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I've been seeing an 'expert' at Bangkok Hospital and, frankly don't trust him.

I did an FVC test, where I had to blow into a machine, then take some Ventolin inhaler and wait 15 minutes and then do it again. 

I did this about 8 months ago, when first seeing the doc as I had difficulty breathing. After taking the Ventolin, there was a 12% increase in efficiency but on the recent visit, there was no increase. He said he suspects Emphysema now and had been going on about it definitely being Asthma before. I thought/think it might be Long Covid as I had no issues at all until getting the virus. I run 5 km 4 times a week, swim every day and play golf regularly and breathing isn't an issue now. 

I find the test result strange and actually asked for the printed results but he 'forgot' to give them to me. The second test was exactly the same as the first, which I took a photo of when waiting. 

If anyone has any experience of reading these things, or of Asthma, Emphysema, COPD, please tell me what you think. Was a bit if a shock him suggesting I have Emphysema as there is no cure! 

Here's the photo and as I can see the lung volume seems OK. I have been taking Seretide acuhaler for 7/8 months, but not on the day of the test.

Also, I bought a thing to go on my finger to read the oxygen levels and it is usually 95-98.

image.png.2b4edee30fb8b2a1879540b190d520a7.png

 

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I think these results may be normal but you need to provide the column headings which are cropped off.

 

I assume first column is the reference rsnge and second your result but I need to be sure.

 

Which Bangkok Hospital branch is this?

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58 minutes ago, Sheryl said:

I think these results may be normal but you need to provide the column headings which are cropped off.

 

I assume first column is the reference rsnge and second your result but I need to be sure.

 

Which Bangkok Hospital branch is this?

Hi Sheryl, 

 

here's the missing  part. This is in Hua hin. 

I've had chest x-rays, which show small plate atelectasis, but not getting worse. He wants me to get a CT scan but like I said, I don't trust him. He said I had a sever heart issue and probably pulmonary embolism but when paying more money to see the specialists, I don't have anything wrong there.

 

image.png.4b7505192ad5401628d5456c9b53e863.png

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I was diagnosed as having severe COPD by an <deleted> at Bumrungrad who could only see my smoking history (i have since quit) and seemed blind to the fact that I had developed pneumonia after a bout of COVID.

After asking around someone recommended seeing Dr. Yongyudh Ploysongsang. Cost me 3k for the initial consultation but after a half hour exam and conversation recommended a course of antibiotics that clear my "COPD" up in a week.

worth every penny.
 

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25 minutes ago, Neeranam said:

Hi Sheryl, 

 

here's the missing  part. This is in Hua hin. 

I've had chest x-rays, which show small plate atelectasis, but not getting worse. He wants me to get a CT scan but like I said, I don't trust him. He said I had a sever heart issue and probably pulmonary embolism but when paying more money to see the specialists, I don't have anything wrong there.

 

image.png.4b7505192ad5401628d5456c9b53e863.png

 

 

Your results  are all normal as far as I can tell.  Even the results in the 70 - 86% range are well above thresholds for diagnosing pulmonary disease to the best of my knowledge. But I am most definitely not an expert.

 

I suggest you not  continue with either this doctor or this hospital.  Small private hospitals upcountry in no way have the level of expertise found in Bangkok even if affiliated with a Bangkok based chain. In fact, unless in Chiang Mai or maybe Pattaya, I generally advise people away from private hospitals in the provinces.

 

Since all this started after you had COVID, the effects of COVID are indeed the likely explanation. After effects of COVID are many and varied and still not well understood. Fortunately most improve with time as it sounds like yours have done.

 

Since you have no breathing issues now and can even run 5 km, swim etc without difficulty I think the only real issue is whether and how you can now safely come off the inhaler.  Note that this has to be done through a gradual tapering, not suddenly as that can trigger problems with more than your breathing.

 

I suggest you come up to Thonburi and see one of this pulmonologists there:

 

https://www.siphhospital.com/en/medical-services/doctor-biography?id=68

 

Same doctor can also be seen at Thonburi Hospital on Tuesday evenings and Saturday mornings

https://www.thonburihospital.com/searchdoctor

 

 

 

 

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2 minutes ago, Sheryl said:

 

 

Your results  are all normal as far as I can tell.  Even the results in the 70 - 86% range are well above thresholds for diagnosing pulmonary disease to the best of my knowledge. But I am most definitely not an expert.

 

I suggest you not  continue with either this doctor or this hospital.  Small private hospitals upcountry in no way have the level of expertise found in Bangkok even if affiliated with a Bangkok based chain. In fact, unless in Chiang Mai or maybe Pattaya, I generally advise people away from private hospitals in the provinces.

 

Since all this started after you had COVID, the effects of COVID are indeed the likely explanation. After effects of COVID are many and varied and still not well understood. Fortunately most improve with time as it sounds like yours have done.

 

Since you have no breathing issues now and can even run 5 km, swim etc without difficulty I think the only real issue is whether and how you can now safely come off the inhaler.  Note that this has to be done through a gradual tapering, not suddenly as that can trigger problems with more than your breathing.

 

I suggest you come up to Thonburi and see one of this pulmonologists there:

 

https://www.siphhospital.com/en/medical-services/doctor-biography?id=68

 

Same doctor can also be seen at Thonburi Hospital on Tuesday evenings and Saturday mornings

https://www.thonburihospital.com/searchdoctor

 

 

 

 

Thanks Sheryl. 

You may remember my post before about not actually wanting to start the inhaler, as I was concerned about coming off it. 

I think extremely unprofessional to suggest Emphysema, with no actual reason, apart from getting me to go back in 3 months pay his salary. 

I'm going to the UK soon and might see a doc there, private of course as no time for the NHS. 

If the breathing gets any worse, I'll go to the hospitals you mentioned. I really appreciate your input here, thanks again. 

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13 minutes ago, Neeranam said:

Thanks Sheryl. 

You may remember my post before about not actually wanting to start the inhaler, as I was concerned about coming off it. 

I think extremely unprofessional to suggest Emphysema, with no actual reason, apart from getting me to go back in 3 months pay his salary. 

I'm going to the UK soon and might see a doc there, private of course as no time for the NHS. 

If the breathing gets any worse, I'll go to the hospitals you mentioned. I really appreciate your input here, thanks again. 

You said in your OP he "suspects" emphysema. One could agree to that (concave curve, high VC, flow metrics low normal,  especially FEF25-75) but its a rather weak suspicion (low normal is still normal). Did the doctor know that you are able to swim, run etc?

A follow-up in 3 months is certainly a good idea, whether at the NHS  or one of the doctors Sheryl and Noodle recommended. 

Also ask for a DLCO test.

 

And, yes, I would taper off the inhaler- especially as you said it had no effect at the spirometry.

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2 hours ago, Neeranam said:

I don't trust him. He said I had a sever heart issue and probably pulmonary embolism but when paying more money to see the specialists, I don't have anything wrong there.

Why would you trust him? I had similar w/a routine heart check-up and the doctors told me I had an enlarged heart. And for a mere 500 baht extra they wanted to do an ultrasound... of course I paid... yup, enlarged heart... I left very frightened but 2 other opinions said my heart was perfectly normal... 

 

This should be punishable... it should never happen - mind/body etc...

 

Get a 2nd opinion... 

 

money and medicine don't mix well... 

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6 hours ago, ignore it said:

I've noticed an increased focus on profitability and experienced a decline in quality care at BPH beginning before the Wuhan flu time. Especially noted in the dental and opthamalic departments.

I have to mention that was already after the Tsunami, from that moment on the prices go skyrocket up.

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3 hours ago, Neeranam said:

Hi Sheryl, 

 

here's the missing  part. This is in Hua hin. 

I've had chest x-rays, which show small plate atelectasis, but not getting worse. He wants me to get a CT scan but like I said, I don't trust him. He said I had a sever heart issue and probably pulmonary embolism but when paying more money to see the specialists, I don't have anything wrong there.

 

image.png.4b7505192ad5401628d5456c9b53e863.png

Recently I visit also that hospital and have undergone a CT scan as a result of lung complaints.

But because high prices I did that trough my clinic, bewell, that gets a significant discount on it.

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38 minutes ago, Tubulat said:

Recently I visit also that hospital and have undergone a CT scan as a result of lung complaints.

But because high prices I did that trough my clinic, bewell, that gets a significant discount on it.

Interesting, I'll check that place out, thanks.

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21 hours ago, Tubulat said:

Recently I visit also that hospital and have undergone a CT scan as a result of lung complaints.

But because high prices I did that trough my clinic, bewell, that gets a significant discount on it.

How much did you pay for the CT scan?

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Be aware that there are risks in having a CT or MRI with contrast media  at  an imaging center. A small number of people have severe reactions to the contrast dye and you really do not want to be anywhere but already in a hospital when that  happens.  

 

A CT of the lung (which I can see no reason for OP to have) would oftem require  contrast. 

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3 hours ago, Sheryl said:

Be aware that there are risks in having a CT or MRI with contrast media  at  an imaging center. A small number of people have severe reactions to the contrast dye and you really do not want to be anywhere but already in a hospital when that  happens.  

 

A CT of the lung (which I can see no reason for OP to have) would oftem require  contrast. 

Thanks Sheryl, 

 

I am going to try to come off my Seretide Acuhaler, 50/500 mcg. 

I already have one at a lower dosage, 25/500 mcg. 

 

Does anyone know how people taper off this medicine? The doc I saw said, 'it's not heroin, there are no withdrawals'. 

 

I found a useful chart, but not sure if the medicine shown is available here. 

I am thinking of just taking half a puff, if that makes sense. 

http://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_3/Asthma_step_down.pdf

 

 

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6 hours ago, Neeranam said:

How much did you pay for the CT scan?

When you go to the hospital if I remember well, about 22-23K

Through the clinic about 14K, I have to mention the clinic gives you the results and advice, the hospital makes only the ct-scan.

I recommend Dr. Paemika in the clinic.

About 2 or 3 years ago I visit the hospital directly for a ct-scan (long) and I payed that amount (22-23k).

Before that time I go to the hospital in HH, first I visit Bumrungrad in BKK but was unsure of the outcome.

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50 minutes ago, Neeranam said:

Thanks Sheryl, 

 

I am going to try to come off my Seretide Acuhaler, 50/500 mcg. 

I already have one at a lower dosage, 25/500 mcg. 

 

Does anyone know how people taper off this medicine? The doc I saw said, 'it's not heroin, there are no withdrawals'. 

 

I found a useful chart, but not sure if the medicine shown is available here. 

I am thinking of just taking half a puff, if that makes sense. 

http://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_3/Asthma_step_down.pdf

 

 

I don't know exactly your lung problems but I have a mild form of asthma.

I am prescribed Foster 100/6 and it has had good results for me, it consist of two drugs in one inhaler.

One is a bronchodilator, the other one is anti-inflammatory.

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43 minutes ago, Tubulat said:

When you go to the hospital if I remember well, about 22-23K

Through the clinic about 14K, I have to mention the clinic gives you the results and advice, the hospital makes only the ct-scan.

I recommend Dr. Paemika in the clinic.

About 2 or 3 years ago I visit the hospital directly for a ct-scan (long) and I payed that amount (22-23k).

Before that time I go to the hospital in HH, first I visit Bumrungrad in BKK but was unsure of the outcome.

Thanks. The doc at Bkk hospital quoted 8k. Maybe bewell can get discount on that. 

Actually, I see online package says 6k.

Screenshot_20230203_185600_Chrome.jpg

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1 hour ago, Neeranam said:

Thanks. The doc at Bkk hospital quoted 8k. Maybe bewell can get discount on that. 

Actually, I see online package says 6k.

Screenshot_20230203_185600_Chrome.jpg

That's for a low-dose CT as lung cancer screening, not the same. 

But as Sheryl said,  I don't see the point of doing a CT scan at this time. 

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28 minutes ago, Lorry said:

That's for a low-dose CT as lung cancer screening, not the same. 

But as Sheryl said,  I don't see the point of doing a CT scan at this time. 

Oh, I did wonder. 

Indeed, I've wasted enough time and worry with this affliction! 

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On 2/2/2023 at 11:56 AM, Sheryl said:

Since you have no breathing issues now and can even run 5 km, swim etc without difficulty I think the only real issue is whether and how you can now safely come off the inhaler.  Note that this has to be done through a gradual tapering, not suddenly as that can trigger problems with more than your breathing.

I was taking Salmeterol/Fluticasone Propionate 50/500 mcg in the form of a Seretide Acuhaler 2 times a day. 

Now, taking Salmeterol/Fluticasone Propionate 50/250 mcg in the morning and 50/500 mcg at night. No real difference to note, so going to change to the lower dose, 50/250 mcg twice a day.

 

I can't find any timeline suggestion for this, so going to do it as slow/fast as I feel comfortable with. 

 

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  • 3 months later...
On 2/10/2023 at 12:07 PM, Neeranam said:

Now, taking Salmeterol/Fluticasone Propionate 50/250 mcg in the morning and 50/500 mcg at night. No real difference to note, so going to change to the lower dose, 50/250 mcg twice a day.

Now on 25/125 mcg in the morning and 50/250 mcg at night. Actually forgot last night so might just come off it soon. 

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