The very Best Cancer Care on a Shoe String at Chulalongkorn

[al007]

 

Self Indulgence

 

Before going to surgery I was worried about post op comfort, and found this zero gravity chair on the internet, on ebay, I noted it was made in Thailand 

 

There are two electric adjustments foot rest and whole chair the fabric is leather

 

Will go horizontal and with the foot rest feet can be put above the head, and the body put to horizontal

 

It also removes pressure on the back and bottom

 

It is true luxury and very comfortable, if I had had it in hospital it would have relieved some of the pain

 

It was originally too expensive for me, but with a little detective work  and the internet eventually I found the manufacturer in Bangkok and bought it, direct at a saving of over 30,000 bhatt, still at a price I thought expensive but I did it, they wanted 5000 bhatt to ship, but I got it shipped again after internet search for just under 1,000 bhatt

It is a good looking piece ! like my wife ! unlike most of the cumbersome reclining chairs, I once worked for a man who only employed good looking people, and he was not German, pre 1945 

 

I can sleep watch tv and relax in it, it might also I think help those with back problems

 

 

PS looking at this picture note my fire extinguisher, I wonder how many have thought of the fire risk here and have fire extinguishers, when I bought three my wife wanted to make the place tidy and hide them in cupboards, until I enlightened her

[JLCrab]

Can Colorectal Polyps and Cancer Be Found Early?

 

It can take as many as 10 to 15 years for a polyp to develop into colorectal cancer. 

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html

[al007]

45 minutes ago, JLCrab said:

Can Colorectal Polyps and Cancer Be Found Early?

 

It can take as many as 10 to 15 years for a polyp to develop into colorectal cancer. 

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html

The dispute im my case is despite medicals for over 7 yrs, a colonoscopy showing polyps and no biopsy being done, haemorrhaging and winding up in ICU unit plus big bill, plus MRI scan plus CT scan, and letter from me voicing concern four doctors all said NO problem,  at a private hospital in KhonKaen, I am not allowed to name and shame, but will add it was not the Srinakarin Government Hospital which I believe is the best and safest  for all in KhonKaen, it is is the only one I would trust, many of the doctors who gave me the incorrect answers also work at the other private hospitals in KhonKaen as well

 

The answer I was given I liked, fortunately eventually I took over myself went to India for holep surgery and second colonoscopy and prostate and colorectal cancer identified

[al007]

20 hours ago, Sheryl said:

I think it is well worth complaining, will help the next person. Did you by any chance get the name of the staff person you dealt with?

So I must do

 

Actually I am responsible for me and my family and just needed nudging to do it

 

So lets see if I provoke a reaction

 

text of what I wrote

 

I need some help I live in Khonkaen and am a regular traveller to Bangkok

There is today a choice of airlines and an excellent very comfortable First Class bus, we are lucky to have this choice

Your airline is generally the most expensive

Since your separation from Thai Airways the new Thai smiles has very good on board service, as was the case on Friday

It would be helpful if you could clarify some points before I stop using your airline

On Friday at check in I had shall we say  some very difficult experiences

As I am new to disabled travel I arrive at check in some three hours early, 

I requested a  wheel chair, and my wife was asked why , my wife explains two weeks earlier I had major surgery then presents the fit to fly certificate dated ten days earlier on discharge from hospital

We are told it is invalid since it is over seven days old, is it actually really even required, I had it just in case, please clarify

I reply since being discharged I have had no further treatment, and ask because I have been in hospital once, surely a fit to fly certificate is not necessary each time we fly, I request supervisor, who arrives and looks at my certificate and says with colostomy bag can not fly

Very not nice comment in an already stressed situation, my blood pressure is rising, my Thai wife tries to calm me

I suggest she smell it ( my colostomy) as it does not smell, and have already opened my shirt to show her it

I have since search the internet and no where does it say colostomy bags are not allowed on aeroplanes, in fact to the contrary there is a lot about how to cope with them when flying

I accept things are often different in Thailand

I comment  you carry  often smelly and screaming babies often for free, as passenger we have to tolerate this

Does Thai smile have a policy of not wanting Disabled Passengers if so please let me know and I can go to a competitor,  and need not bother you again, and suggest to many friend they do likewise

I did not get the staff members names because I did not want to aggravate a difficult situation even more, and when one asks the person to write down their name it often does,  however I am sure your computer system will enable you to identify the lady checking me in and her supervisor at the time

Please advise should I next time take a photo on my cell phone ???

I was then left sitting on a wooden bench for 90 mins before the wheel chair came, my bottom has many stitches from surgery and is very painful, when asking what had happened to the promised wheel chair just told we had to wait, not really very nice for a 72 year old man in pain, who has also paid a premium fare to travel with Thai smile

I attach scanned copies of our boarding cards, you will note mine has wheel chair marked on it

I look forward to your reply and input

Kind Regards  

Al***********e FCA

Tel 08*********2

[JLCrab]

I made no reference to your individual case. But many of those who might be reading your posts should be getting a colonoscopy but do not. 

[al007]

1 minute ago, JLCrab said:

I made no reference to your individual case. But many of those who might be reading your posts should be getting a colonoscopy but do not. 

Agreed at Chulalongkorn  in Bangkok they have a special unit doing this, I believe there is a reasonably good chance of the results being properly interpreted and from a man who has no tolerance for pain, with the two stop anaesthetic there is none, a half day experience with the previous night drinking two litres of pretty unpalatable liquid to clean the bowels

 

With biopsies change from 10, 000, also take copies of all results and reports so you can if necessary either by email or post get a second opinion

 

I wish I knew a few years ago what I have learnt the very hard way, and my surgery might all have been avoided

 

I can even show what polyps look like ( have the colonoscopy showing them!! )just did not know how to read the evidence, or the fact that cancer often started from polyps

 

Doing this is very sensible insurance at reasonable cost

[al007]

On 11/8/2017 at 5:13 PM, Sheryl said:

If Stage 2 , sometimes no further treatment and sometimes chemo is suggested and the pros and cons are complex and you would want to read up on it/think about it if this applies to your case.

 

I am looking for guidance here

 

Any pointers

 

Anyone been involved in making this decision

 

I have appointments Chemo man Dec 12

                                      Oncologist dec 13

                                     colorectal surgeon dec 14

 

I want to be prepared to make decisions at that meeting if necessary

[Sheryl]

As I mentioned, chemo is not done for Stage 1 and is definitely indicated if Stage 3

 

If Stage 2, it is controversial but what I have read generally suggests that the benefits are small and this has to be weighed against the risks, which are greater for an older person.

 

"Though there may be a role for adjuvant chemotherapy in the treatment of patients with stage II colon cancer, its incremental benefit is small, at best, and comes with the risks of real and rarely fatal complications of chemotherapy."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655109/

 

"Adjuvant chemotherapy is not recommended for routine use in patients with stage II colon cancer. However, in certain situations, it may be reasonable for you and your doctor to consider adjuvant chemotherapy. This recommendation is based on the results of clinical trials, which show that patients who receive adjuvant chemotherapy have about a 4% to 5% greater chance of survival at five years after surgery, compared with patients who did not receive adjuvant chemotherapy. (The exact benefit is not known with certainty because not enough stage II patients have been included in clinical trials.)

In other words, patients who receive chemotherapy after surgery have a very small chance of reducing the risk of their cancer coming back compared with patients who do not receive the extra treatment. Given the potential risks of chemotherapy, patients should talk to their doctors about whether this small benefit is worth the risk of extra treatment."

https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/adjuvant-chemotherapy-stage-ii-colon-cancer

 

Routine use of adjuvant chemotherapy is not recommended for patients with Stage II colon cancer, but it may be considered for some patients, particularly those whose cancers have high-risk features.2

Characteristics that may indicate a higher risk of recurrence include the following:3 4

• High grade cells on pathologic exam
• Less than 12 lymph nodes sampled during surgery
• Perforation or obstruction of the colon due to cancer
• Stage IIB tumors (tumor has extended beyond the wall of the colon)

"

The overall health of the patient must also be considered when weighing the risks and benefits of adjuvant therapy. Patients with fewer other health problems (such as diabetes, obesity or heart disease) will better tolerate adjuvant chemotherapy."

https://www.texasoncology.com/types-of-cancer/colon-cancer/stage-ii-colon-cancer

 

If you are Stage IV. chemo will be offered but you may wish to consider whether to accept it.

 

General questions to ask if chemo is suggested are:

 

1. Statistically, how much increase in the chance of 5 year survival would I get from chemo? Put another way" what are my chances of surviving  with and without chemo"? When talking with doctors like this make clear to them that you understand there are no certainties and that all that can be offered are statistical odds.

 

2. What are the risks of chemo for someone my age and in my general state of health?

 

3. How long would the chemo last? How long after each session might I experience side effects? (In other words, if the chemo will run over X months, for how much of that time are you likely to be feeling ill from its effects?)

 

4.Which drugs are suggested and why?

 

5. Am I a candidate for the newer targeted therapies? (warning - they are very expensive)

 

 

 

 

[al007]

I refer to my healthcare as being on a shoestring, because that is how I approach the whole thing, and so far have not had to compromise on the surgeons, yes some of the waiting around is difficult but always I remember I can have the same man without the waiting time at five times the cost

 

My shoestring way, still had modern  private room with wonderful view, and the nursing care in my room was equal  to the best private hospitals

 

 

I received by PM this morning the following 

 

"Thanks.  Agreed.  Medical care is something I really trust there.(not referring to Thailand)  It's also amazing to me that the prices for medical procedures like this are set entirely by the government, to the second decimal point.  Surgeons there still make very good money, but don't get obscenely rich like here.  Some Thais in the know told me they easily pull in a million Baht a month."

 

I believe  the number of doctors making this sort of money in Thailand is maybe small but they have to be avoided at all costs

 

To do that we need to be vigilant and have plans for emergencies to avoid putting ourselves where we are prey to the vultures

 

My surgeon only received his monthly salary from the university for doing my eleven hour operation

 

I had a friend a while ago wound up in the Queens Heart Hospital in KhonKaen, at the week end a specialist regularily drives from Bangkok to KhonKaen to supplement his income, this surgeon charged my friend 350,000 for a thirty min procedure and the bill then  had hospital costs added

 

When in pain and on a stretcher we are very exposed and vulnerable, so please PLAN PLAN and make sure the wife knows the plan

 

 

[lopburi3]

20 minutes ago, al007 said:

My shoestring way, still had modern  private room with wonderful view, and the nursing care in my room was equal  to the best private hospitals

Actually you paid for that room - a normal patient would not have it - and not much less than you would have been charged at most private hospitals.  As for nursing care being equal to the best private hospitals have a slightly different opinion (and had 2 SIL working at government hospitals - and can say that they would agree) - but do agree this is often subjective and as long as nothing major negative happened hard to compare and agree a negative can happen in either facility. 

 

As for doctors making money being vultures; what can I say?  Most of us work to make money in today's world I believe.  Obviously 350k for 30 minutes would be extreme if just doctor fee but that is not normal and expect it may have included equipment costs

[al007]

11 hours ago, Sheryl said:

As I mentioned, chemo is not done for Stage 1 and is definitely indicated if Stage 3

 

If Stage 2, it is controversial but what I have read generally suggests that the benefits are small and this has to be weighed against the risks, which are greater for an older person.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655109/

This recommendation is based on the results of clinical trials, which show that patients who receive adjuvant chemotherapy have about a 4% to 5% greater chance of survival at five years after surgery,

 

https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/adjuvant-chemotherapy-stage-ii-colon-cancer

 

Routine use of adjuvant chemotherapy is not recommended for patients with Stage II colon cancer,

 

The overall health of the patient must also be considered when weighing the risks 

https://www.texasoncology.com/types-of-cancer/colon-cancer/stage-ii-colon-cancer

 

 

I have shortened Sheryls reply to the salient points for ME

 

Very valuable information for me especially the references that I would have found hard to locate

 

I have three specialists and I will write with a summation of my views before the december meetings, I shall also include the web sites Sheryl has given

 

I fortunately have the email adressof my John Hopkins Trained oncologist

 

At the moment I am working on the basis my cancer is stage 1 or 2

 

Even with a 25% chance of improvement I would be unlikely to opt for more chemo

 

I am 72 approaching 73, quality of life short term is important, living is guaranteed TERMINAL, yes 100% certain, my main objective may be to get the reversal done

 

I do not wish to be going all the times to hospitals spending money which is an important commodity for little real return

 

I keep and open mind and continue with research

 

Discussing this on the forum helps greatly to clarify ones mind and  thoughts

[al007]

21 minutes ago, lopburi3 said:

Actually you paid for that room - a normal patient would not have it

So lopburi3 I take it you are suggesting, I am not a normal patient, a very observant  and valid comment, I agree I am far from the norm, and long may that continue   

 

Yes I paid for the room 3500 bhatt per night including food with couch for the wife, never anywhere suggested otherwise, very excellent value, and a low cost but high quality upgrade at a government hospital, and I would recommend it to everyone going my route

 

As for a "normal" patient; this room and facility is available on request to anyone, and I believe is a case of minimal money be put out for maximum return, I might not have survived a public ward due to ME not the hospital ! !

[al007]

On 11/11/2017 at 2:08 PM, JLCrab said:

Can Colorectal Polyps and Cancer Be Found Early?

 

It can take as many as 10 to 15 years for a polyp to develop into colorectal cancer. 

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html

Can not get this link to open is it correctly stated

 

Thanks

[lopburi3]

7 minutes ago, al007 said:

So lopburi3 I take it you are suggesting, I am not a normal patient, a very observant  and valid comment, I agree I am far from the norm, and long may that continue   

 

Yes I paid for the room 3500 bhatt per night including food with couch for the wife, never anywhere suggested otherwise, very excellent value, and a low cost but high quality upgrade at a government hospital, and I would recommend it to everyone going my route

 

As for a "normal" patient; this room and facility is available on request to anyone, and I believe is a case of minimal money be put out for maximum return, I might not have survived a public ward due to ME not the hospital ! !

Actually such rooms are often hard to obtain and not as freely available as you seem to believe, and often not available until the last minute, - but agree they are good value: but most private rooms/food/services would not be 5x's the price.  It is the doctor fees and medications/most tests that are much cheaper.

 

[al007]

Just now, lopburi3 said:

Actually such rooms are often hard to obtain and not as freely available as you seem to believe, and often not available until the last minute, - but agree they are good value: but most private rooms/food/services would not be 5x's the price.  It is the doctor fees and medications/most tests that are much cheaper.

 

I would be interested on the source of information, was this the situation at Chula before the new wing 30 story block added

 

I can only comment with my own experience at Chulalongkorn

 

When we first checked in at Chulalongkorn were told a private room had not been assigned to us, however within 45 mins all OK

 

On floor 25 there were a minimum of four rooms empty, may have been more, was not something I was concentrating on

 

Before discharge told if I wanted to stay longer no problem, we did add one day two would have been better

 

We were also told for reversal surgery request the same floor and we will get the same nurses, and maybe same room, note my pictures in first post

 

In any case all working very well for me, but then I am not the norm !!!

[lopburi3]

For Chula it was before the new building but for another very large Bangkok government hospital have experience from one year ago where room could not be assigned until after surgery and only if available at that time.  In most hospitals it can be an issue from my understanding.

[JLCrab]

47 minutes ago, al007 said:

Can not get this link to open is it correctly stated

 

Thanks

well maybe just go here and click on the COLON & Rectal Cancer box --

 

https://www.cancer.org/cancer.html

[al007]

25 minutes ago, lopburi3 said:

For Chula it was before the new building but for another very large Bangkok government hospital have experience from one year ago where room could not be assigned until after surgery and only if available at that time.  In most hospitals it can be an issue from my understanding.

This may be very important and worth noting for those who follow my route

 

The Room booking appears to be in the admission in the old part of the hospital, next time I shall visit and smile or whatever well before admission

 

It makes to me, at least a very major difference on the acceptability of the hospital,also wife has 24/7 access not the case in the public ward, the ICU does not matter as generally you are at that stage out of it

[faraday]

Not wishing to dilute this thread, just adding my experience for the Surgeons fee on my hip replacement - which was 4 months ago today, at Udon Army Hospital.

 

My op was 4.5 hours, & his fee was 15k baht. I was surprised at how little it was. Lovely private room was 1800/night.

 

Sure I've got the bill somewhere, if anyone is interested in seeing it.

 

Btw Al, thank you so much for taking the time to make these threads. They are so helpful.

 

Of course, I wish you a speedy & comfortable recovery.

 

 

 

 

[lopburi3]

19 minutes ago, al007 said:

This may be very important and worth noting for those who follow my route

 

The Room booking appears to be in the admission in the old part of the hospital, next time I shall visit and smile or whatever well before admission

 

It makes to me, at least a very major difference on the acceptability of the hospital,also wife has 24/7 access not the case in the public ward, the ICU does not matter as generally you are at that stage out of it

For us told room assigned when admitted - then on admittance told have to use ward until after surgery and then room assigned if available.  As 2 1/2 days before operation (to fast/clean system) was not a pleasant experience and very hard on wife having to travel each day.  Would not do again. 

[al007]

2 minutes ago, faraday said:

Not wishing to dilute this thread, just adding my experience for the Surgeons fee on my hip replacement - which was 4 months ago today, at Udon Army Hospital.

 

My op was 4.5 hours, & his fee was 15k baht. I was surprised at how little it was. Lovely private room was 1800/night.

 

Sure I've got the bill somewhere, if anyone is interested in seeing it.

 

Btw Al, thank you so much for taking the time to make these threads. They are so helpful.

 

Of course, I wish you a speedy & comfortable recovery.

 

 

 

 

In my not so humble opinion, anything on hospitals surgeons and how we as expats deal with medical here in Thailand is very valuable content

 

You now I believe I know quite a lot of Chulalongkorn ( I am definately no expert) however what lopburi3 says about availability of rooms is so very important to me

 

When we know of a hurdle or pitfall with advance warning it is easier to negotiate

[al007]

6 minutes ago, lopburi3 said:

For us told room assigned when admitted - then on admittance told have to use ward until after surgery and then room assigned if available.  As 2 1/2 days before operation (to fast/clean system) was not a pleasant experience and very hard on wife having to travel each day.  Would not do again. 

Excellent but without knowledge we turn up, and are faced with immediate decision, refuse to stay or leave, very tough time to make that decision also very hard on the loved ones, also leaves me without interpreter

 

I am now working on plausible reason as to why I have to have private room all the way, need to think a bit, maybe need some phobias !! language is one and need for interpreter but alone will not be enough, maybe nightmares and screaming in the night, do not want to disturb other patients getting better but still need to do better

[lopburi3]

Indeed it can be very messy - on day of operation they allowed wife to visit at 0700 prior to scheduled operation (normal open time was noon until about 6PM).  But when operation canceled due no ICU room they demanded wife depart until normal visit time - so unable to make plans until afternoon or know what was going on (they refused to say how long a delay would be - only when pressed one on one in afternoon did they admit it might be 3-4 or up to six months delay).  I had made decision to go elsewhere prior to learning this in any case.

 

That said many do not have such issues and can honestly say they have good experiences.

[TallGuyJohninBKK]

Just a relative comment on the issue of hospitalization costs:

 

I have an upcoming trip back to the U.S. planned, and was needing to arrange travel medical insurance. But I soon realized, after years here, I've totally lost touch with medical/hospital costs in the U.S. So I started to do some checking, and fortunately, my state passed a law requiring some standardized disclosure by hospitals, with the most recent data being for 2015.

 

Although not specific to the particular treatment/surgery being discussed in this thread, when I checked a variety of better regarded private and government hospitals in a large U.S. state, I found total hospitalization costs (everything included) averaging between $15,000 and almost $40,000 per night (the latter at one of the top private university hospitals in the country). The average stay tended to be 5-7 days, so total costs in the $75,000 to nearly $200,000 U.S. per inpatient hospital stay on average as of 2015.

 

That's a range of 2.5 million to 6.6 million baht.  I think I need to find an anesthesiologist! 

 

[TallGuyJohninBKK]

As for the OP's original post, it made for very interesting reading, and he's certainly been through a lot. I guess I can understand his appreciation for and curiously positive evaluation of his stay and treatment at the hospital.

 

But just based on his own account, I found some things I considered to be pretty disturbing, and not unexpected based on past accounts of medical treatment here:

--nurses reluctant or refusing to follow doctor's instructions.

--needed medical equipment not available or not being provided.

--reluctance to provide sufficient pain medication to a patient clearly in considerable pain.

--general lack of transparency/clarity in interaction, whether it be the hospital's finance office being unwilling to provide specific cost information, or the nursing staff not being able to communicate directly with the patient.

 

Those were just a few of the main things that stood out for me in the OP's very detailed account.  Obviously, it's very important to have a skilled and knowledgeable surgeon. But one would hope the supporting staff and care at a hospital would at least begin to approach the same level...

 

 

[Sheryl]

Communication barriers with nurses and also administrative staff (finance office etc) is indeed a problem and by no means limited to government hospitals, even in the highest priced "international" hospitals nursing staff often speak very little English.

 

Regarding cost info, in Chula I think it is just inefficiencies, the finance office has to get information from the various hospital services and the whole process is not very efficient.  In private hospitals it is more an issue of transparency.

 

I think the private room situation in Chula is now vastly improved thanks to construction of the new building. Room availability may remain scarce in most other large government hospitals.

 

 

[TallGuyJohninBKK]

37 minutes ago, Sheryl said:

Communication barriers with nurses and also administrative staff (finance office etc) is indeed a problem and by no means limited to government hospitals, even in the highest priced "international" hospitals nursing staff often speak very little English.

 

Regarding cost info, in Chula I think it is just inefficiencies, the finance office has to get information from the various hospital services and the whole process is not very efficient.  In private hospitals it is more an issue of transparency.

 

I think the private room situation in Chula is now vastly improved thanks to construction of the new building. Room availability may remain scarce in most other large government hospitals.

 

 

Sheryl, I noticed you responded to the several non-medical points I excerpted from the OP's account.

 

But you didn't respond on the medical care points that I highlighted from his report...

 

Quote

 

--nurses reluctant or refusing to follow doctor's instructions.

--needed medical equipment not available or not being provided.

--reluctance to provide sufficient pain medication to a patient clearly in considerable pain.

 

 

[al007]

2 hours ago, TallGuyJohninBKK said:

But just based on his own account, I found some things I considered to be pretty disturbing, and not unexpected based on past accounts of medical treatment here:

--nurses reluctant or refusing to follow doctor's instructions.

--needed medical equipment not available or not being provided.

--reluctance to provide sufficient pain medication to a patient clearly in considerable pain.

--general lack of transparency/clarity in interaction, whether it be the hospital's finance office being unwilling to provide specific cost information, or the nursing staff not being able to communicate directly with the patient.

Thank you for your summation of some of the problems I encountered

 

I believe staying positive even in negative situations helps 

 

One of the very reasons I started this thread is to let others know, these things happen and we can contribute to our own luck, to be forewarned is to be forearmed

 

Sometimes to challenge is difficult, and generally upsets

 

Since coming out of hospital, I have learnt even more about some of the inadequacies of the nurses, especially at 22 hrs after surgery when the nurses say fever is rising, you do not need to be a rocket scientist to know this is a critical time in recovery, I have seen no doctor for around 13 hrs,I am told I was only given antibiotics for the first 24 hrs, I want to hear from a doctor not a nurse that no more are required.

I was prescribed paracetamol, I thought by a nurse, I had to be very strong and when told there was no doctor available, it was Sat night insist they get one from casualty, or somehow I was going to get myself to casualty where I was certain there was a doctor

 

I called a doctor friend in khonKaen and he said insist on a doctor

 

I look back on this was I correct definitely in my personal view, and I got a doctor, my first question have you read my notes, are you aware my immune system maybe lower than many

 

Eventually the fever subsided, but if out of control could have quickly gone the other way even through this period of fever, my times between monitoring stayed the same

 

I would urge others to remember this and in similar circumstances do the same

 

I still remain with my original view that bearing in mind this is Thailand, I feel Chula is pretty good and probably no worse than private hospitals and definately better than many, I also remain grateful

 

[TallGuyJohninBKK]

I think the difficult thing is when someone has just undergone major surgery, they're probably weak and miserable -- and that's not likely the time many people can summon the energy and fortitude to aggressively advocate for their own needs as opposed to just laying suffering in bed.

 

In the OP's case, despite his condition, it seems he managed to do that. And I think that should be a lesson for anyone else considering a major operation here in particular -- you need to be your own strongest advocate. Because of you don't stand up for yourself (figuratively) even while hospitalized, who else is going to?

 

[al007]

3 hours ago, TallGuyJohninBKK said:

That's a range of 2.5 million to 6.6 million baht.  I think I need to find an anesthesiologist! 

 

Yes and I would need two visits

 

Wow, and yes if there are a few inadequacies in treatment here, maybe we have to accept that, and lets not forget I will be facing another similar length  hospital stay when reversal is done and again more bills, I am pencilling in similar costs  for my own budgeting,  even though operation next time will only be around two hours

 

All the inadequacies I identified; with perseverance and determination, I was able to remedy, and did not die; being simply put down to post op complications and file closed

 

For me I am not worried and can cope financially but the USA would be a whole very different story