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The Ecuador Chronicles - 2010-40
A Pain in My Shoulder;
                 A Visit to the Orthopedist;
                                             Treatment for the Problem
This week we feature another Medical Chronicle by Dalynda Hester Almand.  Dalynda tells us about dealing with her rotator cuff problem in Quito.
by Dalynda Hester Almand

My Shoulder Pain 


My shoulder has been giving me a problem for more than a year.  It is more of a annoyance, but I have to be careful about how I use it.  When we were in Quito in June of this year I decided to have it checked out.  We are interested in learning about the Ecuador medical system, and right now we are on a high deductable ($10,000) health insurance policy so we try to cut medical costs where possible.  Live Well Ecuador associate Juan Cevallos did some research for me to find a good Orthopedist - as he did in finding a dentist, covered in an earlier Chronicle.  I chose Dooctor Esteban Holguin who has a modern office and is associated with Hospital Mertopolitano.


After a short examination Doctor Holguin diagnosed a rotator cuff problem.  The Doctor works a lot with athletes - mostly soccer players.  He has had much success with young athletes from something called AGF Growth Factor therapy followed up with intense physical therapy.  This has also worked well with many non-athlete patients with rotator cuff problems.  This therapy involves taking some of your own blood and reducing it down until it is rich in AGF Growth factors.  This is injected into the injured area to promote healing.  (Please don't quote me on the technical aspects of this treatment!).  I liked the idea of this because I had not reached the point where I wanted to deal with surgery.


An MRI would be necessary to verify the rotator cuff diagnosis and to determine if I was a candidate for the AGF treatment.  We were headed back to Atlanta the next day so there was not time to do it on this trip.  Doctor Holguin had said that this was not a acute problem so there was no urgency about treatment.


Medical Office Building




Straight Ahead to Doctor Holguin's Reception Area


Orthopedic Art in Doctor Holguin's Office



Back to Quito for Treatment 


I returned to Quito in October for treatment.  I made appointments with both Doctor Holguin and Axxiscan for a shoulder MRI.  Axxixcan is a modern facility - the staff is friendly and helpful.  The MRI process was similar to the one Ray had on his knee several years earlier in Atlanta.  I laid on sort of a bed and was pulled most of the way into the machine.  It made a lot crashing noise and took about 15 minutes - they gave me headphones.  I understand that these days in the States there are more open and quieter machines available - but this seemed to work fine for my problem, and I liked the cost:  $180.  I think this may be about a tenth of the cost in the USA.


Entering Axxiscan


Axxiscan Reception


My MRI Bill



Doctor Holguin reviewed the MRI results - the rotator cuff was torn and I was not a candidate for the AGF therapy.  I was so disappointed.  We discussed my options. 


Surgery would be an arthroscopic procedure involving making two small holes in my shoulder.  A small camera type device would go through one and a device to repair the tear through the other.  I would be under general anesthesia during the operation.  It sounded straight forward, and the cost was reasonable - Doctor Holguin estimated about $2,000 for everything, not counting the follow-up physical therapy.  I think this is probably a fraction of what such a procedure would cost in the USA.  But I was still not ready to deal with surgery.


Another option was to undergo extensive physical therapy to strengthen the other rotator cuff muscles so that I could use my shoulder more with less pain.  I decided to do this - even though I may only be delaying the inevitable.



Physical Therapy 


The physical therapy clinic is a part of Doctor Holguin's office.  My chief therapist was Marcelo Baldeon, and the clinic has a staff of maybe 12 or 15 professionals.  My regimen was to be ten sessions, one per day, of intensive therapy.  From one to three people were working on me at a time.  This involved use of cold, heat, electrical impulses, massage, and of course exercise.  There was all kinds of equipment available.  Each session lasted one to one and a half hours.  The cost per session was $16 - when Ray had his knee surgery in the States under full insurance a few years ago, the co-pay per therapy session was $15.  Marcelo and his team did a good job - I would rate it a success.  My pain is less and I have greater movement of my shoulder.  I now have a regimen of exercise that I am to follow every day to maintain the improvement.  But this may be the problem - making myself do it.  While I do a lot of walking and running around, I have never been good about regular exercise.  So, watch this space - someday you may see a Chronicle from me on rotator cuff surgury.


Part of the Physical Therapy Clinic





A Sports Medicine Facility -

Doctor Holguin Works with us Regular People as Well



Thank You Dalynda 


This has been a very interesting and informative Chronicle.  I hope you keep the exercise program going.  We would like to hear more from you!



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