Tag Archives: medical care other countries

Four Reasons I Could Kiss Dr. Chiang

21 Aug

Dr. Chiang is the sleep specialist and surgeon who performed a UPPP surgical operation on my throat to improve my obstructive sleep apnea.

1. Oxygen reaches my brain easily and more consistently when I sleep.
2. I can also breathe better when awake. When standing and in any position in which my neck is slightly bent, I can relax my neck muscles and still receive a lot of oxygen.
3. Cost of surgery = $256 USD (7,680 NT). In case you’re interested, here’s the breakdown:
  • Initial consultation appointment – $16 USD
  • Over-night sleep test with polysomnogram – $50 USD
  • UPPP throat surgery and four nights of hospital stay/care including cost of medicine used for the week during and after my hospital stay – $140 USD
  • Three post-opp check-ups with surgeon and medicine for those two weeks – $50 USD
I do have the Taiwan national health insurance, which anyone who works a legit full-time job here can receive.
4. He is a very nice man, and I didn’t even have to threaten him like my mom suggested. He just knew I should be handled with care. The Taiwanese handle everyone with care; it’s in their blood. His job is difficult, though. I think it’s safe to say that doctors here are overworked and underpaid. From a patient’s point of view, though, I’m really going to miss this place.
If you are interested in sleep apnea, Taiwanese medical care, or my health this post might be of interest to you. It’s fairly detailed because that’s how I roll, but you can scroll to the part you’re interested in.
Why This Is Important to Me:
If I can help just one person realize she has sleep apnea and that the situation can be improved, this post will have been worth it. Life is actually easy and enjoyable! I really didn’t know life could feel this good. I figured I just didn’t like people much and that for some reason I feared mistakes more than other people did.
Maybe that “depression” I had in junior high and high school was largely sleep deprivation. Young children sometimes have sleep apnea, especially those with large tonsils, large tongues, and or lower jaws that encroach on their throat space. My sister and I are pretty convinced I’ve had this sleep ailment since I was young. She’s observed my cessation of breathing and the resulting gasp for breath several times as I slept. And my whole family has had the unpleasant experience of waking up in the same house as me. I’ve been reminded of how we would eat breakfast in the dark because I would throw a fit about the lights being on in the kitchen. Normally my parents didn’t cater to bratty whims, but there were so many battles to fight with me in the mornings, that I think this was one they just decided not to waste energy on, no pun intended.
I could go on and on about all of my negative past events that are possibly linked to sleep deprivation. But, I’ll sum it up like this: I felt like I was in a fog, I could barely manage to be on-time to anything, and until I learned to cope with it by sleeping for many hours at night, I wanted to fall asleep everywhere. I know teenagers sleep a lot, but I’m telling you it wasn’t quite normal. My friends were always waking me up when it was time to switch classes (I’d sleep right through the bell). I’m surprised I had any friends at all considering how often I had strange imprints on my face and a binder full of drool. And as I’ve said, pre-surgery I was grumpy and easily irritated. I’m sure it’s not too hard for you to imagine. You’ve been tired before. I was perma-tired.
Why didn’t I do anything about it all these years? I think we all know how it can be when we live with something for so long; it seems normal, so you spend your time coping without even realizing you’re coping or how much better things could be if..
The Diagnosis:
After reviewing my sleep test results, the doctor said that my case is very mild, not even qualifying as moderate sleep apnea. I cannot fathom how people with moderate to severe sleep apnea function at all! I suppose those are people at severe risk of falling asleep at the wheel (this is how many sleep apnea patients get diagnosed unfortunately), and in rare cases, some may even die in their sleep if they have taken any sedative-like drugs because their brain could theoretically not be active enough to wake them up from a sleep apnea episode. My sleep apnea episodes lasted from 30 seconds to a full minute, with a frequency of 2 per hour and 11 per every hour of REM sleep. This means that my brain was not getting oxygen for that amount of time. Then my brain was alerted to the problem and woke my muscles up enough to allow myself to move my tongue and tonsils out of the way and breathe again. But waking up your muscles like this is counterproductive for a restorative sleep.
My results show that I usually went right back into the level of sleep I was in, but the quality of sleep overall was still suffering. During stage 3 sleep, your body repairs itself and hormones are released, aiding in muscle growth and development.
During REM sleep, sleep apnea patients have the most problems because the body is in a state of paralysis while the mind is very active in reviewing the day’s events, converting short-term memories into long-term ones, and conserving body energy so that upon waking, the body is ready for a new day. In this state of muscle paralysis, though, the throat muscles and especially the tongue are so relaxed that they may slide into the airway and try to murder you.
One interesting thing I came across in my research is something that may bring to light a horrible cycle that sleep apnea patients deal with. Sleep apnea sufferers are often overweight, but perhaps this is why!
“Sleep helps us thrive by contributing to a healthy immune system, and can also balance our appetites by helping to regulate levels of the hormones ghrelin and leptin, which play a role in our feelings of hunger and fullness. So when we’re sleep deprived, we may feel the need to eat more, which can lead to weight gain.” http://www.sleepfoundation.org/article/how-sleep-works/what-happens-when-you-sleep
More Diagnosis and the UPPP Surgical Option:
Besides my upper throat obstruction, the one I just corrected with surgery, I have two other causes of the sleep apnea: large tongue and poor placement of my lower jaw, both of which have their special corrective options. Nasal passages are another common problem area related to sleep apnea, but not in my case.
I chose to focus on correcting my upper throat obstruction area because it is virtually free in Taiwan with the National Health Insurance and because I’ve always felt like my tonsils are a nuisance. UPPP is a surgical operation removing upper throat tissue, my uvula (dangly thing in back of throat), and tonsils. I was of a certain percentage of people whose tonsils never shrink down after childhood.
My doctor is known internationally and worked with Stanford University, a leader in sleep science, so he performs the more modern method of not removing the upper palate tissue and uvula completely. Instead, he creates some sort of flap that reduces and relocates the tissues with the option of returning them to the previous glory in the case of a patient experiencing the regurgitation of liquids up their nasal passages when swallowing, which is one of the main complaints of a UPPP surgery. Other complications that have given what was once perhaps too popular a surgery a bad reputation are: potentially deadly bleeding during recovery, abundance of scar tissue forming that may eventually negate positive effects of surgery, and reduced effectiveness of CPAP machine (this device forces air down a person’s windpipe to further help someone who has sleep apnea). Apparently, those with severe sleep apnea are much less likely to see drastic improvements from the UPPP surgery alone; they usually need to deal with their lower throat obstruction instead of or in addition to.
Did I mention that the UPPP reduces snoring? According to my sleep test, I snore 130.7 times per hour. This is enough to scare a boyfriend back to his own apartment for sure. Post-surgery my snoring is probably much improved if not gone. I believe some people get the surgery mainly for this reason.
My Surgery and Hospital Experience in Taiwan:
Hospitals in Taiwan are a very popular place compared to hospitals in the United States. Most Taiwanese have had an overnight hospital stay at least once by the time they are my age, 28. They take health matters very seriously here and the cost of visiting a doctor or staying at the hospital is very low compared to many western countries. The most common forms of going to any doctor in Taiwan include these two avenues: Chinese medicine doctors who give Chinese medicinal herbs and acupuncture and the doctors in the hospitals who will prescribe pills. A hospital here is like a super market for health. You can get your eyes checked, your teeth cleaned, and blood work all while you wait to see a doctor about your lower back ache.
One catch is that you do a lot of the leg work yourself. The system is fairly advanced and organized, but you will be running around to little rooms, knocking on the doors, waiting in the hall for a few moments, sitting in a tiny room with five other people, talking to the doctor briefly and possibly in front of the other five people, and then going on your way to the next little room. The pharmacy is on the first floor, so you can easily pick up your medicine before you leave. They even print out the labels in English if you request it. When you pay for everything at the end, the bill always makes your jaw drop because it’s all extremely cheap, even if you don’t have insurance.
During most of my five days in the hospital, my friend Jason was with me. Without him, I’m not sure it would’ve even worked because like I said, you have to do a lot of things yourself. I would have had to get all my water and food by myself. People don’t drink the tap water in Taiwan, but each floor has a water machine. Not to mention I can’t read most of the paperwork or communicate with at least half the staff. The nurses were especially glad about Jason helping me because their English is really not good enough to speak to me. Sometimes I would try to ask them for something, and when it didn’t work, I would say, “Let me get my friend,” and the relief on their face would make me feel guilty for even trying by myself.

Jason wrote this note for me to show the nurses when I wanted to be unhooked from the IV in order to go downstairs and have my hair shampooed and dried at the salon.

The day before surgery, I did a bunch of paper signing, x-rays, etc., and then I checked into my room. I had one roommate who was attended day and night by a girl who is probably from the Philippines or Malaysia. They were very quiet other than their Chinese soap operas blaring every waking moment.

Oh NO! You spilled yogurt on my poofy, pink dress!

I’m angry ennough to talk about the yogurt for 10 minutes.

Your rant is hurting my son’s ears! Poor poor thing, now he’ll be scared of poofy, pink dresses forever.

I was instructed to not drink or eat anything starting at midnight the night prior to surgery. I wasn’t worried about this until I was told I will have my surgery after all the young and old people, since I’m healthiest. That’s fair. But I didn’t go into surgery until 3pm the following day! And they have strict instructions not to drink anything for 6 hours after surgery, so it was a full 25 hours that I had no water. I guess I was hooked up to an IV after surgery though. When I awoke from the 2 hour surgery, I felt nauseated and nobody was around to care. I began banging my hands on the arm rests of my hospital bed so that I could tell someone my stomach hurt by pointing to it. I was really worried I’d have to throw up, and since I couldn’t even swallow my own spit at this point, I didn’t know if throwing up would even be possible. Then I passed out again from the anesthesia.
When I was wheeled back to my room, my throat felt like no throat should ever feel, and I was scared. Swallowing was my enemy, so I had to spit into a napkin constantly. After about 10 minutes, I ran out of the napkins I brought, so Jason went to the convenience store inside the basement of the hospital to get more. Mornings were the worst because the swollen, raw wounds in my throat would dry out and hurt fiercer than anything I could have previously related to. I wore a surgical mask at night to prevent drying out, but it still didn’t prevent the pain in the morning. Drinking even the tiniest bit of water was a huge feat. Creamy products like the Nutrimeal produced by USANA and oatmeal drinks were better than any other food because they would slide right on down without irritating my throat. The instructions about salty products being a really bad idea didn’t get translated to me correctly, so I tried to eat the broth of a soup from the hospital kitchen. Sooooooo bad!!

The adjustable beds are so convenient. I really didn’t want to leave on day 4 after surgery.

I gained about 3 kg of liquid weight from this being pumped into me for almost the entire five days I was in the hospital. When I left, I could barely fit my swollen feet into my sandals.

Maybe trying a couple soups is what caused ulcers to form in my mouth. The ulcers came the day I left the hospital, day 4 of post-op, and it was one week after that when I found out they were ulcers. I spent that first week at home thinking that something was terribly wrong with my recovery because the burning was so bad. I can only describe it like this: Every liquid felt like I was swallowing acid water. And when I tried to drink a banana smoothie, it felt like pure acid on that ulcer spot.
It’s now day 14 and the pain has been easier to tolerate these past two days. Around day 7 and 8, I searched online to see if the level of pain I was experiencing was normal. So if you are reading this for the same reasons, do not fear! It does get better. And the enormous holes you see in your mouth do fill up with scar tissue. I kept looking at one of the holes thinking, “It will get infected! I know it will; it probably already is, and that’s why it hurts so badly.” But it wasn’t infected. The fact that my stitches on one side of my throat fell out on day 6 doesn’t seem to matter now; that side is looking somewhat like a human mouth lately. The ulcers just caused me to lose more weight (10 lbs altogether so far), so I’m now at my ideal weight for my height. The weirdest part of this whole process has been the side effects I experienced while on the steroid prednisone.
It wasn’t until I was home from the hospital that I realized how crazy I felt. As the steroid built up in my system and I became more and more sleep deprived (prednisone gave me insomnia), I began to feel like I was in an alternate world, like I was a character in a movie and everyone was watching me deteriorate from my addiction to methamphetamines. Why didn’t I stop taking them? Because the pharmacist had put a star on that one, saying it must be finished. And because I couldn’t just call up the doctor’s office and speak to someone in English. And because I knew steroids would help with the inflammation.
But on my first post-hospital visit, I asked the doctor if I can please stop that medicine, and he said yes, a week is enough of the steroids anyway, and that I was having an adverse reaction that some people have- excess of energy. Jason had spent only four hours with me under those conditions and he was about to shoot himself. I was fidgety and spoke rapidly, but I talked in circles. I even had hallucinations during my nights of not sleeping. Unfortunately the week of my craziness with the steroid was also my last week of work and when I needed to pack and move out of my apartment. Luckily, Carrie was sympathetic and helpful.
Now she’s gone back to America. I put the finishing touches on our apartment and sealed the deal with the landlord. He gave us this note:

But it’s not bon voyage for me. Not yet. I still have a wonderful two weeks ahead of me. I plan to cram in as much Taiwanese fun as I can, but it’s looking like at least two typhoons are headed for Taiwan in the very near future. My plan is to post on here every other day or so, even if I’m posting about past events. I have files and files of photos and stories to share with you, so check back soon 🙂
If you are ever put on a liquid diet for any reason or if you want to lose weight in an easy, healthy way, I highly recommend you try Nutrimeal. My friend Jason can help you buy a bag of strawberry, vanilla, or chocolate for $1,100 NT which has at least 12 meals in it. I think the strawberry is the best flavor. I added vanilla ice cream to it and still lost 5kg in a week, but I’m sure that’s not the recommended method. It doesn’t have a ton of taste, but it’s pleasant and creamy and has all the protein and vitamins your body needs.
Jason
0918-868-342
yen.jason@gmail.com
Here’s some more information about the surgeon I had at Shin Kong Wu Ho-Su Memorial Hospital in Shilin (along the red line MRT).
RAYLEIGH PING-YING CHIANG
M.D., M.M.S.
Address: 95, Wen Chang Rd, Shih-lin, Taipei, 11120, Taiwan.
Department of Otolaryngology.
Shin Kong Memorial Hospital
Office: + 886-2-28332211 ext. 2551
Fax: + 886-2-28389335?
E-mail: rayleighchiang@ntu.edu.tw or sleepapneasurgery@gmail.com
Website in National Science Council Researcher’s Website: http://researcher.nsc.gov.tw/rayleigh_stanford/en