My Experience at Brumrungrad Hospital

I have been dealing with swollen, sore feet since our time in Guatemala. Several of the symptoms were "gout-like" and upon passing a lab in Australia, I popped in to see if they could draw blood and run some tests. Getting this done without a doctor was a little tricky but ultimately they agreed and proceeded. The results took 24 hours and by then we were going to be in another city, but they were willing to give me the results over the phone given our circumstances. Long story short, the results came back negative and we could rule out the gout theory, which no doctor had ever really suggested to begin with, but we are grasping for straws at this point. While there is relief in knowing this is not the issue, there is great anxiety still in the unknown.

We flew to Bangkok the next morning and learned from some local missionaries of a great international hospital there, and at the prompting of my always more intelligent wife, I decided to try to see, yet again, a doctor in hopes of unlocking this mystery. Over the last few months, I have been to an ER, a podiatrist, and a general doctor all the while conversing several times with a doctor-friend back home. Additionally, we have been researching on the web, trying to self-diagnose the situation. It feels like a lot of wasted time and money (though not much) for little results.

I must admit that I had some real hesitations about heading to a hospital in Thailand given our inherent American attitude of Health Care superiority. Spoiler alert: I could not have been more wrong.

My first half-hearted attempt at an appointment was to just access the hospital web page and request an appointment online. I wasn't thrilled about wasting one of only 4 precious days in Bangkok with doctors who could not provide answers as I felt like I had done this enough. At the same time, my problems were not getting better and I had run out of the medicine that helped the most and had no ability to get more without a prescription. So my thought was go online, figuring they would never get back to me anyway. Then at least I tried, thus fulfilling the wise expression: happy wife = happy life.

Within two hours of entering some general info online, I had an appointment with an Orthopedic Specialist THE SAME DAY!  Imagine that at home. I was shocked, and this was only the beginning of this amazing place. They emailed me back with thorough instructions on what to do and where to go, and I left the family for the afternoon to head to the hospital, a bit depressed but with a tinge of hope.

Upon arriving at the registration floor for international patients, here is what I see - yes that is a Starbucks!! It's as if I have died and gone to hospital heaven. :)

Starbucks in the hospital! Brilliant

Registration is smoother than anything experienced back in the States as they take my photo, create an ID card, give me a bracelet, and send me to another floor. All this, mind you, took roughly ten minutes.

Upon getting to the orthopedic floor I notified them that I'd arrived. I was early and hoping that I could see see the Dr. ahead of time so that I can catch up to the family (they had told me this might be possible). They ask me to sit and about 60 seconds later a nurse comes over and tells me that I am number two in the que. Shocking - I am about an hour and a half early and going to see the Dr at a time that is convenient for me, instead of their scheduled appointment time!

Sure enough, about 15 minutes later I am taken to see the doctor. We visited and I explained my story, he listened thoroughly, did his exam, and recommended some x-rays. I left his office, waited about two minutes and then a nurse took me to the x-ray room. This machine rivalled any of the most advanced machines we have back at home and this was all fairly routine. I sat back down and waited another 15 minutes or so before I saw the Dr again. He pulled up the pictures on his computer where he proceeded to zoom in and out and did some very hi-tech measurements. He gave me his thoughts and ultimately recommended steroid injections and that I see a Rheumatologist. His assistant disappeared to check on schedules. In fairly short order they found a slot for me to get the injections that same night (at 7pm) and got me an appointment for the next day with a Rheumatologist. Another lady also came up and gave me the estimate for the injections (imagine that - knowing the cost BEFORE the procedure!)  I would have been flat out against any injection in a foreign country had I not been so highly impressed up to this point.

I had to wait about an hour for the injection and, despite the incredible pain, it went fine. This concluded about 7:45PM and I was done for they day. They took me down to the cashier where I was given a paper with a number on it. About five minutes later, my number was called and I payed a total of $308 for everything (Dr visit, x-rays, and two steroid injections). I hopped in a tuk tuk with a driver who had no idea where our accommodations were, so I had him drive me to the train station. Ultimately I was back home around 9:30 and crashed into bed.

The next day my appointment was at 11:30AM but I was also worried that I had a clogged ear, which needed care, as this is common once or twice a year due to my psoriasis. So my plan was to leave early and try to get this taken care of in the ER before my other appointment - a bold plan indeed.

I proceeded to the ER and talked with a nurse. Flushing the ear was an easy procedure in Bangkok, whereas the red tape made this quite the ordeal back at home. So my thought here was that while the ER may cost more it would be quicker since I could not miss my scheduled appointment. The nurse asked if I was in pain, to which I said no. She then explained that  I should see an ENT (ear, nose, throat) and told me which floor to head up to. I made my way to the floor and registered at the station. Mind you, I had no appointment for this. They took my info and shortly told me I was number two in the que. I was shocked but feeling good about my plan. About ten minutes later I saw the doctor who knew exactly what I needed and told me to lay on the table. Here is where it got cool. At home they always do this with me sitting up while they flush water into the canal to clear out the gunk. Here, this room had a giant flat screen on each wall next to me (facing each other) which I was curious about. The doctor pulled down a device to look in my ear and it showed up on the TV screen, so I could actually see. So very cool! He then used a small vacuum to clear my ears and just like that I was done. This was faster, more efficient and less painful that something I have done regularly back at home. I headed to the cashier, paid about $100 and then went up to the other floor for my 11:30 appointment. That entire ear situation took about an hour and I was an hour and half early for my rheumatology appointment, again hoping to be seen early because we have tickets to see Star Wars (IMAX 3D) at 2:00.

The appointment with the rheumatologist was as efficient and thorough as everything else and concluded with the desire for blood work. I got that done and they wanted me back at 1:30 for results (lab work only takes 2 hours here vs 24 in Australia, and these tests were substantially more thorough). That won't work for Star Wars, so I ask if I can come at 5:00. Sure, no problem they said. Imagine telling a hospital what actually works for you and have them be accommodating!

I returned at 5 and spoke more with the Dr who said he believed I am dealing with psoractic arthritis. An actual answer! This is fairly common to develop in people with psoriasis and the meds I was on in the States would have been taking care of it, which explains why I never had this issue before. But because I am unable to take them while traveling, this has triggered. 

An answer was great, but the risks are potentially problematic as well. Untreated, this can lead to permanent damage which has left us in a bit of a quandary moving forward. My case is mild and while it has not worsened over the prior months, it's also not going to go away. This depresses me and leaves us with an uncertain future. Nothing is certain and so it's sort of a lose-lose scenario. We are finally at a point where no one in the family desires to go home - that was a goal of mine for this trip and only recently came to be. To quit now will leave us with an unfinished feeling, potentially forever. At the same time everyone agrees that it's not worth continuing if the result leaves me disabled. Only time will tell how we are to handle this and we are praying for clarity and wisdom. The notion of being dependent on meds angers and saddens me (especially when seeing so many who have nothing let alone access to medical care) and having foot issues for life scares me. Is this God's way of sending us a different direction or Satan's goal of thwarting our work? Right now, we are not sure and don't want to make any rash decisions, so we soldier on.  A friend has helped us investigate acquiring alternative medications in Thailand and we are pursuing this as an option, communicating with my Bangkok doctors and so on.  Certainly appreciate prayers.