Traveling and in center hemodialysis

Discussion in 'General Discussion | Travel' started by iolaire, Jan 7, 2014.  |  Print Topic

  1. iolaire
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    iolaire Gold Member

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    In December I started dialysis with in center hemodialysis, something I knew was coming for at least five years. (Two weeks before I received my first call from the Kidney transplant list, but the match was not good - ideally this is a short term situation.)

    It seems like I’ll be able to keep up our travel schedule of a few international trips each year as long as I plan out my in center treatments (three times per week). Non US travel will be self-pay so that will be an added cost to each trip.

    Does anyone here have any experience traveling with in center hemodialysis? I’m really interested in real life experiences, good centers and self-pay costs etc…

    (cross posting on FlyerTalk)
     
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  2. chrislacey
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    chrislacey Milepoint Guide

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    Hi iolaire,

    I have no experience, but did want to wish you all the best with your treatment and hopefully only a brief wait for the transplant. Hopefully someone else can chime in with some real life experiences for you.

    -Chris
     
  3. Newscience

    Newscience Gold Member

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    iolare
    I can only second Chris Lacey's response. Let's hope that someone on Milepoint or TOBB can help you with direct hemodialysis experience. In the absence of that, I'd be chatting up all the relevant physicians to get the best medical opinions possible, but I'm sure that you already have done that. I hope that a new kidney transplant news will be quick in coming, and absolutely don't hesitate to reach out for advice and assistance!
    Newscience
     
  4. iolaire
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    iolaire Gold Member

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    Here is an update on what I’ve found at this point. I’ll post some pricing quotes from Singapore Centers after I return. My DaVita center will only schedule travel for me to visit other DaVita centers in the US. That's helpful but doesn't cover the world.

    I'll be in Singapore in a few weeks and set up my own appointment (via email) at a Fresenius related center. My DaVita nurse helped fill out their forum with everything expect for orders for a current HIV test. I emailed four different centers found via http://www.fmc-sg.com/patients-and-caregivers/holiday-dialysis/select-a-destination to get pricing (all around $500 Singapore dollars/session) and all responded. I’ve learned that out of the US as a Aetna member I’m self-pay but may be reimbursed 50% as an out of network treatment.

    It seems like Fresenius is the best source of global centers at this time. There is another site that tries to list centers with reviews - http://www.globaldialysis.com/ - but it doesn't seem like it has much traction and the reviews are very spotty. Also the forums at http://ihatedialysis.com/forum/ have some travel related information with comments on some centers in places like Italy and Croatia.

    Also interesting all the places in Singapore do 4 hour dialysis sessions, versus here where its 3.5 hours (or less depending on the persons weight).
     
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  5. iolaire
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    iolaire Gold Member

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    (This post will be cross posted on flyertalk and the ihatedialsyis forums.)
    Holiday Dialysis in Singapore

    Background, in December of 2013 I started dialysis (hemodialysis) at 39 years old. Dialysis is three days a week for three and half hour commitment hooked up to a machine that filters my blood to replace kidney function. Amazingly, you can live with zero kidney function. My loss of kidney function was due to SLE (Lupus) damage in the early 1990s. At that time, I knew that my kidneys would get worse and i would have problems, but at 18, I didn't really have a clue what it would mean. Fast forward to 2007, when I was in the hospital for high blood pressure and was told it was kidney related. So for the past six years, I've been seeing a nephrologist tracking my kidney decline. It was helpful having a trained kidney doctor guiding me. He had me get a fistula on my arm, i.e. connect an vein to an artery on the arm to make an enlarged vein that would allow a huge amount of blood to flow back into the arm. He also pushed for me to get listed on the kidney transplant list. Because of that, I received my call on the first potential donor three weeks before I started dialysis.

    I'm on in center hemodialysis. There are other methods of dialysis, and many people manage dialysis at home. I hope to be the recipient of a kidney transplant at some point relatively soon I'm no planning on moving from the center. That means if I travel I will need to get in center hemodialysis.

    So dialysis is a change, and ties down Susan and myself a bit. But, I'm generally healthy, my lupus has been in remission since 1993 and am able to handle work and daily functions, which is a blessing. So my goal is to let it change my life as little as possible. And our pre Dialysis life is lots of travel - in 2013, we visited Austin and Petersburg, Alaska for my 20-year high school reunion, St. Louis, Cape Cod, Budapest, San Antonio, San Francisco, and Cabo San Lucas.

    I was happy that our next trip was Singapore - a truly modern location and a good place to my first out of the country dialyses. My Davita center will help schedule dialysis at other Davita centers in the US, but only will help fill out the intake paperwork for other faculties - so I was on my own to find my Singapore center. And it's still unclear if my heath insurance will pay for international dialysis, it should cover it as out of network but I envision having some issues completing the reimbursement paperwork - so the overall cost was important to me.

    Google searches for Singapore Dialysis found Raffles Dialysis Centre which even had a web page setup for their center. An email to them resulted in rates that were $500 each session plus one $125 doctors consultation. That pricing is much less than my center charges ($1,400) but seemed a bit high. I was having problems finding other centers so I moved to the Duck Duck Go search engine and found the Fresenius Medical Care Singapore website which had a holiday dialysis webpage that listed various centers by region of the city of Singapore (http://www.fmc-sg.com/patients-and-caregivers/holiday-dialysis). Through that site I emailed a few locations and finally settled on NephroCare S&J Dialysis Centre (http://www.fmc-sg.com/nephrocare-s-j-dialysis-centre) which charged $400/session, plus one time $60 registration and $80 doctors consultation fee. The ideal thing is I was able to setup the two sessions entirely via email. The more complex requirement is that they needed an HIV test, which my dialysis center would not order, so I had to go to my primary doctor to get that filled.

    So how is Singapore dialysis different than here in the US? For one thing, they didn't think I would fit in their seats so they put me in a (short) bed. In my center, the techs prep all the material they need in advance in a bundle and distribute it to the machines - in Singapore they had a commercial pack that included everything that was needed, but they they don't use single use alcohol pads, the pack included a plastic box like a lunchables container, which they added both saline to, as well as alcohol, so they could pull what they had needed from. Then, they did use a single use alcohol pad to wipe the needles before they were removed from my arm.

    Best of all - likely due to the British influence in Singapore - they offered tea or coffee and crackers mid-dialysis!

    So looking forward to 2014 we will take more domestic quick weekend trips from early AM on Saturday to Sunday or Monday so I don't need to scheduled dialysis away from my center. And for international travel we have a trip to South Africa in September, there we will give up one of four safari days so I can get my dialysis in the Johannesburg area twice, before moving on to Cape Town and completing a few more sessions.

    I think we will do more travel to Europe and more developed destinations and I will end up being dialysis at more Fresenius centers since they seem to be a global brand with centers throughout Europe and even Asia. Of note my center uses Fresenius dialysis machines.

    Photos attached of me on dialysis, the tea and crackers, and then a shot of Susan and myself in transit.
    IolaireBed.jpg Food.jpg SusanFlight.jpg IolaireFlight.jpg
     
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  6. iolaire
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    iolaire Gold Member

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    And now time for a quick trip report on dialysis is South Africa. Last November I talked my wife into heading to South Africa for a quick safari and then some time in Cape Town.

    Qatar Airways ("the five star airline") had just joined the OneWord airline alliance so we were able to us our American Airlines miles for a One Word Explorer award, the benefit of this now retired award was that it is distance based and you could do stopovers as you desire as long as you fly two One World carriers. That allowed us to fly business class to Johannesburg via Doha on Qatar, go on a Safari near Johannesburg and then continue on to Cape Town on British Airways. Nothing too complicated for this type of award but still a great award - especially in light of the fact American retired the award as part of their merger with US Airways.

    So I booked our flights in November and then in December started dialysis. In February I was able to get my Dialysis in Singapore - which is a very modern destination and found the center very similar to my center at home. But still I had some reservations heading to Africa and getting my dialysis. But from my research and feedback on the forum ihatedialysis.com ( http://ihatedialysis.com/forum/index.php?topic=30787.0 ) it sounded like the private healthcare system in South Africa is good - but not the public system. Also throughout the summer I received some calls from the kidney transplant center so I thought by the time the trip hit I'd have a new kidney and need to cancel the trip. So we bought good travel insurance and waited until the departure day.

    Using the website globaldialysis.com I reached out to two centers in Johannesburg via email and only FMC Morningside Kidney and Dialysis Center responded ( http://www.globaldialysis.com/compo...2Task=centrez2Details&catid=&centrez2Id=43038 ). The prices sounded reasonable and they took some orders from my center with out the need for a specific form or an AIDS test like Singapore required. A few weeks before departure the coordinator at Morningside recommended a Cape Town site and I was able to get spots there. In general the centers were very accommodating and let me have my preferred times. I appreciate that since at some centers that means someone gave up a time slot to accommodate me.

    Finally the day arrived and we headed out to Dulles and waited for our flight in the stylish Virgin America lounge. The Qatar Airways business class service was wonderful, not as intimante as first class but the food and service was comparable. We arrived in Qatar just in time to do the last free city tour of the day. Braving 104* weather a 8 PM we got to see some of the new downtown that sprung up since 2004. Then when we returned to the airport for a lounge dinner, then headed to the Marriott for four hours of sleep before continuing on to Johannesburg.

    Our Doha to Johannesburg flight was on the fairly new Boeing 787 Dreamliner. It was a nice flight, but for couples it doesn't really offer close seating, and when in a bed position the window seats have a fairly tight area for your feet. My personal feeling is that for couples the older Boeing plains flying to Dulles are nicer.

    Upon arrival to Johannesburg we took the nice modern Gautrain to Sandton and walked a few blocks over to the Hilton. After waiting about 45 minutes for checkin we were offered a decent suite with lounge access. The excitement for the nap was a stewardess entering our room well we were napping - I guess its hard to figure out when you put someone in room!

    So the next morning at 5 am I walked over to the dialysis center. It looked to be in a business park connected to a hospital so I entered the hospital and they had someone walk me over through the dark business center to the appropriate building.

    At the dialysis center I found very modern facility with newer machines. As in Singapore they provide a drink and a snack during the session, which is quite nice. The snack was actually a grilled cheese. Clearly the labor costs are lower as there are people doing specific jobs, such as serving food, setting up the dialysis machines and cleaning throughout the day. Overall it was a comfortable center and I was done a bit earlier than I expected so I was back at the hotel prior to Susan getting picked up to go on the Safari - which was good as I'd expect the driver would have had a hard time finding where the center was.

    We spent three great nights at the lodge and got to see our fair share of animals! The highlight was a herd of about seven elephants visiting the watering hole right in front of the lodge.

    After our safari we drove back to Johannesburg and I went directly to dialysis well Susan headed to the airport. Our 7:50 flight had been canceled so we were on a 7 PM flight with me arriving to dialysis at about 1 PM, however I was not hooked up until about 1:45 PM so I quickly realized that I could not do the full 3.5 hour session and cut it short to 3 hours. Even with that the time to get to the flight was very close. After I disconnected and walked out onto the street I experienced my first experience of a bleeding arm, so I had to head back for more tape. Luckily I arrived at the Gautrain just as one was arriving and I got to the airport with maybe 15 minutes to spare.

    In Cape Town, I found a smaller facility, but with the same modern equipment. The snack was a cold chicken salad sandwich, apple, and tea. Not quite as good as the hot grilled cheese, but still much more civilized then at home, where nothing is offered. The one downside is the center was about 30 or 40 minutes from City Bowl. Later on the street we saw a dialysis center very close to Long Street and City Bowl, that would have been much more convenient - but harder to schedule since it didn't show up on the Global Dialysis site.

    So far I've only seen very good facilities when traveling and see no need to let dialysis keep you at home - as long as your underlying medical issues are stable and you have private insurance that reimburses the session cost.

    Once you move to Medicare (after 3 years) they don't cover outside of the US treatment. So far international treatments have been just under $300 per session. (That is about what Medicare pays at home, versus my insurance that is billed $5,400, and then pays a negotiated rate of $1,400.)

    In addition to international travel I've had treatments at DaVita centers in Austin, Boise, and Kansas City and they are are comparable to my local center.

    Photos attached show the Johannesburg center's checkin, machines, my snack and a few safari photos.
    IMG_0688.jpg IMG_0691.JPG IMG_0772.jpg IMG_0806.JPG IMG_0865.jpg IMG_0872.JPG IMG_0892.jpg
     
  7. Mapsmith
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    Mapsmith Gold Member

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    Thank you for your description. Although I have not (and have no plans) to require me to undergo dialysis, my Father-in-Law was on dialysis for about 3 years before he got a new kidney (at 80 years of age.[Florida allows kidney transplants up to age 85 as long as there is no evidence of cancer]) He, and the kidney are doing fine.
    Will keep the globaldialysis site in mind. I have had several people come into the store and express desire to still travel but are worried about overseas dialysis. I usually recommend taking a cruise with www.dialysisatsea.com. But you have shown that there are other options.
     
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  8. iolaire
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    iolaire Gold Member

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    Another good site would be http://www.hditravel.com/, its a site setup by Fresenius Medical Care which is the maker of my dialysis machine in my center and the brand of center that I was at in both Singapore and South Africa.
     
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  9. I have heard that you need to reduce the amount of liquid that you have while on dialysis
     
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  10. iolaire
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    iolaire Gold Member

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    Yes, as your kidneys fail they stop filtering liquid from your blood so the dialysis process removes it. But your blood becomes out of balance so it needs to pull the liquid from other parts of your body, too much liquid removal causes bad cramps.

    Luckily I still have kidney function to remove water so I'm not yet limited to two kilograms of water every two days (that is two liters of liquid).
     
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  11. Dublin_rfk

    Dublin_rfk Gold Member

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    Thanks for providing the info, great to have. Keep us updated and I hope you get your match soon.
     
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  12. Is it okay to put info on how to donate to Kidney Research
     
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  13. iolaire
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    iolaire Gold Member

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    I don't really know what you are asking. If you want to promote a specific charity I think that is ok.

    I'd advocate for everyone to get listed as a organs donor (upon death), and make sure their loved one's know your wishes so they are ready to donate your organs if you die. In many US states you can sign up to be an organ donor as part of your drivers license registration. I don't know if it is that easy in other countries.

    When we talk organ donation its not just the Kidney's, but also corneas, livers, and hearts etc... When the organs are harvested from a brain dead patient many people benefit.
     
  14. iolaire
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    iolaire Gold Member

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    Dialysis in Santiago, Chile (cross posted to milepoint, ihatedialsyis and flyertalk)
    Over Thanksgiving, Susan and I took a quick trip to Phoenix and Las Vegas. Our excuse for visiting Phoenix is we bought two nights of hotel for the Palomar Phoenix, one of the trendy Kimpton hotels, at a silent auction. Since we were in the South West, we decided to add in a few nights in Las Vegas. We should have known better, but we arrived in Phoenix on Thanksgiving day and were surprised to find everything closed in the Downtown. Luckily, there was one speakeasy open nearby that opened at 9 PM, so we were able to have a drink and eat some pizza. We made plans to visit a craft market located in the building complex of the hotel on Black Friday. However, when we woke up my RSS feeds pointed out that Copa Airlines had a strong sale going on, resulting in $330 airfare to Santiago Chile... Some how it seems like fairly often when we are on vacation great airfare sales hit! I'd say a good price to Chile would be in the $600-$700 range, the $330 price is the lowest I've ever seen for that destination. Luckily, we were still in the room and Susan and I agreed on heading to Santiago for the Martin Luther King holiday week. I made a few booking attempts for a normal Saturday to Sunday trip, but it kept erring out after the purchase, so I moved to MLK Monday to Tuesday the following week and was able to complete the trip purchase! The rest of the trip in Phoenix and Las Vegas was good. Dialysis in Phoenix worked out good, as usual. I'm very appreciative of Google Maps and how it integrates with public transportation, allowing me to confidently take the bus to the Center. After Dialysis, Susan met me at a Pizza restaurant with a outdoor seating and we enjoyed beers, a great pear & blue cheese salad, and pizzas. Las Vegas was good, we stayed downtown at the Golden Nugget and I enjoyed Cirque du Soleil's risque Zumanity show a bit more than Susan. Heading home, we enjoyed 8 am cocktails and snacks at the American Express Centurion lounge in the LAS airport.

    Back home in DC it was time to figure out dialysis in Santiago. This was one of the few times where I need to plan my dialysis quickly, usually I have well over four months to plan out my treatments. I searched around and found one website with centers throughout Chile but only two in Santiago. Later I found the Nephrocare (Fresenius) website, which had many centers in Santiago, so I promptly emailed two centers which looked well located. And at that point started waiting for a response which didn't come.

    All the dialysis websites have phone numbers for the centers, but generally I don't like talking on the phone, and especially when the center has a different language! So I was excited when I figured out that DaVita will help coordinate foreign travel. My social worker has been great about setting up US dialysis but didn't know the company could help with foreign travel. All that I had to do was call 1-800-244-0680 and give them information on the two centers that would work for me. At that point someone else took over contacting the centers and setting it up. That was very easy. And of course they took care of getting the dialysis orders sent, except they required me to get my HIV lab results on my own, for some reason the center stays away from ordering/tracking those results. When it was all said and done, I had my preferred time at my preferred center, and a regional Nephrocare contact in Mexico City.

    It turned out very good that we were departing on Monday since I had a rush project at work that I was able to complete on Saturday and Sunday prior to leaving. If we had left on Saturday, I probably would have had to try get that work done while on vacation...

    We arrived in Santiago at 6:30 AM, took the bus and the metro to the Radisson Blue in an upscale area near the largest mall in South America. I picked the Radisson because I have gold status as part of their credit card offering, which also offers two award nights for the price of one, because of my status and the size of the hotel I thought that they would let us into the room early. They offered us the breakfast buffet while we waited, and at 10 am they offered us the choice of a standard room, or waiting longer for a junior suite, we jumped at the standard room, took our bath and a quick nap. Then we were off to one of two (or three metro) accessible wineries. There was no english tour that day by we still enjoyed the $15 spanish language tour, we only got lost when they described why their premium wine was premium (likely very old vines). The downside is the included wine tasting was three very small sips of wine, similar to what we would find in a non specialty grocery store. That turned me off to future winery tours.

    The next morning, I set out for my first dialysis session. Again thanks to Google Maps, it was easy to plan out how to get to the center via the Metro (or bus). It was fairly obvious when I arrived that the center staff was not ready to speak english, and my basic Spanish only allowed limited interactions with the staff. However, it seems like the process is the same where ever you are with limited differences as to how they clean prior to inserting the needles and how they use tape, so its fairly easy for me to just let them set me up how they usually do and let the process work.

    It's always interesting to notice the staffing difference, which to date has had many more employees than my center at home. And like other foreign centers they offered a snack which was a grilled cheese and tea or coffee.

    The one problem I did encounter both days is my blood pressure was higher than normal. That could have been due to a miscommunication where I though they were asking the pump speed so I said 400 and they were asking how much liquid to take off. Since I still urinate (a lot) I would have not taken off more than 1,000 ml, so 400 ml is not that bad. (I personally think I urinate enough that I would not gain weight if they stopped taking off liquid.) Regardless, the high blood pressure and low communication ability did stress me out a bit, and the center's doctor had me sit around afterwards until my blood pressure settled down.

    The one thing about Santiago is it felt like they are less used to English speaking tourists, and also they have their own Spanish dialect, so it was harder than normal communicating. For example, usually Susan and can read the menu, but in Chile she could not recognize the main dishes so the meals were more of a guess. So at each meal we were happily surprised.

    We spent the week exploring Santiago, going on "free" for tips walking tours, eating and drinking... We went a few times to a bistro that offered wine flights and enjoyed tasting the local wines withe more generous pours than the winery. Also we hit up the local ice-cream shop more than a few times. The weather was in the low 80*'s but quite warm when you were out walking in the sun.

    One day, we took the bus under two hours to Valparaiso on the coast for a day trip. This town was the main port after the ships came through the Straits of Magellan in the gold rush days. Lots of the town is situated on hillsides, similar to San Francisco but with more burro sized walking paths rather than streets. One modern attraction is tons of murals, so we arrived by 10 am for the "free" for tips walking tour and got to see the highlights of the town.

    For lodging we started at the Radisson, then moved to a local business type hotel, and finally moved to a hostel for the final three nights. The first night at the hostel they advertised a pub crawl, which we deiced to join. After an hour of free beer, we had a great night visiting other bus, and ending with dancing at a nightclub. Some of the locals made a movie of Susan and I dancing, i.e. the old folks dancing. I realized next time we should save the more comfortable Radisson for the final two nights since we really are ready to relax by the end of the trip.

    It just so happened our flight was at the end of the year for United upgrades so on the way home we enjoyed a more luxurious return thanks to an upgrade to business class on the Panama to Dulles segment thanks to a milepoint forum member. Thank you...
     
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  15. Dublin_rfk

    Dublin_rfk Gold Member

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    Thanks for the travelogue. I am glad to hear that your trip went well. You make Santiago sound extremely interesting, maybe enough to have my +1 want to go.
     
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  16. milchap
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    milchap Gold Member

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    Greetings iolaire. I do hope that kidney becomes available asap.
    I still remember fondly our trip crowded in the Tesla at SFO Kiva D0 2.
    All the best to Susan.
     
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  17. iolaire
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    iolaire Gold Member

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    Ireland Trip May 2015

    Just returned from a trip to Ireland, scheduling dialysis was an ordeal. We bought tickets via an AF sale so we left a bit earlier than planned. Using DaVita’s travel coordinator I tried to schedule dialysis with about a month notice. She could not find a spot and heard from the Irish Kidney Association that they had no space in the entire country until June at the earliest!

    So I started trying to find space in London with the hope that I could fly over for treatments on Ryan Air. But after a week or so of not receiving confirmation of space in London, my wife reached out to the same Irish Kidney Association who said there might be space in private centers.

    So I two weeks before departure I sent out emails to all the private Dublin centers I could find and received two responses, including the Fresenius center the previously did not have space. That kicked off a lot of lab work. The Friday before departure we finally received confirmation that they would take me at the Fresenius center!

    At that point my option was to be in Ireland for Sunday – Wednesday AM and use United points to fly back if dialysis was in the cards.

    -----

    We returned from our Ireland trip last night. It was a great trip with friends, but we had to do a ton of driving to see both the Dingle Peninsula (instead of the longer Ring of Kerry loop) and the Cliffs of Moher.

    To get dialysis I commuted to Dublin from Limerick via train and back to Galway on the bus on Wednesday. I took the city bus to the dialysis center in the suburbs.

    I was happy that I didn’t miss my bus stop despite the cellular service from “Three Ireland” that completely conked out in Dublin. (Later I purchased a “Lycamobile Ireland” SIM card that worked MUCH better.) From what we could tell “Three Ireland” is not a good option despite some recommendations online and the €20 unlimited plan…. “Lycamobile Ireland” worked much better under more limited €10 plan. My friend with a newer Galaxy 6 had better “Three Ireland” service for voice and texts, but not for data.

    We returned to Dublin on Friday as a group so I had pickup and drop off at dialysis.

    Overall the trip was great. We were fairly rushed the entire time because it did take a long time to drive everywhere. We arrived at the B&B each night at about six or seven and did have dinner out but we were completely beat most nights.
     
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  18. moongoddess

    moongoddess Silver Member

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    Thank you for posting these detailed trip reports, iolaire! I'm sure there are many hemodialysis patients out there who want to travel and who will find this information extremely useful.
     
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  19. iolaire
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    iolaire Gold Member

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    Good hospital based dialysis in Brussels Belgium

    I received three HD treatments at Saint Luc in May/June 2016. The facility was very large (might have 60+ chairs in pods/rooms) but the care team was helpful.

    There was a little confusion when I arrived because there was not a check in desk visible, but one of the doctors tried to find where I should go. Fairly quickly they figured out who I was and set up a machine for me. It sounded like my paperwork had not made it to the care team from the coordinators. However despite the confusion the wait was not long. The doctors spook good English, the nurse or tech who connected me each data had at decent English.

    One day there was some confusion from a nurse/tech who didn’t really understand that I do not use button holes. She missed the first stick in a new part of my arm that I just started using but had no issues when she went to my main fistula area.

    As a US patient pre-payment was required of 1,500 euro (for three sessions) wired to a bank account prior to travel.

    Its located on the subway with the stop about three buildings from the main hospital, there is good markings on the walkway leading to the hospital. Wifi is available via a French only sign up form without SMS confirmation (so you can sign up without a working phone number). I was able to by a local Lycia Mobile SIM in the convenience store on the ground floor of the hospital.

    I would return to this center.

    Holiday Dialysis URL
    http://www.saintluc.be/services/medicaux/nephrologie/holiday-dialysis-english.php
     
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  20. iolaire
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    iolaire Gold Member

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    We just returned from a second trip to South Africa thanks to great low priced coach airfare (under $500) from Washington Dulles Airport on South African Airways via Accra Ghana. We had a great trip with one wine tour via Wine Flies. Their tour was great, and far superior to the company we had to use last time because they were booked up. This time we reserved far in advance to insure we could go with them. Then we did a Cape of Good Hope tour with daytrippers, that was a great excursion as well. Finally we got up Table Mountain for their after 6 PM Sunset special when the cable car is half off and spent about an hour and a half watching the sun set. It was a great trip despite about 24 hours in transit each way in coach.

    Two sessions dialysis at NRC CAPE TOWN CBD. I did not use that center last time because its address is entered as "Cnr Bree & Church Streets" and goggle maps doesn't recognize it so it put it out in some random place, but we saw the center so I knew to look for it again this time. The correct location is at 181 Longmarket St, Central, Cape Town, 8001, South Africa. Its a small center with maybe 12 beds in a small space. Price was 1794.4 rand per session or $133.63 USD. Had they gotten me the quote sooner they would have liked me to wire prepayment, but it came a few days before we left so I paid cash and the office manager deposited the payment and gave me a receipt. They would have provided a drink and a snack but each session was right after lunch so I actually turned down both offers of drinks.

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