Tag: doctor

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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!
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Getting an X-Ray Here

Clinica Santa Fe in Alajuela where I went for my foot X-ray

Clinica Linea Vital in Atenas where I see Drs. Candy and Anna. (Google Photo)

Okay – I’ll try to make a long story short. The last two weeks my right heel has been painful to walk on, especially during the night (getting up to go to bathroom) and when I first arise in morning. (I’m afraid it is because I have been living in sandals for 9 months, walking everywhere in them. Now I’m using walking shoes with a heel cushion.) Dr. Candy looked at it maybe two weeks ago and gave me an anti-inflammatory which worked great during the 1 week I was taking it. Then the pain came back. So I return and was surprised she now has an associate, Dr. Anna who was on duty. (Yeah, I know, all my docs are women here, including the dentist!)  🙂  Anyway, Dr. Anna questioned me and felt of it an said she believed it is a bone spur on my heel (plantillo espolon). In addition to a different medication I am to take 3 times a day for two weeks and soaking my foot in warm Epsom salt water followed by ice cold water daily, I was asked to go get an x-ray (de rayos x or imagen radiológica). She wrote the prescription and said her assistant at the front desk would give directions (he is also a nurse and EMT and ambulance driver – 2nd photo at Clinica Linea Vital with ambulance). This is all happening yesterday morning.

The Map  –  In case you need
to go to Clinica Santa Fe, Alajuela
🙂
He told me there was a place in Atenas for an x-ray, but he did not recommend it and that it would be better if I went to Alajuela, our province capital, where I go by bus regularly anyway. (I did not ask what was wrong with the place here in Atenas.) So I ask him for an address (Silly me! There are no addresses here.). First he said it is easy to find, just opposite Santamaria Park (as I give him that blank stare and say “Not Parque Central which I know?”). So then he drew one map and decided it was not good enough and drew a second map of how to get to it from the bus station (parada de autobús) of Atenas in Alajuela. Perfecto! I call for an appointment and she did not speak English, so I hand phone to my EMT and he learns an appointment is not necessary, just walk in. Gracias! Adios Amigo!
So, I walk straight to our bus station here and when I get to Alajuela his directions easily take me straight to the Clinica Santa Fe in top photo. It is about four blocks from the bus station near Parque Juan Santamaria which I will tell you about tomorrow! I walked in at about 11:20, was x-rayed before 12, but told they had a lunch break and to come back at 1:00 for my film. So I went to eat a quesadilla, check out the park that is new to me, and some public art I found. Back in clinic at 12:55 and she handed me my x-ray film to take to my doctor. I had already paid the 14,000 colones or $28 USD for the pictures of both heels. (Bet your insurance company pays more than that in the states!) I rush back to bus station but just missed the 1:00. (Buses are the only thing punctual here.) Since the next bus was not until 2:00, I took a $2 taxi to PriceSmart for some items I was needing and another more expensive taxi all the way back to Atenas (20 miles) with my large shopping load and home by 2:00. My Alajuela driver I now call personally, is named Carlos and loves to help me with my Spanish and will drive me all the way to Atenas for a little more than $20. Not bad! And still a lot cheaper than owning a car! 
Carlos stops by the Atenas clinic where I leave the x-ray film and then home for the rest of the day, I think. I have been so busy lately I can’t remember how my days stay so full. Glad I cancelled the Manzanillo trip. I’ll share more about Alajuela the next two days, a really interesting city. 
And that is how we do x-rays in Costa Rica!  🙂    Pura Vida!

“The art of medicine is in amusing a patient while nature affects the cure.”  
~Voltaire
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Doctor & Dentist in 2 Days

Well, I keep meaning to ask Dr. Candy (my primary care doctor) to recommend one of the many

Oficina de Dra. Karina Valerio Rodriguez

local dentists or dental clinics. How do I choose? Some have shiny new offices, speak English and most of their patients are expats and dental tourists – yes, that is what they are called. Americans and Canadians come here to get dental work done at a fraction of the cost in the states even with insurance. And do a little tourism while they are at it! There are many more in San Jose but there are some here. The English-speaking clinics charge a lot more than the local Spanish language dentists. So how do I choose?

I finally got another excuse to see Dr. Candy since I seemed to have bruised my right heel walking around town in sandals. I just walked in without an appointment thinking her assistant could probably help me with both needs, but she was there and I walked right into her office. They check my vitals, feel of my heel and she says I have some inflammation and gives me 7 anti-inflammatory capsules to take one a day for a week then come back in to see her. In two days my heel quit hurting, but I’m taking all the med and will see her next Wednesday. No charge for anything because I am a member of her clinic now at $42 a month. I have unlimited visits with all meds and supplies included and ambulance service. Her assistants are both EMTs and they have their own ambulance. 🙂 I’ll have to get photos and show her office later.

Then I told her that it was time for a dental check up and teeth cleaning. Would she recommend someone? She said, “Sure!” (She treats me like she’s my mother and is quite direct about some things.) “I think you should see Dr. Karinna just around the corner.” That dental clinic is just a half block from Su Espacio where I have my main Spanish lessons and David, my Spanish teacher, was delighted when he learned this. Dr. Karinna is a dentist the locals use and she speaks only Spanish. “And,” he said, “She charges half what the English speakers charge.” David is not only very price-conscious, but is always trying to put me in situations where I have to speak Spanish (like the barber he sent me to). And that might have been part of Dr. Candy’s motivation for the choice. Candy speaks good English but knows I’m studying Spanish and need to learn and use it.

So, I walk down to the dental clinic and walk in, ask for an appointment and get it for the next day at 1:00. It was a delightful experience with only essential communication needed in Spanish, but then one can’t talk much at the dentist anyway!  🙂  A complete checkup (no x-rays) and a very thorough teeth cleaning by the dentist herself in maybe 45 minutes at a total cost of 18,000 colones which at today’s conversion rate is $33.97 USD. Not bad!  🙂  I told her I would return in six months, Retorno en seis meses. So, one more routine is now transferred to my new country and culture!  I’m settling in!  🙂  And I got her email address for my Nashville dentist to email her my records. Pretty cool!

Telling more briefly about my new dentist in Spanish on Aprendo Español en Atenas.

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I Have a Bee-ruus

I’m beginning to learn how Costa Ricans speak Spanish. I went to Dr. Candy today sick. Though she speaks perfect English and pronounced “virus” the way we do in the states, her assistant in the office and my taxista pronounced it “bee-ruus.” There is not a Spanish word for virus, so they use the English word with local pronunciation. Although there is a separate “V” sound in Spanish, a little more lispy than in English, most in Central America pronounce it like “B.” All “I’s” are pronounced like a long E and most “U’s” are pronounced like uuuu. Languages are fun!

I have meds and electrolytes to take and a list of what foods I can eat and not eat. So I should feel better soon. I am to go back if not better by Thursday. Medical care here is done very well, just mostly in Spanish!   🙂

Since all my posts have photos, here’s an unrelated butterfly shot made recently:

Colored like a Duskywing and tail like a Swallowtail but no match so far!
And a green head! If you know what it is, please contact me!
charlie@charliedoggett.net
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El Doctor y Farmacia Today

Now I have an English-speaking doctor, Dr. Candy, a caring and perceptive medical doctor less than a mile from the apartments or maybe one mile. I have her number and can call at any time. She has a lot of local patients but also does a lot with expats and tourists when needed and on call anytime. The visit and examination, diagnosis, and suggested treatment cost only $50 USD, while the four prescriptions cost a little more than that. Plus I must ride in Taxi’s and not walk until I’m breathing better she prescribed.

I have something like bronchitis that could develop into pneumonia, thus antibiotics for 5 days and see how I’m doing. Plus I got one of those bronchial breathing things, cough syrup, and something else to help clear out the phlegm.

My intention was to go from her office to a place I can buy a sim card for my phone, but she said no, get meds and go home and rest. So I am resting on a hot afternoon, but not using a/c, just staying on east side of apartment. Nights are very cool and use at least a blanket with window open.

So much more to tell and share, but one little bit at a time. Today I had soup from the Quebec couple above again and my next door neighbors from Switzerland made my doctor appointment. My friends from tour, Mark & Tina will be back the 1st. 

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Waterfalls, Great Kiskadee, and Sickness

This morning’s veranda tea included watching two Great Kiskadees land in the tree next to my neighbor’s apartment along with hearing a flock of parakeets and many other birds, most small and hard to see, plus speed will make it difficult at times as with the speeding toucans yesterday.

I’m staying in bed 9 to 11 hours each night and trying to rest. There was surely a public clinic open over the holidays, but the English-speaking doctor my neighbor knows about is not open until tomorrow morning  (Monday), when I will take a cab to see him.

The first three days I walked up the steep hill to town for groceries and to eat. I did not yesterday nor today, though the fresh air and sunshine might have helped. I did walk across the big yard in front of the apartments to the Rio Cajon, our southern boundary, and photographed some of the waterfalls in our yard.

The first two photos are inside the property and the third just outside the gate on the landmark Rio Cajon Bridge in Barrio Fatima, our neighborhood name, which helps taxi drivers find us. There are not house numbers here, no street addresses, no home delivery of mail. And oh yes, I know better than to photograph in midday sun, but did anyway.  🙂

This is upper part of the one below,
seen from a different angle.

Plunge pool view of above double falls.

The double falls at our entrance gate by the public bridge over Rio Cajon
Last night the Quebec couple invited me to go to dinner with them and then invited to local girls who of course had a big SUV, one being a doctor’s wife, the other her twin sister. The place they wanted to take us was not open (they take holidays seriously here!) so we ended up at Antano just off the main plaza downtown which is where I had eaten lunch the previous day, but well worth a repeat! 
A fun evening even if I don’t feel well. I did not try to go to church this morning because I was feeling worse at the time and pretty lousy right now. It is sore throat, some coughing, some sneezing, runny nose, and achy body all over. It started before I left Nashville. I’m taking Tylenol and two kinds of throat lozenges Millie Goodson got for me the night before leaving. Thanks Millie! They help!
Today I met another resident from Switzerland who is married to the girl from Spain. We are a pretty international group in these apartments! And oh yes, last night in the restaurant an American looking woman came over to our table and said, “I just must find out where this southern drawl is from!” I smiled and said “Nashville” and then learned her and her husband are from North Carolina and have lived here for 9 years. She still works as a photographer, doing weddings and children portraits. Got their phone numbers to call if I ever need help. So it is starting to happen like I expected even without going to church yet. 
Well, this first long post just wore me out. Pray for a quick resolution of my cold, allergies, flu or whatever!