Out cruising-may need surgery

[mauser]

Here is one of the finest surgeons I have ever met:

Wallace A. Arneson, Jr., M.D. graduated from Harvard Medical School in 1974. He subsequently completed his General Surgery residency at the University of Michigan Medical Center in 1980. He joined the faculty at St. Joseph Mercy Hospital in 1980. Dr. Arneson is a Clinical Assistant Professor in the Department of Surgery at the University of Michigan Medical School. He is the Assistant Program Director of the General Surgery Residency Program. He is the surgeon champion for ACS-NSQIP program. His clinical interests include endocrine and breast surgery. Wallace A. Arneson, Jr., M.D.

Mauser

[Svdestiny]

Thanks to all who have responded.

I wish we had More savings, which was eaten up by my husbands previous medical problem which has resolved, theoretically. He was never sick a day in his life until then . We can save up to have it done in February/March ish. Depending on how much of course.

Currently he is better after having months of frequent attacks of RUQ pain, n/v/d., finally saw local doc, ultrasound showed 20cm stone, treated with antibiotics, anti-inflammatory meds, and diet. Now has occ attacks (2 in four weeks), but overall improved.

Boat is mid sole replacement and porthole replacement, and is on hard, So can't get to states quickly. We have two wieird dogs and a cat so can't fly up for possibly lengthy time. hubby is reluctant to go alone.

I am trying to get personal recommendations for doctors, hospitals in Guatemala but its not easy, and harder when you are shy I am an RN so I can take care of him, but it's hard to find out infection rates of hospitals here. And stuff happens, as we all know

time , money, quality creating a rubix cube type dilemma.

[Canibul]

Keep in mind that a lot of the people here telling you how wonderful the US system is don't have any experience with anything else. The docs in many of these places trained at the same schools the docs in the US trained at.

Look into http://http://www.clinicabiblica.com...p/en/contactus for one.

Ask them your questions. Follow up with some of the references.

[jpstevens]

You state that you have medicare. Do you have part "B" and any kind of supplemental policy? If so, you can come to UT Southwestern or Baylor Medical Center here in Dallas, and get the surgery done expeditiously without significant out-of-pocket costs. If you do not have a supplemental policy, phone calls to either of these medical facilities will clear that up. Large institutions like UTSW take Medicare without any problems. Payments by you depend upon the supplemental policy which you may or may not have. O'Care has nothing to do with the issue, and having lived in Latin America for many years, and I would not elect surgery there rather than at a top center in the US.

[JPA Cate]

Hi, svdestiny,

I think in part you're buying into the idea that medical care in the US is the best in the world, a prejudice many American cruisers have. It is hard to get beyond that emotion, or was/is for me. Yet, I have had medical care in Mexico; in Tahiti, in Cook Is., in NZ, in Australia, and in New Caledonia, as well as the US (spinal decompression, bilateral TKR, and bilateral TKR revision are some of them). So some experience in hospitals where I don't speak the language fluently. [In fact, my French is so poor that they say I don't speak French!]

I think you and your husband will do fine in Guatemala. I also think it is your husband's choice, as it is he who stands the health risk of waiting to do it, as well as the risks of surgery. You, of course, stand the risk of losing him and being a sudden widow in Guatemala, who owns a boat in the middle of a re-fit. Life is not risk free. Talking out this issue with your husband will help both of you.

Your plan of enquiring around is a good one. Greater understanding of exactly how they plan to do the surgery, and a look at where it will be done will set your mind at ease relative to their competence. I am sure Guatemaltecos have their bladders out, and if many were dying, it's published somewhere where you can find it. There may even be ratings of post-surgical infections rates available.

I also think the hospital care will be more user friendly than in the US, in spite of the language issues that may apply. Make sure beforehand that your husband knows the phrases for communicating well with the doc--or hire an interpreter.

Travel back to the States is not free. The issue of US travel should be on the back burner for now--too much going on where you are. Maybe at a later date, make travel plans to visit there if you're pulled in that direction, but for now stay focused on saving money, working on the boat. [Make sure he does the heavy work before the surgery, so you can continue on the projects.]

Good luck with it to both of you.

Ann

[Time2Go]

I have no complaints at all about the American Health Care system
So when I travel ( most insurance will not pay out of country)
I purchase an emergency care policy with a repatriation clause.
In most cases they will arrange everything even ambulance flights back to
the US. It's relatively inexpensive because once they get you back to the states
your other insurance takes over.
I wouldn't leave without it
But I am curious, let's say your British, French or any other countries citizen
and you are out of your country, Would you still be covered in a foreign country?
Good luck with the Gall Bladder, hope everything works out well
Cheers

[Shrew]

Originally Posted by Capt Phil

If you get caught up in the American Health System(read Obamacare), you will wish you were dead anyway!

The Healthcare System, Medicare, and Obamacare are three mutually exclusive topics.

Obamacare IS NOT related to Medicare. Obamacare is a insurance mandate. In fact, those involved with Medicare wouldn't be involved with Obamacare plans. Healthcare is private in the US. What you're discussing is whether it gets paid for by Private Health Insurance (Obamacare), Public Assisted Insurance (Medicaid and Medicare).

Please get your facts straight before spouting your politics as 'advise'.

[jcapo]

If it was me, it would depend on the cost out of pocket in Guatemala vs. out of pocket cost here in the US. Medicare only pays 20% so the out of pocket cost can be expensive unless you have a supplemental policy.

There are many doctors and hospitals here in the US that will accept medicare. You can research that online, with email, and with a few phone calls from Guatemala. I'm on medicare and had prostate cancer treated two years ago. i had no problem at all finding a urologist, oncologist, and a hospital that accepted medicare.

The 20% that medicare doesn't pay can be a lot of money. I'm still paying it off.

[Uliad]

First let me say: I am a practicing US physician. I also recently finished 5 years cruising so I understand both sides of this.

My first advice is: don't get your medical advice from forums like this. (whoops, guess that excludes me). If you are recovering from acute cholecystitis, there are good reasons to let the inflammation calm down a while before removing the gall bladder--less inflammation means less bleeding, easier for the surgeon to see what s/he is doing, fewer complications.

Second advice: As others have mentioned, you will find caring, qualified, Western Trained physicians using the latest techniques and equipment almost anywhere in the world if you look around. The US embassy is a good place to start. I would not be afraid to get it done there if I were you.

Third advice: While you are waiting around for your gall bladder to cool off, you could certainly call a general surgeon's office or two in whatever city in the US you might choose to go and use your Medicare. If they know in advance your unique situation (travelling from overseas, tests already done, want to go to you because of your stellar reputation, etc), they will be able to schedule in advance a consultation, and surgery tenatively planned for a few days later.

[Canibul]

Originally Posted by Ann T. Cate

Hi, svdestiny,

I think in part you're buying into the idea that medical care in the US is the best in the world, a prejudice many American cruisers have.

Ann

Yep. Like nobody else in the world has medical care. You should hear the people in Boston. They act like medical care in Houston is essentially peyote and a shaman shaking a gourd. I've had friends and family beg me not to get medical care done out of the US. Very provincial attitudes.

Just got 10K worth of dental surgery done right here in Providenciales.

What happened with the knees? Why the revisions?

[JPA Cate]

What happened with the knees? Why the revisions?
__________________

Had to have the inserts replaced.

Why? I don't really know. The surgeon who did the first surgery didn't want to hear about the instability. I went to "a great teaching hospital", and the surgeon who the revision said maybe my knees' internal geometry had changed slightly, or maybe the original insert (the plastic between the titanium) was too thin. It was computer selected for size; other surgeons hand fit them, like a mechanic shimming a transmission.

Luck of the draw. First surgeon picked because of recommendations of friends and the hospital has very low incidence of post op infections. The "great teaching hospital" gave me a serious post op infection, and local GP didn't get on it aggressively when I first showed up with it. Bad stuff happens.

fwiw, I think it is harder to find a top flight GP than a surgeon.

Ann

[Talisman 2]

I'm a retired surgeon who lives in Miami. If you arrive with valid Medicare you should have no problem finding a qualified surgeon. You most likely would want to have it removed laproscopically (what most people miscall laser technique). You can email me at Talisman2@bellsouth.net & give me your phone number. I'll call or I can give you my info.

I have a friend, a retired Coast Guard Captain who advised me in a medical urgency get into international waters and call the USCG rather than chance local hospitals. I personally have no info on these hospitals, bu would try to get home if at all possible.

Re fees. These are predicated by Medicare and all surgeons must accept them. The most you would be responsible for is the yearly deductible and the 20% of the total Medicare does'nt cover which can probably be negotiated; no guarantee. Understand the surgeons fee is going to be $7-8.00, but the hospital fee more and thus their 20% also more. I'm sorry I'm not more exact but I've been retired some years.

[hellosailor]

The OP seems to think social security or Medicare will determine the scheduling of the surgery. Not at all so! The SURGEON will determine the schedule, the delays, or the necessity based upon their examination of you, and their personal schedule. Some surgeons are booked up two months in advance for elective surgery. Others will fit "emergency" surgery into their schedule even at 3AM on the day you've first seen them.


As for calling the USCG or otherwise getting a medevac to ensure emergency surgery...forget about it. You will still be examined by a doctor(s), and they will still make the diagnosis as to whether and when surgery is needed.


In your shoes? I would ask the embassy, or the commodore of the ritziest local yacht club, or some investment banker....someone who is likely to have some familiarity with "better" local medical resources, and arrange for a thorough exam and diagnosis.


Meanwhile, decide who and where your first choice would be if you came back to the States. IF the diagnosis you get locally advises surgery "quickly", contact that doctor in the US and ask them if you can forward the diagnostic results NOW and set up an appointment Real Soon Now to proceed to confirm if surgery is necessary--and when that might be done.


Every physician and hospital is different. Some won't even tell you if they do certain procedures, others (like the Cleveland Clinic group, who aren't just in Cleveland) do things differently, and if they don't do a certain procedure, they'll still tell you who and where to go for it--without any fuss. They are one of the few hospital groups that are based on "medicine can be done well, and still run as an efficient business" and that means top notch care, efficiency, AND not gouging the patients.


And obviously, don't let any surgeon cut anything, without a second opinion.

[achil]

Originally Posted by Svdestiny

Okay we are currently in Guatemala and my husband MAY need Gallbladder surgery. It can be done inGuatemala, but Considering returning to USA to get it done there . we no longer have a real home there (cruising on and off since 1999) but do have family, inland.
Thoughts?

If you opt to go back to the US just go to the emergency room. Make sure to check the reputation of the hospital.

[hellosailor]

Pat-
If you just pick an ER, and you are not in crisis, you may not even be admitted. You may be told to go see a doctor at home. Even if you are admitted, there may be co-payments and other expenses (Medicare doesn't cover everything fully) that using the normal process would not incur.
Not to mention, if you go in through an ER and they say "OK, we're doing this tomorrow" you get whatever surgeon is on shift tomorrow--not a surgeon that you've chosen for their skill or manner. (And if it is a teaching hospital, no guarantee that the listed surgeon actually does the procedure, a student may.)
Something to think about.