I have been lucky in many ways. First and foremost is in marrying the right woman and in still having her now, more than 40 years later (and of course, I like my children, too). My wife and I share many interests, especially foreign travel. So, in November 2006 we booked a three-week tour of China.

The trip would have been excitement enough, but I had more. That month, I saw my new Internist/Cardiologist, Dr. Joseph Vassallo (Bethesda, MD). He said I was overdue for a nuclear stress test (considering that I hadn’t had one since my angioplasty 16 years earlier).

In February 2007, we did the test and I felt fine, but my doctor didn’t like the looks of the results. He sent me to the NIH Heart Center at Suburban Hospital (Maryland) for an angiogram that showed that the blood vessels supplying my heart were blocked in several places. I was told that I needed a multiple bypass, as soon as possible.

We scheduled the surgery at the same hospital for the following week, just 10 weeks before we were to leave for China. I was very glad my wife had purchased trip insurance. I had no idea whether we would be able to make that trip.

I had a quadruple bypass. After the surgery, I saw two nurses monitoring me continuously (my wife confirms this). Just knowing that I had great care made me feel better. Then, four days after surgery, they sent me home! That was a bit startling, but they said you will get better faster at home than here at the hospital.

The major surgery on my heart, my chest, and my right leg (to get the veins to make arteries) left me very weak. I couldn’t do much more than sleep and get up to use to the bathroom. But the surgeon’s staff and the visiting nurse urged me to walk a little more every day.

In a few days, I walked from the house to the sidewalk, then on the sidewalk across the front of the house, then across my house and my neighbor’s. And I slowly built up strength. When I could walk further, I could keep up with my neighbor, walking to the corner with our canes. I was walking a mile after four weeks.

By my fifth week post surgery, I went into the office for a few hours, and then I came home to nap. After six weeks, I worked longer hours. Then I didn’t need the nap when I got home.

Two weeks before the date of the trip, I could work 8 hours a day. The surgeon and my cardiologist said I could go to China, but to take it easy. They said that if I feel tired, just stay on the bus.

Continue with Ed’s trip July 6, 2009.

Edward Stern

Ouch! Airline companies are ordering new planes with 12 more seats than before in the same space provided in the Boeing 737-800. The Wall Street Journal, on June 4, 2009, reports that American Airlines has purchased new Boeing planes with the same-size cabins as their old 737-800 fleet. Here’s the catch: each plane will have 12 more coach seats, raising the total number to 160.

Delta Airlines and Continental also have added 10 seats to reach the 160 total in their new 737-800s. Where is the space coming from? Airlines are taking out food galleys, since they no longer serve free food. Others are replacing old seats with new ones that have slimmer frames and cushions.

Bulkhead seats, in the first rows will also lose legroom.

Seat pitch, the distance between a point on one seat to the same point on the seat in the next row, is also decreasing to 31 inches. In the old configurations, the seat pitch could be 33 inches. Exit rows will still have more legroom about 39-40 inches.

Some airlines are giving an inch or two more pitch in the front rows of coach and 31 inches for the back. Betcha these front seats will cost more and even be called “economy plus.” Those who fly know that pitch affects the extent to which the passengers in front of you are in your face or lap, when they recline.

There are health implications that concern triphealthy.com.

1. It is difficult to leave your seat to exercise your legs or go
to the bathroom. Presently, from an aisle seat, you must climb over
the armrest to become free.
2. How will you do exercises in your seat?
3. More passengers mean more polluted air from sneezing
and coughing.
4. If the guy in front is reclining, how do you reach your medications
that you carry on board?
5. Turbulence? Can you reach and use your “barf” bag?

You, the passenger may feel paranoid. First, the airlines are penalizing those who are too fat. (See: http://www.triphealthy.com/index.php?en ... try090521-). Now, it looks like the airlines are targeting those who are too tall.

EF

The Transit Security Administration (TSA) is taking over watch list matching responsibilities from the airlines. On May 15, 2009 TSA, as part of its Secure Flight passenger vetting program, began asking passengers to enter their names on their airline ticket reservations exactly as it appears on government-issued identification with which they will travel. http://www.tsa.gov/weekly/051109.shtm

While the TSA claims that by providing the same name, passengers will help prevent potential misidentification that causes delays when checking in. All well and good for TSA, but for me it means that I must give up my valiant struggle with my husband over my middle name and initial. Moreover, I have to check all my documents to see if my name matches his expectations.

I truly love the man I married many moons ago, but I hate his last name and love my maiden name. In the olden days, you couldn’t place a check on a form that stated that you were keeping your birth surname. You had to go through a costly and time-consuming formal and legal process. And so I kept his name.

Over the years, I began to place G., as my middle initial. Since the new TSA ruling, I checked my documents and discovered that any form I filled out has G. and any that my husband completed says R. My driver’s license has G., my passport has R. Credit cards, where I am primary has G., where he is primary has R. The names on frequent flyer programs, depends on who subscribed.

Starting in August, 2009, airlines will collect the passenger’s date of birth and gender, in addition to the name when making airline reservations. For those of you who lie about your age or are cross dressers, consistency may very well be a lousier deal than potential misidentification problems. C’mon TSA, do you think the real baddies on the watch list use the listed names when reserving a flight???

EGF

Triphealthy.com completes this three part series on medical vacations (see June 15, 2009, and June 18, 2009) with tips for our readers to consider before planning this type of trip.

You must inquire about the process and the health providers!

-Investigate where the physicians who will treat you were trained.

-Ask if the doctor is board certified in whatever specialty covers your treatment.

-Find out how many times the doctor has performed the treatment or surgery you need or choose to have.

-Discuss the treatment plans with the overseas doctor before you depart!

-Bring a travel companion. He or she can help get prescriptions filled and discuss matters with the doctor and medical staff. He or she can keep you company while you are away from home in a foreign setting.

We suggest that you use an experienced medical tourism agency to help you address these important issues.

Note: Triphealthy.com has written about finding facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations, on
http://www.triphealthy.com/index.php?en ... 908-062611.

We discuss finding an English speaking doctor on http://www.triphealthy.com/index.php?en ... 904-062338

Travel insurance:

Triphealthy.com has written about travel insurance and recommended that you should purchase a policy that covers emergency medical assistance and medical evacuation, see: http://www.triphealthy.com/index.php?en ... 526-064834

It is important for you to investigate, when looking for travel insurance, if the insurance plan covers you as a “medical tourist.”

In addition, check with your own health insurance company to see if it covers some overseas care.

As always, discuss the type of travel with your trusted health provider!

Readers; Please comment:

1) About any experiences you have had.

2) About any experiences you have heard about from your friends or relatives.

ML

This entry continues our series on medical vacations and medical travel begun on June 15, 2009.

Is medical travel for you? There are reasons for you to consider a medical vacation, you may:

1. Save money.

2. Have medical treatment that you might otherwise not be able to afford.

3. Obtain medical treatment without a long waiting period.

4. Combine medical care and a vacation in an exotic locale.

Still the decision is not easy to make. Here are questions to help guide your decision process:

1. How much can you budget for medical treatment (necessary or elective)?

-Do you lack health insurance?
-Does you health insurance plan cover the cost of the procedure at home...especially elective surgery?
-Even with a health insurance plan that partially covers the costs, is the procedure too expensive for you to supplement the benefits provided?

2. Are you on a long waiting list for a certain procedure, physician or medical facility at home?

3. Do you need or desire a medical procedure that requires several days or weeks of recovery (e.g., cosmetic surgery)? Would you want a “vacation” while recuperating?

There are also unpleasant possibilities for you to address:

1. What if something goes wrong in a foreign country far from home?

2. Will there be medical personnel to explain things to me in my language?

3. How difficult is it for me to find a hospital or medical facility with a trained staff and equipment to handle anything that could go wrong during or after a medical procedure?

4. What will replace family support if I have treatment abroad? And if I choose to take someone along, can I afford the extra expense?

5. Will the stress of travel leave me vulnerable to infection and slow my healing process?

6. Will I be able to recover damages from an unforeseen event, negligence, misdiagnosis or incompetence?



Triphealthy .com will continue with the third installment in this series, offering tips for those of you who decide to travel for medical care, on June ,2009.

ML

What are medical vacations or medical travels?

Travel abroad for necessary or elective surgery? More and more people are doing this. An estimated 750,000 Americans will take a “medical vacation” this year either to save money (and have a vacation) or because they can’t afford to undergo treatment in this country. Usually it is because they have little or no medical insurance; or their insurance would not pay for the procedures that they need or want. The procedures may cost as little as a third of the fee at home.

Patients are traveling for a host of medical procedures! These include: dental work, orthopedics, neurosurgery, cancer treatments, and heart, eye and cosmetic surgery.

Where?

Medical facilities and personnel devoted to medical travelers can be found in dozens of countries. It is becoming a major business, in order to attract dollars into developing economies.

Different destinations may specialize in different treatments. Costa Rica, for example, is known for dentistry. Brazil is becoming popular for plastic surgery. Thailand is a site for knee replacements.

India is a country that caters extensively to international patients. Many doctors have trained in the US. And, English is spoken in many facilities.

Malaysia is becoming a popular destination site. Other countries include: Turkey, Thailand, South Africa, Philippines, Mexico and Panama.

How do you plan for a medical trip?

There are many medical tourism agencies available to assist with travel and medical arrangements. Be prepared to pay a little extra for the convenience of their experience and contacts.

Remember that travel for medical and health reasons is more complicated than picking up a phone and making an appointment with your local health providers. You need to deal with visas, airfare, hotel bookings, translators and a host of other travel-related concerns.


Ask the medical tourism agent about the services that the agency offers and does NOT offer. Clarify the total cost of the trip. Check into what legal recourse you have in the event that something goes wrong.

Triphealthy.com will continue this discussion on June 18, 2009.

ML

I am repeatedly finding questions on travel sites about carrying drugs abroad. We have offered advice in earlier entries to be sure to carry your medicines with you and to bring adequate amounts (see for example, http://www.triphealthy.com/index.php?en ... 508-064226). There can be problems, however, with getting through customs with both prescription and over-the-counter medications.

Many countries restrict stimulants and sedatives from crossing their borders. In the US, for example, we can purchase sinus medicine that contains Pseudoephedrine; abroad these drugs may be confiscated. Sleeping pills that contain barbiturates are other suspects. Medicine that contains Morphine or Codeine probably won’t be allowed to accompany you out of the airport. Some countries are leery about syringes and needles. There are also limits to the amounts of medicine that you can bring with you.

Japan provides a good example. The Japanese Ministry of Health regulates the list of allowable items. They may not allow inhalators, allergy and sinus drugs, such as Actifed, Sudafed, and Vicks inhalers. Prozac and Viagra also may be confiscated. You are allowed to bring a 4 month supply of vitamins, 2 month supply of non-prescription drugs and a 1 month supply of prescriptions. If you are carrying syringes or wearing pumps for injectable drugs, you are required to obtain a so-called “Yakkan Shoumei,” or an import certificate in advance and show these with your prescription drugs at Customs.

Suggestions to Avoid Problems:

1. Consult the Embassy(s) or Consulate(s) in the US of the countries
that you intend to visit about allowable and non-allowable drugs.

2. If you still are unclear ask the US State Department for an
English speaking doctor at your destination whom you could call and
ask questions.

3. Ask your doctor for a letter listing your medications and why
you need each drug.

4. Get your doctor to write a prescription for each of your drugs.

5. Keep your medications in their original bottles. Bring receipts
from your most recent purchase of the medicines.

6. Bring enough drugs for your entire stay. Remember, you can’t mail
drugs into the country. They will be confiscated by customs. This
is especially important for students enrolled in yearly study
abroad programs.

Readers, any experiences or tips to share?

EF

A major rule to follow when abroad is don’t lose your cool. Getting angry, and raising your voice adds to frustration and exasperation and accomplishes nothing – believe me an A*** personality. You will become stressed and ill and gain absolutely zilch.

Encounters never go quickly or smoothly and you can bet it is never your fault. The problem should not have happened and being abroad only exacerbates the situation. While you get a stomach ache, the transgressor always has the last word. WHY???

1. You are in a foreign country and people speak a foreign language. No matter how well you can speak that language, it’s not yours and they can shut you out. “No English.”

A. OK – The English speak English. Yes, but you speak American. A restroom is a place for you to sit or lie down. A bathroom is a place to take a bath. The correct answer is Loo, whatever the heck that means.

2. There are strong and unfamiliar cultural norms. The Swiss are officious and Germans are rule (or national law) enforcers.

A. In a Swiss bank, stand behind the line until the teller calls you. The bank may be empty and the tellers not doing anything, but don’t you dare go beyond the line. You will be rudely ordered back.

B. Germans are fierce about you (not them) obeying their laws. Don’t step down from the curb, until the traffic signal indicates that you can walk. If there is an elderly person with a cane nearby, you will be hit in the shins until you get off the street.

3. In Turkey, nothing is a problem and in Japan, everyone is polite.

A. I told a Turkish jeweler that I wanted earrings with a clip, as I do not have pierced ears. “No problem” – he steps out and returns with a rusty instrument that pierces.

B. In Japan, I asked several people, if they could direct me to a place on the map. They bowed and conferred for 10 minutes. They called several others over, who also bowed and conferred. We had quite a crowd, after an hour. An American who lived in Japan came to see what was happening and he told me, “It is impolite to say I don’t know.”

4. In Italy, complaints are answered by volume and hand gestures. I had a clogged sink in a hotel room. A plumber was promptly sent to the room. He looked at the sink and started mumbling, then shouting and gesturing. I wasn’t sure whether he was angry with the sink or me. I ran out of the room and asked the front desk for help.

THE SOLUTION: “Don’t worry, be happy,” it is all part of the travel abroad experience.

EF

Readers – Please share your experiences with us.

We wrote, on June 1, 2009, about counterfeit and substandard drugs. This entry provides several tips to avoid obtaining and using these fake medicines, especially when you are traveling abroad.

1. Be vigilant in monitoring your newly purchased medicines for
anything unusual or different. Check the shape, size and color to see
if they are the same as your usual drugs, before you take the
medication. Try to note its feel and taste. Recognize any unusual
effects after taking it.

2. Be suspicious of tablets that have a peculiar odor, taste, or
color; or that are extremely brittle, chipped or cracked.

3. Pay attention to the packaging for any damages.

4. Make sure that all drugs you purchase abroad are in the original
package. Inspect the packaging, because many times, poor quality
printing indicates a counterfeit product.

5. Purchase your drugs at home, in advance of your trip, from your
accustomed sources.

6. Be sure to bring along enough of your medications; l ½ times
the number of days that you expect to be away from home.

7. Take along a list of your drugs’ generic and brand names. In case
you run out, a local pharmacist may be able to look for the correct
product for you.

Triphealthy.com reminds you to always pack your medication in your carry-on bag, not in any checked luggage. Also, remember to pack them in their original containers. Bring a doctor’s letter explaining the need for your drugs, and any medical supplies. See entry: http://www.triphealthy.com/index.php?en ... 508-064226

Source: Centers for Disease Control and Prevention, www.cdc.gov

ML

Buying drugs abroad, just to save money, is foolhardy, dangerous and could be life threatening. A traveler may encounter counterfeit or substandard medications; especially in China, India and underdeveloped African and South American countries.

Counterfeit drugs are not what they say they are. They may be labeled with a well-known brand name or have familiar packaging. They may not have the same active ingredients as the real medication. They may contain the wrong active ingredients, not enough or too much of the active ingredients, or no active ingredients at all.

Counterfeiters may also acquire expired drugs and repackage them with new expiration dates. The package also may not provide truthful information about the ingredients or who made the drug. In essence, you can’t be certain what you are getting and putting into your body.

Fake medicines may not even help the condition that you want it to treat. In fact, it may lead to dangerous side effects or allergic reactions. Your health could worsen if the medicine is ineffective.

Substandard drugs are those which some manufacturers produce as ways to avoid costly quality control and good manufacturing practices.

The quality of commercially available drugs varies greatly among countries. In some countries, there is a lack of regulations and quality control. Poor formulation can affect the release of active ingredients, with some tablets releasing very little, if any, drug.

Some drugs may be contaminated with other substances. Poor storage conditions, especially in warm and humid tropical environments, may lead to chemical degradation of many medicines.

The US Food and Drug Administration (FDA) urge you to purchase drugs from licensed and reputable pharmacies. This way enhances your chance that the medicine you purchase is safe. (www.fda.gov/consumerinfo).

Triphealthy.com is preparing tips for consumers so that you can avoid counterfeit and substandard drugs. We will report these in our June 4, 2009, entry.

ML