Does Bangkok have Home-Call Doctors that can prescribe Hard Medicines ?

[easybullet3]

Hi,

I know someone in Bangkokthat is bed-ridden at home with heart problems, blood pressure problems, vertigo and seizures!

he is throwing up when he moves too much, and often has seizuers. (he knows he doesn't have long to live).

he is very sick. and he refuses to go to any hospital.

he just wants a doctor to come to his house sometimes to check him and give him medicine for Seizures and Anxiety and some strong medicine for Pain.

.. at the moment he is self-medicating with Codeine and Alcohol. (which is not the best choice.. as both alcohol and codeine trigger seizures).

Do any of you guys know if there are Home-Visiting Doctors in Bangkok that actually give medicine to patients.

i'm not talking cough syrup!.. i am talking about maybe Morphine or Methadone (which is what hospitals give to patients to manage severe pain).

Basically I want to find out if house-call doctors or personal doctors are available in Bangkok, and are they allowed to prescribe a full range of strong medicines without the need for visiting a hospital ?

please dont bother with suggesting that my friend goes to a hospital.. he wants to die at peacefully at home.

Thanks

Edited July 17, 2015 by easybullet3

[Sheryl]

No, not possible. The meds you speak of can only be issued by a hospital pharmacy, or as an inpatient.

Also from the sounds of him, any medical professional on arrival would call an ambulance and have him admitted.

He would be best served by going into a hospital to get stabilized as regards his seizures and blood pressure. If he refuses to do this, there isn't much you can do.

None of the conditions you mention would cause severe pain, unless it is angina (pain from ischemic heart disease) in which case treatment to relive the underlying cause, rather than strong narcotics, are what is indicated. (None of these conditions should be terminal either, so perhaps you have left out some pertinent diagnosis.)

[easybullet3]

No, not possible. The meds you speak of can only be issued by a hospital pharmacy, or as an inpatient.

Also from the sounds of him, any medical professional on arrival would call an ambulance and have him admitted.

He would be best served by going into a hospital to get stabilized as regards his seizures and blood pressure. If he refuses to do this, there isn't much you can do.

None of the conditions you mention would cause severe pain, unless it is angina (pain from ischemic heart disease) in which case treatment to relive the underlying cause, rather than strong narcotics, are what is indicated. (None of these conditions should be terminal either, so perhaps you have left out some pertinent diagnosis.)

I'm re-quoting what his wife is telling me.

as far as I know. he completely refuses to go to any hospital.

he is having about 1 to 5 seizures per day.

puking 5+ times per day.

and what she is saying he has several conditons:

- Cerebral Small Vessel Disease (lack of oxygen to a certain part of his brain causing dimentia)

- Arteriole sclerosis (hardened arteries)

- Enlarged Heart

- Enlarged Aorta

- Kidney Disfunction.. (i have no idea what level)

- High Blood pressure (over 190 or 200)

- eating minimal food.

I have gone to great lengths to get her to call an ambulance and bring him into a hospital. but he just keeps saying he wants to die at home and hates hospitals.

he just seems to be at home, waiting to die, self medicating on Codeine and alcohol.

i find it frustrating coz I know he can be better off with the correct medication.

also: a hospital can perhaps feed him with a tube. (coz at the moment he is eating next to nothing).

Anyway, thank you for your advice..

and I agree with you. As much as I personally prefer to sort out medical conditions by correct nutrition and health; there is a time and place for hospital,, and this is defintly one of those times!

its frustrating he wont go! (and its a shame there is no Home-Call doctors as such, because that would have been a huge benefit)

Edited July 17, 2015 by easybullet3

[Sheryl]

There are a few places that will provide (for a hefty price) home call visits. But 1) they cannot dispense narcotics and 2) what you describe is far more than they would be able to handle. They wouldn't even be able to get to the bottom of what is causing his symptoms as lab tests would be needed.

In addition, even as an inpatient narcotics in Thailand are reserved for treatment of severe pain, not to knock somebody out so that they can endure untreated seizures etc.

It is impossible to tell from the information given how treatable his condition is or is not. Another pertinent question is what the quality of his life was like prior to this. Which depends on how bad the dementia is and how severe the renal disease.

Both seizures and vomiting can result from renal failure and while resolve with treatment, though dialysis might then be needed long term several times a week for the rest of his life.

He is likely going to lose consciousness soon at which point nothing to stop his wife from calling an ambulance, if she so chooses. May lead to a whopping hospital bill though...

[easybullet3]

thank you again for sharing your thoughts.

and yes. I already told the wife that she needs to have a PLAN for when he goes unconscious.

i guess thats when he ends up in hospital (with the huge bill) as you mentioned. - I think they are ok for cash though.

ok,, thanks again

[Sheryl]

Well short of unconscious he will get to a point where he's confused enough that ambulance staff, if called, would pay no attention to anything he might say and just haul him off. (I assume he is lucid enough now that he can understand what is going on and firmly voice his wishes.)

Well off or not, bills for a hospitalization that may include dialysis will be sky high at a private hospital. His wife should choose a hospital now and get its ambulance number. If she calls a general emergency number she'll have no control over where he gets brought.

[chubby]

is he off his seizure meds? why can't he manage to get seizure meds.

he will likely get dehydrated , from the emesis/vomiting before the food issue,

sounds like he has CHF, congestive heart failure, which may not be terminal, but then it again is might, trick is to have a nice death, if one is to die, sometimes, hospitals make it worse, i suppose, too bad he can't tell his doctor what type of thing to do and not do ...... like does he want to be intubated or have CPR ........

why and where does he have pain ?

[NickJ]

Find the correct hospital. Sedate him and then transport him.

[chubby]

maybe he'd vomit less if it's from the vertigo and you can get him some meclizine, and anti-nausea meds like some phernegan, if they have that in thailand to keep it down, if he is just going to vomit, no medications are going to work very well, if they're not absorbed because of the emesis

[Sheryl]

There is no history of a seizure disorder mentioned so likely his seizures are secondary to azotemia from renal failure or possibly hypoxia and in either case treatment needs to address the cause.

[Sheryl]

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