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editor’s message Source Media Group info@sourcemediagroup.ca

PUBLISHER |

The face of Canadian health care is changing With the advent of private clinics specializing in certain types of diagnostic testing or elective medical procedures in Canada, plus the wide variety of international options for professional medical treatment, people have more choices than ever before as to how, when, and where they go for care. It shouldn’t come as any surprise, then, that more and more Canadians are seeking health care solutions abroad. There are three main factors driving this change: wait times, availability of specific treatments, and cost. Everyone’s heard the horror stories, or has one of their own, of how long it took someone to either get in to see a specialist or actually have a test done. My wife has multiple sclerosis and we are all too aware of how long the waiting list is for an MRI or CT scan. We’ve gone to a private diagnostic centre in Calgary, and we’ve checked it out in the U.S. as well. Turns out the cost of the actual procedure (not including travel) was close to the same, but you could have the testing done the next day in the U.S., and the results the day after that. As an added bonus we’d get to travel to Palm Springs. When you’re wondering if you’ve got cancer or not, or a brain tumour, or MS, or a CSF leak, time is definitely of the essence. Of course, not all treatment procedures are even available in Canada. The liberation treatment for MS isn’t. Stem Cell therapy isn’t approved in either Canada or the U.S., but it is in Mexico and a few other locales, where they’ve had some success treating things like cancer and strokes. Most hockey fans know the Gordie Howe story. I had the opportunity to attend the Gordie Howe Pro Am hockey tournament banquet in Calgary earlier this year, in support of Alzheimer’s related dementia research, and the Howe family spoke in glowing terms about the results achieved by taking Gordie to Tijuana for treatment. The other main reason people go out of country for various procedures is cost. This is especially noticeable with dental practices. You can literally pay for your trip AND your dentist visit for the same or less than you’d pay your dentist here. For things like crowns and implants, which most insurance plans only offer partial coverage for, or for people who don’t have dental coverage, it’s a very legitimate option. The Medical Travel Show and this accompanying magazine, Destination Medical, are intended to help shepherd interested Canadians through the process. What procedures are offered where? For how much? Who does the work? How do I get there and where do I stay? What’s covered by Alberta Health Care? These questions and more will be answered both in this magazine and at the show, which features exhibitor booths specializing in dentistry, bariatric surgery (weight loss), stem cell and even medical travel facilitators who specialize in giving expert advice. It’s the first year of the show, so while there’s only a few booths, we have secured some of the very best practitioners in some of the most requested medical fields. It’s a good place to start for our very first Medical Travel Show, and a good place for you to begin your search too.

Jim Zang Editor

4 | DESTINATION MEDICAL 2016

Jim Zang jim.zang@sourcemediagroup.ca

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contents

PREMIER ISSUE • 2016

6

A world of choices for care

For many Canadians seeking medical treatment, the waiting truly is the hardest part

9

Is your mouth a money pit?

6

Cost savings motivate many Canadians to seek dentistry abroad

13

As Time Goes By

Wait times in Canada have improved — but remain a key reason for seeking treatment abroad

15

Before You Go…

Albertans seeking medical procedures outside of Canada should brush up on their health care coverage

17

the inside story

Bariatric procedures help keep the weight off

19

healing power

Stem cell therapy has shown promising results

21

Reading the Fine Print

Know what your travel health insurance policies will — and will not — cover

19

23

A guiding hand

Medical travel facilitators connect patients with information and treatment

25

homeward bound

Medical travel patients should know their responsibilities and care options post-procedure

26

Do your homework

13

30

medical travel show guest speakers

9

Make sure you’re going to the right place for the right reasons

28

STORE MY TUMOR

Cancer vaccines can extend your life

DESTINATION MEDICAL 2016

 | 5


A world of

choices for care

For many Canadians seeking medical treatment, the waiting truly is the hardest part

M

aria Vanderzwaag was in pain. A mom with two young children, she was on a waiting list for the abdominal surgery that would ease her suffering. And she couldn’t get out of bed to look after her kids. The situation was becoming intolerable, says Vanderzwaag’s sister, Adele Kulyk. Kulyk felt she had to do something. “I had a friend who had gone to Mexico for surgery, and so I contacted her,” Kulyk says. “That was on a Thursday. On the following Tuesday, Maria was on her way to Mexico. She had the surgery Wednesday.” The procedure went perfectly. That was in 2010, and Vanderzwaag has been healthy ever since. Having to wait for surgery is one scenario that motivates Canadians — more than 45,000 of them last year (including 4,616 Albertans), according to the Fraser Institute’s most recent research — to choose to leave the country for medical treatment. Wait times for procedures are one of the main reasons people seek medical treatment options outside Canada, Kulyk says. After witnessing what her sister went through, she started Saskatoonbased medical travel facilitator Global Healthcare Connections Inc. to help other Canadians understand and connect with medical travel options. Calgary company Global Health Shift is another one of the small but growing number of organizations helping Canadians learn and make decisions about medical travel. “We help people get off the wait list and save money by using international health services,” says T Stoodley, a director of the year-old firm. Her codirector, Tanya Greffard, points out that the choice

6 | DESTINATION MEDICAL 2016

to travel is in no way a criticism of the calibre of care or the quality of doctors here at home. “It’s not about finding better doctors,” Greffard says. “We have fantastic doctors here in Canada. It’s about finding a great doctor you can see on your own schedule.” In 2015, the most recent year studied, the average time between seeing a specialist and receiving nonemergency medical treatment in Canada was 9.8 weeks, according to the Fraser Institute’s research bulletin Leaving Canada for Medical Care, 2016. That’s three weeks longer than what the doctors themselves considered to be clinically reasonable, the bulletin says — and it doesn’t include the average 8.5-week wait to see that specialist in the first place.

five types of medical treatments

performed outside the country on Canadians in 2015 urology

(4,974)

opthalmology

(4,635)

general surgery

(4,495)

internal medicine*

(3,959)

orthopedic surgery

(3,259)

*such as colonoscopies and gastrocopies


Quality of life Orthopedic surgeries are often cited as examples of wait times gone overboard. Because hip or knee operations, for example, don’t usually address life-threatening or life-shortening conditions, patients may have to endure long delays. Although about 80 per cent of orthopedic surgeries are completed within 26 weeks, there are exceptions. Kulyk says she helped one patient who had been waiting about a year for a hip replacement. She was able to book him with a surgeon in Palm Springs, Calif., and his operation was done inside 30 days. “His only regret was that he didn’t do it sooner,” Kulyk says. “The impact on quality of life is tremendous.” From dentistry to cosmetic surgery and experimental cancer treatments, Canadians who look at the international scene are finding they can save time — and sometimes money — by crossing borders. At dental treatment centres such as the MDC Group in Cancún, Mexico, U.S.-educated dentists work in state-of-the-art facilities that cater to an international clientele. Canadian patients who require major procedures such as implants can realize significant savings there, even with travel costs factored in. “Dentistry is the main reason people travel,” Stoodley says.

Looking at alternatives People facing debilitating or terminal illnesses may also look outside Canada’s borders for alternatives and clinical trials. One well-known recipient of an experimental treatment was the late all-time hockey great Gordie Howe. In late 2014 Howe, then 86, suffered two strokes which left him with partial paralysis and speech impairment. His family decided to pursue experimental stem-cell therapy for the iconic athlete, taking him to Tijuana to receive injections and infusions as part of a clinical trial under the auspices of San Diego-based Stemedica Cell Technologies. When Tanya Greffard’s sister was advised in early 2015, at age 59, that her cancer had progressed to the point where she should consider palliative care, she immediately began to look into alternatives. “We did a bunch of research,” Greffard says. “She was looking at four or five clinics in Europe, Mexico and the U.S.” She eventually settled on the Hope4Cancer clinic in Mexico, where she received a program of alternative treatments. “She had been given a very short window to live and she’s still here a year and a half later,” Greffard said

in June 2016. “Had she just given up, she may have never had a chance to meet her first grandchild.”

Adele Kulyk with Global Healthcare Connections.

Support for patients From cosmetic procedures and fertility treatments to neurosurgery, internal medicine procedures, ophthalmology and urology, crossing borders for treatment is not a new phenomenon, Kulyk says. In fact, Canadians have long been going to U.S. facilities like the Mayo Clinics or Johns Hopkins for care. Johns Hopkins Medicine International, based in Baltimore, treats about 4,500 international patients each year, says Katherine Deruggiero, vicepresident of patient services for Johns Hopkins “Typically, they have highly complex cases and are seeking medical treatment that is not available in their home countries,” she says. Most patients considering medical travel have two questions: Is it safe, and will my doctors back home be okay with it? With the proper research and planning, the answer to both can be “yes.” “It is best for you, as a patient, to discuss [the medical travel you are considering] with your doctor prior to making a decision,” Kulyk says. “This way, you’ll know that you have support for any follow-up care. In our experience, informed physicians do their best to support their patients.” International facilities also play a role in the continuation of care. “After the patient departs, we will take care of transferring complete medical records back to his or her health care team at home,” Deruggiero says. In the end, knowledge and research are the key to weighing costs, risks and benefits to get the best care for each individual’s situation. That will often be close to home or in another province, but there’s also the whole world of options to consider. “We still have explaining to do,” Kulyk says. “There’s a huge educational curve in this industry. This is a new concept for some people.”  DM DESTINATION MEDICAL 2016

 | 7


Is your mouth a

money pit? Cost savings motivate many Canadians to seek dentistry abroad

F

or Canadians used to having medical treatment paid for through our health care system, the price tag on complex dental procedures can induce a serious case of sticker shock. When they discover they can save thousands — sometimes tens of thousands — of dollars by having those procedures done outside Canada, some are tempted to book appointments and travel. And many do. In Mexico, clinics specializing in implants, crowns, veneers, dentures and other pricey procedures see a steady flow of international patients. Dr. German Arzate, director of Cancún Cosmetic Dentistry, says his office sees between 800 and 1,000 foreign clients annually — and about a third of them are from Canada. “Almost 300 Canadians are coming every year, and for the same amount of money they would spend at home they are getting their dental work done and getting a vacation,” Arzate says. That may actually be an understatement; in some cases the cost for treatment, travel and accommodations combined is quite a bit less than what patients might spend in Canada, says Adele Kulyk of Global Healthcare Connections Inc., a Saskatchewan company that helps patients book medical travel. “I have patients who need implants — one was going to be $40,000-plus [at home], and in the end the total was $18,000 including travel cost to Cancún,” Kulyk says. Dr. Shirley Baker, director of dentistry at Tijuana Clinic for Cosmetic Dentistry, also sees a steady flow of Canadian patients. She says 14

per cent of her clients, or more than 200 a year, come from here. “We see a large percentage of cosmetic, reconstruction and denture cases,” says Baker, who opened the clinic in 2010 after practicing in the Tijuana area since 2005. “These, along with crowns and root canals, comprise a large part of our business and are the procedures that a patient can really save on as well.”

Money matters According to medical travel resource Patients Beyond Borders, the cost of dentistry is an almost universal reason for medical travel. “Medical travelers who seek dental care outside their national borders have a single thought in mind: money,” says the organization on its website. While Canadians and Americans look to Mexico ➤

DESTINATION MEDICAL 2016

 | 9


IS YOUR MOUTH A MONEY PIT?

(continuation)

Cancún Cosmetic Dentistry clinic

and Costa Rica, Europeans flock to Hungary and Australians to Thailand for the same reasons. “Dentistry is the main reason people travel for treatment,” says T Stoodley, co-director of Calgary medical travel facilitator Global Health Shift. The Canadian dental community has for several years recognized that cost is motivating some to either forgo treatment or leave the country. “The emergence and growth of dental tourism raises serious questions concerning whether more dental services ought to be covered under public health insurance plans, employer-provided dental plans or a combination of public and private health insurance programs,” wrote Dr. Leigh Turner in a 2009 opinion piece for the Journal of the Canadian Dental Association. “Where dental care is an ‘out-of-pocket’ expense, low-income patients have a much reduced chance of obtaining access to timely, affordable care.” The more complex and involved the procedure, the more it’s likely to cost — especially work that’s deemed cosmetic. That’s where travelling for treatment can offer the largest savings. “We do all types of dental procedures with Canadians and Americans, but usually they don’t come for basic work,” Arzate says. “It starts from crowns and veneers all the way to implants and complete full mouth makeovers. Implants here are 60 to 70 per cent below the price they can get back home.”

The more complex and involved the procedure, the more it’s likely to cost — especially work that’s deemed cosmetic. That’s where travelling for treatment can offer the largest savings. 10 | DESTINATION MEDICAL 2016

Snowbird services Another factor causing Canadians to seek treatment elsewhere is the fact thousands of us spend several weeks or months of each year in vacation homes outside Canada. Florida, Arizona and California are popular snowbird destinations, and some Canadians find their dentist of choice in their home away from home. In the Greater Palm Springs area in California, for example, Canadian-born Dr. Bruno Lemay and his clinic, Desert Dental Alternatives, advertise directly to Canadians living in or visiting the area, inviting them come “be treated by a fellow Canadian.” But for Canucks looking to save loonies on a major procedure, Mexican — and to a lesser extent, Costa Rican — clinics remain the biggest draw. San Jose, Costa Rica, is home to several well-regarded dental clinics that cater to North American patients, including Meza Dental Clinic, Nova Dental and Advance Dental Clinic. Back in Mexico, Arzate notes that all the materials his clinic uses are imported from the United States or Germany, which increases patients’ level of confidence. “Cancun is beautiful, but we don’t produce any materials here. We have the same FDA-approved materials they use back home.” He calls the Cancún Cosmetic Dentistry clinic “stateof-the-art, clean, modern and also a stylish place,”


“We see a large percentage of cosmetic, reconstruction and denture cases. These, along with crowns and root canals, comprise a large part of our business and are the procedures that a patient can really save on as well.” adding the American Academy of Implant Dentistry regularly sends groups of doctors to the facility for training in implant placement. “I’m so happy to be part of this movement to improve the quality of implant dentistry all over the world,” he says. Baker says being able to control the quality of care was the main reason she started Tijuana Clinic for Cosmetic Dentistry. “It’s a platform to fulfill my own vision of what quality dentistry should be,” she says. “I was able to construct the kind of environment that makes my patients comfortable and is comfortable to work in, day in day out. Also by owning my own practice, I can be more discerning in the labs and lab work I choose.”

background check But of course, in an industry powered by profit, common sense dictates that anyone considering dental travel needs to do some homework. As in any industry — in Canada or abroad — there are sub-par practitioners who are happy to take your money. And a professional-looking website and well-designed advertising are not necessarily indications of highquality work, notes Patients Beyond Borders. “Don’t assume that one dentist is as good as another. Although professional societies and accrediting agencies set standards, compliance varies widely,” the organization says. Internet research is a good start. Follow up by talking to people experienced in dental travel. “Seek out evaluations from previous patients, and don’t forget to ask for proof of competence before

you make an appointment. You are paying the bill. You have a right to know everything there is to know about your dentist’s training and experience.” Visiting clinics in person before deciding on treatment is a recommended step. “Even though I was skeptical, I decided to go down [to Mexico] and see what the facility had to offer,” says Cassey, a Canadian patient, in an online testimonial for Dentaris Centre for Dental Excellence, which has clinics in Cancún and Playa del Carmen. Cassey had been quoted a price she “never would have been able to afford” in Canada, she writes. “I was lucky enough to be a critical thinker and not stop my search.” The search led to Dentaris, and a successful outcome: “It´s one of the best decisions I have ever made.” The flipside of the positive testimonials, writes Turner, “is that patients risk receiving inferior care in regions with lower regulatory standards and limited oversight of dental clinics.” Still, dental tourism is proliferating, he adds. “Travelling for dental care is becoming common place. Researchers and professional associations are paying limited attention as dental care shifts from being a local service and enters a competitive global marketplace of cross-border economic transactions.” dm

dr. German arzate, director of cancún cosmetic dentistry

DESTINATION MEDICAL 2016

 | 11


As Time Goes By

Wait times in Canada have improved — but remain a key reason for seeking treatment abroad

T

he Canadian health care system tries to keep wait times for priority procedures under control — but what constitutes an officially acceptable wait time may still seem long for some patients. “It’s ridiculous what waiting does to our lives,” says Tanya Greffard, co-director of Global Health Shift, a Calgary company that arranges medical travel for clients. In 2004, Canada’s first ministers made a commitment to reduce wait times as part of the 10-Year Plan to Strengthen Health Care. Target wait times were established in consultation with the medical community, and the most recent study by the independent Canadian Institute for Health Information shows the majority of procedures are being done within those benchmark times. In the case of hip and knee replacements, about 80 per cent of Alberta patients had their surgeries done within the established acceptable time period of 26 weeks — or about six months. And that doesn’t include time spent being referred to, and waiting to see, a specialist and then recovering after surgery.

The benchmark wait for cataract surgery is 16 weeks, and in Alberta that target is reached 64 per cent of the time. For radiation therapy, the goal is to get started within four weeks, and that occurs in 98 per cent of cases, while the 48-hour target for hip fracture treatment is met 86 per cent of the time. The study, released in March this year and based on 2015 data, also shows the system has improved steadily over the past decade in reaching wait-time goals for most procedures. But for some patients those ideal waiting times can be unacceptably long, and that may drive them to seek treatment outside Canada, says the Fraser Institute in its 2016 report on Leaving Canada for Medical Care released October 12. “Given the long wait times Canadians face in Canada, it’s likely this is one of the reasons they travel abroad. “And this is, in addition to other factors, such as maybe cost, the unavailability of certain medical technology and things like that.” For patients awaiting hip and knee replacements, six months of pain and limited mobility may feel like an eternity. “It’s debilitating,” says medical travel facilitator Adele Kulyk, founder of Global Healthcare Connections Inc. “We have people in their 50s and 60s where the impact on their quality of life is devastating, and the pain.” As Canada’s population ages and risk factors such as obesity increase, the demand for procedures is likely to grow. That will make it difficult for the system to improve, or even maintain, the wait time standards it has achieved, says the Canadian Institute for Health Information’s report. Greffard says in her experience most people considering medical travel are not seeking a higher quality of care. Instead, wait times are a major motivator. “It’s not about finding better doctors,” Greffard says. “We have fantastic doctors here in Canada. It’s about finding a great doctor you can see on your own schedule.  DM DESTINATION MEDICAL 2016

 | 13


14 | DESTINATION MEDICAL 2016


Before You Go… Albertans seeking medical procedures outside of Canada should brush up on their health care coverage

P

atients looking to travel outside of Canada to undergo medical procedures are encouraged to do their homework before booking their trip. While in their home province residents are covered for many traditional hospital and medical costs under the Alberta Health Care Insurance Program (AHCIP), leaving Canada or even Alberta can often mean patients having to pay out of pocket for medical costs. Alberta Health spokesperson Carolyn Ziegler says it’s best to check prior to finalizing travel plans what may or may not be covered under the AHCIP while out of province at www.health.alberta.ca/AHCIP. “We do suggest that if you are travelling outside of Alberta that you have insurance, whether that is through an employer or a private company,” says Ziegler. “Outside of Canada most things aren’t covered. There is a stipend ($100 for in-hospital care and $50 for outpatient per day) that you can get if you were in a hospital, that you could submit and get payment for. That is not going to cover a lot.” Alberta Health has an Out-of-Country Health Services Committee that determines what medical costs will be covered outside of Canada. Procedures that are, as well as exclusions — such as hospital services provided in a private health facility — are listed online. As is the case in Alberta, cosmetic surgeries, unless deemed necessary by a doctor, ambulance service and prescription medications are not covered outside of Canada by AHCIP. “There is a committee and an appeal panel where we cover the costs of procedures or services outside of the province or outside of Canada — it’s generally not something that’s available in Alberta. The rationale would be that it’s a procedure only offered in one or two facilities in the world and we don’t have a doctor in Alberta that does it,” explains Ziegler. And if it’s not yet been proven medically, it’s not eligible for coverage or reimbursement. “Trials or experimental procedures are generally not covered,

as well as if it’s something that’s available in Alberta. Also, if you say ‘I want to go to the States because there is a doctor there that I want’ but the surgeons of Alberta cover that, then it’s generally not covered.” There is an information sheet and an application form on the Alberta Health website, but both must be filled out by a physician and submitted with supporting medical documents, Ziegler cautions. “It’s really important to start the process before you go. Sometimes people come back (after a procedure) and then try to submit claims, and it’s possible that things could be covered but it’s not necessarily guaranteed. It’s always important you talk to your doctor and you check with the committee — and you do that well in advance.” Albertans with any questions about the Outof-Country Health Services Committee or what AHCIP covers can call 780-415-8744. “The main thing for Albertans, before they leave, is to know what is covered and not covered within the Alberta Health Care Insurance Plan, and there probably is some confusion with some people. We do also have a section in general on insurance and answering all the questions you might have about your Alberta Health Care Insurance,” concludes Ziegler.  DM DESTINATION MEDICAL 2016

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the

inside story Bariatric procedures help keep the weight off

F

or many people, bariatric surgery is key to losing weight — and keeping it off. And at Tijuana Bariatrics in Mexico, you can get it done, for considerably less money than you’d pay for comparable surgery in Canada. “Bariatrics refers to a surgical procedure to lose weight,” says Dr. Paola Velazco, the on-site and follow-up physician at Tijuana Bariatrics. “The surgeries are very safe, even if patients are morbidly obese,” she adds, and many patients notice big differences in a short time. A range of procedures are offered, but the most popular is gastric bypass, where the stomach is literally made smaller, so you feel full with less food. “This is the gold standard of bariatric surgery,” Velazco says, noting that it even works for those with weight-related illnesses such as diabetes. “The recovery time is fast and discomfort is minimal because it is minimally invasive.” Another form of bariatric surgery, a gastric sleeve restricts about 85 per cent of the stomach. “It works but it is restrictive,” notes Velazco. “If you’re a good patient, very disciplined, it will work for you.” The duodenal switch “is less common and is the most aggressive procedure,” she says. “Patients choose it as their last resort.” A typical client is an obese adult from the U.S. or Canada; they turn to Mexico

“The recovery time is fast and discomfort is minimal because it is minimally invasive.”

as a more affordable option to what they find at home. Prices depend on the operation chosen and a person’s body mass index, but are roughly a quarter of what you’d pay for similar surgical procedures in Canada. Potential clients sign up by filling out a health questionnaire at tijuanabariatrics.com and every case is reviewed beforehand by one of the surgeons. Wait times are short, as little as a week or two, but for one week before surgery, each patient must follow a strict diet that includes no over-thecounter painkillers, alcohol or high-fat foods. Typically, patients are picked up at the Tijuana airport by a representative from the clinic. They spend a night in a hotel and are picked up early the next morning and delivered to the hospital for their procedure. A patient will then remain in the hospital for one to three nights. “We ask patients to spend another two days at the hotel, just to make sure they don’t have any complications,” Velazco says. Tijuana Bariatrics was started five years ago, and is still owned and operated by the same group of professionally trained and licensed doctors. A followup team, which includes a nutritionist, works with every client for up to two years post-operation. Unlike many clinics, the Tijuana Bariatrics team focuses entirely on bariatric procedures, meaning that the clinic’s two surgeons are experts in a narrow field, and they operate on an average of five to seven clients per day, five days a week. “They are very qualified surgeons who have been doing this a long time,” says Velazco. “We really care about our patients, and we all think and work the same way.”  DM DESTINATION MEDICAL 2016

 | 17


healing power Stem cell therapy has shown promising results

I

magine you’re in charge of a factory. It’s humming along until one day an entire section of the facility starts to lose efficiency. Equipment breaks down, production slows — and you don’t know why. Now imagine you could send in a special type of worker to deal with the situation. Someone who could analyze the problem, quickly learn the skills to solve it, then call in reinforcements. Soon, your business is back up to full capacity. That, in basic terms, is the promise of stem cells in medical treatment. In the ideal scenario, stem cells will go to the problem area, specialize then replicate themselves, repairing and rebuilding diseased or damaged tissue and organs. “Stem cells are the foundation cells for every organ and tissue in our bodies,” explains the U.S.based International Society for Stem Cell Research. Beginning with research at the University of Toronto in the 1960s that established their existence

and function, stem cells have shown both power and potential in the treatment of a tremendous number of medical conditions and injuries.

Exciting possibilities Although there are several types of stem cells, they all have in common the ability to self-renew, or make copies of themselves. They can also differentiate — literally transform into distinct mature cells that make up the various parts of our bodies — and that’s the part that has researchers, patients and doctors most excited. “I have fixed in my memory some cases where patients have had extraordinary and dramatic responses, seemingly miraculous,” says Dr. Luis Romero of ProgenCell, a clinic in Tijuana, Mexico, that specializes in autologous stem cell therapies — that is, treatment using the patient’s own cells. “That encouraged me, seeing patients with distressing diseases, with no hope of any improvement, who have ➤ DESTINATION MEDICAL 2016

 | 19


HEALING POWER

(continuation)

improved their condition with this kind of work.” Although stem cell therapy is still considered experimental for many conditions, the method has a long track record of success in others. The use of bone marrow cells to treat leukemia and other blood disorders has become standard, for example, and stem cell therapy is effective in treating various bone, skin and eye diseases and injuries.

Ethical issues Experts acknowledge that stem cell therapies have tremendous potential. Research and trials continue in Canada and the United States, but the work has been slowed by ethical concerns. The most powerful stem cells — with the ability to generate every type of cell in the body — are those contained in the embryo in its very early stages of development. The idea of creating human embryos through in vitro fertilization for the purpose of harvesting stem cells is a tricky concept, and one that has cast a controversial light on the entire topic. “Adult stem cell research has been very challenging with all the misinformation and confusion about embryonic stem cells,” American cardiologist Dr. Timothy Henry told National Geographic News. Authorized by the U.S. Food and Drug Administration to conduct clinical trials of stem cell treatment for heart conditions, Henry saw what he felt in 2008 were promising results despite the difficulties.

Travelling for treatment The very real scientific excitement about stem cells combined with the controversy around the topic has meant treatments that Dr. Jorge could theoretically Gaviño help people with serious diseases are often readily available only by travelling to foreign countries. In Mexico, ProgenCell offers therapy for a wide range of conditions including immunological, neurological, metabolic, orthopedic and ophthalmic issues, using the patient’s own stem cells — not embryonic cells — in its treatments.

20 | DESTINATION MEDICAL 2016

For patients who were virtually immobile and can now lead normal lives, the power of stem cell therapy is very real.

The clinic points out on its website that “current use of stem cells is experimental, and the investigative results can be used to further refine treatments in the future.” But for patients with debilitating, painful or life-threatening conditions, the therapy holds hope. “Important benefits have been achieved in some patients. And generally, they are patients with few options of therapies or treatments,” says Dr. Jorge Gaviño, who together with Romero founded ProgenCell in 2008. “They have very complicated diseases, so this treatment option gives them hope and results.” In Lima, Peru, Dr. Jorge Tuma has been offering autologous stem cell therapy since 2005, treating more than 7,000 patients. Tuma, a cardiologist by training, has had papers on stem cell treatment for cardiac, liver and diabetes patients published in several American medical journals and served as a visiting assistant professor at Columbia University in New York. “Our treatment has been shown to be highly effective for the heart, as for other organs,” Tuma says on the website for his clinic, Rejuvenare. “I always tell my patients this is…a tremendous new alternative to improve quality of life,” he told National Geographic News.

Results ‘remarkable’ When outcomes are positive, people who participate in trials or travel for stem cell treatments often say their quality of life has taken a turn for the better. In the U.K., a trial program involving about 20 patients with relapsing remitting multiple sclerosis, or RRMS, produced results from stem cell therapy that were called “remarkable” and “miraculous” by neurologist Basil Sharrack of Sheffield Teaching Hospital, where part of the program took place. The treatment being evaluated was intense. It involved using chemotherapy to knock down the patient’s immune system, then “rebooting” the immune system with an infusion of the patient’s own stem cells, harvested earlier from bone marrow. Speaking with the BBC earlier this year, ➤ Sharrack said the treatment is only suitable for a

(continued on page 22)


Reading the

Fine Print Know what your travel health insurance policies will — and will not — cover

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hether it’s for a shorter wait time, lower cost or for access to a procedure either not proven or unavailable here, medical tourism is fast becoming a popular option for Canadians. From orthopedic, cardiovascular, and neurosurgery procedures to weight loss, cosmetic or plastic surgery and sex reassignment, Canadians are increasingly hopping flights for the U.S., Mexico, India, Europe, and myriad other destinations before going under the knife for necessary and optional procedures. Among the associated costs with medical tourism, a first priority should be insurance, say policy experts. Though it’s still a bit of a grey area when it comes to what can be covered by travel health insurance, it’s well worth considering as a relatively small investment in the overall cost. What many may not realize is that it’s difficult to find insurance to cover the procedure itself. “Typically policies in the Canadian market will not cover individuals for the services that they are going to get,” says Will McAleer, president of the Travel Health Insurance Association of Canada (THIA). “Policies that you buy on an individual basis are for emergencies, something sudden and unexpected that required an intervention of a medical practitioner.” McAleer advises looking at travel insurance as an expense that can save you money and worry in the event of an unrelated injury or medical emergency. “Let’s say you are down there and you are getting a procedure done and you cross the street and get hit by a Will McAleer car,” he cautions. “Your typical travel insurance would cover you for that as long as it’s not related to the treatment you were going down there to get.”

Insurance can also cover you if you need to cancel your trip, he notes. “Let’s say just before you were to go on that plane you need to cancel it for one of the reasons you can cancel it. You get way too sick to go on the trip, someone in your family suddenly and unexpectedly passes away or you lose your job. Trip cancellation would pay to reimburse you for the non-refundable cost.” McAleer stresses that honesty is the best policy when dealing with insurers. “You need to make sure you are disclosing any medical conditions and answering truthfully on applications and that you are actually taking time to look at the policy and make sure that it lines up with coverage you are expecting you would have. When you are in an emergency room in a foreign country that is not the time to look at the fine print of your insurance contract.” Sharmin Hislop, spokesperson for Sharmin Hislop Alberta Blue Cross, says when she has clients who are travelling for medical reasons, she commonly refers them to other insurance brokers and providers. She says while Alberta Blue Cross will generally not cover nonemergency medical procedures in its policies, it’s the company’s mandate to “cover you or find someone who will. You can’t leave people without insurance.” Like McAleer, Hislop recommends always being up front with your insurance provider about the purpose of a trip, and perhaps even more importantly, to read the fine print in any travel insurance policy. “We always say with any coverage that the first page they should read is the exclusions page.” One of the companies Hislop commonly defers to is Calgary-based Simpson Group Insurance Services. “You are going to find that a lot of policies will not ➤ DESTINATION MEDICAL 2016

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Reading the fine print

(continuation)

even insure a person to travel when the purpose is to seek medical attention,” says Jeff Simpson, president of the Simpson Group. “But there are policies, certainly ones that we work with, that will insure unrelated to the condition or related conditions that might arise from whatever the procedure that they’re going for. We write that kind of coverage on a pretty consistent basis.” Simpson says that it might also be worth it to ask the operating facility in the country you are travelling to just what insurance options they can offer. “Those would be questions that I would encourage people to look into if they are seeking treatment in a centre Jeff Simpson of excellence as an example, to have the discussion with them up front ‘do you have any insurance policies with them up front to cover the risks associated with the specific treatment that I am going for?’ Some facilities will have that specific type of coverage.”

He says he has also seen provincial government policies foot the bill in special cases. “There are also people that, having exhausted the Canadian system, the specific treatment that is necessary or is available in another country, hasn’t been approved in Canada or is not available in Canada, there are times when those procedures are coverable by Alberta Health or other provincial providers. I have seen examples of that.” Simpson advises also finding out exactly what will be covered up front. Even if Alberta Health has agreed to pay for a surgery and its associated costs, travellers may be on their own for any additional costs that ensue. “Just because Alberta Health will cover a medical procedure that you’re going to have in another country or in the U.S. it doesn’t mean that if you suffer another medical emergency that they’re going to pick that up as well,” he explains. Simpson says even if a medical procedure is not covered by insurance, he would recommend travellers always invest in travel insurance before taking off or hitting the road. “The greater risk is that something is going to happen while they are travelling on the highway and roads or something else is going to happen.”  DM

healing power (continued from page 20) very specific group of MS patients. “These initial results need to be confirmed on a much larger scale and over a longer period,” he added. Still, for patients who were virtually immobile and can now lead normal lives, the power of stem cell therapy is very real. “I got my life and my independence back, and the future is bright,” patient Holly Drewry told the BBC. Two years after treatment, the

25-year-old reported no relapses and her scans showed no evidence of active disease. In a case well-known to Canadians, the late hockey icon Gordie Howe travelled to Tijuana in 2014 for therapy as part of a clinical trial through San Diego-based Stemedica Cell Technologies. Howe, then 86, had suffered two strokes, which left him with partial paralysis and speech impairment. His son Marty called the treatment’s results “miraculous,” saying Howe had regained the ability to walk and speak more clearly. Howe passed away at 88 in June 2016, and Marty told news media that his father had simply died of old age.

Encouraging improvements Although researchers continue to push forward on the scientific and ethical fronts, many stem cell treatments still fall into the “unproven” category, and results vary. “When you see improvements, it encourages the medical team to go ahead,” Romero says. “Of course there are also disappointments. I hope that as we learn more about stem cell treatments, more and more patients will improve — and we will see our efforts benefiting our patients.”  DM

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A guiding hand Medical travel facilitators connect patients with information and treatment

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ou read the success stories and you hear about people who got excellent care and saved time and even money by travelling outside Canada for medical or dental treatment. Sounds worth looking into, right? But with so much information and marketing online, and so many choices, how is a person supposed to zero in on options and make a decision — and then set up an appointment and plan travel and accommodations? It can seem overwhelming. That’s where medical travel facilitators come in. “Let us handle the details so you can concentrate on healing,” says T Stoodley, director of Calgary-based Global Health Shift. “We help people get off the waiting list and save money by using international health services.” That help is very much in demand, says Adele Kulyk, whose company, Global Healthcare Connections Inc., is based in Saskatoon. “We still have explaining to do. There’s a huge educational curve in this industry — this is a new concept for some people.”

In reality, the idea of travelling for medical care, whether to another province or another country, isn’t new at all, Kulyk says. “There have been people from Canada for years going to the Mayo Clinic, for example. That’s medical tourism.” The strength of companies like Stoodley’s and Kulyk’s is that their expertise takes a lot of the tough legwork out of the equation for patients themselves. They can serve as a kind of filter, understanding clients’ needs and offering a pre-screened range of high-quality choices. They can also take care of the entire process, from booking treatments and procedures to travel and accommodations. Operating like travel agents, they normally take no money from patients — they are paid by the facilities to which they bring clients. ➤

“Our company doesn’t recommend any doctors we haven’t met, or facilities we haven’t walked through. That fact gives people a lot of comfort.”

DESTINATION MEDICAL 2016

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a guiding hand (continuation)

“Our whole business model is based on taking the fear out of it,” Stoodley says. “Our company doesn’t recommend any doctors we haven’t met, or facilities we haven’t walked through. That fact gives people a lot of comfort.” Canadian clients are valued by the international medical community, so acting as a connector between patients and services is both demanding and rewarding, Kulyk says. “We talk to a ton of providers — doctors from all over the world contact us throughout the year to be part of our program,” she says. “We stick to highly regarded, well-established facilities, usually medical travel facilitators for several reasons: to connected with universities in their areas.” get off waiting lists, to receive highly specialized Even so, patients are understandably wary. The treatments or to save money, for example. most common questions asked of medical travel Wait times for non-life-threatening procedures facilitators are “is it safe?” and “what if I have a in Canada can extend into problem when I return home?” months or even years, and for Stoodley says medical travel patients who can afford to pay, has the same level of safety as Top reasons people orthopedic surgeries (specifically any type of treatment regardless leave Canada for hip and knee replacements), of location, as long as you inform treatment: bariatric procedures for weight yourself and utilize accredited • Wait time for bariatric and loss, gender reassignment facilities and professionals. As for orthopedic procedures and cosmetic surgeries are the second question, it’s all about top reasons for looking into keeping your doctors in Canada • Desire for highly specialized or travel, Stoodley says. informed and getting their buyexperimental treatment Special or experimental in to what you’re planning. • Cost savings for dental and treatments for cancer or chronic “When you’re considering cosmetic procedures conditions such as multiple travel, it’s best for you as sclerosis, and clinical trials related a patient to discuss this to new procedures such as stemwith your doctor prior to cell therapy, also motivate people to travel for treatment. making a decision,” Kulyk says. “In our experience, “But dentistry is the main reason people travel. informed physicians do their best to support Alberta is very well-known in the dental centres in their patients both pre- and post-treatment.” Mexico,” Stoodley says. That’s because when it comes People seek out medical tourism and come to to major dental procedures, the savings can be significant. Kulyk mentions one client who Top procedures and key destinations: travelled to Cancun, Mexico, for dental implants. The total cost • Orthopedic surgery — U.S., Mexico, Europe including travel was $18,000 — a • Cancer treatment — U.S., Mexico, Germany bill she says would have been • Bariatric surgery — U.S., Mexico closer to $40,000 at home. • Stem cell treatment — Bahamas, Mexico, Thailand, Singapore With those kinds of numbers, • Cosmetic surgery — Mexico, Latin America it’s not hard to see why helping • Dentistry — Mexico Canadians arrange medical travel is a growing business.  DM

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p h oto by d o n m o ly n e aux

T Stoodley (left) and Tanya Grefard of Global Health Shift.


homeward bound Medical travel patients should know their respo ities and care options post-procedure

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ccording to a study by Deloitte, the burgeoning industry of medical tourism — Canadians travelling to foreign soil for medical, cosmetic and dental procedures — accounted for an investment of some $40 billion US by the end of 2010. But this growth in the trend of medical tourism can also raise questions, not the least of which concern ethical responsibilities and legal obligations of the medical community to patients after they return home, for followup care or worse — Dr. Jeremy complications related to Snyder the procedure. Dr. Jeremy Snyder, associate professor in the Faculty of Health Sciences at Simon Fraser University, says doctors and dentists have an ethical responsibility to offer their patients care, even if their emergency is based on or the result of care received outside of Canada.

Doctors and dentists have an ethical responsibility to offer their patients care, even if their emergency is based on or the result of care received outside of Canada.

Canadian doctors are bound by oath to do their best to address patient concerns and health care needs, Snyder says. “The Canadian Medical Association has a professional code of responsibility of physicians to patients. That’s not a legally binding document — but it is something that speaks to the ethics of doctors. They have a responsibility to help patients and prevent them from getting hurt, but there are limits to what one can do in that situation … It is a balancing act for sure.” Snyder’s team at Simon Fraser also produces its own website on medical tourism (medicaltourismandme.ca), that features general advice about things to think about before going abroad for procedures and possible things to consider that might go wrong. Dr. Trevor Theman, CEO and registrar of the Alberta College of Physicians and Surgeons, says Alberta doctors follow the Canadian Medical Association’s Code Dr. Trevor Theman of Ethics, under which physicians and surgeons must: “Provide whatever assistance you can for any person with an urgent need for medical care. You apply that to the patient that goes elsewhere to get a hip replacement or a kidney transplant or laser eye surgery or a cosmetic procedure and the answer is that if they have an urgent need, then physicians have an obligation to provide assistance.” Theman urges patients who may be looking at having surgeries or procedures done outside of Canada ask the right questions before going under the knife of the health care team at the facility. “One should be very cautious about understanding what the qualifications and training are, if you see somebody and they call themselves a dermatologist or an eye ➤ DESTINATION MEDICAL 2016

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HOMEWARD BOUND

(continuation)

doctor or a cosmetic surgeon. Cosmetic surgeon, for example — there is no accredited program for cosmetic surgeon in Canada. We have plastic surgeons and they do cosmetic surgeons, but their training is in plastic surgery… If they call themselves a cosmetic surgeon, what are they actually? What kind of rules are there around what they can call themselves? One should be cautious around that.” Dr. Randall Croutze, CEO and registrar at the Alberta Dental Association and College, says like doctors, Alberta dentists are bound by oath to help patients who come to their office with dental needs, even if it’s based on follow-up care or complications from a surgery done elsewhere. After all, it’s not always practical to return to Mexico or India if something happens with a crown or dental implant. “Anyone that presents to us with a dental concern we are certainly going to examine that

patient and take a look at what problem they have,” assures Croutze. “We wouldn’t treat them any different than any other patient presenting to the office.” Croutze suggests that patients looking Dr. Randall Croutze at care abroad or in the U.S. first consult with their local dentist to ensure it’s a procedure they need. For more on the Alberta College of Physicians and Surgeons ethical responsibilities to patients, visit www.cpsa.ca and for tips on dental health and standards of the Alberta Dental Association and College, go to www.dentalhealthalberta.ca.  DM

Do your homework Make sure you’re going to the right place for the right reasons

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edical tourists have a world of choice in health care and are taking advantage of this. But, With so many different countries now taking part in the medical tourism market, it can be difficult to decide on the best medical tourism destination for you. For example, some people do not enjoy destinations that are radically different from life at home, while others relish experiencing a new country and a new way of life. The Medical Travel Quality Alliance (MTQUA) advises patients looking for medical care and treatment abroad to seek out accurate up-to-date and reliable information. Things like accreditation status and word of mouth recommendations are important, as are issues such as patient safety and security, marketing integrity, and, of course, quality of work. Because a medical tourism trip is much more than just a holiday, here are some things to think about when choosing your medical tourism destination. •How far is it? •How expensive is it to get to? •How expensive is it to stay? •What is the standard of the healthcare facilities? •What are the tourist facilities like? •Will language be an issue? •Are you putting your medical treatment first?

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While all of the above points should certainly be considered when choosing a healthcare destination abroad, the most important is to find the right treatment. Never compromise on your care just to see a certain country, or commit to travelling further than is safe or comfortable. The MTQUA regularly reviews hospitals for their annual list of World’s Best Hospitals for Medical Tourists, using some of the criteria below. 1 Medical quality and outcomes 2 International patient communication and care management 3 International patient marketing 4 Value for service 5 Patient safety and security 6 Transparency and disclosure 7 Attention to other unique needs of the medical traveler 8 Website 9 Management 10 Partnerships, alliances and external support See the Top 10 list of World’s Best Hospitals for Medical Trourists visit www.mtqua.org  DM


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Store My Tumor Cancer vaccines can extend your life

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t might not be something you want to keep at home in the refrigerator, but experts are touting a new potential cancer treatment that involves storing peoples’ tumors. The company is called Store My Tumor, and that’s exactly what they do. Here’s how it works. Your tumor is removed and stored cryogenically — alive — at the company’s facility in Philadelphia, they are affiliated with the University of Pennsylvania. Usually, when a tumor is removed, it’s discarded. However, researchers have found that each person’s tumor is unique and contains important genetic information that can help increase the number of treatment options available. For example, without your tumor sample, cancer treatment is pretty much limited to chemotherapy and radiation. When doctors have the living tumor to work with, they are able to consider alternatives such as chemo-sensitivity testing, which tests out the chemo on your tumor cells first, to see how it’s going to work for that patient, before submitting your actual body to the procedure. There’s also the potential for developing a custom cancer vaccine for that person, harnessing T-Cells to help boost the immune system, and utilizing genetic sequencing to identify and target cancer cells — allowing doctors to better match the right drug or other treatment to attack just the cancer cells and spare the healthy ones. The development of these ‘cancer vaccines’ especially has shown extremely positive results for many patients. Basically, like all vaccines, this method uses the living cancer cells to ‘farm’ the natural immune system antibodies which are then injected into the body, recognize the enemy (cancer cells) and attack

ACTUAL RESULTS* Progression-free survival at 6 months Time to progression

them. It’s important to have the plan in place with both Store My Tumor and your hospital or clinic so that cells are harvested and preserved correctly and forwarded to the storage facility. The best time to consider this kind of treatment is as soon as possible after surgery and chemotherapy as it boosts the immune system rapidly, extending time in remission and decreasing the chances of recurrence (see chart). In fact, according to Store My Tumor spokesperson Pat deGrouchy, 90 per cent of their patients are interested in the cancer vaccines, with more than 50 per cent using their stored tumor within the first year. As an added bonus, the vaccines are non-toxic, with none of the major side effects experienced with chemo or radiation. One of their patients, Emma, probably puts it best: “I am so glad to have found Store My Tumor. It allowed me to receive my colorectal cancer surgery next to my family, in Toronto, then later participate in Vaccine + Chemo Chemo (alone) a personalized whole tumor vaccine treatment 76% 45% in Germany.”  DM 15 months 6 months

1-year survival

100% 60%

2-year survival

75% 47%

*Tanyi et al, J Clin Oncol 33, 2015 (suppl; abstr 5519) ASCO meeting June 2015

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guest speakers

Dr. Jorge Gaviño

serves as the president of ProgenCell’s Scientific Committee. He graduated from the University of Sinaloa and at the University of Baja California School of Medicine, having served an internship at Tijuana General Hospital and a residency at El Centenario Rural Health Center in La Paz, Baja California Sur. Dr. Gaviño is board-certified by the National Council of General Practitioners and is a respected member of the Medical Association of Tijuana and of the Tijuana Association of General Practioners and Family Medicine. Doctor Gaviño is also a professor at Instituto México, where he teaches health sciences, biology, and anatomy.

Dr. German Arzate Dr. Paola Gerardo

has been a practicing surgeon physician with the Dr. Fernando Garcia Medical Bariatric Team since 2011, conducting on-site and followup care for bariatric procedure patients. She graduated from medical school in 2002, interned at Tijuana State General Hospital and has held positions at several different hospitals and medical centres in both Cabo San Lucas and Tijuana. In addition to her expertise in the field of bariatric medicine, Dr. Gerardo also brings with her a genuine enthusiasm for patient care before, during and after each specialized procedure.

Adele Kulyk

has years of experience in Dentistry, placing Dental Implants, and practicing Advanced Cosmetic Dentistry and cosmetic dental rehabilitation. He’s a member of the: • American Dental Association (ADA) (Membership No. 397366094) • Medical Tourism Association (MTA) • American Academy of Implant Dentistry (AAID) (Membership No. 044751) • American Academy of Cosmetic Dentistry (AACD) (Membership No. 39843) He has vast experience placing dental implants, All On 4 and Snap in Dentures. He also speaks English fluently.

is the CEO and Founder of Global Healthcare Connections® and a frequent speaker at Medical Tourism industry events. Adele established Global Healthcare Connections in 2010 to help people navigate healthcare and connect with clinics and specialists worldwide. An award winning Marketing Executive and Lifelong Entrepreneur, Adele combined her love for business, marketing and research with her love for helping people to provide options for those wanting to take control of the direction of their personal medical choices. She has a talent for teaching people how to cut through all the noise and just do the things that matter. Adele’s passion is helping people to connect to experts in the fields of Cancer, Multiple Sclerosis, Orthopedics, Obesity and Stem Cell Treatments. She has a talent for taking this knowledge to present choices and advice to clients who come to her looking for medical treatment options.

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A D V E R T I S I N G F E AT U R E

Bio Dental Center Putting smiles on faces across North America

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he American Bio Dental Center, located in Tijuana, Mexico, is a leading-edge dental facility that offers affordable dental care for North Americans and beyond. Services include everything you’d expect from any major professional dental clinic: crowns, dentures, retainers, partials, bridges, regenerative medicine and prosthetic devices — with a focus on holistic dental care that addresses a patient’s entire health. But, unlike many mainstream North American clinics, the American Bio Dental Center is a member of the Huggins Protocol, a system that provides effective alternatives to traditional dental practices that may contribute to chronic health problems — for example, mercury-based fillings. “We recommend the Huggins Protocol because we want you to have better health inside your mouth and within your entire body,” it states on Americanbiodental.com. The American Bio Dental Center was started 17 years ago by Alessandro Porcella Senior, who operates the clinic with his son, Alessandro Porcella Jr. They currently have a team of eight dentists working for them, all trained in Mexico under the world-renowned Huggins system. “We guarantee all of our work,” Porcella Jr. says. “And one of the biggest compliments we get is that we have friendly staff. It feels like a family here.” Most patients are American, but many Canadians visit too, especially from British Columbia and Alberta. Others come from as far away as New Zealand, Sweden and the U.K. Prices vary. A standard cleaning and polishing is $25 US; a panoramic X-Ray is $35 US. A crown will cost $500 US, while a threeunit permanent bridge will cost about $1,500. It takes about two weeks to get an appointment. Spring break, July and August are the only quiet times, although the clinic is closed between Christmas and New Year. The clinic offers a free shuttle from the San Diego

airport to the clinic. And, if you drive from San Diego, the staff recommends parking on the U.S. side of the border at the Border Station Parking Lot and having their shuttle pick you up there at 8:30 in the morning. This free courtesy shuttle service will take you straight to the clinic and return you there at the end of the day. Porcella Jr. suggests patients who are getting extensive work stay at the four-star Grand Tijuana Hotel, where the clinic is located. And bring any current dental records from the past six months. But if you don’t have records, don’t worry. An on-site lab can take care of all your needs. “It makes things quicker and more efficient, and at the same time, we can guarantee the quality of the work,” Porcella Jr. says. “Plus, we monitor all of the materials that we use, and none have aluminum or BPA.” In other words, you’ll improve your he alth. You’ll improve your smile. You’ll save money. And you’ll be happy with the results. Just ask Scott Huckabay, one of the many patients who have offered testimonials for the American Bio Dental Center website. “Working with American Bio Dental has been truly an amazing, life-changing experience for me in so many ways,” says Huckabay. “They are the only dentist I will allow and trust to do the quality work on my extremely sensitive teeth.” n


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