Medical tourism in Thailand (and beyond)

Medical tourism…again

2024-02-08T02:30:00.000-08:00

You know what that is? Hospital food. And that’s just the entrance to the Food Experience at Bumrungrad International Hospital in Bangkok. I’ve been coming to Bumrungrad for years, not just for the food, but for the completely integrated *excellent* care and transparent pricing. I look forward to hospital visits here.

First up is the executive physical. Height, weight, blood pressure, vision, color blindness check, EKG, blood draw to test just about everything, then on to change into a gown for the rest of the physical. Time for the stool and urine sample. Here’s a pro tip - you can get the stool sample kit a day in advance so you don’t have to deliver on demand. The very first time I did a physical here, I managed to squeeze something out, but it wasn’t easy. Then there’s the chest x-ray and ultrasound of your internal organs. Done? Not yet. Time for continental breakfast and maybe you’ll peruse the Bangkok Post while you wait for the doctor. Right. In about 30 minutes, the physician reviews all of your test results with you, right there, and does an additional physical, you know, lymph node check, stethoscope and prostate check if you’re a guy. They also review/compare all of your past years of health data to look at trends. And then, they ask if there’s any other concerns you have. And I did. I always like to visit my dermatologist here (I had an appt to see him on the same day) and wanted to get my shoulder checked out. Oh, Sports Medicine is on the 20th floor. I’ll let them know you’re coming. That’s right. I had a concern. They sent me to a specialist right after my physical. Turned out to be the same doctor who had done an operation on my hand two years ago. He did some basic movement/resistance tests, then suggested I had a torn rotator cuff. He requested an MRI that was approved after a few days, saw the tear and now I’m scheduled for inpatient (two days in hospital) surgery. They used my health check up to satisfy the pre-op lab work, chest x-ray and EKG and then gave me an additional HIV test.

I also got a root canal done on a molar that was super sensitive before. The procedure was painless and it’s all better now. I am going to get a crown replaced at another facility in Bangkok, Bumrungrad has increased their dental prices and I didn’t find their dental center to be as modern as their surgical facilities.

Time for another hospital food snack. We spend a lot of time there, and we get hungry.

Gwyne is at Bumrungrad every day as well. We both got a clean bill of health with our physicals, but wanted to follow on with some specialists. She has always had trouble sleeping and had an appointment with the neuro science department for later on in the week, but wanted to see if she could get it moved up as she’s leaving a few ticks on the clock sooner than me. Their response? Is today at 12:00 okay? Why yes, yes it is. We met with the doctor, Gwyne explained her sleep woes and the doctor recommended a sleep study. Everything at the hospital is booked up for two weeks, but we can do it at your hotel - would tonight be okay? We can send a nurse to your room to hook you up to the sensors. Scheduling a sleep study in Alabama has about six months wait time. But at Bumrungrad, they’ll do it tonight. At our hotel. Stop it. Turns out Gwyne wakes herself up 33 times an hour and just got a CPAP. I won’t be hearing that train a comin’ in the future

Ready for a peaceful nights sleep? I know I am!

Gwyne likes to say, “Everything isn’t a contest, you know.” My response is typically, “That explains why you’re losing so much.” But on this trip, she beat me. In about 18 days, she weighed in with 35 appointments at Bumrungrad, I only managed to get 19 appointments under my belt. As we age, it’s just a good practice to get things checked out. And in the US, it just seems to be harder. It takes such a long time to see a specialist and then the results aren’t shared with other specialists you may see. At Bumrungrad, when we were talking to the neuro science doctor, she pulled up Gwyne’s physical immediately and looked at her as a whole person, not just bits and bobs. She saw and reviewed all of the specialist appointments that Gwyne had been to and her upcoming schedule. My orthopedic physician immediately looked at all of my health records prior to evaluating my shoulder. That’s just not the way it is in the US and that’s why we - and people from all over the world - keep on coming back to Bumrungrad for the excellent integrated medical care. And the hospital food. We come back for that too.

Som tam ingredients (green papaya salad)

2022-10-13T20:34:00.001-07:00

It's been a minute since I've updated this blog. Unconventional retirement/medical tourism. I was set to fly to Thailand on March 17th, 2020 for my 60th birthday physical (and colonoscopy - yay!). But that's all in the rear view mirror (so to speak). I cancelled that trip on March 16th, at the very last minute, to the immense relief of my parents. This blog was all about retiring early, without Medicare. We still haven't cracked the insurance nut in the U.S. We've been on COBRA, and it's pricey for two people. The ACA (aka Obamacare) is our option after that expires and it offers plans tied to your income. Gwyne's business has been doing so well that our premiums would more than twice what we pay for COBRA.

So here’s a story from my last medical tourism trip to Thailand trip and from my current trip in Turkey. The first part began where I always like to start out, at Bumrungrad Hospital.

What does your hospital’s food court look like?

It’s like a visit to a 5 star hotel to get your physical. I’ve done more than a few physicals there because when you get older, it makes sense to get things checked out. I knew to stop by one day ahead to get a container for the stool sample. The first time I had a physical there, I was surprised when I was asked to produce a stool sample on demand (c’mon, who can do that?) so I planned ahead on subsequent visits. The process is extraordinarily well choreographed. Station to station, vitals, blood draw, vision test, EKG, stress test, chest X-ray, ultrasound of internal organs and then you are directed to the buffet breakfast, because you had to fast for the blood work. Eat a pleasant meal, read the Bangkok Post and hang out for about a half an hour because then you get to visit a doctor who has reviewed all of your tests. That day. They review everything with you, maybe make some recommendations and ask if you have some other concerns. I did. I had two cysts on my head. My doctor felt them and said they are cysts, and they are benign - do they bother you? Yes they do. Would you like to get them taken out? If so, you’ll have to go to surgery for that, they’re on the 18th floor, I can let them know you’re on your way up. And just like that, I hopped on the elevator and was talking with the surgeon. He felt my bumpy head and said, “They’re cysts. Do you want to remove them?” I said, “Yes.” He asked if I had time to do it now, I replied, “Why yes, yes I do.” Before he did anything further, he sent someone to get a cost workup to let me know exactly how much it would cost. We had insurance that would cover it, but still, here’s how much it will cost, do you want to go ahead? And just like that, a few pricks of a local anesthetic and a few slices and stitches and they were out.

Just for reference, when I was back in the U.S. and had a skin flare up, I called my dermatologist and asked for an appointment. They asked for my name and DOB and said, “We’re not taking new patients for at least 6 months.” Then I told them I was an existing patient (Bumrungrad would have never missed that) and they looked it up and said, “Oh. Yes, there you are.” But there was still a 6 month wait. I thought that was batshit crazy, but wait, there’s more!

I had some discomfort with a tooth and went to get it checked out. Some facility was running a $99 check up for new customers, so I bit (again, so to speak). Nice place, modern and they got me in quickly. They recommended I have two crowns replaced. Cost? $1700+/crown. I had been planning a trip to Turkey for a while to take advantage of their currency/inflation crisis and I contacted a few dental centers there. Literally within minutes, the WhatsApp messages were flying, all super, super responsive. Price to get a crown replaced in a posh modern facility there? About $250. So it will be about the same price to fly to Turkey, have an interesting vacation and get some dental work done that I would have had to get done in the U.S. This includes flying business class because I'm old and I also think flying economy on long haul flights is inhumane.

Mosque on the morning walk

Feral cats. All over. Relax. I just want to take your picture.

Not in Alabama anymore.

Hagia Sophia (spell check initially changed that to haggis, whoops!) Haven’t been inside yet.

A caveat, some of the many dental centers in Turkey are pushing what they call the ‘Hollywood Smile’ treatment, which would turn your teeth into a smile that matches Donald Trump or Joe Biden (veneers/crowns) and they will do it at an incredible price, but that holds zero interest for me. I’m okay with my imperfect, coffee stained smile and teeth. Gives me character. As I update this right now, the call to prayer is blaring out from the speakers at the Blue Mosque (and every other mosque around), that’s a plus for the tourism side of medical tourism, but wait, once again, there’s more! I also had a visit with a Doctor here to get recently diagnosed hypertension checked out. The Doc-in-the-box in Alabama gave me a cursory examination and some medicine, which I took for three days, and today was my appointment with the physician in Istanbul. Extremely modern and clean facility. I had been in email/WhatsApp communication with the hospital, so they knew what I wanted checked out. I had brought my health records from Bumrungrad along and the doctor questioned me about exactly what I wanted evaluated. She reviewed my records, made lengthy notes and comments and then gave me a thorough exam. This type of medical service does not exist in the U.S. I have to go back twice more for a form I need filled out, but it will be my pleasure. When I went to admissions, I gave them my passport and insurance card and they said Cigna wasn’t in their system, I’d have to pay cash and I could submit that to the insurance company. This was before I saw the doctor. They pushed a thin, small square paper towards me with the fee for what would be the 55 minute evaluation. 1,642 Turkish Lira. In USD? $88.40. Color me pleased (so far) with this medical tourism trip.

Retirement and...edging.

2014-07-12T13:43:00.001-07:00

The big question looms - if you have the means to retire, what the hell do you do with your time? The first part of the retirement equation is about money, and a large part of that formula is paying for a roof over your head, some form of transportation, and health care. That's what this blog has been about, the ever increasing cost of health care and how to afford it if you decide to retire unconventionally - overseas, early, and without the safety net of a Medicare or other state sponsored health care system. And that's what the focus has been of pretty much every thing I've read - how to afford retirement. But if you can, what do you do with your time? Once the closets are organized on the third day, then what? And for me, and anyone else that's contemplating retirement, I think that's a bigger question.
I just spent 4 months in Texas doing manly things around our house in Texas after a magnificently failed attempt at retirement. Sure, I did some fun things, visited some friends in Huntsville, Alabama, took a wild hair up the ass trip to Fredicksberg, TX to see the Pacific War museum and the highlight (apart from being with Gwyne - that was a good catch there, eh?) was a sailing trip with my brothers from Santa Barbara to Santa Cruz, hanging out with them and my parents. But I did learn a few things about how I don't want to spend my time in retirement. Pushing a lawnmower is not exciting. When Gwyne got home from work and asked what I did, I told her I edged. I edged the driveway. Both sides. I edged the sidewalk. All four sides. It looked really good. But I edged. That was the highlight of my day. After coming back from Afghanistan, passing through Dubai every four months, the highlight of my day was edging. That shit doesn't work. While life in Afghanistan is certainly not comfortable, it is definitely interesting and exciting. Hanging out around the house in a master planned community in Texas is definitely comfortable, but not very interesting or exciting.
I think the first part of the retirement equation is solved - the money. We'd like to have a home base in the U.S., but retire unconventionally, retiring overseas greatly reduces fixed costs. But if the highlight of your day is edging, well then why retire?

I've spent the last 130 days in Texas. Partly, due to having arthroscopic surgery on my knee, retirement hasn't been that great. Sure, there have been enjoyable moments, strolling the uncrowded aisles of Costco on a weekday with the rest of the retirees in what seems to be the retiree uniform of khaki shorts, a polo shirt or t-shirt and sneakers, that's been fun. But sorely lacking in excitement.

I've had a few extended periods of time off in my life - here they are in review, with lessons learned.

1. One and half years traveling around SE Asia after college graduation and working for 8 months.
2. Six months off when I resigned my position due to ethical issues in the Marshall Islands.
3. Five months off after I completed a contract in Kuwait and moved for my wife's job.
4. Four months off after I completed a contract in Afghanistan and went to Texas.

#1 and #2 were fantastic, #3 and #4 were fails.

Why? Well, #1, I think, is pretty easy. Traveling around SE Asia, move when I want, where I want - I once left Nepal on a whim because I tasted curry in my morning coffee (c'mon, you have to admit that is wrong). Yup, that got my knickers in such a a twist, I got on a bus to India that morning. What are the chances of getting a little curry in your coffee in India? Well, it was the closest country and I was pissed. It was a wonderful period in my life, traveling so freely, exploring, learning everywhere I went and always meeting interesting people.
#2 was great as well, I was able to stay in the Marshall Islands as a house husband and I surfed, windsurfed, fished, cooked, took care of the kids - in my mind, the perfect kept man. Tough to top that.

Yeah, #3 and #4. #3. Moved to San Antonio with Gwyne for her job - to be fair, I was her dependent in Kuwait (I was working for the same company) and well, most of the smart people left over concerns of the company's long term success, which was, of course, coupled with the future of their success. But still. Kuwait was a great gig and we really loved living there. I'd done a year there before as a geographical bachelor and was thrilled to share the Kuwait experience with Gwyne. And then we moved to San Antonio for my wife's job. I wasn't working - I thought I'd love it, but didn't. Bicycled a lot, but was mostly bored, dealing with the hassles of moving from one country to another. And boredom, my friends, is a dangerous thing. So I went to Afghanistan for a year. Because I was bored. And then, moved back to Texas, of all places. Not quite sure how that script was written, someone, other than me, has a great sense of humor. The Texas part, not Afghanistan.

#4. This has't worked out so well either, due to knee surgery and ongoing physical therapy. That and the mf never ending edging. Going from an exciting, fast paced, never ending changing work environment, meeting customer's needs to...edging.

So, here are some lessons learned for what I think a successful retirement looks like. It includes a schedule - a purpose. Our time is organized in life by a schedule - school, work - times, responsibilities, deadlines, you have to meet them to be successful. But retirement? We don't need no stinking deadlines. Well, I think we do. The recipe:
1. You have to take care of yourself. Without your health, your life, let alone retirement, is so restricted. So, you need to take care of yourself, have scheduled exercise and eat well. I've seen so many retirees end up at McDonalds every morning showing the latest picture of their grandkids on their iPads to their friends. Might as well edge that lawn.
2. There needs to social interaction (other with than your spouse or partner). Most of our social interaction came from school or work in the pre-retiree life. My friends came from school and work - we have history, shared experiences. It's kind of hard to generate that when you're not in that structured environment. "So, what day of the week do you think is the least crowded at Costco?"
3. I think there should be some kind of productivity every day. Part time job, writing, gardening, home improvement, whatever works for you, but my days feel more fulfilled when I have a productive list and I cross things off. And when I edge.

The rate of recidivism is high in Afghanistan. They asked me to go back for 4 months at a very fortuitous time for them - I had just finished edging the lawn. And they called. I think the edger was still quivering in my hand when I answered the phone. I was weak. Perhaps with a bit too much excitement in my voice, when asked nicely if I'd consider a return trip I said, "Oh, pretty please sir, can I have some more?" So, here I am in Dubai, getting ready for another 4 month gig in the sandbox. For now, I'm just another recidivist, still working out the retirement formula. And a few more shekels won't hurt the plan, but I've been told that I have to figure out how all this retirement stuff works. Look for an ad on Craigslist for a used edger to kick things off.

2012-11-15T12:24:00.003-08:00

Health insurance in the U.S. It is something else. We've been spoiled for the last 7 years or so. We worked for the U.S. Government while in the Marshall Islands and had a great health care plan. When we worked for a large corporation in the U.S., the prices were attractive as well and when we were in the Middle East, the plan was superb. We just returned to the U.S. and my wife is working for a small, woman owned business in Texas. The insurance options are not that appealing. Here are the choices - about $98/month for her, but around $580/mo for the two of us. There is also a $5,000 deductible, and you are pay 20% after you hit the deductible. Wow.

My mom just had her aortic valve replaced and she is doing great. She is on Medicare and has a supplemental plan as well. A friend of ours who is a doctor came in while she was still in intensive care and she casually asked how much the surgery would have cost if she did not have the insurance she had. He said, "In between 450 to - 500K." Know what the approximate cost is to have your aortic valve replaced at a top notch facility in India that does nothing but replace aortic valves? Between 6 and 9K. Throw in another 2K for the plane ticket. So let's just say I need to get my aortic valve replaced (and I don't). With the insurance offered and if it were done in the U.S., I first would have to shell out 5K for the deductible. Then I'd have to pay 20% of the balance. Take the low end of 450K, that's an additional 90K I'd have to pay out of pocket. 95K vs. 11K at the high end overseas. Medical retirement is looking better and better when you look at the numbers. Just saying.

The middle seat

2012-04-06T06:44:00.001-07:00

This is the wing of the hospital my wife went to in Kuwait - fitting.

Medical tourism or medical retirement or a combination of both? Medical tourism: going to another country, combining a vacation to get some level of medical care that is much cheaper than you could obtain in the U.S. Medical retirement: moving to another country because the level of care you need well, there won't be any tourism when you get to that stage. So the premise is that it's cheaper to move there and live there to obtain the medical treatment than it is to live in the U.S. and get decent medical care. I'm close to retirement. I'm 52. How did I get here? The short version is best described by a Dickens quote: "Annual income twenty pounds, annual expenditure nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery." Save more more money than you make every year, it's a pretty simple equation. As I get older, the cost of medical care is a huge component and concern of retirement. There are a few options for medical retirement, that's next. But I think it's a damning indictment for health care in the U.S. that it can be cheaper to fly to Thailand (or a number of other countries), have a bit of a vacation and get medical care that would be cheaper than the whole kit and kaboddle would be in the U.S. There are, of course, thresholds that have to be passed and you have to have some pretty major work that you need/want to be done to pass the cost/benefit analysis to make it work in your favor. But if you are going to retire unconventionally (without medicare and a pension prior to age 62) in the U.S., then you have to have health insurance, or you are a huge gambler. The insurance business makes money from you being healthy. It's pretty simple, much like weight loss and gain. If you take in more calories than you expend, you will gain weight. If you expend more calories then you take in, you will lose weight. There are a few ways to skin that cat, but that's really the basics. And with insurance companies, if they take in more money than they pay out in claims, they make money. If they pay out more in claims than they take in premiums, then they lose. And the healthier you are, in general, the less you use medical services. So insurance companies want you to keep that weight off. Again, a broad brush stroke of the industry, but accurate.

And for either medical tourism or medical retirement, as a rule, you're probably going to have to get on a plane. And from my earlier travels, here's a bit about airline travel:

The Middle Seat

We are, of course all familiar with Newton's third law of motion, for every action, there is an equal and opposite reaction. Well, here's Alan's law: for every piece of good news, there is an equal and opposite tidbit of bad news, and here's mine - I live in an absolutely magical place. Unfortunately, I also happen to live in the middle of the Pacific Ocean, and to get anywhere in the world, I have to fly. For the record, I am not particularly fond of flying. But I am also a logical guy, and when I have to cross 2500 miles of ocean to get from point A to point B, well, I hop on that plane like a gibbon.

Now the last trip I took, as usual, I made reservations in advance for an aisle seat. I'm a restless fellow and I like to get up and walk up and down the aisle without disturbing my seat mates. I should make mention at this point that I flew about a month after 9/11. I was anticipating a less than full flight, and was even hoping for ghetto first class - a luscious empty row to myself.
Of course, you are thinking there were problems. You are right. Otherwise, where would the story be? As I checked in, I was informed that there were no aisle seats left. I pleaded, I whined, I cajoled, I begged. I had made the reservation, they said there was no problem, an aisle seat was reserved for me, can you check again, is there any way there might be an aisle seat on another computer reservation system? Please? Is there any kind of special fee I could pay to get an aisle seat? Can you upgrade me to business class? No. No, no, no and no. I was stuck in the middle seat. Now I know there is no written protocol about the middle seat, but I really think there should be. Here's the way I see it: The person in the window seat has the side of the plane to lean on, and an armrest all of their own. The person in the aisle seat has unfettered access to the aisle, and an armrest, their own personal armrest, on the aisle. The passenger in the squeezed in between, the occupant of the lowly middle seat should get both remaining armrests to compensate for the advantages the window and aisle seat passengers have. It's not written, but we all know that's the way it should be, right?
When you have just boarded the plane, you are really only focused on looking for your seat, finding where you will spend the next 5 hours of your life and getting as comfortable as possible. But when you are already sitting down, and there is an empty seat or two next to you, every passenger strolling towards you becomes a possible interloper. Don't deny it, I know we all think like this. We try to casually observe the other passengers as they approach your aisle and wonder: Is someone going to occupy the precious empty seat next to you? If so, then who? Is it going to be a pretty girl or guy, if you go that way? (Chances are slim) Will it be the elderly lady with stories of canning vegetables in Iowa and pictures of her grandchildren? (Odds are improving) The family of four, will they sit next to you, and will their 4 year old sit directly behind you, kicking your chair and lifting and letting the tray slam down, again and again and again? (A savvy Vegas gambler would be happy to take that bet) Or is it going to be the man who plops down in the seat next to you and says, "It's going to be a long flight. I just had 12 beers and I need to piss like a racehorse, so I'm going to be hopping over you all night long." (This actually happened to me before)
As I boarded the plane, intent on finding my seat, I saw, much to my dismay, two men nervously watching the passengers sauntering down the aisle. My seat, the dreaded middle seat, beckoned. Both had their elbows firmly ensconced on the armrests of the middle seat, which was understandable at that point because the seat was not yet claimed. They look at me and I at them, then at the seat. I put my briefcase under the seat in front of me and sat down. Their elbows, amazingly enough, remained firmly on the armrests that clearly belonged to me. A grievous breach of middle seat protocol. "Okay," I thought to myself, "let the games begin."
The gentleman in the aisle seat was perhaps in his early 50's, slightly built, a hint of an Asian background, longish gray hair, wire frame glasses, polo shirt, khaki pants and deck shoes. I look at my watch. Five minutes, I think to myself, before that armrest is mine, mine mine! The guy sitting in the window seat was probably in his early 40's, about 180 pounds, long pointy nose, clearly Caucasian to the bone, Nike running shoes, short pants with a fancy braided belt and a shirt that had the logo Blue Lagoon Dive Shop Truk over his left pocket. This fellow's elbow was protruding brazenly at least one full inch into my seat, my space. That's right. Not just on the armrest, but on the strategic inner part of the armrest closer to the seat, jutting out so that when I sat back, his pointy elbow, when I sat back, would poke into my back. Hmmmm. I gave him 10 - 15 minutes before I vanquished his elbow to where it belonged: on his lap.
I'm going to be careful a out what I write next, so as not to incur the wrath of women readers. Oh, the hell with it, I'm just going to say it. Women are no problem when it comes to middle seat protocol. There are a couple of reasons for this. Women are much more sensitive and caring creatures than we callous men, they recognize the inherent indignity that the poor mug who has been relegated to the middle seat has to suffer and usually, they withdraw their elbows before you even sit down. Sometimes, however, they don't. What to do? Insinuate your elbow on to her armrest (which, if you are in the middle seat, is by all rights yours anyway) and begin to make skin to skin contact. The elbows of the female species almost always make a hasty retreat, although on rare occasions, you really wish they wouldn't.
But I had no lovely lass to sit next to, no elbows to rub, well not the ones I wanted to rub anyway. I started out by perching my elbows on the armrests, moving them back slowly, centimeter by centimeter until I engaged both men in a little physical contact. Okay, let's get this this thought, the one that must be going through your head right now - I do not enjoy, nor am I entirely comfortable with male to male skin to skin contact. I was just trying to claim what was rightfully mine and was hoping that these guys would get the heebie jeebies quickly when my elbow nestled against theirs because I wanted both of those damn armrests. Middle seat protocol, you know. The older man on my left put his tail between his legs and his arm on his lap after about 30 seconds of elbow to elbow nuzzling. But my opponent on the right was proving to be a much tougher challenge than I anticipated. He seemed to have absolutely no discomfort a out or forearms resting together, and his elbow, his pointy elbow was still encroaching on my personal space. Again, hmmmmmmm. I looked at him, then down at his elbow and turned my back slightly so that it rested against his elbow and began applying slow, increasing pressure. Nothing. The man was like a block of granite. I looked at him again, then down at his elbow. He smiled ever so slightly.
To better assess this worthy adversary, I got up and took a stroll to clear my head. It was an all night flight, he would be asleep soon, perhaps I could pull the push, replace and pretend (push his elbow off, replace it with yours and pretend to be asleep) as soon as he nodded off. I went to the bathroom and washed my hands. I washed all the way up to my elbow and did not bother to completely dry it off. Let's see how he reacts to this, I thought. A damp elbow placed against mine would get an instantaneous reaction. He merely pursed his lips slightly and his elbow remained completely immobile. I had severely underestimated him. I then placed an in flight magazine magazine against his elbow, a pillow over that, and leaned against the pillow, once again with ever so slowly increasing pressure. His elbow seemed to be an immovable force. The man was a master! And so it was that I spent the rest of the night, leaning against the pillow, that was propped against the magazine, that separated me from the maestro's elbow.
The flight mercifully began to descend and finally landed. I had not exchanged a word with this man the entire flight. As the plane taxied to the gate, we stood up and he said in a voice that Michael Jackson would have coveted, "That wasn't a bad flight at all, now was it?" Perhaps from his perspective, but from mine, not so much.

2012-03-05T11:33:00.000-08:00

It's all about medical today. I've written about the efficiency of the medical services in Thailand, and also noted that it is quite the value for the baht. And now we're back in Kuwait, the wife had a follow on operation for the screws that backed out of her soft bone. Here's some comparison and information. When you move to Kuwait, you actually legally emigrate - the whole enchilada (not a pork enchilada, though) - you become a legal resident with certain rights and privileges. My Civil ID, the national ID card, is the one above in the picture. Every resident in Kuwait has a Civil ID - a national ID card# that is tied to a database - tracks when you enter and leave the country every time. Tracks if you have a travel ban. It's something that you have to have with you at all times. Responsibilities and rights. One right that residents have is health care - once you have run the gauntlet of a police background check in your home and one here as well and a physical to ensure you don't have TB or are HIV positive, you get a health card (grey, bottom) that entitles you to health care at a local hospital for chump change. But you do indeed get what you pay for, which is why there are many private hospitals and why many Kuwaitis go elsewhere for their healthcare. There was no shortage of of Kuwaitis at Bumrungrad. The private hospitals vary in quality in Kuwait and they aren't cheap, particularly compared to Thailand. We choose the private hospital here. Post op in Kuwait, Gwyne had to get a cast for her foot. Cost? 50KD - about $180. Inexpensive, perhaps, compared to the U.S., but wildly on the right hand side of the bell curve if you have just come from Thailand. The care we are getting here is quite good, and the doctors are great. Whether you are in Thailand or Kuwait, you are going to be working with doctors who do not speak English as a first language. Unless you speak Thai or Arabic, well, then you are going to be conversing in Anglais. And one thing I've learned in life is that if you are communicative and have a good sense of humor in your first language, you are going to be a good communicator and be able to have a good chuckle in your second or third language. At Bumrungrad, we did not have the most communicative doctor. Very competent, but like Strunk and White advised, he omitted needless words. Dude, it was a writing guide. So when we asked questions like, "How long can she be on her feet every day?" We would get a noncommittal response, "Ummm, not too much." Contrast that to our doctor in Kuwait, his response was, "I want you to use your feet. I want you to exercise, to move. Walk the first day in the boot. As much as you can." And the doctors in Kuwait, both of them Egyptian, had a much better sense of humor as well. When Gwyne was waiting for her surgery in Kuwait, an assistant was revving up the drill they were going to use to screw her bone together as she was on the operating table. The younger doctor said, "Are you ready?" There had been no anesthesiologist in sight. Think that drew a weak laugh from Gwyne, very weak, but a much heartier guffaw from me when she told me the story. Medical care in the private hospitals in Kuwait (New Mowasat Hospital http://newmowasat.com/) in particular has been great. Dental insurance, however, is notoriously stingy, so if you need major work done, medical tourism in Thailand makes economic sense. And if you have need a complex operation that is not covered by insurance, you'd probably be on a plane for Bangkok, or elsewhere in SE Asia, not Kuwait City. But for now, we're quite happy to be home in Kuwait.

2012-02-28T11:45:00.000-08:00

When the medical tourism doesn't go so well, then what do you do? We left Thailand and took what seemed to be the wheelchair express from BKK to Kuwait - flew Emirates via Dubai. There were quite a few folks on the plane in wheelchairs, many of whom had flown to Thailand specifically for medical care. Gwyne was supposed to locate an orthopedic surgeon in Kuwait to get her feet wrapped once a week for 4 more weeks. We went to a local hospital, told them the story, and the Egyptian doctor asked what procedure she had done. Hallus vargus, (buinionectomy) both feet. He said, "Both feet?" Gwyne said yes. He cocked his head, spread his hands and said, "Why?" It sounds much better with an Egyptian accent, I can assure you. She told him she still had pain, he had her feet x-rayed, turns out the left foot hadn't healed - it was still broken, the screws had backed out. He took the film to the head orthopedic surgeon, and he recommended surgery as soon as possible to repair the bone. The bunionectomy was successful, this was just to fix a bone that wouldn't heal otherwise. They both seemed very knowledgeable and competent. Here we go again. He said that no matter where you get any surgery done, things don't always go perfectly. We couldn't go back to Bumrungrad, and when you have to get a broken bone fixed, well there aren't a lot of options. There is definitely a huge cost difference - the entire operation, hospital stay, medicine, everything cost about 10K (covered by insurance) for both feet. Today, when we went to get a blood test prior to the operation, they wanted about $300. For the blood test. There is a delicate dance between hospitals and insurance companies - one wants to charge for a service provided, the other wants to pay only what is covered. What do you do when the medical tourism doesn't go according to plan? You change the plan.

While I was doing something the first day we were at the hospital in Kuwait, Gwyne was feeling a bit weepy. A gentleman from somewhere in the Middle East sent his 5 year old daughter over to her with a candy and packet of tissues. He then came over and asked if Gwyne if she was okay. She said she was, she was just feeling sad. Then he said to his daughter (and again, this sound soooooo much better with a Middle Eastern accent), "Go. Give her hug." What an incredible, genuine act of kindness. My daughter is all grown up, so I can't send her over to strangers to give them a hug, but I'll try to find a way to reciprocate that kindness somewhere else.

2012-02-27T07:03:00.002-08:00

Okay, I lost my wallet once too, which probably accounts for my compulsive patting of the pocket to touch my wallet. Or maybe I just like to know that bad boy is still there. I didn't lose it while I was traveling, but still. We were living in Saipan at the time, I was teaching 4th grade. One day, my wallet grew legs and then up and walked away. I looked everywhere, but it was gone, gone, gone. Probably a few hundred dollars gone, credit cards replaced, new insurance cards ordered, new driver's license, forms to fill out explaining how I lost my wallet (I don't know, it's gone, if I knew how and where I lost it, I would go back and find it...) It was no fun. Smack dab in the middle of the rainy season, two and a half weeks later, I wandered past my pick up truck parked inside the school grounds. Hundreds of urchins passed by my truck every day, hundreds, I tell you, hundreds! The black bed liner of my truck happened to be the same color as my wallet. And there my wallet sat, cleverly camouflaged, at the bottom of a pool of water in the bed of my truck. Those darn urchins never peeked in the bed of my truck and found if for me. I had probably thrown my wallet there after taking my windsurfing gear out to rig to get on the water for a quick sail. I clearly didn't remember to take it out. But that's just another notch in my belt to cinch in as I get underway whatever uptight journey I'm on.

And because this blog is about medical tourism in Thailand, here's a story from a monastery in the south of Thailand back in the day for the tourism side of the house. Pictures to follow...

The Vipassana Romance

When I was just a young man, I spent four months in a Buddhist monastery in Southern Thailand, but not consecutively. For the first 10 days of each month, participation in an intensive Vipassana (Thai for awareness of the breath) meditation retreat is mandatory. How intensive, you ask? It includes the optional early sitting meditation 4:30 - 5:30, 5:30 - 6:30 yoga session, 6:30 - 7:30 sitting meditation, 7:30 - 8:30 breakfast, 8:30 - 9:30 sitting meditation, 9:30 - 10:30 walking meditation, 10:30 - 11:30 sitting meditation, 11:30 - 12:30 walking meditation, 1:30 - 2:30 sitting meditation, 2:30 - 3:30 walking meditation, 3:30 - 4:30 sitting meditation, 4:30 - 5:30, tea and a very, very, very light snack, 5:30 - 6:30, a talk given by a monk on Dharma, or Buddhist philosophy and teachings, then 6:30 - 7:30 walking meditation and finally, a 7:30 - 8:30 sitting meditation. Whew! In my older age, it exhausts me just thinking about it. When you add it all up, it is a minimum of 10 hours of meditation a day.

Just to add a little bit of background, at these retreats, there is one meal a day (in the morning, prepared and served by an older lady that everyone called the Dragon Lady - if she liked you, you might get an extra dollop of curry on your rice) and seconds, if she would allow it, were highly recommended. Talking is not allowed, and of course, there is no smoking or drinking or killing any living thing, including the clouds of mosquitoes that dive bomb you as you meditate, or do anything. The monastery (Wat Suan Moke) is set in the jungle and the mosquitoes are as big as flies and as plentiful as Mitt Romney supporters in Utah. The mosquitoes? You're supposed to brush them off with 'loving kindness.' And yes, I exercised a little less than 'loving kindness' on more than few of those blood sucking bastards. Essentially, it's just you and your precious little thoughts for 10 days. Now there can be a couple of funny things about meditation retreats. I like what an American monk referred to as 'the Vipassana romance." The whole point of meditation is focus your mind on one thing, whether it is your breath, a candle, your entire body; the trick is not to let your mind wander and think of other things, for example, finances, the itch on your nose, how the curry was too hot this morning or the hot girl meditating next to you, breathing in and out, in and out. Quite a trick. Like anything else, you get better with practice. And hey, it's not my fault the curry was to hot that morning, or a mosquito just bit me on the nose (which, although I wanted to squash, I brushed off with loving kindness) or the girl meditating right next to me is well, meditating right next to me, breathing in, breathing out, in and out...whoooooo hooooooo! Oh, did I forget to mention that any kind of sexual activity was not allowed? Ahh, this is where the notion of a Vipassana romance comes in. The monk told a story about when he was doing a Zen retreat in Japan and was facing a wall and to his back, another woman was facing a wall in the opposite direction, meditating for obscene amounts of hours in a day. Obscene, I tell you, obscene! It seems as if their minds weren't always focused on what they were supposed to be focused on, which I guess is the essence of a Vipassana romance - letting the mind wander to the thoughts of the girl meditating next to you, or even all the way across the room, if you're a really good meditator. After the retreat, he approached her, told her he had deep loving thoughts about them being together, getting married, meditating together, having little meditating children (I think he was a bit of a naughty meditator, personally) and she said, "Oh my God, I had the exact same thoughts...about the guy sitting next to me!" It crushed him. Maybe that was the turning point for him that led to him ordaining as a Buddhist monk in Thailand. My point is that it's quite hard to focus your mind on just one thing for such a long time. With the exception of your Vipassana romance. It seems pretty easy to focus on that.

And it is a long time. At least 10 hours a day. How do you know when it's time for yoga in the morning? When it's time to switch to a walking meditation? The bell rings - softly - to let you know it's time to switch things up. One participant in the retreat is assigned to be the bell ringer for the duration of the 10 days and has to gently hit the oxygen bottle hanging from the tree with a piece of wood. We wouldn't want to jar anyone's thoughts away from the girl meditating next to him now, would we? After 3 retreats, the monks had approached me to be the bell ringer for the 4th retreat. I had been there for a while and learned quite a bit, so I agreed. Clearly, they thought, I could have a Vipassana romance, I mean focus with the best of them for 55 minutes and then gently ring the bell.

As I said before, meditation is hard. It is difficult to focus the mind on one thing for extended periods of time. Where does the mind wander? What do you think of? Aside from fixating on your Vipassana romance, let me tell you what one absolutely universal mind wandering thought is at retreats: "When the hell is that damn bell going to ring?" Yes, we're all making progress, learning about ourselves, concentrating, discovering things like, "Oh, so THAT'S why I compulsively pat my pocket to see if my wallet is still there. It's all clear now!" But make no mistake, everyone, at some point during the retreat, wonders when the bell is going to be rung. In the 55th minute, if your thoughts are not totally consumed by your Vipassana romance and thoughts of where you and your hot meditating wife and little children will live, you may perhaps start directing your thoughts at the bell ringer, quietly at first...ring the bell...ring the bell...look at your watch...loooook at your watch...it must be past time now...RING THAT DAMN BELL you finally scream in your mind. I'm sure that the really silly folks must have had the song Ring my bell, ring my bell ohh hooo ding a ling a ling going through their heads, but not a serious guy like me, oh no.

Well, as the bell ringer, now I was sitting on the other side of the fence, so to speak. And yes, you can feel the thoughts being directed at you. Your friends peek, look at you pleadingly, you can almost hear them, "Please ring the bell Alan. Ring that damn bell. I'll buy you a beer after the retreat if you ring it now." I can swear I heard that precise thought a few times. You look at your watch, look at them and shake your head once, almost imperceptibly, perhaps wiping your face with two fingers showing, indicating that they have two more minutes to go before the glorious release: the gentle sound of wood against the oxygen cylinder. Ding. Ding. Ding. And here's the dirty secret I've been carrying around for so long: I once rang the bell 5 minutes early. I guess the sound of ring my bell was running through someone else's head so long and hard that I caved in and rung it baby. Ding!

2012-02-23T08:15:00.001-08:00

I am a very uptight traveler, and I have done a lot of traveling, for both business and pleasure. The first time I traveled with Gwyne down to Bali, she was dumbstruck by the change in me once the trip got underway - getting to the airport on time, ensuring travel documents were in order, well, just about everything switched from the easy going guy she fell in love with to one of the most tightly wound people you can imagine. She identified three events that contributed to me being not a fun person to travel with, at all. In chronological order and with lessons learned, here they are.

Act I. It must have been 1985. I was just wrapping up a year and a half long trip around SE Asia. My entry point back in to the U.S. was going to be Honolulu, Hawaii. Off the Philippine Airline flight, I tumbled, and I was quite a sight. I had a fairly filthy blue backpack, round glasses, longish hair, a stringy beard, a shirt that said Kathmandu on it, red baggy pants made in India and a pair of zori that were literally stitched together. Like I said, quite a sight. I fit the profile of a drug smuggler. So, as I waltzed through customs, the uniformed officer looked at my completed form and said, "Welcome back, Mr. Taylor. Where have you been and how long have you been gone for?" I took a deep breath and began, "Thailand, Malaysia, Indonesia, Burma, India, Nepal, Sri Lanka and the Philippines, maybe about a year and a half?" A pause. "What do you do for a living, Mr. Taylor?" My snotty, 25 year old answer was, "Phhhhhft, I don't work." I think it was the 'phhhhhhft' that sealed the deal. There was no pause in his next action. Come with me Mr. Taylor, we're going to search your bag and person. There were pants dropped and a rubber glove involved in the searching of my person. Lesson - painful lesson learned - be respectful to people who have the authority to snap the rubber glove on and when you travel, dress like you have a job, even if you don't have one.

You've come a long way, baby.

Act II. We were traveling in Indonesia, Dominique, my daughter, daughter's friend and myself. We were on Bali and decided to take a trip to Borobodor, the world's largest stupa, located in central Java. We flew from Bali to Yogajakarta and had a bit of an adventure finding a place to stay, starting on the very, very cheap side of town, eventually taking two becak's (cycle powered tricycle thingys with a seat in the back for 2 - 3 passengers) through the rain, being separated - again, all in the dark ages of pre internet/cell phone travel. Dominique was not pleased with the separation during the travel, as I had all of our passports and money and we had no way to contact each other should our becak drivers not managed to find each other on the other side of town. It all worked out though and we ended up on the $17 - $25 side of town in comfortable digs that included breakfast and a pool for the girls. That night, we went out to a restaurant not too far away from our guest house. I had a kind of black canvas brief case that held said passports and about 2K in cash, might as well throw in the tickets too. Remember, pre internet days, we had paper tickets. As we ordered, I clutched my bag on my lap. Dominique said, "Will you relax and put that down? We're here on vacation. Just put it down." Always the dutiful husband, I complied. Had a lovely dinner. Left. Went home. The next morning, I looked for the bag. In that sparse room, it didn't take more than a minute to realize it wasn't there. Panic. I played things back in my mind and realized I must have left it at the restaurant. We woke up at about 0700, the restaurant didn't open until 1000. Those were three verrrryyyyyy long hours of waiting. On top of losing my passport, there was my daughter's, my Canadian wife and my daughter's friend - we had been entrusted to take her on vacation with us - maybe 10 years old at the time? And we had no money. And no tickets. There was going to be some serious 'splaining to do. So we trundle down the road to the restaurant and camp out at about 0930. 1000 comes and goes. Okay, we are in Indonesia, after all, jam keret (rubber time), it wasn't really going to open at 1000. 1015. 1030. I figure they found the passports and money, have pasted their pictures in our passports and I picture them somewhere, speaking clipped English with our passports and money somewhere having a wonderful time. I begin to wonder where the embassies are. 1045. 1100 comes and someone rolls in. The bag was there, contents intact. It turns out there was an hour time difference between Bali and Java. Lesson learned? Hold on to your travel documents. Don't let your wife talk you into relaxing. Not even for a second. But mostly know where your travel documents are at all times.

Act III. I was in Canada getting Lasik surgery, staying with family. Had the surgery, all went well, headed back. They drove me to the airport (about 2 hours away), hugs all around and I went into the terminal. I look at the board. Nothing. I walk up to the absolutely empty counter and ask about my flight to Hawaii. They ask to see my ticket. It's for the next day, which explains the lack of a queue and general emptiness of the airport. I was there a day early. I was too embarrassed to call anyone and let them know I had blown the date, found a hotel close to the airport and checked myself in. Lesson learned? Pay attention to times and dates. Be early, but jeez, not that early...

The finale? All of those scenes had a long lasting impact on me and I anticipate playing the part of a well dressed, rule following, uptight traveler for many years to come. And then I'll get out of the airport, train station, boat or whatever mode of transportation that got me from point A to point B and cut loose.

2012-02-21T20:54:00.000-08:00

Bangkok has plenty of expensive shops where the prices are marked, but the streets are lined with stalls selling knockoff kit - movies, tv series, designer bags, sunglasses, watches, shirts and food, food, food. The food is fantastic and you don't really have to bargain for that, but everything else sold on the street, it's about getting the best price, or just paying the ridiculous first price they ask for. Don't feel bad about negotiation 'cause no one is ever going to sell you something at a loss - they will always make a profit. Some people don't like to bargain, but here's a few tricks to go with the flow. Smile, you are in the Land Of Smiles, after all. It's not the end of the world if you spend a few extra baht for that t-shirt. Learn the basics of the language - the numbers, how to say how much, that's too much and what's your best price. If you ask the price in Thai, you'll automatically get a lower starting price. Once you get that lower starting price, counter with an offer 50% to 75% lower than what they asked for. Remember, they won't sell at a loss so it's worth a go. You should always know about what you want to pay and what a fair price is - you can ask a local what price they'd pay, then you can expect to pay a little more. 'Cause you're not a local and that's just the way it works. And if you're Japanese or from the Middle East, you automatically get a higher starting price. 'Cause that's just the way it works.

Towards the end of the bargaining, I'm a big fan of the walk away. The other day, I was buying a soccer jersey - the price I was quoted (the popular tool to avoid language confusion is a large calculator, all of the shop vendors have them) was pretty darn high. I shook my head and walked. I took the nuclear option - I walked away before any bargaining started. He asked me how much, what my price was, I just shook my head and kept going. Wait, wait, wait. A new number appeared on the calculator. 75% less than the his first attempt. That was a starting point I could live with and I got a few more baht off of the final price. I prefer to employ the walk away towards the end of a transaction and I'll usually use it when the starting price isn't so far out there that it's next to Neptune.

Tomorrow is the start of our trip home, flying Emirates to Dubai and then home to Kuwait. Our trip was much more medical than tourism, but that's why we came here - the medical part. And I did manage to sneak in a bit of tourism. Our two big lessons learned were:

1. If you have insurance and are in a place where there is good medical care, stay at home and get it done there. BKK streets are anything but ADA friendly.
2. If you don't have insurance or want something done that is not covered by insurance, this may be the trip for you. There are lots of medical facilities in Thailand, but Bumrungrad International Hospital is the mother ship and particularly in medical care, you get what you pay for.

World class, great experience.

2012-02-20T01:32:00.000-08:00

It's potentially a bust. The real underlying premise of this blog was to document that it was much cheaper to retire overseas than it was in the U.S. And it can be. But one of my pervasive themes has been that you get what you pay for. And those of you who know me well will have heard me say, yes, it is all about the money. You can live in another country and with lower expenses, but no matter where you are, some things are going to cost you - a roof over your head, health insurance, food, transportation and utilities. And then there are taxes that pay for things like education, roads, sewer system and public safety. I've got a friend who's headed to Thailand in a few weeks to give it a go. I'll use him as a nameless guinea pig and see how long he lasts. Like me, he has a wife of Japanese descent who, although I don't know that well, I suspect she will be all into the running water, power and wifi access things that drive the monthly bill up.

So can you live for less in Thailand than other places? Sure, but (all together now) you get what you pay for. And it's also about who is around you as well - the retirees I've seen here have not struck me as the best and brightest. They are not the type who have done the analysis, come away with hard facts and made an informed decision. Most of the guys I've seen have been all about the young girls who adore their money and pretend to adore them. What you are looking for in a place to live? It's back to the drawing board for me. In no particular order, here's what some of my criteria looks like:

1. Proximity to an international airport.
2. Interesting cultural events.
3. Nice restaurants.
4. Bike paths or a bike friendly community.
5. Parks.
6. Temperate climate - just like Goldilocks, I'm looking for not too hot and not too cold, but jusssstt right.
7. Public transportation.
8. A good education system - an educated community is more interesting and they typically have jobs.
9. Good health care.

A nice juxtaposition of the old and the new in BKK

For me, here's a few points Thailand falls short on - temperate climate (please, no comments from my Canadian family here) parks, bike paths or bike friendly communities and an educated community. The whole taxes and rule of law stuff come in to play as well. I'll use my criteria as a benchmark to keep on looking, because I'm not quite finished working yet - my dad retired at 55, and I'm a competitive guy, I plan beating him and retiring before him, as well as my much, much older friend who is headed to Thailand next month...game on!

2012-02-18T05:20:00.000-08:00

The Blue Romance Coffee Shop

Loading the bikes on the boat

It's all about tourism today. Gwyne gave me a pass from my manservant duties to go out on a bike tour, so I took the shortest one available from SpiceRoads cycle tours (www.spiceroads.com) which was the jungle tour and took us through the streets of Bangkok and across the river. For B1000 ($32), it was totally worth it. Supplied are a bike (of questionable quality, in my case), helmet, water and an English speaking guide. Our guide's name was Bottle and he was great. Unfortunately, my phone battery died, so I couldn't save the GPS map from the Cyclemeter app that I like to use. The ride starts out at the Blue Romance coffee shop off of Soi 38 and takes you about 5K through the streets of Bangkok. That was kind of hairy. But very quickly, you get from the big fancy streets and shops to the back streets of Bangkok which are not nearly as well kept as the front streets of Bangkok which are really not that well kept to start with. Places I've certainly never seen before, and that gave a real insight as to where the GDP distribution comes from.

Long tailed boat from one side of BKK to the jungle...

You get what you pay for, and while that $32 may be a big chunk of change to many Thais, it doesn't buy a lot of safety. There was a quick briefing about signs used (turn signals, pointing to the ground when there might be a hazard, like dog poop) and when we should ride single file and I will say this - the drivers on the street were great - they gave way to us as a group and were super polite. But helmet use was not mandatory and we were, after all, cycling on the streets of Bangkok and we had to cross a number of very well trafficked streets. And this trip, I was most pleasantly surprised to see a real bicycling culture in Bangkok - quite a few cyclists putting themselves out there along with the buses, tuk-tuks, cars and motorcycles. Progress. And then we got to the boat that took us across the river. I'm a very good swimmer, so that didn't phase me at all, but this boat, loaded up with 14 bicycles and 14 people I didn't know and 0 life preservers, well, that did give me a tiny pause for thought. We crossed the river, unloaded the bikes and set off. Bottle tells us that the path is mostly about one to one and a half meter wide. Be very careful. Don't ride with one hand while taking a picture with the other hand. You might fall in and there is water on either side.

And there most certainly was. Most of the ride (about 25 km) was on the concrete path, on the other side of Bangkok, quiet, picturesque, and a bit on the warm side, even though it was the perfect temperature for Bangkok, overcast and not in the summer. I took up the rear position, I'm an avid cyclist and there are usually two guides in the group, one in the front to lead and one in the rear to ensure that no one gets left behind or lost. The rear guide went somewhere else with a different group and I'm not a big fan of getting lost in foreign countries (although I have done more than my share of that) so I took that role on. I know that if the ride was my gig, I would have taken phone numbers of people riding so that if they did take a wrong turn, I'd be able to contact them - I like logistics, I like processes. The ride was very nice, through a lovely jungle, so very welcome after my return to Kuwait, which features very little in the way of foliage. There is some green in the Kuwaiti flag, but that's about it. On our ride? Lots of coconuts, jackfruit trees, mango, papaya and unidentified greenery. Nice. There were also many dogs, but they were the most docile dogs I have ever come across as a cyclist. We did have to lift our bikes over two very large dogs that were sleeping on the way across the river (and the same two on the way back - didn't look as if they had moved at all) and weren't barked at or chased by any other of the motley crew of canines that crossed our paths.

Taken from my phone, while riding with one hand

The raised concrete path made for an interesting ride and the houses in the jungle, connected to the path by wood planks were a world apart from Bangkok. There was the occasional ubiquitous 100cc motorcycle on the path we all had to stop for, but we did get to a lovely floating market - the first one I had ever been to in Thailand. This was not at all touristy - there was a group of older people singing karaoke and it looked like the only farangs to be found there were our group. Additionally, all of the people we passed on our ride seemed very happy to see us - lots of hello's, sawadee kaps and smiles, so the route must not be that well worn yet.

As I was a floating market virgin, I enjoyed the short break we took there to buy snacks and stroll through the market. If you're in Bangkok and have an interest in taking this trip, I'd recommend a few tweaks on this trip - pack cycling shorts, a lightweight jersey, bring gloves and have a decent level of competence on a bicycle. As we were riding, and I watched the guy in front of me suffer through a number of fits and starts, I couldn't imagine that everyone made this trip without a miscue - someone must have not made one of the many, many, many 90 degree angle turns and fallen into the swampy, Burmese python riddled water (that's speculation on my part, but it was the jungle tour after all) and not all of the trips over the side were short drops. I didn't know any of the people on the ride, didn't know what their skill levels were, and no attempts were really made to ascertain what mine was prior to the start of the ride. So at the floating market stop, I asked Bottle how many people he had lost over the sides of the path. He seemed to shiver, then smiled through his braces and said, "Many. Many." Although his English was quite good, I thought he may not have understood my question, so I asked the question a different way, and asked how many people had fallen off of the path and pantomimed falling down off a bicycle, and he said, "Many. Very many." But I'd do it again in a second.

2012-02-17T00:22:00.000-08:00

Medical tourism part of the post - there was a tiny counting problem with the pain medication they gave Gwyne, take this one every 4 - 6 hours as needed for pain, come back in a week. They gave her 10 pills, you do math. So, while we were at Bumrungrad for the fitting of the crown (think teeth, people, not tiaras), we thought we'd pop by the orthopedic department and see if we could get some additional medicine a tich stronger than tylenol. We were advised to return at 1300 for the stand by queue. We came a little early, and shortly after 1300, we were taken in to see a doctor, got a prescription for some additional medicine and were out. The cost of the doctor's visit and the medicine would have been $55, but insurance covered it, and it was delivered via the vacuum tubes that so impresses me. For the level of care, the efficiency and the price, it's amazing.

Now for the fun part of the post. There's a restaurant down the street that advertises Bangladeshi food. It is not a packed establishment and it may be because it sells Bangladeshi food. Here's a short story from one of my trips to Bangladesh, back in the day.

Dacca, Bangladesh, January 2^nd, 1984. Rickshaw heaven or hell, depending on your perspective. I had just flown in the night before from Burma on Biman Airlines, the national airline of Bangladesh. For those not in the know, Biman is the absolutely cheapest ride in Southeast Asia; and yes, there is a direct correlation between price and their service and safety record. I had an onward ticket to Calcutta for the next day, but for some reason, (Recklessness? Youthful naiveté? Pure foolishness?) I had wanted to cross Bangladesh by land. I had one day to locate the embassy to get an extension on my visa to accomplish the land crossing or I would have to fly out.

Now the Lonely Planet guide book, which was the Bible for frugal travelers in Southeast Asia, said that English is widely spoken in Bangladesh. They lied. Perhaps there are pockets of Dacca where English is widely spoken, but they must be very cleverly hidden. As a result of reading the guidebook, I put absolutely zero time and energy into learning any Bengali. And let me tell you, among the rickshaw driver population, English isn’t spoken at all. (Mental note to self: Don’t believe everything you read.) Anyway, my challenge was to find a rickshaw driver who spoke English, knew where the embassy was, if it was open on January 2^nd, and, on top of that, I had to negotiate a price for the ride as well. The tough part, as you can now imagine, was finding a rickshaw driver who spoke English. I had been through about 20 boys, pointed at them, asking quickly, “English? English? English?” I had received 20 shrugs of the shoulders and now they formed a circle around me, gawking at me with their heads slightly tilted and their mouths wide open. I finally found a rickshaw wallah, who in response to my question, “Do you speak English,” enthusiastically wagged his head back and forth as they are wont to do on the Indian subcontinent and said, “Yes, yes, yes baba, get in.” My sigh of relief was audible. “Thank goodness. I need to extend my visa. Do you know where the embassy is?” Again, the head wagging followed by “Yes, yes, yes baba, get in.” “Oh, good. Now, do you know if the embassy is open today?” His head appeared as if it were mounted on gimbals, the way it was wagging as he said, “Yes, yes, yes baba, get in!” The teensiest alarm bell went off in the back of my mind. “How much?” I asked as I squinted my eyes suspiciously. His response? “Yes, yes, yes baba, get in!” The alarm bell was now clanging wildly, the sirens began to wail. “Why you don’t understand one single fucking word of English, do you,” I slowly enunciated. “Yes, yes, yes baba, get in!” (Mental note to self: Don’t ask any more yes/no questions in Bangladesh.) Now remember, I was a reckless, youthful, naïve, foolish guy back then, so what did I do? I got in. After all, he did have that phrase, “Yes, yes, yes baba, get in!” down pat, and that was more than I had gotten from anyone else.

He cycled around for a while and found one of the very few English speaking people in the enormous metropolis of Dacca who translated for me. Everything worked out just fine and dandy; I got my visa extended and I got a good price for the rickshaw ride too. I had asked the translator what a fair price to pay for the trip would be and he said (as he too wagged his head back and forth furiously), “Do not pay that thieving rickshaw wallah any more than 10 taka – he will try to tell you the price is 30, 40 or even 50 taka, but 10 is a fair price.” He was so vehement in his insistence that I pay only 10 taka that I wanted to say, “Now have we been cheated by a rickshaw wallah before?” But I exercised restraint.

I made my way across Bangladesh in about a week’s time, using just about every imaginable mode of transportation along the way. I remember getting into one, well, kind of like a bus, but with benches on either side of the vehicle. Bangladesh is a predominantly Muslim country, so there were all the veiled ladies on one side, and all the skull capped men on the other side. Now remember, young, reckless, naïve, blah, blah, blah, right? I figured the odds were in my favour, one man, 45 women, so I naturally sat with all the women. Before I could wink at them (after all, I couldn’t see their faces, but I could make eye contact), the men had me sitting on the wrong side of the bus with them. (Mental note to self: Do like the locals do in the future.)

It was time to head out of Bangladesh and into India. I had been staying in a very small village and had consumed some of their not so pristine water. I wasn’t feeling well at all. To get to the border, I had to take a rickshaw, boat, train, bus, and finally an oxcart. To get the ox to move at a decent pace, they usually put a stick between his enormous testicles, and give them a poke whenever the ox slows down. Remember, I really wasn’t feeling well, and seeing this poor fellow’s testicles get prodded when he slowed down to less than a trot wasn’t helping matters at all. I’m a very sensitive man when it comes to any kind of testicular prodding. After bouncing up and down on the oxcart for what seemed like an interminable amount of time, I finally made it to the border. My innards were beginning to quiver. I needed to find a toilet fast, or my entry into India was not going to be a pretty sight. I pinched my cheeks together, and found a row of stalls – all occupied except for one. With my fists clenched, I went in, barely got the door closed, and, well, let’s not go into the details there, okay? I think a good story should leave something to the imagination.

Now in Southeast Asian squat toilets, there is no toilet paper. Folks there clean themselves with water and their hands, which is why you’re not supposed to touch anything with your left hand in that part of the world. At least that's the way it was done back then. Perhaps the places charging more than $1/night had fancier facilities. I had been traveling for a while and had adopted that custom out of practicality. So, I reached over to the spigot and turned it on and waited and waited for the water pressure to build up, waited for those first few drops of water to drip out, but there was absolutely nothing. A moment of horror gripped me. It had not been, as a friend once put it, a ‘no wiper.’ And then, in one of life’s great ‘aha’ moments, it hit me. There I squatted, on the border between Bangladesh and India. The guidebook! I would certainly have no need for the Bangladesh portion of the book in India! Not only did I come up with this brilliant thought, but I also had the presence of mind to look for the particular page where it said that English was widely spoken in Bangladesh. That page would be put to the test first. The texture is certainly not recommended for non-emergency situations, but it was functional. I derived no small amount of pleasure from looking for inaccurate entries in the guide book and disposing of it properly. (Mental note to self: Save a few extra sheets of the Bangladesh guidebook for the train ride to Calcutta…)

2012-02-16T03:45:00.000-08:00

Cialis, Viagra and Valium - available on the street

I don't like this side of town. It is uncomfortable for a middle aged white male to walk down the street by himself - unless you have your 1,000 yard stare down pat (and I do), you can be accosted, with the assumption that you are in Thailand for what many other white middle aged males are here for. Reading glasses are a big seller over here (I'm a 2.0 guy, myself). Viagra and Cialis (most certainly knockoffs, but still) are for sale on the street. Prostitution is all out there. I've never been on this side of the city before, and it certainly isn't pretty. I kind of get it - the old men get the hottest women you can fathom - it's a transaction. As a German woman I traveled with back in the '80's said, the men get what they want - sex and companionship, the women get what they want, clothes, jewelry, running water and the potential to get the hell out of their country. I expected her to have an issue with it, but she didn't have a problem with it at all. I still don't understand it. What could you possibly talk about after the sex is done - and that's what it's all about it for me, the connection, you have to be able to connect and talk with someone. I can ask my wife where she was during the bicentennial and not only will she NOT ask me what the bicentennial is, she'll be able to tell me where she was and what she was doing. The little things.

But that's where we are - Bumrungrad International Hospital, one of the most advanced medical facilities in the world happens to be right around the corner from one of the biggest sex trade corners in the world. Quite the juxtaposition.

2012-02-15T23:07:00.000-08:00

Not really anything about medical or tourism today, just an observation about three trends.

Angry Birds. They are everywhere. The Arabs seem to favor the clothing (a bit inappropriate, I think, for an adult to walk around in matching shorts and shirt Angry Bird clothing), the kids of all cultures seem to like them and I saw a nurse with an Angry Bird hanging off of her uniform. What caused the Angry Birds to go from a popular game to a worldwide phenomena? I do confess to having played the game. I removed it from my Itunes because, well, I played the game. A bit too much. What made the leap from a fun game to an aftermarket money maker? Dunno.

Iphones. They are everywhere. I have the 4s, my wife has my hand me down 4. They are slick, slick machines. I love all of the apps, love comparing what people have and use on their phones, which are really powerful computers with great cameras in your pocket. But so many people here have Iphones, and they aren't cheap. We bought our phones directly from Apple, unlocked so you could use a sim no matter what country you are in - and here, they are all unlocked GSM phones - which means you pay full price, not the subsidized prices charged in the U.S. and the providers then make their money off of long term cell phone contracts. So, with a GDP of $8,900 and the cost of an Iphone 4s at $749 for the cheapest model, how do people afford so many of them? Dunno.

The Chinese. They are everywhere. About a year and a half ago, I had to take a business trip to Guam from Hawaii on Continental Airlines. I was a veteran of that route a few years ago, and it was filled with Chamorro's and Japanese. This time, it was jam packed with Chinese. Plenty of signs in Hawaii and Guam in Chinese. Everyone knows about the Chinese economy, 2nd largest in the world, one of the fastest growing, blah, blah, blah. But I also saw them aplenty in Dubai - where they most certainly weren't two years ago. This is not the standard, run of the mill Chinese diaspora - these were and are tourists (but not the ones I've seen in Kuwait - they were there for business) who had tourist dollars to spend. And while there is an enormous Chinese influence in Thailand, they are here as well, but the ones I'm seeing are not selling dried squid or dried something or other on the streets, they are here on vacation. 2nd largest economy in the world, but with a GDP per capita of $7,600, lower than Thailand. Whoa. Really dunno. But all of it is something else.

2012-02-14T22:50:00.000-08:00

We had another day at Bumungrad International Hospital - both for Gwyne's experiences, dental in the am and her ortho doctor in the pm. Staying at Bumrungrad Hospital Suites, right around the corner, was the right choice for us - Gwyne is pretty much immobile and they have porters to take you to the hospital in a wheelchair. I also kind of like the guys at the front door who click their heels when you come in - they have metal in the inside of their shoes to make that smart sound when they snap them together as they greet you. During Gwyne's dental appointment, I went in and picked up our physical results. Finally, a victory for me - I knew I had high cholesterol, but Gwyne's is higher! Everything else was just swell - the report lists all of the results and ranges so you see where you fall. I did not need to travel to Thailand, however, to be told the color of my stool is brown and the consistency is soft. Could have told you that from Kuwait. Yeah, that was kind of a tough one, traveling for a few days, routine out of whack, and they hand you the containers for urine and poop and motion towards the bathroom. It's tough to produce on demand.

The orthopedic experience in the afternoon was uneventful, but I love the processes. At the end of the appointment, they wheel you over to the cashier, the cashier processes your insurance (or takes your money), then the medicine the doctor has prescribed is shot up or down - from a vacuum tube from somewhere - at the counter right behind you. A very efficient process. In and out quickly. For me, the medical tourism experiment was a bust. Teeth whitened, physical, visit with the dermatologist - all things I could have done in Kuwait, and with the insurance, no real extra cost. We came because we didn't trust the level of care in Kuwait for a major operation. Medical tourism works if you don't have insurance or what you want done isn't covered by insurance - like the sex change I mentioned in a previous post. Gives me the shivers.

And of course, medical tourism really only works if you have the money to afford it as there is still the cost of the plane ticket here, transportation and a place to lay your head. The food can be as cheap as you want or as expensive as you can afford - the economy in Thailand has been doing well, although just like the U.S. not everyone is making out like a bandit. The CIA fact book for 2010 puts Thailand at number 93, with a GDP per capita of $8,700 - compare that with the U.S. number 9 at $47,200, and also look at Burundi and Democratic Republic of Congo - tied for dead last, number 193 GDP per capita of $300. It's all about perspective, but judging by the number of braces on the teeth of Thai people and the many, many expensive apartments, cars, restaurants whatever else you want to spend your money on, Thailand is doing quite well, thank you. And in the end, you get what you pay for. When I was a young lad traveling through SE Asia, I was in Singapore and was looking for a Walkman knock off (yes, that's how old I am) - I found one for $10. I asked the gentleman of Indian descent if I could open the packaging and listen to the sound quality of the player. He wagged his head disapprovingly at me and said, "Baba, if you are going to pay $10, you are going to get $10 quality." Point to the proprietor. The analogy in Thailand is that you can eat off of the street food for a little over a dollar a meal, or you can spend some serious coin - just saw the Valentines Day specials - $150 for a set menu/couple. It's all about perspective. I remember talking with my Canadian family once, and the question came up, what was the most you've ever spent on a meal out. One of them had spent $900. I think our entry at that time was $100, for a family of three. Perspective.

Dried something or other at one of the Chinese shops on the way to Wat Po

The picture I took of the monk some 25+ years ago was next to one of these statues.

Today, I took some time off and took a trip down memory lane, kind of. Like I said, I used to stay on the hippie/traveler side of town. A jaunt to the other side of the city, usually to get a visa for somewhere, was a big deal that involved a number of non air conditioned buses and pretty much the entire sweaty day. And now? Whisked away on the BTS, transfer, the cheap boat up the river and I'm on the other side of town, and back before 12:00, more than a few baht poorer, but then again, you get what you pay for. I went to Wat Po, where I visited in my youth - one of the most beautiful temples in Thailand that even if it is very touristy today, it is still so beautiful, and shouldn't be missed. I met an unconventional monk there in 1984 who was not wearing the standard ochre robes, his were green and tattered. He carried a begging bowl, like the other monks and he had a large staff. I asked him if I could take his picture, he said, "Yes, but I won't show up on film." And there he is, seems like the rascally rogue monk didn't have superpowers after all.

2012-02-11T21:12:00.000-08:00

Gwyne is going to play hardball with this blog competition. She asked how many followers I had today, I said 7, she has 11. I asked about the friends to follower ratio - 292:7 vs 1,428:11, she said, "Nope, we're going by raw numbers." So c'mon, click that follow button. Just for another week or so.

This has been a very different Bangkok experience for me - my first trip here was in 1983, before the internet, McDonalds, Starbucks, BTS, and if you had a credit card, none of the places I stayed in took them - pretty much everything you'd associate with Western culture wasn't there when I first came. I used to stay in the Banglhampu area, Kao San Road specifically, which is a mecca for young travelers on the hippie trail. Back in the 70's, the three K's to be checked off were Kabul, Kathmandu and Kuta. Kao San Road replaced Kabul when the Soviet Union had the temerity to invade Afghanistan. I was able to drive past the old travelers area in Kabul, but there was no getting out of my vehicle, I was wearing a flak jacket being driven by Personal Security Detail with AK 47's on the way to a vocational school in Kabul. I can start to check that K off the list, but just can't finish the checkmark and feel good about it.

Way back in the day, there were three fairly comical characters on my first flight over in 1983 from LA to BKK - one guy going to India, one going to Nepal and myself, on a completely unplanned, untimed trip to unknown destinations. The fellow heading to India was headed to an Ashram and had a backpack full of shampoo. He heard shampoo was unavailable in India and I guess he really liked his hair to smell clean every day. There may have been no cell phones around in SE Asia and the Indian Subcontinent back in the day, but shampoo was most certainly plentiful. Fail. The next gentleman up was heading to Nepal to climb mountains. Ropes, harnesses, boots and icepicks adorned his backpack. Well, it turns out if you take a short trip around Kathmandu, every third store will be a mountain climber's delight - others who had come to hike and then sold all of their up to date gear on the cheap so they didn't have to lug it back. And then there's me. I'm frugal, which is one of the reasons I didn't choose the Europe backpacker's trip. That's for rich people. I was on the SE Asian trail for more than 1 1/2 years and over that time, I spent more than a dollar a night for a place to stay on two nights. And I'm still bitter about both of those nights. Every overnight bus or train trip was a night I didn't have to shell out baht, ringitt, rupiah, kyat or rupees for a bed to sleep in. But those two nights, where I was taken for big bucks, well, that was a big fail for me. The first night was on a trip from Bodhgaya, India to Varanasi. I walked into the first class train waiting lounge (after purchasing an unreserved 2nd class ticket) as if I belonged. I didn't exactly look like a first class passenger, with my backpack, beard and baggy pants and when they asked to see my ticket, I received a very disapproving head wag and a finger towards the door, out there with all the regular folk. So I splashed out and bought a first class ticket, for a relatively short trip. One of the better decisions I made, as we rolled into the train station at 1:00 am - the second class train was a mess, people getting off of the train through the windows - it was just too crowded to get on or off any other way. And I had my own seat in first class. Best 22 rupees I ever spent. I was ready to lay down on my closed cell foam mat and sleep in the train station with everyone else, but a tout found me, took me in his rickshaw to a place to sleep. $4. Ouch. I had been taken. I was somewhere in Varanasi in the middle of the night. It was stay in that guest house or find a place on the street to cozy up on. It did have hot water and I did drain the hot water tank the next morning (first hot water shower in months and months and months), but then I found myself another hovel the next day for 80 cents. The second time, there is no story, I was headed back to the U.S. and the cheapest flight was on Philippine Airlines so I stopped in Manila. There is not much of a travelers scene there (at least for travelers who are watching their pennies) and the best deal I could find was a $4 room - that $4 seemed to have wings as it flew out of my wallet. I guess the only story there was that I was on a plane the next day to Hawaii and there was a typhoon headed towards the Philippines. Every flight out of Manila was cancelled except mine, and I'm still here.

But today? I've moved from the young travelers side of town to the middle aged white guy side of town - each side has their plusses and minuses, but here's Gwyne, with her boots on on the top floor of the Bumrungrad Hospital Suites. It's more than $1/night, and it's worth it.

2012-02-10T01:34:00.000-08:00

The hospital stay is finished, but the experience is not - we still have some follow on appointments and I have a visit to the dermatologist tomorrow. The inpatient stay was marred somewhat by our roomies. The Thais have a saying, Chinese talking sounds like Thais arguing. The Thais who shared our room must have been of Chinese origin, judging by the volume of their conversation. And poor Gwyne, who only speaks one language had a little difficulty communicating with the Thai staff. They all speak English well, but their accents vary quite a bit - some are much easier to understand than others. I constantly remind Gwyne in Kuwait that she needs to speak slower as much of the interaction we have is with people who do not speak English as their first language. Our work colleagues are fantastic, many of them from India and the Philippines and their English is amazing, but others from the rest of the world aren't always quite as fluent. They need to hear things a little slower and Gwyne doesn't do slow well.

I remember a bike ride I had in Kuwait with a rogue from England, Simon, who commented how English was really the international language and no matter where we went, we could get by on English. Said the rogue, "Worked out well for us, eh?" Yes it did, but it always helps to learn as much as possible of the local language, no matter where you are.

Gwyne sent me out for food today after they wheeled her down the street to our room - literally, down the street. The sidewalks are tiled and a bit bumpy, the streets, smoother, so our porter took to the streets. He did stick his hip out to deflect/deter oncoming traffic from hitting the wheelchair bound passenger, kind person he was. Think I did okay in the food department, some frozen food for the microwave and a hot Pad Thai for when she wakes up. And for me? The dinner of champions: beer (not available in Kuwait) and mangosteen...

2012-02-09T04:44:00.000-08:00

I snuck off yesterday and did something my wife doesn't approve of. At all. Gwyne is half Japanese but she's about a year away from turning 100% Japanese and donning gloves, a surgical mask and walking around with an umbrella. She's a germaphobe and becoming more so each and every day. So while she was somewhere, doing something, I went down to the local food stall and got something that been cooked that morning, but had been sitting unheated for a while. Green chicken curry with those lovely tiny Thai eggplants. She wasn't around, so it was okay. And oh, that forbidden fruit tasted wonderful. So worth it. The price was just about what you'd pay for a good case of dysentery. That's a gamble I've always been happy to take.

Last night was her bunionectomy and all went well. She told someone at the hospital to call me when she was done, but I never got the call - didn't sleep well, waiting for the ringtone, so I checked fb about 1:37 am as I was tossing and turning. Gwyne was on. Just where you'd expect her to be after a major surgical procedure. At least I knew she was alive, and I knew where to check. She's recovering today, we're moving to the Bumrungrad Hospital Suites that's a short wheelchair ride away from the hospital (for at least 2 nights). I've got some definite lessons learned from this experience, and it all comes down to a cost benefit analysis of medical tourism. Medical tourism is the most cost effective if the procedure you want to get done isn't covered by insurance. I saw a sex change operation advertised in the Bangkok Post yesterday for a mere $1,675. And while Gwyne wasn't pleased with the transvestite that winked at me on the way to the hospital, I still say it's a complete bargain, if that's the way you roll. And no, I haven't done the research about how much it would cost in the developed world. Substantially more, I would guess, and I don't think most insurance covers that. I've known people who have come here for boob jobs, face lifts, and one who is considering the trip to get the sized of her butt reduced. We actually came for a medically required procedure that will be covered by insurance. So it's a great deal for the insurance company as the cost here would be much less than in other destinations, particularly in the developed world. Unfortunately for us, there is going to be very little tourism in our trip and a whole lot of medical. Gwyne will most likely take away two things from our trip to Thailand - an efficient Bumrungrad operation, and her walk up and down Soi Cowboy. No temples, no rivers, no mountains, no beaches, no spas, just the hospital and Soi Cowboy. I've got an uphill road to hoe in my effort to get Gwyne to consider Thailand as a retirement location, but I can be a very persuasive fellow.

Cheap and tasty.

Bueller...Bueller...Bueller

2012-02-07T05:02:00.000-08:00

I suffered a crushing defeat today in the audiology department. Gwyne and I got hearing tests today, back to back. We let the audiologist know it was a competition. Gwyne was up first. For those of you do not know Gwyne, I need to key you into the fact that she is loud, loud, loud. Head turning loud. Her hearing, I thought, must not have been up to par. Someone in the family with hard hearing. There could be no other explanation. My hearing? It's on the downslope. So we scheduled dueling hearing appointments. After Gwyne's appointment, the audiologist said, "Hearing normal." I was certain I didn't hear that correctly. My test didn't go so well. I don't hear so well in the higher ranges. I asked the audiologist what that could be from, she said, getting old, genetics, and exposure to prolonged high pitched noise. We both turned and looked at my Gwyne. Ten long years of exposure.

The Bumrungrad experience was great. I'm all about processes. After our hearing test, we were given bar coded cards and a paper to take to the cashier. Small glitch, they charged me $20 for the hearing test - that was later reversed, money refunded, insurance had taken care of it. But, if insurance hadn't taken care of it, it would have only been $20. But I loved the process - bar coded card, computerized, numbers on a screen in Thai and English, wait until your number is called - efficient.

Next up for me was my dental appointment - it was at a different branch and I took a nice long walk to get there. For me, this trip was about my teeth and getting my dad off of my back about the Bozo tooth. Yesterday, I had laser whitening. Today was about getting the crown replaced and getting a veneer on the other tooth to match the crown. The dentist said that she really couldn't make a guarantee that the match on the new crown would be much better than what I had with the laser whitening - maybe what I should do is continue to whiten at home, the crown is still structurally sound. She said, "Up to you. Save money, look just as good." My kind of dentist. So I was sent on my way with a dental tray based on a mold of my teeth and a specialized whitening kit.

And this a competition, healthwise and blogwise. Gwyne's blog. Full of numbers, statistics. Reminds me of the Economics teacher in Ferris Bueller's Day Off. Read her blog. But read it, in it's entirety, in the tone of, "Bueller...Bueller...Bueller..." More on that later.

2012-02-06T05:15:00.000-08:00

A mound of green papaya, ready to be mixed.

The lobby of Bumrungrad International Hospital

Curries. No jello.

Hospital food. Admit it, the phrase conjures up images of jello. Red jello. After that, perhaps a wilted salad and a sandwich. Not appetizing. But on the second floor of Bumrungrad International Hospital, you can visit the Food Experience. Granted, you have to stroll by the McDonalds (with Ronald himself, wai-ing outside the sacred golden arches) and take a pass on a cheeseburger and diet soda (which may have led you to visit Bumrungrad in the first place) and Au Bon Pain, but once you run the gauntlet, you are inside the Food Experience. It's like Thai street food, but sanitized. All types of curries. Soups. Salad. Fresh. Tasty. And they serve beer. Snap!

We stopped by Bumrungrad today, in preparation for some appointments tomorrow. We walked from where we are, on Soi 21 - it was a hike, and the soi leading down to Bumrungrad was unremarkable, at best. But Bumrungrad impressed - more on that tomorrow.

I had a dental appointment today at Bankgok Smile. Again, unimpressive externally, but very nice inside. The dentist, though, really stood out. I had filled out an online form while in Kuwait, answered a few questions and there I was. As I've said previously, I was under the pressure of my father to get rid of the Bozo tooth - a cap that I have had for 35 years that has withstood the test of time, while my original teeth, bathed in coffee, have not. I said in the online form that I wanted veneers. She cut to the quick and asked what I wanted - why do you want veneers, tell me what you really want. I said I wanted my teeth the same color. She said that veneers probably weren't right for me and gave me an alternative - laser whitening, and replacement of the ancient crown. She asked if I was more concerned about the cosmetic aspect or keeping the structural integrity of my original teeth (I know, quite the leading question). I really like the fact that she didn't try to upsell me and give me a mouthful expensive work that I didn't need. Nor did she give me a lecture on all of the Jello I had eaten in the past...

2012-02-04T00:26:00.000-08:00

I go out for a bike ride every Friday with an eclectic group of expats who live and work in Kuwait. Yesterday, I told my Iranian friend Mohammad that my wife and I were going to Thailand for a vacation. Out of the blue, he asked me if I liked to fool around or if I was a one woman kind of guy. I told him I was very much the latter kind of fellow. He said that he heard in Thailand, there were all kinds of young, attractive women who would be happy to accompany middle aged men like me. He also said that he didn't know any American women, but from the movies he watched, it seemed like American women really don't like their men to fool around - do they really take it that seriously? I assured him that they most certainly do, and I'd be happy to introduce him to my wife who would validate what he has picked up from American movies.

So, a bit of a misnomer - we're really not off on a holiday, we'll be going to Thailand for medical tourism. The premise of medical tourism is combining a vacation with some medical procedures, and the cost of the vacation + whatever you get done should be the same or less than if you stayed in your home country. I'll be getting a physical, visiting a dermatologist, but my focus will be on dental work. My wife will be getting her bunions operated on, they are painful and she can't walk very far without her feet hurting. She started a blog about her experience, and I have a slightly competitive streak in me, so here we go. I chipped a tooth when I was a wee lad of about 10 while walking my bicycle across a bridge (of sorts) in Florham Park, NJ. The bridge was two planks laid over two telephone poles, and was our shortcut to stores that stocked candy (which didn't help my dental situation) - I tripped, fell about 12' and landed face first on a shopping cart that had been pushed into the brook. I got it capped when I was maybe 14. Over the years, the porcelain cap stayed the same color and the rest of the teeth, like me, got older. My dad has been particularly bothered by the contrast between the capped tooth and the rest of my teeth - he calls my cap the Bozo tooth. I thought it added character. Well, it's time to get the Bozo tooth fixed and see what else they have to offer - I'll be going to Bangkok Smile for my dental work http://www.bangkoksmiledental.com/dental_veneers.html
and Bumrungrad International hospital for everything else.