We offer diagnosis and treatment of patients by a team of geriatric doctors with expertise in various fields, who can diagnose and treat general geriatric diseases comprehensively, including providing consultation and promoting health prevention and promotion.

We offer diagnosis and treatment by a team of geriatric doctors and specialists in various fields.

• Diabetes Obesity & Endocrinology Clinic

• Nephrology Clinic

• Neurology Clinic

• Respiratory Clinic

• Hematology Clinic

• Mental health Clinic

Diabetes mellitus

What is Diabetes?

Diabetes mellitus (DM) is a group of diseases when your body cannot properly process and uses blood sugar (glucose) which is an important source of energy for cells and especially your brain. There are several types of diabetes and all leads to the condition of having excess blood sugar. Insulin, a hormone made by your pancreas, help facilitate bringing in glucose through cells and ultimately used as energy. If you have diabetes, either your pancreas do not produce insulin sufficiently (or not at all) or cells do not respond to insulin’s actions. Poorly controlled diabetes may lead to serious complications and may be life-threatening.

Common types of diabetes are as followed:

• Pre-diabetes: A condition when your blood glucose is higher than normal but not yet met the criteria to be diagnosed as Type 2 diabetes. Lifestyle modifications are recommended at this point.
• Type 1 Diabetes: An autoimmune disease where your pancreas are destroyed by your own immunity. Type 1 diabetes patients will need continuous monitoring for blood sugar and use insulin everyday.
• Type 2 Diabetes: The most common type of diabetes. Your body does not respond well to insulin’s actions or does not make enough of it. Medications used for Type 2 Diabetes would focus on promoting insulin’s actions.
• Gestational Diabetes: A diabetes developed in pregnant woman and usually resolved after.

Complications which may be life-threatening include:

• Cardiovascular diseases
• Neuropathy
• Kidney damage
• Erectile dysfunction
• Eye damage
• Skin infections
• Wounds not healing well and develop necrosis requiring amputation

Risk Factors

For Type 1 Diabetes

• Family history of Type 1 Diabetes
• Pancreas injury
• Presence of autoantibodies

For Type 2 Diabetes

• Family history of Type 2 Diabetes
• Race: Black, Hispanic, Native American, Asian American
• Obesity
• High Blood Pressure
• Low HDL, High Triglyceride
• Sedentary lifestyle
• History of Gestational diabetes
• Smoking

For Gestational Diabetes

• Family History of Gestational Diabetes
• Race: African-American, Hispanic, Native American or Asian-American
• Obesity

Symptoms

• Feeling more thirsty than usual
• Frequent urination
• Feeling weak
• Blurred vision
• Unexplained weight loss
• Prone to infections
• Slow healing wounds
• Numbness in the hands or feet
  

  Treatment

          Prediabetes: Lifestyle modifications recommended by doctor to prevent further progression and development into Diabetes

          Type 1 Diabetes: Daily insulin intake with individualized dose

          Type 2 Diabetes: Medications with several mechanism to maintain appropriate amount of blood glucose and lifestyle modifications as recommended by doctor

          Gestational Diabetes: Diet modification and exercise where possible and recommended by doctor. Insulin and medications may be offered on individualized approach.

When to see a doctor?

If you think you have clear symptoms which may be diabetes or you have had too high blood sugar in your health check-up, consult your doctor to prevent further disease progressions which lead to serious complications.

High blood pressure

What is High Blood Pressure (Hypertension)?

        High blood pressure or Hypertension is the condition where you have blood pressure higher than normal and rarely has any noticeable symptoms. The higher the blood pressure the more risk for other diseases such as heart disease, stroke, and kidney failure. If left untreated, life-long complications can set in and reduce quality of life with needs to receive more treatment.

        Normal blood pressure is currently defined as 120/80 mm Hg (Systolic/Diastolic) and most major guidelines recommended diagnosis of hypertension when their blood pressure is beyond 140/90 mm Hg although The American College of Cardiology and the American Heart Association defined hypertension is a blood pressure reading of 130/80 mm Hg or higher in which the patient should receive early treatment.

        For most people, there are no identifiable cause for high blood pressure. This type is called Primary or Essential Hypertension. High blood pressure can also resulted from other diseases and conditions called Secondary Hypertension.

Risk Factors

• Obesity
• High salt diet and less consumption of fruit and vegetable
• Lack of exercise
• Overconsumption of alcohol and coffee (or caffeinated drinks)
• Smoking
• Lack of sleep
• Age over 65
• Family history of Hypertension
• African race
• Pregnancy

Symptoms

        High blood pressure is sometimes called a “silent killer” as the patient may not be aware of the danger, but damage has been progressing. Few people may experience headache, shortness of breath, and nosebleeds which are not specific to hypertension.

Treatment

        Treatment often starts with lifestyle modification then combine with medication therapy. Lifestyle modifications include:

• Eating less salt
• Get regular exercise
• Maintain healthy weight
• Limit alcohol consumption
• Not smoking
• Getting adequate sleep of 7-9 hours daily

Medication used to treat high blood pressure can be used as a single medicine or combination of drugs from different mechanisms, depending on your blood pressure and risk factors:

• Diuretics: Often first medicines used to remove sodium and water. Common side effect is increased urination and reduced potassium level as a result.
• Angiotensin-converting enzyme (ACE) inhibitors: Helps relax blood vessels. Common side effect includes dry cough
• Angiotensin II receptor blockers (ARBs): Helps relax blood vessels. Common side effects include dizziness, higher than normal Potassium level in blood, and build up of fluid in skin.
• Calcium channel blocker (CCBs): Relax muscles of blood vessels and some in this class will slow your heart rate.
• Other drugs may be used as individually adjusted to achieve blood pressure goal and treat comorbidities: Alpha blockers, Alpha-beta blockers, Beta blockers, Aldosterone antagonists, Renin inhibitors, Vasodilators, and Central-acting agents

When to see a doctor

        Blood pressure is checked when you visit a doctor. Your healthcare providers may recommend you for more frequent readings if you have high blood pressure and other risk factors. It is recommended for you to have annual health check-up to screen for high blood pressure and other underlying diseases to seek early treatment or you may be able to get a blood pressure reading from nearby healthcare provider for preliminary screening.

Migraine

What is Migraine?

Migraine is usually a moderate to severe throbbing headache or a pulsing sensation on one side of the head that could interfere with your daily activities and decrease quality of life. It is a neurologic disorder that can last for hours or days. Migraine will likely get worse with physical activities, lights, sounds, or smells.

Common triggers include emotional stress, missing a meal, caffeine, hormonal changes around menstrual periods, light, changes to weather conditions, overly tired, changes to normal sleeping pattern, exposure to smoke or other odors.

Risk Factors

• Family history
• Age
• Gender – Women are three times more likely to get migraine than men
• Medical conditions such as Depression, anxiety, sleep disorders, or hormonal change from menstrual cycles

Symptoms

Migraine has four stages in chronological order:

• Prodrome: A preheadache or premonitory stage. Some may or may not experience it. This stage could last a few hours or days. Symptoms include Nausea, fatigue, difficulty speaking and reading, irritability, food craving, increased urination, muscle stiffness
• Aura: Most people do not experience aura. This stage can last 5 minutes to 1 hour. Symptoms include blind spots in vision, seeing bright flashing dots, seeing wavy lines, temporary vision loss, changes in smell or taste
• Headache: Migraine often begins with dull headache and develop into throbbing pain. Most will experience nausea and half would experience vomiting. This can last 4 hours to 3 days. It is common to experience headache 2-4 times per month, but some may get only once or twice per year or as often as every few days.
• Postdrome: This stage can last 1-2 days, and most will experience this. Symptoms include feeling depressed, fatigue, and washed out.

Treatment

        Migraine has no cure but there are many drugs that can treat or prevent them. Medications to relieve pain and headache include:

• OTC painkillers: Non-steroidal anti inflammatory drugs (NSAIDs) such as Ibuprofen, naproxen, and aspirin, and paracetamol. While the drugs are usually effective, overusing them can cause a rebound headache or dependency.
• Triptans class
• Ergotamine
• CGRP receptor antagonists

Medications can be used to prevent Migraine if needed:

• Antidepressants
• Calcium channel blockers
• Beta blockers
• CGRP antagonists
• Anti-seizure medications

What to see a doctor?

        If you get migraine frequently and lifestyle modification did not help prevent it, make an appointment with your doctor to discuss about the headache and ways to manage it. You may be asked to keep record of your migraine attacks to see the patterns more clearly. Contact emergency room or your doctor immediately if you experience headache with fever, confusion, seizures, double vision, numbness or weakness in any part of body as this could be stroke.

Stroke

What is Stroke?

        Stroke is a life-threatening condition when the blood supply to your brain is interrupted or cut off resulting in brain tissue not getting oxygen and nutrients. The brain cells will eventually die within minutes and is irreversible. Early treatment is very essential to delay progression of brain damage and complications.

        Complications can include paralysis, difficulty talking or swallowing, memory loss, emotional problems, pain, changes in behavior. This would be a life-changing condition and may require extra care from family members or caretakers.

Risk Factors

• Obesity
• Lack of exercise and activities
• Heavy alcohol consumption
• High blood pressure (Hypertension)
• Smoking or second hand smoker
• High Cholesterol
• Diabetes
• Cardiovascular disease
• Family history
• COVID-19 infection
• Age more than 55
• Gender – men have higher risk than women
• Estrogen hormone pills

Symptoms

• Trouble speaking or understanding conversations
• Trouble walking
• Paralysis or numbness of the face, arm, or leg
• Blurred, darkened, or double visions
• Severe headache with vomiting

Treatment

        Treatment depends on type of strokes the patient has. Medicines are usually used on emergency and maintenance phase and surgical procedures may be necessary to remove blood clots and brain swelling.

When to see a doctor

        Bring the patient to emergency room immediately upon the signs and questionable signs of stroke as every seconds are precious. Remember the word FAST to identify stroke:

• Face: Ask the patient to smile and check if one side of the face dropped.
• Arms: Ask the patient to raise both arms. Stroke patients may not be able to raise any arms.
• Speech: Although awake, the person may not be able to repeat your sentence and has a slurred speech and strange
• Time: Call 1669 (Thailand) immediately upon the signs of stroke or bring the patient to the nearest emergency room. All seconds count.

For more information, please contact

Medical Center, 1^st floor Thonburi Bamrungmuang Hospital

Telephone; +66 2220 7999 ext. 81120 - 81123