The Costs of an Injury Abroad

When you have a neurodegenerative disease, your movement disciplines and practices quite literally frame your days and weeks. Those of us who are forward-looking and capable build our new lives around the hope of sustaining the movement that we have with vigorous and uncompromising daily exercise. Both cardio and strength training are what many of us who are trying to hold back this leviathan of Parkinson’s have put into practice in order to slow its progression. This kind of routine physical exertion, coupled with a gut microbiome-friendly diet and carefully guarded sleep, is what I credit with my relatively slow progression. This routine, along with the added nomadic adventures, is what defines my new life post-diagnosis.

Introducing an injury to this sacrosanct routine can therefore feel like more than a significant setback. It’s not just losing your grip on the overall physical progress you’ve made. When that vigorous physical outlet gets suspended, it feels like your primary disease-onset control mechanism has been stripped away, leaving you adrift in an unfriendly current, with little ability to affect your progression or destiny. So, preventing unnecessary injury must be at the forefront of our minds, and I am learning this the hard way as I’m working through the aftermath of a recent injury.

It may have been lifting incorrectly in a BodyPump class. It may have been wide weight presses in my Functional Fitness class. It may have been the clapping push-ups I started to get braver with. I don’t honestly remember, as it didn’t just happen all at once. I just remember that it was sore that night and the next day, and the next day, and the next day. Pretty soon, the weeks became months, and it seemed to be getting worse. You may be thinking, “This is such a guy thing, foolishly pushing through an injury,” and that may be true. But in my defense, when you work out vigorously almost every day, you tend to be sore frequently. Generally, it’s a good sore, but it is a very common feature of vigorous daily workouts. I have acclimated to routine soreness and have gotten used to working through it. If I ceased workouts every time I was sore, I would never go to the gym.

Apparently, I had stressed a joint that I had never heard of before. The sternoclavicular joint is not exactly the most common place to get an ailment. Nor is it mentioned in the famously popular “Dem Bones” children’s song. Physiology never captured my fascination in school. Nevertheless, it hurt more and more until it was officially a problem. The damage was done sometime in February, while I was in Armenia at the gym in Yerevan where I was a member, but I didn’t properly deal with it until I was settled in France. The following breakdown of appointments, costs, and prescriptions explains the waypoints I encountered in negotiating healthcare as a nomadic traveler abroad. Americans, Parkinson’s combatants, and slow travelers of many stripes may find this illustrative in understanding this small slice of the French healthcare system compared to what they are accustomed to.

It was April when I decided to do something about this. I had already acquired a general practitioner, or GP, during my first month in France. I will cover this in a soon-to-be-released dispatch. I could have seen my very responsive GP, but I wanted a faster appointment, so I chose to be seen at the Maison Médicale de Garde here in Narbonne. The Maison Médicale de Garde, or “after-hours medical clinic,” is a non-emergency clinic adjacent to the hospital in Narbonne that alleviates some of the non-emergency patient demand on the actual hospital ER. It’s open during weekday evenings and weekends. I went there 35 minutes prior to opening and was third in line to be seen when it opened. My overall wait time was around 45 minutes.

The physician who evaluated me knew English well, but in southern France you can’t always count on that. What I have learned to do, in light of my abysmal French-speaking ability, is to write out what my problem is, translate it into Français via Google Translate, or an equivalent translator, and give the doctor a printout, or at least have it on your phone for them to read. It’s critical to be clear and to reduce the language barrier with your physician, of all people! I explained everything, and she appreciated my thoroughness.

The visit to the Maison Médicale de Garde doctor resulted in obtaining an ordonnance (prescription) for a strong anti-inflammatory drug, a Tylenol equivalent, omeprazole, and an X-ray. The X-ray led to a CT scan, and both the X-ray and the CT scan had to be separately scheduled. Given the intricacies of my health insurance while I’m traveling abroad, I am required to pay the bill directly myself and then get reimbursed later. Here is a breakdown of the raw costs of these drugs and procedures as a traveler in France:

The timeline for all of this happened inside the span of a couple of weeks. I went to my initial visit at the Maison Médicale de Garde on April 13, obtained some of the medications that same evening, and acquired the rest the very next day. My X-ray occurred just two days later, on April 15, and the CT scan happened on April 30. I don’t think you can shake a stick at that timeline, no matter where you’re from.

As for the intricacies of my health insurance relevant to the costs overall, that is outside of the scope of this particular dispatch, but I will also discuss that in greater detail in the future. I possess emergency travel health insurance in addition to my retirement health insurance. The aforementioned costs were all the raw costs of me coming off the street as a traveler, as I don’t yet possess the coveted “carte Vitale” (essential health insurance card), which can be applied for by eligible long-stay residents who remain here after three months of legal residence. Regardless, I anticipate being reimbursed for my expenses in the coming months through my own insurance.

Now that the diagnostic component of this is largely over, all that remains is the $40 follow-up with my GP. It’s of course possible that he may advise for some form of physical therapy, but we will see.

Hopefully, this information is useful and provides a frame of reference to anyone who is considering a slow travel lifestyle, relocating, or simply trying to visualize getting medical services abroad. None of this process has been overwhelming or unreasonable. For many who attempt to visualize the perceived trials and tribulations of health care abroad, and I’m speaking to Americans here, it’s tempting to view the learning curve and unseen peculiarities of a foreign medical system as daunting, overwhelming, fraught with outrageous expense, and even dangerous. That perception is often shaped by the American health care template: fighting with your insurance company to get the health care you anticipated, hidden and uncovered costs, lack of transparency, and other systemic nightmares. Parkinson’s really sucks, but I have had a good experience thus far in France with this particular issue, despite the challenges I have had in other places getting exactly what I needed medication-wise.

All of this cost and time layout illustrates a practical medical care reality inherent in getting an injury, but it doesn’t add all the color to the mental and emotional canvas that is absolutely pivotal to all of this. Parkinson’s combatants must frame their lifestyle around purposeful and intentionally programmatic movement. This cannot be compromised. We have to schedule our exercise, our workouts, walks, gym time, Rock Steady Boxing, or whatever else we do, and make that the fulcrum of our daily activity in whatever country we’re in. Pretty soon, you get used to it and it defines you, and that’s a good thing, because chances are you’ll improve your chassis, the best guardian for your brain, prolong your critically necessary functionality, and feel much better about how you’re holding back the leviathan. So, when this life-prolonging pattern is disrupted by injury, it is no small matter. Guard against injury like your life and peace of mind depend on it, because they do.

This is the Nomadic Parkinson’s Dispatch.