Japan and My Tonsils: The Healthcare Strikes Back

Read Part 1 here.


Part 2

When last we saw our hero, me, I had just recovered from my first bout of Japanese strep throat. I had taken the four days worth of antibiotics, which seemed to do the trick. I felt better, my fever was gone, and my throat was pain free. I was a little concerned however, since my tonsils seemed to be a little swollen. I decided not to worry too much and went on with my life.

After another couple months I got sick again, went to a different doctor who became my primary care physician, and got more medicine. Again, only four days of antibiotics. Then two months later I got sick again. Another four days of the same antibiotics. Three months later, sick again. Four days of antibiotics. I would have been concerned except my doctor seemed incredibly unconcerned. I would go see him, he'd ask what's wrong, and I'd say the same thing as always. He would laugh, "Haha! Again? OK, here's your four days of antibiotics." This went on for years. I kept saying I should have my tonsils out but the doctor said it wasn't necessary. In hindsight, I should have gotten a second opinion. Maybe I could have convinced someone else to give me stronger medicine for more than four days and finally had this strep knocked out for good. I still wasn't confident enough in my Japanese, though, to go to a non-English speaking doctor. And when it comes to English speaking doctors in Japan, the pickings are slim.

Two months ago, over the winter break, I went back to America to visit my family. Two days into the trip I got strep again, as usual. Fortunately I was expecting this and already looked into how my insurance worked to make sure I'd be covered. I was excited. An American doctor with American drugs. The strength of American drugs was probably best summed up by Jerry Seinfeld who said, "Figure out what will kill me and then back it off a little bit." I got ten days of meds at two grams a day. That's almost seven times more powerful than the Japanese meds for over twice as long. Each pill was almost the size of a Werther's Original. It was some powerful stuff. I felt better after two days but of course took the pills to completion. I hoped this would be the end of it.

A month later, back in Japan, I got sick again.

I went back to my normal doctor for the last time. I brought the empty bottle of the giant America pills as proof and explained that if these didn't work, then obviously weak pills for four days wouldn't either. I asked him again about surgery or his opinion on taking literally any other option instead of the same pills for four days. He said he still didn't think I needed surgery. It was just because of this dry Japanese air that I was getting sick. He said he'd try something new though. He handed me my prescription, reminded me to gargle, and sent me on my way. It wasn't until I picked up my meds that I realized it was a prescription for the same pills as before, for five days.

I took the pills but after four days I saw little improvement. It's a bit scary when antibiotics stop working. I realized I needed a change. I needed stronger drugs, or surgery, or something. I didn't really know what to do. I decided to leave that to the professionals. I noticed there was an ear, nose, and throat doctor near my house. My Japanese had improved by this point and I felt confident that I could make myself understood. I went and at first I thought he was great. He looked at my throat with a bunch of different shiny metal sticks and depressors and magnifying thingies. He even wore that classic doctor's reflective circle on his forehead. He seemed confident until I told him that I was already on antibiotics. He asked to see them and I showed him. "But these are for five days! These aren't working?" No, I told him, they weren't. I showed him the American med container and pointed out how much stronger they were. I asked if maybe he could just prescribe me more meds to take with these antibiotics. He sat there with his head down looking at his notes, taping his pen, and muttering "geez, what to do..." Eventually he made a decision, wrote me a script for more meds, and I left.

I was happy. That doctor had seemed to take this seriously. He hadn't laughed and brushed it off like I was used to. I looked at the prescription and was pleased to not recognize it, meaning it was something new. I had hope. I took the prescription to the pharmicist to have it filled. She asked if I had any questions. I asked her if I could take ibuprofin with this medication since I found ibuprofin was always good for pain and fever. She said, "well... this is ibuprofin... so no." Wait, what? I asked her to clarify; these aren't antibiotics? "Nope! Ibuprofin! Here you go! Odaijini!"

Ibuprofin?! A pain killer?! I don't need a pain killer! I need a strep killer! I was frustrated. I went to two different doctors and neither of them seemed to be taking this seriously. Then I started thinking, well maybe it's not serious. Maybe everything I've heard from others and the entire internet is wrong and strep isn't actually dangerous. Maybe I could just let my body fight it off on it's own.

No. I want my tonsils out. I'm sick of them and I want them out, I finally decided. I will deal with these amatures no more! It was time to find a surgeon.

In America, as far as I know, all ear, nose, and throat doctors are also surgeons. They're all qualified to remove tonsils. I wasn't sure of the situation in Japan but I decided I needed to find a good one. If he didn't do surgery then maybe he could recommend a hospital that does. I put my request on Facebook to see if my Japan based friends new of any good doctors. I got a reply from Paul's (this site's owner's) girlfriend, Yoshie. She had taken it upon herself to do research and it appeared there was a famous doctor that was only about 40 minutes away. A famous doctor? Sounds great! I went immediately.

What followed was the most bizarre experience I've ever had at a doctor's office. It cannot be put into words. Except it will be.

Stay tuned for the next chapter, Japan and my Tonsils: Celebrity Doctors and The Looming Surgery!

Japan and My Tonsils: An Epic Tale of Love, Tribulations, and Redemption(?)

Part 1

I hate my tonsils. I hate them and I want them out. Years I've spent alternating between agony and fear. Agony as they swell to the size of golf balls in my throat, raising my temperature, and preventing me from eating delicious foods since starving always seems the better option to the pain of swallowing. The fear would set in as soon as I felt better. As soon as they shrunk to a size that could pass for normal I'd worry about the next time. Possibly the cruelest part was that one of my greatest joys, a night out with friends singing karaoke and drinking beer, seemed to be the magical combination that would nearly always lead to my personal tonsil apocalypse.

Why don't I just get them out? The issue is complicated by my current location. In America I'd simply go to an ear, nose, and throat doctor, pay $5000, and my tonsils would be gone as soon as the check cleared. But I'm not in America anymore. I'm in Japan. The medical system here works a bit differently. But I'm not going to tell you about it. I'm going to show you. I will take you on my adventure from my very first week in Japan until today.

July 2008

It was a long flight. I left from Los Angeles International Airport and arrived in Haneda after 11 hours of flight time. It was also a late night as my new friends and I celebrated our first night in Tokyo, Japan. Long flights, new germs, lack of sleep, and alcohol: the perfect recipe for getting sick. My comrades and I spent four days in close quarters as we attended lectures on how to adapt to our new lives as English teachers in Japan. This time for me was one of wide-eyed discovery. To the new, unwelcome residents of my tonsils however, it was the incubation period.

The morning of the fourth day we set off on the Shinkansen to Osaka. I noticed I had a bit of a scratchiness in my throat and voiced my concern to my new friend, Brian. "It's just allergies!" Oh the young fool I was believed him. We enjoyed the 3 hour trip, making new friends and drinking green tea.

We finally arrived in Osaka and switched to buses to continue our journey to Hyogo Prefecture where we would meet our representatives from each of our respective schools. I was starting to feel a bit cold despite the hot, humid, Japanese summer. I felt a pang of worry as I realized I was indeed becoming sick. "No matter," thought I, being the burly, young man I was, "Immune system! I leave this to you! I have other matters to attend to." My immune system was too busy to respond. My mind moved on to other things as we arrived at the meeting hall. There I met my school's representative who was to be my English speaking go-between. He would help me in all matters in which I may need help while adapting to Japanese life. I said goodbye to my new friends, swearing to contact each other once we acquired mobile phones and the Internet, and continued traveling to the high school in which I would be an English instructor.

The ride was pleasant with interesting conversation. I was happy to learn I would be teaching with this person. My new friend.

Arrived at school. Something wrong. I was hot now. Couldn't think... straightly. Tired. Meeting principal. Hello! Bow. I konnichiwa... hajime... yoroshiku... Bow? Ah tea, yes tea is good. It reminds me of... other hot drinks I've drunk. Yes, let's see the school. It looks nice... where are your beds? I would like to try out... pillows. Tired...

After a couple hours it was finally time to see my apartment. My go-between and the office clerk took me. The bed looked wonderful and I yearned to simply jump inside. But first I had to be shown all the other wonderful details of my new apartment. Push this button for hot water, push this button for hot air, push this button for flushing the toilet, buttons, buttons, buttons. Switches for lights, switches for power, switches, switches, switches. Plugs and outlets and appliances and machines. Cracks and holes and dents and dings. How much time had passed? I wasn't sure. Now it's time for the tour of the city. "NO! BED! Bed would then be too far for sleeping in!" the voice of my immune system yelled in my head. Ol' immuney finally spoke, and he was right. I was sad to admit defeat after trying so hard to make a good first impression as a young, go-getting teacher, but I was finished. I told them I felt sick and just needed to sleep. My predecessor was still around the city and he could give me the tour later. They exchanged looks (concern? disappointment?) and wished me well.

The next day I decided I was sick. Seriously sick. My throat hurt. It was a test of will to swallow. My tonsils were not looking good. They obviously were taking one for the team. I knew what was wrong now though. I had seen this before in childhood. Strep. I was sure of it. I got it fairly often as a kid but hadn't had it in years. I had just arrived in Japan but I thought it was already time to meet my first Japanese doctor.

Strep throat isn't a disease to be taken lightly. Caused by group A Streptococcus bacteria, strep throat usually starts with the swelling of the tonsils which soon become covered in white patches. Other common symptoms are pain/difficulty swallowing, nausea, high fever, and low energy. It differentiates from other throat infections by a lack of coughing and congestion. It is very common in children but rare in adults. It's seen as an annoyance nowadays. Start on a regimen of antibiotics and you'll feel better almost immediately. It's easy to forget the days before Penicillin. This disease was the deadly and feared scarlet fever. If you've ever read the children's story The Velveteen Rabbit the very sick child had strep. Strep if left untreated can do serious damage to heart, kidneys, and other organs. Friends of my parents made the decision to let their daughter recover naturally from strep without antibiotics. Sadly, a month later, she passed away from a ruptured appendix. The link between the untreated strep and her appendix was theorized but not proven. Having recently heard this story I knew that I needed some good, strong medicine.

I went into work and talked to my go-between, "I need a doctor. And medicine." OK! Phone calls were made and he took me to a nearby English speaking doctor. It was his one day a week at that location so I was lucky. I explained my problem, told him I was allergic to Penicillin, and he prescribed me another antibiotic, a cephalosporin. Four days worth. Four days? I thought the worldwide standard for antibiotics was seven to ten days? Isn't four days the point when you feel completely better and stupid people stop taking their medicine and end up creating unstoppable, drug-resistant super-bugs? Well, maybe this is some powerful stuff. I paid my 1000yen, about $10 then, for the drugs and office visit (thank you cheap, Japanese health care!).

I took the medicine and after four days felt great.

But it was not to last.

This tale is not over. It is merely beginning. This was simply the first act. The start of my three year tonsil hell. Stay tuned for the next edition, Japan and My Tonsils: The Healthcare Strikes Back!

A visit to the doctor

I don't know if it's the same in America; maybe it varies by school. But here in Japan, public school teachers must have a health check every year. Actually, it may be all public workers (or I may have made that up). Either way, usually some doctors and nurses come to the school and administer the checkups to the staff here all on one day. This year I was away on a business trip, so I was responsible for getting my own checkup. Only I was limited to one place - I had to be checked there. Why? I dunno - I'm sure there's some bureaucratic reason lurking somewhere.

So I made an appointment, which in and of itself was no easy task. Apparently they were all booked up for the next week or two. After I told them that I had to have this done by the end of August, they agreed to squeeze me in. In retrospect, I don't know what the big deal was...but I'll come back to that.

On Sunday morning I set out. This place was a bus and a train and a 15-minute walk away, so I was plenty hot and sticky by the time I arrived. This isn't the first time I've been to a medical institution in Japan. I've previously been to a hospital in Tokyo, as well as a couple clinics here in Kansai. This place was different, though.

As soon as I got to the reception desk, I noticed that about 2/3 of the people in the lobby waiting room were wearing some kind of blue pajama/scrub hybrid. Joe had mentioned this to me before - that patients at these health check centers have to wear some kind of hospital gown. Luckily, maybe because I had a limited checkup or because my school has a relationship with this center, I didn't have to don the pajama-scrubs.

The place was rather interesting, and different from any checkup I had ever had back in the States. Not necessarily bad different, but certainly different different. For one thing, there were about 20 gajillion nurses calling patients' names and herding them around. And when I say "herding," that's what I mean. Essentially, this place was broken down into at least a dozen different stations. Each station was a different part of the process. You'd sit in the lobby and wait for your name to be called. Then you'd go to some little cubicle in the hallway with the nurse and answer some questions, like when is the last time you ate (there's an X-ray, so you aren't supposed to eat  for like 12 hours prior) and if you've had any illnesses recently. Then you wait again. Then they x-ray your chest. Wait again. Then your name is called and you go pee in a cup (interestingly about that - you don't hand them the cup - there is a little window IN THE BATHROOM that I suppose borders on the lab, and you leave your cup there when you're done). Then you go sit down and wait again. Then you have your eyes checked and are weighed and measured. Wait some more. Then the doctor sees you for about 20 seconds to check your breathing. Then you bring your chart to the front and can leave.

It took me about an hour from the time I checked in to the time I left. I was surprised - although I've had quicker checkups back home, this place was pretty fast and efficient considering how many patients seemed to be flowing through. The only downside is that my overall impression was of cattle being herded around. The nurses and staff were friendly and polite enough (in typical Japanese fashion), so it wasn't so bad, but it wasn't personal at all. Then again I guess that's the nature of this kind of thing - it's not like you're going to see your doctor. Thus I was a little puzzled, in retrospect, that the woman on the phone had told me she could squeeze me in to see the doctor. I spent all of 20 seconds with him!

Probably the strangest part was that after I finished, the lady at the reception desk gave me this ticket to use the public pool in the building. Uh...ok? Let me just change into this swimsuit I brought along just in case.

Only one coupon use allowed per 6 months. Dang.