I'm fresh out of the jungle and glad to have spent a weekend out of the city so i'm refreshed and ready to lay down some info. I went to Mindo, which is a small mountainous town outside of Quito to the northwest. Mindo is lower than Quito, but still about 1300 meters above sea level so it isn't exactly low either. This a great view of the city on the road that takes you up to the zip lines, the waterfalls, and much more. Mindo is very small and a very tranquil town. Its very relaxing at night if you get away from the one main street and one can fall asleep to music of the jungle: birds, water, and whatever else. The girls went ahead of me because I had clinic in the morning, but they picked a great hostal (thats how its spelled in spanish). When you start up the hill to the hostal you can smell the cocao from the chocolate factory that is across the street. On the other side is a small river and when combined with the birds singing, it creates a very relaxing ambience.
Somehow I got stuck up in the loft room. It was funny because I had a hard time getting in and out of the room and the door didn't even come up to my waist when I stood up, but the only part of the room I could stand was the middle. The stairs are very steep and very small. Somewhere between to combination of too many tequila shots, wet shoes, and no room for my feet I fell down the stairs which was comical relief for about everyone but me.... but now its funny. For such a small town Mindo has a lot to do. Butterfly farms, a chocolate factory, zip lining, tubing in the river, waterfall tours, nature hikes, and much more but that's all that comes to mind. Its quite the contrast to Quito. There is only two bars in the town, and really only one paved street. One can easily see the city in less than half a day, but its what's around the city that's important. To get to the main attractions like zip lining, you have to catch a pick-up taxi that takes you up an old logging road. Before 1990 Mindo was a very big exporter of logs to Quito. People were ignorant to the harmful effects of limitless deforestation. In 1990 (this is according to a cab driver who has lived there his whole life) the started passing laws to protect this area, and now any form of deforestation is some serious jail time. Mindo is a cool town because everyone is very friendly, and everyone's primary goal is to preserve Ecuador's forests. The city runs on tourism with a very high amount of Ecuadorian tourists, and of course people form all over the world.
We spent most of Saturday zip lining and after a chocolate factory tour. There are 13 lines of zipping around the cloud forest. It was cloudy the entire time I was there, but I honestly feel that I prefer it that way because it really adds to the jungle feel of the town. It was fun because a lot of times I couldn't see where the zip line ended so you just disappear into the clouds. After the zip line was the Tarzan Swing (to the left). This was quite the rush. You stand on this platform while they hook you to a rope that is about 70ft long (my length judgment has never been good). Then the open the gate of the rail and you fall!! The first part of the fall isn't like a swing at all. It feels more like a free fall which really caught me off guard. The swing then catches you and you swing back and forth through the jungle. Quite the rush!! Afterwards was chocolate factory tour. It was very interesting to learn the history and the process of making chocolate. It started with the Mayans, and quickly spread throughout the world. Its a pretty simple process too. Basically you just extract the cocao seeds from the plant, ferment them for six days, and dry them. Once you have the dry product they run it through a machine that shreds the seeds to make "nibs". Then they press the nibs and grind them and they liquify. The coco butter is extracted, and then the brown "chocolate" is ready to go. In this form it is extremely bitter and I tried way too big of a spoon full. Then the addition of sugar completely changes the flavor to the well known chocolaty flavor. We sampled some of the other products that are made in Mindo including some BBQ sauce that is to die for and some incredibly brownies. I got a copy of the recipe and the VERY important Quetzal chocolate for making them so you loyal readers better start sucking up if you want to try them... and if you want a Mellor steak with Quetzal chocolate BBQ sauce!!
Sunday was waterfall chasing time. We hopped another 4X4 taxi to the top of one of the mountains where we hiked down into a valley where the river (I forget the name) snakes through. Its a really mellow hike, but I could still feel the altitude a little. We only went to one waterfall (Nambillo) because we were limited on time. Apparently one can jump from the waterfall and there is a guide to show you how to do it but I saw no guide, and I couldn't tell how deep the water was so I wasn't jumping in. There was another platform about thirty feet above the river in another area, but after assessing the depth it was barely over my head so there was nowhere I felt comfortable jumping from. The water reminds me of the North Umpqua in about March. The water looks the same, with that light green color, and is VERY VERY cold!! We caught a ride back to Quito with the lady who owns the Hostal we stayed in. It was nice to avoid the bus ride, and we chatted in Spanish most of the way back. A lot of times my bus partner doesn't want to talk to me... She is actually German and her Son married an Ecuadorian women and have two kids. She drives them to Quito every Sunday for school and back to Mindo every friday. Seems like quite the pain but apparently the school in Mindo is a bit below par. Aside from having to commute so much, the kids are very lucky that they're learning German, Spanish, and English.
Since this post is titled "A half-week in Cardiology" I better get on with last week in the Hospital. From wednesday on I was in Hospital Militar with Dr. Aucancela, a cardiologist. If you have been paying attention to past blogs you should be familiar with this hospital (yes there will be a test at the end). This hospital is private for Military personnel and their families, and almost all services are free. For active or formerly active personnel everything is free from their medication to any type of surgery (save for esthetic plastic surgery I would imagine. As a side note, it is very popular here, but not in the hospitals... private clinics). For family everything is free except very spendy surgeries, but are still very affordable. The first day was consults with the Doc (office above). He is very animated, and a great doctor. He has a way of making each patient laugh and smile, and has a very personal feel to his demeanor if that makes any sense. Its no wonder why half his patients bring him a gift, anything from wine, to liquor, to christmas ornaments. He was very great to me and I feel very fortunate to have spent part of a week with him. He would stop in his tracks and sit down and explain everything that I didn't understand. His consults felt like going out for a cup of coffee with friends minus the coffee. I can't even begin to write everything I learned from him because I feel I would bore you with details, and I'm too lazy. I have to write weekly reviews of what I did in the hospital for the credit portion of this program, and i'm not writing everything twice. I know it would seem logical that I could just copy and paste what I wrote, but its very dry and I couldn't do that to my loyal followers.
This is Dr. Aucancela and me on my last day. He usually always smiling and cracking jokes but I think he got a little camera shy.
Diabetes and hypertension are prominent problems here. It is mostly due to sedentary lifestyles, poor alimentation, and diets very high in salt. Every traditional meal here starts with soup, and whats is soup?? Lots of salt!! Plus every other type of food tastes very salty. In short I learned a lot about how hypertension has no cure and how it negatively effects the retina, the cerebrum, the kidneys, and obviously the heart. One fun fact I learned is how pure oxygen is a vasodilator, so a hypertension patient who is taking some form of vasodilator in Quito must lower their dose if they are to vacation to the coast or some other low altitude area. I found this very interesting that the same exact patient with the same medication would be prescribed a different dose by a doctor on the coast and a doctor in Quito.... something I never would have thought of. Almost every patient we saw in consult had hypertension, and the ones that didn't had another heart condition like an 8 month old boy who needed heart surgery.
Thursday was full of Echo Stress tests. The type I saw was Chemical Echo Stress tests. Basically this is used when some type of cardiac irregularity is suspected, whether its an irregular EKG, chest pain, arrhythmia, or most commonly used with suspected Coronary artery irregularities. A patient is a candidate for this test if they fit the "suspicion" criteria, and are unable to exercise. The chemical they use here is Dobutamine, which is a direct-acting inotropic agent that stimulates beta-receptors. So basically it increases cardiac output and induces vasodilation. With the heart under stress, problems are much easier to see with an echocardiogram. The target Dr. Aucancela shot for was 140 BPM. They would observe the heart with four different concentrations of Dobutamine and watch to see how the heart recovers. Of the five Echo Stress tests, only one resulted in a find. A 50 year old woman had a Mitral valve adenoid which was obstructing it. She had the valve replaced 30 years prior, but unfortunately she needs surgery again. It was really interesting to see how the blood would swirl around in her left atrium (I think thats right, forgive my heart anatomy) instead of passing freely through to the left ventricle. The rest of the tests were negative, mainly just old ladies concerned about chest pain. Another note was how all the patients were women. I asked the Doc why that was, and says its due to why a patient needs a Chemo stress test: some type of disability so that they cannot exercise. He says the main examples are old age, arthritis, and knees problems. Apparently that is more common here among women, i'm not educated on the subject because my only Orthopedic background is surgery in Chone.
Now this week I am back a the military hospital in neurology, so hopefully everything follows through, and if i'm fortunate i'll get to see some neurosurgery. This is my last week here, and its going to be a bittersweet departure. I love it here, but I feel its time to get on with my life!!!
I'm fresh out of the jungle and glad to have spent a weekend out of the city so i'm refreshed and ready to lay down some info. I went to Mindo, which is a small mountainous town outside of Quito to the northwest. Mindo is lower than Quito, but still about 1300 meters above sea level so it isn't exactly low either. This a great view of the city on the road that takes you up to the zip lines, the waterfalls, and much more. Mindo is very small and a very tranquil town. Its very relaxing at night if you get away from the one main street and one can fall asleep to music of the jungle: birds, water, and whatever else. The girls went ahead of me because I had clinic in the morning, but they picked a great hostal (thats how its spelled in spanish). When you start up the hill to the hostal you can smell the cocao from the chocolate factory that is across the street. On the other side is a small river and when combined with the birds singing, it creates a very relaxing ambience.
Somehow I got stuck up in the loft room. It was funny because I had a hard time getting in and out of the room and the door didn't even come up to my waist when I stood up, but the only part of the room I could stand was the middle. The stairs are very steep and very small. Somewhere between to combination of too many tequila shots, wet shoes, and no room for my feet I fell down the stairs which was comical relief for about everyone but me.... but now its funny. For such a small town Mindo has a lot to do. Butterfly farms, a chocolate factory, zip lining, tubing in the river, waterfall tours, nature hikes, and much more but that's all that comes to mind. Its quite the contrast to Quito. There is only two bars in the town, and really only one paved street. One can easily see the city in less than half a day, but its what's around the city that's important. To get to the main attractions like zip lining, you have to catch a pick-up taxi that takes you up an old logging road. Before 1990 Mindo was a very big exporter of logs to Quito. People were ignorant to the harmful effects of limitless deforestation. In 1990 (this is according to a cab driver who has lived there his whole life) the started passing laws to protect this area, and now any form of deforestation is some serious jail time. Mindo is a cool town because everyone is very friendly, and everyone's primary goal is to preserve Ecuador's forests. The city runs on tourism with a very high amount of Ecuadorian tourists, and of course people form all over the world.
Sunday was waterfall chasing time. We hopped another 4X4 taxi to the top of one of the mountains where we hiked down into a valley where the river (I forget the name) snakes through. Its a really mellow hike, but I could still feel the altitude a little. We only went to one waterfall (Nambillo) because we were limited on time. Apparently one can jump from the waterfall and there is a guide to show you how to do it but I saw no guide, and I couldn't tell how deep the water was so I wasn't jumping in. There was another platform about thirty feet above the river in another area, but after assessing the depth it was barely over my head so there was nowhere I felt comfortable jumping from. The water reminds me of the North Umpqua in about March. The water looks the same, with that light green color, and is VERY VERY cold!! We caught a ride back to Quito with the lady who owns the Hostal we stayed in. It was nice to avoid the bus ride, and we chatted in Spanish most of the way back. A lot of times my bus partner doesn't want to talk to me... She is actually German and her Son married an Ecuadorian women and have two kids. She drives them to Quito every Sunday for school and back to Mindo every friday. Seems like quite the pain but apparently the school in Mindo is a bit below par. Aside from having to commute so much, the kids are very lucky that they're learning German, Spanish, and English.
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