Tools for Physical Therapy

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.

And will you succeed? Yes indeed, yes indeed! Ninety-eight and three-quarters percent guaranteed!”
– Dr. Seuss

🙂

New Hospital Adventures

Hospital San Rafael de Alajuela, Costa Rica

Adventure 1: New Cardiologist Scheduled

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.   🙂

 

¡Pura Vida!

 

 

Patience is Costa Rican!

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 and everybody 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!

 

 

Inside Basílica de Nuestra Señora de Los Ángeles Church

Surgery Scheduled for Monday Evening

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?

“Getting old is not for sissies.”     ~Bette Davis

¡Pura Vida!

Orthopedic Surgeon Today

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.

SUMMARY REPORT

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.

TWO OPTIONS

(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.

DECISION TOMORROW

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!  🙂

One Person’s Healthcare Plan in Retirement

My “Carne” or government
Healthcare Services Card

One of the newsletters I receive electronically is called Retire for Less in Costa Rica and this month’s edition has an article by Rob Evans titled My 2017 Healthcare Plan for his retirement in Costa Rica. If you click it goes to top of newsletter, so scroll way down past their budget stuff to the article. His plan is very similar to mine though I do not have the gym membership or the private travel insurance plan. And I am keeping my Medicare active “just in case” I’m back in the states and have a problem needing care there.  And like him I have no car, walking several miles every day which is part of my healthcare. I’m probably not as careful as he sounds on food choices as I consider retirement a time to enjoy life, including food! And I do! I eat pizza and ice cream unashamedly!  🙂

Discount card for a private hospital.

If Republicans get their way on healthcare, it will cost middle class retirees like me a third to half our meager incomes in the future. The sad condition of health care costs in the states (read the above linked article) was one of the reasons I chose to move to Costa Rica. There are many options here, but I am doing like Rob and taking the public healthcare program with a discount card (at left) at a private hospital to use if I am not satisfied with the service of CAJA for something like long delays or poor service. But so far I have been happy with the public healthcare even if a little slower.

2nd only to Canada in Healthcare!

HEALTHIEST COUNTRY IN LATIN AMERICA & 

SECOND IN ALL THE AMERICAS AFTER CANADA!   

If considering Costa Rica as your place of retirement, you will be pleased with the results of the latest World Health Organization study on both the health of the people and the quality of the public healthcare provided, especially in regards to premature deaths. (Click above title for article.)  Or see World Health Statistics 2017 from the WHO.
Panama was in second place with regard to fewer premature deaths in Central America (In case you are considering Panama, which was my second-ranked choice for retirement). And in the WHO survey Costa Rica ranks 19th healthiest country in the whole world! Glad I live here now! 🙂
¡Pura Vida!

Cardiólogo hoy

Cardiologist today (cardiólogo hoy) for the appointment (1 pm) I started making 4 months ago.

10:15 – Left the house walking to bus station
11:00 – Bus to Alajuela then taxi to Hospital Alajuela
12:15 – In line to check in on 4th floor Cardiology Department (cardiólogia)
12:30 – Behind the gray screen for weight and blood pressure
12:35 – Wait in front of Door 8
1:00 – Called into Door 8 where she asked questions in español of course. Then created an EKG (ecg) and then sent me to Door 4
2:00 – Dr. Hernandez calls me in behind Door 4. My first and only person of the day who spoke English. We mixed it up, Spanish/English, as he created a little heart-related medical history of me to begin my cardiology file. At one point he had me both sit and lay down on the examining table where he listened to my chest and back and then felt around in my abdomen. He read and wrote notes on the reports I brought from the private cardiologist I had seen earlier and the medication she had prescribed. He told me he would have be back for an ecocardiogram along with blood and urine workup to give him a total picture of my health to help him better monitor my heart. I feel very good about making this young (30-something) cardiologist my primary heart doctor with the government healthcare program generally called CAJA here.
2:50 – I go back to the front desk with really nice young adults who only speak Spanish to make my appointments (citas). The young man had to use his phone to translate to tell me I must first go to the first floor to a desk and have them make a file on me, mi experiencia, which took a while to find the right desk where I took a number and waited.
3:20 – I took my beautifully created large folder for all my medical records there back to 4th floor where the young man called me past the line and put everything in the folder except my two appointments for March 24 & 25 and multiple copies of my prescription for a different but similar treatment of my arrhythmia.
3:30 – Got a taxi to bus station
4:00 – Bus to Atenas
5:15 – I’m eating one of Chef Dan’s Meatloaf Dinners before watching ABC news.

Now all of this cost me exactly $0. The prescription is good until my March visit and it too is FREE! While the prescription from the private doctor even in generic form costs me between $40 and $50 per month.

Yeah, this first visit cost me most of the day and I had to wait a few months for it, but my heart will be monitored and cared for until I die at no other cost than the required $100 a month CAJA cost which is required if I live in Costa Rica, use it or not. I’m going to use it! Save money! And I like most of it even if rather slow! 🙂 Later I will explain how I plan to work the free government system with some limited private system healthcare and a great little local insurance for a private hospital if or when ever needed for just $12 USD per month! Later!

Private Health Insurance, Public Health Coverage and Residential Papers

Boring Stuff for the Few Readers Anticipating a Move Here

That title just means some details only concern the persons actually moving here or retiring here and I don’t want family or friends back in the states worrying about my healthcare. I’m fine! Don’t worry! In a different country, culture or situation some things take longer than you expect and you just work them out the best way you can, sometimes one day at a time.

RESIDENCY & PUBLIC HEALTHCARE
It has been 15 months since I filed my application with Immigration and I am still not approved yet. I now know people who have gotten it in 6 or 8 months and another in 3 years, so the bureaucratic government office is always slow and it often depends on which agent’s desk your application ends up on or what is happening in his/her life at the time. So mine is not that unusual, but I talked with my attorney  by phone this afternoon and here is the update on my application or what is in his control: I am now his oldest application file, so I’m his number one priority now. Good! He has made an appointment with Immigration for May 13 to request “a resolution” on my application. That is between him and the government office, I’m not allowed to go then, but he is planning for approval on that date and has even made a June 1 appointment with the CAJA Office (government health plan) for me to get my healthcare card (Caja Card) which is separate from my residency card (Cedula) and I think that same day we may apply for the “Gold Card” which is for us old people to get discounted or free services like buses, etc. That means we have to do some paperwork and Social Security Office visits between May 13 and June 1. I will try to stay available though I do have a May 20-23 birding club trip. SO I’M HOPING FOR RESIDENCY BY MAY AND CAJA BY JUNE OR JULY. I will not hold my breath! Everything here usually takes longer than suggested!

The primary reason I’m in a hurry to get this residency and public healthcare coverage is because I really can’t afford to keep private healthcare insurance! For a reasonable amount per month I will be on something like medicaid or medicare in the states (only much better!). There will be no co-pay or charges for any doctor visit, surgery, hospital visits, prescription drugs, etc.! I will pay a monthly charge based on a percent of my SS income. I need this kind of “socialized medicine” as some Americans like to call it. Read on to see why.

PRIVATE MEDICAL CARE AND PRIVATE HEALTHCARE INSURANCE
I’m thankful I’ve had no big health issue like cancer or needed surgery, injury, etc.! But private doctors, hospitals and other medical services are so much less expensive here than in the states that for my usual medical needs so far in my life I could afford to have no insurance and just pay cash out of pocket for doc visits, x-rays, EKGs, prescriptions, etc. But prudence makes you plan for the worst and have insurance when you are not on the government health plan yet, as has been my case for the last year.

When I first came, I was could tell my Medicare Supplement Insurance that I was on an extended vacation and be covered for I think it was up to 4 or 6 months. When that expired, I cancelled that policy and purchased a Costa Rica Private Healthcare Insurance Policy which covered 80 to 90% of everything including prescriptions with a few restrictions I won’t get into here. But like in the states it was based on age and for someone turning 75 it was $3,000 paid up front for the whole year. It expires the end of this month and I just sent in my claims for the whole year, so waiting on a check!

Since I still don’t have my residency and thus the almost free government healthcare plan, I figured I probably should go ahead and renew for one more year “just in case.” Well, they do everything at the last minute here and I just got my renewal notice with the shocker that I this year move into the next age bracket of 76-80 years old and thus my renewal cost would now be over $6,000 for the year! NO WAY! That precipitated the above-mentioned call to my attorney and my push to get residency and the government healthcare plan expedited if at all possible.

It is close but the timing of my May residency and June healthcare plan may be just right! Though I may have a couple of months without insurance, so just don’t get sick! Private insurance companies here are about as bad as the states for high costs, but the government plan is certainly a lot better! And I hope to be on that soon!

If anyone considering a move here wants more details, just email and I will be glad to discuss it further and keep you posted on what happens, though I will do that here on the blog too once I’m approved and probably have stories of government bureaucracy to share.  🙂