Paget's Disease - Treatment option for Bangkok resident.

[CartagenaWarlock]

My friend, who is a sex worker, has self-identified as having Paget's disease. She does not have money or insurance. What are her treatment options? @Sheryl Please reply about hospitals (I assume the government) where treatment is available in Bangkok. She lives in Bangkok.

[Pique Dard]

6 minutes ago, CartagenaWarlock said:

She does not have money or insurance

i don't mean to be sarcastic, but can't she discuss this issue with her (many) clients?

[Sheryl]

All Thai citizens not covered by other schemes are autonatically covered by the Universal Health Scheme (AKA 30 baht scheme) and all Thais know this. Which makes her approach to you a bit suspect.  She needs to go to the hospital where she is registered under that scheme. Which is generally based on house registration so might be in her home province. (House registration can be be changed but if she is renting needs the cooperation of landlord).  

 

 

Paget's disease is rare cannot be self diagnosed. Treatment in the unlikely event she actually has this condition would be available at university hospitals like (in Bangkkj) Siriraj and Chulalongkorn.

 

 

 

 

[TheFishman1]

Is she just  Thai I would imagine she would be entitled to getting like their free medical care at the government, hospitals or whatever.
Paget's disease rarely spreads from one site to another. If the disease is in the pelvis, it's not likely to affect the spine or skull. Paget’s generally "burns out" in time, causing no additional pain or damage. Any damage the disease has already caused, however, is irreversible Very exciting.

[CartagenaWarlock]

10 hours ago, Pique Dard said:

i don't mean to be sarcastic, but can't she discuss this issue with her (many) clients?

She may be discussing I don't no. I told her to post in the Thai facebook group where 75% Thais under UCS are covered. 

[CartagenaWarlock]

5 hours ago, Sheryl said:

Which makes her approach to you a bit suspect. 

She mentioned in a line message that she suspected she had Paget's disease and asked me what her options for treatment were—was it a life-threatening disease, etc.? I don't see it as a suspect. As I mentioned, she works as a sex worker in Bangkok clubs I knew her because I had been her customer a few times in the last five years. I told her I didn't know what Paget's disease was, but I would post in an online forum and let you know.  I don't become suspicious when somebody asks me a question.

Edited November 25, 2023 by CartagenaWarlock

[itsallmine68]

12 hours ago, CartagenaWarlock said:

My friend, who is a sex worker, has self-identified as having Paget's disease. She does not have money or insurance. What are her treatment options? @Sheryl Please reply about hospitals (I assume the government) where treatment is available in Bangkok. She lives in Bangkok.

https://en.wikipedia.org/wiki/Paget's_disease_of_bone

[Sheryl]

1 hour ago, CartagenaWarlock said:

She mentioned in a line message that she suspected she had Paget's disease and asked me what her options for treatment were—was it a life-threatening disease, etc.? I don't see it as a suspect. As I mentioned, she works as a sex worker in Bangkok clubs I knew her because I had been her customer a few times in the last five years. I told her I didn't know what Paget's disease was, but I would post in an online forum and let you know.  I don't become suspicious when somebody asks me a question.

What was suspicious was all "have no money or insurance" part. Your OP did not ask about whether it was life threatening etc nor what the treatment was, rather seemed focused on the money and insurance issue and where to go.

 

She has health cover. Where to go, is as explained, the government hospital where she is registered under the 30 baht scheme.  She will have to explain to them what her symptoms are.

 

She cannot possibly self diagnose Paget's disease.  Do you have any idea what gave her that idea? As she cannot walk into a hospital and just announce she has Paget's disease and ask to be treated for it. She will have to explain what her symptoms are and let the hospital go through its own diagnostic processes.  Depending on what level of hospital this is and what her symptoms are they might or might not need to refer her onward to a higher level hospital.

 

The work up is  very, very  unlikely to  lead to  a diagnosis of Paget's disease. That is rare overall, and especially rare in Asians and in people under the age of 50. The odds of an Asian women under 50 having it are extremely low.

 

Paget's disease is chronic but manageable with treatment and prognosis for a full life, with treatment, is good. It is managed by an endocrinologist. But she almost certainly does not have it.

 

If you can find out what (1) what the symptoms are that led her to make this self-diagnosis and (2) which hospital she is registered at under the 30 baht scheme I can better advise.

 

 

 

 

 

 

 

 

[CartagenaWarlock]

Just now, Sheryl said:

She cannot possibly self diagnose Paget's disease.  Do you have any idea what gave her that idea?

She may have read some Thai websites matching her conditions. I did not ask her. She sent me a message just now saying that she went to a hospital (to a skincare specialist, I would guess). Again, I did not ask her the details, and they gave her a cream to use for two weeks. If that does not clear up her conditions, they have to do a biopsy.

[Sheryl]

5 minutes ago, CartagenaWarlock said:

She may have read some Thai websites matching her conditions. I did not ask her. She sent me a message just now saying that she went to a hospital (to a skincare specialist, I would guess). Again, I did not ask her the details, and they gave her a cream to use for two weeks. If that does not clear up her conditions, they have to do a biopsy.

Not remotely sounding like anything to do with Paget's disease, which is a bone condition.  Skin lesions are not a  feature in that condition.

 

Are you sure she said Paget's Disease and not Psoriasis? (Which unlike Paget's is a  a condition with skin manifestations, and relatively common in Thais).

 

There would be no reason to see a skin specialist with suspected Paget's disease.

 

 

[CartagenaWarlock]

1 hour ago, Sheryl said:

re you sure she said Paget's Disease and not Psoriasis? (Which unlike Paget's is a  a condition with skin manifestations, and relatively common in Thais).

I've rechecked her message, and she wrote Paget's disease. Never mind; I wait for her initial cream treatment. I will update if she asks any more questions. 

Edited November 25, 2023 by CartagenaWarlock

[swm59nj]

What it comes down to you need to get more facts for clarification.  A skin doctor will refer a patient to another doctor .  That’s if the dermatologist felt it  was not a dermatology issue.  Obviously the doctor saw a skin disorder and is treating it as such.  And did she discuss her concerns about what she believes she has with this doctor? 
I have also attached an explanation from the Mayo Clinic regarding her concerns:

https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-bone/symptoms-causes/syc-20350811#

[Sheryl]

1 hour ago, swm59nj said:

What it comes down to you need to get more facts for clarification.  A skin doctor will refer a patient to another doctor .  That’s if the dermatologist felt it  was not a dermatology issue.  Obviously the doctor saw a skin disorder and is treating it as such.  And did she discuss her concerns about what she believes she has with this doctor? 
I have also attached an explanation from the Mayo Clinic regarding her concerns:

https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-bone/symptoms-causes/syc-20350811#

I have a feeling Paget's disease was a Google translate  created mix up and she has an altogether different problem. Possibly what she meant was Paget's disease of the nipple which despite the similarity in name is a completrly clinical entity (and often  connected to breast cancer). This would fit with seeing a dermatoligist  receiving a cream and  possible biopsy in the future.

 

 

[Freddy42OZ]

15 hours ago, TheFishman1 said:

Is she just  Thai I would imagine she would be entitled to getting like their free medical care at the government, hospitals or whatever.
Paget's disease rarely spreads from one site to another. If the disease is in the pelvis, it's not likely to affect the spine or skull. Paget’s generally "burns out" in time, causing no additional pain or damage. Any damage the disease has already caused, however, is irreversible Very exciting.

 

That is Paget's bone disease. 

Paget's disease of the breast is a type of cancer.   
 

[Freddy42OZ]

12 hours ago, Sheryl said:

Not remotely sounding like anything to do with Paget's disease, which is a bone condition.  Skin lesions are not a  feature in that condition.

 

Are you sure she said Paget's Disease and not Psoriasis? (Which unlike Paget's is a  a condition with skin manifestations, and relatively common in Thais).

 

There would be no reason to see a skin specialist with suspected Paget's disease.

 

 

 

 

Unless it's this 

https://www.nhs.uk/conditions/pagets-disease-nipple/