Help Sos. Need Cheaper Hospital

[moldy]

I got a simple boil/fistular just right where the sun never shined nor never will. Went to Rama 9 hospital, great doctor, but went on to discover that the price for 1 night stay, xray, epidural, short operation, etc would be 50k baht plus . My insurance trhough Thai life will cover me to 30000 only. I would have thought this is more than enough really, but may be naive on these matters. CAN ANYBODY RECO. A CHEAPER BUT OK HOSPITAL IN BANGKOK? In the meantime I'll scour the forum. I went to the hospital to be cured no get shafted What a pain in the bXXX.

[lopburi3]

Saint Louis Hospital is usually recommend as a reasonable price alternative.

[moldy]

Saint Louis Hospital is usually recommend as a reasonable price alternative.

Thanks for that lopburi3. I'll go there I think. If anyone knows of any other non surgical procedure I'd be eternally grateful. Feeling a bit squeamish. Don't like the thought of being frozen from the waist down.

[junkofdavid2]

Chula Hospital might be cheaper than Saint Louis?

Dunno for sure...

[moldy]

Chula Hospital might be cheaper than Saint Louis?

Dunno for sure...

Thanks also. I'll put it on the check list too. Most grateful for the responses. I feel cheered already.

I've also discovered that there may be alternatives such as general self care and common antibiotic treatment. God, I miss the NHS in the UK. The thing is with a national health service they have an interest in conserving resources, out here they'll just come out with the most expensive option. I understand though that St Louis is non profit, so I may well take their word as reliable.

[junkofdavid2]

Chula Hospital might be cheaper than Saint Louis?

Dunno for sure...

Thanks also. I'll put it on the check list too. Most grateful for the responses. I feel cheered already.

I've also discovered that there may be alternatives such as general self care and common antibiotic treatment. God, I miss the NHS in the UK. The thing is with a national health service they have an interest in conserving resources, out here they'll just come out with the most expensive option. I understand though that St Louis is non profit, so I may well take their word as reliable.

http://www.home-remedies-for-you.com/remedy/Boils.html

[Sheryl]

St Louis is a good bet. Other possibilities would be the Chao Phya Hospital near Siriraj, I know someone who had surgery under general and 2 nights stay for about 35,000 baht, altho that was a few years back, or Phayathai 2 near Victory Mionument

Wherever you go, ask specifically about the possibility of same day surgery..coming in early morning and discharge the same day, come back as outpatient for follow up. It saves a bundle and is often possible.

If all you have is an abscess ("boil") then only local injection of lidocaine should be needed. But since yuou also mention fistula and the doctor was talking about an epidural my guess is that there is more involved.

You might get by with self-treating just an abscess but if you have a fistula you're going to end up with some serious and far more costly problems if you don't get competeent medical care.

Try St Louis or one of the other places mentioned, tell them up front that cost is a factor and ask about "day surgery", offering to stay at a guest house nearby and come in the next day for follow up. In many cases this is feasible and cuts the cost by half or more.

Good luck.

[moldy]

St Louis is a good bet. Other possibilities would be the Chao Phya Hospital near Siriraj, I know someone who had surgery under general and 2 nights stay for about 35,000 baht, altho that was a few years back, or Phayathai 2 near Victory Mionument

Wherever you go, ask specifically about the possibility of same day surgery..coming in early morning and discharge the same day, come back as outpatient for follow up. It saves a bundle and is often possible.

If all you have is an abscess ("boil") then only local injection of lidocaine should be needed. But since yuou also mention fistula and the doctor was talking about an epidural my guess is that there is more involved.

You might get by with self-treating just an abscess but if you have a fistula you're going to end up with some serious and far more costly problems if you don't get competeent medical care.

Try St Louis or one of the other places mentioned, tell them up front that cost is a factor and ask about "day surgery", offering to stay at a guest house nearby and come in the next day for follow up. In many cases this is feasible and cuts the cost by half or more.

Good luck.

Thanks so much for your posting. I'm in a bit of a crisis here. I understand I must have the surgical procedure done. It's the thought of the epidural that is frightening me. Am I right in thinking that I will be temporarily paralysed from the waist down? or do I just lose sensation but can still move my limbs? It may sound silly but I am just plain scared at the thought of paralysis. I really would prefer just to be put under (on pethadin is it? ) as happened when I had my nose reset following a break. The doctors info. and procedure was follows:

Simple short anal fistula as a result of cyst, diagnosed by sight of the outside area and insertion of a probe. He did not recommend any other form of investigation, save an xray which he explained was standard procedure and purely precautionary. He said he could not just use a local pain killing injection as even the pain of introducing a needle might be painful in such a sensitive area. Also an incision has to be made beyond just removing the boil.

He seemed a highly competent specialist and I may go back to him, it was also the cost that concerned me- it started at 60k, then 50, then 45 as we walked.

[moldy]

error: please reread "too painful". I'm in a tizz as mentioned.

[Sheryl]

Epidurals are injected not directly into the spinal cord but into a space nearby and will numb sensation in the perineam (groin area) and, to at least some extent, the legs There are different techniques and also different drugs that can be used in epidural anesthesia. Local anestehtic agents can be injected but so can analgesics (opiates); many times it will be some combination of the two so as to provide maximum pain relief with minimal lose of motion. (A "walking epidural"). I can understand why the doctor suggests it as it is an ideal approach for a procedure such as you need, will block the pain without the cost and after-effects that would be associated with general anesthesia. However, your fears are also understandable and must be taken into consideration. General anethesia is certainly an alternative option (or "deep sedation" combined with local injections). It will cost more and involve more recovery time, tho.

Of course, as with any anesthesia, complications are possible so the skill of the person doing it is important. Your cost will include not only the fee of the doctor doing the surgery but also the fee of an anesthesiologist, whether you end up having an epidural or a general.

Given your concerns I suggest you ask to speak directly with the anethesiologist and explain your fears re paralysis, ask him/her what sort of epidural is planned and whether it will paralyze you temporairly. Or, you can simply ask that a general anesthetic or deep sedation plus local injections be used due to your fear of the epidural process.

Epidural anesthesia requires a high degree of patient cooperation as you have to sit or lie in a certain position and hold still while a catheter is threaded into a space near your spinal cord. Therefore any anesthesiologist will prefer not to do it on a patient who is particulary apprehensive about the idea.

I'm sure you can have this done under a short-acting general or deep sedation, your problem will be doing that without increasing the total cost. Shopping around for a lower price may help but at some point you are going to have to decide what your priorities are and whether or not you are prepared to spend a bit out of pocket to have the type of anesthesia you feel most comfortable with. Do try St ouis, tho, they are likely to be quite a bit cheaper than Rama was and they are a reliable place. And do ask about the possibility of going home the same day although this may be harder tio arrange if you have a general. Still, if it is a short-enough acting anesthetic and the surgery done first thing in the morning it might be possible. Altho the doctors will prefer you to stay overnight just in case. If you do go the day surgery route, don't be alone that night, have someone with you who can get you back to the hospital promptly just in case of any delayed complications. Chances are you'll be fine, but it is an advisable precaution.

[junkofdavid2]

Wherever you go, ask specifically about the possibility of same day surgery..coming in early morning and discharge the same day, come back as outpatient for follow up. It saves a bundle and is often possible.

Problem may be that if you're not covered for outpatient care by your insurance, the insurance company won't pay unless you're admitted as a inpatient.

But then again, I've also heard somewhere in Thaivisa that you only need to be under the hospital's care for 6 hours to be considered an inpatient...

So if it's a minor operation and it's quick, the insurance company might not pay; and it becomes better if you do it the traditional overnight 'long process'.

Am I right?

Edited December 28, 2007 by Sheryl

[katana]

I remember reading anal fistulas can be treated with some kind of surgical glue with an 80% success rate. May be worth looking into, since it seems less invasive than the standard surgical procedure to treat them.

[moldy]

Thanks to you all. You are helping me so much.

Doesn't it all happen at once, my solicitor just fouled up in that he forgot to get a vital piece of paper from the court (I've launched court proceedings against someone), this was providing me with 3 month extensions. I'm not on overstay yet and don't want to be, but can't get the paperwork sorted out in time. I can't do another 30 day, and there is not enough space in my passport for a tourist, so I may have to bail out to UK. So I might go to the hospital there.

I'll throw myself on the mercy of Suan Plu tomorrow and try to get someting sorted, I'm sure I can wangle some deal at St Louis if I can get the visa sorted. I am particularly noting a deal at what price though !, as of course ultimately my health and well being is at stake so I won't cut corners. My primary concern with epidural is being without movement in my legs. As long as I can wiggle my toes I'm sure I'd be happy. I'm a bit puzzled, when I broke my nose and had it reset, I was just knocked out for an hour with an injection, and woke up on a wonderful buzz without side effects - pethidone springs to mind, anybody know anything. Once again so grateful.

Can anybody comment on a blood pressure test of 120/60 with pulse at 47. I'm an otherwise fit 46 year old who is sporty.

[Sheryl]

Hospital policies always (as far as I have ever known) cover "same day surgery" for the simple reason that if they didn't, docs would just admit people overnigth for the same thing and it would wind up costing the insurance company more.

i have only hospitalization coverage (with BUPA) and had same day surgery for carpal tunnel decompression, it was covered no problem and I wasn't anywhere near 6 hours in hospital.

Moldy, re you BP and pulse:

BP is fine.

Pulse is normal if you are on a beta blocker (blood pressure medicine) OR are an athlete/do a lot of sports or working out. You mention sports so I guess that's it. Main things is, is it slow and regular or do there seem to be missed beats? If it is completely regular it's probably fine but if it is slow and the rhthm feels irregular you need a check up with EKG.

For the glue bit, since you also have an abscess at the site this might not be feasible but you can ask about it. An issue of infection and also the tissue needs to be healthy to be "glued" toegther, an abscess even once drained will leave ragged edges.

And yes, the procedure can definitely be done under a short-acting general anesthestic but it will cost more and take more time to recover. The procuedure you need will take longer than your nose did, that's just a momentary procedure, for this you would have to be out longer with ocrresponding longer wake up time but it can certainly be done, and I expect the anesthisologist and doc would be cooperative if you explain that you have a "thing" about being paralyzed. As mentioned the epidural needs active patient cooperation and you won't be the first to decline.

For no space in your passport your embassy can add pages, and hospitals can if necessary provide a letter for vid\sa extension. But of course in the UK you can get it all done un der NHS fopr free. Although the plane ride home may be uncomfortable..............buy one of those doughnut shped things to sit on.

[moldy]

Thanks Sheryl. I'm aware that I am working you overtime and apoligise for my unintended indiscretion on another thread. Yes I have been sporty, walk a lot and am usually on the treadmill 3 times a week. The pain was excruciating at the time, but I'm pain free, and I don't have irregular beats as far as I'm aware. I had been feeling quite hot, headachy and a bit nauseaus on and off for some time. I'd just put this down to a middle aged body being in a hot environment, and the effects of nasal problems, but I think this recurring cyst had a lot to do with it. And I think it will do so again if I don't do something relatively soon.

I can see the funny side and the lesson of not resting on your laurels. This has provided a kick up the backside figuritively too, as I have been unnecessarily shy of life as of late and avoided doing anything difficult.

The visa? well what an interesting "Only in Thailand story", best posted on another thread for general interest and amusement.

[billaaa777]

I know it is not Bangkok, but the Pattaya area. I had a very serious life threatening bacterial infection. I spent one week and had two operations at Bangkok Pattaya hospital and the cost was 350,000 Baht. I then transferred to Satahip Navel Hospital and spent four weeks and had three operations and the cost was 135,000. I highly recommend Satahip Navel Hospital, they saved my life at a cost I did not even believe was possible, especially coming from the United States where the same treatment would of cost somewhere in the range of US $500,000.

[moldy]

I know it is not Bangkok, but the Pattaya area. I had a very serious life threatening bacterial infection. I spent one week and had two operations at Bangkok Pattaya hospital and the cost was 350,000 Baht. I then transferred to Satahip Navel Hospital and spent four weeks and had three operations and the cost was 135,000. I highly recommend Satahip Navel Hospital, they saved my life at a cost I did not even believe was possible, especially coming from the United States where the same treatment would of cost somewhere in the range of US $500,000.

hel_l that sounded nasty. Are you ok? Did you sue Bangkok Pattaya?

I'm not a good patient and need to be the type of person who needs to avoid hospitalisation and take an overdose when the big door begins to open to the pearly gates. I just had an awful day. I resolve never to go to hospital again and kill myself in a an orgy of sex and morphine if ever I have a serious problem.

I booked in at Hosp 1. First thing that freaked me a bit was the barrage of tests. Chest xray??? HIV test???? ECG, and other blood checks. All ok. Which at least settled me. Wheeled in to op reception. Nice nurse at reception but a hacking cough???? Op. went sweet thanks to spinal injection and morphine. 2 hours seemed like 1 minute and no pain.

Back to ward. The drip was dripping away. They sat a jug of water in front of me, let me drink coffee and set down a pisx pot at the end of the bed. Only problem, couldn't pee. Time went on and strain turned to pain, turned to agony. In the end I was like a trapped animal, what with the paralysis and all and just hanging on the rails semi-upright as this afforded the least agony. I mean agony too. Must have lost my marbles, coz started acting irrationally, pushing attempts to help me away. Finally conceded to catheter insertion. Bladder drained, pain went away.

But catheter started really hurting end of penis. So, finally managed to get it taken out. Passed water first time some pain, second time agony- razor blade stuff. Third time the pain wasn't confined to just peeing, agonizing spasms for 30 mins afterwards. I was all in and still the same Thai looks of blankness and denial. So I just upped and went which caused a kerfuffle ,and got a taxi to another hospital mentioned on these boards.

They checked it out and said it was a very good job on the old bot bot, but must have damaged the old man while inserting the catheter. Nothing to do but wait for pain to lapse- 3 or 4 days max.

Still, first hospital phoned and they were very conciliatory. It was just bad luck, the kind that has dogged me for a year and I went to see them to sort problem out. I was impressed, the way they handled it and was honest enough to admit that I am a lousy patient with probably a low threshold of pain. The procedure was correct in tot. My bad luck was to be one of the very few patients whose bladder got temporarily paralysed, and worse whose urethra was contracted too or possibly just narrowed. They used the smallest adult tube.

What's more. The fistula wasn't even a fistula, but nobody could have known that, it certainly looked like one. It was a large infected sinus from a recurring boil.

Cost 36000. Insurance will cough up 16000.

Bad week for both botty and todger- never happened to John Wayne

If I'm being charitable I would reco. both hospitals. I reckon I'm the type of person a hospital can do without. Just make sure you have a good ins. policy (under 15000 prem at age 46 forget it), or hot foot it back to farangland.

[Sheryl]

Moldy,

Indeed, you are a difficult patient, from the sounds of it!

Urinary retention is a common problem after anesthesia, both spinal and general. Management is to wait it out if the patient is not in too much pain and cathetirize otherwise, just as they did.

The pain you have had afterwards may be due to either just inflammation (which will subside on its own) OR infection, which can happen with catheters. If infection you would need antibiotics. I assume they did a urine culture to rule that out.

BTW, there is a medication locally available which is taken orally and anethesthizes the urethra, magically removes the pain (temporialy). Generic name is phenazopyridine, several brand names including pyridium and med-phenazo. It will turn the urine a bright orange-red color and works more quickly if taken with large amount of water. It is only a temporary fix but can be a most welcome one. Naturally if you find the need to take it for more than a couple of days, you need to be checked for infection,

Anyhow...from what you say it does not sound like eithjer hospital erred in any way except for maybe not being very expert in handling dfficult farang patients...!

Glad to hear you've had the problem taken care of.

[moldy]

Moldy,

Indeed, you are a difficult patient, from the sounds of it!

Urinary retention is a common problem after anesthesia, both spinal and general. Management is to wait it out if the patient is not in too much pain and cathetirize otherwise, just as they did.

The pain you have had afterwards may be due to either just inflammation (which will subside on its own) OR infection, which can happen with catheters. If infection you would need antibiotics. I assume they did a urine culture to rule that out.

BTW, there is a medication locally available which is taken orally and anethesthizes the urethra, magically removes the pain (temporialy). Generic name is phenazopyridine, several brand names including pyridium and med-phenazo. It will turn the urine a bright orange-red color and works more quickly if taken with large amount of water. It is only a temporary fix but can be a most welcome one. Naturally if you find the need to take it for more than a couple of days, you need to be checked for infection,

Anyhow...from what you say it does not sound like eithjer hospital erred in any way except for maybe not being very expert in handling dfficult farang patients...!

Glad to hear you've had the problem taken care of.

In the main I agree. I have no complaint and will apologise again when I return for check up with the doctor who now appears to be a friend too. I was in great pain and fear.

On the point of loss of bladder action and it's propensity to cause pain. Why on earth I have to ask, was a full water jug, hot water jug and coffee, set in front of me. Wasn't that just plain silly. Surely, good practice would demand a wait and see approach? How can intelligent people not see that !!!!

Thanks for follow on advice about possible infection. I confirm the diagnosis was irritation withou infection, but amoxclav was prescribed presumably as a precaution.

[junkofdavid2]

Moldy,

Indeed, you are a difficult patient, from the sounds of it!

Urinary retention is a common problem after anesthesia, both spinal and general. Management is to wait it out if the patient is not in too much pain and cathetirize otherwise, just as they did.

The pain you have had afterwards may be due to either just inflammation (which will subside on its own) OR infection, which can happen with catheters. If infection you would need antibiotics. I assume they did a urine culture to rule that out.

BTW, there is a medication locally available which is taken orally and anethesthizes the urethra, magically removes the pain (temporialy). Generic name is phenazopyridine, several brand names including pyridium and med-phenazo. It will turn the urine a bright orange-red color and works more quickly if taken with large amount of water. It is only a temporary fix but can be a most welcome one. Naturally if you find the need to take it for more than a couple of days, you need to be checked for infection,

Anyhow...from what you say it does not sound like eithjer hospital erred in any way except for maybe not being very expert in handling dfficult farang patients...!

Glad to hear you've had the problem taken care of.

In the main I agree. I have no complaint and will apologise again when I return for check up with the doctor who now appears to be a friend too. I was in great pain and fear.

On the point of loss of bladder action and it's propensity to cause pain. Why on earth I have to ask, was a full water jug, hot water jug and coffee, set in front of me. Wasn't that just plain silly. Surely, good practice would demand a wait and see approach? How can intelligent people not see that !!!!

Thanks for follow on advice about possible infection. I confirm the diagnosis was irritation withou infection, but amoxclav was prescribed presumably as a precaution.

Why did the insurance only pay 16,000 out of the 36,000?

Also, which hospital? (You can PM me if you wish).

[moldy]

Moldy,

Indeed, you are a difficult patient, from the sounds of it!

Urinary retention is a common problem after anesthesia, both spinal and general. Management is to wait it out if the patient is not in too much pain and cathetirize otherwise, just as they did.

The pain you have had afterwards may be due to either just inflammation (which will subside on its own) OR infection, which can happen with catheters. If infection you would need antibiotics. I assume they did a urine culture to rule that out.

BTW, there is a medication locally available which is taken orally and anethesthizes the urethra, magically removes the pain (temporialy). Generic name is phenazopyridine, several brand names including pyridium and med-phenazo. It will turn the urine a bright orange-red color and works more quickly if taken with large amount of water. It is only a temporary fix but can be a most welcome one. Naturally if you find the need to take it for more than a couple of days, you need to be checked for infection,

Anyhow...from what you say it does not sound like eithjer hospital erred in any way except for maybe not being very expert in handling dfficult farang patients...!

Glad to hear you've had the problem taken care of.

In the main I agree. I have no complaint and will apologise again when I return for check up with the doctor who now appears to be a friend too. I was in great pain and fear.

On the point of loss of bladder action and it's propensity to cause pain. Why on earth I have to ask, was a full water jug, hot water jug and coffee, set in front of me. Wasn't that just plain silly. Surely, good practice would demand a wait and see approach? How can intelligent people not see that !!!!

Thanks for follow on advice about possible infection. I confirm the diagnosis was irritation withou infection, but amoxclav was prescribed presumably as a precaution.

Why did the insurance only pay 16,000 out of the 36,000?

Also, which hospital? (You can PM me if you wish).

[moldy]

Hi JD2. Loved the quip on the other posting ref pood poisoning poster alive or dead. good giggle.

I'll pm you when I find out how to. But for the benefit of all, there is no question mark overall about the general standard of service of any hospital at all and particularly the ones mention on the board. Everything was standard procedure and the prices were ok. I didn't realise it but I have a deep fear of treatment in general, hiv tests, epidurals, and interference with my self prized private parts in particular. I think this is the over riding factor here.

Ref, the insurance, I have a policy with Thai Life taken out with a farang broker who explained the option to me. He's very good and is the one rec. by the major teaching forum out here. I took out a relatively cheap policy which has a deductible of 20000 as I remeber as a conscious choice. So I'm assuming that as with car insurance, I have to pay the first 20000.

I think anything under 13k at age 46, (maybe 15k) premium won't cut the mustard and is not therefore a good idea. Confirm this was an 'in patient' procedure. had I not have had the deductible, the insurance would have been quite within the limits on all accounts. Indeed the surgeon's fee was only 10k and in fact I feel quite mean.