Let’s Get Physical: Getting a Standard Medical Check-Up in Japan

Preventative medical care is incredibly important in the detection and early treatment of ailments. Few countries on the planet have a better grasp of this than the fine medical professionals of Japan. This is likely why each year people all over the country get a standard medical check-up or what we like to call a physical.

Unlike what most Americans are familiar with the standard medical check-up that the people in Japan receive is quite in depth and dare I even go so far as to say better. This in depth check-up include a long list of standard tests that include body measurements, ophthalmic exam, hearing test, lung function test, circularity organ test, urine test, fecal exam, hematological test, liver function test, pancreatic function test, sugar metabolism test, lipid test, immunological test, renal function test, gout test, chest X-ray, stomach X-ray and abdominal ultrasound. There is also a long list of optional tests that you can choose from. This includes but is not limited to gender specific tests such as prostate exam and mammograms.

Because the idea of getting your very first standard medical check-up in Japan can undoubtably be intimidating and at times confusing I have decided to outline all of the information you need to know in this post. We will cover everything that you need to know from the moment you make your appointment to the moment you get back home. The only thing that I ask of those reading this is to understand that information may vary slightly based on the medical facility that you visit. However the goal of this post is to provide you with the information you need in order to feel comfortable with the process.

Making Your Appointment

The process of making an appointment for your standard medical check-up will vary based on the company that you work for and the medical facility that you choose to attend. In some cases you will have the ability to simply call the medical facility’s reservation hotline whereas in others your company will take care of the reservation for you.

Upon making your reservation/appointment you will be given a list of standard test (listed above) and you will be asked whether or not you would like to receive any of the optional tests. Once you have informed the medical facility of your requests you will then be given a date and time for your appointment and a packet of information.

What is Included in the Medical Packet

A few days before your appointment  you will receive a medical packet in the mail. This medical packet will include a pamphlets with information about your standard medical check-up, urine test kit and fecal test kit. Because the medical facility we used was aware that we were English speakers we received all of the information in English. However, there were some areas which were challenging to understand if you have no Japanese language ability. We will discuss all of that information later in this post.

What Information is Required By You

In your medical packet you will receive a number of forms that will need to be filled out. Much like any other medical examination you will provide information about yourself, medical history and concerns via checking boxes on the form. If you are a female you will be asked for information regarding your last menstrual cycle and any pregnancies (suspected or otherwise). You will also be asked to provide information about your family history including parents, grandparents and siblings. Again this is very simple and done by checking a box. Finally you will be asked to answer questions regarding your lifestyle such as whether or not you smoke and/or drink and how often.

Special Information Regarding Stomach X-ray

One of the standard tests performed is a stomach X-ray. This test requires the use of barium, a milky substance that is consumed at the time of the exam, which helps show the stomach lining. This test is used to find abnormalities in the stomach, esophagus and duodenum such as cancer, ulcers, polyps and so on. During this X-ray you will also be given a shot which stops the movement of the stomach allowing a clear X-ray image to be taken.

Although this process is based on the guidelines of the Japanese Society of Gastroenterological Cancer Screening there are some risks that the medical facility will want to make you aware of. This includes the potential of minor symptoms such as nausea, stomachache, constipation, diarrhea or pain in the stomach region. There is also the chance of fever or allergic reaction. Very rare cases also cause internal obstruction, perforation and appendicitis. Once you read through the release form and fully understand the information that has been provided to you then you will sign indicating that you would like to have this X-ray taken.

How to Collect Your Urine Sample

Collecting a urine sample with a Japanese urine sample kit is slightly different from what I think most Americans are familiar with. Rather than a small cup that can be urinated into directly you will receive a plastic disposable container, tube with a screw cap and single use dropper. After properly cleaning yourself to ensure that there is no contamination you will then urinate into the disposable container and then use the single use dropper to fill the tube with a screw cap.

*Urine sample should be collected the day of your exam in the morning immediately after you wake up.

How to Collect Your Fecal Sample 

Collecting a fecal sample isn’t quite as straight forward as collecting a urine sample. Your fecal sample kit will include three pieces all of which will come to you sealed; 2 rectangular tubes and 1 flushable/disposable “toilet” or “Toreru Paper” (トレールパーパ).  When you are ready to collect your fecal sample put 3 or 4 layers of toilet paper on the surface of the water in your toilet bowl. Then place the “Toreru Paper” (トレールパーパ) over the top of it. Finally dedicate in the “Toreru Paper” (トレールパーパ).

Immediately after you will need to collect your sample. You do this with the small rectangular tubes. The first thing you need to do is twist and remove the cap. You will notice that the cap is attached to a small wand. The very tip of the wand is ribbed. This is the area that needs to be covered in fecal matter in order to have a proper sample. Carefully run the wand along the feces to collect your sample. Be careful not to collect to much as too much will result in the inability to be tested. Carefully insert the wand back into the remaining part of the tube and twist the cap to lock. Store this in a cool dark place until the time of your appointment.

Finally write all of the necessary information on the tube. You will need to put your name (名前), whether you are a man (男) or woman (女), and then the date which is the year (年) month (月) and day (日 ).

*Do not use a gel pen when writing your information. It will smudge.

The Night Before and the Morning Of Your Check-Up

Now that you have filled out all of the necessary forms and collected all of the necessary samples it’s time to consider what need to be done before your exam. The day before your check-up you will be asked to ear a light dinner and ensure that you have finished eating my 9:00PM with no drinking after 10:00PM. You will be asked not to consume alcohol the day before your check-up.

On the morning of your exam you are asked to continue fasting and do not eat breakfast, snacks or drink any water/tea. You will also be asked to refrain from smoking the morning of the exam. Those who take medications in the morning are also asked to ensure that they take them with only the smallest amount of water necessary proper to 6:30AM.

Other Important Information

Women who are menstruating cannot have certain exams performed. If you happen to be menstruating during the time of your scheduled exam you may want to reschedule. Women who are pregnant, may be pregnant or are receiving fertility treatments are required to speak with their doctor prior to this check-up as it is not possible to have an X-ray taken.

Those taking medication should speak with their doctor prior to scheduling a check-up and ask whether or not the check-up is possible and safe. Any medications you are taking should be brought with you to your appointment.

Let's Get Physical #2

Now that you have an understanding of what is required before your standard medical check-up it’s time to talk about what to expect when you arrive at the medical facility. Like most other things in Japan medical facilities are held to high standards. You will find that they not only offer quality but also comfort for the guests. This is refreshing especially for someone like myself who is not very fond of medical facilities in general.

Once checking in for your appointment you will give the attendant all of the paperwork that you filled out in your medical packet and samples as well as your insurance card. At this particular you did not receive your insurance card back until the end of the appointment. This may vary from medical facility to medical facility. At this time you will also select one of two lunch options which will be made available to you free of charge (this is part of the standard medical check-up package).  You will then have to sign your name down next to a number. This number is how you will be referred to during your exam.

Once you have completed the check in process you will be directed to a locker room. The locker room is where you will change out of your street clothes and store your belongings. Each locker, which includes a key so that you can ensure your belongings are safe, is numbered and has a size on the outside. This size refers to the garnets that are inside. After choosing a locker with the appropriate size change into your top, bottoms and slippers. You can leave undergarments on however it’s probably a good idea for women to be cautious about the bras (because of metal clasps and underwires). A sports bra or light support garment may be a better choice than a your regular bra.

Let's Get Physical #1

After changing you will then return to the waiting room and wait to be called to the reception desk. You will then be handed a folder with all of your information inside which you will take with you while the tests are being completed.

When the testing begins you, as well as a small group of other guests, will be guided to a series of rooms. Each room is numbered with the number indicating a certain test that is part of the check-up. A coordinator will direct you to the appropriate room so that you and everyone else can efficiently complete the required tests.

Most of the tests are pretty straight forward with the most challenging being the stomach X-ray. Before beginning this particular exam you will be given barium which is a cider powder coupled with a liquid that tastes like watered down chalk. During this exam you will be required to consume the liquid on command as prompted by the technician. At first you will take some slow sips and finally finish when told. Then, like some type of carnival ride, the platform you are standing on will begin to rotate while you hold yourself in place with two wars and a shoulder restraint. This will allow the technician to take detailed images of your stomach. Once you have completed this exam you will be given a laxative and a series of instructions. Because barium is not digested by the body it needs to be passed so that there are no complications. Couple this laxative with some healthy veggies and lots of water and you will have no problems.

Let's Get Physical #2

Once all of the tests have been completed you will then return to the reception desk and inform then that you have completed the tests. They will then direct you to return to the locker room and change before proceeding to where your lunch will be served.

This particular lunch was fish with mushroom miso and a daikon salad. There was also whole grain oats and rice, sesame salad, pickled egg plant, custard and mochi for desert. The lunch came with a detailed description of everything that you were eating as well as a calorie count. This meal was only 660kcal. Unlike what you would expect from hospital food this meal was absolutely delicious. The ingredients were fresh, prepared well and could have easily been from a typical Japanese restaurant.

Finally after lunch it was time to return to the floor where the testing took place and have a consultation with a doctor. At this time the tests were gone over in basic, easy to understand, terms. You will also be informed that a detailed packet or results and other information will be sent to your home within the next 30 days.

Although it can be intimidating to do anything medical related in a place where your native language is not the one that the medical professionals are speaking this medical facility did a great job ensuring English speaking foreigners were in the loop and aware of what was happening. Although none of the technicians or doctor spoke more than basic conversational English they were capable of explaining information about the tests being given and the results.

Overall the experience was a pleasant one, despite the very unpleasant associations that many people have when they hear “doctor”. Each one of the technicians and members of the staff were friendly, helpful and willing to go above and beyond to ensure you know what to do next. Most important to me is that the whole experience is comfortable.

Have you ever had a standard medical check-up in Japan? Share your experiences in the comments below.



Box Jellyfish – The habu of the sea.

Who can resist taking a dip in the ocean? There’s nothing like it and Okinawa is no exception. After all a trip to the beach is a fan favorite among tourists regardless the hundreds of other things the island has to offer. Although it might be tempting to find an empty spot of shore, strip down to your skivvies and jump right in there are some hazards you should be aware of. One of those hazards is the box jellyfish. 

The box jellyfish or the habu jellyfish as it is sometimes called here in Okinawa is a cube-shaped jellyfish which, much like the habu, is known for its potent venom. A sting by one of these squishy menaces is very painful and can sometimes be fatal (depending on the severity and the species). Unlike other jellyfish the box jellyfish hunts its prey rather then just drifting along and can reach speeds of 1.6 meters per second. What makes box jellyfish dangerous are it’s tentacles which contain about 500,000 harpoon-shaped mechanisms that inject their dangerous venom. In humans once the tentacle is stuck to your skin it will pump in venom (nematocysts) which causes a stinging sensation followed by agonizing pain.

So what do you to if you have been stung by a box jellyfish? The first and most important thing to go is get out of the water. Once you are safely out of the water you are going to need to stop the stinging which you can do by immediately rinsing with vinegar. Although vinegar is not something most people think to bring to the beach it is a good idea especially if you’re at a beach which has not taken steps to protect patrons from jellyfish. DO NOT USE fresh water or tap water because it may reactivate stinging cells and make the entire situation worse. Some sources state that you can then carefully pick off the tentacles ensuring that you do not make direct contact with them to avoid secondary stings. If doing this you should also ensure that you continue to rinse with vinegar throughout the process. Next you’re going to need to seek medical attention. The most important thing to remember during this process is to never rub the affected area with your hand, towel, sand or anything else. This will spread the injury and cause more burning.

The big question is how to prevent getting stung by a box jellyfish. The easiest way to do this is to only swim in areas which have what is called a jellyfish or stinger net. You’ve probably already seen these nets at popular beaches and wondered why people are swimming inside this contained area and nowhere else. It’s not because the Japanese are scared of the ocean (like one blog I read suggested) but rather because these nets create an area for swimmers which is safe from jellyfish. Something else you can do is avoid swimming in areas which have “Danger Jellyfish” or “No Swimming” signs. The signs are there for your protection so follow them.

If you laugh in the face of danger (muah ha ha) or simply can’t be tamed by a jellyfish net then there are a few things you can do to protect yourself although it is important to remember that you will be at a greater risk. Firstly wear a wet suit or long sleeves and leggings while swimming. Some sources also recommend wearing nylons which are known for preventing stings from box jellyfish. Above all never swim alone.


Just Don’t Get Bit By A Habu

Habu. You’ve probably heard about these little buggers in passing while looking up stuff about Okinawa. Since the weather is warming up and everyone else seems to be talking about habu I figured that this was a good chance for me to put in my 2 cents (or yen?) on the matter.

The term Habu refers to a particular type of snake (trimeresurus flavovirdis) which is found in the Ryukyu islands or as they are referred to today, Okinawa Prefecture. These snakes are nothing to take lightly because not only are they venomous but they are also very versatile. The snakes themselves are relatively large growing from 4 to 5 feet although they have been seen larger. (An almost 8 foot long specimen was recorded in 2011.) Coloration of the snake includes light olive or brown overlaid with dark green and brown splotches. Sometimes you can find yellow spots in the splotches as well.

The habitat of the habu usually lies between forests and cultivated fields which pretty much sums up most of Okinawa. They are often found on rock walls, in parks, in tombs and caves. It is also not uncommon to find habu in areas which you might otherwise consider city. Habu can also be found resting in trees and can swim. Is nowhere safe? Naturally this makes it important to be aware of habu at all times, especially in the hotter months of the year and at night.

Needless to say habu are not friendly. They are very irritable and man are they quick. If you’ve ever seen one of these things strike it’s prey it’s quicker then a blink of an eye. And if you’re the lucky target of the habu you can expect some nasty side effects. The venom of the habu is highly toxic however the fatality rate is remarkably low (1%) if medical treatment is sought right away. You’re not out of the woods that easy though. up to 8% of people who are bit my a habu suffer permanent disability. This can be anything from losing limbs or even huge chunks of flesh and muscle.

So what should you do if you happen to be unlucky enough to get bit by a habu? Unsurprisingly enough there are two very different ways to deal with this scenario; The Military Way or The Okinawa Way. Because both of them pretty much contradict each I figure why not just talk about both so here goes:

The Okinawa Way – 

1. STAY CALM AND IDENTIFY THE SNAKE – Although it may be difficult staying calm (i.e. keeping your heart rate down) will slow the flow of blood and therefore the spread of any potential venom throughout the body. Identifying the snake is also very important to ensure that you receive the proper treatment. If you do not get a good look at the snake you can tell the type of snake by the bite marks. Habu have 2 sets of fangs which, on a clean secure bite, will leave 4 total puncture wounds. Typically within 5 minutes the bitten area will swell and become very painful.

2. CALL FOR HELP – Do not run! If you must walk do so very slowly to keep the heart rate down.

3. SUCK THE BLOOD AND POSION OUT OF THE WOUND – Carefully cut the area of the wound and suck out the venom and infected blood. If you have a scratch in your mouse the venom may cause slight inflammation. Although the venom is toxic even if swallowed it is broken down my the stomach and will cause no harm.

4. IF THE HOSPITAL IS FAR AWAY BIND THE AFFECTED AREA – This will reduce blood flow to other parts of the body and prevent the venom from reaching the heart. Bind the area loosely enough to insert one finger. Loosen the binding once every 15 minutes. Do not bind too tightly in order to prevent adverse effects from lack of circulation.

The Military Way – 

1. REMAIN CALM – Excitation can increase the heart rate causing venom to move through the body quicker then normal. Also, reduce movement of the bitten limb as much as possible.

2. APPLY A TOWEL OR CLOTH FIRMLY AROUND THE BITE SITE -This is supposed to slow the bleeding and slow the spread of the venom throughout the bitten area. The military recommends that you do not apply a tourniquet, with an exclamation point!!!!!! This cause pool the venom in one area causing increased damage to the surrounding tissues.

3. ELEVATE THE LIMB – This should be above heart level, well according Lt. Daniel Szumlas, PhD of the US Naval Hospital Okinawa. However, according to U.S. Navy Lt. Cmdr. Lawrence Decker also of the US Navy Hospital Okinawa (listed only as “emergency medicine physician”) it should be below the level of the heart.

4. SEEK MEDICAL ATTENTION IMMEDIATELY – The venom can be destructive especially if treatment is not received within 2 to 3 hours. Also DO NOT (in caps) attempt to make an incision or “such out” the venom, again with exclamation point!!!!! The reason for this is because you could risk cutting arteries, veins or muscles.

Night and day huh? Ultimately the choice comes down to threat assessment, what you’re willing to risk and what it is that you are comfortable doing. That being said I am sure that there are some of you out there who are wondering what I would chose considering that I spend so much time exploring. Personally I subscribe to The Okinawa Way simply because I want a fighting chance. Yes it would be convenient if I were to get bitten by a habu for it to happen in my front yard, 10 feel from my car or better yet in the hospital court yard but that’s not likely going to be the case. You’re probably going to find yourself in a situation where you’re hiking or away from immediate contact with civilization. Then what? Would you chose to be slightly passive and risk the venom getting to your heart or taking the approach where you might lose part of your leg but you’re giving your heart a fighting chance? For me I’ve only got 1 heart and I can learn to live with a disfigured leg or no leg at all.

Once you make it to the hospital treatment (according the the US Naval Hospital Okinawa) will will include pain medication and an intravenous drip. You’ll be monitored for hemolysis and kidney function as well as pain. Treatment for infection and other complications will also be administered but you will not be given an anti-venom right away. This is because the side effects of the anti-venom are relatively serious to include anaphylactic shock. The anti-venom may also cause what is referred to as “serum sickness” which includes a rash, fever and polyarthritis. If you have received the anti-venom previously the risk increases if you have to receive it a second time. This can sometimes result in military personnel being sent off of Okinawa after recovering from a habu bite if they received the anti-venom.

Now that we’ve got all that nitty gritty out of the way lets talk about the simple things you can do to prevent contact with the habu while here in Okinawa. The first thing is save your exploring for the winter months. A lot of people think that summer is the best time to get out and see Okinawa but if it involves being outdoors in the woods or off the beaten path save it for the winter months. Not only will it be better for you because the summer heat can be brutal but you will avoid contact with these types of things. Next you’re going to want to stay away from overgrown areas these are the resting places for snakes and the things they like to eat. When you’re out exploring make your presence known by poking around with a walking stick or better yet get yourself a boar bell. You don’t want to take anything by surprise and give it a reason to feel threatened. Also wear clothing which protects your legs and ankles. Long pants and tall boots are idea when you’re going into an area where a habu might be a threat. Although it might not fully offer you protection is is certainly better then skin to fang contact. Last but not least stay aware of your surroundings even when on base, in the park or in the city. There are grassy remote areas all around the island where creatures can hide out. It is especially important to ensure that children are supervised during summer play for this very same reason.

As scary as I am sure this blog post sounded to most of you who are coming to Okinawa in actuality habu aren’t anything to get overly concerned about. You should know what to do in case you make contact and know what to look out for but you’re not likely to see one of these things in the wild. Whatever you do, just don’t get bitten by one.