Living overseas, living alone etc etc

Help Support ValveReplacement.org:

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
I have a number of life complications related to valve issues::
1) Insurance here in Thailand will not cover pre existing conditions or most outpatient stuff
2) I live overseas/Bangkok
3) I may have to move back to the states for the best care+ the rotten insurance here
4) I dread moving back to the states: I have nothing there and Thailand is my home
5) I have no one to take care of me post op either in the USA or Asia
6) I own no home, have no real family, career, etc etc in either the USA or Asia.
7) I am single, no wife kids girlfriend...Family is dead except for sick house ridden brother in San Jose. Live alone since 2000.

Potential solutions:
1) Finding a partner easier in Asia--still working on it
2) Post op live in help is cheaper here
3) Housing cheap here. Life easy cheap. Don't need a car in Bangkok. Live one KM from major subway, groceries etc etc
4) Going to get registered at a Thai government hospital that does a lot of valve surgeries at low cost. See if I can get a price, check on quality of care etc etc
5) Trying to get an insurance plan that may cover valve surgeries.

About me: 58. American, Diagnosed 2019= went from mild moderate to moderate in 2020. May have been diagnosed in 2010 but didn't know it. Also have mild left ventricle hypertrophy, I had high blood pressure but eliminated it with vegan diet; almost off meds. My weight is sub 160 and lost 20 lbs on the diet. All my other risk #'s low except lpa and CT score and family history.. Recent tests attached for echo, bloodwork treadmill. Just did am MRI--no blocked arteries, heart and valves working great--ditto for recent treadmill.. Exercise and meditate every day, take statins, aspirin, B12, Coq10, hardcore vegan diet, K2, magnesium. omeprezole, gingko, low dose losartan, an anti depressant, ginger, etc etc every day---

Another option is when closer to surgery hop on a jet, get re evaled in the USA, and if needed do the surgery and recover at a shared or solo Air Bnb.

On the best heart diet on earth: FAQ | Dr. Esselstyn's Prevent & Reverse Heart Disease Program

hoping surgery many years away.

Trying to stay in Asia where I am happier than USA,

Medical care in Bangkok is globally known. I know at least one British expat who did his valve replacement at gov hospital
My current heart dr does valve surgeries, trained in the USA and is an excellent doctor

Further thoughts ? Anyone relate; in similiar circumstances ? Cheers Dave
 

Attachments

Last edited:

leadville

Premium Level User
VR.org Supporter
Joined
Aug 28, 2017
Messages
368
Location
Greater Manchester, England
Hi Dave, statins and especially omeprazole jumped out for me.

with a diet ( vegan ) that you chose to follow,

have you tried to stop the drugs ? something is out of whack somewhere
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
I take omprezole for acid reflux and so I don't mix that up with cardiac chest pains

I take statins to keep my cholesterol super low, keep plaques from breaking off and the many other good cardio protective things that statins do.
 

leadville

Premium Level User
VR.org Supporter
Joined
Aug 28, 2017
Messages
368
Location
Greater Manchester, England
that's my point, why do you have GERD given your life choices ?

have you had your esophageal sphincter checked ?

we need stomach acid.
like I said something is wrong somewhere.
 

leadville

Premium Level User
VR.org Supporter
Joined
Aug 28, 2017
Messages
368
Location
Greater Manchester, England
@newarrior I have just read your link about the heart disease programme, thanks for sharing it was a great read.


I found his take on statins interesting .
I fully agree with his take on warfarin & Greens.


Good luck with your complex dilemma living overseas with your current choice options

good luck with it all Dave and I hope you get a lot of support from this Forum
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
393
I have a number of life complications related to valve issues::
1) Insurance here in Thailand will not cover pre existing conditions or most outpatient stuff
2) I live overseas/Bangkok
3) I may have to move back to the states for the best care+ the rotten insurance here
4) I dread moving back to the states: I have nothing there and Thailand is my home
5) I have no one to take care of me post op either in the USA or Asia
6) I own no home, have no real family, career, etc etc in either the USA or Asia.
7) I am single, no wife kids girlfriend...Family is dead except for sick house ridden brother in San Jose. Live alone since 2000.

Potential solutions:
1) Finding a partner easier in Asia--still working on it
2) Post op live in help is cheaper here
3) Housing cheap here. Life easy cheap. Don't need a car in Bangkok. Live one KM from major subway, groceries etc etc
4) Going to get registered at a Thai government hospital that does a lot of valve surgeries at low cost. See if I can get a price, check on quality of care etc etc
5) Trying to get an insurance plan that may cover valve surgeries.

About me: 58. American, Diagnosed 2019= went from mild moderate to moderate in 2020. May have been diagnosed in 2010 but didn't know it. Also have mild left ventricle hypertrophy, I had high blood pressure but eliminated it with vegan diet; almost off meds. My weight is sub 160 and lost 20 lbs on the diet. All my other risk #'s low except lpa and CT score and family history.. Recent tests attached for echo, bloodwork treadmill. Just did am MRI--no blocked arteries, heart and valves working great--ditto for recent treadmill.. Exercise and meditate every day, take statins, aspirin, B12, Coq10, hardcore vegan diet, K2, magnesium. omeprezole, gingko, low dose losartan, an anti depressant, ginger, etc etc every day---

Another option is when closer to surgery hop on a jet, get re evaled in the USA, and if needed do the surgery and recover at a shared or solo Air Bnb.

On the best heart diet on earth: FAQ | Dr. Esselstyn's Prevent & Reverse Heart Disease Program

hoping surgery many years away.

Trying to stay in Asia where I am happier than USA,

Medical care in Bangkok is globally known. I know at least one British expat who did his valve replacement at gov hospital
My current heart dr does valve surgeries, trained in the USA and is an excellent doctor

Further thoughts ? Anyone relate; in similiar circumstances ? Cheers Dave
Hey Newarrior,
I'm not sure that you need to be putting so much pressure on yourself about the decision to move back to the US or stay in Thailand. Your AS is moderate, and closer to the mild demarcation line than to the severe demarcation line. You could very well be many years away from needing valve replacement surgery. Why not just enjoy life and life in the place that gives you the most enjoyment and think about the decision of whether to move back to the US once your stenosis gets closer to that severe threshold. From what you have shared, it does not sound as though valve surgery is even close to imminent.
You have said that you dread the thought of starting all over again in the US. I see no reason why you need to worry about that. If and when that day comes for surgery, you can just come back for a few months and then decide where you want to live. A permanent move to the US is not something that has to be considered, unless you decide that you would be happier in the US.
Either way, I wish you peace and calm in your decision to stay or leave Thailand. But, enjoy every day and every moment. You are very fortunate in that you likely will not need this surgery for a long time and, perhaps never at all.
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
Hey Newarrior,
I'm not sure that you need to be putting so much pressure on yourself about the decision to move back to the US or stay in Thailand. Your AS is moderate, and closer to the mild demarcation line than to the severe demarcation line. You could very well be many years away from needing valve replacement surgery. Why not just enjoy life and life in the place that gives you the most enjoyment and think about the decision of whether to move back to the US once your stenosis gets closer to that severe threshold. From what you have shared, it does not sound as though valve surgery is even close to imminent.
You have said that you dread the thought of starting all over again in the US. I see no reason why you need to worry about that. If and when that day comes for surgery, you can just come back for a few months and then decide where you want to live. A permanent move to the US is not something that has to be considered, unless you decide that you would be happier in the US.
Either way, I wish you peace and calm in your decision to stay or leave Thailand. But, enjoy every day and every moment. You are very fortunate in that you likely will not need this surgery for a long time and, perhaps never at all.
Just got some bad news that my VMAX is moving too fast and I could be at severe in 1-2 then surgery in another 2-3
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
393
Just got some bad news that my VMAX is moving too fast and I could be at severe in 1-2 then surgery in another 2-3
Vmax is one of the three things that they generally watch really closely and is a one of the three classic metrics used to grade the severity of AS. Vmax, mean pressure gradient and AVA(valve area). There is also something called the dimensionless index or DI, which I like a lot. Of the 5 echos I've had over the last 20 months there was one outlier- valve area seemed to get 40% larger, and pressure gradient increased 90%. I now understand why, but it's not important. So, when I toss that outlier and graph out my other 4 echos, it is a very clear picture of how fast I am progressing, Fast. If I progress at the same rate, I am likely to move from severe to critical in 6 months. This surgeon also made this point- it was a very good point. Rate of progression is very important to watch. If it took me 5 years to progress from valve area of 1.1cm2 to .87cm2, it might create strong argument to "wait and watch". But, I went from 1.1cm2 to .87cm2 in 6 months. Seeing similar progression on my other metrics, in my mind, no question it is time to get this done for me.
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
Vmax is one of the three things that they generally watch really closely and is a one of the three classic metrics used to grade the severity of AS. Vmax, mean pressure gradient and AVA(valve area). There is also something called the dimensionless index or DI, which I like a lot. Of the 5 echos I've had over the last 20 months there was one outlier- valve area seemed to get 40% larger, and pressure gradient increased 90%. I now understand why, but it's not important. So, when I toss that outlier and graph out my other 4 echos, it is a very clear picture of how fast I am progressing, Fast. If I progress at the same rate, I am likely to move from severe to critical in 6 months. This surgeon also made this point- it was a very good point. Rate of progression is very important to watch. If it took me 5 years to progress from valve area of 1.1cm2 to .87cm2, it might create strong argument to "wait and watch". But, I went from 1.1cm2 to .87cm2 in 6 months. Seeing similar progression on my other metrics, in my mind, no question it is time to get this done for me.
Thanks..I am learning what valve indicators are important. I may have to move back to the USA soon before my health slides too far down
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
Hi Dave, statins and especially omeprazole jumped out for me.

with a diet ( vegan ) that you chose to follow,

have you tried to stop the drugs ? something is out of whack somewhere
Hey man--had AR for years....
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
393
Just got some bad news that my VMAX is moving too fast and I could be at severe in 1-2 then surgery in another 2-3
Hey Newarrior,
You have another thread going with this Vmax topic, but in case you did not see my comment about whether your Vmax is truly progressing fast there I am also leaving it here on this thread:


Looking at your numbers again, I have to question your doctor's math. .3 m/s progression per year is normal and by my calculation, your Vmax is progressing slower than normal.

May 2020 to Nov 2020: 3.37m/s to 3.47 m/s. This is only .1 m/s over a 6 month period and if you annualize this rate it is only .2 per year. This is less than normal progress.

May 2019 to Nov 2020. So if you take the past 18 months, normal expected would be .3 m/s progression x 1.5 = .45m/s progression. However, yours went from 3.11m/s to 3.47m/s, for a change of only .36m/s, less than would be expected.

Maybe work out the math yourself, as I have done above and have another discussion with your doctor and ask why he would call this rate of progression rapid. I really don't see what he is talking about. Of course, I am not qualified to interpret echos, but just using basic math I am not seeing your rate of Vmax progression as above normal, but actually below normal.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
8,013
Location
Queensland, OzTrayLeeYa
Thanks..I am learning what valve indicators are important. I may have to move back to the USA soon before my health slides too far down
I have read (and responded to) many of your posts, and so in the spirt if a fellow traveller I'm going to say something which is intended to be helpful. Its perhaps going to be hard to fathom.

I lived and worked (as an engineer) for 3 years in Japan where I was becoming fluent (and getting certified) in Japanese. My intention was to live there and work there in the Academic realm. Having worked there with many Americans (who'd also been there many years) you come across to me (you may be different to what you project here) as a classic 外人 (that's Gaijin for those interested).

Now 外人 means "outside person" ... while its commonly understood as foreigner that's a close translation but missing the point. The point is that for the locals you will pretty much always be an outsider. There is no way you'll ever be fully localised.

Speaking as one who has lived in Japan, India and Finland I can say that language is as critical as how your face looks (because people make judgements which few revisit) as soon as they see you. So living in a place where you don't stand out like prawns eyes has advantages.

1614638756028.png


because being an "insider" (rather than an outsider) makes being part of that society possible. No matter how long I'd live in Japan I'd >always< be an outsider, no matter how well I spoke the language, no matter what I would do (and in Japan they really don't like it when gaijin try to go native).

Thus being a foreigner is bloody hard, and unless you are getting something compensatory out of that it will always be hard.

Its so hard I would suspect its part of your health issues. I know that it exacerbated mine.

The next thing I'd say is that the longer you live somewhere the harder it is to "come home". I've been back in Australia now for some time (certainly from Japan, where I doubt I'll ever go back to), but yet "fitting back in" has had difficulties. You do indeed adapt to the new environment (even if the people there never adapt to you), and so when you're back home you'll find things which you got used to in the "other country" which are simply absent ... you never noticed their absence when you were born there, but when you acquired those things as a "way of life" in "the other country" you'll notice their absence when you return.

Sometimes its not an absence, its "done differently" ... that can actually be harder.

My take on this is that if you are not aware of this then "return" to "home" is a shock, ironically its a culture shock.

It can (and does) cause some gaijin to head back to comfort ... but that comfort is only skin deep.

The next problem is "honesty with yourself" ... I'd recommend strongly you read Jordan Petersons 12 Rules for Life, or Jung, but Peterson encapsulates Jung quite well (better than I could and I feel sufficiently well to have not drifted Jungs meanings).

Let me summarise this: we all have "roles" we assume, the role of the professional (and what's expected of me) in my work, the role of the husband (and what I should do and how), the role of the friend (with each of my quite different friends. We seldom (in my case only with one or two friends and my wife) project exactly who we actually are. Worse this assuming of roles (the wearing of a mask) becomes something we can deceive ourselves as being "who we really are".

So my message to you is this:
  1. ask yourself deeply and truthfully why you are somewhere, is it acceptance, is it popularity (because you're different) ... what are you seeking. If the answer is "something transient" (such as a good sex life) then you're looking for the wrong thing in the wrong place (unless its a 2 week sex holiday). If its "cheap living" there are other values in life than money.
  2. understand that life is NOT about seeking happiness. You should be well aware of yin and yang. Thus a cycle is what is true. Seeking to be happy in life is a mental problem which (in my understanding) comes from the USA (who are culturally the angry teenager of historical human cultures). The struggle for life should be seeking balance and resiliance, for after being born the only certainty is "death and taxes" (meaning losses) ... to be able to be happy is founded in resilience. Being sad is not something anyone needs to be taught, but life can cause us to seek happiness (often in distraction)
    1614639770332.png

  3. consider wisely and honestly where you want to go next, because its plain to see you are not in a good place and you are not in balance and you do not seem to have much resilience ... it might be the USA, but to my mind I'd sooner jump back into the meat-grinder of Tokyo than go to the USA (again). You may find that you need a place which is tolerant, which is accepting of multicultural things and in which your face doesn't stick out like prawns eyes for all to see. Clearly you are not where you love or where you can love yourself. For if you do not honestly love yourself then nobody else will either, without their love of you you can not love them and then learn about what love really is
I hope you find peace

(PS, of that song I wrote this in a period of reflection

There is a song written by Linda Creed called "The Greatest Love of All", as a young person listening to it I often wondered about the focus of the lyrics on the self. I felt it was somehow selfish.

As I grew older I became re-acquainted with the song and (having journeyed some more in life) understood how many people suffer from problems of self worth and self respect.

While I now understand the reference to the self esteem it still seems just a prelude to the greatest love ...

Linda was (so I am told) struggling with cancer when she wrote the song lyrics, so perhaps she was going through a bit of an existential crisis (suffering from breast cancer and struggling with understanding her own mortality). Having battled with the loss of my lovely wife and in parallel battled with my personal health issues I think I can relate to personal existential crises. From the lyrics something that resonates with me is the theme of needing to love yourself and teach others to love themselves.
I believe the children are our future
Teach them well and let them lead the way
Show them all the beauty they possess inside
Give them a sense of pride to make it easier
I agree with so much of that. However to make what easier? For me that comes in the lines:
Everybody is searching for a hero
People need someone to look up to
I never found anyone to fulfil my needs
A lonely place to be
So I learned to depend on me
which is at the same time both profound and tragic.
It is profound because the truth is that you must love yourself before you can find strength and before you can even accept love.

It is tragic to me that so many people go through life never loving. Never loving themselves and also therefore never feeling that love from someone else. Linda seems to have learned (from the harshness she found in life?) to depend on herself. Perhaps from that trust then came love.

Speaking of my wife and I, we never walked in each others shadows.
)
 
Last edited:

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
but as @leadville points out something is out of whack.

How long have you been vegan? As horrific as this sounds, being vegan is not natural (nor is being vegetarian) and does not suit some people (while many are metabolically tolerant to this fad / aberration it is not natural).
I become vegan last year and it is has saved my heart-but not my valve--https://www.dresselstyn.com/site/faq/
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
Hey Newarrior,
You have another thread going with this Vmax topic, but in case you did not see my comment about whether your Vmax is truly progressing fast there I am also leaving it here on this thread:


Looking at your numbers again, I have to question your doctor's math. .3 m/s progression per year is normal and by my calculation, your Vmax is progressing slower than normal.

May 2020 to Nov 2020: 3.37m/s to 3.47 m/s. This is only .1 m/s over a 6 month period and if you annualize this rate it is only .2 per year. This is less than normal progress.

May 2019 to Nov 2020. So if you take the past 18 months, normal expected would be .3 m/s progression x 1.5 = .45m/s progression. However, yours went from 3.11m/s to 3.47m/s, for a change of only .36m/s, less than would be expected.

Maybe work out the math yourself, as I have done above and have another discussion with your doctor and ask why he would call this rate of progression rapid. I really don't see what he is talking about. Of course, I am not qualified to interpret echos, but just using basic math I am not seeing your rate of Vmax progression as above normal, but actually below normal.
That come from another dr
 

newarrior

Have moderate AS live in Asia
VR.org Supporter
Joined
Jun 29, 2019
Messages
358
Location
Thailand
@newarrior I have just read your link about the heart disease programme, thanks for sharing it was a great read.


I found his take on statins interesting .
I fully agree with his take on warfarin & Greens.


Good luck with your complex dilemma living overseas with your current choice options

good luck with it all Dave and I hope you get a lot of support from this Forum
Thanks I have hard choices to make
 
Top