A visit to the Doctor(s)

Healthcare is probably concern number one to most expats; here’s the rather mundane story of out latest healthcare experience.

Judy started experiencing knee pain recently: actually, pain in the back of her knee, what we called her “knee-pit.” It seemed to be aggravated by exercise (how convenient!) or a lot of walking, so she cut back on those, did intermittent ice and heat, elevated it, and took over-the-counter (OTC) pain relievers for swelling and pain relief. Sometimes these standard remedies worked, other times they didn’t. Judy did the smart thing: she set a date certain, indicating if the symptoms didn’t go away by then, she was going to contact our doctora. During our recent mini-vacation in Manzanillo, we tried walking back-and-forth in the pool, the kind of low impact activity which should have helped; it didn’t.

So Judy contacted our primary care physician on WhatsApp. It’s a messaging app very popular around the world, except in the US. Individuals, businesses, even doctors give you their WhatApp number, which is just their cell phone number, and you can contact them directly to message or chat. It’s free and very convenient. Our doctora responded quickly that there was no need to come see her; she arranged us an appointment with a local specialist (again on WhatsApp) and we could go straight to see the orthopedista. Cost? Nada.

The orthopedista began the session by asking whether we preferred ingles or español; given this was a medical issue, we decided to stay with our mother tongue to be both clear and understood. He flawlessly changed to English and completed a brief history, then did a physical examination. He quickly identified where and when the pain happened in Judy’s knee; her sudden scream when he slightly twisted it was a dead giveaway! He told us the symptoms were indicative of a meniscus tear, which often will only be fixed by laparoscopic surgery, but the location was odd: it’s not where meniscus should tear. So he ordered up an MRI for further review. Cost for the consult: $1040 MXP or $50 USD.

Off we went to the MRI clinic (cost $6000 MXP or $300 USD) and got the results back (in Mexico in many cases, patients retain their own medical records, not the doctor or hospital, although a copy was sent to the orthopedista). The MRI technician gave us a large portfolio with a one written page of results, several panels of still shots from the MRI, and a disk with all the rest of the MRI shots on it. The written results indicated normal meniscus wear-n-tear, but also added there was a jug-handle tear (which would almost automatically indicate laparoscopic surgery). We could read and understand the Spanish diagnosis, but of course the MRI pics meant nothing to us. So we went back to our orthpedista with the results, expecting to schedule surgery.

Our orthopedista looked puzzled, read the text, then pulled out the pictures. He said there is no tear in the images, despite the text. He then loaded the disc up on his computer to investigate further. We waited, and then he resumed explaining to us that nowhere in any of the images is a jug-handle tear, so he wouldn’t know what to cut if he scheduled surgery, nor did he know why the written results did not agree with the images. He examined Judy’s knee again (very carefully this time, to avoid a repeat yodeling contest). He told me the fact that the back of her knee hurt, and only at a point in rotation, and more so with twisting, was “weird.” I concurred. Cost for this consult: $1000 MXP or $50 USD.

He prescribed an anti-inflammatory and scheduled an ultrasound in Guadalajara with a specialist he knew well and trusted. While an MRI is great for looking at harder objects (think bones), ultrasound ignores them and shows softer tissue (like ligaments and tendons). The orthopedista said this would be a final check on the issue of a meniscus tear, while clarifying if ligaments or tendons were involved.

So we tramped up to Guad for an ultrasound (cost: $1500 MXP or $75 USD). During the exam, the specialist told us (in English, which he apologized for in perfect accent and vocabulary) that Judy’s knee meniscus was fine. He spent some time looking at the back of her knee via the ultrasound, and concluded she had tendinitis in the popiletus, a tendon at the back which gives the knee stability. He sent the results to our orthopedista and we prepared for another consult.

Our final trip to the doctor was short and sweet. Judy’s course of prescription anti-inflammatory medication was working wonders: no pain for several days. The orthopedista told us he concurred with the specialist: tendinitis, requiring only more anti-inflammatory medicine, rest and recovery. Judy could start slowly to exercise in two weeks, and come back if the pain returned. (cost of consult: $520 MXP or $26 USD).

Total cost for an MRI, an ultrasound, and three visits to the orthopedista: $9540 MXP or $ 475 USD. We may never know why the first MRI specialist indicated a jug-handle tear, but the mistake was caught and fixed. We were quite pleased the orthopedista, who specializes in laparoscopic surgery, did not rush to cut, but rather kept saying he “would not cut unless he knew precisely what he would find there.” Overall, a positive experience at a very reasonable price.