Cardiólogo hoy

Cardiologist today (cardiólogo hoy) for the appointment (1 pm) I started making 4 months ago.

10:15 – Left the house walking to bus station
11:00 – Bus to Alajuela then taxi to Hospital Alajuela
12:15 – In line to check in on 4th floor Cardiology Department (cardiólogia)
12:30 – Behind the gray screen for weight and blood pressure
12:35 – Wait in front of Door 8
1:00 – Called into Door 8 where she asked questions in español of course. Then created an EKG (ecg) and then sent me to Door 4
2:00 – Dr. Hernandez calls me in behind Door 4. My first and only person of the day who spoke English. We mixed it up, Spanish/English, as he created a little heart-related medical history of me to begin my cardiology file. At one point he had me both sit and lay down on the examining table where he listened to my chest and back and then felt around in my abdomen. He read and wrote notes on the reports I brought from the private cardiologist I had seen earlier and the medication she had prescribed. He told me he would have be back for an ecocardiogram along with blood and urine workup to give him a total picture of my health to help him better monitor my heart. I feel very good about making this young (30-something) cardiologist my primary heart doctor with the government healthcare program generally called CAJA here.
2:50 – I go back to the front desk with really nice young adults who only speak Spanish to make my appointments (citas). The young man had to use his phone to translate to tell me I must first go to the first floor to a desk and have them make a file on me, mi experiencia, which took a while to find the right desk where I took a number and waited.
3:20 – I took my beautifully created large folder for all my medical records there back to 4th floor where the young man called me past the line and put everything in the folder except my two appointments for March 24 & 25 and multiple copies of my prescription for a different but similar treatment of my arrhythmia.
3:30 – Got a taxi to bus station
4:00 – Bus to Atenas
5:15 – I’m eating one of Chef Dan’s Meatloaf Dinners before watching ABC news.

Now all of this cost me exactly $0. The prescription is good until my March visit and it too is FREE! While the prescription from the private doctor even in generic form costs me between $40 and $50 per month.

Yeah, this first visit cost me most of the day and I had to wait a few months for it, but my heart will be monitored and cared for until I die at no other cost than the required $100 a month CAJA cost which is required if I live in Costa Rica, use it or not. I’m going to use it! Save money! And I like most of it even if rather slow! 🙂 Later I will explain how I plan to work the free government system with some limited private system healthcare and a great little local insurance for a private hospital if or when ever needed for just $12 USD per month! Later!

Private Health Insurance, Public Health Coverage and Residential Papers

Boring Stuff for the Few Readers Anticipating a Move Here

That title just means some details only concern the persons actually moving here or retiring here and I don’t want family or friends back in the states worrying about my healthcare. I’m fine! Don’t worry! In a different country, culture or situation some things take longer than you expect and you just work them out the best way you can, sometimes one day at a time.

RESIDENCY & PUBLIC HEALTHCARE
It has been 15 months since I filed my application with Immigration and I am still not approved yet. I now know people who have gotten it in 6 or 8 months and another in 3 years, so the bureaucratic government office is always slow and it often depends on which agent’s desk your application ends up on or what is happening in his/her life at the time. So mine is not that unusual, but I talked with my attorney  by phone this afternoon and here is the update on my application or what is in his control: I am now his oldest application file, so I’m his number one priority now. Good! He has made an appointment with Immigration for May 13 to request “a resolution” on my application. That is between him and the government office, I’m not allowed to go then, but he is planning for approval on that date and has even made a June 1 appointment with the CAJA Office (government health plan) for me to get my healthcare card (Caja Card) which is separate from my residency card (Cedula) and I think that same day we may apply for the “Gold Card” which is for us old people to get discounted or free services like buses, etc. That means we have to do some paperwork and Social Security Office visits between May 13 and June 1. I will try to stay available though I do have a May 20-23 birding club trip. SO I’M HOPING FOR RESIDENCY BY MAY AND CAJA BY JUNE OR JULY. I will not hold my breath! Everything here usually takes longer than suggested!

The primary reason I’m in a hurry to get this residency and public healthcare coverage is because I really can’t afford to keep private healthcare insurance! For a reasonable amount per month I will be on something like medicaid or medicare in the states (only much better!). There will be no co-pay or charges for any doctor visit, surgery, hospital visits, prescription drugs, etc.! I will pay a monthly charge based on a percent of my SS income. I need this kind of “socialized medicine” as some Americans like to call it. Read on to see why.

PRIVATE MEDICAL CARE AND PRIVATE HEALTHCARE INSURANCE
I’m thankful I’ve had no big health issue like cancer or needed surgery, injury, etc.! But private doctors, hospitals and other medical services are so much less expensive here than in the states that for my usual medical needs so far in my life I could afford to have no insurance and just pay cash out of pocket for doc visits, x-rays, EKGs, prescriptions, etc. But prudence makes you plan for the worst and have insurance when you are not on the government health plan yet, as has been my case for the last year.

When I first came, I was could tell my Medicare Supplement Insurance that I was on an extended vacation and be covered for I think it was up to 4 or 6 months. When that expired, I cancelled that policy and purchased a Costa Rica Private Healthcare Insurance Policy which covered 80 to 90% of everything including prescriptions with a few restrictions I won’t get into here. But like in the states it was based on age and for someone turning 75 it was $3,000 paid up front for the whole year. It expires the end of this month and I just sent in my claims for the whole year, so waiting on a check!

Since I still don’t have my residency and thus the almost free government healthcare plan, I figured I probably should go ahead and renew for one more year “just in case.” Well, they do everything at the last minute here and I just got my renewal notice with the shocker that I this year move into the next age bracket of 76-80 years old and thus my renewal cost would now be over $6,000 for the year! NO WAY! That precipitated the above-mentioned call to my attorney and my push to get residency and the government healthcare plan expedited if at all possible.

It is close but the timing of my May residency and June healthcare plan may be just right! Though I may have a couple of months without insurance, so just don’t get sick! Private insurance companies here are about as bad as the states for high costs, but the government plan is certainly a lot better! And I hope to be on that soon!

If anyone considering a move here wants more details, just email and I will be glad to discuss it further and keep you posted on what happens, though I will do that here on the blog too once I’m approved and probably have stories of government bureaucracy to share.  🙂

Friday of Healthcare Tour

Old Man Tree in Breakfast Room

A stop by CPI Spanish Immersion School in Heredia for one short lesson.

Visited the smaller public hospital in San Ramon.
Public hospitals aren’t as fancy and pretty as private,
but very clean and functional inside.

.

Paul & Gloria’s view with a Poro Tree blooming. Now is time for Poro.
Lunch at home of Paul & Gloria Yeatman with guest speakers.

Visiting the San Ramon Feria or Farmers’ Market Friday afternoon.
Paul & Gloria emphasize this as a part of healthcare!

We also visited a small neighborhood clinic, farmacia, bank, community center, Red Cross which does all the emergency ambulances, a museum, and talked about insurance, the CAJA government healthcare, homecare provided by CAJA, and even a presentation by a volunteer organization encouraging us to volunteer. Whew! A full day! But very helpful. They were showing us what it is really like for medical care in a local community, in this case San Ramon. I will do a separate post on San Ramon and give my comparison to Atenas. This ended the Healthcare Tour at dinner time in San Ramon. I spent the night there and tried to post these photos but the little La Posada Hotel had very slow internet, so I saved them for today, Saturday and will purposefully do two posts. The next one with a few shots of San Ramon sans-healthcare!

Our Healthcare Tour Group

Our group of 8 who have traveled together for two full days visiting many hospitals & similar facilities.
I’m the smiling guy behind the two ladies on the right, in white cap and blue sunglasses, under the toucan.
Thanks to Victor, our van driver, for making the photo!
Paul Yeatman, tour leader, is in blue cap and from Maryland.
Others from Canada, South Africa, Columbia, Minnesota, Florida, Oklahoma & me from Tennessee.
Paul and I are the only ones already living here. Others are preparing to move here.


The internet connection is very slow at my little La Posada Hotel in San Ramon, taking a long time to upload the one photo above. So I will save the several other photos I want to share for after I get home tomorrow, telling what we did. It was another good day with a lot seen and done. Tune in tomorrow for a report! And I have now seen San Ramon for the first time. Opinions tomorrow.

San Jose Hospitals Today

Entering Hospital Mexico, the largest in Costa Rica
and a public hospital
MRI at Public Hospital Mexico

Hospital room at small boutique private hospital, Clinica Unibe.
We saw another similar one called Hospital Metropolintano.

In and out of the van at about 5 hospitals

Clinica Biblica, one of the two largest private hospitals along with CIMA.
We also visited Hospital Catolica, just a little smaller.

An absolutely wonderful Senior Adult Apartments with all levels of care,
great views, and near the second largest mall in Costa Rica.
Verdeza Apartamentos
I would love for this to be my final home before death! Great program!

More tomorrow as we head for San Ramon, a town a little larger than Atenas to visit more of the local healthcare facilities and hear more from Paul and Gloria Yeatman and eat lunch at their house.

Healthcare Tour of Costa Rica

Wednesday & Thursday nights at Adventure Inn in San Jose
A small family-owned, non-chain hotel with good prices!
Adventure Inn San Jose

Because the tour starts at 7:30 in the morning from this hotel, I came the night before like probably most of the participants. Walter’s Tours and Taxis in Atenas takes me for visa renewals usually and so I used his services to get to this hotel today. Door to door friendly and efficient service at a reasonable price and I did not have to fight the San Jose traffic! Saturday morning they will pick me up in San Ramon where the tour finishes. To save money I may use the public bus in future but it seemed more of a hassle with a suitcase and changing buses in San Jose. Kind of nice to be chauffeured!

The tour that starts in the morning (I’m writing Wednesday night) is sponsored by Paul & Gloria Yeatman who do the blog/website/newsletter titled Retire for Less in Costa Rica. One of their posts tells about Healthcare in Costa Rica and this tour description.

Tomorrow night I will report on the first day of the tour, all in San Jose. So keep reading. I expect most of the participants to be people from the States and Canada who are considering retirement here. The Yeatman’s do this in conjunction with another guy who does a relocation tour of Costa Rica, different from the one I took. More about it later too. Tonight I rest, eat in hotel restaurant, do some computer work and play and read. It is fun to be away from home even when you live in a paradise! 🙂

A quote from the founder of my former clinic in Nashville
where caring people still struggle with the
broken American system.
It is good to now live in a country where healthcare and education are
more important than wealth and military. It makes a difference!

Heart Arrhythmia

The Symptom
A couple of weeks ago I went to Dr. Candy because my right foot had been swollen for several days off and on, mainly when I stayed around the house rather than when walking! Strange?

The Standard First Level Treatment
She gave a diuretic to take for 10 days to see if that would reduce the foot inflammation. It did not.

(Side Note on Heel Spur)
You may have caught my earlier report on bone spurs in both heels but hurting only in the right one. This was taken care of by me stopping my 8 month habit of walking all over town in nothing but sandals. (Like walking barefoot!) I now wear tennis shoes, hikers, or regular shoes with a gel orthopedic insert in the heel. Absolutely no pain or problem now from the bone spur! And two doctors now say my new problem is in no way related except for being in the foot!  🙂

Complete Physical
Dr. Candy, my primary care doc, is very thorough and systematic and said it was time for a complete physical with an EKG because she now thinks the problem is circulatory. And I may have done a post on going to the Atenas Laboratorio Clinico for the blood and urine analysis. I walk these reports back to Dr. Candy and she says everything is normal or healthy including blood pressure EXCEPT that the EKG shows an arrhythmia which she thought she heard when listening to my heart. She emailed the EKG to the cardiologist in San Jose she works with and that doc wants me to come in and get wired with a 24-hour heart monitor.

24-Hour Heart Monitor
That was done last Thursday and Friday for my first two bus trips to San Jose and only saw a nurse to be hooked up and then uninstalled. Today I went back for the cardiologist to give me her evaluation. (Note that with a female primary care I’m being sent to female specialists! 🙂 Dr. Bouzid is so good, professional, thorough and explains everything so I can understand it! In English! Thank goodness! I’m slowly improving with my Spanish but not ready for this! She is a part of CIMA, arguably the best private hospital in Costa Rica. My private insurance covers everything after the first $300 which I reached today only when the ultrasound was added! Wow! medical costs are so much less expensive here! And when I get the CAJA, free! And by the way, some people come here from the states for cardiology including heart surgery. They call it “Health Tourism.”

The reason for 24-hour EKG basically is that it shows my real life and not just a couple of minutes in a doc’s office. I do have Heart Arrhythmia as shown in these two contrasting clips from the 24 hours:

This is a fairly regular rhythm which is good – what we want.

This one shows the irregular rhythm and other pages were worse. 

āˈriT͟Hmēə,əˈriT͟Hmēə/
noun
1.         a condition in which the heart beats with an irregular or abnormal rhythm.
Or for a more thorough definition and more info in a sidebar, see Mayo Clinic
Then a Heart Ultrasound
Then she wanted to do an ultrasound of the heart and like everything else, I am given copies of everything. She pointed to parts of the picture on her computer which was moving or a video and tried to explain why not enough blood was being pumped to my right foot. I did not really understand that, but accepted it. And here is my printout of that which doesn’t mean much to me: 
This is actually 5 photos taped to a sheet of paper.
Ultrasound of my heart today. Whatever it means.

More Blood Tests

The cardiologist sent me to Lab San Jose (another Laboratorio Clinico) just two blocks away to check 4 things in my blood related to the heart: NITROGENO UREICO, CREATININA, TSH, PEPTID NATRIURETICO B (BNP) which will be reported to her tomorrow by email. One of these has to do with the thyroid gland which if either over-active or under-active can cause arrhythmia and I’m not sure what the other things are. 
Gave Me a Prescription
I take this for two days twice a day and report to her how I am feeling. This may or may not help. Then
I Go Back to Cardiologist Friday Afternoon
She will then discuss the blood test results and with that may change the prescription or take a different plan of attack. She seems confident that she will get me back into rhythm! 🙂 
And by the way, she says I HAVE A VERY STRONG HEART! It just doesn’t have rhythm!  🙂
🙂  Well, a different kind of rhythm!   🙂
But you should know that they celebrate Elvis’ birthday here!
And most Ticos have lots of rhythm! And love music!

Small Town Billboards and Healthcare

The closest thing to a billboard in Atenas.
That is my Roca Verde neighborhood in background.

There are a lot of billboards in San Jose and a few on the toll road between here and there, Ruta 27, but I guess that kind of advertising just doesn’t pay in and around the farm town of Atenas. Nice! This sign is hardly as big as a billboard but about the biggest you might find around here. It is on the connector road to Ruta 27 near the Feria or Farmers’ Market. Behind it is one of several hills in the Roca Verde housing development where I live.

The sign is for my favorite of several Macrobioticas in Atenas. They are kind of like health food stores, herb or vitamin shops in the states. You can get lots of food supplements, vitamins, and herbs of all kinds. This particular shop is where I get my Melatonin or Melatoninia, Hierba de San Juan, Tilo, as an herbal sleep aid, kind of like the sleepy time teas I can also get there, just in a capsule form. I do still sleep on a CPAP machine most of the time and if it wears out, my doc can get me one here for Sleep Apnea, but I may lick that too! 

I no longer take any prescription medications of any kind including allergy meds and I am doing just fine! I brought a lot of the senior adult one-a-day vitamins for men from the states (generic Kroger brand) and when I run out later this year, I can get something similar at my Macrobiotica Tienda (Tienda=Shop). I not only feel healthier but also save money! And oh yes, very little advertising bombarding me here which is also healthy!  (Tomorrow I’ll tell you about seeing both my doctor and dentist in two days.)

One of the amusing forms of advertising here (though not allowed inside Roca Verde) are a few cars or vans that drive around town with loud speakers advertising something with either a live Spanish speaker talking on a microphone or a recording that plays over and over. I think it is local businesses more than individual products, but not sure. Cell phone and cable TV also advertise this way. Glad they can’t come by my house! I heard them more in the apartments and of course still when walking in town. People live on their front porches or front yards, so it is a great way to advertise! 

Another fun way some products advertise is to set up a table or booth on sidewalk in front of a store that sells that product, like beers do this a lot, advertising a special price or discount or premium you get with it. They do this with very loud pop/rock music and one or two absolutely gorgeous young ladies in very short skirts or shorts, often dancing to the music and inviting you to dance with them. It is so much fun to experience different cultures!  🙂   Pura Vida!

On my Spanish Blog read about the second Spanish Class I’ve joined which is at Iglesia Biblica. I’m determined to learn español even if doing it very slowly! It is a beginner class also, so a lot of repetition which helps me, but this one uses a Costa Rica produced book which has more local slang and idioms. Bueno!

My Health Improves in Costa Rica!

At my target weight now!
First time in 30+ years!

After 6 months in Costa Rica I decided to buy bathroom scales for fear I was gaining weight instead of losing or staying at a healthy level. After all, I have been eating a lot here and learned that Ticos have a sweet tooth like me. Who can resist Tres Leches or Coconut Flan? So at the Alajuela Walmart I got a nice looking glass scales similar to what I had in Nashville. I bring it home and weigh for a pleasant surprise! I am averaging between 173-175 which is what the charts say I should weigh for my height, etc. 173-175. In the morning I am closer to 173 and by night closer to 175. I tried to reach that in the states all of 2014 but usually stayed between 180-185, which was better than the 200 pounds the year before!

One of my favorite dinners is a green salad with Avocado
slices (a whole one this time but sometimes a half), a big 
glass of water and a fruit fresca made from pulp concentrate
this time, but sometimes fresh fruit in blender – yummy! 
And sometime I add a dash of bottled Sangria or 7up. Salad is
seasoned with fresh-squeezed limon and herbal seasoning in 
that little shaker bottle at top. 1 slice of whole grain toast and 
a little guava marmalade for the last bits of toast not finished
with the salad. Reasonable dessert! Some days I have saltine
crackers with either salad or soup. I do cook chicken, fish, and 
some pork with vegetables and/or salad. Eating out less now.
I’m doing okay with homemade veggie soup and gallo pinto
a special Costa Rican seasoned beans and rice, and I’ve always
done great scrambled eggs as a messed up omelet!  🙂 And 
unless after dark, I eat all meals outside on my balcony. 
Which I think is also a healthy addition to my life! And that
black book is my Kindle Fire, my companion for most
meals! I’ve read more than 20 books in 6 months!  

To what do I contribute this? The same two things most people do, eating and exercise. I eat more fresh fruits an vegetables here than I did in Nashville, even living for 10 years across the street from Nashville Farmers’ Market. We have no American fast food restaurants in Atenas! Nada! Now, I can get a burger, pizza, or fried chicken from some Tico restaurants, but rarely do; only pizza or a good hamburguesa. I haven’t had fried chicken in many years! Don’t like it anymore, though popular here, especially with the young. I’m also learning to eat more sensible sized portions most of the time though some restaurants don’t help there, but now I’m eating at home more and that helps.

The best thing to happen to me exercise-wise was to decide not to buy a car, though the temptation pops up every once-in-a-while. I walk almost everywhere in town and when I take a bus to San Jose or Alajuela I walk most places when I get there. I’m averaging 3 to 6 miles every day. Part of the key there is “every day.” If I get a large order of groceries, then I take it back by taxi for about $2, but I’m learning to grocery shop little at a time every-other day which gives me more exercise as I can carry smaller loads and I have fresher stuff!

Walking 3 to 6 miles every day is maybe the healthiest thing
I do or at least equal with eating better. And yes I mostly walk
in sandals, but sometimes tennis shoes. My dress shoes may 
never get worn here! Tennis shoes are hot and sweaty! That
leads to athlete’s foot, so sandals better in the tropics for me, 
except for some hiking and even some yard work.   

I am still debating a bicycle which would be quicker than walking and still be good exercise. The two negatives are the one big “killer hill” between Roca Verde and downtown AND the narrow streets with sometimes sloppy drivers of cars. It could be dangerous! Peligroso! So I keep walking!   And probably will not get a bike.

OTHER HEALTH FACTORS:

  1. I have Costa Rican Private Health Insurance and got to cancel that expensive U.S. Medigap insurance. A big savings!
  2. I have a private practice doctor who speaks good English. (Sorry! Meant to get a photo of her office with an ambulance out front. Her assistant is an EMT, so they can come get me if they need too!)  🙂 I have heard that most of the government doctors speak English too when I eventually go on that program next year. But hope I’m speaking Spanish by then!
  3. Hospitals are all highly rated throughout Costa Rica at half the U.S. prices! Everything from heart surgery to cancer treatment is done here with great competence. I feel secure.
  4. Few weather extremes in our Atenas “perfect climate” which contributes to good health.
  5. Less stress than in the States and not having a car helps with that even more!  🙂 Actually, driving here is the most stressful activity I have done and it can be as stressful as in the states, though maybe people get used to it. Well, opening a bank account was a little stressful, but I’m getting used to bureaucratic paperwork now and to just “go with the flow!”
  6. Surrounded by nature. My cure for everything!  🙂
  7. A relaxed, laid-back culture helps one to slow down and “go with the flow.”
  8. I have slowly tapered myself off the drugs U.S. doctors gave me, first to sleep at night, I’m now using simple, healthy herbs to help with sleep. I get that from one of the local Macrobioticas or health-food (supplements) stores here. Feeling better and sleeping as good! Also stopped all the allergy meds and doing fine without them! (Sorry! Meant to get a photo of my favorite Macrobiotica at the Central Market.)
  9. But eating healthier and walking a lot are still the main reasons for my better health here. I turn 75 Saturday and expect to live a whole lot longer here!  🙂

SOMETHING NEW: I’m finding it harder to write without using some Spanish (or Costa Rican) words. So you will know, I am going to try and put all Spanish (Costa Rican) words in red. Tell me if that is distracting or helpful. 

The Heavens and a Great Kiskadee!

The heavens declare the glory of God,

and the sky proclaims the work of His hands.   

Psalms 19:1 HCSB


January 31 Sunset from my Balcony – Right out of camera, no messing with it!

Today was spent in San Jose for a physical exam for Pricose Healthcare Insurance to get my application approved. Snapped a few shots on phone in San Jose, for later maybe. Also had a flock of Great-tailed Grackles on the lawn this afternoon that I’ll show later. First new bird in awhile! I did get a new and better shot of the Great Kiskadee yesterday on the back balcony of my neighbor’s apartment, so this one is for Urs & Ima from Switzerland:

Great Kiskadee

As always, click a photo to see it a little bit larger with more details.