The beauty of the natural world lies in the details.
—Natalie Angier
Looking across the driveway into my neighbor’s yard.
¡Pura Vida!
Also My Flora & Forest Galleries.
🙂
Enjoying Details
Biopsy Report & Long Range Plans
Yesterday, Tuesday, 23 March, was my big meeting with Dr. Hernández, post-surgery (though I had one earlier visit to remove the drainage tube). Here’s what we did and discussed for over an hour. And by the way, all the doctors here take as much time as needed and never rush you, yet they are very punctual with appointments, meaning that most allow an hour or more per patient for consultations. Compared to the states, better service for a fraction of the cost.
Removed the Bandages
Though we actually talked first, this was one of the reasons for this post-op visit included in the price of the surgery.
He is a young surgeon proud of his ability to provide “scarless” facial surgery by closing up the incision with “internal stitches” that I don’t understand, but there were no stitches for him to remove, just the bandages over the line that still shows right now, but will not later as it heals.
Sorry that my “selfie” doesn’t show it better, but he cut me from in front of and above my ear all the way down my neck to nearly the chin, all on the left side.
Then if it doesn’t gross you out, he peeled back the left cheek skin and cleared out all the tumor he could find, including the whole salivary gland and a part of my facial nerve, then put my face back together again. He said that when the swelling goes down, I will look younger on the left side because he stretched the skin tighter or smoother. 🙂 Like an 80 year man cares! 🙂
The Biopsy Report
He shows or explains everything to me on his large-screen computer monitor including photos of the actual tumor whole and when sliced to show what was inside. Then I receive a 3-page printed version of the biopsy including photos (only 1st page at right) but this version is en español which I roughly understand but he promised to send me an English version soon. Expats are more trouble as patients! 🙂
As expected all along but confirmed by this biopsy, it is cancer – invasive epidermoid carcinoma (translation of Spanish “carcinoma epidermoide invasor”). This is the same diagnosis as the skin cancer removed from my left cheek in 2019 by MOHS surgery which is supposed to assure one that all the cancer is removed. So much for MOHS! 🙂 Dr. Hernández said it is possible that a “root” or even a tiny piece of the original carcinoma on the surface was left in the cheek and it grows fast or matastisizes into the tumor that was not found earlier because of staying home for the coronavirus It was a large tumor, 4.5 X 3 cm.
Radiotherapy Follow Up
For the second time, a surgeon believes he “got it all” but that can never be guaranteed and the closest to a sure way is to follow up with radiotherapy. Thus I already have an appointment this Friday with “the best radiation therapist for head and neck” in Costa Rica, another female doctor who is “the best.” She works for 21st Century Radiotherapy, the only private company doing radiation. (None of the private hospitals do. They send patients to this company.) The only other radiation treatment available in Costa Rica is with the Social Security or Public Health at Hospital Mexico, where I had my angiogram. It would be “free” with my national health plan but Dr. Hernaández says they are too slow and could take months or a year to work me in while this private company can get started within a month or6 weeks which he says is essential for a spreading cancer. And of course that is a private doctor speaking. 🙂
But he also said that Dra. Bonilla would know if public health could get to me soon enough and she might be able to work that out, otherwise I will use my “MediSmart” medical discount card for up to 50% off the regular charge at 21st Century. But we are still talking thousands of dollars and me with no insurance. So Friday will be the next big decision time on this latest adventure.
I fully expect to deplete my saving a bunch more (Getting low already!) and have the radiation done with the private company, but will explore every reasonable option with the public health radiation. So another report Saturday on that! 🙂
And About the Eye and the Mouth
I have an appointment with the Ophathamologist in two weeks to discuss a surgical procedure she has done before that partially closes the eye lid and may allow me to have more use of my eye , where now I just keep it covered all the time. It will not bring the blinking back but possibly more use of the left eye.
The mouth will improve somewhat in time – months – but never back to totally normal. I might regain some muscle use on the left side to help with eating and maybe a less exaggerated lopsided smile. We will see! 🙂
And another little amusing side effect, I just learn that when I wrinkle my brow, it wrinkles only on the right side! 🙂
As Doris Day sang when I was a kid . . .
Que sera, sera
Whatever will be, will be
The future’s not ours to see
Que sera, sera
What will be, will be
And the feature image is another shot of my favorite Triquitraque Flowers still blooming! 🙂
¡Pura Vida!
Wind-blown Kiskadee
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.
¡Hasta mañana!
¡Pura Vida!
Rain!
Is it a freak “Dry Season” once-off rain or a very early starting of the “Rainy Season” this year? We will see! The Jigüirro or Clay-colored Thrush (CR National Bird) has been singing his heart out recently and indigenous tradition is that they are the ones who “sing in the rain!”
It is generally said for the Central Valley (where I live) that Rainy Season is May-November and Dry Season December-April. My first few years here we did not see our first rain until mid to late April and not a lot until May. Last year the first rain was March 24 and this year now March 22, so is it starting early? Almost certainly not daily afternoon showers now (usually by May) but at least I do not need to water the garden for a few more days! 🙂
Always Trying to Capture Rain in a Photo!
And never very good at it! 🙂 The featured photo at top shows the dark cloud this afternoon shower came from and some of us hope it will be regular now (though very early)!
I’ve always preferred the rainy season because it is greener with fresher air and the wind quits blowing! And most of the time we get rain only for an hour or two in the afternoon. Lowland rainforests along both coasts get more rain than we do here and it can be year-around, especially South Pacific and South Caribbean. For more weather information, check out your favorite weather channel or these websites:
- Costa Rica Rainy Season & Rainfall Map – on someone else’s travel blog/website
- A BETTER CHART & Same Map on the Go Visit Costa Rica website.
- And my favorite, Why Rainy Season is the Best Time to Visit Costa Rica, an article from Finca Rosa Blanca, Coffee Farm & Inn.
And to let you know that this first rain is a real rain, since it started I have loaded and processed the photos to web-size, prepared and written this blog post, all in an hour or a little more AND IT IS STILL RAINING – HARD! 🙂 Love it! The tropics! 🙂
¡Pura Vida!
The way I see it, if you want the rainbow, you gotta put up with the rain.
~Dolly Parton
Blue on Blue
Yes, it is a Blue-gray Tanager (e-Bird link), but my first impression of the photo was “Blue on Blue” with him against the blue sky, while sitting in my Cecropia or Guarumo Tree, then flying away in that feature photo at top. A common bird in Central America and northern South America.
See also my Blue-gray Tanager Photo Gallery.
¡Pura Vida!
Variegated Squirrel
I’m back to sharing nature from my garden again for a while and this morning the first thing I saw from my terrace was this Variegated Squirrel (Sciurus variegatoides) is a tree squirrel in the genus Sciurus, the most common squirrel of the 4 or 5 species of squirrels found in Costa Rica. He can be seen at many elevations and is more numerous than any of the others and varies somewhat in looks and color combinations with black, white, gray and reds or oranges.
This Variegated one is found only in Central America from Southern Mexico to Panama and is the most common throughout Central America. For anyone really into squirrels, the 4 others said to be in Costa Rica are the Central American dwarf or pygmy squirrel, Microsciurus alfari LR/lc; Deppe’s squirrel, Sciurus deppei LR/lc; Red-tailed squirrel, Sciurus granatensis LR/lc; and Bangs’s mountain squirrel, Syntheosciurus brochus LR/nt.
IN OTHER BLOG POSTS: Search Results For: Squirrel
And in MY PHOTO GALLERIES:
- Variegated
- Red-tailed
- Pygmy (dwarf)
¡Pura Vida!
What’s a Texas Smile?
A lot of you asked that question, and the answer is sort of a “figure of speech” or a euphemism for an asymmetrical smile or lopsided smile or even a sneer or smirk. 🙂 Possibly the name “Texas smile” came from one of those old cowboy movies my doctor saw, who knows? But that’s what my Costa Rican surgeon called it when, because of the cut nerve, I cannot lift the left side of my lips when I smile. But I’m not sneering! 🙂 Just not functioning normally and hopefully with some exercise we can call up some other nerves to help left that side a little more than now, but no promises. Same hope for blinking and closing my left eye which is burning most of the time now because I cannot blink or close it. In fact that is even more important to me! At night I now use an eye patch and put an ointment in my eye. My two big challenges before we even find out if the tumor was a cancer. Hopefully I will not permanently be “the sneering, one-eyed Charlie!” But if so, I’ll make the best of it! 🙂
The scabs on my lip are where the dermatologist removed growths earlier and they are just slow to heal. And of course I can’t shave on my left side with cheek and neck swollen and sore, so I’m an ugly mess! Like an old house or old car, everything breaking down at once! 🙂
Drainage Tube Removed Tomorrow
At least I have that to look forward to! Tomorrow afternoon the doctor sees me again and says he will remove the drainage tube which is a real bother. Then I think I will have one other post-op visit in another week when I will learn if cancer or not and what else we need to do. So seemingly always something else, but we are getting there – step by step.
Dinner Delivered to My House Every Afternoon
The ladies of Roca Verde have been wonderful! Delivering a “soft” food dinner each evening that will continue into next week. I’m really getting the “royal treatment” from my neighbors! And its looking like enough leftovers for more extra meals than I will likely need. This is the life of being “Retired in Costa Rica!”
Plus Prayers from Around the World!
I’m so thankful to have so many friends and family around the world who believe in prayer and have assured me they are praying for no cancer and a quick and complete recovery. Wow! I’m a fortunate person in so many ways! 🙂
¡Pura Vida!
Hills of Atenas
Here I zoom in on the hills northwest of Atenas as seen at three levels from my terrace.
The Broad View
Zoom Level 1
Zoom Level 2
This was the last post I did in advance of my surgery, hoping to be back online by today! 🙂
¡Pura Vida!
And then there are the Atenas Galleries.
🙂
Report on Surgery
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.
Total Parotidectomy
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.
¡Pura Vida!
Watching Wildlife
Something I’ve always enjoyed is catching a bird with live food like this Anhinga with a fish at Caño Negro Reserva on that river in the feature photo at top.
If all goes according to the doctor’s plans I am today at home still recuperating from surgery and hope to give more “live updates” in the next 2 or 3 days. Thanks for putting up with a week of “pre-scheduled” blog posts! I hope to be current again by the end of this week.
The Trip Gallery for the above two Photos:
December-2020 Arenal & Caño Negro
¡Pura Vida!