Friday, March 14, 2008

March 11, 2008 – Health Focus in Costa Rica

I’ve just passed my first year of retirement! It’s hard to believe that much time has gone by. One of the main things I wanted to do was to focus more on my health. I have found that my method for most of my life is to focus on one or two things at a time – everything else takes a back seat. I had been spending almost all my effort on work, often without leaving enough time in the day to even get a full night’s sleep (let alone all the other important aspects of life). Well, I was determined to change that. So, I spent the first few months just relaxing; downsizing my stress. We spent a few months in Costa Rica – learned some more Spanish and just lived. Then back to the states to work on our house – worked outside in the yard (and the sun!); definitely spent less time sitting at a desk! Then back to Costa Rica for a few more months. This time, we rented an unfurnished apartment within walking distance of downtown (no car). This meant we walked a *lot*! After 2 months, without thinking too much about it, or trying at all, I lost 20 pounds and knocked the bejeezes out of my blood tests - over 50 points off my cholesterol level, 40 off triglycerides, and almost 20 off glucose levels. Of course, doing the laundry by hand helped, and I can´t entirely discount the effects (beneficial?) of food poisoning

But I knew from past experience that I could only go so far, and at least a partial rebound was likely in my future – and I also had so much more to fix. So, we took the plunge, and I had gastric bypass surgery in Costa Rica. This is where your digestive tract is re-routed a bit – 90% of your stomach and the first part of your small intestine is bypassed. It makes you eat less, and digest more of your food lower, so you absorb fewer calories (and vitamins). It also means you have to let your stomach re-learn how to handle food – it has been about a month, and I finally get to try solid, near-normal food.

Rick was uneasy with the idea of my having surgery – let´s face it, it is a serious undertaking. But then he thought about this – our bodies have evolved to be efficient, and to store fat for the times when we need more fuel than we can take in. In these times, that is just not very often… So, if your body is not working the way you need it to, there is nothing wrong with changing your body. It´s still a bit scary, of course…

The long-term effects for most people is that you lose 80% of the excess weight. Some people gain some back, but not all of it. This is a permanent change, and basically forces a change to your eating habits. The other options for bariatric surgery were either not permanent, or were not as positive.

In the short-term, most of the excess weight is lost in the first 6 months. Something called ¨malabsorption¨ continues for 3-5 years – this is where the vitamins are not absorbed completely by the body (you need to take supplements).

One interesting side-effect of this surgery is that your glucose levels stabilize *immediately* - if you have Type 2 diabetes or glucose intolerance, 90% of the time the surgery itself cures this. This is because the section of intestine that triggers glucose over-production is bypassed – so no more triggering. This has led to a modified surgery for people who have Type 2 diabetes without a weight problem. They have been doing this in Costa Rica now for 5 years, with a high cure rate (~85%). The USA is a bit behind the times – the procedure is not FDA approved (yet). Cynics believe this is in large part caused by the pharmaceutical industry – diabetes is a real cash cow in the states, so why would they want it cured?

Some of the differences in health care here in Costa Rica are mind-boggling!

  • Everything happens at its own pace, so sometimes appointments take hours (much of it waiting). But of course, that has happened plenty of time in the states too. However, most of the time, appointments were spot on.
  • I had a consultation with the surgeon ($48), and left with his cell phone number – and instructions to call at any time. Over the course of the surgery and recovery, we must have called him over a dozen times – each time, he was happy to hear from us (really? Well, it seemed like it…).
  • Once we got the surgery go-ahead (passed all the pre-operation tests), we paid for the procedure. This included all the visits to all the doctors, all the tests, and over a week´s worth of prescriptions. It also included a follow-up endoscopy at 6 months.

The question of insurance requires its own entry…

10 comments:

jen poco loco said...

Thanks for linking to my blog Costa Rica Crazy. I will be back to see more of what's going on with you guys too. How funny that you have a CR health thing right after our first big medical situation. How long ago was this surgery? Where in California are all those gorgeous spring photos from? My husband's guessing near Sacramento. The cherry trees (I think) are just beautiful. I miss that part of CA.

vainbrattyprincess said...

that's an interesting insight to having surgery in another country. I hope your went well and you are on the road to recovery!

I apologize for popping in but I stumbled on your blog in my quest to find costa rica vacation info. You've been there a year right? I also stumbled on this other link
and I was wondering if this is really the practice there?

Anyway, I really appreciated your blog post! Cheers!

JulieAndRickInCostaRica said...

Hi Jen -
You're welcome! I love reading Costa Rica blogs - there is just so much information available, and all first-hand!
I had surgery February 8th - so far, my recovery is in the short end of the timeframes they gave me (yay!).
You're husband is sooo right! The Sutter Buttes are about 45 minutes North of Sacramento. Most of the pink -blossomed trees are actually peaches. When my sister moved away, she asked for a weekly photo of the rice fields and orchards. It's funny what things make you get all mushy and homesick...
BTW - if you miss the rocky rivers in the Northern California foothills, check out the river running through the Orosi valley - it will transport you.

JulieAndRickInCostaRica said...

Hi VBP -
Thanks - I feel great! and better each day.
We've been making trips back and forth for 2 years now; we still haven't moved all of our stuff, but we have rented places and lived in Costa Rica for 7 months out of the last year.
We certainly have had at least a few similar experiences as Costa Rica HQ. Networking is everything (the *only* way to find an apartment, and the best way to find a small hotel), and a good number of taxis try to rip you off. The only defense is knowing your destination and knowing how much it should cost - then get tough.
But you know - Lundagin mo beybeh
Pop in any time :)
Julie

Marsa said...

Hi Julie, wow, surgery in another country... did your doctor train in the states?

You mentioned retirement... you know retirement is a state of mind :)

The fact you've lived in Costa Rica for 7 months makes me kind of jealous, so I suppose I'm going to have to hurry up and get down there like my friends who stayed at this place called Maquenqe

We have dogs so we might have to go camping instead.

Get well soon.

JulieAndRickInCostaRica said...

Hi Marsa -

My Doctor (Dr. Zafrani) trained in several countries - Costa Rica medical school, Panama, Florida, and probably a few other places. While I was there, he had visitors from several countries (Panama, Venezuela...) - they wanted to study his technique and the state-of-the-art operating rooms at Clínica Bíblica. He keeps up with the techniques, and is head of (forget the name) some physician's group (like the AMA) in Costa Rica.

You are sooo right - Retirement is all about your mindset. I'm setting my mind slowly :)

Maquengue sounds *fabulous* - I wouldn't mind spending some time on those grounds...

As a friend said to me - "Hurry up!"

Anil said...

I had a picture of Costa Rica in my mind. I got it from CostaRicaHQ.org blog. Now I got additional info. regarding the healthcare scenario in Costa Rica. Many thanks.

JulieAndRickInCostaRica said...

Hi Anil -
glad to help! Costa Rica has so many pictures - both practical and fantastical :)
Julie

Molly said...

Hi Julie, I'd really like to know more about the bariatric surgery for non-overweight diabetics...do you have any links or information you could share?

Thank you!

Molly

Julie said...

Hi Molly - check these:
http://www.cbsnews.com/stories/2008/04/17/60minutes/main4023451.shtml
http://www.medscape.com/viewarticle/555171
Unfortunately, it is difficult to google for a "negative" link (e.g., gastric bypass for non-obese diabetics). My doctor talked about how it had been done for over 5 years in Costa Rica, Mexico, and somewhere else (can't remember now). FDA apparently *still* won't take it seriously. I don't think patients are even routinely checked for blood sugar immediately after the surgery.