Sick and Alone in Mexico

I doubt many of us are really prepared for the serious medical emergency while we are traveling. No matter how well prepared or how seasoned a traveler, when the doctors say “surgery,” you quake inside.

One Saturday evening in my second week on Oaxaca, I became doubled up with intestinal cramps and pain that lasted all night. It let up a bit and so I waited till Monday to go to the doctor. He listened to my symptoms and said “amoeba.” I took the prescribed meds and nothing changed. The pain was acute.

I found another doctor who again treated me for amoeba, and still there was no change. Now it was getting worrisome, and I was getting scared. After a series of tested, including a colonoscopy which could not be finished because of severe and infected blockage, my doctor started mention “surgery.”

This is when the alone part of traveling alone became an issue. First, of course, alone is not the way to be for a medical emergency, especially one that takes you into the finer workings of a foreign medical system. You need someone to talk to and to go to the doctor’s with you, because in the circumstances, your judgement may not really be the best. Hand holding is called for, and someone to talk you off the ledge of extreme fear. Someone soothing who will both let you cry and talk you out of weeping.

Second, in many countries, including Mexico, you are expected to have someone at the hospital with you, and someone to care for you post-operation. Of course everyone back home is working, or if they aren’t, like say a young adult grandson, they don’t have a passport. I checked in with everyone. I got lots of sympathy and concern and apologies for not being available, but it isn’t the same and doesn’t help you with the practicalities of recovery.

So here I was alone and afraid. Between the pain fear, I was crying a lot. A neighbor helped me some with diagnostic appointments, which was helpful, but I didn’t really know her. I sure could not ask her to help me through the whole process.

But it ended up not being necessary to have help this time. My condition started improving, which seems to have had something to do with the total cleansing necessary for the aborted colonoscopy. Between the colonoscopy and a cat scan a few days later, I had started healing. It was then that the doctor told me he had been convinced it was cancer, but it wasn’t, and I was healing well.

This, of course, has been a learning experience. I guess the most important consideration is whether or not you are comfortable having surgery in a developing country. If my cat scan had shown the same condition that the colonoscopy did, then for sure they would have wanted to operate pretty immediately. To go to the US for the surgery, where I have no established relationship with a doctor or medical system, would have postponed things for too long. But everyone was encouraging me to do just that. My doctor assured me that the surgeon here was excellent, and I have been assured by many that the hospital is very good.

Insurance is another issue. For me, at least. I travel “bareback,” meaning I have no medical insurance except for Medicare in the US. Self insuring is good for doctor’s visits and such, but surgery is a different story. My doctor told me the whole thing would be under $2000 US. I have set aside savings with exactly this eventuality in mind. Fortunately all of the testing and the doctor’s visits came to under $300.

I was extremely lucky. First and foremost because I found a doctor who had trained in the US, and who had grown up there. He has practiced in Oaxaca for over 20 years, so he is totally integrated, and integral to, the local medical establishment. His English is spoken with no accent and he understands the needs of American patients. In case you find yourself needing a doctor in Oaxaca, his name is Alberto Zamacona, and most call him Doctor Z.

I was lucky beyond what I every could have expected by having recovered without having surgery. For that I am grateful both to the ministrations of my doctor, and to my excellent immune system. I have been stunned by my recovery.

So, that was my month in Oaxaca. Now I have a couple of weeks left to enjoy the beautiful city and get acquainted with more than the medical system.

I Beat Cholesterol. It Really Does Come Down to Diet and Exercise

Yes. I am astonished. I had no idea. For years my doctors have told me to take statins to lower my sky high cholesterol. I even tried once, about 12 or so years ago, and had a miserable side effect-Burning Mouth Syndrome. My mouth and lips were on fire. To add to my misery, I was living in South Korea at the time, and the good food there is spicy hot. I could only eat bland food, and I was still miserable. That was the end of my experience with statins. I figured with diet and exercise I could control the numbers, but I wasn´t disciplined enough about either. Well, I have spent long periods of time when I have swum a lot and hiking and biking, but the numbers only got worse.

Losing weight is really hard and my weight was in a range where I didn´t really feel a great compulsion to suffer. Besides, all my other heart and health factors have been good. I take thyroid medication and have for many years, but that is all. I´m fairly strong and fit, so I have just suffered the reminders every couple of years that my blood was fatty. And then I would forget and go get another of those lovely Thai sausages.

My only limiting issue has been my knees, which have endured every sort of insult from skiing accidents, 10 K races and daily runs till I was told to stop, falls, and even torn menisci from swimming (breast stroke with frog kick, bad news for knees). My orthopedic surgeon in Bangkok, treating my knees after some serious damage done in Nepal, which resulted in a fall and a broken foot, told me, many times in fact, that the best thing I could do for the knees was lose weight and strengthen my quads. But, I whinged, I am trying to lose weight, and I am always hungry, and I don´t seem to lose anything but my temper. Kindly Thai doctor that he is, he told me that suffering from hunger is a very good thing because it helps you sympathize with the hungry of the world.  I exercised more once I was back on my feet, but my knees hurt and my weight stubbornly increased.

I think most of us of a certain age have heard it: lose weight and all of your health factors will improve. It is good for the blood pressure, cholesterol, aging joints, yada yada. But there is no magic bullet to improve these things, right? It is just a matter of age, and I have felt lucky that my only real problem was my knees. Well, and those nasty cholesterol numbers.

So, what happened that my most recent cholesterol test came back with results in the excellent range, without the use of medications?

As my few darling regular readers know, I headed out at the end of January, with a back pack and a small pension, to explore South America. I have been traveling by bus and in the 4 wheel drive truck of some friends I met along the way. I have hiked my way around major cities and little villages. I have walked for hours every day. And meals have been what can be grabbed along the way, and what fit on my budget. In South America the big meal of the day is between about 1 and 3 in the afternoon. I fell into the habit of eating then and either skipping dinner or just having a snack. My evening meal shrank and disappeared. I accidentally fell into the habit of intermittent fasting before I knew it was a thing. The new diet science (fad of the day?) suggests that if you limit your eating to a 8-12 hour period each day (there is disagreement on exactly how long) you will lose weight even if you eat the same as you would in a normal day. New research indicates that it can be as long as 12 hours. I was doing my eating most days within a 6-8 hour time period.

Last month in Cuzco I started having tingling in my lips when I walked for very far, and soon it spread to my whole right side. It got gradually worse, and finally in Antigua, Guatemala, I went to see a doctor. I was convinced that my high cholesterol had finally caught up with me, and I was going to have a stroke or a blood clot. I was scared to get on my next flight. The doc ordered up lots of tests, and I went back to the hotel and skipped eggs at breakfast. I figured I was going to have to give them up anyway.

The doc and I went over the results. Blood pressure, slightly high but okay, as I was stressed and my BP is normally a bit low. Clotting factors, okay. All other blood work, just fine. Sugars, fine. Cholesterol levels? In the mother fíng excellent range! Damn. I haven´t ever, since having it checked for the first time, had such good numbers. Oh, and I had lost almost 30 pounds! I knew I had lost weight, as my clothes were really not fitting and I had had to buy a new belt to hold my pants up, but, wow! I had not been on a diet. I had just changed my habits to accommodate constant travel.

The immediate problem, the tingling and right side numbness, seems to be my thyroid, and that medicine has now been adjusted. So I am still only on thyroid medication, and I am not taking statins. I am so thrilled I never started them.

So, my friends, it is possible to get cholesterol under control with diet and exercise. I personally think the weight loss and exercise are the most important aspects, because I have been eating eggs and pork all summer, but only in that 6-10 hour window of time. I would highly recommend taking a year off and trekking the world. But of course, that is not practical for everyone, and it is not practically as a lifelong life style. Going forward I will have to manage the exercise and diet while not traveling. But at least I now know that it works, and that I really must make that commitment.

 

Latin America

map_samerica

http://www.gilgordon.com/resources/samerica.htm

It’s huge, and covers a continent and then some. I’ll be traveling around Latin America next year and checking out potential retirement spots. Fortunately in the 21st century a lot of the leg work can be done online. This I’ve been doing for the last couple of years.

I have criteria I’ve been rather loosely applying as I’ve been researching. Concern for affordable health insurance and health care has risen on my list, but the basics remain the same, and the bottom line is being able to live on my Social Security of $1300 a month (plus whatever extra income I can generate).

Here is my current short list:

Mexico

mexico

 http://www.trllavk.tk/map-of-mexico/

Mexico meets a lot of my criteria. Unfortunately, there are rather high financial requirements for a permanent visa, and legal status is required for the national health plan. There are other plusses and minuses, and I’ll be spending time there and filing a full report.

Guatemala

mapcentralamerica

http://www.infoplease.com/atlas/centralamerica.html

Guatemala has risen on my personal list because the visa financial requirements are quite doable, there is good quality affordable health care, and it’s close to Mexico and the US.. Antigua and Lake Atitlan seem to be two favorite spots due to their climate and beauty. Guatemala City may be getting better, but it has a reputation for danger.I plan to spend some time in Guatemala.

Nicaragua

This is another country with low entrance and residency barriers. The health care is reportedly good and affordable. The cost of living is cheap, and they are some beautiful locations. It hasn’t risen to a must visit yet, but I am paying attention.

Panama

Panama offers the best package for retirees. The communities that meet my criteria in terms of climate and size tend to be more expensive than Nicaragua, Guatemala and Mexico. The medical care is reputed to be excellent. Panama City is a cosmopolitan city, with a challenging climate. Like Nicaragua, I am still researching Panama, and it does have a lot to offer.

Columbia

colomb

http://www.infoplease.com/atlas/country/colombia.html

I met someone recently who convinced me that Columbia would be an excellent choice. The visa requirements are quite reasonable. There is very good health care and a national health plan. The cost of living is low, there are great beaches and old colonial towns and cities. Medellin gets good reviews, though it is a big city and I am not convinced that it is as safe as it is lauded these days. I do plan to visit and check it out.

Ecuador

ecuador

http://www.infoplease.com/atlas/country/ecuador.html

There are many publications these days that rate potential expat retirement locations. The income requirements for a visa are quite reasonable. Cuenca Ecuador often tops these lists. In the mountains, it has a springlike climate. There are a lot of expats living in this colonial city. Health care is both excellent and affordable, with a national health plan available to legal residents for about $80 a month. Personally, I am not so keen on the “lots of expats” part of it, and will probably be more interested in places where there is a smaller presence of us. I’ll be checking out Ecuador and will be reporting back.

Next time I’ll go through the map and talk about what places I’ve ruled out and why. Maybe something will move up to my short list, and something else may fall off. I can’t wait to get started!

Health Care as an Expat: Insurance or No Insurance?

bum

This is the sort of room I stayed in last fall at Bumrungrad Hospital when I got food poisoning in Bangkok. There was another bed and another guest in the room (an old Thai woman whose family never left her side), but I had space and a sofa for the guests who didn’t come to see me.

I arrived at 1:00 AM after getting sick in my hotel room and hailing a taxi for the hospital. I was taken to the emergency room where I was pretty promptly seen by a doctor (the promptness may have been facilitated by my screaming in abdominal pain). I was given morphine and that stopped the screams quite nicely. Then I was examined and taken to a room like the one above. I did have insurance from my job in Bangladesh, and regularly visit Bumrungrad for medical stuff when I live in SE Asia, so check in was quite straight forward.

I was there for two nights and attended to pretty constantly. My check out bill was less that $100 US. Of course, without insurance it would have been much higher.

So, what is it like if you have no insurance?

Here is information about real costs at Bumrungrad from their website:

https://www.bumrungrad.com/en/realcost-thailand-surgery/final-bill-estimate-surgery-cost-pricing?Pid=7305&RealCostPid=450

Procedure:
Total Knee Replacement
REALCOST estimates are based on the actual invoices patients paid upon leaving our hospital. They include surgical fees, doctor’s fees, medicine, lab tests, room fees… the total bill for the incident of care.
 
 
BASED ON DATA: January 2014 – December 2014
CURRENCY: USD US Dollar
Median: THB 479,452 (USD 13,382)
Low: THB 451,417 (USD 12,599)
Only about 1 in 4 cases
cost less than this.
High: THB 535,786 (USD 14,954)
Only about 1 in 4 cases
cost more than this.
Here is a comparison of costs in different countries: (http://www.kneereplacementcosts.com)
Country Price (estimates)
Total Replacement Partial Replacement
U.S. $35,000 $17,000
Thailand $15,000 $7,000
Costa Rica $12,000 $6,000
Mexico $9,000 $5,000
India $7,000 $4,000
 No Insurance, or “going naked”:
Going without insurance. to my thinking, is only feasible if you have a reasonably good pension, and/or good investment income. On $1300 a month and a very modest savings, this is not an option for me. I’m fine now, but I’m not 85. We all should know that our health care costs will really go up as we get older.
I’m currently researching countries where there are good affordable health care programs available to expats. So far I’ve been looking at countries in Latin America, and some have great programs. In Columbia and Ecuador, you can get national health insurance and good health care for $100 a month or less. In Nicaragua you can join a hospital cooperative and get good care for a reasonable cost. This week I’ll be doing my homework, as I get my knees checked out in Melbourne, Australia. This is the reason for good insurance – I am sure I am in for some shocking numbers on my knee problems, and will probably appropriately postpone work till I am settled somewhere with insurance.