Thread: Palliative Care Thailand

Palliative Care Thailand


I want to share some of my experiences from the last three years in Thailand, I have posted on the Cancer Sucks thread, but believe this merits a thread of its own


At 73 and on my fourth marriage (10yrs and so far so good sensible age difference she is thirty years younger ! wife no 1 eight years older, 12 yrs and two kids, wife no 2 two years older but she had money! 14 yrs but the Lady was manic depressive and went manic when she gave up her medication, wife no 3 Israeli Russian Jewess and Witch from Hell lasted two months), I am legally married to my wife and this was done at the government offices in Bangkok


For those not legally married, even if married by village ceremonies there can be problems on death as she is not legally next of kin, on my death Embassy approval is not required to release the body


I live in the NorthEast Issan and near KhonKaen, in a beautiful house, on five Rai, we built ; in harmony with four Alsatians and many many tropical plants and flowers


I was a regular poster on Thai Visa, and have posted a lot there on Colorectal Cancer, Prostate Cancer, Holep surgery in India, Colorectal Surgery at Chulalongkorn, Thailands top teaching Hospital, I have also had extensive radiation treatment on state of the Art Equipment, and Chemotherapy


I have also written extensively on Medical Costs in Thailand on a shoe string for those like me who have no insurance for medical expenses, I also have a living will, and found doctors to be very receptive


My previous posting will be found by Googling Thai Visa forum and searching on Al007


My posting ability was withdrawn by Thai Visa since I regulated challenged its moderating policies, and its moderators, sad because I added a lot so I believed, the situation was further antagonised since the moderators did not like my comments on the lack of sense of humour of Americans, It was suggested I was being racial. I am too outspoken for the generally uneducated moderators, who maybe have power for the first time in their lives
I consider on medical matters I have experienced, I am well informed, and wish to help others by sharing my experiences, I have helped four others to go to India for Holep surgery


I will willingly assist others if they PM me


I have yet to fall foul of the moderators on Teak Door


I only post on my own experiences, and matters that I am qualified to write, I am a retired Chartered Accountant, involved with many types of business, one of which specialised in insurance matters and financial advice for Expats


I am registered with about ten various hospitals, here in Thailand have visited many more, to day my primary care comes from Chulalongkorn in Bangkok, and Srinakarin in Khon Kaen, both top teaching hospitals
Until a couple of years ago I never had to go near doctors or hospitals


I have a donor card for my body to go to Chulalongkorn after my death, Srinakarin do not offer this to foreigners, they used to but it became too difficult dealing with families overseas


I also had a successful claim against a hospital since they were maybe negligent, and missed the evidence, that I had two lots of different cancers, the matter was settled reasonably without recourse to courts and big legal bills, and I am grateful for them making some contribution for their oversights


I am cared for by a Colorectal Surgeon, one of the very top in Asia, an Oncologist, trained at john Hopkins USA, a Chemo consultant, a Urologist, and as from yesterday a Palliative Care consultant, and her department at Srinakarin


I saw today at government/university teaching hospital here in KhonKaen, the top Palliative care consultant, mid 50's trained at Edinburgh, and Melbourne, a highly intelligent lady, who is fluent in English


I have been fishing and researching Palliative care for a couple of years, and generally the consensus of opinion, is it hardly exists here and pain suppression and management very limited, to some extent correct, but not here in KhonKaen, Srinakarin is recognised as the top teaching hospital here in Thailand as Palliative Care specialists and Anaesthesia teaching


She acknowledged Thailand was far behind the rest of the world, in pain suppression, for those dying, but said it was all changing


In the Brand new wing they even have large posters advertising Palliative Care, and this is also the case with our local country 40 bed hospital in Bangfang, directly under the Srinakarin control on this function


She assured me that will not apply to me, now I am registered with her they will even come to my house if necessary, if I become bed ridden and administer pain killers


She promised me I will not die in pain, I took her hand, holding it strongly, and repeated you promise she said YES !!


Their first outpost for their new services is my local clinic/ hospital in Bangfang, 3 kms from us, this is all very amazing


I am told I am very young for palliative care, but she has taken me under her wing, and I have a specific nurse as well allocated to me and 24/7 help line telephone numbers


All medical services required, ( even if I had a heart problem, and KhonKaen has a top heart hospital) will be coordinated from this centre, so she is like my GP almost impossible here in Thailand, in fact I know no one here who has in place what I do medically


They will also do annual medical check ups if necessary


I have been asked to provide copies of all my MRI s and CT scans, so far I have eight with two more scheduled this June


I have also been asked to put copy of my Advanced Directive and Living Will on file, anyone who wants a copy please PM me


I believe the UK has overall very good medical care and NHS, but what I have here in Thailand, far exceeds what I could get under the government system in the UK, and whilst I stay in the government domaine here it is also very affordable on my budget, today one hour consultation zero, yes zero


Eleven hours on the operating table in Bangkok, three surgeons, two anaesthetists and an army of nurses, private room on 25 floor overlooking Lumpini park, all for around 120,000 baht, under ten percent of what a private hospital quoted


Remember however waiting times to see doctors on scheduled appointments can have wait times of over four hours


Srinakarin know I have Colorectal Surgeon, Urologist, Oncologist and Chemo man at Chulalongkorn in Bangkok, and say I have the best, they suggest at the moment I change nothing but are ready if my health were to deteriorate to pick up everything here in KhonKaen


However here in NE Thailand Srinakarin here in KhonKaen, is better than BKK for pain suppression


After all my tests in early june in BKK I will go back to Srinakarin and they will review all the results with me


My Palliative care consultant agrees my logic, on not having reversal surgery, it is very nice to have this validation, I write more about this below


She says, to the horror of some, JOKE, I could well have another 10/15 yrs plus, she said all things considered I am remarkably fit medically, today I am on no medication whatsoever


I consider I am very fortunate and lucky, regardless of what the future might hold


For me it is a very big wow, I am so lucky


Many said why are you even checking this out, but I followed my own instinct, they think I am nuts to plan for the future !!!!




Reversal Surgery or Not

Over the last few months I have pondering whether or not to have further surgery or not, I am putting facts on paper and looking to gather input


I will shortly be 73 and can not live for ever, if I were 40 I would have the reversal


I have rectal cancer and prostate cancer, hopefully in remission


In December 2016 I was declared cancer free, but it came back, if in fact, it ever left, I had major surgery in October 2017, and my anus was sealed and I have a temporary colostomy bag


Reversal is scheduled for June this year


The original thoughts of a colostomy bag horrified me, but as time moves on one gets to accept it


After the operation I rejected more chemo, I was told it would increase the chance of cancer not returning by 5%, my thoughts another six months of hell and it still returns in six months time so I have wasted six months


My life at the moment is very comfortable, contented and happy


If the cancer comes back, and I believe it may, it can resurface anywhere, I have already decided to have no more surgery


However I am told advances in Chemotherapy continue rapidly, so I would keep an open mind here


If and when a reversal is done, the anaesthetic itself is a risk, I am still overweight, although have come down 20 kilos


Macmillan (UK) tell me 12% of reversals do not work, who I also consult with regularly and have very good telephone support


Before the surgery my bowel could occasionally explode, with the bag this does not happen


Post surgery it will at best still be the same and might be very much worse


Doctors do not know if my anal sphincter will function correctly


Some people have to stay within feet of the toilet and can not venture out


At some stage I will die, if I were incontinent it is a nightmare for those looking after me, and maybe my wife, with the bag for the carers it is comparatively easy, and one less major problem


Money is sufficient but can not just spend spend, and have unlimited nurses, medical costs could wipe me out sending me to the mercy of the UK government, unlikely but possible


Many people live good lives with colostomy bags for years


I would love to have no bag, but accept one has to compromise again easier with old age


To have the bag removed, and then it does not work and face yet more surgery and again more cost, so two lots of surgery to get back to where I am today, in my book maybe stupid, and I do not like stupidity, and stupid people I am 73 very soon




Dying I accept and know will happen what scares me is the thought of pain, I again believe with thought and planing this can be avoided, and personally at the right time euthanasia please but illegal in Thailand




I also worry these days I am slowly loosing my mind and brain, my coordination can be bad, I can be driving and forget turn, not once but several different times, because as I say my mind is elsewhere


I went through a hour of hell trying to set up an internet account with security checking via my cell phone, the man was so patient but I was only just able to cope, and all at 11.00 am, I was so close to loosing it, I thought I was just a little computer literate, I am definitely loosing it, and past my sell buy date, even wine goes off if not drunk


So why take the unnecessary risks attached with reversal surgery


Today - a random list


I have a loving wife
I have support from ex-wife and family
My daughter is very supportive
We have four loving Alsatians
Where we live is so beautiful and paid for
We have a nice car
We owe no money
I am on no medication
Porn my wife is healthy
We are Ok financially, so long as we stay cautious
I can walk around albeit slowly
I am still driving
I can still go out alone
We have help in the house and gardens
We have nice and beautiful clothes everything we need we have
Most of what we want we have
Some of Porn’s family have problems, but this does not impact them


SO !


Seems to me to rock the boat and have additional surgery rather stupid, without which all the above stays in place, PLUS and a very big plus if I become terminally ill I am easier to look after rather than s **T everywhere


Bonus precious money and time saved

pallative care could easily be a big business for thailand if you situatated a facility near the beach with nice views for people to live out their life in comfort with attentive staff who are able to deal with the failings of old bodies

foriegners from the more inhospitable parts of the planet - like china - would likely take advantage of something of that sort

Originally Posted by al007

I have yet to fall foul of the moderators on Teak Door

it is unlikely that you will

Hi AL007

Best of luck, lets hope you have many more years of quality living. Pain management is the key to a civil exit.

I also have had colorectal surgery with all the trimmings but my plans are for living not for death.

Yes I know it will come but I have no intention of sitting waiting and worrying or making pans for that time.

Right now I am doing what I want to do and doing it as often as possible, there are times like now when I have to be at home sorting through photos and writing reports but I will be on the road again seeing and doing things that few others in this world will ever see or do.

Life is great, live it to the full.

Getting frustrated while setting up an Internet account is really not a sign of anything.

Originally Posted by baldrick

pallative care could easily be a big business for thailand if you situatated a facility near the beach with nice views for people to live out their life in comfort with attentive staff who are able to deal with the failings of old bodies

foriegners from the more inhospitable parts of the planet - like china - would likely take advantage of something of that sort



it is unlikely that you will

There used to be a care facility in Chiang Mai that catered to farangs, but I don't know if it's still there.

CMU has a place in the old town. The difficulty is in finding just how well geared up they actually are for foreigners, as opposed to just the window dressing.

Originally Posted by birding

I also have had colorectal surgery with all the trimmings but my plans are for living not for death.

Yes I know it will come but I have no intention of sitting waiting and worrying or making pans for that time.

Right now I am doing what I want to do and doing it as often as possible, there are times like now when I have to be at home sorting through photos and writing reports but I will be on the road again seeing and doing things that few others in this world will ever see or do.

Life is great, live it to the full.

Good on ya, Birdy...

A straight forward antithesis to the usual morose and depressing tales.

Originally Posted by HuangLao

Good on ya, Birdy...

A straight forward antithesis to the usual morose and depressing tales.

You really have no idea do you Jeff.

FUJ

Originally Posted by birding

I also have had colorectal surgery with all the trimmings but my plans are for living not for death.

Yes I know it will come but I have no intention of sitting waiting and worrying or making pans for that time.

Right now I am doing what I want to do and doing it as often as possible, there are times like now when I have to be at home sorting through photos and writing reports but I will be on the road again seeing and doing things that few others in this world will ever see or do.

Life is great, live it to the full.

Well everyone to their own, I am living to the full as well, and with my plan and homework done, the last bit maybe ten years on will also be easy, and painless !!

No plan , not for me, seems a bit naive shall we say, some might say irresponsible, but live and let live, but then some wind up in hospital with no money, no plan, no honey and plenty of sh**t and ask others to bail them out, NOT FOR ME

Sorry but I don’t have the concentration to absorb such a lengthy intro. I think I got the gist of it though.

Youve clearly had a long and interesting life. To reach the stage where you can devote such attention to your mortality and ultimate demise, is very responsible and considerate for those close to you.

Im 64 and still enjoying life too much to look forward to death with such clarity and consistency. Your efforts are highly commendable. Mine, not so much.

Originally Posted by Switch

Sorry but I don’t have the concentration to absorb such a lengthy intro. I think I got the gist of it though.

Youve clearly had a long and interesting life. To reach the stage where you can devote such attention to your mortality and ultimate demise, is very responsible and considerate for those close to you.

Im 64 and still enjoying life too much to look forward to death with such clarity and consistency. Your efforts are highly commendable. Mine, not so much.

Death never worried me before, but with two lots of cancer there is a chance one may get me, and with no palliative care could be painful, I hate pain, so as I have now ascertained pain can be dealt with I can more comfortably get on with enjoying my life

Originally Posted by al007

Death never worried me before, but with two lots of cancer there is a chance one may get me, and with no palliative care could be painful, I hate pain, so as I have now ascertained pain can be dealt with I can more comfortably get on with enjoying my life

Kudos to you for sorting it in advance.
Im more of a seat of the pants kind of guy and I’m also fortunate to have no personal or family obligations here.
If it all goes tits up for me, I will go back to U.K. and recoup some of the taxes that I still pay every month.
Irresponsible - yes
Naive - probably
Hedonistic - absolutely

Annoying aren’t I.

[QUOTE=Switch;3757433]Kudos to you for sorting it in advance.
Im more of a seat of the pants kind of guy and I’m also fortunate to have no personal or family obligations here.
If it all goes tits up for me, I will go back to U.K. and recoup some of the taxes that I still pay every month. So you do have a plan

Irresponsible - yes NOT necessarily as you add more flesh to your story

Naive - probably Maybe not

Hedonistic - absolutely

Annoying aren’t I. NO

Enjoy yourself, at least you are not sat at home in UK complaining and moaning, Good Luck !!

An update I had two MRI scans last week, at Chulalongkorn, Bangkok class three machines , cost 16,500 with contrast, I saw three consultants around 1200 total, three different days

My colorectal cancer is in remission, I had eleven hours surgery last nov

My prostate cancer still shows evidence of being around, my PSA has risen from 0.2, to 0.4, prior to holep surgery in August 2006 it was 14.0

All my other upper and lower abdomen organs were in a good state, including my liver despite quite high alcohol intake, these results were confirmed in both the MRI and blood test results

I continue with blood tests every three months and subject to these remaining level, consultants every six months (Oncologist, Chemo man, Colorectal surgeon, Dr Chucheep probably the top in Asia, and also urologist)

We have a great deal of history to monitor changes and deteriorations

More MRI next June 2019, long waiting list time so booked a year ahead

Could have chosen to have had colostomy bag reversed but after careful consideration decided to leave as is, and all consultants agreed with this slightly unusual approach my logic was correct

I continue to be very happy with excellent health services, at a very high standard at affordable cost


A week ago I did hear of a patient being charged over 300,000 for two stents at the Queens Research and Heart hospital in KhonKaen, again with planning and outside the box thinking these costs could have been kept to around 70,000

I am talking to Srinakarin Pallative care in KhonKaen, on checking out my Heart, because with planning and monitoring emergency heart surgery can be avoided, and of course emergencies leave less cost options available

Currently 73, and planning for another ten yrs, this month ten yrs with wife number four, and the best yet, a very happy man, and fortunately banned from TV and away from all the doom and gloom brigade !!!

As always if I can help others from my experiences please PM me and always happy to talk on phone

Originally Posted by al007

I continue to be very happy with excellent health services, at a very high standard at affordable cost

Once again good luck and stay strong.

Hey Al, I won't bore you with platitudes, but if you want to play chess or scrabble online when bored, I'll be happy to have the challenge.
Or just chat.

PS, it must be said...many are thinking it I'm sure...a little bit of ganja is easy to get, and if you can't smoke, make some brownies.

Originally Posted by Maanaam

Hey Al, I won't bore you with platitudes, but if you want to play chess or scrabble online when bored, I'll be happy to have the challenge.
Or just chat.

PS, it must be said...many are thinking it I'm sure...a little bit of ganja is easy to get, and if you can't smoke, make some brownies.

​I do like your reply, I also love that it is not immediately censored out, like it would be on TV

I know in the USA,(i come from UK ), it is becoming more acceptable and generally pretty legal

Unfortunately in the jungle we live in here, ideal for cultivation, the penalties for being caught, are so horrendous that it remains off my shopping list

In years gone by I was often a user

Today I stay with Sangsom

Originally Posted by OhOh

Have you connected to any "care" organisations and compared what is available/normally provided for by the NHS in the UK, compared to equivalent Thai offerings?

We have a pretty detailed Thai experience shown here, for a particular illness/patient needs. My experience through my father's last years, was yes "care" is available but overwhelmingly outsourced to region limited, private organisations. While the individuals actually providing the care are willing, the employers are driven more by the profit rather than the patients requirements. An example, a care plan is agreed, a company is assigned who will provide the NHS paid for service, but inevitably, the lack of adequacy in terms of staff numbers and work or personal related emergencies, of staffing, causes delays and concern to an already anxious elderly person.

I am very much of the opinion that final days in Thailand,( I hope for another ten yrs but who knows) the best option and affordable around KhonKaen, for me the UK is hardly an option unless almost bankrupt, in that case flight home and half an hour before landing create situation that will result in ambulance on arrival, at which time UK govt takes over responsibility for rest of life, I have no where to go in UK all friends dead, my children not in the UK

Palliative care is new here, and nice hospital room for last couple of weeks around 1500 bhat per day, would only go there if IV painkillers had to be given, full time nurse also not expensive if you find yourself, to help the wife, we already have two ladies working in the house and gardens

I am lucky, happy contented and believe this is my home

Originally Posted by OhOh

I believe that anybody returning from living abroad isn't eligible for NHS care for 6 months. If you have any assets or cash they will want some of that.

Having seen my father deteriorate mentally and physically, until my family members decided to accept the final care home offer I would suggest ensuring you have in place, a secure funded plan. I have seen the local tesseban working in terms of providing homes and care/feeding/shopping to older Thias where I live. It's available, just ensure your savings are protected from any "problems".

Without wishing to be antagonistic you are not necessarily correct

Return to UK for surgery with intention of leaving not covered

Return with intention of remaining immediately covered, no proof required you just have to say back permanently if asked, if not asked say nothing

I have had this confirmed by two charitable organisations

After having been and had surgery if one were to find it intolerable and you changed your mind you will not get a bill

If and I hope not that I ever returned it would only be because I had little time to live and could not get pain suppression here, and I have been promised I can die here with no pain and can get the necessary drugs

Originally Posted by al007

Without wishing to be antagonistic you are not necessarily correct

No you are correct, it appears I am mistaken.

13.
What is meant by being ‘ordinarily resident’ in the UK?

Answer :

Entitlement to free NHS services outside of primary medical care is principally based on Ordinary Residence in the UK. An overseas visitor is any person who is not “ordinarily resident” in the UK.

A person will be “ordinarily resident” in the UK when that residence is lawful, adopted voluntarily, and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration.

Nationals of countries outside the European Economic Area (EEA) must also have ‘indefinite leave to remain’ in the UK in order to be ordinarily resident here. A person who is ordinarily resident in the UK must not be charged for NHS services, except where statutory charges apply, e.g.prescription charges.

https://pcse.england.nhs.uk/media/12...ance-final.pdf

Originally Posted by al007

AS ALWAYS WILL DO MY BEST TO SHARE MY KNOWLEDGE WHERE IT CAN HELP,

Good on you. I'm sure all info will be useful to others.
Chin up and all the best.