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Saturday, 28 May 2016

Getting Prepared...Popping Pills

After my health check the Doc had solved one problem for me, as she'd prescribed me with Folic Acid, which I picked up as part of my overall costs that day at Bumrungrad hospital (THB1,080 for 6 months of 5mg Foliamin Tablets). So I knew I was covered for Folic Acid, but I didn't know what, or where, I could get overall pre-natal (or pregnancy) vitamins.

Looking in Boots, which was the most obvious place for me to go being a Brit, and also the easiest as the pharmacists normally speak English, I found that they simply do not have pre-natal, or pregnancy, vitamins as we do back home.

So what are the options?

  • Multivitamins plus Iron
  • Multivitamins Minerals plus Ginseng
  • Vitamin C
  • Ginkgo
  • Evening Primrose Oil
  • Calcium D
  • Calcium D plus Collagen
  • Calcium plus Vitamin D plus Minerals
  • Fish Oil
  • Fish Oil plus Evening Primrose Oil
  • Cod Liver Oil
  • Gingko plus Fish Oil
  • Garlic
  • Zinc

They also have Blackmore's readily available in Thailand, but they follow similar themes to above, although you can get standalone Folic Acid as well.

I didn't really want to be popping more than one vitamin tablet a day, along with the Foliamin, and I didn't want to to take too much Iron as a supplement either, so what could I do?

Assuming you live in Thailand you may have already found that it isn't always easy to get a balanced diet in the sense we are used to. Getting a variety of vegetables into your diet, for example, is difficult if you don't cook at home every day and live next to a Gourmet Supermarket. So it was all the more important at this point in my life that I really should be taking some extra vitamins, that I knew I could trust, and would provide me with the right quantities for pre-natal preparation.

But i'm afraid ladies that I simply didn't find a Thai solution for this. Even the Doctor's look blank at you when you try to ask about an alternative to Vitabiotics Pregnacare.

My solution...I did a huge Boots shop when I was back in the UK and bought 6-12 months of Pre-natal and Pregnancy Supplements. On the plus side you will earn your friend/mum a lot of Boots Advantage points (my last "TTC" Boots shopping trip in the UK earned my mother in law GBP18 of points!)

One extra thing I have recently learnt, and I will pass on to you, is that there are sometimes concerns with taking Vitamin K with anticoagulants. Following my first miscarriage I was immediately put onto "baby aspirin" for my second pregnancy. Doctor's here seem very quick to put you on medication that they think might help (and will certainly not harm). As aspirin is an anticoagulant I now pay more attention to content of the Pregnancy vitamins I choose, and for now my doctor advises to only take pure Folic Acid for the first trimester. But that is just based on my medical history and you should always listen to your healthcare provider.

Saturday, 14 May 2016

Getting Prepared...am I healthy? (a costly business)

There are some things in Bangkok that you can easily throw money at, and medical tests are big business here.

I'll be honest that I've been lazy and I've had all my TTC tests done at Bumrungrad hospital. I probably should have shopped around but ease of transport, location, guaranteed spoken English, and reputation has meant that I have only ever used either Bumrungrad or Samitivej for my TTC needs (although I have used medical clinics for Visa medicals and basic pregnancy tests).

My first visit to Bumrungrad was just after we were married. As I was 36 I wanted to ensure that I had a general TTC overhaul to check there were no obvious roadblocks.

I made an appointment online with Bumrungrad. I booked a basic appointment to see a Doctor in OB/Gyn. Here's the link: https://www.bumrungrad.com/en/contact-us/request-an-appointment

Before I go on, just a word of warning for the emotional sorts (like myself). I choose to go to the hospital on my own as I figured this was a routine appointment. But as I sat in the waiting room I realised then and there that I might find out that I couldn't have children...it hit me like a wet fish and I burst into tears. I suddenly felt incredibly vulnerable and in need of a hand squeeze. As an expat, your mum or best friend cannot always be by your side, or even at end of the phone, when you need them, hubby was also unfortunately at work and I knew this was only the start of crazy arse emotions taking me hostage at inopportune moments, so I made the decision to sniff and brave it out - but you may wish to arrange to have a hand squeezer by your side.

So, I had an appointment with Dr. Suleewan Ratanachai. Her English is ok and she seemed to be a very nice lady, but this was my first experience of a doctor in Thailand and I have now come to the conclusion that they can come across as disingenuous. I don't know if the problem is that they are perfectly fluent in technical english, but lacking in colloquial english or just plain culture, but they can often come across as dismissive and uncaring, which I am sure they do not mean to be.

Dr. Suleewan assured me that my age was not a worry and that many women get pregnant at my time of life. I should not assume any problems and should start TTC naturally. But you have to press Doctors here for real information and I kept pressing for information about what could, but hopefully wouldn't, be problems in the future. At this point she suggested that I could have a Pap smear and blood tests. She explained that there are various blood tests, but that detailed analysis of my hormones etc would be expensive and she recommended just a general blood overhaul.

So here is what they tested me for:

I had a Transvaginal Ultrasound to check the size, shape, endometrial echoes and appearance of my uterus, a Pap Smear and they took blood to check for:


Non Panel Items:
  • VDRL
Hemoglobin Typing:
  • Hemoglobin Type
  • Hb A
  • Hb A 2
  • Hb E
  • Hb F
  • Hemoglobin (Hb.)
  • Hematocrit (Hct.)
  • MCV
  • Osmotic Fragility Test

  • WBC
  • Neutrophil
  • Lymphocyte
  • Monocyte
  • Eosinophil
  • Basophil
  • Neutrophilic Band form
  • Atypical Lymphocyte
  • NRBC
  • RBC
  • Hemoglobin (Hb.)
  • Hematocrit (Hct.)
  • MCV
  • MCH
  • MCHC
  • RDW
  • Anisocytosis
  • Macrocyte
  • Microcyte
  • Poikilocytosis
  • Target cells
  • Fragmented cells
  • Ovalocyte
  • Hypochromia
  • Polychromasia
  • Platelet Count

Hormones/Tumor Markers:

Non Panel Items:
  • Free T3
  • Free T4
  • TSH
  • Estradiol (E2)
  • FSH
  • Prolactin

Blood Bank: (note that you should already know this as part of your Visa medical)

Non Panel Items:
  • ABO Group
  • Rh Grouping

Immunology/Infectious Diseases:

Non Panel Items:
  • HIV Ag/Ab
  • HBsAg
  • HBsAb
  • Anti HCV
  • Rubella IgG

They had the test results back the very next day and Dr Suleewan gave me a priority appointment to see her quickly to explain them to me. They aren't very good in Thailand at giving you detailed explanations in words and phrases that you actually understand, they speak in clinical English and lack sensitivity and cultural awareness (cultural awareness of our needs and expectations as an English woman anyway) but she quickly told me that all of my results were fine (thankfully) and then bid me farewell, under advice to try naturally for 6 months and with a prescription for 6 months Folic Acid.

Now, the cost of peace of mind in Thailand does not come cheap. This is breakdown of costs:

THB 6,500   Health Screening Program
THB  1,000  Doctor's Fee
THB     100   Nursing Service
THB     200   Lab - pathologist's fee
THB  1,480   Lab - Pathology
THB  3,760   Laboratory - Clinical
THB  2,525   Ultrasound
THB     675   Ultrasound - Radiologist's fee
THB  1,080  Medicine
THB17,320  TOTAL

Do I think it is worth it, for peace of mind, absolutely, but I didn't really learn as much about myself as I was hoping for, as Thai Doctor's simply don't explain things to us in a way that we are used to in the UK. It was all clinical jargon to me and the only thing I could hold on to was the concluding phrase - no obvious signs of problems.

So, I have made a vow to translate as much of the above in the Glossary section of this blog to help all TTC women in Thailand for the future. You will note that some the test names are in italics, this is because I noticed that they checked for these items more than once. It can be common to be overcharged by medical establishments for non essential tests or doctor's time. I haven't questioned Bumrungrad about this yet, but as time goes on I will keep my eye on this happening again and let you know if there is anything we can do to save ourselves some unnecessary costs.

But for now, don't despair, if you are worried about your chances of getting pregnant and have the money, I would recommend getting these tests done for peace of mind. Of course they are not essential, we wouldn't get this service with the NHS back home, but why not avail yourself of modern technology and your highly prized position as an expat woman.

Sunday, 8 May 2016

Getting Prepared...Getting personal

I think it is normal to worry "If I can have children" whatever age a woman is and it doesn't get any easier with every passing comment from your mother, her next door neighbour, your mother in law, auntie, grandparents or well meaning friend, but in Thailand you have a whole new set of busybodies to deal with.

The Random Stranger
As we were checking out of the small hotel we had hired for our Wedding Party the receptionist (who was about to pop with a baby herself, about 4 foot tall and the same wide) rubbed my stomach and told me (with a smile of course) that I must get pregnant soon. Whilst this wasn't a revelation to me, I know my eggs aren't getting any younger and I'd found my Prince just in the nick of time, I wasn't prepared for a random stranger to be so personal...but prepare yourself ladies because it comes at you from all angles....

The well-meaning work Auntie
All offices in Thailand are full of 3 types of women - young girls with desks full of mirrors and cuddly toys, middle aged women breast pumping milk at their desks and well-meaning Aunty's who spend 50% of the time smiling at you but saying something utterly condescending or two-faced. Beware the later generation also speak much better English than they let on and will forever haunt you if you dare to mutter anything under your breath in retaliation or defence, and I do believe they have la direct line into Buddha himself to report Farangs that deserve damnation and a spell in Naraka. Anyway, moving on, these "old bats" will make it their mission to make you think about being pregnant all of the time, worry about getting pregnant all of the time, worry about getting too old to get pregnant, worry that your husband will make someone prettier, and younger, pregnant...you get the picture. My "old bat" actually started up before I got married. She took it upon her self to give me a little motherly lecture about the birds and the bees before I got married. She explained to me the importance of marriage and how Thai people believe it is important to have a family and that I must try for a baby as soon as I am married, I must stop stressing about work, be healthy, look after my husbands needs and give him a baby, as if I can go to Central Chitlom and buy one off the shelf just as soon as I've saved enough money. She didn't stop there, it was the first thing she spoke to me about after the wedding and is still the first thing she asks me every time we meet (1 year later). I have even told her that I've had two miscarriages and she still smiled at me and told me its my duty to have a baby and that it will happen, apparently she knows I am a good person and she knows good fortune will come to my husband and I (I wonder if this is a direct message from Buddha and the only way to keep me out of Naraka!?!

The Expat Wives Club

I don't want to be too bitchy here because someone reading this blog is likely to be an expat wife themselves, but I do hope you aren't one of the worst stereotypical expat wives out there. I have literally had women from the British Club turn their back on me when I asked if there were social events that I could attend outside of work hours. Also the fact that I do not (yet) know the first thing about any International School Programme, the apparent horrors of live in maids, or the exact floor plan of EmQuartier it would appear that I am not fit to join any of the wives clubs at this precise moment. Anyway, moving on again, whether you are in any of the clubs, or not, you cannot avoid all 'stay at home expat wives', you will have dinners with them, attend drunken annual balls with them etc and for all such events, along with your Spanx, you should always wear body armour to protect yourself against ill judged comments about when are you going to get pregnant? are you trying to get pregnant? Are you trying naturally or going straight to IVF? (after all apparently you can through money at any problem here), will you get a live in maid? will you get a driver? when will you give up work? Fundamentally, when will you become one of us? It's not so much the questions that fill me with dread but often the fear of not measuring up when it's my legitimate time to join yummy mummy clubs. Will my child be wearing the correct attire, and more to the point will I be wearing the correct attire, will I have found the miracle eye cream to at least give the illusion that my child sleeps occasionally and will I have kicked and punched at enough Muaythai bags (noting I haven't kicked at any so far in this life time) to lose enough baby weight to earn my badge of honour as a yummy mummy.

The Estate Agent
They say moving home is meant to be one of the most stressful things you do in life...not as an expat. As an expat, moving home becomes as normal, and as easy, as shopping for groceries. You pick what you like and someone else does all of the hard work packing it up and getting it to your chosen location. I've known women orchestrate a house move whilst 8 months pregnant, a toddler in tow, a husband in another country, and all from the relative calm of a coffee shop eating cake with girlfriends. But there are some very crucial decisions you are forced to make that can cause constant reminders of your TTC journey. The big questions...do you move into a condo with that extra room that 'could' be the nursery, do you consider your commute to work when you are heavily preggers and its 40 degrees outside, have you checked to see if there's a playroom or kiddies pool? Well don't worry because your friendly Thai estate agent will make it her business to know everything about your life, your bank balance, your husband, his bank balance, where and when you go on holiday and last but not least, your childless status. My estate agent, and landlord, made it a point to extol the virtues of the local hospital for emergency childbirth, the nearest University for our future child's education, the best room to use as a nursery and the various complications with choosing a live in nanny, apparently varying from murder (if she is Burmese), work permit (if she is Filipino), lazy (if she is Thai) and of course, sleeping with my husband (if she is a Swedish aupair).

The bottom line, don't put any extra pressure on yourself. Tell all busy bodies only what you want, when you want to, they will be happy with any answer. My responses have varied from "its in the hand of the gods", "we have our pet cats, that's enough for us", "its too hot to start a family in Thailand", "I work too much" to bursting into tears. The Thai's are simply nosey and normally only want to know what their future opportunities for repeat custom (to your mutual benefit) will be. 

Smile through gritted teeth and you'll actually start to enjoy the freedom of telling random strangers about your life, its not very British, but sometimes its just nice to tell someone.