My First Medical Experience in Boquete

 

Few people enjoy hearing about other people’s physical ailments, but Jan thought this would be a good topic for a post.  Just for the instructional aspect and perspective offered, I think she might be right.

Our first night back in Texas, in the first week of November, 2015, I picked up a backache after sleeping in the bed of our former next-door neighbors. I’d spent nights before in this bed without any problems whatsoever. It was nothing major, just annoying. And for me, a very rare event. I never get backaches.

After 3 weeks of putting up with this, I’d had enough. Especially since it was going from annoying to somewhat debilitating. I broke down and went to see a doctor.

Back in the spring of 2015 when I was getting the contents of the storage units ready for transport, I recalled trying to move a really heavy plastic storage bin. It weighed several hundred pounds easily. I was holding a plastic handle at one end and pulling with all my might. It felt as if my body was at a 45 degree angle to the ground in an effort to get maximum leverage. I remember thinking at the time that this plastic handle is not going to hold. It’s not going to hold. I was right. It didn’t. In a heartbeat I was holding a handle that had suddenly become very, very light. I landed on the concrete floor with my butt absorbing the full force of contact. Ouch and damnation! Eventually the excruciating pain eased.  Thereafter it bothered me only occasionally.

This, it was agreed by all the medics who would hear the story, was the start of it all.

My first inclination was to visit the new doctora in town that advertised her arrival back around September. But I couldn’t remember her name or location. I’m sure I saved it somewhere where I could easily retrieve it later. Know what I mean? But as we gringos so often do when we’re unfamiliar, we went on the referral of another gringo. Another doctor was recommended, not cheap we were told, but good. But “not cheap” is relative.

Appointments seem to be the exception rather than the rule here, so we just showed up at the office. Turns out the doctor is a doctora, but she wasn’t in. Come back at 2PM. OK, we did that.

Her office bore not that much similarity to a stateside doctor’s office. A set of drums just behind the receptionist was our first clue that maybe this place serves double duty.

Reception area

Reception area

But it was a fairly nice office. Especially considering the one Jan saw upon returning from her last trip to Europe. (I don’t know what bothered me more. The fact that the doctor looked more like a kids’ soccer coach, or the fact that he did his training in Cuba, or the fact that he admitted to being 27 years old.)

The nurse/receptionist weighed me and took my temperature and blood pressure. Then we were shown into the doctor’s office. She invited us to call her by her first name. Can’t remember the last time a doctor did that. I liked it. A good sign. No hint of pretension.

Then she interviewed me for my medical history, drug regimen, etc. She palpated the left lower back area and agreed it was sore, not tender. I guess that meant something.  She gave me a double-dose injection of something along with prescriptions for a muscle relaxer and an anti-inflammatory. And she ordered x-rays. And a blood test, to look at uric acid levels. I took the opportunity to get a lipid panel test at the same time. for an unrelated reason.

She suggested that I might end up better off with a chiropractor. I was surprised to hear an MD say that, but I’m told the times they are a changing. But let’s give the shot and the meds time to work and see what the x-rays say, if anything.

As I didn’t have my (temporary) pensionado ID with me, we decided to wait until morning for her various prescriptions. (The pensionado qualifies one for a 20% discount on medical services and prescriptions. But Jan didn’t realize this at the time. She thought it applied only to prescriptions. As such, we paid full price at the doctor’s office and everything else.)

The first order of business the next day was the blood lab, as I was fasting for the lipid test that I had wanted for some time now. Somehow two years had elapsed since this was last done. This test cost $25. The uric acid test that Lilliana wanted cost $3. We would have results by noon.

From previous experience, we learned that the drugstores in town can have prices that vary wildly. So we checked at two before making a purchase. In this case the prices were very close. And high. The muscle relaxer was only $12 but the anti-inflammatory was over $80. Those of you who know me, and those of Czech heritage, can readily understand how I chose to use ibuprofen for my anti-inflammatory.

The soonest we could get an appointment for the X-ray was the coming Thursday.

We took the x-ray to Dra. Lilliana’s office and she looked at it at great length. Made me wonder if she really knew what she was looking at, especially since she asked if we had a radiologist’s report, which we didn’t. This was never mentioned until now. She suggested an MRI at this point.

As my pain showed no significant signs of abatement, I got another injection, triple dose of something. What the hell.

The pain got much worse over the weekend and Jan and a visiting friend made arrangements for me to see both an acupuncturist and a chiropractor at a resort spa called The Haven. The place had a good reputation. I have never been to an acupuncturist in my life and not a chiropractor since my childhood years, but with the pain I was in I was willing even to see a witch doctor.

Howard, the acupuncturist and spa owner, made me initially wish I’d never shown up. The acupuncture was not painful but his reflexology and especially the pressure he applied to the sore spot on the back, most assuredly was. But by the time I left his office, I was tremendously improved.  Not cured, but improved.

From Howard’s office I walked just a short distance to Rhody’s chiropractic office. More interviews. He reviewed the X-rays, which we had on a CD, and right off suggested an MRI. The x-ray just lacked sufficient detail. The MRI could tell if it might be time to get a neurosurgeon involved. (Groan!)

After initial improvement the pain became worse again. And in an unbelievable act of carelessness (stupidity?) I rammed my left knee into the sharp corner of a coffee table. At first it seemed like no big deal, but that leg was to soon become the central focus of my pain.

It was decided to get the MRI, which requires an order from an MD. Best we could do was Monday Dec 14.

A neurosurgeon was recommended to go with the MRI. When Jan called for an appointment, she learned that he works in Panama City but comes to David once a month. She left word for the doctor to call her.

Not the doctor, but a nurse called in short order Saturday morning. The doctor would be in David tomorrow. He could have the MRI appointment changed from Monday to this same Saturday, so that he could see us and it Sunday morning.

12-12-15

We showed up as instructed for the MRI at 11AM. I guess my pain was in clear evidence as “behind my back” they called the neurosurgeon. He instructed an injection and an IV for pain to help ensure that I could/would remain motionless for the 40 minute RMI procedure. I was livid. I DID NOT want or need an IV. I was about to go ballistic and Jan was begging me, do it for her. I was taken to one of the slots you find in emergency rooms and was put on a bed, still fuming. I was giving thought to just storming out of there and dealing with everything later. Then the expression about shooting oneself in the foot hit me. Hmm.  Been there, done that. I started to calm down. After about 10 min on the relatively comfortable emergency room bed I began to realize that there was no way I could lie on even this bed for 40 minutes without moving. They were right. I was wrong. Surprise, surprise.

I got another shot in the butt, a pill and a cup of water, and then while a young, attractive doctora held my attention with conversation on my left, a nurse on my right inserted an IV. Sneaky, but highly effective.

Jan and I both thought the IV ran for only a very short time but I guess it was long enough. I stayed motionless for the entire 40 min procedure.

We had an 8AM appointment Sunday morning with the neurosurgeon. We arrived maybe 10 minutes early. We know that doctors’ times are much more valuable than patients’ times, so we didn’t want to keep anyone waiting. Actually, Jan didn’t want to keep anyone waiting.

When we arrived at the anointed time and place the area was deserted. I asked Jan if she was sure she had the right place. She was. Nonetheless, I asked her to check the floors above and below us just to make sure. She did; she was.

A bit after 8AM the nurse/receptionist arrived. She said the doctor would be along shortly. At precisely 8:39AM he appeared.

We spent an hour and a half with the neurosurgeon for a whopping $60. He took plenty of time to explain the problem, as he saw it, and to discuss the options. He saw it as a stage 3 (out of 4) partially herniated L4-L5 disk, with some other (lesser?) anomalies. He agreed that the episode in the storage units months earlier was undoubtedly the start of it all. Basically, surgery was in order but it could be put off indefinitely if the pain could be managed, or dealt with. Total cost without insurance would be about $20K, of which $7K would be for him. Didn’t take much to realize that if it did come down to an operation, it would certainly be in Houston where insurance would cover almost everything.

Although he seemed confident in his interpretation of the MRI, he nonetheless wanted a radiologist’s report. That could be expected tomorrow. His receptionist would notify us when this was ready.

Ostensibly because of the medication I received in the emergency room prior to the MRI, I had the most comfortable sleep Saturday night that I’d had in 2 weeks or more. That statement precipitated a prescription from him for four more injections a week apart, along with yet another prescription for pain pills to be used in the interim.

It turned out that the restful sleep carried over to Sunday night as well. And then things started petering out. I was most anxious to get another shot after a week was up, but unfortunately this one had little or no effect. Still, my pain was no where near its previous peak levels.

After a full week we’re still waiting for the radiologist’s report.  By now phone messages were left and an email was sent to the doctor in Panama City notifying him that we’re still waiting.

It’s now three days before Christmas and this story ain’t over yet. Tomorrow we absolutely must be in Panama City. It will be a long day but if things don’t get dramatically worse, I’ll get through it.

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