Back to the Hospital

I'll do anything for my readers....

You may recall in July 2021 I shared with you my first experience with Portuguese medicine and what it cost. I had fallen off my electric bike and broken my elbow. I waited around for a week hoping it would fix itself. But after 6 days of shear agony I overcame my fears and apprehension and sought medical care. So many of you thanked me for sharing this experience that I decided to go back under the knife!

Two Surgeries in One

Okay, I really didn’t do this just to increase subscribers. The truth is that I had two items that needed to be addressed.

• First, there was the wire in my elbow that needed to be removed. I guess one could live with it in there (my knees already set off some airport screening devices) but I found it annoying and occasionally painful. So after 6 months, I was told by the guy that put it in there, I could have it removed.

• Second, my foot hurt. I had had a bunionectomy in the States about 1 year before we moved. Unfortunately, I did not have a good outcome. That is the nice way of saying “it was botched”. I actually had more pain after surgery than before the procedure. And to add insult to injury, the podiatrist retired about 9 months after my surgery. So with our move looming on the horizon, I lived with it. Moving to Portugal exacerbated the problem because we walk a lot more here than we did in the States. We even walk when we play golf here … which I love if I am not in pain.

So about 9 months after moving to Portugal I went to my first Portuguese podiatrist. I noted that his care was NOT covered by my insurance. I learned podiatrists in Portugal do not practice the way they do in the States. In short, the vast majority don’t do surgery. They may remove an ingrown toenail…but that is about it. So the first guy told me he couldn’t help me.¹ I spoke to my insurance agent and she agreed. This type of surgery was done by orthopaedic surgeons.

So X-rays in hand, actually in the computer, I went to the doctor who had taken care of my elbow. He took one look and said, “I won’t touch this. You need a foot and ankle specialist”. He made a referral to one at CUF (as we were living in Cascais at that time). But when he submitted the paperwork to my private insurance it was denied. During the first year of my policy, pre-existing conditions were not covered. Oh well, I guess I would wait until after we moved.

I Hate Pre-Authorization

I was able to make an appointment with an orthopedic foot and ankle specialist, Dr. Vide, in Faro for the first week of February. I had brought a CD of my CUF X-rays with me. (BTW the hospital does not charge you for the CD. They know that you own your health data…as such there is no charge for giving it to you.) Anyway, he studied the X-rays, looked at my foot, and agreed the original surgeon should have retired earlier. He explained that his primary office was in Lisbon. That he drove to Faro, where he had been raised, and practiced at Gambelas only on Thursdays and Fridays. He gave me orders for pre-operative testing and a tentative surgery date of 10 March. Progress….

But wait, there is that pesky issue of pre-authorization. Yes the private health system, in many ways, mirrors the American system. The insurance company needs to decide if this is covered by your policy. And in my case, it was a bit more complicated. Over the next month, the practice and the insurance company argued over what would be covered…what codes the doctor could bill for. This was not a simple revision, so the doctor was seeking approval of a lot of different codes. The insurance company argued that some were duplicates. They also weren’t quite sure why a foot guy was taking a wire out of my elbow. (I didn’t want to go under anesthesia twice…so I asked if he would do me a favor and he agreed.) These “discussions” caused the surgery to be pushed back to 31 March.

If you rely on public transit it takes nearly 2 hours (68 minute train, 7 minute walk, 28 minute bus ride.)

Faro is 45 Minutes Away

As I wrote about before, proximity to a hospital may be something you want to consider when choosing where to live in Portugal. But to their credit, the doctor’s assistant tried to make it as painless as possible. She scheduled all pre-operative testing, meeting with the nurse, and consultation with the anesthesiologist on the same morning. (09:00, 09:10. 09:20, 10:00, 11:00)

I received a call the day before the operation asking me to arrive at 14:00 the next day. I found the process identical to what I had experienced in Cascais. I had my surgery at about 17:00 Thursday night. I awoke in the middle of the night, back in my hospital room. Aids and nurses were available when I needed them and were attentive and kind. I only encountered one aid that did not speak English, and I was able to communicate with her having studied words I might need in a hospital the week before.

The biggest difference between my Faro experience and my Cascais experience was the time I left the hospital on Friday. Unfortunately, this surgeon did not round until after lunch, so I didn't contact Denise to come to get me until 15:00. (In the meantime I dozed and binged on the Apple TV+ series² WeCrashed. I had listened to the Podcast and know the whole story, but am still enjoying the TV series.) Also, Dr. Vide did not provide his personal cellphone number. Instead, he gave me his email address and encouraged me to contact him if I had any questions.

Of course, I will have to return to Faro one week after surgery to see him again.

So Far So Good

As I write this it is Saturday morning, 2 April, about 36 hours since my surgery. I must say I was dreading this procedure. My last bunionectomy was more painful than my bilateral knee replacement. And I had been told by Dr. Vide that typically they prescribe Paracetamol (Tylenol) for post-surgical pain. However, when he came in to discharge me he explained it was a difficult procedure and he expected me to have more discomfort. So among the drugs you see above is Tramadol, for pain management. Nurse Denise, yes she actually did practice as a nurse and was kind enough to get all the meds you see above. Grand total: €39. Also, fun fact…one of them is an injectable. I don’t recall anyone telling me that …though the medication did come with instructions. Fortunately, Denise is looking forward to doing this for me.

Update: It has now been 12 days since my surgery. There has been no pain! I find this amazing since everyone I spoke with within the States had had a lot of discomfort after surgery. I wonder what is done differently here ….

1. He actually referred me to another podiatrist that had done a fellowship and practiced for a few years at Temple University Hospital in Philadelphia. He took one look at the X-ray of my foot and said, “Your doctor in California should have retired 9 months earlier.” But the bottom line was that I would have to pay for all costs associated with the surgery.

2. I watched it on my iPad on the free WIFI provided by the hospital. The login and password were clearly displayed where I checked in for surgery. No buffering…a very nice service.