and there isn't much provided by way of emergency care by ambulances here anyhow.

 

Best thing to do unless there is some pressing reason not to, is always to first go to the government hospital where she is registered. They will refer onward if they can't handle it, and payment will then not be an issue.

 

Obviously if unconscious or to ill to speak, and requiring an ambulance, she will end up where the ambulance takes her. In that case, it is clearly an emergency and not her own choice so can request NHSO to pay for up to 72 hours. Note that the "72 hour" provision is a maximum and not a guaranteed period of treatment, the expectation is that the patient will transfer to government hospital as soon as this can safely be done.  One cannot simply choose to stay in a private hospital 72 hours and expect the system to pay. Have to transfer as soon as medically possible.

 

 

 

 

[Captor]

19 minutes ago, Sheryl said:

 

If she chooses to go to a private hospital for reasons of her own she has to pay full price.

It is only when there is no alternative  but a private hospital and a true medical  emergency that the 30 baht system covers emergency care for first 72 hours. If she was unconscious and that is where ambulance brought her, for example --  and even then will usually have to call on NHSO to intervene. Choosing to go to a private hospital, you must pay. Whether or not they would insist on payment upfront or treat first varies with the hospital and the situation.

 

That said, care for vaccine related side effects is supposed to be free for Thai citizens no matter where it is provided. But the odds of needing hospitalization for a vaccine-related problem is astronomically low.

 

The number for public ambulance is 1669.  However unless there is some impediment or contraindication to moving the person (eg suspected spial i njury, broken bones etc) it is usually best to just use private transport or a taxi as that will be quicker and there isn't much provided by way of emergency care by ambulances here anyhow.

 

Best thing to do unless there is some pressing reason not to, is always to first go to the government hospital where she is registered. They will refer onward if they can't handle it, and payment will then not be an issue.

 

Obviously if unconscious or to ill to speak, and requiring an ambulance, she will end up where the ambulance takes her. In that case, it is clearly an emergency and not her own choice so can request NHSO to pay for up to 72 hours. Note that the "72 hour" provision is a maximum and not a guaranteed period of treatment, the expectation is that the patient will transfer to government hospital as soon as this can safely be done.  One cannot simply choose to stay in a private hospital 72 hours and expect the system to pay. Have to transfer as soon as medically possible.

 

 

 

 

No reasons of her own but you mentioned before that it is best to go to Thonburi in case something bad happens and in order to go to the most unoccupied ER. So that is why I am wondering about the payment thing. You said the government hospitals will be overwhelmed with covid patients. That is the reason I am asking about this.

So I wondered what will happen there if she can not pay up front because of very ill.

So they will still treat her the first 72 hours as you said or is it better go to a government right away? Even if it is full of covid patience there already?

 

So iff money is no issue and she is OK and can communicate then Thonburi but otherways an government hospital.

 

Or maybe better go were the ambulance want to take her? Maybe they are updated were there is space in an ER.

It feels most uncertain about the Thai hospital system. Were to go and were to get the best treatment. Look like there is always the money involved and if unconscious or can not talk or something the person is lost if not very lucky. It should not be about luck!

 

So the ambulance is 1669 then. I have in the mean time heard about 191. I guess that is something else.

 

Yes I know the risk is very low. I just educate and learn myself whit things that are great to know in the future if I am going to settle down in Thailand next year. Things that are not the same in my home country but that might be important down the road. No one know.

 

I can for example happen to be the first person at an accident site. Then it is very important if I at least know were to call for help.

[Sheryl]

10 minutes ago, Captor said:

 

So iff money is no issue and she is OK and can communicate then Thonburi but otherways an government hospital.

 

 

 

 

 

 

If she cannot communicate then she will go wherever ambulance takes her and if it is a private hospital you can argue that it was an emergency and should thus be covered under NHSO - important not to sign any papers to the contrary and to tell the staff from the get-go that it is under the 30 baht scheme (in which case they will promptly transfer her to a government hospital if at all possible). Where there have been rulings against the patient in such cases has been where the private hospital insisted the patient chose  to be a patient there as a matter of personal preference.

 

Of course if you are prepared to pay out of pocket then it doesn't matter and can go where you want. Thonburi is mid-range in price as private hosptals go i.e. nothing like Bumrungrad et al.

 

But if seeking to have it paid under the government system, should go to the government hospital where she is registered.

 

I really do not know any clearer way to explain this.

 

1669 is the number for medical emergencies. 911 is general emergency number (was formerly 191; 191 may still work, not sure).

 

But as I explained, little to nothing is provided in the way of on site and en route care, meaning little advantage to calling an ambulance vs taking a taxi or private car - unless it is a situation where unsafe to move the patient (as would be true of many accidents)

[edwardandtubs]

A recent report has confirmed the chances of someone under 50 suffering TTS (also called VITT) are one in 50,000. Here's the full report:

https://www.nejm.org/doi/full/10.1056/NEJMoa2109908

And here's a more user friendly article about it:

https://www.theguardian.com/world/2021/aug/11/oxfordastrazeneca-vaccine-rare-blood-clot-syndrome-has-high-mortality-rate

[Sheryl]

6 minutes ago, edwardandtubs said:

A recent report has confirmed the chances of someone under 50 suffering TTS (also called VITT) are one in 50,000. Here's the full report:

https://www.nejm.org/doi/full/10.1056/NEJMoa2109908

And here's a more user friendly article about it:

https://www.theguardian.com/world/2021/aug/11/oxfordastrazeneca-vaccine-rare-blood-clot-syndrome-has-high-mortality-rate

1 in 50,000 = .002% i.e. it will nto happen to 99.998% of vaccinated people

 

(rate is 1/2 this in people over 50)

 

As a point of comparison, lifetime risk of being hot by lightning is about 1 in 15,000

 

In other words you are 4 times morel likely to be struck by lightening at soem point in your life than you are of developing TTS if vaccinated with AZ or J&J

 

Just to keep  it in perspective...

 

 

[Captor]

41 minutes ago, Sheryl said:

1 in 50,000 = .002% i.e. it will nto happen to 99.998% of vaccinated people

 

(rate is 1/2 this in people over 50)

 

As a point of comparison, lifetime risk of being hot by lightning is about 1 in 15,000

 

In other words you are 4 times morel likely to be struck by lightening at soem point in your life than you are of developing TTS if vaccinated with AZ or J&J

 

Just to keep  it in perspective...

 

 

Yes, and more likely to get TTS or what it is called from Covid I have heard.

About that, My wife´s covid vaccine is cancelled. She looked at the webpage two days ago and her appointment was gone. So we think they not have any more vaccine of AZ or the Chinese stuff.  So I guess she have to check into the page every day and check if there is a new appointment, sigh...

Pity that there is no other way to get some. We would happily pay for it. I hope it will not take too long time before they get more vaccine again. This is at the Paradis Mall in Bang Khae.

 

So this 911 is also for Police and fire department. And 191 is gone. OK, good to know. And that is were ever I am in Thailand I assume. And 1669 for medical issues.

 

 

[Captor]

12 hours ago, Captor said:

Yes, and more likely to get TTS or what it is called from Covid I have heard.

About that, My wife´s covid vaccine is cancelled. She looked at the webpage two days ago and her appointment was gone. So we think they not have any more vaccine of AZ or the Chinese stuff.  So I guess she have to check into the page every day and check if there is a new appointment, sigh...

Pity that there is no other way to get some. We would happily pay for it. I hope it will not take too long time before they get more vaccine again. This is at the Paradis Mall in Bang Khae.

 

So this 911 is also for Police and fire department. And 191 is gone. OK, good to know. And that is were ever I am in Thailand I assume. And 1669 for medical issues.

 

 

My wife mentioned 1646 (Bangkok Emergency Medical Service Center), puh, long name. What is that?

I have googled but not found anything.

When googling it looks like every hospital has its own ambulance service with its own phone number! I hope I will not come first to an accident site. People will die while I try to find the correct number to the closest hospital!

[edwardandtubs]

20 minutes ago, Captor said:

My wife mentioned 1646 (Bangkok Emergency Medical Service Center), puh, long name. What is that?

I have googled but not found anything.

When googling it looks like every hospital has its own ambulance service with its own phone number! I hope I will not come first to an accident site. People will die while I try to find the correct number to the closest hospital!

I've seen people loading accident victims dripping with blood on the back of a motorbike.

[Captor]

31 minutes ago, Captor said:

My wife mentioned 1646 (Bangkok Emergency Medical Service Center), puh, long name. What is that?

I have googled but not found anything.

When googling it looks like every hospital has its own ambulance service with its own phone number! I hope I will not come first to an accident site. People will die while I try to find the correct number to the closest hospital!

Update:

I have found this links now: https://ogocare.com/1669-and-191-emergency-numbers-to-call-in-thailand/

 

https://expatlifeinthailand.com/lifestyle/bangkok-medical-emergency-now/

 

Some scary reading there about hospitals not taking care if not having credit card, passport, insurance and so on. That is about expats or tourists.

That is same for Thai citizen I guess when it comes to the private hospitals. Hence my question about if a Thai person can't communicate but still must come to the closest ER, government or private. So look like government is the best choice if not having a stack of money on the lap.

[Sheryl]

7 hours ago, Captor said:

My wife mentioned 1646 (Bangkok Emergency Medical Service Center), puh, long name. What is that?

I have googled but not found anything.

When googling it looks like every hospital has its own ambulance service with its own phone number! I hope I will not come first to an accident site. People will die while I try to find the correct number to the closest hospital!

That is the number for ambulance service of Bangkok Hospital, a private hospital.

 

Most orivate hospitals have their own ambulance service and these will, of course, take you only to that hospital. If you want to go to a specific ptivate hospital then find out that number and keep it handy.

 

1669 is number for public ambulance service.

 

Again, it is usually best to take nearest form of transportation rather than call an ambulance.

[Captor]

51 minutes ago, Sheryl said:

That is the number for ambulance service of Bangkok Hospital, a private hospital.

 

Most orivate hospitals have their own ambulance service and these will, of course, take you only to that hospital. If you want to go to a specific ptivate hospital then find out that number and keep it handy.

 

1669 is number for public ambulance service.

 

Again, it is usually best to take nearest form of transportation rather than call an ambulance.

Thanks a lot, Sheryl,