Mostly my real time journal and blog posts plus photos and other information that is meant to be inspirational for someone else going through cancer, especially my specific Parotid Tumor Cancer with 68 pages and 87 photos, including a few of my nature posts during that time. 🙂
I also emphasize the value of nature in healing for me. And the title “True Grit” is explained in the book and on back cover, kind of funny! 🙂
Earlier yesterday, before the rain came, I was sitting on the windy terrace hoping a brave bird might come out. A couple of doves flew by, but this Great Kiskadee was the only one brave enough to land in my Guarumo Tree (Cecropia) with a pretty strong wind bringing that rain cloud we got later. Notice how the feathers are affected by the wind. Not a normal pose, but an interesting commentary on the windy day we had yesterday before the afternoon rain.
Read more about the Great Kiskadee on eBird. He is one of the most common birds here and his song or call sounds like his name, “Kiss – ka – deeeeeeee.” He is found almost everywhere in Central and South America, with only a few strays making it into the Southwestern U.S.
Biopsy Report in Tomorrow’s Post
It is intentional that I have been very honest and factual about my new adventure with cancer while living retired in Costa Rica. And I will continue to be. This afternoon at a 2 PM appointment with my surgeon in downtown San Jose, Costa Rica I will receive the biopsy report and his “plan of attack” including possible radiation treatments.
He doesn’t know that some of you have been praying for it to be benign or not a cancer and we might receive that surprise blessing this afternoon, but if it is like all the others he has removed similar to mine, then we will do whatever is necessary and still give God the praise anyway! 🙂 He’s going to see me through this!
I’m wearing an eye patch all the time now because it hurts to have an eye open that can’t blink or close. We will be discussing possible solutions to that also this afternoon and the left side of my mouth. But they are secondary to dealing with cancer.
And because several blog-followers are considering retirement in Costa Rica like I did, I am going to share the costs of this major surgery and what my other options could have been and discuss 3 or more options for radiation, whether needed or not.
It is Wednesday afternoon and I got home about noon today from Hospital La Católica in downtown San Jose, our big, busy congested city and National Capital, about an hour and half drive in reality, though most people say about an hour. 🙂 I have no car and thus use my regular drivers here for the hospital trips.
A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells. Neoplasms can be benign (non-cancerous) or malignant (cancerous). ~Wikipedia
Note that this was the official surgery but the growth extended into the lymph nodes in my neck which were also removed. And I came home with a drainage tube coming out of the left side of my neck.
The best specialists for my problems
I am convinced that I had the best cancer surgeon for this job in Dr. Christian Hernández who specializes in only cancers in the head an neck. He also used a super gerontologist for my pre-op exams and then when we developed a side-affect with the severed nerve he brought in a lady ophthalmologist who may be the best in the country to help with my left eye problem which I will try to explain below.
A Nearly 7-hour Surgery
He said more than 6.5 hours or nearly seven hours and was very tedious going the full length of the left side of my face. He did the kind of thing you might expect from a younger doctor, while explaining it to me he pulls out his cell phone with brilliant blood red photos of what he found in the parotid gland, pointing out a section of the facial nerve that was surrounded by tumor and could not be saved. (No, I don’t have the photo to show.) Then he followed the tumor down to the lymph nodes which he said is a common occurrence. He believes he removed every bit of it but can’t say for positive that it is or isn’t cancer until the biopsy report next week.
A Bad Photo of what I look like right now
Cancer? Probably – Know with Biopsy Next Week
He has seen enough of these to believe it is a cancer and one of two types, but will not know for sure until the biopsy report he will explain to me next week. And if what he thinks it is the additional treatment will not be chemo but radiation therapy called radioterapia here. Thus I will know more specifics next week. In the meantime it is what it is.
How do I feel?
Is what everyone asks and it almost seems like a “loaded question” to me, but I will still try to explain. With that long a surgery I was in and out of sleep all day Monday and into the night when I think I became more aware of things and that my left eye would not close. The only pain I’ve had thus far has been what feels like a “sore throat.” Pain medication has kept me from hurting.
Tuesday I slowly got back to “normal” or at least eating soft food and having bodily functions. I felt pretty good when they wheel-chaired me to the adjacent office building to see the ophthalmologist though she did a couple of things to my eyes that hurt a little, she was finding out that the only nerve in my eye that seems to be not functioning is one of those that helps control the eyelid and we may be able to work with other nerves to get it to close naturally again.
The other problem is the facial nerve controls the left side of my mouth and smile, so Dr. Hernández said I now have a “Texas Smile,” with the lips turning up only on the right side, or maybe a one-sided smirk? The surgeon says that some mouth exercises may help left the left side of my smile and help with managing the food in my mouth which I now can’t control on the left side, making it slower and more difficult to eat! Got to fix that! 🙂
And of course the left side of my face is swollen now and for a few more days.
But I’m generally in good spirits and hopeful for a more functional recovery of everything. And I will keep you posted on this blog.
Since I was a high school boy when Mom gave me that book The Power of Positive Thinking for Young People by Norman Vincent Peale, I have made being positive a part of my life philosophy and really a part of my personal faith in God and the act of following Jesus.
It is kind of like happiness, it is inside you and you actually decide to be happy or not I believe. Then when bad things happen or come to your life, you make the best of them and keep on living. That is what I did for 20 years of a very difficult marriage while she was never happy and I was always happy in spite of the situation. Likewise with those overlapping years of a special needs child with autism and another rebel child. One survives by staying positive and finding the good things and opportunities, even within the bad!
Now don’t jump to conclusions – I’m not announcing my imminent death by cancer! 🙂
What has been for several years little skin cancers all over my body may have grown deeper roots or a separate and totally different cancer may have come that is more complicated.
All those appointments and diagnostic tests lead to this current summary diagnosis with more detail in the online journal:
I have a tumor inside the salivary gland between my left ear and left eye that has grown fairly rapidly to around 3 X 4 cm now.
Though the needle biopsy indicates it is almost certainly a type of cancer only removing it will tell us for positive. Outside chance of no cancer. Prayers appreciated! 🙂
Surgery is scheduled for 15 March at Hospital La Católica in San Jose, Costa Rica
Dr. Christian Hernández Mena is my oncologist and surgeon – terrific in every way!
After surgery, a full biopsy is done, and the exact type of cancer determined, I could be receiving radiation and yes going bald! 🙂 More reports after surgery!
My Blog and Travel Plans Continue
I had to postpone my March trip to Tambor Bay, but hopefully by the time of my planned May return to Arenal, I will be able to travel just like always if radiation schedules don’t interfere! 🙂
For any readers who are also facing cancer, I want to recommend the following website and encourage you to stay positive and continue life as I will with the same kind of travel and nature blog posts right here at Retired in Costa Rica!
is what the Dermatologist says about the cause of skin cancer. But he also says if I continue to get too much sun it will make it worse, so my two wide-brim hats and 60 SPF Sunscreen, called El Protector Solar here or informally protección de sol. I dislike it but when I know I will be in the sun much, I use the sunscreen now and wear my big hat everytime I go out!
SKIN CANCER SURGERY ON MY FACE THIS TIME
The only other skin cancer removed was from my arm a month or two ago and it was comparatively easy with a lot more skin on the arm. Sorry if the photo below grosses you out, but I was really surprised at how much this facial growth had grown with this big of a scar or “more than 15 stitches” said the doctor, though I counted more like 20 or 21 in the photo. My eye is partially swollen and partially closed but it will get back to normal soon. I went back to the doctor the day after surgery (Wed) and he changed the bandage which I will permanently remove Thursday. Air helps healing. And he prescribed a cream I put on it twice a day for at least two weeks when I see him again for a checkup, after my next photography trip of course! 🙂 I have to keep my priorities straight you know!
It was Mohs surgery Tuesday which the link describes or basically it is a pathologist there with the surgeon doing biopsies on every bit removed until there is no sign of cancer. With this he is now more certain he got all the cancer and didn’t remove too much “good skin” which is more limited on the face. He was prepared to graft a piece of skin from my cheek if necessary, but thankfully it was not. And in two weeks or so I will be back to normal with a noticeable scar on my face. No problem! Just call me “Scarface.” 🙂
The 15+ stitches
Surgery day bandage
That’s Life! – ¡Así es la vida!
And tomorrow I will go back to sharing more from my great trip to Maquenque Eco Lodge!(Link is to the Gallery)
And oh yeah, that sunset photo above is one I made at Arenal Volcano National Park. After all, this article is mostly about the sun! 🙂
My prayers go to the Bush Family in their loss . . .
. . . a truly great & humble man!
George H. W. Bush
Humility is not thinking less of yourself,
it’s thinking of yourself less.
~C. S. Lewis
REPORT ON MY BIOPSY: After removing the 10 stitches from my arm (where all that cancer was confirmed removed) and the two stitches from my face for the biopsy, Dr. Gamboa gave me the facial biopsy report:
In brief, it says I have another carcinoma cancer on my face which is a smaller and slower growing type than the one on my arm. No problem waiting until January to remove the rest of it (the biopsy took most of it). Because of the delicate and thinner skin location next to my eye, we will be doing a more complicated and more efficient (more expensive) “Mohs Surgery” with two doctors doing it with a pathologist standing by to make sure they get all of the cancer as he examines each layer as removed (continuous biopsy). It will not be in his office this time but in a clinic, hospital-like, operating room, but still out-patient. He is checking on availability of other doctor and the clinic for the week of 21 January – after my Boca Tapada trip. Remember — the doctors work around my trips! 🙂 Important! That is where I sleep in a tree house 5 nights!
Dr. Gamboa also “PRESCRIBED” wearing a wide-brim hat instead of the ball caps I’ve been wearing and of course sunscreen every day when out. I sure love sunny Costa Rica, just 673 miles north of the equator, but with the value of the sun also comes with some potential dangers for someone like me who loves the outdoors. I have already become more careful, even though the doc says these current growths and cancers were probably caused by sun I got as a child or teen, more sun now can make it worse, so I must be cautious.
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.
In a Blur – How I feel 2 days after surgery – but all is well – saw doc today. Physical Therapy starts soon. And photo from my garden yesterday is a red ginger with background blurred. Happy day to you!
Monday 30 July. Yep! That does seem different, evening instead of morning, but that is the way it is (and maybe when an operating room was available at the small private hospital). And the doctor said the sooner we do it, the less damage will be done to the tendon and the sooner I will be without pain. And instead of using the main Hospital Metropolitano in downtown San Jose we are going to one of their 4 suburban campuses, the only one with an operating room. It is in the Lindora barrio of Santa Ana which is on “my side” (west) of San Jose just off our “freeway,” Ruta 27, and about 30 minutes closer than the downtown hospital campus, especially during rush hour, thus easier and quicker for both me and my driver whom I’ve already scheduled.
I am to be there at 5PM, with the surgery scheduled for 7PM to 8PM with one hour in the Recovery Room and return home soon after 9PM. That should be a good way to get sleepy for bedtime! Ja, ja, ja, (español for ha, ha, ha) 🙂 though the anesthesia is only local.
He says my activities can be normal in a week to 10 days though I will have 5 weeks of physical therapy (2X a week), the hardest part one U.S. friend said. But I did cancel or postpone my August trip to Sarapiqui, which I now have rescheduled for next May. Before then I will be a new man who will try harder to not fall off the bed or on the rough sidewalks of Alajuela! It’s just that time of life! 🙂 No cane yet and hopefully not soon! But maybe needed someday?