Inguinal hernia in Tokyo - advice

In case some of my ex-pat comrades stumble upon this blog because they're going through the same thing as me, I thought I should journal a bit of the process I've gone through in the last few weeks.

If you Googled "inguinal hernia Tokyo" then chances are you've at least gotten a preliminary diagnosis. If not, here are some points:

• Step 1, clinic. In Japan, you'll pay about a $50 fee if you go directly to the hospital without a referral letter. The idea is to promote preventive medicine and get more people to go to local clinics.
  
• It can be almost any clinic; they're used to writing letters. Go to a clinic you're comfortable with. I was lucky to find a bowel/internal guy close to my apartment who advertises "English-speaking Doctor in Tokyo." (He's also on lists on embassy websites. (Check out US, Oz, and NZ sites)
• Double-check health insurance coverage before you go. I'm part time thus on Japan National Health Insurance, which means no access to the "foreigner clinics" in Roppongi/Embassy part of town.

Once you've got a referral, there are some points that might speed up your hospital decision process:

• This is fixed by surgery. Real surgery, anesthesia, sutures, battle scars, the whole bit. BUT NOTE: it's a common surgery with very low risks.
• On the net you'll find information that endoscopic / laparoscopic / video camera procedures might seem like the way to go. Smaller scars, quicker recovery, etc. However, the truth is that method takes twice as long on the table as conventional mesh-type herniorrhaphy (aka hernia repair) with a slightly larger set of risks. (Though still low.) It isn't an every-day procedure in the US, and in Japan it's even more rare. If you really want it, you'll likely have to search or travel for surgery.
• Most doctors speak so-so English, but most staff have broken English at best. If you have a friend / significant figure to help you, use them.
• Seems like most hospitals have ID cards, looks like a credit card. Always keep that handy, it gets swiped a lot.
  
• Important one: Surgeons don't consider this procedure to be a terribly challenging job--it's routine. So, if you go to a renown university hospital, you're almost guaranteed to get a young less-experienced person doing the procedure. A smaller, private hospital is more likely to assign an experienced surgeon when you ask for it.
• Each time you leave the hospital you're likely to stick cash into a machine (as if buying stamps).
  

One more set of information, obtained with help from my anesthesiologist uncle:

• The two common choices for anesthesia are spinal and general. Most surgeons have a preference for one over the other, but if not you might get to choose. Worth asking.
  
• Spinal anesthesia involves putting your lower body to sleep by numbing your spine. A very thin needle is used to administer a single drug directly to the spine. The upper body is awake (& you too).
  • Spinal is super cheap and has less risk of allergic reaction (when only one active drug), but when the numbness wears off most young guys go through a painful, messy, and potentially embarrassing episode with the urinary catheter.
    
  • Some patients want to be able to talk with their surgeon during the procedure.
  • Sedation is an option to help the time pass (and perhaps lessen anxiety) but then the prices jumps back up to the same as General.
    
• General anesthesia involves drugs through the IV line. There's often a mixture of at least two drugs, one to put you 100% out and the other to stop all body movement.
• General anesthesia is pricey, and a tube goes down your throat to ensure that the body gets enough oxygen. It's there for a couple hours, so the throat will hurt and you might be hoarse for a while. The plus side is that you're body is 100% stationary for the surgeon, and you get to simply wake up when it's over.

If you couldn't tell, I chose General. (It was the catheter that did it for me.)

When you get your check-in date, you'll get a list of things you should bring. Some of these things are unlike Western-country hospitals. In case your list is in a language you can't read, it includes: [[**See Edit coments]]

• Slippers with rubber soles. Guess you might have to walk through .. liquid.
• Cup for tea/coffee, if you want it between meals.
  
• Pajamas.
• Robe. My hospital seems to emphasize this point: no roaming in pajamas. I just bought some yukata for summer so I'll bring one to use as a robe and use zori as my slippers.
  
• Kleenex / tissue.
  
• Towels. My hospital has different level rooms; most rooms get towel changes but the cheapest ones don't.
  
• Underwear / undershirts / socks / etc, enough for the whole stay. They don't do laundry, traditionally your family members take care of that.
• Toiletries: toothbrush/etc, soap, shampoo/etc, razor. Too bad hospitals aren't set up like love hotels which (as I've heard) have all that complimentary.

It's a little bit like camping! Though probably anything you need is available at a gift shop or near-by shop. I've made my own supplementary list:

• cell phone charger
• laptop with movies & shows I wanna watch. .. so I don't have to pay for a TV rental card
• AC cord for laptop
• stuffed animal so I can mark where my scar is and not have to awkwardly point to my groin region all the time.
• ATM card. They traditionally get payment at check-out. My bank's machine is even in the lobby! Credit card should also work.
  

That's it! If I have anything to add once it's all over, I'll edit my post and tack new advice below.

I check-in tomorrow. .. Yesterday's appointment with the head of anesthesia reassured me so much that I'm almost dreading the 9am rush hour more than the procedure.. Wish me luck


[[Edit: Comments after checking-out]]

My impression of my stay was as I expected or better. Part of that may be due to a room upgrade for the same price--as explained to me, the lower rate room I'd requested and they said would be available was full, so I was given the much better room for the same price. It included towel service, a cup for tea, and hand soap in the bath room. I was thankful for my shampoo, kleenex, and PC notebook with movies.

Also, I should comment that the swelling near my incision (which is a bit higher up on my body than where my hernia poked out) is substantial, and I was very glad to be wearing a loose / free form yukata on my way home. Perhaps my obi looked like crap since it was tied very loose, but without being able or wanting to use any abdominal muscles, my belly pooches out a LOT now. So.. not having to button trousers has been a very good thing. Loose boxers as underwear has also been great--worn high to reduce pressure on the critical zone.

As far as the procedure goes, everything went as I expected. I'd stayed up late the night before the procedure getting everything packed, and that combined with the many naps I'd taken immediately after the surgery perhaps lead to a hard time sleeping through the night. But the second night I slept great and woke up with no pain. Good stuff. ... Just as it was before the procedure, staying prone and lying down is the best way to be.

Best of luck to any of you going through this too! I'll make occasional comments about my recovery as time goes by so maybe you can gauge how long it really takes.