Palo Alto Jo

I brought in my two cats, nearly two years ago, and we never sent the cats in their carriers through any X-Ray machines.  It's my understanding they are dangerous for both man and beast.  The machines are set much higher than any medical X-Ray machine, and certainly aren't tested for safety to people or animals.  We sent the empty carriers through X-Ray machines and carried the cats through the magnetometers.  In Houston, on leaving, we were taken into a separate small room in the TSA area where our cats where "frisked".  But, never ever should a pet go through an X-Ray machine.

I agree, it was like reading Greek.  Who,what, when, where????   Haha

I had about decided it was thunder that shook the house.  I called 2 people to ask if they felt BOTH, but neither felt a thing.  Finally found them online this morning.  Feels good to be "right" once in a while.  I actually had a few pictures to straighten.  

They were located in basically the same area as the 5.3 we had in April.

If she was there, "someone" would remember.  Me thinks she might have been absent for a few unaccounted minutes.

Thanks for those links, Keith.  And, for the correct spelling for Raly laboratory. I spelled it as it was written down for me ?.  I've asked the administrator to correct it for me.

I made a visit to Laboratorio Clinico Immunotec this morning to get some answers concerning their QC. program.  I hope this helps clear up any confusion, plus I got their assurance that they would not mind being discussed in our forum.  

Immunotec lab, located by the main bridge, does not have an ISO certificate in their lobby, because they are "in process" of completing their certification.  They are actually through with their testing, data collection, paperwork, and continue to run QC specimens from ISO daily, as well as participate in the quarterly examinations of blind samples.  They were required to submit results monthly to ISO for one year, and compare to a peer group.  This part is finished, and they simply await the certificate that will be posted in their lobby.

I did not go to the other labs in town, for one simple reason, Immunotec knows the other peer lab that is in the area that they are compared to, and that lab is Raly Laboratorio in David.  

This doesn't mean other labs aren't good, it's just that they aren't participating in the ISO program.  Also, outpatient labs are in their own peer group, and not compared with hospital labs.  The ISO program is expensive, time consuming, and not required by law in Panama.  It is impressive when we have 2 in Chiriqui Province participating. 

For reasons unique in Panama , I think it's unwise for me to post which labs use ISO controls.  However, it's a question that any lab should answer if you ask.  Also, the local doctors know which labs use the ISO controls, and will point you to a specific lab if you ask.  

Got a bit more info for folks looking for inspection stickers or calibration checks on equipment here in Panama.  As i said in earlier posts, equipment in the U.S. is NEVER  calibrated or checked by anyone , other than the operator.   The U.S. government makes you show results, they dont fix or check your machines.

The little stickers you see here with old dates are simply checks for electrical shortages.   Required in the U.S. by local city ordinances.  They have zero to do with whether the equipment is reporting out good results.   Just that last checked, it will not start a fire.   That's it.  

The good news is, I have found there ARE labs in Boquete and elsewhere  that use "ISO" controls.   These are International standards.  Meaning they run blind samples and prove their equipment reports results that match the rest of the universe.   That was a big eye opener to me, a former lab director.  I now plan to see if the credentials are posted in the lobbies of the participating clinics,  so anyone knows if the lab they are using is comparable to the best labs in the world.

In the meantime, keep double-checking the label on your specimens, because that is the biggest flaw in the system here,  specimen ID.

On 9/1/2017 at 12:43 PM, JudyS said:

Thank you for the excellent information Jo.  One other thing to look at, if you can see the equipment, is if there is a calibration sticker on it.  Check the dates.  I once looked at one on a mammography machine a few years ago.  It did have a sticker, but it was dated 1996 and don

On 9/16/2017 at 11:25 AM, JudyS said:

e in Miami.  They obviously got the machine used from Miami, but I wonder if they ever calibrated it themselves.  I have always wondered what kind of quality control, if any, they do here on their equipment.

On 9/15/2017 at 3:31 PM, Bonnie said:

The polyclinica does have hand sanitizers. That doesn't help with the toilet situation, though.

I'm not sure about the antibiotics. Every time I walk into a doctor's office they foist them on me. But this probably doesn't happen in the public clinics, I would think.

Bonnie, in a small way, agreed not perfect,  hand santizers do help,  even with non flushing toilets.   It's almost always the hand to mouth path that spreads the germs.  Non flushing toilets in a healthcare facility is indeed a nightmare.  But,  cleaning hands is the key!  

Not only are antibiotics less prevalent here, the local chicken and beef certainly get less antibiotics, which I think is the main source of E. Coli, Salmonella,  Shigella,  and Camphylobacter in the U.S.  

I am always amazed at folks who go to PriceSmart to pick up their packaged frozen/thawed 10 times Pilgrim's Pride American Salmonella packages.  I did a study on poultry in the U.S. once.  99% of poultry in the U.S. contains Salmonella.   Yes, you're supposed to cook it.  But,  the poor cook is the one at risk.  If given the choice, I'd cook the local chicken and meat every time.

I would hope that clinics use chemical cleaners when water is unavailable.  Besides having reserve water tanks, I'd hope they have hand sanitizers at the very least.  I know they have hand sanitizers prominent in the Social Security clinic.  Wish they had them at the grocery stores. I bring my own.  Look how fast conjunctivitis spread, and that is mild compared to typhoid or cholera.  I think the best thing Panama has in its favor is the low level of antibiotic abuse versus the U.S.  If we did get an outbreak, it would probably be from an organism that is treatable.  

An outbreak would spread quickly here.  I'm with others here, avoid any place without water, and hope the establishments use good judgment and shut down when appropriate.  

As a newbie here, my Spanish skills are still insufficient to make it worthwhile for me to attend. But, I would love to learn of any new plans or projects.  If I could suggest one improvement it would be to add additional waste containers, and educate people on using them. 

Will there be someone willing to publish items of concern or interests in English?  CL would be a nice place to find out what is planned....hint, hint. 

I've reach an age where I've discovered that I cannot judge people I don't know based on stories, rumors, innuendos.  I try to do the best I can, and am still petty sure someone will decide, without having met me, what my innermost thoughts and feelings were.  It's human nature, I understand.  But, just because someone has a new wife, or bought a large home, doesn't make them evil.  There are so many charities I support, but I see lots of people working for the local animals.  It's a huge relief to me to see these people take care of our animal friends.  But, to be judged because my passions are now free to be spent on struggling humans should not be considered unfeeling about animals.  Or make people whisper that I am evil.  Unless we know these people personally, I'm going to say we ought to treat them as we'd like to be treated.

I've been watching this topic and comments for a week now.  My husband isn't going to like my view on this, as I think he's a speed demon.  He calls me a creeping old grandma.  But, I'm just saying most of the accidents I see here involve speed.  The corners here are not engineered to even be safe for the posted speed.  I love that in Boquete, it is so crowded now, that if you have a wreck in town you might, just might, break a fingernail.  I wish the car inspections here included brakes, taillights, and headlights.  But, for the most part one needs to not  speed and be defensively driving, to avoid being in one of these fatalities.  Slow down, these roads were not built for speed.  

1 hour ago, JudyS said:

There is only one good mammography machine in David.  It is the newer digital mammography machine at Hosp. Chiriqui.  You have to ask them to use that one.  The older machines (one at Hosp. Chiriqui and the one at Mae Lewis) give greatly inferior images compared to the digital machine.  I haven't heard that Mae Lewis has a digital machine.  If anybody knows, please let us know.

You don't need to schedule an appointment at either hospital.  You can just walk in.

Is it possible to get the mammogram images on DVD or other format?  For regular X-rays I usually send them to my U.S. physician for a second opinion.  Does the fee include radiologist's report, which I assume is in Spanish?

Don't you love being charged to covert U.S. dollars to U.S. dollars?  I cancelled any credit card that charges the fee.  One rep told me it costs just as much to multiply by 1 as to multiply by 3.457 , but the companies don't have to check daily for new exchange rates. I know this isn't a transaction fee, but your comment reminded me of that foolishness, too.

I recently decided to drive home via the "scenic route", the Alto Lino loop.  NOW I remember my husband's harangue from a few days earlier.  Just as I got to the closed part, I noticed a police truck ahead turn sharp right.  I quickly followed him, and discovered the detour through "the jungle",  but I did not see any detour signs.  If I hadn't been right behind the police truck, I might have gotten lost.  It's always nice to know one more route home. With the new bridge, I'll have 4 routes to Palo Alto.  

Thanks for posting the picture of the new bridge concept.  I'm really looking forward to the new bridge.  I'd love to be able to avoid the potholes as you exit the main bridge.  The new bridge looks to be built for the future, 2 lanes and high enough to not wash away.  As a newbie here, I was not aware that it had washed away twice before.  Being above the floodline seems like a good idea?

12 hours ago, Keith Woolford said:

There will be tens of thousands of flood damaged cars and trucks to be liquidated in Houston shortly and some of them will end up in Panama, so checking the history of a used vehicle is essential.

I spent 3 fun-filled years selling used cars in Houston, 1997-2000.  There were localized floods from time to time.  I found that  one of the easiest ways to find out if a used car presented for trade-in  had been submerged was to check the trunk.  Look for moldy carpet and leaves.   Lift the carpet, and look for leaves and rust.  People manage to clean the car interior and yet often forget the trunk.

That was "lesser kudu"... Mistyped there.  I really did learn it.... 

Dottie I will do that!  Thank-you.  Interesting that they mix them in the same lab.  I started my career at a lab in Los Angeles where one of our clients was the L.A. Zoo.  Some of the critters normal values of certain analysts were so high we'd have to take apart the machines and  clean them before we could run another human specimen.  There was a lot of carryover.  I did learn the names of animals like "lesser kudo".  I give any lab willing to do both my sympathies, but someone needs to provide vet labs.  Cant wait to visit.  I'll add it to my to do list.

Having spent 35 years working in laboratories in the U. S. I was I curious about the laboratory testing in Panama, and Boquete in particular.  I've used two laboratories in town, and spoken with my doctors about their concerns or recommendations.  The following are suggestions for those of you who are used to laboratories in the U. S., there are differences.

In the U.S. when you get your blood drawn, or drop off a specimen, you are asked to identify the labels they will place on your specimens.  Name, birthdate, ID number of some sort.  Then the date and time are written on the specimen.  This label is basically a UPC code.  With few exceptions, all analyzing equipment in the U. S. simply reads the barcode, sees what tests are ordered,  mechanically opens the tube, analyzes, then sends the results to a computer where a human reviews abnormal results and repeats any abnormals.  The technologists barely touch the tube other than to assure there is sufficient sample.  This is because of OSHA, who forced labs to reduce exposure to AIDS and hepatitis, etc.  Normal results are released with no review and go straight into the patient's record.  So, for most laboratory testing, it is extremely hard to get incorrect results, as long as you verify your OWN name.  Many of the procedures I'm describing here have been in use for the last 25 years.  I was a manager at LabCorp in Houston, we received over 50,000 test tubes each day.  We had to use these techniques or there would have been no way to type each name in before we even began the testing process.  Americans do a LOT of labs.

Now, I'll compare with Panama.   First, let me assure you, their equipment is relatively modern.  Equipment I used in smaller hospitals and labs.  Here, they simply do not add on the barcode readers, computer interfaces, automatic test tube openers, and other "safety" and convenience items .  The tests procedures are the same.  Glucoses are glucoses, the same chemical reagents as are used anywhere in the world.  So, why do you care?

It comes to two things I've observed.  No one asks your name, just scribble it on in light pencil or ink.  They also use test tubes here that do not allow for the blood specimens to have the luxury of sitting on the counter, untested, for more than an hour.  A glucose  that isn't tested within an hour will quickly degrade from very high, to normal or even low.  Other analytes, such as potassium will go higher the longer they sit.  I cannot confirm the tests here aren't run in a timely manner, but will tell you, my fasting blood sugar has been 105-110 for years.  Here, my glucose was reported 76, and surprisingly, that was nearly exactly the same value my husband got that day.  Our A1Cs were also identical, mine low for the first time in years.  

The problem, no doubt, our specimens were misidentified.  So, I recommend these three basic things you can do proactively.  Ask to confirm the names on your specimens before they leave your sight.  NEVER have your labs done on the same day as your relatives with the same last name, if you can avoid it.  Look at your results as soon as possible, the same day is best.  If anything looks odd for your history, ask them to repeat it, either with the old blood they saved in their refrigerator for 5 days, or ask to be redrawn and retested.  

The last advice, always drink plenty of water before going in for fasting blood tests.  Often they will tell you , nothing by mouth, when water is not only allowed it is necessary to find your veins easily.  Black coffee  and sugarless tea are also acceptable.

I hope to update this after visiting the laboratories located in the David hospitals.  They may be altogether different.  

If you have hypertension, like I do, and take your BP medicine, you know how this works.  It opens up your kidneys with a diuretic, to reduce pressure in the vascular system.  Most of us, women especially, know how puffy our hands and feet become when we consume an excess of salty snacks.  Imagine doing that and not taking your blood pressure medicine.  The salt causes fluid retention.  

Thanks for the video posting. With all the illustrations, I could still understand most even with my limited Spanish.

Salt contains iodine, a necessity for thyroid function.  Just as people will get a craving for red clay if they are iron deficient, some people will get a huge salt craving if they have thyroid deficiency.  

I agree though, most people just like salt.  I've noticed they also seem to be like addicts, in that they eventually need more to reach the desired taste.  

This is so exciting to hear!  I have been so frustrated with what I hear about the Blood Bank system here.  One of my biggest complaints is the "blood type on your driver's license" system here.  It is worse than arriving at the hospital with no blood type.  There is a HUGE reason this is not done in the U.S.,  the lab could have been wrong, or people may carry "fake ID".  No lab in the U. S. would give someone AB blood without typing them in the hospital.  I can't tell you how many times, in my personal experience, that someone's little card was dead wrong.. Especially those that were issued to U.S. Service members.  Unless you are re-typed, and then your blood is actually physically mixed into a test tube with the blood they are about to send down your vein, this could be an instant fatality.  The new system as described will bring Panama into the first world category and out of the third world.  

The fact that blood will now be typed, stored, tested for Aids and Hepatitis is huge.  We should not have to put out an all-call each time blood is needed.  Whole blood should NEVER be given, only the red blood cells.  Once a unit of blood is donated, it is good in a refrigerator for 60 days.  We should be able to store 2 units of each type in Boquete, or other town outside of David, and save some lives.  Good news indeed that this is in the works.