“I love it when a plan comes together!”

Back when there were some really funny sitcoms on TV, one had a military (I thinks) team with unusual problems to solve in funny ways as a comedy. (May have been “Hogan’s Heroes?”) And after a quick, bizarre and hilarious way of solving their problem, they always ended with the Captain, Colonel or whatever saying “I love it when a plan comes together!”

I earlier told you about the plethora of “little problems” that were driving me crazy, one of which was my CPAP machine breaking down and the problems of ordering from the states and getting “medical equipment” through Customs here. Then I remembered my new favorite doctor, a geriatrics specialit, Dr. Coto. He had already solved a couple of problems that other docs were not helping me with, so why not the CPAP machine? There has to be a way to get one locally here in San Jose where I’m stuck for awhile. So Monday I checked his online appointments schedule and he had one vacant spot Tuesday which I took. Scheduling docs is quick and easy here! 🙂

He asked what brand I preferred and typed it in his computer, then where to get in San Jose, all in Spanish of course! He got to the screen of Anca médica with phone & web address and told me to photograph with my phone. This morning I called them and the receptionist transferred me to the salesman who spoke English (I can do in español but slow and painful for all). Francisco got on the phone and to make a long story short he delivered my new CPAP machine to the hotel by 4, bringing a therapist to adjust everything for me to get back on it tonight. It costs more than in the states because of Customs taxes, but it is them and not me having to deal with Customs! 🙂 And I will sleep better tonight! 🙂

My latest CPAP Machine from a company in San Jose

Dr. Coto also quizzed me about other health issues and he solved another problem because of his knowledge of practical things. He is not close to where I live, but he is now my new GP Doctor. 🙂 Yes! A geriatrics doctor as my main doc! It’s what I get for being old! 🙂

“Sometime things have to go wrong to go right. “

Sherrilyn Kenyon

¡Pura Vida!

Another Gauntlet of Doctors

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!

1. Today, First of 3 Dental Appointments

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! 🙂

  • Today (Monday) – teeth cleaned and checked out with two tiny cavities found visually that she will fill this Friday. She also ordered a panoramic X-ray of my teeth from the Dental Radiologist one block away where I went next to make my appointment.
  • Thursday – Teeth X-rayed when I will take the resulting X-ray back to Dr. Karina for her to study and see if there are other problems we should take care of before radiation.
  • Friday – I return to Dr. Karina for the two known fillings and anything else she finds on the x-rays.

2. Tomorrow, Tuesday – Appointment with Ophthalmologist

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.

3. Tomorrow, Tuesday – Appointment with Oncology Surgeon

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.

4. Wednesday – Seeing my Dermatologist as Pre-scheduled

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!

5. Next Monday – MRI at the Lindora Campus of Hospital Metropolitano

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.

6. Next Tuesday – CT Scan and Mask-making at Radioterapia Siglo XXI

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.

7. Begin Radiotherapy in San Jose

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!

Biopsy Report: Common Old Man Skin Cancer

You have to click the image at least 2 times to get an enlargement.

Yesterday afternoon I saw my Dermatologist who presented me the lab’s very detailed report with color microscope photos and the diagnosis en español:

“Carcinoma epidermoide bien diferenciado, invasor, de al menos 4 milímetros de diámetro mayor, que alcanza los márgenes de resección.”  Or in English according to SpanishDict.com translation:

“A well-differentiated, invasive epidermoid Carcinoma of at least 4 mm greater diameter, reaching the margins of resection.”

The Doc assures me he can cut it all out by going a prescribed mm distance all the way around it (a big chunk of flesh!) and with several stitches will heal that part of my right forearm back to normal. That’s a $600 surgery or for $4,000 he can do a much tinier section removed while a separate pathologist is testing (continuous biopsy) every little bit of skin to make sure they get all the cancer without taking as much of a chunk! He recommends this for a growth on the nose, etc. where removing more is more obvious. Of course I’m doing the cheaper one which he assures me has always been successful for him and what he recommends. Just a little scar on my right forearm. It is scheduled for 19 November after my next trip which is to Palo Verde National Park 10-15 November. My doctors work around my trips and not vice-a-versa.   🙂

It is interesting that Dermatologists here say the same thing they told me in the states, that these growths that keep popping on my body in old age are caused by getting too much sunshine when I was a little boy. No one told us that back then!  Or maybe I was not paying attention when Mom wanted me to use sunscreen?      🙂     The young are invincible and us old ones just smile at our little problems.   🙂

Since this is a retirement blog, I guess this kind of gory medical report is appropriate. Anywhere you live in retirement you must deal with these things and the medical services in Costa Rica are simply great and so much more affordable that I’m just using a private doctor again instead of the free public ones, which are slower but just as good and free!  🙂  I still use a public doctor to monitor my heart arrhythmia, but other things I’ve been happy with the quick responses of private doctors, like this Dermatologist, Dr. Gamboa.

¡Pura Vida Medico!

Orthopedic Surgeon Today

Because my right shoulder has been hurting now for more than two months I decided I needed to see a specialist and to do it faster use a private doctor who is in the Medismart Group I am a member of (Medical discounts!) The public medical system might have led me to the same results but at a much slower pace.

I chose Dr. Dario Lungo with Hospital Metropolitano in San Jose and rode the bus there after Spanish class this morning. I took with me the x-ray of my shoulder my local general practice doctor, Dr. Candy, had me get at a local radiology clinic. Candy also recommended that I see an orthopedic specialist and let me choose one in my discount plan.

Dr. Lungo looked at my x-ray and had me move my arm in various ways and said it is definitely a rotator cuff problem and then pointed out on the x-ray that the collar bone above the ball joint of my upper arm was touching or did not have the gap between them that they should have. “We need an ultrasound.” Ultrasonido Hombro Derecho  Another 3 hours because radiology  was backed up with jobs! But it paid off! Photo is UltraSound equipment.


US muestra ruptura completa del tendón supraespinoso derecho Leve bursitis secundaria y derrame alrededor del TLB. 

US shows complete rupture of the right supraspinatus tendon, slight secondary bursitis and effusion around the TLB.

The full radiology report is much lengthier with lots of detail, but that is enough to share here with the big serious thing being a rupture of the main muscle/tendon in my shoulder, caused by my two falls in the past two months.


(1) I can do nothing (like our grandparents did) and in 2 to 3 years the pain might subside with a little natural healing, but never the same. (2) Surgery to repair/rebuild the ruptured tendon and other minor repairs that takes at most an hour and a half with local anesthesia as a hospital outpatient. Cost is $4,200 which is a hugh junk for me! This is called “Rotator Cuff Surgery” in the states and the USA National minimum price is $8,400 (twice our cost) and the maximum allowed is $56,200 with a national average of $21,800 (More than 5 times my cost here.) And of course I could get it for free if I waited for public health coverage but afraid to wait.


I will consult with Dr. Candy tomorrow and probably go ahead and schedule it in the next few weeks, if she thinks it best, meaning I may have to cancel my August trip, though Dr. Lungo said I could travel two weeks after the surgery.


On the bus ride back to Atenas from San Jose our full bus broke down (only the 2nd time that has happened to me) in La Garita. The return bus from Alajuela stopped and all of us got on that also-full bus, standing room only from front to the back! As soon as I stepped into the bus a young man popped up out of his seat and made me take it ( I tried to refuse). The respect for the elderly here is simply amazing! But of course that means I look old!  🙂

An Eventful Day

8AM Spanish Class with Hilda my new “more mature” teacher who has been trying to help me understand past perfect participles in Spanish and I’m not sure I do in English! 🙂

An errand-running morning after class with about 5 stops and much accomplished.

2:30 bus to Alajuela gave me time for my late lunch or early dinner there before a 4:30 appointment with another new Jesus in my life, Dr. Roberto Jesús Gamboa Arend, Dermatologist. He looked at all my “tags” and other growths, moles, assuring me that I do not have cancer, then used the nitrogen or whatever to freeze-dry most of them. I have a cream to put on each of them until they fall off on their own, which took two pharmacies to find and I barely made the 5:30 bus back to Atenas which was standing room only. I stood less than a minute when a young man, maybe 20 I guess, got up and insisted I take his seat. This is typical of the high respect given to older people here. A good feeling.

I’m home and tired now with only 1 little errand for tomorrow. Whew! Photo is of sunset from my terrace last night.

¡Pura vida!

Cardiology Doctor Visit Today

So, I waited over an hour but that included having my blood pressure checked, being weighed and measured, and an EKG. I waited longer than that for docs in Nashville I was paying big bucks for! This did not cost me a penny under the government healthcare plan call CAJA (an acrostic for something). Medicare for All is what you guys in the states should do. And as a Senior Adult (adulto mayor) I rode the bus to and from Alajuela for free! They treat us old people nice in Costa Rica, even foreigners! I do pay a monthly fee for CAJA kind of like we do for Medicare in the States and for me about the same price. BUT, this pays 100% of everything, doctors, hospitals, surgeries, procedures, prescriptions!

As I already knew, my arteries were shown to be clear in the angiogram I had in August. I have an appointment (cita) to see Dr. Hernandez (el cardiólogo) again in August 2018 with a separate appointment for the lab 10 days before to get my blood analyzed. And enough prescriptions to keep me on Atenolol & baby aspirin until then. Both Rxs are free for me but I need a new paper prescription each month, only one month at a time supply allowed!—so the doc gave me 10 prescriptions!  🙂   I get them filled at our local CAJA Clinic here in Atenas Central. 

Now back to birding and other fun retirement activities. Life is good! And a trip next week which you will soon hear about! 


Home Business Sign: General Medicine & Dentistry

Home Business Signs: General Medicine & Dentistry
 It appears that husband is dentists & wife the general doctor
 Atenas, Costa Rica

We are still getting the rains from the big Pacific storm that hit the southern Pacific coast of Costa Rica around the little town of Uvita where the “Whale’s Tail” beach is located. Here’s an article about the storm with a beautiful photo of the Whale’s Tail beach made on a sunny day. Also article about the weather closing Manuel Antonio National Park. 


My photo of “Whale’s Tail” Beach is not nearly as good during rainy season in May:

My First Government Doctor Visit

Yesterday I went to see my assigned government doctor (Dr. Zuniga) for my initial visit and he was not there but his substitute was a beautiful young lady evidently just out of medical school (Dr. Arias) and she spoke good English. So it made the first visit easy. No one else spoke English at the clinic. We discussed my medical history and what I am being treated for now and postponed the physical lab work until I finish my current round of heart medicine prescribed by a private heart doctor in San Jose. Then (September) they will evaluate with their own diagnosis and prescription if any. Not all doctors use medication for arrhythmia, even in the states where medicine tends to be overused.

My whole time at the clinic including the nurse weighing, blood pressure, etc. visiting with a doctor, waiting at lab for appointment was only about one hour. One perceived problem with government health programs like this is that you have longer waits. Not so this time! All went efficiently and quickly and I was quite happy with the service! I’m now in a health plan like Bernie proposed for you guys in the states. It is great! Sorry no photos this time. Didn’t think of it at the time.

Ticos just call it “Caja” which is part of the name in Spanish. Here is a summary definition from Wikipedia:

The Costa Rican Department of Social Insurance or Caja Costarricense de Seguro Social (as it is known in Spanish) is in charge of most of the nation’s public health sector. Its role in public health (as the administrator of health institutions) is key in Costa Rica, playing an important part in the state’s national health policy making.
Its services are available to all citizens and permanent legal residents. This governmental entity’s functions encompass both the administrative and functional aspects. It has the obligation (as a public institution) to formulate and execute health programs that are both preventive (such as: vaccination, informational,fumigation, etc.) and healing (such as: surgeryradiation therapypharmacyclinical, etc.) in nature.[2] 

Note that this service includes all medical needs including prescriptions, dental, eye care, etc. with no 
co-pay or additional charge after my $114 a month fee for medical services. This is where I really save 
money over living in the states. 

Sharp Knife, Dusty Volcano & Red Tape!

Whoever told me that a sharp knife is safer than a dull knife . . . I might want to challenge you. I got a new kitchen knife the other day that looked really sharp like the one I have that is usually dirty from slicing veggies, meaning I needed another. Last night I used it the first time slicing some onions and peppers for my guacamole and I sliced the tip end of my finger off and never found the little flap of skin. (I probably ate it in the guac!) A painful, bloody mess! The Doc and EMT this morning fixed it sort of, but she cannot easily do stitches over an open hole. (A last resort.) I cringe just writing about it. Sometimes I do stupid things like slicing the tip of my finger off! It hurts!

So now I have a complicated cleaning and bandaging process every day for awhile. She prescribed a cream or ointment that is suppose to encourage skin to grow over the wound. Hope it heals fast! I’m allergic to pain! A big baby!

All that means to us in the Central Valley is more gray dust blowing in, which is a nuisance at times.  See it erupting on YouTube  The big explosion is more than 30 seconds into the video. 

I’ve got a month to hopefully get everything right for my CAJA appointment that will get me in the more affordable government health program, but bureaucratic red tape comes first!  🙂 And filling out the form in Spanish has become a Spanish Class project we will possibly finish tomorrow.  🙂  They are another support group! And I contacted the embassy today for proof of my SS income. ¡Poco a poco!

So yes, Pura Vida includes this messy stuff too! But I will survive!  🙂 And I’m enjoying another day with high of 79 and low of 65 with late afternoon shower! Sweet!

Making Pura Vida Lemonade Today!

“Pura vida!” is as much an attitude, philosophy, or spirit as it is a slogan for Costa Rica basically meaning “Pure Life.”

“When life gives you lemons, make lemonade” is a proverbial phrase used to encourage optimism and a positive can-do attitude in the face of adversity or misfortune. Lemons suggest sourness or difficulty in life, while lemonade is a sweet drink.   ~Wikipedia

This optimistic, can-do attitude is so typical of Costa Rica, making the Pura Vida slogan appropriate. Well, I’m pleased with my spirit of Pura Vida today when some things didn’t go as planned for me. 

Blurb had a 40% discount on photo books with a deadline of midnight last night. I tried repeatedly last night to upload my Nicaragua trip photo book and it never would work, possibly because too many other people were doing the same thing. I emailed their help center and said to myself it is not meant to be if it doesn’t work. Don’t fret about it! Went to bed! This morning I had an email response from Blurb with one link that got my book quickly uploaded and with an extension of the discount! By not getting angry at technology again (easy to do) I avoided stress and still got my book ordered. See the separate book post below.   


My doctor appointment for a week ago today got postponed until today at 1:00. I decided to go early for lunch in the city and took the 10:30 bus from Atenas. As the bus approached the city my phone rang and it was the doc’s assistant saying she needed to push my appointment up to 3:00 if I could make it. I groaned and said I was on the bus coming into town now. She paused, apologized and said “let’s make it at 2:00 then, but she could be running late and there is another appointment at 2:00.” I thanked her and hung up before sighing. But decided to make the best of it and maybe further explore Sabana Park which is like New York’s Central Park.

Museo de Arte Costarricense

After getting there and walking across the park and eating an early lunch, I still had two hours to kill and suddenly saw in the park Museo de Arte Costarricense or the Museum of Costa Rican Art. I spent more than an hour there and could have spent much more time in a beautiful museum in the park full of art by Ticos. That was so much better than getting angry or hurt because of the inconvenience of a delayed appointment! I had a 4 km walk to the doctor office (and walking helps the spirit too!). All is well with my heart and my foot/leg. When my foot swells again I will simply take 10 minutes to prop it up higher than my heart to relieve the weak veins in that leg, plus I will regularly massage the leg with a lotion which will strengthen them. She also wants me to stay on Baby Aspirin and Concor, a beta blocker, to help control my arrhythmia (plus the med helps me sleep better!). So that is it. A good report!

Friday afternoon is the absolutely worst traffic of the week in San Jose and going west toward the beach (Atenas is west) is the worst, meaning the 45 minute bus ride becomes an 1:45 bus ride on Friday afternoon going back to Atenas. Again I could grumble, curse, be angry and make myself sick. But I chose to read from the Kindle App on my phone until a sun glare stopped that and then I had a needed nap while listening to the bus driver’s Spanish Music radio station (which is suppose to help me learn Spanish). So now I’m ending my busy day without stress or anger and in a happy mood! A very good day! And while I was typing this I listen to Spanish music from some fiesta downtown with beautiful marimba music now. You do know that all of my windows stay open all the time?