Dental Departures, Carlos Vigil and my Mexicali dentist


My apologies to readers – this post is way overdue.  In fact, I had completely forgotten about it – until I received a couple of email inquiries yesterday about dental services in the Mexicali area.

I originally interviewed Carlos Vigil back in October 2013.  We met at the Mexicali Summit, while I was promoting my book.

Carlos Vigil

Carlos Vigil

Mr. Vigil works with an American company called Dental Departures that specializes in dental tourism. Mr. Vigil is part of the sales team for the Baja California area that recruits dentists to participate in Dental Departures.com.

Dental evaluation versus surgical evaluation

If you’ve read any of my books, then you’ll remember that dental evaluation is quite  a bit different that any of the other services (like surgery).   Surgical evaluation requires background research, interviews and observation.  

Dentistry requires more active participation.  In the past, in the name of research and quality evaluation, I (along with a group of volunteers) have undergone extensive dental procedures without the aid of anesthesia.  

One of my colleagues field tests dentistry services with Dr. Quintana and his associates

One of my colleagues field tests dentistry services with Dr. Quintana and his associates

Dental evaluation can be slow, painful work

But this is slow, tedious work and it doesn’t really add anything to the knowledge base that couldn’t be obtained by more traditional routes such as patient feedback. It also requires a longer time commitment – since an important component of quality dentistry is durability.  If six months afterwards, a crown breaks, a patient develops a serious abscess or all your veneers fall off – that’s important information for prospective patients to have.  But – as you can imagine, that makes for very slow writing – and would delay my books significantly.

But  Dental Departures hopes to provide that feedback.  But Dental Departures is more than the International “Angie’s List” of dentistry.  It’s a comprehensive dental clearinghouse that includes 2900 dentists in 29 countries.

So while I am happy to recommend my personal dentist in Mexicali  (contact information below), Carlos Vigil and Dental Departures may be a good alternative for people looking for dentists across the globe.

Now, while I certainly can’t vouch for Dental Departures, (for reasons detailed above), it certainly sounds like a great idea.  Hopefully, readers can give me some feedback as to the quality of goods and services provided using this service.

For a more informal recommendation –

My Mexicali Dentist:

Dr. Luis Israel Quintana Burgos

His address is in central Mexicali – and may be difficult to find for a visitor, but a cab should be able to find it fine…

The address is Blvd Lazaro Cardenas y Anahuac #862, Jardines de Lago, Mexicali, B.C.  

Telephone  557 9151. 

Go down Lazaro Cardenas, then on the left a the corner of (Anahuac), just past the intersection there is an Oxxo. Turn after the Oxxo and enter in the parking lot.  Drive through the parking lot.  Behind the Oxxo is a group of offices – on the right is going to be the Dental Place..

  He is excellent and affordable, and can usually find time to squeeze in patients fairly quickly.   I’ve seen him several times for dental cleanings as well as some fillings.  

First impressions aren’t always correct

Now, the first time I saw him – I wasn’t overly impressed.  There was a very young receptionist who spent most of her time looking at herself in the mirror.  She also acted as if she was annoyed that our arrival to the office had disturbed her beauty routine.  This would have been a non-issue since I was seen quickly and brought back to the dentist’s chair – except that she flounced on back down the hallway to the dental chair with me.

vain

And she stayed – with one hand (and all her attention) on an old-fashion style round hand mirror.  She was ostensibly, “assisting” the dentist, but since she couldn’t drag her attention away from her own reflection for more than a few seconds at a time, the dentist ended up having to get up and move around the room to get everything himself.  It was an awkward situation, made more awkward by the fact that as the patient, I was sitting there as an unwanted voyeur with my mouth propped open, listening to her cooing, using baby talk and practically purring at the doctor.

It was all I could do to sit there, then pay the dentist and get the heck out of there.   I promised I’d never go back to such an unprofessional and uncomfortable situation again.  Except – during a return visit to Mexicali – a member of the Latin American surgery team had a dental emergency, and by default called Dr. Quintana for help.  He got him in right away and I accompanied him to the appointment.

What a difference a few months makes!  The baby sexpot receptionist was replaced by an attractive but professional assistant who was polite, friendly and attentive.

The fumbling in the dentist’s chair was gone.  Instead of an assistant, the dentist has re-organized the office, so all of his needed materials were within reach.  The whole atmosphere of the office had changed – into a professional medical office.

Since that second visit, Dr. Quintana has become my ‘regular’ dentist.  Sure, when I’m traveling – I’ll stop in for cleanings in other cities, but I plan to return to Mexicali and Dr. Quintana for all future work.

sizing the crown

sizing the crown

One of my colleagues has also had several fillings, a root canal and a crown performed in his office.   It’s been several months since the work was performed and there have been no issues.

Dr. Quintana speaks only Spanish but he is in practice with two other dentists that speak some English.

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Medical tourism for pets?


Hello everyone, and season’s greetings from Dallas, Texas!

I am on assignment as a locum tenens for the next several months, so I will be traveling around the United States quite a bit.  In the meantime, this blog post  by Marian Ruiz over at Borderzine caught my eye so I thought I would share.

In the article, Ms. Ruiz interviews Elva Lomas, a California resident who travels to Mexicali for her pet care.  This article drew my attention for a couple of reasons:

1. I know Mexicali, MX.

Mexicali is one of my favorite cities.  I guess it’s an occupational hazard; since Bogotá ranks pretty far up there on my list, as well.

But back to Mexicali –

After spending several months there writing my most recent book, this area of dusty and hard-packed, sun-scorched concrete, asphalt and dry dirt became near and dear to me.

Mexicali sign

2. I have pets.

The other reason this story caught my eye was the part about the animals.  Mexicali was the first time I was able to bring my own pets on one of my writing projects.  Both of our cats, 17 year-old Sid, and 4 year-old Cora came with us for the nine month stay in Mexico.  (We previously transported the cats to the (U.S.)Virgin Islands, and on multiple cross-country car trips, so the cats were veteran travelers, but this was their first international trip.)

Our cats (at our home in Virginia), circa 2010.

Our cats (at our home in Virginia), circa 2010.

Over the course of several months, both of our cats saw veterinarians in Mexicali – including two different ones – on Avenue Maduro and another office, closer to our apartment.  We also went to the veterinary college in Mexicali.

Sid, prior to his final illness

Sid, prior to his final illness

But our experience was a little different from Ms. Lomas and her seven dogs, particularly for our geriatric cat.

In fact, at each clinic, the veterinarian expressed surprise at Sid’s age.    In what turned out to be his final illness, we were forced to go across the border to El Centro, California to get Sid the aggressive, intensive care that he needed.

Sadly, he was too sick and too weak – so we brought him back to Mexicali to our apartment to die.

3. Many Americans have “close” relationships with their pets that maybe considered uncommon in other cultures.

What we found during this experience wasn’t that veterinarians on either side of the border were more or less qualified than the other.  What we found is that the cultural expectations and the role of pets varied significantly by country.  (I am certain that a case could be made that there were several other factors as well – such as our familial and socio-economic status).

For our vet in Mexicali – Sid was our beloved pet, and they were happy to offer compassionate and competent care.   For our vet in El Centro – he understood that like many childless, middle-class couples, Sid was more than a pet – he was family.  [Not everyone feels that way about their pets – but all of us know people who do.. However, not all cultures view this ‘child-pet’ attitude as indulgently as we do.]   This meant that the vet offered more services and treatments (like emergency dialysis, and mechanical ventilation) for our ailing, long-term companion that they did at the vets’ offices in Mexicali.

In the end, it didn’t make a difference, after 17 years, my cat was at the end of his life.  We didn’t put him on dialysis, or advanced life support.  Instead, we made him as comfortable as possible and watched him slip away from us, surrounded by people who loved him (my husband and my dear friend).

The cultural context of care

But the focus of this story isn’t about pets, veterinary care or Mexico at all.  It’s more about the importance of cultural context and cultural values related to health care.  In fact, one of the reasons that I focus on health care / medical tourism in Latin America is due to concerns over differences in cultural expectations related to health care.

Life support despite medical futility as a cultural expectation*

In general, these differences are minimized for people from the United States when they receive care from Latin American providers due to similar cultural backgrounds and cultural expectations.   (A good example that highlights the differences in healthcare related to culture that is often cited in the literature has to do with end-of-life and ‘futile care‘.)  This is care that may be very expensive to provide – and may actually do nothing to prolong life.  It’s one of the hallmarks (or pitfalls) of American healthcare.  But then again, it’s only a pitfall, or ‘wasteful spending’ when it’s not your family member.

Translated this ‘futile care’ means that in most parts of Northern America, metropolitan areas of Latin America, people may receive treatments (like dialysis, prolonged mechanical ventilation/ or other artificial ‘life support’) despite having minimal or a low or no chance of survival.  Ethicists can debate the issues related to the use of limited or scarce resources to keep someone’s elderly grandmother, or extreme ‘preemie” baby alive, but for the most part – doctors (and patients) in Bogotá, Mexico City, Dallas, Texas or Washington, D.C.  all want the same level of care and are willing to provide some level of this care, even when doctors feel it may be futile in nature.  It is part of the culture, and the cultural expectation shared by most patients.

However, if you contrast that with other common medical destinations (by country, not facility), the answer is not always the same.  If the average life expectancy/ infant mortality / or level of available technology is dramatically different, than the cultural expectation of “appropriate care” may be very different.  That isn’t to say that the doctors or families of patients in these countries care about their patients any less.  However, it may translate to a very different level of care in similar circumstances.

For example, I currently work in a surgical program that specializes in providing valve replacement (cardiac) surgery to the extreme elderly (patients in their late 80’s and early 90’s).  In other cultures and societies, expensive and scarce medical resources would not be allotted as freely to this group of patients.  It’s one of the concerns in our own country with the advent of ‘Obamacare’ or a socialized medicine schemata, and it is a legitimate one.

Whether or not we consider it right or appropriate to offer this level of care to high risk groups is often debatable, but as Americans we take it for granted – that we have the right to decide this for ourselves.  We might not be as happy if it’s not offered (or available) to us as medical tourists somewhere else.

*This field of study is a subspecialty of Sociology – while it’s not scientific, the linked description on wikipedia may be helpful for readers who want a basic overview on some of the ways culture affects health beliefs and behaviors.

Mexicali updates: October 2013


Here is some updated information from my recent visit to Mexicali for the Mexicali Summit (Cumbre de turismo Medico):

New Cath facility

Hospital Almater opened their new cardiac catheterization laboratory as part of their long-standing plans to build a ‘chest pain’ center.  The first cardiac cath in the new facility was scheduled to be performed October 18th, 2013.

During a discussion with the owner of Hospital Almater, at the Cumbre, I asked for permission for an ‘official’ tour of the new cath facility so I will have additional details for readers.  My request was denied.

Hopefully, I will be able to provide more information about the cath lab as well as the continued development of the ‘chest pain’ on a future visit to Mexicali.

Loss of full-time heart surgeon/ heart surgery program 

Mexicali has lost its only full-time cardiac surgeon.

Mexicali has lost its only full-time cardiac surgeon.

Several local physicians have reported that Dr. Cuauhtemoc Vasquez is no longer functioning as Mexicali’s only full-time cardiovascular surgeon.  His cardiac surgery program at Issstecali has closed (due to financial reasons), and he is no longer operating at the various facilities in town.  It is a huge loss of the city of a million residents.  Baja California residents will have to travel to Tijuana for surgery – while Imperial Valley residents will continue to travel to San Diego or Los Angeles for cardiac surgery services.

Salud Longevidad

During my visit, I was also invited to visit Salud Longevidad, a new clinic that is the brainchild of Dr.  Jorge Gallegos.  He created the clinic as a place for many of the local therapists and alternative/ complementary medicine practitioners to provide their services.  He likes to joke that he created the centro de medicina alternativa as a way to personally fight of the aging process, so “I will be young forever,” he explains with a smile.

The unassuming, nondescript exterior hides a spacious and elegant interior.  The clinic offers multiple treatments including various types of massage (and couples massage), water therapy, high colonics, magnetic therapies – and other varieties of “alternative” therapies.

The fifteen suite clinic also features a hyperbaric chamber.  Now, this is a treatment I can appreciate since there is a large volume of research on the benefits of hyperbaric oxygen therapy for wound healing and other medical applications outside of the ‘bends’ or complications from scuba diving for which the therapy is best known for*.  It also happens to be one of the nicest, most modern chambers that I have ever seen.  The majority of other chambers I have visited are either former military equipment or vintage models.

Dr. Juan Fernando Medrano, a medical doctor who also serves as the head of medical tourism at the Hospital de la Familia was gracious enough to invite me for a tour, and to watch one of his sessions at the new clinic.  He recently finished training as a medical aesthetic physician, and now performs platelet rich plasma (PRP) treatments (among other procedures).

Salud Longevidad is located on Av. Francisco Javier Mina #200 in Zona Centro (across the street from the parque de Mariachis).

For more information about Dr. Medrano and the PRP – please read my recent article at Examiner.com.

* Hyperbaric oxygen is best known for its use in treating ‘the bends” or complications from rapid decompression (rising to the surface too quickly) in scuba divers.

I have included a limited selection of medical literature on hyperbaric therapy.   However, I also want to caution readers when researching medical information, particularly when reading Chinese journals which have been recently discredited for widescale/ widespread fraud.

References

Egito JG, Abboud CS, Oliveira AP, Máximo CA, Montenegro CM, Amato VL, Bammann R, Farsky PS. (2013).  Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery.  Einstein (Sao Paulo). 2013 Sep;11(3):345-349. English, Portuguese.

While many readers know that I have a background in cardiac surgery – where mediastinitis is a serious/ dreaded complication – I hesitate to embrace these findings too enthusiastically due to the very small sample size (of 18 patients over 2 years).

Cao H, Ju K, Zhong L, Meng T. (2013).  Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage following cerebral hemorrhage.  Exp Ther Med. 2013 Jun;5(6):1609-1612. Epub 2013 Apr 2. A small (60 patient) study looking at the effects of hyperbaric oxygen on depression in patients following cerebral hemmorhage (hemorrhagic stroke).

de Nadai TR, Daniel RF, de Nadai MN, da Rocha JJ, Féres O. (2013).  Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report. J Med Case Rep. 2013 Jun 27;7(1):167. doi: 10.1186/1752-1947-7-167. Did hyperbaric oxygen help?

Delasotta LA, Hanflik A, Bicking G, Mannella WJ.  (2013).  Hyperbaric oxygen for osteomyelitis in a compromised host.  Open Orthop J. 2013 May 3;7:114-7.  Research suggesting hyperbaric oxygen may be helpful in treating serious orthopedic infections in patients with impaired wound healing.

Recommended reading:

Chantelau EA.  (2013)  Benefits of hyperbaric oxygen still doubtful.    Dtsch Arztebl Int. 2013 May;110(21):372. doi: 10.3238/arz9tebl.2013.0372a. No abstract available.  A letter in which the author presents evidence suggesting that any attempt to conclusively state the benefits of hyperbaric oxygen therapy is premature/ misguided (at best.)

Mexicali Summit 2013 : trade show on medical tourism


Yuma International Airport –

I am waiting for the first of several flights to begin the long trip home after attending the Mexicali Summit on medical tourism.  There’s a lot of news to report, so this will be the first of several posts on the topic.

As an independent writer – I was kind of in a class by myself at the trade show which featured clinics, hospitals, doctors and medical tourism companies advertising their services.  There were also equipment and insurance companies presenting their products at the three-day event.  Argentina and Costa Rica also had displays to entice medical tourism agencies to consider adding destinations to their current rosters.

While the event was initially planned as an open event – with the public invited to ask questions and look around, a last-minute executive decision by Carlos Arceo to  change from free admission to 40 dollars eliminated the majority of the public audience.

I was still able to meet and talk to several teachers, including a professor at Cetys University who came to the event to see what economic development the medical tourism could bring to Baja California.  I also met and interviewed several other attendees at the conference.

The mayor of Mexicali, Francisco Perez Tejada, along with the outgoing/ and newly elected Secretary of Tourism came out to open the event and shake hands with attendees.

(Story on the conference with photos at the Daily Economic Monitor)

One of the highlights of the entire event was having the opportunity to present Mayor Perez with a copy of my book, in person.  He was exceeding gracious when I approached him.  Imagine my surprise to see him reading the book of the evening news report on the event (at 1:10 in the clip below.)


In fact, I was pleased to be able to offer a copy of the Mexicali book to the mayor of Mexicali, in person just after the opening ceremonies.  He was exceedingly gracious and spent several minutes looking at the book. It was definitely one of the highlights of the trip.

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


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..

In the operating room with Dr. Victor Ramirez, MD, plastic surgeon


Frankly, I wasn’t sure what to expect when I returned to see Dr. Victor Ramirez.  I had enjoyed talking to him during the first interview back in November of 2011, but as most people know – a lot had happened since then.  It took me a couple of weeks to re-connect with the now somewhat wary and (media-weary) surgeon, but when I did – he didn’t hesitate to invite me to the operating room.  And then – after the first case, he immediately invited me back**.

Dr. Victor Ramirez, plastic surgeon

For readers unfamiliar with the concept of my work – let me tell you, this is usually an excellent prognostic indicator.  It’s certainly not fail-proof – but as a general rule; when a surgeon invites you to his operating room, he is generally confident because he is a good surgeon. 

You’ll notice a couple of things about the statement above – when the surgeon invites me, is important.  Often when I have to ask – it’s because the surgeons are hesitant to let me watch.  Most (but not all of the time) – there is a good reason that a surgeon doesn’t want an observer in their operating room.  (And there are a multitude of reasons – not just a poorly skilled surgeon.)

But there are certainly no absolutes.  I have met fantastic surgeons who initially were not crazy about the idea (but quickly warmed up to it) and I have met less than skilled surgeons who happily encouraged me to visit – and everything in-between.. I’ve visited great surgeons who were hampered by poor facilities, unskilled staff, or limited resources.  That’s why the on-site, operating room visit is so important.  Anything less, is well – less than the full picture.

But back to Dr. Victor Ramirez – in the quirofano (operating room) performing surgery.

Dr. Victor Ramirez, Dr. Perez and Ricardo (RN)

I observed Dr. Ramirez operating at two different facilities – Hospital Quirurgico del Valle, and the Bellus clinic.  Hospital Quirurogico is a private hospital – with excellent operating room facilities.  While there are only two operating rooms, both rooms are large, well-lit, new, and very well equipped.  There are three separate ‘big screen’ tv sized monitors for video-assisted procedures – so if you are looking for a facility for video-assisted procedures such as endoscopy, laparoscopy or thoracoscopy – this is the place.  All the equipment was modern, in new or ‘near-new’ condition.  As a facility specifically designed as a surgical hospital – with private rooms, patients are segregated from ‘medical patients’ with infectious conditions.  (The facility is not designed for pneumonia patients, and other medical type hospitalizations.)

Dr. Ramirez applied the sequential stockings himself (kendall pneumatic devices), and supervised all patient preparations.  Patients received a combination of conscious sedation, and epidural analgesia – so they were awake, but comfortable during the procedures.  (This eliminates many of the risks associated with general anesthesia – and reduces other risks.)  The anesthesiologist himself, Dr. Luis Perez Fernandez, MD was excellent – attentive and on top of the situation at all times.  There was no hypoxia or hemodynamic instability during either of the cases.  (I have been favorably impressed by several of the anesthesiologists here in Mexicali.)

Dr. Perez monitors his patient closely

As for the surgery itself – everything proceeded in textbook fashion – sterility was maintained, and Dr. Ramirez demonstrated excellent surgical techniques.

For example – One of the signs of ‘good’ liposuction (and good preparation) is the color of the fat removed.  Ideally, it should be golden or light pink in color.  Over-aggressive liposuction or poorly prepped liposuction results in more bleeding.  As I watched fat being removed – the fat remained golden-yellow in the suction tubing, and even at the conclusion of the procedure, the accumulated suction canister contents remained just slightly tinged pink.

Results were cosmetically pleasing in both cases with minimal trauma to the patients***- but there will be more details forthcoming in the free book (since the post is becoming pretty long, and may be more detail than casual readers would like.)  I’ll have more information about the doctors, including the anesthesiologists, the clinics and the procedures themselves..

I did want to post some specifics – especially in this case, as the patient told me that her/his parent is a retired physician and had concerns about surgical conditions.

Mom, Dad – you don’t have to worry – Dr. Ramirez runs an excellent OR. Even in the tiny Bellus clinic, there is a full crash cart, a defibrillator and an emergency intubation cart – just in case.

**Given what I know about Dr. Ramirez, I am pretty confident – that if I wanted – I’d be there right now, and every day for a month, or until I said, “stop”..  That’s the kind of person Dr. Ramirez is.

*** In some liposuction cases – the patients appear as if they have been beaten (extensive bruising) due to the amount of trauma and force used during the procedure.

In the OR (and back again!)


It sounds awful to say but it’s a good thing my husband has been out-of-town this week – after all, considering my week in the operating room, he wouldn’t have seen much of me anyway!  But it always drives him a little crazy to see me racing from interviews to operating rooms – stumbling home late, with aching legs and a rumbling tummy, only to climb out of bed and the crack of dawn just to do it again.. then worry that I somehow won’t have time to write it all down – and round and round..  (That being said – he is phenomenal about understanding this driving motivation I have to interview, and to write – even when I’m not quite sure I understand myself.)

So he wouldn’t have complained about my whirlwind tours of the operating rooms this week – or the long days of back-to-back surgery but I would have felt bad about not seeing him all the same..

Instead with my husband thousands of miles away, I hear him smiling in the phone, laughing at my exploits, though I sometimes picture the wrinkle he gets in his brow when he thinks I’m not eating right, or getting enough sleep.. He currently serves as my remote editor for my articles at Examiner.com – calling to give feedback before submission.  He’ll be home soon – and he’ll be patient with me, as always.

Dr. Victor Ramirez, plastic surgeon

Had some great interviews and operating visits this week – including Dr. Victor Ramirez, and most of the plastic surgery community here in Mexicali – but to be fair, I will break it all up into a couple of posts.

Demonstration of techniques for breast reconstruction at Mexicali General

Back in my ‘home’ OR in thoracic surgery – which felt good.  I love meeting and seeing all the different specialties like bariatrics, urology and plastics, but it sure does feel good to come back home again..

back in thoracics (and trying to hang from the rafters)

I could wax some eloquent nonsense about the beauty of a muscle-sparing thoracotomy but then again – the good doc does almost everything minimally invasive, so I never see any.. (and you’ve heard me crow about dual port thoracoscopy.)

with more to come..