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Tom's avatar

Thanks to Brent and Michael for setting this up.

Tom's avatar

If you have any further questions, feel free to contact us directly or through our Two Travelers Facebook Group.

Brent Hartinger's avatar

Thanks, all! And GET WELL SOON, Tom!

Michael Jensen's avatar

Thanks for coming everyone! And thanks Tom and Georganna for taking the time to share your story with us!

Stay safe everyone!

Michael Jensen's avatar

What would do for other health issues? If -- god forbid -- diagnosed with cancer, would you go back to the U.S.

I ask because this is DEFINITELY something I think about.

Tom's avatar

I am not certain. I will go back when I reach Medicare age and select plans and doctors, but knowing what I know now, I think anything not catastrophic I would seek care outside the US.

Georganna Hawley's avatar

Antecdotally, we have heard of other nomads who were given a breast cancer diagnosis outside the US, got treated right away and are very happy they did it all outside the US. And we know of men who were diagnosed with prostate cancer in January and didn't get surgery til May. That is criminal and in the insurance company's fault.

Michael Jensen's avatar

Are there ANY limitations on what you can do once you're fully healed? I know this surgery is incredibly successful but could you ski if you wanted?

Tom's avatar

No limitations that I know of. I probably still won't be able to play the piano, but I can't now anyways. Yes, I can go skiing, mountain climbing. cycling, you name it.

Georganna Hawley's avatar

He is NOT and never has been a mountain climber!

Michael Jensen's avatar

That is just mindblowing! Honestly, I don't ski anymore for fear of what it would do to my knees. Maybe I should get the sugery now! (Kidding!)

Tom's avatar

Here is the contact information for my surgrons;

Drs. Serhat Mutlu and Herun Mutly

Gülce Apt, Zuhuratbaba Mh

Inciril Cd Haksever Sk 8-8

34147 Bakirköy/Istanbul

www.kireclenme.com.tr

+90 5442302010

Brent Hartinger's avatar

I'm curious about your accommodations in Turkey, which you say cost $3000 a month. This seems fairly expensive for Turkey, but I know you wanted a comfortable place for the recovery. Do you think you could have found a decent place for less? Are you happy with what you got for $3000?

Tom's avatar

Yes, we could have found something cheaper. This place has a swimming pool, a sauna, a steam room AND a Hamam, plus a fitness center; all things I planned to use in my rehab. Then my doctors said NO swimming pool. No Sauna. No Steam Room, No Hamam, all due to possible infections. So we paid for all those things without enjoying the benefits. And the cost was $,3000 for 49 days, not 30.

Brent Hartinger's avatar

Oh! I'm so sorry.

Brent Hartinger's avatar

(Just for readers' comparison purposes, Michael and rented a fairly nice apartment on Istaclal Street (in Beyaglu, a great neighborhood) for $650 a month, but this was through a local broker, not Airbnb (fairly risky, frankly) and I don't think it would be big or comfortable enough for a long-term recovery. Plus, it was on the fifth floor with no elevator!)

Georganna Hawley's avatar

Yep, we had to have an elevator. And I wanted the neighborhood to have nice wide sidewalks, and no cars parked on the sidewalks (That's a thing here), so Tom could relearn to walk safely. We are quite a ways from the old, interesting part of Istanbul, but we can get there by metro or tram when he can be in crowded places with confidence.

Michael Jensen's avatar

Someone else wanted to know what you would do if you developed any issues with the new knees. Would you go all the back to Istanbul for treatment? Would that be covered by the surgeons?

Tom's avatar

Yes. They have suggested I com back in 6-12 months for a follow up appointment.

Michael Jensen's avatar

And if you developed complications in the mean time? Would you feel comfortable just seeking treatment locally or would you want to see those doctors?

Tom's avatar

I would call the doctors first, then try to get to Istanbul.

Georganna Hawley's avatar

We are nomads, remember. We can go where and when we want, so it is not a problem. And when we need to be out of Europe after our 90 day limit, Türkiye is on the top of our list of where to go anyhow.

Tom's avatar

Someone also asked about why I decided to go to Turkey rather than wait for Medicare. Here is my ratioanle for that:

Medicare is an 80/20 plan and consists of 3 sections.  A and B and D.

A is for hospitalization.  Everything in the hospital is covered if you are admitted to the hospital.  There is no premium but there is a small deductible.

B covers all out-patient care.  Doctor visits, tests, equipment, etc.  The premium starts at $170/month and can be adjusted upward if your combined household income exceeds $180,000 per year.  The deductible is $341 per year.  

The maximum Medicare will pay is 80% of your total medical costs minus deductible, premium and copays.

Part D is the prescription drug plan.  There are several to choose from depending upon premium, copays, deductible and what medications are covered.  You must coordinate  your surgery with the covered prescription or you may be paying for prescribed medications out of pocket.

If you want to have the other 20% paid, you must purchase an independent Medicare supplement plan.  There are many types of plans from least premium to the most comprehensive plan for a higher premium.

Plan G is the most comprehensive plan available currently.  It pays everything Medicare does not pay, except the Medicare premiums and the Plan G premium.  There may be copays as well that are not paid.

The alternative is to choose a Medicare Advantage plan, Part C.  This is all the various plans (A, B, D and Supplemental plan) all rolled up into one HMO.  But then you are held hostage by the healthcare care provider to approve and pay for the procedure.

If you are of Medicare age, you could have bi-lateral knee replacement surgery and end up paying substantially less than we did.  As soon as Medicare approves the procedure for you.

I didn’t want to wait.   And I don’t need to deal with all the moving parts of Medicare.

Michael Jensen's avatar

That seems insane that your Turkish doctors could X-ray your knee and see it was bone and bone and yet Kaiser could deny you treatment!

Tom's avatar

Exactly. American healthcare benefits the insurance company, not the patient.

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Jul 5, 2022
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Tom's avatar

I just posted the contact ijnformation for my doctors.

Michael Jensen's avatar

My left knee is starting to show signs of problems and I'm thinking the same thing. I won't be waiting either.

Georganna Hawley's avatar

If it gets so bad it influences your day to day life, please seriously look into it. It because so bad we searched for elevators (in Europe that is a challenge), so he didn't have to go down a short flight of stairs. He missed a lot because of what he could not do the last 10 moths. He almost fell getting out of the water on the beach because his knees just would not hold him. Not a way to live life.

Michael Jensen's avatar

Thanks to what you guys have shared, I will. Right now it's only sporadic. But it is definitely something new I've noticed in the past twelve months.

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Jul 5, 2022
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Michael Jensen's avatar

Tom and Georganna and I discussed in the interview the importance of having a medical advocate to help negotiate many of the appointments and so forth. There are different services out there that provide this but Tom had the good fortune to meet someone willing to help them as a friend. They estimate the cost if they had to pay that would've been about $1000.

Michael Jensen's avatar

Tom, I was amazed your surgeons made a house call. Was that part of the package?

Tom's avatar

Yes. the package was also detailed in the interview. They actually visited us twice. The second time they brought a gift: a box of Turksih Delight eclairs.

June Fitzpatrick's avatar

Having had bilateral knee replacements 6 months ago in the USA, I am amazed at how quickly Tom has progressed! He's the Bilateral Knee Replacement Poster Child!!! While I feel my surgeon was skilled and did a great job...I think my follow up PT was lacking, compared to Tom's.

Tom's avatar

I can send my slave driver to you. She will motivate you.

Michael Jensen's avatar

Hi June, in what way were they lacking compared to what Tom has received?

Georganna Hawley's avatar

June has been his cheerleader all along. She sent him pre-surgery exercises to do and has been with us all the way. I cannot stress enough how much that has helped him. "If a tiny little thing like June can do this, so can he!" was in the back of his mind all the time.

June Fitzpatrick's avatar

Glad I could be of some help. Nothing like having and older, smaller, female egging you on!

Michael Jensen's avatar

Ah, this is that June! Nice to meet you June!

June Fitzpatrick's avatar

Hi Michael! Thoroughly enjoyed the interview. It'll be very helpful to others considering a "Medi-Cation".

June Fitzpatrick's avatar

Since it was winter here and difficult to get out, I was allowed home healthcare PT. They didn't start immediately. After 3 PT visits in 2.5 weeks, I had an appointment with my surgeon. He was quite upset that I didn't have more flexibility yet. I then stated going to PT at a clinic and progressed faster...but lost several weeks of prime time to do PT. While in the hospital...the PT was minimal. I also asked for the auto knee flex machine that Tom used, but was told they didn't use them any more. I think that probably helped Tom a lot.

Michael Jensen's avatar

Wow, that sounds terrible. Tom's experience was exactly the opposite. When things were lacking, the staff reacted almost immediately to get him what he needed.

Georganna Hawley's avatar

The way he groaned when he was on the Flex-o-matic machine, I think it helped. It is passive exercise, and we of course are doing exercised where he has to work hard. He still groans.

June Fitzpatrick's avatar

PT hurt like hell! I did more than groan! Another friend from here had one knee done at a time. The first one he didn't have the Flex-o-matic...the 2nd one he did. He said it made a big difference in getting his flexibility back better and quicker...which is why I requested it.

I am extremely glad I did both knees at once and recommend everyone do it that needs both knees replaced.

Amy Rutherford's avatar

How did you find the surgeons and feel comfortable with their care before going under the knife?

Georganna Hawley's avatar

The level of comfort was something you just have a gut feeling for. I have never been in such a clam doctor's office. They take their time with you and you sit and chat., not in the exam room, but in their office. They sit together behind a big desk. No white coats, very relaxed.

Michael Jensen's avatar

She basically became their medical advocate.

Michael Jensen's avatar

Hi Amy, I think Georganna is still offline. I know they found their surgeon through a Turkish friend they made named Yasmin.

Tom's avatar

Our friend Yasmine set it all up. this is in the newsletter interview.

Tom's avatar

Yasmine was amazing. She reached out to her network and found these two brothers who work as a team. They way they run their office makes the whole operation pretty slick.

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Jul 5, 2022
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Georganna Hawley's avatar

We can certainly give you Yasmin's contact offline. She is in the process of setting up her own advocacy service from her home in Fethiye. There are many medical advocacy services in Istanbul. But, I would always go with a friend's recommendation for at least the first consulatation.

Michael Jensen's avatar

Yasmin is looking to eventually establish her own practice, but my understanding is that she hasn't yet started that process. But clearly she should!

Michael Jensen's avatar

Tom, could you talk a bit more about the health insurance company refusing to authorise the surgery. Could you have fought them more on that? How could they just say no?

Tom's avatar

I talked about this in the interview. My healthcare provider kept telling me my knees were not bad enough to warrant replacement. On my last appointment with them in 2021, one PT guy said that they would probably not authorize it for another couple years.

conincidenatlly, that is how long until I reach Medicare age.

Tom's avatar

Georganna is offline. Her computer froze.

Michael Jensen's avatar

Georganna's screen just froze and she's rebooting. The interent in Istanbul can be a little wonky sometimes!

Michael Jensen's avatar

Tom following up on the doing two knees at once, did you have any concerns about that since it wasn't normally done in the US? I confess that would give me pause

Tom's avatar

Besides, if I only did one at a time the recovery period would be doubled. This way it is one and done.

Tom's avatar

I did not. They explained the rationale, and the cost was cheaper than two separately.

Linda Clay's avatar

Reading with interest and envy of all the places everyone is at :)

Georganna Hawley's avatar

Hi Linda! You will be out here with us soon, I hope.

Michael Jensen's avatar

Tom, another subscriber is asking about your weight loss. Was that planned or is that just a by product of the surgery?

Tom's avatar

When I first met with the doctors in February, they told me if I lost 20kg I would feel better and rehab would be easier.

So I cut back on carbs, drank more water and walked all over Europe and we changed our lifestyle to eat only one meal per day.  With the exception of a glass of milk and a banana for breakfast, we would only eat once per day, around 3PM.  

When, I was at the doctors office the day before surgery, my weight was 22kg less than February.

The 5 total days I was in the hospital, I had no appetite.  Hospital food.  And two sets of exercises per day.

Then, going forward I really cut back even more on the quantity of food. The one meal in the afternoon was smaller that it has been in the past.

Now, I do 1-2 sets of exercises, a long walk of about 7,000 steps in early afternoon.  We have our one meal, then I go for another walk with 5kg of ankle weights.  This walk is about 2,000 steps.  I bring a single crutch with me for these walks to help me navigate rough terrain or broken sidewalks and then occasional curb I have to climb.  Otherwise I am walking independently.

Tom's avatar

France will be a problem with their fantastic desserts.

Michael Jensen's avatar

That's absolutely amazing. So you're thinking these changes will stick?

Michael Jensen's avatar

If you're just joining us go ahead and post your question in the comment box!

Rick's avatar

Thanks for doing this. Our conx is slow on the beach so we’ll (Cindy and I) catch up later. Is the names of the surgeons in the article? We have a friend that may be interested

Tom's avatar

No we have their contact infmoration offline.

Georganna Hawley's avatar

Yes, Harun and Serhat Mutlu.

Michael Jensen's avatar

Georganna, here's a subscriber question for you:

Georganna, would you have felt as comfortable as you seem to be in Turkey if you hadn't been nomading for ten months first?

Brent Hartinger's avatar

I was very nervous before we moved to Türkiye (where we lived for three months last year), and it is not the first place I would go if I hadn't traveled before. But it was not as intimidating as I thought it would be, as Georganna says.

Georganna Hawley's avatar

Probably not. It has helped that I knew how to get around here. That being said, Türkiye is an easy country to be in.

Michael Jensen's avatar

Why exactly would you say it's so easy? Is there something about being a woman? Older?

Tom's avatar

Turkey is very safe. She has no concerns about getting around at all time of day or night.

June Fitzpatrick's avatar

Hello...Trying to sign in...states "Technical Problems"...

Tom's avatar

Hi Love. You are here with all of us.

Michael Jensen's avatar

Tom's answer to the first question about why the doctor's didn't do the bilateral surgery is

I don't know specifically, but I imagine it is riskier for one surgeon and I doubt the insurance comnpanies would pay for two surgeons.  My skepticism of the US healthcare system leads me to believe that only one knee is approved because it is cheaper than two.  The longer the insurance company can delay the expense, the more profit they make.  And it worked in my case.  They delayed long enough that I went abroad to have the procedure and the insurance  company spent zero money on me.

One of Georganna's friends said a doctor told her he was not "fast enough" to do both at the same time. These two surgeons working together finished in about 3 hours.

Amy Rutherford's avatar

Hi, it's Amy and Tim in Edinburgh!

Tom's avatar

Awesome. We are going to Edinburgh in August. Please tell us all about your experiences offline.

Michael Jensen's avatar

Okay, let's get started First, we're going to begin with a question submitted ahead of time by a subscriber in Ohio, which is for Tom.  

Tom, why don't US doctors want to do double bilateral surgery? Is it riskier?

Brent Hartinger's avatar

Thanks for doing this, Tom! Glad you and Georgianna are here. Hope our paths cross again soon in person too. :-)

Michael Jensen's avatar

While we give folks a minute or two to get here, feel free to let us know where you're at today. Brent and I are currently in Sarajevo where the heat wave finally broke. YAY!

Tom and Georganna, what's it like in Istanbul?

Georganna Hawley's avatar

Today it was 85 with a nice breeze. Very comfortable.

Amy Rutherford's avatar

If it gets any chillier in Edinburgh, I'm hibernating.

Tom's avatar

I have been hauling my winter jacket with me until we finish with Scotland.

Rick's avatar

We’re at the beach in FL

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Jul 5, 2022
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Georganna Hawley's avatar

Be safe. And please contact us if we can give you any info or advice.

Brent Hartinger's avatar

haha sounds lovely though.

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Jul 5, 2022
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Georganna Hawley's avatar

49 days. We got here a few days prior to the surgery for tests at the hospital and to get the apartment stocked with food, etc. I had to figure out how to get to the store and pharmacy etc. And how to use the transportation system

Tom's avatar

We fly to Edinburgh on August 1.

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Jul 5, 2022
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Tom's avatar

Climb stairs without pain. WE expect to hike Hadrians Wall next month.

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Jul 5, 2022
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Tom's avatar

June 16 was the day. The surgery lasted 3 hours. I was in intensive care for 1 1/2 hours for recovery before being moved to my private room.

Michael Jensen's avatar

And you had an epidural, correct? So we're you awake and/or aware then?

Tom's avatar

Hell no. I woke up when the epidural was wearing off, and I was begging for someone to kill me?

Georganna Hawley's avatar

Yep, an epidural. The anesthesiologist chose for him to be out. Sometimes they do the awake but you can't remember thing. The surgery lasted 3 hours.

Michael Jensen's avatar

I would NOT want to be awake!

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Jul 5, 2022
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Georganna Hawley's avatar

In the hospital he got intravenious self- directed pump narcotics the first couple of days. Now he takes Dolphin two times a day if he needs them, most days only one.There are 9 left, and I think he will not use them all. They gave is a stronger painkiller called Contramal, but he has not taken any of those. Before surgery he took 6-800 mg of Ibuprofin.

Michael Jensen's avatar

I know Tom said they gave him a drip in the hospital that I think he used for four days a fair bit. And then some very strong painkillers that he used for a while but now he's mostly off them, right Tom?

Tom's avatar

Yes, I am currently taking one pill a day. It is bout 500 mg of Diflunisal.

Georganna Hawley's avatar

Keep in mind, that your caretaker should be in charge of your meds. Just to be safe.

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Jul 5, 2022
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Tom's avatar

That was a very real concern for me. I voiced that concern with the doctors pre-op.

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Jul 5, 2022
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Tom's avatar

Of course. I voiced my concerns with the doctors, then followed their judgement.

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Jul 5, 2022
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Tom's avatar

They said they would not cover knee surgery during the application process. So I knew I would either pay out of pocket or wait 2-3 years for Medicare.

Michael Jensen's avatar

Did you look into travel insurance that could've covered this?

Tom's avatar

It is a pre-existing condition. The only country that would cover it is the US. Back to the 30% out of pocket in the US.

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Jul 5, 2022Edited
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Tom's avatar

Not do 40 years worth of home repairs.

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Georganna Hawley's avatar

I think my answer is down below.

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Georganna Hawley's avatar

He will need to learn the PT and be ready to encourage you to do it even when you don't want to. He may have to help you get up off the couch or bed for a couple of weeks. He will have to help you shower. And keep track of your drugs. He will get to do all the housework for a few weeks. It may not be so much with just one knee, but he will need to be there with you every day.

Michael Jensen's avatar

How did you manage the shower or tub with Tom having both knees done? That seems like it would be very challenging?

Tom's avatar

The shower has been a challenge. Thre is a single step up into the shower pan. At first, I stood outside the shower and hosed off. Turned the entire bathroom into a shower room.

Michael Jensen's avatar

That makes sense.

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Jul 5, 2022
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Tom's avatar

I have already mastered the stpes. I climb about a flight of stairs everey day. WE live in a 18 story apartemtn building. i am hoping to be able to climb all of them within a couple weeks.

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Jul 5, 2022
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Tom's avatar

We can send you the link to my surgeons, if you want.

Tom's avatar

I thought it would be a zoom or similar too.

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Jul 5, 2022
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Brent Hartinger's avatar

This is it! Ask your questions here!

Tom's avatar

This is it. You are in the right place.