ENT specialist in Bangkok?

[lambshankredemption]

Can you recommend an ENT specialist in Bangkok? 
 

Focus on throat. 
 

I developed swollen and painful lymph nodes on one side of the neck and a bit of an itchy throat. Covid and influenza test negative on that day and doctor sent me away with an antibiotic.

 

Three days later I developed fever and tested positive for Influenza A (ATK and in hospital). Doctor told me to stop the antibiotics half way in. Four days of high fever and a couple of days to recover but I still have what seems to be swollen lymph nodes. The neck muscle feels like it’s swollen. Difficult to tell the size because it’s difficult to distinguish from the neck muscle. Not painful anymore but noticeable and feeling a bit uncomfortable.
 

I’m wondering if it’s a co-infection or if it was something completely different to begin with (and I shouldn’t have discontinued the antibiotics) and I only caught the flu when I visited the hospital to check the lymph nodes issues (there was a guy in the waiting room who was coughing as if he was about to die). 
 

anyway wanna have it checked. 

[Sheryl]

I do not thing ENT is the right specialist from what you say.  Better an infectious disease specialist.

 

Suggest you see this doctor tomorrow evening

 

https://www.saintlouis.or.th/doctor/dr.kamalas-amnuay/01eeefc9-7c3b-4e79-9464-041ed1f67637

 

If infectious cause is ruled out, may need to see a different specialist (eg oncologist) but start with infectious disease specialist.

[lambshankredemption]

Thanks. Saw an infectious disease person at my regular hospital today and she thought the lymph nodes aren’t too swollen anymore and given the fact they don’t hurt she thought it’s the aftermath of the flu (post viral syndrome). Will give it another week otherwise I’ll go see that specialist. 

[lambshankredemption]

On 6/10/2024 at 8:00 PM, Sheryl said:

 

 

If infectious cause is ruled out, may need to see a different specialist (eg oncologist) but start with infectious disease specialist.

What oncologist would you recommend?

[Sheryl]

29 minutes ago, lambshankredemption said:

What oncologist would you recommend?

No need to see any from the sounds of it.

 

You would suspect possible malignancy only for persistant large nodes unrelated to infection.

 

Recent flu might explain them.

 

Have the nodes increased in size or decreased?

[lambshankredemption]

@Sheryl

 

so I went back to the doc because I still feel a swelling at that right side of my throat and an inflamed throat but also stomach issues. The doc said the lymph nodes are fine and referred me to the ENT. The ENT looked in my throat and prescribed one week of Levofloxacin. 
 

Now I know a bit about antibiotics and this class of antibiotics in particular. I also know a bit about how Thai doctors tend to hand out antibiotics like candy. 
 

Is this really warranted? I know it’s like a the nuke option but I’m reluctant to take such a strong antibiotic without a test confirming (1) a bacterial infection and (2) susceptibility to this (and only this) class of antibiotics. But I also know that a throat swab isn’t always reliable. 
 

After I shared my concerns the doc now changed to Augmentin but I’m still wondering whether I should just empirically take an antibiotic for a week. The first time I came to this hospital they already wanted to send me away with Levofloxacin and it doesn’t make me feel good. 

[Sheryl]

19 hours ago, lambshankredemption said:

@Sheryl

 

so I went back to the doc because I still feel a swelling at that right side of my throat and an inflamed throat but also stomach issues. The doc said the lymph nodes are fine and referred me to the ENT. The ENT looked in my throat and prescribed one week of Levofloxacin. 
 

Now I know a bit about antibiotics and this class of antibiotics in particular. I also know a bit about how Thai doctors tend to hand out antibiotics like candy. 
 

Is this really warranted? I know it’s like a the nuke option but I’m reluctant to take such a strong antibiotic without a test confirming (1) a bacterial infection and (2) susceptibility to this (and only this) class of antibiotics. But I also know that a throat swab isn’t always reliable. 
 

After I shared my concerns the doc now changed to Augmentin but I’m still wondering whether I should just empirically take an antibiotic for a week. The first time I came to this hospital they already wanted to send me away with Levofloxacin and it doesn’t make me feel good. 

Not knowing what the doctor saw when he examined your throat I cannot comment on the need for an antibiotic.

 

What did the ENT say was the diagnosis/ reason for antibiotics? 

 

 

[lambshankredemption]

4 hours ago, Sheryl said:

What did the ENT say was the diagnosis/ reason for antibiotics? 

Not really much of a diagnosis. The main reason was “you have sore throat for two weeks now”. The only examination performed was to look into the throat and into the nose (throat slightly inflamed and nose stuffed). 

[Sheryl]

18 hours ago, lambshankredemption said:

Not really much of a diagnosis. The main reason was “you have sore throat for two weeks now”. The only examination performed was to look into the throat and into the nose (throat slightly inflamed and nose stuffed). 

This could actually be an allergic problem. 

 

If it does not improve on its own (it may) suggest you see this ENT

 

https://www.saintlouis.or.th/doctor/dr.songklot-aeumjaturapat/fa5a6125-2b55-4113-ac50-8c94d64e7300

 

https://www.bangkokhospital.com/en/doctor/dr-songklot-aeumjaturapat

 

https://www.medparkhospital.com/en-US/doctors/assoc-prof-dr-songklot-aeumjaturapat

 

(Same doctor, different hospitals). 

 

 

 

 

[lambshankredemption]

So I ended up getting a throat PCR for STI myself since I’m sexually actively (but most unprotected oral sex) and it came back positive for two pathogens. I’ll go to a hospital now to get treated (and hope the two antibiotics I started didn’t cause resistance). 
 

It seems I really got the flu from going to the hospital on that day. Guess I should have checked for STI directly instead of going to the hospital. in fact, that was actually the reason I went to the hospital in the first place but the infectious disease docs weren’t available so they transferred me to a general practitioner who suggested I should try that antibiotic. Bad luck. 
 

 

[lambshankredemption]

On 6/16/2024 at 10:42 AM, Sheryl said:

This could actually be an allergic problem. 

Would you have a recommendation for a specialist who could test for allergies (including dog allergies)? 
 

It seems the STI test was a false positive:

 

1) Culture 1: nothing found 

2) PCR 1: Gonnorhea and Trich

3) Took treatment for Gonnorhea, not for Trich  

4) PCR 2: Mycoplasma Hominis (no NG and no TV)

5) Culture 2: nothing found 

6) PCR 3: Nothing found 

No sexual activity between the tests. No other antibiotics taken. 

 

Cultures can be unreliable, especially in the throat, so I’ll ignore those. Gonnorhea is a common STI in the throat. Trich seems to be so uncommon in the throat, CDC actually says it’s impossible to get it but I found one case report in a medical journal. But if that first PCR was correct, how would Trich suddenly disappear despite no treatment, an Mycoplasma Hominis randomly show up despite not sexual activity in between? 
 

Looking at the timeline of my symptoms, they started shortly after I had my friends’ dog stay with me for a week and sleep in my bed. A dog allergy would be odd because my ex has a dog and he would always sleep in the same bed on the other hand we didn’t spend much nights together and I also heard an allergic reaction can depend on the specific dog/breed. I cleaned my bed room and turned my HEPA filter on highest setting and thought my symptoms slightly improved and got slightly worse when the dog stayed over again but this could as well be a coincidence or my imagination. Anyway I thought I should check it. 

[Sheryl]

6 minutes ago, lambshankredemption said:

Would you have a recommendation for a specialist who could test for allergies (including dog allergies)? 
 

....

Looking at the timeline of my symptoms, they started shortly after I had my friends’ dog stay with me for a week and sleep in my bed. A dog allergy would be odd because my ex has a dog and he would always sleep in the same bed on the other hand we didn’t spend much nights together and I also heard an allergic reaction can depend on the specific dog/breed. I cleaned my bed room and turned my HEPA filter on highest setting and thought my symptoms slightly improved and got slightly worse when the dog stayed over again but this could as well be a coincidence or my imagination. Anyway I thought I should check it. 

 

There are hospitals which do allergy testing but it is expensive and often nto really helpful. IMO in most cases you can do just as well one your own through trial and error.

 

Dog and cat allergic reactions can not only vary by breed but also by specific animal. I have a cat (no special breed, village rescue cat) who is seemingly hyper-allergenic, many friends and relatives who have never been allergic to cats, are very allergic to him (I, luckily, am not) . I have to keep the guest bedroom strictly off limits to him and always stock loratadine (antii-histmine, also known as clarityn) in the house.

 

Up to you, but to me what you describe above is evidence enough that you had an allergic response to that specific dog.

 

If your problems are allergic in nature they will improve with:

1. anttihistamines

2. avoidance of the cause

 

 

 

 

 

 

[lambshankredemption]

7 minutes ago, Sheryl said:

evidence enough that you had an allergic response to that specific dog.

It’s definitely possible. I just don’t understand why it doesn’t go away once the dog is gone. I have this for almost six weeks now. The dog stayed with me a week before it started and two weekends during the six weeks. 
 

Would it be expensive to test for dog allergy specifically (instead for several different allergies)? And would they need the dog (or his fur or saliva) or can they test without that? 

[lambshankredemption]

I did a confirmatory test to make sure there’s really no STI. PCR test came negative for all seven bacteria. 
 

ln addition the doctor suggested a PCR test that checks for 33 different viral infections. This one came back positive for Rhinovirus. 
 

I understand that’s basically the common cold. Is it possible to have that chronically? It’s been 6 weeks with this and it doesn’t feel like your common cold. I feel and inflammation in the right side of my neck, a dry throat (no pain at all), not much mucus, and a little bit stuffed nose (almost not noticeable).