Julian Dindo, a financial expert from Finland working with Reuters in Thailand, developed a hernia on one of the discs in his neck. Today he is fully recovered after an operation at the BNH Hospital Spine Centre. Dr. Wicharn Yingsakmonkol, the head of the Spine Centre, who is a leading authority on spinal surgery known throughout the world, performed a total disc replacement operation on Mr Dindo using the very latest technology and techniques.

Shortly after Julian Dindo and his wife Susanna, moved to Thailand one and a half years ago, Julian started feeling a strange numbness and pain in his neck and shoulder. Not knowing what it was, Julian had a massage. When that didn’t help, he went to see a doctor who did an ultrasound and prescribed heat treatments. But the problem only got worse. When Julian couldn’t stand the growing pain, he went on medication, a mix of pain killers and sleeping pills but the pain kept on getting worse.

Eventually, Julian was referred to BNH Hospital, one of the leading international hospitals in Thailand, which is located in the Sathron-Convent Road area of Bangkok.

“When Julian came to us he had already received a number of other treatments for his neck pain and the pain in his arm and shoulder,” Dr. Wicharn, head of the BNH Spine Center recalls.

“Apart from the pain, he was suffering from weakness in his arm and shoulder with obvious withered muscles in the right arm.”

Dr. Wicharn discovered that the problem was a hernia on two of the discs in his neck. A hernia on a disc will put pressure onthe nerves as it grows and this will result in pain and the other symptoms in the related arm and shoulder.

The new technique
“I usually tell a patient that their problem can be solved in many ways. The biggest difference among the methods of treatment is not only pain relief but, life afterwards,” Dr Wicharn explains.

“The traditional operation which has been practiced for many years is the ‘fusion operation’, where a disc is cut out and a piece of replacement bone graft from the patient’s hip is put in place before the joint is fused stiff and immovable with a plate linking the two bones.”

“After the operation, the pain will go and the patient can move again, but the joint is stiff so inevitably there is a restriction in movement. Also after some years, the adjoining discs often get damaged by the additional strain put on them by the stiffened joint.”

“The latest method is called ‘Total Artificial Disc Replacement’. Here we cut out the damaged disc and replaced it with an artificial flexible joint,” he explains. “After this operation, not only has the pain gone away but flexibility of movement is restored nearly fully to the level it was before the problem started.”

As soon as the patient wakes up from the operation, the joint can move. Disc replacement is a viable option for both the neck, the lower back area or the lumbar spine. The base of the artificial disc is made of a material that the patient’s bone will grow into, within six months, becoming an integrated part of the disc prosthesis.

This surgical technique has been known for the last 10 years and the FDA in the USA has recently approved it for use there. Dr. Wicharn has been using this method for more than two years and is a pioneer of this type of surgery in Thailand; he is internationally recognized as a leading expert.

Not sure what to choose
“I was really not sure what type of surgery to choose,” Julian says.

“When Dr Wichan explained to me the various operational treatments I could choose between, I researched for two days and called friends and experts all over the world. Dr. Wicharn kept telling me to relax and wait until I felt sure of what I was going to do. He also made sure that I knew that the choice was mine.”

“Eventually, I was in so much pain I couldn’t take it anymore,” he recalls

Dr Wicharn explained that to him it is important that the patient feels good about the operation. The success of an operation can actually be affected if a patient is nervous and tense and doesn’t trust the operation will help or if the operation is carried out before a patient is ready for it.

“Sometimes the patient wants to rush into an operation,” he says. “They want it over. I always tell them to relax. I don’t want them to rush. The success rate of Dr Wicharn is impressive; up to nearly 90 percent based on his practice’s total 300 spine operations a year.

Immediate recovery
In Julian’s case, the operation itself was quite brief, lasting only one and a half hours. To get to the spine inside the neck, the doctors cut from the side of the neck right next to the throat and then replaced the two herniated discs with the new flexible joints. The minimal intrusion has only left a small red scar on his neck that should fade more in time.

“We always operate from the front,” Dr. Wicharn explains showing on a plastic model of the spine why this is important. “In the case of lumbargo, we also operate from the front of the stomach and then move the intestines to the side to get to the spine from the inside. Afterwards the patient can get up and walk,” he adds.

Julian’s recovery was also immediate. “The next morning it felt strange. I was able to move my neck freely without pain,” Julian recalls “I wore a soft collar for one week after the operation. That was all.” “One month after the operation I was swimming and running. Dr Wicharn has only advised me to refrain from doing yoga, but then I didn’t do yoga before,” he jokes.

Covered by the insurance
Julian’s operation was paid for by the BUPA insurance package, which Reuters takes out for all their foreign employees. “It went smoothly. I didn’t even see a bill!” Julian says.

Many Thai insurance policies are life insurance policies, rather than health insurance policies. Therefore they do not always cover the costs of such an operation. The policy holder should check that their policy covers the total cost and every item of the treatment.

Dr Wicharn adds, that sometimes the wording in a policy is ambiguous and difficult to follow. “For instance, in the prosthetics part of the insurance it must say that it covers both permanent and impermanent parts of the body,” he explains.

“A neck is by definition a permanent part, but an arm or a leg is for instance not considered permanent. It is always best to check with the insurance agent to obtain their confirmation of what and what is not covered.”


Scandinavian pioneers

The Spine Center of BNH Hospital has become very popular among Scandinavians in particular. “Around 40 percent of the patients are foreigners and two thirds are in fact Scandinavians,” says Dr Wicharn Yingsakmongkol, who has been head of the Spine Center since it opened two years ago. Initially the Scandinavian patients who came were people living in Thailand. Then by word of mouth news spread to Scandinavians living in neighboring countries like China, Singapore, Vietnam, Malaysia, etc.

“Now we see patients coming directly from Scandinavia and elsewhere in Europe, but strictly on a private initiative as the governments and medical authorities there seem not yet to be ready for the idea of outsourcing even though there is money to be saved.”

Today there is a team of eight doctors at the BNH Spine Centre and an expert in anesthesia who is also an acupuncture expert. Julian actually had a single treatment of acupuncture as part of the operation to relieve muscle tension.

In the Asia Pacific area, Thailand is a leadingcountry for spine surgery with South Korea and Australia.

Dr Wicharn explains that the cost of an operation in Thailand is approximately 25% of what it would cost in the US. “The artificial joint costs approximately 4,500 US$ in Thailand while the same joint is currently sold in the US for 10,000 US$.”


Time to move on..
Julian Dindo grew up in Helsinki and is an expert in building financial models. This was what he did for Reuters first in Finland and later in Switzerland, where he moved with is wife Susanna.

“In Thailand, I am basically doing the same,” he explains. “I am running our financial team here, where we build various financial models and develop websites for Reuters and external clients.”

Susanna is working at the corporate office of the Banyan Tree and is well known in the Finnish community as the current chairwoman of the ‘Finns in Bangkok Society’, a position she took over from Elina Koski.

This summer, when Julian’s two year contract is complete, the couple plan to move either back to Switzerland or back to Finland. That still remains undecided.

“It simply depends on where we can find the best combination of jobs for the two of us,” Julian says.