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This is the type of post I was hoping not to ever have to write. But as we all know, shit happens. The good news is, I’m “fine” now. We both are!

I learned what a concussion feels like as a teenager, and I’ve sprained both ankles more times than I can count. I also know what headaches and migraines feel like since I’m prone to having those on an all-too regular basis. And now unfortunately, I’ve recently learned what extreme high blood pressure and a hypertensive crisis feels like. And I have to admit, it was surprisingly hard for me to figure out that I was dealing with something that was very serious.

When I lived in Seattle my doctor confirmed that my frequent headaches were often triggered by weather and barometric pressure changes, or by job stress. My doctor was always telling me to exercise more, eat better, and quit my job in order to control the things I could control. The job stress aspect was easy to cope with when I finally did quit my job and retire in 2018. The weather and air pressure related headaches have been harder to manage since I can’t control the weather. My doctor also said my blood pressure was high, and since I had a family history of high blood pressure I would likely need to regulate it with medication at some point. But as a naturopath she wanted to avoid prescribing blood pressure medication for as long as possible, which I was fine with since I was only at stage 1 hypertension at that point and medication is not recommended until stage 2 hypertension. We were more focused on the idea that once I quit my job and started traveling my headaches would improve, and they did.

Issues with High Altitude in Ecuador

When we arrived in Ecuador my headaches started up again with a vengeance. Ali did some research about our new location that described headaches as a common symptom of altitude sickness. Ali and I were both born at sea level and had never stayed anywhere over 5,200 ft before, and we both had symptoms of altitude sickness when we arrived in Quito at 9,300 ft. We took the recommended round of Diamox tablets for altitude sickness and after a few days we both felt more energetic, less fatigued, less dizzy, and had better appetites. My headaches also improved and were less frequent as we adjusted to the higher altitude, but they did not go away entirely.

Once my headaches seemed to be under control I noticed a sensation in my head that I called “wobbly brain,” which seemed to jive with my type of sensitivity to higher elevations. After a few days and then a few weeks of intermittent low level headaches, that all started to seem normal. And anytime the pain was intense I treated it with the same combo of Advil and Tylenol that my Seattle doctor had recommended and that helped.

We were in Ecuador for a total of 5 weeks. We traveled between several locations ranging from 5,000 to 11,089 ft above sea level. We spent most of our time in Quito at around 9,300 ft, and I definitely had more headaches at the higher altitudes. I have to admit I was really excited when it was time to leave and head back down to sea level in Panama City. Our flight from Quito to Panama was a quick one, at 1 hour and 52 minutes.

As soon as we were off the plane and on the ground in Panama my head felt like it was hit by a truck. Ali got us to our apartment and I immediately took my Advil and Tylenol combo, chugged some water, and went to sleep. Poor Ali, I know she was scared to see me like that. She closed the blinds and just kept an eye on me as I stayed in bed either sleeping or pretending to sleep for almost 24 hours. The next day I rallied so we could take a walk along the Amador Causeway, partly because I knew Ali was really looking forward to that. I tried to be a good sport and hide the fact that I was uncomfortable. But it quickly became obvious that the intense sun, heat and humidity were too much for me. And the taxi ride back to our apartment made me nauseous so I went right back to bed again that afternoon. I was uncomfortable on than off for the next 5 days until I finally told Ali she needed to get me to an emergency room.

Emergency Room Visit

As soon as I made it clear to Ali that we had to go to the ER she jumped on her laptop to search for hospitals near us and also called the helpline for our international medical insurance to ask for advice. Ali’s search narrowed in on Hospital Punta Pacifica immediately so she gave that name to the insurance agent on the phone, and was told we could go there or anywhere else we liked. We would have to pay out of pocket but should assume we could be reimbursed once we hit our deductible. Before she hung up the phone she had an Uber on its way to pick us up. About 15 minutes later we arrived at Hospital Punta Pacifica. 

When we arrived at the hospital we were both ready to deal with our first emergency medical situation on the road. It was raining so hard when we got out of the car it seemed like rivers were falling out of the sky, which actually made it hard to pick out the right set of doors at this huge hospital. When we marched up to the admission desk Ali asked for someone who speaks English so we could make sure we were 100% clear when describing my symptoms. At that point I was feeling light headed so I sat down while Ali got through that process. About two minutes later we had a translator to relay everything we both said to the person at the desk and get me checked in quickly. And about two minutes after that a nurse escorted me into the triage area while Ali stayed behind to pay an upfront deposit of only $300.

My nurse quickly started checking my vitals. A doctor arrived almost immediately, introduced herself as Dra. Safir Terán in perfect English, and asked me to describe my symptoms. I explained that my headaches started in Quito, continued off and on for a month, and then spiked when we arrived in Panama a few days prior. She held my wrist and asked follow up questions about my headaches, my medical history, and my family history with high blood pressure. I mentioned that I was at stage 1 hypertension one year prior when I was still in Seattle. I relayed my family history of high blood pressure and the fact that I had recently turned 56 years old. The nurses who were checking on various things around me started handing Dra. Safir reports and relaying information, and just as Ali walked in we were all looking at my blood pressure reading on the monitor. It was 176/107.

Dra. Safir was very kind and reassuring. She spoke to me with a combination of perfect and calm English, seasoned with a few words in Spanish for emphasis. That went something like… “Your blood pressure is very high and you are in a hypertensive crisis mode right now. No es buena, su presión es muy alto. The fact that your blood pressure was high and unmanaged for the past few weeks is is not good, but we are going to take care of you and you are going to be fine. We will get your blood pressure under control right away. You’re going to be fine.” Eek!

After that I had a team of nurses swirling around me. Some had perfect English and some spoke no English. As one person helped me change into a hospital gown, someone else very deftly started an IV without me feeling a thing, and another person set the EKG to contumely monitoring me. Everyone seemed very specialized in their tasks. Dra. Safir said she wanted to try to bring my lofty blood pressure down with oral meds so she stepped out to order them, and then another nurse popped in to administer some IV pain meds for my pounding headache and also handed me some oral meds for my blood pressure. And then everything quieted down and we waited. 

After an hour Dra. Safir said my blood pressure had not come down to where she wanted it so she ordered IV meds for a more rapid change, and 30 minutes later she said I was stable and back to a normal hypertension level to treat with daily oral blood pressure medication, which meant I was ready to be released. 

As we were going over my release instructions the doctor said she wanted me to follow up with a cardiologist within a week. But when she found out we were planning to leave town in 5 days she said, “hang on, let me see if I can get you an appointment for tomorrow.” And wouldn’t you know it, Dra. Safir walked over to the desk and called a cardiologist and booked an appointment for me for the next day in the same hospital. Did you get that? The ER doctor called around and found a cardiologist who could see me the next day and booked an appointment for me herself! Ali stood and watched her do that, and then when the doctor came back five minutes later Ali said, “wow I can’t believe you just called and booked an appointment for Alison yourself.” The doctor replied, “That’s the fastest way for me to make sure it gets done.” She also handed over a prescription for blood pressure pills, a print out of my EKG report, printed copies of all of my ER visit test reports, and an order for blood work at the lab downstairs.

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When I was released we headed back to the ER cashier where Ali paid the initial deposit. I had some awareness of ER visit prices back in the US, and of course I was well aware that we were in Panama but also aware that we were apparently in the best private hospital in the country. I was running some quick estimates in my head about how much my 3.5 hour ER visit might cost. We sat down with the cashier and she showed us a bill for my ER visit totaling $521, along with a line item our $300 deposit, and a balance due of $221. I think my blood pressure dropped another 10 points when I saw those numbers and watched Ali hand over our credit card.

From there, we left the ER and walked over to the lab for my bloodwork. I paid $19 for my kidney function blood test, and Ali ran off to fill the blood pressure prescription I was starting off with and buy a blood pressure cuff that was small enough to travel with. Then we were back in an Uber and on our way home after 4 hrs at the hospital. That night I slept deeply with no headache and huge sense of relief.

My Cardiologist in Panama

The next morning we went back to the same hospital complex for my cardiologist appointment. This appointment was in a different tower, and after we checked the receptionist handed me a buzzer like we get when waiting at a restaurant for a table. After about 10 minutes my little device flashed and we were walked in to meet Dr. Carlos Ureña. When Dr. Carlos introduced himself he asked if I wanted him to conduct the appointment in English or Spanish. English please!

We sat down together and Dr. Carlos reviewed all of the notes and records I had brought with me and asked some follow up questions about my general health, lifestyle, and family history. He said he didn’t see a report for a kidney function test and asked if I had done my bloodwork yet. When I went to the lab on the previous afternoon I was told they would email it to me the following morning, so Ali got into my email and found the report which had been delivered that same hour. She handed her phone to the Dr and he reviewed it and said “Ok that looks good.” Then he reminded me that I needed to start monitoring not just my blood pressure but also my kidney function on a regular basis.

Dr. Carlos explained that I had experienced a blood pressure spike in Ecuador due to very high elevation, and had most likely stayed at that new hypertension level over the month that we were there. Which caused the headaches I was experiencing. That was clearly the point when I should have visited an ER and started blood pressure medication. He then explained that our flight to Panama was a very rapid drop in elevation back to sea level, which caused another blood pressure spike to hypertensive crisis levels which I had been experiencing for the past week. Causing the excruciating headaches I was experiencing.

He also said my next steps should be an echocardiogram within the next week and a 24 hour blood pressure monitor after I had been taking my new medication for two full weeks to determine if the dosage was right for me. When I explained that we were leaving for Boquete in a few days he asked, “Do you have time to do the echocardiogram right now?” I think I stumbled out an awkward surprised response like, “You mean literally, right now? Uh, yeah I have time.” And he hopped up and took me to the next room where he administered the echocardiogram himself right then and there. He explained everything he saw in the ultrasound image of my heart in real time. According to his observation, everything was within expected tolerances for a normal range given my age and history with high blood pressure. Then Dr. Carlos said he was going to take a minute to write up his report in English and give me a copy, then print a CD of my echocardiogram to take it with us. He also agreed that the blood pressure pills the ER doctor prescribed were what he recommended I start out with for two weeks, and gave me an extra two week supply of the same pills for free. He reiterated that I had to see a doctor in Boquete to do the 24 hour blood pressure monitor and determine if that dosage was a good fit or if I needed a different medication instead. Then we shook hands and we walked out to the reception area to pay. Since I had a cardiology exam with an echocardiogram, we were handed a bill for $350. And again, we paid with our favorite credit card and left.

Settling Down for a Bit in Boquete

A few days later we arrived in Boquete where we were staying for a month long housesit. We had planned to spend three days with our hosts, who are two of the nicest people we have met during our travels. Over the next couple days we enjoyed our visit with Bill and Cheryl and got to know them, their house, and their dog Brassy.

Bill and Cheryl also drove us all over the lovely little town they had fallen in love with and pointed out the library, the trail heads for their favorite hikes, all of their favorite restaurants, the markets they liked best, their dentist, and finally their doctor’s office.

During our conversations as we toured Boquete, Bill shared that he had a 24 hour blood pressure monitor a few months back as well. He said he really liked their local doctor and that it was really easy to get an appointment with her. Listening to him made me feel really confident that it was the perfect time for us to be planning to stay put for 5 weeks, and we were in the perfect location for that as well. I was really excited to go and see the doctor as soon as possible.

My General Practitioner in Boquete

A couple days later on a Monday morning Ali and I headed downtown and walked into the clinic. I had a big folder full of my reports and test results, along with my passport for ID. We walked in at 10:30 am and I asked for an appointment with the doctor, and was told if I could come back at 1:00 pm I could see the doctor that afternoon. Great!

Ali and I then took ourselves out for a walk and an early lunch at a fun place just down the street so we could return by 1:00. 

On our return we had a chance to see how things functioned in this small town clinic, and it was clear the office was run in a rather fluid manor. Most folks had appointments, but residents also stopped in and got some help from a nurse or doctor in the lobby if they just needed something like a quick blood pressure check or to pick up something that had been ordered for them. I enjoyed watching the doctor give some very sweet instructions to a little kid who was not feeling well.

While I was waiting in the lobby the nurse took my blood pressure and temperature, then weighed and measured me and noted all of that in my new chart. She and I chatted with some English and some Spanish about how I was feeling and she made more notes about that and the blood pressure medication I brought with me. Then, Dra. Sue Loo called me and Ali into the exam room. She spoke perfect English and asked me a series of questions that helped me get her up to speed, and also read through all of my reports at the same time. I also shared with her a very extensive log I started keeping with my blood pressure readings from the date of my ER to that morning. I had been taking multiple readings throughout the day.

Dra. Sue said, “You can relax now. You can stop taking your blood pressure more than once a day. You’re going to be okay Alison.” Ali looked at her and said, “Thank you for saying that. We both really needed to hear that. This whole experience has been pretty frightening for us.” We really were ready to hear that reassurance and we both needed to know this blood pressure issue was under control, and that I was in good hands.

She also said her biggest concern was that I was feeling light headed after almost two weeks on my new medication. Even though the nurse had just taken my blood pressure, Dra. Sue took my blood pressure on my right arm, and then she took it again on my left arm. Then she read through some notes and test results again and decided to postpone the 24 hour blood pressure monitor and change my medication. She wrote up a prescription and told me to relax and enjoy Boquete. Go for walks around town and hikes in the hills, take naps, enjoy the great weather, eat some good food, and I’ll see you again in 10 days. I loved those doctor’s orders!

On our way out, we asked the receptionist for the bill and she said it was $25. We paid with our credit card and then walked across the street to one of the many pharmacies in town to fill my new prescription.

24 Hour Blood Pressure Monitor

We returned to see Dra. Sue 10 days later and took a seat in the waiting room. Before my appointment time, Dra. Sue came out and noticed me sitting in the waiting room. She said something to the guy next to me in Spanish that I didn’t understand, then he glanced at me and said, “No problemo” and gestured for me to go ahead of him. We smiled at each other and I hopped up and followed Dra. Sue into the exam room. That’s the kind of thing I would hope to see in a small town clinic. It was very kind of them both.

It only took about 5 minutes for her to hook me up to the blood pressure monitor. She said,“Don’t touch it or take it off until this time tomorrow. Just come in and drop it off at the front desk tomorrow and I will call you with the results in a few days.” Great! Then we were off for another fun lunch at a new place our Spanish teacher recommended. 

I did as instructed and left the monitor alone. Then we stopped back in the clinic the next day and when I saw the nurse I told her I wanted to let them take it off of me instead of doing that myself. I was nervous I would erase the thing by accident. And then instead of waiting for Dra. Sue to call we just stopped in to see her like the locals do.

I was relieved when I sat down with Dra. Sue to hear the results because she said this was the best 24 hour test result she had ever seen. She explained all of the parameters she had set on the test, and what she was looking for during each part of the day. She then went over the results with me and showed me one spot that caught her eye. “I think you had a nightmare at about 3 am that caused this spike.” Ali laughed out loud and said I did, and that I woke her up when I shouted at 3 am. Then Dra. Sue said she was very happy with how the test went, and with how I was responding to the new meds. She smiled and said we could keep on traveling. The final cost for the 24 hour blood pressure monitor test was $150, and that last office visit cost a little more than our first visit one, at $35.

Bottom Line – What Did This All Cost?

This is a breakdown of all our costs from the moment I went to the ER to when I was cleared by the GP in Boquete, Panama. I can only imagine what would have been charged to insurance in the US and what our portion would have been.

Why Didn’t We Use Medical Insurance?

We do have a global medical insurance plan with IMG. We have a $5000 deductible so we consider that to be catastrophic coverage for emergencies. My medical care including everything from my ER visit in Panama City to my GP visit in Boquete certainly qualifies for reimbursement from IMG, except that our out of pocket costs were so reasonable totaling $1,623 that we never met our deductible. And it was November of 2019 when that all started up. For us that actually means everything is going according to plan because we keep an emergency medical fund of cash to cover all out of pocket medical and dental costs. And even with all of these appointments and tests, in 2019 we definitely did not use up our out of pocket medical fund cash or come anywhere near our deductible. The global medical insurance plan is designed to cover more expensive medical emergencies than this one, and I’m just glad we have that insurance there in case we have to be admitted to a hospital for more expensive tests or procedures.

Finding Medication on the Road

It was kind of a bummer that we had bought a month’s supply of the first blood pressure medication prescribed in Panama City that I couldn’t use, so we donated that box of pills to the clinic in Boquete. The new medication prescribed in Boquete cost $65 for a 28 day supply, which is not cheap from my perspective. But it gave me a new project to research and I was looking forward to finding the best way to buy my new medication while traveling.

After we settled in San Miguel de Allende in Mexico, and familiarized ourselves with the town, we set out to refill my Panama prescription there. I was really curious to see if I could walk into a Mexican pharmacy with that Panamanian prescription and get more of those pills.

There are tons of pharmacies in San Miguel and I was convinced we could find my new medication there. I brought my half empty pill box and the prescription and we went into the pharmacy across from the Mercado Sano for our first try. The pharmacist greeted us and I handed over the box and paper work and explained what I was looking for. The woman looked the medication up on the computer, consulted with a colleague, then brought me a box that did not look like the one I had brought in. Through a combo of English, Spanish, and Google Translate it became clear they did not have the same thing I had gotten in Panama, but they had a similar medicine from a different company and at half the dosage. Since there were another half dozen pharmacies we could easily walked to we kept searching. We walked to the next pharmacy but they didn’t have my medication or the other brand either, then we tried another and also had no luck, and then we went to a few more pharmacies before deciding to return to the first one where I bought a two month supply. Interestingly, a month supply of that drug cost a bit less than what I got in Boquete, Panama.

Since what I found in Mexico was not exactly the same, I tried looking for my new medication at Marks Marine Pharmacy, a Canadian pharmacy that provides international pharmaceutical services online. And sure enough I found the exact same medication Dra. Sue prescribed listed for 25% less than what it cost in Panama. I had used that online Canadian pharmacy before, after I switched between employer insurance plans in Seattle when my new insurance didn’t cover my hormone medication. Thanks to this online pharmacy I was able to get my medication from Canada for $100 instead of $400 out of pocket. When you have to pay for prescriptions out of pocket it helps to shop around.

Since the Canadian price was so great I went ahead and ordered about 3 months of my blood pressure pills online from the Canadian pharmacy. I selected the exact medication I was prescribed in Boquete along with the quantity of pills I wanted, uploaded a photo of my passport and a photo of the prescription, then I entered a shipping address and credit card number. Two days later the pharmacy called for verification of some details and I answered the phone from a hammock in Merida, Mexico. Apparently they were having a little trouble interpreting some of the instructions that were in Spanish on the prescription. I clarified what the doctor’s orders were, one pill once a day. Hopefully they will arrive at my sister-in-law’s house in California in about 3 weeks and I’ll pick them up when we get there in two months.

Moving On

I’m pretty sure there would have been some kind of blood pressure scare someday, and that could have been triggered by a bunch of different issues. It wasn’t ideal to have the experience I had, it would have been much easier to just have a checkup and start taking blood pressure pills without drama. But the important thing is, my blood pressure is managed and under control now. It’s currently 124/80 as I’m writing this post in a hammock in Mexico. I’m looking forward to seeing a GP for a full medical checkup and screening when we get back to San Miguel de Allende in a couple of weeks. We will definitely file a claim with our insurance after we have those checkups, just in case something else has to be claimed against our insurance deductible in 2020.