Is Thai medicine a shotgun?

[Lacessit]

My GF was recently complaining of a belly ache. Off she goes to a clinic.

 

She returns with the following pills:

Flupentixol - a medicine for schizophrenia and psychosis.

Gabapentin - an antiepileptic and anticonvulsant. Why it was issued to her in 300 mg and 100 mg doses is a mystery.

Simethicone - anti-bloat. This one I can understand.

Green pills. No identification on the pills, or the plastic sleeve they came in.

 

She has never shown any signs of psychosis or epilepsy in the 8 years I have known her.

She did get rapid relief after taking all the pills.

 

I am wondering how much of this is a placebo effect. I am also wondering if Thai doctors operate on the principle more is better, or at least one pellet in the shotgun spread will hit the target.

 

[norfolkandchance]

Same Same. I was treated for a burst abscess at our local hospital. Prescribed 4 sets of pills. Googled them when I got back home. Two of them where uppers and downers. Other Two where antibiotics.

[Sheryl]

 

Over prescription and shotgun approach are both common practices here though not all doctors do it.

 

Small private  clinics especially and these are usually best avoided. Usually  have little or no diagnostic capacities.

 

One of the things driving the overprescription is a deeply held cultural belief  that good treatment equals getting many different medications. An unthinkable insult to be given none and second rate at best to be given only one. Even government hospitals (which lose money by it) do this as patients otherwise get very upset.  It is important for Westerners to realize this and proactively tell doctors fhey do not want any unnecessary medications as a Thai doctor may otherwise assume the opposite.

 

Gabapentin is used for nerve pain, not only epilepsy. Flupentixol has analgesic properties and is also sometimes used for pain.

 

If prolem recurs she should go to a proper hospital and see a GI specialist. 

 

[Morch]

I usually get the opposite at our 2-3 local government hospitals.

They give the bare minimum, and not in great quantities anyway.

If I ask for specifically ask for extra (to save refill trips) they oblige.

 

BIL, in Bangkok, just went to the hospital suspecting he caught dengue.

Doctor was dismissive, said it was just 'a fever', had to be coaxed to give any medicine.

 

 

[2baht]

1 hour ago, Lacessit said:

I am also wondering if Thai doctors operate on the principle more is better, or at least one pellet in the shotgun spread will hit the target.

 

 

      They work on the premise that at least one has to work!

[rabas]

 

Given you must leave the hospital or clinic with 4-5 medications, this looks more like a prescription for IBS, Irritable Bowl Syndrome. IBS is common here and most everywhere. It's a chronic often lifetime sentence to intestinal disturbance in part related to food. Doctors often consider anxiety a contributing factor, but not primary cause. The idea is treating anxiety can reduce real intestinal track symptoms.  Both Flupentixol and Gabapentin can be prescribed for IBS.

 

TREATMENT OF IRRITABLE BOWEL SYNDROME: A REVIEW , International Journal of Applied Pharmaceutics (sorry pdf)

 

I know this because my wife has had IBS more than 35 years since catching it while we lived Singapore, and she has been through all the best doctors.

 

Surprisingly, they discovered a major cause of IBS two years ago, which explains how my wife 'caught it'. A real intestinal infection triggers the intestinal immune system to  wrongly remember a food type as a trigger, thus the lifetime reaction to foods. Not all doctors will know this yet.

 

So the question is, why did the doctor think of treating IBS? Did your wife possibly mention prior or repeating stomach problems?

 

Edited November 5, 2023 by rabas

[KhunLA]

@Lacessit Maybe after talking with her, the doc thought she may be a bit stressed, and possibly causing excess acid in stomach & intestinal discomfort. 

 

Which case, they may alleviate that, along with being pain relief & anti inflammatory.

Flupentixol 

Gabapentin 

 

Relief of symptoms would indicate, possible correct diagnosis and prescribing of meds.

 

Doc prescribes meds that apparently work, so I'd call that a success, not quackery.  IF stress was the doc's thinking, try to figure out what is causing that, may be more productive in preventing repeat symptoms.

 

Though I would have asked what the green ones were, so not to conflict with any meds already being taken.   If none taken already, then doc thought it wasn't noteworthy.

Edited November 5, 2023 by KhunLA

[Lacessit]

1 hour ago, Sheryl said:

 

Over prescription and shotgun approach are both common practices here though not all doctors do it.

 

Small private  clinics especially and these are usually best avoided. Usually  have little or no diagnostic capacities.

 

One of the things driving the overprescription is a deeply held cultural belief  that good treatment equals getting many different medications. An unthinkable insult to be given none and second rate at best to be given only one. Even government hospitals (which lose money by it) do this as patients otherwise get very upset.  It is important for Westerners to realize this and proactively tell doctors fhey do not want any unnecessary medications as a Thai doctor may otherwise assume the opposite.

 

Gabapentin is used for nerve pain, not only epilepsy. Flupentixol has analgesic properties and is also sometimes used for pain.

 

If prolem recurs she should go to a proper hospital and see a GI specialist. 

 

She has a history of mild gastritis, I was there for the gastroscopy. If I could persuade her to get off the diet of white rice and sticky rice, I would. I introduced her to Kellogg's All-Bran, which she quite likes.

[Lacessit]

42 minutes ago, KhunLA said:

@Lacessit Maybe after talking with her, the doc thought she may be a bit stressed, and possibly causing excess acid in stomach & intestinal discomfort. 

 

Which case, they may alleviate that, along with being pain relief & anti inflammatory.

Flupentixol 

Gabapentin 

 

Relief of symptoms would indicate, possible correct diagnosis and prescribing of meds.

 

Doc prescribes meds that apparently work, so I'd call that a success, not quackery.  IF stress was the doc's thinking, try to figure out what is causing that, may be more productive in preventing repeat symptoms.

 

Though I would have asked what the green ones were, so not to conflict with any meds already being taken.   If none taken already, then doc thought it wasn't noteworthy.

I did not go to the clinic with her, so I could not ask what the green ones were. She prefers to go alone, says when doctors see a farang, the prices increase.

As far as stress goes, she does have a 60 yo brother who cannot walk due to years of imbibing lao khao. She has to transport him into two hospitals almost weekly. Waiting times at government hospitals are not conducive to being relaxed.

Edited November 5, 2023 by Lacessit

[KhunLA]

1 minute ago, Lacessit said:

I did not go to the clinic with her, so I could not ask what the green ones were. She prefers to go alone, says when doctors see a farang, the prices increase.

As far as stress goes, she does have a 60 yo brother who cannot walk due to years of imbibing lao khao. She has to transport him into two hospitals almost weekly. Waiting times at government hospitals are not conducive to being relaxed.

That would raise my stress level ... bless her heart.

 

Likes All Bran ... 😂 Just got 3 boxes yesterday, trying again for the fiber, and a different digestive issue 🙄  Taste just like I remember-cardboard.   I add lots of raisins & blueberries for some flavor.  Gave some for the wife to taste, facial expression not in approval.  Asked "what, you don't like eating carboard?'   She cracked up laughing in agreement. 

 

Hope she feels better after the scripts run out.

[ChaiyaTH]

2 hours ago, Sheryl said:

 

Over prescription and shotgun approach are both common practices here though not all doctors do it.

 

Small private  clinics especially and these are usually best avoided. Usually  have little or no diagnostic capacities.

 

One of the things driving the overprescription is a deeply held cultural belief  that good treatment equals getting many different medications. An unthinkable insult to be given none and second rate at best to be given only one. Even government hospitals (which lose money by it) do this as patients otherwise get very upset.  It is important for Westerners to realize this and proactively tell doctors fhey do not want any unnecessary medications as a Thai doctor may otherwise assume the opposite.

 

Gabapentin is used for nerve pain, not only epilepsy. Flupentixol has analgesic properties and is also sometimes used for pain.

 

If prolem recurs she should go to a proper hospital and see a GI specialist. 

 

I could imagine the $$$ earned on shotgun approach also helps a lot with that happening more in countries like this one.

[Lacessit]

1 hour ago, KhunLA said:

That would raise my stress level ... bless her heart.

 

Likes All Bran ... 😂 Just got 3 boxes yesterday, trying again for the fiber, and a different digestive issue 🙄  Taste just like I remember-cardboard.   I add lots of raisins & blueberries for some flavor.  Gave some for the wife to taste, facial expression not in approval.  Asked "what, you don't like eating carboard?'   She cracked up laughing in agreement. 

 

Hope she feels better after the scripts run out.

I make my own stewed apple with ginger, eat the all-bran with that and plain yoghurt. Works a treat for regularity.

To give the doctor some credit, he did say to use the medications until she feels OK, then stop.

[Sheryl]

2 hours ago, Lacessit said:

She has a history of mild gastritis, I was there for the gastroscopy. If I could persuade her to get off the diet of white rice and sticky rice, I would. I introduced her to Kellogg's All-Bran, which she quite likes.

Whilw white rice in unhealthy for other reasons it is not a factor in  gastritis. The mainstay of treatment is (1) eradication of h. Pylori infection (usually present)  followed by (2) OPIs  to reduce gastric pH until the mucosa has healed (typically 1-2 months). And avoid smoking and alcohol. 

[scubascuba3]

Talking of gastritis, I had it for several months, I eventually discovered by accident it was the noodle soup I was eating daily, only realised year+ later after not eating it, tried again and almost immediately same symptoms kicked off. Something in those soups

[Mark Nothing]

This placebo effect is a very powerful concept if you play out the possibilities.

 

Have you considered that it is her thought and belief that triggered her immune system into action rather than the synthetic tablets of unknown substance or origin?

[xylophone]

10 minutes ago, scubascuba3 said:

Talking of gastritis, I had it for several months, I eventually discovered by accident it was the noodle soup I was eating daily, only realised year+ later after not eating it, tried again and almost immediately same symptoms kicked off. Something in those soups

 

Maybe too much monosodium glutamate perhaps?? A friend of mine here was just commenting on that a couple of nights ago, and although I know it's a natural substance, it would appear that some folks are somewhat allergic to it in "large" doses?

[retiree]

From my own experience:  gabapentin is a go-to here for patient is complaining about a pain that doesn't have any obvious cause.  It may be favored because it is somewhat soporific -- this got better during the day, but I always got a terrific night's sleep -- and sleeping well often helps people feel better.  Finally, the two capsule sizes may be provided because the standard advice is to increase and reduce the dosage slowly, and spread it out over the day.  

 

There is a great deal of interesting literature about uses of and dosage recommendations for gabapentin on line.  It is also available OTC at finer drugstores everywhere. 

[bignok]

4 hours ago, Lacessit said:

I did not go to the clinic with her, so I could not ask what the green ones were. She prefers to go alone, says when doctors see a farang, the prices increase.

As far as stress goes, she does have a 60 yo brother who cannot walk due to years of imbibing lao khao. She has to transport him into two hospitals almost weekly. Waiting times at government hospitals are not conducive to being relaxed.

They over sell. Money making.

[scubascuba3]

3 minutes ago, xylophone said:

 

Maybe too much monosodium glutamate perhaps?? A friend of mine here was just commenting on that a couple of nights ago, and although I know it's a natural substance, it would appear that some folks are somewhat allergic to it in "large" doses?

Very possible, I can understand the soup seller piling it in to make it taste better, certainly was the best soup around

[bignok]

This is good for stomach pain

[save the frogs]

I don't trust doctors blindly.

 

What I try to do in all situations:

1 - Identify the ailment. This may require a visit to a doctor, but that doesn't mean I will necessarily take the prescribed medication.

2 - Once I have identified the ailment, I will go online and search "natural remedies for ...." and very often there are some sort of off the shelf stuff. If a pharmaceutical is your only option, at least you can research it a bit and be aware of what exactly it is doing in your body and any potential side effects and then determine if the side effects are worth the risk.

 

 

Edited November 5, 2023 by save the frogs

[save the frogs]

Another thing to keep in mind is mixing multiple pharmaceuticals together often entails some risk. 

 

[save the frogs]

7 hours ago, Lacessit said:

Flupentixol - a medicine for schizophrenia and psychosis.

Shouldn't that be only prescribed by a psychiatrist? Sounds like possible medical malpractice to me. 

[Lacessit]

23 minutes ago, save the frogs said:

Shouldn't that be only prescribed by a psychiatrist? Sounds like possible medical malpractice to me. 

I was not aware there was any medical body in Thailand which deals with malpractice.

There may be civil lawsuits. However, I'd say there would be Buckley's chance of laymen winning one.

[Lacessit]

2 hours ago, Sheryl said:

Whilw white rice in unhealthy for other reasons it is not a factor in  gastritis. The mainstay of treatment is (1) eradication of h. Pylori infection (usually present)  followed by (2) OPIs  to reduce gastric pH until the mucosa has healed (typically 1-2 months). And avoid smoking and alcohol. 

She has been prescribed omeprazole previously.

I was thinking it might have been appendicitis, but she was not running a temperature, had no abdomen rigidity, and her breath was OK.

[Pouatchee]

8 hours ago, Lacessit said:

Gabapentin - an antiepileptic and anticonvulsant. Why it was issued to her in 300 mg and 100 mg doses is a mystery.

 

did not know about its uses for this. I was prescribed this to help me sleep because my neck has irreparable damage... and damn does it work fine... other than that first time i hear of anticonvulsant...  😧

[ripstanley]

I have been to my local private hospital and seen a doctor. On 3 occassions I have refused medication as I have already have them. I always ask what medication they want to give me. As a result I was not charge anything. The private hospitals expect their doctors to over supply. That is how they make their money.

[proton]

5 hours ago, KhunLA said:

That would raise my stress level ... bless her heart.

 

Likes All Bran ... 😂 Just got 3 boxes yesterday, trying again for the fiber, and a different digestive issue 🙄  Taste just like I remember-cardboard.   I add lots of raisins & blueberries for some flavor.  Gave some for the wife to taste, facial expression not in approval.  Asked "what, you don't like eating carboard?'   She cracked up laughing in agreement. 

 

Hope she feels better after the scripts run out.

 Eaten all Bran since the 60's. On trip home this year to UK bought a box and its not the same as you get here, it's better almost pleasant to eat. The one in the shops here seems like the old version, maybe they will change it here? Kellogs but even the box was different to here.

[herfiehandbag]

6 hours ago, Lacessit said:

Waiting times at government hospitals are not conducive to being relaxed.

Yes, they are the down side of the otherwise good care available in Government Hospitals.

 

I take a good book - which led to the recent tannoy announcement in the busy main hall : " John Anthony, (they always use my two Christian names, but not my surname), put the book away and come here!"

[save the frogs]

1 hour ago, Lacessit said:

I was not aware there was any medical body in Thailand which deals with malpractice.

There may be civil lawsuits. However, I'd say there would be Buckley's chance of laymen winning one.

Just saying in the West, I don't think a GP is allowed to administer such a medicine.

And therefore, I wouldn't take it.