Mfiorito87's blog

Trip to ED in Brazil

(Long post) Had my first experience going to the ED at hospital in the middle of nowhere - in Bahia, Brazil. Have a known kidney stone (ok it's been there for a while I just ignored it - hematuria since August that I blamed on rhabdo while training for marathon, groin pain attributed to psoas so was going for massage and was doing stretches. Finally a couple weeks before my trip to Brazil I had horrible urgency and finally went to urology and found I had a 3mm stone in distal ureter. Duh! So massage does NOT work for kidney stones! Pain wasn't really an issue just always felt like I had to urinate. Still ran the marathon and managed to PR (3:35). Usually book a surf trip after running the marathon as my reward and is a good way to recuperate. Decided might as well still go on my surf trip since the stone has been there for months, what could go wrong? Brought some various meds including pain meds, zofran, flomax just in case. Say what you will about flomax but when you are desperate you will take whatever you think might help even if a slim chance of helping.

Woke up yesterday at 3am with horrible flank pain, took every med I had and things only got worse. Probably vomited up half of the meds. By 6:30am I was desperate and started calling/texting people I knew to help get to the hospital. In the end, the husband of the manager of the hotel came and took me to the hospital. Walk in to the "ED" and hear in Portuguese that there is no doctor. I assume in my pacing and writhing that I'm hearing this wrong. Hospital is very tiny, only a few beds, mold on the ceiling, not looking very promising. They make some phone calls and get a dermatologist on the phone who spoke with me briefly on phone and ordered some toradol and scopolamine. The "nurse" tries to get a vein despite me having good veins and has trouble and then says the nurse just arrived so she will have her try. So have no idea who was sticking me but would have let her try all day if I had to. Got the meds and felt better but pain came right back. Marcia from the surf camp shows up to stay with me and helps translate. So grateful for her coming to stay with me! Not sure what I would have done without her! She gets a local doctor on phone who calls in some orders. They put an IV in this time and give me fluids and more meds and it takes a while but feel better again. They ask for a urine sample for Ua/micro and cash upfront (about $2). Am given a website with code to review the results when ready - why isn't this a thing in the US??? But I still have not seen a doctor while in the hospital. Was explained to me the local doctors used to all work there but the government decided to hire its own doctors. And on cue an older gentleman with wild grey hair, wearing jeans and a white coat walks by and says "do you like tomatoes and rice?" I'm so confused. I understood the question in Portuguese but not sure how to answer. I'm not hungry if he's offering and otherwise the question is too bizarre. He assumes I don't understand and talks to Marcia and she translates with a strange look on her face. She translates that if I eat a lot of tomatoes and rice I will keep getting this pain. I assume he thinks my left sided colicky pain is diverticulitis?? Luckily he is not my doctor. She then proceeds to explain this is one of the government doctors that works there but he is trained in psychiatry. Thankfully I arrived before he came in for his shift!! It is explained to me that I have an appointment to have an ultrasound and then to see a local doctor (who had ordered everything by phone). After the fluids are done the IV is removed. I'm petrified the pain will return but go with the flow. I get to the private clinic (cash upfront for visit and Ultrasound: $80) and go fairly quickly to ultrasound suite which is surprisingly nice. There is a patient screen in front of me so I can watch the ultrasound. There is a radiologist doing the ultrasound which blows my mind. He knows I'm a doctor so explains things as we go along, no hydro (which surprises me), he gets close to the bladder and I think I see a stone but I think how he could he possibly find the stone. He traces the ureter again and it goes to the stone at the UVJ. Measures at 6mm which makes me wince a bit. He prints out the images and passes them off and then back to the waiting room to see the doctor. See the doctor in the clinic and she writes me for pain meds in case pain gets bad again. Recommends flomax but says is difficult to find in Brazil but is happy to hear I brought my own. And also writes a script for IV setup with fluids which I can collect at pharmacy. If pain gets bad again, they can send a nurse to me to the put the IV in and give fluids and meds so I don't have to go back to the hospital. What a great approach! Overall a positive experience but if I had an emergent issue - no doctor in the hospital is quite frightening! Was told by locals they would drive an hour away to bigger hospital when possible. Spent another $40 at the pharmacy for a ton of meds I hopefully won't need but since I'm here for another few weeks gives me a little piece of mind. $120 is quite a bargain for everything compared to the thousands that would all be in the US. My outpatient stuff from home (CT, UA and 2 urology appts -the total bills, preinsurance was almost 10k). Insurance companies should pay us a bonus to get care outside of US.

Took a couple doses of pain meds last night but this morning am feeling good. No pain today. Didn't eat much yesterday so I woke up starving and ate a huge breakfast. Skipped surfing today  so I could continue hydrating. Hopefully back to surfing on Monday!

Italy day 1

So day #1, landed at 9am, a bit exhausted. Taxi drops us off and says go down that alley and take the second right. Darn pedestrian walkways. We walk and look and look for a sign for the b&b but there is nada. Go to a cafe and ask and they are like it's right there pointing across the street. Still see nothing and walk down the block dragging our suitcases down a cobblestone road. Ask someone else and he is like um, you have the street address have you looked for the number? Duh, no hadn't thought of that, gonna blame that one on being tired. So we finally find #19 and it's just a hotel name next to a buzzer, no sign and it is directly across from the cafe just like the girl said. Rang the bell and someone finally answers and let's us in and we climb to the 5th floor with our suitcases (according to the taxi driver I had the woman's suitcase because it was so heavy....packed running stuff too!)

Owner initially not there, another guest had let us in. Wait about 15 min (we were a bit early) and the owner shows up, doesn't really speak English but luckily speaks great Spanish. But the rooms not ready so out we go exhausted to see the sites. Feeling a bit like a tour guide but I try to give options of things to do so i feel a little less like a guide. It's funny how well I remember Rome, it's been a few years but I remember different restaurants we (me and jaime) ate at and know some vague directions to things.

So we started our tour with a leisurely walk thru piazza navonna and then to campo di fiori, stop for some cappuccinos (the first of many in Italy). Then to ponte sisto and across to the neighborhood of trastevere. Then looped back to the pantheon and instead of wow look at that, my dads response "wow we can just walk in here for free, that's why Italy is broke."

On a side note, I think once you hit over 50 the concept of how to convert euros to dollars is almost impossible. I almost made my dad a little cheat sheet...but that wouldnt have even helped. He asked me multiple times how many dollars would 7 lire be....I reminded him it was the euro and thought he got it until we went by the produce market and it was 5e per kg. He was like how many peaches do i get? After I explained he would also have to convert kg to pounds, I think he just decided he won't be buying anything in Italy.

My dad was getting pretty tired so we stopped for gelato and then back to the hotel for a nap. I have never seen anyone fall asleep so fast in my life.

When he wakes up think we are going to do a nice dinner and turn in early.

Brazil days 10-14

My last week is coming to an end. It has been a great time all around. People often think Im strange for taking vacations by myself, especially family. I don’t mind going with other people but they are often very excited about planning a trip and then at the last minute when its time to book they drop out. So while I don’t mind travelling with others, it also doesn’t bother me going alone. I have gone on several trips by myself and met some great people along the way. My last trip in april I even met up with 2 people I met on a previous trip (Lauren and Jennifer). Just like previous trips, I met some great, friendly fun people to hang out with on this trip.

The other thing people find strange is the vacation that is physically exhausting. There is nothing better at clearing your mind from work/home then putting your mind towards something fun and active. So while I will return home sore/tired, I will definitely be in a better mindset getting back into the work routine. Work was getting a bit tedious the last few weeks – it’s the lull before all hell breaks loose for the winter and all the psych patients and drugseekers were out in force. The only time Ive really thought about work was when I was trying to plan my next vacation request for maybe feb. I have a few friends that’s might also travel during that time so I will wait a little bit before I book my own trip to see if dates can be matched up. Otherwise Im booking on my own again. One of the guys (Sherman) who is here now may also come back in Feb so it would be cool to meet up again. He quit is job and travelling for an undetermined amount of time…..so jealous!

I think I’ve found a new favorite place to come surfing. Brasil is so laid back….ok I hesitate everytime I type Brazil/brasil. Here they spell it with an S which looked weird to me when I got here….now the Z looks off to me when I spell it that way. Anyway, you can walk down the street and there is no one yelling to get you into their store or to get you in a taxi. You go into a restaurant and the pace is generally slow but you will never get rushed out the door….I think you  could sit there all day if you wanted. Not like at home where they are shoving the check at you and cleaning the table to say hey time to go. The beaches are beautiful and clean. Everyone is really friendly.

My arms are so sore from surfing but I cant believe how much my endurance has improved each surf trip. When I first took surf lessons, I needed a couple days between each lesson to recuperate. I was so frustrated at how out of shape I was. Then came the personal trainer, with the goal of surfing in mind. Each trip I have gone on has been better and better. Last year, day 4 was the day I needed a break. This time around (other then the built in Sunday off), I only took a half day off (did a half session). My paddling and balance is much better. Thanks Bobby for all your weird exercises you came up with to help with my surfing (without a pool).

Yesterday we went to Itacarezinho to surf. The beach there goes on for ever. As we arrived the waves did not want us to paddle out. We kept waiting for a lull but it seemed it never came. We immediately missed our nice channel to get out to the waves like at engenhoca. Finally after some persistence we go to the outside and took a rest sitting on our boards. You look back to the most beautiful scenery. Behind and to the side are mountains covered in trees that end abruptly in a cliff face that drop right into the water with the waves hitting them and making an almost eerie mist. The beach itself just seems to go on forever in the other direction. The waves were a bit steeper, faster and stronger at this beach so it took a little getting used to. You had to stand up and turn almost immediately or before you knew it you were at the bottom of the wave holding on for dear life fighting with the foam crashing behind you.

Today we are going back to Engenhoca to surf for my last day in Itacare’. Tomorrow Im off to Salvador. I would have had a 6 hour layover so I decided to just stay overnight and explore the town and to relax a bit. I made sure to book a hotel that had a pool. It also broke up the flights a little bit. It will be nice to get a little break. The last few days Ive had a cold, actually the first night it started I thought I had dengue. We were out at dinner and I started getting a headache, really sore all over and a little lightheaded. Thought I was just dehydrated so I went home early and then realized in the middle of the night I had a high fever. High fever, headache, muscle and joint pains = dengue right?…..the next day I felt better, fever went away and had some URI symptoms so its just a cold but that night I really thought I had dengue!

I’ll do one more quick update after Salvador with some new photos. I already prescheduled a massage online for Phila massage for when I get home. I know after the long flight it will be even more needed! The massage here are more the relaxation type massages, they do nothing to help with the post-surfing muscle soreness. I had prebooked my package with them included but wish I hadn’t because I hear there are much better places to go in town then the one thru the surf camp. Think next time I will stay at http://www.ilhaverde.com.br/ ,its closer to town and apparently a lot cheaper and a bit nicer. The place im at (girrasol) is nice but its across from a non-surfing beach (which I never have time to go to except on Sunday) and has a longer trek to town on a dirt road. I think Im paying more here because of the beach access but it was the place included in the package. So next time around it will be much cheaper booking things on my own separately and I have my visa already which is good for 10 years. Definitely will be coming back. Hopefully in Feb! Have to get ready for surfing....hopefully a good last day!

Brazil days #5-9

Have found myself falling into a bit of a routine. But its a great routine!

Breakfast at the pousada. I usually get an omelet and then try some the various breads and fruit. Fried plantains are awesome. There are these round little breads which appeared the one day - they are basically homemade cheese balls! They are so good, I actually cleared out the basket this morning. I also tried Acai juice which is nothing like what we get at home. But thats to be expected when they make the juices fresh from the actual fruit each morning. If there arent too many people at breakfast they will let you pick what juice you want. So among the choices was cacao (apparently Im staying on the cacao coast). So I ordered it maybe expecting a hint of chocolate but nope not at all. The cacao fruit is just a fruit. Made a very mild flavored juice, nothing real exciting. 

Next is surfing for 4 hours with a couple breaks to rest. Saturday I was feeling really tired and sore but I still had an awesome day (best so far). Was catching waves pretty consistently. The instructors are awesome. You could catch a great wave but they will still point out ways to improve- they will say great wave but dont forget to bring your knees in, etc. At the beach there is a little shack that sells food and drinks. They use tapioca flakes and line the bottom of the pan with it. Then they add whatever you want (ham/cheese/tomato/oregano is my favorite), but they also have sun meat, chicken and even sweat ones with fruit, caramel, etc. The tapioca forms a little tortilla. Its quite odd looking but tastes great after surfing. We also had a bbq on the beach on friday with steak, sausage, rice, farofa, beans, and a tomato salad. Really great food. 

After surfing is a shower and a trip to the coffee shop. I get my cafe gelado (which is basically an iced mocha milkshake) and a piece of pie. Or sometimes we will walk further down pituba (the main street) to the bakery and get a torte or piece of cake.

In the evening, at 7:30 we meet up and watch the video of the day. Get to see what we did well and what we need to fix. They are so good at repeating the things we need to work on. The feedback is awesome and has definitely improved my surfing. I think the thing I like best is they are always trying to push you to the next level. 

Afterwards we all go out to dinner. Last night we went to Casarao amarelo which is restaurant in a refurbished historic building. Sat and ate on the veranda looking out at the water. Had filet mignon and gorganzola risotto. It was so delicious I actually finished every last bit despite the large portion. Then we went to the bar downstairs to watch a band play. They were apparently doing covers but I cant say I recognized many of them but the guitarist was pretty good. After we tired of trying to figure out what song was playing we went on to the next bar called Favela. So some of the bars here are hilarious to look at. They put a big table in the street filled with alcohol and tons of fruit. These muscular guys dressed only in shorts and an apron stand out the street with all their fruit ...and alcohol making drinks with a hand mixer. The first time I saw it I thought maybe we had walked too far and were in south beach or something. Then you enter the bar and grab a table or bar stool. So strange! We stayed out pretty late since we had today off from surfing.

Today (the one day of rest) started with a late breakfast and then wandered around the town a bit and took some photos. Walked down pituba to the other beaches on the other side of town. They are beautiful beaches but I decided to walk back to the beach across from my pousada that has lounge chairs with beach service :) I know its lazy but its my day off! Ran into one of the other surfers (a girl from Switzerland, who also just ran her first marathon just before coming here) and we hung out on the beach most of the day. There was a brazilian drum band playing at the beach which was really cool (so much better than the cover band from last night). Then headed back to town to meet up with others to watch a local soccer game on tv at a bar. Also went to watch a local basketball tournament that one of the surf instructors was in. It was basically just local kids (and some adults) that were playing for fun. Overall a relaxing day and hopefully Ive given my arms enough of a break to do this all over again for another week! 

Brazil Days #1-4

So the flight here was ridiculously long. You really have to want to go somewhere to put up with a 24hr trip to where you are going. There is just no good way to get to this town. It was 3 flights and an hour and a half drive. Luckily I fell asleep on the flight from Miami to Brazil (salvador) but I woke up with the worst leg cramps ever (marathon related Im sure). Then just a quick 45 min flight to Ilheus after a 5 hour layover! Then a taxi ride to Itacare. I finally arrived at the Pousada in early afternoon, unpacked and then walked around town a bit.

Itacare is definitely a town set up for tourists but it seems most of the tourist are actually Brazilian. There are a couple americans and a few europeans but for the most part the tourists are brazilian. The town has a main drag with tons of stores, restaurants, etc. And then along the beach there are lots of restaurants and bars. They all have tables/chairs and then also beach chairs out front. I thought for sure they would charge you to use them, but buying a $2 beer (the cheapest thing on the menu) is all thats needed to get free use. I dont enjoy not knowing the language. Despite the similarities, it is difficult to understand portugese. I recognize some words here and there but its hard. They understand my spanish for the most part tho which does help. Lots of words are very similar and then others arent even close.

So Saturday was spent doing a little exploring and then dinner/drinks at one of the beach places. The dinner was on the expensive side $10 but was huge. Chicken, rice, salad, beans. Then off to bed early to get some much needed rest. Sunday woke up early and had breakfast at the pousda (the hotel) and decided NO exploration today. It would be a day of rest. So I went to the beach and parked myself on a lounge chair and read a book and had some drinks. Went to dinner at one of the beach restaurants and ordered a beef dish with tomato sauce/cheese. The waitress asked "mitad" and I said yes hoping that meant a half portion. A HUGE plate of meat topped with a red sauce and dripping with cheese arrived along with a salad. I thought that was it but then a big bowl of rice and mashed potatoes also arrived. The beef was delicious, the best I could describe it - it was like chicken parm but it was beef. It was amazing. The waitress comes back and I say this is a lot of food for one person, and she confirmed that that was a half portion! Next time I'll have to order a quarter portion! After dinner I came back, showered and relaxed, getting ready to go to bed. But then a knock at the door- which was one of the surf instructors letting me know the plans for the next day. He also introduced me to the other people in the surf class. They were headed out for dinner so I tagged along and just had a drink....no way was I eating again any time soon.

Monday, early breakfast at 7:30 (eggs, and various baked goods including a strange quiche with chicken and corn - odd breakfast choice, along with fruit, hams, cheese, and fruit juices that I still havent figure out yet. Not a bad breakfast at all. Then we walk to the surf shop about 5 min away to meet the van. The waves are better at another beach so we drive about 30-40 min. We hike down to the beach (which was a bit of a trek, path was a little muddy). Beach was a litle cove with a little river next to it. Waves were great, not too big, not too small. First hour I didnt catch anything, was being a bit tentative. And then finally I caught a wave and things got better from there. Caught a few waves - not bad for the first day. Instructor yelled out some pointers (its always the same stuff I forget each time I start up again!). Keep your chest up, etc. Got back from surfing and went to a coffee shop. I asked for an iced coffee and ended up with an iced mocha (How did they know?? ....thats what I always drink at home). Got some hammock time in and then went for our evening videotape session. They videotape the entire session and we get critiqued yet again! It will be good to learn that way. Can actually see what you are doing right and wrong but at the same time its a little painful to see the wipeouts, etc! Went to dinner with the other people from the surf camp - falafel this time - Wow had NO idea how good falafel was!

Tuesday - was basically a repeat of Monday. Heading off for todays video session and to dinner. Scheduled a massage for tomorrow (the prepaid package includes some massages).

So far everythings been great. Surfing for 4 hours a day forces you to relax on the time off so it really does feel like a vacation! Getting some quality time in the hammock, enjoying the beach, getting in some reading (which I never do at home). On book #2 already! Havent even turned the TV on in the room.