Tuesday, January 30, 2007

6. Body Parts

Have you been waiting, wondering what happened when I limped off to India?

While I have been unable to access the internet, life has been full and miraculous.

I am absolutely fine! The incision has healed perfectly. My bones are fusing into the porous portions of the ball and socket that now bear my weight with the help of hand-held crutches.

I am amazed at the smooth precision of this process carried out with enormous human kindness, expertise, and humility by dozens of skilled team members. I will give you more details later.

But something more urgent has been unfolding.

An hour before we were due to leave Apollo Hospital, we were asked if we would like to meet a team of Canadians who have been investigating medical tourism in India.

Vijay Bose, the surgeon who operated on me dislikes the crass commercialism of this term, “medical tourism.” He insists: “It’s medical care, plain and simple.”

Nevertheless, here’s what the Canadians tell us:

“We are so impressed with the 99.2% success rate in India and that their infection rate in these Indian hospitals is only .003% because they sterilize everything. In the USA and Canada, people are being overexposed to antibiotics, which now has created these “superbugs,” highly resistant to antibiotics. So you go into hospital with one thing, and there you pick up a superbug and must stay a long time. In Canada we have had to close hospitals because of it. But in India this doesn't happen.”

He mentions that North Americans are now flying to India for cancer treatments, heart surgery, and even kidney transplants. His words reminds me of our friend, who urgently needs a kidney transplant. A long line of friends want to donate that kidney. Each has been slowly studied and rejected with exasperating loss of time and discouraging expense as our friend grows steadily weaker.

“Which hospital are people going to for kidney transplants?” I ask the Canadians.

“Miot Hospital, here in Chennai.” They give me the website at http://www.miothospitals.com

Is this about faith or foolishness? I wonder. Could he even make such a trip?

And what about the ethics? India’s national newspaper, The Hindu, is running a series on unscrupulous, well-connected dealers who entice the poorest of poor with promises of roughly $7,500 for a kidney--a fortune to them!

Then, after taking the kidney, the dealers refuse to pay. The donor not only has been robbed, but often is unable to work like before.

The next morning, I write a message to our friend, which Phil carries off in his cruzer to find a way to send email.

Even if the low infection rate is true, and even if the hospital takes every precaution, would he ever consider buying a kidney from an impoverished stranger?

Phil spent the next inspiring day at a village among Dalit people, formerly called "untouchables"-- impoverished, but getting empowered since the tsunami burst into their lives. Some have personal knowledge of selling kidneys.

That night Maud keeps waking me up:

Maybe the hospital would let him meet his donor!

Maybe we could build a relationship with the donor’s village, so he doesn’t feel like he is just taking advantage of their poverty.

“Adopt a village?!” I exclaim.

Even $10 a month would make a big difference! Think of all his friends who would want to show their gratitude for that kidney. Maybe they could help build a school or dig a well.

First I want to talk with doctors at Apollo whom I have come to trust.

As usual, Maud wants the last word:

Remember! This is not just some sordid business of body parts! she insists.

This is a relationship!

A week later we return to Chennai for my final hospital appointment on January 30th. I explore Maud’s idea and learn that Apollo Hospital will only perform kidney transplants with organs donated by family members. Great controversy swirls around the issue. India's government is investigating and establishing strict regulations.

Still, I like Maud’s idea.

When I reach the hotel, I send an email to Miot Hospital and later receive this response:

From: chief
To: grant275@cox.net
Subject: Regarding your enquiry - Ms. Anne Grant

Dear Ms. Anne Grant,
 
Greetings from MIOT Hospitals, Chennai.

We perform here related renal transplants only i.e blood-related donors only will be accepted as donors.

We screen the donor including HLA and tissue typing for donors at our centre itself. The receipient's fitness for surgery will be checked by a panel of doctors. 

You also need to bring the embassy clearance of your country for donation of the kidney and accepting of the kidney before arriving here. You need to get an affidavit from your country of domicle for the same on the prescribed Indian Government Formats.

The patient will be required to stay in the hospital for 3 weeks. It will cost US $13000 (US $ Thirteen thousand only). This covers room rent, pre-operative investigations (except C T Scan & MRI), medicines, blood, post-operative intensive care, physiotherapy and rehabilitation, including food. (Laundry, telephone and attendant food are extra.)

The patient is most welcome to come to MIOT Hospitals, Chennai.
 
With best regards,
Yours sincerely,
Prof.Dr.P.V.A.Mohandas


It is good to be on the internet again, where we learn some amazing news. I haven’t time to tell you now, since it is nearly 4 am in Chennai, and we must get ready for the trip home. I will tell you when we get there.

Wednesday, January 10, 2007

5. Googling


Middle of the night, and Maud is at it again.

Are you awake? she asks in a stage whisper.

"No."

Of course you are, she persists.

Phil sleeps peacefully beside me in the king-size waterbed that solved all my back problems for $50 after Kerrie found it for us a decade ago.

"Go away, Maud."

I need you to google, she pleads.

"Google yourself!"

I can't!

I groan, sit up in bed, and take my laptop from the nightstand.

Maud is all smiles.

Now google: women's rights + chennai, india, she commands.

"Got it," I yawn. A list pops up, and we scan it together.

The same name appears in several stories: Fatima Burnad, or sometimes Burnad Fatima.

She works with Dalit women (desperately poor . . . many survived the tsunami but had little access to relief funds . . . suffer routine discrimination under globalization . . . forced into trafficking . . . devote themselves to farming, fishing, demanding clean water for their families . . . are ready to form their own political party . . . .)

We search for her email address and send a message.

Eight hours later a reply appears in my mailbox:

"Greetings!
You are most welcome to visit us in Chennai at the following address. We
can discuss more about women's rights and about the movements in Tamil Nadu.
Kindly let us know the date of your visit . . . .
Thanking you,
With warm regards,
Burnad Fatima. N.

Glad I woke you up? Maud asks.

"Yeah," I grin at her.

Stick with me, kid, Maud promises. You'll be OK.

4. Top Docs

On Sunday afternoon, March 19, 2000, a new yahoo group appeared with a question mark: Surface Hippies?

The first posting reads: "Hello out there! My name is David. I am 46 years old, with a wife and three small children (6, 4, and 9 months). I am three weeks and two days post-op . . . ."

He describes his experiences in recovery from hip resurfacing and concludes:

"This is not a very large group, so it should be easy to remember names.
Let's hear from everyone.
David"

Today 5,547 members post well over 2,000 messages each month at
http://health.groups.yahoo.com/group/surfacehippy/

One of those members, Vicky, instantly takes me under her wing. She has returned from India enthusiastic about Dr. Vijay Bose and offers her research to other prospective surface hippies. She responds to my email in less than an hour and sends spread sheets comparing eight doctors: their prices, the number of procedures each had completed, the length of their incisions, and their rate of "revisions"--operations needing correction. Vicky offers to share this with other prospective surface hippies at
vickymm@comcast.net

Following Vicky's advice, Phil puts x-rays of my hips and knees on a glass table with a fluorescent light beneath. He stands on a ladder and shoots digital photos. (You could also photograph x-rays against a computer monitor. Some radiologists will save you the trouble and deliver your x-rays on CD.)

I email these to four doctors using the addresses Vicky provides. Within an hour my first response comes from Dr. Koen De Smet in Belgium. Credited with 2,107 resurfacings, including Lisa's, he is author of the informative report on the metal-on-metal Birmingham hip resurfacing prosthesis (BHR) that is now state-of-the-art in Europe and Asia:

http://www.hip-clinic.com/assets/downloads/BHRlagomaggiore.pdf

Dr. De Smet writes:

Dear Anne,

Looking at your x-rays you certainly are still a candidate for resurfacing!!!

You have osteoarthritis of both hips.

Right one is bone to bone, left still is not so quite bad yet.

Your right knee has also started arthritis, but mainly at the patellofemoral side (after kneecap)

I think that mainly the knee problem will be from the right hip!

Good bone quality, so best thing to do is resurfacing!!

If you require any further information?, just ask,

Greetz
KOEN

With the intimacy of the internet, we are already on a first name basis. I welcome his lack of pomposity. But his price, while far less than in the U.S., is still twice that in India.

Besides, Phil and I have been to Europe already, but never Asia.

Every few hours I check my email to see if Dr. Bose has responded. I hear from two American doctors, agreeing that I may be a little old for the process, but both consider me a likely candidate.

Where, oh where, is India?

Vicky sends off an email on my behalf to the Apollo Hospital in Chennai, guessing that Dr. Bose is off teaching other docs the procedure. Finally he writes back:

Dear Ms. Grant,
Thanks very much for your mails with the x-rays of your hips and knees.

Apologies for the late reply. I was out of chennai to do some surgeries in another city.

As you are only 60 yrs of age, hip resurfacing would be a much better option than conventional hip replacement. Hip resurfacing would enable you to be very active after the surgery.

I have assessed your x-rays in detail. Your right hip shows bone on bone arthritis but excellent bone stock . I am happy to report that you would be an excellent candidate for hip resurfacing surgery.

Your left hip shows the changes but to much lesser extent.

Regarding your knee, both of them show degenerative changes but nowhere near needing major intervention like a knee replacment. The best option for the knees to have a conservative knee rehab programme concentrating on the patello femoral joint. The patella (knee cap) shows the max. changes especially the right side. The physio combined with a course of visco-supplementation injection would be my suggestion for your knees. Further once the hip surgery has been done, then there is a good chance that your knee may feel better as referred pain in the knee from hip arthritis is very common.
 
I will also need details of your medical history and the extent of severity of your hip problem. Please give information regarding the following: co-existing illness like diabetes etc/ previous surgeries/allergies/ current medications/ previous hospitalisation details (if any). Kindly add a description of your hip symptoms and how it affects you.

I have attached some information on hip resurfacing.

Currently, I do hip resurfacing for about 15 Americans / Canadians every month.

Hip resurfacing is a technique invented specifically for younger patients with hip problems. Conventional Total hip replacement, while being a good option for an elderly person (above 70 yrs) is a poor choice for young patients as it will fail rapidly. The hip resurfacing operation is an alternative to hip replacement and has 3 crucial advantages.The first is that no plastic (polyethylene) is used like in conventional hip replacement. Since an anatomical sized 'metal on metal' bearing is used it lasts for a very long time, manifold  that of conventional hip replacement and is extremely popular in Europe, Australia and some parts of Asia. The anatomy and bio-mechanics after resurfacing mimic a normal hip very closely.

The second advantage is post operatively: patients are encouraged to be very active and must play some sport, do swimming etc. No activity is restricted including sitting on the floor, crossing legs etc. In short, it behaves like a normal hip enabling patients to return to their normal lifestyle. In contrast after a hip replacement one has to behave like an elderly person (for whom this has been designed) to be safe from dislocation and to prolong the life of a prosthesis. There are also other advantages in Resurfacing like preservation of bone stock (as no bone is removed in this operation unlike hip replacement where the head and neck of the thigh bone is completely removed.) Further it has been proven that bone stock actually increases after hip resurfacing due to the restoration of normal biomechanics in the hip and proximal femur.

The 3rd advantage is that the polyethylene 'wear particles' does not damage the surrounding bone like in conventional hip replacement and the quality of bone actually improves with time after hip resurfacing. This makes a revision solution (if at all needed) very straight forward surgery, unlike the very complicated revision scenario in a conventional THR.

The patient is usually made to walk full weight bearing the day after the operation and is usually discharged from the hospital at about 5- 6 days from the operation. They can resume any work at 3 weeks from operation and sport is started 6 weeks from operation.

I have also attached some details of our centre in Chennai, India. The hospital where I work is known as Apollo speciality hospital in Chennai, India, and this hospital is as good as any other facility one sees in Europe or North America. The hospital has an excellent international patients division which would help you with your requirements.  Complimentary pick-up at the Chennai airport is always arranged by the hospital for all International patients.

www.hipresurfacingindia.com

www.apollohospitals.com
 
I have now done more than 700 hip resurfacings and have the largest series of hip resurfacings for AVN & for fused hip resurfacings in the world. There have been many overseas patients including some from Canada, USA and the U.K.

The cost of the Hip Resurfacing surgery package in Chennai, India, at Apollo hospital would be a 'package rate' of U.S $ 7,000 for one side.  This is an all inclusive rate and includes the following:
Pre-op consult with surgeon
Pre-op consult with aneasthetist 
Hip resurfacing  implant. (The BHR manufactured by smith & nephew and the ASR manufactured by Depuy are the ones used.)
Single private suite with toilet, TV, Internet connection etc. This has an
attendant's couch as well.
Professional fees for surgeon, assistant & anaesthetist ,
All pre-op investigations (Surgipak) which includes ECG, Echocardiogram,
Liver, Renal & Clotting profiles.
Consult with cardiologist (if required.)
Diet
Pre & Post op Radiology
Nursing
All medicines
Operation Theatre charges
Private nurse for the first two post-op days. (This is very useful for patients travelling alone.)
There are no additional costs for routine hospital stay apart from personal usages like telephone, laundry etc.
Payment can be made at admission by banker's cheque, traveller's cheque or by credit card. Personal cheques are not accepted. U.S dollars or Euros are the accepted currencies.
 
The hospital arranges for the patient to stay in a seaside resort close to chennai by the name of Fishermans' Cove before flying back. The cost for this would be extra. The resort has facilities for Ayurveda--traditional Indian therapies which are known to rejuvenate the mind and body.

A total of 11 full days gap (Hospital+Resort) from surgery is advised (mandatory) before taking a long-haul international flight.
 
The person to contact regarding travel arrangements like airport pickup and resort bookings is Mrs Shoba Bhasker at shoba_bhasker@yahoo.co.in  She is the International patient co-ordinator. Kindly post a copy of any e-mail to me so that I keep a track of things as well. Kindly take note that a tourist visa is mandatory to travel to India. Please do apply for a tourist visa and not a medical visa as other formalities are involved in a medical visa. A tourist visa can easily be obtained from any Indian consulate. 
 
List of Indian embassies world wide where one can apply for a visa to travel
to India can be found in the following link
www.india-visa.com

This is the link for the U.S embassy
http://www.indianembassy.org/consular/visa_guide.htm
 
If you need any further clarifications please let me know.
 
I have attached the link to a recent article that appeared in the News & Observer published in Raleigh, U.S.A and a link to the CBS 60 mts programme which featured our facility and my patients

http://www.newsobserver.com/672/story/427249.html
http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998_page4.shtml

with best regards
 
Dr. Vijay C. Bose
MS ( Orth); DNB ( Orth); M.Med .Sci ( Trauma) Birmingham; MCh ( Orth )
Liverpool; FRCS(Orth) U.K
Consultant orthopaedic surgeon.
Department of  hip surgery
Apollo speciality Hospital
320, Mount road
Chennai-600 035
India
mobile:   +91-98400-32251
www.hipresurfacingindia.com

His email relieves Phil's anxiety.

Nine days after I had emailed my x-rays, Dr. Bose puts me on his surgical calendar for January 19th, 2007. I am in!

Monday, January 8, 2007

3. Walking on Water



Lisa got me started, telling me how my hip pain is common among baby boomers and that I am still too young (at 60) for "total hip replacement" (THR) as practiced in this country. She told me that a "resurfaced hip replacement" might be better for someone my age--not because THR doesn't end the arthritis pain (it does), but because THR will require another replacement in ten to fifteen years.

Furthermore, THR comes with life-long physical restrictions that don't apply to resurfacing. An avid researcher, Lisa directs me to the online support group for the tribe known as "Surface Hippy." There, she says, I will find everything I need to know:

http://health.groups.yahoo.com/group/surfacehippy/

Several years ago, Lisa established a publishing house called The Writers' Collective. She knows that people with sedentary lifestyles often are overweight. Folks with hip problems often become sedentary, because exercising on land hurts their joints. She set out single-mindedly to lose weight before going abroad for hip resurfacing.

She tried water aerobics--great exercise that imposes no impact on painful joints. But she noticed that most people in her class were not losing weight. She intended to lose a lot before surgery and keep it off.

Lisa researched exercise and the human body. She learned principles to convert fat to muscle mass and to lose weight safely and permanently. She designed her own regimen. Eventually she needed more challenge and added Water Walkers to her repertoire. This speeds up the weight loss while it builds even stronger muscles and increases her bone density.

She achieves amazing results with no special diet except moderation while converting over 55% of her body fat to muscle mass. Lisa has shed 70 pounds to date without ever sacrificing the dark chocolate she eats daily!

After 12 months, Lisa flew to Belgium in September 2006 for hip resurfacing. Initially Blue Cross/Blue Shield refused to pay, calling it "experimental." Lisa appealed their decision, pointing out that the FDA had approved the procedure last May.

She won and now predicts that insurance companies soon will offer incentives to travel abroad, where the cost can be one-third to one-seventh that in the United States, and where surgeons typically have much more experience doing this sophisticated surgery.

Lisa could turn a profit selling snake oil to those who saw her personal transformation. Instead, she contacted the Water Walkers manufacturer and asked them for a discount for hippies like herself who really need them. They agreed--as long as she put the discounted price on her website instead of theirs.

You can read about Lisa's journey and find the link to Water Walkers, including videos showing them in action, at:

http://www.writerscollective.org/whatsNew.htm

Walking on water is not the only thing I learn from the internet.