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Chiang Mai Thailand - All About Chiangmai Thailand


WEATHER-CHIANGMAI

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-- A SPECIAL CASE --
Special Medical Service Center
110/392 Intawaroros Road, Tamborn Sripoom, Muang,
CHIANGMAI, 50200 THAILAND.
Tel : 053-946900
 

 


The begining of a cases.   MALAYSIA

I was never sick since childhood until one “bad day” 5th May 2002, age 45 that I felt increase of weight (10 kilograms) in just a week. A first medical check (ultra sound) at a local clinic discovered and confirmed a mass of fluid in my abdomen. The doctor refers as ascites.  

I was then advice to refer my case to a Medical Centre for a full medical check-up. After a through medical-check, a doctor confirmed and told me that there is a gross ascities in my abdomen and the x-ray shown a right plural effusion and a right lower lobe collapse. My heart was also not functioning well. I was suggested to a Physician and Respirologist, Internal and respiratory Specialist Consultant at a Specialist Hospital in Kuala Lumpur, Malaysia. 

At these Private Specialist Hospital, I undergo a series of Chest X- Ray, ultra sound, eco-gram, blood test, urine test and finally CT scan of the lung, chest, abdomen and pelvis... From these investigations, the CT scan showed Inferior Vena Cava (IVC) Thrombosis. The Pathologist here also reported that there was also a large right sided plural effusion. My right lower lobe is collapsed. There is a gross escites in the abdomen.  My liver, gall bladder, pancreas, spleen, appear normal, there is no biliary tree obstruction, both my kidney are normal in size and appearance. There is no lymphadenopathy seen in the region of the porta hepatis, para-acrtic or para-caval areas, my bladder and the prostate appear normal. Specialist here suspected a various underlying accult malignancy inclusive of mitotic lesion that might lead to theses IVC Thrombosis.  

To find the cause of these suffering, I undergo various investigations inclusive BRONCHOSCOPE, OGDS, COLONOSCOPE and LAPAROSCOPE. None of these scoping had lead to any underlying malignancy. Fluid of these scoping was sent to medical laboratory and the Pathologist reports are as followed: 

  • Fluid for Cytology: Smears consist of many lymphocytes, macrophages, lysed blood, some neutrophils and mesothelial cells. Negative for malignancy.

  • Hepatitis B screening: Non-reactive, no protective level of anti HBs.
  • Bronchial Lavarage for PCR: No Mycobacterium tuberculosis DNA detected.
  • Pleural Fluid for TB PCR : No Mycobacterium tuberculosis DNA detected
  • Bronchial Washing Cytology: Smears consist of some benign and reactive bronchial epithelial cells and macrophages. Negative for malignancy.
  • Pleural Fluid examination for culture and sensitivity: No growth at 37 degree centigrade after 48 hours of incubation.
  • Pleural Fluid examination for culture and sensitivity: No growth at 37 degree centigrade after 5 days of incubation.
  • Citrated Plasma: Antithrombin III (75%), Protein C (26%) and Protein S (58%). Lower protein C levels and borderline Protein S levels detected. Low levels of these proteins may due to inherited deficiency, anticoagulant therapy, liver disease and difficulties in specimen collection and transport.
  • Acid fast bacilli (AFB) stained smear: NOT SEEN.
  • LE Cells: NOT SEEN.

The Pathologist confirmed my liver biopsy core reveals intact lobular architecture and regular liver cell trabeculae separated by congested sinusoids. No significant atypia of hepatocytes is noted. There is no prominent bile stasis. Portal tracts included shown no significant lymphocytic infiltration or bile duct proliferation. No fibrous tissue proliferation is seen. Large areas of the haemorrhage are noted throughout the biopsy fragment. The interpretation of the finding: feature typical of primary or secondary biliary cirrhosis are not seen in my liver biopsy.   

While undergoing the investigation, I was treated with LASIX, ALDALTONE, FRAXIPARINE, WARFARIN and a few other medications on eczema.

I also visited a Physician Haematologist in another Private Medical Center and he performed an ACA, Lupus anticoagulant, some tumor markers and an FBP which were all normal.

Six month had passed and the respective medical centre still fails to identify the cause of my IVC Thrombosis. I then admitted myself to a University Hospital of Medical Science, Malaysia (An Outstanding Government University Hospital in Malaysia) to undergoing further treatment.  Again, a series of Chest X- Ray, ultra sound, eco-gram, blood test, urine test and a CT scan of the thorax, abdomen and pelvis.. After 2 weeks here, the investigation, pathologist reports and the CT scan showed the following: 

  • Thrombosis involving Inferior Vena Cava (IVC), Superior Vena Cava (SVC), Right atrium & ventricle and left ventricle.
  • Focal liver lesion could due to focal modular hyperplasia.
  • Gross right pleural effusion with associated right lower lobe collapse.
  • Gross Escites.
  • The Pathologist here also reported that there is no mass or enlarged paraaortic, paracaval lymph nodes seen. No mass or enlarged nodes seen in the pelvis. Both kidneys are normal. Spleen and pancreas are normal with no focal lesion seen.
  • No intrathorasic and intraabdominal masses.

Medication: I was treated with FRUSAMIDE, ALDALTONE, FRAXIPARINE, WARFARIN and ATARAX, PIRITON, DERMOVANE CREAM on skin problem which the Dermatologist here treated as chronic Eczema. These University of Medical Science Hospital then referred me to the Malaysian National Heart Institution in Kuala Lumpur for further treatment.  

For the next 10 days here at the Malaysian National Heart Institution in Kuala Lumpur, My cases was discussed in their “interesting case presentation” and it was decided that not to proceed with the IVC filters. I was then referred back to the University Hospital of Science Malaysia for further anti-coagulation management. 

I did not return back to University Hospital of Science for further treatment but instead decided to seek treatment oversea. I then come to SPECIAL MEDICAL SERVICE CENTER IN CHIANGMAI, THAILAND.

The continuing of my case.
CHIANGMAI, THAILAND

Met Dr. Siriwan at his home in Hang Dong and explain to her about my suffering. and later advise me to make treatment at Hospital. She then recommended Prof. Dr. Kannika. A retired prof Dr. but still with contract with the Government to be a lecturer at Special Medical Service Centre at Suan Dok Hospital.

10 September 2002, visited Rajavej Chiangmai Hospital at 316/1 Chiangmai-Lamphun Road, Tambol Walkate, Amphur Muang, Chiangmai 50000 and met Dr. Kannika at about 1300 hrs and was waded at Rajavej Chiangmai Hospital. Hospital MRN no: 4512755 (FM-RJV-B/V1). X- Ray, ultra sound, blood test and urine was taken and finally CT scan more for the treatment of ascitis in ther abdomen. Stomach scoop was done by Dr. Kannika the next day ( 22 September 2002 ).

I was discharged from the Rajavej Chiangmai Hospital and to refer to Dr Kannika a week later.

28 September 2002 - Professor Dr. Kannika arranged for me the MRI which was to be performed at Special Medical Service Centre. Register at Special Medical Service Center: Hospital No: H.N 96971.

(ALFA) Performed the MRI of the heart and liver on the 28 September 2002 @ 14:37:07 (SMSCCU) : Axial T1, fat-saturated FSE T2, GRE, Sagittal T1, Postcontrast axial and sagital T1, GRE.

Finding : 9 OCTOBER 2002 (MRI RESULT).

  • A Large intrapericardial lesion is noted in the anterior aspect and the base, partially encirling the heart, but sparing the cardiac apex, lateral wall of the left ventricle and right lateral wall of the right atrium, causing marked compression upon the right ventricle and its outflow tract. It had slight T1 hyperintensity, more than that of the ascites fluid in the abdomen and equal to that of the liver, and mixed T2-hyperintensity with complex multilocular appearance. A few tiny dark foci are seen within the lesion on the GRE images. No significant enchancement is demonstrated.

  • Dilatation of the intrahepatic IVC and the hepatic veins is seen and no obstruction of these vessels is shown.

  • Moderately large ascites is noted in the uppur abdomen.

IMPRESSION : A large intrapericardial mass in the interior and the basal aspects, partially encircling the heart, with mark RV compression. Its nature is uncertain. (BRAVO) Performed heart - ultra sound on the 03 October 2002 (SMSCCU)

09 OCTOBER 2002 - met Dr. Kannika at her Clinic at Rajavej Chiangmai Hospital  and was told to refer to Dr. Tannawat. Made a phone call to Dr Tannawat and appointment was fixed on the 10 October 2002. at 1100 hrs

10 October 2002 - Arrived at Special Medical Service Centre at 1100 hrs but the appointment was postphone to 1400 hrs as Dr. Tannawat had an urgent matter to attend to.  Able to met Dr. Tannawat on the 13 floor at 1500 hrs at his clinic at Special Medical Service centre. He explained the MRI result to me and suggested a Radiogram-Ultra Sound to be done on the heart the same day at about 1600 hrs. I was then allowed to go home and to contact Dr. Tannawat of the ultra sound result at 1800 hrs. I called him at 1800 hrs and he told me that the mass is confirmed and that he will take the case to the committee meeting the next day.

12 October 2002 - phone from Dr. Tannawat and was advise to visit Prof. Dr Veerachai at his brother clinic at Changklan Road. The latter talk to my wife and told her the direction. We immediately proceed from our house and met Dr. Veerachai at his broither clinic together with the MRI and CT Scan Report. He Confirmed the MRI finding and the mass location.  Discussion was done and  Surgery (Operation) fixed on the 09 November 2002 (SMSCCU) . Admission on the 07 November 2002.

13 October 2002
- phone Dr. Tannawat at 053-946909 and told him that the operation is fixed on the 9 November 2002.

25 October 2002 - phone Dr Kannika and told her the operation date. She was going for a convention in Switzerland on the 28 October 2002 and will be back on a week later. She was happy that the operation had been arranged.

Room 1431, 14th. Floor, Special Medical Service Center, Chiangmai!

room 1431 193 X 133

These is the room I was warded from 7 - 20 November 2002.
Room 1431 - 14th. Floor Special Medical Service Center, Chiangmai.

07 November 2002 - Admission to 14 Floor, Room No: 1431 at about 13:00 hrs. X-Ray Taken at the 4 floor. I was fasting today.Break-fast at 5:49 pm

08 November 2002 - Still in Room 1431. At about 10:00 am, Radiogram of the heart again by Dr. Tannawat to reconfirmed of the mass.  at about 1400hrs, ultra-sound of the abdomen was done to confirm if there is any finding. Dr. Alarm come to the room at about 17:45 pm to conducted an interview and get information before the operation. Most question was asked about my past suffering and if I am allergy to. My wife and children visit me. Dr. Tannawat came to room 1431 later and conveyed only the mass is still around the heart but the abdomen is free from mass. Only huge fluid is found around the abdomen.I was fasting today. Break-fast at 6:15 pm.

09 November 2002
- 10:00 am, was given some medicine and about 11:00 hrs, was taken to the operation room and thereafter surgery operation was conduction by Dr. Veerachai and anaestastic by Dr. Alarm. I was able to met Dr. Alarm for while and then unconscious from that moment till thre operation ended. When I woke up, I found myself in the ICU - 4 floor and asked the nurse on duty and was informed that it is about 2:00 am in the morning. I was very weak and asked for some water and then gone to sleep until the next morning.

10 November 2002 - still in ICU - 4 floor. The nurse bath me in the bed and later had rice porridge. Dr. Veerachai came for his inspection and dressed the surgery area. The operation was about 6 inches long and two hose was place beneath the hole to drain the blood fluid out of the heart. At about 11.00 hrs my wife visited me. I was conscious and drink a lot of water. For the rest of the day, I laid down on the bed and watch the nurse on duty performed ther duties.

11 November 2002
- Dr. Veerachai visit at 7:30 am and dress the operated area. Some wire and tube that supple fluid and oxygen to my body was removed and I was told that I will be transfers back to 14 Floor, Room 1431 at 12:00 noon. Dr. Kannika make a visit and told me that he had spoken to Dr. Veerachai and I am totally cured.  About 30 minutes later, I was transfer to 14 floor, Most of the nurse was happy to see me back to room 1431 again. For Breakfast, lunch and dinner - I only request porridge cooked with ikan haruan only. My wife and daughter come in the afternoon and accompanies me until morning.

12 November 2002 - In Room 1431, Wife and daughter left the room at about 6:30 am. Dr. Veerachai daily visit at about 8:00 am and dressing to the wound was done. The two tubes that drain the blood was taken away and the stitches is still left intact. I was asked to take a deep breath and Dr. Veerachai pull it out with a little pain. During Mid-day, had a good chat with VIEW, one of the nurse on duties. At About 15:00 hrs, Dr Alarm paid a visit and we chat more about computer and the web site. Wife and daughter came at about 7:30 pm and stayed overnight. At about 8:00 pm I walk around 14 floor for the first time, and chat with the nurse on duties for about 30 minute before retire back to the room. For Breakfast, lunch and dinner - I only request porridge cooked with ikan haruan only.

13 November 2002 - In room 1431, Wife and daughter left at about 6:15 am. Dr. Veerachai make his routine visit at abot 8:30am and dress the wound. The neddle for the transfusion of fluid, medicine and other medical assisitance was taken away from my left arm. I had my first own bath at 1400 hrs. At. 19:30 hrs, Dr Tannawat visited and told me that the blood mass had no maglinancy and only contained cardialvascular fluid. I tooked his Photo. For Breakfast, lunch and dinner - I only request porridge cooked with ikan haruan.

Medication.
Morning = 1 X pain killer (nurofen 400), 1 lasix (25mg), 1 aldaltone (25mg), 1 searlen + 20mg of Patassium Chloride
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride
Evening  = 1 x pain killer (nurofen 400),  1 lasix (25mg), 1 aldaltone (25 mg), 1 searlen + 20mg of Patassium Chloride.

14 November 2002 - In room 1431. Wife visited at 1130 hrs. Dr. Veerachai make his daily visit at about 1230 hrs. A few muslim friends we happen to meet in ICU (Mary) came with a Taiwan muslim friend and we chat until 1530 hrs. I went to sleep at about 1600 hrs. When I woke up at about 1715 hrs, My whole body chilled and cooled. I put on my sweeter (brand - BodyGolve) and before I could call the nurse, my wife came with the children. I told my wife about the situation and she covered me with 3 blankets available at the room. Staff nurse (NOOJ & LASITA) "I remember" and was busiest attending to me till about 2200 hrs. Blood sample was taken and I was given various drug and antibiotics. A lady doktor visit me Dr. ??? ( I didn't get her name). Blood was taken. I was told it was for culture proposes (???). I was on oxygen again. All the three blanket and the warm suit was remove from my body at about  2045 hrs, after I regained stablity and warm again. My situation improved after midnight and I was able to pass the night without much difficulty.

Medication.
Morning = 1 X pain killer (nurofen 400), 1 lasix (25mg), 1 aldaltone (25mg), 1 searlen + 20mg of Patassium Chloride
Mid-Day = 1Xpain killer (nurofen 400),1 searlen + 20mg of Patassium Chloride, Fluimucil 100mg (Acetycysteine 100mg)
Evening  = 1 x pain killer (nurofen 400), 2X BRM 500, 1 aldaltone (25 mg), 1 searlen + 20mg of Patassium Chloride.
Night  = 2 X pain killer, Caftaxidine at 0800 hrs.

15 November 2002 - Room 1431. wife left with the children at about 0630hrs.Just relax in bed and had breakfast at about 0900 hrs. S/N. VIEW come to my room and we spend some time taking until Dr. Veerachai daily visit at about 1230 hrs with staff nurse NOOJ.. He confirmed the good new about the blood clot and there is no tumur or cancer and no more further investigation is neccessary and considered that I am completely cure. He told me that I need a few more rest at the center and also Dr. Tannawat want to make copies about my CT Scan and MRI and other document for analyst and making a special report. He left and I have a good chat with SN. NOOJ until Mary came in about 1340 hrs. She left at about 1400 hrs to the ICU to see her father. At about 1730 hrs, Dr Tannawat come to visit me. After that I spend time in the room with the computer and rest. At about 2030 hrs, Mary come again to my room and expressed her concern about her father situation in the hospital. I advise her. She left at about 2230hrs.

Medication.
Morning = 1 X pain killer (nurofen 400), 2X BRM 500, 1 aldaltone (25mg), 1 searlen + 20mg of Patassium Chloride
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride,Fluimucil 100mg (Acetycysteine 100mg)
Evening  = 1 x pain killer (nurofen 400), 2X BRM 500, 1 aldaltone (25 mg), 1 searlen + 20mg of Patassium Chloride.
Night  = 2 X pain killer, Caftaxidine at 0600, 1200, 1800, 2400 hrs.

16 November 2002 - Room 1431. I couldn't sleep until 0315 hrs and walk to the counter and chat with SN. VIEW until 0535 hrs. I came back to the room and able to sleep and awake about 0730 hrs when the catering deliver the breakfast and Staff Nurse send medicine to my room and oxygen. I had a good BATH at 0900 hrs and my wife and children arrived with Steam FISH ( Soon hock fish). Everyone is not feeling well maybe due to weather and he had the hospital bill with her. I accompanies her to to 1st Floor to settle for the bill - 100,000 baths and after that asked her to go home as I am afraid that I might get the flu infection from them. Took photo of SN NOOJ. Dr. Veerachai daily visit at 1315 hrs and followed up by Mary until 1445 hrs. Dr. Tannawat visit at about 2000 hrs.

Medication.
Morning = 1 X pain killer (nurofen 400), 2X BRM 500, 1 aldaltone (25mg), 1 searlen + 10mg of Patassium Chloride
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride
Evening  = 1 x pain killer (nurofen 400), 2X BRM 500, 1 searlen + 20mg of Patassium Chloride.
Caftaxidine at 0600, 1200, 1800, 2400 hrs.

17 November 2002 - Room 1431. Wake up at 0610 hrs. Blood taken for culture required by Dr. Tannawat at 0700 hrs. Dr. Weerachai visit at 1200 hrs. Follow by Dr. Tannawat at 1300 hrs. He told me that I am under protein deficiency and have to start eating all the food. Don't followed the old traditional. Wife come with the kid at 1330 hrs. After lunch, permission from Dr. and went with the family to BIG C and Lotus Testco Hypermarket. Return back to Room 1431 at 1745 hrs.

Medication.
Morning = 1 X pain killer (nurofen 400), 2X BRM 500, 1 aldaltone (25mg), 1 searlen + 20mg of Patassium Chloride,Fluimucil 100mg (Acetycysteine 100mg),
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride, Fluimucil 100mg (Acetycysteine 100mg),
Evening  = 2X BRM 500, Fluimucil 100mg (Acetycysteine 100mg),
Caftaxidine at 0600, 1200, 1800, 2400 hrs.

18 November 2002 - Room 1431. Wake up at 0600 hrs, Bowel and urine and walked around the wad, and took some picture. Dr. Weerachai daily visit at 0930 hrs. Later at about 1015 hrs Dr. Kannika visit and we had a good chat and tooked her photo, I send her to the lift and later talked to some of the nurse at the counter. Wife come at about 1730 hrs. Dr. Tannawat visit at 1745 hrs and advise me to drink plenty of water to normalise my body system again. Wife and children left at 1930 hrs.

Medication.
Morning = Fluimucil 100mg (Acetycysteine 100mg), 1 aldaltone (25mg).
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride
Evening  = Anti-biotic.

19 November 2002 - Room 1431. Wake -up at 0630 hrs. Dr. Tannawat visit at 0930hrs. X-ray at 1000 hrs. Wife come with daughter at about 1130 hrs. Left at 15:00 hrs. Dr. Weerachai daily visit at 1630 hrs. Watch Thais celebrated Loy Kratong from the room window. Floating Ballons and fireworks. Wrote a letter. Mariam come at 2130 hrs and bring the Chinese Herb "San Chi" made by her mum for me to try....Put the powder herb in one capsule (IG6 Capsule) at about 2200 hrs.

Medication.
Morning = Fluimucil 100mg (Acetycysteine 200mg)
Mid-Day = (not recorded)
Evening  = Fluimucil 100mg (Acetycysteine 200mg)

20 November 2002 - Room 1431. Dr. Tannawat visit at 1030 hrs. Dr. Weerachai daily visit at 1230 hrs. DISCHARGED from Room 1431. Wife arranged payment and have a last chat with the Staff Nurse and took some Staff Nurses photo. Left the room 1431 at about 1330 hrs. Stop at Lotus Tesco to renew my moblie pjhone account and reach hokme at about 1445 hrs.

Medication after operation.
Morning = 1 X pain killer (nurofen 400), 1 lasix (25mg), 1 aldaltone 25mg), 1 searlen + 20mg of Patassium Chloride
Mid-Day = 1 x pain killer (nurofen 400), 1 searlen + 20mg of Patassium Chloride
Evening  = 1 x pain killer (nurofen 400), 1 lasix (25mg) , 1 aldaltone 25 mg), 1 searlen + 20mg of Patassium Chloride.

RESULT OF THE OPERATION AND THE FINDING ???

Dr. Tannawat is preparing for the results of these case ----
will be available soon.......

Other links to Special Medical Service Center
Special Medical Service Center, Chiangmai, Thailand,
THE BEST DOCTOR at Special Medical Service Center, Chiangmai, Thailand,
Staff Nurses at Special Medical Service Center, Chiangmai, Thailand,

This site was last updated: 25 January 2007

 

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