- 2 Jun 2005
- 729
- 1,226
An aquantence of mine who actually tried to retire back in the city I live so we used to meet in person until he found the whole political division too much during the first Trump run and early covid and went back had an interesting experience with blood clots. I am surprised the diagnosis was so hard for him.
"
I've been off the grid for weeks now dealing with medical issues. In this piece, I discuss how I've been weaving through Japan's medical system here in Tokyo. I will not "name names" of hospitals or doctors as what's important is to see the big picture. As I discuss my experiences, I do not wish to compare Japan's system with anywhere else in the world - similarities and differences are guaranteed on all fronts. Rather, my goal is to share learnings with you and highlight areas of caution in order let you draw your own conclusions.
It all started as a normal cough in late July here in Tokyo, but quickly turned into pneumonia. The doctors I went to never could determine whether it was viral or bacterial, but it was a severe pneumonia with the first week constant dry coughing followed by the second week of constant wet coughing as the lungs started to break up. In week one, I sought out a respiratory specialist at a local hospital who ordered a CT scan and confirmed pneumonia in early August. At no time was I offered to be hospitalized. I guess I was not "sick enough" to warrant that.
In week three, I started feeling dizzy and lightheaded much of the day everyday, so I went to a cardiologist who took my blood pressure and noticed it was rather high. I had been on blood pressure medicine for years which controlled it rather well. For the first time, however, I needed to increase my dosage. But after a week of increasing my dosage, it wasn't working well. So, this cardiologist then listened to blood flow through my carotid artery. It was at the point he ordered an ultrasound which led to the discovery of plaque buildup of 63% producing a blockage. But that is not the cause of the increased blood pressure (which remains undefined).
I credit this cardiologist with being proactive and thinking outside the box. However, even with a 63% blockage no aggressive action is taken to reduce risk as "the norm" is to continue to take cholesterol statins and come back in 6 months for another ultrasound.
My blood pressure rose again to nearly 200 one morning so I called an ambulance which came immediately. Having never called an ambulance in my nearly 35 years in Japan, I learned the following:
1) Once inside the ambulance, you are asked your name, phone number, for your ID card, for your insurance card, and whether you are registered at an area hospital. Fortunately, I was. I suggested my preference and they called the hospital. They accepted me and off we went. The process took about 10 minutes up to this point.
2) I spoke Japanese but the ambulance attendants did not speak English. A word to the wise. However, the 119 (emergency number in Japan) attendants either speak English or have interpreters available in multiple languages with less than a minute waiting time.
3) Whereas in my native USA the ambulance starts rolling to the hospital immediately, this is not the case in Japan. One must be accepted by a hospital first. So, if you're having a heart attack and minutes can mean the difference between life and death, one must still be accepted first before the ambulance starts moving. I am told by friends if you really need to get to an ER quickly, you're better off taking a taxi and call the ER on the way to let them know you're coming (and make sure they will accept you).
The problem with the hospital I chose is the ER staff missed something very important in my case. Having arrived, they took my vitals and drew blood. One hour later (yes one hour later), I was told there is nothing wrong (even though the cause of my high blood pressure was not clear). In short, I wasted my time going to this particular ER as they felt blood pressure at near 200 is not a problem "because it did not stay there". (Note to self: don't call an ambulance with BP at alarm bells levels.)
What the staff missed was written in black and white based on my blood work results. When I got home, I looked at the blood symbols I did not recognize, some of which has an "L" (low) or an "H" (high) written next to it. Something called "D-Dimer" was 3.7 (whereas the normal range is 0.0-1.0). "Hmm", I thought, "That's not good". But what is D-Dimer? It turns out D-Dimer is a marker for blood clots. Troubled, I went the next day to a trusted doctor who ordered an ultrasound of my legs to look for clots. Sure enough, two were found. Immediately, I was introduced to a vascular surgeon who put me on anti-coagulants. Given that the following week I was supposed to fly to the USA, I immediately cancelled my flight (as one is not allowed to fly for at least one month). (Note to self: Why was I, the patient, the one who proactively read the blood results, investigated the "H" reading, and discovered a blood clot? Isn't that the role of the doctor???)
I had other medical ailments as the days proceeded. Each time I went to a different hospital, there was a desire to take a new CT scan so they could get a "fresh" look. "That was two weeks ago. We need to see if anything has changed", they reasoned. Fair enough. But knowing that CT scans give the recipient a rather high shot of radiation, I had to decide whether I should get another CT scan or not. Even when I shared that I've had 2 CT scans in two weeks, they were still interested in a new one. One doctor even said to me, "It's like the same dose you'd get in an international flight (which is not true – it's a lot more). All of this highlights the fact that Japan does not have a shared medical information system, meaning the Hospital A's records are not readily available for Hospital B. This includes MRI's, CT scans, etc. which need to be copied on a DVD/CD and taken with you to go see another specialist. But to get that copied, one needs to get the doctor who originally ordered it to formally request a copy be made (and one is charged a fee for each copy).
There are more stories, but for the sake of brevity let me sum up my learnings:
First Learning: Just because you have Japanese national health insurance does not mean you'll be hospitalized (even with an ER visit). I am told chances are better at being hospitalized if one offers to pay themselves (i.e. – pay full price or with private insurance) which is a very expensive undertaking without Japanese national health insurance. So, if getting hospitalized is your goal, say up front you're willing to pay yourself. Again, several doctors told me this.
Second Learning: You must be your own patient advocate. No one loves you more than you do. Be sure to get copies of everything your doctors do (paper, CD's, etc.) so you have your own copy for future reference and use.
Third Learning: Japan's medical system works, not perfectly but extremely well. It is highly organized and efficient. It is also very inexpensive and currently allows the carrier of Japanese national health insurance to go anywhere insurance is accepted and as often as you deem necessary.
Fourth Learning: As money is made by doctors based on volume of patients they see, I felt some doctors I met with would spend a very limited amount of time with me and not really seek solutions on my behalf, preferring to send me on my way. Others were genuinely interested in getting to the bottom of my ailments.
Food for thought. I hope my experiences are helpful to you. I am still dealing with additional health issues now, but at least I am registered at four different hospitals with ER facilities and have two which are on my preferred list. You may wish to do the same."
"
I've been off the grid for weeks now dealing with medical issues. In this piece, I discuss how I've been weaving through Japan's medical system here in Tokyo. I will not "name names" of hospitals or doctors as what's important is to see the big picture. As I discuss my experiences, I do not wish to compare Japan's system with anywhere else in the world - similarities and differences are guaranteed on all fronts. Rather, my goal is to share learnings with you and highlight areas of caution in order let you draw your own conclusions.
It all started as a normal cough in late July here in Tokyo, but quickly turned into pneumonia. The doctors I went to never could determine whether it was viral or bacterial, but it was a severe pneumonia with the first week constant dry coughing followed by the second week of constant wet coughing as the lungs started to break up. In week one, I sought out a respiratory specialist at a local hospital who ordered a CT scan and confirmed pneumonia in early August. At no time was I offered to be hospitalized. I guess I was not "sick enough" to warrant that.
In week three, I started feeling dizzy and lightheaded much of the day everyday, so I went to a cardiologist who took my blood pressure and noticed it was rather high. I had been on blood pressure medicine for years which controlled it rather well. For the first time, however, I needed to increase my dosage. But after a week of increasing my dosage, it wasn't working well. So, this cardiologist then listened to blood flow through my carotid artery. It was at the point he ordered an ultrasound which led to the discovery of plaque buildup of 63% producing a blockage. But that is not the cause of the increased blood pressure (which remains undefined).
I credit this cardiologist with being proactive and thinking outside the box. However, even with a 63% blockage no aggressive action is taken to reduce risk as "the norm" is to continue to take cholesterol statins and come back in 6 months for another ultrasound.
My blood pressure rose again to nearly 200 one morning so I called an ambulance which came immediately. Having never called an ambulance in my nearly 35 years in Japan, I learned the following:
1) Once inside the ambulance, you are asked your name, phone number, for your ID card, for your insurance card, and whether you are registered at an area hospital. Fortunately, I was. I suggested my preference and they called the hospital. They accepted me and off we went. The process took about 10 minutes up to this point.
2) I spoke Japanese but the ambulance attendants did not speak English. A word to the wise. However, the 119 (emergency number in Japan) attendants either speak English or have interpreters available in multiple languages with less than a minute waiting time.
3) Whereas in my native USA the ambulance starts rolling to the hospital immediately, this is not the case in Japan. One must be accepted by a hospital first. So, if you're having a heart attack and minutes can mean the difference between life and death, one must still be accepted first before the ambulance starts moving. I am told by friends if you really need to get to an ER quickly, you're better off taking a taxi and call the ER on the way to let them know you're coming (and make sure they will accept you).
The problem with the hospital I chose is the ER staff missed something very important in my case. Having arrived, they took my vitals and drew blood. One hour later (yes one hour later), I was told there is nothing wrong (even though the cause of my high blood pressure was not clear). In short, I wasted my time going to this particular ER as they felt blood pressure at near 200 is not a problem "because it did not stay there". (Note to self: don't call an ambulance with BP at alarm bells levels.)
What the staff missed was written in black and white based on my blood work results. When I got home, I looked at the blood symbols I did not recognize, some of which has an "L" (low) or an "H" (high) written next to it. Something called "D-Dimer" was 3.7 (whereas the normal range is 0.0-1.0). "Hmm", I thought, "That's not good". But what is D-Dimer? It turns out D-Dimer is a marker for blood clots. Troubled, I went the next day to a trusted doctor who ordered an ultrasound of my legs to look for clots. Sure enough, two were found. Immediately, I was introduced to a vascular surgeon who put me on anti-coagulants. Given that the following week I was supposed to fly to the USA, I immediately cancelled my flight (as one is not allowed to fly for at least one month). (Note to self: Why was I, the patient, the one who proactively read the blood results, investigated the "H" reading, and discovered a blood clot? Isn't that the role of the doctor???)
I had other medical ailments as the days proceeded. Each time I went to a different hospital, there was a desire to take a new CT scan so they could get a "fresh" look. "That was two weeks ago. We need to see if anything has changed", they reasoned. Fair enough. But knowing that CT scans give the recipient a rather high shot of radiation, I had to decide whether I should get another CT scan or not. Even when I shared that I've had 2 CT scans in two weeks, they were still interested in a new one. One doctor even said to me, "It's like the same dose you'd get in an international flight (which is not true – it's a lot more). All of this highlights the fact that Japan does not have a shared medical information system, meaning the Hospital A's records are not readily available for Hospital B. This includes MRI's, CT scans, etc. which need to be copied on a DVD/CD and taken with you to go see another specialist. But to get that copied, one needs to get the doctor who originally ordered it to formally request a copy be made (and one is charged a fee for each copy).
There are more stories, but for the sake of brevity let me sum up my learnings:
First Learning: Just because you have Japanese national health insurance does not mean you'll be hospitalized (even with an ER visit). I am told chances are better at being hospitalized if one offers to pay themselves (i.e. – pay full price or with private insurance) which is a very expensive undertaking without Japanese national health insurance. So, if getting hospitalized is your goal, say up front you're willing to pay yourself. Again, several doctors told me this.
Second Learning: You must be your own patient advocate. No one loves you more than you do. Be sure to get copies of everything your doctors do (paper, CD's, etc.) so you have your own copy for future reference and use.
Third Learning: Japan's medical system works, not perfectly but extremely well. It is highly organized and efficient. It is also very inexpensive and currently allows the carrier of Japanese national health insurance to go anywhere insurance is accepted and as often as you deem necessary.
Fourth Learning: As money is made by doctors based on volume of patients they see, I felt some doctors I met with would spend a very limited amount of time with me and not really seek solutions on my behalf, preferring to send me on my way. Others were genuinely interested in getting to the bottom of my ailments.
Food for thought. I hope my experiences are helpful to you. I am still dealing with additional health issues now, but at least I am registered at four different hospitals with ER facilities and have two which are on my preferred list. You may wish to do the same."
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