December 16, 2008 - Fixed!

Ahhh – today was a day of fixes.

Although the day was not pleasant *at all,* we did get a lot of long-standing items checked off.

We got up early, skipped breakfast, and took two buses to Clínica Bíblica for my surgery follow-up. I got blood tests, an endoscopy, and met with my doctor. All good news! I have a clean bill of health, I can stop taking medication, and have no more restrictions on what I can eat :-).

To top that off, when we got back to the apartment, we found the landlady working away! She was replacing the hot water system *and* the leaky sink faucet! AND I was able to put our water filter on the new faucet! Ahhh, life is good again!

Some costs (with 10% ARCR cash discount):
- complete hemogram = c10,400
- full lipid panel = c18,500
- fasting glucose = c3,600
- TSH = c18,500
- endoscopy = c58,500

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…