Cardiac Presentation and Best Practice

[wazza]

A very good friend of mine last week, was driving from Kalasin to Bangkok, and suffered a sudden onset of severe crushing chest pain while he was in the car. Stopped and called his wife and asked her to call an ambulance as he knew it was cardiac in nature. His first ever cardiac presentation,

Ambulance with EMT's from Khon Kaen arrived and treated him with O2, Aspirin and GTN spray, but little or no relief, and radioed ahead to the Queen Srikit Cardiac Centre with an update and ETA.

Upon arrival he was met at their Cardiac Centre by a Cardiologist who diagnosed a myocardial infarction ( heart attack ) and took him straight to the Cardiac Cath Lab and inserted a stent in the right main decending coronary artery , which gave him instant pain relief.

He is now back home and going through a cardiac rehab programme

Just goes to show that best practice medicine is available and when applied from the EMT's to the Cardiologist and Cath Lab a successful outcome was achieved.

total cost was 135 K baht and certainly saved his life , with just some minor damage to the R ventricle.

DONT UNDERESTIMATE THE SIGNS AND SYMPTOMS OF CARDIAC PRESENTATIONS AND THE NEED TO GO TO A REFERRING HOSPITAL THAT CAN TREAT YOU CORRECTLY.

In Udon , I think the only Cardiac Cath lab is located at Bangkok Hospital. AEK do not have one and will only use thrombolytic agents to bust the clot , NOT bypass it.

[waanjai]

.....total cost was 135 K baht and certainly saved his life,.... .

Good advice.
But who of the Udon Farangs will have this amount of money available?
Did the hospital ask for an up-front payment of e.g. 50.000 B or more?

[wazza]

He has International Health Insurance.

But treated in the Thai Public Health System and as an expat required to pay.

Would he have received the same level of care with no means of financial support . Not sure..But the Thai Health Department has on numerous occasions stated they are owed $ Millions in non paid accounts to foreigners.

It comes up eveytime the sabres are rattled about Foreigners requiring compulsory health insurance if travelling as a tourist or long term stay.

[hairyharry]

Very interested to learn about the costs incurred and treatment received.

Note of caution about the Thai NHS system.

I need either a stent or bypass and was given an estimate of 400K Baht by the "specialist" at Udon hospital for fitting a stent. He also suggested I could borrow the money from him.

Top cardiac hospitals in Mumbai (India) estimate the cost to be around the equivalent of 100K Baht. The NHS in the UK often sends patients to India because of the low costs. If you can get to India (i.e. you are fit enough to fly) it's well worth considering IMHO. If any of the medical experts on the forum have any views, then I would really appreciate hearing them.

[wazza]

HH

Firstly , it would be done at a Private Hospital In Udon, so costs and admission fees will reflect that. Bypasses are usually costed as to how many you have also, So 3 CABG ( coronary artery bypass grafts ) will be more than 2 or 1 etc, longer theatre times and more surgery in your legs or where ever they grab the veins from. Not sure how many your consultant recommended ?

Secondly and ringing alarm bells for me, totally unethical for the Cardiologist to suggest he will lend you the money. Conflict of Interest and remember you cant sue Medical Consultants in Thailand, Immune, Complaint yes. Might get an out of court settlement if your lucky ? But sue the Hospital and they wouldn't touch you with a barge poll if the fees were posted by the Consultant who stuffed up.

Thirdly - Manilla offers 1st class Private Health care as well, cheaper airfares

The issue you have in any International Medical Health Tourism procedure is the risk of complications and needing more money to cover that. This also applies within Thailand as well obviously.

Hope this assists

[Jing Jing]

In the first post you mention Queen Srikit Cardiac Centre in Khon Kaen and the cost was 135k. Based on this info why even consider a hospital in Udon. The government hospital in Udon has limited ability and the non government hospitals cost too much. In the government hospital QS you can go to the Social Work office and sign a contract to pay the cost of the surgery.

[wazza]

Acute cardiac presentations need angioplasties / stents etc within about 4 hours for expected outcomes.

Cardiac arrests occur within the first 1 hour of acute presentations also.

I suppose you have to way up getting stabilised with O2. Aspirin. Analgesia. drop the BP or even external pacemakers for some arrthymias etc and then off to KK ? Thats about 1 hr 15 mins drive. Those treatments are going to generally take your 4 hours up perhaps????

Living in Udon and the surrounding province could be catergorised as remote for Acute Clinical Care for many diciplines.

Having no health insurance is also a critical part of retirement for expats.

Not aware of the ability to sign a contract to pay off the clinical costs. For K Thai yes. But for an expat imagine a Thai Guarantor might also be required ??

Dare I say it but some clinical providers will fast track your treatments based on your ability to pay with a credit card or insurance card.

[Jing Jing]

I know of a case where a Dr. had a midiocardial infraction in Laos. Fortunately he was with other doctors. They brought him back to Udon Thani Hospital for treatment.

Maybe a little preplanning is needed if you suspect you may be a canidate. Go to the hospital and register, then visit the Doc. (Note at UTH the doc may not be the surgeon) find out about signing a payment contract. If you don't like UTH QS may be an alternative if
it not an emergency operation.

[wazza]

Jing Jing beg to differ a little on your comment that a myocardial infarction requiring a stent or angioplasty is not an emergency situation.

The earlier the blockage is removed the less damage to the cardiac muscle. The longer the artery stays blocked the larger the infarction and subsequent damage and long term complications associated with that. That also includes having a cardiac arrest as a result of the blockage.

Some infarctions require immediate life saving treatments such as external pacemakers or syncronised defibrillation .

To my knowledge the only Cardiac Cath Lab is in Bangkok Hospital in Udon. I could be wrong.

[stickyrice]

I practice internal medicine in the US and until this year was the Chief of Medicine at a local hospital. As to how much stenting or a bypass should cost is almost impossible to make meaningful comparisons. Of course, here in the US the cost is clearly ridiculous and no person can pay out of pocket. BUT, even just comparing stenting to stenting (and not to the much much more expensive and difficult bypass surgery) you can not compare apples to apple. In the old days we used metal stents which often would clog up due being a foreign material in the body. Generally we now use much more advanced drug impregnated stents. But even charging US prices (to insurance companies), the stents are so expensive that if the patient needs more than 2 stents the hospital actually loses money due to the cost of the stent. So when you ask how much stenting cost in different places, it is hard to know what you are getting - good staff and good stent or something less. For sure, don't do it here in the US though unless you have big money to burn.

[Jing Jing]

Udon Thani Hospital has a Cat Lab. My understanding is they have one cardiac surgeon. UTH just built a new surgery building. That is why I previously posted the Dr. was brought back from Laos to UTH. Laos doesn't have this capability.

Often the doctor who practices in the gov. hospital also practices in a private hospital. The Dr. at Bankok Hospital maybe coming from QS in KK or another gov. hospital. The gov. hospital may also have nursing staff that is more experienced then at the private hospital.

There is a big difference between 400k and 135k especially if the Dr. Is the same