Prolapsed Rectum

[John49]

To be brief and make a long story a bit shorter, I need a second Delorme procedure for another case of a prolapsed rectum.

 

I am male, I say that as females are most likely to have a prolapsed rectum (ratio 6:1). In my case, caused by a prior long-term gut infection, then a prior severe diarrhea, and nothing to do with insertion of animate or inanimate objects.

 

My perception is that a Government Hospital may have a waiting list of months, and charge you double for being a foreigner. So, maybe go private for surgery within a week or two but with extra cost…

 

Samitivej Sukhumvit seems like a middle priced private hospital when compared with say Bumrungrad?

For example, for a prostate MRI, I was quoted 15,500 at Prachachuen MRI, then 32,000 at Samitivej, and I read that similar is 60,000 at Bumrungrad. I went with the Prachachuen MRI, no regrets except that it was an older Tesla 1.5 machine - not sure to what extent that affects the scanned details.

 

Other positive reasons for considering Samitivej Sukhumvit – I emailed them one time for the MRI quote and they responded with a quote. Not the “must see doctor first” and then when you see doctor, he says “must see accounts manager”. Plus, I went to this hospital for a blood test and I was able to get one done right away – without the tedium of having to see a doctor first.

 

A second Delorme with the repair of unravelled stitched muscle sounds messy? Of course, I want someone to make the best repair possible.

Any advice on hospital or colorectal surgeon appreciated. I believe only one night in hospital required. My first Delorme was done under general anaesthetic, I believe an epidural injection is an option but don’t like the sound of that and being consciously elevated in ‘the giving birth position’ for an hour.

 

[Sheryl]

Never choose the hospital. Choose the doctor - in your case a colo-rectal surgeon. As success depends totally in the surgeon's skill.

 

The best colo-rectal surgeon in Thailand  is Prof. Chucheep. He can be seen at either Bumrungrad (expensive) or Bangkok Christian Hospital (less expensive) -  https://www.bch.in.th/find-doctor/doctor-profile/?smid=4581

 

He can also be seen through the public channel at Chulalongkhorn hospital but there will indeed be long waits, lots of red tape, you'll have to arrive very early (i.e. crack of dawn) to get in the queue and much of your interaction will be with residents in training under his supervision.

 

 

[John49]

I made an appointment with Dr Chucheep at Bangkok Christian Hospital. It was a busy session with about 40 people listed. He’s obviously a much sort after doctor. I made it clear that I was looking for the perineal solution, and not via abdomen. Firstly, he wanted an MRI to show extent of bowel prolapse.

On my second visit, he recommended a laparoscopy procedure with mesh. I said I’d think it over. He did not mention the risks of abdominal laparoscopy with potentially severing some important nerves, or the potential for mesh to penetrate other organs in time. These being amongst the reasons why I did not want laparoscopy. Plus, being in my late seventies, I did not want to be on the operating table for 4 hours with increased blood clot risk. Perineal is only 1 hour on the table, and the cost of abdominal is say twice the cost of perineal.

 

I visited a private hospital near where I stay, via a recommendation. That turned out badly as the doctor could not see my prolapse and bizarrely had us both squatting on the floor looking for my prolapse. When I came out looking for directions, the staff at Reception had not one word of English between them. I decided that was not the right place.

I decided to try a well-known private hospital in Bangkok, again via recommendation. Subsequently, I had an ‘excision of rectal prolapse’ last week with 3 nights in the private hospital.

 

It did not go well.

 

Firstly, I opted for an enema, but it was not like the kind where they squeeze a small tube of gel up your backside and ask you to sit on chair as tight as you can for 5 or 10 minutes, and then run to the toilet. On this occasion, the nurse had long tube and fed liquid internally. In my case, the liquid just ran out (‘hole too big/tube too small’). This was abandoned. Time was lost while nurse got permission to give me two glasses of laxative. I did not poo on time, operation delayed, with photos of latest stool being sent to surgeon for assessment. I went for the operation.

 

After the operation, just when I woke up, the missing poo then materialised all over my freshly prepared bed.

About 10pm, a nurse took my blood pressure, it came in at 200/142 i.e. seriously high. I asked the nurse to get a doctor. The nurse said “doctor coming”, repeatedly. (BTW, the nurse was without a cap. I was told later this means she was a nurse aide). One hour later, a nurse (with cap) from another floor came and saw the series of high readings. She left the room and came back, about half hour later with one tablet. I swallowed the tablet and after a bit, my blood pressure started dropping. About 2 hours later, the night duty doctor arrived. I asked why my readings were so high (my normal max at home is 135), he said he didn’t know. BTW, I had an echo cardio before the op and my heart was determined to be good condition for my age.

 

I was not allowed to eat (to keep bowel clean), instead I was fed numerous drips. Halfway through third day, I had really bad diarrhoea and simply sat in the shower – black/green slime that looked like seaweed. I was able to check out the next day and have my first meal.

 

Almost one week since my operation, my bowels appear to be normalising. I trust the actual repair operation in theatre went well (the doctor and his operating team all seemed capable and competent during our various talks). However, my pre-op and post-op experiences were harrowing, and I feel more related to nursing issues than doctor issues, especially with almost nil English language for communication with most nurses, and my suspicion that a few were probably housemaids dressed up as nurse aides.

 

[xylophone]

8 minutes ago, John49 said:

I made an appointment with Dr Chucheep at Bangkok Christian Hospital. It was a busy session with about 40 people listed. He’s obviously a much sort after doctor. I made it clear that I was looking for the perineal solution, and not via abdomen. Firstly, he wanted an MRI to show extent of bowel prolapse.

On my second visit, he recommended a laparoscopy procedure with mesh. I said I’d think it over. He did not mention the risks of abdominal laparoscopy with potentially severing some important nerves, or the potential for mesh to penetrate other organs in time. These being amongst the reasons why I did not want laparoscopy. Plus, being in my late seventies, I did not want to be on the operating table for 4 hours with increased blood clot risk. Perineal is only 1 hour on the table, and the cost of abdominal is say twice the cost of perineal.

 

I visited a private hospital near where I stay, via a recommendation. That turned out badly as the doctor could not see my prolapse and bizarrely had us both squatting on the floor looking for my prolapse. When I came out looking for directions, the staff at Reception had not one word of English between them. I decided that was not the right place.

I decided to try a well-known private hospital in Bangkok, again via recommendation. Subsequently, I had an ‘excision of rectal prolapse’ last week with 3 nights in the private hospital.

 

It did not go well.

 

Firstly, I opted for an enema, but it was not like the kind where they squeeze a small tube of gel up your backside and ask you to sit on chair as tight as you can for 5 or 10 minutes, and then run to the toilet. On this occasion, the nurse had long tube and fed liquid internally. In my case, the liquid just ran out (‘hole too big/tube too small’). This was abandoned. Time was lost while nurse got permission to give me two glasses of laxative. I did not poo on time, operation delayed, with photos of latest stool being sent to surgeon for assessment. I went for the operation.

 

After the operation, just when I woke up, the missing poo then materialised all over my freshly prepared bed.

About 10pm, a nurse took my blood pressure, it came in at 200/142 i.e. seriously high. I asked the nurse to get a doctor. The nurse said “doctor coming”, repeatedly. (BTW, the nurse was without a cap. I was told later this means she was a nurse aide). One hour later, a nurse (with cap) from another floor came and saw the series of high readings. She left the room and came back, about half hour later with one tablet. I swallowed the tablet and after a bit, my blood pressure started dropping. About 2 hours later, the night duty doctor arrived. I asked why my readings were so high (my normal max at home is 135), he said he didn’t know. BTW, I had an echo cardio before the op and my heart was determined to be good condition for my age.

 

I was not allowed to eat (to keep bowel clean), instead I was fed numerous drips. Halfway through third day, I had really bad diarrhoea and simply sat in the shower – black/green slime that looked like seaweed. I was able to check out the next day and have my first meal.

 

Almost one week since my operation, my bowels appear to be normalising. I trust the actual repair operation in theatre went well (the doctor and his operating team all seemed capable and competent during our various talks). However, my pre-op and post-op experiences were harrowing, and I feel more related to nursing issues than doctor issues, especially with almost nil English language for communication with most nurses, and my suspicion that a few were probably housemaids dressed up as nurse aides.

 

I hope all goes well for you John.

[Pumpuynarak]

26 minutes ago, xylophone said:

I hope all goes well for you John.

 

Ditto

[Ben Zioner]

On 11/2/2023 at 9:44 AM, John49 said:

I went with the Prachachuen MRI, no regrets except that it was an older Tesla 1.5 machine - not sure to what extent that affects the scanned details.

If the MRI was Multi-Parametric with an Endorectal coil it was ok, otherwise near useless fore cancer detection.

[HauptmannUK]

1 hour ago, Ben Zioner said:

If the MRI was Multi-Parametric with an Endorectal coil it was ok, otherwise near useless fore cancer detection.

In the UK NHS mpMRI is normally done on a 3T machine without ERC.  If a 1.5T machine is used then ERC is required.  

When I needed a prostate MRI back in 2018 the cost on a 3T machine was about ฿50k - same as a private scan in the UK, so I ended up having one in the UK.

 

I know many people praise healthcare in Thailand but my experience of both government and private systems has been rather poor.

For example, last year my wife had some gyno symptoms. Spoke to my daughter in the UK (she's a doctor in Urology) who wasn't sure but suggested it might be endometrial hyperplasia. Went to supposedly one of the best consultants in Bangkok and spent about ฿40k on blood tests, scans consultations etc. Doctor dismissed suggestion of EH and my wife ended up with some hormone pills.  Daughter says 'that doesn't sound right'..  Back to the UK NHS..,  see the GP, two weeks wait for scan, two weeks wait for hysteroscopy. Diagnosed as EH and then two weeks wait for outpatient op with tissue removal device. All done and fine now.

[Will B Good]

3 hours ago, John49 said:

the nurse had long tube and fed liquid internally. In my case

Had eight of those prior a prostate biopsy (poor nurse had to send a photo of the toilet bowl every time).......not the most pleasant experience......and I still got an Ecoli infection....

[azt219]

On 11/2/2023 at 12:30 PM, Sheryl said:

Never choose the hospital. Choose the doctor - in your case a colo-rectal surgeon. As success depends totally in the surgeon's skill.

 

The best colo-rectal surgeon in Thailand  is Prof. Chucheep. He can be seen at either Bumrungrad (expensive) or Bangkok Christian Hospital (less expensive) -  https://www.bch.in.th/find-doctor/doctor-profile/?smid=4581

 

He can also be seen through the public channel at Chulalongkhorn hospital but there will indeed be long waits, lots of red tape, you'll have to arrive very early (i.e. crack of dawn) to get in the queue and much of your interaction will be with residents in training under his supervision.

 

 

 

@Sheryl  Just curious why you consider Prof. Chucheep as the best colo-rectal surgeon in Thailand? By the other poster it seems it's probably true seeing as he seems to be well sought after, but just wondering how he got that reputation.

[Sheryl]

2 minutes ago, azt219 said:

 

@Sheryl  Just curious why you consider Prof. Chucheep as the best colo-rectal surgeon in Thailand? By the other poster it seems it's probably true seeing as he seems to be well sought after, but just wondering how he got that reputation.

He is a senior Professor at Chulalongkorn (the senior-most colorectal specislust on faculty there) and trained in US at the world renowned Ckeveland Clinic. Other colorectal specialusts here also regard him as the top. In fact most studied under him.

 

Besides being the best in the field he is also a very nice, very sincere man. 

[jts-khorat]

On 12/14/2023 at 5:41 AM, John49 said:

However, my pre-op and post-op experiences were harrowing, and I feel more related to nursing issues than doctor issues, especially with almost nil English language for communication with most nurses

 

I hope all goes well and recovery is swift.

 

Just to point out your sentence above; I guess, as you are 70, learning the language is not high on your list, but especially with medical issues, then it is eminently important that you have somebody on call or even right there in the hospital to translate for you.

 

In this case, the experience was "harrowing", but at least you survived. Getting a serious medical issue handled in time when a shy nurse simply might not want to interact with you because of the language barrier is a bad reason to prematurely 'go'.

[John49]

When we first arrived in Thailand about 6 years ago, we decided to take a 6 month ED visa.

We only managed about 3 months and then we had to leave because of commitments outside Thailand.

 

When we arrived back in Thailand, I met up with an old workmate for a coffee.

Still wanting to practise my Thai, I asked for a “hot Americano sai nom ron nit noy” (with a little hot milk).

My old workmate immediately chipped in – “mate, you’re wasting your f’ing time trying to talk Thai; my girlfriend (of 20 years) who was born here and is Thai/European, but when she speaks Thai she gets ignored because her face is European”.

I thought that sounds 'much too much' over the top.

 

I always regretted that we did not do an additional month when we would have covered the first one third of the Thai alphabet (for me always mysterious, or looking like a "load of worms" as described by one friend, depending on your perception).

So, when we came back a second time, we took another 6 month ED visa, mainly to cover some of the alphabet.

Again, terminated early due to overseas commitments.

 

In retrospect, my experience in speaking Thai with Thai people is that mostly, there is 'a communication failure'.

I know understand my old workmate’s comment about “wasting your f’ing time”.

Today, I have given up trying to learn or speak Thai.

However, I do fall back on “ao” and “mai ao” (want, not want) that is always understood.

Also, about 10 other words – like “glai, glaaai, glap baan, tinai hong nam", etc. (near, far, go home, where is the bathroom, etc.).

Recently, I did learn “tilang” (later), that is a good one, just remember to high tone at the end.

Little bit sad, that our time, hard work and success in class for about 5 months, has been reduced to about 20 words max.

I should add that by choice, we lead a very quiet life, presumably if we were more active socially, it could be better.

 

As for my 3 nights hospitalisation for a one hour medical procedure that is not considered high risk or major surgery, and yet having to experience a high risk episode (very high BP 200/142) for over 1.5 hours under the sole care of a nurse aide, I blame the hospital (nursing) management.

 

I paid the hospital over 300,000 baht and expected a high degree of care; care that they purported to offer.

I made a verbal complaint to my surgeon on my last day (where were the supervisory nursing staff, those qualified with the ability to take lifesaving actions, in the absence of a doctor, etc.).

He apologised and said he would pass on my concerns to his board.

That’s it, end of story, move on, but I am definitely not a ‘repeat customer’.