Surprise Heart Issues, where to start in CM?

[muskoka]

Completely out of the blue (no previous issues) I just discovered I have potentially serious heart disease (sore chest area for several days that persisted, checked in to Rajavej Hospital for check-up, visiting [floating] heart specialist(?) advised I check out and look for a hosptial/clinic that has proper specialized equipment & staff for my condition - supplied me with some meds to give time for my research. She wasn't at all clear about where to go but indicated it was urgent - confused, not sure she is a specialist or on top of the current local situation???).

 

I am not looking for diagnostics here, looking for recommendation (Cheryl?) as to who/where are the current trusted clinics etc in CM to get very accurate diagnostics, and best advice for my future options. I understand things are in a bit of flux with changes right now in CM - Gov hospital is expanding their equipment but currently under construction & sending patients to Mai Rim which is very backed up now.

 

As mentioned I am on various meds to give me some time to find the right place to start. Indications are I need to act now and will need some kind of surgery in the near future. I have had 2 EKGs & bloodwork twice, responded well to injection of blood thinner & Isordil.

 

69yo, otherwise healthy, no insurance, have means to pay but not enough $ or time to get ripped off or misguided.

 

Thanks for any and all input!

 

 

[metisdead]

Moving to the Health forum for specialized answers. 

[lopburi3]

Did doctor not advise anything about the type of tests required?  Know from my bad EKG went to Stress Test (which can be done physical with treadmill or medically with injections if you can not physically do the walk).  This is not too high priced in private hospital setting and I have had both types.  In my stress test indicated severe blockage so immediately went to angioplasty but normal would be a computer scan and then if indicated angioplasty/stent if required.   There are also several types of echocardiography tests that provide information on the heart (have had two types).  These are quite simple and non-invasive and no radiation.  Am sure others can provide better information but if you can provide any indication of what tests were suggested it might help them provide recommendations.  

[muskoka]

The problem is I don't think the Dr was a real specialist, plus she acted very hurried, no patience, her English was not good, and she was not very friendly. She confused me as much as she clarified.

 

That is why I stated - "I am not looking for diagnostics here, looking for recommendation (Cheryl?) as to who/where are the current trusted clinics etc in CM to get very accurate diagnostics, and best advice for my future options."

 

I need to start back at the beginning with a real professional who has access to the proper equipment and act on their advice after tests.

 

Thanks for your imput!

 

[meatboy]

for a start what medication were you given.that might tell us something.

[muskoka]

2 minutes ago, meatboy said:

for a start what medication were you given.that might tell us something.

 

She asked if I wanted 2 weeks or one month supply, I said one month...

 

Isordil 10mg, - 90 tabs

Isordil SL 5mg - 20tabs

Atenolol 50mg - 30 tabs

Plavix 75mg - 30 tabs

Aspirin 81mg - 30 tabs

Lipitor 20mg - 60 tabs

 

11,305 Baht total

 

 

[lopburi3]

From that mix would non medically guess they suspect blockage and that you have high lipid levels/hypertension and chest pains and trying to make blood thin to help prevent any immediate event.  Much like in my case.  You can search the medications with google to find why used.    

 

In my case, at a moderately expensive private hospital in Bangkok, angoplasty with two non-drug stents was about 300k

Edited October 6, 2016 by lopburi3

[israthai]

I had been in a similar situation about a year ago. Had good experience with Professor Apichart at Bangkok Hospital Chiang Mai and was later treated by Dr. Konlakrit which included hospitalization etc.

[muskoka]

4 minutes ago, lopburi3 said:

From that mix would non medically guess they suspect blockage and that you have high lipid levels/hypertension and chest pains and trying to make blood thin to help prevent any immediate event.  Much like in my case.  You can search the medications with google to find why used.    

 

I agree totally. Just got the meds last night so early in my research - but I think you are 100% correct.

[meatboy]

11 minutes ago, muskoka said:

 

She asked if I wanted 2 weeks or one month supply, I said one month...

 

Isordil 10mg, - 90 tabs

Isordil SL 5mg - 20tabs

Atenolol 50mg - 30 tabs

Plavix 75mg - 30 tabs

Aspirin 81mg - 30 tabs

Lipitor 20mg - 60 tabs

 

11,305 Baht total

 

 

i dont know she can prescibe you all this lot without you having tests done at a hospital.

anyway i take most of these over 10yrs.here in thailand most are generic.

isordil [angina]  mine are coversyl 450bht.x 30 tabs.   how can she give you 90tabs.

atenolol is a beta blockernot sure what i take.have to look them up.

plavix is for someone who has had a heart attack or stroke.

lipitor is for lowering cholesteral i take bestatin 330bht.x 100tabs.[did you have a full blood test.?

aspirin ?

i am sure shryl will be along to advise you on this lot.

[meatboy]

atenolol  generic name bisoprolol [beta blocker] 650bht. x 100tabs.

i am wondering what if any has she given you for BP.hypertension.

[Sheryl]

Go to the Special Medical Services Center of CMU Hospital (AKA Sripat),  it is a quasi-private channel through which you can consult senior specialists from CMU.

https://www.google.com/search?q=Chiang+Mai+Sripat&ie=utf-8&oe=utf-8&client=firefox-b#q=Chiang Mai Sripat Special Medical&tbs=lf:1,lf_ui:2,lf_pqs:EAE&rflfq=1&rlha=0&rllag=18789430,98974755,54&tbm=lcl&rldimm=7946673953630867207

 

Ask for Prof. Thanawat Benjanuwattra

 

Before doing this, get a copy of your records from Rajavej Hosp to bring along as well as list if all your meds to show the doctor

 

From the meds you were given sounds like the doctor you saw suspected the chest discomofrt was angina due to ischemic heart disease (but if she was not a cardiologist that may not necessarily be correct diagnosis).

 

You will likely need an Exercise Stress Test. Make sure the doctor knows you are taking the current meds as it will be necessary to skip taking some of that on the day of the test, maybe even a day or two before.

 

Prof. Thanawat can also be seen at Rajavej on Saturdays only, but everything will cost more there.  IF you do actually have ischemic heart disease you could be looking at a possible stent placement or bypass which runs to big money so worth going through Sripat to begin with.

 

 

[lopburi3]

isordil -  Angina: 30-120mg daily in divided doses

 

Actually Plavix is excellent at keeping the blood thin and slippery to avoid blockage - you do not have to have had a heart attack to be prescribed them (but it is expensive so often not).

 

Aspirin is the cheap blood thinner that most with known or suspected issues take - may be too much with plavix and it does cause bleeding for many people.

 

Lipitor is expensive but not the same type of statin as Bestatin.  It is generally considered a better choice if money is not an issue.

[ehs818]

Go to RAM Hospital. Good staff and doctors.

[Rob13]

I had some AFib issues that kicked in while I was in CM. I started at CM Ram, they seemed more concerned about getting me admitted for 2 weeks and letting me know I needn't worry about the fees as they will charge my insurance directly. I never brought up any questions about payment and found their approach less than comforting.

 

Next day I went to Sri Pat hospital and found everything to be very professional. I spent 3 days in the hospital there and had weekly appoints with the Cardiologists after that. The cost was  reasonable and was  impressed with the care. Much better than any I've had in the USA. The doctor was US educated and did his medical training in the US, so there weren't any culture or language barriers to get passed. 

 

Hope this helps, good luck with it.

 

 

 

Edited October 6, 2016 by Rob13

[muskoka]

33 minutes ago, Sheryl said:

Go to the Special Medical Services Center of CMU Hospital (AKA Sripat),  it is a quasi-private channel through which you can consult senior specialists from CMU.

https://www.google.com/search?q=Chiang+Mai+Sripat&ie=utf-8&oe=utf-8&client=firefox-b#q=Chiang Mai Sripat Special Medical&tbs=lf:1,lf_ui:2,lf_pqs:EAE&rflfq=1&rlha=0&rllag=18789430,98974755,54&tbm=lcl&rldimm=7946673953630867207

 

Ask for Prof. Thanawat Benjanuwattra

 

Before doing this, get a copy of your records from Rajavej Hosp to bring along as well as list if all your meds to show the doctor

 

From the meds you were given sounds like the doctor you saw suspected the chest discomofrt was angina due to ischemic heart disease (but if she was not a cardiologist that may not necessarily be correct diagnosis).

 

You will likely need an Exercise Stress Test. Make sure the doctor knows you are taking the current meds as it will be necessary to skip taking some of that on the day of the test, maybe even a day or two before.

 

Prof. Thanawat can also be seen at Rajavej on Saturdays only, but everything will cost more there.  IF you do actually have ischemic heart disease you could be looking at a possible stent placement or bypass which runs to big money so worth going through Sripat to begin with.

 

 

 

Thanks Sheryl!

 

I printed down your comments and will follow them exactly as you suggest. My Thai wife is very familiar with CMU Sripat so no issue following this up.

 

Very much appreciated!!!

 

Doug

 

[meatboy]

muskoka are you british or american why i ask is i saw you post$ sign.

i spent 2ys.having test after test,

echocadio-gram.

cardiogram.

ekg.ecg. 

stress tests.

and more.

as i was still in the uk.i was lucky,my surgery would cost me a very large amount,a new heart valve and a double by-pass and the stay in hospital alone would come to a fair sum.

if you dont have insurance can you go home and get it done?

good luck.

[ikwiljou]

1 hour ago, Sheryl said:

Go to the Special Medical Services Center of CMU Hospital (AKA Sripat),  it is a quasi-private channel through which you can consult senior specialists from CMU.

https://www.google.com/search?q=Chiang+Mai+Sripat&ie=utf-8&oe=utf-8&client=firefox-b#q=Chiang Mai Sripat Special Medical&tbs=lf:1,lf_ui:2,lf_pqs:EAE&rflfq=1&rlha=0&rllag=18789430,98974755,54&tbm=lcl&rldimm=7946673953630867207

 

Ask for Prof. Thanawat Benjanuwattra

 

Before doing this, get a copy of your records from Rajavej Hosp to bring along as well as list if all your meds to show the doctor

 

From the meds you were given sounds like the doctor you saw suspected the chest discomofrt was angina due to ischemic heart disease (but if she was not a cardiologist that may not necessarily be correct diagnosis).

 

You will likely need an Exercise Stress Test. Make sure the doctor knows you are taking the current meds as it will be necessary to skip taking some of that on the day of the test, maybe even a day or two before.

 

Prof. Thanawat can also be seen at Rajavej on Saturdays only, but everything will cost more there.  IF you do actually have ischemic heart disease you could be looking at a possible stent placement or bypass which runs to big money so worth going through Sripat to begin with.

 

 

Fully agree with your suggestion. I have perfect experience at CMU Special Medical Service. Could also recomment Dr. Phanumet Srisawang.

[muskoka]

30 minutes ago, meatboy said:

muskoka are you british or american why i ask is i saw you post$ sign.

i spent 2ys.having test after test,

echocadio-gram.

cardiogram.

ekg.ecg. 

stress tests.

and more.

as i was still in the uk.i was lucky,my surgery would cost me a very large amount,a new heart valve and a double by-pass and the stay in hospital alone would come to a fair sum.

if you dont have insurance can you go home and get it done?

good luck.

 

I am Canadian. Been here 8 years now. If I retuned to Canada it would be 6 months before I would be covered there. Besides, my home and future & family is here now.

 

Doug

 

[Jeffrey346]

Had my second stent done yesterday at Princess Hospital in Khon Kaen.. The best cardiac hospital in the NE.

This is a Government hospital and no cost to me as I am married to a Gov employee.

 

B142,000   Just to give you some cost comparison, 

[lopburi3]

Yes stent units themselves cost a lot and that will still be true in a government hospital. 

[NancyL]

Either Dr. Apichart at Bangkok Hospital or Dr. Thanawat at Sripat are good.  Sripat would be a somewhat less expensive, but you'll have longer wait times.  It's my understanding that Dr. Thanawat will soon have some clinic hours at Bangkok Hospital Chiang Mai also.  I've had a complete cardiac work-up at Bangkok Hospital Chiang Mai, including the echo stress test on a treadmill mentioned by Lopburi3 and was very impressed with their capabilities.  

 

Turns out the doctor operating the ultrasound equipment at Bangkok Hospital Chiang Mai used to work at Bumrungrad Hospital in Bangkok.  I have congenital heart problems and am monitored every 18 months or so.  The ultrasound doctor said she didn't really recognize me until she saw my heart in her ultrasound screen and then she knew right away she'd seen me at Bumrungrad where I used to go for my cardiac needs.  Turns out many of many of the Bangkok Hospital CM professionals are people they've brought up from top hospitals in Bangkok.

[ajnamoon]

Hi There

 I had chest pains   too a while went to Chiang Mai Ram   excellent staff and doctors  most speak good English  ,got all the tests done blood ECG ,X Ray  treadmill  etc  ,and was advised to go for a heart scan  which I did,   printed results  and chat with Doctor  an hour after scan ,that was about an year ago  scan cost 33.000 baht ,result was small blockage  and prescribed statins no op necessary    got scan done within 3 days  of booking

 

I think heart scan result will give you a better idea

 

I also went to Bangkok hospital  later on took test results and scan report saw heart Doc  for 2nd  opinion  he agreed no op necessary

Good Luck  

[shaurene]

4 hours ago, muskoka said:

 

She asked if I wanted 2 weeks or one month supply, I said one month...

 

Isordil 10mg, - 90 tabs

Isordil SL 5mg - 20tabs

Atenolol 50mg - 30 tabs

Plavix 75mg - 30 tabs

Aspirin 81mg - 30 tabs

Lipitor 20mg - 60 tabs

 

11,305 Baht total

 

 

Go to a good Pharmacy you will get the mess for a quarter of the price.i have just thrown . Around 500 Lipitor tabs away. I stopped them 2 yrs ago and my colesteral stayed around 4.2.  Buy eating more Thai veg and foods. I also drink a green leaf drink made. In a wizer. Good for your arteries. Eat as much raw garlic as you can. You can also put a glass of water in the micro with garlic cloves, it takes away the garlic smell and strength in your mouth. There is a great hospital in Khon Kaen with all facilities and very cheap compared to many others.

[Toscano]

Khon Kaen has good hospitals , all with out patient care .  There is also a Heart Hospital .  Khon Kaen Ram is private , but both Khon Kaen Hospital and  Synegalind (sp) university hospitals are very good .  If you are a walking patient in not too much pain , medication may be enough .  I had two Stents put in my heart by keyhole surgery at Khon Kaen hospital at a cost of Bt250,000 each one .  I was covered by insurance and stayed in intensive care .  The regular wards are very crowded and frightening , but intensive care superb  .

[abrahamzvi]

4 hours ago, israthai said:

I had been in a similar situation about a year ago. Had good experience with Professor Apichart at Bangkok Hospital Chiang Mai and was later treated by Dr. Konlakrit which included hospitalization etc.

I can only repeat what Israthai stated. I have had heart troubles for quite some time and can state in all clarity that I have been receiving the best attention and treatment at Bangkok Hospital, Chiang Mai. They have specialists that usually are active at the University hospital, including most experienced heart surgeons.

 

Bangkok hospital is by no means cheap, but it's worth its price.

[Kiwi1]

I had a VERY bad experience with Chiangmai Ram.

Have been very well looked after by Sripat ( bowel and prostate cancer surgery seven years ago and in good shape as I write).

A friend recently had quadruple bypass at Bangkok Hospital Chiangmai and we were all very impressed with the high standards there. Not cheap, though.

Good luck and best wishes.

[chiang mai]

Sheryl's advice is 100%, some other points to perhaps consider for the future:

 

Plavix is out of patent, generic plavix, (rouvestatin by Sandoz) 20mg costs about 1,100 for a months supply. There's no reason to buy Plavix any more.

 

Buy your meds. from pharmacies not hospitals.

 

Dr Patarapong at RAM is an excellent cardiologist/interventionist.

 

Perhaps research and understand the differences, cost and otherwise between medicated stents and non medicated stents, the former not not being cost effective or statistically beneficial.

 

Also look at the benefits of stenting versus meds only treatment for asymptomatic cases, it makes you wonder if stenting is actually worthwhile, asymptomatic being the key word.

 

[lopburi3]

B

20 minutes ago, chiang mai said:

Sheryl's advice is 100%, some other points to perhaps consider for the future:

 

Plavix is out of patent, generic plavix, (rouvestatin by Sandoz) 20mg costs about 1,100 for a months supply. There's no reason to buy Plavix any more.

 

Buy your meds. from pharmacies not hospitals.

 

Dr Patarapong at RAM is an excellent cardiologist/interventionist.

 

Perhaps research and understand the differences, cost and otherwise between medicated stents and non medicated stents, the former not not being cost effective or statistically beneficial.

 

Also look at the benefits of stenting versus meds only treatment for asymptomatic cases, it makes you wonder if stenting is actually worthwhile, asymptomatic being the key word.

 

Plavix is not a statin drug.  Believe you mean Lipitor patent has expired and indeed there is a Sandoz alternative - but it is called Atorvastatin and is not that much cheaper than lipitor here in Thailand when even available.  

[chiang mai]

1 minute ago, lopburi3 said:

B

Plavix is not a statin drug.  Believe you mean Lipitor patent has expired and indeed there is a Sandoz alternative - but it is called Atorvastatin and is not that much cheaper than lipitor here in Thailand when even available.  

 

Sorry yes, my mistake, I intended Crestor re: Sandoz Rouvestatin. The case for Plavix being more useful than aspirin seems not proven. Apologies for my error.