On bringing a breath of fresh air to healthcare and medicine.

It’s no easy feat to deal with a patient in critical condition, let alone many – yet this is a daily occurrence for doctors like Assist. Prof. Dr. Chok Limsuwat, who regularly use their expertise to bring someone back from what may initially seem like the point of no return. “As critical care doctors, we take care of very sick patients. That requires a lot of passion, as well as high attention to detail. We’re almost like internists in that we have to be prepared to deal with all kinds of patients, except they’re all sick enough to be in the ICU,” Dr. Chok
explains as I ask him about his speciality in both critical care medicine and pulmonology. “The two specialities actually intersect a lot,” he says. “Most people in the ICU have critical problems with their lungs,
such as respiratory failure, and they may require ventilator support.”

With the advent of the COVID-19 pandemic, I posit that these specialisations must have been in high demand, and he agrees with a self-deprecating laugh. “When I first faced COVID, I was wearing
so many hats. I was teaching in medical school, I was in emergency medicine, and I had to be at the frontlines with the patients coming in with respiratory failure. I had to intubate them, take care of them when
they were in the ICU, and then follow up with them afterwards, as a pulmonologist. I was with a lot of them every step of the way, because my motto is making sure that my patients can go back to their usual
lifestyle before COVID.”

It is this dedication to ensuring his patients’ quality of life that has earned Dr. Chok the admiration of not only his patients but his whole team, who covertly took me aside to tell me how much he’s inspired
them. “He’s won the Star of Bumrungrad award, which is based on patient testimonials,” I was told. “He’s beloved by everyone here.”

With years of experience in both Thailand and the US, where he trained for seven years in internal medicine, critical care medicine, pulmonary medicine, and even sleep medicine, Dr. Chok has not only shared his expertise with his grateful patients, but with aspiring doctors as well, as an Assistant Professor in medical school, where he’s taught for the past six years.

He shares some of that knowledge with me as I sat down to speak with him further about his specialisations, and the impeccable patient care they offer at Bumrungrad International Hospital.

Aside from taking care of patients in critical care, your expertise covers pulmonology – what does that entail?

As lung doctors, we take care of diseases from the upper respiratory tract until the lower respiratory tract, which is the lungs. This means we deal with patients who have anything from upper respiratory tract
problems, lung tissue disease, pneumonia, interstitial lung disease (scarring of the lungs), or rare diseases such as blood vessel abnormalities in their lungs. I see a variety of patients here, from all over the world,
and it’s definitely a challenge, as patients coming from different part of the world are exposed to different environments, and may have a variety of lung diseases as a result.

What are the most common lung diseases here in Thailand, and what are the symptoms we should look out for?

The most common lung diseases, not just in Thailand but in many countries, are chronic ones like asthma, and COPD (chronic obstructive pulmonary disease). Asthma is a disease of the airways which can affect
people of any age: kids, adults, and the elderly. Symptoms include coughing, shortness of breath, and risk factors include family history with the disease. With COPD, patients will often have coughing or
secretions for many months, dyspnea or shortness of breath, a decline in exercise tolerance, and may be unable to walk long distances or keep up with their peers.

Smoking and pollution create a lot of lung problems as well, especially in Thailand. For example, with the smog, the main problem is the PM – the particulate matter. PM 2.5 is renowned to be deadly because the particles can go down into your lungs, and high concentrations can increase the risk of inflammation of your airways. I’d recommend wearing masks, as they help to filter the PM 2.5.

You mentioned that you were on the front lines of the COVID-19 pandemic. How did Bumrungrad deal with this unexpected pandemic, in terms of resources and patient care?

Here in Bumrungrad, we had to quickly form a team to take care of COVID patients, comprising of infectious disease doctors and heart doctors as well as pulmonary specialists, because COVID patients’ symptoms did not just stop at lung problems.

Bumrungrad gave me all the support I needed in my aim to have my patients go back to their usual lifestyle before COVID, from cutting-edge devices and instruments in the ICU, to our team of talented doctors of all specialities, and providing any tests or medication that we needed. Part of getting patients back to their usual quality of life is dealing with long COVID, which has become a persistent issue for many.

What is long COVID, and what advice would you give to patients who have it?

According to the WHO, what we refer to as long COVID is symptoms that persist 90 days or more after COVID, without any explanation. The most common that we’ve seen are coughing, chest pains and tightness, fatigue, and sleep problems – either they can’t sleep, or they sleep too much. This can even happen to young patients, or those who’ve been vaccinated several times.

My advice is, after COVID, if you still have symptoms that aren’t normal, such as prolonged fever, hair loss, memory problems, fatigue – it could be anything, come see a doctor first. We’ll run all the investigations we need to make sure there’s no other reason for those symptoms, and once we diagnose you with long COVID, we can start treatment, which is usually supportive treatment and some specific medications in particular cases.

Can you share with us some of your team’s success stories?

One case that we’re quite proud of was that of a COVID patient that we had, who was a referral from another hospital. This was back when we did not have much knowledge about COVID and not much research had
been published on it. The patient was about 60 years old, very healthy, with no past medical problems, but his case was critical.

When he came in, he had been intubated, he had air leaks in both lungs, so his body was swelling because the air was reaching his soft tissues, and he was in shock and on the ventilator. We had a big team to figure out how to take care of him, especially as it was still early in the COVID era and we did not know much. Our team had to use our expertise, review medical journals, and use our basic medical science knowledge for this individual case to find a way to treat him! But after four months, we had him walking again, and now, he’s back to playing golf – the full 18 holes! Our goal was not just getting him off oxygen, but caring for his long COVID, and making sure that he could return to this previous life – which he did