A Brain Aneurysm – as I understand it.

A brain aneurysm is a disorder in which weakness in the wall of an artery or vein in the brain causes a localized ballooning of the blood vessel there.

This weakness in the wall is supposed to be a congenital problem -something you are born with. High blood pressure, stress and time cause blood to push against this weak wall and one fine day a sneeze, a fall or a stressful situation can cause it to burst. Then you have a brain hemorrhage. Blood leaks into the brain. Depending on the amount of blood leaking you can end up with a terrible headache or a stroke or death.

Once you have an aneurysm – and it is detected due to a cautionary angiogram or a leak - it needs to be blocked/sealed so it cannot seep blood or burst. There are two ways to go about it – a brain surgery or endovascular coiling. Brain surgery – is surgery, they cut your skull and brain and get to the aneurysm and take care of it. A more recent – since 1991- method is coiling where a catheter is inserted up an artery and used to fill the aneurysm with platinum coils. It is less intrusive and has a faster recovery period. However this procedure is not available everywhere and is more expensive. In certain situations a surgery is the only way to go.

My mother had a brain hemorrhage but many stars lined up to ensure that the leak was very little – she was lying down when it happened ensuring she did not hit her head in a fall, her blood clots easily thus reducing blood flow, she was in a house with doctors so she was not moved around much and above all at 51 she is very young. She was in terrible pain for days and on steroids and pain killers for even more.

The pain after the aneurysm burst can be unbearable and spasms continue for 21 days after, until the blood is absorbed and the pressure in the brain released. The blood in the brain causes pressure and irritation. It is the amount of blood that determines your long term prognosis. Lesser the leakage the better it is.

Brain aneurysm can be detected by a brain angiogram but it is not cost effective (in India it costs about Rs 30K or $600 but I am sure it is way higher in the US) and can have medical complications. However I do hope that the cost and the risks associated with the procedure come down. As at this point I feel that if one has a family history of this issue and faces migraines scheduling a brain angiogram might not be a bad idea.

Medical tourism - the good and the bad

I had heard a lot about medical tourism. People coming to places like India for treatment. It is impossible to get a heart valve replacement for under 15k with quality care in the US (stay and medication included). They have packages for almost any treatment you want - nose job to brain surgery- and try to ensure that hospital facilities are at international standards.
However my stint here - and watching a Nigerian man in the bed next to mom's- made me realize that if you can afford it and the treatment is good then you should try to get treatment in your home country. A place where you understand the language, like the food, trust the environment and can have family and friends around. It is hard being sick but it is worse when you are in a foreign place. This goes for taking parents from India to the US for treatment too. The doctors and facilities are great here if you go to the high end hospitals- maybe better in some cases - and they will feel more at home. Emotional well being plays a huge role in getting better.

Positives (for foreigners):

• It is cheap(er) than in places like US.
• The waiting list (for things like heart valve replacement) is non existent as compared to UK.
• There are clearly structured packaged for a service you want so you are know up front what you are paying.
• Translators are available for patients that do not speak English or Hindi
• There is a special lounge for international patients with tea and coffee, money exchange and news going on on TVs in different languages.
• Plenty of bed and breakfast serving 'fish and chips' (meaning non India food if needed) for dinner have cropped up around the hospitals. They have websites and are very reasonably priced (under Rs 1000 per room + food per day). Many offer pickup and drop off to the hospitals.

Negatives:

• If you are not Indian it is hard being sick in a strange country - in the ICU I have seen patients that don't feel at home - the accent, language and food (however continental they try to make it) is not home like.
• Caretakers can feel a little lost. Indian ways are different - doctors are good but constantly on the phone, the staff might not understand you but will pretend they do.
• Cleanliness is high compared to other places in India but still nowhere near US standards.

Personally for me, Apollo Delhi trying to be a huge medical tourist destination, really helped with my mom's recent visit to the ICU. The equipment (MRI and CT scanner, ER equipment, portable ECG and X-ray) was the latest, doctors and attending staff had impressive bedside manners (unlike the more arrogant and dismissive attitude I had see years ago). Cleanliness and niceness in dealing with the patient's attendants was worth noting.

With my light eyes and brown hair - the foreign look- it was assumed I was a foreigner at many points. When it meant easy access to visit my mom I put on an accent and really rode the medical tourism train. So for me medical tourism is good. Very good.