Category: San Jose

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Biopsy Report & Long Range Plans

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! 🙂

¡Pura Vida!

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Staying Positive When Cancer Comes

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.

New Adventure Started February 11

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.

The Latest Diagnosis

All those appointments and diagnostic tests lead to this current summary diagnosis with more detail in the online journal:

  • I have a tumor inside the salivary gland between my left ear and left eye that has grown fairly rapidly to around 3 X 4 cm now.
  • Though the needle biopsy indicates it is almost certainly a type of cancer only removing it will tell us for positive. Outside chance of no cancer. Prayers appreciated! 🙂
  • Surgery is scheduled for 15 March at Hospital La Católica in San Jose, Costa Rica
  • Dr. Christian Hernández Mena is my oncologist and surgeon – terrific in every way!
  • After surgery, a full biopsy is done, and the exact type of cancer determined, I could be receiving radiation and yes going bald! 🙂 More reports after surgery!

My Blog and Travel Plans Continue

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!

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It’s getting closer!

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!

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Highway West Going 4 Lanes!

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

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One of Best in the World!

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!

 

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Costa Rica by Bus

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!

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Passport Renewal

Why Renew?

Even though I am a legal resident of Costa Rica with a residential card or “Cedula” and thus a national ID number (which I have memorized), I am not a “citizen” which takes longer, is more complicated and is not one of my goals with no particular advantages for me (vote & CR Passport).

Thus I must retain my citizenship in the U.S. and that requires a valid U.S. Passport if “living abroad” (says the U.S.) though I no longer have to have a Costa Rica Visa stamped in it as a legal CR Resident. It just declares where I am a citizen (everyone must be a citizen somewhere), required by both countries, AND is required to travel internationally or even buy an international airline ticket.  While I can travel domestically in Costa Rica with only my ID number or resident card, I used my U.S. Passport on those 3 trips I made to Nicaragua and Panama. A U.S. Passport is good for 10 years with my current one obtained in 2010, thus expiring in 2020, this year, on my birthday in July. And most countries require at least 6 months left on your passport to enter, thus needed now! Not as confusing as it may sound. But . . .

Process Before Going to Embassy

An internet photo of US Embassy in San Jose – against the law for me to photograph.

So, the first week of January I got on the U.S. Embassy Website to make an appointment for the renewal of my passport which they gave me for 28 January. No one can just walk into the embassy here – you MUST have an appointment first. It is like a huge military fortress of paranoid American bureaucrats surrounded by high concrete & steel walls and razor wire. Once you get in with an appointment, you are checked by dozens of armed guards, remove everything from your pockets and enter with no bag, purse, cellphone or anything but the cloths on your back and required paperwork. My two other experiences there were that once you finally get in, they are fairly efficient and rapid with whatever service you need. For us expats there are even IRS and Social Security offices inside the embassy. Passports are by the Department of State.

Required Paperwork Before Appointment

When I made the appointment on the embassy website I also downloaded and printed a 2-page form to fill out along with the 4 pages of detailed instructions (good grief!). I filled in the form with ink and went to a local Atenas photography shop for my passport photos, attaching one of them to the form as instructed. All of the above was before the actual appointment on 28 January and I will continue this saga after my appointment for which I’m hiring my local driver Walter to take me and wait on me while in the embassy, which shouldn’t take more than one hour. Then I will write the next paragraph and post this to the blog.

The Appointment – 28 January 2020

A Comedy of Errors

Their “Official Photo” – I am not allowed to photograph it!   🙂

Walter picked me up at 8:30 AM this morning, saying that we would be early for my 10 AM appointment because it never takes him a full hour to get to San Jose (but I insisted on 8:30). Well, we zoomed up Ruta 27, our semi freeway to San Jose until about 5-7 km outside the city and we screeched to a halt or slow crawl of bumper to bumper traffic, assuming a wreck ahead and sure enough, about 45 minutes later there was a wreck on the opposite side of the freeway! Good grief! It was “rubber necking” or people slowing down to stare at the huge multi-car pile-up on the other side going in opposite direction! Whew! Then we sailed right into town pulling up in front of the embassy at exactly 10 AM, my appointment time!   🙂

But did I go straight in? No! The armed female guard with bullet-proof vest at door asked if I had a cell phone or any other electronic device? I said, “A cell phone which I expect to put in the locker inside.” (like I did last time there) She then tells me that they no longer have lockers, it was too much trouble and they have too many people entering. Walter was already gone and is not allowed to park near the U.S. Embassy, thus he goes somewhere else until I get out and call him for a pickup.

So I helplessly look at her and ask “There is no one here to give my phone to, so that means I cannot go in and renew my passport?” THEN she tells me that the Catholic church a half block down the street has lockers I can rent. So I hike down the street and after asking someone, find the little church building and go in among statues of Mary, pay my 1 mil colones and get locker #13 key (lucky 13!). I put in my phone and at her suggestion my coins and belt with big metal buckle, but keep my wallet because you have to pay for a passport!   🙂   By then this frustrated foreigner was feeling his two cups of coffee from breakfast and had to pay 600 colones to use the baño!  (But my coins are in the locker!)  Ohhhhhhh! I hate the American Embassy!

I rush back to the embassy, late for my appointment, feeling like I was entering the embassy in Afghanistan or Iraq with armed guards and bullet-proof vests, and finally, after a severe security check, I get inside and make it to the correct window for passport renewal (not labeled, just window 15), passing crowds of other people there for visas, and who knows what else? But I had an appointment!   🙂

No teeth-showing smile allowed.

Wow! No one else at the passport window! (In fact the worker there looked bored!) I give him all my paperwork and passport photos (left) which he stared at for a few moments and then said “These will not do. The photographer zoomed in too close to your face.” and he showed me how it was suppose to look. Then he said, “No problem! You can go back out into the lobby to the photo booth and get your photo made properly.”  (Grrrrrrrrrr.)

Official Embassy Photo with “No teeth-showing smile.”

So back out among the throngs of people in the huge open-air lobby with others, mostly Ticos getting U.S. Visas, also waiting to have their photos made. I finally get it and pay the dos mil (about $4 compared to $2 for the Atenas “zoomed in” version).

I take them back to the guy behind the passport window and he asks me, “Now aren’t these much better?”   I wanted to say “No” but rather used the local non-committal “Mas o menas.” (more or less) and then asked “Cuanto cuesta?”  And he says $110 and I give him my MasterCard and it is basically done. . .

. . . until he gives me a little slip of paper written totally in español explaining how it will be mailed to my Atenas Correos (Post Office), but only after I go first to that post office and prepay them the equivalent of $7 for their postal services and email to the indicated U.S. Embassy email address a photo copy of the receipt I will receive, saved as a PDF file only. Then he explains in English that it takes them 2 weeks to get the new passport made and the post office 2 days to get it to Atenas. Then I can go pick up my new passport and the Post Office MIGHT even call or send an email when they have it. The embassy will not send it to my PO Box. I guess afraid of theft.

Oh Lord-y was I glad to get out of that place! I go directly across the street to a tiny coffee shop (Coco Cafe) and get a cup of coffee and 4 miniature cinnamon rolls, los rollitos de canela. I call Walter and by the time I’m finished, he is there for me. All total an hour at the armed fortress and about 2.5 hours on the road! But almost done! And Walter dropped me off downtown where I took care of the post office payment today AND I have already emailed the PDF photo copy of post office receipt to the embassy. Waiting is all that’s left to do.

One less thing to think about for the next 10 years!   🙂   So in 2030 I will do it again as a 90-year old (wiser & more experienced) for the passport that will get me to age 100!   🙂   Then I may need someone to go with me in 2040, but the embassy only allows one extra person who is not the applicant!   🙂  And who says retirement is boring?

Retired in Costa Rica

¡Pura Vida!

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All Over Costa Rica!

I was thinking of doing a Costa Rica Map on a cork board with map pins showing where I’ve been – which is a lot more places than most people I know here among both Ticos and Expats. Then suddenly in my electronic mailbox appears an email from Google Maps titled: Google Maps Timeline 2019 Update.  Yep, it included the feature photo map above and some other stuff  that seems to go back to 2015, my first year here when I began traveling Costa Rica. It seems I approved them tracking me (my cell phone) back then and this is what I get! Should I be afraid of Google or send them a thank you note?   🙂

The big red blob in the middle is the space between Atenas & San Jose that includes Alajuela and all the places I go there including the big SJO Airport. I cannot explain the red dot in the Pacific Ocean, but if you study the map more you will see the large green area in the south-southeast above Panama that has no red spots for my visits. One main reason is that it is the Talamanca Mountains, much of which is indigenous reserves with no public roads going through there plus protected national forests not allowing travel. My May trip will put me on the Western edge of that area at Chirripó and my visit to the Bribri Yorkin Reserve had me on the eastern edge. And that is it!   🙂   So just 17 more parks/reserves to go!   🙂

After 37 national parks & reserves are visited, I will do a photo book like I did with all of Tennessee’s State Parks in my photo book A Walk in the Woods Through All 54 Tennessee State Parks. There are technically only 28 national parks here! But the nine reserves count as equals and for my nature photography purposes especially, so I’m saying 37, with only 17 more to go! I don’t have a car which slows me down a little! But I will get there!   🙂

See links to the photo galleries of the 20 National Parks & Reserves I have already visited  or for all of my travels over Costa Rica browse through the family of galleries:

Costa Rica Trips (80) which is the best collection of my photos here!

 

“My wish is to stay always like this, living quietly in a corner of nature.”

~Claude Monet

¡Pura vida!

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When? Rain stops? New airport?

The clear skies from my terrace on today, December 1 (feature photo above), hint at what the next 5 months could be like as the rainy season slows down and stops for no rain in the Central Valley Dec-Apr. But like weather everywhere, there are sometimes exceptions and as a gardener I happen to like rain!   🙂    Either way, I will adapt!

The above shot is a single shot on my cell phone.

Below is a composite shot on big camera yesterday with clouds.

Nov-30_Panorama1 copy

Plans for New Airport in Orotina, Costa Rica on Hold

This Article Title link is to an old newspaper article that still holds true today as the government here is not yet ready to spend billions of dollars on a new airport (25 minutes west of Atenas) which would be in a lower, flatter, larger valley of farm land for much greater expansion than the current international airport in Alajuela (45 minutes east of Atenas) which is basically land-locked with expensive developments, though closer to the capital of San Jose. The new one would be closer to the Pacific Coast beaches and resorts.

The debate will probably never end (seen in responses to above article) and it will never happen until both the president and the legislature make it a priority which they still have not done. I expect to die before it actually happens, if ever, and it really doesn’t matter that much to me. 45 minutes is close enough to a major airport!   🙂

New Airpor Artist's Renditiont
Artist rendering of new airport in Orotina.

And a “Profile” is on the CAPA Center for Aviation website.

Plus I’m happy with the new Domestic Terminal (my photo gallery) at the current airport, since my only flights now are short hops within Costa Rica on little local planes with Sansa Airlines. So if you’ve heard there will be a new San Jose Costa Rica International Airport, don’t expect it before 2030, if ever, unless you want to donate money to the government to build it and maybe get your name on it!   🙂

¡Pura Vida!

 

 

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Rain in Paradise

I think I forgot that they are on the Caribbean Slope – east of continental divide  (their rivers flow into the Atlantic) meaning November is maybe the rainiest month!   🙂   As soon as the plane got out of Central Valley over the mountains it was raining and hasn’t stopped since. But I love the rainy season in general and have had some great experiences in the rain, like at Esquinas Rainforest Lodge, so I scheduled all my birding hikes and will do the best I can even if under an umbrella!   🙂   Funny thing is I tried to book this trip for Christmas week and they were already full nearly a year ago. I’m thinking about booking for Christmas 2121.   🙂

The best photos in this post (I think) are the “Plane Shots.” Enjoy and expect some wet reports this week!

Plane Shots

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Corner Room

Click image to enlarge.

 

Two Birds

Click image to enlarge.

 

¡Pura Vida!