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Escazoo indeed! I fear I am a mutt among purebreds! Maybe I should consider a veterinarian…I am following Scott´s threads on the forum and starting with Dr. Loyola as a point of departure. I hope I don´t get trampled on by the hordes of medical tourists….I guess there is always the risk I could go into CIMA for a hernia repair and come out with a nose job!

[quote=”maravilla”]i can’t help you with doctors in the Escazoo area who are affiliated with Cima or Biblica because i live way up in the campo where our main concern is having a p.c.p. who is also affiliated with the CAJA. but surely Scott could recommend someone as he lives in that area and knows everyone worth knowing!! jejeje[/quote]

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Thanks again Maravilla for the most cogent advice. I hear you about the differences between BIG MEDICINE and more humane paths to total health sans the medicine cabinet. I know reducing body weight, more exercise and dietary sanity can help get the cholesterol bogeyman under control. In fact you are right, cholesterol can be your friend in the right quantities in terms of healthy body tissue. I take 3 grams of fish oil capsules daily (Omega 3 fatty acids) which seem to have a good effect on cholesterol levels and health generally. Anyway, can you offer advice about how to find a good primary care physician here? From what I have read on this forum, some affiliation with CIMA or Clinica Biblica seems prudent. As for the snakes in Washington DC, my only extrication was to head south to pura vida. I much prefer the snakes here in CR. At least they are honest and professional….and I think they enjoy their work. DC Bob

[quote=”maravilla”]getting the primary care doc here would be a good first step. i know lots of people whose docs here had vastly different ideas on how to treat their “condition” — and several people i know were given rx’s to go to a nutrition class to help with their diabetes and cholesterol problems. but in many ways, the docs here are locked stepped with Big Pharma the same as they are in the States. their usual first reaction to my cholesterol levels is to tell me i need lipitor. but when i point out that my HDL is 3x’s what the minimum is and is a number they can’t even achieve with drugs, they back off. i love my cholesterol!!! but then all they know about cholesterol is what the drug rep told them and now it’s coming out that the drugs may actually be more dangerous than the numbers they are trying to lower. and a change of lifestyle can really do wonders and that may have a really good influence on what you are being treated for. if you were in the snake pit, it’s time to extricate yourself.[/quote]

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Thanks David for the thoughtful ideas. This dialogue has helped me reshape my thinking about what is most important for my next steps when it comes to my health care. My top priority really should be obtaining a permanent primary care doctor here in CR to assess and hopefully redefine my medical regimen which may include a different medication protocol altogether. I am hoping for the CR health/well being dividend of my new life and lifestyle here. Figuring out the most cost effective strategy for paying for everything can come later. As I think of all the snake pit lifestyle environments I found myself in while I lived in the U.S., it is a wonder I wasn´t taking maintenance medication for snake bites!. Regards, DC Bob

[quote=”DavidCMurray”]As is so often the case, I find my self agreeing with maravilla and also disagreeing.

It’s certainly true that many generic medications are as effective as the brand name ones and can be had here, over-the-counter, much cheaper than in the U.S. But that’s not universally true. Some are not cheaper, and despite the claims, some generics are not bioequivalent to the brand name preparations, and generics are not available for all medications.

Likewise, the CAJA does provide medications for virtually all conditions, but whether they are the meds that are effective for your particular needs are another matter altogether. The medication that controls my diabetes is simply not available through the CAJA and my endocrinologist says that the one blood pressure med they provide is not worth taking.

It is true, of course, that lifestyle changes can make a real difference in one’s need for medication, but those changes are not always easy to make, nor are they always effective.

In the matter of obtaining one’s medications from a U.S. mail-in pharmacy (assuming you can get the scripts written), you must consider both the physician’s charge, the co-pay imposed by the mail-in pharmacy, and the costs and delays associated with actually getting those meds into Costa Rica. Despite using a few physician-prescribed meds, I’ve determined that the saving in importing them isn’t worth the headaches, so I buy everything here.[/quote]

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Thanks again Marvilla for your assistance. My situation is a little complicated but I will try to summarize. My real need as a mostly permanent resident of CR is to find a local primary care doctor who will attend to my health including prescribing of medications as necessary. I am not looking for a mere prescription writer, but I am trying to make maximum use of my U.S. health insurance coverage. I am retired from the U.S. government and the benefits include a generous health insurance coverage which includes federal contributions. I would be foolish to ignore that benefit. With respect to my residency status, I am cautiously waiting to see how the CR immigration regulations play out regarding the CAJA 13% of income contribution. It all depends on what the 13% is calculated from (gross, net or some other portion of my monthly income) and as far as I can tell that is not yet clearly defined. I now pay about $200 per month as my share of a very comprehensive medical insurance plan in the U.S. that I would be foolish to discontinue. That plan actually will pay a fairly generous reimbursement to me for medical care here according to a cost schedule for services. On the final point about drug cost comparisons, I ran out of one of my medications here and bought a small supply here as a stopgap until my Medco package arrived. After visiting the Walmart and a private pharmacy (Fischel), I discovered that they did not have a generic version of what I needed and I ended up paying $4 per pill.
I do not know how to say “sticker shock” in Spanish.
Regards, DC Bob
P.S. Medco will only fill prescriptions from doctors who have a DEA registration number regardless of the type of drug.

[quote=”maravilla”]if you haven’t investigated the cost of generic drugs, how do you know they will be 3 to 10 times higher? typically, most drugs are cheaper than in the US. are you not a legal resident? because if you were, you could use the caja system and get the drugs for FREE!! also typically, i know a lot of people who came here, changed their lifestyle, and no longer needed to take the handful of meds some US doctor rx’d for them. every time i buy something in the farmacia, i am amazed at the prices — a creme i use on my face costs $135 a tube in the US, not counting what it costs to see the doc to get the rx. here i buy it over the counter for $21. another creme i had to buy to lighten some pigmentation costs $50 in the states and $5.00 here. the DEA registation number is so a doc can rx a particular class of drugs.[/quote]

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Thanks, Marvilla and David. I could buy the medications here, but the cost to me could be 3 to 10 times higher even if I use generics. The Medco supplier in the U.S. is in effect subsidized by my medical insurer which in turn is supported by my medical insurance premiums in the U.S. I have not yet investigated the cost differential to buy in CR, but my roughly $50 per month out of pocket cost for 4 prescription medications could rise to several hundred dollars a month here. Not necessarily a budget buster, but I already pay for my insurance coverage in the U.S. and my personal purchase here would be the open market price. I would be interested in being able to contact your physician David if she agrees. DC Bob

[quote=”DavidCMurray”]There is, in fact, a U.S.-licensed physician living in the San Jose area who has reviewed my medication regimen and written prescriptions for me which Medco has honored. I’ll contact her to see if she wants me to make her name known.

If she agrees to be identified, I’ll forward her name and contact information to you if you e-mail me at: daveandmarcia@gmail.com.

That said, I tend to agree with maravila that buying locally is much less complicated and maybe less expensive. The combination of Medco’s co-pays and Aerocasillas’ charges have convinced me to buy everything but my glucometer test strips here in Grecia. The test strips I use are not available in Costa Rica.[/quote]

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Thanks. I like the sound of cola de gato. Where do you buy seeds locally? I have seen a seed store in Escazu Centro a block east of the iglesia, but can´t seem to find what I want.

[quote=”costaricafinca”]I have many varieties of hummingbird seeds avaiable, including many varieties of Salvias and although they are used extensively in North America they are not the plants of choice here.
BTW the annual salvia available here, are not hummer favorites. We get twelve varieties of hummingbirds throughout the year.
Other plants, native to Costa Rica are what the hummers prefer, Stachytarpheta frantzii, Portersweed or locally called ‘Rabo/cola de gato’ being #1
If you can, purchase a book by Michael & Patricia Fogden, “Hummingbirds of Costa Rica” and look at the plants used by the hummers.
My first Ruby-throat migrant arrived yesterday!:D[/quote]

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Thanks again Maravilla. I will try the Koenig bread flour. I will also order the salvia seeds and reserve a package for you as the reward winner. I will check with Scott Oliver about how to get them to you. For the WLCR forum members who are friends of hummingbirds in CR here is one link to a salvia seed supplier:
http://www.swallowtailgardenseeds.com/annuals/salvia.html
DC Bob

[quote=”maravilla”]i totally understand the food obsession! Koenig flours are available in macrobioticas, and i think they also have a webpage from which you could probably order products. If not try Belca Foods — they are like Sisco in the states. as for the salvia seeds, a bubble envelope would work. i’ve sent as many as ten packets of seeds to a friend of mine here and customs never opened anything and it had a custom’s dec on it saying it was lettuce seeds.[/quote]

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Thanks Maravilla. I don´t know Koenig products. Where can I get them? Alas, in retirement I have these obsessions for things like Italian 00 semolina flour for the perfect Neopolitan pizza that do not stand the test of cost/benefit analysis except perhaps for the RT ticket price from SJO to Naples. I will try the Koenig flour if I can find it. With respect to the seeds, you raise a technical question that will keep Aerocasillas management up late at night. A package of salvia seeds could fit into a standard 1 ounce letter so I could send through Aerocasillas with nary a look from CR aduana officials. If I send as a parcel, then it must go through customs and that is where I don´t know the result.On a technicality (you are the first responder)you may qualify for the seed package reward. Thanks for your interest. DC Bob

[quote=”maravilla”]that will be the most expensive loaf of bread you ever baked. by the time you pay normal shipping to florida from italy, then pay Aerocasillas and the customs duties, you will not be able to afford to part with the flour to bake bread!!! Koenig has very good bread flour here. i wouldn’t spend the money it’s going to cost to order if from abroad. as for the seeds — hmmmmmm, have them sent direclty to your PO box.[/quote]

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[quote=”Disabled Veteran”]As an additional suggestion. “Pura Vida orgasm,” with rum, passion fruit, mango, pineapple and mint.[/quote]

Concept has a good feel to it, but could be a little dicey with the government tourism folks…Even Mexico has its own favorite cocktail but with a more family rated air:

http://seattletimes.nwsource.com/html/restaurants/2015078673_happyhour18.html

P.S. Does Fidel Castro ever drink a Cuba Libre?

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[quote=”DavidCMurray”]DC Bob, you wrote,”
I have given up trying to be creative with the Pista del Sol Avalanche and decided to go with common Tico practice: A used large McDonalds cup with ice and an Imperial and a splash of Cacique….gotta go with the old saying, “if aint broke, don´t try to fix it”

To this I would add a tablespoon of Tang for that extra measure of authenticity.[/quote]

Good idea David, but we must be careful about turning a national cocktail into a food group…Bob
P.S. If we go in that direction (real nutrition not merely diversion), how about a Bloody Lizano? (tomate jugo, tequila and a dash of Salsa Lizano with limon and a sprig of culantro). For a real meal, how about Pura Vitamin? (serving of ceviche mixto with 2 ounces cold Cacique and culantro sprig). I just read in AMCOSTARICA that gringo tourists in CR are declining in numbers and making a national cocktail a new sport could reverse the trend.

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[quote=”johnr”]In Ocotal at Father Rooster’s they have a house drink called the Tica Linda. I don’t know what all is in it but I do know my headache usually beats a 6 on the richter scale on Sunday mornings after a couple. Needless to say you sleep very well – even if the electicity is out. 😆

Perhaps someone can get the secret recipe and this can serve as the signature drink of the entire Rim.[/quote]

Seems to distill the flavor of Costa Rica…good candidate for signature CR national cocktail….when I was working on the Temblor Tumbler, I thought a good marketing slogan could be “Sharp jolt with only minor damage reported”, but that might fit your Tica Linda better…

A visit to Octal seems in order. Bob

P.S. Your last comment about electricity invites another concoction named “CR ICE Out” in honor of the beloved power utility.

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[quote=”baontheriver”]How about a drink called “The Volcano” with fresh fruits blended with rum and ice until it can be peaked in a glass and grenadine poured over the top.[/quote]

Sounds very tasty…could be a real crowd pleaser with an added chip of dry ice to simulate Poas-like venting.

I have given up trying to be creative with the Pista del Sol Avalanche and decided to go with common Tico practice: A used large McDonalds cup with ice and an Imperial and a splash of Cacique….gotta go with the old saying, “if aint broke, don´t try to fix it”

Keep the creative juices flowing so to speak. DC Bob
P.S. a little playa sand will add authenticity

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[quote=”Scott”]Love your sense of humour ….

Does anyone else have any other suggestions?

Scott[/quote]
Scott: This is serious business! Do you know how much the Nawlins hospitality trade makes off the sale of Hurricane cocktails and those dumb looking bulbous glasses made in China? It could erase the Chinchilla deficit…..without much threat to public safety. Thanks for the comment. Bob

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Thanks everyone for the information. I will try out some of the suggestions. Bob

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Be comfortable with being well intentioned but only partly wrong…Please put your energies in more important directions like price fixing in the guaro industry…I was in Puntarenas yesterday looking at the drill ship….very interesting and sitting deep in the water (lots of fuel and ballast for stability at the sea surface for deep drilling)…passed some GOM (Gulf of Mexico) tatooed roughnecks heading out from the pier asking where the Hotel Del Rey could be found…Some things are universal…

[quote=”Scott”]I will be genuinely thrilled if I am proven 100% wrong…[/quote]

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