Serious Infection Post-surgery; With Anemia

[PeaceBlondie]

question: WHERE'S THE BEST INFECTIOUS DISEASE SPECIALIST IN BANGKOK, and does she know anything?

History:

16 July 2005: motosai accident, serious shoulder dislocation; surgery at ChiangMai Ram

6 Dec 2005: wound area becomes inflamed, red, swollen. Only that area.

6 Dec 2005: complete physical. Anemic; white blood cells and leukocytes normal.

7 Jan 2006: orthopedic surgeon who did operation sees no problem. Anemia worsening, although I'd been on iron pills and iron-rich diet for a month. However, I reduce my calcium intake from 7000 mg/day to 2000 mg/day.

Jan & Feb 2006: see lots of GP's and specialists in Hua Hin. Literally, mai kojai. They think it's a rash, immune rejection, simple infection or dermatitis. I take standard antibiotics - no change, except hematacrit level is even lower.

2 Feb 2006: see great orthopedist at Samitivej Hospital, BKK. Says screws are coming out, but can't explain inflammation. Recommends ESR and CRP bloood tests to rule out infection.

6 Feb 2007: blood restults: ESR is 75, CRP is 24, both of which are way off scale, suggesting massive infection. Cause and type unknown. Dr. starts me on massive antibiotic injections of Rocephin, 2 grams per day for five days.

10 Feb 2007: as I'm getting last injection of the five days, the ESR count has increased to 88.

10 Feb 2007: Thailand continues to be the land of "mai kojai." Nobody knows nothing nowhere.

So, the question: WHERE'S THE BEST INFECTIOUS DISEASE SPECIALIST IN BANGKOK, and does she know anything?

Thanks. I need something more than herbs, mantras, ineffective medication, ignorance, and good intentions.

[Sheryl]

question: WHERE'S THE BEST INFECTIOUS DISEASE SPECIALIST IN BANGKOK, and does she know anything?

History:

16 July 2005: motosai accident, serious shoulder dislocation; surgery at ChiangMai Ram

6 Dec 2005: wound area becomes inflamed, red, swollen. Only that area.

6 Dec 2005: complete physical. Anemic; white blood cells and leukocytes normal.

7 Jan 2006: orthopedic surgeon who did operation sees no problem. Anemia worsening, although I'd been on iron pills and iron-rich diet for a month. However, I reduce my calcium intake from 7000 mg/day to 2000 mg/day.

Jan & Feb 2006: see lots of GP's and specialists in Hua Hin. Literally, mai kojai. They think it's a rash, immune rejection, simple infection or dermatitis. I take standard antibiotics - no change, except hematacrit level is even lower.

2 Feb 2006: see great orthopedist at Samitivej Hospital, BKK. Says screws are coming out, but can't explain inflammation. Recommends ESR and CRP bloood tests to rule out infection.

6 Feb 2007: blood restults: ESR is 75, CRP is 24, both of which are way off scale, suggesting massive infection. Cause and type unknown. Dr. starts me on massive antibiotic injections of Rocephin, 2 grams per day for five days.

10 Feb 2007: as I'm getting last injection of the five days, the ESR count has increased to 88.

10 Feb 2007: Thailand continues to be the land of "mai kojai." Nobody knows nothing nowhere.

So, the question: WHERE'S THE BEST INFECTIOUS DISEASE SPECIALIST IN BANGKOK, and does she know anything?

Thanks. I need something more than herbs, mantras, ineffective medication, ignorance, and good intentions.

From what you describe I am not at all sure the problem is infection. It sounds more like an autoimmune reaction, possibly to a drug or drugs given or to the screws. In whichcase antibiotics are only lijkely to make it worse.

Eleveated ESR and CRP indicate an inflammatory response more than infection per se. Unless you also have fever, and elevated white blood count, or an obvious absecess or purulent drainage fronm the wound I'd be inclined to think you shoukd consult an immunologist.

The dropping hermataocrit is worrisome. Unless there is some internal blood loss (in which case you'd probably see the shouklder swelling in size and have increasing pain), it may indicate decreased bobe marrow production of red cells which again suggest an anutoimmune process.

The hospital with the most immunologist s on staff is Bumrungrag, they ahev at keast 5, go to their website and use the doctor search engine to review qualfications, pick one who has studied and been board certified abroad.

If you DO have an elevated whiteblood count, pus draiaining from the wound then that's a dfifferent story, you need to have the wound cultured to see exactlu what is growing in it. Good infectious disease specifalists can be found at Samitivej, Bumrungrad and Bangkok General, all of which have search engines showing hours and qualifications of the docs.

Good luck

[Digger]

Dr Mattana Hanvanich is an infectious diseases specialist who works evenings at Bumrungrad Mon-Fri. During the day she is an infectious diseases teacher at Chula uni med school. Very knowledgable and perhaps more importantly knows everybody - if she wants someone else to look at you, she will advise you who she suggests and odds are it will be one of the doctors also teaching at Chula and having private practice at Bumrungrad. She actually specialises in HIV, but her level of knowledge is amazing. This is not a 5 minute consultation doctor - she is very very thorough and speaks perfect English - expect to be with her for 20-30 minutes but beware as a result of this she is always running late - if you have the last appointment (e.g 7.45pm) odds are you wont see her until 10.00pm as she spends so much time with her patients. Consultation fee is between 400-600 baht and you must book to see her - she runs full appointments every day.