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Repatriate or not? Is this serious or....?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:34 AM in Neck Pain: Cervical
Hi everybody, I'm Linda 26 y/o and this is my first post. I think it's gonna be quite long, but I need to explain some things first:

The last 1,5 years were full with up and downs. I had some strange symptoms in the beginning like brain fogs, pressure on the head, neck pain, dizziness etc. First the doctor thought it was MS, but the MRI of my head was clear. So the label "stress" was placed there...

After a year, the symptoms became more mild (only headaches and neck pain stayed) but still very annoying, so I decided to ask for a MRI of the neck, because I thought that was the source of all my problems. And voila, the result was indeed that there were some problems in the cervical area.

Now, I'm living in Indonesia but am originally from Europe. The doctor here is saying I should go out of the country because of the lack of knowledge. On the other hand, my insurance says the results are "not that serious", so I should seek physiotherapy or whatever over here. For me, that's no problem, I just want to get rid of the constant neck pain, daily headaches, dizziness, blurry vision, migraines etc. But my question is, should I seek some different help then plain physiotherapy? I went a couple of times to the chiropractic and found some relief there, but I don't know if I should continue, because it might not be helping me in the end...or is it safe to go there again?

So here is my medical result from the MRI. For me, as a non-native english, it is not clear what the meaning is;


Cervical MRI was done axial and sagital slice in T1W, T2FSE, and MR Myelography without contrast,
Axial T2 blurred.
Alignment of C spine, there is evidence of posterior slip C5-C6 to C7
Straightening of Cervical curvature,
There is no evidence of abnormal area hypointense / hyperintense T1T2 at bone marrow C
There is evidence of slight flattening at C6 body spine,
There is evidence of slight disk compression at C4-5, C5-6 and C6-7.
Decrease signal intensity at all C disk
There is bulging disk at C4-5, C5-6, C6-7 to postero medial, stenosis anterior thecal sac, not compressed spinal cord, no stenosis nerve root.
There is no evidence of osteophyt formation at C body spine
There is no evidence of abnormal hypointense / hyperintense T1T2 at spical cord C

Impression: Cervical MRI shows,

1. Protusion disk herniation at C4-5, C5-6, C6-7 to postero medial, stenosis anterior thecal sac, not compression spinal cord, no stenosis nerve root.
2. No sign of abnormality at spinal cord
3. Slight retrolistesis at C5-C6 to C7
4. Slight compressive C6 body spine
5. Straightening of C curvature, paraspinal muscle spasm


So I would love to hear some opinions from you. Also, is this something that I will carry my whole life or is there something to be done?

Thanks for your time and have a great day!


  • Welcome to SH!!!

    My experience is that physical therapy can be an excellent first step. But, its important to be consistent with it, go for all your visits and then do the home program they will give you. In other words, do your homework. Physical therapy takes time to work. If you can get pool, aka aqua or water, therapy, I found that especially helpful.

    Myself, yikes, would never go for chiropractic manipulations of my neck. I haven't heard too many good things about that route. I have heard some good things about accupuncture though.

    As far as anything else that MAY need to be done in the future, I don't know enough about Indonesia's health care. I would do a lot of research on that.

    Best wishes to you and again, Welcome to the best spinal site out there in cyberland........

  • with mariripn
    doesnt look like surgery in necessary yet so physical therapy now your best bet. for the future a good spinal surgeon would have to try to predict. if it was me guessing i think you can control symptoms for many years....
    i hope so....
  • Hello Linda and (unfortunately) welcome to spine-health.

    I cannot comment much on your MRI except to advise that they are only part of the puzzle and a bulge in a disk may not be affecting anything or it may. While you may be able to read and understand what each part of the MRI Report means (e.g. what is a bulge in a disk or an annular tear) it is unlikely you can do much more and need to go over the report with the doctor and be confident the course of treatment will bring symptoms you described under control. You will also see on this site the problems people have in their home country and the need for multiple opinions to ensure they are confident with the treatment.

    As an Expat (based in the Netherlands) I am in a similar position. What I have seen from the various sources (including this forum) the quality of Medical care everywhere appears to be highly variable regardless of the country. As such if you are more familiar with the culture (i.e. wherever you are from) you are better able to pick up on the discussions, interpret them and provide you greater confidence (even though it may be the same advice). In addition when combined with a good network of friends and advisors you may be able to work out which are the better service providers, in your case more easily identify the ones with a good reputation for spine-neck treatment which again makes you feel more comfortable.

    Here in the Netherlands I attended the Emergency Room of one hospital (pushed to get X-Rays and was given the incorrect interpretation of the X-Ray (not broken then broken Ulna) before getting the correct interpretation of broken Radius (both arms). I have known of an Ambassador with heart conditions to be sent home (same Emergency Room) with antacid only to die that night and yet the same hospital can provide excellent service (just avoid the ER)! Ambassadors in this city were up in arms over the quality of the services and now act as if they had a 3rd world country posting and often travel home for even minor ailments and have their emergency medical evacuation procedures. I attended a different hospital (that has a better benchmarked rating by customer service) for my current condition (lower Lumber disk Hernia) but still not comfortable (they actually lost me in their outpatient tracking system after visiting ER but they are conducting an investigation)! As such I have lost confidence in most of the service delivery (but this could have happened to a local many of which go to Belgium).

    One thing with a recovery process is your mindset and if you have little confidence in the system (which sounds like the case) this will affect you and your recovery. This can happen in your home country if you think the doctor is wrong and should rest more (letting muscles go) or exercise more (causing further damage). As an Expat if you have doubts in the system then any doubts you may have in your doctor may be amplified. Another factor to consider is family support (parents, brothers, sisters etc) which can take pressure off the family if you have a partner and / or children.

    My decision from my personal set of experiences is to get as well as I can and leave the foreign country permanently. I will move to a country where I can swim before work and alter my lifestyle to minimize the impact of my condition. Without my health I am no good for my daughter, employer and myself (in terms of my longer term sanity).

    Just a few practical questions you may wish to ask yourself!
    • Are you a by yourself or with family i.e. is it only you are to think about?
    • What is your home country and how to you rate their ability to provide care?
    • Is your current health insurance with an Indonesian Insurer or is it an international policy administered from your country of origin?
    • If it is an Indonesian based insurance then will you have coverage back in your home country upon return (you now have a known condition to declare to a new insurer)?
    • If you are working, is there work back in your country of origin?
    • If you are working as a posting then can you be reposted back (and how important is the posting to you and your career in the long term)?
    • How safe do you currently feel moving around (walking) following the recent bombings?
    The most overwhelming factor that would convince me to leave is your doctor who knows the system and has advised you to “go out of the country because of the lack of knowledge”. To me you need to consider your well being (i.e. health) and stay there only if you feel your health is not compromised!

    Kind Regards
  • Hi Linnie,

    First let me say welcome to spine-health, look around and gain knowledge of the words on your MRI. You may want to check out the FAQ section as there is link on "preparing to meet with a spine specialist", that you may find very useful. Also please she the video section for cervical radiculopathy and see if any of those apply to you as well.

    Looking at your MRI there is one word that sticks out to me. The retrolistesis. My concern is this has been seen with you laying in a flat position for a MRI. Typically that is seen on flexion and extension films. In my opinion, i think you need a set of flexion, extension films to see the degree of this, if a set has not already been done. Most often that doesn't show on a MRI as positioning doesn't allow it to as the neck is straight and fixed for a MRI. It doesn't mean you need surgery but stability issues need to be considered with anyone performing anything on you. With that being said I doubt I would be using a chiro if i was in your position. Further, if it were me I would see about seeing a doctor back in your homeland just to check what is going on and bring the films with you as well. I would hate for you to find out sometime latter that damage has been done that could have been stopped with the proper treatment. But in place of wondering what should be done, you would then have your answers and feel more comfortable with your decisions. Good luck and keep us posted.
  • I am sorry to hear about your situation. I've had 2 operations on my neck and if you can avoid surgery thats what I would do. Surgery should be the last option. The pain from surgery is far worse then the pain before the operation in both my cases. Surgery for Necks only relieves the limb pain also, I still have neck pain. I was told to never see a chiro never. It may seem like it helps for a bit but then the pain returns worse then it was before. Over 70 percent of patients with herniated discs find relief getting physical therapy or traction therapy for herniated discs. I would put as much energy into therapy first before any thing else. Poster has a lot to do with how our necks feel too. I wear a soft cervical collar at my desk at work to help the muscles relax some what. You can strain that area and that will increase pain levels. The aqua therapy or pool therapy is a good idea too. Positioning when your sleeping is important too, I use a travel U shape pillow when I sleep at the base of my neck to keep things comfy so I don't fall off my pillows at night. I hope this helps good night:)
    2005-ACDF with Corpectomy at C3-C-5.
    2006-L4-L5 diskectomy.
    2009-Cervical laminectomy at C3.
    Steroid injections series x 4.
  • Wow, thanks for all your comments, I think they're pretty helpful :). Still at work so only short reply;

    I'll send my MRI scans along with a family member back to the Netherlands (that's where I'm from) who is here at the moment, and let them get a second opinion over there. Further more I'll push my insurance to or let me go back, or to let me go to Bangkok, Singapore or KL to check up, it's more close. But I really prefer to talk to a doctor in my own language of course.

    And for the time being, I'll do some research for therapy here, overall the pain is not that bad, so I can handle it for a while, I just hope that it doesn't get worse...

    Again thanks!
  • Hi Linnie (Salamat Datang and that is about all the Bahasa I can remember assuming you picked up that level)

    Where in the Netherlands are you from? I may have said some “not so good” things about some of my experience in the Netherlands but that was meant to show that Health services are variable and that applies around the globe. I have a Dutch Colleague that had some lower back (spinal) work done in Den Haag that went bad and found a surgeon in Arnhem (for others they are both Dutch cities) that had to fix his poorly done first surgery so again bad and good!

    Are you with the Foreign Affairs, government agency, non-profit or a private venture and do they have a medical repatriation policy (as opposed to your insurance company).

    Are you with a Dutch Insurance Company (think asked that previously) in which case there is little to discuss and you could just fund the airfare yourself and take a week holidays. If you are going to get on a plane anyway it is only one more hop of 12 hours (Singapore Airline has direct flight to Schiphol and round trip economy around Euro1k return) and family to stay with (I assume). I would also be worried about some of the other locations you mentioned for the same concerns we expressed of confidence and language issues. Going to those locations also make it hard for you to pop in for a follow up. In addition if doctor sick or cancellation for emergency then you may be in hotel for several days while rescheduled.

    Are you in Jakarta (the capital) or elsewhere? If in the capital I would be surprised if they do not have someone that can help (maybe a University Hospital) but it is difficult in any hospital when you cannot talk to the receptionist, nurses etc.

    I actually lived in KL for a while but you will still face language issues (they went more nationalistic since I was there but believe most have English as their 2nd or 3rd language and doctors often educated in English systems), but you may face the same problem and will not want to complete your treatment there. I would also be worried about some of the other locations you mentioned for the same confidence and language issues.

    One other minor thing you should think of is that if you send your MRI back with a family member that is only one part of what the specialist will need to see to come to a diagnosis (they need you)! Your family member may also be given lots of misinformation if you send them in advance. I have had several people here (including removals company doing a quote) tell me I had herniated disk and had surgery so can give you the name of my doctor at a hospital in Rijswijk. The person servicing my hot water service even said their friend recovered most of the way and then went to Morocco to be buried up to the neck in the hot sands as a final treatment and been good ever since! There is lots of misinformation as anywhere including here in the Netherlands. It will be difficult to work out the good doctors from the not so good even with reasonable contacts. If you need to see anyone else before you get where you are going I would keep the original CD with yourself (i.e. see if can make a copy for your family member).

    In the interim there is some books that seem to be highly recommended (my Fysio-Manueeltherapeut in Den Haag recommended for my lower back Mc Kenzie exercises which seem to be well regarded for spinal health and there are Physiotherapist practices certificated in delivery) so suggest you get a copy of the book:
    Treat Your Own Neck 4th Ed (Paperback) by Robin Mckenzie
    and one of the closest places may be from Australia
    http://www.fishpond.com.au/Books/Health_Wellbeing/General/product_info/3945791/ but should be able to find an on line bookshop in Indonesia.

    If you want to Private Message me for an Expat perspective then please do so.

    Kind Regards >:D< >:D<
  • Terima kasih Terry!

    To give you some answers;

    I'm staying in Bali, but I haven't heard quite good stories about JKT, so I'm not really looking forward to go there actually.

    In The Netherlands I stay in the neighborhood of Den Haag (The Hague) and Rijswijk (in the middle actually, what a coincidence). So when I actually go there, maybe you can give me some names of good doctors / therapists ;).

    My insurance is international, so if I really have to I'll fly there myself and let them cover the rest, but I'm earning Rupiahs so it's not really that easy to just go there.

    I'm self employed, so if I really have to go back more permanent it wouldn't be that big of a problem, but it would be like throwing a dream away. I'm not done here, not just yet.

    Luckily I have my BF here and quite some family back in NL so I'm not alone.

    Gotta go back to work now, thanks again for your reply!

  • Just got news from my insurance, they're willing to let me go to Singapore for a check up! Well, I think it is much better then Indonesia, so I'm pretty happy!

    The insurance recommended to see a "orthopedic"? I don't know about that one... shouldn't I go to a neurologist or something like that? Or both? Who is the best to see when I'm there?

  • Singapore sounds OK (but again if I was Dutch would probably return but the delays and bureaucracy in NL may cause major frustration). Singapore made their official language as English for strategic trade reasons when they became a nation which sounds like you will follow better than Bahasa. In terms of Orthopedic or Neurosurgeon see http://www.spine-health.com/treatment/back-surgery/how-select-a-spine-surgeon Just need to make sure spinal specialist (but as related to headaches etc would tend to go Neurosurgeon but one of the Neck people on this site may be able to advise).

    There are articles on this site to help prepare you for meeting the specialist. Stay positive as agree with other comments and hope/believe all you need is a good consultation, specific information on management of your condition and exercise. With that in mind see if you can communicate with the specialists staff in advance to recommend and line up a Physical Therapist appointment for the following day to get you on the right path. The culture is very Business like and driven to efficiency so be prepared and on time and hope you find a doctor that will explain everything and you can relate to.

    If you have not been to Singapore it is basically one big city that is extremely organized (fines for spitting out Chewing Gum or not flushing WC so some describe negatively as police state etc but did not find it that way) and you will enjoy seeing around and maybe shopping for things you cannot get where you are.

    Best Wishes >:D< >:D<
  • Hey everybody! It's been a while but finally the insurance will let me go "back home" to The Netherlands! Yay!

    I tried to convince them it would be cheaper for them to send me there cause I can stay with family and that it was better to speak my own language, and it worked!

    I don't know yet when I get to go, the appointments with the doctors need to be made first.

    Will keep you up to date!
  • Well Done. I am sure your family will be pleased to see you. I expect will take several weeks to line up appointments etc. I will PM you the details of my Physical Therapist, in case you cannot find one that is suitable closer to where you will be staying. While you will be moving back to within a few km of where I live now, I doubt we will ever meet. I expect I will relocate quicker than you will make an appointment. In any case I hope all goes well.

    Please note that many doctors are very skilled at rattling the patient and then pushing them out of their office (and onto the next patient). Please make use of this site to prepare for your meeting, after all you are flying nearly ½ way around the world for the appointment. Write down all your questions and don’t leave the Doctors surgery until answered, you understand what is going on, what tests he needs to have done to be sure of his diagnosis, what you can expect from the Physical Therapist and under what conditions and when you will have next appointment.

    Best wishes >:D< >:D<
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