Away from home x2

[AlwaysAbroad]

Hello everyone,
I'm trying to gather opinions on what to do in the situation I am currently in. Have to make a decision in approximately 15 hours from the time this is posted.

First off, I was diagnosed with Crohn's in mid-2015.

I'm currently in a country that I’m on student exchange to. My main university is also not in my home country. This past week, I was taken to the ER with a huge amount of pain. After tests, they found approx. 25cm of stricture, and a fistula has formed. It took a couple days because of no bed space, but I was just transferred to the gastroenterology department today. Now being in the GI dept, they want to hold me for 14 days for bowel rest and parenteral nutrition (all nutrients fed through a major vein near my clavicle).

Now the question is, do I go for this option or ask for the treatment in the next sentence? When I was hospitalized about 10 months ago in the other country, they released me after 5 days with 7-week prednisone and long-term azathioprine prescriptions. Stupidly, about 4 months ago I stopped taking the azathioprine as well. No excuses about that one, just plain stupid. As well now, I have school commitments and I am being required to pay for all services up front and submit a claim to my student insurance on discharge. I’m currently at 615 USD/525 EUR in charges, and they already have 850 EUR in deposit that I could scrounge up for them to authorize further care. While of course this is nothing compared to the costs of healthcare in the US, being a student abroad is not helpful in this situation, and I don’t have other sources of funding except savings. I’m worried than another 2 weeks is going to really drive the bill up, and in the end, I may not have significant improvement compared to using medication.

I’m happy to answer any questions that develop from me not being clear in this post or follow up to know more to formulate an answer/opinion and really appreciate anyone’s time who reads this.

 

[Guerrero]

Health is a first priority.
I'd follow the advices of the doctors there if you can trust them

 

[ronroush7]

What treatment are you talking about if you don't do as they recommended?

 

[AlwaysAbroad]

Getting some sort of anti-inflammatory and getting back on Imuran if possible. The "IBD specialist" here is only wanting to go with the possibility of total bowel rest, and does not want to use any medication, even if I stayed inpatient. When I ask why, I'm only told the answer "because the IBD specialist said so". I haven't met this person, and they were not part of the group of doctors that came around for rounds this morning.

I'm only on antibiotics, Sodium chloride, and a nutrition IV. I haven't needed painkillers for almost 4 days now.

 

[Jabee]

I would think you could ask for prednisone, imuran, and stay on a liquid diet and see how you do. Inpatient costs are high and it’s unrealistic of your doctors to expect you to be able to afford two weeks in the hospital. You’re still in the hospital, right? It sounds like bowel rest has helped a great deal (no pain killers for four days) and I can understand why they want to continue it. A 25 cm stricture is pretty large and a fistula is no small thing either. Can you ask for a consultation with the “IBD specialist”? Are your doctors aware of your insurance situation? I would hope they would want to help you keep costs to a minimum. Have you spoken to anyone in hospital billing to ask them about your situation? Of course all these conversations are hard when you’re not feeling well; I have a very hard time advocating for myself while in the hospital. I don’t know where you are located, but in the US many hospitals have social workers on staff and you could ask to speak with one about what you should do. When do you return home so you can get whatever care you need? Can you take a leave from university? It would be a real shame to lose credit from your student exchange program, but if it’s a question of your health versus not completing a program right now I would vote for your health.

 

[AlwaysAbroad]

I would think you could ask for prednisone, imuran, and stay on a liquid diet and see how you do. Inpatient costs are high and it’s unrealistic of your doctors to expect you to be able to afford two weeks in the hospital. You’re still in the hospital, right? It sounds like bowel rest has helped a great deal (no pain killers for four days) and I can understand why they want to continue it. A 25 cm stricture is pretty large and a fistula is no small thing either. Can you ask for a consultation with the “IBD specialist”? Are your doctors aware of your insurance situation? I would hope they would want to help you keep costs to a minimum. Have you spoken to anyone in hospital billing to ask them about your situation? Of course all these conversations are hard when you’re not feeling well; I have a very hard time advocating for myself while in the hospital. I don’t know where you are located, but in the US many hospitals have social workers on staff and you could ask to speak with one about what you should do. When do you return home so you can get whatever care you need? Can you take a leave from university? It would be a real shame to lose credit from your student exchange program, but if it’s a question of your health versus not completing a program right now I would vote for your health.

I have asked for these exact items and have been refused, even having them inpatient for further observation. As well if I self-discharge, they have said they will give me no prescriptions, saying "this isn't a supermarket". They are aware of the insurance issue, and now the chief of this department has apparently stepped in for a direct billing or submission of documents by administration to be done, however my experiences so far in bureaucracy here have shown that something will block that effort. Hospital billing is a fairly unyielding section as well, and do not speak English. I'll ask about a social worker, but again the language barrier will exist and the only ones who are fluent enough are some of the doctors themselves, which they likely won't pull even for reasons like this (again just an assumption, but it's been the general attitude of the society).

I do return to my home university country by February 1st, and I feel more comfortable finding care there, as the level of English is much higher among all staff. However, I only have one semester following this to complete my studies, and due to the structure of the program, I will have to wait a year for courses required for graduation to be available again. A leave is likely not possible without losing the credit for this exchange semester at the least, plus having to pay back the stipend that I've had to dig seriously in to.

I'll ask for a consult with this specialist, but it's likely they haven't come around because they don't speak English.

Ever since I've said that I was considering self-discharge, the attitude has become really frosty. I now asked for a little more time to make the decision about staying, but if I do self-discharge without meds, it could be an even bigger problem. I've also considered to go to another hospital, but this is the largest in the city I'm in, and will have issues with the upfront payment again if I go to the capital city, and no guarantee I could get meds there also.

 

[Jabee]

Gosh that sounds awful. I don’t recommend self-discharge, just because the hospital will probably become more unyielding should you need treatment during the rest of your program. Does the program itself have people who could advise you? Or your home university? I’ve gotten seriously ill while studying abroad, but was covered by the UK’s national health service and when I had to return home (luckily in between terms) when I got even sicker. Can the hospital provide an interpreter? Also, can you contact the consulate/embassy of your home country to see if they can help? These are all just suggestions, of course, and you’ve probably already thought of them. I wouldn’t recommend trying to go without medication for the rest of your program, and that puts you in a really tough place. Do you have family that can help? I know here in the US there are programs to help pay hospital bills, and many hospitals can reduce bills. Since you’re in a foreign country with a language barrier I imagine that hospital policy is different and if the billing office can’t communicate effectively with you there’s really no way to find out if they have similar programs. Talk about stress. I’m so sorry I can’t be more helpful.

 

[Guerrero]

Couldn't you call your doctor from home?
I thought prednisone or steroid would have been a standard treatment in your case... i'd check with your trusted gi what are the guidelines in your home country...

 

[Guerrero]

You can probably find prednisone without prescriptions and find liquit diet such as ensure or modulen easily too

 

[AlwaysAbroad]

Quite a lot has happened since my last post. I was transferred to a previously empty standard room yesterday evening, as it turns out I had been placed in the ICU of this gastro department initially (at a cost of 200 euro a day). This was after I expressed that I was ready for self-discharge, but not fully committed to that choice. Soon after, a junior doctor came into the room, and said that they had read my file and was wondering what was holding me back from taking the guidance of the doctors. I finally got the answer of why they are refusing to give me corticosteroids. According to the medical standards, it would be detrimental to the healing of the fistula that has developed. While my inflammation would go down in the small intestine, the fistula’s ability to self heal would also be affected, therefore a Catch-22 situation. In addition, this doctor told of a precedent with people who are on long-term total nutrition to be allowed to leave for a few hours into the city to take care of business and other items, which would allow me to attend classes and changes of clothes/toiletries/etc. They also emphasized that unless I received care, no matter where it would be, I could be back in hospital care within 24-48 hours due to the nature of the strictures.
Now having all this information which was not clearly expressed before, I made the decision to stay on total bowel rest. In addition, a senior doctor has stepped in about the insurance issue, and is directing administration to back off about payments while I’m in care (they wanted another deposit of about 900USD) and to explore other options including contacting the exchange program about any insurance that may exist within it. This, along with a guarantee letter of cover from the student insurance I hold, has resolved that issue for now while I’m receiving care.

As for reducing bills, this is a country with socialized health care. Typical in-house stays are about 5 USD a day for their citizens, and an ER visit is 3 USD. Major other charges are also incredibly low. So an idea of reducing bills or simplifying them is almost out of the question with the bureaucratic nightmare that exists here, since it’s a situation they almost never have to deal with, so why make any efforts now in their minds.

It’s been really a wild ride.

 

[ronroush7]

Best to you