Our Medical Adventures of 2018

This year we had two big medical adventures in Kazakhstan.  The first one involved me (Spencer), and the second involved Veronika.  Both were big and a bit scary, but we came out of our experience with a greater appreciation for our health.  We also changed our attitude about the healthcare system in Kazakhstan.

Earlier in the year I had noticed some blood in my stool.  It was after I had eaten shellfish in San Francisco, so I thought I had maybe gotten a piece of shell or something.  However at the end of August I had it again and so I asked Yulia to make an appointment with the doctor for me. We had switched insurance a few years ago to a local company and hadn't really done much at the doctor.  I wanted to get a colonoscopy, so that is what I told the doctor when I got there.

However, she made me describe my symptoms and gave me an initial diagnosis was of pancreatitis (which was a bit interesting because I don't drink, which is one of the major factors in that disease).  I was put on a strict diet and had a bunch of tests ordered: blood, urine, and stool samples as well as ultrasounds of my guts.  My blood pressure was a bit high at the first visit (but subsequently fine - I was just a bit stressed about the situation I guess) so that was the major concern of the doctor.

The initial analyses supported the need for me to lose weight (true), but did not really confirm the pancreatitis diagnosis, so I was scheduled for an endoscope of my stomach.  That procedure was very uncomfortable and yielded nothing but the knowledge that my stomach was a bit inflamed, but I had no ulcers. So then we were back to the original plan - do a colonoscopy.

The doctor sent me to the University hospital to get the colonoscopy, but I had to consult with an anesthesiologist first.  The anesthesiologist did not like my EKG or my weight so she refused to do the procedure without a consultation with a cardiologist.  That required another trip to the doctor's office where I had an ultrasound of my heart and major blood vessels in my shoulders and neck.  My heart is great (an athlete's heart, the cardiologist said) as were my blood vessels, so with that endorsement, my colonoscopy was on.

The colonoscopy procedure was pretty simple for me. They put me under and I didn't really remember anything. However, they found a large polyp ten centimeters up my colon. They took a picture on the phone of the technician (this is important later) from the video screen and took a sample for analysis and sent me home.  I was sore for a few days in my guts, but otherwise fine.  I was told to come back in a week for the biopsy result.

I went back without Yulia (who had accompanied me to the endoscopy and colonoscopy appointments) and was met by three solemn doctors - one who had done the procedure and two more.  The biopsy showed cancer.  They told me that the doctors in Kazakhstan would want to take out a big section of my colon and do major surgery, but in the West the surgery would be less invasive - but that there was an Israeli specialist at the Presidential Hospital (a step up from the hospital where we were) and that I should go right over.

Yulia met me at the bus stop and we went to the Presidential Hospital where we were met by the head of their endoscopy department and the Israeli "specialist" who was a young lady doctor.  She said that in Israel they wouldn't do anything until they had a full scan of my body to know if the cancer had spread and that would dictate their next move.  So within an hour we had a PET scan arranged for me for the next morning.  All paid for.  It was the most expensive procedure that we did (over $800) but was also covered fully by insurance.

The PET scan was an interesting morning.  I went on my own and spent the morning in a kind of underground quiet world.  I had a few IVs (including the one where they put the radioactive tracers in) and was made to lay down in a quiet room for about two hours.  I had a lot of time to think.  They did the scan twice - the first time they saw something under my armpit (an unfortunately-timed zit) that they wanted to check out again.  The initial results were that I didn't have any anomalies beyond the polyp in my colon.  But my full report wouldn't be ready until the next Monday afternoon.  Here in Kazakhstan they are very cautious about radiation (only Japan has as high of standard for radiation) because  of their experience with Soviet nuclear weapons testing at Semipalatinsk, so I had to sign a number of waivers and agree not to be around children or pregnant people for the rest of the day. 

At the hospital, waiting for an endoscopy appointment.

My endoscopy.

My Endoscopy was at the "Mother and Children's Hospital" and this limousine was there to pick up a new mom and her baby.  Wealth has its privileges I guess!

After we got our results, our insurance called us and told me I needed to be at the Presidential hospital on Tuesday morning to meet with the head of the oncology department.  He told me that I needed to have a bowel resection to remove the area where the polyp was located.  He was convinced that this would be possible to do without necessitating a colostomy.  He wanted me to have a consultation with the head of oncological surgery at the city's Oncology center (which is where he had come from before moving to the Presidential hospital) and so I left there planning on doing a surgery.  The next week was fall break so it was a good time to schedule things (although we had a trip to Greece planned, so that was not fun to miss).  The insurance called us and told us we had an appointment that afternoon at 4:00 at the oncological center.  I had an appointment at the embassy, but Yulia met me and it worked out for us to be where we needed to be by 4:00.

We were met by one of the insurance ladies at the oncology center.  We wandered around for awhile - being told that we would not be meeting with the head surgeon as planned, but with the head of the oncological endoscopy unit.  The center was rundown and had the feeling of an old Soviet medical system.  Yulia immediately wanted to run away - until we met the doctor.  He was young and Russian, but he was very calming.  He said that the picture and description of the polyp was not enough to go on - he wanted to get a real good look at my colon before he made an recommendations.  It was 4:30 p.m. and he said that there was an appointment open at 8:00 the next morning.  He wanted me to drink three liters of preparation (a product similar to miralax) instead of the 2 they'd had me drink before if I could get started by 6:00 p.m.  We stopped at the pharmacy on the way to the bus stop and got the preparation.

I spent the evening clearing everything out.  Again.  The next morning we arrived and I was taken into a room where I sat in a chair similar to a birthing chair (feet up in the stirrups) and had another colonoscopy - this time with no anesthesia.  The procedure took quite awhile (Yulia was in the hall) and after about thirty minutes I asked him what was going on.  He told me that he had cut out my polyp and was doing a full colonoscopy on me.  It turns out I had a second polyp near the top of my colon and he cut it out, too.  That one was a bleeder and he needed to take some extra time to stop the bleeding.

I was cleared to go on the trip to Greece, but to be very mindful if I had any bleeding.  I didn't have any and we had a nice trip (those posts will be coming).  The polyp was biopsied and didn't have any cancer cells in the stem, so I should be okay (just regular check ups). The month of September was pretty much a roller coaster.  I was at the doctor 2-3 times a week and went from thinking that I needed major surgery to having the surgery I needed on kind of short notice and without anesthesia.  The whole thing didn't cost us anything, and we were really taken care of.  Our insurance and the different doctors didn't want foreigners to have problems on their watch, so we were really taken care of. 

The Cancer Center building

My polyp, removed.

My graduate class brought me a cake. It was nice of them.

Posing with my cake.

On Thanksgiving Nika's stomach started hurting.  We though maybe she had a stomachache or some kind of bug.  When it didn't stop by Monday I told Yulia to schedule her for an appointment.  Her stomach stopped hurting, but Yulia took her to the doctor.  They scheduled an ultrasound for her in two days, and so I took her to that appointment.  At that appointment we found out that there was a large cyst on her ovary.

The doctors were very cautious (they wanted Nika to stop all physical activity - we had her take it easy at track and to monitor for pain) but wanted her to go through a menstrual cycle to see if the cyst would change size on its own.  She didn't have any pain until her next period, and when we went for the follow-up the cyst had not changed size.  The doctors recommended surgery and sent us to another doctor for a consultation.  That doctor felt the cyst and also recommended surgery.  We scheduled it for the week of Christmas before the New Years break (the big holiday here).

Checking Nika into the hospital was an adventure.  We were told to be there at 9:00 a.m.  The doctor who was doing the surgery was in meetings and so we talked with the intern for awhile.  Then we had to check Nika in - that involved waiting and then she and Yulia doing paperwork with me excluded.  They took Nika in to the women's ward at about 10:30, but didn't let me in so I was just pacing.  Nika's room wasn't ready, so at 13:00 we took her downstairs to the cafeteria and fed her lunch.

Yulia, Lina, and Babushka went and visited during visiting hours in the evening (Christmas day - December 25th) and I stayed home with the twins.  The next morning Yulia went and stayed with Nika in the morning.  The surgery was scheduled at 12:00 and they took her then.  The surgery took about an hour - the cyst was wrapped around the Fallopian Tube and was a bit bigger than they expected.  They drained 600 milliliters of fluid from it!  Nika came out of surgery and Yulia stayed with her.  I came at 5:30 during visiting hours.  She was very sore and still bleeding a bit from her stitches (she did laparoscopic surgery so she had four small holes) but was doing pretty well.  We got her up and she went to the bathroom and we did a few laps in the hallway.  We left her tired, but in good spirits.

Thursday (December 27) Yulia visited in the morning and then ran a few errands.  She, the twins, and I went back during visiting hours and spent a few hours.  On Friday she was released to come home in the late morning.

We were very blessed to find the problem, to have it fixed very well and very quickly.  Nika's doctors and nurses were very good to her and she had a positive experience.  The bill for the surgery and the hospital stay was about $900.00 Insurance paid it all.

Nika checked in the hospital the night before her surgery having a visit from Babushka and Polina.

Nika post-Surgery watching a movie sleepily.

Taking a walk with Papa the first night after her surgery.

Eating lunch in the cafeteria on the first day of checking in. The food in cafeteria was very good and very cheap.

When we started the year we didn't expect to have any major medical issues - let alone two!  However, we felt very lucky and blessed to have great insurance and to have had the medical personnel who knew what they were doing and could help us solve our problems.  We are looking forward to a boring medical year in 2019!