If you are currently planning on moving to the Philippines, the following article should be required reading. Hopefully my personal experience with health care can help you both envision and prepare for the onset of aging, and all the problems therein. It is not a post about the quality of medical care in the Philippines, rather it is one person’s experience and is designed to be a thought provoking read. Everyone’s situation is different but we all have one thing in common, we will all age, suffer ailements, become ill, and need medical care – eventually.
Pre-Thoughts Are Invalid!
I made a promise to myself years ago that I would never do it. And I had 3 perfectly good reasons why I would never undergo back surgery. My father. I can remember way-back when (circa 1969) when my father had his first lower back surgery. It could have been a year either side of that, but I’m not real sure. He was a truck driver at the time and ‘blew out’ (ruptured) a disk while climbing into the cab of his truck. As he told it, he was half way up the ladder with his left hand on the steering wheel pulling himself into the cab when he sneezed. That is all it took – to be in somewhat of an awkward anatomical position, and then sneeze. It wasn’t long after that when he was operated on and had that disk replaced by an artifical one. As good as the technology was back then, a disk replacement would have to suffice until his next flare-up a few short years later (around 1978). I’m not sure what the second surgery was all about, but I know it was related to deteriorating conditions of the lower back, and likely related to the first surgery. From what I can remember, each surgery that he undergone brought him some relief from the pain, but the relief never lasted that long. His third surgery occured sometime around 1989 (at the age of 67) and the doctors found his lower back to be in such poor condition they actually performed a spinal fusion of three of his lower vertebrae (L3-L4-L5 I believe). Spinal fusion is a procedure which permanently connects two or more bones in the spine, relieving pain by adding stability to a spinal fracture or used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk. Throughout his later years, I can remember him being in pain more than when he wasn’t in pain. Shortly after his fusion, it was subsequently discovered that the fusion effectively held only on one side, but not the other. The family watched him suffer for many years though all this, but he was always a soldier about it (although he complained allot) and continued mowing lawns until he couldn’t stand up any longer. At age 82, he requested yet another surgery through the VA but they refused because of his age. It simply was not safe to have a patient face down with his backside opened up on an operating table because of the threat of cardiac arrest. It’s kind of hard to roll a patient over when they are in the middle of surgery is what they told him. So he lived out the rest of his life with back pain and Tramadol until he passed in 2010 at the age of 88.
My Personal Testamonial.
It was my father who initially advised me, should I ever be in this position, to never put myself through all the trauma of a back surgery that holds nary a promise of repair or relief. It amounts to “a shot in the dark” he used to tell me and it’s just not worth it. Actually, I heard that same analogy repeated throughout his later years, over and over. He was never a fan of his own surgical experiences, at least with his lower back anyway. His advice never left my mind, and for good reason. It was further supported by so many other negative outcomes and testamonials when it comes to spinal surgery that it just didn’t seem like it would ever be a good option. But, my own set of circumstances would eventually dictate otherwise. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat. For me personally, there has been no effective long-term conservative treatment for my own spinal stenosis (and bulging discs), and I’ve tried most every option; Chiropractic, injections, transcutaneous electrical nerve stimulation (TENS), physical therapy, heat treatments, inversion, and exercise. After exhausting all these conservative treatment methods, I finally decided the only option left to address my persistent and disabling pain was surgery (I rejected the idea of acupuncture and a procedure called radiofrequency ablation (rhizotomy), a nonsurgical, minimally invasive procedure that uses heat to reduce or stop the transmission of pain. Radiofrequency waves ablate, or “burn,” the nerve that is causing the pain, essentially eliminating the transmission of pain signals to the brain. Nope, I wasn’t going there.
Everyone’s Story Differs.
I originally put the hurt on my lower back when I was in the U.S. Navy stationed in the Philippines back in the early 80’s. As part of an “Mobile Environmental Team”, our mission load-outs included large cases of computers and peripheral equipment, supplies and numbers of large compressed gas cylinders containing helium. Normally, we would use the Ship Repair Facility cranes to load our equipment and supplies for our short deployments. But because our missions were usually tasked on very short notice, many times there was no time to order shipyard crane services. So we would load ourselves, after hours, in the dark, and manually – all two of us (getting shipboard personnel to voluntary help us do manual labor in the Philippines heat and humidity was another challenge). There is just something about all that humping of heavy equipment cases and large gas cylinders up multiple vertical ladders and around and through tight passages that can affect the anatomical integrity of even a 30 year-old indestructable young adult. Over the last 12 years, I have had no less than 5 MRI’s, 2 CT scans, a Mylogram (ughhh), Xrays, numerous steroidal injections, and many visits and consults with both orthopedic and neuro surgeons. Not until recently have I ever considered surgery to be a good option. Believe it or not, the best treatment option for me has been playing racquetball 3-4 times per week. Doctors have agreed with me in the past that as long as I can still play (stay active), it will help in managing my day-to-day pain, even though it will only delay the inevitable scapel. Over the last year, I’ve reached the point where I would need moderately heavy doses of ‘anti-inflammatory’ meds in order to even get on the racquetball court to play. Popping large Ibuprophen tablets was just part of my pre-game warm up you might say. And just as one should never say never, I finally reached that crossroads, where a decision had to be made. It was only then that I made the decision to go forward with the invasive fix – Surgery.
Staying Active Should Be in the Plan.
So, as sure as Perseus cut off the head of Medusa, I thought I was totally prepared to move to and live and spend the rest of my life in the Philippines. My plan was to stay as active as possible. It just wasn’t in the cards and nor did it happen the way I envisioned living my life there. After 4 years there, I gradually became more and more seditary before we eventually set up another residence on the island of Guam (for other reasons). After living here now for over two years (and back into the active groove), things have finally caught up with me and it became apparent that surgery now was my best option to potentially eliminate all my lower back and leg pains. There was never any guarantee by my current doctor that he could eliminate the more-normal discomforts generated by ‘degenerative disk disease’ – the affliction when normal changes take place in the disks of a spine due to age. And arthritis. That is something that most all living beings learn to live with, but compared to the sharp pains I was experiencing, that will be like a walk in the park! And my neurosurgeon; he did present me with an extremely high percentage of surgical sucess, one that was hard to pass on.
It’s been well over a month since I began all the workups required for pre-surgery and just two short weeks ago, I underwent ‘elective’ back surgery. At age 65, and although the physical circumstances were completely different than my father’s, I staved off back surgery and surpassed my father’s surgery by nearly 19 years. The procedure performed on me was a laminectomy and a foraminotomy. The entire 3-hour process was a ‘cart-before-the-horse’ scenario where the first procedure was needed to achieve further access to the spine in order to complete the second procedure; the work on the foramin. A Foraminotomy is a medical operation used to relieve pressure on nerves that are being compressed by the intervertebral foramina, or in my case, a bulging disk into the foramin passage of the vertebrae where the nerve bundles extend from the spinal cord to the body. In the illustration below, the spinal nerve root on both sides was being pinched by the disk (grey matter in photo below) encroaching into the foramin cavity . The foraminotomy procedure serves to enlargen the foramin passage by carving out some bone matter to allow for decompression of the nerve. I am happy to say that after tormenting myself for many years over the idea of having surgery, I am now (knocking on wood) pain free, although a little sore post surgery.
It is well documented that physical activity or exercise can improve your health, helping to reduce the risk of developing diseases like type 2 diabetes, cancer, and even cardiovascular disease. Physical activity and exercise can have immediate and long-term health benefits and most importantly, can improve your quality of life. Apparently, it has worked for me all these years as I have no other health issues like high blood pressure or diabetes or such. My plan is to heal and get right back at staying as active as I can. With a little patience in my healing process, I can be back on the court in just a few more short weeks.
Accessibility and Affordibility.
WHY?… (you are probably thinking) do I write about this in a blog that is supposed to be about moving to and living in the Philippines. Well, it’s simple. I have learned (through my own unguarded weakness) that the decision making process [to retire and live in the Philippines] can be somewhat void of one’s medical and long-term health care requirements. It shoud be of the highest priority and should not to be taken lightly. And considering that the overall living conditions (environment) in the Philippines is not a healthy one, one’s health concern should be even more paramount. Notably, our own health concerns were probably our weakest link when we made the decision to retire and live in the Philippines – everything that is health care related including insurance and what might be a proper amount of health care coverage. Although we do have insurance, and I could have obtained the same medical care mentioned above if I were to travel to Manila, it would come with large upfront costs, with the hope of re-imbursement.
It has become all to apparent in recent years where I hear or read about expats who find themselves in a huge bind with respect to managing their healthcare, where they may not have enough cash or no insurance, and in the worst case, absolutely NO ability to get well when one becomes health stricken in the Philippines. In retrospect, the quality of both preventive medicine and health care that I (and the Mrs.) have received over the last 18 months while living on the island of Guam could have never been realistically obtained while living on the island of Samar (or the far reaches of any province for that matter), unless I traveled to Cebu or Manila, where good health care is available. And even then it would be encumbered by the costs of travel and that of the actual care. While there may be some excellent doctors, health care professionals, and services available in the larger metropolitan areas of the Philippines, one should look at their own individual access to these services, and the costs of obtaning such services. Even though we have U.S. based insurance coverage, the initial out of pocket costs to us could potentially still be prohibitive during a major medical event. Truth be told, neither the wife or I were prepared to have all our long-term medical needs met while living in Samar, Philippines. And now that I am Medicare eligible, that option is only available on U.S. soils. I’m sorry I can’t address the general health insurance concerns of other expats, but the bottom line is this – in the Philippines, like most other expats, we were at risk of being unprepared to handle a major medical event. Are you?
In my case, it was something that I just didn’t think enough about at age 58 years young and still indestructible. What a difference 7 years makes.
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