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Posted

I saw Dr. Nanthadej Hiranyasthiti at Bumrungrad hospital a few years back for back issues (disc issues). I really liked him and thought I go see him again

I see that he has moved to SamitiveJ Hospital

My questions are

1. What is this hospital like? I am not familiar with it. Good? Fair Prices?

2. Also anyone have any recommendations on Back Doctors (Disc Dengeneration) that are high quality and are not just going to push me for operations but give it to me straight?

Thanks all

Posted

It is a fine hospital.

The best spinal doctor IMO is Dr. Wicharn at the BNH Hospital Spine Center. he will give it to you straight and if he tells you that you need surgery, you do. he most definitely does not do that with everyone. I went to him quite ready to have surgery, he told me not needed. Dtto others. Converesely, he told my sister that it was down to bone on bone and only surgery would helps. he proved right in all these cases.

(BTW my experience with Dr. Nanthadej was that he goes to the opposite extreme, telling everyone that surgery is the last resort and they should try PT first, without even really reading the scans first. My sister wasted a lot of time accordingly before switching to Dr. Wicharn. Some orthos -- a lot, in fact -- will insist on putting patients through a trial of conservative therapy even if they have already had more than a year of it with no result and/or the scans clearly show that nothing but surgery will help. )

Posted

thanks I will look into Dr Wicharm. I liked Dr Nanthadej last time because the other two doctors i saw were so excited to do surgery and all 3 doctors have totally different opinions on what should be done

each doctor saying the other doctor was incorrect... at least Dr. Nanthadej was not so anxious about it but your right perhaps he is too anti surgery.. thanks for your thoughts on this

Posted

Since there is always a small risk with surgery some doctors like to put the patient through a long trial of conservative therapy just to prove to the patient that surgery is really necessary, or to cover their own behinds by showing they did surgery only as a last resort. Some will do this even when there has already been such a trial that failed or when the s cans clearly show a cause correctable only by surgery. A lot of time and money can be wasted with this if if the pain is due to something that only surgery will relieve. Seen it happen a lot here.

Other doctors do this without even looking at the test results because it is true that most back pain will resolve on its own (actually without PT either) so it is a time-saving short cut... for them, not the patient (same reason why so many Thai doctor prescribe antibiotics without first getting a culture and sensitivity).

Yet other doctors sense that people want to hear surgery is not needed so tell them what will make them happy (and will prove to have been correct in most, but not all, cases).

What I like about Dr. Wicharn is that he takes the time to thoroughly review the scans and make an individualized determination.

Pain that is solely due to pressure from a protruding disc will usually resolve in time and there are medications and exercises/PRT that can hasten that process; a protruding ("slipped") disc is almost never reason for surgery. Pain that is due to muscle or tendon strain rather than bone issue, will always resolve without surgery. But pain that is due to insufficient space for the nerve root to exit the spine, or to nerve compression from a bone spur, will usually not resolve without surgery. In that case the patient's individual surgical risk profile, age and the extent to which the pain is interfering with daily life all need to be weighed up.

It is sometimes advisable to do nerve conduction studies to determine what is actually causing the pain - a herniated disc present does not necessarily mean that is causing the pain. These exist in lots of people and can be completely asymptomatic. Nerve conduction studies are especially advisable if surgery is contemplated so as to minimize the possibility that pain will persist despite surgical correction of what was assumed to the the cause.

Posted

I used Dr. Wicharn under Sheryl's recommendation for a nerve related issue and found him to be very competent and easy to communicate with. He encourages questions and actually listens.

  • 1 month later...
Posted

I saw Dr. Nanthadej at Bumrungrad and found him excellent. I had a long history of back problems and went to him after being told that Bangkok Pattaya were going to fuse me- end of.

He ordered an MRI, talked to me about my history and after assessing the scans told me surgery was my only option, however microdiscectomy as opposed to fusing. Been right as rain ever since,.

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