Palo Alto Jo

11 hours ago, Keith Woolford said:

Here’s the Lunch Specials menu. Pretty reasonable prices considering the inclusions.

We've eaten there twice, and are big fans!  The staff are great, the food is great.  We've tried 5 items so far.  Just one word of warning.  The menu changes at 3 p.m. to the dinner menu.  The entrees are a bit bigger, but, it no longer comes with soup, or fried wonton, or fried rice.  Plus, it cost nearly twice as much.  I think lunch is the better value.

Bud and Marcelyn,

Thanks so much for giving Chiriqui Province a great place to share information.  I do appreciate a place where the disagreements are kept friendly, where information is always the best and most current.  I know you put a lot of time and effort into Chiriqui.life while often taking the backseat in allowing both sides to speak respectfully.  

I want to take this time of year, when gifts are given, to thank you both for your efforts and gift to our community.  You are one of the cutest couples I know.  And you are blessed to have found each other.

Merry Christmas, and Happy New Year to both of you!

3 hours ago, Brundageba said:

Yes... I get it.  Call it false negative.  Know that if your stool spec comes back negative and you still feel shitty with abdominal pain and diarrhea you may still have Giardia.  It is not easy to find Giardia in stool ( I believe it's more difficult than worms)  . Hey I'm not a parasitologist but a nurse of 50 yrs experience who has worked treating Ngobe with intestinal disorders here for about 5 yr with a doctor in a clinic. 

This topic was about water and intermittent supply of it.  I know the worm discussion diverts a bit...BUT open pipes and untreated water  does flow with the parasites and worms.....All of us here get the creeps when it comes to bad water and possible illnesses from it.  This is a very good discussion methinks. Maybe it will make us all a bit more patient regarding the pitfalls of putting in our new water purification system in town.  ( ha ha ...THEN we'll gripe about the Chlorine !)

 

I can feel the pain of trying to analyze a stool specimen in the jungles of Panama.  I had every piece of modern equipment, centrifuges, specific dyes that only attached to ameobas, etc.  And glowed under a florescent microscope.  Kudos for doing it the hard, old-fashioned way! I'd love to be involved in a future project, or have a microscope and check everyone's water for Giardia. 

3 hours ago, Brundageba said:

Parasite ( giardia) &  worms ( hook, pin etc)are  two different entities requiring very different treatments.  Giardia ( metronidazol or Flagyl)  worms like hook, pin, round ( albendazole)  Those are common drugs used to treat each entity.  If you are discussing giardia, then using the term "de-wormer" might not be 100 % accurate.   O& P studies often (more than not) miss the entity in the stool.  For this reason in the US the standard practice is three samples ( fresh)  on 3 consecutive days....if you want to know 100% after sample #1 comes back negative and you still feel shittty ( iterally).  

A small correction.  The reason standard protocol is 3 consecutive days of specimens, is not because labs "miss" Giardia.  It's because their life cycle has cycles we call shedding.  One day there is less shedding and the number will be lower.  Guardia is by far the most common "parasite" in the United States. Only it's eggs are ovas, so when I speak of an adult Guardia I did call it a parasite, as I thought that would be easier and still accurate.  Labs look at stool specimens in 3 different preparations, some directly from specimen some concentrations, so as not to "miss" anything.  It's an all day process, and not enjoyable!

Correct Bonnie.  Protozoans , such as amoebas and Giardia, are treated similarly even though one is a large single-celled organisms, the other are various worms (tape, round, pinworms, etc).  Many amoebas are relatively harmless, but I didn't mean to describe them as beneficial or harmless.  I should have been more careful in the use of the word parasite.  I was using it to speak of organisms that we become inured to, that live off us for their nutrition without killing us.  The treatment for all is similar.

57 minutes ago, Bonnie said:

Great info, Jo, but I'm not sure you answered my question. Looking at it anew, I don't think the question was clear. I am curious to know if one who has lived here long enough to have developed a resistance to, say, giardia, sacrifices that resistance when he takes an anti-giardia medication? Does starting again with a clean gut, free of giardia, make one susceptible to it once again?

Oh, I am sorry, I didn't answer that correctly.  The truth is everytime your body sees Giardia, it adapts to it attacks it.  After a while, untreated, your body sort of decides it's no big deal and that it can live as a "host".  You'll continue to have the parasite, if untreated, but the symptoms will lesson.  Clearing them out with a de-wormer won't make your immune system forget that it ever saw them.  It would be like getting over a bee sting reaction.  Your immune system will never again forget how to fight a bee sting, and the next you are stung your body attacks it even quicker.  So, a recurrence of Giardia after de-worming will probably still be milder in people whose bodies have decided to live in peace with the parasite.  Some people's bodies will always react strongly to Giardia, others won't.  But, de-worming will simply wipe them out until the next time you are exposed.  And in general, it's better to not have Giardia than to run around as a host, possibly passing it on the others.  But, out of caution, if it were me, I would never take any de-wormer unless I had an ova and parasite study done to see if I needed it.  I think the medicine should be reserved for when you actually have it.

On a separate note, in Africa, where my dad was a doctor,  every patient that walked in for any reason walked out de-wormed.  I'm sure that was because they were so common in the population.  I'm not sure they are that common in the Chiriqui population to deserve a prophylactic de-wormer on everyone.

2 hours ago, Bonnie said:

For those who have been around long enough to have become enured to a parasite, will taking an anti-parasite medication make him or her vulnerable to those parasites again?

Interesting question Bonnie!  The treatment for parasites is so different from microbes aka bacteria,  that there is no chance you and your personal parasite can build up a resistance to the medicine for worms or parasites.  The medicine, so far, continues to be extremely effective when taken.  This is because it causes the worm or parasite to be broken down in the gut and literally absorbed as food.  They have been using you as their source of food, and the medicine makes them your food.   Parasites don't seem to be able to quickly change in the presence of medicine like bacteria who can become resistant to antibiotics in days if not killed outright the first time they encounter an antibiotic.  People who don't complete their antibiotic prescription are going to kill us all...  If a bacteria survives an antibiotic, it's progeny will also be resistant to it.  

However, let's all hope we never reach a time when LARGE organisms can't be killed.  They could take over the universe.  One thing about parasites is they can adapt to survive as long as they can find a patsy to provide their needs.  They are your basic squatters.  

21 hours ago, Brundageba said:

 

Regarding Giardia.  You CAN have it and not be symptomatic.

This is true, because if one becomes ill with Giardia, and go untreated, their bodies eventually get accustomed to the parasite.  Chances are they ignored the first or second episode.  Then, they become healthy carriers.  Same is true of Salmonella, thus we had "Typhoid Mary" running around working in the restaurant business.  It's possible to have such a mild episode of either so it could be easily dismissed by some people.

50 minutes ago, Dottie Atwater said:

Thanks for the tip. Does he speak any English?

I'm sorry, Dottie, I don't know.  I haven't personally spoken with him.  My gut guess however is the more specialized, the more likely to speak English.  Endocrinology is one of the most gruelling trainings, as it includes Internal Medicine specialty before going to the subspecialty of endocrinology (in the U.S.).  If you find out, though, let me know.

Chiriqui.life healthcare Resources lists him as "good English".

1 hour ago, Dottie Atwater said:

I wish some medical person in this area is knowledgeable about bio-identical hormones!

In the U.S.this is generally done by hormone specialists.  Endocrinologists.  There is one in David at Mae Lewis. Dr. Alvaro Pachon Burgos phone, 775-4176.  You could try checking with him, if you haven't already.  With enough demand, he might be willing to begin offering the therapy, or at least discuss alternatives.

Keith,  I love your observation.  No one is lined up in clinics with some waterborne disease.  I've never had a case of food poisoning, or Noriega's revenge, since coming here, 4 years now.  I do eat out, buy food from the Central Market, have managed to undercook a few hamburgers or chicken breasts (sorry Honey!!!), but we still have not gotten sick, much as I've tried to, haha.  Luckily, our medical problems are all caused by self-inflicted wounds, or traveling on airplanes filled with coughing folks from who know where.   We have had bouts of pneumonia, but that's about it.  If I do get food poisoning, it will still be less often than the number of times I got it in the U.S.  The chances of pathogenic E. Coli being on your poultry in the U. S. is about 90%. If it were that high here, where people are often not as fastidious (no bacterial wipes at the grocery store for our cart handle....gasp...), we'd definitely see people lined up at clinics.  Food poisoning occurs within 2-24 hours of consumption.  It just isn't a big problem here, compared to the U.S.  

12 hours ago, Siempre Soluciones said:

 

Uncle Doug,

You wrote:

"The US State Department doesn't monitor water quality or quantity anywhere in the world."

The US State Department is engaged in water and sanitation projects all over the world executing their Global Water Strategy through their USAID organization.  Panama is not a participant but a friend of mine who visited me here in Boquete in 2014, a State Department employee, fell in love with the place and has been evaluating Boquete as a potential retirement location.  However, as we know, after Boquete's sewer/water project commenced, water issues became a common day occurrence.  In fact many of our mutual friends canceled vacations to Boquete due to this reason.  One of our friends who is familiar with many of Strategy's projects joked that Boquete is worse than many place in Africa.

I don't know how much you get out, but many of the tourists I run across aren't happy about waking up in their hotel without water and then later visiting an eatery for breakfast also without water. 

Mr. Hampton,

I used to think along the same lines until I reached graduate school where there were no text books and the only dumb question was the one that wasn't asked.

The US State Department doesn't monitor water quality or quantity anywhere in the world."

The US State Department is engaged in water and sanitation projects all over the world executing their Global Water Strategy through their USAID organization.

The one problem of contention is USAID checking water around the world.  Even if they did, or cared about our water outages in Boquete (like Keith said, they can't check water in West Texas or Flint, MI), the USAID is NOT part of the State Department.  So, perhaps, we can all agree that the State Dept. of the United States is not working on Boquete's water problem,  nor will be in the future.  Neither is USAID going to be helping us.  It's one of the things I love most about Panama.  My ability to not be treated like a child.  I feel more alive when I have to watch where I'm walking because there could be a 12 foot drop off on the sidewalk.  I love that I, and I alone, am in charge of looking out for me.  At age 60, I do not need a daddy.   I like figuring out my own survival. If I'm not interested in keeping me alive, I'm pretty sure I shouldn't expect the country of Panama to step in and fix that.  With the freedom comes responsibility and self-preservation.  But, what a glorious, and sometimes frustrating, feeling that I'm making it with "mostly" my own bootstraps.  I didn't move to outer Bratsylvania, I came here with my eyes opens to what might and might not be available.  

27 minutes ago, Bud said:

27 minutes ago, Bud said:

Finally, even with our attention to the purity of our water supply, our doctors (US based as well as our local primary care doctor) recommend that we undergo a prophylactic anti-parasite regimen. We do that once a year.

In the case of Giardia, you'll know if you have it.  But, a once a year wormer never hurt anybody.

1 hour ago, Brundageba said:

Palo Alto Jo

Question.   We as well had our water tested at the lab on the street in town where the bridge goes to BCP.  It came back negative.  But they only tested for E Coli.  I had asked for Giardia specifically...but you know how that goes.  When i got the results they told me they do not test for Giardia.  Sooo my question is , where did you get that test done?

Thanks in advance

Alison

Alison

You will need to ask the lab, including the one by the bridge, to add on a microscopic exam for Giardia.  Even if It is not done on a routine water analysis, the test requires a slide, microscope and a drop of blue dye.  A 10 minutes, easy test.    There is an additional fee.  However, they are already doing this test on fecal samples, and so I know they can do it on water, as that is even easier.  Unfortunately, Giardia does not grow on routine agar plates as it is a parasite rather than a microbe.  

E. Coli is grown on an agar plate.  The plate is kept in an incubator, checked daily for growth, and considered negative if no or scant growth appears after 3 days.  If there is E.coli, it is considered the "canary in the coal mine".  The lab is not going to report anything but E. Coli, however none of the other bad actors are found alone, outside the presence of E. Coli.  So keep in mind, If positive for E. Coli it could very likely also contain hepatitis virus, Cholera, Salmonella, Shigella, anything passed through fecal matter.  E. Coli present simply means feces is in the water.  The source of Giardia, a parasite, is through animal urine or feces for the most part.  Giardia look evil.  I've attached a photo of an adult Giardia lamblia.  It appears to be enjoying life.

11 minutes ago, Keith Woolford said:

If I'm not mistaken, Jo and Doug live very close to a source and are not on the Boquete system.

I think more problems with purity are encountered downstream because of the current patchwork that feeds el Alto.

This is true Keith.  Good water quality and supply were a top priority for us.  I guess I'm glad Doug insisted after hearing of so many problems.  I'm hoping once the upgrades are completed everyone will have access to good, plentiful water.

1 hour ago, Brundageba said:

Giardia Lamblia is present in untreated water to varying degrees here.  Our water currently is untreated in Boquete.  You are naive.  Reverse Osmosis and other modes of purification are the only for-sures right now.  Clarity of water does not insure it's purity.

Ouch!  I do have a degree in microbiology/parasitology and had hoped not to be categorized as "naive", but  I've been called worse!  I did have my water tested at the point where it enters our subdivision.  It was negative for E coli , and Giardia.   I still use a millipore/UV light filtration system because I can't test daily.  However, our water's great taste comes from the rocks and minerals it passes through before it reaches my house.  I've lived in many countries, both first and third world, and this is the best tasting I've ever had.  And it's clean.  But as Pantah noted in an earlier post, the quality of the water is moot for those without water.

3 hours ago, Siempre Soluciones said:

The US State Department is engaged in water and sanitation projects all over the world executing their Global Water Strategy through their USAID organization.  Panama is not a participant

Siempre S.  I think you may have contradicted yourself when you stated the above.  Uncle Doug and Keith both get "out and about" , and are involved in Boquete, neither is hunkered down behind private security guards and gates.  We've all had a few times with water outtages, personally mine have only been caused by a broken pipe on my own property, but it's never fun to be out of water.  That said, my guests are amazed at our beautiful, clear, clean, tasty water.  I have clear glass bowl sinks and they stay clear after use.  No spots.  It is better than any bottled water I've ever drunk.  No chlorine, and no pathogens.  Amazing water, something my visitors love.  I'm always surprised to see tourists filling their grocery carts with bottled water, we should do a better job of bragging about our water.  Patience is required when there are temporary problems, but when it is running, the water is fabulous.  

I lived in Africa.  We either boiled our water or added iodine.  It tasted terrible, we lived on Kool-Aid powders to mask the taste and hide the particulate matter.

On 12/18/2017 at 5:52 PM, Bonnie said:

I'm not a huge fan of Facebook because it can be time-consuming, but I have found that giving it a look is essential to knowing what's going on here. There are at least four different Boquete FB pages, and I usually come away with some information that makes my life here easier. I've learned how to skip through it quickly to what is important to me.

I admire your discipline Bonnie!  I have no Facebook account, it seems to be useful, but for me it drove me crazy to make comments there.  I have seen too many folks get in all kinds of trouble and lose friends or embarrass themselves, haha.  I should try it again, perhaps using an anonymous handle.  I think I've matured....?

On 11/15/2017 at 8:03 AM, Keith Woolford said:

Not sure you can hold the Mayor responsible for the actions or inactions of the water service contractors.

Thanks for pointing out this simple fact.  While the buck often stops at the highest person on the totem pole, we need to remember that there are others who can take responsibility, too.  The mayor cannot and should not be held responsible for every bonehead decision made by some contractors and their underlings.

I cannot even imagine the sorrow, anger, desolation felt by this family.  While such things are not new, it is nevertheless one of the largest horrors any human could face in their lifetime.  I'm saddened to hear that it has happened so close to home.  Hopefully the pervert who perpetrated the deed will discover justice.

7 hours ago, Penny said:

Irma recommends Dr. Cerrud in David as a pulmonologist. I think that's close to what she said his name is. Does anybody have any information on him. He's not in the Health Care Referral List.

It's Dr. Serrud I think.  It appears to be on the list now.  I think he specializes in pediatric pneumonology, but if Irma recommends him, that's all I need to hear to at least give him a try.  

Based on what I read in the article this could stop investors from engaging in future major projects.  It could also  bring a growing economy to a halt.  Governments don't create wealth or jobs, but they sure can stop them.  I hope this case moves to a higher court for review.  I'd also hate to see any bank failures, as they often domino.

I have a couple of other names.  Maybe one of these ring a bell.

Dr. Rafael Tirado 6618-1615 ,  

Dr. Avid Julio. 730-3608,

Dr. Eric Tortosa 774-0128 ext 3226/cell 6612-6484

Dr. Rafael Camano. 730-4440

As a newbie here I don't know what it was before?  What will it be now?  Is it a bar?  Or more?

Sounds exciting.  I need to get my otherwise healthy cats a check up and pick a good local vet.  Their coming on board , thankfully, got me motivated to get going on that task.  If there is a particularly good feline vet, please recommend.  Most vets, I'm assuming, here are generalists.