Author: jbeech258

Aš išgyvenau!

Here I am! A full thyroidectomy in a foreign country so little-known it is unsupported by PayPal, and I join you here today. This has been an incredible learning experience. I’ve already shared in a previous entry about the cultural education we’ve received, so here I want to share with you my newfound wisdom on what it takes to actually get through a serious planned medical procedure in an unfamiliar place. I say planned, because of course, emergencies happen and there are many items on this list that one would simply have no control over if merely adventuring with no expectation of poor health. If you’re like me, poor health was the entire cause for the journey.

THE BASICS – A few things to ask yourself about choosing your destination

  • Pick a country where you are most likely to be able to communicate with the people around you. Not only will you need to navigate in your new environment, but you will also need to schedule appointments, tell hospital staff your basic medical history, and how you’re feeling before and after the procedure. Many people in the medical communities popular for medical tourism (Mexico, India, Thailand, etc.) do speak English, but not all of them. For example, both my surgeon and anesthesiologist spoke enough broken English to understand the basics of what was necessary for my procedure, but the nurse in charge of me immediately upon waking from anesthesia spoke NO English. Lithuania, as a former Soviet republic, has a greater population of Russian speakers. Even in a stupor, being able to mutter enough Russian to her to express how I was feeling saved me a great bit of discomfort. Things may have turned out differently still if she had only spoken Lithuanian, because my grasp of this language still sits somewhere around that of a toddler’s. If you still only speak English, I’d recommend picking a second language and starting to learn today. Seriously. There are so many free phone apps. Any language you’re curious about. Go for it.
  • Pick a location where procedures like the one you need are done frequently. The statistics on complications from nearly any surgery go down significantly when the surgeons have a greater amount of experience. This doesn’t necessarily have to narrow your choice down to one specific clinic or hospital, but consider the rate of occurrence in the region you’re looking at, as well as any genetic relationship you might have with the native population there. Anything that is more likely to occur in the native population has definitely been seen more times by the doctors that live there.
  • Find a list of medical facilities and/or doctors there and start reading reviews. When you feel like you’ve found the good ones, reach out to them. Tell them what you are looking to have done and within what time frame. They will let you know if and how soon it’s possible. I recommend reaching out to multiple facilities if you find several you’d feel comfortable with. This will allow you to gauge their level of comfortability and communicability. Now you can cherry-pick the best one. Keep in mind, it’s rare for any hospital or clinic to respond to someone immediately. I reached out to about 4 different hospitals and clinics in Vilnius, and their responses ranged from 3 to 10 days after my emails.
  • You received your responses, you picked the best one, and they’ve told you when they can make your first consultation. You’ve emailed them back now and scheduled your first appointment abroad. You did it! The next step is essentially the same as booking a vacation with just a few caveats: how long in between your consultation and your procedure? How long will you need to recover afterward before being able to safely travel home? How likely is a complication to delay your return? A mistake I made when booking my trip was to book a return flight date without really knowing how long the gap between consultation and surgery would be. It caused me to incur fees when I had to change the return date, and also put a greater amount of time pressure on healing afterward. If I had booked my return flight after my procedure, I would have had a better feel for the complications that presented themselves after my release and given myself an extra day or two before flying back. My first two nights’ stay outside of the hospital post-surgery were in a hotel room, after which we moved back into our AirBnB. My personal preference was for the AirBnB for comfort and affordability, but arguments could be made about the benefits of having a clean hotel room and room service. If you do choose an AirBnB, check on their cancellation policies and overbook your days, just in case. I looked for a place where pets were not allowed, simply on the basis that it was more likely to be a cleaner environment post-op. It’s also important to consider floor level and accessibility when looking. Booking a flat on the 4th floor of a building with no elevator would not be the move for someone getting a hip or knee replacement.

Once you’ve booked your flight and accommodations, you’ll have some time before your departure to practice your language skills, pull up a map of the area, and research a few of the NOT SO BASICS:

  • If you choose to stay at an AirBnB, chart out nearby grocery stores and make a plan for when and how many groceries you’ll need to purchase to keep yourself stocked for a sufficient amount of time before and after your procedure. Buy enough before your procedure to nourish yourself beyond any possibility of complications. Learn about any dietary needs specific to your procedure. In my case, we needed to look for foods rich in iron and calcium to keep anemia and hypocalcemia at bay. Keep in mind the logistics of transporting your groceries back to your lodgings. The last thing you want is to feel unwell and need to force upon yourself the added strain of making a grocery run.
  • If you choose to stay at a hotel, take a look at room service policies and prices. Does the room have a refrigerator for you to save food, or store your own outside purchases? You’ll also want to look at any of the restaurants nearby. Make sure you’ll have access to NUTRITIOUS food. Recovery on cheeseburgers, while not impossible, is not advisable.
  • Look to see if there is any type of food delivery service available in the area. If something goes wrong with your previously laid food plans, these can absolutely save you until you’re able to make other arrangements. At home, these are services like UberEats or GrubHub. In Lithuania, there is a similar service called Wolt. We did not need to use them while we were there, but it was a great comfort to know we had the option.
  • As you can see from the previous three bullets, food is pretty important. But, you’re there for a medical procedure and that means so is medicine! Find out which pharmacies exist between your clinic and your lodgings. Note the differences in the days and hours they’re open. A pharmacy closer to a more highly populated area is more likely to have a greater variety of medicines on-hand. Read their reviews. Pick your favorite, and then pick a back-up. Then pick another back-up, because you have no way to know that your first two choices will definitely have what you need.
  • After your procedure, you’re going to have some downtime. You can sleep through a lot of this, but you’ll need something to occupy your mind with when you’re awake. Depression and anxiety are common after surgical procedures, and sitting in a room with only your thoughts to yourself for days could actually drive you crazy. If you’ll have internet access, you might be able to stream movies to watch, but just know that not all streaming services are available worldwide. In Lithuania, Netflix worked, but Hulu, Youtube TV, and HBOGo did not. These will be different everywhere, so check with the providers before you go. Books and games are a good fallback if you won’t have internet access, but they will take up real estate in your luggage. I’d suggest a pack of cards as a back-up, because in this case having something is better than nothing.
  • Look up the local policy on the heating and air conditioning for housing if you’re staying in someone’s house or apartment. In some places, these things are controlled centrally rather than in the individual units. If the weather in an area is unusually warm or cold compared to normal, the local governments are unlikely to deviate from their standard policies on climate control. For me, this meant that our apartment had no heat available during the coldest spring Lithuania has seen in ten years. Check the weather forecasts and pack to be your most comfortable.

My final words of wisdom here are to bring a buddy. I was lucky enough to have my father join me on this trip, and I can only imagine how much more stressful it would have been to have gone alone. If you’re world-wise and used to the ups and downs of a new place, depending on the severity of the procedure, I think one could do this without the help of another person. However, I don’t think anyone should go it alone. Any trustworthy person to have your back in a strange situation and offer another perspective outside of your own is a plus.

Thanks for reading yet another blog entry! I’ve got just one left after this to discuss the real breakdown of how much it really cost for me to do all this. For anyone with more curiosity about how my thyroidectomy went, scroll down for a picture of my new permanent smile (not for the squeamish).

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Smile!

Viskas bus gerai.

As I’m writing this we are winding down our eighth day in Vilnius. We are about halfway through our journey here. Today though, was the final day of our “vacation”. Tomorrow begins the medical treatment portion of our time here, and the remainder of my time here will be used to heal. Before I go into detail about my upcoming medical procedure, I want to reflect a bit on how our time was spent.

I’ll gloss over the typical vacation stuff. Of course my dad and I are going to bed and waking up whenever we please. We try one new restaurant a day, but otherwise have bought groceries to sustain ourselves. Eating out is less expensive here than back home, but making your own food in a kitchen anywhere will always cost less. Our apartment does not have a microwave, and learning to use the gas stove and oven has been an enlightening experience on its own. Pun intended. My advice: do not rest the matchbox on the oven door. The stress of putting a flame to gas will make you forget it exists, and when you close the door… whoops! We were lucky it landed somewhere other than the open flame. Sorry Birute! Birute (bee-ROO-tay) owns the apartment we’re staying in, and she has been a most gracious hostess. She even spent a full day driving us through the countryside and taking us to see some very majestic sights:

A view of the Neris River from the Gediminas Tower.
Galve Lake with Trakai Castle in the distance. One of the many glacially formed lakes in the area.
The hill forts of Kernave, a UNESCO heritage site. The former home of King Mindaugas, leader until 1263 AD.
Our hostess and I shortly before ascending one of the hills. The dark line you see to the right of the hill behind us is actually a staircase to the top. It was a tough climb, but worth the view. Photo Credit: Darryl Beech

As you can see our days have been filled with abundant sunshine. Pretty good for a land that’s actually named as such because it rains so often (Lithuania refers to itself as Lietuvo; their word for rain is “lietus”). There was a whopping twenty percent chance of rain today, so we spent a bit of time indoors at the Zoopark. There they gave ample opportunities to feed some of the animals (rabbits, big fish, birds, guinea pigs) and I was delighted to find that they did not think it necessary to cage either their lemurs or tamarinds. Imagine never having been allowed to touch a monkey and suddenly being in a room with ten or more of them climbing around you as they please. I know the sign said “Don’t Touch”, but did I pretend not to know? You bet, and I have no regrets.

This trip so far has been fantastic, and whether or not it counts as a true vacation does not change the fact that these memories will last me for the rest of my life. In addition to seeing more of the world, I’m thankful for the friends we’ve made here. Somehow, when choosing this place, I stumbled upon a location in the world where by only four degrees of separation I found a person with a similar condition who has not only had the procedure I’m expecting tomorrow, but by the same surgeon. To clarify, Lilija is my boyfriend’s aunt’s best friend’s sister. She and her husband Ed have been making sure I get to all of my appointments on time by picking us up and driving us there and back. They’ve called the clinic on my behalf as advocates in their native language to ensure that things were progressing as they should be. A lot of coincidence had to happen for us to find each other, and I cannot speak for them, but I feel something powerful in it. I am extremely thankful for their kindness.

So tomorrow afternoon we head to the clinic for my full thyroidectomy. I’ve been told there’s no evidence of metastases in my nearby lymph nodes so far, though they’ll be removing a few of the central nodes just to be safe. They’ll biopsy the pieces they remove and later let me know what they’ve found. Several people have told me I’m brave for leaving home and seeking medical treatment abroad. Frankly, I think this surgery would be just as scary at home. I would be in an operating room of people I’d only just met either way. The same complications exist there that exist here, and I’ll be sedated should they occur. My time here has only served to make me more confident in the decision I made. Thank you for taking some time to join me here, and I look forward to returning here next on the mend and hopefully cancer-free.

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Aš mokausi.

I am learning.

Today I learned a little bit more of the native language here and a lot more about how healthcare works in this country. Our lovely AirBnB hostess stopped by to pick up a few items and provided us with some local knowledge on the inner workings of how people are taken care of here. I also did some research on my own, and here’s what I found:

  • Citizens here, in order to be insured by the country’s National Health Insurance Fund, are asked to contribute 9% of their income. The minimum pay here is €400 (about $444) per month, so for as little as €36 ($40) a month you can be insured. Once you buy in for any amount, all funds are available when needed. Depending on the type of job you have, your employer may pay 3%, and you are responsible for the remaining 6%. By comparison in America (and this varies depending on age and overall income, just my own experience here), my health insurance through the Healthcare Marketplace would have taken about 12% of my income for a mid-level plan. Some employers in America can afford to help their employees cover their costs. Personally, working for a small family business with 5 employees, a couple of whom are already covered by their spouses, another who is sticking with a plan because he’s almost hit the lifetime max on deductibles…. there are no business options to insure two people, or even one person and another person with a family, that are cost effective. So that’s out for me or any other small businesses in a similar situation. I digress. Back to 9% vs. 12%. Only 3% difference right? Let’s consider what this 9% buys against what our 12% buys.
  • Emergency medical care here for those with insurance is FREE. Hit by a bus? Free. Brain aneurysm? Free. Heart attack? Free. Brain worms? Ok, I’ll have to get back to you on if that’s an actual emergency, but if it were, you’d be covered. If any of those items listed happened to a middle class American, there are two scenarios. I picked middle class because typically hospitals only provide charity to those below the poverty line. Those in the upper class already have the funds in hand. Scenario A) The patient is insured. Medical treatment will only cost up to a deductible. But that deductible is $10,000 and likely not obtainable because that person probably has little savings because they instead gave their extra 12% to their insurance company. For funzies, the patient lives in South Carolina and only has access to one company and that company’s plans only. The patient’s bill was only $8,000 and whoops! He’s now in debt to the hospital and still has to pay his premium next month. Great news though, he was injured again the next year and it was only $4,000 this time. He got $2,000 automatically. Psych! Deductibles reset on an annual basis. He owes $12,000 in two years but had insurance. At least now he’s only $68,000 away from his lifetime maximum. Scenario B) The patient is uninsured. Remember, middle class. There’s not really a great definition for what middle class is, but let’s say he’s on the lower side and makes about $30,000-$40,000 a year. With no insurance and some wiggle room above the poverty line (currently set around $12,000 a year for a single male with no family), he was able to live frugally and save up about $4,800 before his accident. He loses his savings, but only owes $3200 to the hospital. Patient B is also re-injured. Now he owes $7200. Who can pay their bill faster? A or B? Patient A shows no ability to save up money and only benefits slightly if he’s injured again within the same year. Patient B can pay off his debt in less than 2 years. The hospital wins in Scenario B, but they’re actually both losing here because they’re in debt. What would be better? Getting hit by a bus abroad instead of at home, where the costs are significantly lower? Maybe. Being able to buy into a system where you wouldn’t owe any money at all? YES. And it’s clearly possible because they’re doing it here in Lithuania every day.

So these are a couple things I was able to gather today, and I do think it would be interesting to compare Lithuania’s healthcare plans to other systems other than just the American way. If you’ve got information about health insurance in other countries, I would love to learn more. If you’re interested in learning more about how Lithuania handles healthcare for children, invalids, and the unemployed, I found this to be a useful resource: http://www.vlk.lt/sites/en/health-insurance-in-lithuania/ If you yourself are a member of the American middle class and those scenarios blew your mind, you may want to reconsider where you put your money and/or contact your government representatives. Ačiū, kad skaitėte.

Laba Diena.

So far these are the first words I’ve memorized in Lithuanian. They mean “good day.” Beyond that, all I’ve generally had for people here after they continue to speak to me in Lithuanian are confused looks. Next we try Russian, which works depending on the context. I made a seemingly random choice to learn in college that’s finally paying off. If we’ve exhausted those options, we’ve gotten very lucky finding people who speak English. The people here have been incredibly accommodating, but I still feel a bit embarrassed by the time we’ve gotten to this point. The British Embassy is just down the street, so even though they speak English Americans are not as common here and my accent is a little strange to them. What is this American doing here?

They would be surprised to learn that I’m here for medical treatment. I don’t look sick. I don’t look like the typical image of a cancer patient. America has great doctors. Why did I come all this way? I met with my Lithuanian surgeon yesterday (who at first insisted we speak in French, because my name is Jacqueline, and quickly discovered to his disappointment I speak no French). While waiting for my medical records to upload for his review, we had a discussion in broken English about the American healthcare system. He understood well enough why I had never purchased insurance. I’m only 30, and prior my thyroid cancer diagnosis had been very healthy. A question he asked my father and I gave a huge insight to the foreign medical community’s view on the matter: “You have purchased health insurance. What do you get for free?” My father and I, almost stifling laughter, answered in unison, “Nothing.” Another question, regarding the amount my surgery in America would have cost, “You mean sixty or sixteen [thousand]?” “Sixty.” By this time my records had loaded, and he began poring over the 15 pages to determine the best course of action for me. We are planning a full thyroidectomy for the beginning of May.

If you’re curious and want a further explanation of how I ended up here, I encourage you to click the “Donate” link up top and read the description of the GoFundMe. You’re under no obligation to donate. My goal here is simply to publicize my experience for others who may find themselves staring down the barrel of lower middle class income (read: worked hard for entire adult life) and no health insurance in America (read: did not want to choose between the paying for insurance I was not likely to need and living a normal, not impoverished, lifestyle). Medical tourism is a relatively new and scary thing, but it is an option I’d highly encourage some to consider. Ačiū (thank you, my next words learned) for reading, and if you do choose to donate or already have, an even bigger ačiū to you. I’m sending you a postcard.