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… THAI DOCTORS AND HOSPITALS – Finding and Managing Quality Medical Care


brutox

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Thanks 

 

I actually found your post well written and informative.

Gives food for thought,and should we have doubts about ourselves or loved one ( after all we know our bodies n loved one better than a on call HCP ) then do not put blind faith in them and push further or ask if concerned.

Only time loss of faith does not matter is our Health and if we upset somebody so be it

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even though they are pissing like a double-dick quarter horse on a flat rock.

Bravo. 

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Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

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Had surgery two days ago at Pattaya Memorial Hospital. I can recommend the hospital no problem , but I wish I'd read this post first. Especially IX, that's exactly what happened, a drip that maybe wasn't needed and antibiotics pain killers and sleeping pills in my goodie bag. All itemised on the bill, which said the anaesthetist got 6k and the surgeon 18k out of a 120k bill. 

 

 

 

 

 

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Posted (edited)

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

Edited by Joeleg
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46 minutes ago, palmtree said:

Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

And sorry I butchered your name.   Don't know how my fingers decided to type Brutus instead of Brutox   😄

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27 minutes ago, Joeleg said:

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

@Joeleg, you bring up a good point about traveling home. Not just cost, but also ability to.  If one is in a bad situation, making the trip itself may not be feasible - especially the 24 hours if you live in the US.

More reason to get accurate diagnoses early and to stay on top of things.   If you let things go too long, your options become really limited.

 

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@brutox  Thanks for the write up!  Can tell a lot of time and effort went into it.   As a first year expat,  plenty of food for thought!

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I've never been there but while researching I heard from a few places that Bangkok Pattaya Hospital is pretty expensive, the rooms are like four star. Suites, so the family can stay. 

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1 hour ago, Joeleg said:

Thanks @brutox.  Medical tourism is big in Thailand. People talk about it. I know that their main selling points are prices, packaging into easy to read / understand categories and listing in details all the test and procedures to be done 

But I have always wondered the basis of their medical history and practice. They were never colonised. Examples are Malaysia and Singapore. The foundations were laid by the British including the exams. In Singapore, it done all in English and for their specialisation they head to the UK, OZ and US. 

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai. 

The second concern is refusal for long time expats to head home for second opinion and or treatment. Acknowledge that it will be question of cost. Aussie are lucky in this respect as it is much closer. 

 

I think you might be over-thinking the colonized/non-colonized basis for Thai medical system .. countries all over the world are adopting best medical practices .. some faster than others.

And yes, I have found very few Thai doctors who did medical school overseas .. to practice medicine here, medical students must pass Thai medical board examination, which is given only in Thai .. I know of only two foreigners to pass the Thai medical board exam .. a Brit and a Swiss.

If you look deeper in Bumrungrad's "Find a Doctor" option, you can find Thai licensed physicians who did their residencies and fellowships at some of the world's best teaching hospitals and clinics .. those are the guys for whom you are looking .. Johns Hopkins, Cleveland Clinic, MD Anderson, Stanford, Harvard, Mayo Clinic,etc. .. they are there .. but unless you are willing to take your place in a queue, you have to do the work to dig them out.

And you will find these guys are overwhelming proficient in English and sometimes Japanese, Chinese, and Teo Chew.

 

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2 hours ago, palmtree said:

Brutus, thanks for this.

one thing I wonder about is whether expats - particularly those who have recently moved there - could be extra susceptible to bugs that locals have developed immunity to.   Your friend’s case made me think of that - although the added risk there was probably more due to not knowing to not do push-ups in the grass.

What do you think?  And do you think physicians would think about this?

You are correct about a farang's immunology being vulnerable to an unfamiliar environment .. our immune systems are a product of the environments in which they develop .. but some bacteria and viruses are going to nail us, no matter how strong our immunities.

I did not look it up, but I suspect murine typhus is not a bacteria for which a natural immunity is common .. it beat my buddy up pretty good .. locals who are exposed to similar bacteria for which  they have built a natural resistance might have handled it better, I suppose.

But, yeah .. some guys can eat stuff that would make a pig puke and not get sick .. locally sensitized immune system.

Raised throughout Asia and having lived in 11 countries exposed me to lots and lots of bugs along the way .. but, I've gotten food poisoning only twice in 24 years here (both times in nice sit down restaurants - Mexican and Indian) .. I eat tons of street food, but I do avoid street carts serving any seafoods or steamed chicken after about mid-day.

My immune system also completely expunged HepB after 20 years .. I have a family history of an overly active autoimmune disease, so I think my immune system is really tuned for my lifestyle out here .. 555.

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Posted (edited)
41 minutes ago, Bobmoore said:

I've never been there but while researching I heard from a few places that Bangkok Pattaya Hospital is pretty expensive, the rooms are like four star. Suites, so the family can stay. 

Yeah, well, so nice 'hardware', eh? .. but, that is what can make the quality of medical care delivered by the 'software' so deceptive .. it is all about the doctors Bobmoore.

Being treated in the lap of luxury for viral pneumonia when you are suffering from bacterial murine typhus (my buddy's situation) is just not quality medical care.

Edited by brutox
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Posted (edited)
27 minutes ago, brutox said:

f you look deeper in Bumrungrad's "Find a Doctor" option, you can find Thai licensed physicians who did their residencies and fellowships at some of the world's best teaching hospitals and clinics .. those are the guys for whom you are looking .. Johns Hopkins, Cleveland Clinic, MD Anderson, Stanford, Harvard, Mayo Clinic,etc. .. they are there

To be fair, I did. Hence I chose as comparison Gleneagles in Singapore well known by the expat community. Singapore local doctors have their education in English, and for their speciality  are admitted to the various colleges such as Royal College of Physicians of Edinburg, Royal Australian and New Zealand College of Obstetricians and Gynaecologists etc. There are many such prestiges schools for specialists. 

These are not short term attachments to Mayo Clinics etc . You have to spend time sometimes up 6 years and sit for exams and this is after you qualify as a young doctor. None of the Bumrunguard doctors that I looked at had that. And I looked at many of their profiles. All of them had local Thai and some did short term attachments overseas but not sit for Specialist exams for admission to such 1st world colleges. One chap graduated from a medical school in Delhi. 

In Singapore, not just Glenageles, it’s the norm in public and private hospital as well. 

Here is a link to Singapore largest public hospital and I did a search for general surgeons and 5 came out. Look at their qualifications

https://www.sgh.com.sg/patient-care/find-a-doctor?SpID=17be2c92-14d9-462f-8393-2c16946d6c5a&InstID=8e9834e6-3ccb-4ee2-bdb9-45837e8602f8#abdomen

Out of 5, 1 got his basic medical degree - MBBS in London, another in Australia and a third in Ireland. All 5 were admitted to colleges for their speciality to the Royal College of Surgeons in Edinburg. 

Edited by Joeleg
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Posted (edited)

Related well to this thread as I got two hip replacements in Phyathai 2 by this doctor:  https://phyathai2international.com/doctor.php?pid=60&lang=en

Smashing success, back in the gym working legs after a bit more than a year.

Edited by Bruce Mangosteen

Working at getting laid in Pattaya is like working at drowning at the bottom of the ocean.  If you want to get the most out of Pattaya, take the chicks for granted, and enjoy life like you would on any other holiday.

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12 hours ago, brutox said:
  • I once checked on a radiology machine that a physician friend in the US assessed as only a few years behind the most advanced equipment in the US’s best hospitals and clinics .. for it’s use (radiating an encapsulated liposarcoma), he said perfectly sufficient; however,
  • Far, far more important is the ‘software’ – the physicians, and how they utilize the hardware.

This immediately made me think of the radiological event in Samut Prakan in 2000.  Hopefully the people operating the hospital equipment aren’t products of the same educational system as the people who try to scrap the hospital equipment. 😄

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13 hours ago, Joeleg said:

Compare the qualifications of Glenegales Hospital in Singapore and Bumrungrad International Hospitals. The latter, all their qualifications I checked at random are local Thai universities. Their training education and training all in Thai.

If you look where the best Thai University stands in the International Ranking, that will give you your answer. This Hospitals targeting the International Markets are all nice to look at with nice looking nurses, short waiting times and so on. Big show but then the problems may start. Most of brutox examples have been from the best Hospital in this country. They still screwed up. That should tell you something. 

Thank you brutox for taking the time to analize this all and to point it out to us. 

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Posted (edited)
11 hours ago, Joeleg said:

To be fair, I did. Hence I chose as comparison Gleneagles in Singapore well known by the expat community. Singapore local doctors have their education in English, and for their speciality  are admitted to the various colleges such as Royal College of Physicians of Edinburg, Royal Australian and New Zealand College of Obstetricians and Gynaecologists etc. There are many such prestiges schools for specialists. 

These are not short term attachments to Mayo Clinics etc . You have to spend time sometimes up 6 years and sit for exams and this is after you qualify as a young doctor. None of the Bumrunguard doctors that I looked at had that. And I looked at many of their profiles. All of them had local Thai and some did short term attachments overseas but not sit for Specialist exams for admission to such 1st world colleges. One chap graduated from a medical school in Delhi. 

In Singapore, not just Glenageles, it’s the norm in public and private hospital as well. 

Here is a link to Singapore largest public hospital and I did a search for general surgeons and 5 came out. Look at their qualifications

https://www.sgh.com.sg/patient-care/find-a-doctor?SpID=17be2c92-14d9-462f-8393-2c16946d6c5a&InstID=8e9834e6-3ccb-4ee2-bdb9-45837e8602f8#abdomen

Out of 5, 1 got his basic medical degree - MBBS in London, another in Australia and a third in Ireland. All 5 were admitted to colleges for their speciality to the Royal College of Surgeons in Edinburg. 

Clarifications to my original post ...

Hey, Joeleg .. I have no reason to doubt Singapore's Gleneagles Hospital (a developed-world medical system) has more internationally trained and credentialed physicians than Bumrungrad (a still developing-world medical system).

This thread is not about comparing Thai hospitals to Singaporean or any other country's hospitals .. it is not even about comparing a Thai hospital to other Thai hospitals .. it is about finding quality medical care in Thailand by comparing Thai physicians to other Thai physicians.

[To restate my physician friend's emphasis to me .. 'shop for a diagnostician, first and foremost .. not a hospital.']

Someone in Thailand with the resources to seek treatment in Singapore should go there .. this .. is not that thread.

As I qualified in the original post, I vet for US standards of practice.. I am unsure how the British-based medical training you cite differs from the US's .. I am sure the British-based system produces competent physicians.

For reference, the US system is:

  • 4 years medical school; then,
  • 1 year internship; then,
  • 3-7 year residency in their chosen specialized field; then,
  • after residency, physicians take the government-administered examination (each US state has their own examination) and become licensed to practice; then,
  • also after residency, physicians can test for the highest US medical credential  American Medical Association's (AMA's) Board Certification in their area of specialized medicine; then,
  • optional 1-3 years fellowships in advanced medicine.

My experience here is that the overwhelming majority of Thai physicians choose post-medical school and advanced medical training in the US over the British or EU systems .. for me, Thai doctors completing US residencies, fellowships, or AMA Board Certification are the go-to guys .. search again using those credentials.

Using the British-based medical system I think you refernced, you found none of the 1,200+ physicians practicing at Bumrungrad meeting their standards.. lots and lots of physicians to cover there, so I will assume by 'none', you don't literally mean 'none' .. 555 .. change your search criteria .. some very competent physicians are there, as well as at other Thai hospitals .. US credentialed in the full range of specializations all the way up to neurosurgery.

Hope that clarifies the basis for my original post above.

Edited by brutox

 

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6 hours ago, ZRHuser said:

If you look where the best Thai University stands in the International Ranking, that will give you your answer. This Hospitals targeting the International Markets are all nice to look at with nice looking nurses, short waiting times and so on. Big show but then the problems may start. Most of brutox examples have been from the best Hospital in this country. They still screwed up. That should tell you something. 

Thank you brutox for taking the time to analize this all and to point it out to us. 

To emphasize .. this is not a hospital comparative .. I recommend blowing past the tricked-out hospital lobbies and pretty nurses and go more granular .. the .. physicians.

 

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Posted (edited)
1 hour ago, brutox said:

Clarifications to my original post ...

Hey, Joeleg .. I have no reason to doubt Singapore's Gleneagles Hospital (a developed-world medical system) has more internationally trained and credentialed physicians than Bumrungrad (a still developing-world medical system).

This thread is not about comparing Thai hospitals to Singaporean or any other country's hospitals .. it is not even about comparing a Thai hospital to other Thai hospitals .. it is about finding quality medical care in Thailand by comparing Thai physicians to other Thai physicians.

[To restate my physician friend's emphasis to me .. 'shop for a diagnostician, first and foremost .. not a hospital.']

Someone in Thailand with the resources to seek treatment in Singapore should go there .. this .. is not that thread.

As I qualified in the original post, I vet for US standards of practice.. I am unsure how the British-based medical training you cite differs from the US's .. I am sure the British-based system produces competent physicians.

For reference, the US system is:

  • 4 years medical school; then,
  • 1 year internship; then,
  • 3-7 year residency in their chosen specialized field; then,
  • after residency, physicians take the government-administered examination (each US state has their own examination) and become licensed to practice; then,
  • also after residency, physicians can test for the highest US medical credential  American Medical Association's (AMA's) Board Certification in their area of specialized medicine; then,
  • optional 1-3 years fellowships in advanced medicine.

My experience here is that the overwhelming majority of Thai physicians choose post-medical school and advanced medical training in the US over the British or EU systems .. for me, Thai doctors completing US residencies, fellowships, or AMA Board Certification are the go-to guys .. search again using those credentials.

Using the British-based medical system I think you refernced, you found none of the 1,200+ physicians practicing at Bumrungrad meeting their standards.. lots and lots of physicians to cover there, so I will assume by 'none', you don't literally mean 'none' .. 555 .. change your search criteria .. some very competent physicians are there, as well as at other Thai hospitals .. US credentialed in the full range of specializations all the way up to neurosurgery.

Hope that clarifies the basis for my original post above.

This thread is about Thai medical practice and nothing in this World can amount to much unless there is a close peer comparison made. 

I acknowledge that Thais prefer US medical for post grad. Would be happy for anyone to show a sampling of US post grad that Bumrungrad doctors have done that follows the same regime as UK college system of admissions and examinations.

Out of respect to OP, I would not do any more comparisons. 

But appreciate the content made as it indeed informative and educational. 

 

 

 

Edited by Joeleg
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I was misdiagnosed and treated by 1 GP and 2 specialist here in Thailand about 10 or 15 years ago. Went back to the US and the American Dr diagnosed me correctly immediately. I no longer trust Thai doctors unless it's something minor.

The problem in what the OP suggest is how can a total lay person know which Thai doctor is the better diagnostician and which is not?  

My plan is that unless I need emergency treatment, to fly back to the US for anything major.  

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Posted (edited)
1 hour ago, Billy Shears said:

I was misdiagnosed and treated by 1 GP and 2 specialist here in Thailand about 10 or 15 years ago. Went back to the US and the American Dr diagnosed me correctly immediately. I no longer trust Thai doctors unless it's something minor.

The problem in what the OP suggest is how can a total lay person know which Thai doctor is the better diagnostician and which is not?  

My plan is that unless I need emergency treatment, to fly back to the US for anything major.  

That, @Billy Shears is the dilemma for which the solution is found in your own deep due diligence and judgement, and by manipulating the odds in your favor.

Developed in his many years as a research cardiologist working with diagnosticians in one of the preeminent medical research facilities in the world (I'll ignore the NIH's ignominious role in the Covid-19 debacle), my friend's checklist characterizes physicians with traits that identify best prospects to be good diagnosticians .. but, no guarantees .. with none of them, the odds seem to me pretty long:

  • The advanced, specialized training in western medicine is part of his checklist .. simple recognition and deep knowledge of the individual pieces of a medical condition;
  • The other part is experience and judgement  intuition .. when it comes to making difficult diagnoses, not too few years, and not too many years (as I described in the original post).. for simple diagnoses, many years is an advantage; and,
  • Another part about which my life in Asia informs me is the critical thinking process characteristic of western education and training.. as with most Asians, the preponderance of Thais are still products of a rote learning and training culture.. to that, add Thailand's strict social hierarchy that avoids making socially privileged Thais vulnerable to social discomfort, by discouraging questions, debate, and open discussions.. sure, rote learning trains people to deal with the more obvious individual variables of a data set that all fit together nicely .. no problem .. but throw at them an unexpected, disparate variable that doesn't fit the memorized pattern, and rote thinkers are challenged to integrate it into an innovative solution, as critical thinkers do —such as, say .. a complex set of medical data.

So, yeah .. finding these guys is hard work and a bit of a gamble, but the deck can be stacked in your favor .. I've found some great medical care here.

Edited by brutox
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Brutox wrote about doctor's attitudes "trust me, I am the doctor, I know best, who are you to question me"

Yes, I have encountered that, it was a well known eye specialist in one of the better hospitals, who acted like that, when I consulted him (ten years ago) about cataract surgery. He was reluctant to take my questions seriously. He omitted telling me that the variable lenses he recommended would cause a light reduction of 80%, which resulted in me now needing a torch to read the menu in most restaurants. Same hospital different surgeon, did the cataract in one of my wife's eyes, outcome less then satisfactory. A second opinion, after the fact, by a surgeon in Rutnin eye hospital confirmed that , considering her complex history of eye surgery, he should have chosen a different type of lens.

Both these docs were male. I have noticed that as a whole, the attitude of doctor's arrogance is far more an issue with male doctors than female, and especially older male doctors. But, going back of my 23 years of experiences in Thai hospitals, my sense is that over time this is slowly changing. I have had numerous male doctors over the past 8 or so years that did not have that attitude, but, instead, went out of their way to ensure that I understood the issue we were dealing with and patiently and carefully replied to all my questions and concerns. Mind you, I may have become more selective in choosing my doctors over that time.
But bottom line, I will almost always choose a female doctor if I have the option. My eye doc in Rutnin is a woman aged around 40, trained in the US, excellent (American) English, taking great care to ensure I know and understand everything that is relevant to my issues. The Rutnin cataract specialist who investigated my wife problem happened to be her mother...

Just very recently, I was diagnosed with prostate cancer. I am 77, so no great surprise. I had an operation at Bumrungrad 7 years ago, using a laser, to widen the urethra going through my prostate, since I had Benign Prostate hyperplasia (BPH). The specialist who treated me (over an 18 months period, prior to this procedure, was an older man. When he described the procedure, which involved sticking a laser instrument up your urethra and using it to burn off tissue, I was a bit nervous. An added factor was that when we talked about infection, he seems to want to tell me that infection meant the same as inflammation, which I disputed.
So I decided to get a second opinion on this procedure, and went to consult a specialist at a Pattaya hospital. He listened to my story, probed my prostate (Delicately, this time), then asked "Who is that specialist who is suggesting the laser procedure?"
I mentioned his name, my consultant smiled and said "This is the doctor (I think professor) who introduced this relatively new procedure into Thailand and is responsible to training probably every specialist in Thailand in this procedure, you are in very safe hands".

And, although it was a rather scary experience, since the whole procedure was done with only local anesthetic, so I was fully awake all the time, It didn't hurt and I recovered quite rapidly. The one thing I remember was that after he finished, the old doc bent over close to me and said "Don't you agree we have some very sexy  nurses working here?", with a big smile on his face. (a remark that might have gotten him in trouble in some western hospitals) My reply "Doc, while you were doing your thing I was trying hard not to look at the nurses, to stop myself from causing complications for your operation!"
My concern would have been that a possible erection at the time of being lasered might be both disturbing the procedure as well as been rather embarrassing. But I'm sure they would have thought of that and taken precautions to prevent this from happening. (I do remember the issue of erections being a source of embarrassment in my massages early in my time in Thailand, before I learnt that this is all part and parcel of the experience).

Brings me to anal probes of my prostate. I believe that all urologists should as part of their training be made to do a session with an experienced sex worker, preferably one trained in prostate massage. I have had numerous sessions with ladies who inserted a finger in my arse and virtually each and every one used plenty of KY and were painless, while more then half the doctors (all male) who did a digital exam of my prostate were rough, fast and didn't use KY, causing considerable pain. One, my NZ general practitioner, was so rough and caused such unnecessary pain that I changed doctor, never went back to him.

Back to my recent diagnosis of prostate cancer:
I had an all over medical check up about four years ago, a package where for fixed price they test a wide range of things, blood, stool, urine, Ultrasound, Xray of chest, ECG etc, about 4 years ago. Early this year, I found the old report, realised it was four years old, so decided to do another one.

Only two things found, slightly high cholesterol (Doc's advice "Go back on Statins"). and elevated PSA (Doc's advice "Go do check up with urology"). everything else was fine!

Went to Urology, accepted the random Urologist on duty, who interviewed me, looked at my records, ordered another PSA test. He said the procedure on my prostate of 7 years ago had a usual result of losing its effect over about 6-8 years, so nothing unexpected. He ordered (I think, if I remember correctly ) an ultrasound. Then based on that and the PSA still high after two or three weeks of medication to bring it down, he suggested an MRI. The MRI indicated medium risk of cancer, but no signs of it spreading, so he ordered a biopsy. Biopsy confirmed cancer in the prostate, so he recommended a CT scan of lower abdomen to check further for metastasis. Plus a Bone scan, same reason.

Now in every step we took over the past six weeks, he was meticulous in explaining the details and meaning  of each result and how the values measured in the testing indicated the percentage chance of certain outcomes. These were based on longterm statistical records of similar tests in different people. On the whole, I found his approach appeared scientifically sound, his patience in explaining and willingness to answer my questions was commendable. So, to date, I haven't checked his background.
A couple of days ago, the result of the CT scan and the bone scan came out. He showed that all the previous tests including the CT scan supported the same conclusion, prostate cancer, but no other signs of cancer spreading. 
The bone scan hinted at three or four small indications that they're maybe a cancer elsewhere, One near my pelvis, and two in my vertebrae, one high up, one low down. But the last two were 'possible indications, contradicted by the other tests, and even the third was dubious. Also no signs of other problems in those location, no pain. His conclusion was that they probably represented false positives in the bone scan.

His advice was getting a second opinion, from an oncologist that specialised in radiation therapy. We saw him the next day, a man in his late '40s, with a very pleasant attitude and way of communicating. He went over the material presented to him, agreed that it was highly likely that the contradictory results of the bone scan was a false positive. But he also said he would run this stuff past a colleague for a third opinion.
That was a relief.
The urologist explained two options of dealing with the prostate cancer, radiation therapy or surgery. He went through the pros and cons of each and his opinion was that both of these options had about similar risks of adverse outcomes, and the choice was really mine. When I reminded him that I was a layperson in terms of medical knowledge and would like to know his own personal choice, what would he do if he were in my shoes. He thought about it, and replied he'd go through the operation rather than the radiation. he is a urologist and a surgeon.
Next day, I asked the radiation oncologist the same question, he thought about it and replied he's go for radiation therapy.....
Each to their own.
We haven't decided yet, no rush.
One small discrepancy:
The Urologist suggested radiation therapy would take place in the Rayong Cancer treatment centre, the nearest to Pattaya (and in fact, half an hour closer to my home than to BPH in Pattaya. But the estimate was it would take between 30 and 40 daily visits for radiation.
That alone made me reluctant to chose this option.
However, the oncologist recommended a different radiation method, done in Bangkok, where they have different (better? More modern?) equipment and more options. He suggested that I'd have some markers implanted in my prostate to guide the radiation and it would take only six sessions to kill the cancer. the newer method was more precise and less likely to cause secondary damage, making it less likely to damage the closing muscle to my urethra (damage could cause incontinence) and less risk of damage to my sphincter. He also mentioned using a gel to build a insulation layer between my probate and my rectum, protecting the latter from radiation damage.
That new option would make the Bangkok radiation option much more attractive. Added to that, the likelihood that the Bangkok option would have a much higher patient throughput, meaning its doctors would probably have more experience.

Altogether, although the whole process from PSA test to where we got now was a rather nerve-racking one and some of the tests downright unpleasant, my overall opinion was positive. It came across as professional, based on science and statistics and it inspired confidence in the final outcome. Nothing is certain yet, but it could have been a lot worse.

All this came during the same period as I was personally involved with TheJoker's last weeks and his cremation, which made it all a bit more doomladen. It is highly likely that this the end of my mongering career, bu at 77, I had "good innings", I had 25 years of enjoyable mongering, I was running rather low on libido anyway and I think I can leave it behind me without too many regrets.

I'd be interested to hear from others who have had prostate cancer and what their experiences were.

My last case history is about my ankle, not sure if I have already told it here.

In 1976 I had a motorbike accident, (farangland) broke both tib and fib on my left leg. Leg set by the ambulance staff on the spot, taken to hospital, Xray, Doctor ruled it was set well, and slapped plaster on. Some months later, plaster came off, leg OK.
20 years later, while traveling in Canada, I developed an acute pain in my ankle, getting rapidly worse, making it impossible to walk. Hospital, Xray, Docter said you have arthritis in your ankle. I said "Nonsense, I am too young for arthritis."

"Wrong", he said. "You had a leg break long time ago, set slightly out of line (out of kilter?), which caused pressure on your joint, the 20 years of pressure wore down your cartilage, very little left now."

He prescribed anti inflammatories and recommended I see a podiatrist to get orthotics, which may relive the stress on the ankle joint.
That worked, until 4 years ago. Then these two remedies were not enough and I started having great pain while walking.
So I went to an orthopedic surgeon in a Pattaya hospital. He did an Xray, identified  the ankle's complete loss of cartilage. He said "we can fix it, two bolts through the ankle bones, basically locking them together." That would remove some movement up and down of my foot, maybe cause a limp, but get me walking again. But he added that I'd better do it soon, waiting too long it might get too damaged to be fixed again.

The solution worried me, I went to a different hospital for a second opinion. Youngish doctor Samitivej Sri Racha. He gave me a similar story, two titanium bolts to permanently fuse the bones, but said he's use a different operation method (Open Vs closed). Two docs, two different views.  But he added "Or maybe, we could do better, replace the whole joint with an artificial joint (again Titanium) That way, no immobility, no limp".
"Would you do that here?"
"Oh, no, I wouldn't , I'd take you to my teacher in Bangkok, he specializes in it."
"What's his name ?"
"Dr Chamnani"
I am a longstanding patient at Bumrungrad, I looked up their website and he is a consultant there. So I called Bumrungrad and made an appointment. looked him up on internet, lots of positive feedback, no negatives.
Saw him, he said "X-rays are interesting, but not enough, need a CT scan".
I had the scan, went back to see him. "You have some complications, you have some cysts in the bone of you lower leg, if you want an ankle replacement , I need to look at this a bit more, consult with some of my colleagues and the people who trained my overseas, to see if I can do that in one go, or need two separate operations."
He was very thorough, both in his explanations as well as his research, he tried not to influence our decisions by giving pros and cons of the options and ended up saying that he could do the joint replacement in one operation, 70% chance only one, 30% chance he'd have to follow up with a second one. He got back to us two weeks later, consultations completed. 
We went ahead, 8 months into Covid, since we couldn't go out anyway, just as well spend a few months in a chair or wheelchair.
Everything went OK, walking a bit after two months, walking pretty good after 4 months, still fine 3 years after that. Very happy with the outcome. he predicts a lifespan of the joint of about ten years, so if I get old enough, I may need another one, or not....
So a success story. My insurance paid about ¾, I paid the rest, total cost about 700K.

In my country, even with insurance (which would have had annual premium three times higher than here, I would have had a waiting time, six months to two years. here, almost instantly operated.
In my country, a simple scan for a suspected prostate cancer can be six month wait, an operation maybe a couple of years.

I am thankful for living in Thailand and having the means to pay for limited insurance as well as the money to pay the non insured parts.

Sorry, I got even more longwinded then Brutox..

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@Encora

My friend here in OZ is going through prostate treatment. It sounds very much like what you describe. It is called "Cyberknife" the place what he calls gold seeds in the prostrate and he had six radiation sessions. Finished his last one on Thursday last week. He had no il effects and his doctor said that there was a 95% success rate with this treatment. My friend mentioned that with this treatment its does not affect erections  none of the other complications with any of the other treatments.

I am starting to have inflated prostate counts so if I need to I think I will go this route.

Hope this helps you.

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Posted (edited)
40 minutes ago, Encora said:

...
It is highly likely that this the end of my mongering career, bu at 77, I had "good innings", I had 25 years of enjoyable mongering, I was running rather low on libido anyway and I think I can leave it behind me without too many regrets.
...

Was there any mention of closely monitoring of the prostate cancer as an option? From your description it sounds like the cancer detected isn't an aggressive one, so my question to the Dr's would be, given an age of 77 would I have a better chance of dying with cancer rather than from it?

Edited by forcebwithu
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