Suggestions/advice on where to have an endoscopy and gall bladder surgery?

[Mobi]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

Can you please confirm the cost was 200,000 Baht? (not 20,000??)

That's not far off the amount I paid for open heart surgery, 2 days in ICU, a new heart valve, and a week in a VIP room last year.

Edited November 2, 2013 by Mobi

[Sheryl]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

Can you please confirm the cost was 200,000 Baht? (not 20,000??)

That's not far off the amount I paid for open heart surgery, 2 days in ICU, a new heart valve, and a week in a VIP room last year.

I'm sure it won't be >200,000 at a military hospital.

22,000 does seem low for laparoscopic though, and 3 days in hospital is also inconsistent with that. I wonder if he had open procedure, for that 3 days in hospital and 22,000 is possible.

[Thai at Heart]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

Thank you for that.

Yes, when I read on the ultrasound report that my gallbladder was full of sludge I Googled it while waiting to see the specialist and read that sludge could indeed be the cause of my symptoms.

But when I saw the specialist he said that as there was no inflammation (cholecystitis) in the gallbladder it was unlikely that sludge was the cause and recommended that I have more tests.

I told him that I had just read that sludge can be the cause, and he said that he could take out the gallbladder if I wanted him to, but I would complain if it didn't solve the problem.

I was then passed onto another surgeon who performed the endoscopy and gastroscopy and nothing more was said of the sludge.

My symptoms match those of gallbladder problems, with the pain attacks manifesting in the upper right/middle part of the abdomen, just under the rib cage and are so painful that I can hardly bare it.

But the pain doesn't gravitate to my upper shoulder and back, which apparently is fairly common and I have no fever. Even right now, when I have no pain, if I tap my upper abdomen, it is quite tender.

Your post has made me wonder yet again what I should do for the best.

I have just read that a drug called Ursodiol can be taken to dissolve the sludge and/or gallstones. Maybe I should try this, or am just tinkering with things that I shouldnt?

It has to go. It can get chronically infected and then you will have a massive problem.

Yes, but don't I first need a positive medical diagnosis? it still could be something else that is causing the problem... or not?

I was diagnosed with an ultrasound and a blood test. The test I had done in the UK, because my father's mate was 99.9% sure what the problem was. Once the duct is semi blocked like this, ask that can be done is to pull the bladder out. Very difficult to dissolve the stones, and the problem is very likely to recur.

To this day, I am not entirely sure how the test differentiates whether it can be removed by scope or incision. Maybe it checks for any level of infection.

I was diagnosed in about a day. In for the op on Monday morning, out Tuesday night. Wednesday drove to Edinburgh from London.

Bit sore. Healing time. Fine by 10 days, one month, done.

Your guts will be a little sensitive to very fatty foods afterwards, but after that pain, I would never consider not to remove it.

Edited November 2, 2013 by Thai at Heart

[Thai at Heart]

I know this can be controversial, but are there any non-surgical methods to clean up sludge in a gall bladder, or to prevent the sludge from building up in the first place?

I have read with some skepticism about cleansing with large quantities of olive oil and Epsom salts. But the rather graphic pictures of the "stones" that were excreted looked a lot more like hardened olive oil than any kind of crystal stone.

Still, the idea that adding something like olive oil to my diet over the long haul would be preferable to surgery in the end. But I'd want something more authoritative than the wing nut conspiracy websites (yes, I'm a fan) to suggest it.

What does the peer reviewed medical literature say?

As I already said, diet and exercise, no short cuts.

Gall bladder problems are related mainly to lifestyle problems.

Diet yes.

However, the reasoning for blockages is more likely down to pure genetics of the shape of the duct or a small abnormality in the shape of a stone.

Everybody has stones, but in most cases they pass through and no one notices. I was given mine, like bouncy small pepper corns except one wasn't round, but had a flat side to it.

That was the one that got stuck first.

[Mobi]

Just spent an hour with a gi specialist at phayathai. After checking carefully where the pain is she is pretty sure I have chronic pancreatitis. anyway I am having a MRCP scan tomorrow morning which should reveal what the problem is once and for all. Lets hope its not cancerous. ..

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

[bunnydrops]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

Can you please confirm the cost was 200,000 Baht? (not 20,000??)

That's not far off the amount I paid for open heart surgery, 2 days in ICU, a new heart valve, and a week in a VIP room last year.

22000, One of the reasons I went to the military hospital is because S. Mary quoted me 200,000.

[bunnydrops]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

Can you please confirm the cost was 200,000 Baht? (not 20,000??)

That's not far off the amount I paid for open heart surgery, 2 days in ICU, a new heart valve, and a week in a VIP room last year.

I'm sure it won't be >200,000 at a military hospital.

22,000 does seem low for laparoscopic though, and 3 days in hospital is also inconsistent with that. I wonder if he had open procedure, for that 3 days in hospital and 22,000 is possible.

S. Mary wanted 100,000 for open procedure, One reason for the low cost at the military hospital is that I did not get a private room. I was number 4 on the list when I went in Since it is a military hospital, military personnel get priority. Open procedure was not an option unless there was a problem. I got 4 small holes. I think the 4th was because they decided to do biopsy on a spot that showed on the MRI. (no problem there:) )

[thaiexpat21]

Just spent an hour with a gi specialist at phayathai. After checking carefully where the pain is she is pretty sure I have chronic pancreatitis. anyway I am having a MRCP scan tomorrow morning which should reveal what the problem is once and for all. Lets hope its not cancerous. ..

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

Just to unravel the acronym !

MRCP stands for magnetic resonance cholangiopancreatography.

See my earlier post about needing a more detailed scan.

[Thai at Heart]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

Can you please confirm the cost was 200,000 Baht? (not 20,000??)

That's not far off the amount I paid for open heart surgery, 2 days in ICU, a new heart valve, and a week in a VIP room last year.

I'm sure it won't be >200,000 at a military hospital.

22,000 does seem low for laparoscopic though, and 3 days in hospital is also inconsistent with that. I wonder if he had open procedure, for that 3 days in hospital and 22,000 is possible.

S. Mary wanted 100,000 for open procedure, One reason for the low cost at the military hospital is that I did not get a private room. I was number 4 on the list when I went in Since it is a military hospital, military personnel get priority. Open procedure was not an option unless there was a problem. I got 4 small holes. I think the 4th was because they decided to do biopsy on a spot that showed on the MRI. (no problem there:) )

Indeed. Doing it with scopes leaves virtually no scarring. They pulled it out through my belly button.

Looks a little odd if I get a tan.

[Sheryl]

Pancreatitits is common in people with a history of alcohol abuse. So could be. Let us know what the scan shows.

[Mobi]

I had the MRCP (MRI) this morning which lasted for over 2 ½ hours, (with a 20 minute break after 2 hours). It included injecting some liquid into my vein and I can only assume that they did a very thorough job.

The result is that I have chronic pancreatitis with atrophic changes in my pancreas, no doubt brought on by alcohol abuse over many years.

I have been prescribed a med called Creon 10000 (pancreatine) which I must take with my meals, and will provide enzyme supplements to help with the digestion of food. They are the most expensive meds I have ever bought, (from Fascino - didn't have them at the hospital), and if they do work they work they will almost double my monthly meds bill.

I will see the doctor in a week’s time to assess progress – if any.

At least I now know what’s wrong with me; the gallbladder does not appear to be the culprit after all.

However, it sticks in the craw when I recall asking the doctor from Sirikit, (the one who told me, ‘nothing wrong’) if it could be my pancreas. She said, ‘no – the symptoms don’t fit.’ Yet at no time had anyone at that hospital had sight of my pancreas, (via x-ray, scan or otherwise), so how could they be so sure?

Well, I live and I learn, I guess.

So far, I have to report that I am very happy with the GI specialist at Phayathai. She is very knowledgeable, very painstaking and bends over backwards to explain everything to me and answer my ignorant questions. She treats me more like an equal than a stupid patient who should stay quiet and not waste her time.

[TallGuyJohninBKK]

The good and the bad of medical care in Thailand, both on display in different settings.

Glad that you finally seem to have gotten an informed and fact-based diagnosis from a doctor who's willing to communicate in a meaningful way with her patient.

[Sheryl]

Yes, and thank goodness you did not proceed with what would have been unnecessary gallbladder surgery. Not only would it have been needless pain and expense (and risk, especially given your diabetes and cardiac problems) but the exposure to general anesthesia might have worsened the pancreatitis.

Moral of the story: if your gut (no pun intended) instinct leaves you dissatisfied with what a doctor has told you -- persevere and get other opinions.

If the Creon works, you can probably save a bit by buying it in bulk from the distributor (i.,e. a year's supply at a time, they won't usually sell less than that). Zuellig Tel: 0 2656 9800 Fax: 0 2656 9801 Email: [email protected]

If the pain persists, there has been some success treating the pain of chronic pancreatitis with nerve blocks. You'd have to make the rounds of pain management specialists to find someone able to do it so it would be a last resort, but it is a possibility. Some articles: http://link.springer.com/article/10.1007/BF03005428 http://www.ncbi.nlm.nih.gov/pubmed/11232683

Thanks for the feedback on the GI specialist at Phyathai Sri Racha, very good to know for future reference.

[FBN]

Don't absolve the gallbladder just yet..

Search "ampulla of vater".. Thickened bile may block the normal drainage of pancreatic enzymes into the smaller intestine just as a stone would as it is the common duct to drain both bile and pancreatic enzymes into the duodenal part of the smaller intestine, resulting in a backup of pancreatic enzymes in the pancreas which has really bad consequences for the organ; may have the same effect as alcohol.

Advise to continue with treatment from who is clearly a competent physician but keep it in mind..

[TallGuyJohninBKK]

I'd do more than keep it in mind...

I'd be asking my doctor about it the next time I saw him/her....

Anything that might be pertinent to my diagnosis, I'd always want to be discussing and evaluating with my MD... even if it's just to rule it out.

[Mobi]

Don't absolve the gallbladder just yet..

Search "ampulla of vater".. Thickened bile may block the normal drainage of pancreatic enzymes into the smaller intestine just as a stone would as it is the common duct to drain both bile and pancreatic enzymes into the duodenal part of the smaller intestine, resulting in a backup of pancreatic enzymes in the pancreas which has really bad consequences for the organ; may have the same effect as alcohol.

Advise to continue with treatment from who is clearly a competent physician but keep it in mind..

Thanks for the input, FBN, and I will certainly take this up with the specialist next Monday.

In the meantime I attach copies of the MRCP report.

It is difficult for a layman such as I to understand much of it, but to my uneducated brain it seems to me that maybe the point you have raised does not apply. However, I am the first to admit that I don't really understand all this medical 'gobbledygook'.

Any thoughts?

Thanks,

Mobi

[Mobi]

The good and the bad of medical care in Thailand, both on display in different settings.

Glad that you finally seem to have gotten an informed and fact-based diagnosis from a doctor who's willing to communicate in a meaningful way with her patient.

Yes. Thinking back, I had always known that Sirikit hopsital would be fine for standard procedures, but not the best place if the problem was more complex. I went there because following the original diagnosis in the UK which seemed to fit my symptoms to a tee, I thought all I needed was the confirmatory ultrasound test followed by removal of said organ.

Unfortunately, it didn't quite work out as planned....

I still wouldn't rule out Sirikit hospital for routine medical problems, if you are looking to save money. I found them very polite and helpful, although to see any doctor you will always have to wait for many hours, even on follow up, as everyone is told to be there before 8 a.m. and the docs rarely arrive before 10 a.m,, sometimes much later.

[thaiexpat21]

Don't absolve the gallbladder just yet..

Search "ampulla of vater".. Thickened bile may block the normal drainage of pancreatic enzymes into the smaller intestine just as a stone would as it is the common duct to drain both bile and pancreatic enzymes into the duodenal part of the smaller intestine, resulting in a backup of pancreatic enzymes in the pancreas which has really bad consequences for the organ; may have the same effect as alcohol.

Advise to continue with treatment from who is clearly a competent physician but keep it in mind..

Thanks for the input, FBN, and I will certainly take this up with the specialist next Monday.

In the meantime I attach copies of the MRCP report.

It is difficult for a layman such as I to understand much of it, but to my uneducated brain it seems to me that maybe the point you have raised does not apply. However, I am the first to admit that I don't really understand all this medical 'gobbledygook'.

Any thoughts?

Thanks,

Mobi

MRCP SCAN CROP 1.jpg

MRCP SCAN CROP 2.jpg

An essentially normal scan result apart from the pancreatic findings.

[properperson]

The result is that I have chronic pancreatitis with atrophic changes in my pancreas, no doubt brought on by alcohol abuse over many years.

I think your problems started when you drove past that sign that said 'Drink Canada Dry'.

[Mobi]

The result is that I have chronic pancreatitis with atrophic changes in my pancreas, no doubt brought on by alcohol abuse over many years.

I think your problems started when you drove past that sign that said 'Drink Canada Dry'.

Didn't stay there long enough - a few months in 1971 (I think) and a couple of weeks in 2000. Even with my legendary capacity, I just didn't have enough time...damn it!