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"Doing Latin America, Mostly by Luck"

Episode 5 - December 2008

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Por La Salud

Some of you have been solicitous towards me since this whole poor health thing hit a week after I arrived in Costa Rica.

The bronchitis episode grabbed my butt for three weeks, yet even after the infection was licked, a shortness of breath and swelling ankles ensued and worsened until I couldn’t walk more than 20 meters without stopping to catch my breadth. Today (Tuesday, the 23rd) I had to stand up in a meeting because I couldn’t breath easily sitting down.

Jennifer, the owner of the Mono Azul Hotel caught me acting strange and went into action. She got one of her hotel staff to transcribe my experience into Spanish, called her personal doctor (Dr. Mojarro) and made an appointment for me at 4PM. This man circulates at the hospital all day long and then opens his own office at 4:30 PM to treat more dudes like me, not closing until he’s emptied the waiting room, which is usually 8 to 8:30PM. Ron N. from the Pacifico Group showed up unexpectedly because he thought I might need someone who speaks Spanish better than I. Right on. I learned that Ron has a degree in Spanish.

Two other groupees, Paul and Skip (both fugitives from Rhode Island and old friends renewing acquaintances here in C.R.) assigned themselves to my case and Skip provided a van to haul me around so I wouldn’t have to walk, huffing and puffing around Quepos.

I found Dr. Mojarro to be an excellent doctor, thorough, gentle and knowledgeable. He read the “note” I brought with me, asked me the usual questions about other medications (none) and conditions (none), examined me slowly and thoroughly with a stethoscope, then ran an EKG. After this he turned to Ron and me and said he wanted an X-ray of my Thoracic Region which can only be done at the main Quepos hospital (in Inmaculada) located near the airport. Ron said, “Maňana?”, the doc said, “No, ahora.”  That’s when I began to like the good Doctor’s methodology. So off we went to the Hospital where we quickly obtained the necessary film for 10,000 Colones (about $19) and returned to Quepos Centro to the doctor’s office, all in less than an hour.

Of course, having the film in my grubby little hands, I couldn’t resist examining it and making my own diagnosis. Many of you know that my record in personal diagnosis is abysmal but once an engineer, always an engineer. The first thing I noticed was that I couldn’t see my heart on the picture. The lungs appeared normal, although I suspect a really normal person would yield a lighter shade on his or her lung pic. Hearing my comments that my heart was missing (refrain from putting those thoughts you’re thinking to paper or conversation please), Ron went back into the hospital to make sure we got the whole picture. The tekkie assured him we had it all.

When Dr. Mojarro flipped the film onto his light-box back at his office, he called us over and described what he saw. The heart was indeed there but it was so large as to overwhelm the area below the lungs and the outline was barely visible, coming through as a large white area. Furthermore, the whole area was saturated and surrounded by congestive liquid. Old Bobbo has an enlarged heart and is actively working on congestive heart failure. Finally, the problem was identified. Incidentally, this diagnosis had been suspected earlier by Beth, Gail and Ron E., the Golden Gringo’s stateside nursing team.

Dr. Mojaro quickly shifted to his treatment mode and proposed a two-prong strategy. “First, we must get the swelling down and reduce the congestive fluid. This means two different diuretics, one for the swelling in the ankles and legs and the other for the heart stuff. And then we’ll need blood and heart rhythm regulators such as Coumadin and a product to put back the Potassium one regulator takes out. I expect the regimen will take about two weeks to stabilize you. After that I want you to see a cardiologist (San Jose) for an examination and analysis ‘mas profundo’.” 

Here’s the regimen set by the good doctor:

1.    Digoxino – 15 Drops in the morning.

2.    Lasix 40 mg – 1 at 8 AM and 1 at 4 PM

3.    Aldactone 100mg – ½  cap at 8AM and ½ cap at 4PM

4.    Enalapril 5 mg – 1 at 8 AM

5.    Coreg 12.5 mg – 1 at 8 AM

6.    Coumadin – 3 caps the 1st day, 2 caps the 2nd day, one cap per day thereafter.

So here’s the guy who never took medicine in multiples, or on a continuing basis, finally accepting to take true drug cocktail. Joo doo what joo gotta do to keep breathing, Senores.

Talk about service. The drug store evidently was out of Coumadin the day the doctor called for the other five. So Dr. Mojarro promised to meet me the next day on his return from the hospital with some of the hospital stock. He did indeed and called me in the afternoon of Christmas Eve day to let me know he’d be at Pali, the nearest supermarket to me and I should met him there. I huffed and puffed down to Pali along with my landlady’s son David, the interpreter, and the good doctor turned over a box of Coumadin to me at no charge. Then he cautioned me to get complete rest and no exercise as I huffed and puffed back to mi casa.

So my Christmas stocking was filled with drugs this year, and I’m very grateful.

(Post Mortem, I mean Post Script: Three days later under the regimen my breathing has improved significantly and the swelling is beginning to go down – amazing these modern drugs!)

Dios Te Bendiga, Amigos.   

Roberto de Quepos,

El Kahuna

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