Thyroid cancer

This is my story about finding out I had thyroid cancer.

It started back in January, I had a little cough.  It seemed to be worse at night when I was laying down in bed for some reason.  This went on for about a week, I was thinking I just had a little cold or maybe some allergies to something.  After all, I live in the tropics and we had foreign company that week.  Then it felt like I had something stuck in my throat, just a little tickle in the back and it wouldn’t go away.  This went on for a few days when it dawned on me that I should probably see a doctor because my thyroid is right there.

As you all can tell I live in Costa Rica and our healthcare system is a one payer system.  It can be very slow at times.  But you can purchase private health insurance and you can visit a private doctor and/or clinic if you like.  We do not have private health insurance, but I did go private for a lot of my tests; so I use the two systems together.  Using the public one payer system there is no out of pocket expenses.

So, I go to my primary care physician and she feels around on my neck and tells me that she wants me to get an ultrasound done of my thyroid.  She does suggest that I go and have it done privately so it will be done quickly.  No problem.  I go to a clinic and have it done for around $70.  I get the results right then and there, I get the images, and take everything back to my doctor.  It does show a small nodule in my thyroid.  She says she wants it biopsied.  Again, I go private for this and it’s around $250.  I get the test results back in a few weeks with a suggestion of getting my thyroid removed because of the type of cells that were found; Hurthle cells.  This is when I really start doing some research on the subject.

It seems that Hurthle cells are rare and even rarer if they are cancerous, it seems that I am rare.  So, I decide to go to a private endocrinologist here in Costa Rica.  Cost for an office visit was $100 without insurance.  He orders some tests, another ultrasound, and can’t figure out for the life of him why they would want to remove the nodules when they are so small.  I’m already put off at this point with him after hearing him say that.  But I get the tests done and send him the results.  Blood work was actually fine and the new ultrasound showed another small nodule on the right lobe of my thyroid.  Private endo still wants to wait.  In the meantime I am waiting on getting in with the public system so I don’t have to pay anymore.

I made a trip to the States to visit my family, this was back in June.  Had a great time, my cousin and I took our kids on a road trip for their high school graduation.  Got to see my sister, which is always important to me.  Got back and got my appointment with the public system finally.

By this time it is the end July when I finally get to meet with an endocrinologist.  She was very nice and spoke pretty good English.  She reviewed everything and set me up with what they call a thyroid clinic at the hospital.  That appointment was August 11th.  During this appointment I met with an oncologist, endocrinologist, pathologist, a surgeon, and about 12 interns as it is a teaching hospital.  I liked the idea of meeting with everyone at once.  This kept everyone on the same page at the same time and I didn’t have to go to multiple doctors appointments and it saved a lot of time.  The decision was made that yes I would have surgery.  We just didn’t know when.  So, my husband and I ran all over the hospital getting all the paperwork ready and I got on the waiting list for surgery.  I also got another appointment for another ultrasound, this appointment was in October.

In the meantime, I’m trying not to freak out too much.  This is a lot to take in, still didn’t know if it was cancer or not at this point either.  A good friend of mine talked me into going up to Florida to see if I could get the surgery done there any quicker.  I went to an endocrinologist in Florida who told me not to worry about anything because the nodules were small and it was probably just papillary thyroid cancer and those nodules are very slow growing.  This doctor had all of my tests results and was bilingual, so he could read Spanish, and no where did it say papillary only Hurthle!  I was so angry.  His suggestion was to come back in six months and he would do a genetic test on it to be sure.  This doctor reminded me of all the stories that I have read on the support pages about how doctors don’t listen to their patients at all, I was in tears when I left there.  So, I came back home.

Somewhere along the line I actually lost the order for my next ultrasound.  I have no idea how I had done this.  But, I had taken a picture of it on my phone!  So, I went private.  Again, I paid the $70 for the ultrasound and the doctor was very nice.  She explained everything to me that she was looking at…well, almost everything.  My husband was right there with me the entire time like he was for every other test.  I get the results and head back to my primary care doctor to see if she can get them to the hospital for me.

It turns out that she can’t get them to the hospital for me and that I have to take them myself.  This is a two hour drive each way.  But, the results now show that I do have cancer.  So much for those doctors telling me not to worry about anything.  My husband and I decide to take the results down on a Friday and drop them off.  I get to my endocrinologists office and wait for the door to open so I can hand him the results.  He looks at them and then looks at me and asks, “You still haven’t had surgery yet?”  Nope, I’m still waiting for them to call with an opening.  He told me to come with him that he was admitting me right then and there!  He said this was not waiting and couldn’t wait and yes it is cancer.  I was starting to freak out at this point.  I like to be prepared for things and I was not prepared for this at all.

I went in on Friday afternoon to the hospital and had my surgery on Tuesday.  All of the nurses and doctors were very nice and treated me very well.  The food was terrible though!  If I ever eat rice and beans again it will be too soon.  My surgeon told me that the surgery went beautifully and I actually got to come home the following day on Wednesday.  I was super happy to be home.  After all, I was only home for a few days from Florida before I went into the hospital.  My poor cats and dogs were freaking out when I got home again.

It’s been a week since I had my surgery and I got my stitches out of my neck today.  I told my husband I could be Frankenstein’s monster for Halloween now.  I did get a secondary infection after I got home, which seems common for me to do; I have had many surgeries in my life.  I am now taking my medication everyday and I will have to continue to take it everyday for the rest of my life if I want to live, which I do.  I will go back for some blood tests pretty soon to monitor my hormone levels and to see if anything needs to be changed.  I will have to continue getting ultrasounds every so often also to check for any regrowth of any tumors.  This battle may be over, but the war still rages on.  It’s an ongoing war with this, many people are never right after the surgery and so many more people don’t understand what they are going through.  The thyroid is a very important little organ and it controls so much in your body, once it’s gone it can be very difficult to get balanced again.  They call thyroid cancer the “good cancer”, but there is nothing good about it.  You still have to try to live, take medicine everyday for the rest of your life, hope you can get it balanced.  Many doctors won’t listen to their patients about it either, I’m glad that mine is listening.  I told her today how much I appreciate her.

So please, if you know someone who is going through, or who has gone through a thyroidectomy for cancer…be patient and understanding with them.  Listen to them because many feel like no one is listening.  Many get left behind by friends and family because they just don’t have the energy anymore to do the things that they once loved doing.  We feel tired, all the time, no matter what we do or don’t do.  I’m just starting my journey and I have a long way to go with it.  But I am learning, and I have found support with my thyca sisters and my husband.  I hope to paint again soon because that is what I love to do.

Until Mañana, pura vida!

Life in general

I know it’s been a while since I posted anything.  So, I will try to update now.

Yesterday we had a guy show up at our gate asking about the house across the street, it’s vacant now.  I used to have the woman’s phone number but couldn’t find it anymore.  There is another house down the street that is vacant also and is a little bigger.  It took us a while, talking with our neighbor, and a few phone calls, but we finally got the number for the house down the road.  It’s a small Tico style house with two bedrooms and a big kitchen, going for 60,000 colones a month.  The house across the street, we finally found out is no longer being rented but they want to sell it for 15 million colones; I wouldn’t give you 5 million for it.  It’s in really rough shape.  We bought our house just four years ago and only paid 15 million for ours and we have three bedrooms.  I wonder what our house would go for now with all the work we have done to it?  The house across the street was being rented for 45,000 colones per month, the guy told us that the same house in San Jose would go for around 150,000; I about fell out of my hammock.

Anyways, about the guy.  He had been in our town for about three days and working in the pineapple fields, which is really hard work.  His family lives in San Jose and he is trying to get them out of there and bring them up here.  He said his neighborhood is very dangerous and wants them to be safe.  He is only 21 and has three kids, he started early.  But I can tell you that he does want to provide for his family, so much so that he resorted to sleeping on the streets just so he could work up here.  He said he couldn’t find a job where he lives.  Everything he has made he has sent back to his family in the city.  He was here for a while, we made him a sandwich and had some coffee.  (We didn’t let him in the house though.)  He was very polite and I really felt sorry for him.  My husband did take him to town to write down numbers off the signs for other houses to rent, and we let him charge his cell phone here.  I guess today he is working.  I just hope that everything works out for him and his family.

We headed over to a friends house after that, I had some things that I needed to return.  Turns out that one of our friends had broken several toes and another bone in his foot.  Poor guy is on crutches now.  Today we took him over my crutches to use because they are much lighter than the wood ones.  We let them know that if they need to go anywhere to just call us, he is the only one with a license in the family and he can’t drive now.

Friday, my cleaning lady never showed up.  We waited and waited.  This was very unusual for her, she always let me know if she wasn’t going to make it before.  Turns out she was babysitting for her neighbors.  So she showed up Saturday but I had an appointment for another ultrasound for my thyroid.  I told her not to worry about it.

I went for my ultrasound at another clinic I found that was a lot closer to where I live and a lot cheaper.  I had been noticing what felt like another lump in my thyroid, but this time on the right side.  Turns out I was right, I now have another tumor in it.  This makes three now.  But they are all still pretty small, just bothersome.  If I talk a lot my voice starts to go hoarse.  One of my friends was joking with me today and said that makes me the perfect woman.  I couldn’t help but laugh and I know that he was only kidding with me.  After all, I had been picking on him for breaking his toes playing soccer.  He is like a brother to me.

As for the area I live in, Sarapiqui, it has been extremely hot here these past few weeks.  It has been getting into the upper 90’s, which is unusual for here.  Even the locals are in disbelief at how hot it’s been.  We haven’t been getting the rain like we normally do this time of year either.  It’s made it difficult to cook or bake anything in the house as we don’t have A/C.  When it does rain I may just run outside and dance in it.  The little beach areas at the river have been packed on the weekends with everyone trying to cool off.  I looked at it today and was very tempted to go home, put on some swimming clothes and jump in.  I haven’t been down there in a while.  I really feel sorry for my cats and dogs though, it’s almost impossible for them to cool off.

I did start painting again, but now I am out of canvas.  I did a geometric design in oil and an abstract in acrylic.  Looks like I will have to keep painting in acrylic because I can’t find oils where I live.  Acrylic is easy to clean up though too, plus you don’t get the smell from the oil or the paint thinner.  Would like to sell them to help cover the costs of a few things.  (Like saving up for surgery.)  In order to keep painting though I will need to take another drive to Guapiles, which is about an hour away, to get more canvas.  It’s a heck of a lot cheaper there compared to what I found here.  I can get it for 1,000 in Guapiles and around here it’s over 3,500 for the exact same size.

Well, that’s what’s been going on in my little corner of Costa Rica.  Not much really.  We have been to a couple of get-togethers with friends and met some more wonderful people.  It’s very relaxing here and I have started reading another John Grisham novel.  We are trying not to do a whole lot because we don’t know how much my surgery will be, we will be self paying for it.  Until Mañana, Pura Vida!

 

 

 

Endocrinologist

Well I finally went and saw an endocrinologist today.  He was a very nice doctor at Hospital Clinica Biblica.  He went over everything with me and spoke really good English.  He was really surprised that my public doctor wanted me to have the biopsy done with how small the tumor is, but he stated that it was a very good thing that she had me do it.  There are some cells in the biopsy that are very questionable at this point.  Basically, it is a 50/50 chance that it could still be cancerous.  He knows the doctor very well that did the lab work for the biopsy and was surprised to see him even give the recommendation to have it surgically biopsied.  He said this is very unusual at this stage.  He doesn’t want to jump right in and do surgery on me; especially with how many I have had done already.  I went over my surgeries with him and I thought he was going to fall out of his chair as I went down the list.

Three eye surgeries, Tonsils and adenoids; plus a cyst that was found, Wisdom teeth, gall bladder, appendix, bilateral lipomas four times, sinus surgery three times, plus countless removals of cysts.  I think I am trying to see what all I can live without.  And that is not even the complete list of stuff done.

So, I have a list of blood work that needs to get done.  I will be having that done through the public system as it doesn’t take too long to get the appointment and get the results back.  Then next month my specialist wants me to have the ultrasound done again.  He said I can e-mail him all the test results and if I have any questions I can e-mail him anytime.  My next appointment with him is in June, if all the test results are fine.  If things change I will probably be going to see him sooner.

He has ordered me to relax, no exceptions!  He said if it is cancerous I still don’t need to worry because it is easily treatable.  I know that it is, but it still makes me worry.  The doctor spent a very long time with me today and made sure that I understood everything.  Total cost of today’s appointment, with no insurance, was under $100 and this was at one of the best hospitals in the country.  He didn’t order any unnecessary tests, or prescribe any unnecessary medication.  He is taking it one step at a time to make sure that surgery is the last option.  I like this.

Until mañana, Pura Vida!

Update: Biopsy results

I got the results yesterday, it’s good new but not great news.  It’s NOT cancer!  That is such a relief.  But I did sit down and talk to one of the doctors at the clinic about the results.  There is some stuff still going on with the tumor and it is causing problems for me.  He is thinking that it is causing some hyperthyroidism and I need treatment for that and then I need to have the tumor removed completely and biopsied again.  I really do not want another surgery but it seems I don’t have a choice in this.  The doctor wanted to me to go and see my regular doctor, but we were about an hour away from home and it was getting late.  It was a really long day yesterday, and it’s already been a long one today.

We had dropped the car off for a radiator flush and then went to see if our new cedula cards had come in.  After waiting a month we finally had them!  This is the longest it has ever taken.  The radiator flush ended up only costing us under $24, way cheap for that.  Then we went to Pequeño Mundo to return a couple of shirts, and of course I picked up some more dark chocolate espresso bars.  After that we stopped by the clinic and got the test results.  I am still not sure how I am feeling about it.  I know I should be happy that it’s not cancer, but I just still feel down about everything.  Maybe it’s because of having to face another surgery.  I hate having my neck touched, and to think of someone having to cut into it just freaks me out.

Then on the way home we get a flat.  We just bought these tires in December.  But something definitely cut the tire causing it.  So we pull over, my husband and I get out and he starts getting everything out of the trunk.  He pulls out the spare tire…that one is flat too.  This is not fun.  I started calling some people, but they are either not close by or didn’t answer.  About then is when someone pulled over to help.  We loaded both tires in the trunk and I rode with him to get air in the spare and to see about patching the other one.  I got that done and it only cost $8, I bought the guy who stopped a small soda and asked him how much for the ride there and back, $6.  Not bad, I will take that.  We finally get the spare on, we decided we didn’t feel safe with the patched tire, and we finally made it home.

I got up early this morning to go and see my regular doctor.  I didn’t even think about this being Holy Week.  Everyone in the town is trying to get in before the clinic closes on Thursday and Friday.  There were no more appointments left for today.  This is actually the first time this has happened to me.  So, I will get up earlier tomorrow and see about getting one.  (Thursday, I am sleeping in!)  We went and picked up some more materials for our fence that we are building and then went and got a new tire.  Turns out when we got the flat we bent the rim also.  At least we have a full size spare so it’s not too bad.  My husband then took me to the other clinic to see about refilling my medicine.  Now, we just got our new cedulas yesterday.  Our carnet, which is like an insurance card, expired with the old cedula.  We couldn’t get a new carnet without a new cedula.  Even though we have our cedulas and proof that we paid for the insurance, they wouldn’t let me refill my medication.  Even after I explained to the woman why I didn’t have the new carnet.  So, I said “F” it and had my husband take me to the pharmacy and paid out of pocket for it.  It was about $16.  That was actually less than my co-pay in the States.  He asked me if I wanted to go back to our clinic to see if we could get the new carnets today; nope, just take me home so I can relax.  It can take several hours of waiting to get a new carnet and I was already frustrated.

So, that has been my yesterday and today.  I am tired and grumpy right now.  I am thinking of taking a nap, or taking up drinking.  I haven’t decided yet.  Until Mañana, Pura Vida!

Update 4

I got some good news yesterday.  My blood test results came back normal.  This was the thyroid hormone test.  So, maybe there is light at the end of the tunnel.  Just still waiting on that biopsy result.

I also had a cyst removed yesterday on my back.  I believe I am genetically cursed with these things.  The worst part about the hole procedure is getting the anesthesia injection to numb the area.  I could tell that part way through the procedure it was starting to wear off.  I didn’t complain because I definitely didn’t want another shot.  He got it completely out and even showed it to me.  They all kind of giggled when I said, “Cool.”  I do have a medical degree so these things rarely gross me out, I usually find them fascinating.  I got three stitches in my back and I go back in a week to get them removed. (I don’t know what it is either but every time I get stitches the first one always pulls out, it doesn’t matter who does them or where I get them done at.)  He put me on some antibiotics to prevent infection.  All of this was covered by the public healthcare system that we pay into.   My husband was right there by my side the entire time yesterday; just like when I had the biopsy done.  He is such a great man and I feel so lucky to have him.  Also, he has been making sure to wash my wound for me since I can’t really get to it.

Tomorrow I am going to Nicaragua with some friends.  My husband told me that I need a vacation after this week!  I agree.  This is my first time making the border crossing and I will be sure to tell you all about it.  We are just heading up to San Carlos for the day.  I am hoping to find something special for my husband, he is staying home with the furry children.  I am looking forward to going, just not looking forward to getting up before the sun.  Until mañana, Pura Vida!

Update 3: Biopsy

I am really tired now from today.  This biopsy took a lot out of me, plus I didn’t get a lot of sleep last night; probably from just being worried about today.

We got up this morning around 7, that is a little early for me.  I usually get up around 8.  It is difficult for me to get a good night sleep because my back always hurts so I am always changing positions during the night.  We had our coffee and a bowl of cereal, yup I still eat cereal, and then headed out around 8.  My appointment was set between 11 and 1, but we were expecting heavy traffic.  Of course today, there wasn’t any traffic on the way there, there was a road closure so we thought there would be more but in fact there was less.  We get to Guapiles early and went and made the house payment at the bank.  Actually got in and out of the bank quickly today.  Then we decided that since we still had plenty of time we would head over to the Maxi Pali and do some shopping.  There was a tour bus in the parking lot and a whole bunch of gringos in the store.  I am not used to being out in public with a bunch of people from the US around me.  From there we stopped by the vet and stocked up on cat food for the month.  Some things are a little cheaper in Guapiles than where we live so we stock up on those few things for the month.  After that we headed to the clinic.

The same greeter was there again, always smiling, she walked us over to the counter to get registered and to pay.  Total cost of the biopsy was less than $250, cheaper than our monthly insurance premium in the States.  Then we waited.  We did wait quite a while until I got called back.  My husband went in with me.  I had the same, very nice, gentleman that I had before for my ultrasound.  He remembered me and made sure to speak English, even his assistant spoke good English.  He sat me down on the edge of the bed and got me to relax, he knew I was nervous.  My legs hung off the end and I had a pillow under my back so it made my head lean really far backwards; this makes it easier for him to do the ultrasound and biopsy.  He found the tumor again, it is still the same size.  Then he took the needle and inserted it into my neck.  Keep in mind that I had no numbing agent either.  I felt a little pinch going in, not so bad.  But then he had to take the needle and move it in and out a little to collect the cells, he did tell me everything he was going to do before he even started the ultrasound so I was prepared.  The needle was going in and out, think of a plunging motion, and boy did it start to hurt.  I wasn’t allowed to talk or even to swallow, I had to stay perfectly still.  My husband was next to me holding my hand, more like me squeezing his hand really hard.  At one point I noticed tears in my eyes, but I stayed still.  I just kept twirling my feet.  He pulled the needle out, then informed me that he had to do it again because he didn’t get a big enough sample.  I wanted to cry at this point.  But I went through it again.  I remember feeling myself tense up and he would calmly tell me to relax, then I would take a deep breath and try to relax a little.  It worked.

He finally collected a big enough sample to send to the lab.  He got a paper towel and wiped off my neck and he and my husband help to get me in a sitting position.  I got so dizzy at that point.  I was so hot too.  My neck was super stiff and it hurt to turn my head to the side.  The technician told me to take all the time I needed, there was no rush.  He was very polite the whole time.  Even as I was leaving he did the tradition Costa Rica farewell of a small hug and a kiss on the cheek and shook my husbands hand.

This is not anything that I would wish upon anyone, but it was a good experience.  The staff and personnel at this clinic are absolutely amazing.  Now we just play the waiting game on the test results.  Anywhere between 10 and 15 days.  If they call, it’s not good news.  If they don’t call, it’s good news.  These next two weeks are going to take forever.  Until mañana, pura vida!

biopsy

update 1: Feb 2, 2016

So, I went and had my ultrasound done today at a wonderful clinic in Guapiles.  I walked in and there was basically a hostess.  She greeted me and asked what I was there for and then directed me where to go.  The lady who checked me in was extremely nice to me and giggled when I told her that my Spanish wasn’t that great.  She said I did fine with it.  I paid in advance for the ultrasound, just under $70.  I did not have any private insurance for this.  My husband comes in after parking the car and I sit next to him.  The lady who originally greeted me walked over and asked if we would like any coffee or water.  I forgot my water bottle at home so I definitely needed some.  She brought it to me with a smile.  She was one of those people that had a contagious smile.  I didn’t wait very long and they called my name, always mutilating it here, and took me back to another waiting area.  I sat there for a little while, maybe 30 minutes, and got to go in.  The appointment was set between 11am and 1pm and was a first come first serve basis.  I think I actually got in before 11.

The technician was very nice.  He spoke great English, better than he thinks.  He got me to relax and told me everything that he was doing and when he was doing it.  I did let him know that I do have a medical degree so I am not going to be too surprised by anything he finds.  He did find a couple of things.  There is a tumor that is on the big size and it will have to be biopsied.  He also found a cyst, which I have had a cyst removed in my throat before when I was a teenager.  I asked him straight up on what the chances are on the tumor being cancerous and he told me 50/50.  I can deal with that.  Thyroid cancer is normally a very easy cancer to cure.  There are several different types and if it is cancer we just need to figure out which one it is and go from there.  Tuesday I go for my blood work, I hope I get the same phlebotomist that I had last time, she was great.  I guess I will take the ultrasound results to my doctor either Wednesday or Thursday as I don’t want to go on Monday…that’s my birthday.

On a good note, for those of you that have been following, I found a wedding cake today!  My husband and I are having a wedding here in Costa Rica to renew our vows and to have a marriage certificate for here.  It is a beautiful cake that they can make with purple roses, purple is my favorite color, three tier and under $70.  It’s gorgeous.

I take the good with bad.  I try not to dwell on the bad and I try to celebrate the good.  Until mañana, Pura Vida!

 

This is the ultrasound machine, made by GE.  Excellent equipment.

ultrasound

Nervous

It probably started a long time ago, but noticeable symptoms just popped up last week.  Not thinking much of the original symptoms, after all I am getting older.  It started off with my hormones being whacky.  That can be normal for a woman in her early 40’s.  I went to my gynecologist and had some tests done.  He put me on some light hormone therapy and it helped.  Thinking this was all it was I continued on with normal everyday life.  Then a few weeks ago I developed a cough.  I had gotten bronchitis after my trip to the US and just thought it might be that coming back.  Plus, I do smoke.  But then it felt like I had something stuck in my throat that wouldn’t go away and my voice started getting hoarse.  I needed to get in to see the doctor.  You know, sometimes I think it was a mistake getting a medical degree because I know what these symptoms can point to.

I get up early and the power is out.  I sat there for a minute wondering if I should go down to the clinic or not with the power out.  Well, it’s Costa Rica and they will work with or without electricity.  So, I roll out of bed, brush my teeth, get dressed, and head out the door.  I get down to the clinic and there is almost no one there.  Very unusual.  I guess everyone slept in with there being no electricity.  I get inside and am trying to dig everything I need out of my purse and wallet to make my appointment, in the dark.  The receptionist was nice enough to shine her flashlight over to me so I could see better.  I finally found all of my documents and got my appointment for 7am.  I have never had one that early.  It was already 20 till 7 so there was no point in leaving and going back home, so I just sat and waited.

I let the doctor know what was going on and she checked out my throat. (I don’t like people touching my neck at all, my husband doesn’t even touch my neck.  It brings up too many bad memories of a situation that happened over 16 years ago.  That is another story though.)  She said my thyroid is definitely enlarged right now.  Something is definitely going on.  I gave her as much of a family history that I could, I only know half.   I have no idea who my biological father is so I have no information about his side of the family.  Thyroid cancer can be genetic.  I also informed her that I used to live close to a uranium processing plant.  The doctor gave me a couple of prescriptions for cough medicine and some acetaminophen, these prescriptions cost me nothing out of pocket.  There was no co-pay to see the doctor either.  She wrote me up an order to have blood work done, I go on Tuesday for that.  She also wants me to get an ultrasound done.  There is no out of pocket expense for the blood work.  For the ultrasound I am going to go to a private doctor because it is much closer to where I live.  If I went to the hospital to have it done there would be no extra cost either.  The out of pocket expense for the ultrasound at the private clinic I go to, and I don’t have private insurance either so this is the full cost of it, is just under $70.  I go tomorrow for that.

After the blood work is completed I will go back to my doctor with the ultrasound results and find out what is going on.  It will probably take about a week.  I am worried and nervous, but I am not scared.  I am not writing this for a pity party or for you to feel sorry for me.  I like to discuss things that I have personally experienced and pass that knowledge on to others.  We do have a one payer healthcare system here, what you pay is based on your income.  You can still go to a private doctor if you like.  You can still purchase private health insurance if you want.  I use both systems together and it has worked so far for me really well.  I will post updates on what is going on and let you know the results of the tests.  But please, if you think something is wrong with your body, or that something just isn’t right, get yourself checked out.  If I do have thyroid cancer it is usually very easy to treat.  If it is just a benign tumor, I will just have to have it removed.  I am not letting this get me down at all.  I live in a beautiful place with wonderful friends and a very supportive husband.  Until mañana.  Pura Vida!

New Law

Laws are constantly changing in the country, especially when it comes to immigration.  The new one they have now is about the stupidest one I have seen yet.  This one even effects those of us who already have our residency.

When you are a temporary resident, like we are for the next year, you have to renew your residency every two years.  You also must pay into the medical system here for your medical insurance.  You may still purchase private health insurance if you want, but you are required to pay into the public system.  The amount you pay will vary based on your income.  My husband is a pensioner and I am his dependent, so for the both of us we pay around $100 a month.  Those of us here refer to the system as the CAJA, pronounced Ca-ha.  It can take a little while to get used to using the public system and it can be frustrating at times.  But when you have no co-pays or deductibles, I don’t complain.

OK, back to the law.  When your residency expires so does your CAJA, you have to renew your residency and then go to your local office to renew your CAJA, which is basically just getting a new insurance card.  The law that they have passed here states that you must produce a new marriage certificate for every time you renew your CAJA.  The marriage certificate must be notarized, apostled, and not more than 30 days old.  For many of us this is impossible.  My husband and I got married in Las Vegas, we eloped.  For us to get a new marriage certificate we must order it from Nevada, then have it mailed to a friend of ours in another state.  She would then have to fill out a form and send it to the state of Nevada to be apostled with a self addressed stamped envelope to be mailed to us here.  This can easily take more than 30 days considering how slow the mail is here.

Who ever wrote this law only had locals in mind.  Because there are people from over 100 different countries living here and for many of them this is impossible.  This law is going to be contested at the Supreme Court here in Costa Rica.  But in the meantime…what do we do?  We get re-married here in Costa Rica!  I spoke with my attorney here where I live, he did some digging for me to find out how he can do this legally.  Because it is technically illegal to marry someone who is already married.  But he finally found out how to get around that since we are already married to each other.  So, I finally get to have a wedding!  My husband and I got married in April and that is when we are getting married again.  I bought a simple and cute dress today, nothing very fancy.  We have a small list of friends that we want there.  And we are going to fire up the BBQ.  I am feeling young again!  Our attorney is charging us $200 to preform the ceremony, he is giving us a discount, plus we are feeding him.  I am really looking forward to this.  I still have to pick out a cake though.  Really nervous and excited at the same time.  I love my husband so much that I want to marry him again.

So, a word of advice.  Do your research before moving here.  Remember that the laws are always changing and always try to keep up on them; especially when the new year rolls in.  There is always a way around something, legally.  Don’t do anything illegal.  Go with the flow and roll with the punches.  It will be OK.  Don’t let something stress you out too much, it’s bad for your health.  Until mañana, Pura Vida!

The medical system

Now, I can only comment and tell you my personal experiences when it comes to healthcare in Costa Rica.  So, keep that in mind.  Someone again today asked me to explain how our system works here and I thought I would just share a little more on that topic.  My husband and I are on the Pensionado residency status, so we pay based off of our income.  We pay just under $100 a month right now for both of us.  This covers everything, medical, dental, vision, and specialists.  We have no co-pays or deductibles to meet, no out of pocket expenses.  Then I always hear, well someone is paying for it.  Yes, we all pay for it, just like you do in the United States with your insurance premiums.  If you think that your insurance premiums are just for you, then you are sadly mistaken.  Your premiums are pooled together to help someone else pay their medical bills.  You do not just pay for yourself, you pay for everyone that is signed up with that insurance provider.  I love it when people say that they shouldn’t have to pay for someone else to have medical coverage, well, you already do.  Get over it.

People ask, can it take a while to get into to see a specialist, yes.  Just like it can in the States sometimes.  I know of one specialist in Colorado that has a six month waiting list to get in to see him.  So, it happens there too.  Does it take a while to get into see your doctor, no.  I can go in the morning and make an appointment for the same day.  If it is an emergency, I go down to the ER clinic and get in there.  Does it take a long time to have surgery, it can.  Just depends on what is going on.  Yes, I had a very long wait for my surgery, but it was done the same day.  They saved my life.  They saved the life of my daughter also.  She had to have an emergency surgery while visiting.  She was under 18, so still a minor.  There was no charge for minors, they believe in caring for ALL children no matter where they are from.  I almost broke down in tears, as we are on a fixed income and was worried about the cost.  We both had great care in a public hospital, many doctors and nurses spoke English.  I even had a doctor the other day ask me if I could teach her English because she wanted to learn.  Amazing people here.

So, how is it paid for?  This is where we help each other.  Everyone who has a job, the insurance comes out automatically, just like where you pay into medicare and medicaid in the US.  We do have a higher sales tax, like many European countries.  We do have a very high import tax also.  But, I don’t mind paying these if it is going to help my neighbor get her cancer treatment.  She is now enjoying her time with her first grandson.  She is cancer free.  Is our system in trouble, yes.  I won’t lie about it.  Could it be better, yes of course.  It is not perfect.  One thing I have noticed about being here, the money that is invested into our local hospitals and clinics through the public system is about care.  It is not about making the building look beautiful and perfect.  You can go to my clinic here and think this place looks like a dump, but once you get to know the staff you feel the love and care and the pride they take in their job.  I hobbled in the other day, I saw the pharmacist and she waved and said hello to me.  The receptionist came out and brought me a wheelchair.  So, the wheelchair didn’t have leg rests, who cares, I was sitting and off of my ankle.  I am not too picky and I have worked in the medical field in the States.  I am more concerned about my quality of care, not what it looks like.  They do keep it very clean there.  The lady who cleans the clinic, cleans all day and everyday.  She is always sweeping and mopping the floors, wiping down walls and counters, and cleaning the bathrooms.  They love to clean.  There is paint coming off the walls, no screens in the windows, only a few rooms with A/C.  But I am always made to feel comfortable and relaxed about being there.  You can have the most beautiful clinic there is, but without the care it means nothing.  I have worked in a very nice clinic in the US and the people there were ugly, they told patients lies.  They had no integrity.  I feel very lucky to be here where I am at in the beautiful country.  Pura Vida!