Seeking Recommendation For Pediatrician For Digestive Problems

[buzzer]

Hi,

My friends have a little 3 + year old daughter that has some serious entrenched digestive disorder, and needs some advice, or referral to a good pediatric physician with a good background in digestive disorders.

Sara started having high - 40+ fevers at about 8 months. These were accompanied by vomiting, stomach pain, and, at times a rigid stomach. Some of these ordeals are so prolonged that she looses a considerable amount of weight. Finding good health care has eluded us completely for her case.

She went with her father to his home country and had an attack of the same symptoms, exacerbated by her being separated from her mother and younger sister. So, again she had 40+ fever, couldn't eat much without vomiting, loss of appetite, stomach pain, rigidity of the abdomen, some diarrhea, general malaise and weakness. About a week ago her father reported that she had a yellow cast to her skin, so add jaundice to the long list. Some of the previous bouts of vomiting also were green, indicating bile.

I have very little faith in the quality of medical service in Thailand. Every time she gets bad, the parents take her to the govt. hospital, usually in Nathorn, Samui. There, the doctors give her a gamut of drugs, which, I believe usually include antibiotics, and something to stop the impulse to regurgitate her food. No testing is done beforehand, and no follow-up testing is done, either. She seems to get better, but within a few days to a couple months, it's the same old story again.

After her return from abroad, we took her to St Louis Hospital in BKK. The first doctor we talked to seemed to be pretty good, but all they did was give her an IV to replace some electrolytes, and gave her some medicine. The venipuncture for the IV was not pleasant for her, or for any bystander, and I hoped that the blood samples would be put to good use. Not so! I should have dictated what tests I wanted them to do, because, in spite of the jaundice, they performed no liver panel, just a CBC, and check for some antibodies. They were most interested in getting her lungs x-rayed for TB, in spite of the fact that her symptoms did not include coughing. They also stripped her naked to look for the scar from an inoculation she would have received as an infant, and were worried that they didn't find any scarification consistent with that inoculation. They would have collected a stool sample, but with her not eating, and the short time she was in the hospital, were unable to. Feeling that they had really started off on the wrong foot, when we had requested a comprehensive check-up, we yanked her out of there, especially after the doctor on Friday said, "She's fine!".

Fine, indeed! Last night she had a 40+ temp and was vomiting. In my personal opinion, she probably has some organism that the doctors have been making more intractable through their ill-advised misuse of antibiotics. She needs - bottom line - the full gamut of tests, not a piecemeal approach. If I could find a natural alternative, I'd try it if it was my daughter, but it might be difficult convincing her parents to go that route.

Thank You! Any suggestions you have will be carefully considered.

Buzzer

[Sheryl]

Given the fever, I would start with a specialist in pediatric infectious disease rather than a GI specilaits

Suggest trying one of the following:

Samitivej Hospital

Tassanee Sookpranee , ASST.PROF. M.D. (female)

Specialty : PEDIATRICS

Sub Specialty : กุมารเวชกรรม - โรคติดเชื้อเด็ก (PEDIATRIC - PEDIATRIC INFECTIOUS DISEASE)

กุมารเวชกรรม (PEDIATRICS)

Expertise : Pediatrician

Language : ENGLISH, THAI

Certificate in Pediatric Infectious Disease

Diplomate Thai Board of Pediatrics

Date Time Office

MON 09:00-17:00 Samitivej Sukhumvit Hospital

Child Health Institute

TUE 09:00-16:00 Samitivej Sukhumvit Hospital

Child Health Institute

WED 09:00-17:00 Samitivej Sukhumvit Hospital

Child Health Institute

THU 09:00-16:00 Samitivej Sukhumvit Hospital

Child Health Institute

FRI 09:00-15:00 Samitivej Sukhumvit Hospital

Child Health Institute

SAT 09:00-14:30 Samitivej Sukhumvit Hospital

Child Health Institute

Bumrungrad Hospital

Name: Dr. Prasong Pruksananonda (male)

Speciality: Pediatrics (Children), Pediatric Infectious Disease

Language: Spoken: English,Thai

Qualifications: Medical School:

- M.D., Faculty of Medicine, Chulalongkorn University,

Thailand, 1978

Board Certifications:

- Diploma of The Thai Board of Pediatrics, 1982

- Diplomate of The American Board of Pediatrics, 1988

- Diplomate of The American Board of Pediatrics, 1995

- Diploma of The Thai Sub Board of Pediatrics Infection Disease, 2005

Special Clinical Trainings:

- Pediatric Infectious Diseases/Immunology, University of Rochester, Rochester, N.Y., U.S.A., 1990

Instructor and Fellow in Pediatric Infectious Diseases and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA, 1987-1990

Special Clinical Interests:

- Vaccines, Virology

Day Time Location

Mon 09:00 - 19:00 Children Center

Tue 09:00 - 19:00 Children Center

Wed 09:00 - 12:00 Children Center

Thu 09:00 - 19:00 Children Center

Fri 09:00 - 19:00 Children Center

Sat 09:00 - 12:00 Children Center

Sun 09:00 - 16:00 Children Center

Dr. Sasithorn Likitnukul (female, and an Associate Professor)

Speciality: Pediatrics (Children), Pediatric Infectious Disease

Language: Spoken: English,Teo Chew,Thai

Qualifications: Medical School:

- M.D., Faculty of Medicine, Chulalongkorn University, Thailand, 1975

Board Certifications:

- Diploma of The Thai Board of Pediatrics, 1979

Professor, Chulalongkorn University, Thailand

Fellowships:

- Pediatric Infectious Disease, Southwestern

Medical Center, USA, 1986

Special Clinical Interests: Infectious Disease, HIV Infection.

Day Time Location

Tue 17:00 - 20:00 Children Center

Sat 17:00 - 20:00 Children Center

Good luck, and good for you to help these folks!

[H2oDunc]

I'm no doctor but it sounds very like an allergy. I would first stop dairy products for a period and see if this helps then stop wheat products as they are 2 of the most common. The above post gives some some good advice which would be good to folow up on also. Good luck

[bina]

the other thing u can check for is depending on the parents' ethnic background as there are several reoccuring diseases that are based on ethnic genetics with those reoccuring fever and stomach (and other presentations) symptoms. mediterranean cyclical fever and similar, usually when one or both parents are from the mediterranean area and or north africa/ it is often misdiagnosed unless u live in an area that has doctors that are familiar with that...

familial Mediterranean fever and familial Hibernian fever are two types, there is a non ethnic based one also.... but all are similar and need a good doctor for a differential diagnoses: try googling for cyclical fevers and read through... worse comes to worse the doctors say it doesnt sound like this, but i come from a country where it IS fairly common and is one of the possibilities when a child presents with symptoms like 'sara's' and that is the first thing i thought of since i know of several children with the syndrome that is common here.

this doesnt rule out a zillion other things also that have to be checked for ...

bina

israel

[buzzer]

Hi,

Thanks for the concern. All good advice so far. We're in Ko Samui, and it's difficult enough finding a good doctor in BKK, let alone here. What can you say about a hospital (actually 2) that had no doctors because of Songkran?

The idea of allergies sent up a red flag with me. She eats a very bad diet, unless her father cooks. The rest of the stuff is junk from 7-eleven. Among the things she eats a lot of is milk, and corn, both of these give a lot of people problems. Wheat too! And shrimp! And a whole host of other things we don't think twice about.

So I gave her father some advice to cancel all processed foods because even a hot dog might contain milk, corn, and wheat products. I advised him to stick with rice and simple fruits and vegetables and little meat. I'll read up more on how to go through the allergy elimination process, but this will do for a start.

I'm like a grandfather to this child, and have been close to the family since shortly before she was born. I don't like some things I see the parents doing, but it's not proper for me to criticize to strongly. One thing notable is that she's not been weaned at 3 years! I think it's just a gesture, because I believe her mother stopped producing milk, but I'm not sure if this a factor or not.

Ethnically, she's Asian (mixed, but no Mediterranean, or African ancestry) - to answer Bina's observation. But I know a lot of Asians can't handle milk, and corn has only been in Asia since it was brought here after the discovery of the Americas. So I suspect a lot of Asians have problems with corn products, as they haven't had that many generations to adapt to it. Same can be said of Europeans, and everyone who isn't North or South American Indian, in fact. But I'll google around based on that suggestion. Even ruling out something is a step in the right direction.

Thanks for the help so far. If anyone has additional suggestions, please feel free to post them. This disease cycle has just gone on too long, and been aided by to much bad medicine.

Thanks!

Buzzer

[bina]

most food allergies wouldnt cause re occurring fevers but some virus do also, mono is one, cmv is an other...

to do food allergies u have to keep a record of everyhting the child is eating, and also when vomiting , and listing temps, to see if there is, indeed a cycle, or cooincedental...

corn is usually never a problem. wheat gluten maybe but not sure if celiac is common in a rice eating society.

breast feeding at 3 yrs has no problems other then social ones if the mother or child find it irritating. mother has little milk, and not the most nutritious bbut definately wouldnt cause digestive problems or fevers.

at three years, shrimp et al are usual foods in thailand.

junk food with preservatives can cause problems but usually not fever.

what about malaria and other indigenous diseases including blood diseases that are asian inherited?

and some antibiotics cause stomach problems

what about giardia (fever and stomach but usually diahrea, not vomiting) same same for some persistant types of salomanella.

in israel, though wer are more or less first world, we still have lots of these diseases in children, enough that doctors recognized them.

bina

israel

[Sheryl]

Yes, the presence of hiogh (40 C) fever makes allergy unlikely and is why I recommend seeing a specialist in pediatrioc infectious diseases.

To minimize costs be sure to bring with you the results of any and all tests that have already been done, especially any cultures taken during an acute episode.

[buzzer]

Hi,

Again, Thanks for your responses. She's been feeling somewhat better during the last couple days, but I fear it's only temporary, given her history.

I think what is needed is for 1 good doctor to test her before, and after an episode. I agree that food allergies would probably not be responsible for a high fever, but it's worth looking into anyway. I could send a stool sample to the US to Genova labs. It would be expensive, but they're very thorough. I could send a nasal smear slide to a reputable doctor I know that can tell worlds of information from the evidence he finds on those. Before you criticize, this helped save my life back in 1999.

I checked out the latest medicines they've prescribed, and, as usual, there is an antibiotic in there. Now if she did have a bacterial problem, that was knocked down somewhat by the antibiotics, is is certainly possible, if not likely, that these doctors are just strengthening the bacteria with the antibiotics. I never went to the hospital, or clinic until I went to St.Louis in BKK. What I believe is happening is that they just go from one so-so doctor to another and he, or she just throws an antibiotic at her hoping it will make her better. I know it's difficult to isolate exactly what the pathogen is, but, if they don't do the gamut of tests, they won't find out, and prescribing just any old antibiotic, not for a long-term but just until the majority of the pathogens are dead, doesn't make any sense. Now, I hate antibiotics. I have a chronic condition (or two that I feel are the result of anti-biotic abuse which started with my doctors), but IF antibiotics must be taken, then they should be taken for long enough to kill all the bugs.

So, I think it might be wise, when this happens again to go to BKK. Right now a blood test or stool test would be useless, because she's been on antibiotics for a few days. But I'm no expert in this area. There's many times I wish I didn't live in Samui especially when I want to go to the hospital or a good, cheap restaurant

Thanks again,

Buzzer

[Thanyaburi Mac]

Hi,

Again, Thanks for your responses. She's been feeling somewhat better during the last couple days, but I fear it's only temporary, given her history.

I think what is needed is for 1 good doctor to test her before, and after an episode. I agree that food allergies would probably not be responsible for a high fever, but it's worth looking into anyway. I could send a stool sample to the US to Genova labs. It would be expensive, but they're very thorough. I could send a nasal smear slide to a reputable doctor I know that can tell worlds of information from the evidence he finds on those. Before you criticize, this helped save my life back in 1999.

I checked out the latest medicines they've prescribed, and, as usual, there is an antibiotic in there. Now if she did have a bacterial problem, that was knocked down somewhat by the antibiotics, is is certainly possible, if not likely, that these doctors are just strengthening the bacteria with the antibiotics. I never went to the hospital, or clinic until I went to St.Louis in BKK. What I believe is happening is that they just go from one so-so doctor to another and he, or she just throws an antibiotic at her hoping it will make her better. I know it's difficult to isolate exactly what the pathogen is, but, if they don't do the gamut of tests, they won't find out, and prescribing just any old antibiotic, not for a long-term but just until the majority of the pathogens are dead, doesn't make any sense. Now, I hate antibiotics. I have a chronic condition (or two that I feel are the result of anti-biotic abuse which started with my doctors), but IF antibiotics must be taken, then they should be taken for long enough to kill all the bugs.

So, I think it might be wise, when this happens again to go to BKK. Right now a blood test or stool test would be useless, because she's been on antibiotics for a few days. But I'm no expert in this area. There's many times I wish I didn't live in Samui especially when I want to go to the hospital or a good, cheap restaurant

Thanks again,

Buzzer

How about checking in with the Chula University Hospital in Bangkok?

Bhor Por Ror 8 Building

Pediatric Clinic Telephone : 0-2256-5248

xxxxxxxxxxxxxxxxx

Mac

[khun_j]

hi,

we´ve been seeing this one and she was quite competent and thorough with our child:

VORANUSH CHONGSRISAWAT , Associate Professor, M.D.

Specialty : PEDIATRICS

Sub Specialty : กุมารเวชกรรม (PEDIATRICS)

Expertise : PEDIATRIC GASTROENTEROLOGIST

Language : ENGLISH

THAI

Education : M.D.

Diplomate Thai Board of Pediatric

Diplomate Thai Sub-Board of Pediatric Gastroenterology and Hepatology

Certificate Fellow in Pediatric Gastroenterology and Nutrition,Children's Hospital Boston, USA

Certificate Fellow in Pediatric Gastroenterology and Nutrition, Royal Children's Hospital, Australia

Date Time Office

FRI 17:00-20:00 Samitivej Srinakarin Hospital

Child Center

hope you will find the cause for the problems soon.

[buzzer]

Hi,

Thanks for your responses, I'll discuss all these with the father and mother. Right now Sara is doing just fine, but this is all part of the cycle, I'm afraid, and, unfortunately I believe it's only a matter of time before this thing rears its ugly head again. I hate to wait until she gets sick again to do something, but I don't know if tests taken when she's experiencing her times of wellness will provide any results. Difficult to say. Still open to information & suggestions, though.

Thanks,

Buzzer

[Sheryl]

Hi,

Thanks for your responses, I'll discuss all these with the father and mother. Right now Sara is doing just fine, but this is all part of the cycle, I'm afraid, and, unfortunately I believe it's only a matter of time before this thing rears its ugly head again. I hate to wait until she gets sick again to do something, but I don't know if tests taken when she's experiencing her times of wellness will provide any results. Difficult to say. Still open to information & suggestions, though.

Thanks,

Buzzer

I think you are right. Wait until she is symptomatic and then bring her to a specialist in Bkk (without first taking any antibiotics!)

In the meantime if you can compile records of prior test results, treatmens given to bring along, that would help

[buzzer]

In the meantime if you can compile records of prior test results, treatmens given to bring along, that would help

I am afraid that this, due to the lack of proper oversight, and the general hubris of the Thai doctors, that this would amount to little more than an oral report by the parents of what she's been through. Still, I'll ask them if they can dig up anything. Most of the tests (if there were any) would have been done at the govt. hospital in Samui.

Thanks,

Buzzer

[LazyCat]

I think they should do a general checkup on the child... last time I read in the forums that the child started having high fevers and vomiting, they were curing her of digestive problems but it came out to be a tumor in the brain....I hope it is not your case but id does not sound like an allergy to me...

[WarpSpeed]

I hope this is not too late, since you're in Samui there is a very good Pediatrician that practices in Phuket at Phuket International hospital, he has spent most of his career practicing and was a Diplomat of the American Board of Pediatrics before coming back here and is one of many reasons I was very unhappy to leave the area. He is an older Thai gentleman and speaks and understands perfect English with western sense and is also very willing to listen to his patients parents concerns without being dismissive.. With our combined efforts as a team we managed to get my boys asthma under control where before it was an almost monthly hospital stay and even in critical care several times in danger of requiring respirators..Having his knowledge and experience as well as being able to communicate clearly with a practical western sense was very reassuring to us..

His name is:

Dr. V. Soodjinda

07-624-9400

Hope this finds you in time to do some good..

Edited May 28, 2009 by WarpSpeed