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.
