liver cancer liver fluke

[francescoassisi]

Sheryl, although the basis of your advice is sound, you seem a little confused about fish sauce and "nam prick" and fermented fish paste as well as the many forms of Som Tam.

Transmission is from raw fish, but I understand that some kinds of fluke are transmitted also from consumption water plants which form a common accompaniment to many Thai dishes.

Self diagnois and over the counter treatment is NOT recommended as the treatment takes a long time and often different drugs; Egaten (Triclabendazole) and Praziquantel are allegedly the most effective.

I am well aware of the difference between fish sauce and fish paste.

Both can transmit liver fluke. Though in the case of fish sauce, only if homemade. Nowadays most people use bottled.

As to types of Som Tam, I find that definitions vary in different parts of the country. In many places, including where I live, "som tham thai" includes raw crab. Raw crab is as much a risk as raw fish.

I think you need to take a closer look at your menu and recipes.i think you're confusing fish sauce with pla-ra and nam prik.

BTW apparently if you freeze any potentially contaminated food for a period of time the parasite will die.

Son Tam Thai should not contain those crabs - it is called Thai because it is the Thai version of the Laos / Issan dish and can contains seafood but not the freshwater stuff.Of course there is no guarantee that every somtam lady is aware of this definition.

However as most somtams are made in the same mortar, I wouldn't be at all surprised to find that the parasite can survive the pummelling and continue on its cycle.

Edited January 31, 2014 by francescoassisi

[Sheryl]

Again, I am well aware of the difference between nam pla and fish paste.

Most people use bottled nam pla, no problem. But if homemade, could be an issue.

Where I live (and in provinces I've lived in the past), they put the crab in som tham thai. I've seen them do it in Bangkok as well. Possibly this is not the "pure" definition of som tham thai, but it is a common practice.

[macleans]

It is not a common practice by the vendors. In its original recipe Som tam Thai is free of crabs unless you ask the lady to specifically put crabs in it (some Thais do eat som tam thai that way, but it must be specifically ordered).

[Sheryl]

not the vendors where I live and have lived in the past....

[Briggsy]

I am interested in how the flukes get on or in the crabs. The flukes live in the scales or fins of the freshwater fish. When fermented fish is prepared, the whole fish, scales, fins, head, everything is chucked in, so the fluke can continue to its mammalian host, in this case, the human consumer of the pla raa. Since a crab has an exoskeleton, how does the fluke survive on the crab? Also since the crab is pickled, even if the fluke could survive on the exoskeleton somehow, would it survive the pickling process?

I have heard numerous times about the danger of eating unpasteurised fermented fish but never the crabs before.

[SantiSuk]

I had opisthocarsis 4 years ago - very unpleasant - developed from gastroenteritis type symptoms to frequent flash fevers and general unwellness/lethargy within a week. All three of a Pattaya private, small town UK and regional UK hospitals missed the correct diagnosis. Luckily the London Hospital for Tropical Diseases hit on it (and my local Sisaket doctor told me that my dietary habits would have been an early question when I chatted through my experiences with him some months later).

Rarely seen in the UK - Praziquantel had to be imported specially for me and St James Hospital in Leeds who referred samples to LHTD will now be one of the few to catch the diagnosis quickly!

Needless to say I no longer eat laarp bplaa unless the fish is cooked, nor som tam palaar (and my wife catches anything else uncooked with palaar in it). I do still eat tham thai, the one with peanuts and no palaar in it. Have to say Sheryl that I've not eaten a tham thai with crab in, but maybe that can happen outside Isaan.

Liver and bile duct cancer is the top cause of cancer deaths in my part of Isaan (Health District 10 - Ubon, Sisaket, Yasothon, Mukdahan) and untreated opisthocarsis is a top cause within that. My local doctor told me that some towns in Isaan dose the water supply with Praziquantel, though I've never seen that confirmed and it seems an unlikely-to-be-accepted expense to me!

Surely in any developed country the use of palaar would have been banned long ago?!

[kriswillems]

Som tham phuu maa : They will put big pieces horse crab (from the sea) in there, usually raw, not dangerous.

Som tham Thai :

sometimes they but little raw back crabs in it (puu naa). If they do this it's dangerous.

sometimes they use little horse crabs (especially in central Thailand): not dangerous

sometimes they don't put crab in there: not dangerous

Som tham Plaa raa: They will put fermented fish in it. There are 2 kind of Plaa raa.

- Plaa raa dib : fermented uncooked fish : very dangerous!

- Plaa raa suk : cooked fermented fish: not dangerous.

About the fish sauce. If you go to eat at a restaurant/shop there's a 99.9% chance they will use industrial fish sauce because it's much cheaper : not dangerous.

If you go to eat at peoples home they might use self-produced fish sauce : dangerous

Edited July 26, 2014 by kriswillems

[GaryB1263]

I have tried Som Tham before with crab. Is annual worming indicated? I live in Jomtien. If I had the flukes wouldn't I know it?

[FruitPudding]

On 1/15/2014 at 2:14 PM, Sheryl said:

Yes, praziquantel . That is the generic name. It is available without prescription under many brand names, not hard to find.

Be sure she avoids som tham thai and fish paste, too.

Would that be the recommended drug to use for a routine cleanse just in case?

 

Does albendazole cover the liver flukes?

[Sheryl]

9 hours ago, FruitPudding said:

Would that be the recommended drug to use for a routine cleanse just in case?

 

Does albendazole cover the liver flukes?

"Routine cleanse just in case" is not recommended for liver fluke unless one both lives in a highly endemic area and consumes raw fish....which not many expats do.

 

Praziquantal is the preferred treatment for liver fluke.  Albendazole is a possible alternative but requires a prolonged course of treatment.

 

 

[dddave]

On 1/15/2014 at 5:21 PM, Sheryl said:

I think bottle fish sauce is Ok but avoid homemade as they may not have boiled it first. fermentation does not eradicate the flukes, in fact fermented fish paste is a major culprit.

Som tham: What you need to avoid is not only fermented fish but the little raw crab they like to put in.

One time when I was living in an Udon Thani Moo Ban, they sprayed the paddy fields with a powerful insecticide.  Immediately, there was a rush of villagers to pick-out the  dead and dying river crabs from the paddy irrigation ditches.

 

[bunnydrops]

On 1/29/2014 at 9:35 PM, 96tehtarp said:

Please don't laugh. Now I am worried.

I eat som-tam with home-made Palaa (raw fermented fish past) and Poo Na Khem (raw salted fermented small black rice paddy crabs) probably 3-4 times per week.

I also eat raw buffalo meat, cooked in lime juice.

On special occasions I eat Roooo, that's fresh raw uncooked pig's blood in a stew of boiled pig's head (no pig's brain it's been removed). They add the blood at the last minute just before eating it.

I've never had a problem, other than mild diarrhoea maybe once every 12-18 months over the past 15+ years.

Should I be screening for liver flukes, or worse? I take Mebendazole once every three months just in case, for other worms.

I don't want to end up with liver cancer. I did some google-ing and found that some of these parasites can end up in your brain eg. neurocysticercosis!

Don't laugh, I know I probably shouldn't be eating the above, but they all taste really good, once one acquires a taste for it.

All the meds listed are very cheap in Thailand. Should I be concerned enough to talk to a Thai doctor?

Wow, you have jumped into the Thai life style. I felt bad that I had to refuse the field rat that my brother in law offered me for lunch. I heard that "IF" the palaa is fermented long enough, it does kill the flukes, but that is rarely the case of the stuff sold by the local sellers at the market.

 

I just saw how old this post is.

Edited September 16, 2023 by bunnydrops
addition

[HauptmannUK]

Jumping onto this topic.....anyone know a pharmacy in Pattaya or Jomtien that stocks Praziquantal?  Asked at a few without luck. Surprisingly Fascino don't have it and it doesn't even appear on their computer system.

Wife buys bags of bits of rotten and fermented fish and shrimps and boils it up with various other odds and ends added to make a sauce. Its not bad actually, I have acquired a taste for it but I want to take precautions.

Edited September 17, 2023 by HauptmannUK

[fredjaidee]

Just following up to see if anyone knows where to buy Praziquantal?  I also asked at several pharmacies including Fascino and no luck.

[Sheryl]

6 minutes ago, fredjaidee said:

Just following up to see if anyone knows where to buy Praziquantal?  I also asked at several pharmacies including Fascino and no luck.

where are you located in Thailand?

[fredjaidee]

I am in Hua Hin but I know a lot of pharmacies ship.

[Sheryl]

Try asking Medisafe

 

www.medisafepharma.com

 

[fredjaidee]

1 hour ago, Sheryl said:

Try asking Medisafe

 

www.medisafepharma.com

 

That's where I asked first, I have friends all over Thailand if someone knows a pharmacy.  Otherwise the only option I see is ordering it from India.

[Sheryl]

13 hours ago, fredjaidee said:

That's where I asked first, I have friends all over Thailand if someone knows a pharmacy.  Otherwise the only option I see is ordering it from India.

Try contacting YAIPAIBOON on Line app or call them at 02-013-9588 (message probably better as Thai pronunciations of drug names can be very variable and they often just don't recognize what was asked for even though they have it.)

 

Or message to this pharmacy:

https://www.facebook.com/profile.php?id=100057067615501