Hospital For Cag

[WarpSpeed]

I did find out I had an AAA to (absominal aortic aneuriysm)...ughhh....it was only 3.4 cm so is not bad and they don't worry about fixing that until it grows to 5 or 5.5 and that can fixed with a stent also but is not something I look forward to....yikes....dam_n 50's huh....

My mother had an AAA and hers was not a major concern either now some years later it has actually encapsulated without intervention and is not considered any threat what so ever she's now 81 and that was at least 10 years ago..

My father had a AAA, and it's what ultimately got him. He had a stent, but it slipped a bit and the artery popped just at the edge. I had just taken him to the doc to have it xrayed and checked out...4 weeks later he passed.

My uncle just had a stent put in. I guess it is hereditary. So, at 53, I'm going to have it checked out. My father's doc even pulled me aside during his checkup and told me to have mine checked as it is highly possible I have an aneurysm also....

Getting old sucks!!!! Shouldn't have eaten so many big mac's with fries when I was younger!

It's all a lottery isn't it?

They used a stent to correct an aneurysm? Or did I misunderstand that his stent caused his aneurysm when it slipped, another scary thought, one causing a tear. I've never heard of a stent being used in that case as it's usually corrected only with surgery since it's an outward bulging of the artery and the stent is placed internally for the purpose of support and dilation of the vessel...

Yep sounds like you shouldn't be playing the lottery, it does suck to get old but not as much as it did even just a few decades ago when this thread wouldn't exist because the Internet didn't exist . But besides that neither did much of this technology to give options and life extensions..

Edited December 12, 2010 by WarpSpeed

[craigt3365]

Dad had an aneurysm. AAA. After a certain size, they put in a stent to control it. Worked for several years. But it popped just outside the stent. The doc said it had slipped and allowed the aneurysm to burst. I'm no doc, so hope I am explaining this properly. It was very sad as he would have survived if he had not lived where he did...in a remote town out in the desert with a clinic instead of a full blown hospital. The air ambulance didn't arrive in time. But, he lived in his dream location...so good for him. We don't last forever and at 79, had a great life.

You are right. It is a lottery. One life changing event for me was the passing of a good friend at the age of 47. I was also 47 at the time. He was the CFO of our company. Rich, never drank, never smoked, ran every day. Massive heart attack and died on the spot. He had physicals every year and nothing ever turned up...ya just never know...

[WarpSpeed]

My father had no symptoms of an MI except that his lungs would begin filling up with fluid when he lied down so he was forced into the hospital to have it checked and this was in an area where there are a lot of retirees and back in the States so no reason not to be more educated about symptoms but the hospital he went to was clueless that he was experiencing a blood back up from a blockage so he laid there for 2 days without improvement before he was finally scheduled for a cath angio and then they found the 99% blockage and he was rushed by ambulance, flashing lights and sirens to a heart center just 10 miles south for open heart bypass (this predates stent technology too 25 years ago)..

The whole thing was a complete cluster f_-* as I went to this house to pick up some personal things for him and his wife went with him to the hospital in the ambulance but before I left they had him laying outside, on the gurney, wrapped in blankets, after he had come out of a 78 degree cath room, loaded with monitors laying between his legs and sweating bullets in 98 degree heat, unshaded in the hot sun, in Florida 100% humidity while they fumbled with getting the equipment into the ambulance. Nothing like further taxing a heart patient to the maximum ..

I'm branded the more emotional one in the family so in order not create waves and confrontation I tried to sit back and let my step mother and my sister try to handle it, but they were both out of it completely and to this day I regret not being more aggressive and stepping in as I understand these things better..

Bottom line is that he was rushed into emergency surgery at the heart center (which was very good unlike the prior hospital) and he had a triple bypass and heart valve replace as it had degenerated having blood backed up for so long and not getting good oxygen the tissue was necrotic. Add in the blood thinners he had been taking it was very difficult to control bleeding and the surgeon was not very optimistic as he said he did not have any "healthy tissue" to suture the valve to and you could see it in his body language as he reluctantly mentioned he could have done far more had he gotten my father even a day earlier (hinting to us without directly implying that the his previous doctors were incompetent and completely dropped the ball, professional courtesy and all that)..

My father ended up expiring from a hemorrhage of the valve early the next morning after he had to be rushed into surgery earlier in the night to control bleeding, so the moral is again about the lottery even in a location where the medical should be up to standard and readily available the result can still fall short..

He had also had a stress test just 2 weeks before this happened as he was preparing to make a solo cross country trip by camper and was in the process of preparing the camper when this all happened. If there is any good to come out of this beside my awareness and education, that is this was it. That he wasn't on the road far away and secluded from the family when this happened..

Basically he did everything right and they still managed to kill him with an MI that he wasn't even having originally.. That's the tragedy and frustration as the last thing you need in those situations is more stress trying to convince the professionals that your not a hypochondriac and they should take proper care as they're always cautioning us to take it seriously and when we do..........................????

Edited December 13, 2010 by WarpSpeed

[craigt3365]

Sorry to hear that. I didn't elaborate on my father, but he passed in the ER as they tried to figure out what to do. He had a AAA, all the symptoms of it bursting, and they just left him in the ER for 6 hours. When the helicopter came, 6 hours later, it was too late. He died as they were putting him in the copter. This was in a small town about 60 miles outside Las Vegas. There is a hospital there, but it is a small one.

Like you have said, it is a lottery. Enjoy life while you can. It's why I retied early, even though financially, it wasn't a good decision!

[chakatee]

It's all a lottery isn't it?

They used a stent to correct an aneurysm? Or did I misunderstand that his stent caused his aneurysm when it slipped, another scary thought, one causing a tear. I've never heard of a stent being used in that case as it's usually corrected only with surgery since it's an outward bulging of the artery and the stent is placed internally for the purpose of support and dilation of the vessel...

Yep sounds like you shouldn't be playing the lottery, it does suck to get old but not as much as it did even just a few decades ago when this thread wouldn't exist because the Internet didn't exist . But besides that neither did much of this technology to give options and life extensions..

They have been using stents to correct AAA's or other aneurysms since the 90's. Minimally invasive way to reduce pressure on the artery wall and to artificially create new artery walls.

[WarpSpeed]

Delete: misunderstanding...

Edited December 13, 2010 by WarpSpeed

[Phil Conners]

Just noticed another thread with more interesting information about this:

Hm, and a not-so-positive story about this procedure at BPH

Both from 2008 so just two years ago....

I'm also interested in reading several suggestions that angioplasty only lasts about 3 years after which the stent is so overgrown again that a new angioplasty may be necessary.

Edited December 13, 2010 by Phil Conners

[WarpSpeed]

It's all a lottery isn't it?

They used a stent to correct an aneurysm? Or did I misunderstand that his stent caused his aneurysm when it slipped, another scary thought, one causing a tear. I've never heard of a stent being used in that case as it's usually corrected only with surgery since it's an outward bulging of the artery and the stent is placed internally for the purpose of support and dilation of the vessel...

Yep sounds like you shouldn't be playing the lottery, it does suck to get old but not as much as it did even just a few decades ago when this thread wouldn't exist because the Internet didn't exist . But besides that neither did much of this technology to give options and life extensions..

They have been using stents to correct AAA's or other aneurysms since the 90's. Minimally invasive way to reduce pressure on the artery wall and to artificially create new artery walls.

Thanks for that but see this is what I don't understand? How does it reduce pressure on the interior when the stent is perforated the pressure is still just as great. Once the arterial wall is weakened to the point of an aneurysm it requires support from outside not internally.

It would be like putting mesh inside of a balloon and continuing to blow it up with water, air or whatever, it will still blow up eventually. Consider a tire that has a blister, it has plenty of other support but it will still leak eventually and moreover the in tact surrounding tissue places more stress on the weakened area. Put the same balloon inside of a mesh bag and you can put in far more pressure without bursting..

I know I'm using mechanical examples here but this is all applicable and where doctors would like you to think we are so different as human machines, but we aren't, it's all relative and the mechanics being applied don't work. When the risks of having one placed are so high regardless of how routine it has become and adds other potential problems to the mix, I can see it eventually reducing pressure if it begins to be grafted into the surrounding tissue but that takes months to years to happen and potentially never if it's a medicated stent as that's the purpose of the medication to slow or prevent. Seems like in the mean time a long time to be playing the odds of a hemorrhage not happening..

Personally with the advent of arthroscopic in so many areas these days it seems far more effective and realistic to develop a sleeve that clamps around the outside to support and locks into place and can easily be applied in such a procedure..

Edited December 13, 2010 by WarpSpeed

[WarpSpeed]

Just noticed another thread with more interesting information about this:

Hm, and a not-so-positive story about this procedure at BPH

Both from 2008 so just two years ago....

Don't know if you're doing any other research but I've just been looking into the differences between medicated and regular stents and there is some serious debate on the difference between the 2 and whether or not the medicated is the way to go especially considering the cost difference you might want to look into it..

Yeah he mentions stent size and also proper installation making certain it is fully inflated which is VERY important and can cause all sorts of issues that are potentially life threatening including blood clots which is even worse then the original stenosis..

Not so routine it seems ....

Edited December 13, 2010 by WarpSpeed

[Phil Conners]

And that drug-eluding stents only elude drugs for about 3 months.

Sorry for the notes-like comments, but I'm trying to collect my thoughts here...

[WarpSpeed]

I also wanted to note that another poster mentioned his confidence in a university hospital being related to the "student" doctors being well supervised etc. in terms of quality for procedures and I'd just like to say that I don't share that point of view where my person is concerned.

Though I'd consider a university hospital due to cost, general level of care, etc. I'm not really enthused about having a student using me as a teaching toy where my life and future health/complications are concerned, sorry I'm not that benevolent.

Regardless of supervision it only takes one slight slip in such a delicate procedure to turn into a life threatening/changing situation and for that reason I think it is far more reassuring to know your physician has the most experience possible IMO. Save the teaching for the joint surgery or something. Remember this procedure is under local anesthesia and while being awake, can you imagine hearing the student go "Ooops"! That alone would be enough for me to have an MI .. Nope! Not for me!!....

Edited December 13, 2010 by WarpSpeed

[WarpSpeed]

And that drug-eluding stents only elude drugs for about 3 months.

Sorry for the notes-like comments, but I'm trying to collect my thoughts here...

Yeah they are requiring a year or more of blood thinners like Plavix to be certain when the sales pitch for the stents is only 3 months or in the case of the only other available brand 6 months....

Yeah a lot of information to assimilate..

[FBN]

Undoubtedly, a discussion on AAA will be revived after the Richard Holbrooke incident but we can open another thread on that if so. For the moment, there are some similarities in the development of aneurisms and coronary artery occlusions by arteromatous plagues. Both start with damage to the innermost lining of the arterial wall, the intima, as a result of occlusion to the bloodflow and nutrients and oxygen to this layer. Blood platelets attach to this microscopic area of injury and this enlarges over time, calcifies and forms what is called an artheromatous plague. Here is where high cholesterol and high LDL levels contribute.

In a coronary artery, this leads to progressive occlusion while in a major artery such as the aorta, it can actually lead to a separation of the inner lining of the artery and a structural weakening in and around that area and an aneurism develops. In surgery for an aneurism, the aorta is physically clamped above the aneurism, the aneurism is opened and the blockage removed; the weakened part of the artery is then reinforced with a synthetic graft, cut to whatever length is required to cover the defect. This is made from a synthetic material and is not rigid like a stent and allows for the inside to be covered again by a lining of endothelial cells, semi-integrating is into the artery as living tissue. The outer walls of the artery is then closed around this graft.

Problem with the AAA that often leads to fatalities is the location; if this is situated at and involves the renal arteries where they originate from the aorta (fairly common location), it can lead to acute renal shutdown. If the stripping of the inner lining suddenly axtends upward (dissecting aortic aneurism), it can be fatal. Perhaps in the Holbrooke incident..

Stents, as well as just a balloon angioplasty, as was initially performed, can last for 10 years or more but this depends on many variables such as lifestyle changes or treatment to reduce cholesterol etc as well as, initially, complications associated with the procedure itself. Discussions and research are still ongoing about medicated stens vs non-medicated stents and I don't think there is a clear answer yet.

[Phil Conners]

In spite of the good impression I had of the doctor at BHP I am still concerned with the much too many stories where they have been pushing for unnecessary operations there. I wonder that a hospital with less profit concerns would take a CT scan first before "going in" and perhaps that BHP would go ahead and insert stents even if really not necessary.

For that reason I've decided to consult Dr Taworn - but of course as these things go, he has this Saturday off at Bangkok Christian Hospital so it won't be possible to have a consultation until 25 December and that's really a bit long to wait. Now trying to see if there is any alternative way to meet with him, even if it means having to fight some red tape.

[WarpSpeed]

Looking forward to hearing your results and impressions. As for the CT scan just request it, they should not have a problem doing it first in essence it may add to the bill potentially but in the long run for you it may provide a bit of piece of mind.

[Phil Conners]

I know I can just ask for it, but if this doctor has set his mind of doing an angiogram anyway it would probably be pointless. Found Dr Taworns office in Chula, seems he is off until Thursday, then we'll see.

[Phil Conners]

Update.

The first opportunity to meet Dr Taworn would have been 18 December. We luckily called Bangkok Christian to verify and they told us he had taken that day off. So next opportunity would be 25 December - christmas day and after that 1 January - New years day. I.e. It probably wouldn't happen until 8 January.

In order to not wait that long we thought we would take a chance and try to meet him in Chula. Bad idea. This place is not just crowded, it is chaotic. We left Pattaya early morning and arrived at Chula 1pm. Check in was quick enough, then onto the queue at the heart center. OMG. There must have been 700 people waiting just in that particular department. Asked for Dr Taworn ... but he had apparently just decided to take that day off too.

We couldn't get confirmed if he was going to be there tomorrow so decided we probably had to wait until we could see him in Bangkok Christian on the 8th of January.

Let's hope the pump will keep working until then

[BAYBOY]

I was at the Heart center at Chula today also.

Arrived at 10.30, had a blood sample taken, then an ECK test,sat with a friend for an hour talking, had lunch at their cafe, and went to my 1.00pm appointment with the doctor.

Actually 1.00 pm is the time he starts his afternoon duties. Saw the doctor at 1.45. The cosultation took half an hour, excellent english, and in my mind a very through assesment of my heart problems. Out side got given number 449 for payment and the medicine pick up. All finished by 3.15 .As I left saw that the highest number on the screen was 560.

Cost of blood test, ECK test and doctor /nurse = 510 baht

Sure many people and a little chaotic but sitting and looking, it all some how works and things get done!

BAYBOY

[a99az]

Hi XXpate48USA,

Thanks for the description. While I do understand that it is probably mainly painless, the idea of they having to cut open my leg to push some sort of rod up inside my body gives me shivers. But of course, if it has to be it has to be.

Yeah I know it's pretty routine for the doctors today, but it's a brand new experience for me

I posted about the second opinion up in post #11. Maybe you missed it.

I had to have this test, had it done in London some years ago now, it had me scared shitless too. I went into the theater and after the nurse got me all settled down the surgeon came in told me I would feel something like a bee sting in my groin. It did sting but I must say thats all I felt. After he finished he told me that if his hart was that good he would be a happy man. I was so relieved I could cry. After further tests back in Gibraltar the problem turned out to be Chrons Disease but have it well under control. You should also remember they have a team of surgeons ready for you should they need to do an op there and then, at least they did when I had mine done.

All the best hope you get it sorted OK.

[Phil Conners]

I was at the Heart center at Chula today also.

Arrived at 10.30, had a blood sample taken, then an ECK test,sat with a friend for an hour talking, had lunch at their cafe, and went to my 1.00pm appointment with the doctor.

Actually 1.00 pm is the time he starts his afternoon duties. Saw the doctor at 1.45. The cosultation took half an hour, excellent english, and in my mind a very through assesment of my heart problems. Out side got given number 449 for payment and the medicine pick up. All finished by 3.15 .As I left saw that the highest number on the screen was 560.

Cost of blood test, ECK test and doctor /nurse = 510 baht

Sure many people and a little chaotic but sitting and looking, it all some how works and things get done!

BAYBOY

We were told the doctor was there from 1-3 pm so we left Pattaya 9am thinking that would be plenty of time. Actually traffic was terrible and we arrived just at 1pm but was told by the nurse that people had started registering at 7am and that we probably would be able to see a doctor at 4pm. It was my intention to see Dr. Taworn and since he was not there we left again.

I'm surprised I didn't see you as we were there at about the same time. A sea of people but I didn't see any foreigners.

[Phil Conners]

Just came back from Bangkok Christian Hospital and a consultation with Dr Taworn. We arrived at the check-in at 8:30 there were already 25 others in the queue before us. I saw the doctor at 12:00. He basically confirmed what the other doctors had said and scheduled me for angiography/plasty Monday. Yes, this Monday.

Re Chula Hospital,

I have just spent 3 nights there in the CCU, and having treatment for my heart. Experienced discomfort some days earlier and after 3 nights at a local Private hospital was taken down to Chula last Sunday.

From addmittance to discharge I was totally impressed by the care and attention of all staff... doctors ,nurses, aides, even the cleaners! Had several tests done, blood tests, xrays, ultra sound. and an angoiplasty.

The angioplasty found a blockage in a graft from a previous by- pass some 8 years ago. The doctors are confident that it will self clear in time, and and have advised me to take things easy for the meantime.Given several pills and have follow up checks due in 8 days.

I have experienced several hospitals here in Thailand, private and public, and without a doubt the 3 nights I had at Chula would be the very best for care, treatment, assistance, food, etc.that I have had. The Nurses are just wonderful and all are so proud of being nurses at Chula.

By the way the total bill........everything 34064 baht. Makes a mockery of what the private hospitals charge today. To hear of figures of 300,000b for an angiogram, one wonders at the actual "real" profits these hospitals are making.

BAYBOY

He mentioned 200,000 as a max. figure. When I asked him about 34,000 he said that even one stent cost 40,000 so there is no way you can have an angioplasty for that price. Perhaps you just had an angiography, that way the figure would make more sense?

He also said that Chula was too full but he would put me up in BCH instead, and transfer to Chula just for the intervention.

To be continued. I hope.

[craigt3365]

Good luck man! Look forward to seeing you at Bert's drinking a beer soon!!!!!

[BAYBOY]

Yes all the very best for tomorrow. Look forward to hearing how it all went

Sorry about the confusion re the Angiogram/ angio plasty. Yes it was an angiogram..... apoligies

BAYBOY

[Sheryl]

All the best. You are in excellent hands.

[Phil Conners]

Back out alive with one big stent and a sore crotch (where they went in). Thanks for all the good wishes. More details later.

[Phil Conners]

I arrived at the Bangkok Christian hospital at 10am and presented myself at the registration. Immediately the "machine" was started, first I was lead to the cashier to put up a deposit of 100,000 baht, then lead to my private room, a nice, light, spacey room with TV (BBC) and Wifi. Was told to change into hospital garbs, and was tapped a vial of blood for some standard pre-op tests.

After that a few hours to relax until I was picked up at 3pm for the short ambulance trip to Chula where the intervention was to happen. Everything had been arranged for me so I was immediately brought to the operation area and prepared for the intervention. After about half hours wait I was entered into the operation room, a huge place that looked more like a datacenter than an operation room. I got two local anestesizing shots to the groin are before they injected the cathether. I'm not sure but there didn't seem to be any cutting involved so the cathether obviously must have a sharp point for insertion. I could sometimes feel the cathether as it was travelling inside my veins, not really uncomfortable, but definitely a bit weird. No pain at all. The team (6-8 people) was extremely professional, everyone seemed to know exactly what to do and when to do it. Never did I have a feeling of being under the care of students in any way.

The procedure took about half an hour and after that I was wheeled to a side room with full EKG monitoring gear, probably to monitor that everything went well. After about another half hour the professor came in and told me the procedure had gone "perfectly" and that I'd had one large (95%) stenosis in my right coronary artery and that he was surprised how I had been able to live with that without feeling any pain except under load. Anyway the stenosis had been opened completely and a stent inserted.

After that I was driven back to BCH and put in ICU for overnight monitoring. Nothing to report about that except it is very boring, can't read anything, cant' do anything, just lie there and watch a curtain from around 5pm to 9am next morning, when they wheeled me back to the room. Spent the rest of the day watching TV, using the Wifi, eating, until I was discharged at 5pm.

Total cost 118,937 baht. Most of this went to Chula who got 89,584, the professor who got 18,000 and the remainding 11,353 for the hospital (room, tests, food, ICU, ambulance etc). All in all exceptional good value and as someone else said, making a mockery of the 300,000-400,000 charged by the private hospitals here.

Oh, and I got a CD with the xrays recorded during the operation. Cool.

I hope this short story may help others in a similar situation both to know what to expect and the alternative available to the private hospitals.

Edited December 29, 2010 by Phil Conners

[craigt3365]

Congrats! Glad to hear it went well and thanks for the update. I think I will be there in about 3 weeks. Not sure what will happen, but have to have things check out again.

Great news that all went well.

[Phil Conners]

Thanks Craig. Good luck. Let us know how it goes!

[BAYBOY]

Good news, so pleased that all went well for you, now plenty of rest and then into light exercise.

Yes the op. room at Chula is rather overwhelming.Remember when I had my angioplasty in New Zealand back in 1988 the op. room had 1 small TV moniter, which both the doctor and I watched as he went about the op.

Cheers

BAYBOY

[Sheryl]

Glad to hear that all went well. Thanks for sharing the details. Value for money, to be sure.