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Sheryl,

 

I asked you this a few years ago, but I could not find the thread where you replied.

Apologies in advance for asking for the similar information twice.

 

My situation is I am a 67 year Englishman.

I have Afib.

 

What has concerned me is my BP recently has beein in the range of 162/85.

 

This is not good.

 

I have a new Omron BP machine, so I assume it is correct?

 

I measure BP most days.

 

What really concerns me is that I DO NOT:

 

- smoke

- drink alcohol

- drink caffeine

- have a stressful life - my life is pretty stress free in fact.

- eat processed western food.

 

I DO

 

- play football 4 times a week for a total of 6 hours - I have played sport all my life

- I am 6 feet tall and weigh 75 KG so I am not overweight

- eat a diet that is mainly steamed rice, fish (mackeral in sauce), chicken.

 

I tell you this so that you can see there are no obvious vices that I can give up to improve my BP!!!

 

It means that I will almost certainly need an operation to sort this out.

 

Sadly I don't trust BPH as I had a bad experience with them some years ago.

 

(although I am going to use their dental facilities today that I find to be excellent).

 

Anyway, what would you recommend I do.

 

I think you recommended a training hospital in Bangkok.

 

That was just for the Afib though and where I could get the Afib Ablation surgery carried out professionally.

 

Now I would probably need a hospital that would do other surgeries as well.

 

Certainly the first step is for me to be examined by someone who can advise (honestly) what tests I need and what I need to do next.

 

If you have any advice you can offer me, as always I would much appreciate it as your advice has always been excellent

 

Thanks and regards

 

David

 

 

 

 

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6 minutes ago, dsfbrit said:

I tell you this so that you can see there are no obvious vices that I can give up to improve my BP!!!

 

It means that I will almost certainly need an operation to sort this out.

What about seeing a doctor for a first line solution which would be a mild BP med ?

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Indeed it is not the hospital you should choose but the doctor. All hospitals have some bad doctors and most have at least some good ones.

 

There is no reason at all to think you need an operation because you are hypertensive. You might well want to have a noninvasive proicedure to correct your AF, but that is another matter (more on that later).

 

AF does not cause hypertension - instead the opposite relationship is more true though it is not a direct causation. Hypertension is a risk factor for AF.

 

You need to start on medication to control your BP immedfiately. Many people require medication for hypertension without being in anyway out of shape or overweight etc.

 

If you are on blood thinners (aspirin, warfarin or other drug) -- as you should be if you have AF -- then controlling your high BP is especially urgent as you are otherwise at risk of a cerebral hemorrhage which could be catastrophic. Do not delay.

 

There are noninvasive surgical approaches to AF (ablation) and from what you describe of yourself,  you may a good candidate for it.  It is  often worth correcting AF through ablation, especially in younger people, as it can avert the need for blood thinners and improve cardiac output.  But even if successful it would not correct your hypertension, because the AF is not causing the high BP. 

 

I highly recommend this US trained cadiologist at Bangkiok Christian hospital

 

https://www.bch.in.th/find-doctor/doctor-profile/?smid=4730

 

Once your BP is under control you should discuss the pros and cons of ablation with him. If you decide to proceed he might refer you to someone else as only a few doctors in Thailand are really experienced in it. I would trust his referral.

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Sheryl,

 

Thank you very much for your detailed reply. I will spend some time reading it and decide what to do next. I think the first step is to contact the doctor you recommended.

 

Yes, I am on 300 Mg aspirin and Metoprolol Beta blockers, but that is all.

 

Thanks again

 

regards David

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Thanks for the reply LopBuri3.

 

Yes I agree, I say the same thing about hospitals and would try to find a good doctor there that the hospital will certainly have.

 

The trouble I find with some International commercial hospitals, is they 'seem' to have a culture where they to find things that 'need' to be done and don't necessarily provide a service based on what I really need.

 

I won't phrase it any differently than that, but I am sure you know what I mean.

 

I had to go to BPH today to have some root-canal dentistry carried out. I find the dental

department there excellent and the 2 dentists I usually ask for are excellent as well.

 

They have a package price for their procedures and there is nothing but good advice and

service in my experience. I have been going there for 17 years.

 

If only my experience of another department there had been so positive 15 years ago, maybe I would not be so distrusting now.

 

When they took my BP, it showed the same (slightly higher) reading as I got on my BP monitor at home. I was hoping it would be lower as you can imagine...

 

 

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21 minutes ago, dsfbrit said:

Thanks for the reply LopBuri3.

 

Yes I agree, I say the same thing about hospitals and would try to find a good doctor there that the hospital will certainly have.

 

The trouble I find with some International commercial hospitals, is they 'seem' to have a culture where they to find things that 'need' to be done and don't necessarily provide a service based on what I really need.

 

I won't phrase it any differently than that, but I am sure you know what I mean.

 

I had to go to BPH today to have some root-canal dentistry carried out. I find the dental

department there excellent and the 2 dentists I usually ask for are excellent as well.

 

They have a package price for their procedures and there is nothing but good advice and

service in my experience. I have been going there for 17 years.

 

If only my experience of another department there had been so positive 15 years ago, maybe I would not be so distrusting now.

 

When they took my BP, it showed the same (slightly higher) reading as I got on my BP monitor at home. I was hoping it would be lower as you can imagine...

 

 

But that could be white coat (especially having a RCT).  My BP in hospital is normally in the 160 range but at home between 95-105 and there seem to be a lot of us with very large increase outside home (more than the 20-30 points normally mentioned).   I went so far as to buy two Omrom meters before I could believe readings at home could be that much lower - and have checked against hospital readings also.  Sorry I missed the "I have Afib" in your OP so highly advise you make appointment with doctor Sheryl mentioned and cost should be reasonable even considering the travel to Bangkok required.   Take your meter with you to check it and if you have record of testing type it up.  

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LopBuri3, I used to have the 'white coat' effect. Not any more though.

 

Since I had to have my first hip operation 10 years ago and was in the ICU for 3 days being 'stabilized' for the operation, I have had no fear of needles nor anything at all really.

 

It was the first time my AFIb was detected during the pre-op exam and they said they would continue with the operation, but would need to check my heart condition in great detail to make sure I would survive a full general anaesthetic.

 

They stuck lots of tubes in me and drip fed me all manner of fluids to make sure I would survive the surgery.

 

Knowing I had Afib explained why I had so often felt very faint at times. I thought I just needed breakfast or a pick me up.

 

I used to drink power drinks and diet Coke to pep me up when I felt dizzy. The cardiologist was

amazed I was still alive 'curing' Afib faintness wich caffeine!!!!!!!

 

Anyway, my heart was very strong and I was very fit apart from the Afib.

 

I was also no longer fearful of anything a hospital could do to me.

 

I actually nearly fell asleep in the dentist chair yesterday as I was a bit too relaxed.

 

My blood pressure has dropped back quite a bit since the weekend.

 

Now it is 'only' around 150/82.

 

Not brilliant, but I did some research and it seems that as I had a large abscess develop on my rear tooth that had to have the root canal work, that can have an effect on BP.

 

That surprised me a lot, but it seems to be a possible reason why over the weekend and before the dental work, the SYS figure was about 15 points above today's reading of 153 ?

 

I have arranged to see the doctor in Bangkok for next Thursday.

 

Now I have to avoid Covid.

 

I have only had 1 jab (AZ) to date.

 

I could drive to BKK airport, part the car and the get the MRT to SIlom OR go to Ekamai by bus from North Pattaya and then get the BTS.

 

I suppose I could get a taxi.

 

I have avoided Bangkok completely over the last 18 months and am not excited about going there

now to be honest!!!!

 

Anyway, stay well Lopburi 3.

 

 

 

 

 

 

 

 

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11 hours ago, dsfbrit said:

I could drive to BKK airport, part the car and the get the MRT to SIlom OR go to Ekamai by bus from North Pattaya and then get the BTS.

 

I suppose I could get a taxi.

I would go with the bus/taxi myself - taxi is easy to get and not expensive in Bangkok (although often issues from airport).  

 

If you had abscess surprised they operated as normally they cure that first as they tend to draw the pain killer and none gets to the nerve otherwise.  Been there and it is not pleasant at all.   For me it is not just hospitals - any outside activity seems to increase BP.  If you feel like it an update after doctor visit might be helpful to other readers.  Good luck.

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Sheryl,

 

Just a quick MASSIVE thank you for recommending Dr. Thavorn Suthichaiyakul to me.

As you said, what a nice man.

Lopburi3 suggested I document what happened yesterday, so I have done that in the next post.

 

Thanks again

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Lopburi3, this is what happened yesterday.

 

Rather than try to pick out bits and explain it that way, I will just write what occurred from the time I left my home.

 

I left Pattaya at 5am.

 

Arrived at the airport short term car park at about 6.20 am and was on the Airport Rail Link to Makkasin at 6.40.

 

I changed there to the MRT Blue Line to Silom, arriving at the hospital at about 8 am.

 

I registered by showing my passport and the appointment letter I had received last week before by email.

 

My BP was taken and I waited for the doctor to see me.

 

I was in his surgery at 9.15.

 

I did not have a specific time, just 9-12, so I was pleased to be in there so early.

 

I had with me my medication, my medical history, my BP monitor and a letter I had written with everything that I wanted to say.

 

I sat down and read through my letter that detailed everything to do with the heart over the last 10 years - including my healthy lifestyle and my inabilty therefore to change my lifestyle to solve my heart problems.

 

It took about 10 minutes that was all.

 

He then questioned me about it in some detail.

 

He got me to show him how I used my MP monitor machine.

 

He said I was using it wrong and that the arrow on the device MUST be over the artery. The artery does not go straight up and I needed to rotate the cuff about 2 cm.

 

I then took my BP.

He said with these home BP machines I should ALWAYS take 3 readings after sitting down and relaxing for 10 minutes.

This I did.

The first reading he said should be ignored. That is always a bit high.

 

I should wait only 15 seconds and then take a second reading.

 

I should then wait another 15 seconds and take the third reading.

 

I should then take the AVERAGE of readings 2 and 3.

 

This is not how I have used the monitor in the past, I have always avoided taking 2 readings without a 15 MINUTE gap between readings.

 

I will do it in future as he said.

 

We had already talked for a lot of time - 30 minutes - talking about my BP history and the measurements I had stored in my new BP monitor and the one I replaced with readings from 2 years ago.

 

He was not really focused at all/very much on the BP reading, only on my heart rate that was 45 BPM.

 

He sent me for an EKG to see what was going on with the electrical signals in my heart.

 

When he got the EKG back, we discussed the long gaps produced because of the 45 BPM heart rate.

 

That BPM should be at least 60 BPM.

 

He explained my beta blockers were not helping me. He suggested I stop taking both the BB's and the aspirin.

 

He seemed quite pleased when I pulled all my tablets out of my bag and put them in his waste bin ????

 

We discussed the 45 BPM issue and AFib Ablation and Pacemakers for some time.

 

Namely, what it does and the advantages and disadvantages.

 

Without going into it in depth, he was not a big fan of AFib ablation, as he agreed with my concerns that the Afib could come back.

 

I play a lot of sport and asked him if I could carry on playing now and if I had a Pacemaker fitted.

 

He said I could in both scenarios

 

I have a follow-up appointment in January.

 

Before then I have to monitor my BP daily using his averaging method and without any meds.

 

If that HR BPM does not get higher than 45 ie to 60, then we could be considering a Pacemaker being fitted early next year.

 

I was with the Dr for about an hour in total and we discussed a lot of issues.

 

So I cannot fully explain for any reader of this how much the BP may reduce with a Pacemaker.

 

I do know that the stored measurements on my old BP monitor when the BPM were nearer 80 than 45, that my BP was about 140/80. Not brilliant, but a return to these numbers would be welcome for sure.

 

He gave me various subjects to read/learn about on Google so I will be fully/better informed of the issues when we meet again.

 

The Total cost for this very long consultation (nearly an hour) and the EKG was 1200 baht. The EKG was 500 baht.

 

I forgot to ask the cost of this procedure, but a quick Google search suggests in Thailand it is probably starting (?) at around 200-300K Baht.

 

I will contact the hospital today and see if they will email me the operation costs and length of stay in the hospital.

 

If anyone wants any more info, please let me know.

 

Although, at this stage, this all I really know.

 

Edited by dsfbrit
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Dear Sir, 
 
Thank you for your email.
 
The estimated cost for pacemaker procedure is 250,000 +/- THB. Includes doctor's fee, 2 nights hospital stay and procedure. NOT INCLUDES physical check-up before the procedure and/or any expenses incurred due to complications. 
 
Medical Coordinator
BCH 
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