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!