Helplessly Mute: A Trip to the Dentist

“Blessed are they who hold lively conversations with the helplessly mute, for they shall be called dentists.”
― Ann Landers

We’ve been searching for professional and trustworthy dentists in Nicaragua for three years. Finally, after excellent recommendations from several friends in Granada, Nicaragua, we found the perfect couple to attend to our dental needs.

Ron had major teeth problems and I needed a thorough cleaning. So, we contacted Dr. Erwin Esquivel Chavez through an email for an appointment. He responded the same day and set up appointments for our dental exams.

IMG_3759Meet the dentists: Dr. Erwin Esquivel Chavez and his wife Dra. Ximena Urbina Ordoez
Website: Clinica Dental Esquivel-Urbina
Office Phone: 2552-0664
The oral surgeon,Dr. Gilberto Martinez, aka TITO,
comes every Friday.
IMG_3760Dental Tourism is growing in Nicaragua. Dr. Erwin specializes in oral rehabilitation and implants. His wife, Dra. Ximena specializes in root canals.

State of the art dentistry at its best. Modern, sterilized equipment is provided for every procedure.
IMG_3762Gentle care: Dr. Erwin cleaned my teeth for over 1 and 1/2 hours. He took 5 x-rays and showed them to me immediately on his computer screen. He stopped often to ask if I felt any sensitivity. When my fingers started playing Fredric Chopin’s Polonaise (over the stereo system), he stopped suddenly, concerned that I was in pain. “Not at all,” I said, “I used to play this on the piano.” He was impressed…lol…because it is an extremely difficult piece to learn.
Ron had five teeth extracted by the oral surgeon. Next, he has to decide whether to get implants or partials. Where else can one sit in the office, watch the step-by-step extraction with a detailed explanation of everything in fluent English, and receive HUGS after it is over?


I asked the dentists if they are required to have liability insurance or malpractice insurance and they said that Nicaragua doesn’t have anything like that. So, the savings are passed down to the patients.
1. Teeth cleaning: $45
2. 9-10 x-rays:     $100
3. tooth extraction: $60
4. Ron had 5 teeth extracted, injections to numb his mouth, and stitches: $300 for all of his dental work.
5. Antibiotics and pain pills  $15
total: $460 for both of us
If he wants implants, they will cost $1,200 each for everything. For a partial denture: $300
Nicaragua is generally a cash only society, and the dentists were no exception.

If these same procedures were done in Tennessee, I calculated the cost using this website:
Dental Cost Calculator in the United States

1. Teeth cleaning     $84.71
2. single x-ray          $17.34                 for 10 x-rays    $170.34
3. Tooth extraction   $ 126.82             each additional tooth  $131.87
for 5 teeth  $ 654.30
4. Initial surgical consultation    $84.71
5. antibiotics and pain pills        $80

total:  $1,074.06

One Implant Placement:  $2,407.31
Partial Denture:                $1,544.97

We could have shopped around for a good dentist that would have been considerably less money. For example, Ron went to a dentist in Rivas and had a tooth removed. It cost $25. But, for the comfort, sterile environment, modern equipment, and dentists who speak fluent English, it was worth the extra money. They were wonderful and I would recommend these dentists to anyone seeking dental procedures. In fact, after our first appointment, we stopped at a main street cafe…a very touristy area. Two groups of people overheard us talking about the dentists and came over to our table to ask us more questions. Did I ever tell you how much we love Nicaragua…even when we are helplessly mute!

Also, see my new friend’s blog article Holes in the Head about her experience with these dentists.

Dr. Google and Cyberchondriacs

“Be careful about reading health books. You may die of a misprint.”~ Mark Twain

Without a doubt, the internet fundamentally alters all aspects of health care. Dr. Google has been my reliable internet physician since we moved to a small, isolated tropical island in Nicaragua. Online information empowers passive patients of the past, like ourselves,  where symptoms can be diagnosed with the click of a key, a bonanza of data appears instantly, and treatment options are dispensed freely.

Yet, sometimes, I feel like a cyberchondriac. I can find a wealth of worse-case scenarios for my symptoms, all leading to …You’re gonna die. If I have a sore throat…I’m going to die of throat cancer. Dr. Google diagnoses a minor stomach ache as an infestation of cyclosporiasis, the same rare parasite called Cyclospora cayetanensis, that sickened 466 people in 15 states. I’m sure this must create a major new headache for doctors throughout the world. A bit of information can be a dangerous thing.

I’ve decided that the only way to cure cyberchondria is to have regular health check-ups with real doctors. Ron and I bought the Silver Plan health discount for Vivian Pellas hospital last year. Health Care for Expats in Nicaragua  Since we’ve had the health discount for over 6 months, we received a 30% discount for extensive health exams. So, we made an appointment with Arlen Perez at Vivian Pellas for our super-duper exams last week.

IMG_3368We arrived in Managua at 7:30 am. Within a few minutes, Arlen met us in the lobby with a printed schedule of our procedures for the day. She took us to the lab where we gave blood and other bodily fluid samples. Then, Arlen’s new medical tourism partner, Maite Soto, filled out a questionnaire for us in Spanish.

Maite spent the rest of the day with us, translating, attending meticulously to all of our needs, and taking us from lab to lab. After our blood samples, we had EKGs and stress tests on a treadmill, then ultrasounds, chest x-rays, and I had a mammogram. What astounded me was that we could ask the technicians, “How does it look?” and “Do you see any abnormalities?” Try that in the states and you will get a response such as, ” You will have to wait until the doctor reads the tests and you’ll find out in a couple of weeks.” Instead, the technicians reviewed the exams with us and reassured us that everything looked fine.

At noon, we finished the major procedures. Maite took us to the cafeteria for our free lunch and COFFEE! Since we had to fast the night before, I missed my morning coffee. Then, we had an hour to wait for our consultations with the doctors, and my gynecological exam.

We walked around the well-manicured grounds, where I discovered the children’s burn unit. You must read the experience of Vivian Pellas and why she started the children’s burn unit. Love Without Limits: Health Care in Nicaragua

IMG_3369A friend, who lives on the island, took her small son to Vivian Pellas Children’s Burn Hospital for a badly burnt foot. Poor little toddler accidentally stepped on a ground fire. She was very impressed with the care and attention he received and all expenses were free.

Our private consultations with English-speaking doctors were held in the afternoon. They carefully reviewed all of our test results and gave us plenty of time to ask numerous questions. The only test result that wasn’t available was my Pap test because I had just completed my gynecological exam 30 minutes earlier.  But, not to worry. They would scan the results and email me within two days. ( AND…they did! )

Now, I know you are curious about the cost of these exams. What would be your guess?
The public price for the Male over 40 Physical is of U$ 350
With the 6 months discount (30%) is of U$ 245
With the 3 months discount (25%) U$ 262.50

The public price for the Female over 40 Physical is of U$ 420
With the 6 months discount (30%) is of U$ 294
With the 3 months discount (25%) U$ 315

We were at the hospital until 5:00 pm. All exams were professional and we received same day results! They sent us home with hugs and packets complete with our x-rays, ultrasound pictures, EKGs, thoroughly reviewed blood analysis’, and most importantly recommendations for improving our health as we age. Although, I am proud to announce that we are in excellent health for two aging baby boomers. 🙂

Was it worth it? Absolutely! Would I recommend Vivian Pellas to other expats? Without any doubts! Their medical tourism program is growing rapidly. Many foreigners come to Vivian Pellas for hip replacements, cosmetic surgery, and other procedures at 1/4 of the cost of procedures in the states.

Does this mean that I’m abandoning Dr. Google? No, of course not. But, now I can make more informed decisions about my health care because of the thorough services I received at Vivian Pellas. Is my cyberchondria cured? Yes! Thanks to the attentive, caring doctors and staff at Vivian Pellas. It is very reassuring to know that we have an excellent expat hospital, same day results, and hospitable staff available in Nicaragua. Have I told you how much I LOVE this country?

Health Care in Nicaragua: A Hypochondriac’s Story

Nasty ant bites, swollen foot

Last September, I was hauling brush away from the beach, when I felt a strange tingling sensation. It started at my toes, and like a super charged lightning bolt, the sensation passed through my body to the top of my head. I began to itch like crazy, then my upper lip swelled and became numb, as if I had just received a shot of Novocaine.

Living on a tropical island, we have learned to take charge of our own health care. There is a hospital in Moyogalpa, the port town; however, I have been there with Marina, and I don’t want to return. EVER! Our workers, propped my foot on two cement blocks, and gave me a little cap full of…I think it was Benadryl…because I fell asleep upright on the only piece of furniture we had in our house at the time. (a purple plastic chair)

My foot swelled to the size of a small papaya and I was unable to put any weight on it for a week. I’m not one that likes to be incapacitated, so I began to research ant bites and allergic reactions. The locals know the insects, plants, and animals intimately. They all agreed that I had a horrible allergic reaction to ant bites.

Thank God for the internet! Once I determined the cause of my swelling and the treatment, I hobbled to the closest pharmacy armed with an array of new Spanish words..swollen foot, allergic reaction, numb upper lip, cortisone cream. Prescriptions are unheard of in Nicaragua. One only needs to discuss the symptoms with the pharmacist and the pharmacist will dispense one pill, or as many as one needs or can afford to buy.

Six years ago, Ron thought he had parasites. We went to a little shack…literally…where they had the only centrifuge in town. A man handed Ron a little plastic cup and said, “I need poo poo.” Then he directed him to the outhouse. As the centrifuge whirled the poo poo around and around, we waited patiently on the front porch, watching a long string of leaf cutter ants hauling their loot to their nests to make a fungus for the queen.

“Poo poo white,” he announced. “No parasites.” So, because of the white poo poo, he sent us to the pharmacy with a little scrap of paper that told the pharmacist what we needed to buy. All for the cost of one dollar.

Health care is cheap in Nicaragua. Even at the best hospital, Vivian Pellas Metropolitano, in Managua, expect to pay much, much less for all procedures. For example, a hip replacement in the USA is approximately $53,000. At Vivian Pellas, a hip replacement will cost $8,700… hidden costs. And, that price is without purchasing their insurance plan. With the Silver Insurance plan, take an extra 40% off the total cost of the hip replacement. I know you are wondering how much the insurance costs for Vivian Pellas….$26 a month!!!!

When we retired and moved to Nicaragua, we could have continued on our group health insurance, Cigna. However, the monthly cost of $500 would have been taken out of my tiny teaching pension check. Too young for Medicare ( which isn’t accepted in Nicaragua), and too poor to have $500 deducted from my pension, we really didn’t have any options. Before Vivian Pellas started to cater to expats, we had to take charge of our own health and care for our own aging bodies. Plus, we were at a disadvantage because of living on an island…with a one hour ferry ride to the mainland.

After my allergic reaction to the ant bites, I became a hypochondriac. Every sneeze, every ache, every insect bite, everything kind of out of the ordinary…I researched. Most of the little health issues were just due to an aging body. Yet, due to the fact that we are growing our own food, walking and swimming everyday, and always active, we are healthier than we have ever been before.

A retired RN lives close to us, now. I have become friends with a homeopathic doctor, who has a clinic in Moyogalpa. We found a great chiropractor in San Juan Del Sur, and an acupuncturist in Moyogalpa. Soon, we will have an airport a quarter of a mile away from our house. Should a medical emergency arise, we can hop on a flight to Managua for less than $50. Vivian Pellas hospital is getting better all the time, with international awards, U.S. trained doctors, and medical tourism programs.

Now, the only thing we have to worry about is health coverage in the states. Fortunately, we don’t return to the states often. But, when we do, the only health coverage we can get is on our car (stored in our garage back in the states). We upped the medical coverage for accidents in our car. So, if I break my leg, or anything else that requires immediate medical care, I have to do it in the car to be covered. What a shame! Health care in the USA is a mess. But, that’s another story for another day. A story I have no control over.

Here in Nicaragua, I have control over my own health, and a wonderful group of professional friends, and locals who can help us identify and treat the minor problems. If we need immediate medical attention, Vivian Pellas is only an hour’s flight away. What more could we want?