Heart treatment info needed

[ezzra]

A friend of mine, UK guy in his 60' need an urgent Angioplasty ( the unclogging of the arteries with a balloon)  procedure done as 70% of his arteries are blocked, no health insurance to rely on, any ideas where to have it done the best and cheapest way? he's in Pattaya but will travel anywhere.

[KhunLA]

Don't know about Patts, but he can expect to pay around 200k+/- for a stent placement at govt hospital.  Not really a high tech, high risk procedure, and chance are, same doc will do there & private hospitals in the area.

 

If that's his only issue.

[KhunLA]

dupe

[dddave]

A friend in Khon Kaen had urgent bypass heart surgery at SriNakarind Government Hospital in Khon Kaen City last year.  He believes he got excellent care and had a full recovery. All of his Doctors were proficient in English though many of the nurses were not.

Most private hospitals quoted B1M but his came out to about B300K, all in.  If your friend needs a private room, it will be more and he will require a care giver to be in the room with him.

Angioplasties with no complications usually require no more than a day or two confinement.  Probably significantly less than my friends's bypass.

[NanLaew]

If the OP's friend already knows he has 70% blockages, then he must have already been given this medical assessment and given a quote for the angioplasty? Was this as a private hospital? Unless he gets this diagnosis in writing, typically this would still need to be reassessed at whatever, cheaper place he finds.

 

Government hospitals are a safe bet for a lower-cost alternative with the same doctors as pointed out by @KhunLA. I have also heard good things about the Queen Sirikit navy hospital down Sattahip way.

[NanLaew]

6 minutes ago, dddave said:

A friend in Khon Kaen had urgent bypass heart surgery at SriNakarind Government Hospital in Khon Kaen City last year.  He believes he got excellent care and had a full recovery. All of his Doctors were proficient in English though many of the nurses were not.

Most private hospitals quoted B1M but his came out to about B300K, all in.  If your friend needs a private room, it will be more and he will require a care giver to be in the room with him.

Angioplasties with no complications usually require no more than a day or two confinement.  Probably significantly less than my friends's bypass.

Good call. The Queen Sirikit Heart Center of the Northeast is part of the above mentioned hospital which is a university teaching hospital.

 

https://heart.kku.ac.th/

[KhunLA]

2 minutes ago, NanLaew said:

If the OP's friend already knows he has 70% blockages, then he must have already been given this medical assessment and given a quote for the angioplasty? Was this as a private hospital? Unless he gets this diagnosis in writing, typically this would still need to be reassessed at whatever, cheaper place he finds.

 

Government hospitals are a safe bet for a lower-cost alternative with the same doctors as pointed out by @KhunLA. I have also heard good things about the Queen Sirikit navy hospital down Sattahip way.

@ezzra

Yea, if already told a 70% blockage, then he has most of the info he needs.  Did he get quoted a price he can't afford, and as stated, which hosp.?

 

What was that price, and for what ?  Blockage at 1 spot or 2 or 3, requiring 3 stents maybe, or something more major ?

[lopburi3]

The big question is if enlarge with balloon or also insert stents (with stents price increase greatly and with medical stents even more and requirements for long term medication).  70% I believe is the normal level to allow preventive stent use.  Is he having issues or was this just a test result?

 

Others have mentioned using India for much lower cost for medical procedures so might want to check that path.  But you say urgent so maybe not an option (although 70% is not normally that serious from my understanding).

 

Quote

How serious is 70% blockage in the carotid artery?
Narrowing of the carotid arteries between 50-70% carries a low risk of stroke and should be monitored. Narrowing of the carotid arteries more than 70% carries a 2-4% risk of stroke per year (10-20% over five years).

https://gwdocs.com/specialties/vascular-surgery/carotid-artery-disease#:~:text=Narrowing of the carotid arteries between 50-70% carries a,20% over five years).

[Tim16]

I had procedure done at Khon Kaen Hospital in February 2023

Had 95% blockage -2 stents inserted

Total cost was 236 K Baht

[Sheryl]

lKKU Heart Center would certainly be the best in terms of good quality at lowest price but is quite a distance from Pattaya.

 

Queen Sirikit in Sattahip Pattaya does not, AFAIK, have a cath lab or do interventional cardiology. BPH does but quite expensive.

 

In Bangkok I would recommend Bangkok Christian Hospital, this cardiologist (he is older and no longer does the angios& stents himself but will oversee it) 

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

 

OP please clarify, to know he has 70% blockage (of unspecified number of arteries, plural?) he must have already have had an angiogram. Where was the angiogram performed and why was stent not inserted at the same time? How many arteries are blocked and what % for each? Stents are usually done at 75% blockage and even then not always if it is a minor artery affected.

 

Does he have the angiogram report on disc?  The angio alone carries a cost which is why stent placement done at same time, to avoid paying for it twice.

 

 

[grain]

ezzra, you say your friend will travel, then his best bet is to head up to KK and go to the The Queen Sirikit Heart Center. I go there a couple times a year for check ups. They offer more expensive VIP services, but you can just take the regular route. All the charges for tests I've had have been very reasonable. There's plenty of cheap accommodation around, much of it close to the hospital.

[ezzra]

Thank you all for the useful information, my friend had a stress test today and this is where he was told about the severity of his blockage, they recommended to do angiogram  as an assessment procedure and take it from there but by the look of things he might have to do angioplasty with stents put in.

[Sheryl]

53 minutes ago, ezzra said:

Thank you all for the useful information, my friend had a stress test today and this is where he was told about the severity of his blockage, they recommended to do angiogram  as an assessment procedure and take it from there but by the look of things he might have to do angioplasty with stents put in.

OK then the extent of blockage is not sure.

 

But yes, likely one or more stents will be needed. Stent is done during angiogram if findings indicate it. As the stents themselves are the main cost driver, cost will greatly depend on how many.

 

BKK Christian in BKK, about 250k if 1 stent (Includes angio), more if more. Khon Kaen Queen Sirikit Heart Center (not to be confused with Queen Sirikit Navakla Hospital in  Sattahip) will be less but of course more of a trip. The savings will especially add up if he needs more than 1 stent.

 

 

 

 

[voyagerUSA]

Just something to keep in mind - studies show that in case of stable heart disease stents do not improve survival as compared to medical treatment. They only seem to improve survival when done during a heart attack. It is probably best to think of stents as a palliative measure that helps improveunpleasant symptoms such as chest pain, but they dont seem to prevent heart attacks unfortunately, at least this is my understanding...

[mania]

14 hours ago, ezzra said:

my friend had a stress test today and this is where he was told about the severity of his blockage, they recommended to do angiogram  as an assessment procedure and take it from there but by the look of things he might have to do angioplasty with stents put in.

See this is the thing he may want to avoid on "their" word alone

 

Seek another opinion via a CT angio scan with dye perhaps to get a more solid assessment before allowing a angio with them deciding then to stent or not.

 

Maybe even just go get a simple CT Calcium score test & look at that as a precursor. Of course not  as accurate as a CTA with dye but very non invasive & inexpensive place to start. Bangkok Hospital had a cardiac test package for like 4000 baht that included the CT Calcium score test & more

 

This is Thailand & a second opinion is a good idea.

 

Lastly does he have any actual symptoms other than a bad stress test? Chest Pain etc?

 

Because so many overweight out of shape men have problems with a stress test as they do zero daily exercise. That does not guarantee blockages

 

Good Luck to him though but again this is Thailand do not assume they do not prescribe unnecessary procedures they do.

 

I have first hand experience with it (although kidney not heart related) & flew back to the USA to find their diagnosis was just that....wrong & prescribing an unnecessary operation

 

 

PS: Bangkok Hospital does list some price ranges for angiograms stents ablations etc

https://www.bangkokhearthospital.com/en/package/coronary-intervention-packages

 

 

[lopburi3]

47 minutes ago, mania said:

with them deciding then to stent or not.

Actually that is your decision as you are awake during procedure - if indicated you will be advised and of the options and make the decision at that point to have or not or what type.  Been there.

 

Agree out of shape seems to be a factor (although does not seem to be mentioned much).  My  physical stress tests were not much better after stents than before but chemical stress tests were fine.

[mania]

4 hours ago, lopburi3 said:

Actually that is your decision as you are awake during procedure - if indicated you will be advised and of the options and make the decision at that point to have or not or what type. 

Well yes but truthfully your in a vulnerable state mentally during that procedure laying there & like you did ....I would guess the majority at that point do not decide but instead agree with what ever the doctor states is "their" pref.

 

My guess is no western adult in their 60's could go for a angio & not have a doctor say Oh yes a stent would help because that is quite likely

 

I believe it was Dr Pritikin that did autopsy/tests 19-21 year old dead American Soldiers during the Vietnam war & found a large amount had their main arteries occluded by large numbers due to our cheeseburger diets & what else we were raised on in those years ????

 

But lastly it seems some believe Stenting is overused in many countries

 

 

https://www.aarp.org/health/conditions-treatments/info-2021/heart-stent.html

 

 

[lopburi3]

40 minutes ago, mania said:

My guess is no western adult in their 60's could go for a angio & not have a doctor say Oh yes a stent would help because that is quite likely

I was about 73 and went for angiograms after bad physical stress test and no blockage of 70% or more (including previous 2 stents) so unless having systems doctor advised against treatment and session ended.

 

[Don Chance]

https://www.hospitalsurf.com/free-heart-surgery/

[mania]

58 minutes ago, lopburi3 said:

I was about 73 and went for angiograms after bad physical stress test and no blockage of 70% or more (including previous 2 stents) so unless having systems doctor advised against treatment and session ended.

 

Yes of course & most like you would hopefully have improved your diet & lifestyle .......after you already had 2 previous stents ???? But what I was saying was directed at probably who you were before your two stents

[NoDisplayName]

If travel is an option, then consider India.

 

I had a valve replacement at Apollo in Chennai.  Roundtrip flights from southern China, a week recovery at a beach resort.  Total was about 10% of the cost in the USA......essentially equal to just the cost of the valve itself in the US.

 

They accept visa/mastercard.

[marin]

2 hours ago, mania said:

I believe it was Dr Pritikin that did autopsy/tests 19-21 year old dead American Soldiers during the Vietnam war & found a large amount had their main arteries occluded by large numbers due to our cheeseburger diets & what else we were raised on in those years ????

 

gonna call BS on that. Not during a war that occurred 50+ years ago.

[Sheryl]

2 hours ago, mania said:

 

 

My guess is no western adult in their 60's could go for a angio & not have a doctor say Oh yes a stent would help because that is quite likely

 

 

 

 

 

Not remotely true.

 

A doctor will not even do an angiogram unless there are clear indications for it. And they will often say no stent needed (or needed yet) based on angio findings.

 

The indications for stenting are quite clear.

 

 

[Sheryl]

5 hours ago, mania said:

See this is the thing he may want to avoid on "their" word alone

 

Seek another opinion via a CT angio scan with dye perhaps to get a more solid assessment before allowing a angio with them deciding then to stent or not.

 

 

"They" do not decide whether to stent or not. Patient decides based on doctor recommendation. Of course, best to think it through beforehand and discuss pros and cons with doctor beforehand.

 

Doing a CT angiogram first will add to costs and still be less conclusive than an angio.  Where it is useful is if the patient is asymptomatic as it may avert the need for an angio. If significantly symptomatic he should definitely proceed to angio IMO. 

 

We have no idea if this patient is symptomatic or not. And that, together with the extent and location of any blocakge,  makes a big difference in terms of whether stenting is of likely benefit

[TimBKK]

“I referred him to the Premium Clinic at the Queen Sirikit Hospital, Khon Kaen, the superior cardiac clinic, both in management and cost, in this country.”

https://thepattayanews.com/2023/04/25/guest-article-medical-bytes-thailand-no-86-fast-to-furious/

[mania]

13 hours ago, Sheryl said:

 

Not remotely true.

 

A doctor will not even do an angiogram unless there are clear indications for it. And they will often say no stent needed (or needed yet) based on angio findings.

 

The indications for stenting are quite clear.

 

 

Well actually it is true that most do have occluded arteries & there are articles showing even in young healthy men/soldiers as I mentioned

 

As for you saying doctors will not even do a angiogram unless clear indications for it again in my experience not true. Although here in the USA

 

My experience last August....I am a fit athletic 66 year old. Cycle 8-10k miles a year. Low BP. low Cholesterol..Have had psvt or pvc's & pac's for over 20 years but recently had a long run of pvc & pac .

 

So went to a Heart specialist with a sports cardio clinic.

Had me do a 16 min stress test at very high output 165BPM on cycle with echo's following

Showed heart was excellent structurally

 

Then said well just to be sure I would like to either do a angiogram or a CTA scan with dye

I asked which would he choose if it were his choice.

 

He said the Angio because that way if he see's anything he can just stent it

I chose the CTA but later changed my mind as my father lost his kidneys to CTA dye

 

Went to another cardiologist that could not believe the previous cardio ran me on that stress test at those outputs for that amount of time. He said there is no way I needed a angio

 

Instead I have requested a Calcium score just to check later this week which is almost a year later

I know it is not the same but can at least give me a indication. If bad I will go from there

 

While I would like to believe no doctor is business driven I am sorry to say in my life I have found different

This is no slight against you as I know your in the medical profession & often I appreciate reading your responses here.

 

But yes in my case I have not found what you said above to be true. Doctors will & do often push tests & procedures that are no needed both in Thailand & the USA

 

 

 

[Chicksaw]

On 6/12/2023 at 12:46 PM, ezzra said:

any ideas where to have it done the best and cheapest way? he's in Pattaya but will travel anywhere.

If cost is a constraint but travel isn't then get in touch with a hospital in Chennai or Kolkata and fly over. Cost will be 1.2 lakh to 1.6 lakh rupees (link) which is less than 70k THB. Care is excellent at top Indian hospitals and they cater to foreign patients.

[lopburi3]

6 hours ago, mania said:

So went to a Heart specialist with a sports cardio clinic.

So you base one instance, of the about 17,000 cardiologist in another country, (and admit second opinion said first doctor was crazy) as proof that all cardiologists would do such worldwide to everyone over age of 60?  Logic - there is none.

[Sheryl]

8 hours ago, mania said:

Well actually it is true that most do have occluded arteries & there are articles showing even in young healthy men/soldiers as I mentioned

 

As for you saying doctors will not even do a angiogram unless clear indications for it again in my experience not true. Although here in the USA

 

My experience last August....I am a fit athletic 66 year old. Cycle 8-10k miles a year. Low BP. low Cholesterol..Have had psvt or pvc's & pac's for over 20 years but recently had a long run of pvc & pac .

 

So went to a Heart specialist with a sports cardio clinic.

Had me do a 16 min stress test at very high output 165BPM on cycle with echo's following

Showed heart was excellent structurally

 

Then said well just to be sure I would like to either do a angiogram or a CTA scan with dye

I asked which would he choose if it were his choice.

 

He said the Angio because that way if he see's anything he can just stent it

I chose the CTA but later changed my mind as my father lost his kidneys to CTA dye

 

Went to another cardiologist that could not believe the previous cardio ran me on that stress test at those outputs for that amount of time. He said there is no way I needed a angio

 

Instead I have requested a Calcium score just to check later this week which is almost a year later

I know it is not the same but can at least give me a indication. If bad I will go from there

 

While I would like to believe no doctor is business driven I am sorry to say in my life I have found different

This is no slight against you as I know your in the medical profession & often I appreciate reading your responses here.

 

But yes in my case I have not found what you said above to be true. Doctors will & do often push tests & procedures that are no needed both in Thailand & the USA

 

 

 

Sports clinics are known for this type of thing and best avoided.

 

By your own account second cardiologist said no angio needed.

 

So hardly  the case that all or most  doctors in US are likely to advise unneded stenting. You encountered unethical practices in a partucular type of commercial establishment known for that sort of thing.

 

Having some blockage does not mean a stent is indicated.  >70/75% blockage and symptomatic yes but even then not always. Depends on which  vessel and overall clinical picture. Having a heart attack yes. 

[mania]

14 hours ago, Sheryl said:

Sports clinics are known for this type of thing and best avoided.

 

By your own account second cardiologist said no angio needed.

 

So hardly  the case that all or most  doctors in US are likely to advise unneded stenting. You encountered unethical practices in a partucular type of commercial establishment known for that sort of thing.

 

Having some blockage does not mean a stent is indicated.  >70/75% blockage and symptomatic yes but even then not always. Depends on which  vessel and overall clinical picture. Having a heart attack yes. 

No actually...Sorry if my description lead you to believe it was that type of "specialty sport clinic"

It was in fact the largest Hospital in the State. Not some "commercial establishment known for that sort of thing"

 

In their cardiology department they have "Sports Cardiology program" that looks at cardio problems in athletes. The main cardiologist at the hospital thought I was a good candidate for the program due to my history in sports.

 

That aside I never said all or most doctors I said sorry in my experience "Doctors will & do often push tests & procedures that are not needed both in Thailand & the USA "

 

I have actual experiences in both countries of doctors pushing unnecessary procedures/operations. The Doctor & Kidney specialist at what is probably the largest hospital chain in Thailand did just that. Thankfully I flew back to the USA where they laughed at the idea of that operation & 8 years later I am still problem free

 

As for Stenting in general even the AARP has said as much

"doctors assumed that stents would help with other blockages due to heart disease. "

But

"But that thinking was turned on its head in 2007, when a study in the New England Journal of Medicine of over 2,000 people with heart disease found that those who had a stent implanted as a preventive measure had similar rates of heart attack and death as those who just took medication."

 

https://www.aarp.org/health/conditions-treatments/info-2021/heart-stent.html

 

In any case ...again I am only relaying my own experiences not theories

But it seems quite disingenuous to claim these things do not happen at "real" doctors offices/hospitals

 

Anyway that is all I have to say on this subject & sorry to the OP for any distraction

I repeat my original reply that I think it important for him to get a second opinion & not inform the second tester of anything the first claimed