1) How would you have got through post and pre op
100% solo ? Grocery shoppiing, bathing, get meds, social support, was the lonelyness killing you, was it scary,
run errands, lifting things, emergency support, showering, transportation, exercising, going to the bathroom, mobility
going to the doctor, driving, going to the pharmacy, food prep, cooking, lifting things, etc etc ?
2) What did you do pre op to prepare your home ?
3) How bad is the ticking of the valve and anything you can do to mitigate it ?
4) Are you an actor or do you have work or other activities that
require you to be publicly miked up ? Does the mic pick up the sound of your valve ?
5) Describe your diet and how your have kept your INR in line if you have got a mechanical valve?
6) Are you single how has dating been post op ? Socializing ?
7) Do you have other health issues or mental health issues that have been aggravted by
having cardiac issues ?
8) Has having cardiac issues/surgery impacted your self esteem ?
9) Do you feel more alone and disconnected from the average person who is
not afflicted by cardiac challenges ?
10) Describe your recovery as far as getting back to exercise, work, sex, dating,
socializing, running errands, self care, activities of daily living ?
11) How long did take for your sternum to heal ? To get used to a new valve ?
12) Did you have depression and anxiety before surgery? How is it now ?
13) Describe some of your post op complications? PTSD ?
14) If you were single, not working, had other disabilities that limited you what were your motivations
recover and go through the surgery ?
15) If one 100% lived alone and had zero support post op what/how would you get help to mitigate this ?
16) Was anyone uninsured or had to pay for substantial part of the surgery ?
17) What do you take for pain if cannot take ibruprofin or aspirin ?
I'm in Bangkok; I like living here in Thailand/Asia and have no interest in moving back to the USA.
I am looking at doing a mechanical valve due to my age though I am concerned about Warfarin and managing my diet/lots of Vitamin and how to get pain relief if I/we can't take aspirin or ibrupofen how do to get pain relief when in pain ?
However private health insurance in Thailand will NOT cover pre existing i.e. for me cardiac. There may be a few plans that will cover pre existing conditions but the cost may not be worth it.
SWOT type analysis to follow:
1) Lifelong exerciser.
3) Financial. I am well off, live cheap, am frugal and have a low cost of living. Zero commitments i.e no pet, family, partner, roomates, house, car (don't need one in Asia) . I live off the grid and have few of the complications of a typical middle aged man my age (except bad health !!!).
4) Good at following through: Meds, screenings, diet, research, seeing doctors, exercise, etc etc.
5) Low weight low BMI most risk factors eliminated via exercise, meds, diet, no drinking etc etc
1) Aortic Valve stenosis probably caused by high Lipoprotein (a) and low HDL which also probably caused my high calcium score (over 600). Also genetic risk (family dies early of heart attacks). Diagnosed with CAVS 2019; was at mild moderate now at moderate. Via statins, exercise and a vegan diet I have driven down most of my cardiac risk factors to sub clinical low levels and am looking a few things that may lower Lipoprotein. I've also been a lifelong exerciser, former triathlete, hiker, backpacker etc., etc.
Silicon Valley/California native that's how we roll).
2) Mitral valve prolapse mild
3) Aformentioned family risk, Lipoprotein(a) and high calcium score low HDL
4) Mild left ventricle hypertrophy related to exercise, past hypertension and AVS
5) Hypertension. Gone. I am almost off losartan due to the vegan diet. Kicking it !)
1) Health issues
2) Lack of cardiac Insurance
3) Lack of anyone to take care of me--regardless of where I live. Family dead, would not count on friends, single, live alone
4) Lack of career not working (but don't need to work in Asia-cheap)
5) Other health issues--none fatal
6) Family history of heart disease
I have 4 options:
1) Stay in Asia with insurance that excludes anything cardiac (where I am at now) and pay for anything that comes up myself.
A good government hospital here quoted me at $11, 500 to $13,000 for a mechanical valve, ICU, 8 days or so in the hospital and the surgery. Pre op not included.
At a top private hospital 25,000 USD. Again pre op ni. Cardiac rehab included in one of the quotes I can't remember.
Those prices aren't bad but if I had complications, further surgeries costs could add up.
I can absorb these costs if I stay in Thailand; however they could eat into my ability to restart in the USA/
2) Stay in Thailand but buy a pre loaded expensive plan-that may not cover surgeries or some of the costs
3) Go back to USA when AVR is more imminent: Hop on a plane, get seen by USA drs, get an Air Bnb for a few months, get the surgery, recover and head back to Asia in a few months.
4) Cut bait and move back to the USA--the safest plan but something I don't want to do. Which doesn't totally eliminate coming back to Asia but given my age, health, Covid 19 etc etc may feel like a final exit from Asia and the end of a 10 year dream.
Post op home care would be cheap in Asia--plenty of nurses and others would could care for me. Already have a Filipina lady who cleans my place.
I am trying to determine future risks via tests and consults with doctors. My fears would be heart attack, repeat AVS, mitral surgeries and arrythmia related issues or a stroke
Thoughts ? Anyone else been in a similar situation ?
Thanks and have a great day !
I have 3 sets of questions so please bear with me)
1) I just came back from a new doctor in Bangkok; they looked at
my 3 echoes since my calcified aortic stenosis was found in May 2019;
they are saying VMAX is the best way to assess progression.
Normal progression rate is .3 a year and when you get to 4.0 then it's
considered severe. They said my progression is rapid, more than normal
and that I will be at severe in 1-2 years and need surgery 2-3 years after that.
Please look at my echoes and let me know further thoughts).
2) Can anyone detail the process from start to finish relating to aortic valve
replacement i.e pre op prep, op, post op prep and complications post op or op and what happens post op ?
What if you are flying 100% solo; what kind of help does one need at home post op ?
3) If one had AVS around age 60 mechanical or non ? TAVI/TAVR or OHS ?
How long do non mechanical valves last ? How bad is the ticking/warfarin with
mechanical ? I am vegan for my heart and my diet is largely made up of greens; does taking
warfarin really exclude greens ?
Complicating all this is living overseas without cardiac coverage; insurance in Thailand
can and will exclude PRE EXISTING i.e. cardiac conditions. Being utterly alone and single AND facing a potential
complete restart in the states at age 58 and all the grief of leaving everything behind in Asia
+ having to deal the with the hassles of restarting from ZERO in the USA at age 58.
What are some of the ups and downs post surgery ?
Will it be harder to find a love partner post surgery and/or as I move close to severe ?
Anyone use plastic surgery to remove post op scars ?
Sorry for the long winded email. I have decisions I need to make quickly before my health falters
which will limit my ability to make drastic change.
I love Thailand and Asia but I have concerns about staying here especially if I can't get partial
or full cardiac coverage. The cardiac care is good for OHS but not as good for TAVI/TAVR.
I have no home, family, career, etc etc in the states so I dread going back. I like living in Asia/Thailand. No interest in ever living in the states but AVS is maybe forcing my hand where to live.
I dread a move back to the states but due to issues around insurance (I have free healthcare in California via Medi-cal FYI).
1) Get the surgery done in the USA when the time comes if I am fit to fly and recover at an Air Bnb for a few months--either alone or shared
2) Keeping looking for insurance here in Thailand that may cover part or all of cardiac
3) Check out government hospitals which I am doing to lower cost
4) Go 100% cash at a private or government hospital
BTW--I have a new term for those of us who 100% fund our cardiac care, "cashies" (maybe dummy is a better term !).
I am trying to avoid moving back to the states
Any relate or been in or have been in similiar circumstances ? Cheers
Hello everybody my name is David a California Native living in Thailand. I'm a bit overwhelmed by my diagnosis. I'm wondering if anybody is interested in communicating over the telephone or via social media? I'm happy to send you my number. I'm 15 hours ahead of the West Coast of America. I hope everybody's doing well. Thank you.
This is me doing an acting job for a Thai television series in Bangkok last Friday. I move to Thailand three years ago at age 54 dropped everything to move here)
Update posted on...
September 23, 2020
Hello and good day. I am sending this message to all my heart valve related groups so if you are on more than one of my groups please accept my apologies as my intent was not to spam.
My name is David and I am an American living overseas in Bangkok Thailand. I have moderate aortic stenosis, which was diagnosed last year at age 56. Year over year progression was terribly slow. I am keeping myself healthy in the interim. Bangkok has great doctors many who have trained stateside and speak fluent English as do the nurses and staff. Thailand is filled with lots of retirees from the West, drawn by the climate, dating scene, food, temples, islands, low cost, medical care, etc. etc. Thailand is a famous medical tourism destination and our Covid 19 cases are at zero. The quality of life here is amazing and I have no interest or intention of ever moving back to the states.
About me: Single, 57, no kids wife girlfriend pets de; family in USA all dead; no career or job no home in USA no one to stay with in USA. I get by by my investments which are doing well and my simple low cost of living here in Asia. In good health at present but family history of heart disease. I am fanatic about health—vegan bp meds and statins and aspirin, lifelong exerciser, never drink or do caffeine, do constant screenings, meditate, LDL down to 60 weight at 159 low BP etc. etc. Slight LVH. Calcification score and Lpa high. Other #’s outstanding. Low stress low cost easy life with zero commitments.
My question is this: Insurance in Thailand does NOT cover preexisting conditions i.e. valve related issues as well arrythmia issues. I am covered for heart attacks and strokes. My concern is any out of pocket expenses should I have the surgery in Thailand. Depending on any complications and/or cost of the actual surgery my estimates are from $30,000 up to $100,000; most likely closer to 50K USD. I can afford that as I am single and live cheaply. However, that would cut into my ability to buy a home stateside in the future.
1) Scenario #1—I miraculously find an insurance here that covers preexisting. Unlikely and if so costly. I have checked into this before and looks grim.
2) Scenario #2—Do all surgeries here in Bangkok and hope when that day comes cost and complications are low
3) Scenario #3 I can get medi-cal to fund my surgery here. I passed my USA insurance info on to my hospitals here. Thailand has some of the best healthcare in the world at the lowest prices and they are setup to work with all kinds of insurance. This would be my top scenario.
4) Scenario #4 Move back to states—ugh-I would almost rather die.
5) Scenario #5—favorite scenario after #3—get surgery done in California and bounce back to Bangkok when I recover. Tricky part: where to stay? This is where I need support: Skilled nursing facility; short term air bnb either solo or as a roommate? Or other short-term rental options? Again, no family or friends to stay with and I have no housing stateside. Also, I am utterly single and alone so I may need outside assistance post op.
1) Cost and quality of valves when I need surgery
3) Age when I get surgery
4) How technology evolves
5) My health at time of surgery
6) My finances at time of surgery
7) If I will need a 2nd valve surgery in my lifetime
8) If a pacemaker is needed
9) Will I have a partner to help me post op?
I have vetted this plan by my American doctor at UCLA, my American doctor here, and my Thai heart doctor as well as a few trusted friends and they like it. I am trying to vet the plan with Medi-Cal Anthem Blue Cross, 1-2 more heart drs here in Bangkok and a heart doctor I saw in Los Angeles a year ago.
Further thoughts Questions? Thanks!
Anyone living in Asia ? I live in Thailand-my cardiac issues are pre existing/not covered by insurance. So I'd have to go back to California and do it there if I am still ok to fly...and then there is the issue of where to stay and who to take care of me post op as I am single and have no living family and no home