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Nasty health problems in the Philippines - What to do?

Ask questions and get advice, or share advice. Disclaimer: Any advice you take here is at your own risk. We are not liable for any consequences you might incur from following someone's advice here.
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Postby Contrarian Expatriate » Sat Apr 17, 2010 5:15 pm

Life abroad has its health challenges indeed. Some of the things I recommend to protect my good health are:

I maintain a physical fitness regimen to keep my resistance to disease and infection high.

I take a multivitamin-multimineral supplement every day.

I never eat salads in restaurants nor do I consume ice unless it is from bottled or distilled water.

I have a high end dentist and the "expat" medical facility on my cell phone just in case.

These are steps that have worked for me over the years.
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Postby Repatriate » Sat Apr 17, 2010 8:49 pm

Winston i'd recommend running as a good exercise. It takes motivation to do so and you'll feel like crap the first few months of running but when you get into it and can do at least 1.5-2 miles a day you'll be extremely fit and feel much more energetic all the time.
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Postby momopi » Sat Apr 17, 2010 9:50 pm

There are many people in the world who live in more extreme environments than the Philippines. Your ability to adopt to local environment varies.

Personally, I cannot handle cities with heavily polluted air, which is why I refuse to live or work in downtown Los Angeles.
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Postby Winston » Wed Apr 21, 2010 7:39 am

Hi all,
I just went to the eye doctor the other day here in Taiwan. He said that my long term eye infection is a minor thing that would have gone away if I hadn't kept rubbing my eyes with my hands and picking at the crusts that harden on my eyelashes from the discharge from the eyes. He also said that the antibiotic eye drops that the doctor in the PH gave me (Tobramycin) were overkill and prescribed two healing antibiotic eye drops for me instead.

I was told not to look at the computer screen or TV for a week, but for me that's VERY hard to do! So I'm not even supposed to be on here right now. But my vision is improving. I still wake up with blurry vision in the morning though.

Another doctor, a general practitioner, drew a blood sample on me and a urine sample to test to see if I had any early signs of diabetes that might be causing my drowsiness all day. If I do have early stages of diabetes though, is there any way to reverse it or prevent it? Does anyone know? Or is getting diabetes inevitable if you have the early stages?

But I am not as drowsy anymore here in Taiwan as I was in the PH, so that's a good sign at least. Perhaps the extreme heat and bad air caused the drowsiness? How can I know?

Any thoughts Momopi?

Also, my ace inhibitor medicine for my hypertension doesn't seem to be working anymore. My diastolic blood pressure is consistently at 100 or 110 now. I was thinking of going back to Atenolol, a beta blocker, again, but the doctor said that if I have early diabetes that that medication is bad for it. What other choices are there for hypertension?

Exercise doesn't seem to reduce hypertension in me by the way. Must be a genetic thing.

Thanks all.
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Postby Winston » Wed Apr 21, 2010 1:36 pm

Hi all,
I just got my blood test results today. Fortunately, my blood sugar level is normal, so I don't have diabetes.

But there are numerous other problems. My GOT and GOD are very high, 3 to 4 times the normal level. I was told that they have to do with liver function. So that means my liver has some problems. But I don't know why or what the cause is. I also have a high rate of "uric acid" in urine.

The doctor gave me some medicine for my liver. He said it if doesn't work after a week, then I will be sent for an ultrasound test.

What is the cause of high GOT or GPT in your liver? Anyone know?

I was told that it might be due to Hepatitis B?

The liver dysfunction or abnormality might be causing my constant drowsiness in the PH? I don't know but it seems to be better here.
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Postby momopi » Sat Apr 24, 2010 1:54 am

If tests are cheap in TW, get the ultrasound, and full STD panel (including Hep-B). You can also try seeing a different doctor for a second opinion.
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Postby Adama » Sat Apr 24, 2010 11:51 pm

Winston wrote:Hi all,
I just got my blood test results today. Fortunately, my blood sugar level is normal, so I don't have diabetes.

But there are numerous other problems. My GOT and GOD are very high, 3 to 4 times the normal level. I was told that they have to do with liver function. So that means my liver has some problems. But I don't know why or what the cause is. I also have a high rate of "uric acid" in urine.

The doctor gave me some medicine for my liver. He said it if doesn't work after a week, then I will be sent for an ultrasound test.

What is the cause of high GOT or GPT in your liver? Anyone know?

I was told that it might be due to Hepatitis B?

The liver dysfunction or abnormality might be causing my constant drowsiness in the PH? I don't know but it seems to be better here.


You could ask your Dr these questions on your next visit, Winston.
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Postby Winston » Fri May 07, 2010 3:44 pm

J.Adama wrote:You could ask your Dr these questions on your next visit, Winston.


It's not that simple. Often when I ask them, they look indecisive and unsure, like they are fishing for answers. So I'm not sure about the competence of doctors in Taiwan, or at least in my town.

Momopi, what is your evaluation of doctors' competence in Taiwan?

Other times, they seem abrasive and impatient and I feel intrusive if I come back and ask them a question I forgot.

Also sometimes what they say and what the prescription drug websites say are different. I was given these eye drops called fluorometholone eye drops, for instance. The drug sites say not to use it over a week, but the eye doctor here said I can use it up to a month.

Who do you believe in such cases?

Anyhow, my eyes are still not completely back to normal. I still wake up with blurry vision, and the computer screen hurts my eyes sometimes. The drops do help clear up my vision. And there is still a little discharge emanating from my eyes, kind of like a gooey substance, which often crusts on my eye lashes. Plus one of my eyes is smaller than the other now. You can see it in my recent youtube videos.

How can that be? How can this infection last over a month? I don't get it.

I don't want to go back to my eye doctor here again. He is a smart ass and I do not get good vibes from him. He seems to be condescending and immature and I'm bound to give him a piece of my mind at some point.
Last edited by Winston on Mon May 10, 2010 2:05 pm, edited 1 time in total.
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Postby Rock » Fri May 07, 2010 4:34 pm

Winston

Have you had your blood tested for hepatitis A or B? If not, you should to rule those out.

I asked my doc about liver function recently and had the tests done - 24 IU/L for GOT (AST) and 18 IU/L for GPT (ALT) so OK. GOT over 37 and GPT over 41 is the top limit of normal range according to the standards of my hospital (Taipei Medical University Hospital). Do you know your numbers or did you doc just say they are very high?

Other causes of problem liver could be excessive drinking (probably not you), hygiene (maybe given your environment in Philippines), poor diet (some vegetarians miss important nutrients depending on what types of non-meats they eat), or certain medications.

While you are here, you should really get to the bottom of this. Minor liver problems have a significant impact on life quality and major ones are life threatening.

If you don't already have it, consider joining the National Health Insurance system here which your passport allows you to do. Premiums are extremely cheap (NT$659 per month) as the system is largely government subsidized. If you ever needed major surgery such as a liver transplant, the insurance would cover almost all your costs including hospital stay. You can also use it for dental care. A few months ago, I had rotary cuff tear surgery which involved general anesthesia and a 3 day stay in the hospital. Total charged to me including medications was just NT$5,200 (US$165). The health plan covered everything else. After some weeks of stretching by a very cute physical therapist, also provided by the hospital as part of the package, the surgery turned out to be a complete success (total recovery of function).
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Postby Winston » Fri May 07, 2010 5:01 pm

Rock wrote:Winston

Have you had your blood tested for hepatitis A or B? If not, you should to rule those out.

I asked my doc about liver function recently and had the tests done - 24 IU/L for GOT (AST) and 18 IU/L for GPT (ALT) so OK. GOT over 37 and GPT over 41 is the top limit of normal range according to the standards of my hospital (Taipei Medical University Hospital). Do you know your numbers or did you doc just say they are very high?

Other causes of problem liver could be excessive drinking (probably not you), hygiene (maybe given your environment in Philippines), poor diet (some vegetarians miss important nutrients depending on what types of non-meats they eat), or certain medications.

While you are here, you should really get to the bottom of this. Minor liver problems have a significant impact on life quality and major ones are life threatening.

If you don't already have it, consider joining the National Health Insurance system here which your passport allows you to do. Premiums are extremely cheap (NT$659 per month) as the system is largely government subsidized. If you ever needed major surgery such as a liver transplant, the insurance would cover almost all your costs including hospital stay. You can also use it for dental care. A few months ago, I had rotary cuff tear surgery which involved general anesthesia and a 3 day stay in the hospital. Total charged to me including medications was just NT$5,200 (US$165). The health plan covered everything else. After some weeks of stretching by a very cute physical therapist, also provided by the hospital as part of the package, the surgery turned out to be a complete success (total recovery of function).


I said exactly that, but my parents and their doctor said that I should keep taking the Livorin medicine first for two weeks before getting a hepatitis B test. I was told that things have to be done in steps here. I can't skip the steps. If the doctor doesn't order the test, then my insurance will not cover it and I would have to pay for it out of pocket. That's how they keep costs down, by eliminating unnecessary tests and exams involving specialized equipment.

A patient can't just order the tests at their own volition. Otherwise, everyone would order every medical test on themselves at their health insurance's expense, to make sure and rule out every possibility, and then health care costs would skyrocket astronomically. That's what I was told. Doesn't it make sense?

Yes my numbers are about four times higher than yours. So they are much higher.

I am already covered by the national insurance plan, cause I am a citizen here. But as far as I know, we do not pay for my health insurance. It is free since we are Taiwanese.

What is rotary cuff tear? Congrats on that.
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Postby momopi » Fri May 07, 2010 5:37 pm

Winston wrote:Momopi, what is your evaluation of doctors' competence in Taiwan?
Other times, they seem abrasive and impatient and I feel intrusive if I come back and ask them a question I forgot.



You don't know how to ask a question.

Taiwan's national health care system pays doctors per patient visit. Doctors are not allowed to prescribe any drug or treatment not covered by national health care system. Thus, they cannot make extra $ on the side from drug companies or referring you to a private clinic for specialist treatment.

This means their only source of income is from seeing as many patients as possible. About a decade ago they were paid $8 per patient, and I do not know what the current pay scale is. In the US a doctor might see 15 patients in the morning. In Taipei they see as many as 100 patients in the morning, then go to another hospital in the afternoon to see 100 more.

And that's exactly what you're worth, $8 a head (in early 2000's). It's not the doctor's job to sympathize or understand your situation. He just wants to give you some drugs to take care of your immediate needs and have you leave. If he cannot explain something to you, it's because he never acquired the knowledge to explain medical terms in layman's terms -- it's not his job, nor is it in his best interest to take time to explain it to you. He's got another $8 head after you, and another, and another, and another.

If you want personalized care, you need to build personal connections (guan-shi) if you can't find a "nice" doctor. You're in Taiwan, learn to do things the Chinese way. My aunt was the head nurse at a hospital in Taipei. If I needed medical care in TW I'd go to her and she'd walk me to a doctor personally and do an introduction (the favor will be repaid later). Your cousin is a doctor, go talk to him and learn to ask FEWER questions more POLITELY.

People wanted a national healthcare system, and they got one. Enjoy it!

==========================

Learn how others translate your words.

Q. "Answer these important questions",
Translation: "Questions that are not important to me"

Q. "Answer these valid points..."
Translation: "Irrevelent time wasting crap"

Q. "You're just afraid to answer my questions! I dare you! What are you afriad of? Nayk Nayk Nayk!"
Translation: "This dumb a$$ kid never left the sandbox"

Q. "Doctor, can you answer these questions..."
Translation: "Can you waste time and delay seeing the other 98 patients lined up today?"

What the doctor would like to say, is "get the f*ck out of my office". But he can't say it to you, so it's written all-over his face.
Last edited by momopi on Sat May 08, 2010 5:32 pm, edited 3 times in total.
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Postby Rock » Sat May 08, 2010 11:43 am

@Winston

1. You get free National Health Insurance? Are you sure your parents don't pay for it? How did you get your NHI IC card? My local girlfriend pays for her coverage. When she works for a company, they pay a portion (I believe its 80%) of the premiums and she pays the rest through a payroll tax. But when she doesn't work, her mom pays the full amount on her behalf.

2. IMO, Taiwan's universal health care system is pretty good. Its not perfect. But it has razor thin administrative expenses (less than 2% of total cost) and I like it best of systems from the countries I've lived in for over 3 months (USA, UK, Hong Kong, China, Brazil, Colombia, Thailand). My experience has been that the detailed rules are sometimes interpreted and applied differently from hospitals to hospital and doctor to doctor. Like all systems, it has its loop-holes. Taiwan's total health care costs account for about 6% of GDP vs. 16% for the US. The US is insanely high but Taiwan's is still significantly lower than the OECD average. A few more +s: you are allowed to see a specialist without a recommendation, no gatekeepers or long waiting lists, basic medical records from different hospitals are are combined electronically and centralized.

3. Not all Taiwan doctors are the same. If you click with one of them and they are sufficiently competent, you will get a lot more out of the visits and he will be more generous with his time, even if the incentive system works against that. My current urology doctor spends 10-15 minutes with me per visit going over my blood work, answering my questions and educating me according to his experience. For example, I'm interested in testosterone treatment. We've discussed the pros and cons of oral medications, Nebido injections, Androgel, HCG injections, anastrozole, androgel, and pellet insertions. He is willing to prescribe me expensive anastrozole among other treatments so most of the cost would be covered by NIS. The other 2 docs I saw at that same hospital refused. Sometimes, you can also get very different results by seeing a doctor in a different department (there is overlap) for the same issue. For cardiovascular care, I visited four different doctors in three different hospitals until I found one I liked. With my rotator cuff (muscles and tendons around the shoulder), the first doctor did not want to have me do surgery but I wanted it so he referred me to another one who is known to be more aggressive in his treatment plans. After reviewing my x-rays and MRIs, he agreed and I got what I wanted. So, as long as you can afford the NT$350 per doctor visit and time it takes to shop around, there is a good chance you will get what you want within a few tries.


4. I think another cause of liver problems may be lack of sleep or stress. My forex broker is a workaholic, sleeps 4-5 hours, and keeps irregular hours too depending on how the markets are moving. He's been doing this for over a decade and his skin has a strange yellow hue. I believe this is from a liver issue attributable to his lifestyle.
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Postby Winston » Mon May 10, 2010 2:10 pm

Momopi,
That's a pretty grim view of Taiwan health care, but it does explain my experiences with it. The doctors seem hesitant and unsure about answering questions, and so that's why I ask for info here or from my scientific advisor or I look on medical websites. Some of the sites have professional doctors that give advice too.

Fortunately though, our family doctor is very calm and patient like a Buddhist master. I have no problem with his personality. But when I ask him questions, he does look unsure and hesitant to provide answers. That's the problem.

Rock,
Btw, you were right. I just asked my dad. My health insurance here is not free. We pay around 600NT a month for it.
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Postby momopi » Thu May 13, 2010 2:44 am

Medhelp.org

Pay a few bucks and a doctor will answer your question.
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Postby momopi » Thu May 13, 2010 2:44 am

Medhelp.org

Pay a few bucks and a doctor will answer ONE question.

You must pay for EACH and EVERY question asked.

You can post the question without payment, and someone (not necessarily qualified) might comment on it for free.
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