More medical services…Dermatologist visit
March 6, 2017
This is just a quick post about another of the medical services available in Chiang Mai. Now, don’t get me wrong, I am generally quite satisfied with the medical care in Canada, but they just do some things really well here. Peter and I wanted to get our skins checked by a dermatologist for sun damage. I had tried to do that before I left, but couldn’t get an appointment. My nurse practitioner told me to email her in a few months so she could get me in after we returned.
I got the name of a dermatologist last night from a friend in the building. The doctor is Thai, but trained in Boston for 3 years so came recommended as a capable English speaker as well as a good dermatologist. She works at a new skin clinic at Chiangmai Ram Hospital, about 2.5 km from here.
I filled out the appointment request on line when I woke up this morning. Within 30 minutes the office phoned and offered us an appointment at 10:15 today. I gave our names, birthdates and nationality.
We got a ride to the hospital and were met at the door by a woman in a suit and heels. She was the greeter. When we told her we were looking for the skin clinic she told us it was in another building and to wait in a seat. Within 3-4 minutes a golf cart shuttle arrived to drive us to the new clinic.
The nurses, who still wear uniforms and white hats with a black stripe, met us as we arrived. We completed information sheets that included our address here as well as at home. They asked if we needed a receipt for insurance purposes. This clinic is obviously used to dealing with medical tourism.
We were called in to have vitals taken-weight, height, temperature,blood pressure and blood oxygen. After about 15 minutes we took our turn with the doctor.
After a complete check from head to toe, most of the growths are attributed to aging. She asked him about any serious sunburns to his face, which he had when high altitude climbing. He did have a couple of spots of sun damage on his face. She removed them immediately with liquid nitrogen and assured him that they would heal easily and the damage was gone. She reminded him to use sun screen on the beach but that a hat with a big brim was the most helpful thing in the city.
I was also checked thoroughly from top to bottom. Any spots that I obviously knew about, she reassured me that they were normal, without even asking. She let me know that the scrape on my knee from November could take 6 months before the color disappears. This getting older sure has lots of unexpected side effects. The rest of me was fine. Since I had a suspicious mole removed a few years ago, she recommended getting checked again in 6 months. I guess I’ll have to get back to Chiang Mai in time for my next appointment. She also gave me a couple of sunscreen samples to try.
We had heard that the cost was reasonable but we weren’t sure. We just hoped that Alberta Health Care might cover the cost of what it would be at home. Here are our bills:
Wendy Doctor fee $30.38
nurse and office fee $4.69
Peter Doctor fee with procedure $38.22
nurse and office fee $4.69
liquid nitrogen $11.47
We were out the door by 11:00 am, reassured, treated and enough money left for a coffee at Starbucks.
Travel Vaccines and Medical Care for long stay travel to Thailand
March 3, 2017
We didn’t know much about travel vaccines or medical care in Thailand before we left. After visiting the travel clinic at home, and experiencing medical care first hand, we are comfortable with being in Thailand for a long stay.
Travel Clinic Visit
Before leaving home, we met with the pharmacist at the travel clinic at London Drugs in Red Deer. We had to pay $40 each for the consultation but we could make our appointment on-line from home and see what fit best with our schedule. The health unit in Red Deer also has a travel clinic for about the same price. The following information relates to our experience and may not be applicable to everyone. Be sure to see a professional before you travel to get the most up to date information.
We filled in our medical history on-line in advance and specified where we were planning to travel. The appointment took an hour and we discovered that we should have made this appointment sooner in the process. You need 4-5 weeks to complete immunizations for travel, especially when you are behind on some of the usual ones. She was able to accommodate our schedule, although we will need a booster when we get home.
You don’t need any specific immunizations to enter Thailand, unless you are coming form a country where Yellow Fever occurs. We needed our 10 year boosters for diphtheria, tetanus, and pertussis. The health unit does those free of charge. They also gave us a measles, mumps and rubella booster. We have probably had all those diseases as children, but if there is a measles outbreak, we have evidence of being protected and would not be seen as carriers of that disease.
Some of the immunizations we chose to get for Thailand I felt were necessary and some optional. Most of these shots last 10 years or more, so we won’t have to go through this each time we travel. Typhoid and Hepatitis A/B seemed obvious for travelling to a developing country. Japanese Encephalitis is mosquito born and in some cases is serious so we added that.
Rabies was one that we discussed for a while. The pharmacist recommended it because of the stray dogs in Thailand, and the amount of time we were away. She also said that lots of tourists get monkey bites and scratches because they act so excited when they see this animal, they intimidate the monkey.
We had all 3 shots. If we do get bitten or scratched, we will still need 2 more doses of immunization. If someone has not had the vaccine ahead of time, they will require 4 doses as well as Rabies Immune Globulin. It is a blood product and is not always available in smaller centers. A flight to Singapore would probably be needed to ensure this product.
The fact that my extended health plan covered these vaccines made the decision easier. Since I don’t need to use my plan for much else, and I have to pay for it myself now that I’m retired, I felt it was good to go ahead and have the shots ahead of our trip. Fortunately, so far the dogs are friendly and I have stayed well away from the monkeys.
This is the first disease I think of when imagining travelling to a tropical country. I learned that it is not common at all in urban areas. We received copies of maps of all the countries we thought we might visit showing where there was the greatest risk of being bitten by a malaria carrying mosquito. It’s hard to know where you might end up when you have 5 months to decide where you want to spend each day, or week.
We brought a supply of anti-malarial medication with us that you only take when you expect to be in a higher risk area. You begin them 1 day before you leave, while you are gone and for 7 days after your return. I had heard that this treatment made you feel as sick as the malaria, but our pharmacist assured us that this particular drug, taken with food had a very low reaction rate. I haven’t had a chance to try it yet, as we have stayed out of most of the malaria areas.
We had heard that the medical care in Chiang Mai was excellent. I’ve met people who had surgeries here. One of the local hospitals promotes check up screenings for a reasonable price. My friends in Cambodia come here for skin checks for cancer and an ultrasound follow-up that couldn’t be done in Canada in the 4 months she was home last year.
Earlier this month I had a chance to check it out firsthand. While my sister was visiting, I felt like I had the flu. I had a fever that came and went. My joints ached, my eyes hurt and I had a constant headache. I didn’t have any vomiting, but some bowel issues that I just put down to Thai food but I was also really tired. After a tick bite in December, I worried that it might be a reaction to that, although enough time had passed to make that fairly unlikely.
A doctor owns our building and does “house calls”. I explained my symptoms to him and he said that there was a flu going around and that his doctor daughter had seen many cases recently. I took him at his word and finished showing Nancy Chiang Mai, although with more naps and some skipped meals where she and Peter went out without me.
The day after she left, I awoke to a rash all over my body. It sort looked like a measles rash, although it wasn’t on my face. The palms of my hands and soles of my feet were very red and itchy. After entering my symptoms into google, It was time to get this checked out.
Hospital Day 1
We took Uber to the hospital recommended by Dr. Smith. It was about 15 minutes away. After giving them my name, address and passport number, I was asked to wait. Within about 5 minutes, they had taken my temperature and blood pressure and recorded my symptoms. After another 15 minutes or so, I was in to see the doctor.
He didn’t think it was related to the tick. He felt it was probably Dengue Fever, which is a virus you get from mosquitos. It affects your bone marrow production of platelets and white cells, as well as causes plasma to leak out of you blood vessels. Serious cases can turn into hemorrhagic Dengue Fever which can cause internal bleeding. It needs to be treated with blood transfusions. It was fortunate that we decided to get it checked out at the hospital, even though I had only a mild case.
He was surprised though, as there had only been a couple of other cases in the hospital all month. It is much more common in the rainy season. We had only been back from Laos for a couple of weeks, so maybe the bite happened there. He said the rash is a sign that you are starting to get better and was the bodies reaction to the virus. He sent me for blood work.
The blood results were back in about 45 minutes. I waited a little longer for the doctor who said that the Dengue test takes longer, but that my white blood and platelet counts were below normal and that indicated Dengue. He sent me home with Tylenol for the headache and fever, antihistamine and Calamine for the itch. He also arranged for an “appointment” page to come back the next day for another blood test.
We waited about 10 minutes to have the appointment printed, the medications filled and went to pay the bill. Within 90 minutes, 2 doctor talks, blood work and medication, the bill was 672 baht, or $25 Canadian.
I wasn’t very hungry but was craving some comfort food. We had a couple of boxes of Kraft Dinner in our kitchen that we had been saving for just such an occasion. It did make me feel less far away from home.
Hospital Day 2
After sleeping most of the next day I returned the hospital, but this time I turned in my “appointment” and was sent directly to the lab where the blood was taken and processed. I met with the doctor after about hour from arrival. She showed me that the white blood and platelet count had gone down some more. The previous test also confirmed it was Dengue fever. The doctor suggested that I should stay at the hospital to have an IV to ensure I wasn’t dehydrated. Since I wasn’t vomiting, I said I wanted to stay at home, but would come back if I had any signs of bleeding. She sent me home with electrolyte powder to mix with water and another “appointment” sheet for the next day.
Again, it took about 90 minutes and with the extra Dengue test, the cost was 942 baht or $35.91!
Hospital Day 3
I woke up the next day feeling like I had a little more energy. My headache was less severe and I felt like some food. I did more reading and watched a movie. We went back to the hospital in the afternoon and they took me right in for my blood work. They also wanted to check liver function and do a urine test. When I saw the doctor, he showed me that the platelets and white count were on their way back up and that I didn’t need to come back. He recommended continuing with the electrolyte drinks for a couple of days and continue to rest but all was well.
The wait time was about the same but I had more lab tests done. The final bill was 1337 baht or $50.96. In total I paid about $112 to the Rajavej Chiang Mai Hospital.
It took a few days to get my energy back. As my appetite returned, I felt better. The rash lasted about a week, but it was only itchy the first couple of days. By the time we returned from Cambodia about 3 weeks after the first fever, I was ready to get back to the gym and find my lost fitness level. I am also much more vigilant in using the DEET every day. My Thailand hospital experience was very positive, but I’m in no rush to experience it again anytime soon.