Annual Heart Check-up Adventures I

All medical appointments here are adventures, whether it is getting there or struggling with the language since everything is in español! Plus for my heart only right now, I am using the public healthcare system which here means all doctors and other staff work for the government, which always slows things down everywhere.   🙂   My October appointment had already been moved up to this November week because I was getting a new doctor.

This year they also decided to divide my appointment into two appointments, one for the EKG called electrocardiograma here with no initials used. Both appointments were last week (Tues & Thur), my first week back from a trip, already busy with the usual catch-up:

TUESDAY

I get a taxi to the 12 noon bus to Alajuela for my 2 pm appointment which in theory I should take the 1 pm bus (45 min ride), but there are too many possibilities like bus breaking down and long lines at hospital. — I arrive Alajuela before 1:00 and with a taxi to the big government hospital a little after 1 pm, show ID & cita (appointment) to guard and take elevator to the 4th floor for Cardiology and wait in this regular line (photo below):

Waiting line to check in for doctor.

It is to check in for my 2 pm appointment and then realize the adulto major (senior adult) line is a little shorter and I move to it and from a chair in it I took the above photo. Both lines move very slow and at nearly 2:00 I’m the second person in line for check-in when over the loudspeaker they call my name among several Hispanic names which is always funny (Gonzalez, Rodriquez, Doggett, Rojas). And of course my name is hard to pronounce. This means they see we haven’t checked in yet and so they call us to front of line and check us in. (So why wait an hour huh?)

She sends me to Puerta nueve (Door 9) where I wait with about eight other people for our EKGs. After about 20 minutes I am called in and of course an EKG only takes a few minutes and I’m off to the front door and a waiting taxi to get me to the Atenas Bus. Not bad for free medical service!

And oh yes, now they don’t worry about communicating with each other, the technician gives me a paper copy of my EKG folded into an envelope for me to take with me to my doctor appointment on Thursday. – Now the taxi ride to bus is easy with Oscar, a nice young taxista who handles the Alajuela traffic well and I include a good tip as always (it pays off in the long run as you will see).

It was not until I arrived in Atenas that I realized my cell phone was not in my front pocket. I walk back to our bus station and the nice folks there did not find my phone on the bus, but the Spanish-only young man grabbed a high school kid to translate and long story short he dialed my phone and Oscar in my Alajuela taxi answered and suggested two options of either him driving  here to deliver it or me going back to Alajuela to meet him at a place of my choice.

Zipper in front right pocket.

I chose letting him drive to me, all the way to my house mind you! I paid the fare and a healthy tip thinking all the time about how much a new phone would have cost.

Now – Why did it slide out of my pocket in Alajuela? I was wearing some new hiking shorts (almost all I wear here) and I have not yet had my seamstress sew a zipper in my front pocket to prevent the phone from sliding out while sitting. I lost a phone in a San Jose taxi in 2017 for this same reason and all my old shorts got zippers in the front right pocket then. See my 2017 zipper post. Monday or Tuesday I will take my new shorts to the seamstress for zippers!   🙂   Might be Tuesday since I have to go back to Alajuela Monday after my Spanish class to get my prescriptions!   🙂

 

And that is not nearly all of my heart exam adventure which continues on

Thursday

Since my doctor appointment is at 12 noon and we have a 10:20 bus to Alajuela, I took it. (All other buses are on the hour and I have no idea why this one is at 10:20!) But anyway, same procedure – get off the bus in Alajuela and grab a taxi (in long pants today since phone doesn’t slide out of them).   🙂

Get to hospital only 45 minutes early this time and go straight to the old folks line and wait to be called to one of these windows to be checked in again:

Check-in windows to see 4th floor doctors.  I’m sitting in row of chairs at right.

 

Same thing happens again today. I wait and wait and I’m second person in line and they call my funny name out among the normal names. I walk up to one of those windows and she checks me in, puts my EKG in my file folder and hands it to me, explaining that I must stop first at the vitals station for temp, blood pressure, etc. before wait at Puerta dieciséis (Door 16) for Dr. Garcia to call me in. I’m given a slip of paper with all my vitals (weight, height, temp, pulse, blood pressure and one more thing). I Carry that and my file folder to door 16 and wait about 20-25 minutes which is really not bad.

My new heart doctor is a kid, looks like right out of medical school (like one I had at my private doctor’s office in Atenas once) or maybe I am just old!   🙂   He was very nice and tried to explain simply to me in English (most of the younger ones speak English) why my current EKG did not show an arrhythmia this time but I still have the condition and he is going to keep me on the same medication, Atenolol  and a baby aspirin every day. Last year the doctor wrote one prescription, signed it, then made 11 more copies on his copier and printed out official-looking 12 stickers from another machine with changing numbers and stuck one on each of my 12 months prescriptions. (They are not allowed to give out more than one month of any drug at anytime.)  I take these prescriptions once a month to the Public Clinic Pharmacy here in Atenas to be filled for free! Last year he even included the baby aspirin.

Dr. Garcia said they have now consolidated that at the front desk and I had to take my folder back up front and wait in line again for the front desk to print out my prescriptions and make my appointments for next year. I waited about 15 minutes in the same line when one lady called out my name again and took my folder and typed a lot in her computer, then she said (all in Spanish with a nearby lady helping me where I did not understand)  “We no longer make appointments a year ahead. You must come back to the “platforma” in main lobby in March to make your appointments – so it was moved from Doc to front desk and now to main lobby in a later month – hmm. I had almost forgot about prescriptions then turned around and asked about that and she told me through the nice lady translator that I had to wait until Monday and then go to the Farmacia in the lobby for the prescriptions. She pointed to which slip I took there and which one for next March. Bureaucracy in paradise! So now I get to go back Monday and again next March 20 (which is sort of an appointment to get an appointment which I now remembered happened once before.) Maybe they think I’ll give up and not return or just die before then!   🙂

BUT HEY! IT IS ALL FREE! The private doctors here (like my GP and Dermatologist) are more punctual and provide a whole lot more services and speak English but you pay for those services! I figure my once a year heart exam was a good way to experience the local “CAJA” medical services like the majority of Ticos. Plus the private Cardiologist in San Jose Dr. Candy sent me to the first time charged much more than fifteen hundred dollars for her heart exam and her prescriptions were going to cost more than $100 a month! So I’m saving around $3,000 or so a year by using the public doctors and getting something for the monthly payment I am required to pay into CAJA as a legal resident.

Below is the Hospital Lobby where I will make my appointment in March and Monday I will go to the Pharmacy off this lobby for my prescriptions with many other people both times.

Alajuela Hospital Main Lobby

empinado o inclinado (Steep!)

The steep hill I walk up every day!
It’s just outside the Roca Verde gate.
At least 45 degrees!
HEART HEALTHY!
Atenas, Costa Rica
Going downhill is easy! Calle Boquerón o Avenida 8
Atenas, Costa Rica

Doctor Visits

CARDIOLOGIST
Monday I had my first follow-up visit with my CAJA (government healthcare program) at Alajuela Hospital where my cardiologist did another EKG and a ultrasound of my heart. Then he personally monitored a treadmill test of my heart followed by another ultrasound he monitored. It was amazing to me that I was in and out of there in 45 minutes. He told me that the only other test he would like to have on me is an angiogram which he could not order until he consulted at least one other cardiologist there in the Alajuela Hospital because there is not much indication that I would have any blockage. He said he would call if it was approved and then I would have to go to Hospital Mexico in San Jose, which is the only one with the equipment to do an angiogram. It is the primary or main hospital for Costa Rica CAJA or government healthcare.

Well, his technician called me today y hablando sólo en Español. We both struggled through but basically I have to go back anytime tomorrow and get some “documentation” or paperwork from them in Alajuela to take to Hospital Mexico for an appointment for the angiogram. If I understood her correctly, my Mexico appointment is April 10 at 10 AM, but not clear yet if that is when I get the angiogram or, if like most things here, I may just be making an appointment for one much later. I should find out tomorrow.

This is how “single payer” or government or what Americans like to call “socialized medicine” works with priorities given to more serious things, emergencies, etc. It took two months for my first appointment with my cardiologist. No problem for me to wait for this as I don’t believe I have a serious problem. Best of all: No more cost for me now that I have a CAJA card, even if it led to the unlikely case of heart surgery.  I will keep you posted. Dr. Hernandez is basically building a file on me and my heart for any future needs and trying to be responsible for my heart. I appreciate that!

DENTIST
Today I visited my dentist who also speaks only Español and we managed fine for my annual teeth cleaning and checkup by the dentist herself and not a technician. She says once a year is fine and not the every 6 months U.S. dentists request to increase their income. She found the need for one tiny filling which I’m scheduled to get next Tuesday. And that is it for a year! And cheap! Many Americans come here for dental work to save thousands of dollars in what is sometimes called “medical tourism” or even “dental tourism.” A friend in Tennessee has come here twice for his dental work and saved a lot more than his plane ticket and hotel bill. That is for big work like bridges and caps.

Someday I will think about taking a photo at one of these places! It just hasn’t been on my mind with everything else to do like getting there and communicating!  🙂

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. 

LEMONADE FROM LAST NIGHT’S PROBLEM
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.   

TODAY’S MAIN SCHEDULE LEMONADE

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!

RETURN TRIP LEMONADE
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?

Heart Arrhythmia

The Symptom
A couple of weeks ago I went to Dr. Candy because my right foot had been swollen for several days off and on, mainly when I stayed around the house rather than when walking! Strange?

The Standard First Level Treatment
She gave a diuretic to take for 10 days to see if that would reduce the foot inflammation. It did not.

(Side Note on Heel Spur)
You may have caught my earlier report on bone spurs in both heels but hurting only in the right one. This was taken care of by me stopping my 8 month habit of walking all over town in nothing but sandals. (Like walking barefoot!) I now wear tennis shoes, hikers, or regular shoes with a gel orthopedic insert in the heel. Absolutely no pain or problem now from the bone spur! And two doctors now say my new problem is in no way related except for being in the foot!  🙂

Complete Physical
Dr. Candy, my primary care doc, is very thorough and systematic and said it was time for a complete physical with an EKG because she now thinks the problem is circulatory. And I may have done a post on going to the Atenas Laboratorio Clinico for the blood and urine analysis. I walk these reports back to Dr. Candy and she says everything is normal or healthy including blood pressure EXCEPT that the EKG shows an arrhythmia which she thought she heard when listening to my heart. She emailed the EKG to the cardiologist in San Jose she works with and that doc wants me to come in and get wired with a 24-hour heart monitor.

24-Hour Heart Monitor
That was done last Thursday and Friday for my first two bus trips to San Jose and only saw a nurse to be hooked up and then uninstalled. Today I went back for the cardiologist to give me her evaluation. (Note that with a female primary care I’m being sent to female specialists! 🙂 Dr. Bouzid is so good, professional, thorough and explains everything so I can understand it! In English! Thank goodness! I’m slowly improving with my Spanish but not ready for this! She is a part of CIMA, arguably the best private hospital in Costa Rica. My private insurance covers everything after the first $300 which I reached today only when the ultrasound was added! Wow! medical costs are so much less expensive here! And when I get the CAJA, free! And by the way, some people come here from the states for cardiology including heart surgery. They call it “Health Tourism.”

The reason for 24-hour EKG basically is that it shows my real life and not just a couple of minutes in a doc’s office. I do have Heart Arrhythmia as shown in these two contrasting clips from the 24 hours:

This is a fairly regular rhythm which is good – what we want.

This one shows the irregular rhythm and other pages were worse. 

āˈriT͟Hmēə,əˈriT͟Hmēə/
noun
1.         a condition in which the heart beats with an irregular or abnormal rhythm.
Or for a more thorough definition and more info in a sidebar, see Mayo Clinic
Then a Heart Ultrasound
Then she wanted to do an ultrasound of the heart and like everything else, I am given copies of everything. She pointed to parts of the picture on her computer which was moving or a video and tried to explain why not enough blood was being pumped to my right foot. I did not really understand that, but accepted it. And here is my printout of that which doesn’t mean much to me: 
This is actually 5 photos taped to a sheet of paper.
Ultrasound of my heart today. Whatever it means.

More Blood Tests

The cardiologist sent me to Lab San Jose (another Laboratorio Clinico) just two blocks away to check 4 things in my blood related to the heart: NITROGENO UREICO, CREATININA, TSH, PEPTID NATRIURETICO B (BNP) which will be reported to her tomorrow by email. One of these has to do with the thyroid gland which if either over-active or under-active can cause arrhythmia and I’m not sure what the other things are. 
Gave Me a Prescription
I take this for two days twice a day and report to her how I am feeling. This may or may not help. Then
I Go Back to Cardiologist Friday Afternoon
She will then discuss the blood test results and with that may change the prescription or take a different plan of attack. She seems confident that she will get me back into rhythm! 🙂 
And by the way, she says I HAVE A VERY STRONG HEART! It just doesn’t have rhythm!  🙂
🙂  Well, a different kind of rhythm!   🙂
But you should know that they celebrate Elvis’ birthday here!
And most Ticos have lots of rhythm! And love music!