My Experience with Dr. Joya, Tips for Hospital, Hotel and Home
This is a narrative to tell you what my experience was like and to hopefully make it easier for you while in Mexico.
My daughter and I arrived at the airport, and zipped through customs. You walk out the airplane, down a corridor and down a ramp where someone looks to see if you have the form you received on the plane properly filled out. There are bathrooms across from the ramp should you need one. Then you walk through customs where you will be given a stub from the form you filled out. Do not lose the stub; you will need it when you return home. You turn to the right behind the customs booth and walk about 300 feet to the luggage carrousel. After retrieving your luggage, go through the gate where there is a red or green button you must push. This leads to a room with a large opening on your left. Look to the left as this is where the Taxi coordinator is located. We quickly saw our taxi coordinator holding up a sign with my full name. He took our luggage and walked us to the pre-paid taxi. It took about 7 or 8 minutes to arrive at the hospital. You don't see it but the airport is nice, has several places to eat and shop. It also has a group of massage chairs where you get 15 minutes for $18.
San Javier Marina Hospital is a small hospital but very nice. In front of the hospital are two doors, the one on the left is the emergency room entrance, the one on the right is the lobby entrance. Go to the emergency room to meet Natalie. The ER has a single registration page to fill out so if Natalie hasn't arrived, or is with another patient, you can complete that paperwork. The lobby doors are locked at night, but access is available via the emergency room doors. If you go into the lobby from the main door, there is a pharmacy immediately on your left. The ER is at the other end of the pharmacy. There is a door adjacent to the pharmacy that opens to a hallway to the ER.
You will then go with Natalie into a room off the ER lobby to fill out Dr. Joya's paperwork: consent forms and such and give Nathalie your payment. I showed her my extra emergency cash that we are required to bring, and she told me hang on to it. So be prepared with a lock for your luggage. You are also weighed here, take a good look, this is the last you'll ever see of those numbers. This takes about 5 minutes, and then it is off to your hospital room. If traveling with someone, this is nice because the room is assigned immediately.
The room is spacious, cleaned 3 times a day, and has a sofa that converts into a narrow bed. The staff brings linens, but you may have to ask for a pillow. There is also a nice recliner. There is plenty of closet space with room for luggage for two travelers. The bath is smallish, but has a walk-in shower with good water pressure. If you have had a long trip, your travel companion will be comfortable here while waiting for your return from surgery, or they may take this time to leave the hospital for a meal.
The hospital provides in-room meals for your traveling companion if they are not interested in eating outside the hospital. Be sure to ask for the meal tray if it is not delivered. Unlike the US, breakfast is not at 6am, but is served about 8 or 9 o'clock. Lunch is a larger meal served about 2 PM. Dinner is a lighter meal served about 7 PM. The food is good, and well prepared. If your traveling companion wants to venture out, there are two restaurants within walking distance: El Mero and Outback Steakhouse. My daughter NEVER talks much about food, but raved about el Mero. Both are on the same side of the street as the hospital. Turn to the left as you walk out the hospital, go about 2 blocks to el Mero, Outback is just one more block. To the right as you walk out of the hospital, about 3 blocks away is a Sam's Club and a Wal-Mart. Directly across the street is a service station that sells soft drinks and such. We brought soft drinks and snacks into the hospital with no problem. Let me offer one word of caution; the humidity is vicious, so if you are not used to the heat, be careful not to overextend yourself walking too far.
I arrived in Mexico September 12th, Tuesday, about 3 PM. I went into by-pass surgery about 6 PM that same evening. I had 45 minutes prep, 2 hours surgery, and 4 hours in recovery because I was slow to wake up fully. So I was back in my room about 12:00 AM. At 5:30 AM I got up and walked unaided to the bathroom. No serious pain, just mild discomfort and some tenderness at the incision sites only. Wow! I found Dr. Joya, and his staff professional, caring and very good at their chosen profession.
When I woke up later I felt like I had overeaten in a big way; actually it is the gas they inflate the abdomen with to do the surgery. It is a very uncomfortable feeling - so walk, walk, walk to get rid of it. It may not pass the first day, but that is normal. You might also rub your tummy to help. I felt much better once that overfilled feeling was gone. There is also some generalized swelling of the abdomen, this is normal and will go away in a few days to a week. I had and still have some tenderness on my left side because during surgery the liver is retracted, even in laparoscopic procedures.
Having a warm shower and washing my hair the first day was wonderful! They disconnected the IV and I took my time. There is a chair in the shower if you need it, just remember not to overdo. Everyone I talked to says the same thing - fatigue hits suddenly and hard. When I got back in bed the nurses changed my tape and gauze over my 5 tiny cuts. You will also have a drain in your right side. You see a rubber, rectangular shaped pouch to catch blood with a round mouth having adhesive attached to your skin. Inside the pouch is a flat rubber tube that is placed inside the abdomen and extending into the rubber rectangular pouch. The pouch is emptied by the nurses daily and for the squeamish - you can't see the blood in the pouch.
After the surgery, I had a sore throat and coughed up a tiny amount of bloody mucus, but that is normal since they place a scope down the throat to check the inside of the stomach, and you are intubated during surgery so there is some irritation there. This occasional bloody mucus lasted about 3 days. I also had an allergic reaction to the mild pain reliever they put in the IV; symptoms were a red flushing on my face, upper chest and upper arms, I felt feverish, but my temperature was normal. The drug is a pain medication similar to Advil, so be very sure to let them know if Advil is a problem for you. They gave me Benadryl in my IV and it worked like a charm.
I take Meripex for restless leg syndrome; unfortunately, they do not have this drug here. I was allowed to take it by mouth with a tiny pill cup of water, even though I was still in the" nothing by mouth" phase. If you take any medication you can not skip for a few days, be certain to discuss this with Natalie (so a good translation is in your records), your Doctors and nurses. I was allowed to take my normal meds by mouth once I was sipping water. I used to gulp down 8 pills at one time, now I just do it a few at a time, just to be careful. So far, there have been no problems at all. Check with Dr. Joya, as medications may need to be crushed or in liquid form for the first few weeks after your surgery. It is best to check before crushing your pills, as many common medications are time-released and cannot be crushed.
You will be "nothing by mouth" for 4 days following the surgery, but will be getting fluids in an IV. Pain medication and antibiotics are added to the IV. I have bad veins, and "blew" a total of 4 because of the medication added to the IV. I asked the pain medication be stopped after the first day and it did help some. To keep your mouth moist, you can brush your teeth but do not chew gum. Chewing causes gastric juices to be released and could create a problem for you. Just rinse your mouth often and brush for a moister mouth and use Chap Stick for moist lips.
After 4 days, you will do the leak test; some people call it the blue test because you drink a blue liquid. You will be given a cup of water containing a blue dye that you are to steadily sip on for about 4 hours. Don't gulp it down. Then, the nurse will check the fluid accumulated in the rubber drain pouch. If it contains no dye, you know the surgery procedure has a good seal, with no leaks. You also have a blue tongue for a while. After the test, I graduated to a cup of ice - remember to suck, don't chew. Finish that and bottled water is next. But remember, start slow, small sips, and wait a few minutes between sips. And remember to walk.
A clothing hint - bring pajama bottoms to wear with the hospital gown, which you might want to wear backwards. I wore my gown open in the front, and didn't reveal anything. I felt choked every time I sat down with the gown tied in the back, this way I can tie the gown strings to make a v neck in front, and that is much more comfortable while moving around in bed. And they have gowns that are big so you don't feel constricted - just ask for them. This also meant I didn't have to fight with a robe when I wanted to walk.
Also, I asked the IT guy at the hospital to give me wireless access and he did at no cost. They may not always do it, but he did for me. So, if you are traveling alone, and need email to stay in touch with family, ask. As for cell phone coverage - be sure you know the exact charges for roaming and calls before you make them. My cell phone service was sporadic at best. Better to call family in the States collect or just use the internet.
On day 4 in the hospital one of the surgeons removed the drain tube. First he removed the rectangular drain catching pouch. There was a soft rubber tube placed in the right side of my upper abdomen. It had 2 small stitches holding it in place. These were cut and the drain tube was pulled out. He told me to take 2 deep breathes and blow out, on the second exhale he pulled it out. Please, believe me...this did NOT hurt. You then have a small incision that does not even need a stitch to close. It will heal by itself. A new pouch cover was placed over the incision to catch any fluid that might continue to seep out. The next day the pouch was removed before I was released. The same surgeon visited me at the hotel every morning about 11 o'clock. He removed the stitches about day 8 at the hotel; again, this did not hurt at all. He said not to cover the incisions but for the next week or 10 days there has been a small amount of leakage on my bedclothes. It is pale yellowish almost clear in color, and makes a stain about the diameter of a pencil. The surgeon said not to be alarmed, it was normal. Two of my incisions seemed to have opened wider; he didn't seem alarmed by this at all as it will eventually close completely.
One thing I want to share is information on San Javier Marina Hospital in Puerto Vallarta. This is not a hospital for the general population. It is privately owned, has good security, top staff and is very caring. My room was cleaned 3 times a day and linens changed as I wanted. Only government officials, the financially blessed and top social families come here. Language was not a barrier. Most doctors speak English well, and the nursing staff knows some common words and phases at the very least. A good investment before going might be an English - Spanish dictionary to be sure you can tell the native countrymen what you want. On one occasion I wanted something and the desk nurse called someone else in the hospital to translate. The bottom line is if I needed another surgery I would come back here.
I talked to the Nutritionist at the hospital. She is a wonderful young woman who speaks English very well. She helped me understand about what foods are good and what to avoid once I am off the recovery diet and eating regular foods. I asked one of my doctors for a consult before I spoke with her. If you have very poor eating habits, she has a list of foods to limit and suggestions to replace them. Again this is NOT a recovery diet, but suggestion for change in eating habits AFTER recovery.
I walked to the rooms of other Dr, Joya's patients and introduced myself. In this way I met my bypass buddy. We are going to stay in touch and hold each other accountable and encourage each other to stick with the program. It is easier to stay focused when you have someone who you met face to face and going through the same thing. And I hope by encouraging my buddy and her supporting me, we'll become "big losers"!
When you are released, Natalie comes to the hospital and gets you. You receive a copy of your records for your home physicians and a receipt for your paid bill. She gives you Cipro - an antibiotic and some pain pills that I never opened. She also has information concerning your recovery diet - read this carefully. Then it's off to the Krystal. Natalie takes you in her car. She will help you get checked in and answer any questions you may have. I tipped Natalie $20 at this time. I had an opportunity to call Natalie once during my hotel stay, I called her office and they connected me while I waited on the line. She will give you her business card with her office and cell phone number.
The Krystal has carts that shuttle you around the grounds, a 50 cent tip for cart drivers is what I usually gave. Taxi rides are $4 to just about anywhere, with a $1 tip. I tipped housekeeping $1 each day. In the lobby of the hotel tower where you will stay there is a breakfast each morning consisting of sweet breads, fruit and coffee and juice. In the evenings about 6 PM there are hot snacks such as bar-b-que ribs, fried chicken fingers, beef-kabobs, quesadillas and shrimp. This is at no charge, and very tasty for your traveling companion. Popsicles for you are available at the store near the internet café and in the lobby.
Try the massage, hairdresser, or nail salon - all are very reasonably priced and a great value for the money. TV channels are limited; bring a laptop and movies for entertainment. Or you can watch older American movies on one of the 2 movie channels. Although the room was nice, (marble inlaid floors) clean and roomy; the beds are hard! Even with an egg crate foam topper, which you should ask for at check-in, I was uncomfortable. Perhaps I should have asked for two!
Do try a day trip into downtown for the market. It is enclosed and has stalls with jewelry, clothing, toys, hats, and a vast array of pottery and pewter work. Ask the bellman to tell the driver you need a smooth ride due to surgery - it will help. Bring a money belt or fanny pack so your hands are free and you don't have to carry anything you don't have to.
I got tired of the jello, crystal light and soup broth quickly. So I tried what the locals do, I spiced up my taste buds by adding a little fresh lime juice to the soup - it was wonderful! And warmed crystal lite is good too. The lime popsicles are the best. The water at the hospital, hotel and local restaurants was safe; we had no unexpected visits to the ladies room. Bring a small electrical pot for heating water or broth. Electrical outlets are the same as here but you may need an extension cord if you bring a laptop, heating pad or something else. The hotel body cream is cucumber and very nice, the shampoo a little harsh. There is a wall mounted make-up mirror and hair dryer. The marble tub is mid sized to large and has a hand held shower attachment.
In all, the trip was good, the surgery not as painful as I imagined and my recovery is going better than expected. It is day 14 after my surgery. You will probably gain weight in the hospital because of all the fluid they give you - so I tried very hard to skip the scales until I was at least 14 days out. I have lost 22 pounds! I can stay up and moving or busy about 3 - 4 hours then I need to nap.
I'm eating about 3 ounces at a time about 6 times a day. Recently, I ate too fast and about two ounces too much; it caused a very uncomfortable full feeling and I threw up. It didn't hurt, but I don't plan on doing that again anytime soon. I then later had an episode of expelling a small amount of frothy vomit. Keep yourself hydrated. Your pouch will instinctively protect itself when over-stimulated or over-dry by producing a white mucous liquid (referred to as frothing) which may make you feel nauseated. As the new pouch heals, mucus sometimes is excreted to help break down food. With some patients, this mucus backs up in the esophagus and causes frothy clear vomiting. Frothing is not a complication, so try drinking ho****er ½ hour prior to your meal to lessen the mucus. Your meal should then be better tolerated. Pay attention to your body's signals of fullness. One extra bite may cause pain and discomfort. My advice for myself and you - watch your portion control and eat S-L-O-W!
Do contact me if you think there is a question I might answer.
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Wow sherry what a great report I was banded by Dr Joya in June at the Cornerstone Hospital just down the road a bit but was equally as nice....you were very accurate in your descriptions of the way it is there didn't you feel so glad and lucky you found him! Your information is a great description for anyone thinking of using him
Thanks for the info it was great! I am leaning towards Dr. Joya at the moment but still have some research to do. If you don't mind me asking what was your total cost? I want the RNY but would like to stay in the 10,000 or cheaper range.. But want a good doctor too !!!! I am not willing to sacrifice my health to save a dime. I have some money saved but need to know how much I am going to need total because I would like to do this in the next 6 months or so. Thanks again for all your help !
Tammy 
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