Any good Haematologists or Oncologists here in BKK?

[tagme55]

(Sorry for the repeat post )

Hello all,

My father was recently advised to consult a haematologist based on the fact that his Hb showed a decreasing trend, and routine investigations didnt quite show any significant abnormalities.

He consulted an Oncologist at Bumrungrad hospital who had him do a panel of tests and then advised him to opt for a cancer screening package which includes a bone marrow biop.

Personally, i think that this is a little too extensive as the only indication for these tests seem to be a Hb of 11.8.

I would be extremely grateful for any recommendations or advice.

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Edited November 18, 2015 by tagme55

[oncearugge]

A decreasing Hb is a significant "abnormality"

What time scale is associated with this anaemia ?

Haematologists are easily found here is one.

https://www.bumrungrad.com/doctors/Narongsak-Kiatikajornthada

Has your Father had a full clinical examination undertaken by a General Physician ? If not then one of the Heath Screening packages, offered by most private hospitals, which include a chest x ray and an abdominal ultrasound examination may be a good place to begin.

An Hb of 11.8 may be "normal" for an elderly person who may be eating an inadequate diet.

Bone marrow studies are not usually undertaken unless there is specific reason to do so.

Edited November 18, 2015 by oncearugge

[tagme55]

Thanks for your respone @oncearugge.

My father had a check-up done not too long back, and nothing out of the ordinary came up at any point.

His cardiologist noticed the decreasing trend in his Hb when he did his annual cardio-work up just days back and advised that we see a haematologist because the tests that he had ordered did not show any abnormalities ( serum iron, ferritin, TIBC , coombs )

I feel like more tests should be done before a bone marrow test is advised. Just felt like all the doctor wanted to do was get us to do tonnes and tonnes of tests. He even had his assistant ring us up twice to make sure we would be doing the test...

It would be acceptable had he been able to explain why such extensive tests were required, but not being able to show any proper indication for the tests just made it hard for us to accept..

I have gone through the list of doctors on the site and was hoping for a personal recommendation, or even one by word of mouth..

Sometimes its just so hard to find the "right" doctor in a foreign land.

Edited November 18, 2015 by tagme55

[oncearugge]

Thanks for your respone @oncearugge.

My father had a check-up done not too long back, and nothing out of the ordinary came up at any point.

His cardiologist noticed the decreasing trend in his Hb when he did his annual cardio-work up just days back and advised that we see a haematologist because the tests that he had ordered did not show any abnormalities ( serum iron, ferritin, TIBC , coombs )

I feel like more tests should be done before a bone marrow test is advised. Just felt like all the doctor wanted to do was get us to do tonnes and tonnes of tests. He even had his assistant ring us up twice to make sure we would be doing the test...

It would be acceptable had he been able to explain why such extensive tests were required, but not being able to show any proper indication for the tests just made it hard for us to accept..

I have gone through the list of doctors on the site and was hoping for a personal recommendation, or even one by word of mouth..

Sometimes its just so hard to find the "right" doctor in a foreign land.

Judging from what you say there is nothing which would indicate a need for a bone marrow study.

Unless the "decreasing trend" is based on serial measurement it means little other than that your Fathers HB is a little lower than the norm.

As the battery of tests you describe have not revealed any abnormality it would seem there is little indication for a consultation with hematologist .

The "cardiologist" will be focused on issues relating to cardiology which is why I suggest a broader based health screening.

Others , hopefully , will have other views, opinions and recommendations for you to consider.

[Sheryl]

First of all we need to be completely certain that the lab work done did not in fact show any abnormality other than a low hgb. A bone marrow biopsy would be recommended if leukemia or lymphoma was suspected, is it possible to show here the results of the various blood tests? Particularly important would be the results of the peripeheral blood smear. Also important to know if his B12 and folate levels were checked.

If indeed all of these are normal then the usual next step would be to test the stool for occult blood and, if positive, to do a colonoscopy. If your father is over 50 years old and has never had a colonoscopy, he should have one anyhow. One of the most common cause of anemia in older people who are not iron deficient is GI bleeding which can be small enough not to be noticeable to the eye.

I raise all this because you have already seen a hematologist and unless there were abnormalities identified beyond the low hgb, or unless some basic blood tests were not already done, there is little point in seeing another hematologist because the cause likely lies elsewhere. Specialists tend to have tunnel vision so consulting the wrong specialist can be an exercise in futility.

Has he had a recent complete physical including a PSA, manual prostate exam etc?

[tagme55]

Hi Sheryl,

Thank u for ur reply..

Going over my fathers blood work, everything seems to be normal except for the fact that Hb 11.8, Hematocrit 34.2, Direct Coombs- weakly positive and vitamin B12 1322..

Serum Fe 102, TIBC 294 and Ferritin 141.1 were all normal.

I doubt it could be a GI bleed as he has no history of melena, haematemesis, abdominal pain or any other symptoms of a GI bleed..

And yes Sheryl, he has been seen by a urologist; everythings looking fine in that department .. PSA - normal..

Having one hematologist say that he requires a bone marrow is troubling; and so i just want to consult someone reliable for a second opinion; someone who would not want to take us for a ride by doing unwarranted invasive tests.

Know any good hematologists here in bangkok, Sheryl?

[Sheryl]

Yes of course but as I said, I am not sure a hematologist is who he should consult. Hence the request to see his lab results. There is a lot more to a blood panel than the values you refer to. If possible please show the actual lab reports. In particular the RBC morphology and MCV.

With malignancies of the GI tract, the bleeding is not visible to the naked eye. It is very small blood loss over time and there will not be any of the symptoms you mention him as not having (they would in fact be unusual). Hence the recommendation for a stool test for occult blood and possible colonoscopy.

Cancer of the colon is one of the most common causes of anemia in elderly people who are not iron deficient, and is curable if detected early. It is imperative to exclude it in someone with unexplained drop in blood count. Seeing a hematologist will not help you on that score.

But as you are determined to see a heamtologist, here are some good ones. I deliberately do not mention any at Bumrungrad as it might be awkward given that you had consulted one there already. Be sure to first get his medical records from Bumrungrad, specifically all the lab results, to bring with you.

Bangkok Hospital: Dr BUNDARIKA SUWANAWIBOON http://www.bangkokhospital.com/index.php/en/find-a-doctor

Samitivej Hospital: https://www.samitivejhospitals.com/en/doctors/wirote-lausoontornsiri/

Saint Louis Hospital: Prof.Dr. Tanin Intragumtornchai

Of these I would probably opt for Bangkok Hospital as should he prove to have a malignancy of any type they have an excellent cancer hospital.

If you do decide to get a GI workup (as he should unless another obvious cause for the anemia is found), recommend Dr. RUNGSUN RERKNIMITR or Prof.Dr. VAROCHA MAHACHAI at Bangkok Hospital. I cannot stress this enough - cancers of the GI tract are a very common cause of anemia and this occurs through minute occult blood loss over time. It is not expected that there would be obvious melena, and vomiting of blood (hematemesis) occurs only with upper GI lesions. Similiarly, abdominal pain is a late, not early, symptom, of GI cancers.

[Sheryl]

P.S. There are also benign GI conditions which can cause this, especially if your father is on an anticoagulant as many cardiac patients are.

[bark]

I just want to say " Well done to all the people who are try to help you"

Best wishes to your Father. Hope all goes well.

[tagme55]

Thats the thing Sheryl.

I for one felt that there were several other tests that needed to be done before jumping to a bone marrow test! Just felt like the doc was skipping a few steps, and i didnt like that.

The cardiologist recommended we see a haemato-oncologist which is why iv been asking for a recommendation, but thats not to say that i dont understand what you mean. I do..

I am thinking ill make an appointment to consult one of the above docs and depending on how things go, shall go on to get a proper GI work up done "if" not advised by the haemto-oncologist himself.

Thank you so very much for your invaluable advice and support Sheryl. It means a lot.

[tagme55]

I just want to say " Well done to all the people who are try to help you"

Best wishes to your Father. Hope all goes well.

Thank you @Bark. [emoji120]

You're absolutely right! Both @Sheryl and @Oncearugge have been of great help!!

Edited November 19, 2015 by tagme55

[chubby]

http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm