Seeking Gyno And Urologist Recommendations

[ding]

My wife (Thai) has an early fibroid condition and she no longer trusts US doctors. She had some unfortunate experiences here. So we're coming back to Thailand to check it out with a good Gynocologist, and treat it if needed.

She has chronic lower left back pain as well. One week out of the month she has 'womb pain' on that side. She has had a tubal ligation here (one Dr wanted to do a complete hysterectomy for some reason). She had an ultrasound done in the US which detected it, but the medical clinic lost the record and we may need another there.

I'm going to a Urologist while there and considering these;

Dr Thanoo Choovichian at Samitivej

Dr Viroj Chodchoy at Bumrungrad

Any recommendations and advice is welcome please!

We have insurance here but the copay is higher than the treatment cost in Thailand, and the quality of care is a coin toss here.

[Sheryl]

Both Dr. Thanoo and Dr. Vijoy are excellent. Dr. Thanoo is no longer performing surgery due to his age so if your problem is likely to require surgery, you might prefer to see Dr. vijoy, otherwise either one will be fine.

it is a little hard to make a recommendation for your wife based on the information provided, I am especially unclear what is meant by an "early" fibroid, I suppose you mean a small one? Although that ios hard to reconcile with the level of pain reported, a small fibroid would usually be asymptomatic.

The points that would bear on shoice of a Gyn for her are (1) whether there is any suspicion of possible malignancy, in which case I recommend Dr,. Panon at Samitivej, or (2) whether she has endometriosis in which case she should see a GYN specializing in that (for which I'd need to do a bit of research) vs (3) neither of these and only a simple fibroid.

And, if it is just fibroid, it makes a difference whether or not she is prepared to consider surgery (does not have to be a hysterectomy, there are other options including minimally invasive approaches) or not, and how old she is (since fibroids will naturally improve after menopause).

And lastly whether she is amenable to seeing a make GYN or feels strongly about it being a woman. (While there are plenty of female GYNs here, most of the Gyns specializing in mininmally invasive surgery are male).

If her back pain is due to fibroid(s) she is going to either have to live with it or have surgery, although as mentioned there are less invasive options for it including endoscopic removal of only the fibroid (usually done in women still planning to have children, but can be done in any woman who objects to removal of the uterus), or vaginal hysterectomy (removes the uterus without need for any incision).

Should be aware though that in case of myomectomy (removal of only the fibroid) the problem may later recur.

[ding]

Both Dr. Thanoo and Dr. Vijoy are excellent. Dr. Thanoo is no longer performing surgery due to his age so if your problem is likely to require surgery, you might prefer to see Dr. vijoy, otherwise either one will be fine.

it is a little hard to make a recommendation for your wife based on the information provided, I am especially unclear what is meant by an "early" fibroid, I suppose you mean a small one? Although that ios hard to reconcile with the level of pain reported, a small fibroid would usually be asymptomatic.

The points that would bear on shoice of a Gyn for her are (1) whether there is any suspicion of possible malignancy, in which case I recommend Dr,. Panon at Samitivej, or (2) whether she has endometriosis in which case she should see a GYN specializing in that (for which I'd need to do a bit of research) vs (3) neither of these and only a simple fibroid.

And, if it is just fibroid, it makes a difference whether or not she is prepared to consider surgery (does not have to be a hysterectomy, there are other options including minimally invasive approaches) or not, and how old she is (since fibroids will naturally improve after menopause).

And lastly whether she is amenable to seeing a make GYN or feels strongly about it being a woman. (While there are plenty of female GYNs here, most of the Gyns specializing in mininmally invasive surgery are male).

If her back pain is due to fibroid(s) she is going to either have to live with it or have surgery, although as mentioned there are less invasive options for it including endoscopic removal of only the fibroid (usually done in women still planning to have children, but can be done in any woman who objects to removal of the uterus), or vaginal hysterectomy (removes the uterus without need for any incision).

Should be aware though that in case of myomectomy (removal of only the fibroid) the problem may later recur.

Thanks Sheryl, as always. You're a true gift. We've saved your post and will bring it along.

My 39 y/o wife (+/- a year or two ) goes to a male Gyno here, as well as female Doctors.

Her ultrasound was not very clear (?) the Doctor said. It is a fairly recent diagnosis - so it may not be a young fibroid in reality, just recently found. She's had a tubal ligation so child bearing is not a factor.

Her Doctors have never mentioned that they suspect endometriosis when she presented these symptoms;

• dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis. (recently a pretty severe episode)
  
• chronic pelvic pain – typically accompanied by lower back pain or abdominal pain. (lower left basck in her case)
  

Edited December 13, 2011 by ding

[Sheryl]

Of course I don't know exactly what diagnostic tests have been done and the findings, but the clinical picture you describe sounds quite likely for endometriosis. There are also some other more serious possibilities although perhaps these have already bneen excluded.

It may need endoscopic surgery to confirm the diagnosis.

The degree of pain you descriobe would not usually be explaiend by a fibroid.

I suggest she consult this doctor at Bumrungrad

http://www.bumrungrad.com/en/doctors/Suvit-Bunyavejchevin

Bring along all test results and the actual film of sonogram to save $ on repeat tests.

Don't be surprised if endoscopy is recommended. It is not a big procedure (day surgery with just a tintyband aid incision) but will cost. However it may be the only way to get a deifnitive diagnosis and it sounds like she is in more than enough pain to warrant it.

If it is endometriosis there are medications which can be taken which will usually help. Other alternative is hysterectomy (usually complete, i.e. ovaries too) byt that's a last resort especially given her age. The arrival of menopause solves the problem).

[Fgis]

Hello,

Can i know where is Dr. Vijoy ?

And if he is working in private hospital do you know any good one for fibroid in public hospital ?

Thanks a lot for yoru help.

[Sheryl]

I think you are confusing Dr. Viroj, who is a urologist, as the Op concerns both gyn and male urologic issues.

Fibroids are a very common condition and the Thai public health system is well able to diagnose and management it. the only problem that may be encountered is that IF treatment is required (it usually is not) , they may be apt to push for hysterectomy if she's say over 30 or already has children.. Which is fine if it is what the woman wants -- they can do the procedure without difficulty. if however she wants to pursue other treatment options (see link below) then she might need to go private.

http://www.mayoclini.../treatment.html