is what the Dermatologist says about the cause of skin cancer. But he also says if I continue to get too much sun it will make it worse, so my two wide-brim hats and 60 SPF Sunscreen, called El Protector Solar here or informally protección de sol. I dislike it but when I know I will be in the sun much, I use the sunscreen now and wear my big hat everytime I go out!
SKIN CANCER SURGERY ON MY FACE THIS TIME
The only other skin cancer removed was from my arm a month or two ago and it was comparatively easy with a lot more skin on the arm. Sorry if the photo below grosses you out, but I was really surprised at how much this facial growth had grown with this big of a scar or “more than 15 stitches” said the doctor, though I counted more like 20 or 21 in the photo. My eye is partially swollen and partially closed but it will get back to normal soon. I went back to the doctor the day after surgery (Wed) and he changed the bandage which I will permanently remove Thursday. Air helps healing. And he prescribed a cream I put on it twice a day for at least two weeks when I see him again for a checkup, after my next photography trip of course! 🙂 I have to keep my priorities straight you know!
It was Mohs surgery Tuesday which the link describes or basically it is a pathologist there with the surgeon doing biopsies on every bit removed until there is no sign of cancer. With this he is now more certain he got all the cancer and didn’t remove too much “good skin” which is more limited on the face. He was prepared to graft a piece of skin from my cheek if necessary, but thankfully it was not. And in two weeks or so I will be back to normal with a noticeable scar on my face. No problem! Just call me “Scarface.” 🙂
The 15+ stitches
Surgery day bandage
That’s Life! – ¡Así es la vida!
And tomorrow I will go back to sharing more from my great trip to Maquenque Eco Lodge!(Link is to the Gallery)
And oh yeah, that sunset photo above is one I made at Arenal Volcano National Park. After all, this article is mostly about the sun! 🙂
My dermatologist (after 2 skin cancers) says I have to wear a wide-brim hat everytime I go out along with sunscreen. Bummer – but here’s my first one (a Dorfman Pacific Safari Hat) which is like what a neighbor wears everyday, so I won’t be alone! 🙂 Then with a Christmas gift certificate I ordered a Panama Jack Safari Hat which might be more stylish. The price you pay living close to the equator! ¡Pura Vida!
My prayers go to the Bush Family in their loss . . .
. . . a truly great & humble man!
George H. W. Bush
Humility is not thinking less of yourself,
it’s thinking of yourself less.
~C. S. Lewis
REPORT ON MY BIOPSY: After removing the 10 stitches from my arm (where all that cancer was confirmed removed) and the two stitches from my face for the biopsy, Dr. Gamboa gave me the facial biopsy report:
In brief, it says I have another carcinoma cancer on my face which is a smaller and slower growing type than the one on my arm. No problem waiting until January to remove the rest of it (the biopsy took most of it). Because of the delicate and thinner skin location next to my eye, we will be doing a more complicated and more efficient (more expensive) “Mohs Surgery” with two doctors doing it with a pathologist standing by to make sure they get all of the cancer as he examines each layer as removed (continuous biopsy). It will not be in his office this time but in a clinic, hospital-like, operating room, but still out-patient. He is checking on availability of other doctor and the clinic for the week of 21 January – after my Boca Tapada trip. Remember — the doctors work around my trips! 🙂 Important! That is where I sleep in a tree house 5 nights!
Dr. Gamboa also “PRESCRIBED” wearing a wide-brim hat instead of the ball caps I’ve been wearing and of course sunscreen every day when out. I sure love sunny Costa Rica, just 673 miles north of the equator, but with the value of the sun also comes with some potential dangers for someone like me who loves the outdoors. I have already become more careful, even though the doc says these current growths and cancers were probably caused by sun I got as a child or teen, more sun now can make it worse, so I must be cautious.
As I continue choose between the free government healthcare (with monthly payment like states do with Medicare) and the mostly affordable private doctors using my MediSmart discount card I have so far been well cared for in my various medical needs and either free or at very reasonable private costs.
In earlier reports I have explained how the public system includes a cardiologist I like and I feel well cared for. When my various “tags” and other skin growths began to increase, I decided to try a private dermatologist and have been equally pleased with his services and prices.
One growth on my right arm he suspected and did a biopsy which proved positive for a melanoma cancer, Tuesday afternoon he cut a chunk out of my arm and is pretty sure he “got it all.” His guideline is to take 4mm to 5mm all the way around the growth. That meant 10 stitches in my arm, but that will heal. I decided that a photo of it would be too gross. He also took a sample from a growth on my face that has not healed from an earlier nitrogen treatment (freezing it off). So when I go back for my stitches to be removed in 2 weeks I will get the biopsy report on that. Hoping for no more malignancies, but we do what we have to do and I’m still enjoying my monthly adventures with doctors working around my travel schedule! 🙂 And by the way, my rotator cuff surgery has healed very well, thanks a lot to the physical therapist Andres! Pretty much back to normal use, though now I have 10 stitches in that same arm! Sigh.
I walk regularly and eat reasonably well if not maybe too much! 🙂 So my overall health and heart condition is great, just this little skin cancer bother that is caused by too much sun when I was a kid or teen, says the doc. I’m more careful about the sun now!
The Grand Feast
Tony & Rose Mary, the couple who plan our expat trips almost every month put together a group eating traditional American Thanksgiving Dinner at the Baron’s Resort on top of a hill here in Atenas with beautiful views. It was delicious in every way and the turkey was cooked perfectly – moist not dry! And they even had pecan pie! (My favorite if you don’t know.) The resort is now owned by my local attorney, Cecelia Tristan, and she is doing a lot of extras to make their restaurant appealing to locals. I will eat there again from time to time.
And no excuse for not snapping a cell phone photo – just didn’t!
Yesterday afternoon I saw my Dermatologist who presented me the lab’s very detailed report with color microscope photos and the diagnosis en español:
“Carcinoma epidermoide bien diferenciado, invasor, de al menos 4 milímetros de diámetro mayor, que alcanza los márgenes de resección.” Or in English according to SpanishDict.com translation:
“A well-differentiated, invasive epidermoid Carcinoma of at least 4 mm greater diameter, reaching the margins of resection.”
The Doc assures me he can cut it all out by going a prescribed mm distance all the way around it (a big chunk of flesh!) and with several stitches will heal that part of my right forearm back to normal. That’s a $600 surgery or for $4,000 he can do a much tinier section removed while a separate pathologist is testing (continuous biopsy) every little bit of skin to make sure they get all the cancer without taking as much of a chunk! He recommends this for a growth on the nose, etc. where removing more is more obvious. Of course I’m doing the cheaper one which he assures me has always been successful for him and what he recommends. Just a little scar on my right forearm. It is scheduled for 19 November after my next trip which is to Palo Verde National Park 10-15 November. My doctors work around my trips and not vice-a-versa. 🙂
It is interesting that Dermatologists here say the same thing they told me in the states, that these growths that keep popping on my body in old age are caused by getting too much sunshine when I was a little boy. No one told us that back then! Or maybe I was not paying attention when Mom wanted me to use sunscreen? 🙂 The young are invincible and us old ones just smile at our little problems. 🙂
Since this is a retirement blog, I guess this kind of gory medical report is appropriate. Anywhere you live in retirement you must deal with these things and the medical services in Costa Rica are simply great and so much more affordable that I’m just using a private doctor again instead of the free public ones, which are slower but just as good and free! 🙂 I still use a public doctor to monitor my heart arrhythmia, but other things I’ve been happy with the quick responses of private doctors, like this Dermatologist, Dr. Gamboa.
Every day I do a few simple, light exercises to regain the movement in my right arm toward recovery from the rotator cuff damage and surgery. (Up to 3 times a day.) Thanks to Andrés for loaning me some of his tools to use at home! Photo captions explain the use of each one.
While in the Caribbean next week I will continue to exercise but may not take all of this equipment. 30 pound baggage limit on the small plane.
The dish towel is for polishing the table top. Remember in the movie “Karate Kid” polishing the car? I have several movements with the broomstick, the good arm does the work but gets the other one moving! And the big rubber band is for strengthening.
2.5 lb. weight is for mild strengthening.
The rope and pulley is similar to the broomstick, good arm doing the lifting work.
I use rope and pulley on a door.
“And will you succeed? Yes indeed, yes indeed! Ninety-eight and three-quarters percent guaranteed!”
– Dr. Seuss
It was time for my one-year checkup with my public hospital cardiologist yesterday, 27 Agosto, made by the doctor one year ago, Dr. Hernandez. In the meantime I heard around June from someone else with the same cardiologist that Dr. Hernandez (whom I really liked) had gone to Spain to study heart surgery and I would be getting his substitute whom the other person also liked very much, especially because he spoke English! So I was already expecting a new doctor, whom I learned today is Victor Andres Garcia Rojas (called Dr. Garcia) – and I will do another article below on Spanish Names using his.
Adventure 2: I Forgot Pre-appointment Blood Tests
Yeah! No good excuse! It was on my calendar that I wasn’t watching and I forgot that appointment a week earlier. The results were to be with the doc by yesterday so they would be part of his evaluation of my heart. I rationalized and said, “oh well, he will reschedule that and add to my file later. No big deal! Pura vida!” Well, it is a big deal! Hospitals are very serious!
So I wait in the adultos major line (for old people & shorter than other line) for about 30 minutes. When I get to the desk there is suddenly a computer problem with a bunch of supervisor types coming in to explain something on the computers to all the clerks. Then finally my clerk takes my cita (appointment paper) and my cedula (ID card) and starts to check me in and I casually tell her about forgetting the appointment for blood workup. She stares at me, shakes her head and tells me she is sorry (this is all in Spanish of course) but “the doctor cannot see you without the blood tests.” Thus she makes a new appointment for me with Dr. Garcia on September 5 (Whew! I leave Sept. 6 for my Caribe trip!) Then, with multiple attempts, she explains to me that I must go down to main lobby (photo at top) and wait in line at the laboratorio for a new appointment and show them that it is needed for a Sept. 5 doctor visit. By then I remember waiting in that line a year ago for the missed appointment. My punishment for living a pura vida life! 🙂
So back downstairs to that crowd in top photo and actually the laboratory line was not as long as some of the others. I had my new lab appointment for this Friday in less than 45 minutes! This girl was not as slow a speaker or as patient with my bad Spanish and so she used her phone translator some with me, though I was understanding more of her Spanish than she thought. Language is all part of the adventure!
So now, (with all the complaints about slowness in public healthcare), I’m doing blood workup this Friday (just 4 days later!) and I see the doctor next Wednesday! Pretty fast I think! And this delay is the fault of my forgetfulness or not setting the phone calendar alarm on my lab appointment! Now I get to go back to the hospital two more times (More adventures!). And I will remember to fast 12 hours before my 6am appointment Friday! Aren’t I lucky? 🙂
Adventure 3: Spanish Names – Why 4?
Be aware that this can be slightly different from country to country, but for the Costa Rica explanation I will use Dr. Garcia as my example:
Dr. Victor Andres Garcia Rojas
Victor = First Name; Andres=Second or Middle Name;
Garcia=His Father’s Last Name; Rojas=His Mother’s Last Name (maiden name)
Most people go by their father’s last name, thus he is “Dr. Garcia.” But on legal documents and other places they use all four names, like on the Cedula (ID Card) and in the hospital. Since I have only 3 names, the hospital or national healthcare program has given me a fourth name that is on all my hospital records = “Noindicaotro” as a replacement for my Mother’s last name. Interesting since it is not a word in my Spanish Dictionary! 🙂
Adventure 4: Talkative Old Man on Bus
On the bus ride back to Atenas (45+ minutes) I sat next to a very talkative man who did not stop talking and even singing the entire trip. It was mostly in Spanish with an occasional English word or phrase to show me that he knew some English. I had a crick in my neck when I got home for having my head turned to the left the whole trip. And no, what he said was not very interesting, but I appreciated his friendliness and I guess he appreciated me listening attentively. 🙂
Your have heard me brag about the tranquility and great weather of my little farming town of Atenas – and the “muy amable” or very kind people here. But one thing that many hyper and efficient Americans don’t always realize when they move to such an easy-going society, is that to be that way means everything andeverybody moves slower here! No rush! ¡Pura vida! To not adapt to this slower way means you will not be happy here. Always frustrated at the inefficiencies!
My example of this today is my efforts since Monday to pay my surgeon for the work he did. (No pressure from him.) I made arrangements in advance with my Credit Union in Nashville to move the needed money from Savings to Checking so I could easily pay with my debit card. Hospital payment was quick and easy as I had planned, but the doc requested to be paid separately. Okay.
The doctor comes in my room with his little portable credit card machine, saying he doesn’t like to wait for the hospital to reimburse him if I pay through them (the most efficient way), saying they sometimes take a full month to forward the money to him. Okay. He tries repeatedly and his machine doesn’t work or at least he blames it on the machine and not my card which had just worked for the hospital. He leaves and returns in a little while with a bigger machine he plugged into the wall (still dependent on hospital WiFi). And it did not work. He then says we will take care of it when I see him at his office later this week (Wednesday). It still did not work there. He then gives me his account number at Banco Nacional and asks that I just transfer the money to his account from my account – but that account (my SS check auto-deposit) is just for housing costs, so I still have to get the money from Nashville.
Thus Wednesday afternoon I go to the bank with my CU debit card and ask them to get the needed money from it and put into my local account so I can transfer it to the doctor’s account. Sure! The teller aims to please, and tries repeatedly (7 times – service is important!) and he continues to get “denied” or “acceso denegado.” I call Nashville and they raise the cash advance limit (I thought they had already done) and say everything else is cleared – it should work! It did not! I told the patient teller (not the long line of people behind me) that I would return tomorrow and try again. Lo siento señor, mañana es un día festivo, no estamos abiertos. And I reply, Hasta el viernes. Tomorrow is a holiday and we are closed. See you Friday. 🙂
Well, Thursday was Virgen de los Angeles day, (patron saint of Costa Rica) with only Christmas and Easter being bigger for Catholics here, when thousands make the pilgrimage to Cartago Cathedral to touch the black stone Maria. So nada yesterday! (Click above link to learn about the holiday.)
This morning I call the Credit Union again and make sure the card is good for a large amount of cash on this day and I’m assured it is. I go to the bank with teller lines going outside onto the sidewalk and street, more than an hour wait for a teller, so I tell the guard I need the “special services desk” and go wait nearly an hour for it, but those persons are more accustomed to “different” transactions like mine and I figured they could handle it better, maybe quicker, and once I finally got to a desk, it worked very smoothly, though taking another 25 minutes to do it! Remember – everything is slower here! Why rush? But she did go ahead and let me pay my monthly CAJA (public healthcare) with her and not have to go wait for a regular teller to do that.
Sooooo . . . an hour and a half at the bank, another chapter read in my latest book (which is so, so), my doctor bill is paid AND my monthly CAJA (public healthcare) bill paid! I breathed a sigh of relief and headed home for a more relaxed weekend! Pura Vida!
And, if you are wondering, the reason I didn’t use CAJA for the surgery, is that I would still be waiting to see a surgeon and I chose not to have patience for that! Choices and Patience! Retired in Costa Rica! 🙂 ¡Pura Vida!
Monday 30 July. Yep! That does seem different, evening instead of morning, but that is the way it is (and maybe when an operating room was available at the small private hospital). And the doctor said the sooner we do it, the less damage will be done to the tendon and the sooner I will be without pain. And instead of using the main Hospital Metropolitano in downtown San Jose we are going to one of their 4 suburban campuses, the only one with an operating room. It is in the Lindora barrio of Santa Ana which is on “my side” (west) of San Jose just off our “freeway,” Ruta 27, and about 30 minutes closer than the downtown hospital campus, especially during rush hour, thus easier and quicker for both me and my driver whom I’ve already scheduled.
I am to be there at 5PM, with the surgery scheduled for 7PM to 8PM with one hour in the Recovery Room and return home soon after 9PM. That should be a good way to get sleepy for bedtime! Ja, ja, ja, (español for ha, ha, ha) 🙂 though the anesthesia is only local.
He says my activities can be normal in a week to 10 days though I will have 5 weeks of physical therapy (2X a week), the hardest part one U.S. friend said. But I did cancel or postpone my August trip to Sarapiqui, which I now have rescheduled for next May. Before then I will be a new man who will try harder to not fall off the bed or on the rough sidewalks of Alajuela! It’s just that time of life! 🙂 No cane yet and hopefully not soon! But maybe needed someday?
Because my right shoulder has been hurting now for more than two months I decided I needed to see a specialist and to do it faster use a private doctor who is in the Medismart Group I am a member of (Medical discounts!) The public medical system might have led me to the same results but at a much slower pace.
I chose Dr. Dario Lungo with Hospital Metropolitano in San Jose and rode the bus there after Spanish class this morning. I took with me the x-ray of my shoulder my local general practice doctor, Dr. Candy, had me get at a local radiology clinic. Candy also recommended that I see an orthopedic specialist and let me choose one in my discount plan.
Dr. Lungo looked at my x-ray and had me move my arm in various ways and said it is definitely a rotator cuff problem and then pointed out on the x-ray that the collar bone above the ball joint of my upper arm was touching or did not have the gap between them that they should have. “We need an ultrasound.” Ultrasonido Hombro Derecho Another 3 hours because radiology was backed up with jobs! But it paid off! Photo is UltraSound equipment.
US muestra ruptura completa del tendón supraespinoso derecho Leve bursitis secundaria y derrame alrededor del TLB.
US shows complete rupture of the right supraspinatus tendon, slight secondary bursitis and effusion around the TLB.
The full radiology report is much lengthier with lots of detail, but that is enough to share here with the big serious thing being a rupture of the main muscle/tendon in my shoulder, caused by my two falls in the past two months.
(1) I can do nothing (like our grandparents did) and in 2 to 3 years the pain might subside with a little natural healing, but never the same. (2) Surgery to repair/rebuild the ruptured tendon and other minor repairs that takes at most an hour and a half with local anesthesia as a hospital outpatient. Cost is $4,200 which is a hugh junk for me! This is called “Rotator Cuff Surgery” in the states and the USA National minimum price is $8,400 (twice our cost) and the maximum allowed is $56,200 with a national average of $21,800 (More than 5 times my cost here.) And of course I could get it for free if I waited for public health coverage but afraid to wait.
I will consult with Dr. Candy tomorrow and probably go ahead and schedule it in the next few weeks, if she thinks it best, meaning I may have to cancel my August trip, though Dr. Lungo said I could travel two weeks after the surgery.
AN ASIDE STORY: NICE PEOPLE HERE!
On the bus ride back to Atenas from San Jose our full bus broke down (only the 2nd time that has happened to me) in La Garita. The return bus from Alajuela stopped and all of us got on that also-full bus, standing room only from front to the back! As soon as I stepped into the bus a young man popped up out of his seat and made me take it ( I tried to refuse). The respect for the elderly here is simply amazing! But of course that means I look old! 🙂