Thursday, February 27, 2014

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, 


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