Urgent cardiologist needed for old mate

[actonion]

On 3/25/2023 at 7:04 PM, blackshadow said:

DOCTOR manuan.....i think his name is at bkk pattaya hospital.....

looked after my friend who had heart problems....

Second that,     Dr Manoon  Cardiologist , yes in Bangkok Pattaya, but his  initial consulting  fee is 650b   as of 3 months ago,  the nursing fee   blood pressure taken etc. which is extra charge can be refused, as can the Medication which can be bought outside...

[sandyf]

On 3/25/2023 at 8:21 PM, aussienam said:

Thanks. Think I'll suggest this to start with.  Other hospitals in Chonburi I'll explain if he needs further specialist care and if he'll accept the travel costs and distance to get there.  

Seems there are no private clinics around. 

I am registered at both Bang Saen and Chonburi hospitals and I can assure you Bang Saen is far better than Chonburi and a bit nearer. Quite easy from Pattaya, you can get a minibus from top of Pattaya Klang to far end of Nong Mon market and then baht cab to the hospital.

I see a cardiologist there regularly, 100 baht a time, think I was about 5K for an ECHO.

It is a university hospital, the building is relatively new and well organised.

Once registered you can get a walk in appointment.

http://buh.buu.ac.th/buh64/index.php

[Sheryl]

3 hours ago, sandyf said:

I am registered at both Bang Saen and Chonburi hospitals and I can assure you Bang Saen is far better than Chonburi and a bit nearer. Quite easy from Pattaya, you can get a minibus from top of Pattaya Klang to far end of Nong Mon market and then baht cab to the hospital.

I see a cardiologist there regularly, 100 baht a time, think I was about 5K for an ECHO.

It is a university hospital, the building is relatively new and well organised.

Once registered you can get a walk in appointment.

http://buh.buu.ac.th/buh64/index.php

This is not called Bang Saen hospital. It is Burapha University Health Center. A much smaller facility than Chonburi Hospital or Red Cross hospital with fewer capacities. If only needing consultation and basic tests would be fine but description of OP's condition suggests he may need much more than that

[sandyf]

27 minutes ago, Sheryl said:

This is not called Bang Saen hospital. It is Burapha University Health Center. A much smaller facility than Chonburi Hospital or Red Cross hospital with fewer capacities. If only needing consultation and basic tests would be fine but description of OP's condition suggests he may need much more than that

Don't be ridiculous. If I had used the proper name Burapha University Hospital unlikley the OP would have known where it was. Of course you are free to call it what you want but there is only the one hospital in Bang Saen.

I never mentioned Red Cross, never been there but having been inside Chonburi hospital many times as a visitor and had one of my covid there it is not somewhere I would recommend, like something out of the dark ages, but obviously you are free to do so.

As far as the OP is concerned the first step would be an echocardiogram and that can be done at Bang Saen in a modern facility for a reasonable price. If you think it can be done cheaper at Sri Ratcha then that may well be a better option being nearer.

[Sheryl]

10 minutes ago, sandyf said:

Don't be ridiculous. If I had used the proper name Burapha University Hospital unlikley the OP would have known where it was. Of course you are free to call it what you want but there is only the one hospital in Bang Saen.

I never mentioned Red Cross, never been there but having been inside Chonburi hospital many times as a visitor and had one of my covid there it is not somewhere I would recommend, like something out of the dark ages, but obviously you are free to do so.

As far as the OP is concerned the first step would be an echocardiogram and that can be done at Bang Saen in a modern facility for a reasonable price. If you think it can be done cheaper at Sri Ratcha then that may well be a better option being nearer.

Actually with a slow heart rate first step would be EKG, not Echo. And depending on what is found out, he may need a pacemaker.

 

It is a mistake to equate the newness of a facility and its physical condition with the quality of the medical care within it.

 

Pretty much all the regional government hospitals are in bad need of physical improvements. They are chronically underfunded and choose -quite rightly - to prioritize other things over new coats of paint, comfortable waiting rooms and the like.

 

I would likely myself prefer Burapha to Chonburi Hospital for simple outpatient care -- I too prefer to be in comfortable surroundings - but I do have reason to suggest the person referred to in OP go to either Red Cross Hospital or the regional Hospital and it has to do with the level of care he may require.

[sandyf]

12 minutes ago, Sheryl said:

Actually with a slow heart rate first step would be EKG, not Echo. And depending on what is found out, he may need a pacemaker.

Not being a cardiologist I can only go on experience.

I had a check up at the Chonburi Cancer hospital and was advised to see a cardiologist who straight away carried out an echo, never bothered with an ECG.

No doubt in your infinite wisdom you will now say what he should have done.

BTW the OP never said slow heart rate, said falling heart rate, not necessarily the same thing.

[Sheryl]

2 hours ago, sandyf said:

Not being a cardiologist I can only go on experience.

I had a check up at the Chonburi Cancer hospital and was advised to see a cardiologist who straight away carried out an echo, never bothered with an ECG.

No doubt in your infinite wisdom you will now say what he should have done.

BTW the OP never said slow heart rate, said falling heart rate, not necessarily the same thing.

 

 

Per OP his friend has " heart rate falling dangerously low"  which means a slow heart rate. First step for that is an EKG. Your condition was likely something altogether different.

 

 

[ubonr1971]

Shyrly is correct. They will start with an EKG and then Echo for sure and probably a 24 to 48 hour heart monitor.

 

If the heart function is low he should go on Entresto 100mg twice a day. Its the new miracle drug that raises heart function with proven results. Its half a beta blocker half something else that I cant be bothered looking up. My friend was on it and it worked for sure. Pacemaker might be required depending on diagnosis. 

 

Why go to the small hospitals when top private hospitals as so close in bkk??? 

[Sheryl]

3 hours ago, ubonr1971 said:

Shyrly is correct. They will start with an EKG and then Echo for sure and probably a 24 to 48 hour heart monitor.

 

If the heart function is low he should go on Entresto 100mg twice a day. Its the new miracle drug that raises heart function with proven results. Its half a beta blocker half something else that I cant be bothered looking up. My friend was on it and it worked for sure. Pacemaker might be required depending on diagnosis. 

 

Why go to the small hospitals when top private hospitals as so close in bkk??? 

He cannot afford a private hospital.

 

But there are 2  large tertiary government hospitals in Chonburi province. 

[sandyf]

On 3/28/2023 at 5:30 PM, Sheryl said:

 

 

Per OP his friend has " heart rate falling dangerously low"  which means a slow heart rate. First step for that is an EKG. Your condition was likely something altogether different.

 

 

It will be up to those concerned.

The OP looked for local information and in the usual arrogant manner tried to dismiss local knowledge. I notice you didn't give the OP any info on how to get to the hospital in Sri Ratcha or Chonburi.

A trait on this forum, full of good ideas ignoring the practicalities.

[BigStar]

18 minutes ago, sandyf said:

I notice you didn't give the OP any info on how to get to the hospital in Sri Ratcha or Chonburi.

A trait on this forum, full of good ideas ignoring the practicalities.

Google isn't hiding the locations of those cities and will give detailed directions from one's location. No need to address the obvious unless asked specifically.

 

You need to back off. You're way out of line.

[aussienam]

Thank you all posters.  My friend attended Red Cross hospital Sri Racha and managed to get ECG and report outlining heart condition.  

Unfortunately, due to finances, that's as far as he can proceed.  

 

 

[scubascuba3]

1 hour ago, aussienam said:

Thank you all posters.  My friend attended Red Cross hospital Sri Racha and managed to get ECG and report outlining heart condition.  

Unfortunately, due to finances, that's as far as he can proceed.  

 

 

Might as well as gone to Bang Lamung Hospital and got meds, we knew he didn't have enough money for other medical procedures

[connda]

On 3/25/2023 at 8:25 PM, aussienam said:

Thanks.  My friend has already done this (Will). Quality of life is the issue as he is suffering with side effects. 

I wish him the best!

[aussienam]

On 3/28/2023 at 6:24 PM, ubonr1971 said:

Shyrly is correct. They will start with an EKG and then Echo for sure and probably a 24 to 48 hour heart monitor.

 

If the heart function is low he should go on Entresto 100mg twice a day. Its the new miracle drug that raises heart function with proven results. Its half a beta blocker half something else that I cant be bothered looking up. My friend was on it and it worked for sure. Pacemaker might be required depending on diagnosis. 

 

Why go to the small hospitals when top private hospitals as so close in bkk??? 

Any idea where to get Entresto?  How much is it?  My friend is interested in seeking a doctor that may determine whether this as an appropriate medication for him. 

 

Private hospitals too expensive. Public is only option for him.  We are talking very little funds to spare.  He won't travel to Bangkok due to costs and the stress of travelling too far.  

 

Thanks again.

 

 

[Sheryl]

55 minutes ago, aussienam said:

Any idea where to get Entresto?  How much is it?  My friend is interested in seeking a doctor that may determine whether this as an appropriate medication for him. 

 

Private hospitals too expensive. Public is only option for him.  We are talking very little funds to spare.  He won't travel to Bangkok due to costs and the stress of travelling too far.  

 

Thanks again.

 

 

What exactly did the cardiologist who saw him at the Red Cross hospital say/advise? Enresto improves cardiac output in people with heart failure, it does nto treat heart block or other conduction defects which  slow heart rate suggests might be your friend's situation.

 

Entresto can be gotten at large pharmacies or online here https://medtide.com/product/entresto-50-mg-28-tablets-box/

(they have it in multiple strengeths, from 50 to 200 mg)

 

It is an imported and new drug so expensive. Anywhere from 3,000 - 7,000 baht a month depending on the dosage

 

And absolutely should not self prescribed. Among other  things there are potential interactions with other medications he may be on. Other medications for blood pressure may need to be discontinued or adjusted, for example since Enresto is a combination drug that includes an antihypertensive.

 

I could advise better if given some idea what the findings were when he went to the hospital. Not all heart conditions are the same. Would also help to know what medications he currently takes.

 

Would also help to know his nationality - some Embassies will help with airfare home in cases like this, some won't.

 

 

[Liverpool Lou]

On 3/26/2023 at 9:46 AM, JimTripper said:

I would check with church run hospitals for free care. There is one in Bangkok, catholic I think. Seems like they would have something for the poor. 
 

https://en.m.wikipedia.org/wiki/Camillian_Hospital

 

The hospital is operated by Saint Camillus Foundation of Thailand and has charity programs to treat poor and low income patients.

The chances of his qualifying for free treatment are zero...

"The Saint Camillus Foundation of Thailand is a charitable organization in Thailand, set up and run by the Camillian monastic order.

In 1995, the foundation, with the participation of an Italian priest Father Giovanni Contarin, established a Camillian Social Centre in the Rayong Province. The center was built to provide shelter and care to homeless, indigent, and rejected people living with HIV/AIDS.^[ Special emphasis was placed on women and children, as they were most vulnerable.^[4]

Saint Camillus Foundation also operates Camillian Social Center Sampran, caring for elders; Camillian Social Center Prachinburi, caring for lepers; Camillian Social Center Chantaburi, caring for elders; Camillian Social Center Chiangrai, caring for tribal children; and two hospitals, including Camillian Hospital in Bangkok and San Camillo Hospital in Ban Pong, Ratchaburi Province".

Edited April 1, 2023 by Liverpool Lou

[ubonr1971]

21 hours ago, aussienam said:

Any idea where to get Entresto?  How much is it?  My friend is interested in seeking a doctor that may determine whether this as an appropriate medication for him. 

 

Private hospitals too expensive. Public is only option for him.  We are talking very little funds to spare.  He won't travel to Bangkok due to costs and the stress of travelling too far.  

 

Thanks again.

 

 

You can buy it from any pharmacy or most pharmacies. 30 tablets 2700 baht I think but my memory is going. Maybe its 3700. Unsure. Public hospitals have it in their own pharmacies cheaper of course but not by much because its made in Switzerland and not thailand. Obviously he should first confirm that he has low heart function and an echo cardiogram is the cheapest way to test this. (EF). 

[JimTripper]

3 hours ago, ubonr1971 said:

You can buy it from any pharmacy or most pharmacies. 30 tablets 2700 baht I think but my memory is going. Maybe its 3700. Unsure. Public hospitals have it in their own pharmacies cheaper of course but not by much because its made in Switzerland and not thailand. Obviously he should first confirm that he has low heart function and an echo cardiogram is the cheapest way to test this. (EF). 

Maybe get a written script from the dr so they don’t end up getting confused and taking the wrong medications.

[ubonr1971]

48 minutes ago, JimTripper said:

Maybe get a written script from the dr so they don’t end up getting confused and taking the wrong medications.

If he goes to a public hospital and the cardio dr does an echo and if he has low ejection function EF then he can maybe prompt the dr about Entresto. Otherwise they will put the guy on a heart med thats been around for 20 yrs. If he values his life and can pay 5000 to 10000 go to a proper private hospital in bkk for sure. Ive tried public hospital drs here in Thailand and most of them are unimpressive to say the least. 

[Sheryl]

1 hour ago, ubonr1971 said:

If he goes to a public hospital and the cardio dr does an echo and if he has low ejection function EF then he can maybe prompt the dr about Entresto. Otherwise they will put the guy on a heart med thats been around for 20 yrs. If he values his life and can pay 5000 to 10000 go to a proper private hospital in bkk for sure. Ive tried public hospital drs here in Thailand and most of them are unimpressive to say the least. 

He has already been to a public hospital and seen a cardiologist and seemingly this medication was not advised. But without more details it is hard to know, we are not even sure what the nature of his cardiac issue is, might be hart block (which Entresto will not address) or angina/CAD.  From the report indicating  next steps were  advised that he could not afford I am guessing either pacemaker or angioplasty/stent. But OP would need to confirm.

[JimTripper]

Maybe try a go fund me with the treatment plan cost attached, rather then just asking for money with no documentation. It’s pretty easy to set up. It gets in the news or something it’s paid.

Edited April 2, 2023 by JimTripper

[aussienam]

On 4/1/2023 at 7:34 PM, Sheryl said:

What exactly did the cardiologist who saw him at the Red Cross hospital say/advise? Enresto improves cardiac output in people with heart failure, it does nto treat heart block or other conduction defects which  slow heart rate suggests might be your friend's situation.

 

Entresto can be gotten at large pharmacies or online here https://medtide.com/product/entresto-50-mg-28-tablets-box/

(they have it in multiple strengeths, from 50 to 200 mg)

 

It is an imported and new drug so expensive. Anywhere from 3,000 - 7,000 baht a month depending on the dosage

 

And absolutely should not self prescribed. Among other  things there are potential interactions with other medications he may be on. Other medications for blood pressure may need to be discontinued or adjusted, for example since Enresto is a combination drug that includes an antihypertensive.

 

I could advise better if given some idea what the findings were when he went to the hospital. Not all heart conditions are the same. Would also help to know what medications he currently takes.

 

Would also help to know his nationality - some Embassies will help with airfare home in cases like this, some won't.

 

 

Thanks for info.  My friend relayed to me he went to Red Cross, got ECG and report and went home. He did not get to consult with cardiologist.  He mentioned a blockage detected, low heart function. 

That's all I know.  

He is possibly going to try Jomtien Hospital, which someone he knows recommended.  Travelling distances for him at moment is too much.  He won't be returning to Red Cross. 

He really needs to see a cardiologist ASAP of course. He said he will save up as much as he can to pay for appointment. 

 

He's from England.  But no connections back there anymore = no accommodation and prohibitive costs.  He stated that he also cannot afford flights.  I had suggested he should go back there and get NHS cover. 

 

Enresto med - would be too much for him anyway after seeing now the costs involved.  

 

I appreciate feedback from everyone.  It's in God's hands pretty much from here on. 

 

[Sheryl]

34 minutes ago, aussienam said:

Thanks for info.  My friend relayed to me he went to Red Cross, got ECG and report and went home. He did not get to consult with cardiologist.  He mentioned a blockage detected, low heart function. 

That's all I know.  

He is possibly going to try Jomtien Hospital, which someone he knows recommended.  Travelling distances for him at moment is too much.  He won't be returning to Red Cross. 

He really needs to see a cardiologist ASAP of course. He said he will save up as much as he can to pay for appointment. 

 

He's from England.  But no connections back there anymore = no accommodation and prohibitive costs.  He stated that he also cannot afford flights.  I had suggested he should go back there and get NHS cover. 

 

Enresto med - would be too much for him anyway after seeing now the costs involved.  

 

I appreciate feedback from everyone.  It's in God's hands pretty much from here on. 

 

Why on earth did he leave without seeing cardiologist? And how does he know next steps are unaffordable if he did not see cardiologist?  Not making any sense.

 

An EKG cannot show "low heart function". It CAN show a low heart rate, which is different. To assess cardiac output would need an echo. But if EKG showed low heart rate due to heart block (electrical conduction defect) then pacemaker would be next step. 

 

Posdible meds would cost less at govt hospital.  But still very unclear if Entredto would be appropriate in his case.

 

Jomtien is private. Less expensive than other private but still more than govt.

[JimTripper]

32 minutes ago, Sheryl said:

Why on earth did he leave without seeing cardiologist? And how does he know next steps are unaffordable if he did not see cardiologist?  Not making any sense.

 

An EKG cannot show "low heart function". It CAN show a low heart rate, which is different. To assess cardiac output would need an echo. But if EKG showed low heart rate due to heart block (electrical conduction defect) then pacemaker would be next step. 

 

Posdible meds would cost less at govt hospital.  But still very unclear if Entredto would be appropriate in his case.

 

Jomtien is private. Less expensive than other private but still more than govt.

When people get old they don’t take initiative like a sick younger person would. They kind of just sit around or make it there and not really understand what is going on, getting lost in the shuffle.

 

Someone needs to go to the hospital and guide them around to appointments, and advocate for them as it were, or it just never gets done.

Edited April 3, 2023 by JimTripper

[Sheryl]

1 hour ago, JimTripper said:

When people get old they don’t take initiative like a sick younger person would. They kind of just sit around or make it there and not really understand what is going on, getting lost in the shuffle.

 

Someone needs to go to the hospital and guide them around to appointments, and advocate for them as it were, or it just never gets done.

Agree. Someone did take him there but not sure if  they did more than give a ride. 

 

What is reported to be the outcome (recommended treatment or further investigations unaffordable...yet never saw cardioligist)  makes no sense. 

 

OP please probe and find out why he did not see cardiologist and where this "next steps unaffordable" comes from given that he did not. I am suspecting immediate problem was not money but difficulty navigating/tolerating large crowded government hospital.(Though depending on his condition money may indeed be a barrier once he is actually given diagnosis and treatment plan). 

 

Also if you can please post the EKG report with his name blacked out. 

 

[Old Croc]

I have a slow heart rate, resting about 48, this prompts many doctors I visit for other reasons, to check further. I take medication. Over the last 1/2 dozen years I've had 3 or 4 EKGs and several Echo tests. I self-insure, and it is not cheap to get these tests done in a private hospital. Not a problem for me because before moving here, I made sure money would not be an issue with any future unforeseen event.

My last EKG was in a small government hospital and cost peanuts (Under $25 including some blood tests). The downside was that the doctor was not a cardiologist, and any more advanced treatment would involve travel and expense. Low cost rarely gets top level care.

My wife lost both parents in the last couple of months. The care available locally was minimal, but neither of them, nor family, would move to the big hospitals in the capital which may have prolonged their lives. I did offer to cover costs.

The OP doesn't want to hear this, but if you move to a foreign country with the bare minimum funds and no insurance at all, the only thing left for you is the charity of others.

I wish the subject well and hope he has enjoyed his life choices. 

[Sheryl]

28 minutes ago, Old Croc said:

I have a slow heart rate, resting about 48, this prompts many doctors I visit for other reasons, to check further. I take medication. Over the last 1/2 dozen years I've had 3 or 4 EKGs and several Echo tests. I self-insure, and it is not cheap to get these tests done in a private hospital. Not a problem for me because before moving here, I made sure money would not be an issue with any future unforeseen event.

My last EKG was in a small government hospital and cost peanuts (Under $25 including some blood tests). The downside was that the doctor was not a cardiologist, and any more advanced treatment would involve travel and expense. Low cost rarely gets top level care.

My wife lost both parents in the last couple of months. The care available locally was minimal, but neither of them, nor family, would move to the big hospitals in the capital which may have prolonged their lives. I did offer to cover costs.

The OP doesn't want to hear this, but if you move to a foreign country with the bare minimum funds and no insurance at all, the only thing left for you is the charity of others.

I wish the subject well and hope he has enjoyed his life choices. 

His EKG was done at a huge tertiary level government hospital with full cardiology service.  Quite a far cry from small local government hospitals. But, correspondingly crowded and can be very confusing to navigate especially if without a Thai speaker along.

 

First we were told he could not take it any further because whatever was recommended as next step was unaffordable but now we hear he left without seeing cardiologist so there cannot have been any such next steps outlined to him, as next step after EKG would certainly be to see cardiologist.

 

OP's friend (it is not OP) does indeed need to take more responsibility and this includes understanding that you don't get rock bottom public hospital prices without attendant difficulties and inconveniences. (Some of them pretty rough e.g. long waits in extreme heat, often no free seats etc...though for those unable to tolerate standing wheelchair or stretcher can be obtained. Need a friend or companion to push it though) .

 

Lots of  people on this board with limited means who rely on government hospitals. Sounds like OP's friend simply walked out (or opted not to return for next appointment - this part unclear) after deciding the difficulties were too great. But if as stated he has no money for private care, these difficulties simply have to be faced. Plenty of other old, weak farangs manage to do this.

 

 

[JimTripper]

Another thing the Op may be coming to realize is that family is where you find it. What may initially be concern for a mate has become more of a caretaker role. Nothing wrong with that, but it may or may not be what you originally had in mind.

 

The elderly don’t need just a hand up, it’s more like a full time caregiver as someone gets older. Now if they are out of funds the buck can’t be passed on (pun intended) so to speak to someone else like a care home, so you end up becoming the care giver in many demanding ways.

[simon43]

[quote]

I have a slow heart rate, resting about 48, 

...

[/quote]

 

That doesn't always mean that there is a problem with your heart.  My resting HR is about the same, but only because I am rather fit, a result of daily jogging/exercise.