Sunday, May 27, 2018

SHIPPING A PRESCRIPTION TO MEXICO: What Worked and What Didn't

Running Short of a Prescription Medication While in México

     What happens when you are in México and realize you are going to run out of one of your prescription medications? And then you find out it’s one of those specialty medications that is not available from any pharmacy in México? That’s what happened to us this winter and we had to figure out how to have a bottle shipped to us from the United States.
How Did We Run Out? 
     Each fall when we return to our home in México, we plan very carefully and bring a year’s supply of all of our prescription and over-the-counter medications with us. But this winter, Jon’s doctor doubled the dose of one of his prescriptions, meaning he was going to run short by about 90 tablets before we returned to the U.S. in July. 
What About Having FedEx Ship a Prescription to Us?
     We had to try to have the prescription shipped to us. It was not a controlled substance such as pain pills or sleeping medicine, just a maintenance medication, so it should be no big deal, right? We’ve had two other items, a Zumba poster and a digital scale shipped to us in the past and eventually received them. But what about prescription drugs? We had to try.
     We know from past experience that FedEx can’t find our home address and the Mexican mail service is very undependable. So, we decided we could have our son send the prescription bottle through FedEx to our new FedEx office at the Lollipop Toy Shop in Sayulita.
Sayulita's FedEx Store at the Lollipop Toy Shop

     First Step: We had the Costco mail order pharmacy ship the prescription to our son in Bend, Oregon two months ago.
     Next Step: Our son packaged the bottle with its receipt, as required for international shipping, and sent it via FedEx to the Lollipop Toy Store/FedEx office, at a cost of $115 US dollars, including shipping and import tax, about the same value as the medication. A week later, FedEx sent him an email stating that his package was hung up in customs in Guadalajara, México (Aduana de Guadalajara)
Customs Office in Guadalajara (Aduana de Guadalajara)

     Customs wanted five forms completed before they would release the package:
1. NOM Letter (Whatever that is)
2. Value Manifest
3. Health Permit
4. Import Register
5.Technique Information
     FedEx also suggested in their email that we hire an importation broker to handle completion of the forms. This sounded like more money and lots of hassle, but Jon doesn’t give up easily. He googled importation brokers in Guadalajara and Puerto Vallarta and contacted several of them, but none would do it (probably too much work for one little pill bottle).
     FedEx stated that they could ship the package back for another $115. We decided that was too much expense, so we were going to have them dump it in the trash. But before we knew it, another email came to our son stating that the package was on its way back to him and his credit card had been charged another $115. Frustrating! On the bright side, we could pick up the 90 tablets of Jon’s medication from our son when we arrived in Oregon this summer.

Moral of That Phase of the Story
     Don’t try to ship your medication into México. I’ve since learned that it doesn’t work to ship liquids of any kind into México either. We tried having a case of 7th-Generation Free and Clear laundry detergent shipped to us because I’m allergic to fragrances and dyes. That made it to the El Paso, Texas border and then was “lost”. We learned that lotions, shampoos, and other liquids are not allowed to be shipped internationally. But, there are other ways...


We Needed A Mule!
     We still needed to get the medication somehow. I’m a member of the Mexico Mule Forum, a Facebook group where people in México connect to ask someone who is traveling from another country into their area if they will bring an item down for them, usually in exchange for a small gift, gas money, or as a favor. I thought about posting a request for help on the Mexico Mule Forum to see if we could find someone who was coming to the Puerto Vallarta area and would bring Jon’s prescription medication down with them.
     And then I recalled that some friends of ours were coming to visit Sayulita in about a month. Maybe they could help. I emailed them and asked if they were willing to “mule” Jon’s medication down with them. They heartily agreed. I then asked if they would mind if we had Amazon ship a special RV tire pressure gauge since ours had broken recently and we really needed a good quality one for our motorhome trip back to the U.S. this summer. They were happy to bring that, too.
Could Our "Mule" Haul Down a New RV Tire Gauge, Too?
     Jon contacted Costco mail order pharmacy and asked them to ship another 90 tablets to our friends’ home in California, explaining that the first order had been lost in shipment. He ordered the RV tire pressure gauge to be sent from Amazon.com to our friends’ home.
     A month later, we met our friends for dinner at Miro Vino, one of our favorite restaurants in Sayulita, and they handed Jon his package. Friends helping friends—that’s what worked.


Announcing My NEW RELEASE!

JUST ANOTHER MANIC MOMENT: A Novel

eBook only $2.99 or FREE on kindleunlimited!

     When they fell in love, it was powerful. Then Jake was diagnosed with depression and bipolar disorder. Could Lindsay tolerate the chaos from Jake's wild mood swings? Would newly discovered gene assays and blood tests indicate choices for a better treatment? Would escaping their stressful lifestyle and moving to México give Jake and Lindsay the new start their relationship needed?
Available on Amazon worldwide!
To Read More and Download: Amazon.com
          Canada: Amazon.ca
United Kingdom: Amazon.co.uk
                     Mexico: Amazon.com.mx

                   Australia: Amazon.com.au *

     I invite you to SIGN UP for my "Healthy Living and Traveling in MexicoNewsletter", published monthly with stories about our latest adventures, my recent blog articles, and news about my books.
Terry L Turrell, Author

Follow me on: MyFacebook Author Page

Tuesday, May 22, 2018

HEALTH CARE AND MEDICAL INSURANCE IN MEXICO: What We Do as Expats

A Common Question When Thinking About Moving To Mexico

Sayulita UNIMED Urgent Care & Ambulance
      Moving to Mexico at the age of 58 and Jon at 65 years old, having easy access to quality health care was high on our list of priorities. Medical and dental care seems to be one of the biggest concerns when people ask us about retiring in Mexico. At this age, most of us consider what we will do in case of a heart attack, stroke, cancer, broken bones, broken teeth, or other physical ailments. And then there are the mental health issues, such as depression, anxiety, Alzheimer’s, and other possible disorders during aging. We want to be prepared, just in case.
Hospital CMQ Riviera Nayarit in Bucerias

Medical Care
    When we were deciding where to retire in México, access to health care was included in the Top 10 Reasons We Moved to Sayulita, Nayarit. We found that good medical and dental care are available at various clinics in Sayulita, the San Francisco General Hospital five miles north in San Pancho, the new Hospital CMQ Riviera Nayarit 13 miles south in Bucerías, and several medical centers in Puerto Vallarta, including Hospital Medasist and Hospital CMQ Puerto Vallarta 30 miles south.
Bandaras Bay Pharmacy & Medical Clinic in Sayulita

     Some pharmacies in México (farmacias), especially in small towns, have a doctor’s clinic associated with them, usually right next door. The Banderas Bay Pharmacy andMedical Services on Calle Manuel N. Navarette in Sayulita is one such service which has two doctors, does house calls, and has a phone number for 24-hour urgent care. We keep their brochure and phone number, as well as the one for the Unimed Urgent Care clinic near the Pemex gas station at the entry to Sayulita, posted on our wall in case of emergency. I recommend having a name and phone number of an urgent care or doctor handy for the area you decide to move to, preferably one who speaks English if your Spanish is not good.
Pharmacies in Mexico Often Post Common Medications Stocked

     Pharmacies in México have a good selection of common maintenance medication, most of which do not require a prescription. Controlled substances and antibiotics often require a prescription, which you can usually obtain for a small fee. However, prescription medications are not necessarily inexpensive compared to the price we pay for a one-year supply of generic drugs that we take. 
      In addition, specialty drugs and nutritional supplements are generally not available in México, even in the larger Farmacia Guadalajara, Wal-Mart, or Costco pharmacies in Puerto Vallarta. We are careful to bring a one-year supply of all of our prescription medications, nutritional supplements, and over-the-counter medications with us once a year, including fish oil capsules, calcium carbonate with Vitamin D, Vitamin C, ibuprofen, 82mg aspirin, and many others. Vitamins, minerals, and other nutritional supplements can be found at GNC stores but are relatively expensive compared to in the United States. 
Jon at Farmacia Guadalajara 

     Fear of illness or injury while living or traveling in México is a real concern for many people. It may ease the minds of those new to México to know that pharmacies, Urgent Care Clinics, and hospitals are readily available in tourist areas of Mexico.             Here is one story of a time that my husband, Jon, needed to treat a minor health issue while in Mazatlán that I hope will help others realize that medical care is easily accessible in most areas of Mexico: TwoTrips to Pharmacies in Mazatlán: Treating a Mild Infection While in Mexico.

     The next service we researched was ambulances in our area. When we realized there are three companies that have ambulances in town or nearby, Baywatch, Banderas Bay Medical Services, and Unimed Health System (Urgent Care), we programmed the direct phone numbers of all three services into our cell phones. We have the 911 emergency service in our area, but the dispatcher may not speak English and will send whatever ambulance they choose. We prefer to call the ambulance directly and make sure they are available immediately and can take us to the hospital of our choice.
Ambulance at Unimed is Associated with AirEvac International

Find a Primary Care Physician
      We wanted to establish a relationship with a primary care physician we trusted in case we had medical issues beyond that which an urgent care clinic could handle. Our dentist in Sayulita recommended a doctor she trusted for his medical expertise and that he would not take financial advantage of us as gringos by charging high prices or by charging for a false diagnosis.
     We decided to give this doctor a try when Jon had been experiencing a troubling eye pain for a couple of weeks. We rode the bus to his office in La Cruz de Huanacaxtle about 11 miles from Sayulita. As is common, his office was next to a pharmacy.
     The doctor was personable and spoke English well. He spent about a half-hour talking and examining Jon, then told Jon he should wait a week or so and see if the pain would go away. He said to come back if it didn't. When asked how much we owed, the doctor said, "Nothing. I didn't do anything." Wow! 
     Then he gave us his cell phone number and said if we had an emergency to call him first and he would meet us at the hospital, partly to make sure we weren't overcharged, since we are gringos. We felt good about our new primary care physician. The eye pain did go away in a week, a mystery to us, and we haven’t had to return to see the doctor since.
DENTAL CARE

     We feel fortunate to have a good pair of dentists in our town at Dental Office Sayulita, Dra Carla Governi and Dr. Roberto Conti-Vecc. They are both skilled and their prices are reasonable, which we appreciate since we don’t have dental insurance and pay for all dental care out-of-pocket. Finding a good dentist in the area you will move to in México is as important as finding a good doctor, we feel.
     We have our teeth cleaned twice a year in Sayulita. Dr. Carla does the cleaning herself and she is very thorough. She charges us 1000 pesos (about $50 US dollars) each. I had her replace one of my broken fillings and was pleased with her expertise and price.
Dra. Carla is a Very Professional Dentist
     Jon has had two crowns done by Dr. Roberto in Sayulita and says they are the best crowns he has ever had—each one fit perfectly the first time they were placed on the tooth and required no grinding. Dr. Roberto took the impressions at his office and then sent them to a crown-making lab in Puerto Vallarta. Since the lab specializes in making crowns and uses a process that is exacting, the results are very high quality.
     To give an idea of the cost of having a crown replaced, here is the breakdown for Jon’s most recent dental work. Dr. Roberto removed the old crown and found there was not much old tooth left. Jon wanted to save the tooth, not have it pulled. But there was pain and infection in the tooth so he had to take ten days of antibiotics and then go to a specialty dentist in Puerto Vallarta for a root canal (see below). After the root canal, Dr. Carla did a core buildup of the tooth in resin which cost 900 pesos (about $45 US dollars) after the cash discount. He opted for the more expensive zirconium crown which cost 8820 pesos (about $440 US dollars) after a 10% cash discount and included the removal of the old crown.
Specialized & Advanced Dental Office in Puerto Vallarta

     To have a root canal done in our area, Dr. Roberto and Dra. Carla sent Jon to a dentist at the Specialized & Advanced Dental Office in Puerto Vallarta which specializes in root canals. She only does root canals in her practice and therefore, she is very skilled at doing them. The total cost for the root canal was 3200 pesos (about $160 US dollars).
     Since we pay for our dental care out-of-pocket, we have saved a great deal of money by having our dental work done in Mexico rather than the United States. The crown replacement and root canal cost about $645 US dollars in Mexico. If Jon had had this work done in Oregon, we estimate it would have cost about six times as much.
     
Health Insurance
Mexperience Offers Medical Insurance Options For Mexico

     For those who wish to purchase medical insurance that covers health care while living in Mexicoo, the Mexperience website has a couple of good explanations and services to offer. I would refer you to their Guide to Healthcare Services in Mexico. One of their recent blog articles has a nice summary of Healthand Medical Insurance Options in Mexico.
     After reading many Facebook Expat group discussions on this subject and speaking to other expats we have met in México, I find every person does something different. There isn't a “one plan fits all”. Jon and I have looked at both Mexican public health insurance and private insurance plans for expats and we just don't feel either is a good option for us.
     Here's what Jon and I have decided—we pay out-of-pocket for health care while here in México. It's relatively inexpensive for quality practitioners and hospitals. In case of a major emergency, we will pay out-of-pocket. We are both pretty healthy, so it feels like the right decision for us. But it's not for everyone.
Medicare Can Only Be Used In the U.S.

     Jon has Medicare Medical and prescription insurance which he can only use in the U.S. so he gets an annual physical and a year's worth of medication when we are in Oregon each summer. He has his doctor write his prescriptions for a quantity to last for one year, then has the pharmacy fill it for the maximum allowed by the insurance, which is usually a 90-day supply. Then he asks the pharmacy technician to call the insurance company and request that they cover a vacation supply, usually another 90-day supply. Finally, he has the pharmacy fill the balance of the prescription for a cash price. Using generics, this is usually the least expensive route, though if a generic medication is very inexpensive, we find it is best to have the entire prescription quantity filled as cash and bypass the insurance billing altogether.
     I am 61 years old and am eligible for an affordable health insurance plan in the U.S. due to my low income. I only take out enough from my IRA to live simply here in México and that qualifies me for this inexpensive plan with a low premium and high deductible. This covers my annual wellness physical and mammogram while we are in the U.S. It also allows me to purchase a year's worth of prescription meds while in Oregon, using the same insurance billing procedure as described for Jon above. Purchasing a year's worth of generic prescription medications and supplements such as vitamins, calcium with Vitamin D, fish oil, as well as over-the-counter medications such as ibuprofen and aspirin 82mg while in the U.S. is far cheaper than buying them in México.

Here are a few other sources of information for Medical Insurance while in Mexico:
2.  Expat Insurance Solutions by Expats (Medical, Evacuation, Auto, Home)
https://www.weexpats.com/ (Worldwide including US and Canada health insurance with WEA)


     This is an interesting article from the Yucatan Times, giving us confidence in the quality and low cost of health care we have in this country: Mexicoamong the 5 countries with the best healthcare in the world for retirees. In this article, “International Living’s Mexico Editor, Glynna Prentice, says, ‘In Mexico, I have access to two affordable healthcare systems: public and private. In Mexico’s private healthcare system, costs—pretty much across the board—run 25% to 50% of U.S. costs for comparable services. And as a legal resident in Mexico, I also have access to Mexico’s public healthcare system, which runs most people around $300 to $400 or so a year—or less,’ says Prentice, one of an estimated 1 million Americans now living in Mexico”, according to International Living. Jon and I are legal residents of México but have concerns about wait time in Mexico’s public healthcare system and so have chosen not to go that route.
     I recommend that when you consider where to move in México, you evaluate the quality of health care facilities available in the city you like and how far they are from your home. Having high quality medical clinics, dental offices, and hospitals nearby has been a comfort to us since we moved here. Though we are in fairly good health and have rarely needed medical care, we are more comfortable living in México knowing where to go when we do need it.

     I invite you to SIGN UP for my "Healthy Living and Traveling inMexico Newsletter", published monthly with stories about our latest adventures, my recent blog articles, and news about my books.


ANNOUNCING MY NEW NOVEL! eBook only $2.99 or FREE on kindleunlimited!

Just Another Manic Moment
     When they fell in love, it was powerful. Then Jake was diagnosed with depression and bipolar disorder. Could Lindsay tolerate the chaos from Jake's wild mood swings? Would newly discovered gene assays and blood tests indicate choices for a better treatment? Would escaping their stressful lifestyle and moving to México give Jake and Lindsay the new start their relationship needed? 

Available on Amazon worldwide! 
JUST ANOTHER MANIC MOMENT: A Novel
(In Sickness and In Health #1)


Terry L Turrell, Author
Follow Me On: 
My Amazon Author Page 
My Facebook Author Page

Monday, May 14, 2018

JUST ANOTHER MANIC MOMENT: My Novel is Now Available!

A Love Story Set in Mexico and Oregon
Explores the Challenges of Depression and Bipolar Disorder

JUST ANOTHER MANIC MOMENT
A Novel: In Sickness and In Health #1
      Exciting news! My novel Just Another Manic Moment is now available for pre-order on Amazon worldwide! Order your copy now and receive it on your device May 22, 2018!

Pre-Order: Amazon.com
In Canada: Amazon.ca
                 UK: Amazon.co.uk
               Mexico: Amazon.com.mx
             Australia: Amazon.com.au

     I have been writing this story for over two years, intertwining the love of two people with the complex challenges of mental illness. Of course, living in Mexico plays a part in this tale, as the search for treatments evolve and the hope for a healthier life unfolds.

     My goal in writing this novel was to focus more attention on depression and bipolar disorder, in hopes that more people who suffer from these mental illnesses will seek and receive appropriate treatment. Bipolar disorder affects millions of people in the world. The numbers are difficult to determine because many never seek treatment, numerous men and women with untreated and under-treated mental illness ending up in the homeless community. 

     According to a National Alliance on Mental Health fact sheet produced by the College of Psychiatric and Neurological Pharmacists, "Bipolar disorder is a brain disorder (mental illness) which exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million Americans each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many of those with this illness don't receive treatment."

     Remember this blog article? "Winter Blues", SAD, Clinical Depression, Bipolar? Another Reason to Retire Early... and Go Find Sunshine! Here's an interesting tidbit...
RV Life on the Beach in Mazatlan, Mexico
     ...that has been my second most popular blog article of all time. This indicates to me that many of my readers have an interest in this topic, either because they themselves have one of these disorders or someone close to them may suffer with one.

     While I hope this novel is enjoyed by many, it may be of special interest to those who deal with mental illness on a daily basis in one way or another. This story illustrates that life includes times of love, romance, struggles, and pain. But, in the end, there is hope and help.


Book Description:
     When Lindsay and Jake fell in love, it was magnetic and powerful. Jake declared that the “chemistry of love” pulled them together, that they were split-aparts, lucky to have found each other. Lindsay agreed, ecstatic that she had found her soulmate. When they exchanged wedding vows, they meant every word. … “for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, till death…”
     Then Jake was diagnosed with clinical depression, a major depressive disorder that took the joy from his life. Later, periods of rage and anger changed his personality, testing his relationship with Lindsay. A phase of manic euphoria and frenzied spending forced Lindsay to take drastic measures.
     Jake’s revised diagnosis of bipolar disorder, a manic-depressive illness, a radical brain disorder, caused the wonderful life he and Lindsay had built to begin to disintegrate. Would their wedding vows be enough to get them through the strain on their marriage? Could Lindsay tolerate the chaos caused by Jake’s severe mood swings, high energy and activity levels during periods of mania, replaced by months of sadness, anxiety, isolation, and despair when depression took over?
     Would Lindsay be able to keep her vow “to have and to hold… in sickness and in health…”? Bipolar disorder and depression, mental health issues, fell into the category of sickness, but no one warned her it would be this difficult.
     After years of psychiatrist visits, medication changes, counseling sessions, and other recommended therapy for Jake’s bipolar disorder, his moods still were not stabilized. Would newly discovered gene assays and blood tests indicate choices for a better treatment? Would escaping their stressful lifestyle and moving to México give Jake and Lindsay the new start their relationship needed?
     Lindsay was determined to find the answer to balancing Jake’s brain chemistry so he would return to her as the split-apart she had fallen in love with. She hoped the chemistry of love would hold them together long enough to overcome this horrible disorder.

     Get your copy of Just Another Manic Moment now on Amazon:
Pre-Order: Amazon.com
In Canada: Amazon.ca
                  UK: Amazon.co.uk
                Mexico: Amazon.com.mx
               Australia: Amazon.com.au

     I invite you to SIGN UP for my "Healthy Living and Traveling in Mexico Newsletter", published monthly with stories about our latest adventures, my recent blog articles, and news about my books.
Terry L Turrell, Author