Medical Advice Required Regarding Potential Stroke.

[mart29]

Hi, my thai friend has been taken to hospital after experiencing a bad headache, weakness on one side of the body and severe tiredness. THis has happened twice now in the last week and this last time has been much worse, he is on an oxygen machine and cannot walk or talk at the moment.

The doctor however has no idea what is wrong with him. They have run several tests and he says he doesnt know.

Is it possible he is over looking it being a stroke as my friend is only in his 30;s?

Also he does this clicking thing with his neck all the time and i wondered is it possible for him to strain a nerve in the spine and could this cause these symptoms? i know thats a long shot but i dont know what else to think.

I have no one else to ask that i can think of other than asking on here so if anyone has medical training could you please give any suggestions. thank you.

[LaoPo]

Hi, my thai friend has been taken to hospital after experiencing a bad headache, weakness on one side of the body and severe tiredness. THis has happened twice now in the last week and this last time has been much worse, he is on an oxygen machine and cannot walk or talk at the moment.

The doctor however has no idea what is wrong with him. They have run several tests and he says he doesnt know.

Is it possible he is over looking it being a stroke as my friend is only in his 30;s?

Also he does this clicking thing with his neck all the time and i wondered is it possible for him to strain a nerve in the spine and could this cause these symptoms? i know thats a long shot but i dont know what else to think.

I have no one else to ask that i can think of other than asking on here so if anyone has medical training could you please give any suggestions. thank you.

I suggest you send an urgent PM as soon as possible to Sheryl:

http://www.thaivisa.com/forum/index.php?showuser=14639

If the doctors have no idea I question what kind of hospital he is in....?

In the meantime I will send a 'report' message to the Mods so maybe than can act more quickly than I can.

Good luck

LaoPo

[Crow Boy]

In the meantime I will send a 'report' message to the Mods so maybe than can act more quickly than I can.

Good luck

LaoPo with all due respect I don't think there is anything we can do. The advice that this person take his friend as soon as practical to a hospital and have him checked by a qualified medical practitioner is the only thing I can suggest.

Hope it works out and thanks for the report

Crow Boy

Moderating Team

Thai Visa

[JetsetBkk]

I have no one else to ask that i can think of

Go to a different hospital(s) and get a second/third opinion.

[Pepe']

Hi, my thai friend has been taken to hospital after experiencing a bad headache, weakness on one side of the body and severe tiredness. THis has happened twice now in the last week and this last time has been much worse, he is on an oxygen machine and cannot walk or talk at the moment.

The doctor however has no idea what is wrong with him. They have run several tests and he says he doesnt know.

Is it possible he is over looking it being a stroke as my friend is only in his 30;s?

Also he does this clicking thing with his neck all the time and i wondered is it possible for him to strain a nerve in the spine and could this cause these symptoms? i know thats a long shot but i dont know what else to think.

I have no one else to ask that i can think of other than asking on here so if anyone has medical training could you please give any suggestions. thank you.

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

When you get to the hospital, you should request CT scan with contrast. Depending on results

MRI with contrasy. Has anyone checked pupilary contraction and reflexes.

Best of luck with this.

[mart29]

thanks for all your replies,Pepe i will find out tommorow and make sure this is being done. I just found it hard to believe they couldnt diagnose it.

The hospital is Rama hospital.

If they havent done those scans i will request they do them. They are keeping him in now and they said the next 3 days are critical...critical in what way i dont know.

Thanks all of you though.

[WaiWai]

All the best, mart29.

[Pepe']

Also you say he does this "clicking" thing with his neck.

Impossible to say without seeing the patient. It really doesn't sound like a case of nerve impingement. Possibly loosened some plaque in one of the carotid arteries.

In this case you should hope for the best but think what is the possible worst case scenario.

I'm sorry it sounds as though he's had a stroke.

There is strong evidence and good research that demonstrates aggressive acupuncture therapy done asap helps to restore cerebral function greatly.

Dr Lee is in BKK I don't have her number at hand but I would try to locate her. She is a veteran practitioner.

Also I am hearing lately about treatment in hyperbaric chamber being very helpful but I don't have experience with this.

What ever you do you must act quickly.

[sriracha john]

Yes, mart29, your friend needs to have a CT scan and proper diagnosis.

For your own educational benefit, I would suggest this informative site:

http://www.webmd.com/stroke/guide/stroke-topic-overview

Best of luck to the both of you. Stay positive...

*edit* Could one of very courteous mods move this to the Health Forum? Thank you.

Edited November 15, 2007 by sriracha john

[mart29]

Is it really possible that they have missed the fact that it is a stroke, im really hoping its not but it does appear that way, he had a minor attack of this a week ago and was in hospital for a couple of days but didnt really get better as such and then had it really strong yesterday and here we are. bad headache and what i outlined above, communication is an issue so i cant be fully clear but i can get enough from his girlfriend.

Do you know if there is any reason why they wouldnt tell his girlfriend and myself that he had had a stroke?

[PeaceBlondie]

Moved to health forum.

I had a mild, first stroke (cardiac infarction) on 23 May of this year, and we went promptly to our best hospital and got treated, CAT scan, neurologist, etc. Here's hoping the patient will get the best possible care.

[Pepe']

My ex brother- in-law from Samut Sakorn told me some thing once a long time ago that I never forgot.

He said it was very common for a doctor to find a serious problem then not tell the patient or family because the doctor did want to say some thing that might make them feel bad?!

Don't know if it's true or not but knowing Thailand as I do it wouldn't surprise me.

Try to locate Dr Lee in BKK.

Good luck with all this. You've got a lot on your plate now. Take care of yourself as well...

[LaoPo]

In the meantime I will send a 'report' message to the Mods so maybe than can act more quickly than I can.

Good luck

LaoPo with all due respect I don't think there is anything we can do. The advice that this person take his friend as soon as practical to a hospital and have him checked by a qualified medical practitioner is the only thing I can suggest.

Hope it works out and thanks for the report

Crow Boy

Moderating Team

Thai Visa

Thanks Crow Boy; I think I missed to point out that it was meant if one of the Mods could have contacted 'Sheryl' since she usually comes up with good ideas regarding health issues.

Anyway I hope the OP's friend is in good hands.

LaoPo

[WaiWai]

He said it was very common for a doctor to find a serious problem then not tell the patient or family because the doctor did want to say some thing that might make them feel bad?!

Yes, very possible that is the case.

Try to get another doctor who has experience with foreigners, and who will be open with you, on the case. One of the nurses might be able to help. Have someone try to explain you are a strange farang and you NEED to know what is going on.

Or (I would) consider moving him to another hospital. Telling them that you will move him might help them understand your need for information.

Whatever, find a way to make sure he's getting the diagnosis and treatment needed ASAP.

All the best.

[JR Texas]

He said it was very common for a doctor to find a serious problem then not tell the patient or family because the doctor did want to say some thing that might make them feel bad?!

Yes, very possible that is the case.

Try to get another doctor who has experience with foreigners, and who will be open with you, on the case. One of the nurses might be able to help. Have someone try to explain you are a strange farang and you NEED to know what is going on.

Or (I would) consider moving him to another hospital. Telling them that you will move him might help them understand your need for information.

Whatever, find a way to make sure he's getting the diagnosis and treatment needed ASAP.

All the best.

First piece of advice: Go see a qualified doctor and ignore what you read on TF.

Second piece of advice: Go to Bumrungrad Hospital

Third piece of advice: Make sure they check for scoliosis in the neck area......could be putting pressure on something and people that crack their neck a lot sometimes have it and do not even know it

[Flow]

Bangkok hopital has a special Heart Clinic. All doktors there speak excellent English. If this hospital is too expensive for your friend, how about Sirilart Hospital or Chulalongkorn Hospital, both government hospitals?

Or alternatively insist on a heart specialist in that hospital to tell you what he thinks is wrong with your friend. did a cardiologist look at your friend yet?

Edited November 16, 2007 by Flow

[mart29]

Thanks again to all of you for your advice, im going there shortly and will post and update if there is any new information.

Help here is fantastic cant thank you all enough.

[Sheryl]

I've only just seen this as I've been snowed under with work (still am).

As you are not immediate family this may be limiting what the doctors are willing to tell you.

"Stroke"is actually a lay term and covers a variety of medical conditions causing damage to brain tissue. they certainly should knoiw by now whether or not he has had a blood clot or hemorrghage in part of his brain, maybe try asking that specifically.

can you clarify for me..by "Rama Hospital"do you mean:

- Ramathibodhi Hospital, a government hospital in Bangkok on Rama 6 Road (which is affiliated with Mahiodol)

or

- Rama 9 Hospital, a large private hospital on Rama 9 road?

OR

Chiang Mai Ram Hospital I in Chiang Mai, which is a private hospital belongiong to the Ramkamheng Group?

I am guessing probably the last since I gather you are from Chiang Mai. Which is a bit worrisome. I have no first hand experience with the plasce but there has been some very negative feedback in this forum on it and it certainly does not have the degree of expertise in neurology and neurosurgery that a case such as youy describe warrants.

If he is in Chiang Mai, I strongly recommend an immediate transfer to

Chiang Mai Neurological Hospital

Suthep Road, T Suthep, A Muang, Chiang Mai 50200. Tel: 053 222285, fax: 053 217703.

Or if finaces/insurance permit, transfer to Bangkok Hospital in Bangkok, they are at the forefront in neurological problems (private hosp and would probably need special medievac heliocopter by the cound of his condition, so an option only if affluent or well iinsured).

Good luck.

[mart29]

I've only just seen this as I've been snowed under with work (still am).

As you are not immediate family this may be limiting what the doctors are willing to tell you.

"Stroke"is actually a lay term and covers a variety of medical conditions causing damage to brain tissue. they certainly should knoiw by now whether or not he has had a blood clot or hemorrghage in part of his brain, maybe try asking that specifically.

can you clarify for me..by "Rama Hospital"do you mean:

- Ramathibodhi Hospital, a government hospital in Bangkok on Rama 6 Road (which is affiliated with Mahiodol)

or

- Rama 9 Hospital, a large private hospital on Rama 9 road?

OR

Chiang Mai Ram Hospital I in Chiang Mai, which is a private hospital belongiong to the Ramkamheng Group?

I am guessing probably the last since I gather you are from Chiang Mai. Which is a bit worrisome. I have no first hand experience with the plasce but there has been some very negative feedback in this forum on it and it certainly does not have the degree of expertise in neurology and neurosurgery that a case such as youy describe warrants.

If he is in Chiang Mai, I strongly recommend an immediate transfer to

Chiang Mai Neurological Hospital

Suthep Road, T Suthep, A Muang, Chiang Mai 50200. Tel: 053 222285, fax: 053 217703.

Or if finaces/insurance permit, transfer to Bangkok Hospital in Bangkok, they are at the forefront in neurological problems (private hosp and would probably need special medievac heliocopter by the cound of his condition, so an option only if affluent or well iinsured).

Good luck.

THank you for your reply,

No im in Bangkok , the hospital is the ramthibodhi hospital.

The latest is that he is coming out on monday. He appears alot better now. Before he was like a zombie, seeing things and face slumped on the left hand side as if it had melted a little. Not much control over the left hand side.

The doctors said they have perfored CT and MRI scans. from what i could understand, and that everything was "ok"

They decided to released him tommorow. Though he is being held in what was clearly a stroke victims ward, the doctor would not say he had had a stroke, only that they dont know what happened.

I dont know if they will tell him personally when they release him. I have no idea if there is any other possible cause for this.

THe symptoms to me look like a stroke though he is sitting up in bed, completely coherent, no slurred speech. I dont know about coordination though as he isnt allowed out of bed.

Is there anything else this can be, i think mentioned before though that he was really heavy drinker for many years until 2 years ago since then he hasnt drunk anything and has turned heavily to buddism.

sorry for waffling.

[sriracha john]

A possibility with the "ok" CT Scan and MRI...

Transient ischemic attack:

http://www.nlm.nih.gov/medlineplus/ency/article/000730.htm

[mart29]

^^ wonder if thats what it is. Yesterday they released him, he went home and then had another one of these attacks and is now back in hospital, they say he will have to stay a long time.

He is now running out of money and is totally depressed as he is unable to work and cant face life like this.

What happens if he runs out of money and is in hospital?

Is there any treatment for this transient ischemic attack and can you someone spell this phonetically for me so i can say it correctly please. not sure how to pronounce, thanks.

This is very frustrating as the information from the hospital is just"we dont know"

[mart29]

One other thing, is it possible diabetes could trigger this? he hasnt been tested for diabetes and isnt known to have it, but he eats a hel_l of alot of white rice and has had alchahol abuse issues before. I was wondering if he may have diabetes and when he got home ate a ton of white rice, which he often does, and that the blood sugar levels going haywire could trigger this if he is diabetic.

That might make no sense at all but im not a medical person, is that possible?

thanks

[LaoPo]

^^ wonder if thats what it is. Yesterday they released him, he went home and then had another one of these attacks and is now back in hospital, they say he will have to stay a long time.

He is now running out of money and is totally depressed as he is unable to work and cant face life like this.

What happens if he runs out of money and is in hospital?

Is there any treatment for this transient ischemic attack and can you someone spell this phonetically for me so i can say it correctly please. not sure how to pronounce, thanks.

This is very frustrating as the information from the hospital is just"we dont know"

Don't worry; nobody speaks about a transient ischemic attack. It's a 'TIA' or warning/mini-stroke and that's bad enough.

What is a TIA or transient ischemic attack?

A TIA is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke.

Most strokes aren't preceded by TIAs. However, of the people who've had one or more TIAs, more than a third will later have a stroke. In fact, a person who's had one or more TIAs is more likely to have a stroke than someone of the same age and sex who hasn't.

http://www.americanheart.org/presenter.jhtml?identifier=4781

Worrying he's running out of money; not insured ?

Good luck

LaoPo

[lopburi3]

My wife had severe headache and extreme weakness/dizzy several years ago (bad enough to go to ER) and it was due to low blood sugar (she is diabetic) and both number one rated hospital and another hospital failed to check sugar levels (and put her on low sugar diet) and she became worse. In her case the level would not be low for a normal person but it was much below her normal fasting level of 120-30. Low blood sugar for a diabetic can be serious. I had to demand a blood check and when it was 80 they said (normal) and had to have her sister who was a senor government nurse call hospital admin to provide sugar shot as she was going into coma (it turned around in seconds). You do not have a baseline to determine normal but some sugar (as in a candy/soda acts very quickly) in our experience. She now carries hard candy and has not had a repeat (but can sense it coming with hunger/dizzy and eats or takes candy).

This may not have anything to do with your friends condition but diabetes is very common here.

[Sheryl]

TIA is what this most sounds like. Treatment is directed at underlying cause. It will not be diabetes etc because that would have shown up on the routine blood work they will have done when he was first admitted. Also, non-neurologicval causes of coma will not usually present with focal findings (i.e. the one-sided facial drooping).

Another possibility since I gather his symptoms cleared in only a few days (and then recurred) is some type of seizure disorder, seizures are not always obvious as such (i.e. not always any thrashing about) and can leave residual effects ofr a few hours or in some cases a couple of days. If seizures, medication can control them.

Lastly, there is a surprisingly high incidence of young onset Parkinson's disease in Thailand and it sometimes presents in strange ways including one-sided neurological mainfestations. rare but I have known cases.

If it is neither TIA nor seizure nor Parkinsons then it is something rare indeed.

Either way I am afraid he is going to need a lot more tests.

Ramithibodhi is a very good tertiary level government hospital with significant expertise in neurology and is affiliated with one of the 2 top medical schools in the couintry, so I would not worry on that score. Being a govt hospital, amenities are few and staff rished and not inclined to do much in the way of explaining, alas, but that is they way it is in govt hospitals.

It may help some to be sure you talk with the attending neurologist (or "Consultant"if they use the Brit term) rather than the "house staff", the latter are the younger docs who come round usually in a group a few times a day and they are still in training (interns or residents) whereas the attending will be a much older doctor who comes by less frequently but has the final say and the most knowledge. Attendings are also more likely to speak English and while it is harder to get a hold of them they are usually more willing -- and ceratinly more able -- to answer questions and provide information. Ask the head nurse for the name of the attending neurologist and when he is expected to be by and try to talk directly to him.

Regarding your friend's financial problems, there are programs and entitlements that can assist him. He needs to see the social service staff, every government hospital has a social service department (altho open only Mon-Fri working hours), if he is fit enough walk him down there or ask the nurses to have the social woprker come see him. Thais tend to be very hesitant about applying for assistance -- many will forego life saving treatment rather than apply for aid becauzse of the perceived loss of face..or just sneak off without paying. But as government hospitals tend to have the patient pay for the medications etc on a weekly basuis this last is hard to do.

A high percentage of patients in government hospitals are unable to pay their full bills, and the hospitals know this. As a Thai citizen he has every right to avail himself of all available entitlements. But you may need to help persuade him to tackle this openly.

Bless yoyu for being there for him, he is likely in for a long haul and needs all the emotional support he can get.

[mart29]

THanks again for your reply, I think he is now recieving some financial aid. It turns out his last attack was a full on stroke. He has lost control in the left side of his body and some vision in his left eye.He is still having further tests. There seems to be some reluctance all round to refer to it as a stroke but that is what he has had.

plus two TIA's

I think now he just has to undergo further tests and is being given medication. He has been released and i met him yesterday to see how things are with him and his gf.

He is simply a shadow of his former self. i wonder if his character will ever come back. He seemed like a different person to me. Only moments when he laughed and i could see the old him.

[Sheryl]

A stroke at his age would depress the he_l out of anyone. One thing you can tel him (or remind him, as hopefully he has already been told) is that improvements continue to be seen for as much as 6 months after a stroke and his current level of functioning is not necessraily what he is stuck with. there is generalized brain swelling after stroke and that also causes symptoms, it is only as all the swelling subsides that he will find out how much if any permanent effect there has been.

And at all costs, tell him not to smoke!!!! Buig risk factor for having another one, which is the last thing he needs.

[sylviex]

Depression is common after strokes, too. It may help a little if you tell him that.

[mart29]

This just goes on, hes had another one now, minor. And back to hospital for more tests. I dont really know what to do, im trying to be supportive, this is in the hands of the hospital now, i think i can just be a friend and thats about it really, i cant really do much else. thanks for all the help and advice and the comments everyone.