Going back to America when my aortic stenosis becomes severe or stay in Asia? What sayeth my valve peeps ?)

[newarrior]

Dear All,,

I'm in Bangkok; I like living here in Thailand/Asia and have no interest in moving back to the USA.

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.

Medical care in Thailand is outstanding and I know two Westerners who did the AVR surgery here and had excellent results and recovery at a reasonable cost.

Surgery would be free in the USA.

SWOT type analysis to follow:

Strengths:
1) Lifelong exerciser.
2) Diet.
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

Weaknesses
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 !)

Threats:
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 !

PS-Here's me on NY Day 2021--2 weeks before I turned 58. You can see I am fanatical about my health) Not bad for an old coot)

 

[Unicusp]

Hello. Good SWOT analysis. But, you did not mention what your cost would be if the procedure was done in the US. I seem to recall that you previously stated that you have some type of US insurance.
If it is a typical plan, your out of pocket after considering all travel costs, will be at least what you will pay out of pocket in Asia. But, how is the quality at the places in Asia that you are considering?
Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance.
If fact on the way home, we stopped at a Costco to walk around and pick up some items. I did not require any assistance with anything. Sleeping, bathing, making my own meals etc.. No issues. You appear to be perfectly capable of similar.
So, if you trust the surgeons and facilities over there, and you appear to want to stay there, have it done!
I've traveled to Bangkok. A very interesting and beautiful place. Personally, I'd stay there!

 

[vitdoc]

I haven't a clue concerning the quality of health care in Thailand. Probably highly variable with the more expensive private likely more consistent then the public.
For me I would want to go to a place I can trust and has a known track record. So I think going to one of the well known programs for heart surgery in the US is what I would opt for. The decision to stay in Asia or not for me would be not a deciding factor for heart surgery location.
Let's place a sort of devils advocate. Say you had a complication such as a stroke with the surgery. This can happen anywhere you have surgery with any physician. But lets say it happened in Thailand. Would you always wonder if you had gone to a major US center that this would not have happened?
If it happened at a major center in the US would you think you should have had the surgery in Thailand? Probably not. So go to the best place you can which currently is likely to be in the US.

 

[newarrior]

F

Hello. Good SWOT analysis. But, you did not mention what your cost would be if the procedure was done in the US. I seem to recall that you previously stated that you have some type of US insurance.
If it is a typical plan, your out of pocket after considering all travel costs, will be at least what you will pay out of pocket in Asia. But, how is the quality at the places in Asia that you are considering?
Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance.
If fact on the way home, we stopped at a Costco to walk around and pick up some items. I did not require any assistance with anything. Sleeping, bathing, making my own meals etc.. No issues. You appear to be perfectly capable of similar.
So, if you trust the surgeons and facilities over there, and you appear to want to stay there, have it done!
I've traveled to Bangkok. A very interesting and beautiful place. Personally, I'd stay there!

Free in the USA

 

[newarrior]

Hello. Good SWOT analysis. But, you did not mention what your cost would be if the procedure was done in the US. I seem to recall that you previously stated that you have some type of US insurance.
If it is a typical plan, your out of pocket after considering all travel costs, will be at least what you will pay out of pocket in Asia. But, how is the quality at the places in Asia that you are considering?
Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance.
If fact on the way home, we stopped at a Costco to walk around and pick up some items. I did not require any assistance with anything. Sleeping, bathing, making my own meals etc.. No issues. You appear to be perfectly capable of similar.
So, if you trust the surgeons and facilities over there, and you appear to want to stay there, have it done!
I've traveled to Bangkok. A very interesting and beautiful place. Personally, I'd stay there!

Medical care in Thailand is outstanding and I know two Westerners who did the AVR surgery here and had excellent results and recovery at a reasonable cost.

Surgery would be free in the USA.

 

[newarrior]

how is the quality at the places in Asia that you are considering?--Excellent--Thailand is a known medical tourism destination. The best medical care in SE Asia along with Singapore..Most drs have trained in the USA and speak fluent English..many Westerners here including many into their 80's age wise..Thailand caters to old retirees from the West

 

[newarrior]

Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance. "I have not found a valve specialist yet but I have a good heart dr/TAVR dr--working on getting a good valve dr who does a lot of surgeries..I am at least a year or many years away from AVR [I hope])>"

 

[newarrior]

Hello. Good SWOT analysis. But, you did not mention what your cost would be if the procedure was done in the US. I seem to recall that you previously stated that you have some type of US insurance.
If it is a typical plan, your out of pocket after considering all travel costs, will be at least what you will pay out of pocket in Asia. But, how is the quality at the places in Asia that you are considering?
Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance.
If fact on the way home, we stopped at a Costco to walk around and pick up some items. I did not require any assistance with anything. Sleeping, bathing, making my own meals etc.. No issues. You appear to be perfectly capable of similar.
So, if you trust the surgeons and facilities over there, and you appear to want to stay there, have it done!
I've traveled to Bangkok. A very interesting and beautiful place. Personally, I'd stay there!

I am fairly well off and it is cheap here..it's op, post op, and the risk of multiple surgeries or other heart issues that could pop that concern me

 

[newarrior]

I haven't a clue concerning the quality of health care in Thailand. Probably highly variable with the more expensive private likely more consistent then the public.
For me I would want to go to a place I can trust and has a known track record. So I think going to one of the well known programs for heart surgery in the US is what I would opt for. The decision to stay in Asia or not for me would be not a deciding factor for heart surgery location.
Let's place a sort of devils advocate. Say you had a complication such as a stroke with the surgery. This can happen anywhere you have surgery with any physician. But lets say it happened in Thailand. Would you always wonder if you had gone to a major US center that this would not have happened?
If it happened at a major center in the US would you think you should have had the surgery in Thailand? Probably not. So go to the best place you can which currently is likely to be in the US.

True however going back to the USA at age 58 and starting over is not something I want to do..But your feedback regarding a stroke etc is well taken

 

[Meanjellybean]

Hi @newarrior,
This is a decision that you must be comfortable with making and living with what each journey looks like, the good and the bad.

You already make it clear you want to stay in Thailand to live and that you are confident with the medical experts there. So i can see you leaning more towards that.
When you express going back to USA, you are stating it is temporary and that the worst thing would be having to be stuck there.

No including the mention of insurance and costs.

Some people are happy to travel and live their lives on their own calls but others want to feel safe at home even if they have to give up on their dreams and goals. What do you want to do? What are you ok to live with if it does get more complex.

That may mean being stuck in america and starting again after you have surgery.
Or
It could mean having debt but needing more work and getting into more, who knows..
Best of luck on what you choose.. i always find the choice that sits well and not one that brings fear or apprehension is the way to go..

 

[user 16827]

death is not very common statistically from AVR

you could have a post surgical stroke and not recover resulting in life long care.
it's worth factoring all variables

 

[newarrior]

Hi @newarrior,
This is a decision that you must be comfortable with making and living with what each journey looks like, the good and the bad.

You already make it clear you want to stay in Thailand to live and that you are confident with the medical experts there. So i can see you leaning more towards that.
When you express going back to USA, you are stating it is temporary and that the worst thing would be having to be stuck there.

No including the mention of insurance and costs.

Some people are happy to travel and live their lives on their own calls but others want to feel safe at home even if they have to give up on their dreams and goals. What do you want to do? What are you ok to live with if it does get more complex.

That may mean being stuck in america and starting again after you have surgery.
Or
It could mean having debt but needing more work and getting into more, who knows..
Best of luck on what you choose.. i always find the choice that sits well and not one that brings fear or apprehension is the way to go..

Hey I know it's a very personal thing I'm putting out there so thanks for responding I have free insurance in California so obviously going back to the states is the safer decision. However I'm 58 years old I'm single I have no family starting over in America and my age from nothing would be horrible I don't even have housing in America I happen to be from California specifically Los Angeles in the Bay Area so those places are very expensive I don't work I've got arthritis and carpal tunnel I inherited a bunch of money the money is invested wisely at least in Thailand I never need to work again although that was before I found out I had all these cardiac tissues so yeah there is a lot of apprehension towards living in Thailand it's still inherently not my country it's on stable it's harder to work here without a proper work permit at some point they could always throw me out of the country for whatever reason. So it's inherently and unstable place if I did go back to the States I didn't walk into a lot of grief regarding the end of the Asian dream obviously 58 it's harder to get a partner in the states and it would be here although I struggled here as well to find a part of South anyways it's a very complicated decision but basically Thailand is just an easy place to live but my medical stuff probably won't be covered America is my home and obviously it's what I'm familiar with but I've been gone for so long it would be hard for me to start over and adapt anyways with end of the day it's a very personal decision.

 

[newarrior]

death is not very common statistically from AVR

you could have a post surgical stroke and not recover resulting in life long care.
it's worth factoring all variables

That's exactly what I'm concerned about. I could run myself into bankruptcy and be living overseas.

 

[almost_hectic]

Hello. Good SWOT analysis. But, you did not mention what your cost would be if the procedure was done in the US. I seem to recall that you previously stated that you have some type of US insurance.
If it is a typical plan, your out of pocket after considering all travel costs, will be at least what you will pay out of pocket in Asia. But, how is the quality at the places in Asia that you are considering?
Do they have similar success rates? And as you stated, if you need help there, it will be super cheap. But, from my perspective after surgery and getting released on day 6, I did not need any assistance.
If fact on the way home, we stopped at a Costco to walk around and pick up some items. I did not require any assistance with anything. Sleeping, bathing, making my own meals etc.. No issues. You appear to be perfectly capable of similar.
So, if you trust the surgeons and facilities over there, and you appear to want to stay there, have it done!
I've traveled to Bangkok. A very interesting and beautiful place. Personally, I'd stay there!

Wow, you did better than I did. I was still in a good deal of pain and not feeling very strong when I got home.

 

[Unicusp]

Surgery would be free in the USA.

I'd be interested to hear how you were able to get insurance with zero cost in CA. No out of pocket costs at all? You're still paying premiums every year? Were you a State employee or military?
If truly zero cost, then it may be worth considering flying to CA for the procedure at one of the top places. Probably less risk and better outcome. You'll have to do the research.
I would think that you would only have to stay maybe a week after surgery and then fly back. Minimal cost.
Just my opinion. Your call and decision!

 

[newarrior]

I'd be interested to hear how you were able to get insurance with zero cost in CA. No out of pocket costs at all? You're still paying premiums every year? Were you a State employee or military?
If truly zero cost, then it may be worth considering flying to CA for the procedure at one of the top places. Probably less risk and better outcome. You'll have to do the research.
I would think that you would only have to stay maybe a week after surgery and then fly back. Minimal cost.
Just my opinion. Your call and decision!

medi-cal how I have no income. It's for low income or no income people.. you guys think it's safe to go back when I hit the deer liquidate my life in Thailand or keep it going here jump on a plane get an Airbnb for a couple months ago CA regular doctor give refer to the heart doctor and then do the surgery? Or is that too much to be doing when your severe? Either that or just suck it up and do everything here

 

[newarrior]

death is not very common statistically from AVR

you could have a post surgical stroke and not recover resulting in life long care.
it's worth factoring all variables

Again you hit the nail on the head I may have to make an unpleasant decision soon and go back to the states or I could go back when I'm more severe grab an Airbnb for a couple months get rear get acquainted with my primary care physician in America see a doctor and knock out the surgery is that too much to ask? Plus I don't have anybody to take care of me an American or do I family or a home tough call

 

[FishnFool]

I personally would stay in my favorite place to live, sounds like Thailand is yours. I am 55 and just had AVR. Out in 5 days and on my own with very little help. You got this. With the way the USA is heading I would not move back here myself. Its become a polarized place to live. If I didn't have a wife and kids I would leave USA so quick and retire someplace like Thailand. But hey that's my dream, not my wifes and I have a good one, so rv life for us in the USA! Sounds like you are living your dream...keep the dream alive!

 

[newarrior]

I personally would stay in my favorite place to live, sounds like Thailand is yours. I am 55 and just had AVR. Out in 5 days and on my own with very little help. You got this. With the way the USA is heading I would not move back here myself. Its become a polarized place to live. If I didn't have a wife and kids I would leave USA so quick and retire someplace like Thailand. But hey that's my dream, not my wifes and I have a good one, so rv life for us in the USA! Sounds like you are living your dream...keep the dream alive!

I am not happy anywhere and have suffered from severe depression and loneliness most of my life as well as low self esteem, lack of a career/partner/family/job as well as a lot of non cardiac issues that have ruined my life..There are many pros and cons to staying overseas-- a big reason to go back to the states other than insurance and health care is the stability issue.. It does seem like the USA is not such a great place to live anymore--although I have been gone for years so i don't know..Thailand is very harmonious and the Thais are very chill and accepting..No violence, very Buddhist, no Dems vs Repubs, no BLM, no Metoo etc etc...Plus I am from the Bay Area and LA so the cost of living if I move back to those places is a bear...Yes I def had an interesting life including acting and voice over work in Hollywood, SF, San Jose, and Asia...Have a great night

 

[newarrior]

I personally would stay in my favorite place to live, sounds like Thailand is yours. I am 55 and just had AVR. Out in 5 days and on my own with very little help. You got this. With the way the USA is heading I would not move back here myself. Its become a polarized place to live. If I didn't have a wife and kids I would leave USA so quick and retire someplace like Thailand. But hey that's my dream, not my wifes and I have a good one, so rv life for us in the USA! Sounds like you are living your dream...keep the dream alive!

Thanks again for the kind words..Glad AVR went well--sounds like you have a good attitude and were in good spirits good health...Sounds like your recovery went well...Lots of Americans where who hate the USA and love Asia.. I fall more into gray zones...harder to find work here esp sans a work permit..As a singe guy easier to find a younger woman here--no one will call you a creepy guy and no one will judge you..