Monday, January 28, 2013

Getting Complicated

The post-op complication of the victrectomy was an intense rise of pressure in the eye five days after the procedure, during which the silicone oil placed inside the eye last year was swapped out with saline solution.
Pressure problems in the eye are known as glaucoma, pretty much whatever causes it. I traditionally have and maintain good eye pressure, usually between 14 and 18. Over 25 is a cause for some concern. Following the retina reattachment the pressure rose when my doctor allowed the elimination of drops that regulate pressure. That prior and temporary effect did not cause the agony that the recent spell did.
My roommate was tempted to bring me to the hospital. More cavalier, I took percocet and Nyquil and went to bed. The roommate called Doctor Krzystolik’s answering service after ten. She got back to us with willingness to meet us at her office at midnight. I deferred to 7 AM, and the doctor met us then in her office local to me, without any assisting staff.
I was candid that I had lifted and exerted more than I probably should have. She said that effort probably did not cause the problem. One friend did try assigning blame to Krzystolik, that she may have overfilled the eye. I reject the entire line of thought as desperately seeking to assign blame to a standard risk of the procedure. Unlike when I was afflicted with cataract and PRP treatment by associates at Koch Eye, Dr. Krzystolik has been clear and honest with every risk of every step. This blog shows I am not afraid to assign blame and point fingers when appropriate. I don’t find it appropriate this time.
She relieved the pressure by reducing the fluid in the eye with a needle through the center. My roommate was astounded that I didn’t even flinch. I felt it, but it didn’t come across like you’d think a needle in the eye would. I’ve been told by doctors and others that I have a high pain threshold, so I may not be the best judge.
She repeated the process in an appointment later that afternoon. My roommate didn’t watch so closely that time. Through the reduced pressure and regulating drops, the eye pressure has stayed in its normal range. The needles caused two more of those bubbles or cornea scars, but these have also diminished as time marched on, day by day then week by week.
Her willingness to meet me any and all hours and her subsequent treatment have raised my regard for Dr. Krzystolik. The eye still gives pain, but this is manageable with over-the-counter relievers, I’m limping along with my usual steps and stumbles, which my roommate often finds comical to watch.

Sunday, January 27, 2013

Victrectomy Post Op

I described "scars" on the cornea that I thought were left from incisions necessary during the victrectomy. This procedure involves draining the eye of existing fluids and replacing it, usually with saline solution. My highly recommended retina specialist who performed the January 10 procedure, Doctor Krzystolik, said that the circles I can see are more likely to be drops of the silicone oil that was put in my eye during the 2012 retina reattachment. Her theory is probably the case. She’s the doctor and has more experience in these things. From my perspective, the larger circles have begun to either dissipate or have merged.
My vision has changed since the recent procedure, mostly for the better. I can see better at a distance of about four feet, but not particularly clearly or in detail.
Light sensitivity remains a major problem and affects me in different ways. The computer is still problematic, but in different ways. Prior to the victrectomy, I managed the computer by using a 32-inch TV as a monitor, with the screen zoomed in, with a magnifying mouse, and with glasses. Now the glasses actually hinder view of the monitor but remain necessary for me to see the keyboard.
Of course, having a cataract lense that blinded me to close vision remains a major problem. The "Cataract" label will bring up most of the old history on that, as would many of the posts under the "God Complex" label.
I feel more discomfort from the eye since the victrectomy. Redness in the eyeball is common. They eye often feels itchy and raw, and it tears often, as in wetness, not ripping. There’s also frequent pain, in the eye, the socket, and headaches that radiate on that left side of my head.
The pain was worst five days after the surgery, to excruciating levels. I have a high pain threshold, so I can’t imagine how others might describe what I was feeling.
I blamed myself for this onset of pain, because I had exerted that day, lifting barrels of ice melting salt and carrying groceries up all the stairs necessary to get home.
Doctor Krzystolik said she didn’t think the exertion caused the problem.
I was suffering a side effect from the procedure....

Thursday, January 24, 2013

Not Blaming the Blameless

On opening my eyes without bandages and shield following the victrectomy, my vision was improved. Dr. Krzystolik had not been convinced, but I had theorized that this procedure of replacing the fluid in my eye would improve my vision because the new fluid put in my eye would be cleaner. I’m happy to have been proven correct on this, not in any sense of "knowing better" than the doctor but because my vision is better than it was before the procedure.
My vision will never be fully functional. Two great loves of my life are permanently lost to me, reading and driving. It can be hard to explain what I can and cannot see at any given time. It’s not just diabetic retinapathy that limits my vision. Obstructions, light sensitivity, cataract lense restrictions, muscle damage within the eye and other factors all contribute variable conditions. Doctor Krzystolik herself noted on her first examination that I had the most complicated eyes she had ever seen.
I like and respect Doctor Krzystolik. She has been cautious in promising expectations following any treatment. She has told me what I cannot expect for improvement. She has listened to me on every level and addressed some aspects of coping with what’s been going on.
I can’t emphasize enough my approval and satisfaction of this retina specialist with offices in both Providence, Rhode Island and Plainville Massachusetts, for two reasons. First, I have been so candid on this blog when doctors have done wrong that I feel it fair and necessary to accentuate the positives. Secondly, the victrectomy saw complications for which I do not blame Doctor Krzystolik.
There’s a schoolyard oath that I must have vowed then broken during my wayward and turbulent childhood: "Cross my heart, hope to die, stick a needle in my eye." That theory is as useful as if I wanted to blame Doctor Krzystolik , which I don’t.
I think rightfully I still blame Negrey and Michael O’Brien at Koch Eye Associates for most of my current and permanent disabilities. Doctor Krzystolik , however, has done her best to temper those conditions and correct what she could, all without pushing me towards things with a lack of necessary information.
Details of the surgical complications to follow.

Wednesday, January 23, 2013

Surgical Scars

Following the victrectomy, I have spent a lot of time with my eyes closed. I used bandages and shields longer than recommended to keep the left eye dormant. I don’t exactly do much these days, especially while I am supposed to not exert and thus strain muscles that may be connected to the eye, so this has been mostly manageable. My reasoning ties directly to the experience of the complications that darkened my right eye ten years ago.
Back then, my right eye misaligned as the eye looked around the obstruction caused by a temporary cornea abrasion. I recently had an inexplicable minor abrasion on the left eye, which I did not worry about because I couldn’t see out the eye too clearly anyway.
Post victrectomy, the cornea is more of an issue. The procedure involved draining the eye of silicone oil and refilling it with saline solution. I didn’t ask many details about the procedure, because I didn’t want to know details that sound horrific in theory. But my basic ideas of sticking something in the eye to drain and fill seemed about right.
There’s scars in the cornea. They are at the bottom of the field of vision, but can rise to more central prominence as the eye looks around. I tend to look at the scars as they strike me as cool in a morbid way.
The most prominent are three perfect dark rimmed circles in the formation of an upwards-pointing triangle. Aside the dark edges, I can see through these bubbles. There’s a fourth circle to the right of the upper part of the triangle. I can really only see that one when I focus on the strange pattern. Two much smaller circles will also become evident These are the scars of needles or hoses stuck in my eye during the surgical procedure.
I do not expect these scars to be permanent. But until the limited cells of the cornea resettle, the formation is a distraction to my vision. I’m pretty confident that the circles are on the cornea as the formation realigns when I focus on it. The triangle spreads out or flattens and the smaller "needle holes" will rearrange around the larger circles. Unlike the retinapathy flashers or the scar of "light" that is the mark of the original Cialis-induced vitreous hemorrhage, these scars are only visible when the eye is open and hit by light. Closing my eyes makes the circles go away. The next time I see them, they return in their original formation.
I am afraid of any instinct to look around the scars, or to focus on them. My right eye suffered permanent damage to the internal muscular structure by looking around the minor obstruction on the cornea.
I figure better safe than sorry, and the closed eyes help ensure I take it easy during the healing process.

Tuesday, January 22, 2013

Blinded on the Right

Wearing the bandage and shield following the victrectomy is a difficult thing. My right eye is blinder than the left and has its own set of complications.
I don’t usually realize how much the right eye can see because I rely on the better left eye.
The right eye suffered a cornea abrasion in 2003, ten years ago this month. Due to an incident with an idiot and a hot, heavy steak fry, I’d previously had a serious cornea abrasion and knew how to take care of it. Unfortunately, I didn’t take care of the 2003 incident long enough. While active and routine risks had passed, the cornea still contained an obstruction, which my eye looked around rather than through. This made the eye pull to the right. Muscles striated and diabetic complications developed. The right retina detached. The eye went dark except for the outside perineal and a pinhole that aligns with neither the left eye nor my brain’s expectation of where it is looking. The reduced vision is further obstructed by a cataract. When she first saw me, Doctor Krzystolik said that I had the most complicated set of eye problems she had treated, and I don’t think she was exaggerating or that I have been surpassed.
The time of reliance on the right eye was thankfully short. It’s been remarked that I have great aim for a blind guy; that was no longer so true when what I see is actually shifted in position from where I see it. I miss when I put things on the counter. (Yes, we’re out of the bathroom now.) I am more likely to walk into doors and the edges of walls when relying on the right eye. Except for the bad aim, my roommate finds it comical, all except for the bad aim. My realization that the tub presents a much larger target alleviated his burden.

Monday, January 21, 2013

Oil Change

During the January, 2012 retina reattachment of the left eye, the dirty vitreous fluid at the center of the eye was exchanged with silicone oil. Yeah, I guess that amounts to a boob job for the eye. Lucky me, I guess, that no one told me it was too round.
As the vision diminished through 2012, my theory was that the silicone oil got dirty with detritus from the beleaguered eye. Doctor Krzystolik wasn’t too sure, but her reattachment seemed to hold in place and remain healthy looking in and of itself despite increasing vision loss.
This past January 10th, she performed a victrectomy. This seemed less risky than the reattachment as it seemed more basic. Instead of elaborate "welding" on the back of the eye, they would simply be changing the fluid on the inside to a saline solution.
I was surprised to hear the potential risks as Doctor Krzystolik read them off, but these factors did not encourage the slightest hesitancy. I’d gotten too blind to do nothing while any hope remained.
While some doctors do these victrectomy procedures under local anesthesia, I was put under. Maybe Doctor Krzystolik was afraid I’d wake and start giving directions or criticisms. I’d had local-only during the cataract surgery and prefer total unconsciousness and just waking with everything all done.
A bandage and eye shield were set in place. I would be unable to determine any change until the end of the day when eye drops had to be applied.
My range of vision is improved. I can see the knobs and pulls on kitchen cabinetry from across the kitchen. In good lighting, I can see details and if someone is nearby.
But there have been side effects. Complications arose.
I blame Doctor Krzystolik for none of them. I think that on a blog that has been clear with the failures and bad practices of other doctors, I should be clear that Doctor Krzystolik has done very well by me.

Tuesday, January 8, 2013

Victrectomy

The procedure I will undergo this Thursday is called a Victrectomy. Basically the doctor will be draining the fluid in the center of the eye and replacing it. The replacement is usually with saline solution, but that may not necessarily be the case with me. My eye currently holds silicone oil rather than natural vitreous fluid. It’s been this way since the retina reattachment surgery in January 2012. This has necessitated up to five different eye drops daily, covering eye pressure and sterilization, dilation and a steroid. The steroid has given me the most problems from the beginning, including nervous/psychological tics, like I need more of those. Most disruptive is a natural side effect of increased stomach acid production. Water on an empty stomach, too much acidic food or not enough food like milk to act as a base and I have been prone to puking. The last year, obviously, has been less than pleasant. The regimen of eye drops affects my vision at least for a while, and I suspect may contribute to the overall and still increasing decline.
My hope is that the silicone oil has gotten "dirty" over the last year. My vision is now massively disabled by light sensitivity or light processing issues, and a constant fog, not at all unlike early morning fog. The fog has thickened over time, and I can see it as "TV white noise" even when my eyes are closed. The insertion of fresh fluid should provide a clear globe for me to look through.
That’s what I, and my eye doctor, are hoping anyway.
The decline has not been anything like the typical progression of diabetic retinapathy. I’ve been there and done that with the right eye ten years ago. The vision hasn’t gotten darker per se, but the eye cannot process light or readjust to changing light sources and that fog just got thicker and thicker until I could no longer see a foot in front of me.
I consider the
Victrectomy a "procedure" rather than a "surgery," but that is probably hair splitting semantics. There was far more risk to last year’s reattachment, which is why I had told very few people about the surgery. My doctor had to warn me about possible adverse effects, which could be dire, but I don’t think that’s likely.As the vision has gotten worse, I have been looking at–or rather groping for–this surgery as the last chance to improve and be able to stay functional on anything. I know my vision will never be what it was, but regaining any function will be a welcome change.
Wish me luck.

Monday, January 7, 2013

The Long Decline

On January 19, 2012, I had outpatient surgery of retina reattachment. My eyesight in the preceding months had been declining in spurts, mostly with the release of floaters that enter the vitreous liquid in the center of the eye. The floaters cast shadows and darkened the vision with shadows and obstructions. By this time, most of the red cloud of the October 2009 vitreous hemorrhage had healed and cleared. The vision was declining with symptoms of diabetic retinapathy by summer, 2010. Researching the PRP surgery I had undergone after urgent pushing by Koch Eye associates revealed that the side effects of the PRP laser are identical to the symptoms of diabetic retinapathy. Too late for me. What’s done was done, and after the first round of symptom development including flashers that began after the third PRP session and the recession of peripheral, the darkness advanced. Fall 2011 saw it getting worse regularly.
The retina reattachment halted that. Part of that surgery included replacing the natural eye fluid with a silicone oil. The silicone helps to maintain pressure in the eye to keep the back of the eye "glued together." This can increase eye pressure and cause glaucoma, one of the few problems I didn’t have in either eye. Two kinds of eye drops kept that problem at bay. At one point the pressure was too low; stopping the drops on the doc’s recommendation saw a surge in pressure. Resumption of the drops brought that back under control.
From all physical signs from doctors looking at my eye, the reattachment was successful and "stayed together." Looking out from the eye, however, indicates different results. The vision was at a slow decline in the year since the surgery.
The specific problems have not been traditional signs of diabetic retinapathy. Before the retina reattachment, the cloud overwhelming my vision was dark, and had definite, noticeable onsets as "gunk" in the eye released This year’s decline has been different.
I suffered no sudden "setbacks," as I called the release of floaters. Two problems developed and worsened over time.
The first is the light sensitivity and my eye’s apparent inability to process light. Strong light sources blind me with their brilliance and glare. My eye experienced increasing difficulty adjusting to variable light, even that of inconstant and inconsistent outdoor shadows of leafy trees. The reverse also proved true. Not enough light just was not enough light. Night vision is blindness. Vision in overly bright light is blindness.
A new cloud also developed, much like bottled fog that I carry with me everywhere. This was not like the red cloud of the hemorrhage or the black cloud of developing retinapathy. The fog is very clean, and has been since post op. But as "clean" as it has stayed, it has thickened over time. After the reattachment, I could see more than four feet away with finger motion. Now I can barely see overall motion at one foot away.
Without cues of voices, I cannot identify who I am talking to. I cannot see people sitting across a table from me. Moving around even familiar environs is extremely difficult, and always runs the danger of collision with people who assume I will see them and get out of their way. Seeing the computer even with multiple ways and levels of enhancements has become more difficult, and more painful.
Thursday’s procedure may improve the new disabilities.
Maybe.

Thursday, January 3, 2013

On the Road

I went away in late December. I don’t bring this up as automatic excuse for the lack of posts, although that is the main reason. I use the computer not just with glasses, but also with a 32-inch TV as a monitor and a magnifying mouse and at increased zoom levels. Computer things just weren’t possible away from home.
More significant was just how poor my vision has become. Most of the places I go are t least somewhat familiar, none, obviously, moreso than my own home. Removed from that for more than a week, I was totally and completely lost. Even most other places I go locally are familiar, including the same restaurants and grocery store. I do not leave the house alone and can usually get myself at least close to where I need to be within a building. Outside the building, I often cannot tell where the building is.
Yes, it’s gotten that bad.
While traveling, nothing was familiar. I seldom knew what town I was in, and often did not know the state. The layouts of unfamiliar hotel rooms became indecipherable mazes,
I live in a townhouse style apartment on the third and fourth floors of the building. This has become increasingly difficult for a blind guys with a bad foot and permanent reliance on a Crow boot. There’s thirty-three steps up to the apartment, a difficult proposition when empty handed, a challenge when doing something such as carrying groceries.
Away from the familiarity of home and familiar haunts, I was utterly useless. This made the trip harder on me and my companions.
The extent that I routinely utilize knowledge of my surroundings became acutely apparent without familiar surrounding.
Worse, my eyesight is further diminishing daily these days. Away from the familiar, I could not notice the further decline. Once home again, it was evident how much less I could see from barely more than a week’s passage of time.
I‘m coping. Self pitying moods are more common. Despondency is my most prevailing feeling. But I am coping, trying to stay positive.
I can see about a foot in front of me. I can see about two weeks ahead.
"Through Rose Colored Lenses" is due for publication around the 15th. This comedic short story is the only fiction I have written about the experience of going blind. A few days before that, I will be having what may be the last ditch possibility of restoring some level of vision and functionality.