Doctor doctor

 

It's been a fascinating journey negotiating the Lao health system. I'm going to relate the story here at length, mainly so that I have a record for our future reference. There's no need to read it all!

It started as a pain in Trevann's left hip in mid March. He thought maybe he'd tweaked it during his daily 30-minute cardio work-out. For a 75-year-old he is very fit. Two weeks later we flew back to the UK for a month. The pain was getting worse and sometimes spreading to the groin and right hip. He tried Anadin Extra for a few days, then ibuprofen with limited relief.

By the time we had been in the UK for 3 weeks he was finding his mobility impaired, having to crawl up the stairs on hands and knees, especially in the mornings. But of course by that time it was too late to get an appointment with the doctor. We could have one in late May, 2 weeks after we were due to leave!

Searching for informed advice we talked to Roy (chiropractor and old friend in Cambodia), who said that 6 weeks of pain should be investigated with blood tests because it could indicate an autoimmune disorder called polymyalgia rheumatica. But by now we were scheduled to fly back to Laos in a few days.

We decided at this stage to stick to our plan to return to Luang Prabang, hoping that we could get to see a doctor there. And maybe the warmth would help. Dosed up with Naproxen, we set off on the journey.

Safely back in our little house in Ban Naxanvuey all was well so long as Trevann didn't move! The pain and weakness spread at times to his shoulders as well as his hips and made walking difficult. Given that walking is one of our main activities here and indeed is our main mode of transport for getting about, life in Luang Prabang was getting more difficult and expensive. We could no longer walk to town for meals in the evening and now relied increasingly on Kian and his tuktuk for shopping. By this stage Trevann was struggling to lift his foot to put his shorts on and couldn't bend down to pick something off the floor. Mornings were particularly painful.

Soon after arriving we rang the recommended (private) clinic in town and found that no appointments are needed, you just turn up. So we set off (with Kian) over to Phakan's clinic, which is next door to the provincial hospital. On arrival you get weighed and blood pressure taken then given a number. We sat in a small, slightly run down room with perhaps 20 patients, from babies to elderly, everyone very friendly. After about half a hour Trevann was ushered in to see the doctor.

She diagnosed tendonitis associated with hypothyroxaemia (Trevann has been taking levothyroxine for a few years) and prescribed a 5-day course of pain relief and anti-inflammatories, starting with an injection of diclofenac. She also sent us downstairs for an ultrasound scan just to make sure there was nothing visible. Total bill $45.

A week later the pain was back, as bad as before, so we returned to the clinic. Saw the same doctor, blood taken for tests, sent over the road to the hospital to get a pelvic X-ray. A bit of to-ing and fro-ing to get the results (the printer at the hospital was broken so we were instructed to take a photo of the screen with a phone!).

A fine set of hips

Basically we had reached the end of the line with the clinic's facilities. They are unable to do ESR and CRP blood tests and don't prescribe oral steroids. Pain relief is the limit of their treatment options. She suggested we show the results to our UK doctor. Total bill $73.

The main Provincial Hospital in Luang Prabang. Friendly but a bit tired-looking

Back at the house we had an online consultation with our "doctor" Roy, who said that the symptoms were now classic polymyalgia rheumatica. But we needed an ESR and CRP blood test to confirm. Treatment would be with steroids.

At this stage I was thinking we would have to return to the UK to get this sorted. Or at the very least, fly to Bangkok for the excellent healthcare there. But then Sue in Australia suggested that the brand new Thai-funded private hospital in Vientiane might be an option. It was worth a go.

Kasemrad International Hospital opened 2 years ago and is run by a Bangkok hospital, largely to reduce the need for wealthy locals and foreigners to fly to Thailand for treatment. It took a while to find out how to make an appointment but we succeeded, bought our train tickets, booked a hotel and set off for the big capital city!

The hospital is very impressive - all gleaming and modern with purple liveried staff and spacious waiting areas. We were ushered through the process, blood was taken and a short while later we went in to see the doctor. She was very thorough, looked at all the notes from the clinic in LP and said that although polymyalgia was likely we needed to exclude the presence of infection. They repeated the full blood count. No infection showing. Diagnosis PMR and she would prescribe a short course of low-dose prednisolone (steroid). Result!

Kasemrad waiting area

The bill was just short of £200 but well worth it. I don't know whether having such a high-class facility in the country helps the average Laotian, but I can't see that it does harm. We set off back to Luang Prabang on the marvellous Lao China Railway (see next post).

Tablets are delivered in a smart little bag

One day later Trevann is walking around, almost pain free. It's early days but maybe, just maybe ... All fingers crossed!