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Doctor's Consultation  by Dr. Iain Corness

 

Update April 30, 2016

Time for the Family Check-up?

Check-ups are inherently involved in the Quality of Life. Longevity alone, with no quality, just isn’t worth it in my book.
Many people work on the principle that they would rather not know about any underlying or sinister medical conditions they may have. After all, we are all going to die one day, aren’t we? I have always said that despite all advances in medical science, the death rate will always be the same – one per person! But wouldn’t you rather have pleasant final years than one of poor health, infirmity and aches and pains?
And since by the time you are into the final straight and looking for the finish line, it would also be better if your partner was also in good health, surely. This can be done at the Bangkok Hospital Pattaya with some special discount packages.
The guiding principle behind check-ups is to find deviations from normal health patterns at an early stage. Early enough that the trend can be reversed, before damage has occurred. Examples of this include Blood Pressure (BP), as high BP can affect many organs in the body, not just the heart. But an elevated BP generally gives no warning symptoms.
Another example is blood sugar. Again, it requires sky-high sugar levels before the person begins to feel that something might be wrong. And by then the sugar levels have affected vision, the vascular system and many other systems, all of which can decrease your future Quality of Life. Amputation of a limb is a common result of unchecked blood sugar levels.
Cardiac conditions and abnormalities, be that in anatomy or function, can also very adversely affect your Quality of Life, but are very easily found during a routine check-up. Various blood tests and an EKG can show just how well the cardiac pump is functioning, and also how well it will continue to function in the future. The inability to walk more than 50 meters certainly takes the fun out of shopping, yet this can be predicted – if you have some serial records!
Another of the silent killers can be discovered in your lipid profile, with Cholesterol and its fractions HDL and LDL, being intimately connected with your cardiac status.
Let me give you an example. A younger man who was obviously overweight, but played golf three times a week and had no apparent problems. He enjoyed his golf, and the beers at the 19th hole. Just like his other overweight golfing mates.
This chap’s blood tests were not so good, and his diabetic tendency was now more than just a tendency. Despite the fact that he was not having chest pains, he decided to have the 128-Slice CT of the coronary arteries carried out. This showed three blockages. Three corrective stents later he could return to the golf course, but with urgent recommendations to get his weight down and get his blood sugar and cholesterol under control.
There are actually so many conditions that can affect your enjoyment of the future that can be discovered early. Renal (kidney) function and liver function can be monitored through an annual check-up, as can prostate size (indicated by the PSA blood test) or breast tumors (by mammogram).
Hopefully you are now thinking about an annual check-up. And not just thinking about a check-up for yourself, but for your partner as well. If so, I have some very good news for those of you living in Pattaya. The Bangkok Hospital Pattaya has repeated their previous annual promotional packages with big discounts on check-up packages called the Healthy Family 2016. Even better news is that the discount program continues from now through to the end of May, 2016. By purchasing two packages you get an even bigger discount. You can even extend this to the end of June, by pre-paying before the end of May, 2016.
I do urge you to take advantage of this, for your enjoyment of the future, if nothing else. This is a genuine offer, and does give everyone the opportunity of ‘preventive medicine’. Catch anything early and you have given yourself the chance to correct it – and get a better Quality of Life in the forthcoming years.


Update April 23, 2016

Medical Insurance – how much do you understand?

Came across an interesting situation the other day. Chap arranged his own insurance policy with the insurance company, getting it a little cheaper as there were no broker’s fees. Unfortunately, with his next claim he found himself at odds with the insurers, so who could go to bat for him? The insurance company isn’t going to fight itself, is it? For that reason alone, you should work through a broker. It is cheaper in the end, and you are more likely to get a satisfactory result.
Most people take these out travel insurance and the days included are enough to give you cover from the day you leave until the day your flight returns. Simple and easy to understand – but is it enough?
Imagine you are in Singapore and on the day you are leaving you are hit by a taxi. Head injury and a broken leg. You are taken to ICU and then graduate to a ward after three days. Your travel insurance expired three days ago. Where do you stand?
It appears that most, but not all, travel insurance companies will continue to pay for your hospital treatment – but for a limited time only. “Get well soon,” as the sympathy card says!
On to another aspect of medical insurance – do you have out-patient cover as well as in-patient cover? Most people do not, as out-patient treatment is generally very cheap in this country. However, there is this thought in the collective sub-consciousness that if the out-patient bill is going to be high, then just stay as an in-patient for one night and then the insurance company will pick up the tab, because you are “insured”. Do you honestly think the insurance companies are that na´ve? It has never occurred to them that this could happen?
Now put yourself in the role of the insurance company, are you just going to automatically pay up, when it is obvious even to Blind Freddie that “clinically” it was not necessary for you to be hospitalized. You could have easily slept in your own bed and returned to the hospital the next day to get the results of the tests. But you don’t want to because you do not have out-patient insurance! With ‘cost containment’ being the new buzz words in the insurance industry, expect this so-called loop hole to be closed off.
Now anyone who reads this column regularly will know I promote the concept of having annual check-ups. The guiding principle behind check-ups is to find deviations from normal health patterns at an early stage. Early enough that the trend can be reversed, before damage has occurred. Examples of this include blood pressure (BP) increase which is generally symptomless, and blood sugar. It requires sky-high sugar levels before the person begins to feel that something might be wrong. And by then the sugar levels have affected vision, the vascular system and many other systems, all of which can decrease your quality of life in the future.
However, a representative from AA Insurance Brokers brought out an interesting situation, which could be vitally important for someone finding they have a chronic problem. If you have your check-up and find that you have high blood pressure, and then go and take out insurance, it is too late. You “know” about your blood pressure problem at the time of applying for the insurance, so it becomes a ‘pre-existing condition’ and your insurer is within its rights to refuse to pay for the further treatment of your blood pressure, or for any other conditions caused by high blood pressure. Including a stroke.
The answer is simple and that is to make sure your insurance policies are in place before having the annual check-up. In fact, I strongly advise everyone to take out medical insurance. You do not know what is round the next corner. It could be a motorcycle coming the wrong way up a one way street. Even I took out insurance, and I work in the hospital, so I don’t really need it – but I can also be run over in Bangkok, Chiang Mai or Nakhon Nowhere!
Go to a reputable insurance broker and go from there. You will thank me in 15 years time!


Update April 16, 2016

Biting on a bullet!

Surgeons can be the ‘prima donnas’ of medicine, if you like. It is the surgeons who get the headlines in the newspapers. It is the surgeons who are the stars in movies and TV. Who can remember the irascible surgeon Sir Lancelot Spratt (Dr. In The House, 1954) or the young surgeon Dr. Kildare (1961)? Slightly more recent, the American surgeons in M*A*S*H?
However, surgeons have been around for many centuries and have their own Royal College. The origins of the first Royal College of Surgeons go back to the fourteenth century with the foundation of the ‘Guild of Surgeons Within the City of London’. There was dispute between the surgeons and barber surgeons until an agreement was signed between them in 1493, giving the fellowship of surgeons the power of incorporation. In 1745 the surgeons broke away from the barbers to form the Company of Surgeons. In 1800 the Company was granted a Royal Charter to become the Royal College of Surgeons in London. A further charter in 1843 granted it the present title of the Royal College of Surgeons of England (of which I proudly say I am a member).
We marvel at the surgical advances in the past century, but while I take my hat off to the surgeons, the real praise goes to the anesthetists. Without the advances in anesthetics, brawny assistants would still be holding patients down while surgeons attacked with scalpels and saws and the patient lay there biting on a bullet.
The first anesthetic agent was ether, dribbled on to a mask to knock the patient out and allow the surgeon to take his time and become meticulous in his approach. The first public demonstration of ether anesthesia took place on 16 October 1846, at Massachusetts General Hospital in Boston. The anesthetist was William Morton and the surgeon was John Warren; and the operation was the removal of a lump under the jaw of a Gilbert Abbott.
While there have been enormous advances since then, I can remember being a medical student and assisting at an operation in outback Australia in 1964. The anesthetic was ether, dribbled on to the patient’s gauze mask by the matron of the public hospital, and it was a Caesarian section for twins. There was no air-conditioning and it was 43 degrees in the theatre, where the fumes were making us all woozy. Amazingly everyone survived the ordeal, mother, twin sons, the local doctor, the matron and me.
Despite outback Australia, anesthesia progressed in the rest of the world. Chloroform was introduced by James Simpson, the Professor of Obstetrics in Edinburgh, in November 1847. This was a more potent agent but it had more severe side effects, including sudden death. However, it worked well and was easier to use than ether and so, despite its drawbacks, became very popular.
The next major advance was the introduction of local anesthesia – cocaine – in 1877. Things definitely did go better with ‘coke’! Then came local infiltration, nerve blocks and then spinal and epidural anesthesia, which in the 1900s allowed surgery in a relaxed abdomen, and is still used today, especially in obstetric anesthesia, where the mother can be anaesthetized, without the baby being affected as well.
The next important innovation was the control of the airways with the use of tubes placed into the trachea. This permitted control of breathing and techniques introduced in the 1910s were perfected in the late 1920s and early 1930s. Then came the introduction of intravenous induction agents. These were barbiturates which enabled the patient to go off to sleep quickly, smoothly and pleasantly and therefore avoided any unpleasant inhalational agents. Then in the 1940s and early 1950s, there came the introduction of muscle relaxants, firstly with curare (the South American Indian poison, but not administered by native blowpipe) and then agents less dangerous.
Anesthesia is now very safe, with mortality of less than 1 in 250,000 directly related to anesthesia. Nevertheless, with today’s sophisticated monitoring systems and a greater understanding of bodily functions, the anesthetic profession will continue to strive for improvement over the next 150 years.”
On behalf of all patients requiring surgery in the future I thank the anesthetists. No longer do they have to bite on this bullet!


Update April 9, 2016

Acute Sciatica isn’t too ‘cute’

People often ask me how I pick on the different topics for this column. Usually I have direct contact with someone who has the ailment, and this was certainly so for this week’s column. The “someone” was the Executive Editor of this newspaper!
He had noticed that his right leg seemed weak, and he was having low back pain. This got worse until his leg just collapsed and he had extreme difficulty getting up from the floor, and he was suffering from extreme pain as well.
Back pain is one of the commonest orthopedic problems, and the often used terms such as lumbago, sciatica and slipped disc get bandied about at the dinner table. However, an acute bad back is not the sort of condition that you want to chat about. How many people have told you that they have a slipped disc? Would you be one of them? However, would you believe me that nobody actually “slips” a disc?
Let’s begin then with this “slipped disc” problem. First thing – discs do not “slip”. They do not shoot out of the spaces between the vertebrae (the tower of cotton reels that makes up your spine) and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out through the edge of the disc and hits the nerve root. When this happens you have a very painful condition, as anyone who has had a disc prolapse (our fancy name for the “popping out” bit) will tell you. Think of the pain when the dentist starts drilling close to the tiny nerve in your tooth. Well, the sciatic nerve is a large nerve! When the nucleus of the disc hits the sciatic nerve, this produces the condition known as Sciatica - an acute searing pain which can run from the buttocks, down the legs, even all the way through to the toes.
Unfortunately, just to make diagnosis a little difficult (if it were all so easy why would we go to Medical School for six years!) you can get sciatica from other reasons as well as prolapsing discs. It may just be soft tissue swelling from strain of the ligaments between the discs, or it could even be a form of arthritis. Another complicating fact is that a strain may only produce enough tissue swelling in around 12 hours after the heavy lifting, so you go to bed OK and wake the next morning incapacitated. And then you have to convince the employer that you did it on his time and not yours, followed by your insurance company!
To accurately work out just what is happening requires bringing in those specialist doctors who can carry out extremely intricate forms of X-Rays called CT Scans, Spiral CT’s or MRI that will sort out whether it is a disc prolapse, arthritis or another soft tissue problem. The equipment to do these procedures costs millions of baht, and the expertise to use them takes years of practice and experience. This is one reason why some of these investigations can be expensive.
After the definitive diagnosis of your back condition has been made, then appropriate treatment can be instituted. The forms of treatment can be just simply rest and some analgesics (pain killers), physiotherapy, operative intervention or anti-inflammatories and traction.
Now perhaps you can see why it is important to find the real cause for your aching back. The treatment for some causes can be the wrong form of therapy for some of the other causes. You can see the danger of “self diagnosis” here. Beware!
So what do you do when you get a painful back? Rest and paracetamol is a safe way to begin. If it settles quickly, then just be a little careful with lifting and twisting for a couple of weeks and get on with your life as normal. If, however, you are still in trouble after a couple of days rest, then it is time to see your doctor and get that definitive diagnosis. You have been warned! It could be a prolapsed disc and you might need surgery.
There is a branch of the Bangkok Spine Academy in my hospital.


Update April 2, 2016

Fame at last

It’s been a great week. Someone actually wrote to the Pattaya Mail saying how much they liked my medical column! Oh the heady pleasure of fame!
It began many moons ago, though not quite as long ago as when JC played for Bethlehem United, but before Bic biros became commonplace and long before cling film and mobile phones.
I had done very well in my scholastic life, partly through natural talent and partly through un-natural pressure from my late father, who was a teacher at the school where I finished my secondary school education. Can you imagine being a student where your father was on the staff? Dreadful!
I was unsure of what career path to take, as all I really wanted to do was go motor racing, so I was taken to an institute which would show those careers for which I was most suited. After innumerable tests, written and oral, my father and I were summonsed to hear my future direction. “He can do anything he wants to,” said the counselor to my father, as if I wasn’t in the room, thus losing my attention and respect immediately. We had traipsed in and out for these tests and I could do whatever I wanted to. Great! But I didn’t know what that was, as they don’t have trial career offers. “Let’s see if you should be an accountant. Pick up this pen and try pushing it…..”
So it was home again and parental pushing. I had done well in maths and physics, so engineering was proposed. However, my late mother had been a nurse and I had enjoyed books like George Saba’s ‘Guerrilla Surgeon’, so I did have an interest in medicine as a career. I also worked out that if I became an engineer, I couldn’t be a doctor in my spare time, but if I became a doctor, I could fiddle about in engineering in my spare time (and apologies to any engineer reading this)!
So it was Queensland University in Brisbane for six long years. Since those days, the more enlightened universities have made Medicine a post-graduate course and shortened it to four years. This way, the profession gets young people who really ‘want’ to do medicine, and nonsense courses such as Botany are dropped from the curriculum (apologies to all botanists reading this, but I have not used one jot of botanical information in 50 years of being a doctor, but I do know the difference between a carrot and a banana).
My individualism brought me unstuck a couple of times. In those days, the consultants were given god-like personae. I had always considered that to become a deity, it should be given to you, not assumed and then lorded over lesser mortals. I was standing in the Medical School foyer when Dr Konrad Hirschfeld (Australia’s answer to Sir Lancelot Spratt – remember those movies?) barged in, a small portly man with a cigar. I did not move out of his way quickly enough and I was on the receiving end of “Don’t you know who I am, boy?” “Yes sir,” I replied, “But do you know who I am?” Individualism was not fostered in those days!
When we were first issued with ID cards. I read the reverse side which stated “This card will be carried at all times when on university property, and will be shown to any university staff member on demand.” I objected to the “will be” and the “on demand”, so I tore mine up. Very shortly I was summonsed to the Dean’s office. “Why did you tear up your ID card?” he asked. “Because I know who I am,” was my reply.
I ended up sitting my medical finals in the Royal Colleges of Physicians and Surgeons in London in 1966, after I had again upset the establishment in Australia (another long story of individualism and not really relevant today). Six years and 12,000 miles after I had commenced my medical course I rang my father reverse charges from London. Would he accept a call from “Dr.” Iain Corness? He did, and Dr. Iain Corness, with a shiny silver badge, was let loose on an unsuspecting British public!


HEADLINES [click on headline to view story]

Time for the Family Check-up?

Medical Insurance – how much do you understand?

Biting on a bullet!

Acute Sciatica isn’t too ‘cute’

Fame at last