Hernia Surgery-The Mexican Option

After waiting for several years for a inguinal hernia repair, I finally got to the point where I needed to address the problem.  I re-met with Dr. Armando Joya Mungia a few months ago, to reconfirm my problem as it has been bothering me more and more.  He said the hernia probably got larger, so it is time to get it addressed, before it becomes a serious issue and requires emergency surgery.  Looking for a good period to accomplish it, arrange for my mother to come, and also allow time for recovery I scheduled it for the week of January 15th with my actual surgery date being the morning of January 17th.
Having no insurance either in Mexico or the US and even when I did have insurance and a $3000 USD deductible, the option here in Mexico for around $2000 USD was certainly going to be my choice.  No need to go back to the US for the surgery because I felt confident in Dr. Joya's surgical skill and he came highly recommended from Pam Thompson who's company www.healthcareresourcespv.com located in Puerto Vallarta provides an extensive database of physicians who not only speak English, they are highly recommended by Pam.
Finally, surgery day arrived and I was to check-in at 745am to complete the Amerimed Hospital paperwork required for admission to the hospital. The new Amerimed Hospital in PuertoVallarta has recently relocated to a brand new medical facility across from the entrance to the Marina neighborhood and Plaza Marina.  Dr. Joya used to be at Cornerstone Hospital but decided to move here because he wanted to be affiliated with the newest and best hospital in Puerto Vallarta.
By about 830am I was called to come into the pre-op preparation area behind the check-in desk.  I was met with a friendly nurse who spoke English and she prepared me by offering the typical hospital gown, testing my vitals, and inserting the IV catheter for preparation.  About 30 minutes later I was moved to the surgical ward on the 2nd floor and due to sterile conditions in that area, I was transferred to a surgical ward bed.  Then around the corner and I was into the operating room and transferred to the surgical table. The nurse who met me introduced herself and the anesthesiologist introduced himself upon transfer to the table.  I was not doing general anesthesia just a sleeping medication and an epidural.   After a few minutes I was gone and woke up in the recovery area about 2 hours later.   Being still very tired I closed my eyes again and  about 1200pm I was transferred to my room.  The room was a very nice private room with lounge chair, couch, flat screen TV, bathroom, and all of the usual medical devices at hand including oxygen, nurse call button, etc.
The plan was to have me out and on my way home by 7pm, so I rested in my room most of the day.   After a few hours I felt the need to urinate, so with staff help I went to the bathroom but felt faint and had to be assisted from the bathroom.  Immediately staff and the internist on call were present in the room as everyone was concerned about what had happened to me and after EKG, blood test, etc. it was determined that I probably had a slow heart rate due to some of the effects of anesthesia, however, I would be staying overnight for observation to make sure everything was okay.
So my mother decided to stay as well as she would just worry about me being at my condo and the couch in the room as satisfactory for her night's sleep as the hospital provided sheets, blanket, and pillows.
A few hours later I was given a small sandwich snack, sliced fruit, and hot tea for my evening meal.  The nurses were around and responsive when called, however, they were not a constant nag by waking me every 2 hours for some test or medication.  Dr. Joya had heard about my "problem" and he came by around 9pm to check on me and was very supportive and kind.  He told me that the procedure had gone well and he said that I had a "Pataloon Hernia" which is a combination of direct and indirect inguinal hernia in the same area.  That is probably why it was giving me so much more trouble in the last few months.   He assured that me made sure that the internal stitches and mesh would provide me great protection against any re-occurrence on my left side.
Physically I felt pretty good, still a bit lightheaded, but no real pain from surgery, just some normal aches and pains that from the procedure.  I took 2 pain medication injections  during my stay, but otherwise I was getting restless and uncomfortable with lying in bed so long!  I would be seeing Dr. Joya or his partner Dr. Espinosa in the morning for my release.   My night was fine as I found a comfortable position on my right side that allowed my to sleep as well as could be expected, being in a hospital and not home in one's own bed.
The next morning at around 830am Dr. Espinosa came to check on me and allowed me to check out in the next hour, checked my incision, and discussed my prescriptions for the next week.  I had already gotten some pain medication and antibiotics, but he decided to add an anti-inflammatory and a stomach acid medication to my list.   He told me he or Dr. Joya would see me on Tuesday at 1000am back at Amerimed to inspect the incision area.  I had the option of taking a shower in the bathroom, but decided I needed to go home and rest better there.  A friend of mine arrived around 1030am and we were on our way home with a stop at Farmacia Guadalajara to pickup the 2 additional medications.  My only complaint at the hospital was that no food or snacks were available for visitors or patients and one had to go outside the hospital to find something to eat or drink.
At home I walked up the one flight of stairs to my condo and felt no pain. With ice packs on 10 minutes every hour and then relaxing the rest of the day including a nap in the afternoon I was to bed early and took a couple of doses of pain medication.   The pain really only occurred during the transition from sitting to standing or lying to standing.  When I was laying down no pain.  The pain (burning sensation) seemed to be from an area above the incision, probably where the mesh was inserted and the repair done to the stomach muscles.
Day 2- I am up in the morning around 5am, to the bathroom, and some more pain medication and back to bed till the sun rose.  Today I am feeling pretty well and the only pain is in the same area.  Some more resting and a small walk to the pool area, things are going well.   Some additional pain during bowel movements, but otherwise I am feeling good!
Day 3-I am up this morning around 6am and feel that I will not need any more pain medication and keeping the ice going as I can remember it as it seems to sooth the area of the surgery.  Only the slight burning sensation in the area of the mesh when I move a certain way.
Day 4-Doing better each day and just taking it easy, walking around, keep the ice going
Day 5-Feel well enough to take my mother to the beach where we have to walk about 100 yards to get to the beach and all went well!  Did not go into the water, just got my feet wet!
Day 7-Back to the doctor as he wanted to take out the stitches, but decided to wait till the end of the week and took off the gauze and only placed a strip of tape over the incision.  Pain is minimal now and less each day.
Day 10-Back to the doctor for stitches removal and all the mesh pain is now gone.  Only had a few outside stitches as most of the stitches were done internally and they would dissolve on their on.  Just some tenderness in the incision area.  Hope to get back in the ocean water or pool, but have to wait another 10-14 days!  And certainly no lifting anything over 10 lbs for the next month.   All is well and I am certainly in less pain than I was before the surgery and that is always a great sign that I will recover just fine!

Puerto Vallarta Chamber Orchestra Concert

On Monday evening I decided to attend the annual Holiday Concert at the American School put on by the Puerto Vallarta Chamber Orchestra and Chorale.   Conducted by Donald Bieghler who many years of experience in conducting and teach music made the group come together for these events.  I have been looking for my classical symphonic 'fix' for a while now and took the opportunity to experience this group of volunteer musicians who perform only a couple of times per year in the area.   Made up of older full time and part time mostly expats they are from all walks of life but I think their common interest in playing classical music makes the group of about 30 musicians come together for these concerts at only 100 pesos per person.
The music ranged from classical holiday pieces by Bach to the usual classic American holiday songs such as "Deck the Halls", "O Holy Night", and "White Christmas".  The Chorale joined in a various songs and there were even a couple solos sung by their members.   A special treat was a medley of German Christmas songs sung by Kathy Overly and accompanied by a pair of recorders.
The show was entertaining mostly played by very talented musicians.  Sometimes the horn section was a little weak, but was quickly covered up by the rest of the group.   I would have loved to hear more classical music, but I understand that it was a holiday concert and all bases need to be covered.   I look forward to hearing them again in the Spring Concert!

Playa Tehuanmixtle

Another drive today south of Puerto Vallarta to the lovely town of El Tuito and beyond to the beaches of Cabo Corrientes had me going to the small fishing village of Tehuanmixtle.  Tehuanmixtle is located around the corner about 1 mile from Mayto Beach by keeping straight on the El Tuito to Mayto road and turning right down the steep road into the fishing village.   What makes this little village unique is that there are about 4 different restaurants to choose from and we decided to go to Cande's Place as the owner Candelano made a point of welcoming me to his village that he has been a part of for over 50 years!  He told us that his mother has been living here and had another restaurant down the beach a bit for over 120 years!
We were looking for some whole fresh Huachchinango (Red Snapper) and that is what we got!  Since the size of the fish were larger the server suggested we share one and I am glad we did!  That 2.2 kilo fish was huge and plenty for 3!  It was accompanied by pablano chile rice, salad, tortillas, and salsa.   It was wonderful and perfectly cooked with garlic and butter it just fell off the bone and we could not stop eating it!  After the wonderful lunch we moved over the beach side of the village and enjoyed some warming sun rays as it was a bit cool in the shade of the restaurant.
The village is very small on the steep down road and just provides a place to rest, enjoy lunch, and see some different views of the Cabo Corrientes area with miles and miles of beaches in the distant.  Tehuanmixtle is unique in that it is positioned in a very rocky area and has only a small beach, unlike Mayto and the other beaches around the area.
Located about 2 hours south of Puerto Vallarta this area is connected via a dirt road that is about 22 miles away from El Tuito.  The road continues to be improved and paved, but there is still plenty of dirt along the way.  The first 6.2 miles are paved, then dirt until a small town for 1 mile of paved, then back to dirt until you are about 4.5 miles away from Mayto, the road becomes paved again.   So plan on driving at least 1/2 the way on a dirt road that winds itself up and around the hills but steadily downhill to sea level.  El Tuito is at about 2000 feet of elevation, so you have to head back down to sea level.
Any good vehicle can make the drive, but take your time and do not rush.  There are some other small villages along the way and most have a place to stop and get a cold beverage.
It is easily a day trip but you have 4 hours total of driving back and forth.  Get out of PV and enjoy the other parts of Mexico, it is well worth the drive!

Car Legalization Part IV

LICENSE PLATES IN HAND!! We have finally come to the last chapter of my legalization process for my car here in Puerto Vallarta, Mexico.   I did not receive the promised phone call  from Jalisco motor vehicle department, so after 2 weeks I returned and my paperwork was complete.  So now everything was ready for the next step which involved going to the Marina on an upcoming Wednesday for another VIN verification by the State of Jalisco.  It would be scheduled in about 10-14 days as these inspections are only completed on Wednesdays.  My date was given to me to report November 16, however, I already knew I was not going to be in town that day so I immediately asked for the following week.  No, that could not be changed now, only upon my return after the missed appointment date.
Back in town on November 17, so on November 18 went back and rescheduled the VIN verification appointment for November 30th at 8am.   After another 12 day wait, I reported at my scheduled time and I was about 15th in line as the line kept getting longer and longer.  I estimate that 90 people were told to report at the same time!  Now I am wondering how this is all going to happen with a day?
Of course the government officials do not show up till 830am and they begin the process of taking our prepared paper envelopes and asked where we had parked.  Most people like myself parked in the closest and free space, but no, we had to park around the corner in the Marina parking lot and pay.   So everyone moved their vehicles to the proper location.
After about 45 minutes everyone was told to go their vehicles and open the hoods and wait for the inspector to show up.  Within 15 minutes he did and verified the VIN by looking at the dashboard VIN and the one under the hood.  Close the hood and report back to the outdoor canopy area to receive your signed report.   Another 45 minutes later we are gathered together and told to pickup our envelopes and signed VIN verification report in the order that we were in line, so 15th was not too deep on the wait list.  We were also told we had 15 days to get the plates and do not rush over the Jalisco municipal building today to get your plates as it will take a long time.  Hooray!  I did not want to spend the rest of the day doing that as it was the end of the month, payday, and I knew it was be a long long wait!
Returned yesterday after the weekend and went back to the window I thought I needed to go back, but no I should just go to the cashier line.   After a short wait and about 30 minutes of typing info, going to back office twice to get approvals, I was done!!  Of course I had to pay some tax based upon the value of the car plus the license plates fee for a total of 6200 pesos.  I was not prepared to pay that much more, so luckily my debit card was acceptable; paid the fee and was handed the plates.  The plates also came with a registration card, registration sticker, and license plate sticker.  All of the stickers now means I have 4 different stickers on the car; federal import sticker, emissions sticker, registration sticker, and license plate number sticker that have to all go inside the car in various locations.
All told the process was expensive and not for the faint of heart, but I persevered and got it done after about 6 months of working the Mexican government system.  They did not beat me!!  The total cost including transportation costs to the border and all the fees federal and state would have to exceed  $2500 USD.  Below is a photo to prove to you I have them!!!!

The New Malecon in PV & Halloween

Last night was Halloween here in Puerto Vallarta and I have enjoyed the craziness that it provides especially this year with the new boardwalk almost completed!   I am impressed with the work that was done and I think it is going to be a great place to gather in the evenings and weekends for all of the citizens and tourists in Puerto Vallarta.   With a nice smooth street level walkway, access points to the beach, and plenty of seating around planters; it is a fantastic improvement on the old one.   The famous sculptures are on their way back in their new homes of elevated platforms and lighting.
Like most projects of this sort, it was delayed in completion, but I see it coming together now in the coming weeks and it will the main attraction for the city for many many years to come!  
With its first Halloween under its belt, the Malecon provided just the right atmosphere and design that is going to make it a great gathering place for young and old.   Halloween is celebrated here in PV I think because the Americans brought it with them and they seemed to be the only ones who bring candy to hand out to the thousands of children dressed in their costumes.   The most popular ones this year seem to be brides, pumpkins, and skeletons as it has been in the many years past.

We usually enjoy the vantage point from a restaurant (The Cheeky Monkey) and are able to attract quite the crowd down below begging for our candy.    We make an attempt to toss it around, so everyone get's their share!  Happy Halloween PV!

Car Legalization-Part III

The saga continues as it took 10 days to get the factura (invoice) sent to me from Nuevo Laredo. It arrived on Wednesday, so Thursday I am back to the Jalisco Government Offices, thinking I am finally at set.......or was I?   Turns out the factura was made out to another person's name as I got a call from the owner that it would be best to avoid paying the IVA taxes associated with the factura, but I am not sure if that was true. So they did allow me to "sign over"the factura to myself and after copies of the front and back of the factura everything was ready to go, but now I am missing the Emissions Sticker!
Sure would have nice to know that while I was waiting for the factura to arrive, it could have been done any time.  So off I trapes to the nearest place and get the Emissions completed for another 250 pesos.  Return back to the Jalisco Offices and believe it or not I am ready to go now!  Paperwork approved and another 110 pesos for the filing fee, paid at the cashier.  
Now I must wait 2 weeks for a call from their office to tell me the 'paperwork' is ready for the license plates.  Why that could not all be done at the same time....who knows?   So upon my return another 2 copies of the US title, my passport, the legalization paperwork, and the infamous Factura are due.   I will write more in Part IV as soon as I get the call to return to the office.  Could that be the last part?   I certainly hope so!!

Car Legalization-Part II

Seems that things are always not as easy as the may seem in doing business with the governments of Mexico.  Thought I was all set to get the car registered today......but NOT!  I guess I am missing a piece of paper that is issued as an Factura (Invoice) from Hermanos Cuevas the import agency I used for the costs of the process of legalization.   Eventhough I have the receipt from the Banjercito Mexican Customs, that is not good enough!
So standing by, while I am to receive the Factura from them in the coming days!  I will keep you posted!