Jan 28 2019

What’s Up With the Yeatmans? CT Scan, Cancer, and the Caja-Part 3

First off, thank you for your concern, support, kindness, and prayers when you learned of Paul’s cancer scare. It is now 4.5 months since his surgery to remove his right kidney and 6.5 months since we learned the results of the CT scan (“TAC” in Costa Rica) which showed two tumors with a 95% probability of being cancerous. A lot has happened since then. After surgery, Paul recovered slowly but has never lost his positive outlook on life. We delayed our planned trip to Mexico by a month to allow him to get strong enough for the trip. We traveled to Mexico City on September 28th, still not knowing the results of the biopsy, but determined we would take it easy and enjoy every moment of our trip. Paul wasted no time by dancing in the street to the music of a Mexican rock and roll band, though it was short and sweet.

Paul dancin' in the street our last night in Mexico City. Not bad for 8 weeks post-op, huh?

Posted by Gloria Yeatman on Friday, October 5, 2018

After spending three nights in Mexico City, we traveled to the city of Oaxaca to the bungalow that we would call home for the next two months. As many of you know, we spend part of every year in Oaxaca, during Costa Rica’s rainy season. You can see some of the pictures from our time in Oaxaca this year in our last couple of newsletters or click the links in the “Related Articles” section below. Towards the end of our trip, Paul danced in the streets again, this time in Oaxaca’s Zocolo to the tunes of a Mexican blues/rock band! 

He is at it again…dancing in the street in Oaxaca!

Posted by Gloria Yeatman on Saturday, November 24, 2018

To me, this was evidence of how far he had progressed in his recovery from surgery. He was like the Energizer Bunny, he just kept going, and going, and going…

We returned home to Costa Rica on December 1st, did a healthcare tour we’d had scheduled for December 6th and 7th, and prepared ourselves emotionally to get the results of the biopsy at Paul’s December 12th follow-up appointment with the Caja surgeon. Unfortunately, due to the public workers’ strike, the Caja had changed his appointment…until December 1, 2020. No, that’s not a typo or a mistake. His follow-up appointment was rescheduled for two years later as a result of the 2-month-long strike.

“What are we going to do now?” we wondered. Then we came up with a strategy. Thankfully, we discovered the appointment change a few days before, while using the online appointment system to make a routine appointment to renew our prescriptions for 6 more months. We decided we would just go to the appointment as if we didn’t know it had been changed. But we also prepared a written request to get a copy of Paul’s expediente (patient file) covering the time period from the initial CT scan in April up to the present. That way, if we couldn’t get in to see the doctor, we could take the results to a private doctor to review the results.

On December 12th, Paul spoke to the head of the Urology Department at San Rafael Hospital who was also one of Paul’s doctors. She informed us that, yes, that’s correct, the appointment was changed to two years from now…and there is nothing she can do about it. Next, we went upstairs to see Paul’s gastroenterologist, Dr. Moreno, who has been his doctor for over five years and who was the one who ordered the CT scan which found the tumors. He also is a wonderful doctor with a warm, helpful bedside manner. He agreed with us that the delay was unacceptable and he wrote us a referral to the Pathology Department to get a copy of the biopsy results. Thank you Dr. Moreno!

We continued on to the Pathology Department, located deep within the hospital. There we learned that the biopsy sample had been forwarded on to Hospital Mexico (a top-tier hospital in the Caja system) for analysis and that the results hadn’t come back yet. Check back in a month, we were advised.

We also put in our request for the copy of Paul’s expediente and were told that they would count the pages to be copied (which would take 8 days) and we would need to return at that time to pay for the copies at 12 colones per page. Then it would take another few days until the copies were ready to pick up.

Knowing that we couldn’t stand to be in limbo while waiting for things we couldn’t control, we decided to get a PET scan done privately for Paul. While we were still in Mexico, we researched the availability and price of this test in the U.S., Mexico, and Costa Rica. In the U.S., the PET scan would cost about $5,000 USD; in Mexico, it would cost about $1,800 USD and was primarily available in Mexico City. For either of these options, we would have the additional costs of travel and housing. We found that there is one place in Costa Rica that offers PET-CTs and they charged $2,500 USD. We decided to wait until we were back in Costa Rica to have the test done once we had received the results of the biopsy. However, since we still didn’t have the biopsy results, and didn’t know when we would, we wanted to have the test done as soon as possible.

Sample Scan Results for Illustration

We left Hospital San Rafael and drove directly to Imágenes Médicas in San Jose, located right next to Hospital Mexico. Turns out, they are the only radiology center in Central American which offers PET-CTs. We were extremely thankful that they are located just about an hour from where we live in the Central Valley and that we were able to schedule the scan for the following day, after Paul got the necessary lab tests done first thing in the morning. We asked if they gave any discounts and were told that they offered a 15% Senior Citizen discount, so the scan ended up costing us $2,125 instead of $2,500.

One of the reasons for our desire to have the test done quickly is that, prior to our trip to Mexico, Paul had a 4G ultrasound done of his abdominal area. The radiologist who administered the ultrasound had told him that she found “solids” in his liver which may be more potentially cancerous tumors instead of the benign cysts originally diagnosed. Needless to say, we were worried that the cancer had spread before they were able to remove the kidney. Two business days after having the PET/CT, we received the results in Spanish, then a few days later, we received the results translated into English (per our request) as well as the disc with the actual scans. The result? Paul now has no cancer in the areas of his kidney and liver!

Unfortunately, the scans didn’t come out completely clean. They showed “metabolic activity” in a nodule on Paul’s thyroid gland that we will have to have checked out. But, if it turns out to be cancerous, the thyroid can be removed; we have been told that people rarely die from thyroid cancer. So, we are relieved for the most part but plan on staying on top of this. Early detection is so important when it comes to cancer and other potentially deadly diseases.

Overall, how do we feel about this whole experience? On the positive side, the Caja did perform the surgery at no cost to us, saving us about $15,000 USD had we had the surgery privately in Costa Rica. He received great care while in the hospital for those 14 days; we were impressed with the cleanliness and professionalism we observed at Hospital San Rafael. Another positive is that we were able to get a copy of Paul’s patient file. And we have the financial ability to be able to pay for a PET/CT scan privately and to take all of the records to a private doctor for consultation about what’s next. On the negative side, everything has taken longer than expected: the wait for the hospital bed to become available (7 weeks), the wait for surgery once Paul was admitted to the hospital (9 days), and now, the wait for the biopsy results (4.5 months and counting) and follow-up appointment in the Caja (2+ years).

So, What’s the “Take-Away?”

Yes, Caja delays are aggravating, frustrating, and unacceptable. But, this is a good illustration of why we always say it is important for retirees in Costa Rica to have a financial reserve to cover these unexpected expenses and a “Plan B” for these unexpected delays in care. There are times when you will need to pay to see a doctor and have diagnostic tests done privately. You don’t want to rely just on the Caja. Blending the public and private healthcare that Costa Rica offers is the best way to go. If you are able to keep an option in your home country (Medicare, VA healthcare, or socialized medicine) or can afford to purchase international health insurance, that’s even better.

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