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How to avoid a biopsy to test for prostate cancer

99 posts in this topic

3 hours ago, al007 said:

Interesting, and maybe a rather negative post ,I thought this thread was about prostate cancer and other prostate related matters,  I  reserve my judgement on its quality , so are you only here to stir the pot, a bit bored with your life, sorry about that.

 

I personally post with the intention of helping others, no other motives, I am also very grateful on life saving help and advice received from Thai Visa members especially Sheryl, when I was in the depths of depression nine months ago and pretty suicidal and unbalanced, I did not know where to go or what to do

 

I have bounced back, yes just for today !

 

I only provided information in reply to others requests

 

God Bless, and May God be with you and your family, I will remember you in my prayers

 

I apologise if I have interpreted you post incorrectly

 

I quietly and with dignity I hope, still intact, withdraw from this debate

Al007 - I am sorry that you found my comments to be "a rather negative". The point is that the best and most advanced medical technology in the world is only effective if the practitioners who use it have the appropriate experience and skill sets. Further, not every radiology unit that has a 3T MRI does multiparametric prostate imaging. That is in no way meant to be negative, and my only intent was to add what I know as constructive information to the discussion.

 

Good luck.

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5 hours ago, TallGuyJohninBKK said:

But you can darn well bet that if you go to one of the hospitals that doesn't have the latest/best MRI equipment, they're still going to want to diagnose and treat you with whatever they have, even if you could do better elsewhere. And I'd imagine the likelihood of any doctor here saying, well, you might be better off going to XXXXX because they have a better MRI technology, is almost nill.

 

 

 

5 hours ago, TallGuyJohninBKK said:

 

But I guess I should be glad that TVF exists as a place where these kinds of things can be discussed and debated. Because more than likely, you're probably not going to hear about these kinds of choices and differences from your Dr. here.

 

And I'd imagine the likelihood of any doctor here saying, well, you might be better off going to XXXXX because they have a better MRI technology, is almost nill.

 

I would agree, in many cases with the above statement, but this has not been my experience

 

I share here because I want to give something back, for all the help I have had from TV, and from some of my posts it is rather obvious sometimes I am not as tolerant as I should be

 

I can only talk about my own experience, (some which I will leave out just terrible, but assisted my learning curve and taught me not to easily trust doctors here in Thailand, having said that I was compensated without a major fight, they are nice people just incompetent, today I bear no malice)

 

However I first met my colorectal surgeon at Bangkok Christian hospital, (Thanks to Sheryl's guidance,when I was panicking in India, my wife went at 6.00am ,and still only got to  number four in the queue and I saw him at 3.00pm, he is a busy man), on the first appointment he gave me 45 mins, the bill was nominal , he arranged for me to see my consultant Oncologist there the following day

 

I was advised that the chemo and radiology was better and way cheaper at the Government Hospital Chulalongkorn, these two consultants then took me under their wing at Chulalongkorn

 

I was having a long conversation with the colorectal surgeon and he asked where I wanted to have the surgery, he also works a lot at Bumrungrad, so far I have avoided surgery, will I permanently, I do not know,

I reacted better to the Chemo and radiation than anyone dreamt possible, and for this I believe the top equipment also helped greatly

 

I replied if I go to Bumrungrad and you do the operation there, is it better

 

He replied a bill maybe three or four times, but I can do an equal job at Chula, but the floor covering and wall paper is not as good

 

I smiled and said thank you I think the Chula

 

I did check out having the chemo and radiation in both KhonKaen, and at UdonThani Cancer hospital, and they both said yes they could do it, I was still learning, and know today their equipment in both cases is way behind Chulalongkorn, no one told me this I had to find out myself, and even when I started treatment at Chulalongkorn, I was not aware how advanced and up to date their equipment was, my Oncologist also trained at John Hopkins in Baltimore, a leading USA cancer hospital

 

So I consider myself very lucky, but I still have to watch and listen and be my own GP questioning everything, and I do regularly say thank you God, whoever or what ever you might be 

 

At present I have a Colorectal Surgeon, an Oncologist, a Chemo Consultant, and a Urologist, I have no insurance but am comfortably managing the bills

 

One area that needs tolerance is waiting times,  on the route I have chosen, and I am sure at the likes of Bumrungrad this would not be as great, but the costs there maybe I could have met; but then my reserves of cash would have been depleted to dangerously low levels, that I would not have been comfortable with or felt safe

 

Regularly I have waited 3,4,and5 hrs for appointments and I have had many, maybe 50 plus in total

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From my experience with Chula, they will not have acquired a 3 T MRI without also having insured that at least one,likely more, of their radiologists is well trained in its use. How familiar the urologists are, I don't know but one can ask.

In government hospitals the doctors receive a flat salary unlinked to how many patients they treat or what treatment they provide. And the hospital relies on flat capitation payments from the 3 main national health schemes for easily 99% of its income. These too are these independent of what treatment is given or how many patients treated. So there is absolutely no financial disincentive to referring patients elsewhere. That said, there is a cultural reluctance at times (loss of face, not wanting to disappoint the patient) though that varies with the doctor and their perception of the patient's ability to afford going elsewhere.

The opposite situation holds true in private hospitals. However, individual doctors vary in how much they let financial considerations and pressure from hospital administrators influence them. The very best doctors are often impervious to both. They are sufficiently in demand that they can afford to be.

Whether at a private or a government hospital, the choice of doctor is paramount. There are some excellent doctors to be found in Thailand but they need to be sought out. Just walking into a hospital and taking pot luck will not usually end in being treated by the best, often the opposite. If it is a simple problem then even a mediocre doctor will likely be fine but for anything at all complex and/or serious it is essential to seek out specific doctors and worth travelling to see them.

Government hospitals do entail long waits, especially the tertiary level facilities linked to major medical schools, which is where you will find the best doctors and most up to date equipment. This is true even when using their after hours clinics (strongly advised, as through private channel much of the care is from interns and residents in training, with limited time with the senior specialist). It is necessary to come prepared to wait-- bring books and lots if patience.

Another big disadvantage, especially for those living far away or with limited mobility, is that you usually cannot make appointments by phone so have to make one trip just to book.

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33 minutes ago, Sheryl said:

From my experience with Chula, they will not have acquired a 3 T MRI without also having insured that at least one,likely more, of their radiologists is well trained in its use.

is there a difference in reading and analysing the results of a 1.5 and a 3 Tesla?

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35 minutes ago, Sheryl said:


Another big disadvantage, especially for those living far away or with limited mobility, is that you usually cannot make appointments by phone so have to make one trip just to book.

Very true, however there is a  partial way round this, always fix the next appointment with the consultant before leaving him/her, even if you know the date is suspect, it is very easy then on the phone to reschedule appointments

 

Like in August I have six appointments I have rearranged some to see they are pretty close to being on consecutive days, I also have to see the MRI happens two days before the colonoscopy, when it was set up the colonoscopy was originally before the MRI, but the man doing the colonoscopy needs the benefit of the MRI, those administering the appointments miss all this

I also need to see the Colorectal Surgeon is the last to be seen, as his decision affects what happens next

I also send a combined email ten days before, to all consultants, I know a couple of them read it

 

Chula with many appointments happening in close proximity tends to loose my file as I am at the next appointment before my file has been put in its proper place, so with their agreement we keep my file with us for the week taking it away at nights, again saves time later, which could result in appointment being missed

 

Un managed and left to their own devices, it is likely the right sequence will not happen

 

Again on Chula they see their consultants are fully trained in the machinery/equipment, my Oncologist was sent to John Hopkins for a year to train in conjunction with the USA/UK manufacturer, Varian of the equipment

 

This equipment is seriously expensive ( billions not millions) and normally the price includes training of key personnel, there are also many brochures produced by the manufacturer in English detailing what the equipment can do custolmised to Chula hospital, I believe very professional, but then I am I believe justifiably biassed

 

My own belief is Chulalongkorn is the top hospital for cancer treatment in Thailand, I knew little of this when starting this road

 

Chula is building a whole new building to house even more state of the art cancer equipment, atomic science or something I believe, I was talking to the Asia Region Sales Director about this Varian equipment, very impressive, as the final order was being signed and approved, a man from the UK

 

I am not confident the private sector can afford or has the will to train as comprehensibly

 

In the north at two unrelated facilities results of an MRI and CT scan were both not interpreted correctly by totally different people, both these facilities were private and not government, two different cancers in different places were missed

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13 hours ago, bubba said:

So Chula does have a 3T MRI instrument. The next questions would be:

 

- Do they have capability for and experience with multi-parametric prostate imagining?

 

- Do they have a radiologist experienced in interpretation of those?

Finally spoken with a staff member of the radiology department at Chulalongkorn.

They confirmed that they do indeed have the more advanced 3T MRI model. However when I mentioned the Multi-parametric prostrate imagining, they admitted they had never heard of it, let alone being able to offer this particular procedure. So where does this finally leave us, here in Thailand.

Well as it would seem the mr is not available, so we must rely on the 3t model MRI. We then come to the problem of finding a Hospital with competent staff, who can accurately interperate the findings. 

 Luckely we have the experience of a1007,who has directed us to a hospital with the latest equipment, and equally important competent medical staff.

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Nontabury - Not sure what your point is as you said that Chula has never even heard of multi-parametric MRI for prostate, and then you say that AI007 has directed us to Chula with the latest equipment and competent staff? Certainly that does not apply to anyone who requires a prostate MRI. 

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3 hours ago, bubba said:

Nontabury - Not sure what your point is as you said that Chula has never even heard of multi-parametric MRI for prostate, and then you say that AI007 has directed us to Chula with the latest equipment and competent staff? Certainly that does not apply to anyone who requires a prostate MRI. 

Bubba you may have a point, however do you come from USA, have you heard of FAKE NEWS !! you might be guilty of creating it, YES you !!

 

When some people made enquiries at Chula the first response was do not have 3T MRI  but when I call the right department I get the true answer

 

Its a bit like going to Global House no sir out of stock, but whats that on that shelf, the computer says it is not there, please take the box down amazing IN stock

 

It is exceedingly unlikely Chula are not very conversant with all the procedures their machines are capable of, IF YOU ASK THE RIGHT PERSON, 10,000 bhatt bet maybe

 

Think I might win

 

I did suggest earlier on in this thread maybe YOU should do some checking out instead of worrying people unnecessarily , but you declined, and that is also OK

 

Maybe before making assertions you should do maybe a little more research

 

FAKE NEWS YES FAKE NEWS, but it came from someone on the phone at Chula, he says, OH I did not know it was only the toilet cleaner who responded !

 

May I be allowed to correct a quote where it has been suggested I have done something I have not done

 

I have never directed anyone to Chula, I have spoken very highly of it but mainly re Colorectal Cancer, with a far lesser problem Prostate cancer, as a point of principal I would only give anyone some suggestions, with the proviso please do your own checking and do not rely on me, I am unqualified on medical matters

 

Please take this in the spirit in which it is written being my wish to correct maybe erroneous information posted, and not make any personal attack

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BANGKOK 29 June 2017 02:00
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