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Another Gauntlet of Doctors

This happened the week before my cancer surgery and now it has started again two weeks before the beginning of my radiation treatments – tiring – hard to keep up with – but necessary!

1. Today, First of 3 Dental Appointments

Those who have experienced radiation know that you cannot have any dental work done after radiation for a long time, especially no tooth pulled because the radiation does something to keep the hole from a pulled tooth from healing. Hopefully none will need to be pulled! 🙂

  • Today (Monday) – teeth cleaned and checked out with two tiny cavities found visually that she will fill this Friday. She also ordered a panoramic X-ray of my teeth from the Dental Radiologist one block away where I went next to make my appointment.
  • Thursday – Teeth X-rayed when I will take the resulting X-ray back to Dr. Karina for her to study and see if there are other problems we should take care of before radiation.
  • Friday – I return to Dr. Karina for the two known fillings and anything else she finds on the x-rays.

2. Tomorrow, Tuesday – Appointment with Ophthalmologist

This is Dr. Raquel Benavides whom I saw in the hospital and Dr. Hernandez (my oncology surgeon) recommends to see if anything can be done to help my eyelid that will not close now or blink. He thinks she can “stich” the eyelid mostly closed to a sort of squint so that I will not have to keep it covered and can still see with it. Hmmm, I’m not convinced of that yet but maybe she will convince me or have some other solution other than an eyepatch. I’ll find out tomorrow and expect almost anything to come after radiation is completed.

3. Tomorrow, Tuesday – Appointment with Oncology Surgeon

This will be my 3rd “follow-up” or “post-op” visit to the surgeon, Dr. Christian Hernández. He wants to check on the healing of the long incision and the swelling on my left face and neck. Plus he said he wants to hear what the Ophthalmologist says. 🙂 He must not have a mouth specialist friend who can fix one-sided smiles! 🙂 He encouraged me earlier to go ahead and shave on the left side, but because it is tender and sensitive I only lightly run the electric razor over the left cheek and even more lightly on the left side of my neck which is more swollen and more sensitive. So I am not back to normal yet, skin-wise. The pain is less now in the ear and jaw, but still some and I’m now taking an over the counter acetaphetamine locally popular called Panadol.

4. Wednesday – Seeing my Dermatologist as Pre-scheduled

The last time I saw him, Dr. Roberto Gamboa, was when he sent me to Dr. Hernández to take care of the tumor which I will now have to tell him came from that skin cancer he removed in MOHS surgery which is supposed to mean they got it all. Well . . . cancer roots go deep! At that last visit he also treated a little skin cancer on my upper lip which was a black spot on my lip in some of my cancer selfie photos. (I was putting a very expensive anti-cancer medication on it once a day for 20 days.) That scab is gone now and supposedly the little cancer there. Of course he will be checking for any more and he often burns bumps off my skin with nitrogen. He is also my “traveling buddy” who likes nature lodges all over Costa Rica like me. He is the one who recommended Bosque del Cabo Lodge where I’m going the first week of July and earlier got me hooked on El Silencio Lodge I’ve visited twice now! Hopefully he finds no new skin cancers this visit. And maybe the best thing is that he is located in nearby Alajuela rather than far-away San Jose! 🙂 A much quicker and easier drive!

5. Next Monday – MRI at the Lindora Campus of Hospital Metropolitano

This MRI is for the Radiotherapists to help them target the cancer cells in my head, especially in the nerves since the cancer was in the left facial nerve. The best thing about this is that it is in a suburb on this side of San Jose, Lindora, and secondly in the only hospital that takes my Medismart Card for a big discount, as does the Radioterapia Siglo XXI I’m using and thus they are sort of Medismart partners. 🙂 It will take only about an hour with a little less than an hour each way traveling, so not as tiring as going to San Jose.

6. Next Tuesday – CT Scan and Mask-making at Radioterapia Siglo XXI

I assume that the MRI and CT Scan show different things that they need, thus I’m getting both in preparation for the radiotherapy. Both of these will be in San Jose at the Radioterapia Siglo XXI building where I will spend a lot of time the next month and a half.

7. Begin Radiotherapy in San Jose

This is the long-haul treatment of cancer, radiotherapy 5 days a week for 6 weeks and they guarantee that you will be tired at the end – enough so that they encourage you to plan no activities for the following 4 week or in my case, the month of June. It will take place in central or north-central San Jose at Radioterapia Siglo XXI, the only private radiation company in Costa Rica with only one place for the public healthcare patients to get it at Hospital Mexico. I chose to pay for private because it could be quicker, with often very long waits in the public healthcare system and because my oncologist strongly recommended it because of the size of the cancer.

As I shared in an earlier post, I am now planning to travel to San Jose each Monday and return to Atenas on Fridays, staying in a hotel near the therapy location. Even though someone else will be driving, I dislike the long, high-traffic drive that at peaks can be 2 hours between Atenas and San Jose. As long as I feel like it, I will even add a tour or two each week to something of interest in San Jose like some wonderful museums and parks plus history and architecture that interests me and may give photo ops, though many museums restrict photographs. Otherwise I will be pampered with all meals, room cleaning, Wifi, and hotel gardens to relax in between treatments. I will try to turn radiation into a relaxed and colorful, tropical vacation in the center of Costa Rica! 🙂

¡Pura Vida!

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Happy Easter!

Its a beautiful sunny day in Atenas, Costa Rica for Easter Morning with the Yigüirro singing his heart out for the rains to come (any day now) though I cannot photograph him or any birds for several weeks now because of the high winds. The birds are hiding in the thick trees for protection from the wind. Thus I resort to Easter Flower Photos! 🙂

And our online English language newspaper Tico Times also wishes you a Happy Easter with a photo of the oldest church in Costa Rica. It is a beautiful historical place that I have visited once (my gallery link) in the Orosi Valley. The Ruins of Ujarras (Wikipedia link) is the site of Costa Rica’s oldest church, the Spanish colonial church built between 1575 and 1580 . . .

One of my photos of The Ruins of Ujarras in Orosi Valley

Happy Easter!

He Arose!

¡Pura Vida!

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Remembering 6+ Years in Costa Rica

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.”

~Unknown

¡Pura Vida!

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1st Covid Shot – No April Fool’s Joke!

Today (April 1) is the day that our local Atenas Public Clinic & Social Security had scheduled me for the Coronavirus COVID19 Vaccination at 1 PM and I got it right on time! I earlier asked the radiation doctor if the vaccine would be any conflict with what they will be doing and was told “no”, thus continued as scheduled.

In Costa Rica they started vaccinating with healthcare workers and first responders, then the many here in their 100’s, the 90’s and 80’s, just now getting to us who are exactly 80 year olds this week. So when I got to the clinic they sent me around back to a storage building that had been converted into a vaccination clinic and joined about 10 or so other 80-year-olds waiting for their vaccination too. Quick and totally painless. One of the easiest shots I ever received and a guy nurse did it! I had earlier said that girl nurses give more gentle shots, but not over this guy! 🙂 And we are getting the Pfizer type here in Atenas if that matters to anyone. They brought the shots in one at a time in a little hand cooler from the big freezer, quickly jabbed me, and asked me to wait 5 minutes for any reaction – none! My arm is not even sore! 🙂

In a Storage Building Behind the Clinic
Covid Vaccination Clinic

My vaccination card showed that I had the first shot today and that my second one is scheduled for 22 April. I asked if I could get my second shot before beginning radiation on the 19th? The poor guy went all over the place trying to find someone with the authority to change my second appointment. Finally he told me that he was sorry, but I would have to reschedule it through the Clinic by calling them (en español). I handled all of the above in my limited español, but I never do good on the phone, so I will see if Radioterapia can call them and reschedule it as an official medical person speaking Spanish.

My New Vaccination Card with only Covid on it.

Front, folded
Inside, opened

On the way home I stopped by the Farmacia for some more stick-on eye patches (I’ve internet-ordered some better black cloth ones), got some groceries before all shuts down for Easter and then grabbed a Grande Nachos from Donde Bocha and on home. I ate my nachos and then a neighbor stopped by with two desserts for my Easter Weekend and now the day is nearly gone! 🙂 And that is what a big day is like for an old man retired in Costa Rica! 🙂

¡Pura Vida!

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Radiation – The Next Adventure

For the last few days or so everything has been a “moving target” for me with an initial consultation with the radiation doctor explaining everything medically and checking me out and now we are putting a plan together with her staff and on the calendar, plus I’ve arranged to pay for it. And oh yes, this doctor is a specialist in radiation to the head and neck! 🙂 Hopefully my surgery neck swelling will soon be gone and the tender scars on my left face and neck healed better than they are now. I’m still sore and sensitive with only minor internal pain that I treat with Ibuprofen. They prefer these surgery “irritations” gone before they create new ones with radiation! 🙂

Below is their 3-step plan AND

“My Plan to Make it Fun.” 🙂

Continue reading “Radiation – The Next Adventure”
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Got My Vaccination Appointment!

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! 🙂

¡Pura Vida!

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“. . . 35 years earlier?”

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 Grit 1969 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.

¡Pura Vida!

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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!

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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.

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.

¡Hasta mañana!

¡Pura Vida!