The honorific title of “Don” (“Doña” for older women) started in Europe for royalty and leaders of honor in Spain, Italy and Portugal, while today in Latin America it is a term of respect and endearment for senior adults. Since I started my cancer treatments, most of the different doctor offices call me Don Charlie, Don Charles or now my oncologist office lady always calls me Don Carlos. It is kind of nice to have the respect shown and helps to keep you from feeling sorry for yourself. 🙂 Respect for the elderly in Cosat Rica is everywhere!
Report on Today’s Two Doctor Appointments
Like with so many doctor appointments, both gave follow-up appointments with the biggest being with my Ophthalmologist who is doing minor outpatient eye surgery on my left eye this Friday right after the dentist appointment. It is one of her standard procedures to partially close the eyelid that won’t blink or close on its own. It will be down to a kind of permanent squint so the eye doesn’t dry out and water so much like now AND most likely I will no longer need to wear an eye patch! AND I will be able to see with both eyes (particularly helps depth perception). Both eyes are still 20/20 vision so I still don’t need glasses, though over-the-counter reading glasses (magnifying) is okay and sometimes needed for someone my age. I’ve especially needed them while reading with one eye only the last couple of weeks. And maybe the best part, her special ophthalmology operating room is in Ciudad Colon on the Atenas side of San Jose, meaning a shorter drive! 🙂
It was important to squeeze this in before radiation starts to avoid more damage from the radiation. It is like they are rebuilding my body.
And the oncology surgeon just checked the incisions and swelling which is visibly going down now, but can take a month or more. This skin is less and less sensitive in that area. But it could take up to a year before back to “normal.”
A lot of American, Canadian and European retirees choose to spend their last years in the beautiful land of nature called Costa Rica. And I am amazed at how many of them get a house somewhere and just sit on the porch, leaving only for the many necessary functions including immigration paperwork, shopping, medical services, a few for church, etc. While some take an occasional trip to see other parts of Costa Rica, there seem to be only a very small number like me who have a passion for seeing every “nook and cranny” of this beautiful natural paradise. And wow! What most of these gringos are missing! 🙂
For more than two years of the past 6, I traveled to a different park, reserve, or nature lodge every month. Last year I decided to slow it down to one place every two months, then got even that slowed down with the Coronavirus Pandemic. While this year was scheduled for a trip every two months before the villain Cancer came into my life. Meaning only God knows how many more places I will get to visit or revisit as I have been going back to favorite places more lately. Either way I get to be immersed in nature, my passion!
One wall of my living room is covered with photos of birds I’ve photographed here and another wall behind my dining table has photos of me on adventures around the world from Africa to Tennessee with a metal print of my social media logo, meme, or “gravatar!” 🙂 And below that gravatar is a map of the many places I’ve visited in Costa Rica. I just updated that map including my anticipated trip to Bosque del Cabo on Osa Peninsula this July for my 81st birthday, the only “new” place this year. The rest of the year I have 2 or maybe 3 scheduled repeat visits to favorite places, assuming I will be able to travel: Caribe Puerto Viejo and South Pacific Uvita for sure with Tambor Bay a maybe.
Birds Wall
Adventure Wall
Since I’m not sure how much more traveling I will get to do here in my final years paradise, I decided to share the updated map that is on the wall mentioned above. Here:
Places I’ve visited in Costa Rica over 6 years in no particular order.
And just for fun, here’s the Google map that shows where Google has tracked me going all over Costa Rica with the number of times. Of course the solid red blotch is the Central Valley where I live and they’ve tracked me moving around near home a lot! 🙂
Where Google has “tracked me.” This map is more than a year old. And I have no explanation for the dot out in the Pacific Ocean. A Google error I assume. I have not been that far away from land! 🙂
“Jobs fill your pockets, adventures fill your soul.”
They have been calling people for Covid Vaccination Appointments by age, starting with the many people here in their 100’s down through the 90’s and 80’s until they just got to me at age 80 for an April 1 appointment! Yaaaaaay! BUT . . . will it make a difference that I’m about to start radiation? I don’t know! But I will find out tomorrow when I discuss everything with the logistics person at Radioterapia Siglo XI. I hope there is no conflict, but with my second shot due during my radiation treatment, I’m wondering if they will conflict. If so, we will do whatever is necessary and get it when we can. Just another little bump in the road! 🙂
I know that people much younger than me in the states have already gotten both shots and they are just getting to my first shot here. Why? Because rich countries like the U.S. can get anything that money buys quicker! You are approaching 200 million people vaccinated in the U.S. and little Costa Rica just passed 300 thousand. I just read that another 300 thousand doses have arrived this week so we will slowly catch up with a very efficient system that had healthcare and other first responders first, then everyone else by age, oldest first. We all get it from our local public health clinic, with all shots provided by the government.
National Geographic Joins Tik Tok with First Post a Costa Rica Video
That’s according to this article in Tico Times Online. “National Geographic launches TikTok with video of Costa Rica” To view, click on the second video in this article. The first video is a Tico Times promo video. 🙂 You’ll know the difference! 🙂
National Geographic photo of Green Macaw, Manzanillo, Costa Rica — Yes, I have a similar photo from the same place, just not as good as Nat Geo’s! 🙂
You can be sure that Nat Geo knows where to find nature and adventure! 🙂 And of course Costa Rica is the best place in the world! 🙂
Neighbor Mike made this black eye patch for me, neither of us having found a commercial eye patch, just the big oval Band-Aids I’ve been wearing! 🙂 As expected, most people (especially Americans) who see it almost immediately say, “Arrrrrgh – A Pirate!”
Always wanting to be different, I’m going to call it my “Rooster Cogburn Patch!” He was the fictional Rooster Cogburn, U.S. Marshall, Fort Smith, AR in the novel True Grit turned into the 1969 movie True Grit with which John Wayne earned his first Oscar and Glen Campbell a best song oscar. Thanks to my next door neighbor, George, for first calling me “Rooster Cogburn” instead of a pirate! Great idea George! 🙂
Note that there were 3 more movies made about the same story or novel, but as usual, the first was the classic. And because Fort Smith was my mother’s hometown, where we visited Grandmother uncountable times growing up, with cousins still living there – it is a special place! And all of us from Arkansas hated that they filmed True Grit in Colorado with snow capped mountains instead of real Arkansas/Oklahoma scenery where it took place in the book.
When John Wayne received his first oscar as “Best Actor” for Rooster Cogburn in True Grit1969 version, he responded to the Academy, who had by-passed him many times before for oscars . . .
“Wow! If I’d known that, I’d have put that patch on 35 years earlier.”
~John Wayne
🙂
He even has a one-sided smile kind of like mine! 🙂
They tell me you’re a man with true grit.
~Mattie Ross (in the movie True Grit)
And actually I’m going to have my seamstress make me another, one or maybe 2 or 3, that are just a tad bigger to avoid any light coming in and to ride higher on my forehead, but for now, this one works great!
Saving Report on Radiation Consultation for Monday . . .
. . . because what I did yesterday was an hour+ consultation with the doctor going over all the medical details, side affects, procedures, and what I can and can’t do the next 3 months; though she assured me that my scheduled July birthday trip to the Osa Peninsula is still okay. I had already canceled my May return to Arenal, knowing it would be impossible. So I will be ready for my July trip like never before! 🙂
Monday, Karen, who is the logistics person for radiation, will be calling me to make all the arrangements, price discount, schedules and other details when I will then do just one report on the coming radiation therapy. And may share then the total cost of this cancer.
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! 🙂
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.
Great Kiskadee in the Wind, Atenas, Costa Rica
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.
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.
Drainage tube from my neck to a little plastic bottle until tomorrow afternoon.
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! 🙂
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
Face after removal of salivary gland & lymph nodes.
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.
HEALTH UPDATE: Today I visited a geriatrics specialist for the first time in my life at my surgeon’s request“to make sure I’m healthy enough for surgery.” — I AM! — But in the process I’ve come to appreciate a new specialist whom I really liked and appreciated and who can possibly help me manage my lifestyle for my remaining years better than anyone I’ve talked to yet. Already he has helped me! In addition to approving me for surgery! 🙂
Tomorrow I go for a negative Covid Test and then I’m ready for surgery, I think. 🙂
Since I was a high school boy when Mom gave me that book The Power of Positive Thinking for Young People by Norman Vincent Peale, I have made being positive a part of my life philosophy and really a part of my personal faith in God and the act of following Jesus.
It is kind of like happiness, it is inside you and you actually decide to be happy or not I believe. Then when bad things happen or come to your life, you make the best of them and keep on living. That is what I did for 20 years of a very difficult marriage while she was never happy and I was always happy in spite of the situation. Likewise with those overlapping years of a special needs child with autism and another rebel child. One survives by staying positive and finding the good things and opportunities, even within the bad!
Now don’t jump to conclusions – I’m not announcing my imminent death by cancer! 🙂
What has been for several years little skin cancers all over my body may have grown deeper roots or a separate and totally different cancer may have come that is more complicated.
New Adventure Started February 11
Not sure what to expect, I kept a journal of what was happening on one of the “static pages” or non-blog-post pages of my website and called it FIRST RAMPANT FEELINGS ON POSSIBLE CANCER. Kind of long.
The Latest Diagnosis
All those appointments and diagnostic tests lead to this current summary diagnosis with more detail in the online journal:
I have a tumor inside the salivary gland between my left ear and left eye that has grown fairly rapidly to around 3 X 4 cm now.
Though the needle biopsy indicates it is almost certainly a type of cancer only removing it will tell us for positive. Outside chance of no cancer. Prayers appreciated! 🙂
Surgery is scheduled for 15 March at Hospital La Católica in San Jose, Costa Rica
Dr. Christian Hernández Mena is my oncologist and surgeon – terrific in every way!
After surgery, a full biopsy is done, and the exact type of cancer determined, I could be receiving radiation and yes going bald! 🙂 More reports after surgery!
My Blog and Travel Plans Continue
I had to postpone my March trip to Tambor Bay, but hopefully by the time of my planned May return to Arenal, I will be able to travel just like always if radiation schedules don’t interfere! 🙂
For any readers who are also facing cancer, I want to recommend the following website and encourage you to stay positive and continue life as I will with the same kind of travel and nature blog posts right here at Retired in Costa Rica!
