The 3-year long health saga of a medically insured PhD student

Intro

My name is Jason Filippou, and I’m a PhD student in the Computer Science department of the University of Maryland, College Park.

My intention with this blog was, and still is, to post interesting things about Computer Science, music, and maybe some latent psychological elements that I find compelling. I simply find few other items interesting at this time. However, a recent health saga which depicted a level of barbarism and medical malpractice that I never thought possible has made it useful to document my experience on a platform more friendly towards static information dissemination than Facebook, a website tuned towards posting pictures of food or other clearly time-wasting material, and upon which I’ve been documenting this stuff until very recently. I will therefore use the first post in this blog to talk about this. It is important for me to have a static account of what has happened over the 3 years that I’ve been a PhD student in the USA, in conjunction with disseminating this information online to raise awareness of the level of malpractice that even insured people can be faced with in that particular country.

An effort will be made to stick to the facts. I will also avoid mentioning specific names of medical professionals or insurance policies, unless legally advised to do so down the line. This will be a lengthy post, but one extremely worthy of reading to the end, particularly if you are interested in the health system situation of the USA, or perhaps emigrating to the USA. It is advised that it is not read during one’s meal, since it contains references to G.I-related symptoms which could potentially gross people out.


August 2012 – First blood

I arrived in the USA on the 3rd of August 2012. Within less than 24 hours, I ingested pasta sauce gone bad for months and naturally got food poisoning. I vomited twice. More unnervingly, over the next few days I started having frequent diarrhea with bloody stools, in conjunction with abdominal cramping and an urgency to visit the bathroom immediately. It should be noted that, at the time, I had not signed my insurance forms in the US, because I’d arrived two weeks early in order to acclimatize myself with College Park as much as possible before beginning my studies.

Regardless, I decided I should visit a doctor. So I visited the University Health Center in the College Park campus, where I was seen by a G.I doctor on the spot (let’s call them doctor A for brevity), with a rather small charge in my University Bursar account. The doctor, having not had any history of me in the past (I’m a Greek-Canadian dual citizen who’d lived his entire life up until August 2012 in Athens, Greece), laid out the possibilities in front of me, and those ranged from run-of-the-mill food poisoning to colon cancer. I hadn’t been in the States for more than 5 days, I was completely alone since my roommate at the time was on vacation, my parents were thousands of miles away in Greece, and I was presented with the possibility of colon cancer, a pre-existing condition that would probably make it impossible for me to successfully sign insurance forms when the time came.

It turned out that I did not have colon cancer, the final diagnosis at the time being gastrenteritis. Over the next few months, I noticed a shift in the behavior of my G.I tract; I started visiting the bathroom more frequently than I used to, and my discharges had changed in consistency, size, etc. This was not pleasing for me, but considering the fact that my diet had also changed and this can only affect one’s bathroom habits in one way or another, I was not particularly alarmed at the time.


June 2013 – The “treatment” begins

Around the end of the 2013 Spring semester, I started developing symptoms similar to those of August 2012. Thinking that this could not continue, I visited a G.I doctor in my area, let’s call them Dr. B. At that point, I was of course medically insured, let’s call the policy Insurance Policy A. The doctor asked me some questions, and theorized (without so much as requesting a stool or blood sample, for instance) that I am suffering from Irritable Bowel Syndrome and that my hemorrhoids were also inflammated. They therefore prescribed some rectal suppositories (Anucort), suggested some slight diet adjustments and instructed me to see them a month from that date. The symptoms did subside, yet a month later when I arrived at their office for the scheduled appointment, the doctor’s secretary told me that they had tried to contact me because the doctor had to cancel, yet they could not reach me on my phone “a couple of times”. At the time I owned a phone which, while not the best in the market, was endowed with state-of-the-art voicemail technology. It is therefore questionable exactly how the front office could not reach me on my phone every one of those “couple” of times. At any rate, I had to miss that appointment and re-schedule for a post-August meet, since during August I would be visiting my home country of Greece for vacation.


 

August 2013 – A glimmer of hope vanishes fast

During my August vacations, I started developing symptoms again. I arrived at the States on August 31, and immediately requested an appointment from Dr. B. I got an appointment on September 4, during which again no proper diagnosis was made (no rectal examination, no stool samples, nothing of the sort), yet an appointment for a colonoscopy was made for the earliest available date: November 27th. That constituted an 11-week wait for an insured patient with frequent diarrhea, bloody stools, urgency to visit the bathroom and at times severe abdominal cramping.

Instructions for properly cleansing my intestines and colon prior to the procedure were sent to me by mail couple days before 11-27. However, nowhere within the instructions was it mentioned that the day before a colonoscopy the patient should not be ingesting any food after noon. Perhaps it was assumed that this was common, universal knowledge. For a person who prior to coming to the States boasted a perfectly healthy G.I system and had never had a colonoscopy before, it was not. Therefore, I had dinner at 6pm the previous day and at 8pm started drinking my four liters of laxative. Naturally, my colon was not perfectly clean for the colonoscopy despite the laxative treatment and doctor B was not able to have a very good view of my colon. Regardless, they “diagnosed” (I have to put this in quotes, maybe they had to “diagnose” something for insurance purposes? I can’t imagine a failed colonoscopy producing anything like an actual diagnosis.) proctitis and inflammated hemorrhoids, and prescribed the same suppository.


June 2014 – A dreadful decision

Like clockwork, symptoms re-emerged some months later. Early June 2014 I called Dr. B again and requested an appointment. When I heard that the earliest appointment that they had for me would be approximately a month later, I declined the appointment and sought a referral for a different G.I doctor. I received a referral for this doctor, Dr. C, and visited them mid-June. Dr. C listened to my concerns and symptoms and once again theorized (without so much as a rectal examination or stool/blood sample) that I suffer from I.B.S and inflammated hemorrhoids. They asked details about my diet and pin-pointed certain foods about being possible culprits (red onions, creamy soups / salad dressings). They also suggested that in the mornings I have a spoonful of Benefiber with my breakfast and, since I typically had a cup of coffee in the morning and caffeine tends to quickly cause bowel movements, to wait for my first bowel movement of the day before leaving for work. Supposedly, the fast expulsion of the day’s first stools would “train” my G.I tract to cause a bowel movement when I wanted it to, instead of when it wanted to (Dr. C’s words).


Fall Semester of 2014 – False information becomes the norm

I followed Dr. C’s advice, and my symptoms subsided. However, at this point, it should be clear to the reader that my symptoms tended to have seemingly random ebbs and flows. It is therefore not safe to say that my symptoms subsided because my doctor suggested Benefiber and a 20-minute wait after my morning coffee before I took the bus to work.

For our first follow-up appointment, after 3 months, I had made progress, in the sense that I didn’t have grave symptoms such as the ones that made me want to visit a doctor immediately in the first place. However, I still exhibited a bathroom visitation pattern that was markedly different from my previous years in Greece; much more frequent visits (approx. 5 per day), lighter stool consistency, mucus on the stool sometimes, increased flatulence, the works. Dr. C focused on the flatulence and suggested, essentially, that I eat less. The flatulence, in their opinion, was a direct consequence of bacteria in my intestines eating off of the increased amount of food that I was consuming (I’d put on maybe 12lb since I came to the States).

For our next follow-up, late Fall 2014, I mentioned the same things to Dr. C, and they theorized that in addition to my I.B.S (apparently we were settled on I.B.S at the time) I might also be lactose intolerant. Throughout my adolescent life, I tended to consume either a glass of milk or a bowl of cereal on a daily basis, always as part of my breakfast. Never had I had any issues with milk. It is true, however, that many people in their 20s develop lactose intolerance, therefore we opted to run with that. So I switched from dairy milk to almond milk, and whenever faced with the prospect of eating something dairy-based, I would consume a pair of Lactaid tablets.  Symptoms did not re-emerge til the end of the year.


 

January 2015 – Cars, sleet and magic soup

During January 2015, my symptoms came back. Compared to previous times, I would notice a much greater need for a bathroom visit, to the point that I had a public accident once which I covered up as best as I could, and it was good enough. Blood in the stool still existed, as did abdominal pain. In fact, that period of time was particularly distressing for me because I was alone in the house, and I had to walk for 35 minutes minimum to my driving school where I was taking driving lessons. The weather at the time in Maryland was steadily below 30 degrees Fahrenheit (-1 celcius, this is considered cold if you’ve lived in Greece your entire life) and because of snow and frost on the streets, public transportation was unreliable. Being late on any given driving lesson because a bus was late was no option; I would have to repeat the lesson. So I had to rely on my own two legs for walking to my school in the freezing cold, the legs themselves depending on an abdomen that was not under severe pain. This was a dependency that was not met. Long story short, those were very painful walks that took much more than the 35 minutes that Google Maps claimed the on-foot distance was.

The symptoms almost single-handedly vanished after a visit I made to a local Vietnamese food place (one of the various “Pho” places that appear to be ubiquitous in urban areas nowadays) and had a vegetable soup that proved itself therapeutic. I mentioned the entire experience to Dr. C during our regular appointment after two months, and they appeared… pleased. I guess the fact that I had apparently found an herbal remedy of sorts must have somehow backed up their belief that this condition was something I could essentially teach my body to deal with in a somewhat self-healing, herbal fashion.


 

June & July 2015 – A living hell

Late June

Come June 2015, I was working under a different advisor in Maryland, and I was feeling good. Both the people that I have worked with are top representatives of their field, yet the second person appeared to be more in tune with my research goals, and I therefore opted to switch towards them. In conjunction with my symptoms disappearing for couple months (again, ebbing and flowing, it seems), I was feeling good. I had a July 15th deadline that I was working hard for and I had a very good chance of catching.

No matter. Around the end of June, the symptoms hit me the hardest they ever had. 15-20 visits to the bathroom on a daily basis. Most of those visits featuring purely watery discharges or blood. Extreme need/urgency for every one of those visits. Loss of appetite, nausea. Abdominal pain that had me rise from my office chair and head to the nearest bathroom every 20 minutes maximum, praying that the bathroom would be vacant such that I avoid accidents in the workplace. A visit to the Vietnamese soup place that I mentioned earlier did not help at all.

At this point it should also probably be mentioned that I was encountering numerous personal difficulties, concerning the mental strain and computer coding / data cleansing required to catch my deadline, a driver’s skill’s test that went really bad because the person whose car I had to drive had neglected some key elements/paperwork required to prove the driveable status of the car, as well as the fact that my new insurance provider (Insurance Policy B) was refusing payment of one of my two weekly therapist appointments completely illegally and 100% out-of-line with respect to my stated benefits. I was therefore encountering significant personal difficulties even before the symptoms hit me and my emotional state was very fragile. This detail will be important moving forward, such that the reader is able to somewhat put themselves in my shoes and grasp the amount of perseverance that has been necessary to maintain my sanity and be able to type this text as we speak.

First thing I did was call Dr. C on their cell phone around the 22nd of June and request their input on my situation. They told me to take Pepto-Bysmol since “it sounds like you had something bad to eat”. I did that for two days, to no avail. So I called them again on Thursday, June 25th, and they re-directed me to the front office to schedule an appointment.

June 30th

So I then called Dr. C’s office requesting an appointment. A lady booked an appointment for me for Tuesday, June 30th, 4pm in my doctor’s office located in City A. Because of my dependency on public transportation, I had to take an early bus and arrived at the office one hour early, a time at which I was informed that my appointment had been booked by accident in City B. I had no chance of arriving at City B on time, not even if I had a car to drive there.

I was in complete shock. It appeared to me at the time that nothing – absolutely nothing -was going my way, and surely if the reader read the italicized text a few paragraphs ago they might be inclined to feel the way I felt. After visiting the office’s bathroom, I was told to wait in the lobby such that the staff might find a suitable doctor to look me up, given the fact that my appointment had been accidentally booked by a trainee, so the fault lied with them and not myself. I remember frantically texting a friend or two through my phone while I was waiting for somebody else to see me, telling them phrases such as “Nothing’s going my way, oh God, what’s happening, why will nobody care, nobody cares”, and the like.

After about 1/2 hour, a member of the office staff announced to me that no doctor could see me, presumably because of appointment backlogging. At that point I responded: “That’s fine, I will visit the ER next door.” (The doctor’s office was in a building adjacent to a hospital and I was simply under too much pain and discomfort to let this affect me further.) I left and did just that. I checked into the ER and began a 4-hour wait for somebody to see me. My temperature and some bloodwork were both taken almost immediately after check-in, and it was determined that I had a fever. For the rest of the diagnosis, I would presumably have to wait until I moved to the top of the line and a G.I doctor could see me. My phone dying, I was worried that by the time that I was discharged I would have nobody to drive me back home, so I texted a friend, told him that I would need a ride soon but I couldn’t tell them the exact time that I would be discharged (for I did not know it!), and that I would need to shut down my phone for battery considerations. So I was dependent on somebody to pick me up after discharge, but could not confirm with them because I had no means of communication with the outside world.

At this point, it should also be mentioned that, according to Insurance Policy B, I have a co-pay of $150 for every ER visit and, in order to be admitted to a hospital for so-called “inpatient services”, one needs pre-authorization, presumably from a primary care physician or specialist. This piece of information might be important for the reader, such that they develop a full personal view of the way that I was treated.

Once I moved on to the top of the queue, I was given a bed and was administered I.V.s with natural serum and antibiotics (Ciprofloxacin and Metronidazole). Within 15 minutes or so, a doctor (Dr. D) came to talk to me about my symptoms. I explained my symptoms to them, and told them that I was visiting Dr. C for those symptoms. They appeared to have knowledge of who Dr. C was. They also explained to me that I was taking those antibiotics because I had a fever and an elevated white cell count, so we were operating under the assumption of a bacterial infection. Dr. D proceeded to tell me that the goal would now be for me to provide a urine and stool sample and, in the meantime, they would contact Dr. C to get some advice on how to proceed next. As a small reminder to the reader, the plan that day was to see Dr. C about my symptoms, but my appointment had been booked in the wrong city.

During the next hour or so, I was frequently visited by medical staff, who appeared to be somewhat confused about what I was supposed to be doing at any given point in time. For instance, after Dr. D talked to me the first time,  a nurse came over and asked me whether I’d talked to Dr. D. After some time, a nurse came to me and asked me whether I had provided my samples yet, despite the fact that I was obviously hooked on I.Vs (and therefore largely immobile) and I hadn’t been given any information or equipment (e.g urine / stool samplers) that would help me provide the samples.

After about an hour, Dr. D came over and told me that they’d talked to Dr. C and that “he would squeeze me in between appointments the next day”. I basically would have to call the front office the next morning and they would find a time for me.

As mentioned at the start of this post, an effort has been made to stick to the facts, without too much speculation or personal opinion dissemination. However, after talking to some people since this June 30th experience, it appears as it is universally interesting to many people that neither Dr. C nor Dr. D provided a pre-authorization for hospitalization. Here we have a patient with chronic symptoms that involve bloody stools, abdominal cramping, nausea, fever, and seemingly uncontrollable diarrhea, and the best that we can do for him is give him some antibiotics and a next-day appointment while we wait for his stool samples, which were finally requested after about 3 years of no real diagnosis (reminder: the only time I was requested stool samples of was during my first week in Maryland).

They then proceeded to tell me that the game plan involved me providing stool and urine samples and being discharged after this. So after about 15 minutes or so, a nurse came by, unhooked my I.Vs and told me that I would need to visit a bathroom next door, where there existed “multiple samplers” that I could use to collect my samples. Almost contemporaneously, my friend arrived and declared availability to drive me over to my place after I was done, so at least that part had been covered.

In order to collect the samples, I had to visit a very dirty bathroom that reeked of – and was filled with pools of – urine. On a shelf to the right of the door, there were many urine samplers. I did not see any samplers specialized for stool collection, I therefore assumed that they simply did not exist as a notion in the USA and  opted to just use two urine samplers. While it is true that it is phenomenally easy for guys to collect urine samples, this is not necessarily true for stool samples, particularly for a person whose stool is almost entirely watery and bloody due to illness. For obvious reasons I will have to omit the relevant details, but it’s needless to say that I was disgusted beyond belief. I slightly soiled my clothes and my hands, and ended up washing my hands and the outer surfaces of the samplers for 5 minutes straight out of pure disgust. The entire process took me 30 minutes or so.

Once I walked outside the bathroom, samplers in hand, a mobile register was waiting for me next to my bed, in order to charge me my $150 co-pay for my treatment that day. Of course, Dr. D and the hospital got a piece of a much larger pie that day, courtesy of my insurance provider:

Insurance claim for ER Visit.

June 1st

The next day I visited Dr. C. That day was going to be Dr. C’s last day in the States before a vacation that would keep them outside the country until the 22nd of July, so that would be 21 days of a separation between us. The game plan according to Dr. C was for me to undergo an antibiotic – based treatment for about 10 days and, if things did not improve, call the front office and request the first possible appointment for a colonoscopy, because “the fact that you have blood in your stool worries me”.

It becomes increasingly hard for one to stick to the facts and just the facts here. For about a year of appointments, which included complaints from me about the flaring up of my disease from time to time, chief element of which was bloody stools, Dr. C had not been worried about the bloody stools. Only after I had to admit myself to the ER did they become worried about the bloody stools. Now that I am reading this italicized paragraph again, though, it still sounds like fact, I will therefore allow it.

I was prescribed the antibiotics I was given intravenously in the ER (Ciprofloxacine and Metronidazole), to be administered twice a day in pill form. I was also prescribed Omeprazole, to be taken “as needed” in case of nausea. In conjunction with my daily dosage of Lexapro, a common SSRI which I was taking for about a year to treat my depression and generalized anxiety disorder and which was administered and closely monitored by my psychiatrist, at that point I was taking 4 medications on a daily basis, three of which I was taking without any indication that they were actually going to work, because I hadn’t had an appropriate diagnosis. I essentially did not know what I had! At least the depression/ GAD had been properly diagnosed, more than a year ago, and the FDA-approved medicine was used to treat the diagnosed disease.

It was at that point that my situation became quality-of-life destroying (not just debilitating, the word has been carefully chosen) and, as the reader will soon see, even life-threatening.

July 2-6

Starting July 1st in the evening, I started taking my prescribed antibiotics. Very fast (Thursday 3rd) it became clear that I could no longer visit the office. On top of my symptoms, which did not improve, I had a close-to-complete loss of appetite, and an erratic sleep schedule. Any attempt towards creative/analytical thinking, the cornerstone of a successful graduate student and researcher, was hampered by abdominal pain, dizziness, and > 10 daily visits to the bathroom, with the same qualitative characteristics. Clearly the antibiotics were not helping. I had to drop my deadline, which I officially did on July 6, after an e-mail to my advisor and collaborators where I told them that I basically cannot leave the house because of my symptoms.

My situation was dire; I could not work and was staying at home, slumped on a couch, being unproductive, with medication that apparently did not work.

July 7-10

On July 7th, I called Dr. C’s office again, fully aware that Dr. C would not be available for an appointment and that I’d have to schedule an appointment with somebody else. I was told that a different doctor, Dr. E, would call me back with some information for me. They did so immediately (within 5 minutes or less) and proceeded to ask me about my symptoms. They then told me that the goal right now should be for me to combat the diarrhea and proceeded to prescribe to me what might arguably be the most curious prescription of them all: Cholestyramine in powder form. An inspection of the link, as well as the informative leaflet that I examined when receiving the prescription, both have nothing to say about the drug combating diarrhea. In fact, if the reader were to follow the NIH link I just provided, they would determine for themselves that diarrhea is among the known side-effects of Cholestyramine, the drug itself typically used for dealing with high levels of cholesterol in the bloodstream.

At any rate, believing that Dr. E, being a medical professional, knew what they were doing, I proceeded to add Cholestyramine to my list of medications, which was now engrossed to 5 different prescriptions. Dr. E also proceeded to tell me that if I was still having symptoms after taking Cholestyramine, I should contact the front office to arrange a colonoscopy with any available specialist. They also informed me that, on his end, it appeared that the soonest available appointment would be on the 22nd of July, which co-incided with the date that Dr. C would be coming back. Of course, at the time, it was of much more interest to me to actually have the procedure on the 22nd, rather than have another appointment during which I would state the same things over and over and only then would I be able to arrange a colonoscopy which, who knows, could take maybe 3 months or so to schedule, like my previous one in Fall 2013. To add to my temporary relief, Dr. E told me that other specialists in the office had sooner appointments available, even next week. It appeared that I had some help after all.

To no avail. Cholestyramine caused me extreme heartburn and an inability to properly ingest any kind of food. I arrived at a point that I started sleeping with my pillow propped up, in a semi-upright position, because whenever I lied down I felt that my partly ingested food (whatever little food I was eating, anyway) was being pushed upwards on my oesophgaus and I was not keen on dying of gastro-intestinal retrogression. So at that point I started really fearing for my life.

The morning of the 8th I phoned the front office requesting the soonest possible colonoscopy appointment. At that point, I was prepared to demand a same-day appointment if need be, or, at the very least, a pre-authorization to go to the hospital. I was desperate. The person on the phone told me they’d call me back. They did, quite quickly, and told me the soonest possible appointment that they could arrange for me would be August 14. Clearly they did not have the relevant context and attempted to book me through Dr. C, after examining their post-vacation schedule. I informed them that I’d talked to Dr. E and they’d mentioned that there existed closer options than that. They told me they’d look my situation up and call me right back.

Side note: Yes, I do have an excellent memory, which is unfortunate for numerous people that choose to think that, by default, people forget. I also tend to make very detailed notes and am a Google Calendar junkie.

So they did call me and suggested an appointment for July 22nd with Dr. E. At that point in time, with Dr. E’s prescription having brought me to my knees, and the 22nd of July being 14 days away (reminder: this is July 8) I re-iterated to the person that Dr. E  told me that certain doctors had next-week appointments for colonoscopies open, and I asked them to look those options up, because “I can no longer go to work, this is very serious”. They told me they’d look it up and call me back. I received no further calls that day.The morning of the next day, Thursday 9th, I called them again. They told me they’d call me back.

The morning of Friday the 10th, I called again, and I received the same response.

At 4:55pm, I logged into Skype and called my father through Skype credit, on his cell phone. The time difference between the eastern seaboard and Greece is 7 hours, so it’s somewhat fortunate that the man was awake. I asked him whether the private insurance policy that I had in Greece and which he managed and paid for 10 years would cover me in case of hospitalization, to which he retorted that yes, it did, 100%. I told him that in light of this, I would be booking a next-day ticket to come to Greece, and if he could make arrangements such that I’m looked after as soon as possible, that would be great.

And so I did, (booked a ticket, that is) for a hefty cost.

Ticket for Athenian trip

The ticket was one-way, since I had no idea when I was going to be coming back to the States, and in what condition.

July 14-July 22

I arrived in Athens the midnight of 12 towards 13, and spent a day at my parents’. My father had made arrangements for me to visit a local clinic on Tuesday the 14th.

Useful contextual update: Sunday the 12th of July was one of the most climactic days of modern Greek history, since the Greek government was negotiating a financial care package with the Eurogroup. The possibility that Greece would leave the Eurozone (the so-called “Grexit“) was higher than ever and, given the level of collaboration between the Eurozone and the European Union itself, the status of the country as a member of the EU and the corresponding Schengen Area would also likely be jeopardized. To the day of this writing, the repercussions of that negotiation are still visible; banks have issued capital controls which do not allow people to withdraw more than a certain amount of cash on a weekly basis, and there exists massive unemployment and budget cuts across the board. The collective spirits of the Greek people are at an all-time low, and people generally want to leave. It might naturally seem, therefore, as if I was between a rock and a hard place; extreme medical malpractice in the United States on one hand, and a devastated country on the other. Surely this guy’s health is doomed. This might make the following events even more surprising for the reader, and might raise interesting questions about the efficacy of the health system of the United States, generally considered the wealthiest country in the world, when compared to that of Greece, generally considered a failed state.

Upon arriving at the clinic, I was immediately rushed into the ER, where bloodwork was gathered within 5 minutes. Two physicians arrived 5 minutes after that, and asked me questions about my symptoms. Not one hour after I arrived in the clinic, I was on a wheelchair on my way to an ultrasound. Immediately after that, I was sent downstairs for X-rays. Within 2 hours after I arrived at the clinic, I was admitted to the hospital proper, into a room of my own, with all amenities included, including a TV set and a view.

The view from the balcony

Immediately, nurses arrived, hooked me up on I.Vs and gave me both detailed instructions and suitable equipment for collecting urine and stool samples. There was no question of my bathroom reeking of urine; it was spotless. I was also told that if I had any trouble collecting my samples, I should hit one of the buttons on the bathroom wall and I would be receiving help promptly. I did not need any help.

A next day endoscopy and colonoscopy was arranged. In the meantime, my I.Vs (which contained the same antibiotics I received in the States as well as natural serum) were being changed as needed, and nurses would arrive and check my pulse and other vitals every 4 hours. Clear instructions were given to me about the colonscopy: there was absolutely no food after 12pm on Tuesday and at 4pm I started the laxative treatment. The reader can be assured that by 12pm on Wednesday, when I was wheeled towards the surgery room to get my colonoscopy, my colon was spotless.

My diet closely monitored, I had nothing to eat Wednesday and only one light soup Thursday. On that day, I also received my diagnosis: Ulcerative Colitis, along with a touch of Gastritis and Bulbitis, perhaps caused by the Cholestyramine, since I was not having issues with my stomach before taking that particular drug.

A subset of my discharge notes

In order to cause the colitis to go into remission, I needed to start an administration of a cortizone-based medication (Prezolon) and specialized medication for Ulcerative Colitis based on Mesalamine: Asacol and Salofalk. I stayed in the clinic until Wednesday the 22nd of July. By Monday the 20th, after intensive drug treatment and monitored diet, I no longer had blood in my stool. Tuesday I started eating solid food again. On Wednesday, I received my discharge documents and the G.I doctor came to me with the grim news: I would need to follow a very thorough medication schedule over the course of several months if I wanted this to go fully into remission. In detail, I would need to be taking (and am currently taking) the following medications:

  • 6 5mg pills of Presolon in the morning, and 6 at night-time. A steady 5mg per week decrease of the dosage would effectively lead us from 6 and 6 to 6 and 5, 6 and 4… all the way to the end of the 12 week period, well into the Fall semester. The cortisone treatment being as heavy as it is, the doctor warned me that there exists the danger of my body not reacting well to the decrease of the dosage, at which point I will need to have them on call to discuss what to do (and really, the only thing to do would be to go to the clinic again and re-evaluate the drug treatment with them).
  • 3 800mg Asacol tablets, administered every 8 hours.
  • 2 20mg Losec capsules before lunch and dinner.
  • Self-administration of 4gr of Salofalk every night before sleep.

Which of course led to an interesting schedule, drug-wise:

My medication schedule

It immediately became clear to me that given: (a) The number of different medications that I would need to take over the course of the following months, (b) The health risks imposed by the necessity of the cortisone administration and (c) The fact that I simply no longer trusted a single G.I doctor in Maryland with prescribing me meds or seeing me if things went awry, I would not be able to return to the USA until the disease was under control. This would undoubtedly cause me a research roadblock, jeopardize my funding (which did end up going away in its entirety) and, as of the time of this writing, has been causing me major bureaucratic issues with respect to maintaining my student status in CS UMD as well as with procuring documents that I need in order to extend my lawful leave from the Greek Army due to PhD-level studies.

Note: The medically astounding way in which I was treated in Greece is also the product of the fact that I am the holder of a private insurance policy in that country. It is common knowledge in Greece that the public healthcare system, despite having great doctors, is impoverished enough to be lacking in even elementary medical supplies, such as band-aids. I have no doubt that if I had to depend on the public healthcare system of Greece for my treatment, I would not have had this experience. My parents were smart enough to sign me up for a private healthcare plan ten years ago, when the premiums for such plans were still tractable. Ever since, my family has been paying for this plan without me ever having to use it, until now. To make ends meet, my father had to drop his own plan. We are what used to be called in pre-2009 Greece “classic middle class”, and we cannot afford maintaining such plans for all three of us (yes, I’m an only child), nor would we be able to afford such a plan if it had not been signed for 10 years ago.

Given the fact that my family has been paying money for this plan and I myself have also been paying money out of my paycheck for the aforementioned US-based Insurancy Policies A and B, I do not see why my experience with my Greek private healthcare provider does not lend itself to comparisons with Insurancy Policies A and B, merely because the public healthcare system in Greece is lacking.  In fact, if one were to compare the two countries’ public healthcare systems, it is not clear to me who would be the winner even then. Yet this is not the goal of this post. 


July 22 – Present Day & Wrapping up

I am stuck in Greece until January 2016, essentially recuperating from my disease. The disease itself is going to be there for life and will flare up whenever I stress up. If diagnosed at the proper time (Fall 2013 or even sooner), the colitis would not have me essentially miss an entire academic semester in Maryland (I’m currently trying to make research ends meet from a distance of 7 timezones, and it’s anything but easy). It would not have me pay $1200 for a ticket back to Greece, nor would it essentially limit my professional and academic prospects in the US, since my research project is now up in the air and I can’t attend meetings, internship/job interviews, can’t talk to people in person, and so on and so forth.

The aim of this post has been to make my situation known and allow the reader to draw conclusions of their own, particularly now that so many people are transforming themselves into academic Type-A personalities and are considering moving to the States to avoid the financial or other peril of their homelands. Perhaps most striking, in my opinion, is the fact that I’ve been a victim of this neglect from different G.I doctors. In fact, there only appears to exist a correlation between Drs C and E, since they work under the same firm. Drs A, B, D and the group (C, E) are all pairwise uncorrelated as far as my case is concerned, and when a common signal of neglect arrives from all those uncorrelated sources, it clearly means that the patient is faced with one of two conclusions, which do not have to be mutually exclusive:

  1. There exists a general incompetence of G.I doctors across the USA or Maryland board.
  2. There exists something in my insurance policy that makes them not like me.

The other thing that is striking is exactly that which I mentioned in #2 above: I have been a victim of such neglect while being insured. It is common knowledge in the USA that if one is not insured, then they are doomed. But what about insured people? I performed thorough research before selecting Insurance Policies A and B, and my primary factor for choosing both has been the fact that hospital inpatient services are covered 100% within in-network facilities. In the area that I live, essentially all facilities are in-network. Despite this, as mentioned in the section of the text that detailed my ER visit, I was never given the pre-authorization necessary to take advantage of this benefit.

I am currently in a state of complete shock regarding the way that I have been treated by all those medical professionals, and it has made me re-think whether I want to stay in the USA for my future, a fact that would’ve been indisputable for me two months ago. I daresay that for people that are as qualified and hard-working as me (and we are overflowing with such people in CS UMD), it constitutes a fantastic loss for the USA to lose out on us either because the local doctors are incompetent or because the insurance policies they give them are flawed in a fundamental manner, causing doctors to not want to see us.

Thanks for reading.