For the last few days or so everything has been a “moving target” for me with an initial consultation with the radiation doctor explaining everything medically and checking me out and now we are putting a plan together with her staff and on the calendar, plus I’ve arranged to pay for it. And oh yes, this doctor is a specialist in radiation to the head and neck! Hopefully my surgery neck swelling will soon be gone and the tender scars on my left face and neck healed better than they are now. I’m still sore and sensitive with only minor internal pain that I treat with Ibuprofen. They prefer these surgery “irritations” gone before they create new ones with radiation!
They have been calling people for Covid Vaccination Appointments by age, starting with the many people here in their 100’s down through the 90’s and 80’s until they just got to me at age 80 for an April 1 appointment! Yaaaaaay! BUT . . . will it make a difference that I’m about to start radiation? I don’t know! But I will find out tomorrow when I discuss everything with the logistics person at Radioterapia Siglo XI. I hope there is no conflict, but with my second shot due during my radiation treatment, I’m wondering if they will conflict. If so, we will do whatever is necessary and get it when we can. Just another little bump in the road!
I know that people much younger than me in the states have already gotten both shots and they are just getting to my first shot here. Why? Because rich countries like the U.S. can get anything that money buys quicker! You are approaching 200 million people vaccinated in the U.S. and little Costa Rica just passed 300 thousand. I just read that another 300 thousand doses have arrived this week so we will slowly catch up with a very efficient system that had healthcare and other first responders first, then everyone else by age, oldest first. We all get it from our local public health clinic, with all shots provided by the government.
National Geographic Joins Tik Tok with First Post a Costa Rica Video
That’s according to this article in Tico Times Online. “National Geographic launches TikTok with video of Costa Rica” To view, click on the second video in this article. The first video is a Tico Times promo video. You’ll know the difference!
National Geographic photo of Green Macaw, Manzanillo, Costa Rica — Yes, I have a similar photo from the same place, just not as good as Nat Geo’s!
You can be sure that Nat Geo knows where to find nature and adventure! And of course Costa Rica is the best place in the world!
Neighbor Mike made this black eye patch for me, neither of us having found a commercial eye patch, just the big oval Band-Aids I’ve been wearing! As expected, most people (especially Americans) who see it almost immediately say, “Arrrrrgh – A Pirate!”
Always wanting to be different, I’m going to call it my “Rooster Cogburn Patch!” He was the fictional Rooster Cogburn, U.S. Marshall, Fort Smith, AR in the novel True Grit turned into the 1969 movie True Grit with which John Wayne earned his first Oscar and Glen Campbell a best song oscar. Thanks to my next door neighbor, George, for first calling me “Rooster Cogburn” instead of a pirate! Great idea George!
Note that there were 3 more movies made about the same story or novel, but as usual, the first was the classic. And because Fort Smith was my mother’s hometown, where we visited Grandmother uncountable times growing up, with cousins still living there – it is a special place! And all of us from Arkansas hated that they filmed True Grit in Colorado with snow capped mountains instead of real Arkansas/Oklahoma scenery where it took place in the book.
When John Wayne received his first oscar as “Best Actor” for Rooster Cogburn in True Grit1969 version, he responded to the Academy, who had by-passed him many times before for oscars . . .
“Wow! If I’d known that, I’d have put that patch on 35 years earlier.”
~John Wayne
He even has a one-sided smile kind of like mine!
They tell me you’re a man with true grit.
~Mattie Ross (in the movie True Grit)
And actually I’m going to have my seamstress make me another, one or maybe 2 or 3, that are just a tad bigger to avoid any light coming in and to ride higher on my forehead, but for now, this one works great!
Saving Report on Radiation Consultation for Monday . . .
. . . because what I did yesterday was an hour+ consultation with the doctor going over all the medical details, side affects, procedures, and what I can and can’t do the next 3 months; though she assured me that my scheduled July birthday trip to the Osa Peninsula is still okay. I had already canceled my May return to Arenal, knowing it would be impossible. So I will be ready for my July trip like never before!
Monday, Karen, who is the logistics person for radiation, will be calling me to make all the arrangements, price discount, schedules and other details when I will then do just one report on the coming radiation therapy. And may share then the total cost of this cancer.
Yesterday, Tuesday, 23 March, was my big meeting with Dr. Hernández, post-surgery (though I had one earlier visit to remove the drainage tube). Here’s what we did and discussed for over an hour. And by the way, all the doctors here take as much time as needed and never rush you, yet they are very punctual with appointments, meaning that most allow an hour or more per patient for consultations. Compared to the states, better service for a fraction of the cost.
Removed the Bandages
Though we actually talked first, this was one of the reasons for this post-op visit included in the price of the surgery.
He is a young surgeon proud of his ability to provide “scarless” facial surgery by closing up the incision with “internal stitches” that I don’t understand, but there were no stitches for him to remove, just the bandages over the line that still shows right now, but will not later as it heals.
Sorry that my “selfie” doesn’t show it better, but he cut me from in front of and above my ear all the way down my neck to nearly the chin, all on the left side.
Then if it doesn’t gross you out, he peeled back the left cheek skin and cleared out all the tumor he could find, including the whole salivary gland and a part of my facial nerve, then put my face back together again. He said that when the swelling goes down, I will look younger on the left side because he stretched the skin tighter or smoother. Like an 80 year man cares!
The Biopsy Report
He shows or explains everything to me on his large-screen computer monitor including photos of the actual tumor whole and when sliced to show what was inside. Then I receive a 3-page printed version of the biopsy including photos (only 1st page at right) but this version is en español which I roughly understand but he promised to send me an English version soon. Expats are more trouble as patients!
As expected all along but confirmed by this biopsy, it is cancer – invasive epidermoid carcinoma (translation of Spanish “carcinoma epidermoide invasor”). This is the same diagnosis as the skin cancer removed from my left cheek in 2019 by MOHS surgery which is supposed to assure one that all the cancer is removed. So much for MOHS! Dr. Hernández said it is possible that a “root” or even a tiny piece of the original carcinoma on the surface was left in the cheek and it grows fast or matastisizes into the tumor that was not found earlier because of staying home for the coronavirus It was a large tumor, 4.5 X 3 cm.
Radiotherapy Follow Up
For the second time, a surgeon believes he “got it all” but that can never be guaranteed and the closest to a sure way is to follow up with radiotherapy. Thus I already have an appointment this Friday with “the best radiation therapist for head and neck” in Costa Rica, another female doctor who is “the best.” She works for 21st Century Radiotherapy, the only private company doing radiation. (None of the private hospitals do. They send patients to this company.) The only other radiation treatment available in Costa Rica is with the Social Security or Public Health at Hospital Mexico, where I had my angiogram. It would be “free” with my national health plan but Dr. Hernaández says they are too slow and could take months or a year to work me in while this private company can get started within a month or6 weeks which he says is essential for a spreading cancer. And of course that is a private doctor speaking.
But he also said that Dra. Bonilla would know if public health could get to me soon enough and she might be able to work that out, otherwise I will use my “MediSmart” medical discount card for up to 50% off the regular charge at 21st Century. But we are still talking thousands of dollars and me with no insurance. So Friday will be the next big decision time on this latest adventure.
I fully expect to deplete my saving a bunch more (Getting low already!) and have the radiation done with the private company, but will explore every reasonable option with the public health radiation. So another report Saturday on that!
And About the Eye and the Mouth
I have an appointment with the Ophathamologist in two weeks to discuss a surgical procedure she has done before that partially closes the eye lid and may allow me to have more use of my eye , where now I just keep it covered all the time. It will not bring the blinking back but possibly more use of the left eye.
The mouth will improve somewhat in time – months – but never back to totally normal. I might regain some muscle use on the left side to help with eating and maybe a less exaggerated lopsided smile. We will see!
And another little amusing side effect, I just learn that when I wrinkle my brow, it wrinkles only on the right side!
As Doris Day sang when I was a kid . . .
Que sera, sera
Whatever will be, will be
The future’s not ours to see
Que sera, sera
What will be, will be
And the feature image is another shot of my favorite Triquitraque Flowers still blooming!
Earlier yesterday, before the rain came, I was sitting on the windy terrace hoping a brave bird might come out. A couple of doves flew by, but this Great Kiskadee was the only one brave enough to land in my Guarumo Tree (Cecropia) with a pretty strong wind bringing that rain cloud we got later. Notice how the feathers are affected by the wind. Not a normal pose, but an interesting commentary on the windy day we had yesterday before the afternoon rain.
Great Kiskadee in the Wind, Atenas, Costa Rica
Read more about the Great Kiskadee on eBird. He is one of the most common birds here and his song or call sounds like his name, “Kiss – ka – deeeeeeee.” He is found almost everywhere in Central and South America, with only a few strays making it into the Southwestern U.S.
Biopsy Report in Tomorrow’s Post
It is intentional that I have been very honest and factual about my new adventure with cancer while living retired in Costa Rica. And I will continue to be. This afternoon at a 2 PM appointment with my surgeon in downtown San Jose, Costa Rica I will receive the biopsy report and his “plan of attack” including possible radiation treatments.
He doesn’t know that some of you have been praying for it to be benign or not a cancer and we might receive that surprise blessing this afternoon, but if it is like all the others he has removed similar to mine, then we will do whatever is necessary and still give God the praise anyway! He’s going to see me through this!
I’m wearing an eye patch all the time now because it hurts to have an eye open that can’t blink or close. We will be discussing possible solutions to that also this afternoon and the left side of my mouth. But they are secondary to dealing with cancer.
And because several blog-followers are considering retirement in Costa Rica like I did, I am going to share the costs of this major surgery and what my other options could have been and discuss 3 or more options for radiation, whether needed or not.
Is it a freak “Dry Season” once-off rain or a very early starting of the “Rainy Season” this year? We will see! The Jigüirro or Clay-colored Thrush (CR National Bird) has been singing his heart out recently and indigenous tradition is that they are the ones who “sing in the rain!”
It is generally said for the Central Valley (where I live) that Rainy Season is May-November and Dry Season December-April. My first few years here we did not see our first rain until mid to late April and not a lot until May. Last year the first rain was March 24 and this year now March 22, so is it starting early? Almost certainly not daily afternoon showers now (usually by May) but at least I do not need to water the garden for a few more days!
Always Trying to Capture Rain in a Photo!
And never very good at it! The featured photo at top shows the dark cloud this afternoon shower came from and some of us hope it will be regular now (though very early)!
First Darkness – Then Rain!
The first drops on an Elephant Ear plant.
Vertical white lines are blurred rain drops.
Vertical white lines are blurred rain drops.
Raindrops bouncing off driveway.
I’ve always preferred the rainy season because it is greener with fresher air and the wind quits blowing! And most of the time we get rain only for an hour or two in the afternoon. Lowland rainforests along both coasts get more rain than we do here and it can be year-around, especially South Pacific and South Caribbean. For more weather information, check out your favorite weather channel or these websites:
And to let you know that this first rain is a real rain, since it started I have loaded and processed the photos to web-size, prepared and written this blog post, all in an hour or a little more AND IT IS STILL RAINING – HARD! Love it! The tropics!
¡Pura Vida!
The way I see it, if you want the rainbow, you gotta put up with the rain.
Yes, it is a Blue-gray Tanager (e-Bird link), but my first impression of the photo was “Blue on Blue” with him against the blue sky, while sitting in my Cecropia or Guarumo Tree, then flying away in that feature photo at top. A common bird in Central America and northern South America.
I’m back to sharing nature from my garden again for a while and this morning the first thing I saw from my terrace was this Variegated Squirrel (Sciurus variegatoides) is a tree squirrel in the genus Sciurus, the most common squirrel of the 4 or 5 species of squirrels found in Costa Rica. He can be seen at many elevations and is more numerous than any of the others and varies somewhat in looks and color combinations with black, white, gray and reds or oranges.
This Variegated one is found only in Central America from Southern Mexico to Panama and is the most common throughout Central America. For anyone really into squirrels, the 4 others said to be in Costa Rica are the Central American dwarf or pygmy squirrel, Microsciurus alfari LR/lc; Deppe’s squirrel, Sciurus deppei LR/lc; Red-tailed squirrel, Sciurus granatensis LR/lc; and Bangs’s mountain squirrel, Syntheosciurus brochus LR/nt.
A lot of you asked that question, and the answer is sort of a “figure of speech” or a euphemism for an asymmetrical smile or lopsided smile or even a sneer or smirk. Possibly the name “Texas smile” came from one of those old cowboy movies my doctor saw, who knows? But that’s what my Costa Rican surgeon called it when, because of the cut nerve, I cannot lift the left side of my lips when I smile. But I’m not sneering! Just not functioning normally and hopefully with some exercise we can call up some other nerves to help left that side a little more than now, but no promises. Same hope for blinking and closing my left eye which is burning most of the time now because I cannot blink or close it. In fact that is even more important to me! At night I now use an eye patch and put an ointment in my eye. My two big challenges before we even find out if the tumor was a cancer. Hopefully I will not permanently be “the sneering, one-eyed Charlie!” But if so, I’ll make the best of it!
The scabs on my lip are where the dermatologist removed growths earlier and they are just slow to heal. And of course I can’t shave on my left side with cheek and neck swollen and sore, so I’m an ugly mess! Like an old house or old car, everything breaking down at once!
Drainage Tube Removed Tomorrow
At least I have that to look forward to! Tomorrow afternoon the doctor sees me again and says he will remove the drainage tube which is a real bother. Then I think I will have one other post-op visit in another week when I will learn if cancer or not and what else we need to do. So seemingly always something else, but we are getting there – step by step.
Drainage tube from my neck to a little plastic bottle until tomorrow afternoon.
Dinner Delivered to My House Every Afternoon
The ladies of Roca Verde have been wonderful! Delivering a “soft” food dinner each evening that will continue into next week. I’m really getting the “royal treatment” from my neighbors! And its looking like enough leftovers for more extra meals than I will likely need. This is the life of being “Retired in Costa Rica!”
Plus Prayers from Around the World!
I’m so thankful to have so many friends and family around the world who believe in prayer and have assured me they are praying for no cancer and a quick and complete recovery. Wow! I’m a fortunate person in so many ways!
Hopefully my surgery neck swelling will soon be gone and the tender scars on my left face and neck healed better than they are now. I’m still sore and sensitive with only minor internal pain that I treat with Ibuprofen. They prefer these surgery “irritations” gone before they create new ones with radiation! 
