Hello Sheryl...Is there a decent urologist I can see at Vachira government hospital in Phuket

[Adumbration]

Does Vachira have a decent Urologist?  And does anyone know what prostate biopsy options are available at that hospital and the various costs.

 

Edited August 22, 2022 by Adumbration

[CharlieH]

Moved to Health forum.

[The Hammer2021]

Ask at the hospital-Thats what  I would do. Go for an initial check up and test- then start fining your research

[Chainsaw]

Vachira have a brand new clinic about 100 meters north of the main hospital, they have a comprehensive walk-in health check program which includes all blood and urine tests plus chest X-ray and ECG. All very modern and a consultation on your results with a doctor. Around 2000 baht. (promotion)

[eisfeld]

15 minutes ago, Chainsaw said:

Vachira have a brand new clinic about 100 meters north of the main hospital, they have a comprehensive walk-in health check program which includes all blood and urine tests plus chest X-ray and ECG. All very modern and a consultation on your results with a doctor. Around 2000 baht. (promotion)

I've seen the new complex while driving by. Is it actually part of Vachira and government owned? Looked like a private more premium establishment.

[Sheryl]

6 hours ago, eisfeld said:

I've seen the new complex while driving by. Is it actually part of Vachira and government owned? Looked like a private more premium establishment.

It is owned by the hospital but is a semi-private arrangement where the hospital's senior doctors can work after hours.

 

Not much cheaper than the private hispitals.

[Sheryl]

I don't have any in formation on the urologists at Vachira but if you are even remotely near requiring a prostate biopsy (indications for which include at minimum findings on ultrasound suggestive of malignancy, and more preferrably on MP MRI) you should not do it in Phuket, you should come to Bangkok.

 

who has recommended a prostate biopsy and for what reason?

 

 

[Adumbration]

22 hours ago, Chainsaw said:

Vachira have a brand new clinic about 100 meters north of the main hospital, they have a comprehensive walk-in health check program which includes all blood and urine tests plus chest X-ray and ECG. All very modern and a consultation on your results with a doctor. Around 2000 baht. (promotion)

You can get the same program including chest xray at Andalab (samkong and merlin) for 990 baht.  It has been that same price for over a decade.

[Adumbration]

16 hours ago, Sheryl said:

I don't have any in formation on the urologists at Vachira but if you are even remotely near requiring a prostate biopsy (indications for which include at minimum findings on ultrasound suggestive of malignancy, and more preferrably on MP MRI) you should not do it in Phuket, you should come to Bangkok.

 

who has recommended a prostate biopsy and for what reason?

 

 

I have had a weak urine stream for probably 18 months.  Can go but low flow.  During covid lockdowns I had no access to hospital facilities just local witch doctors.  I can now visit Phuket.

 

I have a raft of other medical issues....as you may recall from some of my earlier posts.  

 

About 2 months ago I had one incidence of blood in my semen.

 

I have burning sensation when I pee and dull pain in my uretha.  I am sexual active but only with my long time partner who to the best of my knowledge has not cheated on me.  So no STD risk I would hope but not tested.  It hurts when I ejaculate.

 

I have not had a yet had a PSA or a DRE.

 

Yesterday I started myself on:

 

• morning with breakfast: 100mg doxycycline, 2mg of doxazosin, 600mg ibuprofen
• evening with dinner: 100mg doxycycline
• before bed: 2mg doxazosin

I have high blood pressure and was previously taking Losartan.  I have replaced that hopefully with the doxazosin and so am trying to kill (manage) two birds with one stone.

 

Over the next week I will be self monitoring my bp to ensure the doxa is keeping me in an acceptable range.

 

I intend to stick to this medication regime for 2 months to see if there is any change in my symptoms.  If there is then I will continue on with the doxycycline for another month.

 

If there is no improvement in my symptoms after 4 weeks I will go for a PSA and DRE.

 

No doubt you will tell me I should already of had the PSA and DRE to rule out cancer before starting my prostatitis medication, but I read that many practitioners will often commence a patient on doxy or tsm regardless.

 

I am suffering from a morton's neuroma in my left foot that makes walking very difficult.  In the last few weeks I have felt that one is also now developing in my right foot.  I have flat feet and a morgan's toe.

 

I was already taking ibuprofen to help manage the neuroma.

 

Your thoughts and criticism are welcome.

 

 

 

 

Edited August 23, 2022 by Adumbration

[Adumbration]

39 minutes ago, Adumbration said:

You can get the same program including chest xray at Andalab (samkong and merlin) for 990 baht.  It has been that same price for over a decade.

https://www.andalab.net/health-check-up-programs/

[Sheryl]

4 hours ago, Adumbration said:

I have had a weak urine stream for probably 18 months.  Can go but low flow.  During covid lockdowns I had no access to hospital facilities just local witch doctors.  I can now visit Phuket.

 

I have a raft of other medical issues....as you may recall from some of my earlier posts.  

 

About 2 months ago I had one incidence of blood in my semen.

 

I have burning sensation when I pee and dull pain in my uretha.  I am sexual active but only with my long time partner who to the best of my knowledge has not cheated on me.  So no STD risk I would hope but not tested.  It hurts when I ejaculate.

 

I have not had a yet had a PSA or a DRE.

 

Yesterday I started myself on:

 

• morning with breakfast: 100mg doxycycline, 2mg of doxazosin, 600mg ibuprofen
• evening with dinner: 100mg doxycycline
• before bed: 2mg doxazosin

I have high blood pressure and was previously taking Losartan.  I have replaced that hopefully with the doxazosin and so am trying to kill (manage) two birds with one stone.

 

Over the next week I will be self monitoring my bp to ensure the doxa is keeping me in an acceptable range.

 

I intend to stick to this medication regime for 2 months to see if there is any change in my symptoms.  If there is then I will continue on with the doxycycline for another month.

 

If there is no improvement in my symptoms after 4 weeks I will go for a PSA and DRE.

 

No doubt you will tell me I should already of had the PSA and DRE to rule out cancer before starting my prostatitis medication, but I read that many practitioners will often commence a patient on doxy or tsm regardless.

 

I am suffering from a morton's neuroma in my left foot that makes walking very difficult.  In the last few weeks I have felt that one is also now developing in my right foot.  I have flat feet and a morgan's toe.

 

I was already taking ibuprofen to help manage the neuroma.

 

Your thoughts and criticism are welcome.

 

 

 

 

No reason to think at tis point that you need a prostate biopsy.

 

Prostatitis is indeed a possibility.

 

PSA is nto reliable in the presence of prostatitis.

 

However a urine culture is desirable and it is unfortunate you already started abx as this may make it harder to identify the organism.

 

in terms of urologists in Phuket, if you go through the public channel at Vachira you will have no choice of doctor and likely be treated by an  intern or resident in training. If you go through their new "Special" clinic (after hours, semi-private channel, from 4pm on ward) it will cost about the same as a private hospital.

 

Personally I would suggest

https://www.phukethospital.com/doctor/manoowet-thirawirot/

at Bangkok Hospital. Might also be able to see him at the Vachira SMC but will cost almost the same and waits will be longer.

 

 

[Adumbration]

3 hours ago, Sheryl said:

No reason to think at tis point that you need a prostate biopsy.

 

Prostatitis is indeed a possibility.

 

PSA is nto reliable in the presence of prostatitis.

 

However a urine culture is desirable and it is unfortunate you already started abx as this may make it harder to identify the organism.

 

in terms of urologists in Phuket, if you go through the public channel at Vachira you will have no choice of doctor and likely be treated by an  intern or resident in training. If you go through their new "Special" clinic (after hours, semi-private channel, from 4pm on ward) it will cost about the same as a private hospital.

 

Personally I would suggest

https://www.phukethospital.com/doctor/manoowet-thirawirot/

at Bangkok Hospital. Might also be able to see him at the Vachira SMC but will cost almost the same and waits will be longer.

 

 

Thanks for your input Sheryl.  Dreadful photo of Thirawirot.  Looks like a B grade movie superhero.

 

I will update with my progress or failure in due course.

 

If I had to have a turp or biopsy at Varicha (not the new clinic), surely I would not be operated on by an intern?

[Sheryl]

16 hours ago, Adumbration said:

Thanks for your input Sheryl.  Dreadful photo of Thirawirot.  Looks like a B grade movie superhero.

 

I will update with my progress or failure in due course.

 

If I had to have a turp or biopsy at Varicha (not the new clinic), surely I would not be operated on by an intern?

You do not want to have a biopsy or a TURP  in Phuket. I am not even sure Vachira does either as it is only a provincial hospital not a regional facility.  They might well refer to Surat Thani or elsewhere.

 

THere is at this point no  reason to think you need either but if that changes you should best come to Bangkok. 

[Adumbration]

I have been self medicating now for three days here are some notes for anyone that is interested:

 

Doxazosin

I am taking 2 mg just before I go to bed and 2mg with my breakfast.  I started the first dose just before I went to bed because I read it can make you light headed, dizzy and also cause fainting.  It did in fact make me a little dizzy on the first night but now it seems ok with no obvious side effects.  I am monitoring my BP and it appears that the 4mg is holding me in the same range as the losartan that I was on.   There has been a slight increase in my urine flow, and I can cut and start the stream a little now as well.  So this drug is a win for me so far. A little cheaper than Losartan and serves the dual function of managing my BP and helping me to urinate.  A box of losartan only has 30 pills as well, wereas the Doxa comes in a box with 100 pills.

 

Doxycycline

First two day on this were rough.  It is very harsh on the stomach so I would ensure you take it with a good meal and lots of water to wash it down.  There is some infor online saying it should not be taken with food but that is misleading as it refers to small doses and not the 100mg pills I am taking.  I take it with breakfast and with dinner.  First dose gave me a good deal of nausea but that passed after about an hour.  And the first few days I have had slight diarrhea but that is slowly getting better.  The burning while I pee has gotten a little better I feel, but I still have some pain in my urethra.  If I do in fact have prostatitis I have had the condition for a very long time now untreated, so I would expect that I may need to be on Doxy for 2 or 3 months to see my condition improve.

 

I have of course also researched finasteride thoroughly, however I choose not to start it at this stage.  My plan is based on my assumption that I have prostatitis and after that is cleared up I can then go for a PSA, CEA and DRE.  Should these indicate that I have BPH (and not cancer) I will make an informed decision on whether or not it is prudent I start on Finasteride.

 

Sheryl, just you personal opinion please, do you think it would be preferrable to be on Finasteride indefinitely or would it be better to bite the bullet as it were and have a Rezume, Turp, or Eurolift?

 

And is the Eurolift procedure available in Thailand?

[Sheryl]

2 hours ago, Adumbration said:

 

 

Sheryl, just you personal opinion please, do you think it would be preferrable to be on Finasteride indefinitely or would it be better to bite the bullet as it were and have a Rezume, Turp, or Eurolift?

 

And is the Eurolift procedure available in Thailand?

 

IF you have BPH you should not consider invasive tresatments until/unless conservative treatment (medications) are no longer sufficient.

 

Finasteride in urinary dose should not be started without confirmation of benign prostate enlargement. 

 

 

 

AFAIK Urolift is not available in Thailand . Even Rezum is quite new and available in only a few places.  But you are getting way, way ahead of yourself.

 

 

Aside from prostatitis another possible cause of your symptoms is urinary tract (bladder/urethra) secondary to urine retention secondary to enlarged prostate. In fact given stated sexual history it may be more likely. 

 

Doxycycline will not be effective for that. And if UTI is the cause,  failure to treat may lead to serious kidney infection, even sepsis.  

 

As mentioned before you really should get a urine culture. 

 

 

 

 

Edited August 25, 2022 by Sheryl

[Adumbration]

11 hours ago, Sheryl said:

 

IF you have BPH you should not consider invasive tresatments until/unless conservative treatment (medications) are no longer sufficient.

 

Finasteride in urinary dose should not be started without confirmation of benign prostate enlargement. 

 

 

 

AFAIK Urolift is not available in Thailand . Even Rezum is quite new and available in only a few places.  But you are getting way, way ahead of yourself.

 

 

Aside from prostatitis another possible cause of your symptoms is urinary tract (bladder/urethra) secondary to urine retention secondary to enlarged prostate. In fact given stated sexual history it may be more likely. 

 

Doxycycline will not be effective for that. And if UTI is the cause,  failure to treat may lead to serious kidney infection, even sepsis.  

 

As mentioned before you really should get a urine culture. 

 

 

 

 

Hello Sheryl.  Thanks for your input and support.

 

I was going to ask you about UTI and specifically if bacteria that could cause prostatitis could be passed from my GF to me.

 

I have not been with any sexual partner other than my GF for more than a decade, to the best of my knowledge neither has she.

 

Given your previous advice that having already starting to medicate might impact the efficacy of my urine culture, I think what I will do is take my GF for one:  To rule out that she does not have a UTI.

 

I would be taking her to the andalab in Phuket.  There is a list of available tests on their website:

 

https://www.andalab.net/list_of_medical_tests/

 

You can pick and choose what specific tests you want so as to minimise cost.

 

When I take my GF, what specific test(s) should I be requesting?

 

And also, can I also take the same test or is that entirely off the table now that I am self medicating for prostatitis?

Edited August 26, 2022 by Adumbration

[Sheryl]

5 minutes ago, Adumbration said:

Hello Sheryl.  Thanks for your input and support.

 

I was going to ask you about UTI and specifically if bacteria that could cause prostatitis could be passed from my GF to me.

 

I have not been with any sexual partner other than my GF for more than a decade, to the best of my knowledge neither has she.

 

Given your previous advice that having already starting to medicate might impact the efficacy of my urine culture, I think what I will do is take my GF for one:  To rule out that she does not have a UTI.

 

I would be taking her to the andalab in Phuket.  There is a list of available tests on their website:

 

https://www.andalab.net/list_of_medical_tests/

 

You can pick and choose what specific tests you want so as to minimise cost.

 

When I take my GF, what specific test(s) should I be requesting?

 

And also, can I also take the same test or is that entirely off the table now that I am self medicating for prostatitis?

 

Unlike prostatitis, which can be  (but is not always) due to an STD, bladder infections usually are not. There is no point in bringing your Gf for a test.  UTIs are different from STDs, usual causative organism is simple GI flora.

 

You can try getting a urine culture yourself, but as mentioned having already started an antibiotic may make it hard to detect infection. Nothing lost by trying though.

 

You can try getting on e

[Adumbration]

30 minutes ago, Sheryl said:

 

Unlike prostatitis, which can be  (but is not always) due to an STD, bladder infections usually are not. There is no point in bringing your Gf for a test.  UTIs are different from STDs, usual causative organism is simple GI flora.

 

You can try getting a urine culture yourself, but as mentioned having already started an antibiotic may make it hard to detect infection. Nothing lost by trying though.

 

You can try getting on e

I would be taking her to the andalab in Phuket.  There is a list of available tests on their website:

 

https://www.andalab.net/list_of_medical_tests/

 

Which specific test(s) should I be requesting?

[Adumbration]

2 minutes ago, Adumbration said:

I would be taking the test at andalab in Phuket.  There is a list of available tests on their website:

 

https://www.andalab.net/list_of_medical_tests/

 

Which specific test(s) should I be requesting?

 

[Sheryl]

10 hours ago, Adumbration said:

I would be taking her to the andalab in Phuket.  There is a list of available tests on their website:

 

https://www.andalab.net/list_of_medical_tests/

 

Which specific test(s) should I be requesting?

In order of importance:

 

1. Culture and Sensitivity (urine) -- you only

 

2. Chlamydia antigen test - both of you but note it requires a vaginal swab from her, for you can be done either on urine sample or urethral swab, but urethral swab is more accurate. Note that this tests only for current infection and, in your case, the doxycline could cause false negative. But worth trying.

 

3. Chlamydia IgM (blood test) for both of you. Positive result indicates current or very recent infection but negative does not rule it out as sensitivity is low. An antibody panel that includes IgA, IgG  as well as IgM would be better but is not on the list; you might ask though. This would give more info as it would also capture antibodies from old infection. 

 

With all these tests negative results do not rule out infection, especially since you are already taking antibiotic. But a positive result would be meaningful

 

[Adumbration]

Sheryl

 

Thank you very much for taking the time to give me a detailed reply.  Very much appreciated.

 

My GF went to andalab this afternoon and picked up two urine culture sample bottles.

 

Clinic is closed over the weekend so on Monday we will be waking up and then catching a sample of our morning urine (mid stream) and then ensuring the samples arrive at the clinic within the hour.

 

They told us they only need the one sample in the culture container and can use some of that to do the UTI infection test (which I guess is this sensitivity test you refer to?).  Here is the quoted prices supplied by the clinic staff I was texting with today via whatsapp:

 

1. Urine test infection (UTI) 100. baht - result 1 hr
2. Urine culture 600. baht - result 7 days

 

If it is the case that I have Chlamydia isn't that a moot point anyway now because I am already medicating with Doxycycline?  So what is to be gained from me testing for that STD?

 

On the other hand it would seem prudent to have my GF tested because a positive result would require that she also starts on antibotics.

 

We have been together (and living in each other's pockets every day) for a decade now.  My GF is not from a bar but we did (at my suggestion) have mutual STD package test (at Andalab) at the start of our relationship.  We were both clear and we shared each others printouts.  This was ten or more years ago so I cannot remember what was tested for BUT having just reviewed the Andalab website it is very interesting to note that the STD test program that they currently offer does not include Chlamydia so it probably did not include it way back then either.  I have not had any other sexual partners (and to the best of my knowledge she has not either) so It would come as a shock if she tests positive.  It would either mean that one or both of us already had Chlamydia more than a decade ago and have lived with it unknowingly all that time.  Or that my partner has had sex with someone else.  It is perhaps relevant that I mention that I do not drink or take recreational drugs so there is absolutely zero chance that I have had some drunken sexual encounter that I do not remember.

 

So my plan on Monday will be to get us both a UTI test and Urine culture and to get my GF both a Chlamydia swab and blood test.

 

Your thoughts and criticisms are welcome.

[Sheryl]

Little point to the "infection" test as you will also get the culture. The w hour "infection" test is just a dipstck for nitrates.

 

No point in your Gf bring tested for UTI unless she has symptoms as no reason to think she has a UTI and unrelated to your problem. UTIs are not transmitted from person to person.

 

Chlamydia antigen test for her might make some sense though as it is possible for chlamydia to be asymptomatic, it could be present for years and unlike UTI it is sdxuslly trsnsmisssble to other people. 

 

As for chlamydia testing for you:  you are presumptively  treating yourself for prostatitis caused by chlamydia. We do not in fact know that you even have prostatitis let alone that it is caused by chlamydia and indeed your history makes that less likely than the many other non-STD bacterial causes of prostatitis. Many of which do not respond to doxycycline.   Indeed given the low suspicion for STD it is a bit odd that you have chosen to take this.

 

SInce the doxycycline  may be  unnecessary, and there is chance you need a totally different antibiotic  (or none at all) any information that would confirm chlamydial infection could be useful. Note that chlamydia does not always respond to doxy. Since treatment of chlamydial prostatitis can take a prolonged course of  medication it would be good to have at least some indication that this is the problem.

 

Just a suggestioni since you seem determined to self-test and self-treat. ...which is not the approach I recommend at all. 

 

If cost is the issue you could wait for the result of the urine culture first as if it is positive then the other tests can be skipped st least for now. 

[Adumbration]

Sheryl I am not clear on what you are suggesting.

 

I think your advice boils down to:

 

1. Urine culture for me only

2. Chlamydia antigen test for both of us

3 Chlamydia blood test for both of us

 

Is that correct?

[Sheryl]

4 hours ago, Adumbration said:

Sheryl I am not clear on what you are suggesting.

 

I think your advice boils down to:

 

1. Urine culture for me only

2. Chlamydia antigen test for both of us

3 Chlamydia blood test for both of us

 

Is that correct?

Yes but you could hold off on#3 until you have results of #1 and #2. 

 

If #2 is positive no need for #3.

 

IF #2 negative but #1 positive then #3 would be useful only if treatment of organism found in #1 fails to produce relief.

 

Make sure your urine culture includes sensitivity.

 

And note that if it turns out you do have a UTI, it will probably have occurred due to incomplete emptying of the bladder secondary to an enlarged prostate and once the immediate infection is resolved you will still need to see a doctor for that (DRE, PSA, maybe ultrasound maybe not depending on results of these first two). 

 

  

[Hellfire]

  Who is this Sheryl? I looked at her profile and did not find any additional information. Why is she allowed to advise people on any possible medical condition?  Is she a doctor? Where did she study? What is her specialization? Why people keep asking for her advice?

 

 

Edited August 27, 2022 by Hellfire

[Sheryl]

1 hour ago, Hellfire said:

  Who is this Sheryl? I looked at her profile and did not find any additional information. Why is she allowed to advise people on any possible medical conditions? 

It is an open forum and all members are free to give advise and many  do so. Up to the poster to decide what if any advice to take.  Those who regularly read the Health Forum have a sense for how knowledgable(or not) various posters are.

 

I am the   one responding in this particular thread because, in the title, the OP specifically addressed his question to me.

 

If you read the full thread you will note that I have advised the OP to see a urologist, provided names of suggested doctors to see, and stated that I think it is a mistake to try to self-treat/ self prescribe.  Nonetheless he wanted my personal opinion -- opinion not professional advise -- on what lab tests make sense and I offered it.

 

 

[Hellfire]

10 minutes ago, Sheryl said:

It is an ppen forum and all members are free to give advise and many  do so. Up to the poster to decide what if any advice to take.  Those who regularly read the Health Forum have a sense for how knowledgable(or not) various posters are.

 

I am the   one responding in this particular thread because, in the title, the OP specifically addressed his question to me.

 

If you read the full thread you will note that I have advised the OP to see a urologist, provided names of suggested doctors to see, and stated that I think it is a mistake to try to self-treat/ self prescribe.  Nonetheless he wanted my personal opinion -- opinion not professional advise -- on what lab tests make sense and I offered it.

 

 

What do you base your advice on? A common knowledge? 
 

 

 

Edited August 27, 2022 by Hellfire

[Sheryl]

52 minutes ago, Hellfire said:

What do you base your advice on? A common knowledge? 
 

 

 

Education and experience.

 

If what you are after are details of my education and experience I am not going to post that. This is a social media  chat board . These are not proessional consultations. 

 

Same applies to other forums...DIY, IT, photography etc etc. 

[Chainsaw]

On 8/23/2022 at 6:51 AM, Sheryl said:

It is owned by the hospital but is a semi-private arrangement where the hospital's senior doctors can work after hours.

 

Not much cheaper than the private hispitals.

Wrong!  At approximately 2000 baht it is MUCH cheaper than the private hospitals. I've had check-ups at both and the Vachira clinic is by far the better deal. No ECG, PSA test or chest X-ray at Siriroj unless you pay extra, for example.

[Adumbration]

@Hellfire

 

 Please do not post on this thread.

 

Your comments are adding absolutely nothing constructive. 

 

I started this thread specifically to request input from Sheryl.  I did so because I am very confident in her ability to provide me with accurate and helpful information.