Colonoscopy - best hospital/doctor?

[samtam]

My annual check up at BNH included tests for cancer markers and revealed my CEA (Carcinoembryonic Antigen) as 5.30 ng/mL. I was referred to the Digestive Care Centre and the Gastroenterology specialist. The doctor has recommended a colonoscopy. Naturally I am a bit reluctant to have it. Has anyone had the procedure at BNH recently, and can their experience allay my fears? Are we allowed to discuss doctors/performance?

I am 57 and have never had the procedure. My health otherwise is good. My doctor suggested I could wait and have a further blood test in 3 months to see if the CEA has improved.

[Sheryl]

Actually at 57 it is recommended even in the absence of symptoms or elevated CEA. It is a highly effective means of early detection of colon cancer and recommended every 10 years starting at age 50. http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations

So this would be indicated even if your CEA had not been elevated. Since it was, you should definitely have it done. Colon cancer is quite curable if caught early.

Many TV members have had colonoscopies in BKK, it is a fairly routine procedure. You will be asleep throughout so there is nothing to fear in terms of discomfort. The only uncomfortable part, and it really isn't that bad, is that you'll have to take some strong laxatives before hand in order to "clean out" for the procedure. So basically you'll have a couple of hours of diarrhea, running back and forth to the bathroom. Then an IV is inserted, you're out, and when you awaken it is over. That's all.

See these threads

http://www.thaivisa.com/forum/topic/752384-cost-for-a-colonoscopy-in-bangkok-or-pattaya/?p=8260782&hl=%2Bcolonoscopy

http://www.thaivisa.com/forum/topic/755744-advice-for-colonoscopy-bkk/?p=8323454&hl=%2Bcolonoscopy

http://www.thaivisa.com/forum/topic/660402-who-over-50yrs-old-has-not-gotten-a-colonoscopy/?hl=%20colonoscopy

[samtam]

Thanks Sheryl. I will get on with it after the holiday.

[TallGuyJohninBKK]

Earlier this week, I had my first-ever colonoscopy done, here in in BKK. And before doing so, I spent a lot of time reading on the subject and browsing the various colonoscopy threads here to see recommendations about doctors and experiences with the procedure.

In the end, I believe I ended up having the procedure done by one of the best gastroenterologists in Thailand, and done at about half the price that's typical at some of the larger farang oriented hospitals like Bumgrungrad, BNH and Bangkok Medical Center.

The doctor I used was Dr. Varocha Mahachai, who has been mentioned here on TV in the past by Sheryl and others.

http://www.thaivisa.com/forum/topic/755744-advice-for-colonoscopy-bkk/?p=8315385

She has hours at both BNH Hospital, which quoted me 20,000+ for a colonoscopy, and at Bangkok Medical Center, which quoted me 23,000+ for a colonoscopy.

But it turns out, Dr. Mahachai these days also has hours at the RSU Health Care Center on Sukhumvit Road at about Soi 31. And they are offering the colonoscopy done by Dr. Mahachai for 12,000 including pretty much everything. They also will do a gastroscopy for 7,000, or the combined colonoscopy and gastroscopy for 18,000 baht -- which is less than the price of a colonoscopy alone done by the same doctor at the other hospitals.

Given the pricing, I did the combined colonoscopy and gastroscopy for 18,270b (the extra being a bit of extra preparation I required) along with a prior charge of about 600 baht for the laxative medication to take the night before as a preparation. So, 19,000 all in for both procedures.

Although I was a bit apprehensive, it turned out to be pretty easy. After all the preparation and not eating food for about 24 hours ahead of time, the doctor used IV sedation for the procedures and I slept thru the whole thing. One minute I was laying down, and the next I was awake in the recovery room. The actual procedures, the doctor told me, took about 15-20 minutes each.

The staff at RSU mostly speak Thai, but there are some English speakers among both the nursing and front counter staff there to get by with. And while there probably wasn't as much fussing and hand-holding as you'd likely receive at the big hospitals, I felt I was treated well and well cared for. And absolutely no ill-effects after the procedures. Woke up hungry and thirsty and with a bit of flatulence, but felt fine otherwise, and took the BTS back home.

For the preparation, the doctor gave me a powder called Niflec that is supposed to be mixed into 2 litres of water, and then taken over a two-hour period the night or morning before, depending on the time of the appointment. It pretty much was just like drinking water, except for a somewhat salty, slightly chemical taste. Not something to really enjoy, but not any thick, chalky stuff either.

All in all, I'd say using Dr. Mahachai at RSU Health in BKK is a great deal, especially since I was going to be paying out of pocket for the procedures since my Thai health insurance doesn't cover preventative or check-up procedures/treatment like a colonoscopy.

It's hard to do much better than getting a very good doctor for a great price.

[Lumbini]

Thank you Tallguy for the time you spent writing this I checked prices at Bangkok Christian hospital but did not know who possibly was one of the best doctors at this as the doctor is as important if not more important than the hospital and good doctors move around. The fact that Sheryl recommended this doctor with your actual experience says much . Did they remove any polyps for testing and have you gotten the results yet?

[TallGuyJohninBKK]

Fortunately, my colonoscopy came back clean, so to speak... If there any been any polyps that required removal and/or biopsy, that would have cost extra, of course, same as at any of the big hospitals.

After the procedures were done, I got a single page computer generated report on the findings (or lack thereof) on both of my procedures, that included a half dozen or so small color photos showing what I looked like inside in both areas... not that they mean much to me...

[Lumbini]

Why would they charge extra for removing any polyps ? Seems during the procedure to clip these so they can be stopped and tested would be the time ? Possibly you not have any so they had nothing to clip off and send to lab . I can see lab work extra cost if they find and clip but not to remove during procedure .

[bikerlou47]

There other options then being put to sleep.....you can swallow a camera!

[TallGuyJohninBKK]

Why would they charge extra for removing any polyps ? Seems during the procedure to clip these so they can be stopped and tested would be the time ? Possibly you not have any so they had nothing to clip off and send to lab . I can see lab work extra cost if they find and clip but not to remove during procedure .

Obviously, I'm not a doctor, so I can't speak to all the details of this... But as it was explained to me, if the doctor found anything that needed to be removed for biopsy, there would be extra charges for the lab work associated with that.

Thinking back to the conversation, I can't say for sure, one way or the other, whether there would have any extra charge just for doing the removals -- apart from the extra lab expenses. I didn't go down that road, so I had no reason to delve into the subject too much.

----------------------------

Separately, my wife told me, in the course of all this, that she had a gastroscopy done at a regional Thai government hospital in her home town about 10 years ago -- entirely without any anesthesia, as that apparently was the custom there at the time. And she recounted that it wasn't a pleasant experience, and she felt like she was choking/gagging the whole time.

Similarly, other posters here have reported having colonoscopies done here in Thailand with only light sedation where they were awake and aware for the doctor sticking that VERY long tube up inside their bum and bowels. The general description being uncomfortable, and a bit painful at times. For me, thanks but NO thanks.... I was happy to have slept thru the whole thing and not have any memories of what had transpired -- on either end!!!

[Sheryl]

The extra cost for polyps is the lab fee for biopsy.

[Robby nz]

I have had several of these at Pramonklutklau military hospital both under heavy and light sedation, no problem with either.

With the light I woke while the scope was still inserted and watched the picture on the screen, still under enough sedation for there to be no discomfort.

As has been already stated the worst part is the clean out in preparation.

[Lumbini]

Total sedation sounds comfortable but is that not more stress on body to go under general ?

[TallGuyJohninBKK]

Again... not a doctor... but I don't believe they call the anesthesia that I had a general anesthetic, like what you'd have for full-blown surgery.

They referred to it as "IV sedation" or "light sedation." From my paperwork, it seems to have been Midazolam/Dormicum.

Wiki:

The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnesic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties.^[6][7][8]

Midazolam has a fast recovery time and is the most commonly used benzodiazepine as a premedication for sedation; less commonly, it is used for induction and maintenance of anesthesia. Administration of midazolam by the intranasal or the buccal route as an alternative to rectally administered diazepam is becoming increasingly popular for the emergency treatment of seizures in children.^[9]Midazolam is also used for endoscopy^[10] procedural sedation and sedation in intensive care.^[11][12]

The anterograde amnesia property of midazolam is useful for premedication before surgery to inhibit unpleasant memories.^[13] Midazolam, like many other benzodiazepines, has a rapid onset of action, high effectiveness, and low toxicity level.

So, perhaps Sheryl or other medical folks here can comment further. I'm not sure. Perhaps I actually was awake/responsive to some extent for the procedure, but I certainly don't remember it or anything about what transpired.

[Sheryl]

Usually called deep sedation not general anesthesia. No need for intubation and the like and wears off quickly (though should not drive afterwards). In my experience in Thailand the will start with Midazolam which knocks most Thais straight out but often does not put farangs out. When the latter occurs they will switch to rohypnol or add an opiate such as demerol. The combo of midazolam and opiate will knock out even me, and I am extremely hard to sedate. A great advantage to opiates is that their effect can be immediately reversed by giving another drug, enabling a quick wake up.

No big stress as long as the patient does not have any liver or kidney impairment.

[Lumbini]

Thanks Sheryl , this sound healthier than general but means Dr.'s skill administering these options must be quite good as the sedation techniques is separate and just as important as the procedure . Do you have separate anesthesiologist or does the doctor performing the colonoscopy do the anesthesia ? Thanks

[Sheryl]

I've seen it both ways. Gastroscopy at Mission Hospital = had a separate anesthesiologist and had to pay extra for that. Colonoscopy with Dr. Varocha at a clinic, and second gastroscopy by Dr. Varocha at Bangkok Hospital, in both cases she adminsistered the sedation herself. In the US, I often assisted in procedures done in office that involved similiar sedation given by the physician without an anesthesiologist.

Any competent doctor calculate the dosage and administer these drugs. The bigger concern is that the facility be properly equipped and nursing staff properly trained in the event of an untoward reaction. And, the doctor should first get a general medical history to exclude liver and kidney problems. This being Thailand, ("mai pen rai" makes itself felt in medical practice as well), they often do not, so it is incumbant upon anyone who has liver or kidney impairment to speak up and insist an anesthesiologist be consulted before undergoing any type of sedation.