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In my cancer adventure, yesterday morning was the last set of activities scheduled before beginning radiation therapy and their 3 pre-therapy actions. The dental work and eye surgery . . .
Continue reading “An Overwhelming Morning”
The honorific title of “Don” (“Doña” for older women) started in Europe for royalty and leaders of honor in Spain, Italy and Portugal, while today in Latin America it is a term of respect and endearment for senior adults. Since I started my cancer treatments, most of the different doctor offices call me Don Charlie, Don Charles or now my oncologist office lady always calls me Don Carlos. It is kind of nice to have the respect shown and helps to keep you from feeling sorry for yourself. 🙂 Respect for the elderly in Cosat Rica is everywhere!
Like with so many doctor appointments, both gave follow-up appointments with the biggest being with my Ophthalmologist who is doing minor outpatient eye surgery on my left eye this Friday right after the dentist appointment. It is one of her standard procedures to partially close the eyelid that won’t blink or close on its own. It will be down to a kind of permanent squint so the eye doesn’t dry out and water so much like now AND most likely I will no longer need to wear an eye patch! AND I will be able to see with both eyes (particularly helps depth perception). Both eyes are still 20/20 vision so I still don’t need glasses, though over-the-counter reading glasses (magnifying) is okay and sometimes needed for someone my age. I’ve especially needed them while reading with one eye only the last couple of weeks. And maybe the best part, her special ophthalmology operating room is in Ciudad Colon on the Atenas side of San Jose, meaning a shorter drive! 🙂
It was important to squeeze this in before radiation starts to avoid more damage from the radiation. It is like they are rebuilding my body.
And the oncology surgeon just checked the incisions and swelling which is visibly going down now, but can take a month or more. This skin is less and less sensitive in that area. But it could take up to a year before back to “normal.”
¡Pura Vida!
This happened the week before my cancer surgery and now it has started again two weeks before the beginning of my radiation treatments – tiring – hard to keep up with – but necessary!
Those who have experienced radiation know that you cannot have any dental work done after radiation for a long time, especially no tooth pulled because the radiation does something to keep the hole from a pulled tooth from healing. Hopefully none will need to be pulled! 🙂
This is Dr. Raquel Benavides whom I saw in the hospital and Dr. Hernandez (my oncology surgeon) recommends to see if anything can be done to help my eyelid that will not close now or blink. He thinks she can “stich” the eyelid mostly closed to a sort of squint so that I will not have to keep it covered and can still see with it. Hmmm, I’m not convinced of that yet but maybe she will convince me or have some other solution other than an eyepatch. I’ll find out tomorrow and expect almost anything to come after radiation is completed.
This will be my 3rd “follow-up” or “post-op” visit to the surgeon, Dr. Christian Hernández. He wants to check on the healing of the long incision and the swelling on my left face and neck. Plus he said he wants to hear what the Ophthalmologist says. 🙂 He must not have a mouth specialist friend who can fix one-sided smiles! 🙂 He encouraged me earlier to go ahead and shave on the left side, but because it is tender and sensitive I only lightly run the electric razor over the left cheek and even more lightly on the left side of my neck which is more swollen and more sensitive. So I am not back to normal yet, skin-wise. The pain is less now in the ear and jaw, but still some and I’m now taking an over the counter acetaphetamine locally popular called Panadol.
The last time I saw him, Dr. Roberto Gamboa, was when he sent me to Dr. Hernández to take care of the tumor which I will now have to tell him came from that skin cancer he removed in MOHS surgery which is supposed to mean they got it all. Well . . . cancer roots go deep! At that last visit he also treated a little skin cancer on my upper lip which was a black spot on my lip in some of my cancer selfie photos. (I was putting a very expensive anti-cancer medication on it once a day for 20 days.) That scab is gone now and supposedly the little cancer there. Of course he will be checking for any more and he often burns bumps off my skin with nitrogen. He is also my “traveling buddy” who likes nature lodges all over Costa Rica like me. He is the one who recommended Bosque del Cabo Lodge where I’m going the first week of July and earlier got me hooked on El Silencio Lodge I’ve visited twice now! Hopefully he finds no new skin cancers this visit. And maybe the best thing is that he is located in nearby Alajuela rather than far-away San Jose! 🙂 A much quicker and easier drive!
This MRI is for the Radiotherapists to help them target the cancer cells in my head, especially in the nerves since the cancer was in the left facial nerve. The best thing about this is that it is in a suburb on this side of San Jose, Lindora, and secondly in the only hospital that takes my Medismart Card for a big discount, as does the Radioterapia Siglo XXI I’m using and thus they are sort of Medismart partners. 🙂 It will take only about an hour with a little less than an hour each way traveling, so not as tiring as going to San Jose.
I assume that the MRI and CT Scan show different things that they need, thus I’m getting both in preparation for the radiotherapy. Both of these will be in San Jose at the Radioterapia Siglo XXI building where I will spend a lot of time the next month and a half.
This is the long-haul treatment of cancer, radiotherapy 5 days a week for 6 weeks and they guarantee that you will be tired at the end – enough so that they encourage you to plan no activities for the following 4 week or in my case, the month of June. It will take place in central or north-central San Jose at Radioterapia Siglo XXI, the only private radiation company in Costa Rica with only one place for the public healthcare patients to get it at Hospital Mexico. I chose to pay for private because it could be quicker, with often very long waits in the public healthcare system and because my oncologist strongly recommended it because of the size of the cancer.
As I shared in an earlier post, I am now planning to travel to San Jose each Monday and return to Atenas on Fridays, staying in a hotel near the therapy location. Even though someone else will be driving, I dislike the long, high-traffic drive that at peaks can be 2 hours between Atenas and San Jose. As long as I feel like it, I will even add a tour or two each week to something of interest in San Jose like some wonderful museums and parks plus history and architecture that interests me and may give photo ops, though many museums restrict photographs. Otherwise I will be pampered with all meals, room cleaning, Wifi, and hotel gardens to relax in between treatments. I will try to turn radiation into a relaxed and colorful, tropical vacation in the center of Costa Rica! 🙂
¡Pura Vida!
Today (April 1) is the day that our local Atenas Public Clinic & Social Security had scheduled me for the Coronavirus COVID19 Vaccination at 1 PM and I got it right on time! I earlier asked the radiation doctor if the vaccine would be any conflict with what they will be doing and was told “no”, thus continued as scheduled.
In Costa Rica they started vaccinating with healthcare workers and first responders, then the many here in their 100’s, the 90’s and 80’s, just now getting to us who are exactly 80 year olds this week. So when I got to the clinic they sent me around back to a storage building that had been converted into a vaccination clinic and joined about 10 or so other 80-year-olds waiting for their vaccination too. Quick and totally painless. One of the easiest shots I ever received and a guy nurse did it! I had earlier said that girl nurses give more gentle shots, but not over this guy! 🙂 And we are getting the Pfizer type here in Atenas if that matters to anyone. They brought the shots in one at a time in a little hand cooler from the big freezer, quickly jabbed me, and asked me to wait 5 minutes for any reaction – none! My arm is not even sore! 🙂
My vaccination card showed that I had the first shot today and that my second one is scheduled for 22 April. I asked if I could get my second shot before beginning radiation on the 19th? The poor guy went all over the place trying to find someone with the authority to change my second appointment. Finally he told me that he was sorry, but I would have to reschedule it through the Clinic by calling them (en español). I handled all of the above in my limited español, but I never do good on the phone, so I will see if Radioterapia can call them and reschedule it as an official medical person speaking Spanish.
On the way home I stopped by the Farmacia for some more stick-on eye patches (I’ve internet-ordered some better black cloth ones), got some groceries before all shuts down for Easter and then grabbed a Grande Nachos from Donde Bocha and on home. I ate my nachos and then a neighbor stopped by with two desserts for my Easter Weekend and now the day is nearly gone! 🙂 And that is what a big day is like for an old man retired in Costa Rica! 🙂
¡Pura Vida!
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.
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! 🙂
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! 🙂
¡Pura Vida!
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 Grit 1969 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
🙂
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!
. . . 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.
¡Pura Vida!
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.
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! 🙂
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.
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! 🙂
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! 🙂
¡Pura Vida!
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.
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.
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.
¡Hasta mañana!
¡Pura Vida!
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! 🙂
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.
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!”
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! 🙂
¡Pura Vida!