Seek recommendations internist, GP, Primary Care doc

[Rex (Admin)]

Hi ForumMates!

In conjunction with my consultation at BKK horsepital for hernia surgery, I have been seeing a doc for hypertension, which they naturally want to make sure is under control prior to surgery. My BP goes stratospheric when I visit hospitals/doctors, but is only moderately high other times. Naturally, everyone is concerned about the high "white coat" readings.  However,  this is the first doc I have seen in Thailand who is unhappy with my moderately-high at home readings and is treating the condition aggressively.  With moderately high BP the risk assessment is tricky factoring in obvious and not-so-obvious side effects of taking more than one medication for the rest of my life against the likelihood of cardiovascular or renal events. There is no uniformity of opinion about this either. Anyway, I am glad to find a doc who wants to deal with this aggressively, and fortunately so far, all the meds are generic and inexpensive. In any case, if I decide that a regime is "over-kill" I can always scale back.

HOWEVER, doc is also (appropriately) recommending other tests: Cholesterol, ECG, renal function. Consultations, meds and lab test at BKK Hosp are much more costly than at private labs and clinics, and I can't make BKK Hosp a regular thing, but do  agree overdue for the recommended tests     .....  SO, looking for internist, GP, Primary Care doc at private clinic to handle all this.  I would like a recommendation for those who have had very positive experiences with a private doc, especially with good "bedside manner" and acceptable English. Any personal experiences?

Tks, lah!  Sorry for the long-winded explanation.  Probably more than y'all wanted to know!

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[TerryLH]

Have you asked your Doctor if they have a private practice?
Or explained how the cost is going to be a problem?

I've found that doctors who really care about their patients can be flexible or may be able to offer solutions to your concerns.

Terry

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[Rex (Admin)]

Thanks Terry.  I plan to talk to doc about it next visit.

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[screamer]

I know someone who had to get blood tests done for work at the BKK hospital in Bangkok which suggested he had a couple of problems out of the blue so he had them done again at Bumrungrad which showed that everything was fine.


After my experience with BKK hospital I wouldn't go back even if it was free.

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[fceligoj]

I have yet to hear of anything super positive about BKK Hospital.  Most of their specialists are doctors in absentia.  They are sent to each of the country's BKK locations for certain days of the week or days per month and are not considered residence.  But to each his own.


A majority of the doctors who are here on a permanent basis all seem to have after hours clinics.  Not sure that I would want a hernia operation in a clinic., but like I said, to each his own.


Rex, go get a 2nd opinion on your blood test results.  I would heartily recommend Srinagarind Hospital as the place to go.


I also have been diagnosed with hypertension and  control it with medication along with my cholesterol condition.  My blood pressure is still on the high side a majority of the time, but my US doctor recognizes it and continues to monitor.  Like she has said, some people have moderately high (low 150's) systolic blood pressure and you just have to monitor it (also recommends to lose some weight!)

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[Rex (Admin)]

My systolic at home is normally lower than 150. However, is predictably "white coat" when at the doctor, sometimes 180+ which understandably concerns them and me.  My last GP here in Thailand was unconcerned about it to the point of being cavallier. Used to tease me when I brought in my BP self-monitoring records "Oh, you Americans and your numbers!"  But if you do the research, there is a wide range of "philosophical" opinion about how aggressively hypertension should be treated.   As far as I can tell 140 is no longer regarded as "acceptable" by some or many or most doctors. Do the research.

Unfortunately, as far as I can tell, there simply isn't anything authoritative out that that you can point to as the absolutely appropriate treatment.  Which means that you simply have to do your own research, make your own decision and hope it is for the best.

Having said that, BKK Hosp doc is the only doctor I have ever had in the U.S. or Thailand who is inclined to treat my hypertension aggressively and is not satisfied with borderline results.  She has me on three different meds, and double the dose of the med I have been taking for years. I HATE the idea of so much medication, but the results are proving dramatic.  Near and often way below 120/80 most of the time the 10 days. 

As to the other tests, I haven't had any yet, and for financial reasons would prefer to work directly with a  "Doc in the box" and local lab.

Tks for your comments.

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[screamer]

My systolic at home is normally lower than 150. However, is predictably "white coat" when at the doctor, sometimes 180+ which understandably concerns them and me.

What, if you don't mind me asking, is your diastolic BP when the systolic is 180?

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[Rex (Admin)]

I don't recall.  Maybe 110?  Really high. But I have only gotten those kind of numbers twice;  once 10 years ago at RAM which is what convinced me I needed to take hypertension seriously.  Then last week at BKK Hosp as I explained.  Since new meds the past 2 week, diastolic rarely able 80, mostly in the 70s. There. Now, isn't that more than you wanted to know?

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[screamer]

Thanks.
My systolic is great but my diastolic is borderline at around 87. No meds given.


The danger, apparently, is when you have a very large difference between systolic and diastolic when your arteries are going in and out like a concertina.

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[fceligoj]

Rex, you do as you like but I feel your new doctor is too aggressive.  That may be too low for you immediately after being in the low 150s and also then down to 80 for the diastolic, too fast.  Your ideal should be yours not the average of all people.  I'll bet you should lose some weight like I should do.


I run from about 144/71 to 152/80.

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[Rex (Admin)]

I don't have a distinct opinion about this Frank, but if you do the research, you will discover that 144-150 systolic is no longer considered marginal or "borderline" as it once was.  It is a dilemma, however. Everyone has to decide for themselves.

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[fceligoj]

I see my doctor once a year and she is comfortable with where my BP is at.  She even suggested that I could stop taking my BP medication, or continue it to be on the safe side, if it made me more comfortable.

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[fceligoj]

Oh yes, I have been going to her for about 11 years.

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[Henry]

  I mentioned on another thread here that my wife couldn't find a dentist to pull a tooth because her bp was too high. My sister, a geriatric nurse, told her before she went on medication, to change her eating habits, including, cutting out ALL salt.


 Her bp was,  169/102 and now is around   100/60.  She said her food isn't very tasty, but she feels much better. Just a suggestion.


 I have low bp. Sometimes it gets down to around,  85/53. Drinking alcohol and eating more salt has helped a little. We have a home BP monitor and my bp is always low, but when I go to the doctors, they tell me it's high. I know it's the white coat syndrome, compounded by 45 minutes in Thai traffic. way to control


 In our village, it seems everyone is on high blood pressure medication. They take the meds but make no attempt to change their eating habits. I would think a combination of meds and a healthy diet, would be the best.

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[Rex (Admin)]

Tks, Henry!

Unless one is experiencing a hypertensive emergency, it only seems common sense to try to control BP via lifestyle modification before prescribing meds. The doc at BKK Hosp--whom I like very much and think is competent--didn't mention lifestyle at all! Not a peep!

I don't use table salt at all, but it hard to avoid in Thailand as all processed food is loaded with sugar and salt, and restaurants--even vegetarian--seem to regard it as some kind of religious obligation to add tons of sugar and salt to everything. It is really awful!  And what they do at fast food restaurants is borderline criminal!

I use grated parmesan cheese on things like popcorn and eggs as a salt substitute. 1 tsp GPC = 25mg sodium, compared to 1 tsp table salt = 2,000+ mg sodium.  Tastes good.  Your wifey "might" like it. 

When I see a new doc, I always take my blood pressure monitor alone and compare the results of doc's and mine. I read that the monitors need to be recalibrated. However, modern home equipment seems to be pretty accurate.

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