Deep Vein Thrombosis

My fall through the deck may have done more than I thought. I noticed last night I had a hard knot in the upper calf of my right leg. The knot is painful to the touch.

From an Internet search, I found the condition described perfectly. Apparently the fall may have damaged a vein in a condition called deep vein thrombosis.

I am treating it with heat and ibuprofen, but would like the name of a vascular physician in Chiriquí for confirmation of treatment.

From what I have read, it is of less concern if it is below the knee. I would appreciate information from others that may have experienced the same thing, especially if you have had treatment for it in Panama.

UPDATE: Later in the day.

I need to say that I think I am very fortunate to have some of the best readers in the world that follow my blog. It seems within seconds, I had calls and comments to help me in my decision of who to see.

Besides the comments, I had a Panamanian friend and doctor that reads my blog call from California. He said he felt that it was less serious than what I thought it could be, but did recommend seeing a doctor. I also received a call from another friend who had called his Panamanian wife in the US to get her recommendation.

All of the concern is very much appreciated.

I did take the recommendation of Hilda and saw Dr. Cattán (the Medical Director in Mae Lewis). He took a complete medical history and then sent me to the radiology area for some tests,

One was a sonogram to verify that the problem was less serious than a Deep Vein Thrombosis. Superficial phlebitis is what I think he called it. For that I got a gel to apply and 30 pills. A much better situation.

However with my past history he also requested some spinal x-rays and they showed a degeneration of the disks between several of the vertebras. Todays medical expenses were $45 for the office visit and $131 for the sonogram and 4 spinal x-rays.

After looking at the x-rays, Dr. Cattán recommended an MRI to get a better handle on that problem to be able to prevent more degradation. The MRI will run around $650.

I will say that I felt I was in very good hands and Dr. Cattán’s English was fine and definitely better than my Spanish.

Thanks again for the concern and recommendations. I consider today a positive day because I now have one more doctor to put in my arsenal against old age.

A Must Read

My friend Larry Mathews has updated his blog after returning to the US from Panama. His post is related to healthcare and especially about healthcare for expats living in Panama with COPD.

He compliments the care he received here with the exception that it was limited. The type of problem he mentions I suspect will get worse. I say this for the following reason.

There are many more healthcare facilities being created around Panama. There is a large addition being added to the Regional hospital in David which will provide for,heart transplants. There is the large hospital I mentioned in a previous post in Bogaba. There is a new hospital being created in Volcan. Probably something else being planned for Boquete.

Now you may say, what’s wrong with that? It sounds like healthcare is improving in Panama. Here is my concern. There are not enough good doctors now to take care of people living here. Where are they going to get the doctors to cover these new facilities?

There is protesting going on now to prevent Panama from bringing in doctors from outside Panama. If you are moving here, you have to hope that your needs for health care treatment are run of that mill medical needs.

When I was a kid, you did what your doctor said. He was the expert. Now, you better be willing to invest in researching your own problem. Thank goodness for the Internet.

I still maintain if you are moving to Panama, the first thing you should research is if you are healthy enough to do it. Spend as much time checking out your healthcare options are as you will in choosing which piece of paradise to buy.

Healthcare in the Boonies

In case you are not familiar with the word “boonies”, the following is a definition I agree with.

American, colloquial word for wilderness or places in the middle of nowhere, far from any civilization

When it comes to Panama, I consider the boonies some place remote from a real hospital. There are many areas in Panama that are lucky to have a clinic and often to get to a clinic could take you an hour.

I mentioned the other day that my friend Malcolm, had a recent healthcare experience. Malcolm was on his finca (Finca Tranquila), and slipped in the shower. Hey, it happens to all of us as we get older.

Some how he managed to rip his elbow open and realized that his home medical kit was not going to be enough. His nearest clinic was in Almirante. He told me that he was lucky because the water was calm and it was only a 20 minute boat trip to get there.

Had it been in the middle of a storm, it might have been a minimum of an hour and he would have been thrown all over the boat.

He was pleased with how he was attended to and the quality of the stitching and was allowed to go home. Over the next week, pain increased, he became weaker, and eventually had himself transported back to David and to Chiriquí Hospital.

By the time he got to the hospital, he was in a serious condition. He was told that, had he waited much longer, he might not have survived. It seems that the elbow has a special sack that helps protect the elbow. If it gets ruptured, great care must be taken to avoid infection, because the fluid of the sack would be a conduit for the infection to spread through the entire body. Continue reading

Some Updates

I have been tied up for several days and still don’t have my head completely above water. The other day I, and other Wardens in Chiriqui, met with the New Chief of the ACS Unit for the U.S. Embassy in Panama City. He was in Chiriquí doing prison visits.

I have also been assisting a US citizen who was in Hospital Obaldia and that will probably be another post at some time for lessons learned by me.

Also, My good friend Malcolm Henderson, has had some healthcare experience, that I will share soon.

Now for some feedback that came as a result meeting the new ACS Chief and correspondence resulting from that meeting.

You may remember that I posted a scam warning had been posted on Chiriquí Watch the other day. It appears that what was reported is actually a Panama crack down on people living here on the tourist visa, which allows a visitor to stay 180 days at a time.

Cases have been reported of a people trying to exit on the 181th day, resulting in a huge fine and being advised to get a real visa. This should be considered to be a “Heads Up” for others.

Several people have been required to buy return tickets and provide proof that $500 was in their possession or credit cards to demonstrate financial viability.

All of this implies that those living in Panama using the tourist visa should be prepared for major annoyances at the Panama border.

Another item I have learned is related to converting US driver’s licenses into Panama driver’s licenses. I was advised to remind everyone that the US license must be Apostilled by the Panamanian government before the actual license can be applied for.

That means taking the document that the US Embassy certifies to the MFA on Tumba Muerto in Panama City. Therefore, if a US license is certified by the Embassy at an Outreach meeting, it would still require the person to make a trip to Panama City.

I was also told that they have recently also started to require all first time persons to go to the Sertracen location at Plaza Carolina for their driver’s licenses.   Renewals can be done anywhere, but first-timers need to go there.  You may want to check your local location to see what they say about that requirement.

Some might make the decision that, if that is the case, they might as well just to take the test in David and avoid the trip. My advise is spend the money and have your US license turned into a Panama license. I know of people that have spent two years taking classes and multiple exams and still don’t have their license.

More to follow, when I catch my breath.

Blood Donors/Receivers

Maybe this is worth posting since many are moving to Panama. If you have never paid attention to your blood type, it is worth knowing that Panama is not known for having blood on hand in case of emergencies.

This is even more critical during holiday seasons, because an appropriate donor might be away on vacation.

I am going to post a graph that reflects who are eligible donors and receivers for each blood type.

Other restrictions are often imposed by some hospitals in Panama, but some restrictions, such as age, are waved in an emergency.

Because of the fact that blood is not banked in Panama, it is important to be aware of such groups such as the Boquete Hospice & Health Foundation. They keep a registered list of donors and have helped many people, foreigners as well Panamanians.

Remember if you need to make a request, please provide the following information in order to receive assistance. Other requirements are on the Hospice website.

  • Blood Type
  • Hospital
  • name of recipient
  • Doctor requesting the blood

Following is a graph that shows who can donate for what blood type.

blood_GT

A New Hospital In Bugaba

I was in Bugaba the other day and was shown a new hospital that is under construction. It looks like will not be finished this year, but it was started under President Martinelli.

This hospital is large. It will be a public hospital. It looks like it will be a fine addition to this area.

DSC01017

I think the Panamanians always complain about whoever is in office, but I have seen more accomplished under Martinelli than I did in the two previous administrations.

I see that the Google Map won’t help much, but I was standing HERE when I took the photo.

 

Another Healthcare Reflection

After writing the previous post and reading some of the comments, I am going to follow up with another point to consider.

I realize it is easy to think only of one’s self when it comes to living. It is natural. Most people think of what it takes to make them happy and little on how their happiness may affect others.

When I moved here, for a person to qualify for a pensionado visa, they only had to provide proof $500 a person. Now it is $1,000. If I am not mistaken. many that came with less than a thousand a month are now struggling. Yes, they would be struggling in the US or most other countries as well.

Obviously most foreigners that come for the pensionado visa are 60 years of age or above.This is the age that places the biggest burden on any healthcare system. Many of my age group grew up when smoking was the norm. All movies and TV programs glamorized smoking. Luckily, I never fell into that group.

Because of smoking or other kinds of hard living, many come here in less than a physically fit condition. Many find themselves in need of significant healthcare and many wind up in the Regional Hospital. This hospital is by far the cheapest hospital in Chiriquí and I would say much cheaper than a US hospital.

Even with that, a couple weeks stay can turn into thousands of dollars. Many of the third tier age group wind up dying or needing to return to the US to tap Medicare for their rest of the care. Too many times, either of these situations result in the hospital having a bill that doesn’t get paid.

I can’t tell you how many times I have heard the gringo community (all white non Panamanians are considered gringos) being bad mouthed because of a medical bill that was not paid.

This is one of the reasons that many of the local private hospitals will not take a patient, requiring surgery, without having a large amount paid up front. Insurance or not, they want their money up front. Also few will take on the burden of collecting from insurance, they want you to pay and you to collect.

Now based the fact of many leaving without paying, I can understand the hospital’s point of view.

I had an american contact me a couple months ago that was treated in Hospital Regional and had a hip replacement. She was going to have to return to the US because she could not get the therapy she needed in Boquete. She had been released from the Regional Hospital with an outstanding bill.

She had contacted me to see if I knew a way she could pay the hospital in payments from the US and had been unable to get the answer from the hospital. The Regional Hospital is not equipped to handle international payments.

I finally agreed that when she got to the US she could deposit payments to my stateside account and I would make a local payment for her. Why would I do that you ask? Because I don’t want the perception of gringos running out on healthcare debts and that perception causing problems for other gringos.

Now getting back to my previous post. This is one big reason why I don’t want foreigners coming to Panama with potential health problems. One of these day, I may have to tap the healthcare community here and I want friends in that community and not enemies.

A Caution Before Moving To Panama

I was reading a post by my friend Larry, who recently left Panama to return to the states for health reasons. During his military career, he had developed a form of tuberculosis and was having repeated trips to the hospital.

He finally read the writing on the wall and realized that his condition was only going to continue to worsen, if he tried to stay in Panama.

This is the big caution I give everyone. If you are moving to Panama, have a good physical checkup and make the decision to move only after you get a clean bill of health.

This is not to say that you can’t get treated in Panama for most conditions, but the more complicated the problem, the higher the risk and the closer the bill will match treatment in the US. Add to that the fact that in most hospitals, you will not be getting state of the art treatment. Plus, Medicare is not honored in Panama and insurance is not any cheaper here. It is also much more difficult to get reimbursed.

Now if you are healthy when you move and you come here and get on the healthy diet that Panama can provide you, one containing fresh fruits and vegetables grown just a few miles from where you live. toss in a regimen of good exercise, which can be obtained by walking around this beautiful country, then you might outlive your expectancy in the US. (That may have set the record for the longest sentence I have ever written in this blog)

Certainly the stress level is less here, as long as you don’t mind waiting in long lines to pay your bills, and you don’t get too frustrated because your communication skills are not as good as they ought to be.

I believe healthcare is the first thing you have to feel comfortable about before you pack up and move to Panama. If you come here and like it, then you may decide that this it the place you want to live out your life. However, I have run into many people, through my visits to the hospitals, that are wishing they could figure out how to get back to the states because they know they are going to die in that hospital if they don’t.

I miss Larry being here. I enjoyed his sense of humor. I know that there are many things about the US that didn’t set well with him and he really wasn’t happy about having to move back, but from his recent post, I can see that he knows that moving back was the only way that would allow him to enjoy more tomorrows.

A Small Observation

Over the last week I have had to take several tests. On the whole, Mae Lewis has been cheaper than Hospital Chiriquí. As an example one test was $186 at Hospital Chiriqui and it was $140+ at Mae Lewis.

What this showed me was that it may be worth shopping around before having some procedures run.

Also for women, Hospital Obaldia is cheaper than both Mae Lewis and Hospital Chiriquí.

A penny saved is a penny earned so to speak.