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Forum Name: Gastroenterology Topics

Question: Help! In "nowhere" Thailand with no few medical fa


 shaunapple - Tue Jan 20, 2004 3:20 pm

I'm seeking advice for some sort of illness that I'm suffering from right now. First let me give background on my situation. I'm 23, male, from the USA; but currently in a small town in Thailand (southeast Asia) about 3 hours from Bangkok and 10 from Chiang Mai. I presently stay with a local family. I've been traveling and volunteering to teach English because it's a good thing and great learning experience. I returned from a "visa run" to Malaysia and Singapore about 2 weeks ago. Please note that Thailand is in a time zone that places it roughly a day ahead of the USA. This is not my first time residing in a 3rd world, developing, or developed country (also Fiji, Laos, etc).

I think that I have very good reasons to post about this on the Internet. Namely, I don't necessarily have good trust in the local hospitals. I have one Thai friend who tested positive for Hepatitis B the other day and the doctor at the hospital prescribed a "B-complex vitamins" as a "cure". Thus I'm really concerned of going there to be misproperly diagnosed and / or treated. Especially since I realize that my symptoms could potentially be 20 different illnesses. I'm also concerned about going to Bangkok at the moment while practically bed-ridden; because it's such a large, polluted, and confusing city (I stay in a small provincial town). Please note I'm able to practically buy any medicine over the counter (OTC) here in Thailand.

Sadly, I do not have a lot of money. I also do not have any health care or travel insurance at the moment :(. Unfortunately, I don't have anyone in my family to support me (family history of abuse). If you curious more then you can read more information
about my family history (under Shaun Apple | Autobiography) and travels at my website: http://www.loveacrossborders.com , as you'll see from the site, I'm usually quite active and full of energy (keeping busy).

I've studied nutritional supplements for over 6 years. This is the only sort of "medicine" that I take (except for Amoxicillin Trihydrate) right now. I don't have any known allergies to any medicine. Though I can be quite allergic to various pollens, dust, and animals. Presently I'm taking Omega-3 fatty acids (DHA, EPA), Milk Thistle, and Alpha Lipoic Acid (ALA). I went for a blood test for Hepatitis B on Friday and I tested "negative". While I was there I was checked for the following things: Blood Pressure - 130 / 80, Height - 181 cm., Weight - 75 kg. (though probably weigh much less now :(). I do not smoke and haven't drank any alcohol for about 2 months.

Hopefully this background information helps any doctors out there that would potentially reply to this post. In general, I've experienced relatively good health since I left San Francisco, California for Asia on the 1st of September. The only illnesses I've had is the common cold in mid-September in Malaysia. A month ago I experienced similar symptoms to what I have now, except that it only lasted 2 days and I vomited a few times. When I experienced this a month ago I was staying in the same place that I am now.

<<<<< Start My problem >>>>> For the past 5 days since Friday I've had strong stomach discomfort. I discontinued taking my usual nutritional supplements the same day. I also stopped drinking coffee; but I continue to take Mulberry green tea on a daily basis. For these 5 days I've had very little desire to eat (which is strange for me). In fact I've only had a little bit of food these past 5 days. After a day or so of stomach discomfort, I started to get bad diarrhea which I seem to get every hour or few since Friday 16th Jan. (today is Wednesday 21st Jan.). The diarrhea is mainly all watery (since Friday) and tends to "shoot" out.

I have been getting really bad fatigue. Normally when I feel well, I get between 6 - 10 hours a night. For the past 5 days I've been sleeping about 20 hours of the day. I find it very difficult to move. I feel apathetic and practically on my 'death bed'. I've noticed extreme weakness in my hands and forearms and pain there as well. For the past 24 hours I've been experiencing STRONG back and chest "achy ness". There could also be what could be described as a "tightness" in my chest. I feel a bit of pain when I breathe. I have had a minor headache and fever for these past 5 days as well. Over the past few days I have occasionally felt pain on the "front, top" of my head when I move.

Besides this I'm NOT exhibiting any symptoms for a cold or flu such as: Sore Throat, Cough, "Stuffy Nose", etc. Therefore this leads me to believe that my condition is more serious than a cold :(. I've been drinking lots of electrolyte drinks and plenty of water especially after I have diarrhea.

The little bit of food that I've eaten over the past 5 days has been pre-packaged and shrink wrapped. Because of this I have nearly ruled out food poisoning. I started to take a basic anti-bacterial medicine (Amoxicillin), 500mg about 2 days ago. I take this medicine 4 times a day. After the first dose my stomach felt better for about 5 hours (perhaps it was placebo?); which led me to believe that it's a bacterial infection. However, further normal doses of the medicine have done little to improve my symptoms or conditions. Over the last 24 hours I've felt even worse.<<<<<<< Finish Description My problem >>>>>>

I should also mention that the house which I stay at literally has 1000s of mosquitos. I am bitten a couple hundred times a day (even though I have a mosquito net and try to use bug spray). This is due to stagnant water in front of the house. Additionally, if you're familiar with many (local) houses in southeast Asia; many families keep their water for bathing in a "waterplace" usually made of cement. I'm sure that this is also attracting a place for mosquitos to breed. I have advised them against this however my Thai language is not that good and neither is their English.

I've read about the symptoms of common mosquito bourne diseases and I don't think that I have enough of them to assume that I've contracted Malaria or something else. Though I suppose that I could be wrong :(. As you can imagine, I'm very concerned about my health and well-being at the moment. I feel like the internet is my only chance of connecting with real advice and diagnosis (considering my circumstances).

Please help, reply or e-mail me ASAP, thank you and kindest regards,
Shaun Apple
shaun@slik.org
AIM - applesbliss
Yahoo - loveacrossborders
MSN - loveacrossborders
 Dr. Russell M - Wed Jan 21, 2004 9:50 am

User avatar Hi!

I see that you are suffering from gastroenteritis in Thailand. If dehydration has occured one needs to get hospitalized for intravenous fluids. When one gets dehydrated, the tongue becomes dry, there is decrease in the BP, increase in the heart rate with weak rapid pulse(>100 beats per minute), dizziness, lethargy, etc. At times like these no electrolyte supplementation may even help. And drinking plain water without the necessary salts may exacerbate the situation.

Do you have blood/mucus in your stool? A dysentry with mucus and blood in stool may be caused by amebiasis, in which case regular antibiotics may not help. On the other hand, if life-threatening diarrheas like cholera occur, more than antibiotics, it may be the fluid management that saves lives. Lactobacillus spores are available as pills to replace the gut flora with normal lactobacillus removing the pathogenic organism. This is usually taken with antibiotics.

Tropical medicine is quite different from patient care here in America. One reason medical students are offered exchange programs to learn from the tropical countries. Even an expert doctor from America might not easily settle down in patient care in a tropical rural area, where the system of medicine may be completely different. The doctor might even be at loss without facilities to do a stool culture! So, even if not as sophisticated as the developed nations, the system of medicine in each area has its own unique advantages of experience that may not be replaced by any amount of sophistication. Therefore, I would strongly recommend you to try placing your trust in the local doctors while always getting yourself involved in the care by bearing critical questions.

As for your thai friend's "hepatitis B," no clearcut guidelines are available as to which medication should be chosen even in the United States. The best of antiviral medicine may only decrease the morbidity/suffering and prevent transmission. Some of the antiviral treatments may even be cause for further deterioration of patient health. In situations like this, a nowhere land in Thailand may be "right" in providing "cure" in the form of vitamin B complex, more as a means of dispensing hope, if not a cure.

It would be in your best interests to leave your 'death bed,' and get a hospital bed instead.

I hope this helps.

Warm regards,

Bill

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