Covid-19 in Thailand, a Mystery

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Something strange is  going on in Thailand.  By all measures, Thailand should have been devastated by the Covid-19 pandemic by now.  In January and early February over 1 million Chinese landed in Thailand.  As of mid-February, over 100,000 Chinese travelers were still in Thailand.  Just walking around Chiang Mai in early 2020 felt like walking around a Chinatown.  Most certainly, the SARS-CoV-2 virus landed in Thailand in late December, or early January.  In fact, the first confirmed case outside of China was found in Thailand on January 13.  

 

Thailand is a densely settled country.  The overall density is 354 people per mi2 but this actually understates the reality in the urban areas; Bangkok has a population density of 13,700/ mi2.   Thai’s love to hang out in large groups.  The more the merry here. 

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Chiang Mai’s walking street in mid-January 2020.  If I were a virus looking for a pandemic, this would be a good place to start.

Thailand would seem to have been fertile ground for a new virus that was seeded here early and often by traveling Chinese.  But it never really took off.  Why?

Today, there have been 2,579 document cases of Covid-19 in Thailand and 40 deaths.  By comparison, New York State with a population less than 1/3 of Thailand has 189,415 cases, and 9,385 deaths.  The disparity is getting larger by the day.  Yes, I know we are probably comparing apples to oranges.  There is a very large discrepancy in the testing rate.  As measured per capita, New York tests 23 times more people than Thailand.  But New York has 73 times more cases, so when corrected for the testing disparity, New York still has 3 times more cases as compared to Thailand.   I would argue that the testing disparity is not that large; both New York and Thailand (at least at the beginning) had similar criteria for doing the tests – basically you had to be sick enough to be at the hospital.  I think a significant part of this testing-disparity is because there were fewer people in Thailand sick with Covid-19. I would further argue that the number of deaths is not nearly as impacted by the testing disparity.  Both New York and Thailand have likely undercounted deaths by counting only hospital fatalities.  The reality is that if Thailand had a similar per capita death rate, there should be nearly 30,000 deaths here!  But there are only 40 deaths in Thailand as of this writing.  This huge difference cannot be caused by lack of testing or any effort at hiding the death toll in Thailand.  

Thailand did not go into lock down until around March 20, and even now, the lockdown is not nearly as complete as in New York or California.  Prior to mid-March that it was pretty much business as usual here.  There was no early and aggressive intervention by the Thai government that kept Covid-19 at bay.

What is it that makes Thailand such infertile ground for the SARS-CoV-2 virus?  Could it be climate?  Perhaps the universal inoculation of the Thai population with the BCG vaccine gave them a large degree of immunity to Cover-19?  Perhaps, it’s the Thai habit of “waiing” instead of shaking hands?  Could it be some quick of genetics?  Something in the food here?  Why is this not big news, and why isn’t this discrepancy being widely studied?  Sorry, I only have questions.

Out of the Tunnel

It has already been two weeks since the operation to remove a NET from my mesentery.  My ordeal began on Monday, March 2 at 5 pm when I checked into Cedars-Sinai Medical Center for an unusual early-evening combined colonoscopy and endoscopy.  I remember nothing of these procedures other than waking up about 30 minutes later with a blurry doctor telling me he found of nothing. My innards were perfectly clean as far as he could see, which is pretty amazing considering the abuse I have subjected them to over the years.   Since my surgery was scheduled for the next morning at 7 am, they kept me right there in the hospital.

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Five tiny incisions, and one slightly larger one.  I’m pretty sure I no longer have a belly button.

The next several hours were a blur.  I think they must have slipped me something.  The last thing I remember was looking at the red digital clock across the room and seeing 7:00 a.m.  I awoke amid a misty commotion all around me of doctors and nurses.  I squinted through the chaos and saw another red LED clock that read 10:00 PM……Holy shit!  10 PM???  I remember doing the math and thinking I was out 13 hours!!!! Later I figured out it was really 15 hours!  I was expecting 2-3 hours.  Early the next morning I was told the operation actually took 9 hours, but it took me another 6 hours to come out of the anesthesia.

According to my surgeon, who stopped by the morning after , the surgery took much longer than anticipated due to the positioning of my mesenteric tumor amidst a jungle of critical blood vessels.  If he were to nip one of them, I could lose half my bowels.  He made the decision to go 100% robotic knowing that this would triple or quadruple the time for the operation, but allow for very precise cuts.  As a bonus, they found the primary (e.g. “original”) tumor in my small intestine, which they resected. I have been assured that I won’t miss the 9 cm of removed bowel.  The primary tumor was not visible on any of the previous scans, and that they found it is of great significance.  There was no longer any mystery about the source of my mesenteric tumor, and by removing the primary tumor, my chances of a quick recurrence should be reduced.

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Day 3 in the hospital.  I look way better than I feel.

My doctor asked how I was feeling, and I told him I felt like someone punched 6 small to big holes in my belly, rummaged through my entire digestive tract, then yanked out a sizable section out through my belly button.  And then Mike Tyson used my belly for a punching bag for 5 minutes.  Actually, except for Mike, that is pretty much just what happened.

The next 6 days were a roller coaster of progress and setbacks, including an infection of unknown origin that left me feverish for 2 nights, getting dropped by a rushing X-ray tech (set me back at least 1 day), spasming at my first attempt to drink a clear liquid, and pained shuffles up and down the corridors.  But progress finally won out over the setbacks, and they released me almost exactly 1 week after I was admitted.

I made my final visit today to Cedars-Sinai for a last follow up with my surgeon.  He gave me the good news that I am officially NED (no evidence of disease)!  But Neuroendocrine tumors, even when you’ve had them removed, have a propensity to recur.  So I will be on a surveillance program, with scans every 3 months for at least the first year.  They are recommending that I can stop the monthly injections that I have been getting to slow down the cancers growth (a big relief to my digestive system).  This is all the best news I could have hoped for!

The care I received at Cedars-Sinai was amazing, from the orderlies, nurses, technicians (well, except for that one harried X-ray tech) and the dozen or more doctors that were involved in my care.  My main team consisted of my surgeon, a NET oncologist, gastroenterologist, and urologist.  All of them have been caring, funny, and exuding professional competence.  In spite of this being the most difficult medical journey of my life, I feel like I made the best choice!

I’ve now been staying with close friends just waiting to heal up sufficiently to fly back home to Thailand.  In the meantime, the world has imploded with the Covid-19 pandemic and it’s now a race against time through a dark tunnel to get back home before Thailand closes its gates.  If I can’t get back in time, I will be officially homeless…

Coming Out of the Closet

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Before I come out, just a quick update on my pending NET removal.  I’ve met with the surgeon, had my MRI, and had my pre-op testing completed.  Forward all engines!  My surgeon, Dr. Kosari at Cedars-Sinai Medical Center in LA was very upbeat.  He said the surgery should be buying me many years.  I may get my gall bladder out as a bonus; this is a preventative measure since the octreotide injections that will likely be a long-term part of my life tend to gum up your gall bladder.  Why do we have a gall bladder anyway since we can apparently survive quite nicely without one?  Maybe they should just remove it at birth along with your appendix. My surgery is scheduled for 7 am February 28.  Stay tuned.

At the risk of TMI, now for the closet.  Not the closet you’re all thinking of (sorry to disappoint).  It is an embarrassing medical closet.  It tuns out I am afflicted with another hard-to-treat disease. If you are at all squeamish about the details of men’s anatomy, now’s the time to close your browser………

I have Peyronie’s disease.  You can read all about it here.  I’ll give you the one sentence definition:  It is a condition whereby scar tissue builds up within your penis causing it to bend at a rather inconveniently acute angle (mine is about 70 degrees) that makes any kind of traditional bedroom fun geometrically impossible (not to mention extremely embarrassing).  The cause is thought to be either an acute injury or (as in my case) accumulated unnoticeable minor injuries during intercourse.  Woman-on-top is a big risk factor.  As my urologist at Cedars-Sinai said, it is perhaps just abnormal wear and tear.  Here’s what blows my mind:  According to my urologist, 9% of older men have this condition (and 3% of younger men)!! How could nearly 10% of men have this condition and I never heard of it until Dr. Google revealed it to me?  More likely than not, one or more readers of this blog also suffers this disease.   It’s time to bring this disease out of the closet. Sure, this is an embarrassing ailment, but really is it more embarrassing than hemorrhoids?  Worse than jock rot?  Worse than ED?  Worse than incontinence? We see all of these on tv ads everyday.  Hopefully more awareness will lead to more research and more treatments.  Hence my coming-out party.

I do understand why this malady is in the closet.  It takes a very heavy psychological toll.  Some men have been known to become suicidal.  To be sure, as ailments go, there are many worse diagnoses.  No one has died from Peyronie’s (not counting suicides).  For me, the realization that I had a condition that was not immediately treatable (at least in Thailand), and that would prevent sexual activity, was devastating.  Being otherwise healthy, but realizing sex was not going to be part of my life, hit hard.  With the help of a very understanding partner, I focused on other aspects of life.  In the end, I have to come to the realization that overall I’ve been pretty damn lucky, and there was still plenty to live for.  But not being able to be intimate with my partner is still quite painful.

It started about 18 month’s ago, so I have known about it for awhile.  Unfortunately, in Thailand, the only treatment they know about is radical surgery that sounded to me like partial castration.  I even travelled to a so called “specialist” at a top end hospital in Bangkok.  Surgical straightening, resulting in drastic shortening, was the only option he offered. Maybe I only imagined the sneer on his face.  

This week I found out the good news that there is minimally invasive treatment for Peyronie’s available in the USA. The treatment involves expensive injections of FDA approved, scar dissolving Xiaflex, and physical therapy (kinda sounds like rehabbing a shoulder injury).  My urologist said I am an ideal candidate – my condition has reached a “chronic” phase with no pain and no progression and my scar tissue is in the best location for this treatment.  So there is hope!  The treatment will necessitate anywhere from 1-4 sets of injections (each set done over a 5 day period) with each set of injections spaced 6 weeks apart.  This would necessitate returning to LA from 1-4 times this year (I can’t have an injection while rehabbing my cancer surgery).  Pending insurance approval, my first injection would be in August.  

The question now will be, is it worth it?  If I was 35 years old there would be no question, but at my age?  The cost of 4 trips to the USA will be substantial.  According to the doctor, the success rate is better than 50%, but I still risk spending money for nothing.  This is a decision that I will need to make over the next few months.  For now, I will concentrate on my upcoming surgery and the aftermath.  I will revisit this once I am fully recovered.  Who knows, by the end of the year I just might be once again an upstanding man (groan).

Thank you for allowing me to share this story.  Just getting it out here is a cathartic.  It will be nice not to have hide in the closet, and I’m ready for the inevitable banana jokes!

Medical Care in Thailand: Observations from a Reluctant Patient.

imagesI am now 7 months into my battle with Nueroenocrine cancer.   I have had way more contact with the medical community here in Chiang Mai than I ever wished for.  I always figured that most people died in a hospital bed, so better to stay away.  However, I now feel somewhat qualified to make some observations about health care in Thailand that might prove useful to anyone thinking about retiring or traveling here for medical care.

An Update

But first, a very brief update of my current status.  I have now been on monthly injections of Sandostatin LAR for 5 months.  These injections are not a cure, but intended to stop or slow the tumor growth, and stop or limit the proliferation of tumors.  They do come with some unpleasant, but mostly bearable, digestive side-effects. Suffice it to say that if I had one of the more common side effects then, I would have been a cult hero in my fifth grade class.  Last month, I traveled to Bangkok for another Gallium 68 PET scan.  The scan showed no growth of my one known tumor, but continued to “light up” my prostate, suggesting something might be there too.  Last week, I had a biopsy done on my prostate where my urologist turned it into a pin cushion by removing 24 small cores.  Fortunately, I was in Lala Land at the time.  Early this week I got the results: nothing at all going on there (except BPH which I have known about for years).  Good news!

I will be meeting with my oncologists next week to discuss our next move (surgery or more Sandostatin injections are the two most likely).  Unfortunately, the one known tumor is in my mesentery, and is very unlikely to be the primary.  Where the hell is my primary?  Most likely it is 1. too small to see, 2. gone already due to immune response, or 3.  hidden away somewhere, most likely in the curlicues of my small intestine.  Neuroendocrine tumors (NETs in the lingo) are sneaky nefarious bastards.  Once they have metastasized they are nearly impossible to 100% expunge from your system via surgery or medicine.  This will make the decision to cut or not to cut a difficult one….So that’s where I stand at the moment.  In the meantime, digestive issues not-with-standing, I feel great and life goes on mostly as normal.

Medicine in Thailand

According to the World Health Organization, Thailand ranks #47 amongst 190 countries in terms of the quality of their healthcare system.  For perspective, the U.S. ranks #37.  Thailand, except for the tiny states of Brunei and Singapore, ranks number one in south-east Asia.  Thailand ranks 65 spots above India that magnet for medical tourism.  So by WHO standards, health care is pretty good here.  My own experience corroborates this conclusion.  But it is only good if you have money (or good insurance).

I receive most of my healthcare at Bangkok Hospital, Chiang Mai (BHCM).  Bangkok hospital is a country-wide system of hospitals that was started by a Thai doctor in 1972 as the first private hospital in Thailand. Prasert Prasarttong-Osoth parlayed his medical degree into a $3.2 billion fortune that includes Bangkok Airways and 3 regional airports.  BHCM is in my view the best hospital in Chiang Mai.  From its welcoming lobby that exudes the ambiance of a 5 star hotel, replete with live music from grand piano, to its immaculately attired english speaking staff,  to its state-of-the art equipment and spotlessly clean ORs and examining rooms, anyone will feel confidence in the care they are about to receive.  But the quality of that care comes with some significant caveats.

Caveats

In the course of my diagnosis and treatment, I have seen more than a dozen doctors.  They all impressed me with their caring attitudes, and general intelligence.  However they collectively are the product of an insular system of in-breading.  Virtually every doctor in Chiang Mai obtained their medical degree from Chiang Mai University Medical School.  Many are listed as faculty members there in addition to their hospital posts.  Thai culture’s pronounced stratification, makes questioning one’s supervisors/seniors/elders difficulty at best.  This just has to stifle innovation and the adaptation of new or alternative treatments.

I normally meet with two oncologists, one is an elderly woman listed as a professor emeritus at Chiang Mai medical school, the other is a youngish male with an MD degree from there.  When I meet with them, she does 95% of the talking, while he mostly stares at his computer.  She will suggest something, and he will do his best imitation of a MLB bobblehead doll.  On the rare occasion when I meet with him alone, he becomes talkative, and full of ideas and intelligence.  I would consider asking to be seen by just him, but I am afraid that it would make an irreparable rent in their cultural universe.

Another caveat is the lack of accountability.  Malpractice lawsuits are nearly unheard of in Thailand outside of a few high-profile nose-jobs-gone-wrong that splash across the headlines.  When a doctor makes even an egregious mistake, about the strongest reaction is “oops”.  Doctor’s are looked up to in Thailand to a much greater extent than are western doctors.  Thai patients seldom question their care, and confidently swallow unmarked pills given to them in completely unlabelled baggies with instructions of when and how many to take.   There is a clear advantage for patients if doctors have a paranoid fear of being sued.  I cannot say how much this accountability issue effects health care, but it will weigh heavily on me if I have to decide on invasive surgery.

The bottom line for now is that my health care has, in my view, been very good.  My doctors’ decisions have been verified to the extent possible by Dr. Google and his myriad colleagues.  I also received a “virtual” second opinion from an oncologist at the Cleveland Clinic, who, after reviewing all my records, scans, and even my original tissue biopsy samples, concluded that the care I have been receiving is spot on.  But my disease is uncommon, complicated, and varies from case to case.  Experience here is lacking so I may have to consider returning at some point in the future for evaluation at one of the handful of “NET Centers” in the USA.

Hiking in the Jungle

Almost to the date, 32 years ago, I set out on a 3+ week trek around Annapurna, in the Himalayas Mountains of Nepal.  Next week, I will return to Nepal to begin a 3+ week trek to Everest Base Camp, with a side trip to Gokyo Lakes.  To make this new trek even more fun, I will begin my walk from Jiri instead of flying into Lukla.  This will add an additional week to the trek as I hike the original approach to Namche Bazaar, the gateway to the Everest region.

During that first trek so long ago, I trained by lying in the sun, drinking beer, and otherwise cavorting around Thailand for three weeks before arriving in Kathmandu.  My now 62 year old lungs and legs would have little chance in Nepal if I followed the same training regime this time around.  So, for the last few weeks, I have been hiking the jungle trails up and down Chiang Mai’s Doi Suthep – Doi Pui Mountain.

From Chiang Mai city, Doi Suthep Mountain appears as a large completely forested hulk, with the famous Doi Suthep Temple perched on a promontory about 2000 feet up.  The temple is serviced by a well-travelled, paved road plied by fleets of buses, fans, and songtaews that ferries 1000’s of tourists up to the temple every day.  Only a handful of people take the direct route, up the walking trail.  The first part of the trail, known as the monk’s trail, begins at the mountain’s base, and proceeds up to a lesser known temple, Wat Pha Lat, perched about 700 ft above the trailhead.

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A trail-side shrine at Wat Pha Lat

From there, the “trail” makes a direct beeline for Doi Suthep temple sans switchbacks.  This being the dry season in Thailand, the trail consists of a series of steps stomped into the hard clayey soil.  During the rainy season, I imagine that the trail would make a great muddy waterslide; temple to trailhead to hospital in 5 minutes!

I have now been up and down this trail many times – I know every root and rock along the way – I’m pretty sure I could navigate the trail blindfolded.

Yesterday, as an alternative, I chose a very lightly used trail that diagonals up the mountain toward the northwest to the small hill-tribe village of Ban Khun Chang Kian (บ้านขุนช่างเคี่ยน) a small settlement spilled across a high ridge about 3000 ft above the City.

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Your grizzled hero at Ban Khun Chang Kian

The trail is mostly used by mountain bikers who get hauled up the mountain in the back of pick-up trucks, and then come tearing down the trail, hikers beware.  I also saw a couple of crazy farang trail runners – not many hikers though,  mostly the trail is empty and quiet.

From the village, I traversed about 9 km south to Doi Suthep temple, following a four-wheel drive road that led eventually to a poorly maintained trail.  The first part of the traverse passed by numerous strawberry fields that thrive in the cooler mountain-top environment.  Trail finding was a bit of a challenge – the jungle hides a spider’s web of jeep trails and walking paths going every-which-way.  After climbing over what seems like 100s of fallen trees, I arrived at the bustle of Doi Suthep and descended the steep trail to just above Wat Pha Lat, where I finished the 20 km long hike with a 3 km traverse back to my parking spot along the Doi Suthep road.

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Terraced strawberry fields forever

Hiking this trail gave me a great workout – the distance and elevation gain probably equals or exceeds any day-long segment I will encounter in Nepal (albeit at low altitude).  The trails are pleasant enough, although quite steep in places.  During the dry relatively cool season (temps in the upper 80s- low 90s F) the cooler temperatures up high are pleasant. There were only two real downsides to this hike.  One was the constant cloud of kamikaze gnats that enveloped my head.  These terrorists had a penchant for exploring any orifice of mine they could find, and apparently they thought my eyes were portals to a bug’s paradise.   I spent much of the hike wondering if the swarm consisted of the same 200 bugs who found me at the trailhead and followed me for 20 km, or whether they were a tag-team outfit that each had their own designated section of trail.  I imagined attaching a nano GPS transmitter to a few of the gnats to answer this question.  Such are the thoughts that occupy my feeble brain when my legs and lungs are on autopilot.

The second downside was the 20-30 inevitable spider-web-face-plants.  A face-first meeting with this guy will get your attention!

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I am hopeful that these forays into the Thai jungle will amply prepare me for the hiking in Nepal.  My next post will likely be next week from Nepal….

The Great Cultural Divide

There is no better way to experience the chasm that exists between Thai and American culture than to witness some of the rituals surrounding a visit to a Thai temple.  Recently, I visited Wat Chai Mongkhon with my SO on the occasion of her birthday.  Wat Chai Mongkhon lies on the banks of Chiang Mai’s main river, the Mae Ping.  To my pagan eyes, it seems like a fairly ordinary temple, although its riverside setting is lovely.  That same setting, though does allow for a peculiar ritual that I observed there for the first time.

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The Mae Ping River from Wat Chai Mongkhon

On this propitious day, our first stop was a small shop tucked back in a corner of the temple grounds that sells all manner of live fish ranging from guppy-sized up to small-trout-sized.  The same shop also sells various birds in tiny wooden cages – most of these seemed to be some kind of dove.  They also sold live snails, by the bucketful.  This was no pet store though.  The express purpose of this shop is to sell the animals to merit makers, who then make merit by releasing them.  Hmmmm, more on this in a minute….

From the shop we proceeded directly to the temple’s interior where a quick prayer was said accompanied by a few bows and wais to buddha.  This part of the ritual I am quite familiar with and lasted only a few minutes.  From the temple we proceeded to the river bank, where amidst a few more bows and the recitation of a long prayer read from one of the laminated sheets picked from a basket on the pier, both the snails and fish were released.  Their release was followed by a nearly instant eruption from the river – a vicious feeding frenzy of huge carp-like river fish.  As far as I could tell, the newly freed snails and small fish experienced a few nanoseconds of freedom before becoming dinner to these exceedingly well-fed riverine scavengers.

Ok.  To the American mind, this seems very strange indeed.  So let me get this straight, someone goes out and catches some wild critters, keeps them in tanks, buckets and cages, and then someone else comes along, buys these unfortunate critters, and makes merit by releasing them to the freedom of the river, only for them to become instant dinner to some lucky fish.  One would guess that the freed birds might have a better chance to enjoy their freedom – at least you could enjoy watching them fly away to meet their fate, but alas, their cost is quite a bit more.  The American mind cannot help wondering if the merit made by the purchaser sufficiently cancels the merit lost by the animals’ capturers, keepers and sellers.

Now. Here is how the Thai mind sees it……

Sorry, but I have no clue how the Thai mind thinks about this ritual, in spite of numerous conversations with Thais about this very subject. I do know that each kind of fish/bird/invertebrate has a particular kind of merit that is gained by their release.  Some impart good health, others will bring good luck with finances, still others will impart a long life.  You get the idea.

When I asked who decides which animal imparts which kind of merit, my SO replied that that is like asking who decided the meaning of a word.  Wow, that was a very revealing answer! Apparently this ritual goes far back into antiquity, and involves deep beliefs that have been passed down through so many generations that their origins have been lost.  These beliefs run gut-deep and no manner of western logic will unseat them.  My guess is that if you brought a Thai into the Catholic Church of my youth, they would be equally mystified.

The third and last stop in our merit-making was a ritual that I have experienced on numerous occasions – one of my favorites.  The merit-maker grabs an open-ended cylinder containing about 30-40 joss sticks with each stick bearing a number.  While kneeling in front of a particularly plump and happy buddha, the merit maker gently shakes the container until a single stick falls out.  The number on the stick is then matched to a set of fortunes posted on a nearby bulletin board.  Here’s the fortune we got:fortune

I don’t think you can do much better than that!  All in all it was a very educational visit to the Wat Chai Mongkhon.  Please if any of my Thai friends read this, please leave a comment with your explanation of this interesting and (to a western mind) contradictory ritual.

Why I Retired in Thailand

Why did I choose to retire here in Thailand?  This is a question I am asked often by my American friends – especially those who think I actually live in Taiwan.   Of course there are very many reasons; my decision to retire here was not taken lightly and took many years to formulate.  But the story of my day today serves as a great illustration of why I retired half-way around the world from where I lived for 59 1/2 years.

Actually, the story of today began yesterday morning. As I was eating my green curry and rice for breakfast I had that familiar feeling of a foreign object in my mouth….a crown that covered an upper molar had dropped off into my soup (yeah it has happened before). I fished it out and placed into a baggy,  finished by breakfast, then called the dental clinic at Bangkok Hospital (Chiang Mai branch).

Bangkok hospital is the nicest hospital I have ever been in – far better than any I have been in in the USA.  The ambiance is that of a five star hotel.  You are treated as an honored guest and the facilities (as far as I can tell) are world class.  My call  yesterday morning was answered promptly and in perfect English.  They wanted me to come in straight away, but I opted for the next day (today).  I wasn’t going to let a missing molar mess with my regular Thursday golf outing.

Back to today…I arrived at the appointed time at the hospital and entered their large parking lot where a uniformed attended directed me to an open spot.  As he guided me in, he noticed that my tire looked flat.  He looked closer and noticed the bolt that I had picked up that was slowly but surely releasing the tire’s air.  Shit… when things start going wrong you wonder where it will stop.  I didn’t wonder long though, the attended said not to worry, he would see to it that my tire was changed while I was in seeing the dentist.

Up I went to the 4th floor dental clinic where I had to wait about 90 seconds before being ushered into the examination room.  I ask my American friends: whens the last time you waited for only 90  seconds in and doctor’s office?  The dentist happened to be the same as had just cleaned my teeth a few days before.  She took one look and said “no problem”.  Within 15 minutes my crown was glued back in place.  I had to wait another 5 minutes while they tallied up the bill – the princely some of 1070 baht – about $34 US.  My Thai friends would be shocked at this extravagant price – the same service might be half this much elsewhere.  Such is the cost of luxury here.

When I returned to my car, the flat had been changed and the attendant rushed over to give me my keys.  I asked “how much”, and he shook is head and waived his hands.  I tried to force a tip on him, but he ran off saying helping me  was part of the hospital security service.  No need for AAA here.  I still need to fix my tire because I only had a donut spare – fortunately there was a “Cockpit” tire store 200 m down the road.  It took them 10 minutes to fix the flat with a plug and change out the spare.  My cost?  120 baht or $3.80.

Thirty minutes later I was having lunch with my SO at small cafe – we like to try new restaurants whenever we can.

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Pad Thai at Ombra the Garden

I awoke that day in dread of having to get a new crown (or worse) and having to spend a couple of hours in the dentist chair and the rest of the day with a numbed face.  My dread increased when I saw the flat tire.  What next?  But the Thai’s have a wonderful way of making life easy.  Days like this (i.e. most days) make me happy about my retirement choice.

December 6, 2017 – Cycling Tour of Northern Thailand – A Final Look Back by the Numbers

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Doi Pha Klong National Park east of Phrae

I have been back home now for nearly two weeks.  With a bit of perspective, I would like to take one last look back at my cycling adventure “by the numbers”:

1,079 – Give or take a few this is how many kilometers I road on my tour.  Add another 25 km to that to account for a day trip I took to the White Temple in Chiang Rai.  That works out to an average of 98.1 km per day.

11 – Days of riding.  That is not counting the short day ride I took in Chiang Rai.  An additional 2 days were spent on a golf course in Chiang Rai, and one true rest (and laundry) day in Nan.

10 – Number of mountain ranges crossed.  On two separate days, from Chiang Muan to Nan, and Phrae to Lampang, I had to cross 2 ranges.  For 3 days, from Chiang Rai to Chiang Khong to Thoen to Phayao, I rode on the mostly flat terrain of the basins.

2 – the number of times I had to get off my bike and push it up a steep section of road.  Both of these were on the same day, between Phrao and Fang.

1 – the number of other touring cyclists I saw during my trip – it was a European woman I saw in Chiang Rai with a bike so laden that I am pretty sure she was riding back to Europe.  I don’t count the locals pedaling their cruisers around the many small villages and farms – these were too many to count.

2 – The number of times I crashed my bike.  I already wrote about the first time here.  The second time was even more embarrassing than the first, but two weeks on and I can now write about it without blushing too much.  I was coasting to a traffic light on the outskirts of Lamphun on my very last day of the trip.  I was looking at google maps on my iPhone which was mounted on my handlebars trying to find a pleasant route through the Chiang Mai basin.  I was not looking at the road.  I ran smack into the rear end of an empty trailer being pulled by a motor scooter being driven by a grimy construction worker.  Fortunately I was going slow enough that I didn’t fall over.  Smashed up one finger bloody good (literally), with only a small scratch on a break lever, and no damage to the very sturdy trailer.  A huge gash to my ego.  The only person more startled than I was the driver of the scooter his look needed no translator, it cried out W.T.F.!!!, are you $#@&^ing blind?!!! I tried laugh it off which was difficult with blood dripping down my arm.  I finally got to pull out my carefully equipped first aid kit, and I was back on the road again in 10 minutes.  I put my phone away for the duration.

398 – Number of dead snakes seen on the road.   Ok, I didn’t really count them, but there were a lot, as I discussed here.

1 – The number of live snakes I saw.  A 4-5 footer curled up on the shoulder.  I just missed running over it at 25 km/hour.  By the time I realized that it was a snake I was far enough down the road that I didn’t bother to go back and take a picture.  Now I wished I had….

0 – This is the most amazing number.  This is the number of flat tires I had.  I reckon this is because I was so well prepared with patch kits, tire irons, and spare tubes.  I never even put air in the tires.  This must be a testament to the quality of the tires that come stock on my bike, the Marin Gestalt 2.

-1 – My weight change from the day before leaving to the day after returning.  Thats right, negative 1.  I actually gained one pound.  I would like to think it is because muscle weighs more than fat, but I now the truth: No day’s ride, no matter how long or over how many hills, can make up for the prodigious amount of food I ate and beer I drank while on this trip.  I am talking 3 Thai food dishes with a plate of rice washed down with a large Singha beer, and chased by 2-3 Kit Kat and Snickers candy bars.  That is just an example of one of my 3-4 daily meals.  It was sure fun while it lasted; now I am struggling to eat only 20% of that amount and can still feel my paunch growing.

My cycling tour already seems like ancient history.  I am back in my usual routine of pleasant retirement.  But the itch is still there, this week I booked my next adventure, a 21 day trek to the base of Mount Everest.  Stay tuned!

 

 

November 28, 2017 – Cycling Tour of Northern Thailand, Epilogue and final Thoughts

I have now been back home 5 days already, and it seems like forever.  It seems like I never left.  While I was on the ride, it seemed like the never-ending-tour.  It seemed like I had been riding my whole life, and still had a long way to go.  While on the tour, life became very simple.  Eat, ride, eat, drink, check-in hotel, write, eat, ride, etc. etc.  I had no appointments to keep, no problems to solve, no one to worry about but myself, and no deadlines other than the setting sun.  On my return, I awoke to dead batteries in my car and iPhone, and spent the day replacing both.  I now have appointments to keep, golf tee times to wake up for (I know, I have a tough life), and the everyday nuisances of normal life.  A part of me misses the simplicity of the road (but not the sweat).

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A misty early morning near Fang – one of the many memorably scenes along my route.

Would I do this trip again.  The short answer is no, but I would do a trip similar to this in a new place.  Would I recommend this trip to others.  Yes, if they were prepared to cycle in the relative heat, adapt to the culture of the Thai roads, and wanted a prolonged experience of Thai culture.  Here are some final thoughts that I hope will be of use to anyone considering a trip like this one:

  1. I chose the perfect time of year to go.  November is relatively cool (nothing over 90 F), with relatively low humidity.  I had one 60 minute rainstorm, the rest of the trip was dry with mostly sunny skies.  Winds are light enough to me a non-issue.  Hotels were empty as were many of the roads.  Any other time of year would have meant dealing with higher or lower temperatures, abundant rain, and/or intense heat.  The forests were still green from the rain season, and it was harvest time for the rice, but they had not yet started to burn the fields (which will turn the air foul by February or March).  This tour is certainly doable any time of year November is nearly ideal.
  2. I had the perfect bike for this ride.  The Marin Gestalt 2 is moderately priced, relatively rugged (without being heavy), and easy to fix and maintain.  I am sure better bikes are out there, but probably not for the price.  I added a rack, kick-stand (an absolute necessity!), and fenders which helped keep me and the bike clean.  I do admit though, that an even lower “grandpa gear” would have been nice.
  3. I travelled light.  No rain gear – I figured I would be wet from sweat anyway, and in November, if it is cold, it will usually be sunny.  I carried only a couple of changes of clothing, and was able to do laundry along the way (although this will usually mean  a rest day because clothes must be line-dried).  I carried only a small cache of emergency snacks – food was easy to find almost everywhere.  I stayed in hotels, so no camping gear was needed.  Bottled water is everywhere and cheap.
  4. If I could re-plan this trip, I would avoid the heavily travelled road between Lampang and Chiang Mai, and perhaps take a quieter route from Phrae to Lampang, or skipped that area altogether.  The rest of the route was on lovely quiet roads with only short sections (near towns) of heavy traffic.  I would have like more time spent cycling along the Mekong – this was the most memorable part of the trip.
  5. I had a Cat’s Eye wireless odometer that I can only give a mixed review.  It on occasion just quit working – most likely because the sensor – pick-up gap was too large.  Unfortunately the design of the Gestalt’s front forks made adjusting this gap difficult to impossible.  The real winner was the iPhone mount teamed with the Cyclometer Elite app for OSX.   It gave me all the stats I needed with a very easily read display.  The only downside was the large battery drain on my iPhone, but the back-up battery in my iPhone case more than compensated.

This and my soon-to-come “by the numbers” post will be my last post specifically about this tour.  If anyone is thinking about a ride like this, I am happy to answer your questions.  Reach me at bprhodes@mac.com. I do not no where this Blog will go from here.  I am sure I will find something to say.  Stay tuned!

November 19, 2017 – Northern Thailand Cycling Tour – Summit Day!

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Graph shows distance versus elevation. Ugh!

Wow, that was a lot harder than I thought! My plan for the day called for a ride of just 68 km, by far my shortest ride of the entire tour. What I did not realize at the planning stage, was that this route climbed over two mountain ridges and numerous other smaller ups and downs, resulting in a total of 998 vertical meters – doubling the climb of my next hardest day.  The result is that today actually felt like my toughest day, rather than what I though would be my easiest day.  Even though I got an early start of 7:45, I still arrived in late afternoon.  But I made it!  By reaching Nan, I have reached the ultimate goal of this tour.  For me, Nan has always had the aura of an isolated and remote province.  I initially though I would drive here.  But when knee surgery last year forced my to quit running, I bought a bike, started cycling around Chiang Mai, then decided to cycle to Nan.  My plans became increasing ambitious, resulting in this tour.  I feel like the mountaineer who has reached a long sought summit: bone-tired, a little let down, and apprehensive about the decent – in my case the ride from here back to Chiang Mai.  More on that below.

The ride out of the very quiet Chiang Muan valley began almost immediately, climbing to the first ridge in just over 12 kilometers. Just after reaching the crest of the ridge the road plummeted down to the The Baan Luang Valley.  There I paused for a late morning cup of coffee, and stocked up on my water supply.

Then up I went again, this time very steeply, over a ridge covered in lush jungle.  When I finally reached the ridge crest, it was mid-afternoon already, and quite hot.  The way down to Nan from there was a series of roller-coaster hills where You go up 10 meters for every 15 You lose.  To make matters a little more interesting, one of the steepest downhill sections was being reconstructed and I had to inch down through the mud made by a dust mitigating water truck.  The mud caked between my tires and fenders bringing my rear wheel to a wheezing stop.  Another 30 minutes was spend scrapping out the gooey mud so that my tire would spin again.

I finally arrived in Nan about 3:30 pm, some 3 hours later than expected.  After checking in to the Baan Nan Hotel, I brought my bike to the Nan Cycling shop, and left it for them to clean up, and adjust the gears.  They did a great job for only 250 baht.

I don’t have much to say about Nan.  The idea of the place far surpassed the reality.  Nui, the proprietor of Nan Cycling, was hard pressed to think of anything to see in Nan besides one museum and some temples.  Perhaps interesting sites lie outside of  town, but those will have to wait until I come back in a car.

Every mountaineer, when he or she reaches the summit of a remote, difficult and/or strenuous peak, knows well that the descent will be even more strenuous and difficult than the ascent, and potentially more hazardous.  I am apprehensive about the final 3-day ride back home, my “descent”.  Each day of the three is over 100 km in length and involves crossing at least one mountain range.  I will spend tomorrow – well actually today as I write this – eating, getting laundry done, resting, eating and hydrating.  Hopefully, I will be able to escape my “summit” very early Tuesday morning, bound for Phrae.