Spinal Specialist in Chiang Mai

[motdaeng]

17 hours ago, ThaiPauly said:

Final was 370,000 baht.

She is recovering well at home although in pain, but not the same pain

as she had before the operation. She was on morphine in hospital, but now she is on a standard pain killer and muscle relaxant.

So far so good, although she moves very slowly, I suppose this is to be expected after major surgery?

i wish your wife all the best and a good recovery ...

as i understand Prof Torphong Bunmaprasert did the operation. can you please tell me at which

hospital? thanks a lot.

[Sheryl]

The surgery was done by Prof Wicharn at BNH hospital in Bangkok.

[ThaiPauly]

On 11/18/2019 at 8:10 AM, Sheryl said:

Yes. As the incision heals she will naturally move better.

 

That price is more what I would have expected than your initial quote. I suppose they prefer to quote high

 

Did she get an artificial disk or have a fusion? 

Fusion Sheryl,

 

They took bone from her hip to fashion the discs

[ThaiPauly]

On 11/18/2019 at 12:05 PM, Sheryl said:

The surgery was done by Prof Wicharn at BNH hospital in Bangkok.

No it was done by  Associate Professor Torphong Bunmaprasert at Chiang Mai Ram.

 

You recommended him to me Sheryl, (see post #22 ) and what a lovely man he is and I thought very good, though time will inevitably tell,

Edited November 19, 2019 by ThaiPauly

[Sheryl]

Oh! All this while I thought you were at BNH. (Price certainly sounded like it!).

 

Good to have feedback on Prof. Torphong.

[uhuh]

In these kind of cases,  the long-term results count. 

It would be nice if you let us know. 

How is your wife doing by now? Does she need or get physical therapy, or does she just exercise at home?

 

And maybe give us another feedback in a month or in 2 months? 

 

Thanks a lot. 

[ThaiPauly]

4 hours ago, uhuh said:

In these kind of cases,  the long-term results count. 

It would be nice if you let us know. 

How is your wife doing by now? Does she need or get physical therapy, or does she just exercise at home?

 

And maybe give us another feedback in a month or in 2 months? 

 

Thanks a lot. 

I sent you a pm.

 

Two and a half weeks post operation: She is in a lot of pain and certainly no better than before the operation.

Numbness in hands and feet, pain in back , walking very slowly because of the pain from the hip op to get the bone for the spinal op.

Doc ( not the surgeon, we have not seen him yet as he has been away) says it's pretty normal although it appears that she has more pain than normal, he upped her pain meds and muscle relaxant doses.

He said it can take 2-3 months to get better. Seeing the surgeon on Saturday afternoon.

 

I really hope he's right.

[Sheryl]

1 hour ago, ThaiPauly said:

I sent you a pm.

 

Two and a half weeks post operation: She is in a lot of pain and certainly no better than before the operation.

Numbness in hands and feet, pain in back , walking very slowly because of the pain from the hip op to get the bone for the spinal op.

Doc ( not the surgeon, we have not seen him yet as he has been away) says it's pretty normal although it appears that she has more pain than normal, he upped her pain meds and muscle relaxant doses.

He said it can take 2-3 months to get better. Seeing the surgeon on Saturday afternoon.

 

I really hope he's right.

 

it does not sound at all normal.

 

Pain at the incision site and site they took the bone for graft, yes (though not usually as sever as you describe).

 

Numbness in hands and feet, absolutely not and a serious danger sign.

 

She may have a post op hematoma. Needs to have an MRI or CT urgently and be re-assessed.

 

Do not delay.

[ThaiPauly]

5 minutes ago, Sheryl said:

 

it does not sound at all normal.

 

Pain at the incision site and site they took the bone for graft, yes (though not usually as sever as you describe).

 

Numbness in hands and feet, absolutely not and a serious danger sign.

 

She may have a post op hematoma. Needs to have an MRI or CT urgently and be re-assessed.

 

Do not delay.

Sheryl,

 

She had the numbness before the operation as I stated in the OP,

 

I should have made myself clearer in my last post. The numbness she had prior to the operation is still present

 

No doctor or pain management specialist has mentioned that this was a critical situation before the operation and were all aware of this condition

 

Can you please give me your thoughts on this?

 

Much obliged for your help as always

[Sheryl]

If it is the same degree of numbness as she had before the operation then neither surprising nor critical.

 

Surgery can relieve pain and prevent further nerve damage but can not reverse any nerve damage that already occurred. Which is why if surgery is clearly indicated delaying it is unwise.

 

If the surgery was successful then the pain she had prior to the operation (not obviously referring to the incisional pain but rather the original pain) should be largely relieved. Is it?

[ThaiPauly]

No Sheryl,

 

She is no better than before the operation I am sorry to say.

 

I really don't know what to do about her numbness. I have spent a lot of time reading the Veritas Health Forum which specializes in spine health, mostly in the States and it makes very grim reading. Many people have "pain pumps" inserted into their bodies and are filled up like a gas tank once a month with various meds like morphine

I had never heard of this before and I really hope that things do improve for her and that she never needs one. Have you heard of them? Are they available in Thailand?

But I fear for her

Will be seeing the surgeon who performed the operation on Saturday, so will hopefully know more then

[uhuh]

51 minutes ago, Sheryl said:

 

If the surgery was successful then the pain she had prior to the operation (not obviously referring to the incisional pain but rather the original pain) should be largely relieved. 

Exactly. 

So when you see the surgeon ask him about it. 

 

Numbness can disappear,  and this can take months. 

But it can also persist for the rest of the life. 

 

"2-3 months" as a time frame for improvements of the cervical spine sounds fast to me. I would mentally prepare myself for 6 months. 

Or did this refer to the hip?

 

The patient should by now receive physical therapy. Ask the surgeon about this, too.

If he says she can find many exercises on youtube don't accept this answer. She needs professional guidance.  Many exercises she can do by herself,  but she needs a professional to teach and supervise her.

 

Physical therapy is notoriously poor in Thailand,  and I have no idea where to go in CM.

3 things to keep in mind: 1. Thais like PT by machines,  like traction and many others.  Be wary of the machines,  don't expect too much from them.

Manual therapy and active exercises, taught by a therapist,  are usually better. 

2. Therapists whose real field of expertise is Thai massage,  tend to confuse PT with Thai massage. Thai massage is much too violent. PT is quite gentle. 

3. If you find a suitable therapist stick to this person. Don't change to a new therapist at every session. Actively ask to see the same therapist again. 

[Sheryl]

1 hour ago, ThaiPauly said:

No Sheryl,

 

She is no better than before the operation I am sorry to say.

 

 

 

to be clear - you had previously posted that the original pain was gone and the pain she was having was not the same but rather at the incisional site and hip where the graft was taken.

 

Are you now saying that the original pain (pain, not numbness) has returned?

[ThaiPauly]

8 hours ago, Sheryl said:

 

to be clear - you had previously posted that the original pain was gone and the pain she was having was not the same but rather at the incisional site and hip where the graft was taken.

 

Are you now saying that the original pain (pain, not numbness) has returned?

Yes, that's what I am saying Sheryl. Initially things looked OK a week or so when I posted.

 

The pain from the hip operation is not that important to her, we know that it will get better but initially she had severe upper back pain and the MRI showed damaged discs, hence the surgery.

She still has back pain, I really do not think it is quite as severe as before the operation, but it still gives her a lot of trouble.

 

It's the numbness that's the worst because its a painful numbness and that drives her crazy and she is pleading with me to find a doctor that can help her with it, we have to find someone in CM as on the surgeon's advice she cannot fly anywhere right now. A lot will depend on what he says when we see him in two days, he's a very experienced surgeon so I am sure he will be able to help her

 

I am grateful for anything you can help me with, it's driving me crazy and is 100 times worse for her.

Do you think acupuncture could help her?

 

Where do I start?

[Sheryl]

If she is not already on it medication like Gabapentin or Lyrica may help.

 

Did she have nerve conductiom  study done before the surgery? If not I think may be indicated to isolate what nerves are causing the pain. You can ask the doctor about both.

 

However if the pain was initially better aftet the surgery and has now newly returned or significantly worsened compared to initial post op period then again I suggest a scan to rule out a hematoma. While infrequent this can sometimes happen causing pressure on netve roots or even spinal cord.

 

 

 

[rabas]

10 hours ago, Sheryl said:

If she is not already on it medication like Gabapentin or Lyrica may help.

 

Did she have nerve conductiom  study done before the surgery? If not I think may be indicated to isolate what nerves are causing the pain. You can ask the doctor about both.

 

However if the pain was initially better aftet the surgery and has now newly returned or significantly worsened compared to initial post op period then again I suggest a scan to rule out a hematoma. While infrequent this can sometimes happen causing pressure on netve roots or even spinal cord.

I just want to suggest that post surgery infection might also be considered. Symptoms usually start from several days to a few weeks later. Here is an NCBI summary paper on post spinal surgery infections. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295816/

 

ThaiPauly mentioned a painful kind of numbness starting some time after surgery.  Note from the paper:

 

"The pain may be localized axially near the area of the incision, but also may radiate to the extremities in a radicular pattern. The pain may also mimic the original preoperative symptoms, thus causing a confusing clinical picture.1-6"

 

I wish the OPs wife all the luck in the world, be persistent, you will get there!

 

[uhuh]

You got some good advice here.

 

It is advisable to look for infection or hematoma, probably with a new scan, MRI or CT. These things can be hard to find. 

 

Nerve conduction studies should have been done before the operation. If this was not the case,  do them now. 

Many surgeons don't find them important. You may have to actively ask for this.  The surgeon may not do this,  he may refer you to a neurologist. 

 

Lyrica  (=pregabalin) is preferable to gabapentin, both may help. Both have side effects, depending on preexisting conditions,  but both are quite safe.  Lyrica makes many elderly Thais dizzy,  drowsy, sleepy. For this reason, the dosage prescribed is often much too low. The starting dose of both can be low, but it has to be increased quite a lot to have the desired effect - if the patient tolerates it. 25mg Lyrica once or twice a day are placebo, nothing else. 

Do not use these medications without advice of a doctor who has seen your wife and knows her history.  

 

Acupuncture can help, and won't do harm. 

But if you go to a doctor of Chinese medicine,  he will probably recommend 推拿，a kind of Chinese massage. This is more suitable to her condition,  but it can do a lot of damage.  Thais often do it too violently. If you want to try it,  find a doctor who learned it in China or Taiwan (Taiwan better) and who is gentle. 

[ThaiPauly]

Thank you both for the postings

I will bring this all up so the Doctor tomorrow

[ThaiPauly]

Saw the professor yesterday.

 

He is at a loss to understand what is wrong with her. He says in all his years he has never come across a case like hers.

 

He has rules out hematoma, says definately not, also he says no post operation infection.

I asked him about having an MRI done , he said I would be "wasting my money" at the moment there is no need. He talked about "anxiety" being a possible cause, she has not been taking her Fluxetine (Prozac) for some time as it causes her constipation, which she already has so the meds make it worse, but he wants her to start taking them again.

One  (the only) plus point is that the scars are healing well and the plasters are now off

 

He has referred her to the pain management department and has told her to have an x-ray in 3 weeks time and see him again then.

 

He explained the operation procedure and said that he found nothing amiss and that he had done everything by the book.

 

He also gave her a valium injection which calmed her down, she was pretty vocal about how she felt in the consulting room, she was almost pleading for help, it's so awful to see her like this.

 

We will see now we get on at the pain doctor's office tomorrow, hope she can help her.

 

I forgot to mention about acupuncture so will find out tomorrow

 

He wants her to take all the medications she is on to see the pain management doctor tomorrow

[saengd]

I saw Dr Torphong at RAM about two years ago, nice guy, he has a clinic on the Hang Dong road opposite Airport Plaza. He was somewhat dismissive of the numbness in my toes and suggested I tried physical therapy and didn't schedule a follow up visit. I don't think I would go out of my way to visit him again.

 

Fast forward to the UK this year where my GP was concerned about the numbness and ordered an MRI and a visit to a specialist. As said previously, the consultant Ortho. Surgeon declared there was no neurological deficit but his caveat was that an MRI is taken whilst laying down and without pressure on the discs thus an MRI is not always reliable. That said, there is some slight impingement that is visible on the MRI, presumably that worsens with pressure. The message is that the MRI is not the be all end all diagnostics that some think it is.

[Sheryl]

OP

 

Did she have a nerve conduction atudy before surgery? If not should have one now.

 

I suggest you consider a trip to Bangkok to see Prof. Wicharn.

[Isaanbiker]

I can't give you the name of a specialist, but wanted to let you know to have two opinions on how it could be treated.

 

   There are good and very bad doctors all over the world. 

 

   I truly hope that your wife's getting better very soon. I've had a very serious spinal problem after an accident that took three different doctors to figure out how severe the injury was.

 

  I can call myself lucky that I'm not in a wheelchair now. 

 

   Kind regards

[ThaiPauly]

36 minutes ago, Sheryl said:

OP

 

Did she have a nerve conduction atudy before surgery? If not should have one now.

 

I suggest you consider a trip to Bangkok to see Prof. Wicharn.

She has been advised not to fly for three months, I thought it was until her collar was removed but I was wrong.

 

What do you think another Professor can do that the one we used can't?

What else can a spine surgeon do,? He can't re-do the operation

 

There was no nerve conduction study before the operation, but I was unaware that it would be a good idea to have one, I can ask Thorpon about it

Edited December 1, 2019 by ThaiPauly

[Saltire]

I was sorry to read this thread, I hope things improve for you both soon.

 

Around 5 years ago I had sciatica and lower spinal pain. I went to the RAM in Chiang Mai for a spinal MRI. The specialist could see nothing conclusive. SIx months later it had worsened to the point I had to sit every 50 metres to relive the pain. I went this time to Bumrungrad in Bangkok for another MRI. Again nothing showed up as conclusive, but this did not stop the specialist offering me the same operation as your wife at a cost of about $25k +++ USD. I declined.

 

A week later on returning home (to SIem Reap at the time) I consulted a Swiss, Beijing-trained acupuncturist and with nothing to lose, albeit very skeptical about alternative therapies, had 7 sessions resulting in pain gone, and it has never returned. I still have an issue in my lower back but it's just a dull pain if I walk too far (6 km a day with no issues) or lift stuff, which I just avoid. From the first acupuncture session I almost knew it was going to be effective. The needles were placed in my thigh and buttock and I could feel a pleasant sensation run down to my foot.

 

I sincerely hope you get this sorted. Good luck.

 

 

[Sheryl]

He can do a nerve conduction test and review the original MRI, order a new one if indicated.He can determine if something else is causing the problem and if so what, and what to do about it. 

 

I have known Prof. Wicharn to detect things others missed many, many times which is why (posts 2 and 13) I urged you to take her to  him in the first place.

 

I do not understand why the restriction on flying. Especially for such a short flight. The issues with flying are risk of DVT and prolonged sitting posture, Neither applies for such a short flight.

[meechai]

So sorry to read your wife has not improved.

 

I would agree with Sheryl 101%

One thing in Thailand is if your not getting a result or Doctor seems iffy get out & try another.

Sadly money has been spent but,

 

When he said ..." He is at a loss to understand what is wrong with her"

That would be it for me.

 

[mauroest]

I  was sorry to read about your wife.
Thank you all for lot of information in this thread
 

My italian wife has lordosis with disc protrusion C3 C4 C5 C6, painful  contracture all day.
now she inability to sit comfortably for more than 10 minutes  and numbness start on left arm.Sometime uses collar

Italian MD suggested massokinesi cervical pompage  massages, warm on the neck, thermal SPA

We are in Pattaya for a few months and she will try acupuncture with  Mr. Nigel  Kelsey and a visit at Bumrungrad in Bangkok (if nothing in Pattaya)

[Sheryl]

Since OP's wife is apparently complaining of a painful numbnesss in both hands AND feet something else has to be going on. 

 

OP as you are reluctant to go to Bangkok suggest you consult a neurologist specialuzing in peripheral neuropathies. Will give a name later. Neither her surgeryy nor the prior cervical spine stenosis would account for what she complains of in her feet. Hands yes possibly but nit feet.

 

While psychogical cause is possible one should always first exclude all possible physical causes. Doctors are often overly quick to dismiss problems theycan't diagnose -- especially in women -- as psychosomatic.

 

Does she get emotionally worked up over the pain and hyperventilate?

 

And has Dr prescribed Lyrica or Gabapentin?

 

 

[ThaiPauly]

1 hour ago, Sheryl said:

 

 

Since OP's wife is apparently complaining of a painful numbnesss in both hands AND feet something else has to be going on. 

 

OP as you are reluctant to go to Bangkok suggest you consult a neurologist specialuzing in peripheral neuropathies. Will give a name later. Neither her surgeryy nor the prior cervical spine stenosis would account for what she complains of in her feet. Hands yes possibly but nit feet.

 

While psychogical cause is possible one should always first exclude all possible physical causes. Doctors are often overly quick to dismiss problems theycan't diagnose -- especially in women -- as psychosomatic.

 

Does she get emotionally worked up over the pain and hyperventilate?

 

And has Dr prescribed Lyrica or Gabapentin?

 

 

Yes Sheryl,

She has both , although the Gabapentin is 300mg, which is to strong, she only wants 100mg or she is spaced out.

She does not panic or hyperventilate.

We are going to see the pain doctor now and see what she recommends to contain the pain and discomfort.

 

I agree with what you say about the doctor saying its all in the mind, I have had this happen to me with my ongoing stomach issues, it's an easy "get out of jail free" card IMO.

 

There is a good neurologist at Bangkok Hospital who used to work at Ram and helped me a lot when I had my TIA, her name is Dr. Kanitta, but I don't know if she specialzes in Neuropathy, so a recommendation from you would be very useful.

[Sheryl]

A post has been removed at the poster's request along with quotes to it in replies.