Boomers Requiring Rehab Can Find Options Abroad

While recuperating from complicated hand surgery, I chose to do six weeks of rehab in rural France. I got the idea from my New York surgeon.

For the past 10 years (with a one-year hiatus due to the pandemic), my husband, Ken, and I have spent three months of the year living like locals in the French countryside, building a portfolio of properties that we like enough to rent repeatedly but wouldn’t want to own.

Initially I planned to postpone the operation — to replace the thumb joint in my dominant hand — until we returned from an upcoming trip. That would have meant five more months of disabling osteoarthritis. I was genetically predisposed to the condition, but four decades of working on a keyboard may have hastened the damage. I no longer had the strength to break the seal on bottled water, and it hurt to do everything that I enjoy in life.

“You don’t have to be in pain until October,” Dr. Vipul P. Patel told me during a May consultation. Steroid treatment — the first line of defense — had been ineffective. While friends hinted that we should rethink our lifestyle, my doctor and his staff did everything to encourage it.

At his suggestion, I scheduled my surgery to immediately follow the July 4^th holiday. After two weeks in a surgical dressing, and five weeks in a fiberglass cast, I would need to start physical therapy, Dr. Patel told me. And there was no reason I couldn’t continue overseas.

This raised a possibility that I had never considered, but one that involves a vital issue for aging baby boomers: How far can we venture from home — and where can we go — while recovering from surgery or injuries, or managing a chronic condition. As aging diminishes our use of various body parts, we look for ways to adapt.

Finding Local Support

My ideal place to do that was in Sare, a tiny village (population about 2,800) in southwest France, four miles from the Spanish border, in Basque Country. Set in the basin of the Rhune, the first summit in the Pyrenees, it’s surrounded by green rolling hills. Most of the houses have whitewashed exteriors; red tiled roofs; and wooden shutters, roof and trim, all painted green or chile-pepper red. We’d arranged to rent one of them that was nearly 100 years old. It looked out over farm land, and the village center on the other side of a valley. As I write this sentence, I can hear the percussive sound of sheep bells, squeals of school children on recess, and church gongs that chime every half hour.

The treatment that my surgeon initially proposed would have involved PT by Zoom, but preferring hands-on care, I inquired about what was available locally. Having observed the graying of rural France on previous visits, I had noticed support systems for people my age and older.

A friend — someone I’ve known since our first trip, in 2015 — recommended a masseur-kinésithérapeute (massage-kinesiotherapist), with an office right near the butcher shop. Before my arrival, she took the liberty of making an appointment for me to see him. Coincidentally my friend had recently become a patient, after falling on her basement stairs and injuring her thumb.

In preparation for our trip, I’d tried to jumpstart my rehab by scheduling five appointments in the space of two weeks at New York Hand Therapy, situated in my Brooklyn neighborhood. At my last appointment, on the day of our departure, Moussia Krinsky–Raskin, my therapist there, handed me a printout of her notes, along with her business card, so I could show them to her French counterpart. “Feel free to contact me if there are any questions,” she said.

Setting Up House

My first purchase in France was a 1-pound bag of cheap rice, so I could replicate one of the exercises she had taught me, tossing handfuls of it. My bowl of “therapy rice” remained on the kitchen counter during our six weeks in Sare. For obvious reasons, we never cooked it.

The electric heating pad that I’d been using morning and evening wouldn’t work on French current, and I struggled to find one that would. (Given the high cost of electricity, they aren’t popular in Europe.) At a French pharmacy, I bought a reusable gel one that could be heated in a microwave.

The caretaker for the Sare house, which we had rented twice before, remembered that last year I made fig jam, and saved me eight jars for the purpose. This year the figs were super sweet, she told me, gesturing toward the enormous tree in the backyard. Not sure I was up to it, I pointed to my badly atrophied limb, still in a brace that extended almost to my elbow.

Then again, I’d been encouraged to use that hand, and this wasn’t strenuous activity. The ripest fruit came off the branch with a gentle twist, and I nibbled as I picked. To my surprise, I had the dexterity to wash them, remove the stems, cut them roughly and put them in a pot with a little sugar. Ken squeezed in a bit of lemon — something I still couldn’t do. I had filled six jars with the chunky concoction before my first session with the French therapist.

Trepidation and Transparency

Still, as I waited in his office, I had some trepidation. On a bad day, rehab had been exhausting and dispiriting. The goal was to “reeducate” the brain-to-nerve-to-muscle function — medical lingo for getting my restructured thumb to work. After nearly two months of wearing pull-on pants, I had just switched to ones with a zipper. I saw stars every time I brushed my teeth. Half my thumb was still numb. And my stomach turned when I looked at the 3/4-inch scar that I was supposed to massage twice a day.

Would I miss the upbeat vibe at the place in in Brooklyn, which took the edge off my gloom?

This wasn’t a case of comparing apples to apples. I’d be trading an occupational therapist, affiliated with my surgeon, for a generalist — an osteopath with decades of experience in massage and rehabilitating all parts of the body. Several people in the village had attested to his skill. One of them was a pharmacist — often a good starting point for medical information in France.

Without these contacts, one could search the web using the keywords “masseur-kinésithérapeute” and the location, or use the website https://www.doctolib.fr/. Although my kiné (as they are known for short) did not advertise his services online, many others within a 10-mile radius did.

My introduction to French healthcare began with a framed sign on the waiting room wall, that’s required by law. It indicated that the cost per session for the service I needed (the most expensive of those offered) was 20.43€, or $22.74 at current conversion rates. The same sign informed patients that government-provided health insurance, called assurance maladie would pay 60% of the listed fees. The rest can be covered by private insurance, so that the provider is paid directly by these two sources and the patient has no out-of-pocket costs.

Except for the fee, none of this was relevant to me, though. Medicare’s coverage outside the United States is very limited, primarily involving emergencies at a foreign hospital. Nor would travel insurance be of any help. Our policy, the AXA Platinum Travel Plan ($269 for the two of us, purchased through Squaremouth.com), like most others, only applies to situations that arise during the trip, and specifically excludes pre-existing conditions. Still, my co-pay back home was $30, so I’d be saving about $7 per session.

I was thinking how much more transparent the French system was when the waiting-room door swung open and a tall, slender man in his early 50s greeted me with a broad smile. “Madame Deborah?” Nicolas Jarry asked. Raised in the city of Rennes, where he completed his medical training, he initially came to Sare to care for an elderly couple, and stayed to start his one-man practice. His office has been in the same location, on the first floor of a traditional Basque house, for 26 years.

The logo outside depicts a free-spirited dancer, arms raised, superimposed on a pair of hands. In the anteroom, a stationary bike, an elliptical machine and a ladder-wall keep company with the skeleton that stands beside his desk. Two interior rooms contain massage tables.

Letting Go of Metrics

Our work together began in one of them, with me sitting in a chair and him on a stool in front of me. His initial tone was somber, as he questioned me about the operation — what had been done, and whether I had seen it. (Under conscious sedation, I slept through the whole thing.) He asked whether my doctor had told me that recovery would be a slow process (Yes, he said that it would take a year); and he wanted to be sure that I planned to see my doctor when I returned to the U.S.

Then, as he expertly manipulated my hand, he told me that a gardener who had been his patient had a similar operation. In France, the joint was typically replaced with a prosthesis, whereas mine had involved a tendon graft – a newer procedure.

We met twice a week for the rest of my time in Sare – a total of 11 appointments. It took only a few of them for me to feel the same sense of trust as I did with my American therapist, and to appreciate the differences. The massage was incomparable. As he moved his strong hands over my withered one, Jarry would alternately look away, in concentration, and then turn back, with piercing gray eyes, to watch my reaction to various stretches.

In the U.S., the therapist had measured my range of motion with an angular plastic device called a goniometer, taking notes on a computer. I didn’t find this unusual; so many medical practitioners now seem to spend much of the time with their patients typing. A driving force is the need to code, for insurance purposes, every element of care. The breakdown on my claim form for the last session before I left for France included four different codes. The description for one of them was “therapeutic activities to improve function, with one-on-one contact between patient and provider each 15 minutes.”

In contrast, I never saw Jarry touch the computer on his desk. “Do you take notes on your patients?” I finally asked. Like my therapist back home, he typically treated two other people at the same time. I wondered how he kept it all straight.

“Of course,” he replied. “Not after every session, but after every important thing.”

Conversational French

Though we could have had such exchanges in English, this seemed like an opportunity to practice my French for an hour, twice a week. Spanish had been my second language, but I learned French using the Coffee Break French podcast and the Duolingo app. On past trips, most of my conversations involved food shopping, since I enjoy cooking with regional and seasonal ingredients.

My bi-weekly therapy sessions inspired me to work harder at French than I ever had before. I started with the most essential new expressions: raide (tight); souple (flexible); étirement (stretch); and the one I used most often: Ça fait mal! (that hurts). Knowing that my kiné always asked me how I was feeling, I used Google Translate and the Collins French Dictionary app to prepare my answer before each session.

At one of them, I related how I’d gone to Bricomarché — the French equivalent of Home Depot – to acquire an everyday item that Jarry put to therapeutic use at the previous appointment: a 1/2-inch thick by 6-inch-long hex-head bolt with a nut. The objective was to use my thumb to twirl the nut up (and down) the bolt. When I showed the young salesman in the hardware store my hand, and a photo of what I needed, he held up his thumbs, demonstrated the exercise and wished me “Bon récupération!” Jarry laughed when I told him the story.

Just as important as exercise, was using my hand, and he kept questioning me about that. “Yes, to peel tomatoes, to chop garlic and onions, and spin the salad,” I initially answered.

Big Views and Small Moments

Our sessions were scheduled around the outdoor market held on Tuesday and Friday mornings in Saint-Jean-de- Luz — a picturesque seaside town about 30 minutes away. From past visits, I had my favorite vendors, and it was comforting to find them there again this year. One is a farmer popular with pensioners. Her prices aren’t marked, and as she weighs your carrots, string beans and eggplants, she totals your order in her head. There’s no way of checking her math, but our euros always go a long way at her stand.

When tuna was abundant at the fish market there, I made marmitako — a Basque fisherman’s stew that’s one of my favorite recipes. While it cooked, I held my hand over the bubbling pot and did some of the challenging new stretches that Jarry had taught me.

In Sare, my recovery took place against the backdrop of big views and the small moments. There was the night that fog hugged the village, while stars twinkled above. Each morning we held our iPhones out the kitchen door, to identify a symphony of bird sounds with the Merlin Bird ID app. By the time we left, our list had grown to 21 different species.

And then there were my meditative walks into the village, along a medieval road, for my séances, or sessions, with my kiné. Along the way, I crossed a bubbling brook, free-range chickens, grazing sheep and two of 14 oratories that circle the village — tiny house-like structures devoted to the worship of a single saint. At a brisk pace I could make it in 15 minutes. But I preferred to take my time, stopping to inhale the aroma of cakes or cookies baking in a hole-in the-wall kitchen maintained by one of the local hotels.

Pacing and Progress

Each session was slightly different, combining massage, electrotherapy and exercise. “Don’t look,” Jarry told me one day, as I held up my arm and manipulated a lemon-yellow foam ball. I fixed my eyes on a neighbor’s cats that watched my awkward movements from the window sill. During off hours, Jarry works out in the office and dreams up new routines for his patients. “If you always ask people to do the same thing, they lose interest,” he says.

I was thrilled to report milestones, like the first time since my surgery when I was able to uncork a bottle of wine, whisk an egg or grate cheese. “What kind of grater was it?” Jarry asked, curious to know whether I was moving my wrist down, or in a circular motion.

After the seventh appointment, I announced, “Je suis faisant des progress.” (I’ve made some progress.) After examining my hand that day, he agreed, and we tried working with weighted balls.

I’d been his patient for exactly one month when I asked the most difficult question, “How much is too much?” His answer included the verb doser, which I didn’t immediately recognize. “Check your dictionary,” he told me, motioning to my iPhone which was sitting on the massage table. “You know that word.”

And sure enough, I did. It means “to gauge” or “to measure out,” like a dose of a medicine. He perceived, correctly, that I’d gone a bit overboard with the exercises I was doing at home. My goal was to make this hand strong enough to support the same operation, on the other one, next year. But even three months after the operation, my body refused to be rushed.

The Handoff

At our final meeting, Jarry prepared me for what the French call la rentrée. This broadly used term covers everything from returning home from a day’s activities, to the end of vacation and getting back to real life.

He assured me that with continued use, my strength would return. “Atrophy happens very quickly, but reversing it is much slower. Nature isn’t fair.” he said. “You have to keep working, and not be discouraged.” Again, he urged me to consult my surgeon in New York. We both knew that the jury was out on what he would say.

My first stop upon returning was New York Hand Therapy. Compared with Jarry’s office, where one is barely aware of other patients, it seemed like a beehive of activity. Patients sit together around a horseshoe-shaped table, struggling with exercises that, but-for our injuries or disabilities, would be child’s play. On my first day back, an elderly man beside me was screwing nuts and bolts on an activity board. I took out the hex-head bolt with the attached nut, that I had bought at Bricomarché, and put it in the table.

“Ooh, I like that!” my Brooklyn-based therapist, Krinsky-Raskin, said when she spotted my French “souvenir,” and promptly excused me from being next-up on the bolt board. Then she took four different measurements to evaluate my progress.

Back to Metrics

I was curious about what the metrics would reveal. In broad terms, her findings completely aligned with Jarry’s: My range of motion was improved, but my hand and my wrist were still extremely weak. Several of the exercises she added to my regimen were ones Jarry had already taught me. (I didn’t have the heart to tell her that she could never replicate his skill at massage.)

“Therapy in France was a great idea,” Dr. Patel said at our consultation the following week. X-rays (the third set since my operation) reassured us that there hadn’t been any movement in the bone. A continuing challenge was the chronic arthritis where the thumb comes into the palm. “With manual therapy, over time, the therapist stretches this part out, so the thumb is not in the palm anymore,” he told me. It’s also necessary to break up the scar tissue that attached to the tendon and inhibited movement. The same uncomfortable maneuvers that Jarry had done in Sare, to address both these issues, need to continue in Brooklyn.

And how about the nerve-stimulating machines that Jarry used, delivering low-level electrical current to my hand? I credited E-stim, as it’s called, with restoring the sensation in my thumb. It’s hard to say whether it would have happened anyway, said Patel. Still, he didn’t discount my impression that it had helped.

By any measure, the six-week sojourn had been a success. The change of venue, variety in treatment methods and tranquil living were all conducive to healing. And as my flexibility improved during those 11 sessions, so did my French.

Deborah L. Jacobs, a lawyer, entrepreneur and award-winning journalist, is a former senior editor at Forbes. She is the author most recently of “Four Seasons in a Day: Travel, Transitions and Letting Go of the Place We Call Home.” Join her on Facebook here.