Wednesday, February 20, 2013

Update On Recovery.....

Today marks two weeks since my total abdominal hysterectomy and I'm doing just fine.  Saw the doctor yesterday for the results of my pathology report, which showed no signs of cancer!  But he did tell me that I was lucky because the type of lesion found on my right ovary is fast growing, and would have turned into cancer soon.  And the pre-cancerous cells found in my uterus could have also potentially developed into cancer in the future. So perhaps the gut feeling that I had was right, when I decided to go ahead with the surgery as soon as possible?

The doctor also said that in all his years as a gynecologist, he's never seen anyone recover as quickly as I have.  He kept shaking his head and laughing at how easily I was moving around and giving him a hard time.  In other words I was just being my normal self.  He began writing what looked like a prescription and I asked "what's that for?"  He said "for secretions," but I protested "I don't have any secretions."  He just looked up at me and gave me that serious "doctor look" the kind that says "just do what I say."  My darling husband had to interject by saying "and I have to live with her 24/7 doctor."  The doctor smiled and said "sorry for you."  So then I shut up and said "yes doctor."  After all he did just perform a pelvic exam and perhaps noticed some secretions so using a cream at bedtime won't kill me. 

I wore a dress to the appointment since I expected to be examined and thought it would be easy to just lift up.  But I did have panties to remove and complained to the doctor that he really needed a chair to put clothes on.  He pointed to the hook on the wall which seemed like a strange place to hang my panties for all to see.  Ok so the hook was in a nook of the room and since it was just the doctor and me in the room, this really was a silly concern.  It was just the woman in me putting a feminine touch into a room designed by a man.  Or as Clyde might say I was just looking for something to complain about, perhaps just being me.

But I have noticed that after being active for a few hours I do get tired and need to rest.  Some days I've gone for the two mile morning walk with Clyde and Venus, and other days we've shopped for groceries.  And I do understand that lifting is still something that will have to wait due to internal and external stitches. So life goes on just a bit more slowly as we've completed yet another adventure.....along the gringo trail.

Friday, February 15, 2013

Flames In The Night.....


.
Chillin' on the couch after dinner when Clyde walked by the front window and said "oh s_ _ _, there's a big fire outside."  Although I'd been hearing strange popping sounds outside, I never bothered to get up and look.  This time of year in Panamá is the dry season when it's common for grass fires to pop up just about anywhere.  And since the locals love to burn trash, grass and just about anything else, the smell of smoke in the air is as common as the sound of geckos.







The fire we witnessed was in a large, empty field across the street from our neighbors house.  The flames reached high into the night sky as we stood and watched in fascination.  The old firemen in Clyde assured me that the wind was blowing in the other direction, so the flames posed no harm to us or our house.  I had to wonder if anyone else called the fire department or perhaps we should?  Clyde pulled out his phone and dialed 911 and after many rings someone answered.  He explained to the voice on the other end that his Spanish was basic and she asked "do you need an ambulance?" in Spanish of course.  He explained back that he needed the "bomberos" and she immediately transferred him to he fire department.  Once he had a firefighter on the line he explained there was a large grass fire and told him where we lived.  Within minutes we saw the blue flashing lights of a fire truck come around the corner.  They backed the truck into the field taking aim at the head of the fire, which Clyde said was the right thing to do. He was impressed with how quick they arrived and how fast they took action.  He snapped some pictures and watched them in action, bringing back so many memories of the many fires he put out back in Texas.

The Bomberos Arrive!
Within a few minutes I have to add!


Bomberos to the Rescue!
I walked back to the house amazed to discover that 911 really does work here.  We've asked several of our Panamanian friends who all said they had no idea if or how it worked.  Our house is within a mile of both the police and fire stations should we ever need them for an emergency.  And the firefighters here are also paramedics just like Clyde was during his career.  As I sat down to blog I noticed the blue lights of the bomberos heading back to the station to get ready for another call.  And we can go to sleep tonight feeling safe and secure that the cops and firemen are right around the corner....along the gringo trail.



Sunday, February 10, 2013

A Glimpse Of The Past....An Embera Village

Last weekend we took a step back in time as we visited the little village of the Embera Drua.  One of the indigenous people of Panamá, this small community of 110 people live in thatched huts along the Chagres River.  Once we made our way to the boat dock, we joined our friends in authentic dug out canoes for the long trek up river.  Our canoe came equipped with two, young, Embera men dressed in traditional loin cloths exposing their "natural assets."  Although this is a part of the story my husband wishes I'd forget, it does tend to be a highlight for the ladies. 


Not even on the boat yet and
she has found some new "friends"


Our transportation awaits!


The hunky man in the rear of the boat manipulated the boat motor while the one in the front steered us through shallow waters.  He used his large, deep, dark, chocolate muscles to maneuver the boat through murky waters using a long piece of bamboo only. In the distance we spotted the thatched palm roofs that covered their homes as the children ran to meet us on the beach.  They welcomed us with drums, flutes and native dances as our boats made they're way onto shore.  And of course the hunky men helped us females out of the boat as we made our way into the village.


Terry's favorite View


Welcome to the Embera Drua

We are welcomed


We made our way up the long, steep path to the village from the waters edge only to realize that these people do this everyday.  The little village surrounded by tropical, lush, rain forest lies deep within the borders of Chagres National Park.  Within the village is a school house, church, telephone booth and large meeting house where we all gathered.  The women cooked us a lunch of tilapia (fish) and patacones (plantain chips) over an open fire.  The elders told stories of their tribal traditions, culture, and crafts.  The young men and women danced, sang and played instruments allowing us a glimpse into their world.  Our group was then encouraged to get up and boogie with the Embera as the men grabbed us ladies for a dance.  The young man that I danced with smelled fruity and sweet and I just had to tell him "usted huele bueno" which means "you smell good."  Ok I guess I should say that there were also some lovely ladies among the tribe dressed in traditional skirts and beaded tops.  Because if I don't mention this when my darling husband puts the photos in, he'll surely say something about it.  But rumor has it that during their everyday life the Embera women go topless, but since this tends to make the tourists uncomfortable they put on tops.  Clyde is not happy about this either, but perhaps it's what kept him from getting thrown out of their village?


I have to say, they seem happy!


Pretty young Embera Woman



Just chatting with each other


Putting on a show for us



Beautiful Waterfall


Another one of Terry's
"eyecandy friends"

After lunch and dancing we browsed through their village, and picked up a few native crafts.  Snapping lots of photos while asking questions along the way, we thanked them for their hospitality before we headed back to the boats.  Once back in the boats we were taken to another spot where we stopped for a walk alongside the river.  The long, steep, rocky walkway led us to a beautiful waterfall where we took the plunge and cooled off in the crisp, clear river.  After a while our guides told us it was time to go and we made our way back to the boats for our journey home.  We arrived back at the boat dock tired from a full day of exploring a civilization lost in time.  A journey back to a time when life was simple and there were no computers to blog about such adventures.....along the gringo trail.

Click below to view a video of our Embera Trip!

Video of our Embera Trip

Saturday, February 9, 2013

Recovery In The Recliner......

Today is the first day of Carnival here in Panamá, the biggest celebration of the year.  Businesses are closed down for the four day, pre-lenten celebration that's evident throughout the country.  But for us we'll  be hanging close to home as I recover from surgery.

Apparently, Clyde is dreaming about Carnival Queens


Lounging on the reclining sofa with my legs propped up and laptop on my legs, the past week has been a roller coaster of emotions.  The whole thing started when I decided it was time for my annual checkup of the lady parts and decided to try out a new clinic near the beach town of Coronado.  The results of the pap test showed abnormal cells growing in my uterus that were pre-cancerous in nature. Since I had the exact same results pop up about eight years prior to this appointment, before we even went to talk to the doctor my mind was made up.  I had decided that IF one of the choices was a hysterectomy I would certainly choose that option.  After all eight years ago I was told by my doctor in Texas after he scraped out the cells in a D&C procedure, that "these things CAN come back."  He instructed me to never skip a pap just in case, so I've never let a year go by without having one.

So here we sat before my Panamanian gynecologist who presented me with two treatment options.  One was to treat the pre-cancerous cells with creams and pills for one month and then re-test.  The other option was a hysterectomy.  I chose the later and we proceeded to contact our insurance broker in Panama City about our insurance coverage that we purchased through her.  Assuming that the insurance would cover the surgery without a doubt, but we were soon told differently.  Our agent Priscilla explained that the insurance would not cover this procedure until I was on the policy for at least ONE year, and then it would need to be pre-approved.  As of February 15th I would have been on the policy for one year, so all seemed good there.  But then Priscilla told us to wait another month or so, just to be sure the insurance company didn't think we were waiting until that one year period was up to get them to pay for major surgery.  And then the doctor would have to submit for a pre-authorization first, after which the insurance company would probably want a second opinion. 

The doctor on the other hand felt that the surgery needed to be done as soon as possible, because pre-cancer could turn into cancer.  Also he said that insurance companies have doctor's on staff and that doctor would realize that this condition didn't develop overnight which made it a "pre-existing condition" which they also didn't cover.  So at his recommendation we decided to self-pay for the surgery as not to jeopardize my health any further.  I also had that female "gut feeling" that the surgery needed to be done now, and not in a few months.

Since  I'm no stranger to surgery as I've had many in my lifetime, I certainly wasn't afraid of a surgical procedure. But I was afraid of what it would be like in a foreign country where I didn't fully understand the language.  Although we've heard many wonderful stories about health care here in Panamá, this time it would be my story and that was the scary part.

Hospital Nacional in Panama City, one of the older hospitals here

On the morning of February 6th we made our way into Hospital Nacional in Panama City around 9 am as instructed by my doctor.  We were sent to "admissions" where we were immediately attended to by a Spanish speaking women.  Just like in the states she asked me a bunch of standard questions and I signed some papers.  Once done I was sent to "recovery" which turned out to be a large room full of beds like many I'd seen in the states.  This room resembled a "day surgery" or "recovery" unit where a dozen beds divided by curtains are centered around a nurses station.  I signed in with the nurse who told me in Spanish that my surgery was scheduled for noon and I was to have a seat in the waiting room.

The lobby made us feel like we were walking into a
four star hotel instead of a hospital.

So we played the waiting game for several hours in a crowded, over-air conditioned room full of people waiting for their loved ones having surgery.  Several families nearby had balloons and flowers announcing "it's a girl" or "it's a boy" in  English....apparently waiting for babies to be born.  Clyde instructed me that I was definitely NOT to come out of surgery with any little critters, and we laughed to lighten the mood.

A view of admissions office in the background and a statue of hyppocrates on the wall.

Finally around 11:30 am I was called by the nurse.  I kissed Clyde and left him behind in the waiting room, nervous about the story that was about to unfold.  The nurse took me into a little room where she handed me a gown to change into.  She explained as she handed me little blue covers that they went on my feet and head, just like in past surgeries I'd had in the states.  I put my clothes in a bag and was escorted into the big room and over to one of the beds.

Another view of the entrance to the hospital with
the "By-Pass Cafe" to the right



Clyde ate a few meals here


The bed was covered with bright, mint green sheets with an aqua-emerald green pad in the middle of the bed.  Once I laid down I was covered with a fluffy light green blanket as the room was frigid.  The staff was dressed in similar colors of light green and dark greens giving the room a pretty glow, instead of the stark white usually seen in the U.S. Over the next twenty minutes someone came over to start an IV, a few other people asked me questions which I tried to answer in Spanish. My vital signs were checked and eventually I was wheeled over toward the door, as if it was time for my surgery.  As I laid there I recognized the familiar face of my doctor walk into the room still wearing street clothes.  He came over to chat and handed me a paper to sign before walking away to scrub for surgery.  An attractive Panamanian women in a brown business suit approached me carrying a clipboard.  She said something to me in Spanish which I didn't understand and I looked up and said "que?"  She asked in English if I understood Spanish and I said "un poquito." 

Because I've had gastric bypass surgery for weight loss nine years ago, we've always been instructed NOT to use aspirin or any type of NSAID drugs.  So my doctor knowing this wrote down that I was "allergic" to aspirin and I was given a bright, red wrist band to wear indicating the drug allergy.  This seemed to freak out one of the nurses because when she asked "was I allergic to anything," I said, "no."  I  tried to explain in what little Spanish I remembered being nervous that it wasn't really an allergy, but instead was more of a preference because of my stomach which was different. 

The Panamanian women in the business suit standing next to me introduced herself as the anesthesiologist.  I asked her if she understood English and she seemed to indicate that she did, so I explained the thing about the aspirin and gastric bypass to her, as best as I could.  She left and eventually I was wheeled into the operating room.

Once inside the operating room I noticed that everyone was dressed in dark green scrubs with light green covers on their heads and feet.  I recognized my doctor who waved as I was rolled by and lined up with the operating table.  Someone instructed me to slide over onto the operating table as someone else began to remove one arm from the gown I was wearing.  She began to apply leads to my chest which would be used to monitor my heart rate.  The anesthesiologist was behind my head and she fiddled around with the IV starting to give me medication to put me into dreamland.  My doctor leaned into me and said "go to sleep," as did the anesthesiologist behind me.  It took a few minutes and suddenly I felt a bit drunk and drowsy and commented to my doctor that "it was a good margarita they were giving me," to which he laughed and told the others in Spanish. 

Next thing I knew someone was saying "Teresa" in a Spanish and I was back in the recovery room waking up from surgery.  Soon after I was wheeled down several long hallways and into a room where the stretcher was lined up next to a bed.  There was a male and female nurse nearby and they smoothly slid me over onto the hospital bed using the sheet that  I was lying on.  Clyde showed up and we suddenly realized that this is where we'd spend the next few days.

The walls of the private room were painted white and a 19 inch, flat screen TV was perched high in the corner.  A large window was dressed in blue and gold curtains which hung under a padded blue, floral cornice high atop the window.  In the middle of the cornice was the hospital emblem "HN" in a metallic, gold round piece.  To the right of the bed was a blue leather rocker, recliner which sat next to a blue leather couch wide enough for someone to sleep on.

Window in my room which had a sun shade on it too

The bed before they put me into it


This is where Clyde slept!

Clyde told me that the doctor came out and spoke to him after the surgery, pulling out his cell phone to show him some photos.  On his phone he showed Clyde a picture of exactly what he removed from my body.  A picture of a bright red uterus, next to a round, red, ovary and a shriveled up fallopian tube sat nearby.  My cervix still attached to the uterus was also visible in the photo.  The doctor explained that he found a cyst on one of my ovaries and removed it, but left the other ovary in place so I'd have some female hormones being produced.

I've never seen a fridge in a hospital room before.  It was neatly tucked away in the closet like in hotel rooms.

To my amazement it was already after 4 pm when I made it to the room.  Since I didn't have anything to drink or eat since the night before, my throat was dry and scratchy. Clyde asked the nurse if I could have water but was told not until 7 pm, so I'd have to wait.  It was after 7 pm when someone came in with a tray from the cafeteria.  On it I found the typical after surgery meal of clear chicken broth, green jello, iced tea and a pitcher of water.  The water tasted so good and I really had no desire to eat anything, but eventually managed to eat a few spoonfuls of jello.  I downed much water the rest of the night especially since I still had a urinary catheter in place and I knew I wouldn't have to get up to use the bathroom.

Hallway of Hospital Nacional, looks like any other hospital



Just like in any U.S. hospital, all through the night staff came in to check vital signs, give me pain meds and bother me every time I managed to fall asleep. In the morning the catheter was removed as my doctor had told me days before that I would be able to get up and use the bathroom.  Nothing else was said about whether or not I should or should not get up and walk around.  After other surgeries I was always encouraged to get up and walk as a way to aid in recovery.  We waited around until sometime in the afternoon for my doctor to show up.  My incision was tender but I really wasn't feeling much pain and later on decided to get up and walk, with Clyde close by of course.  After walking around the room a few times later on I wanted to venture out into the hallway.  We walked down the hall and passed the nursery and neonate unit full of screaming babies.  As we headed back to the room the doctor showed up and his mouth dropped open in shock.  Here I was not even 24 hours after major surgery walking the halls, standing upright and feeling little pain.  He encouraged me to get back into bed and take it easy for the rest of that day, and said I was free to walk as much as I wanted to next day.

A seating area at the end of a hallway where
Clyde waited for me to come to the room


My surgery was on Wednesday and I was supposed to stay in the hospital until early Saturday morning.  My doctor assured us that he would release me very early on Saturday so we could get home before the Carnival crowds filled the highways.  But since I was doing so well on Thursday, when the doctor showed up around 8 am on Friday he told me to go home, and he'd see me in his office on February 19th.  And then just like in the states we sat around for hours waiting for the staff to bring in the discharge papers.  Eventually Clyde took action and went out to speak to whoever was working on my orders.  He received an itemized bill of everything that they used on me while in the hospital and the total bill came to around $4,600 a bit more than we'd expected.  But I did request a private room which cost more too. 

I was given NO discharge orders at all, just a prescription for the local version of Tylenol extra strength along with an anti-inflammatory drug to use for the next week.  It's SO good to be home and so much more comfy recovering in my own personal space than in a hospital bed.

One of the reasons that we choose to retire to Panamá is that the health care is as good, if not better than the U.S. health care system.  So how did it compare?  A total abdominal hysterectomy in the U.S. costs between $30,000 and $40,000 for one night in the hospital.  Here it cost $4,600 for two nights in the hospital.  We paid the doctor $2600 for him and the rest of the operating room team including the anesthesiologist.  After we added it all up, my surgery and stay in the hospital came to about  $4784.00

The hospital food here was ok and one of those things you eat, just because it's there and you're hungry.  Breakfast was some type of bread, not toasted along with a cream of corn cereal with much added sugar.  Clyde and I were able to share the bread and I enjoyed the bowl of fruit that came with it, along with either eggs one day or a slice of turkey breast the next.  We both passed on the sugared corn-meal type of cereal along with the sweetened juice drinks.  For lunch one day I had chicken breast with mashed potatoes covered in white sauce.  Along side was a pear in a creamy heavy syrup, and a bowl of carrots along with chicken soup.  For dinner some beef cooked with tomatoes and onions alongside white rice.  On the side another bowl of chicken soup, fruit and veggies.  I picked the healthier of the foods to eat and left the rest since  I didn't have much appetite anyway.

Lunch anyone....chicken and mashed potatoes covered with white sauce.  Carrots, a few potatoes mixed in, chicken soup, and a pear in creamy, sweet sauce along with a juice box of apricot nectar.  And they brought an insulted pitcher of ice water with each meal that I really enjoyed!


Due to the language barrier the staff who spoke NO ENGLISH at all seemed to leave me alone, except to tend to their normal tasks.  Each person seemed to have a different job to do and they knew it and did it well.  One person came in to check my temperature and pulse.  Another came in to take my blood pressure while still another came in to administer medication.  Someone else emptied the catheter during the first day, while another person emptied the trash.  While I was in the shower someone came in to change the bedding and once I was back in, bed a janitor came in to mop the floors.  I will say that since my feet were cold I walked around with white socks on one day and the  floor was so clean that the socks didn't even look dirty.  As I walked more, I switched to slippers which also served to keep my feet warm.  The room did have an air conditioner along with a thermostat that we were able to control. 

In general the hospital seemed just as modern and updated as any U.S. hospital I've been in.  The equipment was just as good but there seemed to be a whole lot more people on staff than I've seen in any U.S. hospital.  My hysterectomy was done "open" with about a 4 to 5 inch incision.  Had this been done in the U.S. it probably would have been done laproscopically.  Here in Panamá my doctor explained that lap surgeries are more costly.  So although my experience was a good one, I hope to not see the inside of a hospital in Panamá or anywhere else for a long, long time. 
And now I'm on the road to recovery and healing nicely, at home....along the gringo trail.

Thursday, February 7, 2013

Terry has had her surgery...

Clyde here...........

Terry has had her surgery here at Hospital Nacional de Panama and is doing great.

We went ahead and drove into Panama City the night before the surgery.  We wanted to make sure we would find the hospital in the morning (she had to be here at nine).  I had mapped out my route using my city maps and even went to satellite maps so I could get some good landmarks in order to find the hospital.  Remember, they don't have street signs here.  Everything was going great and we could actually see the hospital.  But, they had closed the street I was using for subway construction.  It didn't take me long to find my way around and we found the hospital entrance with no problem.

We found a hotel almost directly across from the hospital for our one night stay.  It was a brand new hotel.  The room was small but it had a king sized bed.  The price for the room was $40.  They would not give me the pensionado discount for some reason.  I usually will not use a place that refuses our discount but, the hotel price was cheap and it was very convenient to where we needed to be.

We made it to the hospital after driving around the area looking for a parking space for quite awhile.  The good news is that they are building a multi story parking lot for the hospital.  The bad news is that we had to find a space on the street!

The hospital looked great from the outside and upon entering we were impressed with the grand entry way.  We were guided to administration and the paperwork went very quickly.  They asked for a $1500 deposit which I put on my card.  We were then directed to the second floor to the surgery unit.

We ended up waiting for a couple of hours before they finally called Terry in for her pre-op.  The waiting room was full of people waiting for babies to be born.  We were impressed with how modern and clean everything was.

Finally they took Terry off to surgery and I was left to wait.  It was freezing in the hospital so I decided to run to the car for my jacket.  As I walked into the hospital, I was surprised by the site of Betsy.  Our very good Panamanian friend that had rented us our first home in Panama.  It was quite a emotional time for me as I was holding everything in. Betsy stayed with me as long as she could but she had to get home for her daughter who was getting out of school.

Anyway, we were waiting in the "sala de espar" for the doctor.  I looked up and there he was.  He motioned me over and the first thing he did was show me his cell phone.  I was confused until I realized the was showing me a picture of the "female parts" he had removed.  He ended up removing the uterus, most of the cervix and the right ovary.  Evidently, the precancerous cells were in the uterus, there was a lesion in the cervix and while in the operating room, he found a cyst in the right ovary.  The good news is that one ovary was left in.  This ovary should produce the hormones she needs so that the amount of hormone therapy should be reduced.  (This will depend on her labs as time goes on.)

We were able to acquire a private room so I can stay with her both day and night.  It is a very nice room with a small couch that makes into a bed.  I was surprised that someone came in and put a sheet on it with a pillow and a blanket for me.  The room is very nice, very modern and very clean.

Well now to the important part.  Terry is doing great!  She spent the night with an IV and a Cath so she would not have to get up to urinate.  She was given some meds last night for pain and to help her sleep.  This morning the Cath and IV were removed and she has been up walking.  Her pain is minimal.  She does have a cut right below her bikini line.  She just explained that it hurt her a little when getting out of the bed but no pain when walking.

We are both happy with the hospital, the doctor and that her recovery is doing so good.

Gotta run now, they just came in to give her a shower and change the linen on the bed

Thanks for your prayers!

Clyde

Saturday, February 2, 2013

Ready For Another Adventure.....


Since it was that time of year for my annual checkup of the "female parts" I thought I'd try out a new clinic in nearby Coronado.  "Clinica de la Mujer" offers various services to women including gynocological, obstetrics, and endocrinology.  Although the girl at the front desk spoke no English the doctor did which made it easy to explain my problem.  For much of the time we've lived here in Panamá I've been bothered with female issues like itching, burning and discharge.  Like many of us I'd self diagnosis it and treat the symptoms with over the counter creams and pills.  But while in the presence of a doctor I thought I'd state my complaints and see what he came up with for a solution.  He prescribed the same type of treatment for eight days and said he'd call with the results of my pap test when they came back.  A few days later the doctor called personally and asked me to come into his office the following morning so he could explain the results.  "This can't be good," I thought, although I tried not to worry.  Clyde suggested that I call the doctor back and ask if we could come in sooner.  Since doctor's here give patients their own personal cell phone numbers, it was easy to call him without going through his office staff.

Finally we made our way into his office for the "talk."  Turns out the pap revealed abnormal cells which are "pre-cancerous" in nature and need to be dealth with.  The news was both a relief and what I expected to hear since a pap years ago showed similar findings.  Many years ago I was treated with a D&C which scraped out the bad cells and was told "these things can come back," and advised to never miss a year without having a pap done.  The latest findings also revealed inflammation of the cervix which was treated with a pill for eight days.

Faithfully every year I have gone for my lady check-up and results were ok until now.  Last January while applying for health insurance here in Pananmá, a pap was required prior to being accepted on the policy.  Apparently that pap surely must have been ok, other wise the insurance company wouldn't have offered us coverage.  My treatment options this time being older were to treat it with creams and pills for one month, then retest.  Or the other option is surgery to remove my uterus, and anything else that seemed to pose a problem.  The doctor explained that as women age there's a much greater risk of developing uterine cancer, and recommended a hysterectomy.

Hospital Nacional in Panama City


Although we do have Panamanian health insurance here because the policy began last February 15th, the waiting period states that they will not pay for surgical procedures until after one year. We consulted with our insurance broker who said we should wait until late March to submit for pre-authorization after which the insurance company may request a second opinion. And then they still may not cover the surgery because they know that abnormal cells don't just develop overnight, and have obviously been there a while.  Apparently, health insurance companies here in Panamá don't want to cover any necessary procedures just like in the states. After all it's not like I woke up one day and said "hey, I think I'll have my uterus pulled out through an incision in my abdomen that I paid big bucks to have tightened after massive weight loss."  In my case a hysterectomy is needed to prevent the reoccurence of pre-cancerous cells that can come back and lead to uterine cancer.

So yesterday we visited with the doctor again by walking into his office and asking the girl at the front desk if we could speak to him.  An office visit here is just that....a visit with the doctor.  We sat down for a chat and explained that our insurance broker instructed us to wait until late March to begin the process for surgery.  He immediately said "that's too long, it needs to be done now."  "If you were my wife or family member I'd tell you to do it as soon as possible, " he explained, " to avoid any risk of the cells developing any further."

The doctor suggested the surgery could be done on Wednesday, February 6th at Hospital Nacional in Panama City.  We agreed and he pulled out his cell phone to call the hospital and schedule it. Then we talked numbers to see what kind of cost we'd be looking at.  The doctor explained it would be around $2,600 for his services, an anesthesiologist, a surgical assist, and an instrument person.  Another $1,300 to $1,500 would be added on for three days in the hospital and the use of  the operating room.  Our total cost would be somewhere in the neighborhood of $4,000 and we should get a discount for being pensionados but the doctor wasn't sure about that.  Compare that to surgical costs of around $30,000 and up for a hysterectomy in the U.S. with a day or less in the hospital.

The three of us sat in a tiny office with only a desk and two chairs talking to the doctor.  I asked if we could move into the exam room so he could show me just where the incision would be made.  Since the exam room was connected to his office  it was just steps away.  Not being the shy type about these things I pulled up my dress, dropped my panties and climbed up onto the exam table.  He'll make the incision in my lower abdomen and cut into an existing incision from a tummy tuck I had done eight years ago after massive weight loss.  Since I'd expressed a concern about him "messing up" my tight ab muscles he said "if I do mess them up, don't worry I'll fix them."

Today we ran over to Clinica San Fernando in Coronado so I could have some lab work done for the procedure.  The total came to around $48.00 for four different tests to be performed.  The lab tech told me that I could pick up the results on Wednesday. I explained that these were needed on Tuesday prior to surgery on Wednesday.  Then we spoke to the girl upfront who spoke English and she said we could pick them up late on Tuesday.  Confused by the different responses we left and had planned to let the doctor know since perhaps he could get them done quicker.  As luck had it Clyde was making a "retorno" or "u-turn" to go home when I spotted the doctor buying lottery tickets in front of a restaurant.  I opened the window and asked the doctor "if you win the lottery is my surgery free?"  He laughed and said "sure."  We explained about the lab tests to him and he said that he could pick them up early Wednesday morning and bring them to the hospital, so not a problem.

The doctor also told us that the hospital room will be private and Clyde will be allowed to stay with me the whole time.  Since the hospital is in Panama City which is a 90-minute drive from here my follow-up appointments will be done at the local office in Coronado.  The doctor even said after I'm home if I have any problems he'll gladly come over to our house to see me. 

By the way this doctor drives a large King Ranch Edition Ford pick up truck.  The famous "King Ranch" is in Kingsville, Texas about 45-minutes from where we used to live.  This ranch is one of the largest, continual working cattle ranches in the world.  We asked the doctor if he bought the truck here and he said  "no,  he went to San Antonio, TX to pick it up."  Clyde grew up in San Antonio and he and I spent lots of time there since it was only a 2 -3 hour drive from Corpus Christi.

http://www.king-ranch.com/legacy_overview.html

So we're about to have another adventure here in Panamá.  The good news is that every gringo that we've talked to that's been hospitalized here said the experience was wonderful and the care was great.  Some didn't even want to leave the hospital and asked to stay longer.  When have you ever heard someone say that about a hospital in the U.S.? Don't know when I'll feel up to blogging about it though but stay tuned for our first hospital experience   ....along the gringo trail.