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Free pdf:

Mexicali! a mini-gem guide to surgery in Baja, California

The pdf has been uploaded to Google books, and several other sites.

Low-cost e-format:  I managed to work out a kindle format, but Amazon.com won’t allow independent publishers to offer our books for free (except as part of a limited trial on KDP select.)  However, I have received several emails specifically asking for the Mexicali book to be placed on Amazon.com – so I am reluctantly doing so.  Please note that this e-format version is priced at the minimum – of 99 cents with a free download trial period.  (In case you are wondering, Amazon.com collects 65% of that.)

Update:

Paperback book:  The paperback version of the Mexicali book is now available!  I had hoped to offer a color version (for fans of medical photography) but for small-run books, it was going to be 28.00 a book, which seems excessive to me.  I’ve priced it at just above the cost to produce and offer it on Amazon channels for less than 7.00.

 

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Well – this book has gone through the first-pass round of editing.. Now it’s on to the second step (another round of editing) before final formating and publishing.  As I’ve mentioned previously – I will be offering free pdf downloads at multiple outlets for interested readers.  (I would love to be able to offer it as an e-book but it costs quite a bit to have it professionally converted – and my previous efforts to convert books to electronic formats were exercises in extreme frustration.)

I wanted to take a minute to thank my additional content contributors:

Dr. Joanna Calzada, MD and Dr. Cuauhtemoc Cairo Robles.

Their assistance and contributions have been invaluable!  Dr. Calzada absolutely threw herself into helping me uncover the life and history of Mexicali – and as a second-generation Mexicali resident – her input was amazing.  We crisscrossed the city several times to get information to include in the book for our readers.

with Dr. Joanna Calzada, MD – book contributor (life & culture of Mexicali)

Dr. Robles, a professor of architecture at the Universidad Autonoma Baja California, and expert on Mexicali architecture was equally outstanding.  Not only did I use several of his publications as references and resources on public buildings – but Dr. Robles stepped right in to offer photographs, stories and local history on all of the amazing houses and other buildings I fell in love with (such as Mexicali’s Graceland.)

Lastly, special thanks to Elizabeth A. Warren – who is currently editing my book.  She is my former college roommate (and thus has been editing my writing intermittently over the last 18 years.)  She is also an English teacher in Memphis, Tennessee where we attended college together.

I felt quite the poor friend when I offered her the ‘opportunity’ to edit my book for free – (since I am budget less at the moment.)  But, as always – Libby was up for the challenge.  (Let’s home my improper use of grammar doesn’t get the best of her.)

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Busy day yesterday – spent the morning shift with Jose Luis Barron over at Mexicali General..  Then raced over to Hospital de la Familia for a couple of general and bariatric cases.

The first case was with the ever charming Drs. Horatio Ham, and Rafael Abril (who we’ve talked about before.)  with the always competent Dr. Campa as the anesthesiologist.   (Seriously – Dr. Campa always does an excellent job.)

Then as we prepared to enter the second case – the director of the hospital asked if I would like to meet Dr. Marco Sarinana G. and his partner, Dr. Joel Ramos..  well, of course.. (Dr. Sarinana’s name has a tilde over the first n – but try coaxing that out this antique keyboard..)

So off to the operating room with these three fellows.  (This isn’t my usual protocol for interviewing surgeons, etc. but sometimes it works out this way.)  Their practice is called Mexicali Obesity Solutions.

Dr. Marco Sarinana and Dr. Joel Ramos, Bariatric surgeons

Dr. Alejandro Ballesteros was the anesthesiologist for the case – and everything proceeded nicely.

After that – it was evening, and time to write everything down!

Today should be another great day – heading to IMSS with Dr. Gabriel Ramos for a big case..

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It’s a busy Sunday in Mexicali – presidential elections are today, so I am going to try to get some pictures of the nearest polling station later.. In the meantime, I am spending the day catching up on my writing..

a polling station in Mexicali

Lots to write about – just haven’t had the time..  Friday morning was the intern graduation which marks the end of their intern year – as they advance in their residencies.. Didn’t get a lot of pictures since I was at the back of the room, and frankly, unwilling to butt ahead of proud parents to get good pics.. This was their day, not mine and I was pleased that I was invited.

I did get a couple of good pictures of my ‘hermanito’ Lalo and Gloria after the event.  (I’ve adopted Lalo as my ‘kid’ brother.. Not sure how he feels about – but he’s pretty easy-going so he probably just thinks it’s a silly gringa thing, and probably it is..)

Dr. ‘Lalo” Gutierrez with his parents

Lalo’s parents were sitting in the row ahead of me, so of course, I introduced myself and said hello.. (They were probably a little bewildered by this middle-aged gringa talking about their son in atrocious Spanish) but I figured they might be curious about the same gringa that posts pictures of Lalo on the internet.. I also feel that it’s important to take time and tell people the ‘good things’ in life.  (Like what a great person their son has turned out to be..)

Same thing for Gloria.. She is such a hard-worker, and yet, always willing to help out.. “Gloria can you help me walk this patient?”  It’s not even her patient, (and a lot of people would say – it’s not our jobs to walk patients) but the patient needs to get out of bed – I am here, and I need some help (with IV poles, pleurovacs, etc.)  and Gloria never hesitates.. that to me – is the hallmark of an excellent provider, that the patient comes first .. She still has several years to go, but I have confidence in her.

She throws herself into her rotations.. When she was on thoracics, she wanted to learn.. and she didn’t mind learning from a nurse (which is HUGE here, in my experience.)

Dr. Gloria Ayala (right) and her mother

She wasn’t sure that her mom would be able to be there – (she works long hours as a cook for a baseball team) but luckily she made it!

Met a pediatric cardiologist and his wife, a pediatrician.. Amazing because the first thing they said is, “We want nurse practitioners in our NICU,” so maybe NPs in Mexico will become a reality.. Heard there is an NP from San Francisco over at Hospital Hispano Americano but haven’t had the pleasure of meeting her.  (I’d love to exchange notes with her.)

I spent the remainder of the day in the operating room of Dr. Ernesto Romero Fonseca, an orthopedic surgeon specializing in trauma.  I don’t know what it is about Orthopedics, but the docs are always so “laid back”, and just so darn pleasant to be around.  Dr. Romero and his resident are no exception.

[“Laid back” is probably the wrong term – there is nothing casual about his approach to surgery but I haven’t had my second cup of coffee yet, so my vocabulary is a bit limited.. ]  Once I finish editing ‘patient bits’ I’ll post a photo..

Then it was off to clinic with the Professor.

Saturday, I spent the day in the operating room with Dr. Vasquez at Hospital de la Familia. He teased me about the colors of the surgical drapes,(green at Hospital de la Familia), so I guess he liked my article about the impact of color on medical photography.  (Though, truthfully, I take photos of surgeons, not operations..)

Since the NYT article* came out a few days ago – things have changed here in Mexicali.  People don’t seem to think the book is such a far-fetched idea anymore.  I’m hopeful this means I’ll get more response from some of the doctors.  (Right now, for every 15 I contact – I might get two replies, and one interview..)

Planning for my last day with the Professor  – makes me sad because I’ve had such a great time, (and learned a tremendous amount) but it has been wonderful.  Besides, I will be starting classes soon – and will be moving to my next location (and another great professor.)

Professor Ochoa and Dr. Vasquez

But I do have to say – that he has been a great professor, and I think, a good friend.  He let me steer my education at times (hey – can I learn more about X..) but always kept me studying, reading and writing.  He took time away from his regular life, and his other duties as a professor of other students (residents, interns etc.) to read my assignments, make suggestions and corrections when necessary.    and lastly, he tolerated a lot with good grace and humor.  Atrocious Spanish, (probably) some outlandish ideas and attitudes about patient care (I am a nurse, after all), a lot of chatter (one of my patient care things), endless questions…  especially, “donde estas?” when I was lost – again.

So as I wrap up my studies to spend the last few weeks concentrating on the book, and getting the last interviews, I want to thank Dr. Carlos Ochoa for his endless patience, and for giving me this opportunity.  I also want to thank all the interns (now residents) for welcoming me on rounds, the great doctors at Hospital General..  Thanks to Dr. Ivan for always welcoming me to the ER, and Dr. Joanna for welcoming me to her hospital.  All these people didn’t have to be so nice – but they were, and I appreciate it.

* Not my article [ I wish it were – since I have a lot to say on the topic].

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As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

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Dr. Gabriel Ramos, Oncologic Surgeon

Been a busy week  – (Yea!) but now that it is the weekend, I have a chance to post some more pictures and talk about my day in the operating room with Dr. Gabriel Omar Ramos Orozco. 

Despite living in a neighboring apartment, interviewing Dr. Ramos proved to be more difficult than anticipated.  But after several weeks, I was able to catch up with the busy surgeon.

Outside of the operating room, he is a brash, young surgeon with an off-beat charm and quirky sense of humor.  But inside the operating room, as he removes a large tumor with several cancerous implants, Dr. Gabriel Ramos Orozco is all business.

It’s different for me, as the interviewer to have this perspective.  As much as I enjoy him as a friendly neighbor – it’s the serious surgeon that I prefer.  It’s a side of him that is unexpected, and what finally wins me over.

Originally from San Luis Rio Colorado in the neighboring state of Sonora, Dr. Ramos now calls Mexicali home.  Like most surgeons here, he has a staff position at a public hospital separate from his private practice.  It is here at IMSS (Instituto Mexicano del Seguro Social) where Dr. Ramos operates on several patients during part of the extended interview.

Operating room nurses at IMSS

During the cases, the patients received a combination of epidural analgesia and conscious sedation.  While the anesthesiologist was not particularly involved or attentive to the patients during the cases, there was no intra-operative hypotension/ alterations in hemodynamic status or prolonged hypoxia.

Dr. Ramos reviewed patient films and medical charts prior to the procedures.  Patients were prepped, positioned and draped appropriately.  Surgical sterility was maintained during the cases.  The first case is a fairly straight forward laparoscopic case – and everything proceeds rapidly, in an uncomplicated fashion.  45 minutes later, and the procedure is over – and Dr. Ramos is typing his operative note.

Dr. Gabriel Ramos in the operating room

But the second case is not – and Dr. Ramos knows it going in..

The case is an extensive tumor resection, where Dr. Ramos painstakingly removes several areas of implants (or tumor tissue that has spread throughout the abdomen, separate from the original tumor).

The difference between being able to surgical remove all of the sites and being unable to remove all of the gross disease is the difference between a possible surgical ‘cure’ and a ‘de-bulking’ procedure, Dr. Ramos explains.  As always, when entering these surgeries, Dr. Ramos and his team do everything possible to go for surgical eradication of disease.  The patient will still need adjunctive therapy (chemotherapy) to treat any microscopic cancer cells, but the prognosis is better than in cases where gross disease is left behind*.  During this surgery, after extended exploration – it looks like Dr. Ramos was able to get everything.

“It’s not pretty,” he admits, “but in these types of cases, aesthetics are the last priority,” [behind removing all the tumor].  Despite that – the aesthetics after this large surgery are not as worrisome as one might have imagined.

The patient will have a large abdominal scar – but nothing that differs from most surgical scars in the pre-laparoscopy era.  [I admit I may be jaded in this respect after seeing so many surgeries] – It is several inches long, but there are no obvious defects, the scar is straight and neatly aligned at the conclusion of the case – and the umbilicus “belly-button” was spared.

after the successful removal of a large tumor

As I walk out of the hospital into the 95 degree heat at 11 o’clock at night – I admit surprise and revise my opinion of Dr. Ramos – he is better than I expected, (he is more than just the kid next door), and he deserves credit for such.

*This may happen due to the location of metastatic lesions – not all lesions are surgically removable.  (Tumor tissue may attach to major blood vessels such as the abdominal aorta, or other tissue that cannot be removed without seriously compromising the patient.)  In those cases, surgeons try to remove as much disease as possible – called ‘de-bulking’ knowing that they will have to leave tumor behind.

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Finally caught up with the busy Dr. Gabriel Ramos, MD, oncologic surgeon and spent several hours with him in the operating room at IMSS (the social security hospital) for a couple of cases on Wednesday..  I’ll be writing more about him soon.

Dr. Gabriel Ramos, Oncologic Surgeon

Yesterday was a full day with clinics here and San Luis.  Also – more homework, so I have to get some studying in before heading back in this afternoon.

On the radio with Cartagena Surgery:

Recorded my very first radio interview with Ilene Little at Traveling 4 Health..  I hope I don’t sound too bad (when I get nervous, I laugh..)  It’s not a pre-determined format, so I didn’t know the questions until she asked them – which makes it more interesting, but I sound less polished as I search my brain for names, dates, places etc.  Trying to remember the name of the researchers who published a paper in 1998, 2008, or 1978 is daunting when you worry about ‘dead air’.. I was so nervous I was even forgetting my abbreviations.  I hope it comes across better to listeners.

We talked about the books, what I do (and how I am surviving on savings to do it).  We also talked about some of the great doctors I’ve interviewed, treatments such as HIPEC as well as some of the quackery and false hope being peddled by people with a lot to gain.. I kind of wish HIPEC and quackery weren’t in the same segment.  Since it was off the cuff – I didn’t have all of my medical references and literature to talk about to distinguish the two (so if you are here looking for information on HIPEC – search around the site – I have links to on-going studies, and research going back over a decade, both here at BogotaSurgery.org .  Of course, the crucial difference between the two is:

HIPEC is a new treatment, but there is NO assurance of success – in fact, some patients die from the treatment itself.

– There is a body of scientific literature on HIPEC for advanced abdominal cancers (ovarian, uterine, etc)

Quakery or pseudo-science can be a bit trickery.  Maybe they take an existing or  promising treatment (like therapies for stroke, Parkinson’s etc.) and apply it to something else – like treatment of serious cancers.  (Yes – people will find papers written about the ‘treatment’, but these papers may not meet scientific rigor, or may not be about the condition or treatment that they are receiving.)  They also promise miracles and cures.

In medicine, even the very best doctors and surgeons can’t promise these things – because medicine itself isn’t an exact science, and different people respond to the same treatments differently – ie. one patient may have complications and another patient doesn’t.

Lastly  – we just touched on it – but I think it’s an important concept – is patient self-determination.  That no matter what I, or anyone writes, does or says – people always have the right to determine their own medical treatment.

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