Phew! Not Dengue!

I do not have Dengue!

We had a little scare here this last week - I got sick on Thursday, and by Saturday morning, I had all the classic symptoms of Dengue Fever.  Fortunately, ALL in miniature, so not a whole lot of pain or life-derangement :-).  I felt well enough to go to class Saturday, although I was not really with it (but no tests, so lucky me!).

By Monday, we had decided that I'd better see a doctor to find out if it really was Dengue.  We had read that not everyone has the severe symptoms, so even though mine were minimal and very short, it was still possible.  The most important reason to know for sure whether or not I had it, is that the second time someone is exposed to the virus, it can be life-threatening.  Dengue Hemorrhagic Fever is a high risk when someone has the dengue antibodies from a previous bout. 

Well, it turns out that the EBAIS is closed on national holidays* (imagine that!), and Monday was Juan SantaMaria Day.  We made our trek to the clinic, not really expecting it to be open, but we didn't know for sure (now we do!).  We couldn't go Tuesday, so that left today.  By the way, each trip to the EBAIS means getting in line somewhere around 6:00 a.m., getting an appointment for later that morning, perhaps returning for tests, etc.  Basically, you get up too darned early, and your day is shot.  But, you get pretty much everything taken care of all in one day.  Today was only slightly different, because dengue is a public health issue, and so the blood test for it is "urgent."  So, after my morning doctor's appointment, we went to the urgent laboratory at UCR, got blood drawn, then went to the cafeteria there for brunch.  We returned to the clinic for the results.  We had a little language mix-up**, and so were two hours late :-| but they fit us in!  And... NO DENGUE!  Turned out it was a bigger relief than I anticipated!  I'll still worry a bit about mosquito bites, but if the bugger is carrying dengue, at least I am back at square one in that progression.  Square one is a *good* thing sometimes!


* In case you didn't know, next week is Semana Santa, and Thursday and Friday are national holidays too.

** language mix-ups are no fun!  And here's an easy one:  12:30 sounds like "dosayeemedia" and 2:30 sounds like "doseemedia"  - say that fast and see what happens...  The fix is this - write down the numbers and confirm those with the person giving you the appointment.  It's a bit harder to *remember* to do this...

Happiness Around the World

Sign seen while waiting in an office:
¨Gaiety takes you halfway to good health.¨

It reminded me of my quote (on the right) - ¨Every hour spent angry is 60 minutes of happiness wasted.¨

Nice to see this sentiment, wherever you are!

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

Hot Water? Only in the Shower...

A lot of people are surprised when they come to Costa Rica and find that the only hot water is in the shower. This can require some mental adjustments, especially if you are used to washing clothes and dishes in hot water. Most people's first thought is "gross!" how do you get anything clean!?

For me, washing clothes in cold water is nothing new - we did it this way my entire life. It saves energy, and doesn't make much difference in the cleanliness.

Dishwashing was an entirely different story though. It took me a while to get over that icky feeling of washing dirty dishes in cold water. True, the soap in Costa Rica is specially formulated for cold water, and the dishes *look* clean, but what about germs? Could 4 million Costa Ricans be wrong? Well, guess what I just found - a study :D.

The FDA recommends washing dishes in 110 degree F soapy water, rinsing, then soaking in sanitizer. Ohio State University researchers added bacteria to dishes with dried-on food, and found that these dishes washed in soapy room-temperature water, rinsed, and then weakly sanitized with ammonium-based chemicals achieved FDA-acceptable results.

However, dishes that were especially difficult to get clean were forks, because food stuck to the tines. Also, milk-coated glasses hung onto the bacteria more than any other food.

Recommendations from the study were to
1) spend extra cleaning time on forks
2) wash dishes right away before food dries - this saves washing time and gets rid of problematic places where bacteria might be able to survive washing and drying

My added recommendation is to rinse and/or soak dishes if you can't wash right away - this keeps the food from drying on the dishes.

Of course, some people go whole hog and get a hot-water heater connected to a dishwasher...

Welcome back to California - medical bills!

Welcome back to California - here are your medical bills - yikes!

We had a busy week going to dentists and doctors. I will say right up front, I would not even consider going to any other dentist or doctor in the states - ours are great! However, this is a pure illustration of the differences in the cost of health care between California and Costa Rica.

Cost for a thorough teeth-cleaning, exam, and x-rays:
California = $255
Costa Rica = $90

Cost for a filling - composite:
California = $250 (plus $115 for happy gas and topical numbing, 'cause I'm a baby)
Costa Rica = $50 (as reported by Saratica)

The same week, Rick went to the Doctor for a sinus problem, and came away with three prescriptions for almost $300. We're waiting for the bill from the Doctor, but I am sure it will be over $100. The last time we saw a Doctor in Costa Rica, the office visit was $12.

And people wonder why medical tourism is taking off...

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…

Visitors to Hospital Mexico

You can see our friend Joe's account of his experience with hospitals in an earlier post. Here is our experience *visiting* him. Rick and I agreed - we're very glad our first trip to a public hospital was as visitors. Now we will be a bit less worried when we go as patients (you know it will happen eventually).

So, after getting our Cédulas and driver's licenses in San José, - yes, all this on the same day :)

We catch the Alajuela bus towards the Hospital México, and ask the driver to tell us when we get there. He says he will, but... Of course, we miss the stop. We get off on the next stop - fortunately not too far, walk back and on to the Hospital. The hospital is like a circus, so we ask for help at an information window. They can't find Joe for quite a while, but finally tell us he is still in emergency. At about 4:00, the nurse leads us downstairs, and we wave to Joe through the window. She tells us to wait for the Doctor; it should be about 20 minutes. Well, about 4:30, we walk back to where we saw Joe, and the security guard shoos us into a waiting room - we have to wait for visiting hours at 5:00. Linda is there right before visiting hours start - she's been through this before; we give Joe's name, and they let us see him one at a time for about 5 minutes. He seems ok - he has a full face oxygen mask on, and can't talk without taking it off - we're just there to let him know we are looking out for him.
5:15 - we're back on the bus to Alajuela; it's rush hour, so we don't get to the last stop for another hour.
Boy, are we tired! We have our leftovers and conk out.

... The next day...

We caught the 11:00 bus from Alajuela, and got off at the correct stop for Hospital México. As we got off the bus, a very nice lady helped us cross the "muy peligrosa" street. She just grasped my hand, and we followed when she crossed. I am finding that this is so typical - so many helpful citizens. I felt like a Boy Scout in reverse :D

At the hospital, we go directly to the emergency waiting room (doesn't that sound like an oxymoron?), and wait for 12:00 visiting time. Linda appears, and we queue up. Then we find out that Joe is no longer in the emergency room (why didn't we check on this before?). We run around for a few minutes, then Rick asks the right guy - we have Joe's bed number, but (of course) visiting hours for the wards don't start until 2:00. So, Linda drives us all into San Jose, and we go to ARCR to get our hands held. Annabel is very nice - she talks to us a lot, and we feel a bit better about the situation. The hospital will not release Joe just to get him out of the way (what were we thinking?!?).
We grab a bite to eat, then head back to the hospital. My navigation skills are excellent - I was always able to point to the correct turn-off as we passed it :(.
At the hospital, we get in the line for the 6th floor visitors just before 2:00 (we're about the 4th group). Well... The people who run the visiting center don't even show up until 3:00 - by this time, I'm sitting down, and Rick and Linda are very tired of standing. To accommodate the long lines, the hospital folks had opened the doors to the outside. It was very strange seeing all these people zip up jackets and pull up their hoods against the breeze. It had to be 74 degrees! I guess it is all what you're used to.
We got to see Joe one at a time, but there was no time-limit. He was *much* better! He gulped down the yogurt drink I brought (he probably wasn't supposed to have it tho). He had a better oxygen system - no full-face mask, so he could talk easier without reducing his oxygen. He told us about the other patients in the room (there were 6 beds in the room). He said he is very happy with the care he is getting at the public hospital (all covered by his $36/month insurance).
Linda drives us all back to Jalapeño's in Alajuela - whew!