Need a good allergist and ENT

[emgthailand]

I just moved to Bangkok. I need to find a good allergist and ENT/otolaryngologist for treatment of severe environmental allergies (pollen, dust, etc) and chronic sinusitis.  I'm not even sure how the medical system works here.  Can you see a doctor of your choosing or do you just have to go to a hospital and get whoever is on duty?

 

Recommendations appreciated. 

[TallGuyJohninBKK]

Most if not all of the larger private hospitals in BKK have their own ENT departments, usually with quite a number of different doctors on staff. The major ones --  like Bumrungrad, BNH and Bangkok Medical Center, among others -- have English language websites that allow you to search for doctors by specialty and see their basic credentials and the days/hours they've available for appointments.

 

Just bring your passport and go to the hospital of your choice, where they'll typically register you and issue you a hospital patient card. If you have expat or tourist medical insurance, they'll typically accept that if your insurance covers foreign hospital services. The doctors all pretty much can speak English, although the language capability of the support staff varies by hospital.

 

At the big foreigner oriented hospitals with greater English language skills, you can figure about 1000 baht more or less for a basic outpatient doctor visit. Any diagnostic tests and procedures will be extra. The hospitals/doctors here like to prescribe lots of medications, whether they're needed/useful or not, at varyingly inflated prices. A lot of basic allergy and sinus medications can be obtained on your own at private pharmacies at lower prices, although one exception is pseudoephedrine, which only is available from hospitals.

 

There are lots of threads and posts here on various ENT doctors and recommendations, and I've seen a lot of them, but really haven't been much impressed, particularly when it comes to them being able to correctly diagnose anything out of the ordinary/obvious.

 

But AFAIK, the ENTs aren't necessarily going to be skilled allergists. They may prescribe anti-allergy medications, but I haven't found them to be the kinds of doctors who can do sophisticated allergy testing, for example. An allergy specialist is going to be a harder thing to find here than a general ENT, AFAIK.

 

[wordchild]

there is a lady at Chula, who I believe is regarded as one of the leading allergy specialists in Thailand; she is a teaching professor at the university and also does a clinic a couple of times a week at the hospital there.   We took one of our sons to see here a few years ago.  I am sorry i cant remember the name but maybe someone else can help with that.

[TallGuyJohninBKK]

One of the local, inexpensive allergy medications you can obtain here from pretty much any pharmacy is called Zyrazine, which is a local version of Zyrtec/Cetirizine. It's been helpful for me with no noticeable side effects. Typically runs about 50 baht for a set of 10 tablets.

 

[wordchild]

i get sinusitis from time to time. One thing that i have found to help (ie reduce the incidence)  is a twice daily nasal  flush with salt solution, you can buy this at any pharmacy. its a little uncomfortable at first but once you get used to it its no issue. my children have all done it since they were toddlers  and for them its just 2nd nature to flush out their noses along with brushing their teeth.

[Sheryl]

You can go directly to a specialist in any private hospital and also through the private channels that some government hospitals have.

 

For ENT I recommend this doctor at St Louis hospital, a private non-profit on Sathorn road, easy walk from the BTS Surasak stop 

 

Assoc. Prof. Songklot Aeumjaturapat

http://www.saintlouis.or.th/index.php/component/doctor/index.php?option=com_doctor&task=searchEn

 

I would start just with him as it sounds like you already know what you are allergic to. He will be able to manage the sinusitis and related symptoms. If you do need  to see an allergy specialist per se, I suggest either 

https://www.bumrungrad.com/doctors/Hiroshi-Chantaphakul

 

OR

 

Prof. Jettanong Klaewsongkram at Chulongkhorn hospital - after hours clinic (you have to go in person to make appointment and there may be a long waiting list. 13 th  floor main OPD building).

[emgthailand]

On 9/2/2016 at 2:38 AM, TallGuyJohninBKK said:

One of the local, inexpensive allergy medications you can obtain here from pretty much any pharmacy is called Zyrazine, which is a local version of Zyrtec/Cetirizine. It's been helpful for me with no noticeable side effects. Typically runs about 50 baht for a set of 10 tablets.

 

 

I bought enough Zyrtec to last me a year :-)  But if I run out without being able to get back to the US, I'll check it out.  Thanks

[emgthailand]

On 9/2/2016 at 6:36 AM, wordchild said:

i get sinusitis from time to time. One thing that i have found to help (ie reduce the incidence)  is a twice daily nasal  flush with salt solution, you can buy this at any pharmacy. its a little uncomfortable at first but once you get used to it its no issue. my children have all done it since they were toddlers  and for them its just 2nd nature to flush out their noses along with brushing their teeth.

I do nasal washes, I have done them for years.  Question - when you rise the nasal wash bottle, do you rinse it with bottled water?  I don't think it would be safe to clean it with tap water here.

[emgthailand]

On 9/2/2016 at 3:27 PM, Sheryl said:

You can go directly to a specialist in any private hospital and also through the private channels that some government hospitals have.

 

For ENT I recommend this doctor at St Louis hospital, a private non-profit on Sathorn road, easy walk from the BTS Surasak stop 

 

Assoc. Prof. Songklot Aeumjaturapat

http://www.saintlouis.or.th/index.php/component/doctor/index.php?option=com_doctor&task=searchEn

 

I would start just with him as it sounds like you already know what you are allergic to. He will be able to manage the sinusitis and related symptoms. If you do need  to see an allergy specialist per se, I suggest either 

https://www.bumrungrad.com/doctors/Hiroshi-Chantaphakul

 

OR

 

Prof. Jettanong Klaewsongkram at Chulongkhorn hospital - after hours clinic (you have to go in person to make appointment and there may be a long waiting list. 13 th  floor main OPD building).

Thanks. I definitely need to manage my allergies, so I'll check out that doctor at Bumrungrad.  I have private medical insurance so not worried about cost.

[emgthailand]

On 9/2/2016 at 1:30 AM, TallGuyJohninBKK said:

Most if not all of the larger private hospitals in BKK have their own ENT departments, usually with quite a number of different doctors on staff. The major ones --  like Bumrungrad, BNH and Bangkok Medical Center, among others -- have English language websites that allow you to search for doctors by specialty and see their basic credentials and the days/hours they've available for appointments.

 

Just bring your passport and go to the hospital of your choice, where they'll typically register you and issue you a hospital patient card. If you have expat or tourist medical insurance, they'll typically accept that if your insurance covers foreign hospital services. The doctors all pretty much can speak English, although the language capability of the support staff varies by hospital.

 

At the big foreigner oriented hospitals with greater English language skills, you can figure about 1000 baht more or less for a basic outpatient doctor visit. Any diagnostic tests and procedures will be extra. The hospitals/doctors here like to prescribe lots of medications, whether they're needed/useful or not, at varyingly inflated prices. A lot of basic allergy and sinus medications can be obtained on your own at private pharmacies at lower prices, although one exception is pseudoephedrine, which only is available from hospitals.

 

There are lots of threads and posts here on various ENT doctors and recommendations, and I've seen a lot of them, but really haven't been much impressed, particularly when it comes to them being able to correctly diagnose anything out of the ordinary/obvious.

 

But AFAIK, the ENTs aren't necessarily going to be skilled allergists. They may prescribe anti-allergy medications, but I haven't found them to be the kinds of doctors who can do sophisticated allergy testing, for example. An allergy specialist is going to be a harder thing to find here than a general ENT, AFAIK.

 

 

How much pseudoephedrine will they dispense at a time?  I bought way more than I'm probably legally allowed because I wasn't sure if I could get it here.

[TallGuyJohninBKK]

1 hour ago, emgthailand said:

 

How much pseudoephedrine will they dispense at a time?  I bought way more than I'm probably legally allowed because I wasn't sure if I could get it here.

 

Under current Thai law, pseudoephedrine is only available via a hospital doctor's prescription from a hospital pharmacy. It used to be an OTC drug that could be purchased from regular pharmacies, but that changed a few years back.

 

Most of the Thai ENTs I've encountered, and that's quite a few over the years, seem reluctant to prescribe it, or if they do, usually only in very small portions like 10 to 20 pills per appointment, as in a 7 to 10 day supply -- which is pretty useless for someone with chronic sinus problems.

 

And I can only presume that's because of the Thai government's imposed legal restrictions on the drug and the fear it's going to be used illegally for meth production.

 

For me, it's long been one of the most effective sinus drying medications I've ever used. And the substitute phenylephrine doesn't seem to work nearly as well. Though I did find one BKK doctor lately who recognized my sinus problems and did prescribe a decent supply of pseudoephedrine, somewhat to my surprise, considering the difficulties I've had with it elsewhere.

 

Edited September 8, 2016 by TallGuyJohninBKK

[TallGuyJohninBKK]

1 hour ago, emgthailand said:

I do nasal washes, I have done them for years.  Question - when you rise the nasal wash bottle, do you rinse it with bottled water?  I don't think it would be safe to clean it with tap water here.

 

For nasal washes, you really want to be dealing with sterile/boiled water for the nasal rinsing solution, and very clean water for cleaning the bottle. I personally wouldn't use just plain tap water for cleaning the bottle.

 

For the rinsing solution, I use home filtered water that's later boiled and then cooled. For cleaning the bottle, I use that same water and a bit of pure liquid bleach to soak and disinfect, and then rinsing it out with the same clean water.

 

You can also buy bottles of sterile water from Thai pharmacies, but that tends to get expensive and I'm not sure it's any better or safer than using properly filtered and boiled water at home. But even if I was buying Thai "sterile" water from the pharmacies, I'd probably still boil it at home anyway, considering the shoddy reputation that Thai bottled water has.

 

Edited September 8, 2016 by TallGuyJohninBKK

[wordchild]

6 hours ago, emgthailand said:

I do nasal washes, I have done them for years.  Question - when you rise the nasal wash bottle, do you rinse it with bottled water?  I don't think it would be safe to clean it with tap water here.

i dont make up the solution myself. you can just buy normal saline by the bottle here. every pharmacy sells it. not expensive

[sinbin]

10 hours ago, TallGuyJohninBKK said:

 

 

Most of the Thai ENTs I've encountered, and that's quite a few over the years, seem reluctant to prescribe it, or if they do, usually only in very small portions like 10 to 20 pills per appointment, as in a 7 to 10 day supply -- which is pretty useless for someone with chronic sinus problems.

 

And I can only presume that's because of the Thai government's imposed legal restrictions on the drug and the fear it's going to be used illegally for meth production.

 

 

 

It's more likely so that the doctor can check to see if the medication isn't causing side effects. If it is then he can adjust your dosage at short notice. Hence why it's on prescription only. The side effects can kill.

 

•  

  Quote

   

  • fast, pounding, or uneven heartbeat;

  • severe dizziness or anxiety;

  • easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms; or

  • dangerously high blood pressure (severe headache, blurred vision, ringing in your ears, anxiety, confusion, chest pain, trouble breathing, uneven heart rate, seizure).

   

   

Edited September 9, 2016 by sinbin

[TallGuyJohninBKK]

That's a reasonable idea. But in practice, that's not the way it really works.

 

The Thai ENTs simply don't generally want to prescribe it, or much of it, even if you're seeing them on a multiple repeat visit where any side effect issues have already been determined.

 

Pseudoephedrine has been a widely used, OTC prescription for years, both in Thailand and in the U.S. The only reason both countries changed the drug to controlled status is because of of the illegal meth issues, not because of potential medical side effects.

 

And FWIW, I've used the drug periodically for years, and never had any of the side effects you mentioned above. In general, I believe, it's considered a very well tolerated medication.

 

[sinbin]

With Meth/Yabba likely to be made legal in Thailand soon, you may not need to obtain a prescription for Pseudoephedrine in the future.    

Edited September 9, 2016 by sinbin

[TallGuyJohninBKK]

6 minutes ago, sinbin said:

With Meth/Yabba likely to be made legal in Thailand soon, you may not need to obtain a prescription for Pseudoephedrine in the future.    

 

Well, the proposal that's been aired by the government for marijuana, kratom and yabba only calls for allowing those 3 drugs to be legally prescribed by doctors -- not that they be freely available over the counter or legal to obtain/possess on the street.  So I'm not getting my hopes up too much as regards pseudoephedrine.

 

 

[Sheryl]

That suggestion was pretty rapidly shot down. Not going to happoen IMO.

 

And yes, it was concern about meth production that caused the government to restrict pseudophedrine. Furthermore, since at least one hospital pharmacy was found to be supplying meth labs with large quanitites, the hospital pharmacies are under close scrutiny as well. Hence the nervousness about prescribing large amounts at a time.

[TallGuyJohninBKK]

That was my sense as well, Sheryl. I've kind of got the feeling over time that the doctors feel that if they're found to be prescribing too much pseudoephedrine to their patients, someone at the hospital or elsewhere up the medical chain might start looking at them and wondering what they're up to.

[emgthailand]

On 9/8/2016 at 11:49 PM, TallGuyJohninBKK said:

 

For nasal washes, you really want to be dealing with sterile/boiled water for the nasal rinsing solution, and very clean water for cleaning the bottle. I personally wouldn't use just plain tap water for cleaning the bottle.

 

For the rinsing solution, I use home filtered water that's later boiled and then cooled. For cleaning the bottle, I use that same water and a bit of pure liquid bleach to soak and disinfect, and then rinsing it out with the same clean water.

 

You can also buy bottles of sterile water from Thai pharmacies, but that tends to get expensive and I'm not sure it's any better or safer than using properly filtered and boiled water at home. But even if I was buying Thai "sterile" water from the pharmacies, I'd probably still boil it at home anyway, considering the shoddy reputation that Thai bottled water has.

 

 

Why does Thai bottled water have a shoddy reputation? I did a nasal wash yesterday with water from a 6L jug of Nestle bottled water and just rinsed it w/ the same water.

[emgthailand]

On 9/9/2016 at 4:00 PM, TallGuyJohninBKK said:

That's a reasonable idea. But in practice, that's not the way it really works.

 

The Thai ENTs simply don't generally want to prescribe it, or much of it, even if you're seeing them on a multiple repeat visit where any side effect issues have already been determined.

 

Pseudoephedrine has been a widely used, OTC prescription for years, both in Thailand and in the U.S. The only reason both countries changed the drug to controlled status is because of of the illegal meth issues, not because of potential medical side effects.

 

And FWIW, I've used the drug periodically for years, and never had any of the side effects you mentioned above. In general, I believe, it's considered a very well tolerated medication.

 

Well good thing I brought enough to last me at least 6 months of taking it as-needed. I don't take it daily.  But when I get really bad allergies or an infection I take it 2-3 times per day.

[TallGuyJohninBKK]

34 minutes ago, emgthailand said:

 

Why does Thai bottled water have a shoddy reputation? I did a nasal wash yesterday with water from a 6L jug of Nestle bottled water and just rinsed it w/ the same water.

 

There have been MANY past news reports and lab tests done on varieties of Thai bottled water, including retail varieties sold at supermarkets, delivered by water suppliers and even from vending machines, showing substantial portions of those products have varying levels of contamination.

 

You don't want to be doing any kind of nasal rinsing with any Thai sourced retail bottled or tap water unless it's been first boiled and cooled, at least. And that's regardless of whatever you may read on their labels about the methods of purification they've used, etc etc.

 

 

 

 

Edited September 11, 2016 by TallGuyJohninBKK

[TallGuyJohninBKK]

53 minutes ago, emgthailand said:

Well good thing I brought enough to last me at least 6 months of taking it as-needed. I don't take it daily.  But when I get really bad allergies or an infection I take it 2-3 times per day.

 

I'm not sure about this. Maybe Sheryl knows better. So let me preface the following comment with that note.

 

However, I believe Thai law also has some limit on the quantity of pseudoephedrine that can legally be possessed by a person even when obtained by prescription. I'm guessing a 6 month supply might well be over that limit. So it might be warranted to be careful about that.

 

http://www.nationmultimedia.com/2011/07/22/national/FDA-tightens-control-over-some-cold-and-allergy-me-30160864.html

 

Edited September 11, 2016 by TallGuyJohninBKK

[emgthailand]

On 9/12/2016 at 0:41 AM, TallGuyJohninBKK said:

 

There have been MANY past news reports and lab tests done on varieties of Thai bottled water, including retail varieties sold at supermarkets, delivered by water suppliers and even from vending machines, showing substantial portions of those products have varying levels of contamination.

 

You don't want to be doing any kind of nasal rinsing with any Thai sourced retail bottled or tap water unless it's been first boiled and cooled, at least. And that's regardless of whatever you may read on their labels about the methods of purification they've used, etc etc.

 

 

 

 

Thanks for the explanation.  How do your filter your water before boiling?

[JJGreen]

[TallGuyJohninBKK]

1 hour ago, emgthailand said:

Thanks for the explanation.  How do your filter your water before boiling?

 

A PUR brand water filter container from the U.S.  I like it because it doesn't involve having to tie in the filters to the home water piping, since its a counter-top pour-in unit with replaceable, one-piece filters.

 

But, there are many different types of filtering systems available.

[emgthailand]

On 9/16/2016 at 11:27 PM, JJGreen said:

 

 

This is quite interesting.  I've only ever done it using NeilMed bottles or a neti pot. I've never used a syringe like this before.

[TallGuyJohninBKK]

FWIW, I wasn't much impressed with the Bumrungrad video (but thanks to the poster who posted it).

 

#1 -- the amount of water irrigation you'd get from using that kind of syringe is really small and not enough to do the kind of job that all the ENT's that I've ever discussed irrigation with have ever suggested using. The normal amounts are more in the range of 8-16 ounces per. You'd be surprised how much space you actually have up and inside your sinuses.

 

#2. -- using the tiny syringe "needle" like that doesn't at all seal the entrance to your nostril where the water's going in, meaning a lot may just drain down/out without ever really getting up and into all the reaches of your sinuses. Once again, all the ENT's and materials I've ever read on irrigation recommend using something that seals with the nostril at the entry point.

 

It is true that you don't want to put too much pressure on the water, because overdoing it can force the water into your eustachian tubes connecting to your ears. And similarly, ENTs don't recommend doing nasal irrigation if your sinuses are already so completely clogged/blocked that you can't get water out from the other nostril.

 

But ideally, you want to have some pressure and enough to get the water to flow up into one nostril and then drain out the opposite nostril -- something you pretty much don't see happening at all in the Bumrungrad video.  That's the kind of process you get using a so-called Neti-pot, which relies entirely on gravity. Likewise with using an electric powered Water-Pik unit with a nasal tip on the end, which shoots water up into your sinuses.

 

But, somewhat similar to the Bumrungrad video, there also are specially designed large syringes made for nasal irrigation that have an end tip that's made to fit into and seal your nostril. I have one at home here, and use it at times, and it works just fine.

 

Looks something like this:

 

 

NeilMed, a sinus products company in the U.S., also makes very simple and inexpensive sinus squeeze bottles for nasal irrigation, in 8 and 16 oz. sizes. And I've used those, but I don't care for them much. It's harder with them to keep a stable, steady flow of water that you get from slowly compressing a nasal syringe, where as the NeilMed bottles are more prone to pushing all the water in a shorter, stronger gusher as you squeeze their pretty thinly made plastic bottles.

 

Edited September 18, 2016 by TallGuyJohninBKK