We had our annual poor weather one week ago, when the overnight temperatures plunged to the high 40s while the daytime highs still lingered around 70 degrees. We even had a Saturday which was overcast with some rain in the middle of the dry season! Which led me to fact-check one of the best arguments for living lakeside: the incredible weather. Having spent almost an entire year lakeside, I feel I can now make a better analysis of the “world’s 2nd best climate.”
Let’s start with the biggest statistical category: beautiful days. About 80% of the time, I wake up and make my plans without considering the weather in any way. I take my dog out for a quick walk in the dark at 6:45 am while still in my pajamas, because, well it’s dark and the weather won’t matter (and no, there are no pictures; you can thank me later).
If we’re in the rainy season, I know the rain may be intense, but generally not last long. If we are in the dry season, it may seem chilly (50 degrees, remember, I am in my PJs!), but once the sun comes up it will warm up considerably, around 70 degrees at least. You don’t need a coat, or a sweater; you may want a hat or sunscreen, but that is about all.
What about the rest of the time? About 15% of the time it gets a little too warm and dry. This is at the end of the dry season, especially the month of May leading into the first few weeks of June, when the rains return. Temperatures can get into the 90s, with a blazing sun. Humidity remains low, so it is not too uncomfortable, but the sustained heat really warms up the brick-and-stucco casas, which will continue to bake for an hour or so after sundown. The predictable weather pattern makes this time of year a favorite for travel away from lakeside.
The final 5% is too cold, generally in short bursts in December or January. Once again, the thick house walls act to insulate, this time keeping it a little cooler than outside temperatures in the late morning. Now when I say too cold, let me admit this is VERY relative. During any cloudy or cool day in the dry season, you can see Mexicans wearing ski vests, hoodies, or coats and gloves. Long time expats complain of “thin-blood” and similarly break out sweaters, long pants, and coats. You can easily identify the recent arrivals (like me) by our short-sleeves; new expats from the Great White North even sport year-round shorts and sandals (with white socks, natch!).
We still have no means of heating our home; we do have a nifty heated mattress pad, which means we get a toasty warm bed in winter. As I mentioned last post, we are putting in mini-split air conditioners in our living room and master bedroom, just for those few hot weeks. We have some warmer clothing which is mainly for travelling back to the States. That is all the accommodation to inclement weather we’ve made.
Whether our weather is the “second best in the world” or not, after a year I am prepared to say it is not an exaggeration to call it amazingly comfortable. What stands out is that any semblance of regular weather (say rain or wind or humidity) is so surprising as to require notice. Otherwise, it is just right.
One final note: I thought about including some photos of how folks dress around here, but then thought better of it. No one wants to be famous on the internet as an example of peculiar sartorial splendor!
Actually, we don’t need more power, but we’re getting some anyway. We just had solar panels installed, which led me to reconsider one aspect of expat life in general: utilities.
Utilities are something you take for granted NOB. The water works and is potable, the electricity is always on and the voltage constant, mail is delivered whether “sleet or snow” and sewage just goes away. This is not always the case lakeside. Of course you pay for the luxury of not thinking about your utilities NOB, while here in Mexico we might pay less, with less certainty.
For example, consider electrical power. The line voltage can wax or wane, so you may need to purchase a voltage regulator, or use local appliances designed to operate in such conditions. Power is generally stable here, although we do get occasional outages during especially powerful storms in the rainy season. Given we endured several such outages in our last apartment in Arlington, Virginia, I can hardly complain. My dear wife tells me our electric bills NOB for a small apartment averaged $105 monthly; I wouldn’t know, as I never paid a utility bill in my life (thanks, dear!). Like typical Americans, we had a TV running constantly, air conditioned/heated to 70 degrees year-round, and had all manner of computers and appliances plugged in continuously.
Electric power in Mexico is heavily subsidized by the federal government. There are varying rates for electric use, with the smallest use being very cheap. Once you cross over into high use (called by the acronym DAC) your rates triple. This is meant to deter energy waste, but it is still cheap by NOB standards. The DAC measurement is based on a running 12 month average, so it is not a one-time trip wire, but once you go into DAC you stay at the triple rate until your average goes completely below the limit.
I was really focussed on NOT being an ugly American energy waster when we moved down, so I was a fanatic the first month at turning off lights, unplugging small appliances, etc. Then my first bill came.
Now that bi-montly bill only totaled about $27 USD per month. But as you can see, the usage arrow is way over in the red, the dreaded DAC. ¡A poco! Our bills hovered in the same area the rest of the year. Meanwhile, we sweated through a particularly hot end of the dry season in May and June, which forced us to reconsider the standard no-heat-and-no-air conditioning mantra of lakeside. But if we went with mini-split air conditioners, we would bust DAC permanently.
All of which led us to consider installing solar panels. The purchase and complete installation of four panels with microinverters and a monitoring system ran us approximately $3000 USD, which is still cheap. And yes, I know that even considering the permanent DAC costs, this was not a great move in terms of return on investment. It was more about peace of mind while not worrying about our comfort. We’ll soon follow-up with two mini-split air conditioners. Even after that, our electrical usage should be back down into the low or very low range.
Believe it or not, a full year has passed from last Halloween, the day I retired from active federal service. So I thought it was time to take stock and consider what surprised me and what didn’t about retirement.
First, I loved my work, but I don’t miss it at all. I miss the people, who are some of the most talented, dedicated public servants you could imagine. I still follow current events, and wonder sometimes about the “rest of the story” behind the headlines, but that is as far as the itch goes. That was then, this is now.
Second, you really must have some hobbies, commitments, or things you want to do with those hours that are suddenly all yours. Yes, you’ll sleep-in longer, take naps, eat leisurely meals, read those books you always meant too, and maybe even work out regularly. Guess what? I did, and there is still more time available on your clock. I have covered my new interests in past blog posts, but everyone who retires faces this key question: what do you want the next chapter of your life to be about? For the married and retired crowd, it is important to pick up some mutual interests. Yes, every couple needs alone time, but all relationships are either strengthening or weakening, and you can’t improve what you don’t work on together. For example, I ditched running, and Judy and I hike and work out at the gym together. I can easily see how couples who retire and don’t plan ways to spend time together could grow apart.
Next, we got to spend more–and better–time with our grandkids. Scheduling out visits with four working adults was always stressful, and put a lot of pressure on the actual visit. Now we can adjust to our kids schedules, and that makes it so much easier. We are still figuring out the fly/drive options, the week/weekend options, the summer/school year options, and (oh yeah) the holidays! We don’t have it perfected yet, but man was it great getting to spend “days-n-days” with grandkids.
Stuff: we have a lot less of it! Once we got into the habit of not routinely acquiring things we saw or heard about, and then got rid of what we had acquired by putting it to the “do we really need this?” test, the burden of owning stuff mostly evaporated. It feels so much better, costs a lot less, and I can only think of one or two things I got rid of that I later thought I should have saved.
Mexico? Mexico has delivered as promised: less cost, less stress, great quality of life. The US President’s need to constantly berate Mexico has driven the Peso down and caused some irritation among the proud Mexican people, but they easily distinguish between what the US government says and does, and their expat neighbors (so far)!
Judy’s health has been outstanding; I feel the best I have in years, but have been plagued by a series of minor issues: higher cholesterol, some other blood work numbers out of kilter, more cavities, a nagging cold/cough/allergy of some sort, and that health scare right after we arrived here. The best news is the quality of the doctors and dentists has been good, and the costs really low. Judy will get a tooth crowned next week for about $200. We finally figured out how to submit our health insurance claims online back to the States, and the reimbursements have been quick and consistent.
Living in a small town, we have rediscovered what Edmund Burke called “the little platoons” we all belong to: communities. We have groups of friends: the Church group, our neighborhood(s), the Focus group, and so on. These groups continue to expand as we become more active in the expat community. Within each group we have made lasting friends that create a source of mutual assistance, understanding, and resolve.
Finally, my biggest surprise was this: once the stress of work/life was off, I could re-evaluate long-time personality quirks and habits and decide whether they were still necessary. I drive slower–not slowly mind you, but slower than before. And I hardly ever get angry while driving; I’ll get there, God willing, and if someone else needs to cut the line, Vaya Con Dios! I am somewhat less punctual. I still don’t buy into the fashionably late concept, but I don’t feel like I’ll waste the artillery bombardment if I don’t cross the LD on time (military jargon–sorry!). I am enjoying little things more: a sunset, or a hummingbird, or a video-chat about nothing in particular with a grandchild. Judy reminded me there is no Sunday-night-stomach-ache-ahead-of-the-workweek in retirement. She’s right. She’s always right: that is probably the least surprising part of retirement!
The final leg of our Great American Road Trip included visits to New Hampshire and Maryland. The former was for the ordination of my brother-in-law as a Deacon in the Roman Catholic Church; the latter for my niece’s Bat Mitzvah.
Newly-minted Deacon Rick Hilton, welcomed by the Bishop
The juxtaposition of these two family events got me to thinking about one thing you bring with you as an expat: your faith. As the famous philosopher Buckaroo Banzai once said, “wherever you go, there you are.” In the context of being an American expat, you bring your faith with you to the new environment, and it will almost certainly be an environment very different from the States.
Take Mexico, for example. Mexico is an overwhelmingly Catholic country: 91% Catholic according to the 2010 census, making Mexico second only to Brazil worldwide for numbers of Catholics. Every Mexican town has a Catholic church in the main square, and that church is the center of town life. The festival for that church’s patron saint is a major party, and other saints have similar festivals which involve early morning bands, parades, parties, and day or week-long fireworks. Some churches broadcast daily prayers, like a rosary, over loudspeakers for the whole town to enjoy. So Mexico is noisily Catholic.
While Catholicism is prevalent in Mexico, it is not overwhelming. There are growing numbers of younger Mexicans who are culturally Catholic, but whose beliefs and practices more closely resemble the “Nones” NOB. The missing nine percent from the 2010 census belong to a variety of other Christian churches, which have proselytized in Mexico for years. Most importantly, the Catholic church in Mexico has had a contentious relationship with the federal government in Mexico City, going all the way back to the Mexican War of Reform (1857-1860). During the revolution in the early 2oth century, the Church opposed the socialist groups which consolidated power, and the eventual winner, the PRI (Institutional Revolutionary Party) returned the favor by expropriating Church property and outlawing public displays of religion. By the 1920s, this led to the Cristeros rebellion, which was especially brutal. After this inconclusive conflict, both sides remained combative, but over time a gradual truce developed where the Church was left alone as long as it stayed out of politics. So Catholicism in Mexico may sometimes be out of sight, but rarely out of mind. Learning all this was quite enlightening to this Irish Catholic, and put the culture wars NOB in a different perspective, since the culture wars down in Mexico were real wars!
When choosing where to live as an expat, you’ll need to consider how your faith will fit in with your new country. Lakeside is unique for Mexico in terms of the number and diversity of faith offerings for expats. Having a faith community to welcome you can be a big boost psychologically, and can provide important assistance during the critical early transition period. Likewise, not understanding local religious practices can lead to a rocky start. I have heard more than one expat complain about the noisy Mexican patronal saint celebrations, expressing surprise at something that happens every year on the same date, usually with a big build-up in the weeks preceding!
Especially for Americans accustomed to faith being a personal or private matter, it can be a challenge adapting to other cultures where faith is something very public and shared! Not insurmountable, but still one more thing to consider in deciding to go the expat route.
While we continue our travels across the US (currently in New Hampshire), we try to keep up with news from back home in Mexico. Judy found this embedded video on FaceBook. It is from some media source called CGTN America, of which I have never heard, but it captures some of the different aspects of life around Lake Chapala. It is 16 minutes long, but worth the watch.
What I think is unfair in the video are the several mentions of Americans arriving in Mexico because they disagree with the state of politics in the States. I don’t doubt some expats move abroad for such reasons, but if you are running from something rather than toward something, your expat experience is far likelier to fail.
The bottom line is there are, according to the US government, 10,000 baby-boomers retiring every day for the next 20 years! Most real estate markets in the States have recovered from the real estate bubble many years back, so retirees who need to sell their homes to pay for a retirement place can now do so. Mexico remains close at hand, inexpensive, and fairly welcoming. Thus we’ll see a continuing stream of newbies trying out the expat lifestyle.
Our Stateside mail is delivered to our daughter’s home; she kindly screens it and lets us know if we need to respond to anything important. We visited her recently, so we got our snail-mail in real time. One afternoon, she said “you got a letter from the IRS…it’s probably nothing; they sent me a survey last week.”
I glanced at the envelope and noticed official notification language, and a an action identification number, and I knew this was no survey. Now everybody dreads hearing from the IRS: they don’t bring good news. I was especially upset because of a past experience; let me explain.
Twenty years ago when I was filing my taxes, I did a worksheet showing my child care expenses (using TurboTax), but when I finished compiling my income, the program informed me that I was not eligible for a child care credit due to how much we earned that year. So I went ahead and filed and received a notification my 1040 was accepted and later deposited my refund. About three months later, I received an envelope from the IRS. In it was a notice informing me that I had incorrectly filled out my 1040, that I WAS eligible for the child care credit, and attached was a check!
I knew they were wrong. The check had a 30 day expiration date, and I spent that time trying to get ahold of the IRS (before the internet, and before 24 hour call centers). On the last day before the check expired, I cashed it, figuring maybe the IRS knew more than I did, and I sent them a letter re-explaining the whole episode. I soon received a response from the IRS claiming I should NOT have cashed the check, that I was NOT eligible for the child care credit, and that I owed the money back to the federal government immediately WITH INTEREST. Three cents interest, to be exact. I sent them a check; I was tempted to put three pennies in the envelope, but I knew the IRS had no sense of humor, so I added the three cents interest to the check. The next IRS letter acknowledged my payment, but claimed it was deficient, since I actually owed six cents of interest, and I should immediately remit the remaining payment.
I lost patience at this point, and I sent them another letter explaining it was all their fault, I did not owe them anything, and I was not going to respond to them any longer on this issue. Only then did I get a final note saying the matter had been “settled.”
It was with this history in mind that I confronted this new IRS missive. It said I had not accounted for the profits from the sale of my home in 2015, and I should file the appropriate forms and schedules and pay them the appropriate amount, including penalties. The good news was, I took a loss on that home sale, so I owed no taxes. Only in the loopy world of taxes is a loss good news. That was what I filled in on a TurboTax worksheet that year, but apparently it did not generate a form and schedule letting the IRS know, so as far as they were concerned, I owed them money. Here is where the tie-in to being an expat comes in. See, the IRS is very impatient, and since this issue dealt with my 2015 taxes, they demanded I respond within 21 days. And I was in the US on a visit for six weeks. And my records were all neatly organized and stored in….wait for it…Mexico.
I was literally driving cross-country the next day, so when I arrived in the late afternoon, I called the IRS response phone number and dutifully waited until my call was answered by the next available IRS agent, about 30 minutes. I dreaded this call. I did not have any documentation with me, I did not have easy access to same, and I knew (by reviewing my 2015 1040) that I had not submitted the proper forms, so the best I could hope for was an extension, which would leave this issue hanging over me throughout my trip. I knew that while my paperwork was wrong, I did not owe any taxes. Still, based on my past experience, I did not relish proving that to the IRS.
When an agent came on the call, she asked me a few questions to get to the appropriate case materials, and then asked how she could help. I reviewed with her the instructions on the material the IRS sent me to ensure I understood them correctly. I mentioned that I noticed I had not properly filed the forms, due to an error in my TurboTax worksheet, so I understood why the IRS was looking for a payment. The agent was silent. I mentioned my documentation was not readily available, but I could retrieve it next month. I said I could quickly file the forms, showing the loss I incurred. The agent interrupted me at this point, “you took a loss on the sale? How much?” I replied with the sum, and she said, “oh, ok, well let me check this.” She paused for a moment, then returned with “I just took care of it. You will receive a notification that this action is cancelled within a week.” Now it was my turn to be silent. I probably should have said “thanks and good-bye,” but I stammered out “you don’t need any documentation?” She said no, and I relayed that this was most unexpected, but welcome. She laughed, and asked if there was anything else I needed. Pressing my luck, I told her “I bet you don’t hear this very often, but this phone call was the best interaction I could ever imagine with the federal government.” She laughed again, and said, “no, not very often.”
As she promised, the next week I received an official notification from the IRS informing me that the matter was now closed, and I owed them nothing. Judy attributes the near-miraculous outcome to her prayers to the Blessed Virgin; I would be hard pressed to disagree, since I invoked Our Lady of Guadalupe several times myself. On a practical note, American expats still owe federal taxes on all income, and are still liable to the long arm of the US federal government. If you plan to live outside the US, you need to establish a legal domicile in the States, you need a way to receive mail and official notifications, and you need to keep all the same tax records as if you were still in the States.
If you are going to live the expat life, you’ll be away from family and friends for months at a time. This is one of the negative aspects, but it also means you’ll on occasion travel back to visit. We are on one of those visits right now, after six months setting up our casa in Mexico. Is there anything better than seeing old friends, or getting together with your family, especially your grandkids?
The BrewDogs strike a pose
We recently spent a long weekend renewing friendships at a small reunion with my old “college classmates”. I use that term only the your familiarity, because I did not go to college, I went to West Point, which has a passing similarity to college, in the same way that a Sunday drive in the country is similar to the Indy 500. I like to say we did not matriculate, we were institutionalized. Anyway, the Long Gray Line has a way of instilling lifelong friendships, so it was great to get together and share stories, learn of life’s twists and turns, and just talk. Because of our shared experiences, we all feel very comfortable around each other and easily fall back into an openness which belies the years apart.
Tunnels & Hills aplenty
As enjoyable as old, lifelong friends can be, nothing bests family, especially grandkids. Lately I have spent mornings constructing an awesome rollercoaster, taking a canoe trip down the Little Miami river, and having an epic water gun fight, all with my oldest grandson, Ian.
It is a simple joy, but simple pleasures are most often the best. It is hard to pack missed months together into a week or two, but we plan to take advantage of our newfound leisure time to visit more frequently. We are blessed in that Ian’s other set of grandparents live nearby, so even if we miss him, he does not lack for grandparental attention!
Next up, a mini-family reunion and a visit to “the Shrine.”
One challenge every expat faces is “what to do about the local language?” Do you just ignore it, speak English very loudly, and hope for the best? Do you learn a few phrases, so you can ask for another beer, or where the restrooms are, and just get by? Do you rely on Google translate and hope we get the Universal Translator before you croak? Do you just keep trying through experience and osmosis to pick up the language? Do you go online and try the free or pay language training sites? Do you take language classes in person?
We always assumed we would learn Spanish, just to be comfortable in our new home. We both have foreign languages in our past: I spoke German and some French; Judy also spoke German and had four years of high school Spanish. We thought we would find some immersion training in Guadalajara, since it has a major university and is known for immersive language training. However, most of the immersion training is aimed at college students, and we weren’t interested in moving into a dorm for six weeks (imagine that!).
We found many great language aids online. YouTube is full of decent instructional videos. We weren’t partial to Rosetta Stone, but we did like Synergy Spanish and look forward to following Destinos when we learn a little more vocabulary. We really like free apps like Memrise or sites like Spanishdict.com, which can really help with practice or training aids. Judy has done a great job putting new vocabulary words on flashcards on Quizlet.
In the end, we needed more structure: we learned many phrases and short questions/answers, but we weren’t learning the language. So we decided to try a local language school, Olé México. We meet three times a week, for 1 hour and 45 minutes each class. Our class is just four students and one teacher, so we get ample opportunity to practice speaking.
Class, L-R: Judy, Nadia, Darcy, Penny
We started with the alphabet and pronunciation drills, and then began conjugating regular verbs. We keep adding vocabulary by learning sets of words, like directions, or adjective pairs (strong/weak, short/tall), or noun groups (Mom, Dad, Son, Daughter, Family). We just tackled the ever-difficult “when to use Ser versus Estar” lesson. For those who don’t know, Spanish has two different versions of the English verb “to be”, and they are used for different qualities of “being.” Ser is for essential characteristics, and estar is for more transitory characteristics, mas o menos.
I always heard from language teachers that Spanish was the easiest foreign language for English-speakers to learn, because many words translate almost directly (like anything ending in -ion), and in Spanish the vowels and consonants have only one sound and you sound them all out.
Our teacher, Nadia, has done a great job. We enjoy lessons where she asks us to describe our favorite actor or singer, and the class has to guess who it is. We just finished describing our extended families. Or sometimes she asks us a basic question like “where were you born?” and then asks us to describe the differences between that place and where we live now. It is a lot of oral practice, but we can already see a difference in our language capabilities. We can hold basic conversations with merchants, exchange pleasantries with people we meet, and at least make ourselves understood, even if we don’t always know the correct terms.
Perhaps I will try out a dual language post in the not too distant future!
On Wednesday I duly fasted and then headed to the clinic. I immediately saw the cardiologist, Dr. Salas, who reviewed my current health and family history. He took one look at my previous ECG and discarded it, saying that device was notoriously inexact. He even showed me on the computer print out where it said left ventricle when the data it showed as abnormal was about the right side of my heart. He told me based on my physical condition, he really doubted I had any heart issue, but he had his own ECG machine with him, so he wired me up and ran the test. He said it looked very normal, with just one reading slightly “off.” He suggested I come up to the hospital on Monday for a stress test, to put the issue to rest. I agreed, and he reiterated he felt confident the test would find nothing.
Next I popped into the surgeon’s office, who gave me another ultrasound. Sure enough, you could see my gallbladder very clearly. It is supposed to be a long oval; mine looked like a pair of connected golf balls. The surgeon told me this was probably a condition I was born with, but the small connection between the two parts of my gallbladder was probably closing from the gunk (my word) that goes through your gallbladder. This was causing the inflammation and other results noted in my blood tests. He said he has seen this condition many times, and most such patients eventually have their gallbladder removed. He said I could wait until I have severe pain, or I could just have laparoscopic surgery anytime. I scheduled the surgery and went home.
It didn’t take long for doubts to set in. I was so relieved by the cardiologist’s demeanor I probably would have agreed to a prefrontal lobotomy. Then I started to research gallbladder surgery, and I learned it is controversial NOB, as so many are being performed. Most gallbladder removal is related to gallstones, which are very painful, but could be treated by preventive measures and lifestyle changes. I had no physical symptoms, just blood work and an ultrasound showing an apparently congenital condition. No one had suggested any diet or lifestyles changes. While the laparoscopic surgery is fairly routine, it is still surgery with a potential for complications. Friends reminded me that doctors here are used to older patients with adequate resources, so there is a tendency to over test and quickly resort to surgery.
I e-mailed my surgeon and asked for a written diagnosis so I could get a second opinion via my insurance, and cancelled my surgery. I will send a detailed e-mail to the Cleveland Clinic, which has a program to give second opinions on surgery for my insurance program.
On Monday, I headed to Guadalajara for my stress test. At the Angeles del Carmen hospital, I met with a cardio technician (Carlos) and a nurse (Edna) who would administer a sonogram and then a stress test induced by Douramine. Basically they hook you up for a sonogram and an ECG, then administer a stimulant through an IV which causes your heart to accelerate up to your maximum heart rate. They monitor your vitals throughout, and constantly ask you to describe anything you feel. It was quite odd to feel one’s heart beating rapidly, without feeling the need to breathe quickly or pant, and while laying completely still. Other than that, I felt fine. It took about 30 minutes total time, and cost 5500 MXP (about $300 USD).
After they gave me a decelerant to get my heart rate back down, I went back to the waiting room. Carlos came out and handed me a portfolio with written reports on all my heart data, an annotated ECG chart, and a DVD with all the numeric and visual data (in case I want to entertain my friends?). I went back to Dr. Salas office, where he reviewed the data. He said my heart is perfectly normal! The unusual result that the earlier ECGs showed is something my heart consistently does, so while it is not textbook, it is normal for me. In my records, I had found another stress test done on me at National War College 20 years ago, and when I showed that to the Doctor, he pointed out even that result was consistent with the current ones. He told me to cut back on bad cholesterol, improve the good type, or he will prescribe statins for me. Other than that, all good.
So in the course of a single week, I went from feeling fine/eating whatever, to sick heart/bad gallbladder, to questionable heart/gallbladder, and back to healthy heart/need better diet. It was quite a ride, and a great dry run for dealing with doctors and hospitals in a foreign land, which is a major expat challenge. Lessons learned: be an educated patient, and research whatever your diagnosis is. Ask questions! Know what the doctors in your area are used to; it affects what they see and how they respond. There is an old adage for medical diagnosis: “when you hear hoofbeats, look for horses, not zebras.” It means look for usual causes first, not unusual ones. But what your doctor thinks is normal will be influenced by where they are and type of patients they see.
Sorry for the long post(s) and the unusual delay, but as you can see, I have been busy. Thanks for all the thoughts and prayers!
So you decide to move to Mexico for the healthy living, but you know that it requires more than exercise, good eating habits, moderation in drink, and adequate rest. It requires good preventive medical care, and if needed, good emergency care. We have been here a few months, so it was time to get started on picking a doctor, dentist, etc.
Dra Candy on the right
So the first thing we needed to find was a dentist. We heard good things from other expats about Doctora Candy Ugalde who has a small practice in our town…yes, I know, a dentist named Candy. Anyway, we made an appointment about a week out, and went in for an exam and cleaning. The office was clean with all the usual modern equipment, the staff bilingual and very friendly. We were seen on-time, and the visit lasted about 30 minutes. We did not receive any pressure to get x-rays or
Note the open doors…
whitening. My dentist, Juan, is Candy’s brother, and he said I will eventually need to get an x-ray, but no rush; when I asked about a whitening, he told me about a discount they are offering, but that was it. Total cost for exam and cleaning for two people: 600 pesos (a little over $30 US dollars). You can see why some expats bring their grandchildren down for dental (orthodontia) tourism. Overall experience: very good.
Before I get to medical care, first I need to explain something about our health care situation that makes us different from the typical expat. Based on my federal service, we have excellent health insurance, based on the US Foreign Service Benefit Plan. It is one of the thousand or so insurance programs offered by the US government to its employees, and it continues to cover us in retirement. This program was initially developed to support US foreign service personnel stationed overseas. As such, it is very familiar in dealing with foreign languages, foreign currencies, and working with customers anywhere in the world. When overseas, the program works on a reimbursement basis (100% for preventive, emergency, and inpatient services, 90% for office visits, surgery, and outpatient services), with all doctors and healthcare providers outside the US considered “in-network.” Deductible of $300 USD each per year. So while we are responsible for paying upfront for care, our health insurance is set up to immediately reimburse us via electronic document submission and direct deposit.
We decided we needed emergency coverage when we are travelling around Mexico, or around the world. Our Foreign Service Plan continues to cover us in these instances, but we wanted coverage that would give us the option to be medically evacuated at our own request (this last phrase is important). Most insurance, even emergency travel insurance, only approves medical evacuation when it is medically necessary, which is a decision of the doctor and the insurer, not you. We wanted a service which left that decision up to us. We signed up with SkyMed, which specializes in coverage for expats, covers our medical stabilization onsite in the event of a medical emergency, and leaves the decision to evacuate up to us. Many expats here in Mexico sign up for such coverage, so that in the event of a very serious condition, they can be evacuated back to the States to get care. Here’s where we differ: we got this coverage so we can be brought back to (drum roll) Guadalajara. We feel the care here in Mexico is so good, this is to where we would want to be evacuated, if we got sick or hurt out traveling in the wider world.
Nobody ever closes the door around here
For our family doctor, we chose Doctora Lupita at Integrity Medical Clinic. We had some false starts here. First, we made an appointment one day for the next morning, arrived, and found no record of the phone call or appointment we made the day before. The office called to postpone our second appointment, because the Doctora was having emergency dental surgery (ouch). When we were finally seen, we each had a nice office call with the Doctora, who ordered a standard suite of blood tests. We had these done at the lab across the street, and got the results by e-mail later the same day. Costs were 400 MXP each for the office visits, and a total of 2500 MXP for the lab work, or a total of approximately $230 USD for both of us.
We scheduled to meet back with Dra. Lupita to review our results, and here is where things got interesting, as they say. Judy’s review went perfect, with all normal results across the board. I knew I had a few lab results which were out of the normal ranges, but the trouble started as soon as the nurse came to take my vitals. She took my blood pressure/pulse four times, using two different machines. Any time the nurse asks you “are you having chest pain?” that is NOT a good sign. Then she asked the Doctora to come in and do it again. I felt fine: thirsty, as I had salty foods for both breakfast and lunch, and I had worked out at the gym for 90 minutes before lunch, but otherwise great.
The Doctora said my pulse was racing (over 100 bpm), and she wanted to do a ECG right there and then. They brought the cart in and hooked me up; a few minutes later, she shared my results, indicating left ventricular distress, possible a blockage. She said she wanted me to see the cardiologist in her clinic on Wednesday (two days hence) for another ECG and consult. Oh, and the lab results said I probably had a gallstone; her ultrasound could not confirm it, since I had just eaten lunch, so she wanted me to fast on Wednesday and she would have a surgeon follow up on that, too.
To say I was shocked would be a severe understatement; in shock would probably be spot on! Those who know me know I was a lifelong, daily runner, in very good shape, and rarely had so much as a headache. Since we arrived in Mexico, I even lost a few pounds, took up an every-other-day weightlifting/stretching/stationary bike routine and hiked once a week up the mountains. I never felt better. I just could not square the results staring me in the face with how I felt. I had 48 hours to kill until the cardiologist visit, so I dug up my old records and took to the internet.
First I learned that gallstones and even a ventricular irregularity could be asymptomatic; meaning feeling fine was not out of the ordinary. Gallstones, although painful, looked like the lesser concern: some never end up causing pain, and surgery to remove the gallbladder is practically routine. So I decided to focus on my heart’s ECG results. Amazing what you can find on the internet: full descriptions of how to read one and what it means in laymen’s terms.
Probably the most interesting thing I learned was that an irregular ECG could result from environmental conditions, such as an electrolyte imbalance. I noticed after I returned home from the Doctora’s office that I was very dehydrated, and Doctora Lupita mentioned that some newcomers have poor ECG results due to their heart’s difficulty in acclimatizing to the elevation here (5200 feet). I hung my hopes on this slender reed and prepared to see the cardiologist and surgeon on Wednesday.
