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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!
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! 🙂
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!
Since I was a high school boy when Mom gave me that book The Power of Positive Thinking for Young People by Norman Vincent Peale, I have made being positive a part of my life philosophy and really a part of my personal faith in God and the act of following Jesus.
It is kind of like happiness, it is inside you and you actually decide to be happy or not I believe. Then when bad things happen or come to your life, you make the best of them and keep on living. That is what I did for 20 years of a very difficult marriage while she was never happy and I was always happy in spite of the situation. Likewise with those overlapping years of a special needs child with autism and another rebel child. One survives by staying positive and finding the good things and opportunities, even within the bad!
Now don’t jump to conclusions – I’m not announcing my imminent death by cancer! 🙂
What has been for several years little skin cancers all over my body may have grown deeper roots or a separate and totally different cancer may have come that is more complicated.
Not sure what to expect, I kept a journal of what was happening on one of the “static pages” or non-blog-post pages of my website and called it FIRST RAMPANT FEELINGS ON POSSIBLE CANCER. Kind of long.
All those appointments and diagnostic tests lead to this current summary diagnosis with more detail in the online journal:
I had to postpone my March trip to Tambor Bay, but hopefully by the time of my planned May return to Arenal, I will be able to travel just like always if radiation schedules don’t interfere! 🙂
For any readers who are also facing cancer, I want to recommend the following website and encourage you to stay positive and continue life as I will with the same kind of travel and nature blog posts right here at Retired in Costa Rica!
How to Keep a Positive Attitude With Cancer
“Choose to be optimistic, it feels better.”
—Dalai Lama
¡Pura Vida!
Yesterday one case of Coronavirus was confirmed in Atenas. Many of our local people commute to both Alajuela and San Jose for jobs, a natural way for it to spread from the two cities with the most cases. Country-wide Costa Rica has 75 cases now and one death. This is a real pandemic!
You spoiled Americans may say, “So what?” but this is a really big deal here in Costa Rica! For years Ruta 3 was the only route from San Jose to the west coast, a narrow, 2-lane, winding mountain road that went right through downtown Atenas (when travelers got to see this charming little town) and then over another set of mountains & one-lane bridges to Puntarenas and Jaco Beaches.
Ten+ years ago they finished an outdated toll road called Ruta 27 from San Jose to Puntarenas with a side branch to Jaco Beaches, much straighter through the mountains but unfortunately most was still just 2 lanes and all the bridges are 2-lane! 🙂 There are 3rd lanes or “passing lanes” on many of the uphill sections to help get around slow trucks, but that is it! Poor planning for the long-term future! See the operator’s video on Ruta 27.
Now it seems the legislature has approved a coming upgrade to widen Ruta 27 to 4 lanes all the way to Puntarenas and Jaco – a huge improvement for those who drive this busy route when it is finally finished, though they are not even starting until 2021! Read all that I know about it on the “Live in Costa Rica Blog” article.
And for those fewer people like me who really like the Atlantic Coast or Caribe as we call it here, you probably know that the widening of Ruta 32 from San Jose to Limon (the flat part beyond the big mountain range) was approved a long time ago and is being widened to 4 lanes right now. It is an easier, quicker job after you get through the mountains of Braulio Carrillo because of the flat land between Guapiles & Limon and I assume they will eventually widen it through the mountains too. Both of these widened routes are important not only for retirees and tourists but especially for commercial trucks delivering goods from our two big shipping ports of Limon & Puntarenas to warehouses in San Jose.
In smaller, poorer countries like Costa Rica this kind of “progress” is slow & expensive, but sure as in this case. I don’t want us to become “too big” or “too developed” but one main highway from coast to coast is a good thing for everyone, though you will sure miss seeing a lot when you zoom by! 🙂 And it passes on the outskirts of Atenas just like the old coast to coast train did in a previous century. 🙂 ¡Así es la vida!
¡Pura Vida!
Thanks to the Interstate Highway System, it is now possible to travel across the country from coast to coast without seeing anything. ~Charles Kuralt
Alma de Café in the National Theater, downtown San Jose, was chosen by a British publication as one of the best coffee shops in the world. I’ve been there and it is a wonderful “Old World” coffee shop that would be at home anywhere in Europe and has fabulous coffee and pastries! I highly recommend it! Read about it’s new honor on Christopher Howard’s “Live in Costa Rica” Blog.
¡Pura Vida!
Someone recently asked me about getting around the country by bus and I think I referred them to the Bus Schedule website which lists all of the option when you type in the “From” and “To” spaces on that website with all bus companies included.
Well, I forgot about an even better help beyond schedules, the Facebook Group Page Costa Rica by Bus on which you can post a question (may have to join group first) and some of the many people who travel by bus will share their experiences and advice. And of course they also recommend the bus schedule site above. And by the way, that bus in photo above is the one I took to Turrialba.
I plan to go to a birding lodge near San Isidro del General in May, so anticipate my report on that bus experience then. I use the bus almost weekly to go from Atenas to Alajuela for many different reasons and have gone to San Jose by bus many times. Some of my other bus adventures have been (with links to photo galleries):
All of this was to simply say that you can travel on a “shoestring budget” and see a lot of Costa Rica whether you live here or visiting. Buses are cheap here! That is the way most Ticos travel! And you can do it without the Spanish language, though much easier and a richer experience if you speak at least a little Spanish.
Now, as a retiree who has made seeing all of Costa Rica my main activity, I do not do everything the budget-way and love to go the longer distances on Sansa Airlines or to places less than 3 hours from Atenas by my favorite driver here in Atenas, but I do not have a car and have basically quit renting cars because of the high insurance cost, thus seeing Costa Rica by bus is one option I still use when I consider it the most practical way. The next bus report comes in May! 🙂
“Live with no excuses and travel with no regrets” ~ Oscar Wilde
I just realized that I did a similar post in 2017, Seeing Costa Rica by Bus 🙂
¡Pura Vida!