Archive for the ‘medical care’ Category

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Medical Travails part 2

June 9, 2018

Posted by Kanga. Please do not reblog.

bouquet of pink rosesSo, in continuation of the last post, I have had yet another hospital experience. For many years, I have had difficulty walking. I have had fibromyalgia, osteoarthritis, and fallen arches for 11 years, but something else was afoot because my ability to walk was gradually declining.

In 2016, I went to a clinic near work to see if I could get some help with this. Unfortunately, it turned out to be a poor choice. The doctor was initially excited about the condition, but after MRI exams and a consultation with a spine surgeon ruled out surgery, the doctor’s interest waned. The next step was a consultation with a neurologist. Now, consultation is a rather grand word for what actually happened. The clinic (they call themselves a hospital, but … uh, no) has a small staff and any specialists are pulled in from the larger Chinese hospitals (genuine hospitals). These specialists do not speak much, if any, English. This meant having an interpreter – the nurse who speaks a micron more English than the specialist. Communication is the biggest obstacle in getting any care for really serious conditions.

After this brief consultation, the neurologist recommended an electromyogram examination. This could not be done at the clinic, so they scheduled it to be done at one of the main hospitals over a month later. This exam was quite an experience in itself. I was met by one of the clinic nurses so that she could guide me to the right place and communicate with the staff. The building was old, crowded, and not well designed for it’s purpose. The narrow halls were crowded with Chinese people waiting to be treated or tested. The exam room was crowded and lacked privacy. The exam consisted of having my leg shocked to test the conduction of my nerves. Being electrically shocked was just as much fun as it sounds. Then they told me they were going to insert an electrode into my muscles. I don’t think anyone was wearing rubber gloves. All in all, I did not get a good impression of one of the biggest and well respected hospitals.

We had summer travel, so it was fall before I went back to the clinic to see what was next. More than once I had to schedule an appointment with the doctor to prod him to move us on to the next step. Ridiculous. When DaddyBird would accompany me, the doctor would look only at him and tell him what was going on as if I wasn’t in the room. I could tell you the nationality of this doctor (not Chinese) and that would explain it, but that would be spreading stereotypes. (Some times stereotypes are earned.) Ridiculous sexism.

Another consultation with the neurologist resulted in a recommendation for a full neurological work up in the Chinese hospital previously mentioned. The clinic doctor was to schedule this. Time went on … I saw the doctor in passing while at a physical therapy session and reminded him. “Oh, yes, next week…” Next week came and went, so I texted him a reminder. Again, no appointment. So, after a month of him not doing anything about it, I gave up on him. By this time, I had breast cancer concerns anyway, so I had to prioritize.

So, fast forward through the breast cancer experience, this spring I decided I needed to get back to my mobility issues. This time I chose to go to the international medical care center that had done DaddyBird’s angioplasty procedures. They had done good work with little hassle. So, after an initial consultation with a neurologist, he recommended I be admitted to the hospital for 5 days to have thorough testing done.

It was a tight squeeze at this time of year because one of my library assistants was leaving for good and I still hadn’t hired a replacement. The end of the school year is approaching, so we are in the midst of getting textbooks back. A busy time.

So, into the hospital I went and the tests began. Another electromyogram, this time done much more professionally and thoroughly. They tested both legs, both arms, and my head. So fun having electrode pins stuck into one’s scalp. They checked my heart, my arteries, my abdomen, my head, my back, etc. On one morning they took 12 vials of blood for testing. All told over the course of 11 days, I think they took 20 vials.

I mustn’t leave out the most crazy test. They didn’t tell me what it was for. I knew I was in trouble when I was wheeled in and saw the machine. It was a chair, not unlike an astronaut’s chair with lots of straps, and it was mounted on a big wheel. They were going to take me for a spin. The technician strapped me in, but not very tightly. My head was secured and black out goggles applied. She told me to keep my eyes open. Then she said that I would be moved quickly, but not too fast. Don’t worry. That is what happened. Unfortunately, she had strapped me in so loosely, that I was banged around in the chair. Not fun for someone with fibromyalgia. I passed the test, whatever it is, but I won’t be joining NASA any time soon.

By day three they confirmed that I had peripheral neuropathy, but cause or specific type was still unidentified. A team of doctors were working on my case, so there was much discussion and different opinions.

Day four was the spinal tap. That is a scary thing to have done, but the painful parts were the local anesthetic shots and the pain after the shots wore off. Also, there was the challenge of getting into a fetal position and holding still. We are just poking into your spinal cord, relax, don’t move.

The tests from that were all normal. That was good news as things like multiple sclerosis would have shown up. Glad not to have that.

By the start of the second week, they decided it was probably Chronic Inflammatory Demyelinating Polyneuropathy OR Vaculitic Neuropathy. The treatment is same for both conditions, so it is a bit moot as to which label we put on it. A 5 day course of IV corticosteroid treatment began. More blood tests, another MRI, and daily exams.

Finally released after 11 days, I will continue to take medications for another month. Will go back for a checkup three weeks from now before summer travel. The symptoms came on over the long term and reversal will take some time. Also, because I have had this condition for so many years undiagnosed and untreated, some of my nerves may have died and there is no coming back from that, so recovery of mobility may be limited. I will take what I can get.

A few cultural notes on being in a Chinese medical facility – English communication is always the big obstacle. Each doctor and nurse has a different level of proficiency. The young female doctor had the best English and was quick with a translation app to make sure medical terms were clear. That was helpful. The rest of my information came from the internet – checking medication side effects, condition symptoms, treatment options, etc.

In China, there is little yielding or waiting for others. For example, people who want to get onto an elevator will wait right in front of the doors and when they open immediately try to push their way in without considering that someone might want to get out and make room for them to get in. The same applied to exam rooms. As soon as the MRI room door opened, my helper had me up and walking in without waiting for the previous patient and helper to exit the room. There was not enough room for four people to pass.

As an inpatient of the international medical care department, I had the uncomfortable experience of being wheeled through a waiting room where about 80 women were waiting for ultrasound tests. I was in and out in about 5-10 minutes. This happens frequently. Foreigners are moved to the front of the line.

Having been through all of this, my recommendation for anyone with a serious illness or a mysterious condition, skip the local “hospital” and go straight to an international care facility connected with a large, well respected hospital. I hope this will be our last experience with major illness. I’ve probably just jinxed us.

 

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Medical Travails part 1

June 9, 2018

Posted by Kanga. Please do not reblog.

bouquet of white and purple roses

You may have noticed a paucity of posts over the last year, or so. There is a reason for that. We have both been involved in medical concerns.

We had a rough spring and summer, then in August,  DaddyBird complained of having a sore throat that wouldn’t go away. Then he noticed that when he was physically active the pain would spread down to his chest. Uh oh, angina. He saw a doctor who referred him to a cardiologist who referred him to a hospital for an angiogram. November and early December involved two angioplasty procedures to clear his blocked arteries.

My part in the medical drama of 2017 actually started in October 2016 when I went in for a routine check-up and a lump was identified in my right breast. Several years ago when we were still in the USA, I found my first breast lump. I freaked and assumed the worst because I have a significant family history of cancer. It took a while to get a doctor appointment, and then due to the joys of HMO medical care, it took another two weeks before I could have a diagnostic mammogram. That lump turned out to be a liquid filled cyst, nothing to worry about, although the delay of medical care gave me plenty of time to think the worst.

This time, the OB/GYN looked at a same day mammogram and said we need an MRI. So I did the MRI. After the MRI, she referred me to the surgeon. I looked at the written reports of both the mammogram and the MRI. They were both vague. “It might be something or nothing.” (That’s not a direct quote.) When I got to the appointment with the surgeon, he had no idea why I was there. The OB/GYN had not communicated anything. #*%($)#*%*! He scrambled around and finally found the written report for one of the tests and said “It’s probably nothing. Come back in 6 months.” I went away quite displeased. The clinic sent me an automated survey asking about my visit. I let them have it with both barrels. I named both doctors and explained how they had dropped the ball and I was not pleased. (I haven’t received one of these survey requests since. Probably threw their customer satisfaction statistics off.)

So … six months later, I go back to this surgeon. He is much more attentive and prepared this time. He gives me three options – Wait and see, Biopsy, and Lumpectomy. I cannot think why I would want to keep this lump and have to be periodically checking on it to see if it has turned against me. So, lumpectomy it is. Let’s just get rid of it. So, May of 2017 the first lump is removed, easy peasy. The procedure is so minimal that I am back at work the next day. The pathology report came quickly and the surgeon said “nothing to worry about.”

Yes, you read right. I said “first lump.” By the end of August I had a second. This time it hurt. Constant pain. Back to the surgeon. They do an ultrasound. I had seen the first lump and the second on the ultrasound screen and they look very different. The first was like a walnut, the second looks like an ominous black cloud. The lump is close to the suture for the first lumpectomy. The surgeon says “not to worry, what has probably happened is that the space where the lump was has filled with liquid, come back in one month.” He gives me ibuprofen for the pain, completely ineffective for pain relief.

So … back in one month, now the surgeon has changed his tune. He consulted with someone who actually understood the ultrasound and it is not fluid. Now he says that the first surgery may have triggered other tissue to grow into a lump.  Once again, my options are – Wait and see, Biopsy, and Lumpectomy. This time I opted for biopsy, thinking it could be done quickly. HA! At this clinic it could only be done once a week on Saturdays, so it was scheduled for 2 weeks hence. Then I got a call postponing it for another week. 3 weeks. After 2 weeks I was laying in bed with my boob hurting so bad that I couldn’t sleep and knowing that it was getting bigger. It seemed clear to me that the surgeon was guessing. I decided a second opinion was needed.

Right before the first lumpectomy, the insurance company had recommended a different clinic with surgeons who specialize in breast health. I had brushed off that suggestion because I didn’t want to delay. I wanted that lump out and it seemed straightforward. Now that things are more complex, I attempted to make an appointment at that clinic. The person who answered the phone spoke only Chinese. So, I tried the website “make an appointment” form, which did not work. So, I contacted the insurance case nurse who had suggested the clinic in the first place by email and asked her to help me make an appointment. She did. (Our insurance company is freaking fantastic.)

In late October, I switched doctors and went in for a biopsy. Since it was supposed to be a simple collection of a bit of tissue, I was awake for this procedure. Once she opened it up, she just took the whole thing out. I don’t recommend vivisection. Not fun.

At the beginning of September the second lump was 2.5 cm. By the end of October when it was removed it was 5 cm. Doubled in size.

It was supposed to take 5-7 working days for the pathology report, but it actually took 3 weeks. A very long difficult 3 weeks. I went back to the original clinic and got copies of all the reports. Now that I had the original pathology report I could see that it said “borderline” not “benign.” The second pathology report finally came and this time it was “malignant.” The report took 3 weeks, but by 2 weeks I already had a third lump.

A third lump.

Turns out I have a rare type of breast cancer. The good news is that it rarely spreads beyond the breast. The bad news is that it tends to reoccur, as I can attest after a third lump.

I found this out only by research on the internet. The main obstacle all along has been language barrier. If one speaks NO Chinese (to my shame) and  the doctor speaks only enough English to get by, it can be impossible to have the kind of in depth conversations that are necessary with major illness.

So, next step, another surgical procedure to collect tissue that had been around the second lump for on-the-spot testing. If it was malignant, the surgery would turn into a mastectomy. If not, I would get to keep my mangled breast. It was a big week for us as DaddyBird was to be in another hospital for his second angioplasty. He got me settled into my hospital and was there when I came out of surgery, but then was off to his own hospital experience. Different hospitals, so we communicated via chat and video call. We were both released on Friday.

The results of the third surgery – removal of the third lump and the test of the neighboring tissue was not malignant. Two boobs enter, two boobs leave.

With exactly one week between release from the hospital (for both DaddyBird and I ) and our flight to Prague for Christmas with BabyBird, we tried to leave the stress behind and enjoy the holiday.

In late January, I had a post surgery ultrasound in search of lump number four.

Surprisingly and happily, there is no lump number four. So far, so good.

So, now you know why I have posted so little of our adventures over 2017.

Medical adventures continue …

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Oliver the Loud, Eater of Steel Wool

November 16, 2014

Posted by Kanga. Please do not reblog.

You may have noticed that there has been a nearly month long gap in posting to this blog. One reason is that we were a bit preoccupied with our dear cat Oliver who had major surgery. He is quirky, funny, loving, charming, and loud, but he is not the smartest penny in the coin purse when it comes to aluminum foil. He thinks it is tasty, so we endeavor to keep it out of reach. This has worked for over five years.

Unbeknownst to us, there was a steel wool scrubber lurking under the kitchen cupboard, left by a previous tenant. Oliver found this one day, proceeded to play with it quietly in the kitchen, tear it apart and eat some of it. Long story short, this resulted in a three inch piece of steel wool becoming lodged in his intestine. The answer to that was major surgery to remove it.

white cat with plastic cone and belly suture

Surgery always carries the possibility of not making it through, so we worried a bit. After surgery, there was the possibility of infection, so more worry about that. There was also the ridiculous number of pills we were supposed to shove down his throat. If you haven’t tried to administer pills to a cat, count yourself lucky. By the second week, he became complacent enough to swallow them without too much fuss.

As with his experience in quarantine, Oliver was majorly stressed just by being in the vet clinic, so they resorted to giving him Valium just so he would relax enough to eat food. Once he was home again, he was much happier.

man with white cat laying on his shoulders

DaddyBird had to play nursemaid for two weeks – minding feedings, litter box activities, medications, and supervised “baths”.

Happily, it all worked out and Oliver is back to his old self. He was in the vet clinic for five days. The interesting by product was seeing how lost Bert was without him. We have always assumed that Bert puts up with Oliver, but he was very lonesome without his buddy. Everything is back to normal now, for both.

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Sohailia, How I Miss Thee

October 24, 2013

posted by Kanga. Please do not reblog.

There is one more American thing we miss — good dental care. Specifically, good preventative dental cleanings.

En Amérique un dentiste au travail [soignant un molosse] : [photographie de presse] / [Agence Rol]
En Amérique un dentiste au travail [soignant un molosse] : [photographie de presse] / [Agence Rol]
Source: gallica.bnf.fr

We were spoiled by Sohailia. She was such a good dental hygienist that I looked forward to my cleanings. With her range of picks she would carefully clean each and every tooth with such a light touch that it tickled. She would examine each tooth for problems and evaluate the state of the gums. When she finished, she would report to the dentist any and all problems that she observed.

American dentistry is amazing. It comes complete with guilt trip. You can count on being asked how often you brush and if you floss. If you admit that you don’t floss, you’ll get a little lecture about how important it is. The last time I was at an American dentist office, they took a swab of my mouth and showed me the bacteria from my mouth under a microscope to try to shame me into spending more effort on my oral hygiene.

They also go to extreme lengths to retain teeth. I had the root canal done in one tooth three times before a dentist finally admitted that the whole thing had to go. The truth is that I would have been a lot healthier if it had been extracted instead of remodeled.

In the UAE, dentists are everywhere, but hygienists are few and far between. Every “cleaning” I’ve had so far has been done by the dentist with an electric powered tool. This cleaning tool experience is unpleasant, at best. It sure doesn’t hold a candle to Sohailia’s light touch.

The first two dentist experiences I’ve had in the UAE were unpleasant. I specifically requested anesthesia for any drilling to be done and the dentist blatantly ignored this request. I did not go back for more. Our insurance makes it even more annoying, because everything has to be preauthorized, even diagnostic x-rays. So, the first visit is a bit of a waste, because nothing can be done unless you are willing to pay for it out of pocket.

I seem to have finally found a good dentist. The cleaning still involved an electric power tool, but I survived. Before working on fillings, she asked if I wanted anesthesia and then actually gave it to me. Hoorah! She rebuilt a broken tooth rather nicely.

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Whole 30 Diet

March 5, 2013

Posted by Kanga.

small pumpkin

For the last month I have been on the Whole 30 Diet. It boils down to no dairy, no grains, no sugars or sugar substitutes, and no alcohol. I’ve been eating meat, vegetables and fruits.

pork chops, gingered carrots, red cabbage

The main purpose of this diet is to improve health. We learned of this from my mother-in-law whose testimonial can be read here. I have to admit that weight loss was the main motivator for me. However, I was tiring of the increased fibromyalgia, and painful muscle cramps. My blood pressure had been high and the doctor had placed me on medication for it. I was more than ready for better health and less weight.

lettuce wrapped tacos

The diet is actually very easy. It is just a matter of what is eaten, not how much is eaten. I stuffed myself plenty of times with yummy food and still lost weight. The only thing I truly longed for was chocolate.

plate of chicken livers

The result of one month is that I’m 13 pounds lighter. I don’t wake up with muscle soreness. I’ve had very few muscle cramps. My blood pressure is nice and low.

I’ve added chocolate back in, in moderation. It is organic dark chocolate lightly sweetened with raw cane sugar. The diet continues and we’ll see what happens.

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A Balance of Patience and Persistence

October 31, 2012

Posted by Kanga.

Part of me wants to sing the praises of health care here and say it is much better than back in the States, but that isn’t true. It is just different. It has different challenges and different advantages.

The big advantage is being able to be seen right away or at least same day. You may have to wait awhile, but they will get you in. This is in contrast to the States and having to call for an appointment, that, if you are lucky, is a week away or waiting until after 6 pm so you can go to “urgent care.” (Nothing quite like having a urinary tract infection and they want you to wait a week to see the doctor or having a lump in your breast and having to wait two weeks before you can get a mammogram to determine whether it is benign or killing you.)

The most prominent challenge is that you have to be both patient and aggressive to get what you need. In the States, clinics and hospitals are very structured and have built in barriers to keep the patients contained and controlled. There are several layers of employees between you and the doctor and their job is to make sure you stay in line. It is very clear where the “public areas” of a clinic are versus the inner sanctum of the exam rooms, labs, etc. There is a certain organizational benefit to this structure. Patients wait their turn, get treated equally, and know their place. There’s a certain comfort in that. It involves a great deal of patience and NO aggressiveness. Aggression is frowned upon.

There is a semblance of this structure here, but not the reality. There are receptionist desks, waiting rooms, nurses, etc., but none of them pose a barrier to waltzing into the exam room unannounced. In fact, the receptionist might tell you to go straight to the radiology department and ask them to perform your test without a doctor’s involvement. Of course, the radiology department will send you back to the receptionist, because you don’t have a health card and they can’t do anything until you have a health card or a number in their system. The doctor may examine you, then send you off to radiology and the lab for tests and tell you to just come back after you finish there and she means “just come back to the exam room and come on in.” I knocked and waited, because some habits cannot be shed so easily.

There will also be a dearth of signage, directions, and clear communication. When sent back to radiology for the third time to insist on getting the test done today, not next week, and dropping the name given by the doctor of the person who said the test could be done today, you may be waved on in a general manner down the hallway with no real indication of where to find this person who will do the test. So, after knocking on doors and asking random people, you join the collection of patients waiting in the makeshift waiting area and hope for the best. When someone new comes along and starts shaking hands and maneuvering for his wife to be next, you have to step up your game and make sure you get in next. After the test is done, don’t expect the technician to politely tell you that the test is done and that you can get dressed now, but she will act surprised when she finds that you are still laying on the table because she hasn’t told you. When you ask if there is paperwork that you should wait for, she will give you a vague answer which leaves you waiting outside the door hoping that it is not for naught. When you go to get your blood drawn for tests, there won’t be good signage or a reception desk. You are supposed to just poke your head in the rooms until you find someone willing to take your blood.

Then it is back to the doctor for the wrap up. Finally, you are given medication prescriptions and can call it a day. It only took from 9:00 a.m. to 12:33 p.m.

We had to go to the government run clinic because the private hospital didn’t have the staff on duty (holidays) who could do the ultrasound, so our insurance didn’t count. Out of pocket expenses: 200 AED to get a number in the system, 80 AED for the blood tests, 100 AED for the ultrasound. ($103.50) Prescriptions purchased at a RX across town – 187 AED ($51.00). I am fairly certain you could not get all that for $154.50 in the States.

black and white blurry images

The upshot is that there is no deep vein thrombosis, only a minor infection. Back to business as usual.

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Medical Care

April 10, 2009

We went to see a doctor last evening in hope of getting some of Daddybird’s prescriptions renewed. The particular drugs are not easily available here. The doctor actually got on the phone and called three or four pharmacies to ask if they had what Daddybird needs in stock. None of them did. It was fun to hear the doctor complain to them in Globish — “What to do for the patient? What kind of country is this?” So, we have the prescription orders and just have to find a pharmacy that can supply them. We will probably have to drive to the predominantly “Westerner” side of town to find these in stock. Maybe one of the big resort hotels will have a pharmacy with a supply. What fun.