Medical Bytes Thailand no 110: ‘That’s your job!!”
The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
- On Sunday, 12th May, Tai, a 44-year-old Thai national, sought my opinion.
Ostensibly, the previous day she had visited a local clinic in Pattaya, whose name was withheld due to Thai laws. The doctor in attendance, whilst focussing on his mobile, asked Tai what was wrong. She explained that she thought she had Dengue Fever. Without examination, and despite Tai explaining that she also had abdominal pain with vaginal bleeding, the doctor affirmed the Dengue diagnosis. He treated her accordingly with iron supplements and Vitamin B12 tablets.
Before Tai had time to leave his office, the doctor was, once again, focused on playing the game on his mobile phone.
- Tai’s husband, Stephen, was not satisfied with this diagnosis, so he brought her to see me for a second opinion.
Tai told me about her suspicion regarding Dengue, having suffered this illness previously whilst living in Khon Kaen. I advised her that she did not have Dengue Fever.
The female Aedes Aegypti Mosquito, see photo 1, which carries the Dengue virus is not prevalent on the seafront. This mosquito prefers fresh water to lay its eggs in and a cooler darker environment than that found in Pattaya. Indeed, it appears from the world distribution of Aegypti that this mosquito is not found in Pattaya, see photo 2.
- After taking a full history, I was concerned about Tai’s abdominal pain, her loose motions and her abnormal vaginal bleeding, which was not menstrual bleeding.
- On examination; she did not have a fever, a rash, a headache, nor joint and/or muscle pains, typical of Dengue Fever. Her abdomen was tender on the right side, which was swollen. Vaginal examination indicated that she had a mass in her lower abdomen, seemingly arising from her right ovary. The size of the mass was equivalent to a 14-week pregnancy. This abnormal finding concerned me. Ovarian cysts are not uncommon in nulliparous (no previous pregnancy) women. They are usually small, asymptomatic and they tend to resolve spontaneously. Tai’s cyst was large and it was causing abnormal vaginal bleeding.
- With Gavin’s help, Tai had an ultrasound that afternoon at the PhyaThai Hospital, Sriracha. The scan confirmed a 9cm, multiloculated right ovarian cyst, with internal blood flow, see photo 3. These findings are of concern. As stated previously, innocent cysts are common. They are not large and multiloculated and they do not have an internal blood flow. They do not cause PV blood loss.
I was concerned that Tai’s cyst was cancerous. Her blood tests for ovarian cancer; CA125, BHCG, CEA, CA19.9, were all within normal limits. This was reassuring. However, these tests did not prove that her cyst was innocent.
- I discussed my concerns with Tai and her husband. I opined on the necessity for surgical removal of her cyst and the excessive costs raised by the private hospitals in Pattaya. Tai was registered for free public hospital management in Khon Kaen, where she was born. I advised her to either return to Khon Kaen for further management or seek a referral from her local KK doctor to authorize public hospital management in Pattaya.
Tai has been living in Pattaya with her husband for 10 years. She suggested the option of renewing her ID card, citing Pattaya as her principal place of residence. The process took 3 days. She is now registered for free public hospital medical care in the Chon Buri Province. This simple alteration will save Stephen hundreds of thousands in medical costs.
- I have referred her to the Someday Public Hospital, Sriracha, for the removal of her potentially dangerous ovarian cyst.
The 5-year survival rate for ovarian cancer, if removed early in stage 1, is 94%. Delayed treatment reduces the 5-year survival rate to <49%.
- Reflecting on Tai’s case, I have heard many examples of Thai doctors accepting the diagnosis given to them by the patient. Word of advice: Give the doctor your symptoms only. If the doctor asks what is wrong with you, simply reply “That’s your job!!”
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.
