Neurologist Recommendation

[Niranut]

My father-in-law is in his 70s and had been having leg pain for a while, before being unable to walk at all a week or so ago. Sister-in-law took him to a neurology clinic in Udon where the dr. gave him a preliminary diagnosis of spinal stenosis. He did not do any scans or tests, just sent him home with some meds. He's been on the meds for a week now and hasn't seen any really improvement other than a bit of pain relief. He'll go back next week for a follow-up visit, where it is likely the dr. will order an MRI. There is just one MRI center in Udon where they will have this done. But it is sounding like they may need to take their test results to a neurologist in Khon Kaen, as there really isn't anyone with much expertise with spinal stenosis in Udon.

I've looked around a bit here and Dr. Wicharn at the BNH Spine Clinic is mentioned often for neurology needs. If we do end up coming to BNH, what types of tests should be done beforehand to avoid spending time on that kind of thing in BKK. The MRI has already been suggested, and it sounds like a spinal x-ray would also be helpful. Anything else we should ask about?

And does anyone know of any similarly qualified/recommended neurologists in Isaan?

Also, just out of curiosity, how much does an MRI cost? My sister-in-law was told it will be about 20,000 baht at the MRI center in Udon. We're happy to pay, just wondering if that's the going rate...

Thanks.

[Sheryl]

It's an orthopedic specialist, not a neurologist, that you need. An orthopedic specialist with specific expertise in spinal problems.

Should it turn out the pain is due to a spinal problem and it's not something that physical therapy is likely to improve and he's not a surgical candidate then you might want a specialist in pain management which would be either a neurologist or anesthesiologist. Chulalonghorn Hosp in Bkk (teriary govt hospital) has a pain clinic. But start by getting the cause of the pain ascertained for sure.

In terms of tests, MRI and spinal Xray will do.

When you say "unable to walk" do you mean because of severe pain or literally incapable of walking as in paralysis? If the latter this is an emergency and he needs to see a spinal specialist at once.

You won't find what you need in Ubon. Closest option is probably Khon Kaen University Hospital, which is a major tertiary teaching hospital.

20,000 baht sounds high for the provinces, it's close to what an international private hosp in Bkk would charge. But then, if there is only one facility, they probably have the market cornered.

[Niranut]

Thanks, Sheryl!

It's hard for me to make sense of things as I'm not there and just getting reports from my sister-in-law. And it was a little confusing trying to figure out what she was saying (my Thai medical vocabuly is not so good...), and what was the best way to proceed. For the not being able to walk, he's just in so much pain that he can't walk. No paralysis.

And I do believe they were talking about the Khon Kaen Univ. Hospital, as they aren't expecting much more in Udon, but I will certainly double check to make sure.

Good to know about the MRI pricing-- there is only the one facility in Udon, and it's the only one for quite a ways up there.

[Sheryl]

If the Provincial Hosp in Ubon is talking about sending him to Khon Kaen that to me indicates they have the matter properly in hand. (Kohn Kaen is a referral point for provincial hospitals in the case of patients needing more specialized care). In that case I'd suggest letting the system do its work first before thinking of getting a private consultation, it may not prove necessary or if it does, it can be in the form of a second opinion of a diagnoisis and recommendation made by the govt hospital docs. (Not to mention that the best specialists are in Bkk and the floods)

He should be able to get the MRI paid for under the govt health care system. BUT it is possible that to do so would entail considerable waiting time and that by getting it done at the private facility he can get treated more rapidly. Is that the case? (Should probe this point i.e. why the MRI requires private pay).

[lopburi3]

MRI is not cheap even when done in government hospital as it is related to the very expensive equipment and procedures (although have had family member in extreme distress with allergic reaction that attending personal did not even observe (a passing nurse noticed). After that in top rated government hospital would prefer to pay about the same price in a private facility if he must pay. My wife has extreme calcification in lower lumbar causing nerve damage and this transfers to her left leg making it very hard to walk and when extreme became unable to move until medications help to relax and operation clears the opening. It is very much a specialist operation but only the MRI will tell if needed or perhaps medications/exercise might be viable alternative. In the wife's case meds/exercise did not work.

[Niranut]

Just talked to my sister-in-law and what she understood was that the reason he didn't get the MRI right away was because the dr. wanted to have him on the meds for a couple weeks to see if that did the trick. His follow-up appt. is the 13th, and if things have not improved (which they don't seem to be doing), then the dr. will order an MRI. Without the dr.'s ordering the test, it isn't possible to get the MRI. It sounded like we were responsible for paying for it.

But if we have to get a dr. to order the test, perhaps it will be covered? But then why the need to make sure we were able to pay for it? She's going to check on it. Either way, he needs it and we'll get it for him as soon as we can.

So will see how things turn out after he has the MRI and visits the Khon Kaen Univ. Hospital. Will post more info as we have it, as I've never been through this type of thing before and just want to make sure we do everything we can.

Thanks for the feedback!