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5 posts from December 2013

December 30, 2013

I tend to stress about things a bit

from time to time. I take a seemingly innocent pain or pang and despite my best attempts, somehow turn it into something that it's not.  And having the ability to search anything night or day on Google doesn't help when you are trying to avoid that which has got you a wee bit scared.

About three weeks after we moved here, I began to have a crazy back pain. I chalked it up to a bad mattress (ours hadn't arrived yet, and my back just can't handle firm mattresses) and realizing the a/c was directed right on my spine. I switched sides of the bed, ordered a tempur-pedic like mattress pad, and the pain slowly started to go away. In fact, the only time it really returned would occur when I was attempting to do a back bend of sorts during yoga.

One friend wisely suggested I quit trying to do back bends (and also suggested I avoid Google...well, 1 out of 2 isn't bad) while I tried to figure out what was wrong with my back.  The pain never completely went away, but only occurred at certain times. It wasn't getting any worse, didn't prevent me from running or other exercise, but it was still there when I moved certain ways.

Finally, one day I got up the gumption to go to the health clinic. I figured given it was likely not something horrible, maybe I should figure out what it really was.  I was given a quick exam, briefly expressed my worst fears, and it was suggested I get an x-ray as that might help determine what it was.  Of course, it was assumed that I just had a back issue related to a slight scoliosis, but what exactly was it?

So, that afternoon Peter and I headed to the imaging center and for a whopping $60, I walked out with several x-rays of my lumbosacral region.  While it only took an hour, it was a stressful hour as I feared the worst.  When I was first taken back to the x-ray room, I was so freaked I didn't catch everything the technician told me.  Luckily, I quickly figured out I was supposed to change into the gown hanging on a stand.  I only screwed up once by putting it on backwards.  Well, until I tried to stand for the x-rays.

The technician told me to point at my belly button, and I did. However, he wasn't thrilled with the way he was pointing (or maybe didn't believe the location) and called Peter into translate.  That didn't change a thing, but I felt a little better on the off-chance he asked for some crazy position that would require a dictionary for me to translate the request.  As the technician ran off the first time to hide and snap the x-ray, shouting "No respire! No respire! No respire!" I just suddenly couldn't help but think of people who visited the States without having much English.  

While I understood enough of what he was saying, I could only think of those who might be in a similar situation, but not understand what was going on...or not have insurance and thus, not know how to pay for it.  He kept changing my position, running and hiding while shouting "No respire!" and I continued to think about scary medical situations in foreign lands, as it was less frightening than what I was stressing over.

Finally, after an hour, we were headed back to the Embassy.  The x-rays were reviewed and while I understood the commentary on the diagnosis sheet, it was helpful again to hear that there was likely nothing wrong with me other than old age.  However, since it was only an x-ray, there are certain things that would not show. 

The offer of an orthopedist was out there, and since visits are but $40 (yes, for a specialist), I opted to go and just get a definitive diagnosis.  A week later I found myself in his office.  I explained my basic history, he did a quick exam, and then he asked a more thorough history and I had to discuss, well, that of which I don't like to speak. Thankfully, it was a short conversation and he said he was sure nothing had anything to do with that, but an MRI would likely show exactly what was going on.

At first that seemed logical. Yes, an MRI. Of course, it will show any issues with my spine and that will be that. It wouldn't be anything too scary and then I could get going with physical therapy.  Then it hit me I better check the price of said MRI, since we have to pay out of pocket and then be reimbursed.  Then I realized that I also needed to ensure that we didn't need to precertify AND that we would absolutely be reimbursed...as in, was the reason good enough to get reimbursed?

I set up an appointment for the day after Christmas, and a few phone calls confirmed that there would be absolutely no issue getting reimbursement for the test.  We even took names down just in case, but everything indicated it would be fine.

Finally, the 26th arrived. I'd spent the 25th halfway enjoying Christmas and halfway fearing the next morning.  I was not fearing the MRI itself, but what the results might say...and I'm not the sort of person who generally shares these fears in advance with anyone (except a few people, like Peter, poor guy). After my worst fears were realized three years ago, it's hard to believe that any test will ever fall in my favor again (the fear lingers even though I've not had an issue since).  We arrived on time, only to find there were several emergencies ahead.  

Two hours later, we were called back by a delightful technician named Edwin.  He was cheerful and chatty and loved discussing his training time in the U.S. He set me up in the machine, and 5 minutes later I was slowly being encased in the tube.  Now, I've only had two MRIs before in my life, and I guess I've been lucky enough to have the open MRIs.  I never understood the issue with claustrophobia before last week.

Now I get it.  The minute he sent me up in the tube, I started a mild freak-out. He asked if I was okay, and I lied and squeaked out a feeble, "Yes!" just so I could get the test over with.  I realized things were much better if I just closed my eyes, and managed to soothe myself into a nap of sorts.  By the time the first set of clanging came through the headphones, I  was nearly asleep.  I kept dreaming odd dreams, as one would expect, and would wake up reminding myself not to move.

Finally, much sooner than I expected, Edwin called out that the test was over and I had done very well.  Guess the twitch in my leg towards the end didn't affect anything after all.  He then stated that my resultados would be ready the next day after 12 p.m.

Despite our best efforts, we could not get an appointment with the doctor over the phone so that I could just get the review of the MRI completed.  After work on Friday, we headed straight to the imaging center. They had already shuttled the results off to the doctor.  We had a lucky moment when we headed up to the office and one of the few secretaries in the office was his.  She managed to get an appointment for Saturday a.m., and we headed home so I could stress some more and Google more nefarious diagnoses.

Saturday morning came and we had back and forth with Nick as to whether he'd go with us or stay home with the sissas.  I was so nervous, I didn't care which, but realize if something was really wrong, I'd prefer he not be there.  He ended up opting to stay home and we hurried to the hospital. The doctor wasn't quite there yet, but arrived quickly after his secretary called him.

We sat in the office and he started reviewing the MRI charts.  I did the worst possible thing of trying to look at them at the same time and silently freaked out, even though nothing (to my not-so-knowledgeable eyes) appeared askance.  Well, not in the way that I fearedc.

Finally, as the doctor was reviewing the films with us and going over the physical therapy I should start (for being, well, for lack of better terms, old and fat), I said something like, "So, there's nothing weird in there?"

He then said, "Oh, no, there are at least 3 weird things here!" and started showing me the areas that were not in such fabulous shape.

Peter then finally broke into the conversation and said, "No, she means there's no...(insert scary word here)!"

The doctor just looked, shook his head and sort of laughed.  "No, no, no, nothing like that!"

And there we have it. I'm old, need to lose weight (duh, but since I'm still having pulled muscles from last summer's surgery, insanely vigorous exercise is not terribly easy), and I have a bad back.  I'll start (inexpensive, I'm sure) PT soon, make sure I spend half my lunch hour at work doing something active, take up tennis again, get more massages,  and will soon (two weeks, maybe?) be able to swim on a daily basis in my own backyard.

More importantly, I haven't Googled anything in the past 24 hours...well, anything medical that is. Now if I can just keep that up for a very, very, very long time.

December 24, 2013

Christmas Spirit

Last night, as I was wrapping gifts, I remembered that Nick did not have anything specifically for Kelsey. Sure, he could add his name to our gifts, but it's always nice to have a little something from him.  I somehow completely blanked on shopping, and while it would have been ideal for him to find something at the holiday fair, I didn't think about it until it was over.

Today as I was working in the office, he popped in with a wrapped gift and said, "Look! I'm giving this to Kelsey!" He had found something of his he thought she would like (I'd said nothing at this point), went into my room, and covered it with bits and pieces of leftover wrapping paper (those scraps always come in handy).  He taped it up, and brought it into me to ask for help with the card.

I folded the paper for him and he wrote out the card, taped it to the gift, and put it under the tree.  I know what he gave her (no worries, nothing living), but won't spoil the surprise.  I can't wait to see the look on her face tomorrow, as it's interestingly enough, not terribly different from her gift to him (already wrapped, under the tree, and sparking many questions from Nick).



How I love the creativity this time of year inspires...

December 21, 2013

Nothing says Christmas like

a real tree.  The beauty of nature in one's living room, even with the occasional shedding of pine needles, has no comparison.  I vowed early on that I would always have a real tree for Christmas, no matter what.  There was nothing like walking into a house with a real tree that just imparted the Christmas feeling.

We have only broken that vow once, when we acquired a tree from the base in Reykjavik for Christmas 2005.  It was last-minute, and as I was terribly sick and grief-stricken, my only thoughts were of not really wanting to deal with Christmas either way.  In addition to being a 110 tree in a 220 country, it was a pain in the rear to put together and take down.  It just screamed "fake tree" and we donated that sucker as soon as we remembered to take it down in February.

We deliberately did not bring an artificial tree to post with us, as we figured either we would A. find a real tree somehow, B. travel locally for Christmas and not bother, or C. if truly desperate, buy an artificial, but only a used one.  Artificial trees just have so many chemicals in them that make them flame-retardant, that I really don't want one around unless we are truly desperate.  Even then, I'm thinking we'd just do without or find some kind of real alternative.

Luck was with us and we learned in the early fall that our favorite organic market sells trees each year.  We had to wait for our tree stand to arrive, but we are not early tree people anyway.  The stand arrived this week, and when we went to pick out a tree, we learned a fresh batch would be in by Friday.

Last night, we headed over to the market.  The actual tree saleseman was not there, but we were able to put a hold on our favorite tree to be picked up today.  It was not too large or heavy, and looked like it would fit perfectly in the back of the car.  Peter and I enjoyed a leisurely dessert (is there anything better than passion fruit mousse?) and glass of wine and then headed home.  

While we all all would have loved to return to pick up the tree, it's a good thing we didn't.  It barely fit in the car with only Nick and Peter inside.  I was woken up by Nick upon their return, "Hurry, mommy, hurry, you've got to see what we did," and surprised by the tree being perfectly set up in our living room.

Normally, we always put non-Santa gifts under the tree as soon as they are wrapped. However, the kitten has already scaled the tree once, and declared war on the pine cones in a table decoration...so we will have to see.

A few hours and only one collapse later (turns out Peter had forgotten to lock something), the tree is up, lit, and fully decorated.  The scent of pine is filling the air, the needles that fall can be swept outside, and when all is said and done and the 12 days of Christmas are over, the tree will be properly composted.

I don't know that we will spend Christmas at home each year while posted here, but 'tis so lovely to know that while we are here we do have the real option....

December 19, 2013

Call us medical

expats, if you will.  Or, really, dental/orthodontic expats would be more accurate.  We didn't bid on Managua knowing how inexpensive, yet good, the dental care would be, but it's definitely something we will keep in mind for future bidding.

We've known for a while that at least two of our three children would need braces at some point in time.  Kelsey still has a wee bit of time, where as Caitlin was nearly over due by the time we moved here.  She was close (but not quite ready) in California.

Then we moved to Virginia, Peter went to Iraq, all you-know-what broke loose, he came back and that was the end of that.  I was lucky to get the kids to the dentist (which nearly required valium for me, as it turned out Nick liked the dentist even less than the lady who cut his hair), and I completely forgot about things like well check-ups and such.  Thank goodness the kids have immune systems like rocks from all of that rolling in the dirt and such.  The dentist we finally stuck with (Nick finally liked) noted that Cait was finally ready for braces some time during our second year in VA. This was all well and good, however, braces are notoriously expensive.  When you are still recovering from a year of lost extra income and dealing with unexpected medical issues, braces aren't something you want to think about.

We did have dental insurance, but had not yet come close enough to being able to use the orthodontic portion (and, of course, now they've cut the waiting period in half), and FSBP only covers so much.  Then we started to think about the possibility that we might have to wait, no matter what, as we knew we would be moving and that any work on Cait would take at least 2, if not 3, years...time we no longer had in Virginia.

We ended up finding a great local orthodontist in Falls Church.  Cait went to see him twice for thorough exams and just as I was trying to calculate exactly how much we would have to lay out for braces, the doctor came to the conclusion that while it wasn't spectacularly ideal, it would be far better to wait until our arrival in Managua.  We could have one doctor see Cait through the whole deal, and we had started to research the issue and noted that prices seemed to be a bit lower.

Now that we are here, I can say "a bit" doesn't cover it.  Without even submitting our claims to our regular insurance company, our maximum yearly dental exam bill (2 times a year x 5 people) would be $300/year.  Subtract out the insurance paid, and it will run us about $60/year out of pocket (which will be paid from our health FSA).  

Given that we were so close to being to the end of the waiting period, we opted to start Cait with the orthodontia.  We then asked the price and without batting an eye, the dentist said, "$1600.  You pay $300 down and then $54/month for 24 months."  I repeated the information back to her with a stunned look and she had the look of understanding.  She knew we were used to the higher prices in the States, and like many, were surprised that something like this could be so affordable without insurance.

Then I started thinking about the dental insurance we had planned on keeping.  I did the math and realized that we would pay more in premiums over one year, than we would for Cait's braces (paid over two).  Additionally, our regular health insurance will cover the cost of the first $1000 of Cait's orthodontia.  In the end, we will owe $600 out of pocket, all of which will likely be paid from our FSA.

It didn't take long for us to realize that given it was open season, we needed to make a few decisions.  After taking another long, hard look at the numbers, we opted out of dental insurance for next year and likely won't think about it again until we go back to the States (and even then, we will have to really run the numbers).  And the irony of something so basic (good dental and orthodontia) being so reasonably priced, is not lost on me.  As much as we think of the U.S. as being so advanced, they have a lot to learn about reasonable pricing for medical care, as well as dental.  Even a recent trip to the ER (an hour long visit) only ran $69 (which is less than our co-insurance payment in the U.S.).  

After we received the quote, we set up a visit with the orthodontist.  He did a tiny bit of preliminary work two weeks ago, and then today was the big day:  the braces.  I figured Cait didn't need me pacing in the waiting room, so I grabbed lunch across the street.  Thirty minutes later I returned, and 5 minutes after that, she was completely ready to go.  I knew it would be fast, but that was ridiculous.

During that last 5 minutes, I signed the paperwork, paid the cash down payment, and received the receipt that, when we returned home,  I promptly filed online with our insurance.  We will go back (for now) monthly, have the braces checked, and pay the $54 fee, providing there is nothing to be fixed (broken brackets, etc.).  She's not entirely thrilled, but we are ecstatic, knowing that instead of stressing about paying (egad) I don't know how much for braces, that money will instead be put in other savings accounts.  Her teeth will be nearly perfect, and our wallets still intact thanks to the low cost and being able to save $1600 plus a year on dental insurance.  And we are also thinking that Kelsey should be ready soon, so might as well take that plunge, too, while we are here...


A rare photo of Cait smiling with the new jewels. The photo cost me a chocolate muffin, but worth it for the smile.



December 08, 2013

I'm not a Black Friday kind

of gal. The idea of getting up any earlier than I absolutely must to buy stuff I don't need at prices lower than regular price just does not appeal to me.  Even if we were in the States, I can't imagine wanting to stand in lines like that (or deal with such crowds) for any reason.  And when you are living in a developing country, you quickly learn to redefine "need."

We might want a grill for our outdoor patio, but let's face it, that's a want.  Our kids might each want their own iPad (an example, no one has yet asked), but that's so not going to happen, since they each already have computer access when they need it.  I want new cookware, but other than one particular pan, do we really *need* it? No.

Hence, I find the race each year to the stores to be entertaining at best.  Quite honestly, I don't even know what people could want to buy. We had Black Friday sales here (which lasted all weekend), which I found to be just bizarre.  If anything, seeing the spread of the idea is just depressing. Then there is the whole Cyber Monday idea and the shopping just never ends.  Occasional shopping I certainly understand, but this manic-crazed thing is just not my cup of tea.

Instead of making me feel better about the approaching holidays, it's just seems rather sad to me. I'm reminded of my mom, who was so good about buying gifts all year round, really finding unique items that people wanted, catching every hint, and then squirelling things away until it was time to start wrapping.  She thrived on real craft fairs (hand crafted wooden items, pottery that had been lovingly shaped, glazed, and fired, and the like), and managed to find exactly what folks wanted and needed.  Oh, sure, she still shopped traditional stores when need be, but took her time and still managed to find the perfect gift for everyone, even the year she died.

To give myself credit, I tried.  However, after she died, Christmas lost a lot of its luster.  To this day, I still randomly find myself in a market thinking, "Oh, that would be perfect for Mom!" and then it hits me 5 seconds later that it just doesn't matter. After a few years, I finally started to get back into enjoying the holidays, until fall 2010 hit.  Christmas again took a blow, as it's very hard to enjoy when you are in the midst of recovering from something you shouldn't have to deal with, ever.

Each year has gotten a bit better, but even with Peter home last year, it was still stressful as he was absent during so much of the 'prep' time.  I found myself doing  a lot of last-minute shopping (which I loathe) and vowed it would be different this year. 

Unfortunately, this year I've been thrown off by a new schedule and a lack of seasonal changes.  The schedule I can deal with, but the lack of seasons just throws me off.  While it's nice to know that we may be able to swim outside on Christmas afternoon, it's hard to get into the mood hearing Feliz Navidad in the stores while I'm wearing shorts and Tevas.

Then last Friday rolled around....it was the much-anticipated holiday fair that was put on in the Embassy by my office.  I can officially say that as long as I have this fair to look forward to each year, I will have no problem getting myself psyched up for the holidays.  We had such an amazing range of vendors, from local smokehouses to those who made adorable hair baubles for wee ones to absolutely amazing handcrafted wooden creations.

Finally, gifts that I know cannot be duplicated, and not only would they not break my wallet, they would help fill someone else's.  From the father/son duo making the wooden salad bowls that would run close to $100 in the States, to the handmade pine needle baskets, we had so much choice.  Suddenly, I was not only glad that had brought my shopping basket, but wished I'd thought to bring a few more reusable grocery bags.

Here are just a few of the samples from the day...and just think, if you visit, I'm sure we can arrange for you to meet with any one of the vendors, should it not be fair time.

Teachers' gifts, homemade marshmallows, and a pine needle basket from Fabretto.


Handcrafted leather purses. Think similar to Coach, but with one third of the price tag.

I misunderstood the propietor at first and thought he said, a pair of hand-carved earrings would be $50. Nope, 50 Cordobas (local currency), which equals $2.
Hand-made barrettes and headbands...utterly adorable!


The paintings and designs were all created by children with disabilities and are available for sale year-round at a local children's hair cuttery.
More leather goods...
We might have purchased a set of salad bowls...
Pine needle baskets made by women in the Pinos Fabrettinos initiative.
Nica HOPE jewelry is made by children who benefit from Fabretto's programs. You can read about some of the artisans here.

If you are enchanted by either the jewelry or the pine needle baskets/coffee, you can see more online and purchase from Fabretto!  Click here and you can see all of the items available for purchase.  Oh, and, yes, we might have been a bit selfish...we did buy ourselves an early Christmas gift, but at $38 for the whole set, just couldn't pass it up.



Christmas shopping that gives in several directions and far more directly to those who need it.  Unique items that can't be found elsewhere...did I mention we also have a spring fair?  Just saying....