Rolled the dice...and won, so far

[ThailandBob]

I haven't said much online about contracting acute cholecystitis from a gallstone and, in the course of diagnosing that, finding a mass on a kidney. I figured I'd share what I experienced with the expat community in hopes that it might be helpful for others in similar situations.

I first started having these "stomach attacks" in mid-November last year. At the time, my wife, Em, was stuck in the USA, visiting two of her kids who moved to Colorado with their dad about 7 or 8 years ago. We agreed that she should go spend a portion of the next couple of years there until her youngest son graduates high school. When she left in August, I had only been living in Thailand for 4 or 5 months. Her family is all in the extreme North except for her oldest son who lives and works as a web developer in Bangkok. I give you the background to illustrate that I am alone here where we live.

The first attack felt like something was eating a hole in my stomach. I tried antiacid which did nothing. Eventually the pain was so bad that I drove myself to the Bangkok Hospital in Hua Hin, about 30-40 minutes north of my residence. There, the ER doctor ordered a CT scan which showed that I had acute cholecystitis but also a 5x5x5 cm mass on my right kidney. They gave me some antibiotics and were about to admit me for treatment but their prices were high (minimum of 11,000 baht a day compared with Hua Hin Hospital's (HHH) VIP room rate of 2,000 baht per day. I decided to get back in my car an continue up Petchkasem to HHH's emergency room where they put me on antibiotics and started injecting me with morphine which DOES NOT WORK. The pain was continuous and intense. There was no doctor available, as it was by then, about 2:30 AM. They sent me home and told me to walk into their clinic in the AM.

I went home and returned 4 hours later, signed in, and waited in the queue. Even though I was there a 7 AM, I was still around 20th in the queue. As I sat in the waiting room, the pains started getting worse. I called my wife in Colorado to tell her the situation and she asked to speak to someone at the desk where the clerks who handle the patient paperwork are. I gave my phone to one of the clerks and they arranged to have me admitted, basically circumventing having to wait to see a doctor. An orderly showed up with a wheelchair and I was whisked back to the ER where they put me back on more antibiotics and morphine. After a couple of hours, I was moved to the 7th floor Mens General Surgery Ward. We had requested a VIP room on the 10th floor, but there was no availability and more importantly, VIP rooms require patients to have a spouse or a qualified nurse present 24/7.  With my spouse not around, I wasn't going to be able to find one in my condition, especially if I don't speak much Thai. So I was in "general population."

I was put in a room with two other men whose wives were literally camped out for there for the week. When I say "camped out", we're talking mats, blankets, towels, clotheslines on the balcony, food, utensils, and all the comforts from home. It was definitely needed, as this ward offered no bedside assistance.  I was catheterized and put on multiple IVs. Doctor's orders were to stay for 5 nights while the infection cleared. Being in the middle bed, there was not much room for maneuvering beside the bed, so things were constantly being knocked into my IV stand, lights on and off all the time, and worse yet, there was an 80-year old British guy in some type of delirious condition, screaming every 5 or 10 seconds. This went on for the entire 5-day stay.

Eventually, the infection cleared and I was discharged. I made an appointment to see a gastric guy at HHH in mid-December, now 3 weeks away.  At that time, the Thailand Pass system was up and running and Em was able to book COVID tests, flights, and SHA+ reservations for a reunion on December 9th. I was sure to give the Thailand Pass system enough time to hiccup and schedule the appointment for December 15.

While waiting for Em to return, I spent an unsettled couple of weeks dodging occasional gallbladder attacks. I had seen a post by @thaifarmer on the TT Forums, recommending luk-tai-bai tea, found the capsule form on Lazada for 78 baht a bottle and ordered 4 bottles. I started taking two of those capsules daily. 

I sent a copy of the CT scan CD to my long-time general practitioner in Boca Raton, Florida. He immediately called me and told me that yes, the gall bladder and kidney should both come out. HIs rationale on the kidney was that there's more risk of triggering metastasis with a fumbled biopsy sample than with a complete removal. My Colorado doctor concurred on both.

We went to the appointment on December 15th and a urologist and an internist collaborated to arrange a two-for-one in mid-February. In the meantime, I needed to keep from getting reinfected. Those capsules work, and I recommend them. 

That brings us to February 3rd. I got a call from the internist that there was an opening in the schedule for Friday, February 5. I jumped on the opportunity. The process at HHH is to admit you one day before surgery. There, they prepare the patient for surgery, shave your nuts or do whatever else needs to be done but most importantly monitor your vitals and ensure nothing is ingested orally after midnight. This time we were able to get a private room on the VIP floor. Per night cost was 2,000 baht. The nurses and aides were all professional and attentive without exception. That was the story for the entire stay.

My surgery was mid-morning and lasted about 3 hours. It was "open" surgery, not laparoscopic. The wound pain was pretty intense but after the 3rd day, I was ready to go home. We went to the cashier to pay the bill. I was expecting it to be around 200,000 baht. I was way off. Total was 74,101. That comes out to about $2,400 US.

I have to say, this gamble paid off. I would have spent $2,400 US just flying back to the US, not to mention whatever hidden deductibles and co-pays for in-patient medicare that my Medicare plan had. Plus, after surgery, I'd need to fly from Colorado to stay with family on the east coast to convalesce as I had sold my Colorado home and now have no other ties to Colorado other than my Medicare plan is for Colorado residents. I wanted to share this little nugget in case someone with a limited budget has reservations about the Thai government hospitals.

From what I can see, the treatments are exactly the same as in the US. How the treatment is delivered sometimes differs. Case in point, once your catheter is removed, you need to have your pee measured. In the US, you'd be charged for the specially designed portable urinal bottle with the measurements on the side. Here in Thailand, someone cuts a small water bottle in half, then shoves the severed top of small bottle upside down into a 1.5L water bottle marked with sharpie. It's little cost-cutting things like that which are different but the overall care here was BETTER than both Boca Raton Regional Hospital or Cleveland Clinic in Fort Lauderdale. I spent time in both.

 

Edited February 9, 2022 by ThailandBob

[Faraday]

Thank you for posting this Bob, a dreadful ordeal for you,  your wife must have been so worried.

I have found that when administering Morphine here, they don't give nearly enough, so the pain lingers in the background.

Through my experience of being a patient twice in the Army hospital here in Udon, that the care by the nurses & doctors was excellent.

The only difference I can see, when using one of 'top' hospitals here, is better decor & higher costs.

Anyway, I'm glad you're on the mend, take it easy, eat well & relax.

 

[ThailandBob]

I forgot to add that the internist cut open the excised gall bladder and all that was left of the 0.8 cm gallstone were a few little dark brown flakes. The staff gave it to us in one of those little dipping sauce bags that vendors supply with various street food.

[dj230]

A girl I am close with in Thailand had the exact same issue, gallstones

she had the same gallstone attack stomach pains a few time, and nothing helped, I told her to go to the hospital several times but she didn’t. 

eventually one night the pain was too severe and she went to the ER at bangkok hospital, they did an ultrasound and found acute cholecystitis and gallstones. 
 

They kept her overnight, next afternoon did the surgery and she was back home the following morning. Surgery was laparoscopic and she recovered within 24 hours. Was a really mild surgery, no catheter, just IVs, she was put to sleep though. 

 

Cost was 180,000 baht if I remember correctly, was done at bangkok hospital in bangkok. Cost was for the surgery, private room, 2 night stay in hospital and all the pre-op scans/tests/medicine + follow up

 

glad to hear you’re better and that your bill was much cheaper 

 

Edited February 9, 2022 by dj230

[DwizzleyMatthews]

Worrying times @ThailandBob, glad to hear you are making a recovery.

I had gall bladder issues some 20 years ago, diagnosed with an ultrasound, and operated ( keyhole) in Brazil to remove the gall bladder, I had the offending stone for a while looking like a boiled sweet and 20mm in dia !

My only experience here was kidney stones a couple of years ago, 2 nights in hospital and luckily I passed them. 17,000 baht and treated very well with a great private room, was very satisfied with the level of treatment/attention and cost.

Have upped my water intake drastically since the kidney stones, not a pain I would like to endure again.

The gall bladder was more of a very strong dull ache that I couldn’t pinpoint, seemed to move from stomach to back. Giving a stool sample showed traces of blood ( later found to be nothing serious ) which enforced a colonoscopy ……. the less said about that the better !!

[ThailandBob]

Interesting how Bangkok Hospital has multiple levels of cholecystectomy packages, ranging from 205,000 to 385,000. No pricing for nephrectomy. Assuming it's in the same ballpark as a cholecystectomy, it would have been 400k minimum at BH. That's what their ER doctor quoted me - minimum of 400k. Which is why I left under advice not to, and went to HHH.

[dj230]

1 hour ago, ThailandBob said:

Interesting how Bangkok Hospital has multiple levels of cholecystectomy packages, ranging from 205,000 to 385,000. No pricing for nephrectomy. Assuming it's in the same ballpark as a cholecystectomy, it would have been 400k minimum at BH. That's what their ER doctor quoted me - minimum of 400k. Which is why I left under advice not to, and went to HHH.

I just checked their website and you're right, it seems they've raised the prices or they gave her a Thai citizen price, I remember she was quoted the level 1 Laparoscopic Cholecystectomy at 179,000 baht. They mentioned it was supposed to be a level 2 Laparoscopic Cholecystectomy but since she was young (18 at the time) they said she probably only needed to stay 1 night in hospital post surgery and charged her the level 1 price (difference between level 1 and level 2 being length of stay) 

The doctor at Bangkok hospital did mention the treatment quality/standards is the same at government hospitals versus private hospitals, the only difference is the wait times for procedures. He recommended since it was an acute cholecystitis with infection she could either do the surgery or try to wait it out with antibiotics and go to the government hospital and have the surgery done there. 

Edited February 9, 2022 by dj230

[ThailandBob]

2 hours ago, dj230 said:

The doctor at Bangkok hospital did mention the treatment quality/standards is the same at government hospitals versus private hospitals

Yup, one of my HHH doctors actually told me he works at BH as well as San Paulo, another private hospital in Hua Hin. He said the only difference is the prices (and scheduling). 

[dj230]

4 hours ago, ThailandBob said:

Yup, one of my HHH doctors actually told me he works at BH as well as San Paulo, another private hospital in Hua Hin. He said the only difference is the prices (and scheduling). 

Oh yea I hearing many doctors that work at private hospitals also work at government hospitals

Edited February 9, 2022 by dj230