Umbilical Hernia Repair - Chapter 1 - The Happy Beginning

This story started 10 years ago, give or take.  I was in Tampa Florida and managed to tear my stomach wall at the Umbilical area creating a very small hernia.  Over the years I ignored it, was told my doctors it wasn't important and that I could repair it, or not.  On a couple of different occasions I managed to strain myself in such a way as to increase the rip.  The last time I did managed to increase the tear was just three weeks before the surgery had been scheduled.  The last tear hurt and quite frightened me, but the surgery was already scheduled so I didn't panic.  Looking back, I really should have had this repaired before I moved to Thailand.  I had opportunities and access to military hospitals in both El Paso and San Diego.  It's so easy to look back and see what we should have done, isn't it?

On 21 June 2013, I received a complete physical at Rajavej Chiang Mai Hospital.  Everything was fine except that my platelet count was very low at 31,000.  When I went to review the results with the doctor I was left with the impression that it wasn't a critical thing; that in all likely hood it had been caused by some infection, or perhaps a case of dengue fever I had some time before.  He prescribed a regiment of anti-biotic and had me come back a couple weeks later.  On the 2nd test the platelet count was a bit better but still low.  The doctor was not at all concerned about the results.  Foolishly I took his lead and promptly forgot about the matter.  Today, I don't blame him, I blame myself for being apathetic about something as important as my health!  Please, gentle reader, be smart, understand the results of you medical tests, stay out of denial and don't be afraid to ask questions.  The real issues here are your health, quality of life and life itself your life!

A month ago, give or take a few days, I made an appointment for a consult to get my hernia repaired.  My surgeon is a Doctor Ekachai Paiboonworachat.  He's great!  His name fails miserably in my spell checker so from here till the end of this article let's just call him Doctor P.

Yesterday, I checked into Chiang Mai Ram Hospital in Chiang Mai, to have the umbilical hernia repaired, finally!   I'll talk about the comparative levels of care in the final chapter.  For now let me say that I went to Chiang Mai Ram primarily because they have an attractive relationship with my insurance provider,  Tri-Care for life.  The level of care I received, the professionalism, the compassion, and even the ambience is far above all the other Chiang Mai options.  More on all of this in the final chapter.  Maybe I'll call it "Lessons I learned  - Hope they are useful"

Pre-op included blood work, and Electrocardiogram and a chest x-ray.  Every thing was fine except for one thing.  Doctor P. came to my room a half hour before we were scheduled in the operating room and told me the surgery was being cancelled because my platelet count was a mere 38,000.   He went on to explain that normal would be between 150,000 and 400,000.  Platelet levels as low as mine put a surgical patient at risk because of the bloods inability to coagulate.  In other words incisions would be very slow to heal creating several dangers.  The good doctor took his time and explained all of this to me and then told me he was turning me over to the Hematologist , Doctor Tamatorn Thamprasit.  Again, for simplicity, I'll refer to him as Doctor T.

Sure enough, Doctor T. came by an hour later, introduced himself, asked a battery of questions, answered the ones I could think to ask and prescribed extensive blood work.  Soon after, a couple of nurses came by and drew a large vial of blood.  A couple of hours later Doctor T. returned to let me know that my liver, kidney and all such were fine, and that I have no infectious disease.  However, my platelet count had dropped from 38,000 to 31,000.  There is no obvious reason why the platelets are being killed off like soldiers serving under an incompetent general.  Maybe the problem is the bone marrow is not producing platelets in normal abundance.  Doctor T. told me to stay overnight and in the morning he would take some bone marrow and perhaps do a biopsy. 

Early this morning both Doctor P. and Doctor T. came to see me.  As they were asking about my situation and my spirits, I was really impressed with there true compassion.  These gentlemen are really great people;  I truly like them both.   Doctor P. made sure I understood there would be no elective surgery until the platelet mystery was solved and the solution a success.  Doctor T. promised he would come back and do the bone marrow aspiration in another hour. 

An hour later he returned and tried the aspiration at the base of my spine.   That didn't go well, not sure why.  I can tell you the local hurt like hell.  Doctor T. quickly changed his mind and did the procedure at the sternum.  That's wasn't too bad at all; more painful that typing on my Nexus 7, but not much. Those interested in details about these procedures are invited to google "Bone Marrow Aspiration" .  I will tell you that as I write this, perhaps 11 hours after the procedure, I've had no pain from this procedure since the moment it was over.

Doctor T. came back a couple hours later and reported he had found nothing abnormal in my bone marrow.  He did say he was sending off for a couple of lab tests, but he suspected they would be negative as well.   So there is almost certainly  nothing wrong in my bone marrow that is preventing the production of platelets and there is nothing obvious that's killing the little suckers.   I suggested that it might be a result of the dengue fever I had a couple of years ago.  Not at all likely was his response.   It would be easy to slip into denial or even apathy but Doctors Ekachai Paiboonworachat and Taratorn Thomprasit will have none of that nonsense!   Chapter 1 draws to a close as a happy beginning.  I have an appointment with Doctor T. on the 10th of March to discuss the results of the lab tests and to discuss solutions.  The 2nd chapter will be posted after that appointment.   Until the, gentle reader, if you have a medical issue, get it taken care of now.

Abundant Blessings, 

Jerry 

Lanna Care Net to the Rescue!

Some time ago I became aware of a small organization called Lanna Care Net.  Their basic mission is to help old foreigners who are in trouble in Chiang Mai province.  The vast majority of their clients have a serious medical condition, some at the end of life, and most are without sufficient resources to cover the costs.  I applaud their structure, organization and efforts.  They have an extremely low budget, just simple operating and transportation costs really.  The officers take no compensation.   What they do have is extremely good credibility within the Thai and ex-pat communities.

Lanna Care Net (LCN) is appropriately named.  One of the definitions of Lanna is Northern Thailand.  Care is what they facilitate.  Net is short for network, and that's what they really do the most and the best.   The organization has no paid positions, no company cars, or big offices. The composition is that of compassionate people networking to help those in need.  Their mission is really two fold:  First they provide assistance to aging foreigners who are in trouble, usually people with insufficient financial resources to deal with serious medical conditions.  They lighten the burden of the hosting Thai community by helping their clients understand what is possible within the Thai health care system.  

LCN finds resources, both local and ex-pat, and facilitates their clients interaction.  Notable is another volunteer organization called Cancer Connect, the consulates from various foreign governments especially Great Britain and the United States, Alcoholics Anonymous, various churches and of course most of the health care facilities in the province.

They regularly coordinate with air-lines to facilitate transport of patients as well.

To describe what LCN is about let's look at it three ways, NO, YES, EXAMPLE:

NO:

• LCN does NOT provide financial assistance.  However, in many instances they can and will assist a client in obtaining emergency financial assistance.
• LCN does NOT provide health care.  They do advise clients on appropriate nursing and medical care.

YES:

• Facilitates care through liaison and cooperation
• Advises clients on their options

• Trains volunteers

• Advises and educates the community on how to avoid problems associated with aging.

EXAMPLE:  There are many, this one I know because the man is a dear friend of mine.   Jim has a degenerative condition in his spine, I'm not sure of the exact diagnosis, but I do know that he has had back surgeries in the past.  For several years ago he has been comfortable and physically fit.  He even made the 490 mile Camino de Santiago Pilgrimage  last summer.  Several days ago he found himself with excruciating back pain.  With the help of some friends he was admitted to the Chiang Rai hospital where he languished for a week.  Chiang Rai hospital acknowledged that they did not have the expertise to help him and suggested he go to Chiang Mai University hospital.  The best specialist would be there every Tuesday he was told.  He was also told that the two hospitals were networked.

The next Tuesday morning Jim came down to Chiang Mai by ambulance, arriving about 8:00 a.m.   The hospital had no idea that who he was, or why he had been sent to them.  They had zero communication from Chiang Rai.  Another friend stayed with Jim most of the day while the hospital tried to figure out what to do with him.  I even went and relieved Steve for part of the time.   Finally, after an ordeal that might be good background for a fictional work, he was admitted to the hospital around 5:00 pm.

I called LCN on Wednesday to give them a heads up.  They had already been notified by the hospital that he was there and were on the way to assess his situation.  Thanks to the credibility LCN brought to the case, Jim was able to get an MRI and other needed treatment without having to pre-pay.  On Friday the results of the MRI were known and the orthopedic spinal specialist  saw Jim and presented him with his options, which frankly are very few.  Jim has choices to make.  In the meantime LCN was researching  various options.  

What came to light was the fact that Chiang Mai University Hospital was ill equipped to handle Jim's case.  Not surprising when you learn that his medical condition was so complicated that the Mao Clinic had him as a study case.  His back problems started with a viral infection in his spine. That was over 30 years ago.  His February 2014 MRI pointed multiple problems with his spine.  After a week it was decided the best course of action was to return him to Chiang Rai hospital for physical therapy and work on sending him back to the United States.

Jim is a guy with a big heart and a great attitude.  His friends and family were very supportive.  They marshalled by his bedside to give support where they found themselves often laughing at Jim's humorous stories.  When he was in the orthopedic ward at CMU hospital, he established a goad of making all the other patients smile.  He succeeded!  He even made them laugh, but the "enema story" is best kept for another writing.  The bottom line is that as he laid in a hospital in terrible pain, not speaking the language and being attended by people who had great difficulty understanding the specifics of his condition, he was concerned for the other patients.  I'd go see him and maybe the pain he was suffering was apparent, but the moment he'd see me, especially if I had a camera, he would light up.    He has the best attitude of anyone I've ever seen in a hospital setting.  The great attitude was not enough to keep his problems at bay.  He needed health insurance and a degree of financial solvency.

Jim being visited by Maliwan.
They made each other smile! 

Some friends raised money to defray his medical costs, coordinate transportation and provide conveniences.  In the middle of  fray I noticed the volunteers from LCN working quickly and efficiently to provide suggestions for the best options.  They accomplished several things that simply could not have been done without them:

LCN negotiated with CMU to allow Jim medical testing, including an MRI without pre-payment.  Then on discharge from CMU hospital LCN negotiated a 20% discount.

LCN was instrumental in allowing Jim and has family and friends to understand the medications prescribed, and in convincing the Thai doctors to prescribe appropriate dosages.  They also made sure that Jim knew what meds he had and when he should be taking them.

A wheelchair was provided for his use while he was still in country.

LCN coordinated with the airline, friends and family to make sure that Jim's trip back to the United States was as comfortable as possible. 

Jim at CNX - Wheels up minus 3 hours

The nurse gave me this.  Maybe the bear can help me know it's meaning! 

Frankly, it doubtful that Jim would have been able to get back to the United States to receive the treatment he needs if it hadn't been for the good work of the LCN volunteers.  When I gave LCN a heads up that I would be writing this they asked not to mention their names, just provide the phone number and website.  In keeping with this request, I'll simply say thank you three angles, two in Chiang Mai and one in Chiang Rai.  You have been instrumental in improving the quality of life an reducing the suffering of my dear friend Jim.

Lanna Care Net makes it blatantly clear that they DO NOT want you to be their client.  They don't want anyone to be their client.  The truth is that there are many people here who need or will need their help.  They make suggestions that as an ex-pat getting older in this country, I am taking to heart.  LCN will be happy to advise you on any of these points which include:

1. Execute an Advanced Health Care Directive.    Do you want someone to guess what you might have wanted if you were not able to communicate?   The Thai doctors will honor these directives and welcome the guidance.
2. Establish a relationship with a primary care physician.  There are many reasons for this, not the least of which is having some one who knows you who can prescribe pain medications as needed.  -- Jim had not done this! 

3. Purchase health insurance ( or at least personal injury accident insurance) and put some cash away for emergencies.  Many ex-pats are here because they simply can't afford to live in their home country.  Many live month to month here.  WE need to have health insurance and we need to put away some money for emergencies.  Unless you have health insurance, most hospitals will not begin to treat you without an initial deposit of at least one-half the anticipated amount of your entire bill!  -- Jim was uninsured, without Lanna Care Net's help negotiating with CMU hospital it would have been much worse! 

Lanna Care Net can be contacted at +66 85-709-8801 (085 709 8801) and at www.lannacarenet.org

This was sent by email from Jim's sister 20 February at 5:05 am Bangkok time.

Jimmy arrived on time and safely.  The transition went smoothly.  However, our experience at the hospital emergency room could have been better.  The attending Dr. was reluctant to perform tests or admit him to a room.  He suggested that we go to a facility that had neurosurgeons on staff.  Finally xrays, and bloodwork was done and they have a MRI scheduled for tomorrow afternoon.  They did end up putting him in a room for the night.  Jimmy is exhausted and broke down once.  Things seemed to pick up after I made a call to Hospital Social Services.  I just spoke with her and we are getting together tomorrow to discuss Jim's condition and options for us.  I feel so badly for him!  I am doing research on neuro-specialists in a 100 mile radius.  The xrays revealed extreme degenerative disc disease, but he already knew that.  Hopefully the MRI tells us more and will warrant a longer stay so he can be transferred to a facility where intensive physical therapy can begin to work for him.  Will keep you all posted.  Love.  Joy