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.

Final expenses for 31-nights in a hotel in Buenos Aires…We’re off to Ushuaia!…

Due to the poor signal in this crowded Wi-Fi cafe in Ushuaia, we cannot upload any photos.  As mentioned in earlier posts, we’ll continue to make every effort to maintain our usual style of posts.  Would you please excuse any typos and formatting issues?
Yesterday was quite a busy day, and today won’t be much different. By the time you see this post, we’ll be at the airport getting ready to leave Buenos Aires to fly on a chartered plane to Ushuaia, Argentina, where we’ll board Ponant’s Le Soleal to begin our expedition to Antarctica.
We’ve been excited about this for a very long time. The situation with my knee put a bit of a damper on our enthusiasm. Still, now that I am on meds to hopefully alleviate the discomfort, we’ll be able to settle in on the cruise and enjoy this once-in-a-lifetime adventure.
Getting out the door in the middle of the night wouldn’t be my preference. For Tom, after 42.5 years on the railroad, he was used to getting up and out the door at all hours of the day and night. But, now after retirement, even he cringed at the early hour.
Today, we wanted to share two important aspects of the 31-nights we spent in Palermo Soho Buenos Aires, Argentina; one, the reasonable expenses we incurred staying in the Prodeo Hotel, a fine boutique hotel two, a short review of the hotel itself.

First, let’s start with the expenses we incurred in total for the 31-night stay in the Prodeo as shown below: (Due to a poor Wi-Fi signal, we’re experiencing formatting issues):
 Expense   US Dollar   Argentine Pesos 
 Hotel – 31 nights $                  2,480.00 47,076.69
Flight – Round trip- inc
in cruise
                  –               –
 Taxi   $                       65.31 1,239.75
 Groceries & Dining
out- inc tips 
 $                     987.87                     18.752.28
 Laundry  $                        56.00 1,063.02
 Tips for hotel staff   $                     158.05 3,000.19
 Pharmacy & Misc.   $                     477.52 7,157.48
 Total   $                  4,224.75 59,537.13
 Avg Daily Cost    $                     136.28 1,920.55

We’re thrilled to have spent this amount while staying in a hotel and dining out every night, the exception when we purchased groceries for Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day when most restaurants were closed or only offered outrageous prices on fixed price meals, not suitable for our budget or, my dietary restrictions.

This was surely a bargain compared to the cost for groceries, rental cars, and vacation/holiday homes. And we imagine that a traveler desiring a month in this fascinating country could even do better with proper planning and careful spending.

Would we return to Buenos Aires in the future? Possibly, with our plans to return to South America in the distant future for some specific sites we’d like to visit such as Machu Picchu, the Galapagos, and the Pantanal. 

A contributing factor to our enjoyment in the area has been the quaint and charming Prodeo Hotel, a contemporary boutique hotel, architecturally interesting in a fantastic location, staffed by some of the most OK people in the land. We generously tipped all of the staff members who made this stay memorable.

During this less-than-busy summer season in Buenos Aires, there were many days we were the only hotel guests. However, whether it was a whole house or the only guests, we were always treated with the utmost kindness, generosity, and attention.

As shown in the above expenses, we booked the hotel through a corporate rate at US $80 (ARS 1,532) a night, a reasonable rate for this busy city with many other hotels twice as much or more. No doubt, our extended stay helped us with pricing, but the competitive nature of boutique hotels does allow for some special pricing from time to time. It never hurts to ask.

Any issues while we were here? The power went out four times when the city was having problems.  Our bathroom sink wouldn’t drain, but after a few hours of bringing it to staff’s attention, it was repaired. 

Housekeeping was inconsistent at times, but our room was always clean and well-kept. The complimentary breakfast was repetitive, most of which we don’t eat (fruit, granola, cakes, bread, etc.). We appreciated the daily sliced ham, cheese, and hard-boiled eggs. Tom enjoyed the coffee while I sipped on my turmeric tea concoction each morning. 

The atmosphere is pleasing, comfortable, and inviting.  The bar has many types of beverages from fine wines to eclectic beer and serves some traditional Argentine empanada and other types of local food (none of which I could eat).  We never dined in the bar/dining room but enjoyed drinks from time to time.

The intimate hospitality by far surpasses what one may find in a large hotel, and we’ve discovered we mainly have found smaller hotels tend to suit our needs. We highly recommend Prodeo Hotel for your next visit to Palermo, Buenos Aires.

Small did OK getting up at 2:30 am and getting out the door in time for our 3:15 taxi to the airport. Check-in was a bit challenging and time-consuming, but Aerolineas, an Argentine airline, was seamless. Moving right along, we’re currently sitting at a tiny table at a tiny little bar with Wi-Fo in Ushuaia.

We both watched a free movie, Hacksaw Ridge, a stunning film on our individual monitors during the flight while the 3.5 hours passed quickly. Once we collected our bags, we were off to the bus with our Ponant group of passengers.

After a ride through the gorgeous town of Ushuaia, recognized as the most southerly city in the world or “the bottom of the world,” we headed to a local Accor Hotel for a magnificent buffet lunch with many foods I could have.

At our assigned table of English-speaking passengers, we met two fun couples and had a taste of the lively conversation yet to come with our cruise mates, most of whom are serious world travelers.  Not necessarily like us, but world-traveled, nonetheless.

We’ll be back with more as Wi-Fi allows, hoping to be able to stay in touch with all of you!

Take care until then!

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

Andrew and Ian Smith, father and son and innovative owners/managers of Willie Smith Organic Apple Cider and Apple Shed, including restaurant, cider shop, and museum. (Not our photo). For more photos of this popular landmark in Tasmania, please click here.

Traipsing around the town…Why visit Atenas?…

This morning when I perused through our photos to see what to post, I stumbled across this funny photo showing my hands and camera in the rearview mirror while taking the photo of this rug vendor walking along the street. Vendors don’t pester passersby, asking only once if interested.

“Sightings from the Veranda in Costa Rica”

Cattle sheltered under the shade of a massive tree during a sunny morning in Atenas.

Walking through the town of Atenas is quite entertaining. The endless array of shops lining the streets, many worn and tattered on the exterior but bustling with energetic business on the interior, creating a fascinating peek into the daily lives of “Ticos,” the acceptable and unoffensive nickname for the locals.

Few tourists are to be found when walking through the town although it’s reported there are about 1500 expats in Atenas of its population of about 5000.

Although an older comment, this quote from a contributor on TripAdvisor provides a reasonable explanation about Atenas. We can’t imagine it’s changed much over the past six years. (See selection below this photo).

A sign was announcing at the Patron Saint Festivities from October 14 through 24. 
Re: Things to do around Atenas
Atenas is a quiet town, authentic Costa Rica, and it could be used as a home base.
Many “well-to-do” Ticos who work in San Jose choose to live there and commute. Kind of like folks living in CT and commuting to New York in the USA.
No crime to speak of, lots of farms, some great locally grown coffee. The area produces five different varieties, only 3 of which are exported (they save the best for local consumption)
I dig it. I used to live in a bustling tourist town here. When I left the coast, Atenas is the town I moved to for a time. I was looking for a city that had zero tourism and found it. I then bounced over to Grecia, but now live in between the 2.
IMO an interesting choice but a good one. No tourist crowds, down-to-earth pricing compared to towns more tourism-oriented. Not much in the way of local attractions, Poas mentioned by ex-beachers is probably one of the closer ones, the metal church in Grecia is something to see and not far away, also there is a great little central park full of green parrots in the town center of Atenas. 
If you are looking for an authentic Costa Rican experience, then it is a good choice.
Cheers”

This is our kind of town, quiet, attractive, friendly and filled with a variety of treasures that easily keep us entertained and engaged (including many birds) during this extended 113-night stay. 

In almost every case, when we chose an extended stay over 90 days, we encounter visa issues.  We’re inclined to avoid such extended stays when possible. But, when we opt for an extended stay, we do it for a reason, often to accommodate the next leg of our travels.

However, the time spent here has definitely been worth the hoopla of having to leave in nine days to fly to Nicaragua to get our passports stamped. Besides, with our five-year anniversary on October 31st, we’ve usually done something special to celebrate…a mini vacation…a special night out, etc. The two-night stay in Managua will fill the bill.

Don Juan Pharmacy where I purchased a bottle of contact lens solution for US $20, (CRC 11,401) usually priced at around US $7.95 (CRC 4,932).

We’ll be back at the villa on the 30th, most likely staying in and celebrating here at the estate on our actual anniversary date on October 31st. It will be easy to celebrate in this outstanding property which far exceeds any five-star hotel we’ve seen to date. 

Would other travelers be content in this small town? Yes, in many ways. Its central location makes it a good base for sightseeing and if one enjoys traveling on mountainous roads the scenery is exceptional as we’ve shared in many posts. 

Atenas is conveniently located near the airport. There are seven hotels listed in Atenas, at this link with more in surrounding areas, some modest and unassuming and others more deluxe (none are five-star rated). Most are well under US $75 (CRC 42,752) per night. 

We’ve heard parrots may be seen in the trees in the park.  We’ve visited several times to no avail.  We’ll keep trying.

There are 39 restaurants listed in Atenas which may be found at this link. These restaurants don’t work for my way of eating but for most, they’ll be ideal with fresh local ingredients and flavors commensurate with local tastes and customs.

Of course, for those interested in the privacy and convenience of a vacation/holiday villa, nothing can beat this exceptional home with three large bedrooms, each with an en-suite bath, plenty of storage space, ceiling fans, and ultra-comfortable beds and bedding. We love the “screening room” with a large flat-screen TV, surround sound, and comfortable seating.

The granite and stainless steel gourmet kitchen with a second “clean up” kitchen is over-the-top with every imaginable amenity and kitchen tool and gadget.  Well, I could go on and on but most of you have read our comments in past posts about how much we’ve loved this property and location.

Nothing is as pleasant as a blue sky during the rainy season.

The downsides are few in this area. However, if dancing until dawn is your “thing” you may be better off staying in the “big city” of San Jose which has every type of nightlife one can imagine.

Although there are a number of clothing, souvenirs and “sports” shops in town in the area, if shopping is high on your list of priorities, a trip to San Jose would satisfy even the most enthusiastic shopper. Atenas lacks in this area.

Also, for the more extended stay, one must consider that its best to arrive in Costa Rica with every possible item you’ll need during your stay. Prescriptions cannot be mailed into the country, although non-narcotic items can be purchased at several pharmacies without a prescription. Keep in mind that brand names and many ordinary doses for many things are impossible to purchase.

There are many tall trees at the central park.

Shipping supplies into the country will result in long delays due to customs with high tariffs on items that may not be worth shipping into the country with the added expense. From what we’ve been able to perceive to date, Costa Rica is very protective of what enters their land for a few primary reasons.

One, they don’t want any hazardous products entering their country possibly affecting the delicate ecological system. Two, they prefer to sell locally grown and manufactured products offered by their vendors. Three, they can collect taxes on locally sold items.

As a result, expats, used to shopping on Amazon, for instance in their former lives, may become frustrated knowing they have to return to the US or their home country to load up on supplies. 

A water fountain at the park.

We particularly understand these restrictions when we realized I’d run out of my one of my regular prescriptions (I take three) while we were here when unable to purchase an alternative in any close proximity to the original dosage. Thus, I am spreading what I have left, missing one pill every fourth day to no ill effects so far. This plan will get me to Florida where my prescriptions will be waiting in our box of supplies at the hotel.

I could go on and on about Atenas and add more information over our remaining days in Costa Rica until we depart on November 22nd. For those considering moving to Costa Rica, we’ll discuss more on this topic in future posts.

Have a lovely day! 

Photo from one year ago today, October 19, 2016:

In Bali, a large visitor came to call after high tide during the night. Check out those eyes! For more photos, please click here.

Warning to all tourists taking prescription drugs…Could result in a Costa Rica nightmare…

Yesterday we shared a photo of an Owl Eyed Butterfly, and today, we have a winking Barn Owl.

“Sightings from the Veranda in Costa Rica”

Ulysses was creating a perfect trim on the hedges at the villa.

After yesterday’s scathing tongue lashing on Monday’s less than a pleasant attempt at renting a car, we hesitated to go down a somewhat negative path two days in a row.

For the majority of tourists, today’s post will have little significance. You book a vacation/holiday in Costa Rica, staying at a resort for a week or two. If you take prescription meds, you bring along a sufficient amount for your entire stay. If innovative, you bring enough for an additional few weeks in the event of some mishap or delay in returning to your home country as initially planned.

Creatures in Costa Rica are colorful, including this massive spider in her web.

However, suppose travelers like us plan to stay for an extended period. In that case, it’s an entirely different scenario when no prescription drugs (including non-narcotic meds) may be shipped into the country. Also, no vitamins or supplements may be shipped into Costa Rica and will also be confiscated.

Why is this? These are stringent drug laws, coupled with Costa Rica’s intent to create a revenue source from selling their prescription medications in the local and chain pharmacies. As a result, other than prescribed narcotics, mood-altering, or brain function medications, most medicines are sold over the counter without a prescription.

I take low doses of three non-narcotic meds for the following conditions (bad genes); hypertension, thyroid, and a hormone…fairly innocuous items, all typically requiring prescriptions from a doctor in the US.  (Other country’s laws may vary).

It was frustrating, taking photos through the fences, but these birds weren’t ready to return to the wild after their rehabilitation.

When I noticed my supply dwindled these past months, I decided to purchase over these next few months from ProgressiveRX, where I’ve been buying refills regularly over these past five years through their online service, comparable to buying from any online pharmacy in Canada.  

Easy as always? So I thought. This has never been an issue in any country in which we’ve lived over these past years. So I’d make the online purchase well before I needed them (slow delivery times) and have them shipped to wherever we may be at any given time. 

Although one shipment was lost while we were in Italy, the company happily replaced the lost items at no additional charge. Luckily, I’d planned the shipments months before I needed the pills and never missed a dose through the lengthy process of replacing the lost items.

Three Barn Owls at Zoo Ave, the bird and animal rescue facility in the Alajuela Valley.

While in Australia, for the sake of convenience, I received new prescriptions from a doctor we’d visited for physical exams while in Trinity Beach. But, unfortunately, I couldn’t get more than a six-month supply, which is typical, even through online pharmacies. 

Thus, again with a several months supply on hand, I ordered more from ProgressiveRX, which we had shipped to us in a box of supplies from the US from our mailing service.

I’d also considered making the purchases of a few month’s supply while here in Costa Rica since both of us must have physical exams no more than 60 days before the upcoming cruise to Antarctica. So we’d have the necessary exams and purchase my meds while here at any pharmacy.

Three Barn Owls were sharing a tree branch.

On Monday, the day of the rental car fiasco, I’d brought along the pills in the bottles with clearly marked labels to the Walmart Pharmacy. As it turned out, I’ll run out of two of the meds before the time we leave on November 22nd, thinking they could easily be replaced by some Costa Rica versions of the same frequently prescribed drugs for these conditions, common throughout the world.

Oh, foolish me. Walmart could not supply me with any of the three meds without changing doses and brand name components. One of the meds required the brand name when I tried alternates to no avail in years past.

After the pharmacist and I counted what I had left, we discovered I’d run out before leaving. “Local pharmacies don’t carry what you need,” explained the kindly pharmacist. So it’s a lost cause. I contemplated my options which included taking wrong doses and wrong meds and decided against it.

These birds were too high up to get clear shots without a tripod.

During the last month, when I’ll run out of two of the three meds, I’ll take doses every other day.  Doing so should not be life-threatening, although it may create some unpleasant symptoms. I’ve experienced worse. I’ll be fine.

In the interim, I’ll place an order from ProgressiveRX to arrive at our mailing service in September or October (at the latest) and have them shipped in a box of other supplies we’ll be sending to our hotel in Miami, where we’ll stay one night before boarding the 30-night cruise to South America.

How will we ensure the proper timing? We’ll have the shipment arrive from Nevada to Florida at least two weeks before our arrival on November 22nd. The hotel will hold the package for us until we arrive. 

Parrot sitting atop a perch at Zoo Ave (Ave means “aviary” in Spanish).

At that point, I’ll have enough to hold me for a few months until I place another order for a shipment to South Africa. That will work. We received a shipment while we were in Marloth Park in 2014 without incident.

The result…bring enough medication with you when you come to Costa Rica unless you’re confident you can purchase refills from a local pharmacy of the products/brands/doses you typically use. You are allowed to bring a regular supply into the country commensurate with your stay, plus extra for unexpected events.

Did I learn a lesson? I suppose regarding Costa Rica, I sure did. And, of course, in the future, I will check if there will be an issue receiving medication by mail from countries where we aren’t quite sure. But, after five years of world travel, this is the first time we’ve run across such a situation. 

A bit blurry from afar but a pretty parrot nonetheless.

But, like the rental car situation (BTW, we did get a refund from rentalcars.com for which we’re relieved and pleased), one never knows what may be encountered in unfamiliar territory. Neither of these scenarios would be an issue for a typical short stay by most travelers. 

Our unique nomadic lifestyle can be challenging at times. And we continue to learn as we go.

Be well.

Photo from one year ago today, August 30, 2016:

Shorter than he’d usually prefer, Tom’s buzz cut in Phuket Thailand held through the 33-night cruise, which began on October 31st. For more details, please click here.

We figured out how I became ill…See our many photos below in the second half of this post…

Views across the Huon River.

There’s no doubt we’re running low on photos. Having been increasingly ill over these three months, I wasn’t feeling well enough to go sightseeing once we arrived in the Huon Valley, five weeks ago. I’ve barely been well enough to do much of anything. 

Tom makes the bed, does the laundry, washes the dishes, and helps make dinner. The cleaner comes once a week leaving us with not much more than tidying up after ourselves. 

I had mentioned that I wouldn’t continue to discuss this health issue. This was prior to having a diagnosis anticipating that our readers would tire of my whinging. But, now that I have the diagnosis of Helicobactor Pylori (the bacteria that causes ulcers and gastritis, we both felt it was important to share this information with other travelers. 

These conditions may become prevalent for travelers to certain countries and after eating certain foods. After all, to the best of my knowledge, I may only have exacerbated this condition while living in Bali for four months. 

These comments are by no means intended to criticize or berate the two lovely cooks, the property, or the diligence of the owners or managers. They were very conscientious to ensure our visit was safe and sanitary. 

Rolling hills in the Huon Valley which apparently were bright green in the spring, before we arrived.

However, certain climates with ultra-high humidity and rampant insects and ants may be a breeding ground for illness.  Also, one never knows the handling conditions when purchasing produce, fish, meat, chicken, and eggs from vendors in farmer’s markets which we’ve done regularly.

We often hear of infectious disease as a result of bagged lettuce and other produce purchased in the US and other highly developed countries in traditional chain supermarkets where one may easily assume everything is safe to consume, only to discover it is not, in some circumstances. 

When looking back and discussing where we’ve been these past few years and when in fact this illness may have started we reviewed many of our past posts. Most of us carry the H. Pylori bacteria which may be activated over a long period of time, often exacerbated by certain conditions.

Sailboat on the Huon River on a cloudy day.

When we received the diagnosis a few days ago, we both racked our brains trying to recall when, in fact, some of these symptoms began. Without a doubt, the symptoms started with an outrageous and uncomfortable sense of fullness after eating a normal-sized meal, once we arrived in New Zealand where we lived for three months on an alpaca farm.

Most of our meals consist of medium sized portions of protein, one or two cooked vegetables and a salad.  Eating none of this foods should or previously caused any intestinal distress. 

Previously while in Fiji, where we spent three months living on the island of Vanua Levu we literally cooked every meal.  During this period we didn’t consume a single portion of seafood when we’d discovered all local fish was caught close to the shore.  See this photo below and our post from December 29, 2015 for our mention and fears of eating fish in Fiji.

Photo and caption from December 29, 2015:  “We’d been warned against purchasing locally caught fish when its often caught close to the shore where bacteria is heavy in the waters from sewage disposal.  As a result, we never purchased any fish during the past four months (in Fiji).  I’m looking forward to cooking fish once we arrive in New Zealand.”  Eventually, I did eat the fish.  See text below for details.

At the end of the three months we left Vanua Levu to fly to Viti Levu where we stayed for one additional month.  This was during the busy holiday season that we dined out a few times, once on Tom’s birthday on December 23rd and again on Christmas Day.  On each of these occasions I ate shell fish and/or squid both of which meals were consumed in a five star hotel. 

Here’s my dinner on the night of Tom’s birthday in this photo below with more seafood.  Here’s the link to that meal:

My fresh plate of food on Tom’s birthday on December 23, 2015.

But, here’s the one that tops it all from Christmas brunch December 25, 2015:

This is what I ate for Christmas brunch at the five star hotel in Vanua Levu, Fiji; baby octopus all of which are caught close to the shore.  Please see this link for these facts.  Those heads were a bit tricky to chew.  I ended up eating four of them, less one head, never giving it a thought since we were dining in an upscale environment.

Once we left Fiji on January 4, 2016, we cruised from Sydney, Australia to Auckland, New Zealand where we lived on the alpaca farm for three months. It was during this period the bloating symptoms began, most likely the onset of full blown H. Pylori.

On January 11, 2016, I posted this story with a seafood photo on a cruise, here again exacerbating my condition by eating bottom feeding, caught-close-to-the-shore seafood.

This is the entrée I ordered for four evening meals in a row on the cruise to new Zealand, seafood on a bed of cooked cabbage and vegetables.  Here again, more high risk seafood.

How many times did I mention the risks of eating seafood caught close to the shore which is often infected with a wide variety of bacteria, including Helicobactor Pylori?  More times than we can count. 

Any yet, foolishly, I continued to eat squid and bottom feeding fish which seems to be the biggest culprit in causing my illness as shown in these photos. At the time, I made the assumption that dining in upscale restaurants and aboard cruises would eliminate these risks.  How wrong I was!

Today, as I experience some side effects of the massive doses of two different antibiotics, one of which includes 2 grams  (2000 mg) of Amoxicillin per day, twice the recommended dose for strep throat or penumonia.   The other antibiotic is Clarithromycin at 1 gram (1000 mg) per day.  The third drug is a PPI (proton pump inhibitor) always taken in combination with these two antibiotics is intended to reduce the acidity of the intestinal tract during the treatment and for two months thereafter (by continuing the PPI).

The course of treatment ends next Monday at 7 pm.  Thirty six hours later we’ll board the cruise in Sydney.  I can only hope I’ve learned something here:  that the cosumption of squid and other close-to-the-shore and bottom feeding fish will now be forbidden in my diet, eliminating one more of the foods I’ve enjoyed over the years. 

We’re grateful for our almost 1700 daily posts.  Through researching our photos, we were able to piece together why, when and how I developed this bacterial infection.

However, no food(s) is ever worth a serious health condition of any type.  We hope this post may have provided some insight into what may be recommended to eliminate from one’s diet while traveling.  One can never be too cautious, a lesson I’ve learned the hard way.

Be well.

__________________________________________


Photo from one year ago today, February 22, 2016:

These foals in NZ were hard to get close for more detailed photos when they’re very shy  If you click on this link, it will take you to last year’s post where, if you scroll to the bottom on the page, you’ll see a hysterical horse photo we’d taken in Hawaii.

Dealing with life’s everyday challenged while traveling the world…

A billy goat tied to a tree.

Finally, Tom is on the mend. After considerable research, we speculate that the abscessed tooth he had pulled may have resulted in the gastrointestinal infection that began to plague him 48 hours after the extraction, lasting for almost a week.

He suffered from severe gastric symptoms, fever, chills, body aches, and weakness. He took over-the-counter medications to alleviate the fever every four to six hours for the first few days until the fever subsided, sleeping most of the day on the sofa in the living room.

A bubbling brook.

The simple fact is that pulling the tooth released bacteria from the abscess in his bloodstream and stomach, resulting in what appeared similar to the bacterial infection I had in Marrakesh, Morocco after eating raw vegetables in a restaurant the first day of our arrival. 

After traveling for 17 months at that point, I should have known better. Now, we’re more cautious than ever in less developed countries. I had waited three weeks before succumbing to a three-day dose of Cipro which we’d brought along for exactly this reason.

Recently, we read a study that discovered the depth of the intellect of horses and their innate ability to connect with humans, even reacting to expressions on a human face.

Within hours I began to feel relief. In Tom’s case, we didn’t want him to take antibiotics a third time since his first dose for the abscess was in November, the second in January, on two occasions when the abscess flared up. Thus, he waited.

It wasn’t until he started feeling better yesterday that we conducted research to make the connection to the abscessed tooth extraction and the gastric. Had we suspected this earlier, calling the dentist to inquire, most likely he’d have recommended antibiotics, which we didn’t want Tom to take once again unless it continued for more than a week.

A creek we encountered on a drive.

Its in these types of scenarios that not having a “regular” doctor and dentist puts us in a tough position. In our old lives, if we were sick for more than five days we’d make an appointment to see the doctor often having tests and leaving with a few prescriptions. 

We don’t have this luxury now, 40 months after leaving Minnesota. For those family members and friends who are reading today…please don’t worry…if one of us exhibits life-threatening symptoms, we’ll immediately find our way to an urgent care facility or hospital. 

Even on cloudy days, the countryside has a special charm.

It may seem as if we’re often sick as we share the details of our daily lives. Most likely it’s no more than most of our readers. The difference is that few document each virus, infection, injury, and days of being under the weather. Most likely, twice a year we experience a malady of one sort or another.

After considerable discussion, we’ve come to the conclusion that moving from one location, one country to another, we have little time to build an immunity to local viruses than those who live in one location occasionally traveling who seem to build an immunity.

Stopping to admire cloud-covered Mount Taranaki.

On cruises, passengers are exposed to a variety of illnesses from living in tight quarters for a few weeks.  Luckily, we’ve never had Norovirus even during periods when there’s been an outbreak.

Although on four of our past cruises either one or both of us has developed the common “cruise cough,” the worst of which was on the cruise from Hawaii to Sydney with horrible symptoms lasting three weeks after the cruise ended. By far, that was the worst illness either of us has experienced since we left the US. 

Horses we encounter are animated and friendly.  Check out the cute pink spot on his nose.

When the ship disembarked we were so sick with a fever and a cough neither of us hardly recalls the time we spent picking up the rental car at the Cairns airport and finding the house in Trinity Beach.

We caught this awful virus toward the end of the cruise when a woman coughed on me in the elevator which, once my symptoms manifested, Tom was infected developing into the same whirlwind of awful symptoms.  

We each spent the last few days of the cruise in the cabin (it was an 18-day cruise) in an attempt to avoid infecting others. Otherwise, this was one of the most enjoyable of our 12 cruises to date, making many new friends with whom we’ve continued to stay in touch.

Another creek we crossed on a drive.

Most recently with Tom’s abscessed tooth, we ask ourselves what we may have done differently once the symptoms manifested. We were living in a remote area of Fiji. We visited a dentist within days of the first symptoms, taking antibiotics as prescribed. 

His second bout of symptoms occurred on the day we boarded this last cruise from Sydney to Auckland. The only solution was another round of the same antibiotics. As required in the case of antibiotics he continued with the full course of the medication. 

Once we arrived in New Plymouth, within two weeks of arrival, we were in the dentist’s office when at that time, no new symptoms were present. We feel we did everything we could. Then, he developed the awful gastrointestinal infection plaguing him for almost a week. 

A winding country road.

Now, he’s able to eat again, is feeling well and life will continue on as always, always, stress-free, filled with simple daily pleasures and the comforts of living in the countryside in this beautiful country. Soon, we’ll head back out to tour more of this exquisite location, sharing new photos along the way.

We feel blessed and grateful for each and every day of our lives. But, no one “said” life of world travel would always be easy.  It’s not. And, it’s the times it’s not easy that make us appreciate greater periods of good health and simple pleasures. Overall, we were very fortunate during these last 40 months.

Thanks to all of our readers for sharing this journey with us during periods of both excitement and the mundane events of daily life.

Be well.

Photo from one year ago today, February 13, 2015:

Thousands of feral chickens populate the island of Kauai. It is speculated that Hurricane Iniki in 1991 blew away hundreds of chicken coops, letting them loose to proliferate. It’s quite a sight to see! For more Kauai photos, please click here.

Counting down the days with a bit of trepidation…What do world travelers like us do without a primary care doctor?…This morning’s new photos….

This Cattle Egret is sitting atop a tree in the backyard, a usual sight to see. Most often, they are on the ground near where there is landscaping, grading, and excavation in the process. They seem to know that such scenarios are excellent opportunities for foraging for bugs and worms.

After a fitful night of listening to science podcasts, at 6:00 am, I literally rolled off the edge of the bed, exhausted and wishing I could lay back down for a few more hours.

My mind was doing a number on me. I had to get up and try to call the doctor again with no response after yesterday’s call.  ER doctors don’t usually participate in any aftercare for patients they’ve seen on an emergency basis.

We no longer have a primary care doctor. It’s simply been too long since we last visited our former doctor in Minnesota, which was in September 2012, a month before we left. 

The egret couched down watching me open the door to take the photo.

I knew he wouldn’t participate in any health care questions at this late date when several months ago, I inquired to the Minnesota clinic with an online request for a relatively innocuous medication refill, never receiving a response. At that point, I knew he was no longer in our court. Too much time had passed. We get this. They have “rules.” 

Travelers maintaining a home base would have no difficulty contacting their primary care physician for advice.  Although in Hawaii, prescriptions can’t be “called in” from an out-of-state physician.

It’s a little late to establish a relationship with a doctor in a private office or medical clinic in Kauai. Besides, none of the testing equipment required for a diagnosis is readily available at any of the local clinics and a trip to the Wilcox Memorial Hospital in Lihue would be required. 

This morning’s view from our lanai while it rained off and on.

From what we’ve discovered most doctors refer patients to the hospital if their condition can’t readily be treated with meds. I suppose this is not unlike many clinics worldwide, let alone in the US.

Finally, this morning at 7:00 am I reached the ER doctor I’d seen on Friday asking for a different, perhaps more effective antibiotic. This is often necessary with a variety of infections, which don’t respond well to a particular drug which seems to be my case at the moment.

Ah, the perils of world traveling without a home base!  We knew this going in. We also knew that having only major medical insurance (which pays 100% of any hospital stays, doctors, tests, and medications rendered while in the hospital) would be a risk. 

I edited this photo to be dark in order to show the two rainbows that developed after the rain.

By purchasing the international policy, we chose the option of major medical only or paying outrageous fees to include doctor visits. However, if we had made a choice to include doctor/outpatient services, the policy still didn’t include any necessary medical care as long as we’re in the US, as we are now. 

Since Medicare doesn’t pay outside the US, we opted out of Medicare’s Plan B which pays doctor visits with a copay of as much as 20% for which most seniors purchase an additional policy. This would not be a sensible option for most senior travelers especially those who periodically return to a home base. They can easily purchase a specific travel policy for their trips, event by event.

This individual trip policy was also not available to us when our lives consist of one continuous “trip.” No such policy exists for us other than the 12-month international policy that we purchased almost three years ago and renew each year.

It was raining when we got this rainbow shot. If the hill and the trees hadn’t been in the way we’d have been able to see the end of the rainbow in the ocean.

When we consider the potential out of pocket costs for tests at a hospital, we cringe but fully accept that potential no matter where we may be. We’ve dodged a bullet to date but, we knew sooner or later the scenario could change on a dime.

In any case, the ER doctor refused to “call-in” a different prescription without my having additional tests. We understand her dilemma. As an alternative, I presented her a list of all of the antibiotics we currently have on hand and she suggested Cipro, the “big guns” for infections. 

She emphatically stated that if I’m not better 48 hours after taking Cipro which will be Thursday, we’ll be heading to the hospital for more tests. Both Tom and I agree that this is our only option. At that point, it will be only 10 days until we depart on the cruise. 

It’s hard not to appreciate the seeming magic of a rainbow.

What do ex-pats do in these cases? They either purchase insurance available in the country in which they live, purchase international insurance such as ours, or in some cases, pay for medical care out of their pocket when medical costs in some “retiree friendly” countries are surprisingly inexpensive. 

From what we’ve read online to date, a typical doctor’s office visit in Australia may be around US $50, as opposed to $100’s in the US. Once we arrive in Australia, we won’t hesitate to see a doctor if we deem it necessary at the time.

These berries on this plant remind me of Christmas.

If this illness had occurred a few months ago I would have followed the doctor’s instructions and not given it much of a thought. The current time constraint is weighing heavily on my mind at the moment.

My sister Julie worriedly reminded me of how many times we’ve been sick since we left the US, more often me than Tom. I must admit that at least twice a year I’ve picked up some type of infection, viral or bacterial.

With a history of inclement health for most of my life (mostly due to heredity and inflammation), my immune system continues to remain vulnerable regardless of how hard I’ve tried to offset it. It was equally precarious when we lived in Minnesota, still contacting some type of virus, sinus infection, or respiratory infection once or twice a year. 

Sunset from the front lanai.

Then again, how many of us don’t “catch” something once or twice a year? Tom would push through such conditions and continue to work as did many of the guys he worked with on the railroad, often infecting one another while working in close quarters on a train. 

Having a home base has what we now refer to as “luxuries” that come with it; easy access to medical care, cable TV, working cell phones, appliances such as a clothes dryer, quality Internet services, shopping centers, and grocery stores with familiar products and services.

We don’t share this personal story to elicit sympathy, although bless the hearts of many of our readers for sending their good wishes. We continue to tell our story for the purposes of sharing both the good and the bad of what it’s like to be traveling the world without a home base. 

And, we appreciate the beauty of flowers blooming in the treetops at a distance from the lanai.

The vulnerability we express here at times even surprises us when in our old lives, we only shared a degree of personal information with our close family members and friends.

How foolish we’d be to hide the realities of our daily lives only sharing the details of the most exciting of locations and adventures. With that, we’d only be a travel log, extolling the virtues of where we’ve been, and what we’ve seen, a place for a degree of braggadocio. The manner in which we share our lives is done so with a much bigger intent; truth and reality.  

We have no doubt that at times, some of our readers may become bored with our truth, reality and mindless drivel. Then again, daily life for most of us is mundane at times, isn’t it?

We’ve come to appreciate the simplest of life’s amenities, never taking for granted that which is available to us, including the potential of more medical care in Hawaii. If we must go, we will. If we luck out and I’m well again in a few days, it will be time to rejoice and start packing!

Have a superb day!

                                             Photo from one year ago today, May 12, 2014:

A year ago today, we were three days from leaving Morocco. We were definitely ready to be on the move. For details on that day, please click here.

Much to do…Retirement isn’t a free lunch….Photos from dinner in the souk…

A complimentary bowl of spicy olives is served when dining at Arabe restaurant.
There’s never a day that passes that doesn’t require tasks related to our travels. In reality, it’s comparable to a full time job. Fortunately, we don’t mind doing most of the tasks. Although, it’s easy to lie in bed early in the morning thinking about everything that must be handled, we try not to make ourselves crazy or worried with the responsibility of accomplishing them.
The overlook to the shops below from Terrasse des Espices Restaurant.

Let’s face it. There’s no free lunch. We all have many tasks in our daily lives continuing well into retirement, if not until the end of our lives should we be so fortunate to be able to continue to do our own tasks. 

For most of our readers, daily household tasks and maintenance preoccupy a good portion of each day. Add the responsibility of handling medical insurance, medications, health appointments, paying bills, grocery, and other shopping, visiting family and friends who are ill or in nursing homes, and entertaining family and friends, it is exhausting.

Complimentary bread sticks are provided at Arabe restaurant.  The price of cocktails is high in Morocco, as much as US $10 per cocktail. As a result, Tom doesn’t bother to drink any alcohol. With us dining out three or four times per week, him not drinking could easily be saving us over US $100 per week.

Although we have eliminated some of the above items from our “to do” list, since we no longer have a home, we have other tasks to perform that replace them, mostly wrapped around our continuing travels.

In other words, being retired is not being “retired’ from anything other than going to an outside job each day. The perception that many younger still working people may have is that life is free and easy. Ha! It’s hardly the case.

A pigeon we spotted while dining on the rooftop.  Their cooing sounds permeate the air in the riad each day, along with the crowing rooster who crows every 5 or 10 minutes.

Although at times I consider myself in the retired category, I am far from retired. I work half or more of each day with our website, writing, editing, taking photos, and generally being continually aware of the creation of the inspiration for the next story. That’s hardly retired. The fact that I enjoy doing so is incidental.

Add the financial management, record keeping and the daily task of handling of the budget, logging each penny spent, my days are full, leaving a little time for playing Gin with Tom, watching a few shows and of course, getting out to explore.

This is the usual crowd we must maneuver each time we go out to dine, get cash from an ATM, roam around the Big Square, or to exit the Medina in order flag get a taxi. 

This morning I spent an hour placing our few pills into our pill cases. Tom’s case holds two weeks of pills. Mine holds four weeks. The end result is that I have to do pills every two weeks. Now, this should be an easy task. I take a few prescriptions and Tom takes one. Adding the few vitamins and probiotics we have left and it seems that it shouldn’t take so long.

But, as time has moved on, we’ve used all of our US prescriptions and are now into the one year’s supply of the those we’ve purchased from ProgressiveRX, a reputable online pharmacy company. (They don’t take insurance).  Each pill they dispense is individually wrapped in foil requiring a huge amount of time to get each pill out of the right wrapping.

As we dined at Le Jardin, Mr. Turtle stopped by, hanging out for “crumb patrol.” Of course, we complied with his request for vegetable tidbits from our plates as he stared up at us, which he savored with delight, quickly snapping them up. He rested between bites at my feet.

Today, I unwrapped over 100 pills for the six weeks total of pills I placed collectively in the little cases. As I’ve aged, good grief, I’ve noticed my fingers are not as adept as they may have been 40 years ago. Small handiwork is not my forte. 

Also, several years ago I had surgery on my right thumb and it’s basically useless. Try unwrapping those tight little tin foil packs when right-handed and the right thumb doesn’t work. What a time consuming ordeal.

Mr. Turtle and his companion, another male, scour the floor of the restaurant all day, as customers come and go. The staff feeds them their usual diet of fresh greens but they particularly seem to like the cooked vegetables from our plates.

After performing this task this morning, I thought, “Why don’t I unwrap them all and put them in the plastic bottles I saved from the old pills?”  Simple reason. As we are stopped by airport or cruise security, we’ll fare better with them in the labeled foil packs than in the white plastic bottles I saved that I plan to toss before we leave Morocco.

This morning, I performed the pill task earlier than usual after being awakened at 5:00 am by the crowing rooster next door. He’s obviously going nuts now that its spring, continuing to crow throughout the day, until dark. 

Fresh produce is offered for sale at Le Jardin including these pretty oranges.

Looming in our minds has been the car and flight we still need to book for leaving here in 27 days which invariably proves to be a lengthy process when making every effort to get a good deal. We postponed booking these two items as we considered the possibility of leaving a few days earlier. Now, that we’ve re-framed our thinking, we’re content to stay until our departure date of the 15th of May.

In addition, we still have four more family members to book for Hawaii as we continue to watch rates on a daily basis. We plan to have their bookings completed by the first week of May.

Notice the two buds growing behind the flower.  Photo taken from a tree in Le Jardin a restaurant we’ve found that stays open at all hours.

Yesterday, we created a detailed spreadsheet listing all the places we’d like to visit in the next year including prices and details of possible cruises and the flights to travel to those locations, the cost of rent, rental cars, and other expenses. As a result, we created a budget for the next year. It feels great to have accomplished this task.

When realizing that the cost of our “wish list” was more than we’re comfortable spending, we knew that the next step in the process was to whittle it down to an acceptable level. That it itself is a time-consuming process.  However, that business-related part of me still enjoys creating and updating spreadsheets. Good thing. It’s definitely not within Tom’s skill set or desire to learn.

A hand-carved head on display at Le Jardin.

Assigning tasks to each of us helps to avoid redundancy. At the moment, Tom is researching future travels while I document his research. This works well for us. I’m researching the remaining flights for our family, while Tom keeps checking our booked cruises for rate changes. (If prices drop, we get the benefit of the lowered price, if done so prior to 90 days before sailing).

As a result of the division of tasks, neither of us, ever feels there is an imbalance in responsibility, very important in keeping peace when together around the clock. Resentment over the balance of responsibility is often a source of disharmony in relationships which has never been an issue for us.

As I shot this photo of this parakeet in a cage at Le Jardin, she shook her tail feathers.

Without a doubt, I spend more time “working” each day as I write and post photos. But, the fact that it is a pleasant task, doesn’t make it feel as if it’s work.

As much as life for retirees may seem like a walk in the park, most of yours and our days are filled with tasks and responsibilities, none of which we can easily ignore or postpone.

This guy refused to awaken from his nap while I took these photos.

Maybe next time our hard-working, still working, family members or friends comment about the “easy” lives of retirement, they can ask us how we spend our days. Then, perhaps, they may realize it is not as simple or easy as it appears. Sadly, they eventually find out how difficult it is when we get so old that we can no longer perform our own tasks, and they have to take over.

It’s for all of the reasons we must grab at every moment we can, finding joy, pleasure and meaning in our lives.  And, it’s for this very reason, that we find ourselves in Morocco in spring of 2014, living life to the fullest, the best way that we can.
                                              ______________________________________

Photo from one year ago today, April 18, 2013:

Photo Tom took from our balcony at sunrise, as our ship made it’s way to Sam Juan, Puerto Rico where it spent the day. For details of this date, please click here.

The trials and tribulations of taking prescribed medication while traveling the world….

The comments here today are in no manner intended to be any form of medical advice. We are not medical professionals. Please see your medical professional for advice and consultation.
Decorative doors in Morocco are common. Some believe symbols and a beautiful door may drive away evil spirits.
Where do I begin? Here we go, me doing my best to describe a situation that easily may become a dilemma for seniors or those taking medications while traveling. No matter how hard I’ve tried I am plagued with hereditary health issues. Since I was 16 years old, I exercised, watched what I ate, stayed slim (except for a few short periods which I later remedied), and lived a healthy lifestyle. 
I was motivated by fear, watching family members fall prey to diabetes with subsequent amputation and untimely death, morbid obesity, heart and arterial disease, thyroid disease, and the painful condition I changed a few years ago by changing to my restrictive diet.
With my efforts all these years, I have no alternative but to take a few medications, one for high blood pressure. But, let’s face it, millions of seniors over 65 take medications for this and other conditions. It’s not unique.
These doors have similarities that many who designed the riads found particularly appealing.
Over the years, I’ve read how to reduce the necessity for medications for hypertension and have made huge efforts to eliminate the need for the medications to no avail. Invariably, the symptoms stayed steady and I was merely kidding myself that I could function without them. 

Luckily, almost three years ago, I stumbled across a doctor who steered me in the direction of this strict anti-inflammation diet that I’ll follow for the remainder of my life, that that has changed the quality of my life, now living pain-free (except for the occasional pain in the bum right shoulder which I’ll gladly live with). Without this change, we’d never have been able to travel for a two-week vacation, let alone travel the world for years.

In some of the narrow alleys, we could only take photos from an angle as shown.

After the first six months on the restrictive diet, all of my lipids dramatically improved from bad to normal. But, the high blood pressure, entrenched deep within my genes, remained. I have no choice but to take medication, most likely for the remainder of my life.

As described in this site many times in the past, taking medication while on a vacation/holiday is not necessarily an issue. It’s imperative to bring more medication than you’ll need in the event of delays, with the medication in it’s original labeled bottles along with copies of your prescriptions in the event you are questioned. Only once have we been questioned about non-prescription and prescription medications except in Belize. Long story.  Here’s the link.

Two interesting doors..
We’ve posted many times as to how we decided to purchase our few medications through a reputable online pharmacy, a year’s supply at a time, to be shipped to us wherever we may be. When down to a remaining four months of a drug, we place our order.

Alas, an order of a few months ago that we received in South Africa via snail mail, had a problem. Before sending the medication, they contacted me by email, explaining the dilemma. The pharmacy company, ProgressiveRX was unable to correctly fill the blood pressure medication.

The drug in question is Lisinopril with Hydrochlorothiazide.  The pharmacy company only had the drug Lisinopril by itself without the Hydrochlorothiazide, a diuretic used to reduce fluid in the body and subsequently in the blood vessels (simplification). They didn’t have access to the combination drug or the two drugs separately. The combination of these two medications, available in a single pill was the only drug that worked for me after trying many combinations years ago. 

We also noticed exceptional doors while we were living in Tuscany last summer.

What was I to do?  Find a doctor to write a separate prescription for the required 12.5 mg dose of Hydrochlorothiazide and then take the two pills together?  Worrying about running out entirely, I advised them to send the 10 mg. Lisinopril by itself and I’d figure out the rest. I didn’t want to go to a doctor’s office in Africa unless it was an emergency with fears of communicable diseases in such a place.

Taking my copy of the prescription to a pharmacy in South Africa provided no options. hey didn’t carry the drug or a reliable equivalent. Knowing that I’d run out of my old supply in the first few weeks in Morocco, I realized I’d have no choice but to try taking the Lisinopril by itself and see what happens. Within three or four days, I could feel that my blood pressure was high. Many do not feel any symptoms from hypertension making it important to have it checked from time to time.

A serious kitty nap at the base of a tree.

I know many of you will write to me suggesting I don’t self treat. Medical care in many countries is sketchy at best, especially with the language barrier. That’s why we have emergency evacuation insurance. 

In fairness to medical professions in every country, surely, there are fine doctors in most countries. Finding one’s way to them is tricky, can be costly and time-consuming. We didn’t determine this dilemma to be a medical emergency at this point.

With Spring Break on the horizon, yesterday the souks weren’t as busy as usual.

Taking a copy of the prescription with me as we wandered through the souks and Big Square on several occasions we stopped at a few pharmacies, none of which could understand the dilemma. Alas, on Monday, before we started our sightseeing tour, Samir directed Mohamed to take us to a certain pharmacy, outside of the Medina.

The pharmacist spoke excellent English. We left her with a copy of the prescription and a short time later she called Samir, explaining she could supply the separate drug, Hydrochlorothiazide in 25 mg pills which I could cut in half and add it to the Lisinopril dose each day. 

(Oddly, I had packed a pill cutter. We’d never used a pill cutter until our precious dog Willie was diagnosed with cancer in 2011 for which we were giving him Morphine, cutting the stronger doses in half over the few weeks until he left us.  If you’re a dog lover, you may enjoy reading the first blog I’d ever written, during his last days of life, written from his perspective. Please click here for the link. Please scroll through the archives to read from the beginning. Get out your hanky).

Occasionally, we’ve seen a modern-looking spa-type store in the souk, often selling the popular Argan oil, thought to be highly effective in treating the skin and hair.

We ordered a year’s supply to supplement our year’s supply of the Lisinopril and we’re good until we’re in Hawaii next March. Today, Samir dropped off the prescription order for which we reimbursed him. Heartfelt thanks to Samir for his assistance in this situation.

The entire cost for the years supply was US $33.20, MAD $270. I can only imagine the cost of this drug in the US for a year’s supply, perhaps as much as 10 times more. (I could drag out the soapbox for that discussion but I won’t at this time)!

Had she only been able to get the combined drug, I’d have no use for the year’s supply of Lisinopril for which we’d already paid the online pharmacy. Luckily, it all worked out well. 

The rooftops in Morocco are also similar to those in Tuscany.

An interesting fact that we’ve discovered in many countries including Morocco, is that pharmacies don’t necessarily require a prescription for many drugs. However, this could make replacing a drug one accidentally left at a home time consuming and frustrating. Also, some narcotic drugs (none of which we take) may be acquired in some countries without prescriptions which ultimately could result in an arrest if one didn’t have an accompanying verifiable prescription on hand. 

I ask myself, “What could we have done differently to avoid this situation?” Not much, really. Now, feeling like myself again after the addition of the second drug and the recovery from the recent illness, we feel we did the right thing.

The last archway we enter on our long trek to Pepenero.

Traveling long term has its challenges. We don’t have all the answers since we, like many of you, learn as we go. Hopefully, today, if one of our readers gleans a morsel of information from us sharing this story, our efforts are well spent.

Tonight, we’re dining in after a fabulous dinner yesterday at our favorite, PepeNero. OK, we’ll admit it, we’re already doing repeat restaurants. But then again, Madame Zahra’s amazing dinners are surely repeats that we can’t resist.

Tomorrow, we’ll share photos of artifacts from the interior of our riad that we’ve found rather interesting.  Hopefully, you will too!
                                                ______________________________________

Photo from one year ago today, March 27, 2013:

Our veranda in Belize was located at the left edge of this sidewalk.  We couldn’t have been closer to the Caribbean Sea than we were.  For the post from that date, please click here.

Health concerns for travelers of any age…Questions and answers applicable to all…

Sunday’s sunset from Jeri and Hans’ third-floor veranda, the last rain-free day.

The following comments are not intended in any manner to substitute for professional medical advice. This post is entirely based on our personal travel experiences regarding preparedness in the event of medical issues or emergencies.  Please seek the care of your medical professionals in regard to your personal healthcare.

Coupling our interest in health and well being with our worldwide travels has been important to us. Many seniors and younger travelers alike choose to address health concerns before traveling. Many others “wing it” hoping for the best, in many cases a poor decision or, simply a lack of a decision at all.

Checking online over the past almost two years, we have discovered a wealth of resources available that may be of assistance, too many to list here.

We’ve found that researching credible medical sites are crucial, not simply the opinions of a few travelers with a good or bad experience, often seeking a place to vent frustrations and unfortunate experiences.

Some of the questions we had and the answers we’ve discovered that have worked for us, that we’d asked ourselves when planning our world travels include and on an ongoing basis:

  • Will we get intestinal distress from eating uncooked fruits and vegetables? If so, how does one reduce that risk? Yes, illness is often a result of produce eaten raw. This risk does exist when non-purified water is used to rinse produce, which is then eaten raw, such as lettuce, celery, and fruit. Usually, cooking vegetables destroy most of the bacteria. We rinse all of our produce in a bowl of purified water, replacing the water as needed. Always remain mindful of cross-contamination of washed and unwashed produce. We washed all of our produce immediately before placing it in the refrigerator.  This may reduce shelf life, but our “shelf life” is more important.
  • Is it safe to drink the water? Before we arrive at each location we research to determine if the water is safe to drink.If not, we arrange for the property owner to have a several-day supply of purified water awaiting us to ensure we have ample time to get to a grocery store.
  • What about brushing our teeth? This is often a cause of illness. We keep small bottles of purified water in the bathroom for wetting the brush, rinsing our mouths after brushing and rinsing our toothbrushes. Daily, we brush with baking soda and then do a full 20-minute coconut oil gargle which kills bacteria in the mouth, spitting it out when done. Once a week we disinfect our toothbrushes (and my contact lens case) in hot boiled purified water.
  • What happens if get water into our mouths while taking a shower? Immediately, spit it out and promptly rinse the mouth with mouthwash, and brush our teeth following the above process using purified bottled water.
  • Can water be boiled to become safe to use? We don’t recommend this process. Considerable bacteria may remain if the water is not boiled long enough, 15 to 20 minutes, or more. This would only be done in the case of a dire emergency.
  • What about washing dishes?  Ideally, we could use purified water to wash dishes.  Unfortunately, the cost of bottled water is prohibitive and if done properly this isn’t necessary. Wash and rinse dishes, pans, and flatware in the hottest cleanest soapy water your hands can take. Drain on a clean cloth. Wipe dishes dry with another clean towel and leave out, not stacked, to further dry on the clean counter to ensure that no water molecules remain.  Wash your hand before handling dishes which we each do so often it’s ridiculous.
  • Do we need to take malaria pills or other prophylactic medications while traveling? Taking pills for the prevention of malaria depends on the location of your travels. Check with your local travel clinic for detailed maps and information for every country in the world. Other prophylactic medication? For us, we take a Bifidus Probiotic  (30 billion CFU minimum) supplement daily to keep the balance of good bacteria in the gut.  These may be purchased online or at any quality health store.  Research for a quality brand, most of which require refrigeration for freshness.  We have been taking multiple individual supplements for years.
  • What do we do if our luggage is lost or stolen containing all of our daily medications? Do we need to bring along copies of our current prescriptions, written letter explaining the use of medical syringes, if applicable, etc.? Yes! Yes! Yes! We have copies of all of our prescriptions and a doctor’s letter listing all of the supplements we use. Even so, we had trouble boarding a Carnival Ship in Belize (see the posts of April 9th and 10th, 2013 for details of our ordeal).  Also, we carry several Epipen syringes, in the event, we have an allergic reaction (anaphylaxis) to stings from insects or other substances, including a doctor’s letter of authorization.
  • Will our insurance pay if we become ill?  Do we need to purchase emergency evacuation insurance?  Is it costly? Every policy is different.  Check with your policy benefit well in advance of travel to determine what will or won’t be paid. Generally, Medicare usually doesn’t pay outside the US, but check on your supplemental policy’s terms and conditions.  Emergency Evacuation insurance is a must if you’re traveling outside your home country unless your regular policy provides this coverage. Check for specific details well in advance of travel.  On its own, emergency evacuation insurance usually is US $200 to US $300 per person for a two-week vacation. Keep in mind, that “travel insurance” and “emergency evacuation insurance may be entirely different from one another; one if in case of cancellation on non-refundable fares, etc. and, the other is for medical purposes. A few policies have both features combined. Check carefully for details.
  • Do we need vaccinations to travel abroad?  Again, check with your local travel clinic, a highly valuable resource when planning a trip abroad.  Countries in Africa may require proof of vaccination for Yellow Fever and other communicable diseases.  We keep a copy of our entire vaccination record (we had around 18 separate vaccinations) on the inside flap of our passport holders. We haven’t been asked to produce these records yet , but entry into a country can be refused if not provided.
  • How much in advance must we plan for the vaccinations? We both began the vaccination process 6 months in advance of our departure from Minnesota.  Many vaccines require waiting periods between boosters.  Many vaccines may be given at one appointment, which is not detrimental to their efficacy.  The question becomes…how will you tolerate multiple vaccines in one appointment? If dubious, space them out as I did with no side effects.  Many vaccines such as Yellow Fever don’t require a booster for 10 years.
  • Did our insurance cover the cost of the vaccinations?  At the time we had the vaccines, both of us were covered under Tom’s policy from work which much to our surprise, paid 100% of the cost.  With the number of vaccines we chose to receive, the total cost would have been over $1500 each.  If you have Medicare or under the new guidelines, this may not be covered. Please check with your company to determine what, if any is now covered.
  • Will the tours and excursions in which we plan to partake fit within the confines of our current physical conditions and limitations?  Most tour operators specific the “difficulty level” of each of their tours and excursions.  However, these are often minimized, leaving participants gasping for air and exhausted or perhaps at severe risk.  Read reviews and comments online at travel websites such as Cruise Critic and Trip Advisor.  These comments are often a better resource of “factual” information as opposed to the sales orientated tour companies and cruise lines.
  • Did we bring along extra prescription eyeglasses, contact lenses, and supplies, (and hearing aid batteries, if applicable).  What if we lose any of these?  How do we plan to replace them?  We both have our optical prescriptions with us, even if they expire.  In the event of a loss, most prescription eyewear and contacts can be replaced locally or through the mail.  Tom has three pairs of backup prescription eyeglasses and sunglasses. I brought along 24 boxes (6 packs) of contact lenses enough to last three years. I do purchase lens solution at a local pharmacy due to the added weight of the bottles which may be difficult to find in some locations (Belize and Italy).
  • If we use any particular medical supplies, what happens if they’re lost or quit working? Although Tom nor I use any particular devices, we suggest bringing a backup in the event of loss or failure.  We do have a thermometer, small blood pressure cuff, emergency suture kit, and emergency dental supplies (dental glue) in the event a crown or filling falls out or dislodges.
  • What over the counter medications did we include? We packed Aleve, Tylenol, Tylenol PM, aspirin, Milk of Magnesia and Benadryl, cortisone cream, antihistamine cream, antibacterial cream, and hydrogen peroxide.
  • What first aid supplies did we bring? Besides the above comments above, we have Bandaids, bandages, sterile gauze pads, sterile gauze wrap, ace bandage, liquid bandage, and Lidocaine patches.
  • Immediately upon arrival,l in a new location, what precautions do we take in the event we become ill or injured? Upon arrival at our new home, we ask the owner/landlord or property manager the location/phone of the best local hospital, medical clinic, physicians, and dentists in the event of any emergency. For example, here in Kenya, we have the phone number of a physician who will make a house call in the event of a non-life-threatening emergency.  Otherwise, there is a hospital within 10 minutes on the main road.

Yes, I know, this stuff is difficult to address. And for many of you who seldom travel it may be boring. But, for those who travel even short distances on a day-long road trip, being away from one’s home base can present challenging health concerns.

Years ago, I was meeting up with a bunch of girlfriends in Mexico for pre-arranged dinner plans. When they hadn’t arrived after a two-hour wait, I tried calling to no response. A day later, I received a call from one of the other friends in the group informing me that the friend had fallen into a hole under a “grate” on the sidewalk resulting in a serious compound fracture of the leg.

The only way to receive quality medical care was to return her to the US immediately.  With her not having emergency evacuation insurance and the requirement of payment in full in advance of the flight with the air ambulance service, the friend had no alternative but to ask family members for their credit card numbers to cover the then cost of US $25,000 when her own card had a US $5000 limit. Can you imagine the stress of returning home facing your own credit card bill, but also that of the cards of family members? That airfare was 30 years ago. Can you imagine how much it would be in this day and age?

This scenario remained stuck in my mind for 2 reasons; one, don’t walk on grates, wooden boards, or any potentially unstable surfaces on roads and sidewalks (in any location). Of course, Tom has adopted this practice also, as we’ve always alerted one another to possible hazards.  And, the second reason, always have an emergency evacuation policy in effect when traveling outside your home country.

Last night, we ventured out to dinner during a massive rainstorm that had started on Monday continuing all the way through today, Wednesday.  As is typical in Diani Beach restaurants, the walk from the taxi drop off area to the restaurant is long and treacherous with uneven steps, many often twice as steep as we’d expect, multiple tripping hazards, slippery surfaces, and the risk of falling tree limbs and coconuts.

Always carrying our LED mini flashlights has proven to be vital to our safety.  Last night, leaving the restaurant in torrential rains and gusty winds, luckily under an umbrella provided by the restaurant, I hung onto Tom for dear life.  If one of us went down, we both were going down. The long, steep outdoor steps were particularly hard to maneuver when their design was inconsistent and there was not a light or handrail at any point.

We both sighed with relief when we found Alfred, our trusty regular taxi driver, waiting for us and quickly jumping out to open the car doors as we handed off the umbrella to the restaurant server who escorted us. We were soaked all the way through to our underwear, but grateful to have made it to the taxi without incident.

No traveler can sit back and make the assumption that they are invincible and exempt from possible injury or illness when traveling.  With all the effort we’ve made, on a few occasions, we’ve fallen prey to unforeseen illness and injury. We can only hope and pray that we’ve exercised more than adequate foresight to guide us through those tough situations.

As they say on a mindless drivel TV show, Big Brother…” expect the unexpected.”  Doing so need not reduce the quality of our experiences or result in needless worrying.  But, preparedness, certainly minimizes the risks enhancing the quality of our experiences.