Shoulder Replacement, Mexico Style

Walt has had pain in both of his shoulders for many years, and gradually has lost the ability to lift his arms much. Well, a month ago Walt found out the reason was that he had no cartilage at all in his left shoulder and has very little in his right shoulder. Our doctor sent us to an orthopedic specialist who immediately recommended shoulder replacement surgery.

This is how the process went. We tried convincing our doctor in the US about Walt's shoulder pains. He was not terribly interested, and told him to take Ibuprofen. Then our doctor here in Mexico tried exercise and medication almost to no avail (although we have to say that the medications available here are often more effective than some in the US, thanks to the FDA). We were both in for a regular checkup one day and Nancy said to our doctor, "This is only as far as he can lift his arms". He immediately said to see an orthopedist. The orthopedist is one of the many specialists that come down to our local clinic from Guadalajara on different days of the week, so two days later, Walt was talking to the specialist. He asked about arm movement and the like, then said, "Lets go across the hall to get x-rays", looked at the right one and said, "You should think about replacement surgery" then saw the x-ray of the left one and said, "Right away". This was all in the same 20 minute appointment, not waiting weeks and weeks for x-rays or permission from insurance to see a specialist! We then sought council from our regular doctor, mainly to see if Walt was healthy enough and whether we should do it with our Mexican government insurance, IMSS, or not. He said if we can afford to pay for it ourselves we can control who does it and when. So we did our internet homework comparing Medicare costs, out-of-pocket cost and IMSS, which would be no cost, since we are now fully vested (although it would be put off for many months). Since we had the money we decided not to go through IMSS. Then we looked at the cost difference between out-of-pocket and Medicare - if we had even kept up the policy payments. The specialist here said it would cost around $10,000 USD and it actually came out to be $9450 USD. Finding what we could about Medicare allowable expenses, deductibles and then including payment of a Medicare Part B and supplemental policy, we figured we easily saved $10,000 to $20,000 USD. This is based on that we saw that shoulder surgery in the US can cost as high as $40,000 and it looks like Medicare may have taken care of around $10,000. Then, of course, you have to add in the $5,000 we would have spent on the cost of a policy and, just like with IMSS, you don't know who you would get or when it would be scheduled.

Now here is the beauty of the whole thing. We went back to the specialist on his next Friday visit to the clinic and he said, "How about scheduling it a week from this Monday?" What? Not 6 months from now? Then the following Friday he called us in the evening to say only one of the two prosthesis parts had come in (delayed from the US) and he didn't want to operate twice and didn't think we would want that either (that is a joke, btw). A few days later he called again to say the part was in and rescheduled us for a week later. It was the surgeon who called us personally at home to apologize for the delay and to reschedule the surgery. It was not the secretary of the assistant nurse to the specialist's assistant. It was the specialist himself.

So, one may ask, who is this specialist that can give you this kind of attention? After all you are way down in Mexico and they just are not qualified.... Here is his own personal home page, in English yet. His "Curriculum" page is the most interesting.

We went to Guadalajara Wednesday morning, had the surgery around 11:00 am and apparently the surgery was about an hour and a half long. The socket was replaced with a plastic one, and the shoulder ball was replaced with titanium. The doctor came in several times after the surgery to see how things were going. Nancy stayed overnight in the room (she had a nice couch to sleep on), which is the custom here. The surgeon returned Thursday morning with the anesthesiologist in tow. With Walt's three previous surgeries he never got to see the anesthesiologist. In fact, he had chatted with Walt a little bit before the surgery. Walt's last words to the anesthesiologist, surgeon and nurses before he dozed off were "Hasta luego" (See you later)- that got a good laugh.

The clinic we were in is only nine years old and very modern. It is really a tiny hospital more that what one would call a clinic. In fact, the operating room looked like it was some space age place. Here are pictures of the clinic and of Walt recovering.

Walt began physical therapy the day after surgery and, when he was at the specialist Friday here in town, got some more exercises to do. Next Friday the staples will come out and we should be on a full road to recovery. Already the fact that there is no pain whatsoever in the joint is huge! God is good!! Work with a physical therapist should hopefully improve mobility in the muscles that have atrophied over the years.

So this is proof that in places where malpractice suits do not exist, affordable quality health care does exist. The next surgery will be scheduled around our missions trip to Israel at the end of October, plans for Thanksgiving and Christmas and our yearly trek to Thailand, depending upon how fast the recovery process is. So it may be the beginning of November or as late as February of next year.

Brazil Praise Orchestra Trip

From June 1 through June 12 Walt had the privilege of joining a group of some two dozen American Musicians on a trip to Brazil to give concerts and hold Masters Classes for the Brazilians. So this is Walt's personal blog on that trip.

First of all I feel honored and privileged to have joined this group of what I consider professional musicians under the able leadership of Camp Kirkland. Most of us met for the first time in Atlanta, GA for the final flight to Sao Paulo. Then, depending on where and when a concert was, Brazilian musicians would join us. I believe the largest orchestra may have been as large as 50 or 60 players and a couple of times we accompanied large choirs. So it was a real thrill, especially given that we don't have orchestras like that where we live.

We gave thirteen concerts, I believe (I actually lost count), in the nine days we were in Brazil and we toured the very last day. So all in all it was an excellent experience. Here are some photos beginning with our first rehearsal, first concert and going on through almost every concert. At the very first concert at a gated apartment complex my bass did something it never had done in all the years that I have played - it never kept its tune during the first two songs. I loved Nancy's response "The devil was in your bass so great things are going to happen." She was absolutely right as the trip was a total success for many reasons. To hear what we sound like here are some videos of concerts. This was "Jericho" at our first concert in Sao Paulo. Here is "Days of Elijah" in Brasilia and here is "Jericho" in Brasilia. You may want to use earphones or good speakers. My laptop speakers didn't do the songs justice (i.e., you couldn't hear the bass ;-)). You can hear that the Brazilians absolutely loved to join in singing.

One of the reasons the trip was successful is meeting new friends. This includes both people from the orchestra and Brazilians that we met. I was somewhat apprehensive at the thought of leading the rhythm class as we had no idea who or what to expect but we came prepared as much as possible. To me the greatest blessing that I received was a whole new set of rhythm player friends. Yes, I know, we are a strange lot! I am still receiving e-mails from the Brazilians thanking us for the pointers we gave. Here are photos of all my new friends.

However, not only did I teach Master's Classes in Rhythm, the Brazilians taught me to play some "interesting" rhythms. They actually allowed me to play in one of their worship sets. I mentioned this to Nancy as well and loved here response again, "So you are getting more out of this trip than you expected again?" Absolutely! Here is a video of just one of the worship songs they did. My new buddy Marcos is playing the bass in this particular song and my long time Brazilian buddy, CG, is playing drums.

One of the lesser reasons (right!) I enjoy going on these trips with Camp Kirkland is that he likes to eat like I do. I think we both might eat a little more than we ought to just by egging each other on. But it was well worth it. I only took a few photos of our eating sessions because I was more interested in eating then photographing. Here are the photos I took. For those of you who don't know what churrascaria is, you need to find out. They continue bringing different cuts of meat, mostly beef, on skewers or swords until you turn the little green tag to red. It always took me a long time to turn it red. Then I believe we had Brazilian pizza who knows how many times. The chief characteristics of Brazilian pizza are they use little, if any, sauce but substitute the sauce with "large" amounts of cheese. Also, when you have had your fill of pizza they bring dessert pizza - a delicacy to die for.

Our trip to Brazil this time included half the time in Sao Paulo and the other half in Brasilia. The only real touring we had a chance for in Sao Paulo was a special treat to the concert hall to hear Brazil's best symphony orchestra. That definitely was a highlight for all of us. Here are some of the pictures of Sao Paulo. Brasilia was a city planned in the 1950's to be the new capital of Brazil. The main part of Brasilia is very thoughtfully laid out. However, 50 years plus a large migration of people gravitating to the capital have changed the original main concepts, especially in the many towns now surrounding the main part of Brasilia. If you go to Google Earth, you will see that the plan form of the main part of Brasilia is an airplane. Here are photos of some of the highlights of this city.

One highlight while in Brasilia was to attend and observe a rehearsal of the Brazil National Symphony Orchestra. As musicians we really enjoyed this treat. Here are photos of that rehearsal.

As with all these trips, they too soon come to an end. Here are some photos of our departure back home. A video of one of the songs that the group did for us can be found here.

This is not the end yet of a rewarding trip of this nature. Nancy is going to join me in October as we do this in Israel again. This will be her first time and I know she will receive more out of it than she is expecting. For that trip we both would appreciate your prayers. Also at this point I need an additional $1,500 and Nancy needs and additional $2,000 as well. If you feel led to help go to this link.

California Visit

At the end of May we visited San Diego for a few days. Adam, Cindy, Isaac and Anica came to CA to attend Cindy's sisters wedding so we felt it an excellent opportunity to see them and especially our new grand daughter who we had not seen in person yet as well as spend Kirstin's birthday with her. For the Thai and Mexico Heine's the temperature was quite cool.

We managed to do quite a bit while in San Diego. Here are some photos of Adam and Cindy reporting back to their church, Coast Vineyard, and of some of the fun we had relaxing at Kirsty and Will's house and at the park and some time we were able to have with Adam and Cindy's friends, the Wyatts, from Napa CA. We loved meeting and spending time with our new grand daughter, Anica. Here are some photos of her. Then we went to the beach with everyone. Isaac had already been at the beach in Thailand but probably too young to remember it. It was fun watching his and the dogs' reactions to the waves coming in. Here are photos of that day. Here is a video of Isaac challenging the mighty Pacific Ocean.

Fortunately our visit with Kirsty and Will coincided with Kirsty's birthday. Here are a couple of photos of her babies and the time we spent with them. The visit was entirely too short, but Nancy had already been away from home for over 2 weeks prior, visiting parents in Oregon and kids and friends in the Bay area....and Walt had a trip to Brazil in just a few days...More about that in the next blog.

Final Shore Excursion - Barcelona and Montserrat

After twelve wonderful days we returned to Barcelona. Our ship arrived at 5:30 in the morning and our flight was not until 11 pm that night. So we decided we would take a different tour in the Barcelona area to use up most of the day. Still, we ended up spending nine hours in the airport. One thing we forgot to mention on our first stop in Barcelona was the fact that we felt, since have learned Spanish in Mexico, that we could converse with the locals. We soon discovered that all stores and restaurants were using a different language. Then we learned that Barcelona is in Catalonia and the language is Catalan, Spanish is second. And even that Spanish was noticeably different than Mexican Spanish. But we had no trouble with the cab driver - she spoke very little English and we carried on a conversation in Spanish and learned quite a bit about Barcelona.

Since this was a quick bus tour, for the most part, this blog will be shorter than the others. The main part of the tour consisted of visiting Montserrat, a mountain top monastery built more than a thousand years ago. It still is being used as a spiritual retreat for priests but more so as a retreat for young people involved in studying music, including a boys' choir.

The first set of photos are some more generic views of Barcelona. Since we were on our way to Montserrat we were driving through the suburbs of Barcelona, which are distinctly different than the old part that we visited at the beginning of our trip. The photos of some of the outskirts are shown here.

Most of the photos are of Montserrat. The surrounding area is very reminiscent of Yosemite because of the large granite cliffs, a favorite of rock climbers. The monastery is perched way up at almost a 4,000 foot elevation. The photos of the monastery and surrounding areas, including the drive up and down are shown here. A video of a service taking place in the main church is shown here.

We were overwhelmed by the size of the airport in Barcelona. So while we were killing time we took a couple of photos. These are shown here.

Hopefully you enjoyed our little travelogue. If nothing else, when we sit out on our terraza in 20 years we can bring out our computers and reminisce about an extremely enjoyable time in our lives together.

Seventh Shore Excursion - Malta

After another day at sea after leaving Egypt we came to Malta. We really did not know what to expect as we thought it just an island out in the Mediterranean. It turns out it was very interesting and different than we had expected. Our first view was a harbor surrounded by impressive fortresses. They used the cliffs as part of the walls. In many cases there was a road outside the walls and running along the harbor. Here are views of the Port of Valletta as we entered it.

Once we entered the harbor, we left ship for our jeep safari. There were at least 20 jeeps and we all stuck together in one long line. So it was kind of fun. Unlike the jeep safari in Egypt, these drivers kept "pedal to the metal". The back roads are pretty rough so we had a blast. We went on the roads that the big tour buses can't go on.

Here are some generic views, primarily of Valletta, the main harbor we docked at. But there are some other interesting photos taken from the back of the jeep as we drove around.

The cities seemed to consist mostly of condos and apartments with a few single family homes sprinkled here and there. But the single family homes tended to be attached. The country side was what was really interesting with the many produce farms with stone walls seeming to meander all over the place. The farmers' homes tended to be very "square" and small. Here are views of the country side as we drove around.

As usual on all our ports of call were buildings that appeared interesting to us because we have never seen anything like them. Here are some of the interesting buildings we saw in Malta.

The most interesting site in Malta was the City of Mdina. It is an historic city perhaps dating from the Bronze age, although the cathedral was rebuilt by the Normans in 1090 AD, and is now predominantly a tourist site with little shops. The city is fortified by an extremely thick wall and is characterized by very narrow streets. After wandering down one of these streets we noticed doorbells on the doors. So we asked the proverbial why? The answer? People live here. In fact, approximately 350 people inhabit Mdina. We then asked how someone could buy a home. The answer was that there is no way as the homes are handed down generation to generation. If one did become available it would be very expensive and probably out of reach financially. Legend has it that Apostle Paul stayed in Mdina when he was shipwrecked on the Island of Malta. Here are views of the city of Mdina.

We didn't realize this but when they filmed Popeye starring Robin Williams, they built a special town on Malta as a set for the movie. Today it is just restaurants and shops - what else do you do with a cutesy movie set? Here are views of the set. The last picture captures the size of our jeep caravan.

We then left Malta for a last day at sea on our back to Barcelona. Here are views of the departure and what awaited us in our stateroom.

Next and final blog will be Barcelona but a different tour. Our final Barcelona tour was to Montserrat.

Sixth Shore Excursion - Alexandria

On Monday, 5 April, we took a bus tour of Alexandria. It was mostly a bus tour with a few stops. As usual we were interested in typical scenes throughout the city. Here are some photos of various streets and buildings. As with the other cities that we toured it seems everyone lives in condos or apartments. There definitely is an absence of single family homes. Here are photos of the apartment buildings and condos. As we said in the last blog, we saw a lot of trash along the streets. Clearly one of the buildings seen all over the place are mosques. Here are photos of a couple of mosques, the one is the largest in Alexandria. Here are some photos of other interesting views in Alexandria.

There was one major stop that we made that was very interesting. However, we were not allowed to take pictures. These were the impressive catacombs of Kom el-Shuqafa, an enormous complex of underground burial chambers, was built by the Romans in the second century A.D. They consist of three levels cut in the rock to a depth of 100 ft., connected by staircases. At the highest level is a rotunda entrance with a well in the center covered by a type of kiosk. To get down to the catacombs was a winding staircase consisting of 96 steps surrounding the central shaft. The corpse was lowered to the burial chamber through this shaft and passed through an opening at the appropriate level in the catacombs. The rotunda opens into several rooms with rock-cut niches with false sarcophagi and bas-relief wall decorations in the Pharaonic style, showing ancient Egyptian deities. The heads of statues discovered in the complex are in the Greek style, while their garb is traditional Egyptian. The large room to the left of the entrance is the funereal triclinium, the banqueting hall, where relatives and friends of the deceased assembled for the funerary meal. Poorer family members were buried in corridors leading off the main chamber. Some rooms and corridors were added in later periods. The names and ages of the deceased were marked in red paint on the stone slabs which sealed the niches. The interesting thing is that the catacombs were discovered when someone's donkey stepped in a hole that turned out to be the entrance to the shaft.

An absolutely mind-blowing spot we had some time to see was the Alexandria Library. What amazed us was how modern the library is and the high level of technology available. Here is a link to their home page. It has two million volumes and growing. Everything can be accessed by computer and translated as necessary. There is even a book printing and binding system. Here are photos of this library. We were lucky, this was the day after Easter and a holiday. However, many of the workers chose to spend a few hours of their holiday to let us see the place. After seeing it, we were very grateful.

Montaza (Translated: "The Park") is a neighborhood in Alexandria, Egypt. It is distinguished by its beautiful gardens and royal palaces. It is often visited due to the beautiful sceneries that can be seen there and is considered one of the most beautiful places in Alexandria. Here are photos of the two largest palaces, one now a hotel, in this area. You can also see that the park surrounding the palaces are used by the public for family picnics and the like.

The park was rather full of families because it was Easter Monday and a holiday. So no one was working and everyone was out playing. You could see the many families spending the day around the palaces. Alexandria is right on the Mediterranean so many people were also spending the day at the beach. Here are photos of a resort hotel and then the many people we saw on the beaches. The beaches go the full length of Alexandria and so is very large and, as we saw, very full of people. There aren't any captions because they are just repeated views of the beaches. Note that people sit in plastic chairs under umbrellas, totally different than in the US.

A couple other items of interest were the various head coverings the women wore and the many men that sat outside stores and coffee shops smoking their hookahs, Arabic water pipes. We alluded to the head covering situation in Egypt in our last blog. Here are photos of the wide variety we saw. Notice that in most cases the head covering matches the outfit the lady is wearing - very stylish. As for the hookahs, we observed that there were many tables and chairs outside. Then we saw that this is where the men smoke their hookahs. Trying to take pictures while riding in the bus made it difficult but we managed to capture a few. Here they are in these photos. The hookahs are the large water pipes sitting on the ground and the gentleman is smoking it through a long hose.

Next port of call is Malta.

Fifth Port of Call - Alexandria and on to Cairo

On Sunday, 4 April, we arrived in Alexandria. Here are some photos of our arrival into Alexandria and some first views of Alexandria itself. However, we didn't tour Alexandria until the next day and will have additional photos of that city on our next blog. On 4 April we took a three hour bus ride to Cairo to see Giza and the wonders of that place. As usual we took photos to give a feel of the country. Here are some photos that we took as we entered Alexandria and then on our drive to and from Cairo. Something we observed in the cities visited so far like Barcelona, Rome, Athens and Izmir, they were all very clean. However, our impression of Egypt was the exact opposite, lots of trash thrown out all over the place.

An interesting feature we saw repeatedly on our drive through the country side were pigeon houses. Apparently the Egyptians build these houses for pigeons so that they can retrieve the droppings as fertilizer. Talk about organic. Here are some photos of a variety that we saw. By the way, they are all over the place.

Another characteristic that our tour guide pointed out was the large disparity between rich and poor. She said that we would really notice it as we travel to Cairo. Sure enough, there would be a large elaborate mansion with a shack right next door. Obviously no zoning laws. But we have seen the lack of those kind of zoning laws in all the countries we have been to. Here are some photos demonstrating the economic disparity.

One final interesting characteristic which we observed in both Alexandria and Cairo, but most noticeably Cairo, since it is more rural, are the head coverings of the women. They varied from no covering whatsoever, as was the case with our tour guide to Cairo, to a scarf with a little bit of hair showing, as our tour guide in Alexandria wore, to a scarf that totally covered the hair and finally covering their face totally with a Niqāb, the traditional face covering with just a slit showing the eyes. The more traditional garb was seen more in Cairo than Alexandria. However, the head coverings in Alexandria tended to be very fancy. We will show more of those in our next blog. But here are the first of the head coverings we saw. There is an interesting story that goes with this. Because of the variations we saw, we asked our Alexandria tour guide, the one with partial hair showing, what the difference was. She said it had nothing to do with how "religious" you were. So the complete covering did not indicate being more devote than no covering. As for herself she said she likes to have a bit of style so wanted some of her hair showing. With regard to the women wearing Niqābs over their faces she said "that is purely a 'man' thing". The husband just wants to show his control over his wife. But it ended on a humorous note. Apparently when they buried the pharaohs they removed all the organs except the heart. They left the heart in the body because once the pharaoh crossed over to the other side, ie the afterlife, one of the Egyptian gods puts the heart on a scale with a feather on the opposite side as the balance. If the heart is lighter than the feather then they go to a good afterlife, designating a kind heart. But if the heart is heavier it goes to a bad afterlife. So I asked her, because she was showing part of her hair, how the balance would go for her. She said, "I hope my heart is lighter" and laughed.

After 3 hours of driving, we got to Cairo and then on to Giza to see the pyramids. Our original desire, when we were looking for a cruise, was to see the pyramids so this really represented the highlight of our cruise. The pictures of the Pyramids of Giza can be seen here. After walking around the pyramids we got on the bus for a short trip to the Great Sphinx. Here are pictures of the Sphinx. All we can say is that pictures do not do these marvels any justice. You have to stand beside them to appreciate where you are, what you are looking at and how old they are and the engineering that had to go into building them. Incredible is the only way you can describe it.

After the Giza attractions we went further South for our jeep and camel safari. We signed up for this shore excursion not only for the pyramids but the camel safari. We have ridden elephants in Thailand now it was time to experience another form of travel. Pictures of these two safaris are shown here. After the camel ride we had lunch and then headed, by bus, to Sakkara where the oldest known pyramid exists. This pyramid is called the "Step Pyramid". There were several interesting temples and other things to see, but again, because of time limitations we didn't spend much time at any one location. Here are photos of the Sakkara pyramids and temples.

Subsequent to this was the three hour bus ride back to the ship. It was dark when we got there but had an excellent dinner on board again.

The next day we toured Alexandria. This will be the subject of our next blog.