Lumbar Puncture

[MunterHunter]

Has anyone had a Lumbar Puncture procedure in Thailand? Or ever in fact?

Whats it like? and what was the cost if it was inside Thailand?

[Sheryl]

This is a simple procedure. You lie ion your side an a needle is inserted into your back and cerebrospinal fluid withdrawn via syringe. Some brief pain inviolved but not awful..think of it as an injection with a large needle.

The cost will be whatever the doctor in question charges for a long consultation plus maybe a few hundred to a thousand baht for medical supplies etc and then the lab costs. What those will run to depends entirely on what tests are required. Which in turn depends on why it is being done to begin with.

[zzdocxx]

I'd suggest that you ask them to use a 25g "pencil point" needle, in order to reduce the chances of spinal headache, but most physicians are fairly set on doing things the way they've always done them.

In the hands of an expert it shouldn't be too painful, as Sheryl has pointed out.

Good luck.

May I ask why you are contemplating this?

[MunterHunter]

Its being suggested as the 'next step' to try and diagnose why i am getting chronic headaches for the last 3 months. MRI, XRays and blood test haven't picked anything up and the Doctor is out of ideas... personally i think the guy is guessing

BTW - the hospital i am using in Bangkok has quoted me a ridiculous figure to do the procedure, they want to do another MRI (its been 5 weeks since my last one), they want me to wait in the hospital for 6hrs after the LP, and they estimate the total price (for everything) to be around 80,000 thb.

Somehow i think this figure is way over the top... I'm gunna start looking around for a better Doctor and a cheaper hospital i think.

[BWPattaya]

This is not a procedure to undertake lightly. I have been involved in performing lumber punctures many times in cases where meningitis was diagnosed and CSF needed fo confirm the diagnosis. Strict asepsis is needed to prevent introducing bacteria during the procedure. If it is being done to confirm the presence of blood in the CSF from a lesion higher up then the MRI scan would have shown it.

If nothing has been found so far then perhaps a change of lifestyle that may be causing a high level of stress may be required. Have you tried any anti-migraine medication? Related to certain foods perhaps? Chocolate or red wine etc?

[MunterHunter]

I'm in quite a stressful job at the moment, the original Doctor i saw did suggest stress as being the most likely cause. She referred me to a specialist and now hes talking about LP etc.

Diet has improved over the last 6-12mths with me slimming down a little bit (dropped 5-6kgs this year) alcohol intake has reduced and i've recently stopped smoking (about a month ago) - i'm increasing my water intake and taking vitamin supplements. Trying to get a little more excerise in but thats not really happening that much to be honest.

Wake up in the morning and within a few minutes i develop a headache, then it comes and goes throughout the day, anti-inflammatory seem to suppress the headaches well but the headache medication the hospital provided me doesn't seem to work very well. The headaches are kind of 'mild to moderate' but the fact i've had this everyday without fail for the last 3 months is a concern.

[BWPattaya]

Thanks for the extra information. Instead of wasting a lot of money and risking a severe infection with an LP look at the other factors you mention. Mainly the stress you are under.

Keeping yourself well hydrated is important. Dehydration will give you a headache. Vitamin supplements are only necessary if you are not eating an adequate diet.

[Sheryl]

Since you have already had a negative MRI and evidently have a normal white blood cell count, and no signs other than headache, you might do well to consult a doctor who specifically specilizes in headaches before undergoing any additional tests.

Try:

Prof. Anan Srikiathachorn

BNH Hospital

Wednesdays 5-6 PM only.

He is an Assoc Professor at Chulalonghorn (leading medical school) and heads up their headache clinic. Has published extensively on migraine in international peer reviewed journals.

or

Assoc. Prof Nijasri Charnnarong Suwanwela

Bumrungrad

4- 6 PM Modays & Fridays

Same affiliation as Dr Anan above

[MunterHunter]

Thanks Sheryl.

I am reluctant to go near BNH as they are the hospital quoting me telephone numbers for the LP and have spent 3mths messing around with lots of scratching their heads and giving me bills, and on the same lines Bumrungrad is also expensive. Do these Doctors work elsewhere, like Chula hospital itself?

/Edit: Woke up this morning and within minutes the headache was back, i hadn't even got out of bed this morning... two ibuprofen and a glass of water, 30mins later its gone... been ok until now (some 6hrs later) but its starting to come back a little... from experience i will probably have to take more pills within a couple of hours.

Edited August 28, 2012 by MunterHunter

[Kalbo]

Thanks Sheryl.

I am reluctant to go near BNH as they are the hospital quoting me telephone numbers for the LP and have spent 3mths messing around with lots of scratching their heads and giving me bills, and on the same lines Bumrungrad is also expensive. Do these Doctors work elsewhere, like Chula hospital itself?

/Edit: Woke up this morning and within minutes the headache was back, i hadn't even got out of bed this morning... two ibuprofen and a glass of water, 30mins later its gone... been ok until now (some 6hrs later) but its starting to come back a little... from experience i will probably have to take more pills within a couple of hours.

A few questions if I may. How old are you ? How painful are the headaches ? (say for example, on a scale of 1 to 10), are they throbbing thumping headaches or more of a 'thick' pressure type headache ? If you're still working, do they occur only on workdays , or also on your days off ? If you drink, do they seem to get better after you've had a few drinks ?

[Sheryl]

Thanks Sheryl.

I am reluctant to go near BNH as they are the hospital quoting me telephone numbers for the LP and have spent 3mths messing around with lots of scratching their heads and giving me bills, and on the same lines Bumrungrad is also expensive. Do these Doctors work elsewhere, like Chula hospital itself?

Yes, there is a dedicated headache clinic at Chula. Long waits and lots of initial red tape to get registered, but inexpensive. You may or may not be seen by them, though; can't chioose your doctor. still, worth a shot.

Anogther optuion would be to see if either of them has hours at the "after hours" clinic at Chula, a quasi-private arrangement that is on I think the 13th floor. You'll need to go in person to ask the4 receptionist there.

[MunterHunter]

A few questions if I may. How old are you ? How painful are the headaches ? (say for example, on a scale of 1 to 10), are they throbbing thumping headaches or more of a 'thick' pressure type headache ? If you're still working, do they occur only on workdays , or also on your days off ? If you drink, do they seem to get better after you've had a few drinks ?

I don't mind answering a few questions

Age: 39

Pain score: around 3 or 4 - i would class them as mild to moderate, but the sheer fact they are persistent makes me worry.

The pain type is more like a dull ache, not throbbing and not stabbing... almost like a cross between an ache and a needle being stuck in my head

I get them every day, regardless of work. Even after a long weekend (3 or 4 days) i still have them, i am able to function/work whilst i have the headaches, they distract me and affect my mood but dont cripple me, thus far i am still able to work but i dont feel like i am able to focus 100% on work right now however.

If by drink you mean alcohol, no i dont feel them after a few bevvies, if your talking non-alcohol then no, doesn't seem to make any difference.

Additional info, the headaches are always on the left side of my head, always without exception, they sometimes feel like they are behind the eye sometimes feel like they are above the ear... but never on the right side *always* the left, Some days they hurt more than others and somedays it can take upto an hour before the headaches start in the morning.

[Kalbo]

A few questions if I may. How old are you ? How painful are the headaches ? (say for example, on a scale of 1 to 10), are they throbbing thumping headaches or more of a 'thick' pressure type headache ? If you're still working, do they occur only on workdays , or also on your days off ? If you drink, do they seem to get better after you've had a few drinks ?

I don't mind answering a few questions

Age: 39

Pain score: around 3 or 4 - i would class them as mild to moderate, but the sheer fact they are persistent makes me worry.

The pain type is more like a dull ache, not throbbing and not stabbing... almost like a cross between an ache and a needle being stuck in my head

I get them every day, regardless of work. Even after a long weekend (3 or 4 days) i still have them, i am able to function/work whilst i have the headaches, they distract me and affect my mood but dont cripple me, thus far i am still able to work but i dont feel like i am able to focus 100% on work right now however.

If by drink you mean alcohol, no i dont feel them after a few bevvies, if your talking non-alcohol then no, doesn't seem to make any difference.

Additional info, the headaches are always on the left side of my head, always without exception, they sometimes feel like they are behind the eye sometimes feel like they are above the ear... but never on the right side *always* the left, Some days they hurt more than others and somedays it can take upto an hour before the headaches start in the morning.

Please note that I am NOT a qualified (or unqualified) Doctor or health care professional, and I am only offering an opinion, but the headaches do sound as if they are stress or maybe hormone related. How's your basics ? ( i.e. blood pressure and cholesterol levels ? )

[MunterHunter]

Please note that I am NOT a qualified (or unqualified) Doctor or health care professional, and I am only offering an opinion, but the headaches do sound as if they are stress or maybe hormone related. How's your basics ? ( i.e. blood pressure and cholesterol levels ? )

Don't worry about it, even the specialist I've been refereed to is stuck... so any general advice or brainstorming is appreciated.

Blood pressure is normal, slightly elevated but i have family history of high blood pressure so mine is low compared to the norm. When the Nurses/Doctors take my BP these days they just say 'normal' and move on. Cholesterol levels haven't been checked recently so i cant say, but they were slightly high last time i was checked which was 18-24mths ago, I've been eating healthier this year, dieting to bring my weight down and getting a little more exercise, so whilst i cant say for sure i would expect my cholesterol levels to be at least slightly lower than they were. Blood sugars are up a little last time i checked but the Doctors didn't seem too worried about that.

I've moved to a new area in the office, to see if its environmental, i.e. office strip lights, air con units etc, the company i work for is expanding rapidly so we all get moved around occasionally to make room for new desks etc, the last 'move around' was around 4mths ago (a month before the headaches started) so i did wonder if that was related, too early to tell if it will make any difference yet.

Also moved to sleep in a different bedroom in the house, we have lived in this (rented) house since Feb this year, so i don't think its home environment related but i'm willing to give anything a try

[franksur]

I just had a LP done at Bumrungrad 6 days ago. I started getting headaches 2 days later. I wake up in the morning fine, then the headache (mild-moderate) slowly develops as the day progresses. The doctors at Bumrungrad said it's not a spinal headache related to the LP because they said I'm able to stand and sit without it getting worse. They said if it was a spinal headache and fluid was leaking from the spinal cord, that the headaches would be excruciating, especially when sitting/standing.

I don't what to believe. Can't seem to get credible answers from Bumrungrad. Hope the headaches go away though.

[uptheos]

/Edit: Woke up this morning and within minutes the headache was back, i hadn't even got out of bed this morning... two ibuprofen and a glass of water, 30mins later its gone... been ok until now (some 6hrs later) but its starting to come back a little... from experience i will probably have to take more pills within a couple of hours.

Sheryl's advice is all good.

Do you have high BP and sleeping with your head too low? Don't just accept 'normal' get the numbers.

Have you injured your neck (cervical area) or is your pillow not supporting your neck?

Do you drink lots of water during the day or do you go to bed dehydrated?

Any noticeable food triggers?

Any eye/reading problems?

Just a few points - lots of other good advice on this forum.

[Sheryl]

MunterHunter -- my advice to see a specialist in HAs stands. There are many, many causes for chronic HA ...sinus congestion, allergy, stress/tensiopn etc etc. A dedicated HA clinic would be best able to identify what it is in your case and as mentioned there is one at Chula.

Franksur: what was the lumbar puncture done for? As this may be relevant to the HAs you now have.

[MunterHunter]

BP at last check was 122/78 i think it was, down from my usual 140/90

Recently i've increased my water intake by quite a lot (now having to pee at least a dozen times a day!)

Head too low/neck not supported - difficult to tell, i sleep OK and don't remember feeling any neck pain when i woke, sleeping position stays the same and my head/neck feels comfortable when i sleep.

No food triggers that i have noticed/aware of, but the eye sight/reading does feel worse than it was before, i did mention this to the Doc's and they sent me to the eye clinic where they checked my eyes, but my glasses prescription remains the same. Basically if i'm reading a lot of text on the computer screen i do struggle to read/focus sometimes so need to take a break for a few minutes. The eye checks didn't show anything unusual and my prescription is only a light one anyway 0.75 in one eye and 0.50 in the other (i think, from memory) - this matches the glasses i have.

Last few days the headaches have woken me up in the morning, which is a little unusual, as im normal up for a few mins before that happens, but the typical "2 paracetamol or ibuprofen" solves the headaches pretty quickly.

[franksur]

MunterHunter -- my advice to see a specialist in HAs stands. There are many, many causes for chronic HA ...sinus congestion, allergy, stress/tensiopn etc etc. A dedicated HA clinic would be best able to identify what it is in your case and as mentioned there is one at Chula.

Franksur: what was the lumbar puncture done for? As this may be relevant to the HAs you now have.

Sheryl -- they did a LP because I was diagnosed with polyneuropothy and they wanted to rule out a viral infection and malignancy. Prior to the LP, they did tons of bloodwork, MRI's of the lumbar and cervical, nerve conduction and electro tests. Results from LP showed negative for everything so they're assuming my symptoms are simply genetic.

I developed tinnitus 3 days prior to the LP over the stress of the procedure and stress of what they were looking to rule out. Not fun.

[MunterHunter]

I just had a LP done at Bumrungrad 6 days ago.

If you do not mind me asking, how much was the procedure? PM me if you don't want to discuss on the open forum. Thanks!

[FBN]

Perhaps just going back to the original post..

Lumbar puncture is a procedure that is reserved for the investigation of headaches only when an infective cause is suspected. Other reasons may include diagnosis of possible multiple sclerosis. MRI is probably a much more sensitive diagnostic method here.

If you insist to have this procedure, the local hospital will probably perform it but it is an invasive procedure not without potentially severe complications which may include actual aggravation of the headaches.

Look up "atypical migraine" or "cluster headaches" as one of these may be a possible diagnosis here.

Be also aware that it is well known that headaches may also be caused by the very analgesics used to treat them; especially if used over a long term.

[MunterHunter]

If you insist to have this procedure...

I'm not the one insisting, infact i am the one pushing back on the Doctors here, asking them why they want to perform this procedure and what they expect to find... just find its always best to research these things yourself as well, as sometimes even Doctors can get it wrong