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!

“Costa Rica Culture” by 7 “Kids”

Back in May 2018 I reviewed here and told about the Costa Rica made movie “Güilas” the title of which is the Costa Rican slang word for children like American English “Kids.” The movie is actually seven short stories about seven different kids, each in a different one of the seven provinces of Costa Rica thus visually showing many parts of this beautiful country and its varied cultures by my favorite Costa Rica Photographer, Sergio Pucci (I use one of his CR Calendars every year for his beautiful photography!). This is one of the best movies I’ve ever seen anywhere and is definitely the best one on the culture of Costa Rica! Well worth $10 USD from Vimeo!

One of the 7 Stories:

One of the seven short stories – this in the Caribe, Limon Province.
Continue reading ““Costa Rica Culture” by 7 “Kids””

I Registered for a Coronavirus Vaccine Today!

On my round of errands this morning, one stop was at the public clinic to sign up for my Coronavirus Vaccine as one of an expected. 3.7 million to be vaccinated in Costa Rica this year, basically the whole population. It has begun all over the country as a free vaccination provided by the government with millions of doses already in country. As an older adult I should be called in before younger people and within the month the technician told me. I just wait for the phone call, in Spanish, and hope they speak slow enough for me to understand! 🙂

Though millions of doses are already here, more have been ordered says this Tico Times article: Costa Rica to purchase coronavirus vaccines for 648,000 more people

I also saw my female private practice GP doctor this week and already my hurting knee is much better and less swollen. Medical services here are really good! Both public and private and cheap or free!

¡Pura Vida!

Tico Youth Making Fun of Themselves

In an effort to include some Costa Rica Culture in my blog, I copied this from the Golden Gringo Newsletter, which is okay because he copied it from a local online newspaper! 🙂 He came here a year or so before me from the states as a retiree (younger than me) who chose to live near a beach and fishing place, Quepos on the Pacific Coast near Manuel Antonio NP. He’s a lot different than me, but I semi-follow his newsletter for his impression of things here.

And note that the original list below was most likely aimed at and/or written by young adult or teen Costa Ricans (Ticos) as a form of humor. But there is some real culture here! 🙂

Feature photo is mine of young adult Ticos in an Atenas parade (for a traditional look), but the copied stock photo above is more typical of young people here! 🙂 Below copied from Golden Gringo Chronicles:

10 SIGNS YOU WERE BORN AND RAISED IN COSTA RICA


This gem appeared in the Costa Rica Star newspaper recently and GG thought it was interesting . . .

“We’re Not the Happiest on the Planet for Nothing” 🙂

You had your first coffee before you were 5 years old. Your mom would mix it with extra milk so it wouldn’t taste so strong. She’s the reason you developed an addiction to it and now drink at least 3 cups a day. (But their also have been numerous articles in the press in recent years on the health benefits of coffee)

You don’t refer to someone as a person, you say “mae” (pronounced my). ‘Mae’ is everyone and anyone, either feminine or masculine (esa mae or ese mae). When talking to your friends, it’s not uncommon to hear the word mae at least 50 times in one conversation. (especially among teenagers, the closest modern equivalent to “mae” in English being “dude”)

You include partying in your monthly budget.
It doesn’t matter if there’s nothing going on, you will find a reason to celebrate. You double your party budget if La Sele (the national soccer team) is playing that month. (in Covid times you can still watch the Sele on TV)

You don’t say 1000 colones, you say “un rojo.” (rojo, a “red” or un mil)
In Costa Rica the 1000 colon bill is red in color (rojo in Spanish), so you denominate money as un rojo, dos rojos, diez rojos, and so on. For example, you say “I paid diez rojos for that ticket.” One million is “un melón,” just because it rhymes.

You use trees and house colors to give directions.
From the mango tree, turn left and keep going 2 apples (blocks), it’s the third house on the right, watermelon color with a palm tree in the front. Street names — who needs them?

You know about Tico time.
If someone says: “I’ll meet you at 4,” you know it probably means the person might be leaving the house at that time. Not proud of this one, but we Ticos are not exactly known for being punctual.

You say Pura Vida for everything.
Used a hundred times a day to say hi, goodbye, thank you, you’re welcome, to express well-being, or to say something is good or nice, Pura Vida (pure life) is your mantra.

You eat tamales for breakfast, lunch, and dinner on Christmas and New Year’s Eve.
Your mom makes a huge batch of traditional tamales for the holidays and you are responsible for eating half of them, it’s your duty.

You honed your salsa dancing and merengue skills in family reunions.
Your aunt, uncle, mom, or cousin made you dance with them at all family gatherings. You might have hated it back then, but at least now you can dance.

You secretly speak Pachuca (street slang).
Even though you might not use it often, you can speak it fluently. You know that tuanis means good, that mopri (a mix of the letters of primo) means mae, that the police are los pacos, your car is la nave watched over by el guachi, and your job is el yugo. En ‘toas…it’s good, mae!

¡Pura Vida!

And for more photos of people & culture + art, see my People, Fiestas & Arts Gallery.

The “Retire for Less” Newsletter RETIRES!

Today I received the final edition of the “Retire for Less in Costa Rica” Newsletter. This wonderful couple, Paul & Gloria, are really retiring themselves now and it is about time! I have recommended them many times and they are keeping their website up for awhile, so check it out now if you haven’t before. They give the most practical advice of anyone on retiring in Costa Rica and they will be greatly missed, though maybe I will get to see them again for other reasons or socially. I hope so. They will be dividing their time between Costa Rica and Mexico which is an unusual way to retire, but very interesting.

In their last newsletter they included a summary of their philosophy over these 12 years that has not changed. I will try to copy it here:

What is the Retire for Less Philosophy?

Sometimes we tell people that we live the “retire for less lifestyle,” or perhaps we notice that others are also living in a similar way. So what exactly is it?

Conserve, simplify, enjoy. These three words sum up the Retire for Less Philosophy or lifestyle. We believe one can:

  • Enjoy the simple things in life
  • Discard some old beliefs regarding retirement
  • Count your cash, get your Social Security, and go where it’s cheaper
  • Reinvent yourself and begin a whole new, adventurous phase of your life
  • Look at your life differently, embrace the new culture, and try not to be ethnocentric
  • Scale down, live within your means, and learn to have fun, fun, fun!
  • Conserve energy, go green, and live without air-conditioners, heaters, dehumidifiers, and cars, as much as possible
  • Live without debt, reduce expenses, and reduce expectations
  • Save money, spend less, use less, and be satisfied with less – less is more

Conserve, Simplify, and Enjoy! Read our entire Retire for Less Philosophy here.

They will be missed and have certainly helped a lot of people retire here and elsewhere. Now I will just continue my very simple life in Costa Rica, not owning anything including a car. Zero debt. Walking almost daily. Enjoying the simple things of life in a simple country that puts people and nature above industry and money. Where nature is king and we will be carbon neutral in a year or so! (99% of electricity now.)

¡Pura Vida!

Las Gemelas Waterfall

Okay, for you Spanish readers, yes, that says “The Twins” Waterfall and thus you may ask, “Where is the second one?” Well . . . sometimes my better judgement overrules my sense of adventure. We had already hiked about 4 km and waded across the ice cold, rock-strewn river with Bryan, my personal guide, helping me wade across the slippery rocks just to get this photo of the biggest of the twins. To see the other one we would have had to wade up a separate stream of slippery rocks to the left of the bottom of this falls maybe 50 meters. Bryan had already said “I can’t believe I’m helping an 80 year old do this hike!” He was doubting the wisdom of going further and after nearly slipping down more than once. I did too! But I was thankful that I could make the hike solo with my excellent young masked guide who was perfect for me in every way! Most of the holiday weekend crowd have gone. We have a max of 9 guests the rest of the week, so very tranquilo! Which I prefer! 🙂 And yes, I love this place! Already another favorite and I have so many favorites in Costa Rica. Here’s just a few shots of the Las Gemelas Falls Hike and notice that weird V-shaped bridge over one of the streams, like none I’ve seen before:

See my Waterfalls Gallery for more Costa Rica Waterfalls.

Or see THIS TRIP GALLERY: 2020 El Silencio Lodge & Reserve.

¡Pura Vida!

On the trail to the waterfall this sign was laying on the ground. My guide said that the biggest danger is sudden flash floods when there is a rainstorm in the mountains above.

Widening our bridge

One of the things that drives perfectionist Americans crazy about Costa Rica is the multitude of one-lane bridges all over the country even in the cities! Look no further than right outside the main gate to Roca Verde Housing Development! Our entrance gate is on Avenida 8, better known by the little bario (neighborhood) there as Calle Boquerón. Just outside our gate going towards central Atenas you cross the little rainy season stream that goes by the cow pasture in front of my house. And of course on a one-lane bridge! Don’t know why or who influenced it, but the city of Atenas is widening that little bridge.

The concrete tubing for water flow has already been extended and fill dirt and rocks added around it and as I photographed Monday they were pouring concrete for maybe a base to something or a wall? These two school kids out of school for Coronavirus will probably soon be joining the city construction team as they sit here and learn how easy it is to build a bridge over a concrete pipe.   🙂

20200330_111052_002-WEB
Walking from town, the bridge is just before Roca Verde gate on the right.  Note also on the right the pedestrian sidewalk & bridge built by volunteers a few years ago.

 

20200330_111126_001-WEB
School’s out and these two boys are learning how a bridge is built here over a big pipe!

 

“If Rome had been built in a day we would have used the same contractor.”

¡Pura Vida!

Alajuela Coronavirus Adventure

Friday I went to Alajuela early for my appointment at the government hospital to get an appointment scheduled with my Cardiologist in Nov-Dec for my annual checkup (yeah, its weird to have an appointment to get an appointment), plus I had a package to pick up at Aeropost and a couple of items to get at PriceSmart.

Wow! I had not been to Alajuela since the Coronavirus scare hit and it has nearly as many cases as San Jose as the second largest city (and my provincial capital by the way).  EVERYTHING WAS DIFFERENT!

1st, to get to the hospital early enough for shorter lines, I took the 6:30 AM bus, which is usually packed with people going to work, shopping, appointments, visits, etc. There were just 5 of us passengers on the bus – scattered out one to a seat. And at the entrance to bus was a bottle of hand sanitizer.

Empty streets!

2nd, as the bus arrived in Alajuela I could immediately see a difference with fewer cars and people – some streets like a ghost town!

3rd, no wait for a taxi with few people there to use them.

4th, when I got to the hospital, there were few people out front as I was expecting by now, but I wasn’t expecting to be turned away! When I got to the door a guard was stopping everyone and I showed him my cita (appointment paper) and he rattled off several things rapidly that I did not fully understand but I think he was basically telling me “no” that “all appointments not emergencies are canceled.” Bottom line, he would not let me in!   🙂

I got there early on purpose to avoid a long wait, yet I still expected to spend an hour or more. But I spent only 5 minutes there and it was now about 7:20 AM, with Aeropost not opening until 9 and PriceSmart at 9:30. Ugh! Oh well, I drank no coffee at home that morning and had only a bowl of cold cereal, so I took my time walking about 8 blocks to the nearest McDonald’s for breakfast.

5th, I entered the biggest MacDonald’s in Central Alajuela with only one other customer inside! Like the bus, they had hand sanitizer at the counters.  I took my time with ham & eggs and lots of coffee while reading the Washington Post. At about 8:30 I began the 6 block walk to Aeropost, getting there 10 minutes before they opened officially.

6th, at Aeropost I only waited a few minutes before one of the clerks, who recognized me through the glass (I’m a regular), came out with my little package, so I did not even have to be one of their limit of 3 customers inside the store – see sign below. And the bright red & green sign reflected backwards in their window is a MegaSuperMercado, a downtown chain-supermarket across the street! The English translation of their home-made sign:  “Maximum 3 customers within the branch.” In what they call a “branch office.”   That is also the feature photo and the recommended “Social Distancing” to help stop the spread of the virus. Costa Rica is doing its part one little business at a time!   🙂

“Social distancing!” inside banks and businesses.

7th, Because of the time I saved from the hospital rejection, I had about 30 minutes before PriceSmart even opened, so I just walked the 12 or so blocks to PriceSmart which opens at 9:30. This is one way I get my exercise!   🙂   And in so doing, I walked by Alajuela Central Park which, like the one in Atenas, is closed with yellow tape wrapped all around the whole block:

“No large public gatherings” thus all parks are closed in Costa Rica!

8th, at the entrance to PriceSmart (our store like Costco or Sam’s Club) they not only had a bottle of hand sanitizer, but specifically asked me to please use it while the lady wiped off the handle of my push cart. But unlike everywhere else I had been that morning, they were full of people and at opening time! Full with long check-out lines! And still some crazy bulk-buying by the panicked!

I actually don’t like this store which is too expensive, too large a quantity of things, and not consistent in their stocking; BUT they usually have about 5 or so items I cannot get anywhere else – things I really like. (Another option might be at AutoMercado, an American-styled supermarket specializing in American brands, but their location is not as handy for me as PriceSmart, as a bus rider.)

When I got out of PriceSmart it was a little after 10, meaning I had just missed the 10 o’clock bus! In the mornings the return buses only run on the hour (tho every 30 minutes in the afternoon), so I just slowly walked the 6 blocks to the bus stop for Atenas and still had time to read a little of my new mystery book before it left at 11. Oh well, another morning is gone! But hey! I’m Retired in Costa Rica and this kind of virus-influenced inconvenience is simply part of my daily adventure! Its what you do when you are retired in Costa Rica!    🙂

“An adventure is only an inconvenience rightly considered. An inconvenience is only an adventure wrongly considered.”
― G.K. Chesterton

🙂

¡Pura Vida!

 

Indigenous woman?

Maybe – or maybe not – just art that my second dentist (Ureña) likes or maybe a relative made. He has these in his lobby and 3 appear to be the same indigenous woman from behind but in different clothing and accessories. Whatever the story behind them, my first impression was good and I snapped photos with my phone. The other appears to be an early migrant from the Caribbean Islands to the Caribbean (Atlantic) Coast of Costa Rica, where most of the Afro-Costa Ricans live and have roots in Jamaica or other Caribbean Islands, originally brought here by Spaniards to work their banana and other farms. We have the largest Jamaican population outside of Jamaica.   🙂    Anyway, I think it is good art and I enjoy art!

 

The job of the artist is always to deepen the mystery.” 

~Francis Bacon

¡Pura Vida!

 

And a local sense of humor at Tico Times Digital Newspaper:

Since all the people are staying at home, the native animals are reclaiming our Costa Rica parks, even Jurassic Park!   🙂    Or is that the lake in downtown San Jose’s Sabana Park?

Native animals return to Costa Rica as coronavirus forces humans indoors
The Tico Times – Mar 21, 2020

🙂

el irlandés

I subscribe to a “word of the day” service in Spanish and today it is:

el irlandés

(eer-lahn-dehs)

Irish

HAPPY ST. PATRICK’S DAY!    🙂

¡Pura Vida!