It Always Happens Suddenly
23 February 2021 – At my computer in my rent house, Atenas, Alajuela, Costa Rica trying to put together the story of the last few days, the beginning of a new adventure I did not plan. After I “catch up” on what has happened since the 11th of February, this will be diary type report on the story of this tumor.
I’m not ready to broadcast this through my blog and the usual post link through Facebook, but feel it important to write down my very rampant feelings of the last few days as I learned of a probable new cancer in my body, more serious than those skin cancers earlier.
After nearly a year of not seeing my dermatologist because of Covid 19, I go back and he burns several new skin growths on my face with Nitrogen and deadens my lip to surgically remove a strange little growth there to send off for a biopsy. I return on 11 February, 3 days before my trip to El Silencio, to get the results of my biopsy (non-malignant) and then showed Dr. Gamboa something I had forgotten to show him the previous week, a lump on the left side of my face between my ear and left eye, almost on the same spot he surgically removed a skin cancers in 2019 in a serious surgery with an anesthesiologist.
Catching Up Time Before Today
First Emotional Feelings
11 February 2021 – Dr. Roberto Gamboa is my friend now, a “traveling buddy” if you please, who likes to visit exotic lodges all over Costa Rica like me (except he takes his family of 4). We share experiences and recommend places to each other. He was the one who recommended El Silencio Lodge to me and he has three of my photo books and took his family to Manquenque Lodge tree houses at my recommendation – so he is more than just another doctor! 🙂
When he saw and felt the bump on the side of my head the look on his face was not good and he immediately said, “This is serious. I want you to get an ultrasound as soon as possible.” I asked if doing it at our radiology clinic in Atenas was okay (instead of traveling back to Alajuela where he is located). He said, “Sure” and wrote out a prescription to take to our very efficient radiology group as a part of Clinica Santa Sofia in Atenas. I went straight there from the bus stop on my return to Atenas, but they could not get to me during the 3 days I had before El Silencio, thus it was scheduled for yesterday, Monday, 22 February. The night before that, I wondered into the night about what would be found and if this was now “my time to die? I’ve always said that I am ready – but then it seems more imminent as I touch the bump on my head, there is something more real about death. I need to tweak my will and finish my story on the website and . . . and . . . and . . . 🙂
Second Emotional Feelings
22 February 2021 – The radiologist scanned both the lump and my neck as Dr. Gamboa had requested. In addition to sending a written report by email to Dr. Roberto Gamboa, he prepared a big envelope for me with the photos and the written report, in Spanish of course.
Then he said he would do his best to explain it to me in his limited English (much better than my Spanish!). In short the tumor on my head is a (he gave a technical name) and is most likely a cancer, 2 X 3.4 cm. I also have a small, less than one centimeter, nodule on my thyroid gland which could be but is less likely a cancer, using again some possible technical names for it. And so I walk out of that clinic with the funny feeling that, yes, I probably have a serious cancer. “This could be it! My time!”
My knee still hurts some, but I needed to walk and walked the 2 blocks to Donde Bocha for a delicious chicken wrap and michelada, completely forgetting about the cancer during a good meal.
And then a further walk to the taxi stand for a ride home. I slept well, thinking about it only briefly, mainly about some “loose ends” I want to “fix” before I die and otherwise slept well most of the night. 🙂
Back into Real Time Now
The third and now practical feelings
23 February 2021, Tuesday Morning – Instead of emailing Dr. Gamboa last night, since my ultrasound wasn’t until 5 pm, I waited until this morning to give the radiologist time for his email report (which I learned later he sent immediately after my visit). And Dr. Gamboa beat me to it this morning, with an email from him right after breakfast. He explained in English pretty much the same thing as the radiologist and asked that I immediately make an appointment with the specialist who can help me best, Dr. Christian Hernández at Hospital Católica in San Jose. (“Muy bueno!” said Dr. Gamboa) He is an oncologist – surgeon and of course we all know what that means and I don’t look forward to another surgery on my face/head. It took three tries to get through their busy phone line and then I made the appointment (cita) in English with a very nice young man “secretary” to the doctor who emailed the details and location directions to me for another late afternoon appointment, 5 pm today, in San Jose. Then I called Walter and scheduled a driver for 3 pm this afternoon to be sure I get there on time during rush hour which can be terrible in San Jose. My driver will wait on me and then return me to my house in Atenas. Then I will finish this report late tonight or tomorrow morning.
23 February 2021, Tuesday Afternoon – Walter recently had shoulder surgery like mine (rotator cuff) and is not driving much now, but he came with his new and very good driver Randy (I continue to be amazed at how many young Ticos have Anglican rather than Spanish names) who drove me recently to both San Gerardo de Dota and El Silencio. But Walter is trying to take care of me I think, since I’m the same age as his father.
We left my house at 3 PM and as expected, the hour drive to central San Jose took an hour and a half and it is better to be 30 minutes early than 30 minutes late! 🙂 When we got there Walter went in with me to make sure I was in the right waiting room for my new doctor, then he went with Randy to a restaurant while I waited.
Hospital Católica at right is larger than photo implies and was the first private hospital in San Jose.
Dr. Hernández was very punctual and I walked into his office at exactly 5 PM. We first got acquainted which is part of the culture here, then he looked at my Atenas radiology report and asked some questions before examining the “bump” and then began to explain that it was a tumor or growth inside my salivary gland which has lymph nodes that attract cancer. The radiologist gave the inside measurements of 2 X 3.4 cm and he measured about 3 X 4.4 on the outside. He explained that it could have come from the “roots” of the skin cancer I had totally removed more than a year ago OR it could be a totally different kind of cancer OR a slight chance of a non-malignant something-or-other tumor. The only way to know for sure is with a biopsy that can be done with a needle stuck into this lump. (Awwww!) 🙂 Plus he said to get a better picture of what it is, I need a CT Scan. And of course it is best done by his nearby buddy doctor at Centro Radiológico Santa Maria. And he wanted to do it tomorrow, Wednesday, but I need to get a blood test first, so he scheduled it for Thursday.
Wow! This is all happening very fast!
I left the full waiting room at 6 PM, a full hour with this very nice young doctor who said all those questions I started asking would be answered by him next week when he knows exactly what it is. (Like; How would this kill me? How long would I live without treatment? What are the options? etc.)
When I got to Walter’s van I asked him about the full waiting room at 6 PM and he said that is because most doctors do only afternoon and evening appointments because most people have day jobs and can’t see a doctor until off from work. Then I realized why all my appointments with Dr. Gamboa had been in the afternoon! Not the American way.
24 February 2021, Wednesday – and not quite as full a day, but busy! I’m always up early on Wednesday because my Maid comes at 6:30 with her niece only now since her daughter is in the University online at Susan’s house every day. I feed them breakfast and they clean my house in about 3 hours. I eat, drink coffee and read the paper until 7:45 AM when I start my virtual Spanish Class on Skype with my teacher Arturo who lives in San Jose. But before class I got a call from the San Jose clinic asking a lot of questions in Spanish and Mayra helped me answer, though she does almost no English, using her phone as a translator. Yes, learning the language is very important and I am – just slowly! 🙂
After class I called a taxi for downtown since my knee is still hurting some (but better with daily ice packs now!). I went straight to our local laboratorio and got my blood test required for the CT at Laboratorio Clínico Atenas.
They sent a copy by WhatsApp to San Jose and gave me a paper copy I will take with me tomorrow, but I had to wait 40 minutes for them to make the report, thus I went to Atenas WorkShop for two Amazon.com packages ready to pick up. I’m trying them instead of Aeropost because they are cheaper and deliver right here in Atenas, even to my house if I request, while with Aeropost I must pick up in Alajuela. They were much slower but told me I could pay extra for overnight DHL service from Miami and have it here in Atenas as soon as Aeropost gets it to Alajuela. So maybe next time.
Since I had some extra time, I stopped by Crema y Nata for coffee and a cinnamon roll! 🙂 Then got my blood test report and a taxi home. A morning in small town Costa Rica!
The Main Diagnostic Tests
25 February 2021, Thursday – Up at 6, continuing my fast of no food and drink, I shave & shower, expecting to read the newspaper while waiting on my driver but no internet service. Thus I read from my electronic Bible and start a new book that I already like. Driver is here early, 7:45, and we are off to San Jose with traffic not as bad as expected at the Centro Radiologico Santa Maria much earlier than the requested 9:40 AM time with a full waiting room already.
The receptionist speaks zero English and I had to use my phone translator for a few words, but we made it together through the registration form and I’m checked in and sit in full waiting room (chairs 2 meters apart) until I’m called by a male nurse to prep me for my first test, the CT Scan.
He first has me replace my shirt with a hospital gown shirt. (Not sure why.) Then he reminded me of the problem nurses had finding a vein in Juli’s arm. He could not find one in my left arm and thus tried again (ouch, ouch, ouch) in my right arm where he finally managed to insert the painful needle for the shunt where they would inject a chemical for one part of the scan. (Later I saw that it made on the tumor turn blue on the CT Scan) I don’t know why but I honestly think that most of the time females do a less painful injecting of needles than most males. (Oops! Sounds sexist!) That was probably the worst part of the day or the most painful!
Then back to the waiting room for a bit until the same nurse calls me into the CT scan room and he is the one who does the scan of my head and neck, once without a chemical in my blood and then once again with whatever he injected into my vein.
Then he tells me I have forty-five minutes to go next door to the little Soda (a small restaurant) and have some Pinto Gallo for breakfast with coffee or anything else I want to eat or drink – the fasting is over! I did not like the looks of their pre-cooked eggs, so I got Pinto Gallo (beans & rice) with sausage, fried plantains and two cups of coffee and I was good to go!
Only a brief time in the waiting room again before I was called in for not one more but two more tests! I was expecting just the biopsy by needle but first this doctor did another ultra sound of both my tumor and my neck (guess the one I had done in Atenas was up to their standard?). He seemed to think my neck and thyroid gland was clean from any cancer, though the CT Scan may show different. And like the other radiologist, he rattled off a technical name for the tumor on the side of my head. I was then thinking I would now go to a different room for the biopsy, but no, the same doctor did it right there in the CT room. And yes – sticking a needle into a tumor hurts! A different kind of hurt than the shunt needle in my arm. Oh well – just one of the prices I pay for getting the most modern medical diagnosis of my problem. Then back to my Spanish-only receptionist to pay less than $500 for three major tests, with a senior adult discount and the total cost less than what my “co-pay” or “deductible” would have cost in the states, and this is in the private system of healthcare here. Public would have saved that money but time is of the essence with cancer and I have high confidence in these doctors.
After paying with my credit card, the receptionist said they would email the results to both me and Dr. Hernandez (my oncologist) by 5 PM tomorrow. With that full waiting room I can see why it would take a full day for a thorough report.
And that is today’s report without a lot of feelings other than wishing my Spanish was better and/or feeling more like a “foreigner” today, the only gringo in the Soda.
And for some strange reason when I sat down in the little restaurant next to the clinic for a late breakfast I remembered or thought about my breakfast in Tefe, Amazonas, Brazil after the 3,000 km boat ride and a night in the Hotel Egas of Tefe, before another boat ride to the floating lodge of Uacari.
Funny how little experiences trigger the memory of other past experiences. Good but different cultural breakfast both times and both times as the only gringo around, with a growing lifetime of unique memories! And this photo of the one in Tefe, Amazonas looked nothing like the one here in San Jose, Costa Rica! 🙂
25 February 2021, Thursday 9 PM – Well, the Doc with ultrasound and biopsy beat their stated deadline for a report. I received it in email as an attached PDF with a full page explanation then a paragraph “Summary.” Since I can’t copy type within a PDF I retyped only the summary:
ULTRASOUND & BIOPSY Report Summary
Translation from Spanish
Solid mass dependent on the left parotid that involves the upper and anterior region of the glandule with probable extracapsular commitment to neighboring soft tjido. There is no deep lobe involvement. There are no suspicious adenopathy. Biopsy guided by ultra sound. Ti-RADS Millimeter Nodule Tieroids 3. Remaining major salivary glands without alteration.
ORIGINAL U-S & BIOPSY SUMMARY en español:
Masa sólida dependiente de la parótida izquierda que compromete la región superior y anterior de la glandula con probable compromiso extracapsular hacia tjido blando vecino. No hay compromiso del lóbulo profundo. No hay adenopatias sospechosas. Biopsi guiada por ultra sonido. Tieroides con nódulo milimétrico TI-RADS 3. Resto de glándulas salivales mayores sin alteración.
STILL WAITING ON CT SCAN REPORT AND DOCTOR EXPLANATION
The most I’ve been able to understand thus far is that I have a pretty good-sized tumor in my salivary gland on the left side of my head between left ear and left eye. The nodules they talk about are lymph nodes which tend to attract cancer, but otherwise I still don’t know if cancer and if so which kind which also can make a difference. Dr. Hernández said he would probably set up an appointment for next week after he gets all the reports. Then he will tell me exactly what it is and what our options are. Sometimes the waiting is the worst part! 🙂
26 February, Friday – Waiting for CT Scan report then appointment with Dr. Hernández. Not much I can do today, so will try to not think about it.
Evening – The email report on CT seems to be only on the neck and not the lump on my head or at least the summary at the end. Maybe there will be another report on tumor or he preferred the ultrasound report for diagnosis or it was included in the full page report before this paragraph summary? I still need to talk with doctor to understand all of this:
TAC DE CUELLO con medio de contraste muesta una masa que se ubica en lóbulo superficial de la parótida izquierda en su porción más cefálica con compromiso de tejidos blandos vecinos y contacto con el músculo masetero y apófisis cigomática del temporal. No hay adenopatias regionales evidentes.
NECK CT with contrast medium Mumps a mass that is located in the superficial lobe of the left parotid in its most cephalic portion with involvement of neighboring soft tissues and contact with the masseter muscle and temporal zygomatic process. There are no obvious regional adenopathy
The Official Diagnosis
Friday, 5 March 2021 – Another high traffic trip to San Jose today with at least an earlier appointment of 2 PM. Dr. Hernandez was his usual friendly and very helpful self, using all of the several diagnostic reports and pictures along with a white board and markers to explain in English (a second language for him). In summary of an hour+ consultation:
- I have a tumor inside the salivary gland between my left ear and left eye that has grown fairly rapidly and is attached to the upper bone near my ear but doesn’t appear to be attached to the mandible (jawbone) to which it runs or nearly touches.
- The needle biopsy does not absolutely confirm it is cancer, but if so it is a slightly different cancer than the skin cancer or carcinoma that was removed in 2019 from the surface of that area of my face, though “roots” of the first cancer could possibly be blamed. Regardless of what it is, it must be removed because it is growing and when removed, a different type of biopsy will determine exactly what it is and yes, if cancer, I will then have to have radiation therapy but he said chemo doesn’t usually work on what they think it is. But with radiation I could soon be joining the totally bald! 🙂
- It is not life-threatening at the moment but removal is necessary to keep it that way.
- The biggest danger is that a facial nerve runs right through that part of my face controlling the opening and closing of my left eye and the left corner of my mouth which could leave me with a weak eye and a one-sided smile! 🙂
- It is a complicated and lengthy surgery taking up to 5 or 6 hours with an anesthesiologist, assistant surgeon, and a special machine to help them avoid cutting that facial nerve.
- I have a medical discount card or membership in “MediSmart” which he is not a part of but he does have surgery permission at the only hospital offering MediSmart discounts, Metropolitano. He will get hospital prices (operating room & 1+night) for Metropolitano and his base Hospital La Católica which he of course prefers and says is better. Unless it is a huge price difference, I will stick with La Católica.
- We then looked at the calendar and scheduled surgery for a week from this coming Monday or Monday, 15 March 2021 in the morning with a minimum of one night in the hospital.
- He then wrote out three more diagnostic prescriptions needed before the operation and called his geriatrics specialist for an appointment this coming Tuesday for a complete physical to make sure this 80 year old is healthy or strong enough for surgery, with two of the diagnostics required before that Tuesday check-up appointment back in San Jose. Wow!
- Then we talked money in “round figures” until next week when he gets quotes from both hospitals. Either way, I will be either cashing in two of my three CDs or closing one of my savings accounts to pay the rather large expense. You are probably wondering about two things here, 1) Why not the public health system which would be free to me? I choose not because of the urgency of time and my still limited Spanish, and/or secondly, 2) Why don’t I have CR private health insurance like I did my first two years here? Simple. The cost is based on age and it got too expensive for me. I do have a little supplementary policy through LifeWay from years ago for “Cancer & Dread Diseases” with AFLAC that will pay some partial reimbursements after the fact with lots of paperwork, which will help on something like this, even at costs probably a fourth or less of what a U.S. doctor would charge, but I have to pay up front and get a partial reimbursement later from AFLAC.
- On the way home from San Jose we stopped in Atenas Centro and got the chest X-ray done and scheduled the 12-hour fasting blood workup for the next morning, 6 March.
Next Day Musings
Saturday, 6 March 2021 – Yes, as so often happens, things like this move fast
This morning I was up by 6:30 to put the trash out for today’s pickup, then showered and at the bank ATM for more cash before my 8 AM Laboratorio Cita – blood tests. Smooth except I will never be happy about a big needle stuck in me! 🙂
Then to reward myself and slow down until the appointment next Tuesday, I went to El Balcón del Café for a nice breakfast!
By the time I got back home and had another cup of coffee and finished the newspaper, I had both diagnostic reports in my email box, the Chest X-ray and the blood analysis; both of which I printed out for Dr. Coto on Tuesday and put in the big envelope with the actual X-ray film that I will take to him Tuesday. LISTO! That is Spanish for “completed, finished or ready!” Ready for Tuesday’s geriatric doctor visit to make sure I’m healthy enough for surgery! 🙂 A great concept or pre-op procedure that gives me even more confidence in Dr. Hernández.
Then just one more requirement (by national health ministry), on Wednesday or later I must go get a negative COVID-19 Test for which I get an emailed report the next day that I will email Dr. Hernández and take with me to the hospital the following Monday morning. Then truly listo – ready! 🙂
I think that I do pretty good as an 80 year old managing all these many schedules plus arranging transportation for everything and money! Whew! Nearly done now.
Last night I postponed my March trip to Tambor Bay to tentatively August with nothing else until my easy May return to Arenal when travel will be no problem the doc says, just more juggling of dates to keep my old brain busy! 🙂
And life continues Retired in Costa Rica not a whole lot different from before! I’m just trying to decide how is the best way to tell everyone on the blog and thus Facebook about this big “C-word” change in my life? The above journal is kind of hidden on the “static pages” of my website under “His Spirit,” my spiritual pages, until I blog a link to them.
And I do think it interesting that last night I read the Scripture Verse for an emailed devotional thought I received daily and this was last night’s verse:
When times are good, be happy; but when times are bad, consider this: God has made the one as well as the other.~Ecclesiastes 7:14
Which doesn’t mean God made cancer and I don’t think he did but like all sin he allows it and that He is still in charge is what the verse tells me and specifically in charge of my life, even in retirement in Costa Rica, so I welcome this new adventure in life and whatever it is God wants to tell me, teach me or otherwise have to happen. And when it is time to go – I’m ready! 🙂 But in the meantime I will continue to enjoy retirement in Costa Rica with many more trips planned!