Chronic liver disease, what next?

[LolaS]

OMG, my friend, non drinker, was diagnosed today, he is young, how this can happen? doctor in Lanna hospital, didnt stated reasons of what is causing, i remember when I moved here and our familly driver ( tuktuk) she died from this disease, she was only 32!! had a husband and a kid,

It was such a shock for me, how would you deal with this? is that cirosis? does he will need transplant?

[jacky54]

Liver disease is very common in Thailand due to diet, phla ra for one thing is something that should never be eaten IMO.

Edited February 19, 2016 by jacky54

[JHolmesJr]

Liverflukes in river fish.

[sunnyjim5]

There are many causes of liver disease but many are not amenable to treatment.

Your friend should follow the advice of his doctor and perhaps seek a second, Specialist, opinion.

[jacky54]

My mate in the UK had cirrhosis, Hep B and liver cancer, clear of all danger from them after surgery for the cancer. It's not necessarily a death sentence.

[Sheryl]

"chronic liver disease" could be several things:

cirrhosis - which can be a result of alcohol abuse, drug abuse, diabetes, severe obesity, chronic hepatitis, infection with liver fluke (present in raw fish and especially common in Issan)

chronic hepatitis without cirrhosis

So it is important to be clear which, and your friend needs a full hepatitis panel if not yet done.

Prognosis depends on the underlying cause, of which there are many, and the degree of liver damage.

[Gutenberg]

Don't eat fish that never saw the ocean.

Anyway, get your friend to the nearest private hospital to clarify what is the reason.

[Sheryl]

Disagree with the above - the best hospital in that area is CM Univ (Maharaj) which is government, not private (though it has a private channel). Pribate hospitals are not necessarily better than public, and indeed the reverse is usually true upcountry.

He has already been to a private hospital (Lanna)

If this person is Thai then should go to the hospital where he is registered and take it from there. Depending on the level of that hospital they may have to refer him to a higher level, but it is necessary to go through that step to have the treatment - which may otherwise prove very expensive -- covered by the government system.

[Gutenberg]

Disagree with the above - the best hospital in that area is CM Univ (Maharaj) which is government, not private (though it has a private channel). Pribate hospitals are not necessarily better than public, and indeed the reverse is usually true upcountry.

He has already been to a private hospital (Lanna)

If this person is Thai then should go to the hospital where he is registered and take it from there. Depending on the level of that hospital they may have to refer him to a higher level, but it is necessary to go through that step to have the treatment - which may otherwise prove very expensive -- covered by the government system.

I don't frequent hospitals but in Phuket, Udon Thani and BKK, I always preferred to be taken care by private hospitals. For that matter, the times I visited in-laws or friends in gov hospitals, I always asked what the problem is. Most of the time they didn't know. Even one time, I sat in doctor's office (gov hospital) with a part time girlfriend and although the doctor could speak English on the same level as me, as soon as I asked about the problem, he stood up, said "we take care" and left the room. So, I favor doctor's letter in English and an explanation what is happening.

[sunnyjim5]

Disagree with the above - the best hospital in that area is CM Univ (Maharaj) which is government, not private (though it has a private channel). Pribate hospitals are not necessarily better than public, and indeed the reverse is usually true upcountry.

He has already been to a private hospital (Lanna)

If this person is Thai then should go to the hospital where he is registered and take it from there. Depending on the level of that hospital they may have to refer him to a higher level, but it is necessary to go through that step to have the treatment - which may otherwise prove very expensive -- covered by the government system.

I don't frequent hospitals but in Phuket, Udon Thani and BKK, I always preferred to be taken care by private hospitals. For that matter, the times I visited in-laws or friends in gov hospitals, I always asked what the problem is. Most of the time they didn't know. Even one time, I sat in doctor's office (gov hospital) with a part time girlfriend and although the doctor could speak English on the same level as me, as soon as I asked about the problem, he stood up, said "we take care" and left the room. So, I favor doctor's letter in English and an explanation what is happening.

I am pleased to learn the Thai doctor refused to break confidence by discussing another persons medical details in the absence of a legal authorisation which may have allowed the disclosure of confidential information.

[Gutenberg]

Disagree with the above - the best hospital in that area is CM Univ (Maharaj) which is government, not private (though it has a private channel). Pribate hospitals are not necessarily better than public, and indeed the reverse is usually true upcountry.

He has already been to a private hospital (Lanna)

If this person is Thai then should go to the hospital where he is registered and take it from there. Depending on the level of that hospital they may have to refer him to a higher level, but it is necessary to go through that step to have the treatment - which may otherwise prove very expensive -- covered by the government system.

I don't frequent hospitals but in Phuket, Udon Thani and BKK, I always preferred to be taken care by private hospitals. For that matter, the times I visited in-laws or friends in gov hospitals, I always asked what the problem is. Most of the time they didn't know. Even one time, I sat in doctor's office (gov hospital) with a part time girlfriend and although the doctor could speak English on the same level as me, as soon as I asked about the problem, he stood up, said "we take care" and left the room. So, I favor doctor's letter in English and an explanation what is happening.

I am pleased to learn the Thai doctor refused to break confidence by discussing another persons medical details in the absence of a legal authorisation which may have allowed the disclosure of confidential information.

Pathetic attempt to defend Thai doctors. "Authorization" is given by invite to join the patient into the room. The same as it is in any western hospital. But to reassure you of the skills of this gov hospital doctor, in the end nobody knew what the problem was and we went to another (private) hospital.

[LolaS]

Disagree with the above - the best hospital in that area is CM Univ (Maharaj) which is government, not private (though it has a private channel). Pribate hospitals are not necessarily better than public, and indeed the reverse is usually true upcountry.

He has already been to a private hospital (Lanna)

If this person is Thai then should go to the hospital where he is registered and take it from there. Depending on the level of that hospital they may have to refer him to a higher level, but it is necessary to go through that step to have the treatment - which may otherwise prove very expensive -- covered by the government system.

Yes you are right, actually I was surprised to learn that a lot of doctor share there practice in maharaj ( Sripath) and other clinics and hospitals, that is allowed in thailand?

are you sure that they are ok? after all they are university clinic and I dont think real doctor work, or am I wrong?

[Sheryl]

It is indeed "allowed" for doctors to work at more than one hospital, and it is quite common. Both in Thailand and in many other countries.

In the University Hospital public channel, most of the care is given by residents in training. They are "real doctors" in the sense that they have their medical degree, but they are still training for their specialty. They work under the supervision of a full fledged senior specialist.

Sripat is a private channel through which one can be privately treated by senior doctors from the Universoty Hospital.

[LolaS]

It is indeed "allowed" for doctors to work at more than one hospital, and it is quite common. Both in Thailand and in many other countries.

In the University Hospital public channel, most of the care is given by residents in training. They are "real doctors" in the sense that they have their medical degree, but they are still training for their specialty. They work under the supervision of a full fledged senior specialist.

Sripat is a private channel through which one can be privately treated by senior doctors from the Universoty Hospital.

my friend told me, that his hospital is Lanna, it is private, but according to Social security payments, he is assigned to go there, and he doesnt pay anything for any services or examinations. Do you think prices increase or it is not appropriate to ask for second opinion in Thailand?

[Sheryl]

I don't understand the question about price increase. He gets free care at the hospital where he is registered under SS, and also at any other facility that they refer him to (if for example he needs something they cannot provide).

Otherwise, he has to pay out of pocket if he wants to go elsewhere.

Getting a second opinion from a professor at Sripat would not cost much if he brings all his medical records, test results etc with him. A few hundred baht, probably, unless additional tests are required. And is a good idea. I suggest Prof. Dr. Kannika Phornphutkul. It is also possible to see her, by appointment on Wednesdays, at Rajavej Hospital but would cost more there.

If your friend is not satisfied with the care he is currently receiving he has the right to (1) change doctors and (2) change the hospital he is registered at. To change the doctor, just need to request an appointment with someone else. To change hospitals, he has to contact the SS Office and get a list of hospitals which are accepting SS clients and they will also tell him how, it can only be done at certain times of the year but may be worth it since this is a long term chronic disease.

[NancyL]

Sheryl -- what about Gutenberg's other statement to "Don't eat fish that never saw the ocean"

I cook tabtim a couple times a month for Hubby and me. I buy a lively-looking one at the Thai market and have the vendor knock it on the head and filet it for me on the spot. That way I know it's very fresh. Of course, I cook it thoroughly -- usually in a Mediterranean-style fish stew, usually to the point that there are just flakes of fish in the stew.

I was under the impression that if fresh-water fish was cooked thoroughly it is safe to eat.

[Sheryl]

cooked thoroughly, no problem re parasites.

Problem in the north and northeast is the consumption of raw fish and raw crabs etc.

[Sheryl]

cooked thoroughly, no problem re parasites.

Problem in the north and northeast is the consumption of raw fish and raw crabs etc.

[Sheryl]

cooked thoroughly, no problem re parasites.

Problem in the north and northeast is the consumption of raw fish and raw crabs etc.