ACL tears - new study shows rehab may reduce need for surgery

Knee issues are one of the main areas where Pacific Medways gets inquiries. It's an issue faced by many Americans. A common problem is an ACL (anterior cruciate ligament) injury - in fact it's probably the number one knee related issue faced by athletes. Treatment is often surgery - and a long period of recovery and physical therapy. Many people delay surgery knowing they will have to face a difficult recovery. The promising news is that a new study may show that surgery is not always the first option to try.

The New England Journal of Medicine just released a study suggesting that rehabilitation might be sufficient -and that those with ACL injuries might not want to have surgery until there has been time to evaluate the effectiveness of the rehab. The NEJM article is heavy reading, but here's a good recap from the Wall Street Journal Health Blog.

Hip Resurfacing

Among the great pleasures we have is visiting hospitals and meeting some great people. One of these is Dr. Michael Moreton at Bangkok Hospital. Dr. Michael has enjoyed a long career in medicine starting in his native U.K. and subsequently in the U.S. and Canada. He is now Bangkok Hospital's international patient coordinator.

Recently Dr. Michael published an article on hip resurfacing, a procedure that medical travelers seek. Hip resurfacing is an alternative to total hip replacement. It was originally developed in Birmingham, U.K. - which is why it's often known as Birmingham Hip Resurfacing. The first procedures were done in 1997 and it became a popular alternative but was not allowed in the U.S. until 2006. It's now common in the U.S. but costly and for those faced with large out-of-pocket expenses it continues to be a reason people travel.

Check to see what Dr. Michael has to say about the procedure. Bangkok Hospital is one of Pacific Medways' providers and we would be happy to assist patients seeking hip resurfacing.

Guadalajara - Mexico's Other City

While in Mexico we also visited Guadalajara - Mexico's second largest city and a great destination for tourists. It's also a large city, but it's metropolitan population of 4 million pales next to Mexico City's 20 million.

Founded in 1537 it is one of Mexico's oldest cities. And like the other major colonial cities Guadalajara has a well preserved center. The central point is the cathedral, which was consecrated in 1618. But Guadlajara's cathedral has one unique feature - it's not on the central square. Instead, four squares radiate from it creating a wonderful urban oasis. And in the historic center are many fine sights like the ornate 19th century opera house known as the Teatro Delgado and the Hospicio Cabanas, an early 19th century building with famous murals by Jose Clemente Orozco, including his Hombre Del Fuego (Man of Fire).

Guadalajara has long been known as both the city of roses (for the fine gardens all around the city) and as "the most Mexican of Cities." The latter nickname comes from the city's and it's surrounding province's contributions to Mexican culture: tequila, mariachi music, the Mexican hat dance and the broad-brimmed sombrero. For tourists Guadalajara is a perfect place to soak up Mexican culture.

But Guadalajara is also a thriving modern city with the highest GDP in Mexico, and one of the 10 highest GDPs in all of Latin America. Beyond the colonial center is a growing modern city with tall office towers, ultra-modern shopping malls and comfortable residential areas. Traditionally Guadalajara's economy was based on commerce and tourism, but a third contributor has developed in the last 20 years - high tech. Known also as the Silicon Valley of Mexico, Guadalajara has a young well-educated population that reminds me more of San Jose, California than Mexico.

For medical tourists the city has a lot to offer. Like Mexico City there are non-stop flights from many U.S. cities. Travelers arrive at a modern, well equipped airport that succeeds in providing ample services for travelers and still retain a very manageable feeling. The climate has more variation than Mexico City - average highs in the summer are in the 80s and lows in winter are in the lower 40s. More extreme temperatures are possible, but rare and usually the climate is mild.

Guadalajara has a wide variety of hotels, ranging from luxury hotels in restored colonial buildings to modern chain hotels. Short term apartment rentals are also available. A wide variety of restaurants are available. And for the shopper Guadalajara is a paradise. Two of Mexico's most famous craft centers are near the city - Tlaquepaque and Tonala. A great day trip is to Ajijic on Lake Chapala. Only 30 miles from the city, this artists colony is home to a growing population of American retirees.

Guadalajara may be Mexico's second city, but it's a premier destination for medical tourist. In a later post I will be exploring the hospitals and doctors in this city with many nicknames.

Mexico City

We start our series on Mexico with the capital city. Mexico City is one of the world's most vibrant and fascinating cities. Located in the valley of Mexico, the city was built on top of the Aztec city of Tenochtitlan. And that's part of the allure. The city has Aztec ruins, gracious colonial districts, grand 19th century boulevards and gleaming modern sky scrappers.

For tourists there is a lot to see and do. Top attractions include the Zocalo with it's 437 year old cathedral, the National Palace (seat of government) and other colonial buildings. Near the Zocalo is the Templo Mayor Museum, with the ruins of the Aztec's main temple. For archeological buffs there is also the Archeological Museum in Chapultapec Park - one of the world's great museums. I have been to Mexico City many times as a tourist and the city continues to excite me. But this trip was different. We were in Mexico City on business and we were evaluating the city as a destination for medical tourists.

Mexico City has a huge population - over 20 million - making it one of the world's largest cities. However, much of the city consists of graceful and very livable neighborhoods. We stayed in an area known as Cuauhtemoc near the Zona Rosa with it's tourist hotels and restaurants. But Cuauhtemoc is mostly residential with well preserved 19th century buildings and tree lined streets. Cuauhtemoc's restaurants cater to the residents. We ate twice at an upscale, trendy Argentine themed bistro - and a full meal with wine cost less than $15 a piece. Nearby was a very popular French bistro and the area had Italian, Korean and Chinese restaurants along with Mexican fondas - the neighborhood eateries that dot Mexico City.

People often ask about the weather and air quality? The climate is one of the world's best. Average highs are 74 and average lows are 49. And amazingly most of the year these temperatures vary little. February to May is warmer and dry , while December and January can be cooler - but generally it's very pleasant. In summer the rains come. While storms can be heavy, they are quick and leave the city green and the air very clean. Air quality has been an issue for Mexico City , which is ringed by mountains that trap pollution in the valley. But the city has made huge improvements since 1990 when a major clean-the-air project was launched. More and more days the air is reasonably clear and the sun shines.

Another concern for medical tourists is language. Spanish is the main language and knowledge of Spanish is helpful to really explore the city. But English-speaking medical tourists will have little difficulty. English is widely spoken in tourist areas and hospitals are creating medical tourism departments to assist travelers. One figure that most do not know: Mexico City has the largest concentration of U.S. citizens living outside the U.S. Estimates of this number vary from 450,000 to 600,000. And more than 1 million U.S. citizens visit each year.

I will cover prices and tourist facilities in another post but there is one final topic on Mexico City - how to get there. Easy access is a major benefit of Mexico City for the medical tourist. Most of the major U.S. airlines service Mexico City and there are non-stop flights from most major U.S. cities, including New York, Chicago, Atlanta, Houston, Dallas, San Francisco and Los Angeles. Flight times vary from 2 to 5 hours - a huge plus for medical tourists who may find 25 hour flights to India a challenge.

In the coming days I will discuss prices, the hospitals and the doctors in Mexico City. But it's very clear to me this great city has been overlooked as a medical tourism destination.

Mexico

Carla and I just spent two weeks in Mexico visiting hospitals. It was a very productive trip and I have come back with a whole new perspective on Mexico as a destination. It's not that I found the hospitals to be better than I expected. I knew there were good hospitals. But I had concerns that were put to rest by actually visiting.

When we first started Pacific Medways I researched Mexico as a destination. I found that most of the medical tourism destination hospitals were in Monterey or other northern Mexican cities - and that prices, while better than the U.S. were high for medical tourism. And getting to cities like Chihuahua or Hermosillo is just not that easy. I stalled on Mexico and we continued to focus on SE Asia.

We just visited a total of eight hospitals - five in Guadalajara and three in Mexico City. What we found were well staffed, well equipped and nicely appointed hospitals. And, both cities shine as great destinations for tourists and medical travelers. I had visited Mexico City six or seven times already, but just as a tourist. I had only been to Guadalajara once, also as a tourist. Seeing both cities as a medical tourism destination had us looking at them through a different lens and we liked what we saw.

In the next few weeks I will be doing a series here on what we found. Topics will include:

• Mexico City for the medical tourist
• Guadalajara for the medical tourist
• Prices and how they compare to other medical tourist destinations
• The hospitals we visited
• The doctors we met

Pacific Medways is very excited about Mexico as a potential destination. Follow us here for the reasons why. In the mean time check out our Facebook page for pictures from our trip.

An Educated Consumer Can Be the Best Patient

I lived in New York City for 12 years and one of my favorite stores was called Syms. For those who do not know the store it was, and still is, a place to buy designer clothing at discount prices - same quality/lower price. It was a very busy place and it took a lot of rooting through things to find the real bargains. Well known brands were mixed with less well known, and often inferior, brands.

Sym's motto was well known by all New Yorkers. "An educated consumer is our best customer." Quite simply if you know the designer brands you like, and what they cost at Bergdorfs then you are likely to recognize true bargains when you find them at Syms.

How does this relate to medical care? For most procedures it's important to know how to prepare, what to expect and what recovery involves. The actual procedure, or options, are usually based on the doctors recommendation.

If you are interested in cosmetic surgery you need to start by deciding your goals. The next step is to find out what procedures can help achieve these goals. The more you know about the procedure you are seeking, the more likely it is that you can make a good decision in selecting the provider. And the more likely you can get the quality you seek for a price you can afford.

There are a number of good resources for people seeking cosmetic surgery. Here's a site that is growing in popularity. Called RealSelf it's where real people talk about their experiences and costs. Take a look. It's interesting and has some good information.

Mark

More Nurses Can Make a Difference

On a recent trip to Bangkok and Kuala Lumpur I visited a number of outstanding hospitals. I met with physicians, administrators and staff from every department. Like those who are considering travel to other countries for surgical procedures, I wanted to know the qualifications of the physicians, the accreditation of the facilities and the general hospital environment. I also wanted to know the ratio of nurses to patients. Many who have been hospitalized here in the US can recount the frustration of trying to get a nurse to come to the room to help with both medical and necessary daily needs. Often the entire hospital experience is overshadowed by what feels like a nursing shortage. Interesting, a recent study reported in the New York Times, suggests, that medical outcomes can be affected when the ratio of nurses to patients is low. Fortunately, in some of the facilities I visited, the nursing ratios were significantly higher than in the US making the whole hospital experience for patients very pleasant and, based on this latest study, a positive influence on their recovery.

So be sure to ask about the nursing ratios in the hospitals that you are reviewing for your surgery. Four to six patients per nurse is the proper ratio for general surgical services and one nurse for one patient in the intensive care unit.

by Mervyn F. Silverman, MD, MPH

Medical Director, Pacific Medways