Tag: cardiologist

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New Hospital Adventures

Hospital San Rafael de Alajuela, Costa Rica

Adventure 1: New Cardiologist Scheduled

It was time for my one-year checkup with my public hospital cardiologist yesterday, 27 Agosto, made by the doctor one year ago, Dr. Hernandez. In the meantime I heard around June from someone else with the same cardiologist that Dr. Hernandez (whom I really liked) had gone to Spain to study heart surgery and I would be getting his substitute whom the other person also liked very much, especially because he spoke English! So I was already expecting a new doctor, whom I learned today is Victor Andres Garcia Rojas (called Dr. Garcia) – and I will do another article below on Spanish Names using his.

Adventure 2: I Forgot Pre-appointment Blood Tests

Yeah! No good excuse! It was on my calendar that I wasn’t watching and I forgot that appointment a week earlier. The results were to be with the doc by yesterday so they would be part of his evaluation of my heart. I rationalized and said, “oh well, he will reschedule that and add to my file later. No big deal! Pura vida!”  Well, it is a big deal! Hospitals are very serious!

So I wait in the adultos major line (for old people & shorter than other line) for about 30 minutes. When I get to the desk there is suddenly a computer problem with a bunch of supervisor types coming in to explain something on the computers to all the clerks. Then finally my clerk takes my cita (appointment paper) and my cedula (ID card) and starts to check me in and I casually tell her about forgetting the appointment for blood workup. She stares at me, shakes her head and tells me she is sorry (this is all in Spanish of course) but “the doctor cannot see you without the blood tests.” Thus she makes a new appointment for me with Dr. Garcia on September 5 (Whew! I leave Sept. 6 for my Caribe trip!) Then, with multiple attempts, she explains to me that I must go down to main lobby (photo at top) and wait in line at the laboratorio for a new appointment and show them that it is needed for a Sept. 5 doctor visit. By then I remember waiting in that line a year ago for the missed appointment. My punishment for living a pura vida life!  🙂

So back downstairs to that crowd in top photo and actually the laboratory line was not as long as some of the others. I had my new lab appointment for this Friday in less than 45 minutes! This girl was not as slow a speaker or as patient with my bad Spanish and so she used her phone translator some with me, though I was understanding more of her Spanish than she thought. Language is all part of the adventure!

So now, (with all the complaints about slowness in public healthcare), I’m doing blood workup this Friday (just 4 days later!) and I see the doctor next Wednesday! Pretty fast I think! And this delay is the fault of my forgetfulness or not setting the phone calendar alarm on my lab appointment! Now I get to go back to the hospital two more times (More adventures!). And I will remember to fast 12 hours before my 6am appointment Friday!  Aren’t I lucky?    🙂

Adventure 3: Spanish Names – Why 4?

Be aware that this can be slightly different from country to country, but for the Costa Rica explanation I will use Dr. Garcia as my example:

Dr. Victor Andres Garcia Rojas

Victor = First Name;     Andres=Second or Middle Name;

Garcia=His Father’s Last Name;     Rojas=His Mother’s Last Name (maiden name)

Most people go by their father’s last name, thus he is “Dr. Garcia.” But on legal documents and other places they use all four names, like on the Cedula (ID Card) and in the hospital. Since I have only 3 names, the hospital or national healthcare program has given me a fourth name that is on all my hospital records = “Noindicaotro” as a replacement for my Mother’s last name. Interesting since it is not a word in my Spanish Dictionary!   🙂

Adventure 4: Talkative Old Man on Bus

On the bus ride back to Atenas (45+ minutes) I sat next to a very talkative man who did not stop talking and even singing the entire trip. It was mostly in Spanish with an occasional English word or phrase to show me that he knew some English. I had a crick in my neck when I got home for having my head turned to the left the whole trip. And no, what he said was not very interesting, but I appreciated his friendliness and I guess he appreciated me listening attentively.   🙂

 

¡Pura Vida!

 

 

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Cardiology Doctor Visit Today

So, I waited over an hour but that included having my blood pressure checked, being weighed and measured, and an EKG. I waited longer than that for docs in Nashville I was paying big bucks for! This did not cost me a penny under the government healthcare plan call CAJA (an acrostic for something). Medicare for All is what you guys in the states should do. And as a Senior Adult (adulto mayor) I rode the bus to and from Alajuela for free! They treat us old people nice in Costa Rica, even foreigners! I do pay a monthly fee for CAJA kind of like we do for Medicare in the States and for me about the same price. BUT, this pays 100% of everything, doctors, hospitals, surgeries, procedures, prescriptions!

As I already knew, my arteries were shown to be clear in the angiogram I had in August. I have an appointment (cita) to see Dr. Hernandez (el cardiólogo) again in August 2018 with a separate appointment for the lab 10 days before to get my blood analyzed. And enough prescriptions to keep me on Atenolol & baby aspirin until then. Both Rxs are free for me but I need a new paper prescription each month, only one month at a time supply allowed!—so the doc gave me 10 prescriptions!  🙂   I get them filled at our local CAJA Clinic here in Atenas Central. 

Now back to birding and other fun retirement activities. Life is good! And a trip next week which you will soon hear about! 


🙂
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First Visit to Hospital Mexico

Hospital Mexico Entrance
It is the largest public hospital in Costa Rica and where most serious
surgeries, tests, and treatments take place; “The Mother Ship” if you please.
There’s a tall building behind this with all the rooms, etc. 

My primary hospital is Hospital Alajuela where I have been seeing a cardiologist (cardiólogo) who now wants a picture of my arteries, an angiogram. Well the only public hospital with equipment for that is the main hospital, Hospital Mexico (named that because it is located in the Barrio México or neighborhood called “Mexico”). It is a huge hospital with lots of doctors, specialists and the ability to do just about anything any hospital can do! And it is paid for by the government healthcare program! I will never have a co-pay or any bill from either on of my two government hospitals. I’m very pleased with my healthcare here and my private options should I ever need them. Just be happier when I can speak better Spanish!  🙂

TODAY – 3 April
I had an appointment to get an appointment. I had to wait and go to three different people which only took an hour which is not bad in a bureaucratic government hospital. One of those was a lady who just created a file on me at that hospital, just like I had to do at Alajuela Hospital to get started there. I’m now one of their patients.
17 April
I have an appointment there with one of their cardiologists who will review the files I have from Alajuela and see if he agrees that I need an angiogram. If so, I assume he tells one of the girls to schedule it. That is two weeks from today which is really not bad. 
Later – Maybe this year or next
I go in for an angiogram (if approved) – Actually I think it will be earlier because I’m gathering that cardiology is considered more urgent, but it could still be 2 months away. We will see.  🙂
Technically, this is my second visit to Hospital Mexico, I did go there briefly in January 2016 on the Healthcare Tour of Costa Rica – which I recommend!

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Doctor Visits

CARDIOLOGIST
Monday I had my first follow-up visit with my CAJA (government healthcare program) at Alajuela Hospital where my cardiologist did another EKG and a ultrasound of my heart. Then he personally monitored a treadmill test of my heart followed by another ultrasound he monitored. It was amazing to me that I was in and out of there in 45 minutes. He told me that the only other test he would like to have on me is an angiogram which he could not order until he consulted at least one other cardiologist there in the Alajuela Hospital because there is not much indication that I would have any blockage. He said he would call if it was approved and then I would have to go to Hospital Mexico in San Jose, which is the only one with the equipment to do an angiogram. It is the primary or main hospital for Costa Rica CAJA or government healthcare.

Well, his technician called me today y hablando sólo en Español. We both struggled through but basically I have to go back anytime tomorrow and get some “documentation” or paperwork from them in Alajuela to take to Hospital Mexico for an appointment for the angiogram. If I understood her correctly, my Mexico appointment is April 10 at 10 AM, but not clear yet if that is when I get the angiogram or, if like most things here, I may just be making an appointment for one much later. I should find out tomorrow.

This is how “single payer” or government or what Americans like to call “socialized medicine” works with priorities given to more serious things, emergencies, etc. It took two months for my first appointment with my cardiologist. No problem for me to wait for this as I don’t believe I have a serious problem. Best of all: No more cost for me now that I have a CAJA card, even if it led to the unlikely case of heart surgery.  I will keep you posted. Dr. Hernandez is basically building a file on me and my heart for any future needs and trying to be responsible for my heart. I appreciate that!

DENTIST
Today I visited my dentist who also speaks only Español and we managed fine for my annual teeth cleaning and checkup by the dentist herself and not a technician. She says once a year is fine and not the every 6 months U.S. dentists request to increase their income. She found the need for one tiny filling which I’m scheduled to get next Tuesday. And that is it for a year! And cheap! Many Americans come here for dental work to save thousands of dollars in what is sometimes called “medical tourism” or even “dental tourism.” A friend in Tennessee has come here twice for his dental work and saved a lot more than his plane ticket and hotel bill. That is for big work like bridges and caps.

Someday I will think about taking a photo at one of these places! It just hasn’t been on my mind with everything else to do like getting there and communicating!  🙂

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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!

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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!