A different view on medical care overseas

Back in October, Alex started coughing. I don't know much about the first week or so, it happened while I was in Tver and the family caught a cold - which was to turn into more than a cold for each of them.

She hasn't stopped coughing. At first the teachers and other parents thought she was still sick and I was accosted and accused for bringing her to school. This continued even after a month - c'mon guys, anyone with an iota of reason knows than more than a month later you don't still have a cold. And she clearly didn't have tuberculosis.

We went through all the obvious things, bronchitis, allergies etc and the coughing never let up. We saw an ENT who diagnosed post-nasal drip. I cut dairy out of her diet in case it was causing the PND. And yet ... she woke up every morning coughing, and spent some time coughing every night before falling asleep. Sometimes she woke in the night coughing. Naptime at school was the same.

A couple of months into all this mess, she told me she had a tummy ache. She pointed pretty high up her chest. We gave her 1/2 a Tums. A few weeks later, it happened again. Then, constant tummy aches, and daily heartburn. I get on the trusty old internet and ... GERD. All the symptoms, none of the causes. The Consulate doctor is away. A friend hands me her bottle of Zantac 150, we look up dosage for children and haphazardly chop up a pill for Alex.

A week later Alex still coughs but not as much. She says her tummy hurts less, but it still hurts every day. I put her bed up on some thick books but I'm not sure it's high enough. We got to see the Consulate doctor, who wants her to finish dinner 3h before bedtime. Yeah, Russian kids go to bed way later than American ones - she's still at detsky sad 3h before bedtime. Doc agrees GERD but is concerned as to why Alex has it - she's not a baby, not an adult, not overweight, doesn't eat any offending foods, etc etc.

She first recommended an endoscopy. Here they are usually done without anesthesia as "without" it's 15 minutes, "with" you have to plan 24 hours in the hospital. So we got to stress out for a few days about whether that is something we want to do at post or if we can/want to medevac. Sounds ridiculous for a 15 minute procedure but the quality of medical care received at post, especially diagnostically, has been bad enough several people have had to medevac after tests in order to get better tests. I am not making Alex go through an endoscopy twice.

THEN we hear back, after the local doctor confers with the American doctor in Moscow, that she first recommends doing a test for h.pylori bacteria as it is the likely cause of this. Does this test exist in Russia? We don't know yet and thus need to continue to worry about Alex's GI health.

Just one more thing that would be so much easier if we lived in the USA. At least we can get broken arms set properly here - something not true at every post!
[note, this post was written in draft form, the last sentence included, before Alex fell and broke her arm again. Quel coincidence!]

Some good things about being posted overseas

As already mentioned, Alex broke her arm yesterday. She fell off the bed, started screaming and crying in that way that means "I didn't just bruise something" although I did get the ice immediately in hopes we were all wrong.

In the USA ... I don't actually have any idea what I would do in the USA. Show up at an emergency room? Call her pediatrician?

In Russia, I immediately called our local doctor, the one who comes to the Consulate every week and is American board certified. Best of both worlds. She called the private clinic closest to us, found out when we could come in for a consult with the pediatric doctor on call (this is a weekend of course) and get an x-ray if he concurs it's necessary. I kept Alex in ice and TV until it was time to go - a little less than an hour.

When we got to the clinic and checked in, we were told to go right up to the pediatric floor. The doctor met us as we were coming out of the elevator. After he checked Alex out, we did have to wait about 10 minutes before heading down to X-ray. When we got there, we waited about another 10 minutes before we got in for the X-ray. They ushered me out of the room (last time they let me stay, just gave me my own lead apron thing) and I saw the x-rays as they came up on the screen. I knew about as soon as the docs knew that yep, she broke her arm across both bones.

From there we went directly to the room where the doctor, who had been with us throughout, met up with an assistant and put on the cast. He told me when to come back next week, and that was it. I paid $350 that I hope insurance will reimburse me for and got home about 2 hours after I left the house.

From friends' stories back home, I imagine the snacks and activities I had throw into my bag before leaving would have been much more heavily utilized had this occurred in the USA.For this trip, the Leapster was more than enough.

Here we go again

322 days ago, this happened.

Today, Zoltan and I were playing in my room.We were pretending to sleep in my bed with 2 stuffed animals who were not doing a very good job of sleeping. Alex came in and perched at the foot of the bed. Too close to foot of the bed, apparently, because she soon rolled off the bed onto the carpeted floor. Cue up the screaming and crying. And holding her hand. And actual tears.

I started to feel nauseated.  Isn't she going through enough right now medically?

Got ice on the arm, got her watching TV to calm down and give it some time. Maybe we're wrong about this. And it is Saturday afternoon and Terry's not here.

When she said she wanted to go get an x-ray like last time my heart sank. Called the Consulate doc, called our upstairs neighbor to see if they could keep Z til Terry got home and we watched another show to distract her til it was time to go.

I was standing in the technician room with the doctor while Alex was in the other room getting the x-ray. I could see myself that damned black line crossing both bones in her lower arm. Here we go again ...

Rite of Passage

Our poor Alex. Yesterday evening she ran into the kitchen to give me some good news (she won a game with Terry) and slipped in her slippery socks and fell, using her arm to break the fall. She complained of the pain, except for when the TV was on. No swelling, no discoloration, she could move her fingers. Figuring she just banged it hard, we gave her Motrin and ice packs and we did dinner, bath and bed.

This morning she continually vacillated between "mommy I hurt so much" and "it doesn't hurt at all" so once it was late enough to call a doctor at home on Sunday I called the Consulate doctor to confer with her. She advised we wait and see for a few more hours and we did, eventually deciding to get an x-ray. She called the clinic that was walking distance from our apartment, set it up and called me back to say they were there and waiting for us. I pack a bag, throw Alex in the stroller and we race down there. We get to the reception area and the girls there have no idea who we are, who we're there to see or why we're there (they do speak English so it wasn't my bad Russian) I eventually have to call our doctor again to put her on the phone with the receptionists and they do indeed find me in their system.

The doctor came out, asked "shto slushilas?" (what happened) and between Russian and pantomime I think he understood that she ran and slipped and fell. He felt her arm and said we'd go for the x-ray. Of course Alex was very nervous but she was brave and did everything the doctors said to do. They let me stay in the room with her too, which helped a lot. The picture came right up on the screen in the room and they showed me the fracture. The doctor even said "fracture" so I am pretty sure that's what it is.

He then said something to the effect that they didn't need to do anything, just the arm needs  .... and then pantomime of something around the arm. I asked "splint"? and he said yes. Turns out that was a miscommunication because he meant that she didn't need surgery and she only needed a cast. So he was probably amused when I asked if she needed to wear it all the time.

He led us to a hallway with a bunch of clusters of chairs in front of doors and said something I didn't quite catch, so I asked Alex if she'd understood. "Yes, he told us to sit down." I am sure she hears that command a few times a day at sadik! so I figured she was probably right. And she was. They put the cast on, which was another nerve-fest for Alex but I held her good hand and she clung to the stuffed animal she'd brought and we made it through. She has to wear a cast practically up to her armpit for 2 weeks, then they can cut off the part from the elbow up and she has to wear the shorter cast for 2 more weeks.

One thing I will say - from the moment the cast went on she had not once complained about pain.

From the minute I walked out of my house to the minute I walked back in was a bit over 2 hours. Not bad for what was essentially an ER visit on Sunday afternoon.

Now that's something different

In April Terry and I will have been a couple of 12 years. That feels like a long time. And in all that time, one particular phenomenon has been a constant: if we both get sick with something, regardless of who got it first, he ALWAYS gets it worse. This means I'm the one who has to keep life going because I'm healthier.

Another constant of my life had been, until the last 3 years, that I don't get the flu. For about 15 years this held true. One of the last two winters we both had the flu and had to call in a nanny on a Friday, or maybe it was a Saturday. In any case we were equally useless and grateful to have someone who could care for our children because they don't have a 10 hour appetite for TV.

Until this week. Because I don't get the flu, I don't get the flu shot. Everyone else in my family did. Hence, I am the only sick one. It's been so long I didn't even remember what the symptoms were or how long it's supposed to take to feel better - I had to look them up.

Next year I will get the flu shot, promise!

Ingenuity and creativity

Alex attends a Russian preschool. Her teachers don't speak English (well, their English is even worse than my Russian so I just go about as though they don't speak any). When they post notices I take a picture on my phone and then look up the vocabulary if I'm feeling adventuresome, or I just ask someone to translate otherwise.

There was a notice on Thursday but I only got around to translating it today. I got as far as: We need to urgently inoculate Alex against something that isn't in the dictionary. Google Translate to the rescue!

p.s. - it was measles. She's has her MMR. We're all cool. Maybe next time I'll be sure to translate the same day though!

Russian Medicine

When you mention "mastitis" to a woman who has ever breastfed, it's like talking to a man about someone getting kicked in the groin - to a one, the women cross their arms over their chest and wince. And for good reason.

I of course had to get to the bad part at night, and the night before a holiday at that. I managed the night and in the morning went about finding a doctor as I knew I needed antibiotics. It was comical when the Russian doc tried to communicate with me before the English speaking nurse came in. When he finally decided to agree with me that yes it's mastitis he "prescribed" in addition to the antibiotic the following practice: soak a cloth in vodka, completely cover the affected breast with it, cover that with plastic and wrap it all up in a scarf. Leave it on for 30 minutes 2x a day. They even did a treatment on me before I left the clinic. The 'net only talked about alternating cold and warm compresses .... but you know, there's a million uses for vodka!

Our babysitter also suggested leeches. I planned to be entertained by that suggestion too but then Terry told me there is a resurgence in the medical use of leeches.

brief update from the States

We do often go silent, but not usually this early in our new adventure. Right now we're living the separated life, as Alex and I have gone home for Zoltan's birth because health care in Russia isn't very good and I don't speak enough Russian to make me otherwise comfortable about the experience. In our 3 weeks in the USA we've been sick, spent a week in Pennsylvania, and had 2 play dates :-) Terry and I have done separations several times in our relationship, but the addition of a child makes it that much harder and I have so much respect for the military and other families who regularly spend time apart.

Terry's in training right now so he isn't home either. If he does much sightseeing in Moscow I am sure he'll post about that. My mom moved to Amesbury a couple of years ago so I am learning a whole new town - and have been pretty happily surprised at what's here. This is definitely not the Amesbury that existed while I was growing up. The next time I take Alex to Cider Hills Farm I'll get some photos - they have apple picking, hay rides, a country store, and farm animals to look at ... and is only about 5-10 minutes away! This whole driving to get anywhere thing has already gotten old to me, but the people in my mom's development are a pretty close knit bunch and nobody minds if Alex runs across their yard or gently pets their ornamental stone animals, so we can at least get some fresh air and exercise without have to go too far.