Hi everyone,

My two previous posts were about the end of the 6  month diagnostic journey I had been on, got to the diagnosis, and referred to the surgery, a left adrenalectomy.   The surgery happened on Friday, Feb 1.

At 4:45 am a Comfort car from Metro West Ambulance Service arrived to pick us up.  Kathy is legally blind and does not drive, so…..Got checked in at the hospital, taken back and prepped, talked with the anesthesiologist – who told me about some scary risks and what they had by my side to deal with any of them, were they to happen.   They also gave me some happy juice through my IV at this time.  After that Kathy got to come back and spend some time with me.  I do not remember anything past that point until I was in the recovery room.

The laparoscopic surgery took about an hour, a bit less than expected.  The surgeon said my height provided plenty of room for all the organs, so it was not way crowded in there.  There were four small incisions made – the largest post-op dressing is about 1.5 inches square.

I was in the hospital for 4 nights.  The nursing and medical staff were outstanding!!  Even the lab techs who left my arms looking well-used.  Kathy was there for all of it.  Our sister-in-law, Laurie, was a champ – transporting Kathy and spending time with us.  We really appreciate that.  Don’t tell her, but a very nice dinner out is in her future.  That took care of the weekend, with Kathy spending the first night at a hotel across the street from the hospital.

On Monday, Kathy took public transportation (bus and light rail) to come see me and to get home.  She had to get home because we have an old cat who needs medication daily.  Anyway, each way took about 2 hours, taking the bus downtown and then a light rail to a stop about a 10-15 minute walk from the hospital.  On Tuesday Kathy came via the public transportation option, and when she arrived I was dressed in my street clothes.  Discharge Day!!   Laurie was able to transport us home.

Was the surgery worthwhile.  You can review the past couple of posts to review the hyperaldosteronism and its effect on my hypertension.  I was on 4 blood pressure meds before the surgery, taking a total of 6 doses.  Here is the current state of affairs:

Pre-op I was taking
100 mg a day of Atenolol,

80 mg a day Lisinopril
37.50 mg of Maxside
10 mg daily of Norvasc

Most pressures were in the 144-150 over 85-98 range

Today I am taking:

75 mg a day of Atenenol
10 mg a day of Norvasc

Most Pressures have been in the 127-143 over 78-90 range

I am beyond delighted!  I am also not taking any potassium supplements.  My expectations have been met and exceeded

If you do a search on youtube for adrenalectomy, you can find some videos.

I am going to have a left adrenalectomy on Feb. 1.

It should improve the BP, resolve the potassium deficiency, reduce cardiovascular risk and extend my quality lifespan.

There is a motel across a small side street from the medical center. Kathy will get a room there for a couple of nights since she stopped driving quite a few years ago.

Gotta get there at 5:30 am. Hope my surgeons are morning people

Got the results of the test. Here is what the endocrinologist wrote to me:

“Your adrenal vein sampling’s aldosterone results are back and I have carefully reviewed and analyzed them.

These data suggest that you have a LEFT aldosterone producing adenoma. CT in December 2012 had shown: “nodularity of the lateral limb of the left adrenal gland inferiorly measuring 2.3 x 1.0 cm.”

I offer you consultation with a surgeon to consider adrenal surgery in the hopes that it will help your blood pressure and low potassium (with successful surgery, blood pressure is rarely cured, but often improved, that is requiring fewer blood pressure medications and potassium supplements)

Alternative to surgery is very successful and effective medication therapy (with Spironolactone or in those intolerant to Spironolactone, Eplerenone).”

Don’t you just love doctor language

I requested the consultation with a surgeon. I think these are usually done laparoscopically. More hurry up and wait.

Hi everyone,

It has been some time since I have posted.  There has been quite a bit going on, much of it medical.  Kathy has had cataract surgery and that has improved the very narrow field of vision she has remaining.  This is a very good thing.

I have been diagnosed with primary hyperaldosteronism.  This is not all bad – it may be partly responsible for my high blood pressure and totally responsible for my chronic potassium deficiency.  It has, however, been a long arduous road from suspicion to diagnosis involving referral to a endocrinologist and multiple tests, including two that required me to do a 24 hour urine collection and take that to the lab.

On Friday I spent 5 hours at the hospital while I was prepped for, taken into a cardiac catheter lab, had catheters inserted through my femoral vein.  These were used to take blood samples from my left and right adrenal gland veins, along with “reference” samples from nearby veins.   This was not great fun, but the people were nice and they gave me a pretty frock to wear (see below).

Here I am before the procedure

There was the little thing about atrial fibrillation that happened during the procedure, but I felt pretty good throughout it.  It also took them a bit longer than they expected, so they shot a little anti-coagulant into the vein to prevent problems from clotting. These happenings extended my stay in the recovery room to make sure the EKG technician had all the time he needed with me, and to make sure that I did not bleed from the anti-coagulant.

So, that meant (having been on an IV for hours), that I really needed to pee.  By really needed, I mean I was in pain from needing to pee.

Real. Pain.

While the nurse thought that I should be able use a urinal laying down (DO NOT raise your head up, that could make you bleed), the flow not happening in that position, not even after she gave me an injection of some sort relaxant.  I did feel more relaxed and less agitated, but……  So, she called in this nice young man who inserted a tube into my urethra to drain my bladder.  This was all quite an experience.  Fortunately the next time I felt the urge I was given permission to urinate the usual way.  Like I said, they were nice folks taking good care of me.

This may not sound too bad to many of you, but remember that I am a man and that men are wussies.  Don’t believe me?  Ask Kathy, she will tell you . Anyway I will get the results this week and those should, hopefully, point us to either surgical or pharmacologic treatment.

In any event, around April or May we’ll head to the Mexican consulate to apply for an immigration status to move to Mexico.  Assuming approval, we’ll have six months to move to Merida, and then 30 days to check in with the local immigration office.  Lots to do here still, but we are looking forward to this being our last winter in Portlandia.

Hope all of you are doing well.  Now that we are moving towards clarity on medical stuff maybe I’ll go off radio silence more often.

Have a ballpark figure of $6,000 for a 20 foot container from Portland, OR to Progreso, Yucatán. We’ll see how that holds up once the fellow does the complete work-up.

In other news, Merlin Cat Smith* has high blood pressure and renal insufficiency. Back to the vet on Saturday, but sounds like some special food and blood pressure medicine.*

Merlin Cat Smith was on a prescription I picked up for him in Illinois when he was a young lad with an infection. Usually called Merlin, that is his full, formal name.

That’s all for now.

Hi everyone,

The house is painted. The fall/winter rains have started.

Kathy is legally blind, according to her doctors. She is meeting with the Social Security Administration in early November to see what they think about that and about her eligibility for benefits.

My last meeting of my regional professional association is in early November, right after my penultimate meeting of my statewide professional association. Landmarks, these are. I just finished the presidential cycle of the regional (Oregon, Washington, Idaho and British Columbia) association last year.

Time to move on to indoor projects and to the sorting of belongings. We plan to scan in many of our photos from over the decades and to sell or give away a lot of stuff.

It is happening.

This stuff is not real exciting to you, the gentle readers, I imagine, but….

The house started getting painted today. It will get finished tomorrow and we get a bid on replacing some fencing tomorrow (neighbor will pay 1/2).

Yes, Virginia, we are getting the house ready to go on the market.

We’re also talking about when Kathy quits working and other Important Matters.

We’ll keep you informed.

The plan is to move to Mérida in late spring / early summer 2013, in order to enjoy events like big band music at Parque Santiago on Tuesday evenings,

Performers at the Thursday Serenata Yucateco at Parque Santa Lucia,

Or the Sunday dances at Santa Lucia.  We have seen this couple there since 2006

So, how are we doing?  We plan to sell the house here, and work on the living room is done.  Labor Day weekend we have some projects planned and we seem to be roughly on target in terms of getting the house ready to go on the market.  We do have some areas of disagreement about what should be done to prepare the house.  I am the minimalist while Kathy would like to do more.  I see compromises in our future.

My plan is to give the college a three month notice of retirement on November 5, the day after my 61st birthday, and to work on on contract from the start of February through mid-May.  Kathy plans to stop working before then, but the date has not been set.

Finances look all right.  A month or so ago Kathy asked me what I did when I felt a little anxious about whether everything would, in fact, work out.  I replied “my spreadsheets, they bring me comfort.” She laughed .  While 2008 was not good for investments, the 3 1/2 years since then have been quite good and I am not overly worried the money aspects of the move – cautious but optimistic may be an appropriate description.  Over the past decade, it seems like an Apple a day keeps the poorhouse away.

So, it seems like all systems are go and the ones that we may have some doubts on (medical, for example), can be cared for as well or better in Mérida as here.

Dennis asked some questions in a comment to another post, and I have decided to answer some of them in this post.  His comment is here. 

I answered the easy ones there, and will work on the other ones here.

1. Why Merida? Did you guys visit there and fall in love with the city and the people?

Yes and no.  We first visited the Yucatan Peninsula in 2003.  We did not get to Merida until our 5th trip to Mexico, in 2006, having been back to the Caribbean side several times and to Guadalajara, San Miguel de Allende, Guanajuato and the Lake Chapala area before arriving in Merida.

First is why the Yucatan Peninsula.  Simply put, we like it.  The Caribbean side is our favorite vacation spot.  Merida, however, is a major city with a symphony orchestra, theatre, dance, museums, art exhibits and galleries, a wide variety of ethnic restaurants, major medical centers and the University of the Yucatan, along with many other post-secondary educational institutions.  Those things, combined with a social network, a 45 minute drive to the Gulf of Mexico and a 4 hour drive to the Caribbean seal the deal for us. There are also free, public cultural events almost every night of the week in Merida.

2. Obviously the cost of living down there is cheaper right? Is that true, and Percentage wise, how much cheaper is it than the US?

The cost of living is pretty directly related to lifestyle. It can be quite a bit less.  We know people who own their home and get by on about $1,000 a month and that includes a part-time maid (they do have a healthy nest-egg for expenses that are not regular, monthly expenses).  We know of folks who spend 4 times that much.  In the past I have done comparisons of food prices based on purchases made by expats in Merida, but I cannot locate those files now, and they are terribly out of date in any event.

Here is a fairly comprehensive article on the cost of living in Merida.  It is from the Yucatan Living website.  The Mexican government has income minimums for holding the two types of visas that most expat retirees use.  For one, generally referred as a non-immigrant visa, the current minimum for a couple at the current exchange rate is about $1760 USD a month.  For one that can lead to immigrant status after 5 years, the minimum for a couple works out to about $2,830 a month.  The required income amounts are based on a multiple of the daily minimum wage in Mexico City, and that changes every year.  Some local immigration offices apply some leeway for people who have substantial assets but may not have pensions, etc. that meet those income standards.

3. Health care – how will you manage it in Mexico? Will it be expensive?

Some of the information for this answer are in the link provided in the previous reply. Here is another link to a lot of information about health care choices in Mexico.  We will have US-based health insurance paid by my employer until I reach the age of 65.  It will only cover emergency care in Mexico, but will cover both of us for pre-existing conditions.  New insurance in Mexico will probably not cover us for those conditions, and we both have some.  We plan to buy major medical insurance in Mexico – either via a private company or via IMSS, the Instituto Mexicano de Seguro Social.  There is information in the linked articles about both of those.

For routine, outpatient care and medications we plan to self-insure.  Medical care is far less expensive in Merida, and there are a range of options from modern medical centers with many doctors who speak English to doctors in solo practice who do may or may not speak English.

Finally, I note that Dennis also lives in Portland.  I work downtown and am wondering if we might get together for lunch some day.

On getting the house ready to move:

Living room project is almost done, and it was a big one – and was done entirely by Kathy.  New paint on the walls, picture window frame sanded and painted, trim all painted, area around woodstove re-done.

Deck ready to receive 4 new boards and get stained (next weekend).  This will be the last staining of the deck.  July 4 week was the last Waterfront Blues Festival, unless we come back for one.

We are roughly on track, contingent on the results of a couple of medical test thingies.  As Gilda used to say “It’s always something.”