Lung Cancer

[banK]

Hi,

I suspect that I have lung cancer and will be visiting probably the Khon Kaen Ram hospital on Monday, my first choice would have been the Bkk Khon Kaen as my Health insurer direct pays when using the Bangkok hospital group, but I don't think that they have an oncology dept there.

The main question of this post is find out the best doctor to see, I believe that Sheryl would be the person to advise, however, I am open to suggestions.

I have my Insurance with Cigna UK which is due for renewal towards the end of March 2016. If I do indeed have cancer, do insurance companies hike up the premiums disproportionately on renewal because of this or would it be just the normal annual increase.

Tks for any advice.

banK

[Aussieroaming]

Good luck with it and don't let it beat you

[Opl]

i'm not living in Thailand but want to give you my feedback on the subject

You say you "suspect" ......The first thing you absolutely need is to have as soon as possible a precise diagnosis by PET Scan, http://www.snmmi.org/AboutSNMMI/Content.aspx?ItemNumber=949

Then after there is a protocol of different exams to determine what is the best option in your case ( if the diagnosis is potitive), according to the type ( small cells , non small cells).

There are different treatments linked to the typology and stage of development of the tumor (size), presence or not of metastases): surgery , radiotherapy, chemotherapy, combination of all.

If thoracic surgery is required, find the best specialist.

It can last a year from the first "suspicion" to the end of the treatment.

Do not stay by yourself, go ahead , if you think you'll be more comfortable in the U.K, then return home.

Edited December 19, 2015 by Opl

[Matej]

Never do self-diagnosnis man ...

Good luck, be strong

[zoza]

what makes you think you have lung cancer? about 12 years ago I was in a similar situation as you say you are in because I was coughing up blood ,

without any contact with thai medical personal I jumped on a plane back to the uk within a few weeks I was diagnosed and given a date for surgery.

at that time the N H S was top notch and after being reassured by the nurses who specialized in cancer treatment that my treatment had very good odds

(the difference between big/small cell is important as well as the stage I believe) I had successful surgery. and after five years was classed as cancer free.

I think speed of treatment is important but also the competence of the medical professionals.

fingers crossed you get a good result.

[banK]

Hi again,

Thank you all for your kind posts.

I have looked up PET -CT scans but not many of those about especially up here in Issan. This seems the most reliable and direct route for a diagnosis/stage. Would it be possible to have a PET scan out of region, bring the results up here and go to the Khon Kaen Ram for any necessary treatment.

Failing that, what would the next best option of diagnosis be.

On Wednesday 16th I thought that I had strained a muscle in the region of the right upper chest. When trying to bring up mucus from the chest It would hurt mak mak - I didn't notice any blood at this time. The following day I took some paracetamols -2 four times, 8 in total. This relieved the pain of bringing up the mucus.

On the Friday, paracetamols again. No need to take them now as there is no noticeable muscle pain. However, when I exaggerate breathing in I can feel slightly the right upper chest. Then if I don't breath and twist the upper body, I can feel the same sensation in the same place, only not as severe.

I noticed the bringing up blood yesterday (Saturday), perhaps there was blood the previous days but I didn't notice any. Reason for not going to the hospital - weekend.

I quit smoking (Roll your own) about 17 months ago - I think I did it the wrong way, no aids no patches, Just stopped after 52 years. This is when problems started. Almost immediately I had incidences of rapid and uneven heartbeats, initially for a day or two and then everything went back to normal by itself, the first few months it happened maybe once a month. Then the time between incidents decreased until eventually it was 1 week of heartbeats and one week of normality.

It came to a head when one Saturday morning in October when I had to squint to see, dizzy and the feeling in my face of what I would imagine a stroke would be like. The symptoms passed within 15 minutes, except the irregular heartbeat.

I went to the Emergency Room of the Bangkok Khon Kaen Hospital. I was admitted into the IICU unit where I was attended to.

Had a brain scan - Clear

Ultrasound of the Heart - Doc. said was ok - All 4 valves working fine.

Blood tests reveal liver and kidneys good but that I was Hyper Thyroid.

I was put on a drip and everything stabilised. I was discharged the following day.

I was advised by the doctor that I would be on tablets for about 2 years. Have had two followups so far and the FT3 and FT4 are now in the normal range leaving the TSH to normalise, it's going in the right direction but will be slow apparently. I now take 3 Tapazole (5mg), 1 Inderal (10mg) , and was advised to take one baby aspirin per day. The tablets have been reduced due to progress except I still take the same one baby aspirin per day.

By the way I am 68 and vary between 71 - 73Kg.

I do have medical insurance (inpatient) but cancer is also covered in the policy. There was a question regarding renewal in the original post, does anyone know the situation generally. I will ask them when I know what the score is, but it would be nice to know what normally happens before I speak to them. Anyone?

I look forward to any replies

banK

[Opl]

" Would it be possible to have a PET scan out of region"

Yes, once you have passed this PET scan, they give you the results both on a paper copy ( photos) and digital copy. Always keep them with you when you have an appointment with a doctor.

I think you must have the diagnosis in English too, so maybe choose the right place to do it .

Edited December 20, 2015 by Opl

[Opl]

sorry double post

Edited December 20, 2015 by Opl

[Sheryl]

As you have Cigba UK they are governed by UK laws and cannot hike up your rates beyond normal age based increments.

Many insurance policies require prw-approval for PET scans and there are only a few places in Bkk that can do them. But you may be getting ahead of yourself here. There are other possible explanations for your symptoms including your hyper thyroidism (which can cause chest pain), some of the meds you are on (ditto) and the aspirin you are taking (can cause bleeding).

I think in your case I would start with the doctor who is treating your thyroid condition and prescribed these meds and see if he thinks it is related. If not then consult a pulmonologist. It is way too soon to be thinking of an oncologist.

BTW as you were recently hospitalized you most likely had a chest xray then which obviously did not show any sign of a tumor. This does not preclude a small one but does make it unlikely you have a large malignancy.

[arunsakda]

Why do you suspect you have lung cancer?

[banK]

Hi again,

OPL - Thanks for your input on the PET scan.

Sheryl - You are probably right in me jumping the gun a bit but its a bit of a shock when presented with blood and a chest pain together. The reason that I thought I would go to the Ram was that they have an oncology unit whereas Bkk KK has not. The Doctor I am dealing with for the hyper thyroidism I think is only there on Saturdays, a bit too long to wait until then - this at the Bkk KK. I don't know whether either hospital has a Pulmonologist but I expect the Ram would have one.

I didn't have a chest x-ray at the Bkk KK.

Thank you for the info on the renewal premium - handy to know and peace of mind.

To put to bed the question of whether there is a mass on the lung/chest, I would really like to know asap the situation of that. What scan should I have done, CT, MRI or normal x-ray?

I'll go to the Ram tomorrow. I have the results of the CBC other blood and mineral tests together with complete updated information of the Thyroid numbers - do you think the Ram would accept the Bkk KK hospital tests?

Noted about the prior approval of a PET-CT scan.

Although I only have an inpatient insurance, cancer is covered for outpatient/day patient and inpatient. Covered regardless.

Tks very much for your time and input

[Sheryl]

A simple chest xray and physical exam would be the first step. Presence of an oncology unit is irrelevant at this stage....and should it become relevant later, khon kaen univ hospital is by far the best option.

Should be no issue that blood tests were done elsewhere.

Make sure whomever you see is aware of your thyroid issue, theeds you are on and that the chest pain and blood in mucous ocurred after starting these meds.

If the chest xray is normal it becomes a judgement call whether to do other scans of the lung especially if the doctor considers it probable that the meds accpunt for the symptoms.

If there is any abnormality seen on xray then of course more investigations will be required

[banK]

A simple chest xray and physical exam would be the first step. Presence of an oncology unit is irrelevant at this stage....and should it become relevant later, khon kaen univ hospital is by far the best option.

Should be no issue that blood tests were done elsewhere.

Make sure whomever you see is aware of your thyroid issue, theeds you are on and that the chest pain and blood in mucous ocurred after starting these meds.

If the chest xray is normal it becomes a judgement call whether to do other scans of the lung especially if the doctor considers it probable that the meds accpunt for the symptoms.

If there is any abnormality seen on xray then of course more investigations will be required

Hi Sheryl

What is concerning me is that I have been taking these tablets for about 10 weeks now and then just the other day the chest pain (which has now subsided very much but still there) and the blood at the same time, to me who has no previous experience, finds this a bit ominous.

What are the ball park figures on x-ray and ct scan or is it mri scan I should have, I would prefer to go for a one off clear scan as opposed to x-ray then the risk of having another scan.

I have had experience with the KKU hospital, taking my friend there who incidentally has liver cancer, he is always left at the end of the queue regardless of what time he arrives - never been less than an 8 hour wait - lost files, indifference etc. No doubt the expertise is there but Farang friendly? not really.

Also, it is not Cigna uk as mentioned before its cigna global which is regulated in Guernsey, a get out anything place!!

So I think I will have to be a bit careful here!

I won't be using the insurance way until I know what the score is, I'll self pay until then.

Tks

banK

[Opl]

"What scan should I have done, CT, MRI or normal x-ray?"

-> with CT angiography, if something suspicious appears, they will analyse a sample

But usually, the step by step process goes by elimination , "it's not a pneumonia, then check if etc.... " , that's why it can last several weeks

Edited December 20, 2015 by Opl

[JHolmesJr]

Sorry to hear of your troubles.

Im a bit confused when you say giving up smoking ABRUPTLY , ie. Not quitting gradually may have brought this on.

[DogNo1]

Well, there are so many other possible causes of chest pain and coughing up blood that there's no need to panic. Take it rapidly step-by-step consulting your thyroid doctor and then having the pictures taken that he or a consulting doctor recommends. Losing a few days before you can consult your Thyroid specialist is not terrible. It will give you some time to prepare yourself to accept any findings calmly. I've been through throat cancer and coronary artery disease and have recovered from each. Remaining calm is half the battle. Good luck.

[loppylugs1]

What are the ball park figures on x-ray and ct scan or is it mri scan I should have, I would prefer to go for a one off clear scan as opposed to x-ray then the risk of having another scan.

I have had experience with the KKU hospital, taking my friend there who incidentally has liver cancer, he is always left at the end of the queue regardless of what time he arrives - never been less than an 8 hour wait - lost files, indifference etc. No doubt the expertise is there but Farang friendly? not really.

Also, it is not Cigna uk as mentioned before its cigna global which is regulated in Guernsey, a get out anything place!!

So I think I will have to be a bit careful here!

I won't be using the insurance way until I know what the score is, I'll self pay until then.

Tks

banK

Yes treated like an idiot in Thailand,hard to break through the language barrier too. Try India,Calcutta two hours away,finest equipment the world has to offer,far cheaper than here too. Just type PET scan Calcutta,or whatever you search for,see the various options stay away from Apollo chain,bit like the BKK chain here,direct hospital not franchised

[jimmym40]

All I have to say is: Get the proper tests done As Soon As Possible. Yes, lung cancer is treatable, but very serious. Good Luck and get tested NOW!

[hgma]

For the record

I quite smoking abruptly after 40 years of smoking (like a chimney) and had NO side effects , aches or pains whatsoever.(01 this year)

I am pretty sure that this was the best decision i ever made.

Wouldn't dream of smoking another cigarette in my lifetime EVER again!

[JHolmesJr]

For the record

I quite smoking abruptly after 40 years of smoking (like a chimney) and had NO side effects , aches or pains whatsoever.(01 this year)

I am pretty sure that this was the best decision i ever made.

Wouldn't dream of smoking another cigarette in my lifetime EVER again!

Well done.

[Sheryl]

A simple chest xray and physical exam would be the first step. Presence of an oncology unit is irrelevant at this stage....and should it become relevant later, khon kaen univ hospital is by far the best option.

Should be no issue that blood tests were done elsewhere.

Make sure whomever you see is aware of your thyroid issue, theeds you are on and that the chest pain and blood in mucous ocurred after starting these meds.

If the chest xray is normal it becomes a judgement call whether to do other scans of the lung especially if the doctor considers it probable that the meds accpunt for the symptoms.

If there is any abnormality seen on xray then of course more investigations will be required

Hi Sheryl

What is concerning me is that I have been taking these tablets for about 10 weeks now and then just the other day the chest pain (which has now subsided very much but still there) and the blood at the same time, to me who has no previous experience, finds this a bit ominous.

What are the ball park figures on x-ray and ct scan or is it mri scan I should have, I would prefer to go for a one off clear scan as opposed to x-ray then the risk of having another scan.

I have had experience with the KKU hospital, taking my friend there who incidentally has liver cancer, he is always left at the end of the queue regardless of what time he arrives - never been less than an 8 hour wait - lost files, indifference etc. No doubt the expertise is there but Farang friendly? not really.

Also, it is not Cigna uk as mentioned before its cigna global which is regulated in Guernsey, a get out anything place!!

So I think I will have to be a bit careful here!

I won't be using the insurance way until I know what the score is, I'll self pay until then.

Tks

banK

1. The preferred screening tool for early detection of lung cancer is a low-dose spiral CT scan. Given your age and smoking history it is a good idea to get this quite independent of your symptoms (which, as explained, could have many causes). It is not however something you can just walk in and request, you have to consult a pulmonologist first and s/he has to order the test. I do not know if it is available in the hospitals up there; also not sure about the quality of specialists outside of KKU hospital. Would frankly advice coming to Bangkok for a couple of days where it is definitely available along with international caliber physicians e.g.:

https://www.bumrungrad.com/doctors/Yongyudh-Ploysongsang

https://www.bumrungrad.com/doctors/Charn-Kiatboonsri

https://www.bumrungrad.com/doctors/Eakachai-Sathianpitayakul

https://www.bumrungrad.com/doctors/Kasem-Sirithanakul

https://www.bumrungrad.com/doctors/Pratan-Vathesatogkit

https://www.bumrungrad.com/doctors/Worakij-Chalermskulrat

I have listed only Bumrungrad as I am positive they can do LD spiral CT there (and have some excellent pulmonologists) but quite likely Bangkok Hospital also can. Not 100% sure though.

You can probably have consultation, Ct and get results on same day or at maximum over two days. If there is a lesion found then of course additional investigations will be needed, what will depend among other things on the location of the lesion. If results are negative, you should probably repeat very few years given your smoking history.

2. Cigna Global cannot, AFAIK, raise individual rates due to the development of an illness. Thai insurers can and do, this is the main reason why having an internationally based policy is wise. if in doubt look at the wording of your policy but I very much doubt, even in Guernsey, that they are allowed to do this - would basically negate the whole point of insurance.

[banK]

Hi again,

Today went to the Bkk KK where I am under treatment for the Thyroid problem.

Explained to outpatient reception my problem, also that I didn't have a chest x-ray done when I was admitted to ICU in October.

After about five minutes handed me a report of the chest x-ray that was done, must have been a bit of the stressful day then, couldn't remember that!

There was one item not normal "A 1.1 cm nodular opacity at right lower lung zone, possibly nipple shadow or pulmonary"

Consultation with the GP who explained the image and suggested another to compare size of this nodule. To eliminate the possibility of the "shadow", the nipples were taped up with a bit of what I presume was metal to identify on the x-ray. The result was nothing there this time, so it was a shadow.

However, there was something else.1. "An ill-defined, soft tissue density lesion is found at right middle lung field, Measured about 2.2 cm in diameter; DDx infection, hemorrhage and tumor."

2."Reticular nodular infiltration at right lower lobe is suspected."

Guided around the x-ray again with the GP. You can just barely see No. 1, and No. 2 even lighter. Anyway, he showed on the internet for comparison several unmistakable tumors - easy to identify.

I have a consultation with the Pulmonary specialist on Wednesday. The GP said that he would probably want a CT scan done, So I asked for it to be done now so as to save time for me on Wednesday.

Job done for today.

Matter of interest - the hospital was virtually empty of customers, it makes the Ram in comparison like the KKU public hospital in terms of crowds.

The Whole bill came to 5290B discount 998B price to pay 4292B.

The GP said that the KKU hospital has got a PET scanner.

banK

[Opl]

Hi BanK,

So you'll have the CT results when you'll meet the pulmonary specialist.

Maybe he'll perform a plethysmography http://www.healthline.com/health/lung-plethysmography#Overview1

[arunsakda]

Can't name and shame but I went to one of the big Hospitals in BKK for "executive health check", just for the heck of it. They told me I have cancer or TB and sent me to a Pulmonary specialist for CT scans. Next the "US Trained expert" recommended invasive needle biopsy so I put the brakes on and went to Cedar Sinai Medical Centre in Los Angeles with CD-roms of the same scans

The Pulmonary specialist saw the same info and was shocked that they had recommended unnecessary invasive testing. I did have unexplained nodules and was ordered to have scans every 6 months for 2 years.

Still have not as much as coughed 7 years later!

Edited December 22, 2015 by arunsakda

[banK]

Sorry to hear of your troubles.

Im a bit confused when you say giving up smoking ABRUPTLY , ie. Not quitting gradually may have brought this on.

For the record

I quite smoking abruptly after 40 years of smoking (like a chimney) and had NO side effects , aches or pains whatsoever.(01 this year)

I am pretty sure that this was the best decision i ever made.

Wouldn't dream of smoking another cigarette in my lifetime EVER again.

Its just that a friend of mine quit while in the UK - his doctor advised gradual weaning off (patches,gum etc.).

It maybe makes sense - after 50 or so years of a drug your body expects it, and when abruptly deprived of the chemical it gets confused and the body goes apeshit.

For me that seems to have happened - never had any notable medical problems all my adult life. Everyone's different I suppose.

Anyway, well done for giving up, I joined the club 17 months ago, a few years a go I never thought I could do it, wasn't that difficult to do either - never a regret!

banK

[banK]

Hi BanK,

So you'll have the CT results when you'll meet the pulmonary specialist.

Maybe he'll perform a plethysmography http://www.healthline.com/health/lung-plethysmography#Overview1

He might but my SPo2 is 96 -97 occasionally 98. No breathing problems.

[banK]

Hi all again,

Went this evening and had a consultation with the Pulmonologist.

The result was not good - l will give the IMPRESSION of CT LUNG. (without intravenous contrast material administration)

- Suspicious malignant pulmonary nodule at posterior segment of right upper lobe.

- Suspected at anterior segment of right upper lobe; DDx bronchoalveolar carcinoma

I have not included the FINDINGS as its rather long winded (I presume the IMPRESSION is the summary of the FINDINGS.

As far as I understand I have two areas of suspicion. One is located inside the Lung which cannot be tested without surgery and one area where a needle biopsy can be done as it is at the wall of the lung.

The hospital cannot do the needle biopsy because of the lack of correct equipment. However, they are able to the surgery. But the surgery is dependent on the result of the needle biopsy..........

She suggested that I go to the KKU hospital and get it done there. However, the snag here is that only a limited number of private rooms available, then fitting it in, wait for the results - all of this could take in excess of a month - even if things went smoothly.

The Doctor gave me a letter to present to them for tomorrow. She indicated what she has found and what needs to be done, more concise and to the point than the IMPRESSION above

RUL nodule with speculate pattern

And infiltrative lesion at RML

And mediastinal lymphadenopathy

Tissue diagnosis is needed

1st perform CT guide TTNA/TTNB if non diagnosis consult CVT for VATs.

Having thought about the time I have before my Health Insurance needs renewing (23 March 2016), and being cynical, I would like to get as much as possible done before that time.

To that end I will phone Bangkok Hospital Pattaya tomorrow and find out how quick I could get the needle biopsy done and take it from there.

A benign result would then entail the expensive invasive surgery to the lung to enable a biopsy done on the node/s.

Even a benign result of the needle biopsy could throw up a good chance of a false negative (believe a 40, or is it 60 percent chance). Damned if you do damned if you don't!!

Of course, if the result is malignant (she said 80 percent chance), then there will be no surgery and just Chemo. So the suspicious thing at the lymph node probably says that it has already gone elsewhere.

Sheryl -

[banK]

Must have pressed a wrong key on the keyboard cos the above post posted itself.......continued.........

Sheryl - I would value your thoughts on the above and of course anyone else who has more insight than me.

tks

banK

[thaiduncankk]

Got to agree with Sheryl on the KKU hospital, by far the best equipped up here.

The RAM is more of a 'business' operation.

[banK]

Got to agree with Sheryl on the KKU hospital, by far the best equipped up here.

The RAM is more of a 'business' operation.

No doubt a fully equipped hospital.

But time of essence and waits certainly await me there!l

Plan to use BPH Pattaya - all tooled up there apparently, able to do procedures much quicker than at KKU hospital.

banK