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Author Topic: Holiday Dialysis in Singapore  (Read 8836 times)
iolaire
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« on: March 09, 2014, 02:20:31 PM »

Holiday Dialysis in Singapore

Background, in December of 2013 I started dialysis (hemodialysis) at 39 years old.  Dialysis is three days a week for three and half hour commitment hooked up to a machine that filters my blood to replace kidney function.  Amazingly, you can live with zero kidney function.  My loss of kidney function was due to SLE (Lupus) damage in the early 1990s.  At that time, I knew that my kidneys would get worse and i would have problems, but at 18, I didn't really have a clue what it would mean.  Fast forward to 2007, when I was in the hospital for high blood pressure and was told it was kidney related.  So for the past six years, I've been seeing a nephrologist tracking my kidney decline.  It was helpful having a trained kidney doctor guiding me.  He had me get a fistula on my arm, i.e. connect an vein to an artery on the arm to make an enlarged vein that would allow a huge amount of blood to flow back into the arm.  He also pushed for me to get listed on the kidney transplant list.  Because of that, I received my call on the first potential donor three weeks before I started dialysis.

I'm on in center hemodialysis.  There are other methods of dialysis, and many people manage dialysis at home.  I hope to be the recipient of a kidney transplant at some point relatively soon I'm no planning on moving from the center.  That means if I travel I will need to get in center hemodialysis.

So dialysis is a change, and ties down Susan and myself a bit.  But, I'm generally healthy, my lupus has been in remission since 1993 and am able to handle work and daily functions, which is a blessing.  So my goal is to let it change my life as little as possible. And our pre Dialysis life is lots of travel - in 2013, we visited Austin and Petersburg, Alaska for my 20-year high school reunion, St. Louis, Cape Cod, Budapest, San Antonio, San Francisco, and Cabo San Lucas. 

I was happy that our next trip was Singapore - a truly modern location and a good place to my first out of the country dialyses.  My Davita center will help schedule dialysis at other Davita centers in the US, but only will help fill out the intake paperwork for other faculties - so I was on my own to find my Singapore center.  And it's still unclear if my heath insurance will pay for international dialysis, it should cover it as out of network but I envision having some issues completing the reimbursement paperwork - so the overall cost was important to me.

Google searches for Singapore Dialysis found Raffles Dialysis Centre which even had a web page setup for their center.  An email to them resulted in rates that were $500 each session plus one $125 doctors consultation.  (All rates are in Singapore Dollars which are at a bit of a discount to USD, so the prices end up being a bit lower, but not significantly lower.) That pricing is much less than my center charges ($1,400) but seemed a bit high.  I was having problems finding other centers so I moved to the Duck Duck Go search engine and found the Fresenius Medical Care Singapore website which had a holiday dialysis webpage that listed various centers by region of the city of Singapore (http://www.fmc-sg.com/patients-and-caregivers/holiday-dialysis).  Through that site I emailed a few locations and finally settled on NephroCare S&J Dialysis Centre (http://www.fmc-sg.com/nephrocare-s-j-dialysis-centre) which charged $400/session, plus one time $60 registration and $80 doctors consultation fee.  The ideal thing is I was able to setup the two sessions entirely via email.  The more complex requirement is that they needed an HIV test, which my dialysis center would not order, so I had to go to my primary doctor to get that filled.

So how is Singapore dialysis different than here in the US?  For one thing, they didn't think I would fit in their seats so they put me in a (short) bed.  In my center, the techs prep all the material they need in advance in a bundle and distribute it to the machines - in Singapore they had a commercial pack that included everything that was needed, but they they don't use single use alcohol pads, the pack included a plastic box like a lunchables container, which they added both saline to, as well as alcohol, so they could pull what they had needed from.  Then, they did use a single use alcohol pad to wipe the needles before they were removed from my arm.

Best of all - likely due to the British influence in Singapore - they offered tea or coffee and crackers mid-dialysis!

So looking forward to 2014 we will take more domestic quick weekend trips from early AM on Saturday to Sunday or Monday so I don't need to scheduled dialysis away from my center.  And for international travel we have a trip to South Africa in September, there we will give up one of four safari days so I can get my dialysis in the Johannesburg area twice, before moving on to Cape Town and completing a few more sessions.

I think we will do more travel to Europe and more developed destinations and I will end up being dialysis at more Fresenius centers since they seem to be a global brand with centers throughout Europe and even Asia.  Of note my center uses Fresenius dialysis machines.

Photos attached of me on dialysis, the tea and crackers, and then a shot of Susan and myself in transit.





(Quick note to ihatedialysis readers - hello, this seems to be my first post.  I intended to do an introduction post, but did not get around to it.  Here is the US people with good credit have the ability to earn huge amounts of airline miles via credit card sign up offices - so I do that - and use the points for international first class flights - thus the flights in the photos at the end are courtesy of American Express and Citibank...)

(This post will be cross posted on milepoint and the flyertalk forums.)
« Last Edit: March 28, 2014, 05:31:32 AM by iolaire » Logged

Transplant July 2017 from out of state deceased donor, waited three weeks the creatine to fall into expected range, dialysis December 2013 - July 2017.

Well on dialysis I traveled a lot and posted about international trips in the Dialysis: Traveling Tips and Stories section.
galvo
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« Reply #1 on: March 09, 2014, 05:13:45 PM »

Iolaire, that is a fascinating story, and so well written. Welcome to our family, and I look forward to hearing more of your adventures.
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ianch
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« Reply #2 on: March 09, 2014, 11:44:26 PM »

I've been to Raffles Dialysis Centre two years ago.  I was not impressed.  The technology was fine but the service was appalling.  I spent $550 to listen to the head nurse complain about my country and the treatment of patients there (over and over).  Funny because at the time I had a tunnel line and when my wife saw how she tapped it she was furious, ripped the bandage off and re-did it.   Overall the experience was cold and heartless, but yes got a cup of tea. 

To be honest I liked the southern Philippine centre in Zamboanga.  It was minimalistic for sure but the nurses were fantastic.  Compared to Singapore where i felt like an intrusion, I was very welcomed in the Philippines. 

The moral is: Its the people not the flash building that make the difference, oh and I got 5 treatments in Zam for one in Singapore     

     
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Ian Chitty
ESRD suffer, IT specialist, and business owner
(<2yrs) 1Y in-center, 9 months HomeD, 4 weeks tourism dialysis (Philippines/Singapore)

https://kiwimedtec.com
The aim of KiwiMedTec is to develop online solutions and partnered networks for dialysis patients, to make coping with kidney disease a little bit easier.
iolaire
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« Reply #3 on: March 10, 2014, 06:09:50 AM »

I've been to Raffles Dialysis Centre two years ago.  I was not impressed.  The technology was fine but the service was appalling.  I spent $550 to listen to the head nurse complain about my country and the treatment of patients there (over and over).  Funny because at the time I had a tunnel line and when my wife saw how she tapped it she was furious, ripped the bandage off and re-did it.   Overall the experience was cold and heartless, but yes got a cup of tea.
Sorry to hear that.  I'm glad that I passed on that site. I think I got the head nurse to hook me up both days.  She was friendly and did things carefully. (They do use much less tape than my center - there didn't seem to be much worry of the needles pulling out).  It was not over the top friendly, but it made me feel safe and relaxed.  I would go back should I ever return to Singapore.  Its location was a 1 Orchard Road, there was a bus (#36) from the Suntec area (we staid at the Conrad) to a block a stop away so it ended up being convenient.  I think the Raffles was much closer but more expensive.

Was Zamboanga a tourist destination?  The Philippines has been lower on our travel list, but it could move higher if access to dialysis is good.  My center's head nurse is from the Philippines (via Ireland).

Also on thing I found interesting about SIN was most of the elderly patients had either their daughters or nurses with them.  Most of the patients were very old and it was nice to see them with helpers.  The helpers silenced a lot of the alarms and fretted over blood pressure and the like.  It was nice to  see a culture where the elderly had extra attention.  My center allows guests to come in, but only a few people get visits occasionally.
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Transplant July 2017 from out of state deceased donor, waited three weeks the creatine to fall into expected range, dialysis December 2013 - July 2017.

Well on dialysis I traveled a lot and posted about international trips in the Dialysis: Traveling Tips and Stories section.
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« Reply #4 on: March 10, 2014, 12:11:37 PM »

No Zamboanga is definitely not a tourist destination.   Has the risk profile of Syria.  The only Americans I have seen there are with heavily armed guards.  There is a US/Philippine airbase there, but the US never leave it the compound.
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Ian Chitty
ESRD suffer, IT specialist, and business owner
(<2yrs) 1Y in-center, 9 months HomeD, 4 weeks tourism dialysis (Philippines/Singapore)

https://kiwimedtec.com
The aim of KiwiMedTec is to develop online solutions and partnered networks for dialysis patients, to make coping with kidney disease a little bit easier.
iolaire
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« Reply #5 on: March 28, 2014, 05:30:13 AM »

I'm pleased to report that Aetna accepted my non standard paperwork for Singapore dialysis and approved reimbursement for that service at 100%! 

I expected it would come back and I would need to fight to get it paid, and that it would be at a 50% out of network rate (despite the cost being 25% of my US in center rate).  But they took may insurance claim with receipts for dialysis, dialysis logs, and credit card bill showing USD charges - with my had written note explaining the service over the part of the forum that the provider is supposed to fill in. 

I'm impressed that they did the right thing and approved the reimbursement with no back and fourth.
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Transplant July 2017 from out of state deceased donor, waited three weeks the creatine to fall into expected range, dialysis December 2013 - July 2017.

Well on dialysis I traveled a lot and posted about international trips in the Dialysis: Traveling Tips and Stories section.
Zach
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« Reply #6 on: March 28, 2014, 06:12:42 AM »

I'm pleased to report that Aetna accepted my non standard paperwork for Singapore dialysis and approved reimbursement for that service at 100%! 

I expected it would come back and I would need to fight to get it paid, and that it would be at a 50% out of network rate (despite the cost being 25% of my US in center rate).  But they took may insurance claim with receipts for dialysis, dialysis logs, and credit card bill showing USD charges - with my had written note explaining the service over the part of the forum that the provider is supposed to fill in. 

I'm impressed that they did the right thing and approved the reimbursement with no back and fourth.

Excellent!
 :beer1;
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Uninterrupted in-center (self-care) hemodialysis since 1982 -- 34 YEARS on March 3, 2016 !!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
No transplant.  Not yet, anyway.  Only decided to be listed on 11/9/06. Inactive at the moment.  ;)
I make films.

Just the facts: 70.0 kgs. (about 154 lbs.)
Treatment: Tue-Thur-Sat   5.5 hours, 2x/wk, 6 hours, 1x/wk
Dialysate flow (Qd)=600;  Blood pump speed(Qb)=315
Fresenius Optiflux-180 filter--without reuse
Fresenius 2008T dialysis machine
My KDOQI Nutrition (+/ -):  2,450 Calories, 84 grams Protein/day.

"Living a life, not an apology."
Simon Dog
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« Reply #7 on: March 28, 2014, 07:14:00 AM »

Quote
I think I got the head nurse to hook me up both days.
When I travel in the US, I find my chances of getting a RN rather than a tech at the clinic I am visiting seem to be much greater than at the local clinic - I suspect this is not unintentional.    But, it doesn't matter so much now that I am a home patient and if I do use a clinic in my travels, I still self canulate.
« Last Edit: March 28, 2014, 07:17:16 AM by Simon Dog » Logged
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