Quinsy

[Guderian]

I've got a Thai friend in her mid-20's who has been quite unwell this year. She's been off work most of the year, and while I've tried to help her out she lives 30 km away and I don't have a car, so I've not been able to see her as often as I would have liked. Also, she can't drive her motorbike much now as she gets dizzy spells. There's also the language barrier, of course, especially when it comes to a specialist area like medical conditions and treatments.

Anyway, she got her doctor to write down in English what her problem is, and he wrote 'allergy' and 'quinsy'. The treatment seems to be just anti-histamines, which would help the allergy I suppose, but as far as I can see would be of no use for the quinsy. Earlier in the year she was suffering quite bad pain in one side of her neck and throat, which seems consistent with quinsy. I'm wondering why they aren't doing something more aggressive like removing the tonsils, or lancing the ulcerated one?

Has anyone had experience with this condition, and how was it treated? Is it common in Thailand? Now that I have a word for her ailment, Google tells me all sorts of worrying things, like the cardiovascular complications that can arise if it is untreated. It's beginning to scare me that something bad might happen to her as a result of medical negligence in a Thai public hospital (she goes to Laem Chabang hospital). If I knew what to do, I would be quite happy to pay to get her treated in Sirikit, or even Bangkok-Pattaya hospital, but I don't want to get on the wrong side of her doctors in Laem Chabang if they are actually doing the right thing.

If anybody has any advice or experience with quinsy, especially how it is usually treated here in Thailand, I should be very grateful for it.

Thanks.

[Damman1]

I suffered from quinsy twice, hospitalisation on both occasions. The first episode was treated with antibiotics and I was allowed home after 5 days with no further treatment recommended.

On the second occasion, five or so years later, the Doctor lanced the ulcerated parts of my throat and drained the areas with a big syringe. After a further week on antibiotics I was then wheeled into the theatre for removal of my tonsils.

This was at the age of 34, 8 years later I have had nothing more than minor sore throats and nothing in comparison to the pain and difficulties associated with quinsy.

With the tonsils gone the threat of quinsy is gone for good.

[Sheryl]

Treatment is antibiotics and, often, incision and drainage of the abscess.

It is hard to believe this woman has not been given antibiotics, as if anything Thai hospitals tend to overprescrive them.

For this condition it is essential that the antibiotic be selecetd based on culture results as soemtimes unusual organisms are involved.

Actually Thai government hospitals are pretty good from the provincial level on up. At district level, which it sounds like where she is being treated, capabailities are very low both in terms of personnel (usually oen or two recent med school grads working off manadatory govt service) and facility. definitely would not have the ability to do a culture, in fact very little in the way of lab back-up.

I would suggest she go to the relevent provincial hospital (?Chonburi? I'm not sure where Laem Chabang is) or to Queen Sirikit, either should be able to manage this and neither would be very costly for what is likely to be outpatient care.

I do not recommend continuing treatment at a district hospital. In fact I don't recommend them for much of anything at all; if someone is sick enough to require a doctor they are usually best advised to head to the provincial hospital even if it means a considerable trip. At least that has been my experience. There may be a few exceptions in cases where, due to an unusually large population center outside the provincial town or unusual distance/physical barriers, a district hospital has enhanced capabilities.

[Guderian]

Thanks for the information, Damman1 and Sheryl. As I only see her a few times a month, she may have been prescribed a week's course of antibiotics that I never saw. I'll try and ask when I see her again next week.

My niece back in the UK has had her tonsils removed recently as they were giving her major problems. Her father told me when I mentioned my Thai friend's problems that it may also have been quinsy (my niece is 30 years old, so the right age). Anyway, a tonsilectomy seems to have fixed her, so I was wondering why they don't do a similar cheap and simple procedure here? I guess that your comments about district hospitals explains that. BTW, Laem Chabang is a small place with a big port, it's Thailand's main deep water port, located between Pattaya and Chonburi city. So the hospital would be a district one, and in all the discussions I have seen on the quality of hospitals in this area, nobody has ever said, "I can really recommend Laem Chabang hospital".

Lots of people living here, though, have said good things about the Queen Sirikit hospital. I'll have a chat with my friend about it when I see her next, though to be sure we are on the same wavelength I will try and arrange an interpreter. I don't think that she'll be very keen on the idea of lancing the ulcerated area and then removing the tonsils, but it sounds like it's the only thing that will fix her.

Thanks again, your time spent responding is much appreciated.

[dumball]

Years ago in England , all children had their tonsils removed because of the fear of Quinsy which can cause you to ckoke to death if not properly treated . We rushed my second daughter to hospital in Canada because of severe throat pain and difficulty in breathing , she was finaly diagnosed with Quinsey , the doctor said that was difficult because it had disapeared years ago . After several days in hospital with special medication , she was released , no further problems .Get your friend to a good hospital ASAP .

[Guderian]

Thanks. I want to get her at least examined by a competent ENT specialist in a good hospital. The trouble is that she has the usual Thai attitude of not questioning the teacher or doctor, just doing whatever she was told by someone of higher status. Although she never told me this, a mutual friend told me some months back that the quacks in RP Laem Chabang had given her suppositories to stick up her backside. Of course, she obediently did as told, but what has that got to do with treating quinsy???

[Sheryl]

May have been paracetemol for fever/pain. Perhaps in suppository form because of pain/trouble swallowing.

But as mentioned, a district hospital is not the right level of care for this problem.

A common failing iof Thai hospitals and doctors is to not say so when the problem in question is beyond their capabilities to manage. Perhaps the "loss of face" thing.

[Guderian]

May have been paracetemol for fever/pain. Perhaps in suppository form because of pain/trouble swallowing.

But as mentioned, a district hospital is not the right level of care for this problem.

A common failing iof Thai hospitals and doctors is to not say so when the problem in question is beyond their capabilities to manage. Perhaps the "loss of face" thing.

Paracetamol suppositories - well, I learn something new every day. It might well be the explanation, as at that time the throat pain was quite bad. She doesn't complain about the throat nowadays, but she gets dizzy spells so she can no longer ride her motorbike, and is constantly listless ('no have power'). I'll see her either on Sunday or Monday and will try and sort something out for her.

Thanks.