Tag Archives: healing

Healing: (very brief) memo from MECFS check-in at Oka-Dai

(while world continues to meltdown in various ways) just finished another multidisciplinary visit to Okayama University Hospital including extended consult with TCM doctor, IV drip of a new pharmacological cocktail, and consult with #MECFS specialist.

Also discussed the terrible pain and impact from the air pressure changes during typhoons, turns out this is very common with people in my situation. Received an “emergency prescription“ for this scenario.

{unrelated photo}

Extended: Neurotropin is main ingredient in cocktail mentioned above (along with vitamin C, and anti-dizziness agent and others) and quite positive impact / also now taking “ketas” (generally used for bronchial asthma), off-label to increase blood flow to brain. Also, lengthy and pleasant consult with traditional Chinese medicine doctor resulted in a new compound of magic powder.

Note to self: provide other Sciency name for ketas, and Chinese name for new compound.

As previous, took a long and memo of notes to be respectful of their time and not to forget anything.

I gave her a book of poetry from Muriel’s Journey “Fire from the Heart” (plus a printed copy of the great article recently in the Atlantic magazine) and my gift was reciprocated by a fantastic book/magazine (in Japan, sometimes these are called “mook”) edited by my doctor with a variety of articles, essays, manga style adaptions and what not about MECFS. I’m really quite amazed to be in this program and to be this “seen”.

Healing Ramble: Story of Ayurveda Health Home, Pokhara, Nepal, 2017

Memo: What follows comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries (Pacifica, Phitsanulok, Cochin, Pokhara, Dikwella/Galle…) visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble Introduction” video for context on this series.

With respect and understanding that not everyone can do *this* – i have another riff about “why” to seek medical care or healing treatment elsewhere (not in US/Canada in this case). For now, use it if you need it, if not just pass along.

Very happy to step into this compound

Handy:

Memo: What follows is transcribed from my diary very shortly after my stay, more or less verbatim, at the risk of being redundant, i have previously shared:

Pokhara, Nepal, 2017

Along my healing journey, I received treatment had the most wonderful Ayurveda Health Home in Pokhara, Nepal.

This company operates two facilities, one in Kathmandu and one in Pokhara where i did my treatment [update: subsequently built a 3rd clinic which looks like a wonderful mix of the 2 and maybe this one is no longer operating?].

The hospitals are part of a German-Nepal partnership. As such, the facility ran on a very prompt German-like schedule, but with exceptionally diligent Ayurvedic practitioners, including several full-time doctor/medical officers.

On the way to AHH

The chief amongst their practitioners is the world-famous Dr. Rishi [update: RIP] – a most elegant and graceful man who emanated healing energy and power. While he is primarily based at the Kathmandu facility, he flew to Pokhara for my intake for which I was very grateful.

Me with Dr Rishi on my “out-take” review in Kathmandu / bless his memory

He had thoroughly reviewed my medical file in advance (including notes from Dr. Veena’s Ayurveda and my tests in Phitsanulok), and the intake was several hours long starting with a long discussion about my symptoms, background and objectives, followed by a massage, then an *extremely thorough* physical inspection.

I should mention that I had originally intended to go back to India and Dr. Veena’s Ayurmantra but for some strange reason, my Indian Visa was declined creating a rapid change of travel plans which became *a little bit expensive* and complicated but I worked through it all by adding in a wander through Malaysia after more hospital tests and treatment in Thailand, OK carry-on…

The days were very busy, but very well organized. I would receive very complete instructions, hands-on, for each of the different treatments, which I would later self-administer.

These included various mouth cleanings, nose cleanings, eye cleanings, eye exercises, meditation, and so on. I also received a series of instructional sessions about the overarching concepts of Ayurveda – the history, background, purposes and information about doshas and the importance of the mind/spirit/body connection.

I also participated on one-on-one yoga sessions. The yoga was very gentle and suited for my body and condition. Rather than complicated poses, started with very simple joint rotations and was very calm rather than stressful experience. (Note: it seems strange to call yoga “stressful“ but doing complicated poses and rapid movement is very difficult for me – as i found later at Peacock Ayurveda Garden).

I received dozens of different kinds of massage, with different oils, different techniques, sometimes two practitioners working on me at once, herbal poultices, salt poultices…

I also went through an extensive series of enemas (don’t freak out)… some to cleanse and some to fortify. It was pretty intense to say the least but I was extremely well supported through the process, and my diet gradually build back up from thin rice porridge and herbal tea, to more substantial food, before I would rejoin the rest of the group for more standard meals.

A warm and welcoming table to convene with other patients
Continue reading Healing Ramble: Story of Ayurveda Health Home, Pokhara, Nepal, 2017

Healing Ramble: Peacock Ayurveda Garden ~ Dikwella, Sri Lanka, 2018

welcome to Peacock Ayurveda Garden

Memo: What follows comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries (Pacifica, Phitsanulok, Cochin, Pokhara, Dikwella/Galle…) visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble Introduction” video for context on this series.

With respect and understanding that not everyone can do *this* – i have another riff about “why” to seek medical care or healing treatment elsewhere (not in US/Canada in this case). For now, use it if you need it, if not just pass along.

Gist: Along my healing journey, I sought treatment at Peacock Ayurveda Clinic in Dikwella (map to Peacock), close to noteworthy Galle, in southern Sri Lanka. I stayed in-patient for three weeks for a complete “panchakarma“ program.

Background: Certainly, Ayurveda has a number of different flavours in terms of quality and type of the facilities… Ranging from “spa-like“ facilities catering primarily to relatively wealthy or western clientele, to very spartan and rustic, often government-run, facilities treating local people (see Dissanayake diary).

Can be difficult to find the exact right fit mixing with medical needs but with comfort and safety enough to have a relatively enjoyable and stress-free period of time.

This is especially important because doing an extended panchakarma (five medicines) program as it can be rather intense. You are quite literally cleaned out inside and out, and your days are quite packed from early morning onwards with yoga, meditation, meals, doctor consultations, various massages, eye, ears, and nose cleaning, and some of the treatments, let’s just say can be rather “delicate“ or even rather embarrassing. Further, the effects of the treatment can be very intense and lay one out for a couple of days.

I researched a lot of different facilities around Sri Lanka and ended up on this one which seemed, from the outside, to be a good fit for me. While overall it was not near as fulfilling of an experience at my time in Ayurveda Health Home in Nepal or Dr Veena’s Ayurmantra in India, it was a learning experience.

“darling, i’am off to a rejuvenating Pachakarma treatment, see you in a two weeks”

Grounds / Facilities: Of the four different (at the time) Ayurveda facilities at which I received treatment, this one was definitely the most fancy and spa-like.

oh hi buddha

There was a pool (which frankly I was really never able to use but that’s cool), lounge chairs, beautifully manicured gardens with flowers in abundance, and overall the facility was very splendid, filled with interesting antiques, and the patient rooms were like a very nice hotel rooms, even with a private patio area for sitting and resting.

the grounds were immaculate and yes sometimes peacocks

Treatments / Schedule: The treatments were performed in a variety of traditional style huts, which were quite functional as well as charming. Each day, I was issued a fresh sarong and shirt and hat as the treatments are very oily. Additionally, I was given a basket of tiny disposable underwear to wear during the treatments.

Most days, I would have a short consultation with either the senior doctor (a gentleman who was very busy and often/mostly offsite) or a junior doctor (a young lady who was clearly still learning and mostly observing but very kindly).

Dave working on healing at Peacock Ayurveda near Galle, Sri Lanka (with Dr.)
Dave working on healing at Peacock Ayurveda near Galle, Sri Lanka (with Dr.)
Continue reading Healing Ramble: Peacock Ayurveda Garden ~ Dikwella, Sri Lanka, 2018

Healing Ramble: Chronic Dude, logistical notes about “how to deal with traveling”

Memo: What follows comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble, introduction” video for context on this series.

(also riffs already from Thailand, India etc + tips about pros/cons and how-to logistics coming…)

Notes & Travel Tactics / summary

  • Comfort Kit and crash kit
  • Flight time: afternoon or energy time (no early or late night)
  • Airport hotels with bathtub for pre and post flight … wheel right to checkin
  • One place and be part of community 
  • Postcard and scrapbooks along the way … send home by Post offices
  • Playlists
  • Stretches – aisle seat
  • Massage
  • Coconut water/hydration
  • Wheelchair service
  • Block out airport stimulation (blue specs, ear plugs… )
  • Break it up / short hops, stay over
  • Medication CBD/RSO (but don’t take it with you!)
  • First on, Last off
  • Pack extra light, easy schlepp, buy stuff if needed and ditch it)
  • Travel uniform (slippers, compression socks, track suit, slip on shoes
  • Pick the right place
  • Places to get medical help: Thai, India, seems weird but… 
  • Confidence
  • Better than home w/ reruns
  • What are yours? 

Tips and Topics:

  • Crash Mode
  • Triggers (list, notice)
  • Warning signs eyes extremities, foggy, stutter
  • Get to safe place to regroup 
  • Quiet
  • Lights unscrew
  • Sound & batteries
  • Kids
  • Warm and fresh air
  • Electric /weighted blankets
  • Hydration coconut water
  • Magnesium etc. 
  • Soup
  • eyes/ears
  • Bath 
  • Candles
  • Epson/Magnesium/THC Salt
  • No interruption
  • Music/med
  • Reduce ? and sadness? 
  • Slow Docu films
  • Art Postcard therapy
  • Recover – ravenous … no junk!
  • Magnesium is handy
  • Cold bandanas around neck and/or temple
  • Moulded ear plugs
  • Comfy eye mask
  • Perfect pyjamas
Continue reading Healing Ramble: Chronic Dude, logistical notes about “how to deal with traveling”

Diary: May 5月, Beguiled (& rather) Bewildered

Oh bye May

Spinning past another month, we’re at the 31st and I’m waiting to try out a new Ayurveda clinic here in dear Okayama. So a few annotations:

Guess it ain’t no secret that I’ve had a hard time bouncing up this month/year, however in the midst of it all I’m out of bed *almost* every day and doing a few things around the house even if it’s just dishes, laundry, compost, making tea and rice. Some days I do a few more things, for example:

This month we had a surprise overseas visitor and we went together to one of the inland sea islands as well as enjoying food & items together – and it was a joy to share my “new life” with a friend from my before times.

I’ve done a few sessions of sorting around in the kura barn and, going through bins of artifacts and taking from “stuff in a bin” to curated collections in binders with labels and themes. It’s a task requiring equal parts organizational theory, temporary nostalgia, celebrating past and imagining futures, specifically “what can I make with all these things to amplify what it means?” None of the items are by themselves significant for the collection of them all creates a tapestry of life. That sounds rather “grand” but in my mind, it’s the usual days in regular life that make life remarkable.

Coming on Two & looking like a young man already

Wonderful child Ichiro has battled through a couple of snotty noses, colds and fevers which sometimes pull him out of school due to “protocols“ but my goodness, the words are tumbling out of his mouth now, the balance is increasing, his awareness of where things go and how to do things is increasing on the regular and I am absolutely proud. I am trying to add to my skill set of how to “tug the reins“ a little bit without being a grumpy Papa and not buying into the fallacy of punishment, which perpetuates and hides problems and always requires escalation and this is proven – throughout forever – to be generally ineffective & mostly unwise.

My treasures and the penguins on a recent trip to Antarctica via Shimane

Darling wife Ryoko is studying for her “tree doctor” level up exam coming up later this year and has also continued work on her charcoal kilns and tidying up her tool shed a little bit for maximum organization efficiency. She’s also been doing some secret live streams while kiddo and I are in the bath and usually get sa couple piano songs out before Ichiro yelled out “bing bong Mama!” and we do our “Captain Ichiro, are you ready?” countdown to exit bath, dry up, lotion and pajamas, stories, cuddles and sleep.

For me, sleep is a struggle – i sleep long but shallow & unrefeshing/replenishing plus make up in fits and starts + dealing with a lot of neurological pain still along with the brain fog, confusion and general crippling fatigue. So, new plan is to change my periodic check ins/administrative visits from the “big city general” hospital to the University Hospital where they have specific departments investigating long-term chronic post-viral inflammation/immune system diseases relating to the current cee-one-nine virus which kinda dovetails into my situation with #MECFS. There is also a traditional Chinese medicine clinic on site i’ll endeavour to try in my quest for new approached for increasing my baseline.

Always have at least a dozen sleeping masks on hand… i mean on face

As I mentioned in a video (I should know that I’ve done a couple more dispatches in my “healing ramble” series if curious) this month was the awareness campaign month for my illness, as well as awareness month for mental health, Asia Pacific islanders, IBS/Crohn’s and other things (Cascadia Day!) which have impacted my life. These notable days – coupled with a few significant anniversaries: me becoming ill and memorial service / for my Mom & Creepers & Chums party; I guess added onto the emotional exhaustion of just being constantly zonked.

Celebrating Cascadia several years back and Evelyn Street, Lynn Valley, North Vancouver, unceded Cascadia bioregion

But hey, here I am talking about it!The important thing is, I have a wonderful family here and great friends around the world, food is delivered weekly, we plant seeds in the garden, postcards and packages come from time to time, I have enough books and records to keep me constantly amused and I’ve even done a bit of scrapbooking about our trip a couple months ago to Shimane.

Tip: send postcards to yourself

Yes, mentally I always feel like “I should be doing more” and I guess felt since was a little kid reading Tintin books that I was meant to be “out there in the world sparking revolutions” – so I remember to pause and think of all the things “accomplished” in the last three years since I came to Japan and all the things in my almost 52 years… So many countries, conversations, projects and so much more to come.

Adventures ahead, adventures behind, same same different different

I also continue to fiddle away at this “creative life archive” / when I run down and stuck in bed, I listen to audiobooks and longform podcast and sometimes tappity tappity on the pocket robot to assemble posts with pictures, musings, memories and what not. I love the feeling of hitting publish and thinking that someone might find a bit of inspiration or amusement.

Getting hot and humid so hoping in June we might have some beach days and also set up the yard for more playtime right here. Ichiro hits two on the 23rd so have an eye on a balance bike and maybe a visit to a zoo.

Always more, we’ve got all the time in the world.

A wonderful painting I came across: Martina Heiduczek
“Coffee and Friendship” / two of my favorite things :)

Healing Ramble: Tips for airports & traveling whilst chronically ill

Memo: What follows comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries (Pacifica, Phitsanulok, Cochin, Pokhara, Dikwella/Galle…) visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble Introduction” video for context on this series.

With respect and understanding that not everyone can do *this* – i have another riff about “why” to seek medical care or healing treatment elsewhere (not in US/Canada in this case). For now, use it if you need it, if not just pass along.

Tactics:

* Request wheelchair service well in advance and use it proudly – Besides getting you around the airport, you fast track through security and immigration lines / You are usually be first on and last off the plane, be patient

* Fly Tuesdays and Wednesdays mid-day, the airports are most mellow at this time (also tickets usually cheapest)

* Dark glasses and earplugs/noise canceling headphones for when you’re in the airport

* I use an aisle seat so easier to go to the back galley area and stretch if needed + restroom breaks without hassle when a sleeping passenger next to you

* Lavender oil, compression socks, eye mask and your most comfortable sweater for the flight, dress respectable to increase chance of upgrades (and because you are sharp like that)

* When flying far – for me anything longer than three or four hours – book a hotel in (or close by) the airport at the other end, in some cases you can get wheelchair ride to the hotel to crash out and recover. Bonus points to get one with a bathtub

* Check your bag, only take a small carry-on with comfort items, don’t try to be that “efficient business traveler” and / or save money with just a carry-on

* Turmeric tea/tincture & aspirin and water water water & coconut water & NO booze – Did I mention noise canceling headphones?

* Put on an audiobook or chill music… Keep the sensory stimulation low by not watching movies especially on the crappy seat back for the videos. For me, the fuzzy screens spin me out plus you see all the other anxiousness and activity going on

* Get a credit card which gives you access to airport lounges… go to the airport early, find a quiet corner and hydrate and snack with protein rich foods so when you’re on the plane, you’re not eating the crap or being interrupted… Plus when using wheelchair service, best to go well in advance as some airports have a limited staff performing this service

* When you board (using wheelchair you’ll probably be first on) introduce yourself to the flight attendants and mentioned that you may need extra water and make sure you are close to bathroom if you need a little sensory de-stimulation

Tip: Oh one more thing, seriously don’t try to do a lot of stuff when you travel, for me I go places to find bookstores and quiet coffee shops and simply be somewhere else.  Just because you are a “somewhere else” doesn’t mean you suddenly have a bunch of energy to go out and about and meet lots of people. Avoid restaurants at busy times as well (i.e. hit lunch after 1:30 get a table in a quiet corner) … for me this reduces sensory overload.

Note: Not all of these tips are applicable to everyone obviously but for me dealing with ME/Fibro find them to be critically handy. All for now, curious to hear your tips or any thoughts about the above.

Also this archive is laden with other riffs about healing elsewhere and taking baths in the Healing Ramble series.

Healing: nine years w/ #me

Nine years doesn’t sound like a long time, but wow, nine years is a really long time. Enough for everything to break and everything to change and everything to rebuild and everything everything

The days stack up in patterns, about the recursive cycles, remind the children, it’s all about the cycles.

Healing: Journals and a Postcard

sorry, i guess – no not at all

As I’m stumbling along on my “healing ramble” series (please watch the intro video for overview and disclaimers, not unusually, finding myself a little bit overwhelmed with all the artifacts, memories, items, even data, to share. So, rather than obsess over it just putting it all out there, even if it’s a bit redundant.

The next “real” dispatches from the series include my “tips for travelling with a chronic illness” (which is rather practical and logistical stuff), plus another entry from Sri Lanka, another from Nepal, a tough one from Pacifica California, more from other places i forgot and maybe I’ll even fill in the missing gaps from Adelaide Australia, Austin Texas, and crossing Canada looking for a home.

In the meanwhile here are the fronts of some notebooks and a postcard which allude to some of the above.

Continue reading Healing: Journals and a Postcard

Healing: Story of Dissanayake Ayurvedic Hospital ~ Galle, Sri Lanka

not really at the hospital but still captures the spirit of the scene

Memo: What follows comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries (Pacifica, Phitsanulok, Cochin, Pokhara, Dikwella/Galle…) visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble, introduction video for context on this series.

Importantly, this is not meant to be a travelogue or creative writing exercise, just laying out my experience as it came to me. I may include some links to other projects or creations that came out of this, maybe… I’m not there yet.

This entry, from is from Galle Sri Lanka, late 2017 and written in the weeks following. It’s now April 2022, i live in Japan, am stable if far from “normal”.  No comments, sympathy requested or accepted. Carry on. 

Dissanayake Ayurvedic Hospital
Dissanayake Ayurvedic Hospital: Sign

Background: Along my healing journey, I received treatment at Dissanayake Ayurvedic Hospital in Galle, Sri Lanka, a government-run, pay-what-you-can facility.

I attended this hospital for Ayurveda treatments for some weeks during Dec. 2017-Jan 2018 and was treated by a kind practitioner called Ruwan. I also met with a wise Doctor who recommended I do a longer in-patient Panchakarma program here, but… some life situations changed and i didn’t do the program. I saw the rooms and talked to the doctors and while it was very spartan and not cozy, the staff seemed to be very intent on their practice.

Dissanayake Ayurvedic Hospital: Lobby
Dissanayake Ayurvedic Hospital: Lobby

Routine: Mr. Prem dropped me off via his Tuk-tuk (he introduced me to the facility in the first place), i then went to a window to announce myself (to everyone’s great surprise!) and then sat in the waiting area. Mr. Ruwan would come back from lunch, i would strip down to underwear and lay down on a wooden table (covered with a vinyl sheet) in a shared room with folks coming and going for massage with loads and loads of oil.

Dissanayake Ayurvedic Hospital: Treatment room
Dissanayake Ayurvedic Hospital: Treatment room
Continue reading Healing: Story of Dissanayake Ayurvedic Hospital ~ Galle, Sri Lanka

Healing Ramble: Pros & cons of living or seeking treatment abroad with a chronic illness

Memo: Above comes from my erstwhile “Healing Journal” – written/compiled on a foggy meandering journey to various countries (Pacifica, Phitsanulok, Cochin, Pokhara, Dikwella/Galle…) visiting all manner of hospitals, clinics and exploring various healing modalities and techniques.

Shared here more-or-less unedited for posterity (whatever that is) and to shed light to those struggling who might come across this riff. Please watch the “Healing Ramble, introduction” video for context on this series.

Importantly, this is not meant to be a travelogue or creative writing exercise, just laying out my experience as it came to me. I may include some links to other projects or creations that came out of this, maybe… I’m not there yet.

This entry was in Pokhara, Nepal, early 2017, written as a letter to someone i met along the way facing health challenges of their own. I never heard back but whatever…

(finally) organized and published spring 2022 – i now live in Japan, am stable if far from “normal”.  No comments, sympathy requested or accepted. Carry on. Note: There’s another post with a review and brief introduction to Ayurveda Health Home as well. 

daveo

Dear [Redacted],

I’ll speak frankly and candidly from my own experience, all of us are different of course – for the record I am at an Ayurvedic clinic in Pokhara, Nepal.

Background:

a medical diagram of me

Like you, and most everyone else with a chronic complex medical conundrum, I’ve spent all the time since my “trigger event” seeking out various treatments.

From overmatched GP doctors, to the anticipation of finally getting into see a “specialist” and the disappointment crash following when they still have more answers than questions, spending everything you got to see various naturopaths, chiropractors, reiki practitioners, massage therapists, nutritionalists… with little to no long-term benefit, spending sleepless nights reading medical abstracts & journals as though you understand them, seriously considering going in significant debt to go to a “fancy famous” hospital, putting up with family and “friends” advice (occasionally well-meaning) but always useless and often completely disrespectful, using up every bit of energy reserves on a daily basis just to get through the day and hopefully feel some vague sense of satisfaction or accomplishment when really you’re just spinning, seeing the stress it causes on lovers and partners who try their best to understand but crack under the pressure from time to time, and acknowledging your own mental well being — which starts to fragment from exhaustion, frustration and so many (often professional) people telling you that it’s “all in your head”.

I made a penciled flowchart of my various options before I headed out this last time, ergo:

(very frank) life options

Shall I do just what the Western doctors and insurance companies want me to do hide myself in a rainy apartment with old folks down the hall filling the lobby with smell of soup?

Go down in flames with late nights of parties and decadence pushing myself to the very limits knowing that it doesn’t really matter if I wake up tomorrow (I’m just not that self-destructive)?

Or, beg borrow and steal to see the litany of well-meaning but wholly ineffective naturopaths, chiropractors, Reiki practitioners, nutritionists blah blah blah? (I have largely done this and have fallen deeply into debt as a result)

Or do I continue this sorta strange wandering life of seeking healing in foreign lands while playing the “cat and mouse” game with the insurance thugs who wish to control me? I guess this choice won for the time being so i’ll break down the problems in the categories:

  • Financial (the cost of simply living coupled with the cost of getting treatment)
  • Treatment (access to reliable and useful services when you need them)
  • Climate (some of us do better and different weather, as well the “political” and social stress of environment)
  • Community (the first year or so it can seem that you have a support network but as years go on, this breaks down and begins to vanish having a net negative affect)
Global Brigadoon Index ™

My experience:

My “western diagnosis” is fibromyalgia and chronic fatigue syndrome/M.E. This all started in May 2013 so I’m coming up on four years. My diagnoses usually affects women and there is support groups etc. have been primarily women, bless their hearts.

Continue reading Healing Ramble: Pros & cons of living or seeking treatment abroad with a chronic illness