Antibiotics Over Prescribed?

Up until I was age ten or so I was at the doctors office every other week with some sickness or because some dumb-ass stunt backfired again and I required stitches. The doctor always patched me up fast and just about every visit included a lollipop ( grape, my favorite ) and a shot of penicillin whether it was needed or not, the penicillin…of course I needed the lollipop!

Those days soon faded away as each new visit to the doctor or hospital saw a rapid decline in the use of penicillin and lollipops, I understood why the penicillin all but stopped but the ” You’re too old for lollipops thing” still irks me. Cherish it while you can kids.

The advent of antibiotics was a revolutionary step in the treatment of infectious diseases, doctors thought they had found the God drug, the miracle bullet and made sure to use it as often as possible, even for minor illnesses that really didn’t necessitate antibiotic use, just to be on the safe side. But, what could it hurt? We know now that the opposite is true.

The Antibiotics Curve over the years

Basically, when we take antibiotics that aren’t needed there are no unhealthy bacteria for them to fight so, the antibiotics go after the healthy bacteria in our bodies. The healthy bacteria then goes on the attack as it sees the antibiotic as an intruder. As the Healthy bacteria battles the antibiotic it finds ways to overcome the antibiotics charms leaving our bodies much more resistant to the drugs over time.

Penicillin was so overused in the States that, I chide you not, the doctor would sometimes give us a double shot of penicillin if we were coughing too much…bastard never gave me two lollipops though.

While the penicillin slowed to a trickle in the seventies we were still given new and hybrid antibiotics such as amoxocillin or something similar that usually did the job, but it took a little longer and sometimes another antibiotic would have to be used in unison to get the same effect. The theory here was that mixing up the antibiotics would leave our bodies less resistant to the drugs. Unfortunately antibiotics were still over prescribed. By some accounts antibiotics are still over prescribed today in the West  by a staggering 40%

If antibiotics are still over prescribed in the West by 40% then there can be no doubt that Antibiotics in Thailand are over prescribed by at least 100%. and most likely more.

Throughout my trips to Thailand, and now that I am living here I have partaken of the Thai medical system here quite liberally, much more than I would like in fact and Antibiotics are a way of life here.

Thailand is much like the West was in the 1970′s. Where we had family doctors to tend to our everyday illnesses in the states, Thailand has clinics, and lots of them. These clinics serve as the family doctor for all minor ailments and if you are smart, once you find a good clinic, you frequent that clinic and build up a rapport with the doctor. Then when the need arises you know that you are being seen by someone that knows your history well. I have been going to the same clinic and doctor in Thailand for over 5 years now.

Unfortunately, the doctors in Thailand never seemed to have gotten the memo on antibiotics, as a matter of fact I think they take their cues from my old childhood doctor who had no problem loading me up with antibiotics, and no, they still don’t give me lollipops, the bastards!

Seriously though, this presents a problem not only for me who is susceptible to many minor ailments such as tonsillitis, conjunctivitis, and most importantly dumb-assitis which struck recently at a local water park. This is a major problem for the Thai population as a whole, especially the children.

You see, many Thai doctors believe in the two pronged approach to curing what ails you. Such was the case this week when I found out I had conjunctivitis. I went to the clinic and the doctor confirmed my fear but this time he was slightly conservative in his approach. Instead of a shot of penicillin and multiple antibiotics he prescribed antibiotic eye drops and 2 different antibiotics in small doses for 3 days.

3 days later my left eye was still pink and swollen so I headed back to the clinic and the this time the nuclear approach was taken. I was given 2 shots of penicillin, cheek to cheek, and 3 prescriptions of different antibiotics to be taken 2 at a time three times a day. That’s 18 pills a day!

Now, as an educated adult I should know better as to why this is not good for me, especially since I am susceptible to tonsillitis, strep throat and conjunctivitis as it is. I didn’t speak up because I knew this would cure me quickly, it always does. As a matter of fact just the two doses of penicillin would be enough to do the trick.

Since I go to the same clinic and doctor the vast majority of time he tends to mix up the doses and antibiotics given to me, he still over prescribes in my estimation but I acquiesce because I’m a sissy and hate being sick. I’m usually right as rain within a few days whereas the same problem in the states I had some time ago with strep throat landed me in the hospital with a severe case of strep because the American doctors didn’t act aggressively enough in treating it.

On one hand I enjoy being able to have the nuclear option or just penicillin when I think I need it ( every few months lately ). I know what works for me and at 45 my body has seen enough antibiotics that I think I’ll be okay with resistance. Many of us think like this and sadly it’s the wrong way to think, more so it’s selfish and could be deadly.

When antibiotics are over prescribed on this level it’s not so much you that will be hurt but the repercussions to the community around you. Children and the old are the most susceptible to bacteria and viruses. Routinely over prescribing antibiotics to  these two groups has a host of negative effects from allergic reactions to death in some cases. In children the over prescription of antibiotics has the worst effect. We are basically raising an antibiotic resistant generation.

All children get sick often it’s just a fact of their immune systems growing and developing. It seems to me though that Thai children get sick much more often and are much more prone to life threatening diseases,bacteria and viruses. The Thai children in rural Issan even more so. The children I have seen and have known seem to have a much higher incidence of cold, coughs and flu and I’ve seen quite a few children that have had had prolonged cases of infections including some very bad flesh eating bacteria.

In some of these cases the only and last resort is heavy duty IV antibiotics that run rampant through the body killing any bacteria in it’s way. This has been readily apparent in rural Thailand on the border with Cambodia where drug resistant Malaria is once again rearing it’s ugly head. A disease that was once all but defeated has adapted to become very resilient to the the normal routine of antibiotics usually given. While steps are being taken and a new antibiotic regimen is being used successfully in these new resistant malaria cases how long will it be before it becomes more commonplace and how many people will die.

There is a real fear here that once defeated diseases that were all but forgotten will once again become commonplace in the world. Already new strains of tuberculosis can be found in almost every country in the world and measles are once again on the rise. Will it take place again in our lifetime that measles or another affliction like it will once again becomes an epidemic killing millions? Many doctors are placing blame on parents not getting their children vaccinated in the case of measles but a growing contingent of doctors are quietly pointing to their own complacency as the real culprit because they haven’t kept up promotional programs informing the public.

These same promotional programs have been lax in the field of antibiotics and its high time this was rectified.

Just to be clear, antibiotics can only cure bacterial infections they have no effect whatsoever on viruses and I was only using viruses in my previous statement to show that many of the once thought dead and gone afflictions humans have suffered have started coming back with a vengeance.

Thailand is a relatively small country in the grand scheme of things but if the over prescription of antibiotics continues it can and will have a large impact on the world. And if American doctors are reportedly still over prescribing antibiotics by as much as 40% you only need to ask yourself how many more countries like America and Thailand are doing just the same.

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I have been missing Thailand more than usual the past few days but not for the obvious reasons of sun, sand and a particular lady. No, the reminders this time came in the form of a massive tooth ache and a trip to my local dentist.

Dentist offices in Thailand are like food carts and 7/11′s, they are literally everywhere and you can usually find at least two dentists per block if you’re in the right area. My favorite dentist in Thailand resides in Pattaya on Soi Buakhao and she makes a normally hated experience for me into one that is highly pleasurable. The fact that she’s a great dentist is just the icing on the cake when you take into consideration she’s beautiful, she’ll sing to you while she works and the big plus, she’s very reasonable even for Thai prices.

The reality is that you can have dental work done in Thailand for a quarter of the price that you’ll pay in the West. A point that was driven home for me yesterday when my American dentist told me that I would need a root canal at a cost of $800. After I picked my jaw up off the floor I made the comment that the price was a bit much, the answer I got in return was you won’tget a better price anywhere else.

The interesting part came when I mentioned that I could actually get a much better price in Thailand. My American dentist, who happens to be from India, exclaimed that getting dental work done in third world countries was dangerous because they use substandard equipment and materials. I had to chuckle at that before I let her in on the fact that Thailand has emerging nation status as well as the fact that the dentists there use the same state of the art equipment and materials.

Obviously there really isn’t an arguement to be had as I am in America,  not Thailand at the moment,   but it’s troubling to me when I keep hearing how well we have it in America compared to other places in the world when the reality is that we don’t have it so well, that’s just a lie we keep telling ourselves. With the health care debate raging in Washington I want to believe that change is possible but I’ve become jaded and I know greed will win out in the end.

You don’t need to look any further for reasons why medical tourism is on the rise and why Thailand is getting their fair share of medical trade. We are the new immigrants of the 21st century, not looking for freedom or shelter from persecution, just looking for decent medical attention at reasonable rates.

If nothing more I’m grateful for the percocet I’m on at the moment, while it deadens the pain it also eases the anger I’m feeling at the country that is letting me down more and more each day.

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Travel insurance

Whether you are going to Thailand for a few weeks or China to walk the Great Wall for the next year, make sure you don’t forget that the most important part of any trip is you, and you need travel insurance. I wrote an article two years ago on Travel Insurance that was important but few people saw it because I was so new to blogging. Read it because it is just as relevant now as it was two years ago.

You are looking at spending thousands of dollars on airline tickets, hotels, new clothes and maybe even some new luggage but you aren’t thinking about the one thing that may save your life and hundreds of thousands of dollars…Travel Insurance. I know what you are thinking, “I’ll be fine, it’s only a few weeks”, what if you aren’t? A hospital stay in a foreign country is stressful enough, trying to figure out how to pay for it when you are injured isn’t going to be fun.

Most travel insurance for a two week trip can be had for as little as $30-$100 and covers everything from emergency medical to flights home. If you go about it the right way you can cover every possible problem of an upcoming trip. Usually most travel insurance companies have modules that you can add in for each type of insurance. You can start off with a basic emergency medical insurance and add in trip cancellation insurance, luggage insurance, flight insurance and just about anything else you can think of.

In countries such as Thailand it’s easy to think that any ailment will be pretty cheap so you could cover any medical expenses out of your pocket, it may be easy to think but you would be dead wrong…and dead could be the operative word here. While minor injuries in Thailand can be taken care of at a clinic for a tiny amount of money the major emergencies will set you back. Yes, they will still cost less than if you were in America but you could be looking at a few hundred thousand baht before all is said and done. At the very least, without travel insurance, this could be vacation ending.

One mistake a lot of travelers make is in thinking that their medical insurance that they have at home will cover them abroad, it won’t. 100% of all medical carriers will not cover you outside of your home country. Some may offer a travel rider that will cost you more but otherwise you are on your own to cover yourself. And still most people don’t.

I know, you’ll never be that person that gets hurt on vacation. Make sure to send out a press release to wherever it is you are going so everyone else there at the time gets with the program too. You may very well play it safe and not plan on doing anything  adventurous but how do you plan for that other tourist who’s plans have changed to include you accidentally? It may not be what you do but what gets done to you that lands you in the hospital.

Some hospitals may not have what is needed to help you or save your life, the right travel insurance will cover air lifts to other hospitals and or countries if needed and they may even include flying in a family member so you don’t have to go it alone.

I’m not here hawking any specific travel insurance, there are many good carriers out there and I suggest you do your own research to find the travel insurance that fits you and your vacation best. I’m just here to nag you into getting travel insurance because it really is the most important part of your trip, not your Ipod.

I’m bringing this up again now because I realized I’ve been at the clinic or hospital every visit to Thailand. From acute tonsillitis  and severe dehydration to cutting my foot open. I planned for none of it but it still happened. In the past month my girl has been bitten by a snake and in a motorcycle accident, both required hospital stays. Fortunately she is fine but it just goes to show you it doesn’t matter who you are or what you are doing , accidents will happen.

And like the old saying ” if you fail to plan then you plan to fail”.  Don’t plan to fail, get travel insurance before you go on any trip. You may never use it but that one time you need travel insurance you’ll be glad you have it.

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Before we go any further let me just mention here I’m talking about real Thai massage not the western vision of exotic naked Thai girls ravaging your body from head to toe before giving you the happy ending, that’s called a soapy massage, I might tell you about them later… No, today we are gonna talk about foot jobs!

The first thing you’ll notice before or as you enter the shop are the ladies waiting to give you a massage. Some young and pretty and some older and not so pretty. The young ones know what they are doing but the older ones have more experience and know how to hurt massage you better. Then you’ll notice the very comfortable chairs.

For roughly 200 baht ($6.00) you’ll get an hour or more of pure bliss and a little bit of pain. The first thing the masseuse will do is cover one leg up to your thigh in hot oil and rub it in then wrap it in a towel. Then she goes to work on the other leg in earnest. Starting at the foot with hot oil she very slowly works the sole of your foot using every bit of her hands from palms to knuckles then she’ll work her way up to your thigh with a very deep massage that can be borderline painful for a second or two until you realize that second of pain leaves the muscles feeling warm and loose.

After thirty minutes on the one foot and leg then it’s time wrap that leg in a towel and start on the previously wrapped leg. Forty minutes in if you aren’t already comatose you’ll at the least be close to sleep.

Now the masseuse tells you to get up and you think “all good things must come to pass” but she hasn’t asked you to get up because you are done. Oh no, now you kneel on the foot rest facing the chair and she starts in on your neck and back, kneading and working all the tight muscles from your hairline down to your butt crack cracking your back along the way.

Some of the thumb and knuckle worth they do on your muscles can be a bit uncomfortable to downright painful but it’s kinda like a short burst of pain followed by a flooding warm relaxing sensation that will leave you feeling awesome afterwords. You’ll feel the affects of a Thai foot massages days later.

If you’re heading to Thailand put it on the list of things to do you won’t regret it!

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If you are a smoker planning a trip to Thailand keep this in mind as there are stiff fines for non compliance. The smoker can be fined 2000 baht ($60.00) and the bar owner can be fined upwards of 20,000 baht ($600).

Also keep in mind that in Bangkok there are stiff littering fines so if you’re outside smoking make sure the butt hits a trashcan or you’ll be facing a 2000 baht ($60) fine if caught.

If you are planning on bringing your own cigarettes into the country Thailand only allows 200 cigarettes per person and anything more than that may be confiscated and you may be fined. To be honest I haven’t had my bags checked coming in but the customs police do tend to check people coming off the plane with duty free bags to make sure you haven’t brought in excess cigarettes and or alcohol. When you get in the plane put your duty free bag in your carry on and you should be fine.

You can buy most major brand names of cigarettes in Thailand but they are usually made in the region and of lesser quality than you are used to.

You also want to check with the hotel or hotels you will be staying in as certain hotels don’t allow smoking on the premises.

All in all the Thai’s have been very diligent on keeping smoking down in their own people and now they are helping their people more by banning smoking in the air conditioned bars and clubs where they work. Anyone that has been in the bars and clubs before the ban can tell you the smoke was so thick you could cut it with a knife.

And of course there are the public advertising campaigns showing smoking in a bad light as well as the mandated pictures on the cigarette packs, pictured above, in hopes to help the Thai’s that do smoke and the foreingers visiting think about their own health as well as others.

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In my trips I’ve been in quite a few tattoo shops in Bangkok and Pattaya and I can tell you for a fact it is very safe to get a tattoo in Thailand. Some of the shops aren’t any bigger than a small room and some are very large but they all put the customers health and safety first. New needles are always used and opened in front of the customer, they all have working autoclaves, and work areas are sterilized constantly. The tattoo shops I’ve been in all used American inks as well. When asked why the answer was “it’s the best”. So, don’t listen to anyone telling you old needles are used or the tattoo shops aren’t safe. If you should be in a shop anywhere in the world and they won’t open the new needle in front of you or it doesn’t seem clean…walk.

There are many tattoo shops in Thailand, in Pattaya alone there must be 500, some as small as a telephone booth. Not only are there many shops but equally as many talented artists doing the work. I did a lot of research before I got work done and originally narrowed it down to 3 shops but finally settled on 13 Crowns on walking street in Pattaya. My brother got his work done first, a very colorful dragon, and I was impressed with their work and everyone in the shop was great. I settled on a dragon myself but all black with a red eye.

If you plan on getting ink done while in Thailand do some research of the shops in the areas you’ll be and I’m sure you’ll be pleased with the end results. If you’re in Pattaya head to walking street and look for a bicycle chopper outside a small narrow shop with a sign that says 13 Crowns…you won’t be disappointed.

My brother ended up getting a second tattoo of a dragon and my girl got a small back tat too…you can see the tattoo’s in the Gallery section or you can click here Getting Ink Done.

Thailand Tattoo

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BUPA- Their platinum plan that covers up to 2 million baht per disability for hospitalizations and Out Patient Benefits up to 50,000 baht total per year. The premium for this coverage is 50,202 baht in the age band of 41 to 45 years of age. If you want coverage for hospitalization only, the premium is much lower at 28,111 baht per year. There are different rates for hospitalization coverage per disability of 1 million and 5 million baht respectively.

Exclusions :
- Coverage is worldwide, but in the United States BUPA will only cover medical expenses, which are the result of an accident
- Annual Check up (one visit per year) covered up to 700 baht
- Emergency Medical Assistance fully covered
- Overall maximum coverage of 2 million baht applies (per disability)
- Pre-existing conditions are NOT covered
- Not covered (this is not a complete list) : Birth control, treatment for infertility, hormone replacement therapy, congenital abnormalities, mental illness and stress related conditions, dental treatment, sexually transmitted diseases, alcoholism, drug abuse, transplant surgery, renal dialysis, treatment for injuries resulting from dangerous sports. Interestingly not more than 200,000 baht will be paid for injuries occurred while driving a motorcycle (or being a passenger). Bacterial infections after an accident are not covered.

IAG -Now known as NZI ( I think). Their Comprehensive insurance package in the age band of 40 to 44 years. Premium is 59,589 baht per year. With increasing age, rates go up . For example between the age of 60 and 64 you would pay 135,897 baht per year.
This package has a standard co-pay per medical condition applicable to out-patient claims of 1,800 baht.

Exclusions :
-Overall maximum of coverage is 80 million baht
-Out-patient treatment is covered up to 340,000 baht (an excess as stated of 1,800 baht per condition)
- Dental treatment covered up to 34,000 baht (but insured person has to pay 25% of the costs incurred per claim)
- Medical check-up covered up to 10,200 baht
- Chronic medical conditions covered up to 34,000 baht per year
- Organ transplants covered up to 13,600,000 baht
- Nursing at home covered up to 170,000 baht
- Emergency evacuation and repatriation covered in full
- Emergency medical treatment outside are of cover up to 2,040,000 baht
- Exclusions (this is not a complete list):
Pre-existing medical conditions. After 2 years of continous insurance some pre-existing conditions may become eligible again
Chronic medical conditions.
Hormone replacement therapy, congenital abnormalities, kidney dialysis, injuries due to professional sports, sleep apnoea, sexually transmitted diseases (including HIV/AIDS)

Several things being excluded are worrisome, such as Dialysis and STD’s.

The pre-existing condition part can be a bummer for most people over 40. High blood pressure is a biggie that leads to many other problems so it seems if you have a heart attack and you had high blood pressure even if it was minor the heart attack wouldn’t be covered. Then what about kidney stones and discectomies? I’ve had both!

Neither seem to have a requirement for a pre screening physical but I’m sure if something happens it can point to another ailment that would leave you high and dry.

I guess I have a lot of looking around to do.

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Travel Insurance

You’ve booked your flight, made reservations at the hotel, got someone to bring in the mail and watch the dogs, what about the travel insurance? I know what you’re thinking, “I’m only going for two weeks”, “I’ll be fine I’m in great shape”, “other people get sick on vacation, not me”, but what if you’re wrong?

Thailand is known for being a bargain for westerners. Cheap clothes, food, hotels, entertainment, even the hospitals and clinics are cheap compared to the west and with some of the best doctors in the world. Contrary to what some people may believe Thailand has excellent health care. Even though Thailand is cheaper than the west in almost every category if you wind up in the hospital for a week or two it’s still going to cost you and it will be more than you bargained for.

If you need some stitches or you pick up a bad case of pink eye then a clinic can patch you up easily and the cost will be minimal…around 700 Baht – 1200 Baht ($20-$30) and thats including all the medicine you’ll need to take for whatever length of time. But if you have seriously problems and are admitted to a hospital then the bills start to rack up. Hospital room, medicine, diagnostics, and so on. Then you could be looking at 30,000 baht and up…you do the math.

Whereas travel insurance won’t be much help for the minor ailments it will certainly be worth the cost if something major comes up. On average for a two week trip most travel insurance will cost you $20-$30 which isn’t much in the grand scheme of things. That amount will usually cover major medical, flights to your home country if it’s decided that’s the best place for you, and most even have an added bonus that if you’re hospitalized for a week or longer they will have a family member flown to you.

Travel insurance can also cover trip cancellations, lost luggage, and a change in travel plans depending on what options you choose. You may not have a great vacation if you get sick but if you have to pay for it out of pocket as well then it’s sure to be a memorable trip and not for the right reasons.

I’m writing this because I came down with acute tonsillitis on my first trip to Thailand. Luckily a few trips to the clinic got me back into shape but it could have been bad and I wouldn’t have been covered as I didn’t even think about travel insurance.

The flight to Thailand is a long one if you live in the states (17 hours non stop from JFK International) Which will have you nice and dehydrated if you don’t drink a lot of water. The temperature in Thailand is HOT which can and will dehydrate you further if you don’t take care. Foreign food, foreign microbes, burning the candle at both ends, endless sight seeing, and a host of other things can and will come back to haunt you if you don’t take care….and even if you do take care to prevent sickness there is always the unexpected and in Thailand that could be anything from an over amorous elephant, a motorcycle taxi running you over, and you did see my article about Thai electrical wiring right?

You may have great insurance in your home country but in most cases they won’t cover you overseas.

Find a good travel insurance and buy it for your trip no matter where you’re going or for how long!

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