Background:
On March 5, returning from Ghana, I incurred a major problem with my right foot that caused substantial pain and swelling, and prevented me from walking. While not initially sure what the situation was, going to the Emergency Room and talking with my primary care physician we were able to confirm over a 10 day period that I had incurred what is called a major gout flare-up.
Very little information was given to me by either medical source related to this situation. Doing my own research, I found out a lot more about gout (it relates to the buildup of uric acid crystal in one’s joints) and its treatment. Further, when I added information related to having a single kidney, the information and cautions related to standard treatments for gout were significant. I settled on a change in behavior related to what I was eating, hydration, alcohol consumption, and periods of foot elevation. This allowed me to reduce the flare swelling substantially, and return to normal walking. I managed the long flight to SE Asia with no deterioration of condition.
Arriving in Medan and discussing the situation with 2B and #2, 2B did further research. This lead to an identification of inter-connectivity between kidney functionality and the occurrence of gout flareups. In short, one can have positive and/or negative influences on the other. This led to a conclusion on my part that I needed to deal with this issue in an integrated fashion.
At this point, the Pu Lee Shah clan adults strongly recommended I take advantage of the Bumrungrad Hospital in Bangkok. It is the ‘go-to’ place for high quality medical treatment for Americans in the Foreign Service in SE Asia. In evaluating this as an option, we discussed the advantages of the speed of medical evaluation and recommendations, and the high likelihood of being able to get the desired integrated advice. Neither of these (speed nor integration) were very likely to happen back in Albuquerque. We made a reservation for me (using #2's top notch assistant) for yesterday.
Report on the Hospital Visit:
As Wife and I wanted to disrupt our stay in Phuket as little as possible, we decided to go up and back to Bangkok the same day. We were able to make very affordable reservations on Air Asia, leaving Phuket at 7:30am, arriving Bangkok at 8:50am, and returning leaving Bangkok at 7:55pm and arriving 9:10pm in Phuket. It takes an hour to get to the Phuket Airport from where we are staying so we were out of the door at 5:30am. I had allocated 2-hours to get from the airport to the hospital and due to traffic and construction we used up all but 20 minutes of that.
Here was my schedule at the hospital (Wife also a consultation during this period as well).
· 11:00am - Register as new patient with the hospital. Get confirmation of all your appointments.
· 11:30am – Blood taken for lab work
· Noon – Ultrasound of kidney, bladder, and prostate. Urine sample taken for lab work
· Between Noon and 1pm – Grab some lunch at hospital snack area
· 1:00pm – Consultation with Nephrologist (kidney specialist). This was delayed a bit because it took longer to get the urine lab done.
· 3:00pm – Consultation with Rheumatologist (joint inflammation specialist)
· 4:00pm – Check out and pick-up prescription
By 4:30pm, roughly 5 and half hours after we arrived, we were done. We were able to catch a Grab rideshare back to the Bangkok airport within minutes and the ride there was only 20 minutes. We were so early, we were able to book a seat on an earlier flight and got back to Phuket at 7:30pm which was earlier than the time we were to leave Bangkok originally. This was good because we were beat. I had communicated with our transfer service and were able to get it changed. We got back into our rental at around 9:21pm and collapsed.
Report on the Medical Findings and Recommendations:
The most important information I sought from this hospital visit was a thorough evaluation of my kidney function. Prior to the donation in 2008, I had been told I could expect my remaining kidney to deteriorate at a small but steady rate after the operation. In fact, such deterioration is the norm for all aging people. However, if you only have a single kidney, and have decreased your overall kidney function capacity, that deterioration might be more meaningful. At the time, I didn’t think much of it as the period projected seemed a long ways away. Oopsie. That time has arrived. 😬 While we have tracked certain kidney performance markers consistently, this is the first time since the donation that I have had a Kidney Specialist actually do a full examination. What he found and reported was as follows:
· Overall, my kidney function is working reasonably well.
· It physically shows no signs of deterioration.
· It is doing the job it should be doing in terms of recycling proteins (one of the two primary functions).
· However, its overall filtering capacity (taking the bad things out of your blood) has diminished. It has gone from ‘good’ (where it was when I donated) to ‘borderline watch list’.
· I won’t bore you with the specific metric but the ‘low risk’ range goes from 60 and up. I am at 59.3, so just barely in the ‘increased risk’ category.
So the overall diagnosis is that I would be advised to be careful with my diet and make sure I am hydrating to decrease the stress on my kidney. And this means being really careful with any drugs that I might use for the gout that are hard on the kidney. However, decreasing the incidence of gout would take pressure off the kidney as well. A conundrum.
So then it was on to the consultation with the Rheumatologist. Here is where the decision to do this at Bumrungrad really paid off. The doctor had the results from the kidney specialist. She went into great detail as to the affect of high uric acid in the blood, how it comes about, how it affects gout, and how it interrelates with the kidney. In her opinion reducing the uric acid count in my blood was a prime objective both to control the gout and help the kidney. She recommended a course of medications tailored in dosage by starting lower than normal to gauge the results and make sure I was not suffering any ill side effects.
She has scheduled a tele-medicine follow-up in April. I will need to get blood work done prior to that meeting and sent to her.
Some Conclusions:
Like any visit to a new system, especially one not in your home country, there were periods of confusion. But nothing really bad. The ability to get all of this done in five and a half hours really boggles the mind. Plus the almost seamless integration of the kidney specialist with the gout specialist was exactly what I had hoped for and was exceedingly skeptical that I would get in Albuquerque. I got adequate time and information that allowed me to make reasoned choices. I found the conclusions and recommendations to be balanced and relevant.
Initially, I told the gout specialist that I would be looking for someone in the U.S. so I had better access ongoing assistance. However, as I have reflected, this doctor is going to be looking at lab work and adjusting medication appropriately. Is that something I need physical access for? I am inclined to continue working with her and this hospital for at least the next year. There is an excellent chance we will be back in SE Asia next year and I would have the opportunity to do another check-up to see how things are progressing.
I’ve mentioned the time efficiency working with this hospital. A comment on costs would be appropriate. The total cost for my visit was $1,030. Of this the actual charge for the doctors time was $320. The remainder was for the lab work, the nursing, other personnel, and the drugs prescribed. It is true that I could have gotten most of this done paid by insurance (maybe, if it was all approved) at home, but it would have taken me months to get the appointments and as mentioned previously, I am not sure at all about having the advice integrated. I very much appreciated having all of this done super-fast and efficiently.
