Got a friend back in Oregon along with his Thai wife. He just sent this email regarding his father in law:

"Symptoms made it look like Dad had a mild stroke with gimpy leg and arm, no effect on speech, and could walk or shuffle a bit. CT now shows no stroke but "nerve problem from bone problem". Doc says he's too old, go home. That is sum total of what we know. Dad is 65 and in great shape and was still a very hard working rice, rubber, oil farmer and buffalo herder. We are near desperate for a reference to a good doc and hospital. He lives in Nakae so half way between NKP and Sakon Nakhon. "

I assume the FIL has been to the local district hospital. I've advised my friend to check why the case has not been referred on to the provincial hospital by the local doctor.

Also sent him this url with listings of hospitals: http://www.thaimedicalvacation.com/newswire/definitive-guide-to-hospitals-in-thailand/3/

Got any recommendations for another facility?

Mac

It sounds to me like the problem is in the lumbar spine and that they do not want to operate due to his age. I have encountered this in other older Thai patients as well even when seen in provincial level hospitals. (A provincial hospital in any case wouldn't have the capacity to do spinal surgery, they would have to refer up the line). Physical therapy - including lumbar traction - can be very helpful but PT services in Thai hospitals tend to be of poor quality.

There are 2 issues here:

1 - Determining whether he requires surgery (and if so, is a good surgical candidate) or would improve with more conservative management. For this I would frankly just go private as costs wouldn't be that much just for consultation 9and conservative management if that is deemed suitable). BUT to conserve costs he would need to get his Xrays and (if done) scan from the govt hospital first to bring with him.

The only really top spinal specialists I know of anywhere near NP are at Siriraj (Thonburi, so still a bot of a trip for him) , this one can be seen privately at the new Siriraj private hospital http://www.siphhospital.com/ortho/index.php/centers/doctor/3

2 - IF surgery is indicated then getting the public system to perform it under the UC scheme. That would take some lobbying/advocacy which might be hard for him to do on his own behalf. Could try going back to the hospital where he is registered, armed with the fact that a specialist consulted privately has recommended surgery, and insisting in referral to an orthopedic specialist able to do spinal decompression. In other words, be assertive and make a pest of himself. If that fails, call the NHSO Call Center (1330 or, if your wife calls from abroad then 66-2-141-4000) and complain. All this only necessary if private doctor assesses that surgery is indicated.

Sheryl

Just had another email from my friend in Oregon. After phone calls to Na Kae, they're not considering taking the older guy to Udorn, hospital not specified.

Seems to me going to the regional hospital in Khon Kaen for evaluation might be better, even if self-funded at the government place.

Any recommendation for Khon Kaen for a doctor to see?

Mac

Fully agree. KKU would be the best choice in Issan.

Dr. Prasit Hanpinitsak there would be best choice.