• Nick

The Japanese experience I could do without.

5 December 2020. These last six months I've been battling pains in my hips with physio and painkillers. It got noticeably worse when we began hiking in the mountains and I guess the optimist in me always hoped it might just come right in time. Unfortunately that was not the case and a few weeks ago we took my Doctors advice and had an MRI, which confirmed that my life of contact sports, heavy gym work, riding (and regularly falling off) horses, has caught up with me, and I will need a double hip replacement. It felt good to know exactly what was going on, but the timing is far from great with our flights back to New Zealand booked for January.

It seems though, that things here in Japan, at least medical issues, are far more efficiently dealt with than back home. Need to see a Doctor? No worries. No appointment necessary, just go to the appropriate specialist, and he will see you. Maybe 30 minute wait max, but probably more like 5-10 minutes. Need a MRI? Easy. Doctors assistant makes the appointment right there and in a few days it's done. Again no que or waiting around. Take the results back to the Doctor a few days later, and he's giving the news that I need my left, and maybe my right hip done. He writes up a referral for a surgeon straight away.

A week after that we were in the hospital bright and early to see the specialist. He looked at the MRI and basically told me my left side is stuffed, and the right side is on it's way out. He wanted to do both at the same time, but also wanted to get a few extra tests done first. Over the course of that day I gave a blood sample (right arm), gave another 400ml of blood (left arm) in case of the need for a transfusion during surgery, had multiple x-rays, ECG, CT scan, signed all the paperwork, and was scheduled for surgery in less than two weeks time. Yesterday I had my pre-admission Covid 19 test so as long as that is clear, on the 10th Dec I will be admitted, the 11th I have my operation, and the 25th (Christmas Day) I should be coming home.

Although things here do seem bureaucratic and bogged down by mountains of old fashioned paperwork, they do manual process better than anywhere else. They love paperwork and details, and take pride in making sure everything is right. The challenge is going to be being stuck in hospital for two weeks, Japanese hospital food, limited Japanese on my part, and limited English from the hospital staff. The kicker is no guests allowed in this Covid world so I won't see Pania until the day I'm discharged.

The other interesting factor is the cost. We have Medical Insurance through Pania's employer providing 70% cover. I think the Doctor appointments average cost was about $12 NZD. All the hospital pre-tests for my admission cost maybe 150 NZD. My Corona virus test cost 2 NZD. The big one we have been worried about was cost of the surgery and hospital stay. With the expense of our New Zealand trip looming, $4000 isolation fees, and all the other holiday expenses, it was concerning. We have since found out that there is a cap on monthly medical billing with our insurance, so while at this time I'm not certain, it looks like we will only need to pay 3-5k for the operation. This is something of a relief considering we were bracing for up to three times that cost.

So here I sit, on a gloomy Saturday, thinking about going into hospital this coming Thursday, surgery Friday, then the joy of two weeks rehab, all in a Japanese Hospital. Thank goodness for Netflix.

Thursday 10 December 2020 Admitted today. Four beds in my room. I’m fortunate enough to get a window bed. I have a pretty good view from the eighth floor and can see Tokyo tower... well at least the top third of it. It’s not unlike any other hospital ward I’ve been in before. The bed is reasonably comfortable but the pillow will need to be replaced. It feels like it’s filled with dried corn kernels. Everything is user pays. You have to hire towels and pyjamas, and you need to purchase credit if you want to use the fridge which was maybe 3 NZD per day. I have the option of pay tv but the wifi is free so will make do with Netflix and downloads.

Because of COVID-19 there are heavy restrictions on visitors. I was lucky enough to be able to have Pania with me for my first few hours where I was given the full orientation with her translating. Once she left it’s been a matter of the nurses using little pocket translators which give some interesting results, and my limited language skills to get by.

Day and night: Views from my bed

Friday 11 December 2020 Operation day and I must admit to feeling a little anxious. Last night I slept well until the guy in the next bed decided to be an inconsiderate arse. He woke the room up at 2:30 after he had been watching tv on his laptop. When he finally decided to get some sleep, it was preceded by 20 minutes of rustling plastic wrappers and bags, sorting his rubbish and fidgeting before he settled eventually down. Then he snored until 5, got up went to the loo, came back and blew his nose super loud in the room. I’ll get him back when he tries to have his mid morning snooze. I promise you that prick ain’t sleeping today. I think the impending surgery has me a little less tolerant than I might otherwise be.

I’ve met with the surgeon who speaks pretty good English and was very reassuring. I’m nil by mouth since 10pm last night except for two 250ml electrolyte drinks I have to take before 10am. I also need to shave shortly as I will be on a respirator for the procedure and the bit that goes down my throat gets taped to my face.

Saturday 12 December 2020 Early morning I was in quite a bit of pain. Initially they had trouble getting meds right because I'm slightly larger than what they are used to dealing with here. They also had pain medication being delivered via epidural, however due to having had back surgery to remove a ruptured disc when I was younger, it was having little to no effect. They were aware this could be an issue beforehand. It was not until I managed to get Pania involved did they really do something serious about it by increasing my dosages, and I think they changed some of the medication. On the bright side, I was up out of bed and in a wheel chair the day following surgery. No walking as pain levels were too high. I also would like to note that the food was terrible. Japanese style food but some stuff I couldn't even hazard a guess as to what it was.

The nurses have also been painful because I've been running a bit of a temp. High 38s and 39s. I've had a constant stream of nurses wanting to take my temp and replace ice packs on my hips and head in an effort to get my temp down. Personally I think if they had got the pain under control and let me get some uninterrupted sleep we could have done better.

Sunday 13 December 2020 Sunday morning, two days after the operation, and feeling much better. Pain control sorted. I was making sure I told them that my pain is higher on the pain scale than it actually is. Temps still low to high 38s but now able to get myself in and out of the wheelchair from bed unassisted. First sponge bath which was interesting. The memory of having the the nurse speak into the portable translator, and a very strange electronic voice telling me she is about to wash my genitals will stay with me for a long time. Sorry, no pics or video of that session.

With the intravenous painkillers sorted I was feeling much better and sleep was not hard to find. I've been shifted to another room with two guys admitted today who will have their respective procedures tomorrow, and another guy who has been here for about a week. Everyone seems to keep to themselves and you don't really see any socializing.

Monday 14 December 2020 Temps back up well over 38 again. This means more fussing and and ice packs. Body temp is a national obsession in Japan... second only to bowel movements. I think I have mentioned the Poo Museum in the past. I had my urine catheter removed today which is probably up there with the more unpleasant sensations one can endure. Highlight of the day though was my first Physical Therapy session. To be able to be getting up and feeling like I'm actually doing something to aid recovery felt great. Definitely more movement than I expected in this short time but still very painful to put downward pressure on my new hips.

Meals seem to be a bit of a lottery as to whether it will be possible for me to eat. Todays lunch was a tough old bit of fish with mushroom and seaweed surprise, and a few boiled root vegetables of unknown origin. I had a go but nearly threw up. Thank goodness my fantastic wife had packed me an assortment of yoghurt, smoothies, muesli bars, and fruit to tie me over in just these situations.

The follow up for dinner was sweet & sour and was actually quite good. They have also offered to swap out all rice dishes with bread. I'm happy about that, although I don't really eat much carbohydrate these days, I definitely feel riced out.

Tuesday 15 December 2020 Not a great nights sleep. The old guy in the bed next to me snores and farts in his sleep and it really is something to behold. He has a rhythm whereby he gets louder and louder until eventually he is so loud, he wakes himself up, whimpers a bit before settling back down quietly, and then repeating the process all over again. I started fake coughing and rattling my bed frame to try and wake him enough that he might roll over and find a new sleeping position... to no avail. It seems that my fellow roomies were also suffering as they began coughing and banging around as well. Sleeping pills definitely required while this guy remains in our ward.

Rehabilitation progressing really nicely. Up and out of the wheel chair unassisted, and walking along the parallel bars. Feeling good about the progress and after my sponge bath, had a shave, fresh pyjamas, some deodorant and moisturizer, and feeling like a million bucks!

The new hips, and feeling great thanks to these bad boys

Boredom is the big issue for me now. I've watched a few movies but find I just want to get out. There's only so much Netflix I can cope with.

Wednesday 16 December 2020 Temp below 37 which has given me some respite from the Ice pack Nazis. Another little milestone is I'm now allowed to go to the loo unassisted, so at least that's one less humiliation I need suffer. Pretty sore today as I have probably been going a little hard on my rehab. Once those pain killers kick in though, the world becomes a better place. Managed to do my Christmas Shopping today... a big thank you to Amazon. I love internet shopping.

Thursday 17 December 2020 Step and repeat from yesterday. Small gains in my rehab and probably still a little more pain than I expected at this stage, although I don't really know what I expected. I can feel my lower back area really pinches when I apply weight. It seems if I was 20kg lighter I could walk unassisted. Just that last little bit, especially on my left side, gets quite painful.

Friday 18 December 2020 One full week since the operation and it's a big day today with lots happening. First up, Blood tests 6am before breakfast. Hopefully the last needle I get in my stay here. After breakfast it's rehab and my Therapist is very happy with my progress. She had me doing a lap if the ward on a crutch today, so I now have the option when I'm moving around the ward to use that or the walking frame. I have to admit the mobility toilets are nicer and there is rarely a wait, so I use the frame whenever I need to go.

Next up... Shower Time!!!! My first shower and I think this was the best one I've ever had. It felt so good to be there under the hot water. Unfortunately I'm still not allowed to get in and out unassisted, so there is that, but I had 15 minutes of blissful alone shower time and that is now a hi-light for each day.

Except today it wasn't the hi-light. I got permission to go alone to the hospital 7/11 and Pania came in to meet me. A bit naughty as we are not supposed to have visitors, however it was great to see her and we had a really nice 30 minute date before I had to get back to the ward.

Saturday 19 December 2020 Well it's eight days since my surgery and probably a good opportunity to try and assess my recovery progress so far. I've started spending time in the communal lounge area since no one can have guests at the moment and it's nice and quiet. There's also been a few patients discharged so the ward is half empty.

So, how has the recovery been going? Pretty good I think. Medication was pretty heavy last Saturday and Sunday straight after surgery and I don't remember much at all about those days. I can go back and see what I've written, and see my messages to Pania but I can't really recall events that well. Over the course the following week, I think there has definitely been gradual yet steady improvement in mobility and reduced pain levels. Today I was given a walking cane and encouraged to use that as much as possible instead of the walking frame. The exercises I am being given in my rehab sessions are getting harder and more challenging however they are happy and suggesting possibly Dec 24th for my release date which Pania and I are really happy about.

I am now allowed to use the toilet and shower without a chaperone which is a massive bonus. I just have to answer a daily questionnaire about my daily motions. Wahoo!!!

Sunday 20 December Hospital life is getting pretty tedious now. Still soreness and swelling, especially before I get those first pills of the day. Todays visit by the surgeon is a very positive one. He is very happy with the progress to date, and also with the X-rays taken one week post surgery. He has assured me that he will be in communication with my rehabilitation team to discuss discharge as early as possible.

Monday 21 December Feeling really good today. Focusing on trying to walk as naturally as possible with the cane, however there is still significantly more pain on my left side than on the right side. I've also had an opportunity to have a good look at the bruising and marks on my back and legs as a result of my surgery. I clearly have finger/hand grip marks where they have been holding me in place while the surgeon has done his thing. There is also heavy bruising on my thigh adjacent to where my operation scars are, and one of my love handles has a massive bruise where someone has gotten themselves a good old grip for some reason. My lower body looks like it used to 24hrs after a game of rugby.

Bruised Love Handles / Scars and bruises

Tuesday 22 December It's been all go since I last updated yesterday afternoon. I have been given the word that they are very happy with my progress and I will be going home tomorrow. I can tell you I am very happy with that news. Initially the 25th was supposed to be my release date. Then, when I saw the surgeon a few days ago, I put it to him that I felt great and could happily go home on the 24th to which he agreed. And then yesterday we were having a conversation about organising transport for me to get home, and we were looking at the calendar for dates for me to come back in for my check up. He accidently said 23rd for my release date before correcting himself. I jumped on that and suggested if he was happy for me to go home on that day then I felt I would be ready. He told me if I could convince my Rehabilitation Therapist I was ready, then he would agree. Needless to say my next session will go down as one of my most determined ever workouts and the rest just fell into place.

Once the decision was made the massive wheels of Japanese process were set in motion. The ward Pharmacist has been to see me and I have been given my painkillers for the next two weeks, so there is no need to worry about going to a pharmacy and sorting prescriptions. I have been sent to occupational therapy where I have been put through testing for normal everyday tasks like putting a pair of pants on, getting on a bus, getting in and out of bed or going to the loo. Pania has bought me a walking stick as having one was a condition of my hospital release. It's actually just a fancy hiking pole so will get plenty of use even after I'm recovered. She's also bought me a stationary bike so I can exercise safely from home. I'm still waiting to find out what happens with my dressings and stitches. Surprisingly to me, the bandages covering my surgical scars have yet to have been changed.

Really looking forward to tomorrow. I have to say the level of care and the quality of the facilities have been fantastic, but there's no place like home.

Wednesday 23 December Home by 11:00am. I am so impressed, and can not speak highly enough of the efficiency of the process, and the care I have been shown these past 13 days, and my last day was no exception.

The day started as usual for me before everyone else at 5am. It's partly a lifetime habit of early starts, and also the result of pain meds wearing off. I was usually able to snack on my supply of food that Pania had arranged for me to tie me over until breakfast which was served at 8am, but I had a pre-discharge blood test which meant no breakfast until that was done. Fortunately they got around to it at about 6:30 which was lucky because with the combination increased pain levels and my empty tummy, I was starting to get ratty.

Blood test done, food in the tummy, painkillers, and the world is suddenly a much better place. I was booked in for my final physical therapy session at 9am so I spent the morning getting what I could packed away and ready to go home. Pania arrived at 8:55 and together we went down to my last session. It was a pretty intense session that lasted about 90 minutes, but in that time I was visited by my surgeon who was super enthusiastic about my recovery and also very happy with his own handywork. I have to say, I have had many operations for a variety injuries over the years, and this guy was by far the most engaged and invested surgeon that I have had to deal with. Both him, and his assistant that aided in the procedure were brilliant, and I would have seen either one, or both of them every day I was in hospital, including the weekend.

The final Physical Therapy session / A little thankyou gift always goes down well

After the therapy session we went back up to the ward to pack up the rest of my things. There was a note letting me know the final bill was ready and we could pay on our way out. And that was it. We packed up, the ward nurse had a quick look around to make sure I hadn't left anything behind.... or pinched anything, and we were out of there.

It's great to be home!

I mentioned earlier about costs. Pre-Op, I think total expenses would have been less than 200 NZD. That's impressive in itself considering it includes Doctors visits, and the number, and types of tests that were done. The final bill for my 13 day stay in Hospital, all inclusive, was lees than 4000 NZD. That is thanks to the medical insurance, which also makes us eligible for monthly bill capping. We also qualify for a rebate on some of that. It's a formula that Albert Einstein would have trouble trying to figure out but we have put a claim in which will come somewhere between $1000-$3500... we think.

Comparatively, if I had the same procedure In New Zealand, Southern Cross charge about 25000 NZD for a single hip replacement. Probably around $35000-$40000 if getting both done at the same time. On top of that, there would have been the costs of diagnosis via Doctors and Specialists, and the tests required for diagnosis. So even with my Southern Cross Insurance which is an 80% policy, I probably wouldn't have seen much change out of $10000 unless I went through the public system. And then I would have been on a 12 month waiting list, and it is most likely they would not have done both at the same time. And I would still have had to pay to get to that point of getting the Specialist referral.

Everything considered, I think the system here was very good and I am grateful to have had the benefit of it. I now look forward to getting fit again, climbing mountains, riding motorcycles, and maybe even surfing again eventually.

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