Medical Issues for World Travelers…A Comprehensive Synopsis…

This exquisite bloom which was the size of a soccer ball.
This exquisite bloom was the size of a soccer ball.

Traveling for extended periods always raises concerns over medical issues for world travelers. Notably, seniors and those with existing health conditions, regardless of age, have asked themselves if traveling for months or years makes sense when at any time, especially in remote locations, a flare-up of any underlying condition or injury can elicit worry, concern over a life-altering illness, or even death, let alone panic in some situations.

Today’s 2000 word post entitled “Medical Issues for World Travelers” will include suggestions on how we’ve managed such circumstances as world travelers for the past eight years. Below are the most commonly asked questions when discussing medical issues for world travelers for those considering long-term world travel:

  1. How will I receive my prescription refills and also, for some, “store insulin and other medications that require refrigeration?”
  2. What do I do if I run out of medication while traveling?
  3. How will I be able to receive my necessary prescriptions?
  4. What immunizations/vaccines will I need to travel the world?
  5. How do I handle everyday aches, pains, injuries, and illnesses that may have prompted me to visit my doctor in my old life?
  6. What do I do about dental care, colonoscopies, mammograms, and other recurring medical tests?
  7. What shall I do for medical travel insurance?
  8. How often should I seek a physical exam if my health is good and I’m feeling well?
  9. What do I do if a severe illness or injury occurs while I’m traveling? Do I return to my home country for surgery or treatment?
  10. How will I handle my protection in avoiding contracting COVID-19 and other such viruses that may be or become prevalent while I’m traveling?

During our past years of world travel, each of the above questions has been at the forefront of our minds at one point or another. As time passes, some of our suggestions and solutions for our situations may change as more and more travelers consider long-term travel once COVID-19 is under control. Today, following in the above questions as highlighted headings below, we will address each of these questions.

Regardless of our past experiences and observations, it’s imperative to discuss your health conditions or potential age-related conditions with your physician and medical professionals before embarking on any trip, if for a week, a month, a year, or longer.

We also suggest you assign a family member or close friend as your medical advocate if you as an individual or a couple are in an accident that may leave you unable to manage your care during severe medical treatment and recovery. It makes sense for couples to go quickly accessible notes on a smartphone with any medical particulars that may be crucial in their partner’s care (such as allergies, medications, conditions, etc.).

It’s surprising how often a spouse, companion, or partner may be oblivious to the health issues of their traveling companion. This may be one of the most critical medical issues of world travelers. So, let’s start working our way through the above ten questions. If, at any time, you have questions on topics we haven’t covered, please feel free to comment at the end of any post. You may do so anonymously if you’d prefer. Here we go:

How will I receive my prescription refills and also, for some, “store insulin and other medications that require refrigeration?”

One of the most frequent medical issues for world travelers is carrying sufficient supplies of necessary prescription medications and getting prescriptions refilled in other countries. Of course, the ideal scenario is to determine how long you’ll be gone and carry all of those prescriptions with you in a secure carry-on bag with copies of the prescriptions from your doctor.

Unfortunately, many travelers’ health plans do not allow a prescription for longer than three months. When we first left the US, the workaround that we chose was to pay for the drugs ourselves without claiming our insurance. We’d asked our doctor to write the three non-narcotic prescriptions for one year each. We’d even be able to negotiate the costs of my three prescriptions from a few pharmacies, who were happy to give us a year’s supply at negotiated rates.

As it turned out, our cost of the prescriptions was compared to the co-pays we’d have paid for the medications using our health plan. However, even if it had required more money out of pocket, we’d been willing to pay considering the convenience. If you plan to return to your home country to visit once a year, you can repeat the same process. Since we didn’t return to the US more frequently than once every two years, we developed another plan.

At the beginning of our travels, while in Belize, we met a couple, and the wife suggested we contact ProgressiveRX, a company we’ve worked with these past eight years, except for those times, we could purchase my medication at a pharmacy without a prescription, which is possible in many countries. For example, in India, where many US medications are manufactured, we don’t need a prescription for any non-narcotic drugs, none of which we use. One needs to write down their medication, dose, and quantity they’d like to receive for most prescription medications. This information is available online.

As for storing medications that require refrigeration, carry a stable cooler block and a small cooler bag to keep the medicine cold during long flights. Since most hotels and holiday homes include a refrigerator, it shouldn’t be a problem. We have what we call a carry-on “pill bag,” which contains copies of original or recent prescriptions and pills in their original packaging, which we don’t let out of our sight. It’s imperative, regardless of the medication, not to leave them in your checked baggage.

What do I do if I run out of medication while traveling?

First off, if you plan, you can avoid this situation while on longer trips by ensuring you have an adequate supply of medications you’ll need, including a few weeks of extra doses in the event of unforeseen delays. If you’re traveling for years instead of weeks or months, you must decide how to renew your prescriptions when most countries requiring medications do not allow you to use your home country physician’s prescriptions. It’s important to check this information in advance of traveling.

In the worst-case scenario, which we’ve accepted as a part of our travel responsibilities, is to make an appointment with a local doctor, bring along your existing prescriptions and containers, and ask the doctor to write new prescriptions for you for at least six months, a year if possible. Doing so is not as inconvenient as you may think.

Ask your landlord or hotel staff for the name and number of a local clinic to arrange your appointment and subsequent filling of your new prescription. Keep in mind, in many countries; prescription drugs are named differently than in your home country. Sure, this becomes a part of medical Issues for world travelers but doesn’t usually require more than a few hours of your time.

If you are on a cruise ship (hopefully possible again in the future), the ship’s doctor generally has the most common medications on hand. However, the cost to see them can be expensive. Being prepared before embarking on a cruise is imperative.

How will I be able to receive my necessary prescriptions?

Using such prescription services as ProgressiveRX may end up taking months to receive in regular mail. If you are staying in one location for many months, this may be possible. Also, depending on mail services available in some countries, you can request expedited service for an additional fee. This may be the case for most online pharmacies willing to use an old prescription as proof. In no case will narcotic drugs be mailed in any country?

For those with chronic pain issues, traveling long term may be a part of substantial medical Issues for world travelers. The only way you’d be able to receive such medications would be from a visit to a hospital, urgent care facility, or a doctor with you providing accompanying paperwork from your home physician describing your condition in detail and your need for narcotic medication. Since we don’t use pain medications other than those over-the-counter, that’s our best suggestion.

What immunizations/vaccines will I need to travel the world?

One of the many concerns over medical issues for world travelers is the necessity of immunizations before embarking on a journey that will include countries where certain diseases are rampant. Most medical clinics or groups have a travel clinic you can visit. It’s imperative to bring a list of the countries you’ll be visiting, illnesses, medications, allergies, and previous vaccinations to your first appointment.

From there, a nurse practitioner along with a doctor will determine what immunizations are recommended for your upcoming travel. We arranged for this appointment a few months before we left to ensure ample time for any necessary spacing of the vaccinations. In all, we each had about 15 immunizations in total. I won’t mention them here because your locations and personal health may be entirely different from ours. Also, we planned to be gone for years, not months, so we needed additional inoculations.

The travel clinic will know exactly what you need, but it’s your final decision as to which, if any, you are willing to accept. We accepted all recommendations. While in South Africa in 2018, we presented our immunization record to our local Dr. Theo, and we had boosters as needed. Our only reactions were from the yellow fever vaccine, leaving me feeling flu-ish for a few hours and Tom, lightly, over a weekend.

It is during this appointment. You may choose to get prescriptions for malaria pills. There are two types of these. The more expensive have fewer side effects. See your doctor for recommendations.

How do I handle everyday aches, pains, injuries, and illnesses that may have prompted me to visit my doctor in my old life?

Another primary concern over medical issues for world travelers is those who may have visited their family practitioner regularly, often monthly, for blood tests, exams, medications, and treatment protocols. If this process has been prevalent in your care, long-term travel may not be ideal for you. Perhaps, shorter trips would be more appropriate.

We’ve had flu, bad coughs, and viruses throughout this period, but we managed on our own in most cases. Otherwise, we have learned to self-treat minor injuries, aches, and pains with ice and hot packs and over-the-counter medication. This may not be appropriate for many travelers, requiring visits to local doctors. I’ve had a few injuries become infected. In those cases, we sought medical care.

What do I do about dental care, colonoscopies, mammograms, and other recurring medical tests?

Before we left the US, we had many medical tests to ensure we were good to go. Once we started traveling, it was almost 2½ years before either of us made an appointment for a check-up and blood test. Contrary to most medical advice, we decided to forgo colonoscopies instead, conducting the home fecal monitoring tests checked by a lab. I haven’t had a mammogram since we left, but I do self-exams regularly.

As for dental appointments, we each had our teeth cleaned every six months in our old lives. Now, we’re lucky to have this done every two years. Not every country is suitable for dental appointments. Of course, generally, dental care would be necessary in case of an infection or abscess.

Based on having had emergency major open-heart surgery in South Africa in February 2019, dental care was ill-advised 12 months after the surgery. Once we return to South Africa, we will visit our favorite dentist in Komatipoort for cleaning and other dental care as needed.

While we were in Minnesota in November 2019, I visited a highly regarded cardiac facility to be checked after heart surgery. It was recommended I return next time we visit the US, which I’ll surely do. Of course, if any heart-related issues presented, I’d immediately seek appropriate medical care.

What shall I do for medical travel insurance?

Overall, the most frequent question regarding medical issues for world travelers is travel insurance. We have written dozens of posts on this topic which can easily be accessed by typing “travel insurance” in our search field on our home page. For purposes here today, I’ll briefly review our experiences.

When we began our world travels, we signed up with a worldwide travel insurance company, Healthcare International, based in London.  As typically the case, worldwide travel insurance doesn’t cover travelers in their home country unless they are willing to pay a much higher rate.

We had opted out of Medicare Part B since it nor its supplemental policies at the time covered medical issues for world travelers like us. There was no point in paying for Medicare Part B or a supplement, as much as several hundred dollars more each month, to cover us outside the US or even while in the US, when we were visiting for such short periods if we needed medical care. At the same time, in the US, which we have paid out of pocket on a few occasions.

We paid US $4000, INR 291,844, per year for the policy and never claimed until in February 2019 while in South Africa, I had to have emergency triple coronary bypass surgery. To make a long story short, the insurance company refused to pay, and we had no choice but to pay out-of-pocket for the expensive four surgeries, including three weeks in the hospital, that was ultimately necessary.

They claimed I had a preexisting condition. I had no idea I had heart disease. But to force them to pay would have required years of legal expenses and time, with the possibility of losing the case. We had no desire to make our lives all about a lawsuit, especially if we could lose the case.

From there, we researched online for a US company. We found UnitedHealthcareGlobal with no pre-existing conditions policy other than no effective medical treatment in the past six months. We qualified by the time we purchased the policy. There are more nuances of the policy, but I won’t get into that here. Click this link for more details. (Due to COVID-19, one must call for a quote, but recently, from here in India, we were able to renew our policy without a problem.

Since we travel full time, our needs are different from short-term travel policies. Also, now as time has passed, there are supplemental travel policies available to US citizens, but not applicable to us since we don’t have Medicare other than Part A.

Often, your travel agency, cruise company, or other travel-related businesses offer short-term travel policies. In light of COVID-19, we encourage you to do your research for such policies for short-term travel. Plus, many of the travel business policies are more expensive than you may find on your own.

How often should I seek a physical exam if my health is good and I’m feeling well?

It is essential to discuss your medical issues for world travelers with your physician before embarking on a year’s long journey. Based on your current conditions, or lack thereof, they will recommend how often you should arrange a check-up from a qualified medical professional in the countries you will be visiting. Also, they may suggest tests that are important for your state of health.

For us, every few years has prompted us to have a basic exam. It was only in South Africa that I had jaw pain precipitating an additional visit to Dr. Theo, whom we had already seen for exams and vaccination boosters, which under normal circumstances would never have predicted my cardiovascular issues when I had a normal EKG and heart sounds during the actual exam.

It was months later that I visited Dr. Theo, who suggested I had an exercise stress test when I was experiencing weird jaw pain. If he hadn’t done that test on me, I might not be here today to tell the story. His determination sent me to a cardiologist and thoracic surgeon only days later for immediate open-heart surgery. We are so grateful to him for “catching this.”

What do I do if a severe illness or injury occurs while I’m traveling? Do I return to my home country for surgery or treatment?

This is a common concern and medical issue for world travelers. I suppose my case was a perfect example. There was no time for me to return to the US for emergency surgery, nor would it have been safe to fly back to the US in my dire condition.

Also, if we returned to the US, the cost of the four procedures would have been around US $1,000,000, INR 72,961,200. Medicare would only have paid a portion, and we’d have been left with much more out-of-pocket expense than the entire bill we’ve had to pay in South Africa. In the end, it all worked out for the best.

However, many less severe conditions can make a traveler worried and stressed as to appropriate action for a travel-related illness or injury, not requiring urgent medical care that may be available by quality professionals in some, not all countries. One must assess the situation carefully and determine the safety of treatment in their current condition.

If anyone had asked me if I could have recovered from open-heart surgery and three other procedures, for three months in a holiday home in the bush in South Africa with no air-con in the living areas with temperatures in the 104F, 40C range, day after day, I would have said absolutely “NO!!!” But, with Tom’s attentive and loving care, we made it through. One never knows their strength and resiliency until faced with situations beyond their control. I wasn’t allowed to travel for three months and could not have returned to the US to recover.

How will I handle my protection in avoiding contracting COVID-19 and other such viruses that may be or become prevalent while I’m traveling?

There are substantial medical issues for world travelers in today’s world is COVID-19. What do I do if I become infected while traveling? Based on the infectious nature of COVID-19, returning to one’s home country would be impossible and risky for others if somehow you managed to get through the priority checking procedures at most airports.

If one becomes infected, it is imperative to immediately arrange for a test to confirm infection and to contact the local health authorities for contact tracing if you are indeed positive. If you are only a carrier without very mild symptoms, you will be required to quarantine for a definite period, most often for two weeks. At that point, you’ll be advised as to treatment based on the severity of your symptoms.

Some countries may require quarantine at a specific location. However, most will allow quarantine to transpire at a holiday home or hotel, never leaving the facility during the critical period. If symptoms are escalating, a hospital or urgent care visit may be necessary. The local health authorities will advise you in either case.

It’s essential to notify the property manager so the holiday home can be properly sanitized after you leave if leaving immediately after the quarantine ends. Stay for an additional, extended period. It may be possible for you to sanitize the location upon full recovery since the virus only lives so long after the infection has ended.

Here again, investigate this with the health authorities and the property owner. Hotels do this cleaning after quarantined parties can vacate. We see the special cleaners in the corridors every day, although we aren’t aware of any cases in this hotel.  But, it would be best if you let them know once you discover you are infected so they can commence proper protection for their staff and other guests.

Taking a test after recovery is equally important to ensure you are no longer infectious. In some cases, a positive test may be present more extended than the two weeks. Also, wearing an appropriate face mask, social distancing, and washing hands frequently always remain reasonable safety measures.

In conclusion, regarding medical issues for world travelers…

It would be possible to write an entire book on this topic. I have well surpassed the 2000 word requirement at well over 3500 words. In each case, we suggest you contact your doctor(s), your pharmacist, and a family member as an advocate before embarking on a years-long world journey.

Even those in the seemingly best health may fall prey to a severe and often life-threatening condition while traveling, especially those in later years. No one is exempt from such issues, regardless of excellent health at the beginning of their travels.

Of course, I am living a healthful life while traveling. Although no guarantee of avoidance of medical issues for world travelers, it certainly is an essential adjunct in predictive outcome in many cases.

Avoiding worry and concern is undoubtedly an essential aspect of enjoying world travel. Being educated on all of these topics, carrying appropriate medical information for health and prescriptions, and researching medical care in each country before visiting can play a vital role in ensuring a safe outcome in the event of an unforeseen injury or illness while traveling.

Be well.

Photo from one year ago today, October 13, 2019:

Shirenewton, Chepstow, Wales, the holiday property
In Shirenewton, Chepstow, Wales, the holiday property we rented is The Studio, but it is more significant than a studio apartment. The main floor consists of a living room, kitchen, dining area, and bathroom. The master bedroom is upstairs on a mezzanine level, a small loft room with a futon bed. For more photos, please click here.

Other medical maladies in times of Covid-19…What can you do if become ill?…It happened to me!…

Tom took this terrific video while we were in a boat on the Chobe River in Botswana in May 2018. Please see that post here with several more videos.
 

Note: To all of our readers visiting our site via a smartphone, please click the “View web version” tab under the word “Home” at the bottom of the page to access the web version enabling you to access all of our archives on the right side of the page. We’ll be updating our site in a few months, making these extra steps unnecessary. Thank you.

Today’s photos are from our post one year ago today. Please click 
here for more details.

When visitors first come to Africa, they often confuse cheetahs and leopards. Cheetahs are easily recognized by the dark “tears” coming down their faces.

This particular article from the New England Journal of Medicine discusses the issues for patients without COVID-19. They are exhibiting medical symptoms that require attention from their doctors or local emergency room/hospital.
Many such patients are terrified of visiting a doctor’s office or a hospital emergency room which may be packed with COVID-19 patients awaiting treatment. 

Lilies are beginning to bloom in the river.

Based on Mumbai as the nation’s worst hotspot and epicenter right now, we’ve known if one of us became ill unless it was imminently life-threatening (from what we could decipher), we’d have to self-diagnose and treat ourselves to the best of our ability. 
With all the hospitals in Mumbai, including the private facilities filled with COVID-19 patients, there is no way either of us would consider a doctor or hospital visit if we became ill unless we determined we had the virus and needed emergency care.

Three elephants on the river.

Most drugs may be obtained without a prescription in India as long as it’s not a narcotic. Tiny pharmacies are found in busy open market areas. Before we were in lockdown, we stopped at one of those street-side pharmacies to refill my meds for hypertension, as mentioned in a prior post. 

, the pharmacy couldn’t refill my exact prescription containing two drugs, so I opted for a dosing alternative. But, no doubt it’s been in the back of my mind about what we’ll do if one of us becomes ill with some other ailment. 

Lois and Tom, friends from the US who came to visit us for three weeks in October 2018. We had a fantastic time when they called and stayed with us.  We hear from them often.

At this point, there would be no alternative but to self-diagnose and treat to the best of our ability. So, when five days ago, I started experiencing pain in my right cheek. I dismissed it as some weird headache. Since I am not prone to headaches, rarely ever getting one, I started to be concerned after three or four days.

When I was diagnosed with advanced coronary artery disease in February 2019, resulting in triple cardiac bypass surgery, the only symptom I had for several weeks was a pain in my jaw on both sides of my face. I had no chest or arm pain, shortness of breath, or tiredness, which often present before having a heart attack.

Tom and I were at Aamazing River View in October 2018 when friends Lois and Tom were visiting for three weeks.

Thus, a few days ago, with a new pain in my face, of course, I worried about the grafts failing and causing a new series of symptoms in my face. I didn’t say anything to Tom, preferring not to bother him, and decided to give it a few more days to see what would transpire.

The pain was exacerbated. By early yesterday afternoon, I mentioned it to Tom, who’d asked me over the past few days on several occasions if I was OK, to which I replied, “I’m fine.” But I wasn’t acceptable.

Happy hippos…

I’d already spent considerable time researching online, unable to find a direct correlation between cheek pain and heart symptoms. But, last year, I’d never considered the weird jaw pain was symptomatic of three 100% blocked coronary arteries.

After all the research, I could come up with two possible conditions; an abscessed tooth or a sinus infection. There’s a facial nerve condition I’d researched, trigeminal neuralgia, but those symptoms didn’t seem consistent with my current discomfort.

A bateleur we spotted in Kruger.

After researching possible antibiotics and treatments for each of these two other options, it appeared the best solution for either condition is almost identical: taking antibiotics, specifically Z-Pack (Azithromycin) for a five-day course, along with hot packs and Tylenol (Paracetamol).

Two females and one male enjoy the shade under a tree in hot weather.

Fortunately, before leaving the US, we stockpiled good-sized supplies of various emergency-type drugs, including Z-Pack (Azithromycin). I decided to start taking the first dose of two tablets the first day and one tablet each following four days.

After taking the tablets with a big glass of water, I began the hot packs using hot water from the tea kettle and a folded washcloth every few hours while continuing with the Tylenol.

It’s easy to spot male lions with the big mane surrounding their faces, whereas the females do not, as shown in the photo we took in Kruger.

This morning I awoke with a 50% improvement. Hopefully, I’m on the mend. We’ll see how it rolls out over the next few days. In the interim, I cut back on the walking to half my usual distance to give myself time to heal.

It’s only under these dire circumstances that I have self-treated to this extent. This information is not intended as medical advice for our readers. We suggest you seek medical care in the event of any medical concerns during this time of COVID-19 and into the future.

We couldn’t have been more thrilled to see a giraffe in our garden.  He took off quickly when he saw us, so this was the best photo I could take.

It’s very different here for us in lockdown while in Mumbai, India. Most of you with any medical concerns can readily contact your usual health care provider for assistance. It’s not the case here during this challenging time.

Stay safe. Wash your hands. Wear a face mask in public. Social distance.

Photo from one year ago today, May 5, 2019:

Lounging lion laying low…For more details, please click here.

Macronutrients…What am I doing in an attempt to avoid future heart issues?…

A calf on a hill overlooking the sea.

“Fascinating Fact of the Day About Ireland”
Over 80% of Ireland’s people are Roman Catholic.”
         
Last night was one of those magical occasions when I slept through the night without awakening until 6:00 am. Tom didn’t do quite as well. But, we bolted out of bed, showered and dressed for the day, and made ourselves scrambled eggs with sauteed onion, grated cheddar cheese, and bacon.

I only had one piece of bacon and one tablespoon of cheese with my eggs adding one of those tiny cans of tuna on the side. This will hold me until I have my required protein smoothie sometime this afternoon.

An old abandoned building facing the bay.
Lately, with all the confusion and lack of good research on how much fat a heart patient can eat, I’ve been keeping track of everything I consume in the free app, Cron-O-Meter, found at this link.
 
I’m attempting to keep my fat consumption under 70 grams per day, protein at 120 grams (As recommended by the plastic surgeon. I’ll lower this after my legs fully heal), and carbs under 50 grams per day (all sourced from vegetables and fruits as mentioned below: avo and tomatoes).  
An occasional sunny day gets us out to take photos.

Note:  Carbohydrates provide four calories per gram, protein provides 4 calories per gram, and fat provides 9 calories per gram.

Thus, my macronutrients are as follows:
Carbs:  4 x 50 + 200
Protein: 4 x 120 = 480
Fat:   9 x 70 = 630

Total calories:  1310
This amount leaves room for a little red wine and an occasional snack after dinner, all of which will increase the above totals bringing it up to a maximum of 1500 calories per day.

Wildflowers are surrounding our holiday home.

Using this app enables me to keep easy track of the above macronutrients and adjust my diet during the day if I end up grabbing something unplanned. I continue to avoid all starches, grains, fruit, and sugar. Although I continue to enjoy tomatoes and avocados, both of which are the only fruits I consume.

My caloric consumption is an ample amount and yet will keep me from gaining weight. Not that I necessarily pay much attention to calories but based on my age, activity level, and current weight this caloric amount is sufficient.

Exciting rocks and seashells line the outdoor ledge of the window.
Perhaps this method won’t have a positive impact on my cardiovascular health in the long run. But add in, walking 8,000 to 10,000 steps a day, not sitting in one position too long, attempting to sleep well, and currently taking vitamins recommended by the doctors:  Vitamin C, CoQ10, Magnesium, Selenium, Zinc, and Vitamin D3. (Please see your nutritionist, dietician or doctor for vitamin doses).

I don’t know what else I can do other than keeping stress at a minimum which is more of a contributor to failing arteries than from diet based on what I’ve researched thus far. 
(These comments are not intended as medical advice.  Please see your doctor for recommendations befitting your medical health).
Stunning view of the bay from our garden.

The only stress I am experiencing now is the ongoing issues with the health insurance company and their refusal to pay, claiming I had a pre-existing heart condition (which I did not).  

Each time I get an email from any of the parties involved, I can feel my heart beating faster with frustration and anger over this unbelievable situation. I can’t wait until this is finally resolved. Each time I think this way, I get up, walk around the house and take lots of deep breaths.
As for today, we’re busy online planning our upcoming trip to the US in less than five months. The time goes quickly, and this has become a priority. Soon, we’ll report back with plans we’ve booked for November.
 
Have a stress-free and pleasant day!
Photo from one year ago today, June 11, 2018:
The rhino’s skin looks a little too large for their bodies. From this site: Members of the rhinoceros family are some of the largest remaining megafaunas, with all species able to reach or exceed one tonne in weight. They have a herbivorous diet, small brains (400–600 g) for mammals of their size, one or two horns, and a thick (1.5–5 cm) protective skin formed from layers of collagen positioned in a lattice structure.” For more details, please click here.

Pain killer issues…More discomfort…

This morning view!

“Fascinating Fact of the Day About Ireland”
“Northern Ireland is governed by the United Kingdom, while the rest of Ireland is an independent nation.”

I deliberated over writing about today’s topic. There’s a certain amount of embarrassment and shame associated with withdrawal from necessary pain medication. We are not talking about non-medically prescribed addiction to opiates which is rampant in today’s world.

Patients often take opiates for medical issues, and when it’s time to stop, they cannot do so or choose not to do so and end up spending months, years, or a lifetime drug-seeking. In a desperate need to acquire more medication, crimes may be committed, relationships destroyed, and even death from overdoses. For more information, please click here for the Mayo Clinic in the US.

That’s not what we’re talking about today. Today, we’re sharing my personal experience over the past three months of taking a prescribed combination drug, Ultracet, which is described as follows: This product is used to treat moderate to moderately severe pain. It contains two medications: Tramadol (37.5 mg.) and acetaminophens (325 mg.), such as Tylenol or Paracetamol.

Although the dose of Tramadol is low, it is a scheduled substance* and considered to be an opiate, a class of drugs described as follows: “Opiate is a term classically used in pharmacology to mean a drug derived from opium. Opioid, a more modern term, is used to designate all-natural and synthetic substances that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant Papaver somniferum.”

*Scheduled medications are described as follows from this site. Please remember that we don’t profess to have any special education or knowledge on this topic. Please see your physician for assistance in this manner. However, I do have a story to tell with the hope it creates awareness and support for those who may have experienced similar issues. You are not alone.

Three months and one week ago, as most of you are aware, I had emergency triple coronary bypass surgery on February 12, 2019. Three of the four of my cardiac arteries were 100% blocked. Angioplasty was not an option.

With the necessity of taking veins from the legs with long incisions, inserting chest tubes and neck IV (PICC line), and opening the chest via another 30.5 cm, (12-inch incision) and then cutting through the strong breastbone. No ribs are broken during this procedure.

After surgery, upon awakening and discovering a tube in my throat (intubation), I was in agonizing pain in each area of my body involved in the surgery. At that point, I was given morphine to reduce pain, cause sleep and reduce the memory of the experience.  

No doubt, the morphine worked when it was added to my IV. Upon waking, hours earlier than expected, I remember asking using hand signals for pen and paper to write, “Take out the tube!  It’s hurting my throat.”  

They didn’t remove the tube. They gave me more morphine, and I slept for several more hours. This next time I awakened, the tube was painfully removed while I was awake. More pain.

Over the eight days in ICU, I was given pain medication via the IV in my hand, morphine for the first day and Tramadol, for the remaining time. By the time we went back to Marloth Park, 11 days post-surgery, I was still in an enormous amount of pain.  

In the first 24 hours back in Marloth Park, I pulled a muscle in my right chest in the middle of the night, and the overall pain was exacerbated by 100%. Although Tom provided professional caregiver attention, the pain was unbearable.  

I was sent home with a box of 60 Ultracet tablets with instructions “not to worry” about the drug since the low dose wasn’t addictive and wouldn’t cause any issues upon stopping.  

The doctor suggested I take two tablets every four hours or as needed.  I chose to take one tablet every six hours. It helped make me more comfortable but didn’t relieve the pain. I decided to “suffer it out” with this lower dose preferring not to take any pain medication if I could avoid it.

Then, less than a month after the bypass surgery, both of my legs became infected. After two surgeries, more morphine and IV Tramadol during the five days, I returned to the hospital for two surgeries, three days apart, on both of my legs. I was sent “home” with another 60 mg box of Ultracet tablets.

The pain in my legs proved to be more painful than the recovery from the bypass surgery, although it was a close second. I continued to take the tablets every six hours as I’d done previously. The pain continued, if not fiercely, even when I was instructed to be on total bed rest for almost a month. Walking was limited, using a walker from the bed to the bathroom or from the sofa.

Less than two weeks ago, we returned the walker to a kindly Marloth Park resident who loaned it to us. Thanks to Louise for posting a notice on the Marloth Park website and getting several kindly responses in minutes. I was instructed to start walking.

The pain continued since I still had a massive open wound in my left leg, which required debridement at the doctor’s office every other day, and I continued to take the Ultracet, never more than three tablets a day, one upon awakening, )

The pain continued on the long 26-hour travel day and for the next several days since we arrived in Ireland. Then, a miracle of all miracles, the leg began to improve. On Friday at 6:00 am, I took the last pain pill, knowing the pain remaining until the wound closes would be manageable. I still have two almost full boxes of Ultracet.

By Friday evening, something was wrong. I had the chills, my hands were shaking, I bordered on nausea although I could eat, and I had such a degree of malaise I could hardly move from place to place. It hurts to raise my arms. Walking up and down the steps took everything I had. I knew what it was after considerable research on reputable medical sites.  

I was in withdrawal, not unusual after such a long run of pain medications, including four surgeries, two hospital stays, and a long, difficult recovery. So what am I doing to get through this?

1.  First and foremost: Not taking more tablets to alleviate the symptoms. This would be the worse thing I could do. I put all the tablets away, knowing full well, I wouldn’t be tempted to take more. I want this over with, not prolonging it by taking more pills.
2.  Stay hydrated and eat – Somehow, drinking non-caffeinated herbal tea is comforting and an easy way to consume fluids.  Plus, it’s cool here, and the tea helps me warm up. We made a great dinner last night…yes, I obliged, and I had seconds a few hours later.
3.  Sleep – I wish I could sleep straight through until this goes away. But that’s not possible. Although I had two good night’s sleep on both Friday and Saturday nights and dozed off and on all day on the sofa, I still feel extremely tired and listless.
4.  Keep active – This sounds like an oxymoron when I mention sleep above. But, I’ve found doing light household tasks, cooking, laundry, and continuing the walking seems to help.  
5.  Keep a positive frame of mind – Easy to say, hard to do. But, this will be over before too long.  Based on the length of time I was on the medication and the dose, I expect the withdrawal to last about five or six more days. Today, it’s better than yesterday, which is encouraging.
6.  Tell loved ones about the withdrawal – For some reason, there is shame associated with the word “withdrawal.” There is nothing to be ashamed of for those who’ve taken the appropriate pain killers for medical reasons under the care of a physician. If I’d continued the meds when I no longer needed them, started “doctor shopping” for more, lying to family and friends, and many more damaging forms of behavior, this could be construed as addiction. Tom is supportive, as always, and will do anything to help me get through it, although I am forging ahead trying to stay active.

Why did I write about the personal situation? Take away the “shame” as mentioned above, and we’re hoping this post, even if it only inspires one person, will make it all worthwhile. We are all in this world, in this life together. Reaching out, regardless of the cause, may open our eyes to new possibilities.

Based on the worsening of the symptoms, we decided not to go out last night to the pub in Carna for drinks at the bar and dinner. Once I’m over this period, I’ll be ready to start “kicking up my heels” once again.  

Be well.
             
                             Photo from one year ago today, May 19, 2018:

There were many rainbows at the falls. For more photos, please click here.

The medical saga continues…One year ago photos today…

Icebergs are so exciting and unusual.  This was massive, many stories high,

Today’s post will not include photos other than the “one year ago” photo at the bottom of today’s post and a few other photos from the “one year ago” link. See here for that post.  

We’re sitting in the hospital lobby with a prolonged WiFi connection, awaiting the results of the cardiac CAT scan I had a short time ago. This test will determine if I need angioplasty or more.  
Yesterday, we’d been told to call the doctor on Wednesday for the results. But today, the radiology department staff said they’ll send the results to the doctor within two hours, after which we’ll see the cardiologist, Dr. Fanie Fourie, once again for the final diagnosis.

In 2007, I had a cardiac ablation in the “cath lab” at Park Nicollet Hospital in Minnesota. I was diagnosed with an extra “electrical” valve in my heart that was causing an extremely high pulse. Once I had the procedure, I was told my heart was now perfectly normal with no plague or other issues.

However, after having a cardiac ablation, regardless of the reason, an EKG can show as abnormal when the heart and arteries are delicate. I’ve been hoping for this outcome, but the recent jaw pain and the few abnormal ultrasound scans yesterday have dampened my hope.
A Crabcatcher Seal was taking the plunge in Antarctica.

After the ablation, I was back at the health club within a week, pounding it out and feeling quite OK. Since that period, there’s been no incident until this recent jaw pain was diagnosed as possible angina, lack of blood flow to my jaw, possibly due to one or more clogged arteries.  So here we are today at Nelspruit Hospital Mediclinic, awaiting my fate.

Rather than drive the 90 minutes back to Marloth Park, by waiting for the results today, we’ll avoid a return trip if I need to have some invasive procedure or surgery, providing they can schedule it within the next 24 hours. Otherwise, we’ll drive back to Marloth Park to return sometime in the next several days.

At this point, our visas run out on February 15th, and we’ve planned to spend the night here in Nelspruit on February 14th in preparation for our early morning flight to Kenya the following morning. Oh, so much is up in the air!

Thus, most likely today, we’ll know what course we must take within the next few hours. If we weren’t leaving in 10 days, this would be less complicated. But, with our visa status, prepaid flight, and expensive prepaid photography tour in Kenya, none of which is refundable, it certainly is cause for concern, right along with the health issues.

In our usual way, we’ll forge ahead, attempting to stay as optimistic as possible while in each of our minds, we roll around the worst and best-case scenarios. It’s impossible not to do so and also impractical not to have a backup plan in place.

The champagne and flute carriers were loaded onto all of the 10 passenger Zodiac boats.

At this point, we’ve only discussed the angioplasty possibility. This recovery is only a few days, along with a week or two of taking it easy. We could make it…the visa expiration date and the photography tour in Kenya, which doesn’t officially begin until one week after we arrive in Nairobi, giving me plenty of time to take it easy at the lovely hotel in Nairobi.

We don’t, at this point, want to project any more severe treatment than angioplasty.  Why put ourselves into a further tither of worry and concern? Besides, all of this could be a moot point if the test results came out good enough for a “watch and see” and possible medication route, which may alleviate the issues discovered. Oh boy! I’d be jumping for joy at that possibility!

We’ll know soon enough. We’ll report back when we do. We both want to express our gratitude to all of our readers who’ve commented and written to us by email. Also, we know undoubtedly, that those who didn’t write are rooting for us as well. Thanks to all of you!

We’ll be back at you soon!

Footnote:  As of the time of posting today’s story, it’s 1400 hours (2:00 pm), and we’re now back in Marloth Park. After waiting for almost two hours, we were told the report won’t be available until tomorrow morning after all, at which time we were scheduled to speak to the cardiologist at 9:00 am. Thus we decided to drive back to Marloth. Tomorrow’s post will include the decision we’ve made based on the collective test results.

Photo from one year ago today, February 5, 2018:

There we were, sitting on a Zodiac boat in Pleneau Bay, Antarctica, sipping on French champagne. Was that ever fun! For more photos, please click here.

We’re still in Nelspruit…More medical tests required…Time is rapidly ticking by for our required departure…

A rickety old bridge no longer used near the Municipal campground, bird hide, and the hippo pool.

Sighting of the Day in the Bush”

A hippo and a cattle egret have symbiosis in their relationship.

It’s 1430 hours (2:30 PM), and we’re still in Nelspruit. The first round of the medical tests is completed.  Unfortunately, I didn’t fall into the 25% margin of error I was hoping for, and tomorrow morning’s test will tell more.

We stayed at the beautiful Leaves Lodge and Spa at the edge of town three minutes from the Nelspruit hospital and adjoining Mediclinic. We checked out of the hotel this morning, optimistic for a good result. 

But alas, we had to check back into the hotel a short time ago when the doctor explained more tests were necessary before a determination could be made. The CAT scan will be performed tomorrow morning, but we won’t have results until Wednesday afternoon.

Subsequently, we’ll drive back to Marloth Park to await the results. I can only imagine our readers out there who’ve been through this same process ultimately ending up with angioplasty or heart surgery of one form or another. Surely, you can relate to the worry and concern coupled with the angst of the unknown.

After a lifetime of taking care of my health, exercising, eating a healthy diet, and staying cognizant of stressful situations, I’m disappointed to discover my efforts were no guaranty of avoiding cardiovascular issues in my senior years.

However, the doctor explained had I not been so astute about my health, I could have had a massive coronary and not be here to tell this story. Of course, I’m grateful! It goes to show that genetics play a massive role in our health. My mother’s side of the family suffered from heart disease, obesity, and diabetes. As a young girl, I observed all this ill health and decided I’d take care of myself in an attempt to avoid obesity and diabetes by exercising and a healthy diet. In that area, I’ve succeeded.

A giraffe we spotted in the bush before the rains.

But the powerful genetics of heart disease isn’t easy to repel, so here I am now trying to figure it all out, only two weeks from my 71st birthday. Of course, I’m worried and so is Tom. On top of that, we’re supposed to leave for Kenya in 11 days, when our South Africa visas expire. If we don’t hightail out of South Africa by February 15th, we’d be considered “undesirables.” Oh, good grief.

We’d be foolhardy and flippant to dismiss this as a mere inconvenience in the realm of our world travels. Without proper care, we could conceivably have little time left to continue our journey.  

Remember? We’ve always said the only thing that would cause us to stop traveling was terrible health. Now, we’re determined to do whatever is necessary to ensure we can continue.

Before closing, I must say thank you to each and every one of our readers, family, and friends who’ve sent the kindest and most “heartfelt” prayers and good wishes for a positive outcome.  

During this quiet time in the hotel in the past 24 hours, I’ve spent most of my time returning email messages from kind and thoughtful readers/friends. At the moment, Tom is watching a replay of yesterday’s SuperBowl game and voraciously munching of a bag of salted peanuts, a great stress reducer.

I’m sipping a hot cup of Rooibos tea and thinking about how nice it will be when all of this is resolved, one way or another, and we can go back to being excited about the future.

Be well.

Photo from one year ago today, February 4, 2018:

Many icebergs form spectacular shapes, portals, and openings. For more photos, please click here.

Stuff happens…The cost of medical care and prescriptions in South Africa…Astounding facts…

In South Africa, prescriptions are dispensed in plastic packs in these boxes, not in bottles.

“Sighting of the Day in the Bush”

Is this a white-crested seedeater?  Please correct me if wrong.

Over the past week, I had an odd discomfort in the front of my right shin, but I didn’t notice any insect bites or injuries. It wasn’t itchy, just painful when I wore anything touching it.

Yesterday morning I awoke to added pain and noticed a raised red circle-like bump the size of a small lemon. I wondered if it was an infection or, more problematic, some blood clot. One can’t be too careful when finding such a thing.
 
I didn’t give it much more thought until we were on our way to the grocery store in Komtipoort while wearing shorts and noticed the redness had increased in a few hours. Since we were heading to Komatipoort anyway, Tom suggested we stop at Dr. Theo’s office and see if he could see me without an appointment. It was close to noon.
This is the receipt for yesterday’s doctor appointment, total cost ZAR (rand) 565 (US $38.24).

After waiting about only 20 minutes at most, Dr. Theo brought me into the exam room. I so appreciated him squeezing me in. Their office with several physicians is bustling, with appointments booked as tight as possible. These quality physicians have quite a following.

After carefully and diligently checking my leg, he assured me it was definitely not a blood clot and most likely an infection. If treated early enough, it could avoid the necessity of taking antibiotics. He prescribed a cream that was to be applied twice daily.  

In the past 24 hours, after only three applications of the cream, its already begun to improve, although there still is some redness. If it doesn’t continue to improve over the weekend, antibiotics may be necessary.

It’s dirty here…lots of dirt and dust constantly flying through the air, especially when the wildlife kick up more and more land from the garden when they visit.  Even the slightest scratch could become infected under these conditions.

The ZAR 49.95 (US $3.38) listed on this receipt was for the two tubes of cortisone cream the doctor prescribed.  The ZAR 1224.49 (US $82,68) balance was for the entire batch of prescriptions, enough to last for four months.

While visiting with Dr. Theo, I asked for prescriptions for the three medications I take and have for years. Here in South Africa, many drugs can be purchased over the counter in small amounts. But, for a several-month supply, a prescription from a local doctor must accompany the purchase.

None of my three medications are narcotic, thus making it relatively easy for a doctor to write a prescription. As mentioned in yesterday’s post describing “what to bring for an African safari,” we breezed over drugs. If you missed that post, please click here.

We were both thrilled over the low cost of the doctor’s appointment and the costs of the prescriptions. Next week we’ll return to the pharmacy for two more month’s supply for the three medications. They had to order them. Then, I’ll have enough for six months.  

Itemization for the three prescriptions, sufficient for four months.

Before we leave South Africa, either in November or February (depending on our immigration status), we’ll try for another six-month supply even if we have to go back to the doctor for the required appointment. At only ZAR 565 (US $38.24) for the appointment, it’s undoubtedly worthwhile.

I become frustrated when medical issues arise and sometimes hesitate to mention them here. But I do. Many of our worldwide readers are traveling or contemplating traveling, and any information we can provide when “things go wrong” may be helpful.  

It’s all a part of our continuing transparency and commitment to our readers to “tell it like it is” with no fluff, no minimizing, no exaggerating…plain and simple, the facts, keeping in mind we do tend to get excited when nature unfolds before our eyes.

Speaking of nature unfolding before our eyes, I need to wrap this up. We’re getting ready to head out for our daily drive to see what more treasures we can encounter in this magical place.

May events in your life bring you excitement and enthusiasm.

Photo from one year ago today, September 14, 2017:

This mom and her calf are our neighbors in this gated community of Roco Verde in Costa Rica. For more photos, please click here.

The Chobe saga continues…Angry elephant and scary looking others…Issues with malaria pills…

This short video clearly illustrates how dangerous an annoyed elephant can be 
when their territory is not respected.

“Sighting of the Day in Chobe National Park”

We’ve rarely been this close to a waterbuck since they remain close to the river, impossible for us to access. What a handsome animal!

Those who have been following us for some time know that we hesitate to mention every little ache and pain or discomfort we encounter in our lives of world travel. We all have some degree of a medical issue on occasion, some noteworthy required medical intervention, and others we can manage on our own.

This elephant was not happy to see ours and another safari vehicle on the road. He started flapping his ears and swinging his trunk, tossing sand. See the above video for details.

Today, I share this with our readers as informational only and do not, under any circumstances, suggest our experience is common, nor are we suggesting any medical treatment or advice. This is an FYI only.

The other safari vehicle was much closer to him than ours. 

Upon the recommendation of a local doctor in Komatipoort with whom we recently updated our vaccinations, we began taking malaria prophylaxis medication one day before departure to Zambia on both this trip and the past three months ago.

And then, it happened.  He approached the safari vehicle, ready to charge. See the above video for more.

We were prescribed to take one tablet daily of the generic equivalent of Malarone (Atovaquone Proguanil), known in South Africa, purchased over the counter at any local pharmacy at the cost of about ZAR 14.35 (US $1) per tablet.

Three giraffes along the bank of the Chobe River.

We started taking the pills last Wednesday, with food, one day before we departed Marloth Park continuing daily during the week in Zambia and Botswana, never giving it another thought with a plan to take them seven days after our return.

We’ve never seen so many impalas on any other safaris in the world.

While in Africa for almost a year in 2013/2014, we took the pills continuously, never experiencing any major issues. While in Zambia for a week in May 2018, we followed the same regimen, never giving it much thought.

Our guide Sampson explained that the only animal that can cause a self-induced abortion by eating a certain poisonous plant does so when conditions are poor, and her calf wouldn’t survive.

(We continued to use insect repellent while taking the pills, which is always a must-do while in Africa and certain other parts of the world).  

Hippo with oxpecker, cape buffalo, and impala all in one photo.

The last time I took the first pill, a few hours later, I had a headache.  I never get headaches. I brushed it off and continued with the pills. While on our first safari in Chobe a few days later, I noticed I had a weird headache-like sensation in my jaw for most of the day. I’d taken the pill on an empty stomach and attributed it to that.

Yellow-billed stork.

After lunch, the headache went away. Thus, it obviously made sense to take the pills with food which we’ve done since. But then again, on Monday morning, while in Chobe National Park on a game drive once again, after taking the pill with food, I noticed that same jaw pain. I reached into the backpack and pulled out a Tylenol, and chugged it down.  

Lilac-breasted roller.

An hour later, the pain was considerably less but not totally gone. At that point, I’d never mentioned it to Tom, not wanting to worry him. We continued and had a great few days in Chobe.

Such a sweet face. Check out those eyelashes!

The second day in Chobe, I noticed my balance was off. I kept bumping into things, not outrageously so but enough to make me notice. On Wednesday night, when we returned to the Livingstone Protea Hotel, I could hardly walk straight. I felt nauseous and horribly dizzy.  

Each day before commencing the game drives, tea, coffee, and muffins were served in the bush.

I didn’t feel like having dinner, but to “tough it out,” I didn’t complain, and we ate in the hotel’s restaurant. I ordered a bit of fish and steamed vegetables, hot tea and drank lots of water.  

The beautiful fish eagle.

By yesterday morning, I struggled to do the post, more than I’ve ever struggled in the past when not feeling well. How I got through it, I’ll never know. By noon with the post uploaded, I was in bed, under the covers with the room spinning, and I couldn’t walk across the room. A few hours later, diarrhea hit hard.

Crocs don’t have sweat glands. If a Crocodile gets too warm, it can only reduce its temperature in three ways: get in the shade, get in the water, or sit quietly with its mouth wide open. This one opted for the latter.

I’d stop taking the pills 24 hours earlier. I knew the pills were making me sick and didn’t think it was something else when I’d read that these two symptoms were common side effects of Malarone and its equivalent.  

A face only a mother could love.

By 1600 hours (4:00 pm), I knew there was no way I could go to the restaurant for dinner, and I knew I had to drink lots of water and should have some easy-to-digest dinner although I wasn’t hungry. Not eating would only make me feel weaker and dizzier.

We watched the sunset from the veranda at the Chobe Safari Lodge.

By 1900 hours (7:00 pm), Tom delivered my plate of grilled chicken breast and a few steamed vegetables. I encouraged Tom to relax and enjoy dinner in the restaurant while I ate half-sitting up in bed.  

Neither of us slept well as typical on the night before we fly away. Fortunately, this morning I’m much better although, still feeling a little dizzy. I’ll be OK to travel today. 

African sunsets are memorable.

After searching online, I found this article from the USFDA on the potential side effects of taking malaria pills. Please click here for details on that report. After reading this and other such articles, I’ve decided not to take malaria pills in our remaining seven months in Africa.  

Here’s an excerpt from that report:
“The U.S. Food and Drug Administration (FDA) is advising the public about strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label.  FDA has revised the patient Medication Guide dispensed with each prescription and wallet card to include this information and the possibility that the neurologic side effects may persist or become permanent. The neurologic side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations. (For a complete list of potential side effects, see Additional Information for Patients).”

I’ll continue as I have all along, using copious amounts of insect repellent every six to eight hours and keep my arms and legs covered as much as possible. Most often, I get bit by mosquitos on exposed skin, not under my shirt and pants.  

Moments later, the sun disappeared, and we walked to the restaurant across the road for a gourmet meal, as shown in yesterday’s post here.

If I wear my insect repellent clothing all summer long in Marloth Park, I will see when we’re in Kenya at the end of February and early March. This time while staying in Marloth Park, neither of us have taken malaria pills. The stay was just too long to continue taking these drugs safely.

Do we worry about getting malaria? We hardly ever give it a thought when taking sensible precautions, but this is up to you, and your doctor should you visit a malaria-prone zone anywhere in the world. This was the last time we’ll take them.  

Tom’s had no issues and will complete his regime for the seven days once we’re back in Marloth Park, but he too says they present too many risks to our liking. We wouldn’t have taken them to Zambia, Botswana, and Zimbabwe had the doctor not insisted it was imperative for these regions.

On the first safari, when we went through the border between Zambia and Botswana, we had to drive through a chemical that cleans the tires to prevent the spread of hoof and mouth disease.

Today, we share more of our photos from this week’s four safari adventures: two game drives and two boat rides in Chobe National Park and on the Chobe River.  As you can see, we were hardly disappointed. Many more photos will follow.

Tomorrow, we’ll post our final expenses for this one week in Zambia and Botswana. I wasn’t up to putting them together these past few days, but once we’re back in Marloth Park, I’ll tackle the numbers and share them with all of you.

Soon, we’re off for the airport, and by 1730 hours (5:30 pm), we’ll be back in our own little paradise. We’re keeping our fingers crossed for an easy immigration transition in Kruger/Nelspruit/Mpumalanga!

We’ll be back with you soon. Have a great day!

Photo from one year ago today, August 23, 2017:

Statue in a roundabout on our way toward San Jose, Costa Rica, known as Rotondo de las Garantias Sociales Zapote. For more photos, please click here.

Busy day in Komatipoort…Impressed with medical care, costs and prescriptions in small town in South Africa…

“To graze on that many leaves, giraffes usually spend 16 to 20 hours per day standing and walking. Amazingly, giraffes don’t need much sleep despite their long days of exercising and eating. They often only get 30 minutes to 2 hours of sleep every 24 hours from the short naps they take throughout the day.”

“Sighting of the Day in the Bush”

This rather large gecko was a new visitor, spending most of the day and evening on the veranda.

Many tourists and part and full-time residents choose not to have vaccinations, other than the required Yellow Fever mentioned in a prior post. We might have done the same if we were “regular” tourists visiting Africa for a two-week holiday/vacation.

Note the size of the gecko in relation to Tom’s water shoe.

However, as we continue to travel the world visiting many countries where certain diseases are rampantly escalating, we’d decided a long time ago to be cautious and keep vaccinations up-to-date as often as possible.

We’re thrilled to see birds stopping by our feeder.  According to our friend, Lynne, these tiny birds are blue waxbills.

There were a few for which we’d fallen behind in getting boosters over this past almost six years.  We met with Dr. Theo a few times over these past weeks (located at Rissik Medical Centre, 71 Rissik Street, Komatipoort, Komatiepoort, 1340, phone #27 013 793 7306), he diligently reviewed our vaccination records.

Each night I practice taking photos in the dark once the bushbabies arrive.

He made excellent suggestions on how we can be up-to-date on all of those he deemed necessary based on our ages, health, and exposure through our travels and that we should be re-vaccinated in 2022.

A proud giraffe standing in the bush as we drove past one of our drives.

Yesterday was my turn for a grouping of vaccines compiled into two injections, one in each arm. One of the injections was slightly more painful than the other, and my arm was a little sore last night but is greatly improved today. Tom experienced the same scenario when he had his injections last week.

Epipens cost in the US is ZAR 7531.07 (US $600) for a pack of two. We purchased two yesterday for ZAR 2126.79 (US $169.44). (In either case, these prices are based on out-of-pocket costs, not insurance paid).

As for any other medical issues we needed to address, with caution to avoid jinxing myself (slightly superstitious, I guess), my gastrointestinal issue is improving. I am off all medication for this issue. I feel discomfort if I eat too much at any one meal or drink too much liquid in any one setting. But I am feeling better utilizing these limitations.

Yesterday, we purchased two EpiPens at the local pharmacy, requiring a prescription from Dr. Theo. See pricing on receipt posted here. 

Based on the improvement and Dr. Theo’s observation at this point, there’s no need for several invasive tests. Let’s face it, as we age, most of us find we must adapt to some changes in our lives to accommodate medical issues of one kind or another. 

Many of our readers have written describing how they’d love to travel the world but have knee, hip, and back problems that make travel difficult, if not impossible. Instead, they live vicariously through us, which means so much to us both. 

My bill for multiple vaccines I had yesterday by Dr. Theo Stronkhorst in Kpmatipoort. Tom’s bill was identical last week.  Our total cost for two office visits and vaccines for each of us was rand (ZAR) 1707.81 for a total of ZAR 3415.62 (US $272.12). 

We only wish everyone who desired to do so could live this peculiar life, generally on the move. We continue to be grateful every day that we’ve been able to continue, even with some issues along the way. This gastro thing has plagued me for the past 2½ years. 

Now, this morning I can sip on my organic herbal tea and not suffer any ill effects. This is a big deal. I really make miss morning coffee! I haven’t tried drinking coffee yet and have decided to give it several more months until I do, working my way up to one or two cups a day, if possible.

Tom’s favorite bushbuck, “My Girl,” is a frequent visitor.

During my doctor appointment, Tom went to Obara, the farm store in Komatipoort, to purchase two more bags of pellets. Now, we have an inventory of three 40 kg bags, enough to last for weeks. The animals continue to visit throughout the days and evenings.

This baby bushbuck has grown considerably over these past few months.

Today, the weather is perfect, with clear skies with a cool and comfortable breeze wafting through the air. We couldn’t be more content and at ease. Later today, a drive through the park may be on the agenda!

May your day bring you contentment and ease as well! 

Photo from one year ago today, May 29, 2017:

Canadian geese are pretty birds but poop two pounds per day in the grass, a real nuisance for homeowners, particularly those living on a lake, as we did in our old lives. For more Minnesota photos, please click here.

How much do we pay for health insurance?… Technology issues… Patience prevails…

Elephant topiary on the church’s grounds.

“Sightings from the Veranda in Costa Rica”

We can’t take our eyes off these adorable tiny birds.
Early this morning, we were sighting of a hummingbird partaking of our sugar water.

Regardless of how far away we may travel from the US, there’s no escaping the responsibility of paperwork required for life in general and more related to our lifestyle of world travel.

With Tom’s 65th birthday fast approaching on December 23rd, it was time for him to waive Part B Medicare, which would result in an automatic deduction from Railroad Retirement for his monthly pension income if he didn’t handle it on time.

Pretty ceiling and chandeliers in the church.

Medicare doesn’t pay for medical care outside of the US (with a few exceptions, here and there) long ago; we purchased  “major medical” international insurance coverage through Healthcare International in the UK.

No more expensive annually than paying the required amount for Part B Medicare and a supplement, our plan doesn’t cover doctor visits. So in the past almost five years, we’ve spent very little for the few doctor office visits we’ve made, the most for physical exams and tests we had over two years ago in Trinity Beach, Australia.

Shrine on the grounds of Iglesia Catolica de Zarcero church in Zarcero Costa Rica.

In total, over this extended period, including the comprehensive exams in Australia for both of us, we haven’t spent more than US $2000 (CRC 1,150,510), averaging at US $400 (CRC 230,102) per year.

Our annual insurance payment to Healthcare International is US $4,000 (CRC 2,301,020) plus the average US $400 (CRC 230,102) for doctor visits, totals US $4400 (CRC 2,531,122) per year.

Faces in the shrubs.  Amazing.

The required payments for Medicare Part B plus a supplement plan, plus all the necessary co-pays, would ultimately be much higher than what we’re paying annually. But, of course, we hardly ever go to a doctor, reserving those for situations where we feel we have no alternative. Thus, it’s difficult to compare “apples to apples.”

As a result, Tom won’t be signing up for Medicare Part B, which required he contact Railroad Retirement (as opposed to Social Security) since he worked for the railroad for over 42 years.  Instead, Railroad retirement (and Medicare) require that the potential recipient complete a form requesting to waive Part B.  I’d done this almost five years ago when I was approaching 65.

More faces.

A few weeks ago, Tom called Railroad Retirement and requested the necessary documentation to sign to waive this option. Unfortunately, it took several weeks to arrive at our mailing service in Nevada, Maillink Plus.

When we receive snail mail at the mailing service, we’re sent an email message that snail mail has arrived. So we log into our account at their site and see who sent the mail but not its specific contents. At that point, we can request the mail be scanned at US $2 (CRC 1151) per page.

This spot may be used for weddings and other celebratory occasions.

Of course, receiving mail from governmental agencies may result in the necessity of having many pages scanned to get to the page(s) were looking for, as was the case here. 

Once the document is scanned (always within hours except for Sundays), we can view or print the copy (if we have access to a printer), which we do here in Costa Rica in this fine villa. Since the document required completion with a signature, printing it was a necessity. We also needed to print the cover letter, which included coding and secure ID numbers. Thus, we ended up with two pages to print.

Not every topiary was indicative of a specific animal or item but, it is still interesting.

Once Tom completed the form, the next step was to get the two pages back to Railroad Retirement. Unfortunately, they don’t accept email for such conditions. That means we’d have to pay for a taxi to go to a post office, pay the postage to the US and also plan it could take upwards of a month to arrive.

But not for us! Our mailing service will handle that for about another US $2 (CRC 1151), preparing an envelope with our return address and a stamp. Then, all we’d have to do is scan the two pages and email both of them to the mailing service. 

Colorful stonework on a wall near the entrance to the church.

This morning I printed the two pages, after which Tom filled out the form, handing them back to me to scan and email. Sound easy, eh? Not so much. For some goofy reason, the software I’d downloaded for the new Brother Scanner we’d purchased from Amazon and received while in Nevada wasn’t working.

The application I needed and had used extensively when I’d done tons of scanning while in Nevada had somehow disappeared from my laptop, nor could we find the actual installation disk I’d used at the time to install it. 

Rainy day view from the church entrance to the topiary.

Sure, I could go online to Brother and install what I needed to complete the process, but I was bound and determined to figure out a solution to avoid doing this. Furthermore, I’d yet to start today’s post and didn’t want to spend an hour fooling around with an install.

Patience was not high on my priority list, but a determination was often the case. After about an hour, I figured out a workaround and got the documents to scan and into my email. Finally, I prepared the email message to Maillink, which they’ll receive and process tomorrow (Monday), confirming that the task has been completed.

Painting of Jesus in the interior of the church.

Today, while Tom watches the Minnesota Vikings game, I’ll work on installing the software if we have a good enough signal for streaming the game and performing a download. We shall see.

Have a wonderful Sunday or Monday wherever you may be in the world.

Photo from one year ago today, September 24, 2016:

In Sumbersari Bali, we met neighbors who invited us for a visit. This is their infinity pool. For more photos of their lovely property, please click here.