Any Doctors Out There?

[Thailion]

Didn't see this before so apologies about putting this in the pub section...

I am looking for advice regarding neurology?

My brother recently was in a very serious motorcycle accident and is currently stable but just beginning to show signs of coming out of a coma after 2 weeks. My questions are about pain management and rehabilitation. With regards to pain management, do they have this facility in hospitals in Thailand (currently in Chiang Mai)? They had him on Tramal 50 but have now switched to paracetamol. I am wondering if this is suitable taking into count that he suffered multiple injuries besides brain injury? I would have thought something stronger would be more appropriate??? Morphine? etc.?

With rehab, they started today by putting him in a wheelchair, as they wanted him to sit up. He can't keep his head straight as his neck is not strong enough, has still not fully recovered from Meningitus and generally quite weak. After this his blood pressure went up for 3 hours and temperature rose again to 37.7. I don't see the point in starting this sort of rehab right now and would of thought a more basic line, like massage or gently moving arms, legs would be more suitable until he regained a bit more strength. I would of thought that rest for a few more days until the Meningitus was gone and his strength was improved would be better???

Any help would be greatly appreciated.

[ProThaiExpat]

There are many neurologists available in Chiang Mai, including Ram Hospital, that speak good English.

Get with them and ask them all your questions. Hopefully one of your brothers treating physicians is one of them. You must push to get the feedback you are used to in the West, but you will rest easier if you get your questions answered.

If you are not local, there is no way you can put your mind at rest. Take trip here?

[Wolfie]

Didn't see this before so apologies about putting this in the pub section...

No problem... i'll just move it over to the Health forum, you are more likely to get responses there.

[bendix]

I don't know about you lot, but if I was seriously ill or injured I would be going to a real hospital or real doctor, not looking for advice from a bunch of ill-informed strangers on an internet forum.

But I guess I'm strange that way.

[Sheryl]

Will you settle for an experienced nurse instead?

1. Pain management: there are distinct disadvantages to opiates (m orphine et al) in people with neurologhical problems since these drugs depress the central nervous system. in other words, there is good reason to switch him to paracetemol as soon as possible and unless you have reason to believe he is really suffering I wouldn't argue this point.

2. Rehab: there are a large number of serious complications which result from being immobile, including blood clots, pulmonary embolus, stroke, pneumonia to name a few, and strong medical justification for getting the patient up and about as soon as possible, even if tghat means propping them up in a chair. We do that in the west too.

Sounds to me like he is being treated properly, just not getting proper explanations of the treatment and reasons for it, which is very typical.

In my experience, more than half the complaints/concerns raised about care in Thai government hospitals stem from failure of the staff to properly explain rather than the treatment being wrong. (True for both westerners and Thais...the problem isn't just language).

[mrtoad]

Will you settle for an experienced nurse instead?

1. Pain management: there are distinct disadvantages to opiates (m orphine et al) in people with neurologhical problems since these drugs depress the central nervous system. in other words, there is good reason to switch him to paracetemol as soon as possible and unless you have reason to believe he is really suffering I wouldn't argue this point.

2. Rehab: there are a large number of serious complications which result from being immobile, including blood clots, pulmonary embolus, stroke, pneumonia to name a few, and strong medical justification for getting the patient up and about as soon as possible, even if tghat means propping them up in a chair. We do that in the west too.

Sounds to me like he is being treated properly, just not getting proper explanations of the treatment and reasons for it, which is very typical.

In my experience, more than half the complaints/concerns raised about care in Thai government hospitals stem from failure of the staff to properly explain rather than the treatment being wrong. (True for both westerners and Thais...the problem isn't just language).

Pretty much agree with that , the fact that people just don't question a doctor, as they always believe him to be right and beyond reproach. The difference between a good and an excellent Nurse or Doctor, is the abilty of the practitioner to involve the patient or the family as much as possible in the plan of care/treatement and make them understand what they are doing in simple tems. The biggest barrier in patient/pratitioner relationships is some of the BS jargon that is used.

[Dakhar]

Would you settle for getting info from a guy that has suffered a TBI, tramatic brain injury?

Yea, I had a skull fracture, so sever, the pariatal bone basically got ripped off of my head, the temporal bone was crushed.

But the benifit of having the largest bone of the skull removed is.... there is plenty of room for the release of pressure caused by a hematoma.

I was patched up, had what I would consider a full recovery. I went on to get a doctorate degree, marry, have a beautiful baby boy, hold a 6 figure job, own a business etc etc.

What Sheryl posted is RIGHT on target. They had me walking down the hall around the second day of surgery. I was released on the third day... (insurance)

Truth is I hated hospitals so much I wanted out, and when the said take a walk around the hospital, we will let you out sooner.... I wanted to jog around the hospital.

I never had mynengitis though....

Wishing you and your brother the best

[Thailion]

Thank you all for your responses.

CM Ram was nothing short of excellent. I can not thank them enough for saving my brothers life. If there is a complaint it would be only regarding communication. The doctors were the easiest for me to talk to but due to their hectic schedules it was really difficult to get the time to talk...hench my frustration. The nurses, while not being rude generally said that this is what we were instructed to do and couldn't offer an explanation. Now that I look back though they were correct in what they did, it was just frustrating at the time as I need to understand everything that is happening. I can not speak more highly of the treatment and care that my brother was given at CM Ram.

About 4 weeks ago I moved my brother to Bangkok solely for the reason that they have better facilities regarding rehabilitation. The meningitis, lung infection, parasite, blah, blah, blah are all cleared and he is continuing his rehab.

One problem still remains however is that he still has pressure in his 3rd ventricle (approx. 10 times larger than normal) which they want to put a shunt in to control. I have been informed if it is not controlled, the pressure will keep building and in turn put pressure on the gray matter surrounding the brain and on the other ventricles possibly retarding parts. His current situation may also be impeding his recovery. My understanding is that a shunt is more of a procedure these days rather than an operation. Obviously with surgery there is always risk but the information I have been given is this is reletively low in this case. I also have read that there is a chance it could block in the future resulting in the procedure being repeated. I have not come across any other negatives. Are there any more that anyone has experienced?

On the positive, this will control his pressure by draining the fluid to his stomach and the fluid will pass naturally through his system. It should help progress his recovery and prevent future pressure mounting.

I obviously wouldn't stand in the way of something that will help my brother but as mentioned earlier I need to understand the facts before authorising things to happen.

Does anyone know someone that has had a shunt? and has there been future problems with it?

Pro, Sheryl and toad...Thanks for your advice.

Dakhar, Thanks for your advice and it is good to hear that you have made a great recovery...it is definately encouraging for me.

bendix...Thanks for your opinion (I guess)...if you are ever in the situation (I pray not) you will find that you are desparate to find out as much information as possible to make the best decision you can...whether that is talking to Doctors, nurses, friends, medical forums, general forums, google, etc, etc... you try to get as much understanding as you can. Smart people will try to understand to make an informed decision...it is a bit silly to drop a loved one off to the doc and say I will come and get him when fixed.

As you do not know me please do not assume that because I have asked questions on here that I would be silly enough not to talk to Doctors.

As you can tell by the responses below your post....people do have experience with this and can offer help and advice.

[Pepe']

Will you settle for an experienced nurse instead?

1. Pain management: there are distinct disadvantages to opiates (m orphine et al) in people with neurologhical problems since these drugs depress the central nervous system. in other words, there is good reason to switch him to paracetemol as soon as possible and unless you have reason to believe he is really suffering I wouldn't argue this point.

2. Rehab: there are a large number of serious complications which result from being immobile, including blood clots, pulmonary embolus, stroke, pneumonia to name a few, and strong medical justification for getting the patient up and about as soon as possible, even if tghat means propping them up in a chair. We do that in the west too.

Sounds to me like he is being treated properly, just not getting proper explanations of the treatment and reasons for it, which is very typical.

In my experience, more than half the complaints/concerns raised about care in Thai government hospitals stem from failure of the staff to properly explain rather than the treatment being wrong. (True for both westerners and Thais...the problem isn't just language).

Pretty much agree with that , the fact that people just don't question a doctor, as they always believe him to be right and beyond reproach. The difference between a good and an excellent Nurse or Doctor, is the abilty of the practitioner to involve the patient or the family as much as possible in the plan of care/treatement and make them understand what they are doing in simple tems. The biggest barrier in patient/pratitioner relationships is some of the BS jargon that is used.

-------------------------------

Sorry to hear your brother was hurt.

1) I am a primary care physician here in San Diego.

2) You have gotten some very good advice from some of the "ill informed strangers" on TV.

3) However it is difficult and unethical to try to attempt to evaluate/manage your brothers case from a key board. At the same time lots of collaboration on cases goes on by email or phone.

4) Don't stop asking questions though! Here or elsewhere. The "squeaky gear gets oiled."

5) I'm concerned about the management of the meningitis and physical therapy being started while he's infected.

6) If you can post more about his progress I will try to help time and circumstance permitting later.

7) There are other physicians on this forum that have been very helpful on cases in the past.

8) It is best to let the erudite pontifications of Bendix and his cronies go in one ear and out the other. Then call me in the morning.

9) I will say a little prayer for your brother.

Good Health,

Pepe

[Sheryl]

Yes, a shunt is a common procedure and necessary if fluid is accumulating. Otherwise, increased pressure within the skull can damage or destroy brain cells.

The main danger is infection but proper technique can reduce that. Shunts do sometimes get blocked and need to be replaced.

Since the risk of not placing a shunt is loss of brain function, it is clearly better to undertake the small risks of the procedure.

Don't know what hospital he is in but sounds like appropriate management to me.

Pepe:

My understanding is that the meningitis has fully resolved, hence commencing rehab.

[Pepe']

Yes, a shunt is a common procedure and necessary if fluid is accumulating. Otherwise, increased pressure within the skull can damage or destroy brain cells.

The main danger is infection but proper technique can reduce that. Shunts do sometimes get blocked and need to be replaced.

Since the risk of not placing a shunt is loss of brain function, it is clearly better to undertake the small risks of the procedure.

Don't know what hospital he is in but sounds like appropriate management to me.

Pepe:

My understanding is that the meningitis has fully resolved, hence commencing rehab.

----------------------

OK Good to hear the meningitis is cleared. Regular PT then is a good thing.