medical advice re: vaccinations

To be honest, it was more difficult to book an appointment to get the vaccinations than to actually get the vaccinations. The US realm of medical care is weird. Not that I have anything to compare it to but it’s definitely weird. When I was 6 months pregnant I changed my OBGYN and PCP (the old ones were not attentive and caring) to Dr. Goldburt, a female practitioner in a group of three practitioners at this local office that was affiliated with the Memorial Hospital of Rhode Island and their birthing center, located 10-15 minutes from my house. She was the best thing I have ever experienced regarding medical/health care. She left the practice when my son was almost 1 year old. My son, husband and I all used her as our PCP. I still liked the other women in the practice so we kept with them after she left. They moved from MA to RI a few months ago when my son was about 15 months old. We went there for his 15 month check up with no problem. A couple of months later, last month-ish, December 2016/January 2017, we got a letter in the mail saying our insurance may not cover our care under that physician as of the beginning of March. Also, the last two times we went to the doctor, our new PCP, Dr. McCleary asked us if we were staying on and was more surprised than excited that we were not changing. Don’t ask my that during our session. And don’t ask me more than once. You’re driving us away? Errrr! You’re losing 3 patients, which as we know = $$$. Okayyyy, well we have a month and a half to get inhalers for my husband and vaccinations before our trip, as well as we’ll need stuff immediately when we return mid-March. Never mind is it flu season and it’s inevitable we’ll get sick before we leave in February, which of course we did. That’s fact #1.

Fact #2 – We wanted to check our vaccination records and gather our medical records to prepare for all of this but the doctor’s office doesn’t have them. I repeat, DOESN’T HAVE THEM. They changed computer software and apparently don’t have licenses to the old software but Memorial Hospital does so go there and get them. I chased down our medical records for nearly a month and they only included what was from that doctor’s office or the hospital and not any other records that had been sent over. Advice – keep your medical records in your own possession. Trust no one.

Fact #3 – You can figure out what you need from the CDC website. Just go to http://www.cdc.gov and find the country of interest and look up the suggested vaccinations (and what’s going on over, current events, etc.). The CDC is obviously thorough and provides details to help you assess which vaccinations are necessary for you. For example, we got Japanese Encephalitis vaccinations because of the duration we were going to be there. If we were staying less than a month, we wouldn’t have gotten that. Then before and when you go to the travel consultant doctor, you know what to expect and why you need what you need, or don’t need or want. In our case, these vaccinations were not required for us to enter the country. They were voluntary and preventative.

Fact #4 – You need to go to a travel clinic to get a consult. You can’t just go to your doctor’s office and get vaccinations. I mean… my son had his boosters, Hep shots, MMR, things like that per standards now. But you can’t get a typhoid shot at the doctor’s office, even if you tell them ahead of time. So, you have to go to a travel clinic, get a consult from a doctor there whom you’ve never met, then get the shots right after you have the consult. We had to go to RI because otherwise we’d need to go to Boston, which is just too far for us and not easy to get to. We booked an appointment at the University Medicine Travel Clinic in Riverside, RI. How the heck did I find that? A lot of calls and research. First we were going to go to Memorial Hospital travel clinic but they’re only open one day per week in the morning, Tuesdays. I work in Boston on Tuesdays and Tom works catering Tuesdays and just no. So I called 2 other places that Memorial Hospital suggested to me. Meanwhile, I’m going back and forth trying to get our medical records together. I really only needed my son’s. I should have had mine too from my previous doctor because I went to Haiti in 2012 and very likely got Hep A and typhoid but who knows because I don’t know how or where to get my records from at this point. It would take a lot of digging and a lot of time that I don’t have because it’s not a priority. They didn’t require my husband and I to provide childhood vaccination records. So I called Passport Health. What a joke! They went through the whole registration process of 3 people with me and made an appointment and THEN told me they don’t take insurance. Yeah, sure, let me pay $750 for immunizations when I don’t need to because my insurance covers it. That was a huge waste of time. Then I called Miriam Hospital to connect me with a travel clinic, which ended up being this University Medicine facility. They’re open more than one day per week, flexible and take insurance. They were good! They were thorough and helpful with our little guy. That was the first time he tried a lollipop and he won’t forget it. He was thrilled! He had two, one for each hand, double fisting, sugar high, sticky mess, passed out on the car ride home. In the end we paid for the consult fee, which was $50 per person and the vaccinations were covered by insurance. One other thing is they said it would take a half an hour but the consultation took an hour itself, never mind actually getting the shots! It took about 2 hours.

Not mad about having HSA at this time. When HSAs first entered mainstream I was not thrilled because the cost of premiums and out-of-pockets increased. Things have changed a bit since then but I wasn’t so mad using my HSA card to pay for the consultation fees (and medications over the last couple of months) because it felt organized and something not to worry about tracking on our bank account.

Fact #5 – The word “fact” that I’m listing for these points are nonsensical but I’m just going to roll with it. We got a number of vaccinations. Here’s the list of vaccinations that we agreed apply to us after meeting with the travel doctor (and reading CDC site). Oh, and they gave us a nice packet that includes information and tips for travelers. Should be helpful!

  • Hepatitis A
  • Hepatitis B
  • Typhoid
  • Japanese Encephalitis (JE)
  • Flu shot

Luckily the little guy had all but JE, which he can’t get a full dose of and it only recently was permitted for infants, so he got a one time half dose. My husband and I got one dose then and will get the second (required) dose a week after the first and before we leave.

My husband and I got the whole package listed above except I didn’t get the flu shot at that time because I was on a z pack for my cold. I’ll have to get that before we leave too.

BTW we’re leaving in exactly one week. We started booking the appointments and things the first week in January. We got our vaccinations February 3rd. My son had a terrible cold (which he so willingly passed off to my husband and I) and an ear infection and low grade skin infection the last week in January/first week in February. We’ll get the second dose of JE February 10th. And I’ll get a flu shot within this upcoming week. Then we’re in Thailand February 17th (leave Boston February 15th).

We went to the minute clinic to get our immediate medical issues addressed because #1 the two guy doctors there are awesome, #2 we don’t have to deal with the laziness and potential insurance issues of our current practice and #3 it’s location and hours of operation are EXTREMELY convenient; walk-in. Our HSA card may have only been used within the last month or so but it has been used many a times good sir.

What am I going to do about the potential loss of our PCP due to insurance discrepancies? Basically the discrepancy is that they moved states, need verification to treat patients with MA health insurance, even though ours covers all of New England. Oh, and the PCP office sent out another letter saying please disregard the first letter but when I talked to the receptionist over the phone before the second letter was sent out she said they’re basically working on it and it’s not an issue now. My interpretation and concern is that it will be an issue when we return and I am not willing to take that risk. So, I set up appointments for my son and husband with a new PCP in MA that I verified IS covered by  our insurance. We’ll need 18 month check up for my son, prescription inhaler for my husband and the second and third doses of Hep vaccinations at the appropriate times for my husband and I. Not messing around with my family’s health.

We could just go to Asia and risk it all. Right now I’m totally risking getting Zikka. I am SO prone to mosquito bites so I am very cautious, almost worried. Not sure how my son is with mosquitos but my husband is the opposite of me, hardly gets bit. I’ll wear deet, constantly. And wait to get pregnant for baby #2. We’re heading to Dolphin Bay in Southern Thailand for a few days in February and Halong Bay, Vietnam for a few days in March, but for the most part we’ll be in Bangkok. Don’t forget to consider all of the areas you’ll be going to when planning vaccinations!

Did you realize how much medical stuff comes into play planning for a month in Asia? Think about all possibilities encountering your medical situation before your trip. Especially during flu season.

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