Palliative Care and Pain Suppression in Thailand

[al007]

I have just searched on Palliative Care in Thailand, and found no specific topic

 

I received the following from a friend this afternoon, by PM

 

"Palliative care and hospice care seem to be non-existent here.  Malaysia may have hospice services http://www.sabah.org.my/pcakks/Affiliates.htm .  

India and Thailand are in the stone age with palliative care and hospice care.  I don't think anyone should die in pain when there are opiates available, but getting them in Thailand takes an act of God, and then getting the doctors to use them in sufficient quantities??? They actually seem to want people to suffer and be in pain.  
I wish we had better options in SE Asian.  Korea and Japan are different, so it's not necessarily an Asian thing.  But neither of those countries are an option.  At my age I do think about these things.  In your condition, I know you think about them.  If you find some answers, please do share. "

 

I have seen Thais dying here in many cases in great pain and it distresses and worries me greatly, I have said to families this is unnecessary let me get and pay for a doctor but generally had to back off

 

I know if I were in the UK this is all dealt with very well but I am here to stay

 

Hence I have started this thread, Being in remission from both colorectal and prostate cancers, I am fully expecting at some time they will reemerge

 

Today I feel good and reasonably healthy and consider myself a happy;  fortunate; and lucky man

 

Last week I was out and about checking out some of the smaller hospitals in KhonKaen for possible Palliative care later if required, my dear wife was shaken and said she will look after me until the end, and my investigations found nothing, absolutely nothing despite asking for where might we try

 

I like a plan; and plan B and C too in life, and that is done better now; than later when thinking and everything has gone to pot

 

I am not scared at all about dying, it will probably be the start of yet another adventure, ( I have to finish my book before I die) BUT I do fear pain, in todays world pain can and should be very optional

 

I have plans and my wife already has a list of nurses who could nurse me at home, but I need to find a doctor who can competently prescribe heavy medication if required and a place to provide such medication and better now than later

 

Maybe I have ten yrs plus left I do not know

 

Both my self and my friend are looking for help and solutions and information especially on legally obtaining heavy medication would I am sure benefit many, I probably need to identify that doctor as well

 

What type of medication might we need, from where can it be obtained in what quantities etc

 

Then of course there is the question of Euthanasia with which I strongly agree, in Holland I understand it can be achieved very reasonably and legally

 

Do I watch my dog or horse die in pain of course not, but what a problem to have a terminally ill Alsatian put down here, but I achieved it

 

I do not consider this a sad or doom topic just one of doing research

[Sheryl]

You need morphine or equivalent and it can only come from a hospital.

 

Doctors here can provide it,  but many are hesitant to do so.  When they do they will only give oral form to an outpatient (and would likely have to be terminal for them to do this). Once you cannot swallow you would have to be admitted to a hospital to get it IV - not like the west were you can get it at home. This greatly bothers me as I would much prefer to die at home.

 

I just hope matters improve here before my time (and yours) comes.

 

There a re a few pain specialist in Thailand who trained abroad and understand palliative care, but not many and in Bangkok.

[Speedo1968]

My sympathies with you and your family.   Although it is difficult, thinking now about the future will help in the future.

 

May I ask if you have considered alternative pain reduction methods such as acupuncture ?

 

Palliative care is a difficult thing to think about for all concerned, even when it is available and, as Sheryl says, it should be available as a choice but, being at home when the time comes would probably be most peoples choice.

 

Another thing to consider is whether or not you should prepare a DNR request ( Do Not Resuscitate ) ?    Please note I carry full medical details and a DNR form with me at all times, as well as posting it clearly in my house and a friend has a copy too.   I made a DNR form in 2012 following serious complications and hospitalisation in Khon Kaen.   I discussd it fully with my doctor and he was in agreement, saying that my wishes would be respected.     

Again this year in June I found myself in a similar situation, firstly with my local hospital ( where I had placed a DNR in 2012 ) and, when moved on to KK hospital for emergency treatment.     At my local hospital I was asked to sign my consent again to the DNR form and a separate one to state my refusal to be given antibiotics (as stated in my DNR form). In KK I only needed to give verbal consent.

Should you need any advice regarding a DNR please do not hesitate to ask.

[al007]

6 hours ago, Speedo1968 said:

My sympathies with you and your family.   Although it is difficult, thinking now about the future will help in the future.

 

May I ask if you have considered alternative pain reduction methods such as acupuncture ?

 

Palliative care is a difficult thing to think about for all concerned, even when it is available and, as Sheryl says, it should be available as a choice but, being at home when the time comes would probably be most peoples choice.

 

Another thing to consider is whether or not you should prepare a DNR request ( Do Not Resuscitate ) ?    Please note I carry full medical details and a DNR form with me at all times, as well as posting it clearly in my house and a friend has a copy too.   I made a DNR form in 2012 following serious complications and hospitalisation in Khon Kaen.   I discussd it fully with my doctor and he was in agreement, saying that my wishes would be respected.     

Again this year in June I found myself in a similar situation, firstly with my local hospital ( where I had placed a DNR in 2012 ) and, when moved on to KK hospital for emergency treatment.     At my local hospital I was asked to sign my consent again to the DNR form and a separate one to state my refusal to be given antibiotics (as stated in my DNR form). In KK I only needed to give verbal consent.

Should you need any advice regarding a DNR please do not hesitate to ask.

 

Very brilliant, thank you, maybe you could post your form with name removed here, I presume it is in Thai as well as English, I had never heard of this before, but actually only an extension of living will

 

To be resuscitated and then die in pain for me madness

 

Today I am doing well, and hope for maybe another ten yrs but maybe in reality unlikely

 

I got blood tests ( approx 20) today for my hospital appointments in Bangkok, done at Srinakarin Government Hospital, Khon Kaen parked on yellow lines this morning at front door, I have a disabled sticker, (if anyone wants one I will send the artwork, print and fix ! ) on my car, 20 mins later in a very busy hospital all done,( 12 booths taking blood) results two hours later and half the cost of all the private hospitals in KK, My PSA remains exceedingly low but my CEA is creeping up at 3.36 against 0 to 2.5 which is worrisome

 

 

 

 

 

Moving on does anyone know if an overseas doctor can sign a prescription for morphine, I have used an overseas doctor to buy valium here, again in Thailand difficult to get and since I found that out I always keep a good supply, seldom use it but if going to dentist for a big fix dose myself up a bit first, also the same with colonoscopy, being a big man the anesthetist tends to under calculate than over calculate, worst result the DNR becomes operational  !! keep smiling sense of humor

 

 

My father a dental surgeon always commented on peoples different pain thresholds, when my lady hairdresser cuts my toenails she can get me screaming, my pain threshold is very low, today I carry a spray of skin anaesthetic which if they are fighting to get a needle into my hand I produce and use, better for me and the nurse

 

We have in Khon Kaen a very large pharmacy dispensary, with people who look professionally qualified, ( well they all wear white coats!!) they are always amenable, and I will address my questions to them and see what they might say, I think this pharmacy also supplies hospitals

 

I will also visit KhonKaen University Medical School and try and make some enquiries with someone who lectures on pain suppression, I will also enquire at Chulalongkorn next week

 

On this pain and dying I need to have all the answers and people who can help on board early and hopefully never need them, there has to be a way to be able to die in ones own home with intravenous administration of pain killers, I have seen many old thais dying in their own homes on drips, so surely there can be a way

 

 

I am also trying to set up donating my body

 

 

My wifes grandmother died three weeks ago, just went downhill for a couple of weeks aged 93, father in law called one night, I think she has gone, but not sure

 

At the cremation I asked what did the doctor say, told none involved, head man signed the authority for the cremation, I asked how do you know she was dead, nobody had an answer, another fear I have is being buried alive or cremated alive, if sent to teaching hospital need to be very sure DNR firmly on the body, do not want to wake up in hospital morgue would be rather cold

 

PS sorry did not reply to accupuncture, and no way needles scare me did however try it once

 

 

Edited August 24, 2017 by al007

[Sheryl]

2 hours ago, al007 said:

 

 

.....Moving on does anyone know if an overseas doctor can sign a prescription for morphine, I have used an overseas doctor to buy valium here...

 

 

I will also visit KhonKaen University Medical School and try and make some enquiries with someone who lectures on pain suppression, I will also enquire at Chulalongkorn next week

 

On this pain and dying I need to have all the answers and people who can help on board early and hopefully never need them, there has to be a way to be able to die in ones own home with intravenous administration of pain killers, I have seen many old thais dying in their own homes on drips, so surely there can be a way.....

 

 

 

1. Prescriptions from overseas doctors have no validity in Thailand and you cannot legally get a prescription-only drug based on that.  Opiates can only be obtained from a hospital pharmacy and these will only provide based on a prescription from a doctor on their own staff.  Benzos are  only legally available in placed with a special license which is pretty much just hospitals and clinics that have gone to the (considerable) trouble of getting one.

 

2. There are pain specialists at Chula . The main international hospitals in Bkk also all have them. There may be less stringent rationing of meds at the private hospitals. Also, as once at end stage yo uare in no shape to be traveling to request doctor appointments (let alone in Bkk), some have upcountry branches. I have had good feedback on this doctor at Bangkok Hospital in Bkk http://www.bangkokhospital.com/index.php/en/find-a-doctor/doctor-profile/?id=649&doctor=Dr_LAKSAMEE_CHANVEJ

As there is a Bkk hospital in Khon Kaen might be possible to be under her care but get prescriptions issued out of Bkk Hosp KK, as they do limit how much supply at a time.

 

3. Drips of course, morphine drips, no, not even if you have nurses from a hospital in attendance. And believe me, I know people who have tried.  Only in the hospital itself. The very idea of injectable opiates in the home is unheard of here. As mentioned, oral opiates no problem if need is legitimate and you have a good doctor.  Ditto injectable in the hospital. The problem is if you cannot swallow oral meds and want to stay at home.  There used to be rectal suppositories of morphine here but no longer, which is a shame as very useful in end of life situations, hospices in the west use them a lot.  Fentanyl patches, if you can locate a hospital which has them, are an option.

[al007]

1 hour ago, Sheryl said:

Benzos are  only legally available in placed with a special license which is pretty much just hospitals and clinics that have gone to the (considerable) trouble of getting one.

I always check out Sheryl and knew little of Benzoes

 

 So I googled 

 

Well this seems the answer to all our problems, how to make Xanax

 

 

 

this with a DNR notice might nicely achieve the required result

[Speedo1968]

On 8/24/2017 at 5:47 PM, al007 said:

 

Very brilliant, thank you, maybe you could post your form with name removed here, I presume it is in Thai as well as English, I had never heard of this before, but actually only an extension of living will

 

To be resuscitated and then die in pain for me madness

 

Today I am doing well, and hope for maybe another ten yrs but maybe in reality unlikely

 

I got blood tests ( approx 20) today for my hospital appointments in Bangkok, done at Srinakarin Government Hospital, Khon Kaen parked on yellow lines this morning at front door, I have a disabled sticker, (if anyone wants one I will send the artwork, print and fix ! ) on my car, 20 mins later in a very busy hospital all done,( 12 booths taking blood) results two hours later and half the cost of all the private hospitals in KK, My PSA remains exceedingly low but my CEA is creeping up at 3.36 against 0 to 2.5 which is worrisome

 

 

 

 

 

Moving on does anyone know if an overseas doctor can sign a prescription for morphine, I have used an overseas doctor to buy valium here, again in Thailand difficult to get and since I found that out I always keep a good supply, seldom use it but if going to dentist for a big fix dose myself up a bit first, also the same with colonoscopy, being a big man the anesthetist tends to under calculate than over calculate, worst result the DNR becomes operational  !! keep smiling sense of humor

 

 

My father a dental surgeon always commented on peoples different pain thresholds, when my lady hairdresser cuts my toenails she can get me screaming, my pain threshold is very low, today I carry a spray of skin anaesthetic which if they are fighting to get a needle into my hand I produce and use, better for me and the nurse

 

We have in Khon Kaen a very large pharmacy dispensary, with people who look professionally qualified, ( well they all wear white coats!!) they are always amenable, and I will address my questions to them and see what they might say, I think this pharmacy also supplies hospitals

 

I will also visit KhonKaen University Medical School and try and make some enquiries with someone who lectures on pain suppression, I will also enquire at Chulalongkorn next week

 

On this pain and dying I need to have all the answers and people who can help on board early and hopefully never need them, there has to be a way to be able to die in ones own home with intravenous administration of pain killers, I have seen many old thais dying in their own homes on drips, so surely there can be a way

 

 

I am also trying to set up donating my body

 

 

My wifes grandmother died three weeks ago, just went downhill for a couple of weeks aged 93, father in law called one night, I think she has gone, but not sure

 

At the cremation I asked what did the doctor say, told none involved, head man signed the authority for the cremation, I asked how do you know she was dead, nobody had an answer, another fear I have is being buried alive or cremated alive, if sent to teaching hospital need to be very sure DNR firmly on the body, do not want to wake up in hospital morgue would be rather cold

 

PS sorry did not reply to accupuncture, and no way needles scare me did however try it once

 

 

Hello aloo7

Hope today is a good day.

 

Thanks for your comments.

I would prefer to send DNR details as a message if that is ok with you ?

The forms, other than my own are based on UK information, about 8 in all.  I have selected the most easy to understand.

For other countries such as the US ( which may even have separate state requirements ) you will have to look online.

Compared with writing a will a DNR is relatively straight forward.

 

My DNR is quite simple but following previous experience I had to ensure no antibiotics were / are used. 

 

If you need further advice / suggestions please do not hesitate to contact me.

 

For pain relief, if you are wary of needles you could try acupressure rather than acupuncture.   There is always some element of discomfort in both forms depending on where the treatment has to be applied.   Make sure that the person who administers treatment is fully qualified and knowledgeable.

[NancyL]

There is a pain clinic and palliative care specialties at Sripat Hospital, the private hospital that is part of Chiang Mai University.  This is a fairly new development, with a western trained doctor trying to educate his Thai students about western ways of pain management.  

 

Several of the cancer doctors in Chiang Mai and the bigger private hospitals are very caring and concerned about mitigating pain at end-of-life.  As Sheryl said, they will prescribe oral morphine and fentanyl patches for those who wish to remain at home, but injection morphine can only be given in a hospital, and even then they don't use a patient-regulated pump like they do in the west, but injections every few hours, so the pain control isn't consistent.  These doctors can order a "palliative care" situation in the hospital so the patient isn't over-treated or subject to unnecessary procedures.  

 

One excellent option here in Chiang Mai is for someone at end-of-life to go to McKean Rehabilitation Center, a skilled nursing facility.  It's cheaper than a private hospital and more home-like.  They have several doctors on staff and many nurses skilled with end-of-life.  They aren't licensed to prescribe morphine, but instead work with someone's primary physician at a full-service hospital in Chiang Mai to obtain morphine prescribed for the patient.  There are apartments available at the Dok Kaew Assisted Living Center if someone's family wishes to join them, or sometimes a bed is brought into the room if it's just the spouse who wishes to be with the patient.  The food is much better than most hospital food, the grounds are beautiful and peaceful, with no traffic and paved trails for walking or taking someone in a wheelchair on a walk.  It's a Christian facility.  Religion isn't something they talk about; no attempt is made a conversion, but the Christian attitude about death, dying, compassion and pain mitigation permeates their every action.

 

People usually say they want die at home, but often when someone is dying of cancer, the final weeks can be very taxing for the caregivers.  Death can be a very painful and messy process.  People become unable to care for themselves, even to move around in bed.  It can be difficult for their family to keep them clean and comfortable.  That's why relocation of the entire family to McKean can be a good option.  The family can be together with their loved one, supporting each other while the staff takes care of the patient, keeping him clean, comfortable and cared for.  The family is able to focus on giving love and support and not doing laundry, cooking meals, trying to move and bathe their loved one. 

[sirmud63]

i have heard conflicting reports of the use of CBD being used for pain managment here .

can any of you shed some light on this please?

[impulse]

1 hour ago, NancyL said:

People usually say they want die at home, but often when someone is dying of cancer, the final weeks can be very taxing for the caregivers.  Death can be a very painful and messy process.  People become unable to care for themselves, even to move around in bed.  It can be difficult for their family to keep them clean and comfortable.  That's why relocation of the entire family to McKean can be a good option.  The family can be together with their loved one, supporting each other while the staff takes care of the patient, keeping him clean, comfortable and cared for.  The family is able to focus on giving love and support and not doing laundry, cooking meals, trying to move and bathe their loved one. 

 

Excellent points.  Any idea what this costs on a monthly basis, and how insurance handles (or doesn't) those charges? 

 

Just a ballpark, as I'm sure anyone in that situation can do a lot more research.

 

One other question of a very general nature, Does Thailand have medical people who help with those who still want to stay at home, or can't afford the cost of such a facility?  If so, where would one look for them in their area?

 

Edited August 27, 2017 by impulse

[impulse]

On 8/24/2017 at 6:47 PM, al007 said:

At the cremation I asked what did the doctor say, told none involved, head man signed the authority for the cremation, I asked how do you know she was dead, nobody had an answer, another fear I have is being buried alive or cremated alive, if sent to teaching hospital need to be very sure DNR firmly on the body, do not want to wake up in hospital morgue would be rather cold

 

My guess would be that, as a foreigner, your death would require additional formalities that would prevent any such possibility.  If all it took was a single signature, there would be hundreds (thousands?) of foreign fugitives being declared dead in Thailand every year, splitting the life insurance with their co-conspirators, only to pop up later under a different name.

 

Edit:  Or is that a thing?

 

Edited August 27, 2017 by impulse

[Sheryl]

Foreigners cannot be (legally) cremated or buried without clearance from their Embassy.

[Sheryl]

3 hours ago, sirmud63 said:

i have heard conflicting reports of the use of CBD being used for pain managment here .

can any of you shed some light on this please?

Not used and not legal in Thailand

[al007]

4 hours ago, Sheryl said:

Foreigners cannot be (legally) cremated or buried without clearance from their Embassy.

Is embassy approval required for a death certificate, if one is donating ones body for medical science it has to be handed over within 24 hrs of death, maybe the death certificate comes first, donation second and embassy approval later

 

I wonder how long this might take with the UK Embassy, if the body were at home what happens in the intervening period, sits in the refrigerated box I presume

[al007]

7 hours ago, impulse said:

 

 

One other question of a very general nature, Does Thailand have medical people who help with those who still want to stay at home, or can't afford the cost of such a facility?  If so, where would one look for them in their area?

 

We already have a list of many nurses working part time at local hospitals, for this eventuality

Many hospitals employ part time nurses, when still in good health visit local hospitals and spread the word and you will be amazed how many possibles you find, all qualified nurses, maybe not in pallaitive care but definite possibles

 

It is also necessary to create a small network of helpful local doctors, and maybe vets ! ! who may be more experienced in what is required

 

My father gone 30plus yrs ago , an eminent dental surgeon, had a patient come in one day with a lot of pain, she said she had been to her doctor, he said why not your vet, she was offended, but as my father explained Vets on some things like teeth and euthanasia, are often better qualified than doctors, who do not generally deal with these topics

 

It is also sometimes challenging to understand we do not leave our horse or dog in pain, but if it is a loved spouse we do nothing

 

I note florida executed a man last week by injection, but we are not allowed free choice

 

A terrorist commits an awful crime and he is often immediately taken out of his obvious mental pain and discomfort

 

Just some personal observations

[al007]

5 hours ago, Sheryl said:

Foreigners cannot be (legally) cremated or buried without clearance from their Embassy.

We need to retain humour even on important and depressing topics such as this

 

Lets remember also what we find  humour in the UK may offend others and this is for those with UK humour and over 18

 

So I live in Issan, I am in suspended animation, about to go into the fire, and exclaim in a foreign language, to those who have already drunk too much of my booze, "Stop this is not Legal" the last I remember was the man said give me another of his excellent whiskies I thought he stirred, that whiskey is doing me no good

 

Door shut case closed until they come to rake the bones for souvenirs a few days later

 

God Bless keep Smiling

[Sheryl]

47 minutes ago, al007 said:

Is embassy approval required for a death certificate, if one is donating ones body for medical science it has to be handed over within 24 hrs of death, maybe the death certificate comes first, donation second and embassy approval later

 

I wonder how long this might take with the UK Embassy, if the body were at home what happens in the intervening period, sits in the refrigerated box I presume

Embassy approval is required to release the body to anyone/anyplace. The purpose is to ensure next of kin are notified. Where there is a Thai spouse, as soon as they verify this fact they will give the OK.

 

If the UK Embassy has an expat registration system, avail of it and clearly list your wife. This registry is the first thing they will check.

[NancyL]

1 hour ago, al007 said:

Is embassy approval required for a death certificate, if one is donating ones body for medical science it has to be handed over within 24 hrs of death, maybe the death certificate comes first, donation second and embassy approval later

 

I wonder how long this might take with the UK Embassy, if the body were at home what happens in the intervening period, sits in the refrigerated box I presume

All of the body donations I've known of here in Chiang Mai have been where the final destination was for anatomy classes at CMU.  In these cases, the body could remain in refrigerated conditions for quite some time.  And they can be very selective.  For example, if someone dies of cancer, they usually turn down the donation.

[NancyL]

9 hours ago, impulse said:

 

Excellent points.  Any idea what this costs on a monthly basis, and how insurance handles (or doesn't) those charges? 

 

Just a ballpark, as I'm sure anyone in that situation can do a lot more research.

 

One other question of a very general nature, Does Thailand have medical people who help with those who still want to stay at home, or can't afford the cost of such a facility?  If so, where would one look for them in their area?

 

The cost of care at McKean really depends upon the services required.  In general, a private room (which is what is recommended for end-of-life) with meals, nursing care, perhaps wound care, etc, is about 60,000 baht/month.  I've know cases that were as high as 100,000 baht per month when the patient had several bad bedsores that required daily dressing changes, with morphine and expensive medical supplies.  In some cases, where money is an issue, an end-of-life patient can be placed in a ward room, with several other patients, but then it's difficult for the family, although very possible for just one family members to spend good quality time with the person.  Then the cost could be about 30,000 baht/month.  The wards at McKean are much more spacious, quiet and have aircon they use when really hot vs. wards at a gov't hospital.  

 

The private rooms at McKean are really very much like the private rooms at the upscale private hospitals in CM, OK but without the designer bath products and 24 hours room service for food like they have at Bangkok Hospital.  But still the private rooms at McKean have aircon, flat screen TV, refrigerator, hot water pot, microwave, nice big clean bathroom, big sofa for family member, enough room where they'll bring in a bed for a family member, etc.  They're a very good deal at 60,000 baht/month for end-of-life.

 

You asked about getting "qualified medical people" for someone who can't afford such a facility.  Ah, here's the problem.  You can't obtain round-the-clock qualified people for home care for 60,000 baht/month, especially if your home isn't properly set up with the correct equipment.  

 

I've seen men who were abandoned by their Thai lovers and even wives during their final weeks because they just couldn't handle the care anymore.  They call the Embassy/Consulate and say "come get him" (it doesn't work that way, of course).  Or they try to soldier on, keeping him as comfortable as possible on a plastic sheet on the floor, so they can drag him into the hong naam several times during the day to wash off the mess that is coming out of many parts of his body.  Sorry if this is graphic, but is is how some people die when they don't have money.  They die in ways worse than any Thai person would have to.  

 

Think about this when you order your third beer of the night or decide to buy the next, latest greatest electronic gadget.  Just about everyone I know, even on a very low income, is able to set aside 5000 or 10,000 baht per month toward a health savings account.  Everyone, no matter how old, can obtain accident insurance.  There is no excuse for living pension check-to-pension check and still being here in Thailand.  If that's your status, you shouldn't be here.  You may be setting yourself up for a very unhappy ending.

 

 

[al007]

22 minutes ago, NancyL said:

The cost of care at McKean really depends upon the services required.  In general, a private room (which is what is recommended for end-of-life) with meals, nursing care, perhaps wound care, etc, is about 60,000 baht/month.  I've know cases that were as high as 100,000 baht per month when the patient had several bad bedsores that required daily dressing changes, with morphine and expensive medical supplies.  In some cases, where money is an issue, an end-of-life patient can be placed in a ward room, with several other patients, but then it's difficult for the family, although very possible for just one family members to spend good quality time with the person.  Then the cost could be about 30,000 baht/month.  The wards at McKean are much more spacious, quiet and have aircon they use when really hot vs. wards at a gov't hospital.  

 

The private rooms at McKean are really very much like the private rooms at the upscale private hospitals in CM, OK but without the designer bath products and 24 hours room service for food like they have at Bangkok Hospital.  But still the private rooms at McKean have aircon, flat screen TV, refrigerator, hot water pot, microwave, nice big clean bathroom, big sofa for family member, enough room where they'll bring in a bed for a family member, etc.  They're a very good deal at 60,000 baht/month for end-of-life.

 

You asked about getting "qualified medical people" for someone who can't afford such a facility.  Ah, here's the problem.  You can't obtain round-the-clock qualified people for home care for 60,000 baht/month, especially if your home isn't properly set up with the correct equipment.  

 

I've seen men who were abandoned by their Thai lovers and even wives during their final weeks because they just couldn't handle the care anymore.  They call the Embassy/Consulate and say "come get him" (it doesn't work that way, of course).  Or they try to soldier on, keeping him as comfortable as possible on a plastic sheet on the floor, so they can drag him into the hong naam several times during the day to wash off the mess that is coming out of many parts of his body.  Sorry if this is graphic, but is is how some people die when they don't have money.  They die in ways worse than any Thai person would have to.  

 

Think about this when you order your third beer of the night or decide to buy the next, latest greatest electronic gadget.  Just about everyone I know, even on a very low income, is able to set aside 5000 or 10,000 baht per month toward a health savings account.  Everyone, no matter how old, can obtain accident insurance.  There is no excuse for living pension check-to-pension check and still being here in Thailand.  If that's your status, you shouldn't be here.  You may be setting yourself up for a very unhappy ending.

 

 

Valuable information, personally I could cope with those costs even at the top end

 

It is on my list to visit, in the short term with the longer term view

 

Question then becomes how do you know when to go 

 

And maybe ambulance from KhonKaen to chiang mai, ( choice travel in ambulance alone, send wife in the car, very heavily sedated, ambulance does not make it normal horrific driving, D O A, problem resolved, excuse my bad humour, but OK for me)

 

I have a terrible mind and then think life very cheap here, pay someone to shoot me 10,000 again done, my outside box thinking, then into box and cremated, better than some of the scenarios you describe

 

You make a very valid comment on accident insurance, I can see no way that would work or an insurance would pay for palliative

 care on that type of policy, have I missed something if it would an absolutely must have

 

 

Yes I agree if nursed at home we have discussed, two full time nurses, the full time home help already in place and the gardening lady as well as the wife, works out more than 100,000 per month, a lot more, in fact nearer double with drugs and some doctors etc

 

Unfortunately  as you say, there are many here who should not be, and if they are from the UK and die in the way you describe they are even bigger fools than we think and have no plan, and they can avoid this

[NancyL]

Usually, by the time people at end-of-life go to McKean, it's often several weeks past the time they should have gone.  It's not usual to see some people improve, once they get into the nice, clean, beautiful and caring surroundings and I've even heard some misinformed friends/family comment that they really aren't at end-of-life when they see the nice little rally at first admission.

 

No, it's because for the first time in months they're in a proper bed, being kept clean, fed western food, in aircon, with unlimited ice cream or soft boil eggs or oatmeal or whatever western treat strikes their fancy within reason.  They're hearing English spoken, perhaps for the first time in months.  

 

An ambulance from Khon Kaen to Chiang Mai is possible.  There have been several ambulance journeys of this length to McKean for end-of-life patients.  Don't wait until you're on a respirator and don't try to risk an commercial airline journey, even the short hop from Khon Kaew to CM.  I've known of people dying on short plane trips within Thailand to CM trying to get to McKean.  Airplane cabins aren't pressurized at sea level.  Air ambulances are different.

 

I suppose there are some insurance policies that would pay for palliative care -- it really isn't very expensive.  Much less expensive than continuing to treat an illness "at all costs".

[NancyL]

Oh, to further answer the question about "when it's time to go to McKean", you should visit the place, see their capabilities and maybe talk with some of their more chatty residents.  Then put criteria into your Living Will or Advance Health Directive, ask in "I want to go to McKean when my bedsheets have to be changed more than twice a week" or "I want to go to McKean when I can no longer give myself a shower".  In other words, give your loved ones clear guidance about when you want to go.

[al007]

2 hours ago, Sheryl said:

Embassy approval is required to release the body to anyone/anyplace. The purpose is to ensure next of kin are notified. Where there is a Thai spouse, as soon as they verify this fact they will give the OK.

 

If the UK Embassy has an expat registration system, avail of it and clearly list your wife. This registry is the first thing they will check.

Thank you, I believe I plan better tan most but am not registered with UK embassy here, nor is my wife

Unlike many the UK government and pension people have my thai address

 

I will register myself and wife with UK embassy, also give them a copy of my will, they probably will ignore the will but can try

 

Also going to get wife a new UK visa just in case we ever wanted to go there, but can not see that with sensible alternative

 

As for Nancies comments on when to go I already meet her criteria, sheets changed every two days and back generally scrubbed in the shower, I am a lucky man

 

I an planning hopefully many more years but lets stay informed

 

We worry about these things but drove from KhonKaen to BKK today, saw so many accidents with the bad weather

 

As always one thing guaranteed living is terminal, I do not buy lottery tickets because when I ask for the guarantee told do not get one  

 

Checked into nice hotel, told the room was exclusive, I asked surely the beds and sheets at their prices included, they were but have in the past had to pay extra for sheets

[al007]

15 hours ago, NancyL said:

 

  I've known of people dying on short plane trips within Thailand to CM trying to get to McKean.  Airplane cabins aren't pressurized at sea level.  Air ambulances are different.

 

 

Nancy I am not your normal run of the mill old man, I am not scared in anyway of dying

 

What I do not want is longterm painful illness that is also difficult for family

 

(deletion by Moderator)

 

However the chances of dying painfully are still low despite two cancers, prostrate and colorectal, I am 72, my father, grandfather, and great-grandfather all died at 70, I was confident that would not happen to me because statistically the odds of four male members of a family all dying a the same age were very safe and in my favor

 

So far no family member on quite a large spread family has died in pain, many gone with simple quick heart attack, and with a DNR in place the odd of going on the operating table also increase

 

I still drive, twenty years ago I needed glasses today I do ok without

 

I have however given up driving when drinking my sober lady does that

 

I do not and will not drive motorbikes, I am considering a bicycle to help loose weight, but again dangerous, and yes I have accident insurance

 

Most people do die quietly and peacefully and not in hospitals, I only have to watch the villages round us people going all the time, roads shut parties and funerals

 

Then in the same villages many weddings, and in Issan I have worked out the average child is born seven months after getting pregnant, happened in the case of a cousin, I said at the wedding she looks pregnant, and was assured no, the child was born 7 months later, must be to do with the crabs in the papaya salad

 

I can think of one way to end it all quickly and that would be for my very Thai, very Issan wife to find me with another woman, but that would be guaranteed very painful and very messy, so that is ruled out

[TallGuyJohninBKK]

19 hours ago, NancyL said:

Oh, to further answer the question about "when it's time to go to McKean", you should visit the place, see their capabilities and maybe talk with some of their more chatty residents.  Then put criteria into your Living Will or Advance Health Directive, ask in "I want to go to McKean when my bedsheets have to be changed more than twice a week" or "I want to go to McKean when I can no longer give myself a shower".  In other words, give your loved ones clear guidance about when you want to go.

 

Nancy, thanks very much for the various informative and very useful posts in this thread. Good info for all.

[Sheryl]

Unfortunately nothing like McKean in otherparts of the country that I know of.

 

I have heard good reports of end of life care at Watta Bangkok Hospital in Bangkok. Key is to be under the care of one of their palliative specialists as your primary doctor.

 

It is an expensive hospital, though with end of life there are no surgeries, scans or the like and the meds are comparatively inexpensive.

[TallGuyJohninBKK]

5 hours ago, Sheryl said:

Unfortunately nothing like McKean in otherparts of the country that I know of.

 

I have heard good reports of end of life care at Watta Bangkok Hospital in Bangkok. Key is to be under the care of one of their palliative specialists as your primary doctor.

 

 

Sheryl, is the place you're referring to above formally called Wattanosoth Hospital, part of the Bangkok Hospital empire? The one I'm asking about is their cancer specialist hospital...

 

https://www.bangkokhospital.com/wattanosoth/web/en/site/corporate/story

Wattanosoth Cancer Hospital

2 Soi Soonvijai 7, New Petchburi Road, Huaykwang, Bangkok, 10310, Thailand.
Tel: 0 2310 3000 Fax: 0 2318 1546

 

 

Edited August 28, 2017 by TallGuyJohninBKK

[connda]

14 hours ago, Sheryl said:

Unfortunately nothing like McKean in otherparts of the country that I know of.

 

I have heard good reports of end of life care at Watta Bangkok Hospital in Bangkok. Key is to be under the care of one of their palliative specialists as your primary doctor.

 

It is an expensive hospital, though with end of life there are no surgeries, scans or the like and the meds are comparatively inexpensive.

Are there other options for hospice and palliative care elsewhere in Southeast Asia?

[Sheryl]

13 hours ago, TallGuyJohninBKK said:

 

Sheryl, is the place you're referring to above formally called Wattanosoth Hospital, part of the Bangkok Hospital empire? The one I'm asking about is their cancer specialist hospital...

 

https://www.bangkokhospital.com/wattanosoth/web/en/site/corporate/story

Wattanosoth Cancer Hospital

2 Soi Soonvijai 7, New Petchburi Road, Huaykwang, Bangkok, 10310, Thailand.
Tel: 0 2310 3000 Fax: 0 2318 1546

 

 

Wattanosoth is the Camcer hospital within the Bangkok Hospital complex (there is also a heart hospital etc - all part of Bangkok Hospital).

 

The palliative care docs there can treat patients either within Wattanosoth or the main hospital, doesn't really matter. But I think the cases I've known probably were in Wattanosoth because they all had cancer.

[Sheryl]

4 hours ago, connda said:

Are there other options for hospice and palliative care elsewhere in Southeast Asia?

Singapore has well developed hospice services both in-patient and in the home.

 

But if you are going to travel away from home could just as well be in a hospital in Thailand. End-of-life care in the better private hospitals, if you have a palliative care specialist as your primary doctor, are OK. The gap is for hospice type care in the home.