Our Most Excellent Medical Tourism Adventure
Mark and Isabel have lived aboard their Seawind 1160 catamaran sailboat JollyDogs since bailing out of their professional working lives in 2014. After several years exploring Pacific Mexico and the Sea of Cortez, they departed from Puerto Vallarta in April 2019 and sailed to French Polynesia where they spent 2 years wandering that vast archipelago. In April 2021 with Asia still in disarray due to Covid-19, they sought new adventures by sailing to the US Pacific Northwest. Objective: explore the Puget Sound in 2021 and Alaska in 2022, with the hopes that by 2023 a post-pandemic world would reopen. About 1500 miles offshore in the North Pacific while sailing from Hawaii to the Puget Sound, their Seawind 1160 catamaran JollyDogs impacted a submerged shipping container, but that’s a story for another time.
Lori Payne is an American ex-pat living in Tlaquepaque, Mexico providing medical concierge services with a focus on doctors who practice at the Puerto Hiero Hospital (a partner with the Mayo Clinic in the USA) in Zapopan, a district on the Northwestern side of greater Guadalajara. Lori generally works with clients to arrange procedures such as hernia surgeries, joint replacements, or cosmetic procedures. Lori helped us arrange a very successful hernia surgery for Mark in 2018, one of the most positive medical experiences of his life. If you'd like to reach Lori, her contact info is:
Upon arrival in the US, reconnecting with loved ones and catching up on routine medical care were high priorities. The cost and schedule challenges of dealing with the US medical system while on high deductible international health insurance policies incentivized medical tourism to get comprehensive exams, including general physicals, eyes, ear nose and throat (ENT), dental, OBGYN for Isabel, and routine colonoscopies. Mark also needed an MRI and orthopedic evaluation for an injury sustained in the mishap at sea. With all that in mind, we contacted Lori and provided our list of medical checkup needs, and she arranged a one-week checkup itinerary that included every medical specialist on our list, while still leaving time for some fun.
We arrived at Guadalajara on a Friday night at 11:30 pm where Lori’s personal driver Cesar was waiting outside customs to collect us. A personable fellow with good English speaking skills driving a clean new model car, Cesar delivered us to our hotel for a $20 fee. The desk clerk at the Boutique Hotel San Pietro in central Tlaquepaque was waiting for us and buzzed us right in. For our 9 night stay which included a great breakfast each morning along with plenty of good coffee we paid $661, or about $73.44/night. Our room was very quiet and comfortable with a lovely outdoor garden terrace and a shower that was like standing under a waterfall - a complete luxury for those of us that live on boats. A delicious breakfast was included and was available after 8 am each morning, about a $10 value given the local restaurant prices.
On Saturday morning Lori met us at our hotel at 8 am and escorted us to a nearby medical lab where we got our initial blood work. Lori interpreted to assist in getting the paperwork done and in about 10 minutes we were finished with the blood draws, returning to the hotel where she joined us for breakfast to discuss the upcoming week’s events. The lab tests cost each of us $108 and the results were emailed to us and the internist physician early Saturday afternoon.
For the rest of the weekend we wandered around Tlaquepaque enjoying the festive atmosphere and local artwork. Saturday we had a great lunch at the mercado - birria for each of us w/ unlimited fresh corn tortillas and a green juice each for under $10, an amazingly delicious artisanal ice cream for $1.40, then dinner at our favorite taco cart with for a total of $5.50. Hector, a young fellow who’s dad owns the taco cart was manning the cash box. Hector speaks great English and is going to university for a degree in international accounting. He offered us his personal cell number if we got into a jam and needed language interpretation or other assistance - how nice is that? Sunday was a lazy day but mid-afternoon we proceeded to our favorite gourmet restaurant Zaguan where we split a delicious appetizer, soup, and coconut shrimp salad. That was enough food for the 2 of us, and along the way we also enjoyed a total of 5 margaritas, 3 made with mescal and 2 with tequila. An amazing meal which only cost $57.20 including a generous tip. Before retiring for the evening we indulged ourselves with some artisanal ice cream and a bit of Netflix. Have we mentioned how good the hotel WIFI was?
Monday morning Uber delivered us to an upmarket district of Guadalajara for our first in a full day of specialist doctor visits. Arriving a bit early we killed some time at a nearby coffee shop before beginning our 2 hour time slot at the dentist, Dr. Jose Luis Villasenor Montano - or Pepe has his friends call him.
Mark got a lower left molar X-ray and work on an ill-fitting crown, using up his hour appointment, then Isabel then got a thorough teeth cleaning. Mark was able to make another appointment for 3 pm that afternoon to get his teeth cleaning. Upon conclusion the cost was $125 for nearly 3 hours time with a dentist. No technician, no floss nazi, just a great dentist.
After our morning dental work we walked about 10 minutes thorough a lovely neighborhood to visit with the Dermatologist, Dr. Jose Fernando Barba Flores. We each received a thorough exam at a cost of $60 for each. Had we required any spots to be burned off with liquid nitrogen, that would have cost a little extra. Dr. Barba did recommend an over the counter lotion for what he described as “covid hands”, a dry and cracking skin condition from too much hand washing and sanitizing.
Afterwards we explored the neighborhood for a great lunch restaurant. We got a recommendation from Lori, and after evaluating a couple of nearby seafood restaurants we elected to kill some time in a coffee shop until Lori’s favorite area restaurant opened. We had an outstanding meal at El Sacromonte just around the corner from the dentist’s office. Mark had a steak and Isabel a cochinita pibil, both dishes cooked to perfection, accompanied by a glass of wine and a bottle of topo chico. The waiter was superb, an old school guy who knew how to look after his patrons. Sadly we had only 1 1/2 hours to dine then make Mark’s afternoon teeth cleaning appointment. The cost for an absolutely amazing meal was $64 including a 20% tip, quite generous by Mexican standards.
Dr. Pepe did a full cleaning on Mark at 3 pm, noting that both Isabel and Mark grind their teeth in their sleep. He encouraged each of us to have custom mouth guards made to help reduce gum recession. Typical recession should be about 1mm per 10 years of age and we seem to be doing worse than that.
Next we walked about 45 minutes for our 5 pm appointment with Dr. Gabriel Avalos, the Ear, Nose and Throat (ENT) specialist.
For many years, Mark has had problems with an often blocked Eustachian tube, a result of breaking his nose back in his college days. This also seemed to prompt some ear infections in the tropical waters of French Polynesia as we were snorkeling almost daily. Dr. Avalos inspected Mark’s ears and nasal passages with a video wand while we both viewed the imagery, then it was Isabel’s turn. Before we were done Dr. Avalos had removed serious wax blockages from both our ears and discussed corrective surgery for Mark. Seeing the real-time imagery of our nasal passage and ears, especially eardrum scar tissue from old infections was really quite amazing and informative. We were out the door for $25 each, then Uber returned us to our hotel.
Tuesday morning, after a lovely breakfast at our hotel Lori collected us at 9 am and drove us to our next round of appointments. We began with an eye exam 10 am at Puerta de Hierro Medical Center.
We spent about an hour with Opthamologist Dr. Daniel Garcia, each of us getting a full checkup and prescriptions for reading glasses, although he commented we could simply purchase off the shelf reading and save money if we wished. We also each got a prescription for a irritated eyes and he noted Mark was just beginning to show signs of cataracts, but insisted nothing should be done until Mark felt it was a problem, likely a few years away. There was a long discussion about wearing better sunglasses (wrap around style) to keep sun out of the corners of our eyes to help minimize early development of cataracts and lower the risk of sunburned retinas. Our exams cost $50 each.
Lori then walked us to our 1130 appointment for general physicals with the internist, Dr. Laura Madrigal Ruiz. Dr. Laura gave us a light physical exam, reviewed our blood work results with each of us, and after discussing our personal medical histories recommended some additional blood work as well as lab facilities for quality results a very competitive cost. As Isabel and I have also had some lung issues recently, she directed us to the SAMCOR lab where we could get low dose CT scans, a basic lung cancer screening exam, for $100 each. Our exams with Dr. Laura cost $45.
Afterwards we bid Lori good day and Uber’d to Cuyo 7, a great seafood restaurant where we had a long lazy lunch with adult beverages for about $71.
After lunch we walked about 12 minutes through a very nice neighborhood for Isabel’s 4:30 appointment with the OBGYN. A highlight included passing an old Roman style aqueduct that reminded us of our last visit to Marseilles, France. Isabel got her routine exam and a pap smear for $60, the PAP smear results emailed to Isabel shortly afterwards. Isabel was absolutely delighted with this OBGYN - stunningly attractive and sweet young woman. We reckon she and her Japanese husband have gorgeous children. Uber delivered us back to our hotel afterwards.
Wednesday morning after breakfast Lori collected us and off to the hospital we went, escorting us to the MRI and each of our doctor appointments later that day. After the MRI of Mark’s right knee ($260), we walked about 3 kilometers to the nearest SAMCOR lab only to discover that particular location didn’t offer CT scans, but the front desk staff was very helpful and directed us to another SAMCOR lab nearby. Uber delivered us to that facility where we found the staff to be extremely helpful and professional, our low dose CT Scans costing $105 each. From SAMCOR we Uber’d to an interesting sounding restaurant only to discover it was closed, so we walked about 15 minutes to El Sacromonte and had a another wonderful and very civilized 2 hour lunch for about $78 before Ubering back to the hospital.
At 4:30 pm we joined Lori to see with Dr. Gilberto Montemayor for our pre-colonoscopy appointments. Dr. Gilberto performed an inguinal hernia surgery on Mark in 2018 and we were delighted with the entire experience. We were delighted to have Dr. Gilberto, a US Board Certified Surgeon and Gastroenterologist, perform our colonoscopies. Mark’s pre-op checkup included Dr. Gilberto checking Mark’s hernia status, noting that a small hernia still existed which might require future attention, however he also encouraged monitoring rather than immediate surgery.
Next Lori delivered us to orthopedic surgeon Dr. Oscar Mendoza for an examination of Mark’s right knee. Even though he had a full appointment calendar, with Lori’s encouragement he was willing to “work Mark in” and spent about 25 minutes examining Mark’s knee, discussing the MRI results and a corrective surgery procedure, total cost $75.
While driving us back to Tlaquepaque afterwards, Lori stopped at several pharmacies to help us purchase our various prescriptions.
Thursday was our colonoscopy prep day, but we didn’t have to begin the procedure until mid-afternoon. Before we broke fast that morning, we walked about 2 km to a Chopo lab where we got the additional tests recommended by Dr. Ruiz. Later that morning we walked back to the area by the lab to catch the light rail to downtown Guadalajara. Our downtown train stop was a pleasant 1 km to the SAMCOR lab where we collected our low dose CT scan results. The light rail cost about 45 cents for a 1-way ticket for each of us, and it was a great experience; clean, new and a very efficient, low stress way to travel through greater Guadalajara.
Friday morning Lori collected us at 7:15 am and took us to the hospital for our colonoscopy procedures, escorting us through the check-in and pre-op areas, providing interpretation services where necessary. Dr. Gilberto arrived to discuss the process then we proceeded in turn. It was pretty just like getting a colonoscopy in the US, with the anesthesiologist and other staff introducing themselves and explaining the procedure in the pre-op area. Post op was just the same and all went swimmingly for both of us, with no hangover from the anesthesia. The polyp biopsy results were provided about 10 days later.
Dr. Gilberto had previously noted “never pay the mariachis until they’re done playing”, so after the procedures were complete we paid our fee for Dr. Gilberto and his team, $350 US for each of us, paid in cash to avoid a 4% credit card fee. The hospital accepted credit cards without a fee and our facility / personnel cost was $305 each. The biopsy fee, if required cost $60 paid in cash during checkout. Before we were even ready to depart the hospital, Dr. Gilberto had provided a summary of our results including images and a write-up, and a USB stick with all data for each of us.
Lori drove us back to Tlaquepaque where the 3 of us sat down to a well deserved lunch at a legendary local restaurant. Isabel and I offered our observations about our “medical week” including what we had learned from the experience and how delighted we were with the care we had received from the various medical professionals. That evening Isabel and I celebrated the conclusion of our medical exams with some delicious guacamole and an adult beverage on the rooftop patio of Restaurant 1910 before visiting our favorite taco cart to dine and chat with Hector. We concluded the evening strolling around central Tlaquepaque, enjoying the dia de los muertos festivities.
Saturday at noon Lori visited us at the hotel to chat about our future medical needs and to assist when a local company arrived to conduct our pre-flight covid tests. That service cost $25 for each of us and the results were emailed to us within the hour. Otherwise Isabel and I enjoyed a lazy day, visiting the mercado for our parting birria chivo and Zaguan for another killer meal. The dia de los muertos festivities were in full swing that evening and we enjoyed strolling amongst the art galleries, street vendors and buskers before retiring for the evening. On Sunday we had a last excellent breakfast at the hotel, offered tips to the housekeeping and front desk staff to acknowledge their wonderful service, then Uber’d to the Guadalajara airport. Soon we were checked in and relaxing at our gate, both relieved that the medical checkups were behind us, and delighted at how much we had enjoyed the week.
Observations and Lessons Learned
Mexican medical culture is a bit different from what we’re accustomed to in the US, so some adjustments in attitude and expectation are necessary. In some cases it’s up to the consumer to be aggressive with questions and concerns. For example, the dermatologist was happy to just look at our arms, faces, ears, whatever skin we presented to him, but it was up to us to suggest that we disrobe to our underwear and have him examine most all our skin. Perhaps this is an example of cultural modesty but he was happy to examine whatever bits we asked about. Unfortunately we both forgot to ask him to comb through our hair and examine our scalps. We’ll have to be more proactive next visit.
In the USA a routine physical with our personal physician has always been pretty comprehensive. We get the full blood and urine labs prior to the exam then visit the doctor and discuss the results. The visit has always involved disrobing and getting a hernia and digital prostrate exam for me or a lady parts exam for Isabel, a look-over for skin cancer troubles, checks of reflexes, eyes, ears, nose and throat, etc. The Mexican internist physician was much less aggressive and comprehensive in comparison, never asking either of us to disrobe. However, she was happy to address our concerns and suggested more comprehensive blood and urine work than we had originally received, communicating her thoughts about the latter tests via email. A lesson there was to communicate our personal health concerns with the doctor prior to the exam so that she could order the most effective lab tests to evaluate our health. As well, the diagnostic lab that performed our initial blood work had requested that we not consume any fluids between 8 and 12 hours prior to our blood draw. When we mentioned this to the internist, Dr. Ruiz advised that blood and urine tests require fasting 8 to12 hours prior to the draw, allowing only water and black coffee in that time period, the same counsel we’ve always received in the US.
I asked Dr. Gilberto about a digital prostrate exam as a simple PSA test might be deceptive. Given that he was about to perform a colonoscopy anyway, it seem logical to me, however he declined, noting that if I wanted that particular procedure I would have to schedule an appointment with a urologist.
Lori had carefully vetted each of the doctors we saw, sending numerous patients to them over the years. We have friends who over the past few years have gotten a knee and hip replacement and a rotator cuff surgery from the orthopedic surgeon (Dr. Mendoza) and they have been delighted with the experience. Lori did a great job of scheduling our visits so that we had enough time with each specialist, yet our days were efficiently used with adequate time to travel between each office location and plenty of time for lunch. When necessary, she escorted us to appointments providing translation for receptionists who often spoke very little English, and generally smoothed the path for our entire experience.
Every physician we saw spoke excellent English, was extremely hospitable and friendly, demonstrating a compassionate and caring attitude and spending as much time with us as we felt necessary. They all offered their personal cell phone numbers and email addresses if we wanted to discuss any questions or concerns. Each checkup involved direct and personal contact with the doctor, so there was never anyone else taking our vital signs, no getting undressed and waiting until the doctor came to the little room, none of that which we’re so accustomed to in America. This is the way we’ve always believed medical care should work.
Mexicans generally eat lunch between 2 and 4 pm so restaurants that cater to business people often don’t open until 1:30 pm. Make sure to allow 2 hours when having lunch in a nice Mexican restaurant. It’s an experience that shouldn’t be rushed, so if you don’t have that kind of time, find a taco cart or quickie food place.
Finally, remember that a medical tourism experience in Mexico is as much about experiencing the local culture and food scene as the medical stuff. We returned after our rather intense medical week feeling like we’d also had a great holiday.
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