Tag Archives: travel

Is it safe to fly after surgery?

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Long haul flights are a health risk for everyone

While the risks of prolonged immobility and pulmonary embolism with long distance travel are well-known, many potential patients are unaware of the increased risks of thromboembolism after surgery.

Increased risks in specialized populations

People with a personal or family history of previous blood clots (PE or DVT), women on oral contraceptives, and patients who have undergone orthopedic surgery are some of the people at greatest risk.

Increased risk after surgery + Long trips

The heightened risk of thromboembolism or blood clots may persist for weeks after surgery.  When combined with long-haul flights, the risk increases exponentially.

In fact, these risks are one of the reasons I began investigating medical tourism options in the Americas – as an alternative to 18 hour flights to Asia and India.

Want to reduce your risk – Follow the instructions in your in-flight magazine

Guidelines and airline in-flight magazines promote the practice of in-flight exercise to reduce this risk – but few have investigated the risks of thromboembolism in post-surgical patients by modes of transportation: car travel versus air travel.

airplane3

But, is it safe to fly after surgery?

This spring, Dr. Stephen Cassivi, a thoracic surgeon at the world-famous Mayo Clinic in Minnesota tried to answer that question with a presentation of data at the  the annual meeting of the American Association for Thoracic Surgery.

This question takes on additional significance when talking about patients who have had lung surgeries.  Some of these patients require oxygen in the post-operative period, and the effects of changes in altitude* (while widely speculated about) with air travel, have never been studied in this population.

Now, Dr. Cassivi and his research team, say yes – it is safe.  Mayo Clinic is home t0 one of the most robust medical travel services in the United States for both domestic and international medical tourists.

After following hundreds of patients post-operatively and comparing their mode of transportation  – Dr. Cassivi concludes that the risks posed by automobile travel and air travel after surgery are about the same.

Additional reading

For more information on deep vein thrombosis, pulmonary embolism and safe travel, read my examiner article here.

AATS poster presentation abstract:

Safety of Air Travel in the Immediate Postoperative Period Following Anatomic Pulmonary Resection
*Stephen D. Cassivi, Karlyn E. Pierson, Bettie J. Lechtenberg, *Mark S. Allen, Dennis A. Wigle, *Francis C. Nichols, III, K. Robert Shen, *Claude Deschamps
Mayo Clinic, Rochester, MN

Schwarz T, Siegert G, Oettler W, et al. Venous Thrombosis After Long-haul Flights.  Arch Intern Med. 2003;163(22):2759-2764. doi:10.1001/archinte.163.22.2759 .  This is some of the definitive work that discussed the risk of long flights with blood clots in the traveling population due to prolonged immobility.

*Most flights are pressurized to an altitude of around 8,000 feet – which is the same level as Bogotá, Colombia.  This is higher than Flagstaff, AZ, Lake Tahoe, Nevada, Denver, Colorado or Mexico City, D.F.  – all of which are locations where some visitors feel physical effects from the altitude (headaches, fatigue, dyspnea, or air hunger.  In extreme (and rare) cases, people can develop cerebral edema or other life-threatening complications at these altitudes**.

** Severe effects like cerebral edema are much more common at extreme altitudes such as the Base Camp of Mt. Everest but have occurred in susceptible individuals at lower levels.

Punta Pacifica, Hospital San Tomas and Centro Medico Paitilla

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**Due to some unforeseen changes in my itinerary, I can only provide just a brief overview of some of the facilities in Panama City, which falls far short of my usual.**

Centro Medico Paitillo (CMP)

Balboa Ave. and 53rd Street

Website: http://centromedicopaitilla.com/

Founded in 1975, CMP has grown to become the largest private facility, though  Punta Pacifica appears to rapidly approaching on their heels.  They have several well-established international health insurance programs and the hallways were well populated with English-speaking visitors and patients.  The hospital has community outreach and health promotion classes as well as a 64 slice CT scanner, MRI and other diagnostic capabilities.

Website is attractive, and well-designed with English and Spanish versions.

Clinica Hospital San Fernando

Via Espana Las Sabanas

Website: http://www.hospitalsanfernando.com

There are two facilities for Hospital San Fernando; a Panama City facility and another facility in Coronado. The Panama city facility is one of two Panamanian facilities accredited by Joint Commission International.  This is a private facility designed to entice foreign visitors and upwardly mobile Panamanians.

Website with English language version that includes price quotes for International travelers. Website is well-designed and easy to navigate.

I have not visited or viewed this facility

Hospital Punta Pacifica

Boulevard Pacífica y Vía Punta Darién
Ciudad de Panamá

Website: http://www.hospitalpuntapacifica.com/

Webpage with English and Spanish versions, and has been designed for international travellers. However, the overall quality of the website is poor. Information has been poorly laid out and is often mischaracterized. For example, visitors to the site who are seeking information about individual physicians are transferred to a poorly typed resume-style pdf. Physician specialties are mislabeled; with cardiologists listed as surgeons, which may cause confusion for potential patients.

Hospital Punta Pacifica was accredited by Joint Commission International in September of 2011. Hospital Punta Pacifica’s main claim to fame, as it were, is that it is John Hopkins International branded facility.  As such, it is aggressively marketed as a medical tourism destination.

It is located in downtown Panama City, just a kilometer from the CMP (Centro Medico Paitilla).

Victoria 001

Hospital Santo Tomas

Calle 34 Este y Avenida Balboa

Website: http://hospitalsantotomas.gob.pa/

Hospital San Tomas is the oldest public hospital in Panama. Originally started as a small facility for impoverished women in September of 1702, the hospital has grown over the last 300 years to become the largest hospital in the country. The hospital now offers multiple service lines including surgical specialties such as thoracic surgery, plastic surgery and general surgery, among others.  The campus includes separate facilities (Maternity hospital, children’s hospital), a blood bank and Cancer center.

Blue Cross Blue Shield of Panama – one of the international arms of the Blue Cross Blue Shield insurance company, and just one of the many insurances accepted at most Panamanian facilities.

What’s this about free insurance for tourists to Panama?

In one of their more effective (and dramatic) public relations gestures, the Panamanian government widely advertises “Free  medical insurance for the visitors”.  This catastrophic policy covers all visitors during the first thirty days of their stay for accidents and injuries (up to $7000.00) that may occur during a stay in Panama.  Visitors just need to show their passports on arrival to one of the participating medical facilities.

The policy also covers up to $500.00 of dental expenses, and economy class air tickets for return home for family members (in case of a death of a tourist) and repatriation of the deceased.  (This may sound like a grisly benefit but from previous discussions with tourists in various locations – this can be quite costly.)

*Just so you know – it doesn’t cover chronic conditions or pregnancy, so visitors can’t come here and expect to have free care for non-emergent problems (ie, elective hip replacement and the like.)

Anthony Bourdain does Colombia

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It’s not his first visit – he’s done several other programs highlighting Colombia, but tonight’s episode on his new CNN show, “Parts Unknown” is definitely his best.  It’s the first time I think  he actually ‘got it’ and was really able to convey a real sense of Colombia to his viewers.

While his previous shows were primarily about food, and local food culture – his episodes on Colombian cuisine were always very wide from the mark..  Sure, he had the names of dishes and such – but he didn’t really bring home the feel of Colombia and it’s people.

http://www.youtube.com/watch?v=qNiF0R1QJpk&feature=share&list=SP6XRrncXkMaVZxpButSnMywWvtINMmjXv

Or that Colombian food isn’t really about intense spices, it’s about the intense and rich flavors that comes from the rich textures of the foods themselves – without overpowering curries or heavy sauces..

Better quality, fresher ingredients and a wide variety make for richer flavors

Better quality, fresher ingredients and a wide variety make for richer flavors

Going home..

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After a whirlwind three months that included trips to Chile, Bolivia and different cities in Colombia, I am getting ready to come home in a few days.  As always, leaving Bogotá is bittersweet.  I miss my friends, and my family but I will also miss the city and all of the nice people I’ve met here.

I am posting a map of Colombia, so even though I’ve taken several trips – you can see that I haven’t really explored the country at all. (I’ve posted little push pins on the areas I have visited.)  I excluded Facativa and some of the closer towns since they are really just suburbs of Bogotá, and it would just clutter the map.

Map of Colombia, courtesy of Google Earth

As you can see – I haven’t explored the southern part of Colombia, or the pacific coast at all.  My Atlantic adventures have been confined to Cartagena.  So, I guess this means, I still have a lot of work cut out for me on my next visit(s).

map showing central Colombia

But I hope that readers have enjoyed reading about my travels, the people I’ve met and the things I’ve seen.  Now – I know this is a medical/ surgery blog but since much of the surgery I write about is in this part of the world, I think that including some of my experiences is relevant/ interesting for people who read the blog.  Once I get back home, I’ll post some more articles on medical quality control and standards – and more of my usual dry fare.

Dr. Alberto Martinez, Sports Medicine/ Orthopedic surgeon

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Dr. Martinez (right) in the operating room

(Out of respect for patient privacy – I’ve done my best to crop the patient ‘bits’ from the photo.)

Spent some time last week with Dr. Alberto Martinez of Med-Sports Orthopedic Clinic here in Bogotá.  Dr. Martinez specializes in arthroscopic surgery of the hips, knees and shoulders.   As we talked about before, shoulder surgery is its own subspecialty in orthopedics due to the increased complexity of this joint.

We talked a bit about hip arthroscopy,which is still a relatively new procedure in orthopedics and the fact that one two surgeons in Bogota are currently performing this procedure.

Arthroscopy is the orthopedic minimally invasive counterpart to general surgery’s laparoscopy or thoracic surgery’s thoracoscopy.  It involves insertion of a camera and several tools through small (1 cm) incisions in the skin.  Arthroscopy itself has been used in orthopedics for many years but it is just now making inroads in hip procedures.

I’ll be publishing an upcoming article based on my observations over at ColombiaReports.com

For more information

Rath E, Tsvieli O, Levy O. (2012).  Hip arthroscopy: an emerging technique and indications.  Isr Med Assoc J. 2012 Mar;14(3):170-4.

Haviv B, O’Donnell J. (2010). The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients.  Sports Med Arthrosc Rehabil Ther Technol. 2010 Jul 29;2:18

The authors found that 16% of patients in their study eventually required hip replacement after hip arthroscopy during seven years follow-up.

Nord RM, Meislin RJ. (2010).  Hip arthroscopy in adults.  Bull NYU Hosp Jt Dis. 2010;68(2):97-102. Review.

Afternoon at the finca, and a day at the market

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We spent Saturday exploring Lerida and cruising around.

Ready for adventure

We stopped at several roadside stops to buy some local fruit before heading off to La Gaviota, a local finca owned by a Brazilian woman.

buying papayas

We bought some delicious sugar mangos, along with some sweet papayas and mandarins.

enjoying sugar mangos

La Gaviota, a finca in Tolima

Now, there are two kinds of fincas in Colombia; working fincas and pure vacation fincas.  A working finca is usually a farm or an orchard – often owned by a city resident but managed locally.  This allows people who live and work in Bogota to have a get-away place that also brings in income.

one of the lakes at La Gaviota

Some of these fincas have been in peoples’ families for generations and produce much of the fruit and livestock products (dairy, meat etc) that are sold in Colombia.

Other fincas are pure recreational homes, and as such, are primarily owned by wealthier Colombians though this is not always the case.  Fincas vary from modest cabin style affairs to elaborate, ornate mansions with swimming pools, tennis courts and private fully stocked ponds.  Since most working people can’t stay at their finca very often, many owners rent out their fincas part-time.  Such was the case with the lovely La Gaviota.

the pool, surrounded by fruit trees

The entire property has been planted with fruits and trees native to Brazil and the staff encourages visitors to sample the many exotic varieties.

Yaca, a fruit native to Brazil

There is a swimming pool, and several lakes stocked with fish.  There is also a hotel, and a restaurant, where they will prepare your fresh catch.  Like many of the numerous fincas that dot the landscape here, they welcome travelers and offer services at reasonable rates.  So we spent the sunny afternoon at the pool.

The next day, we went to the market in Lerida.   We bought some more ‘tipica’ or traditional Tolidense food called lechona from a very nice young man who helps his grandmother.

young man selling lechona

While I vary from vegetarianism to veganism in the states, I never hesitate to try another delicious typical dish when I am traveling – and it was marvelous; warm, savory and flavorful.

There are several variations of lechona, which is stuffed pork but the Tolidense version uses a base of garbanzo beans for the stuffing and comes with a sweet-flavored bread stuffing called insulso on the side.

lechona

The grandmother, also invited us to come to her house where she had other tolidense specialities for sale, including tolidense tamales.

with grandmother

There were other vendors selling panela which is popular sugar product here in Colombia, (and other latin American countries.)  It’s a staple, a form of unrefined sugar produced at the local sugar cane factories in the region.  (I particularly like panela in my coffee and tea.)

panela

We met and purchased several tamales from another vendor in the market, a very nice woman who was very happy to pose for the camera.  I am ashamed to say that I forgot to write her name in my little notebook because my hands were full with all of our great purchases.

homemade tamales

in Lerida

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in the mountains on the way to Tolima

Most Americans have limited exposure to Colombia, and Colombian life.  Other than media reports about drugs and violence, the majority of people’s opinions about the country have been formed by one quintessential little film of the mid-80’s…

“Romancing the Stone” – yeah, that’s right – the silly little romantic comedy with Kathleen Turner and Michael Douglas.  “Is this the bus to Cartagena?” is a line I’ve heard many, many times from people asking questions about my experiences here.

In general, like most things, Colombia is nothing like the movies.  Especially this one, since it was filmed in Veracruz, Mexico.

just outside Lerida at Sunset

But Lerida is that Colombia – the hot, humid, tropical Colombia that people think of after watching that movie.  It isn’t jungle-like here, of course,(that’s further south) but it’s an ancient city with stone buildings and some cobblestone streets interspersed among newer construction; but Lerida has the unrelenting heat and steaminess that people generally picture (and fail to find in Bogota.)  My guide tells me that the city wasn’t quite so hot – until most of the trees were removed when the streets were paved.  It makes sense since the neighboring cities (with thick tree-lined streets) are noticeably cooler.

It’s an interesting city – and more than just miles away from Bogotá – more like decades.  Life is a bit more traditional here, but that may be just the heat, and the ancient appearance of much of the buildings contributing to that perception.  Lerida was first ‘discovered’ in 1538 by Spanish conquistador Sebastián de Belalcazar who was amazed by the richness of the land, but it wasn’t officially ‘founded’ until 1777, which actually makes it technically one of the younger towns.  But as you wander the town, you see that people are still living in many of the original buildings – updated and modernized, of course.  But the original architecture with high ceiling and spacious rooms offers the advantages of cooler temperatures despite relentless sun.

As a mentioned in a previous post about Cali – motorcycles are the preferred method of travel in the warmer climes; relatively inexpensive, and good on gas – you see motorcycles just about everywhere you look; with entire families on bikes.

family on motorcycle in Lerida

Women in high heels, babies pressed between bodies, toddlers riding up front, even women riding ‘side-saddle’.

Coming from a society where motorcycles are used more as a statement than a viable mode of transportation; it takes a minute to adjust to the scene of so many bikes – it’s not a convention, they aren’t ‘bikers’, it’s just another day of running errands and going to work.

line of motorcycles

For more posts about my visits to Medellin, click here.

Road to Lerida, part 1

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Had a wonderful Thanksgiving with some delightful friends yesterday.

I went to the operating room this morning with Dr. Alberto Martinez – but we will save that for later.

This post is for my good friend, Steven Morrisroe who always tells me to devote more posts to ‘everyday life’.  He’s been a big supporter of my work – so Steven – I hope you enjoy this.

Gee.. it doesn’t look that far..

The road to Lerida – part I

The most effective and efficient way to travel in Colombia is by plane; flying to Medellin or Cali is an exercise in ease – by the time the coffee carts comes around (yes, Colombian airlines take care of their passengers), it’s time to sit up your seats and prepare to land.

Not really going to Siberia (been there, done that!)

But the roads are notorious for being poorly designed exercises in endurance and frustration.  It’s something Santos has pledged to address – outlining a massive overhaul of Colombia’s infrastructure, which is desperately needed.  Despite being one of the major roads to this part of the interior of Colombia – it’s a two-lane road, hugging a hill on one side, and a dramatic cliff for the other for the majority of the journey.  While mom-and-pop restaurants and mini-markets dot the roadside, along with tiny houses and laundry lines – this is a heavily trafficked major route for the transport of goods across the country.  There are produce trucks, heavily laden pickups, buses, even several car haulers with brand-new Japanese cars all crowded together with more tanker trucks than I’ve ever seen in my life*.  At one point, I looked out the window at the road ahead and it was all semi-trucks as far as the eye could see in both directions.  It makes this little road as crowded as peak traffic in Bogotá.

this picture is actually from Honda, when traffic finally thinned out..

So much so that what should be a swift and picturesque journey becomes a six-hour crawl as the speedometer stays markedly fixed at less than 30 km/h (yes, that’s kilometers).  The only exceptions being quick bursts of pulse-raising, dare-devil maneuvers as we attempt to pass another in a seemingly continuous line of tanker trucks as we head into another blind and narrow hairpin curve.

passing, but you can’t see the motor cycle passing us..

We settle back into the agonizing crawl, behind more semis.  The line only broken when we attempt such feats as the double pass – passing a tanker truck on the far left as it attempts to pass a slower moving, more heavily laden truck. But at least, it breaks up the monotony and frustration of breathing diesel fumes and enduring the smell of hydraulic breaks being tested by the continuous grade.

this is actually a truck wash hugging the cliff

But don’t get the wrong idea – it’s still a beautiful journey and I am enjoying it immensely.  I just want you to be able to picture the chaos and flurry of activity amidst the serene surroundings.

Once you pass just outside of Bogotá – you are in the country.  Most of the trip is up and over a mountain pass – with a breathtaking view of what must be the Grand Canyon of all valleys.. It’s astounding lovely, but I was unable to get a photo of the massive verdant green valley with rivers and lakes scattered below.  It looks so much like West Virginia, that I have to remind myself where I am more than once.

Where am I?? (Answer: just past Honda)

After twisting and turning for hours – we emerge in the valley below and arrive in the city of Honda..

*My tour guide informs me that the reason there are so many tanker trucks is that despite having ample oil reserves, Colombia does not have a single oil refinery, so all the oil produced travels on this very road to be exported to the USA for refining.

Bogota’s castle

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Some of you may notice that I have temporarily changed my header – to show Bogotá’s castle.  I found it the other day as I wandered some of the carerras.  (Residents of Bogotá know that once you get into the single digit carerras – all logic and inference regarding standard directions goes out the window.)  Once you cross Carerra Septima (Cra. 7) the lovely city layout that makes Bogotá such an easy place to navigate changes into a labyrinth of twisting, winding streets reminiscent of San Francisco..

It’s part of what makes the city so interesting – and at times (such as yesterday, when I was making my way to an appointment) – a bit frustrating.  Just when you think you ‘know’ the city – you stumble upon something completely different from what you were expecting..

Not what I was expecting

The castle which is located at Cra 3 – 74 was the brainchild of Dr. Juan Osorio Morales and is called Castillo Mono Osorio.   While it has the appearance of antiquity, it’s actually only about 100 years old.

Bogotá’s castle

The creator, a local eccentric – was  Colombian cultural attaché to Brussels.   Upon his return to Bogotá, he spent the next twenty years creating the castle which later served as home to his own personal theater troupe.

Like the work of many unconventional artists, after his death the castle fell into disrepair until it was rescued in recent years by one of his descendents and repaired to its current state.

It currently houses several stores including a banquet space, a gift shop and a pharmacy.  Best of all – there is currently space for let.  A new, whimsical office, anyone?

Checking in at Santa Fe de Bogota

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After a year and a half – it was time to stop in at Santa Fe de Bogotá and see what was new.

Dr. Roosevelt Farjardo, MD (general surgeon) has been instrumental in implementing some of these new and exciting changes such as the ‘Virtual Hospital’ that I will be writing about (soon).  He was very nice about taking time to update me on some of his new programs at part of the Center for innovation in education and health.  Telemedicine is just the tip of the iceberg as far as some of the cool things they are doing.

Unfortunately, the same can’t be said of the International Patient Center  – or rather – I can’t report anything other than the fact that Ana Maria Gonzalez (the previous director) has left for a position in the United States and that Dr. Carolina Munoz has taken her place.

I was hoping to get some statistics and report back about some of the specialty programs for overseas travelers – but Alas!  I am unable to bring this information to you.  I waited over 70 minutes after my scheduled appointment with Dr. Munoz – and despite several calls from her staff, she never showed up and never attempted to reschedule.

I wish I could say this is an isolated incident – but I am afraid this is more like a clash of “cultures”.  I say this because I met with Dr. Munoz  previously; during the writing of the book (when she was the Director of the International Patient Center at rival Fundacion Cardioinfantil.)

At that time, (if I remember correctly, she introduced herself as a cardiac surgeon who had retired to “spend more time with her children.”)

Of course, my obvious question – was “oh, and how many children do you have?**”

I thought we were making polite conversation – because at the time, I was less familiar with Colombian customs, culture etc.   In reality, she was reminding me of her elevated stature in comparison to mine (as ‘just a nurse’).  Dense as I was – it became obvious as the interview progressed – as she made sure that I knew that she had replaced her rival (Ms. Ana Maria Gonzalez – RN) who had also worked at Fundacion Cardioinfantil in the past.  I’m sure she resented having to answer questions about the Executive Health Program and other aspects of their medical tourism program from someone she found to be inferior to herself.  (She made that pretty clear at that initial interview back in 2011).

So I guess it is no surprise that she didn’t bother to show up to our appointment this week – which is a shame, as I had looked forward to finding out more about the evolving International Patient Center at Santa Fe de Bogotá.

Luckily for me – there was another nurse there, Sandra Salazar – who could give me some basics.   She was delightful, helpful and dreadfully embarrassed about the whole thing.  She was even able to give me a list of some of the American insurance companies they have worked with in the past.  I had lots of questions about the HIPEC program, which she couldn’t answer – but she outlined the entire medical tourist process – and answered a lot of other questions.  She showed me how they streamline the process for their international patients, and the process for medical and surgical evaluations.

Now, there’s some good news for readers:  You aren’t nurses.  You are paying customers – so I am sure that Dr. Carolina Munoz will put aside any of her personal feelings (whatever they are) towards foreigners and will make time for you.

**The answer as none – as she is not married, and was not planning to be married in the foreseeable future.

Now when I am talking about culture – I am not strictly talking Colombia – America.  I am talking about Doctor – Nurse relations.  Watch some old Turner Classic Movies sometime and you will see what I mean..

Now I debated writing about this, but after talking with some other non-Colombians here in Bogotá, I felt it was important to pass it along because it illustrates quite a few things about my work:

1.  It’s not as easy as it looks (I spend a huge amount of time waiting..)

2.  Cultural differences can cause a lot of problems – so be prepared to be tolerant.

3.  If there is a chance that patients may get poor service – I want to know about it!  (And part of readers need to know about – is my experiences.)

New venture with Colombia Reports

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While I have written several books about surgery and surgeons in Colombia, much of this information I’ve obtained from my research has been consigned to sitting on the shelves of various bookstores.

But, now with the help of Colombia Reports, I am hoping to change that.  As I mentioned in a previous post, Colombia Reports.com and it’s founder, Adriaan Alsema have been amazingly supportive of my work, ever since they printed my first article on Cartagena in 2010.

Since returning to Colombia, I have kept in touch with Colombia Reports while we discussed ways to bring more of my research and work to the public.  Colombia Reports is a perfect platform – because it serves a community of English-speaking (reading) individuals who are interested in/ and living in Colombia.   With this in mind, Colombia Reports has created a new Health & Beauty section which will carry some of my interviews and evaluations.

It is an ideal partnership for me; it allows me to bring my information to the people who need it – and continue to do my work as an objective, and unbiased reviewer.  We haven’t figured out all of the details yet – but I want to encourage all of my faithful readers to show Colombia Reports the same dedication that you’ve shown my tiny little blog, so that our ‘experiment’ in medical tourism reporting becomes a viable and continued part of Colombia Reports.

This is more important to me that ever – just yesterday as I was revisiting a surgeon I interviewed in the past (for a new updated article), I heard a tragic story that just broke my heart about a patient that was recently harmed by Dr. Alfredo Hoyos.  While I was unable to obtain documents regarding this incident – this is not the first time that this has happened.

Previous accusations of medical malpractice against this surgeon have been published in Colombian news outlets including this story from back in 2002.

The accusations are from Marbelle, a Colombian artist regarding the intra-operative death of her mother, Maria Isabeth Cardona Restrepo (aka Yolanda) during liposuction.  These accusations were published in Bocas – which is part of El Tiempo, a popular Colombian newspaper, in which the singer alleges that Dr. Hoyos was unprepared, and did not have the proper equipment on hand to treat her mother when she went into cardiac arrest during the surgery.

story about the death of one of Dr. Alfredo Hoyos' patients.

story about the death of one of Dr. Alfredo Hoyos’ patients.

Kristin 002 Kristin 003 Kristin 004

Now – as many of you remember, I interviewed Dr. Alfredo Hoyos back in 2011, and followed him to the operating room, giving me first hand knowledge of his surgical practices.

Readers of the book know he received harsh criticism for both failure to adhere to standard practices of sterility and patient intra-operative safety (among other things.)  I also called him out for claiming false credentials from several plastic surgery associations – and notified those agencies of those claims..   In the book, readers were strongly advised not to see Dr. Hoyos or his associates for care.

But – as I mentioned, my book is sitting lonely on a shelf, here in Bogotá – and in the warehouses of Amazon.com and other retailers.. So, people like that patient – didn’t have the critical information that they needed..

This is where Colombia Reports – and I hope to change all that.   So in the coming weeks, I am re-visiting some of surgeons we talked to in 2011, and interviewing  more (new) surgeons, more operating room visits..

The people of Bogota

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I’m actually out of the city for a few days – but during my long flight, I reflected on some of the reasons I enjoy this city so much.

Why do I enjoy Bogotá so much?

Well, the people, of course!  Now, I know that people are shaking their heads – but for a small-town girl like me,  a cosmopolitan city like Bogotá is very exciting indeed.   So many festivals, events, galleries and museums**.

But it’s the people who are the heart of the city – and what really brings it alive.   Just this week, I had the opportunity to rub shoulders with and talk to a Colombian film director, a geo-petroleum engineer, a civil rights (labor) attorney  and one of the executives of Caracol.   It’s just that kind of town – like Washington D.C. but down-to-earth and accessible.  [Now, my little eight-year-old friend, Flavia has met President Santos just walking on the street one day, but I haven’t.]  But there are still wonderful opportunities to meet and talk to interesting people who I might not cross paths with in my ‘normal’ life in the hospital.

For example, I found myself sitting next to the film director, Andres Barrientos at a birthday party for a mutual friend. (Of course, the guests at the party were a like a small UN delegation – but less protocol and more fun;  it included Colombians,  two delightful ladies from Venezuelan, a British gentleman, and the guest of honor – another American like myself –except for her beautiful Argentinean Spanish.)  These are all just people and friends I have made wandering around the city..

Of course – talking about the ‘extranjeros’ or foreigners living in Bogotá is an entirely different topic – and one we will get around to one of these days.  But as I chatted with the very normal, very nice Mr. Barrientos (and he politely refrained from laughing at the ridiculousness of my YouTube efforts), it made me consider how many film producers I met in Danville, Virginia, Mexicali, Mexico or Reno, Nevada during my various moves.  (The cumulative answer is: Zero.)  And why would I – on the streets of my small southern town?  But Bogotá is a different matter entirely – it is a global city, with its tenacles on the pulse of Colombia, Latin America and the world.

Global positioning and perspectives

Talking with labor attorneys and several petroleum company officers just brings home some of the amazing lack of insight we (as North Americans) have on some many issues affecting the rest of the world – and our roles within this context.

While Americans are often accused of being willfully ignorant – this just isn’t true.  The reality is that: we are intentionally blinded as citizens to much of the outside world.  I mean, I make a continuous, specific concerted effort to find English language information about issues facing Latin America (for this blog) and it is exceedingly difficult.

What we do see on CNN, BBC and our nightly news and read has already been translated (and censored) for our consumption.  As a result – if it isn’t a  sensationalized report about a bomb going off somewhere – or a huge drug seizure, then there just isn’t much information available – whether we are talking about our southern neighbor, Mexico, the economic powerhouse of Brazil, Colombia, Peru, Chile or any of another dozen countries.

But when you live somewhere like Bogotá – you become more globally informed just by meeting and interacting with all of your fellow Bogotá residents – from UN representatives, other foreign nationals on down to your every day taxi driver.  (Always talk to the taxi drivers – they are usually exceedingly nice, have a wealth of information and different perspectives on everything from affordable healthcare, the American presidential elections, the environment and Latin American economic policies.  You will be surprised what you will learn.)

That’s just something I can’t get on Main Street, Danville, Virginia..

**Speaking of which – they are offering my book for sale at the Festival de Librarias in Parque 93 this weekend.

Sunday in Usaquen

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Sunday streets open for pedestrians

Since I am always talking about Sundays in Bogotá – I thought I would post some photos..

Today we walked along the streets (Carrera Septima) to enjoy the sunshine in Usaquen.

Streets closed to auto traffic to allow Bogotanos to enjoy the city, walking, on bikes, skates, skateboards – and strollers as families enjoy the sun.

We walked to the marketplace and enjoyed the park.  (One of things I particularly love is that when you go to the park – kids are playing soccer, not with their iPhones..  (of course they have iPhones- they just put them aside for a few hours.)

Flavia in park,, kids playing in background

Teaching Flavia some basic gymnastics today – cartwheels, handstands and such..

in the park

A girl offering puppies in the park (with parents, not pictured)

vintage rides in Usaquen

This guy was minding his own business – but he just looked cool (James Dean style)..

 

 

you can see the tips of the marketplace stalls (white tent tops)

 

Thoracic surgery and sympathectomy

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Clinica Palermo,

Dr. Luis Torres, thoracic surgeon

I went back to see Dr. Luis Torres, thoracic surgeon and spent the day in the operating room with him for a couple of cases.   He is a very pleasant, and friendly surgeon that I interviewed last week.  Dr. Torres just recently returned to Bogotá after training in Rio de Janeiro for the last several years at the Universidade de Estado de Rio de Janeiro.  He completed both his general surgery residency and thoracic surgery residency in Rio after graduating from the University de la Sabana in Chia, Colombia.  (He is fluent in Spanish and Portuguese).

I spent some time out in Chia last year with the Dean of the medical school (and thoracic surgeon, Dr. Camilo Osorio).

The first case was a sympathectomy for hyperhidrosis.  I’ve written more about the surgical procedure over at Examiner.com, and I will be posting more information about the procedure – potential candidates and alternative treatments over at the sister site.

 

The second case was more traditional thoracic surgery – a wedge resection for lung biopsy in a patient with lung nodules.  **

In both instances, cases were reviewed prior to surgery, (films reviewed when applicable – ie. second case) and visibly posted in the operating room.  Patients were sterilely prepped, draped and positioned with surgeon present.  Anesthesia was in attendance for both procedures – and hemodynamic instability/ desaturations (if present) were rapidly attended/ addressed / corrected.

Dr. Torres utilized a dual-port technique for the sympathectomy, making 1 cm incisions, and using 5mm ports.  Each side (bilateral procedure) was treated rapidly – with the entire procedure from initial skin incision and application of final bandaids taking just 35 minutes.

Dr. Torres, performing VATS

The second case, proceeded equally smoothly, and without complications.  There was no significant bleeding, hypoxia or other problems in either case.  Surgical sterility was maintained.

** Both patients were exceedingly gracious and gave permission for me to present their cases, photographs etc.

Just as the second case ended – Dr. Ricardo Buitrago arrived – and performed a sympathectomy on one of his patients – using a single-port approach.  (I am currently working on a short YouTube film demonstrating both of these techniques.)