If Doctor Michael O’Brien at Koch Eye Associates had used the typical scare tactic "You’ll be blind in six months without PRP treatment," I would have run like hell. O’Brien did not raise those red flags. His calm and friendly argument that other doctors had been OK with not rushing into PRP was that now something had happened and I could not put it off. He also never openly contradicted or doubted that the Cialis had caused the massive vitreous hemorrhage. Whether he believed that or not I do not know. Unlike his associate Dr. God Michel Negrey, O’Brien possessed a congenial bedside manner.
Koch Eye charges for a three month window of PRP sessions. I first went under the laser on 2 November 2009 and again on 9 November, followed by an exam on the 17th. During the 30 November exam, I reported seeing flashers following the procedure on the 23rd. O’Brien did not really answer. He employed his interpersonal skills to calm the concerns as normal and nothing to be concerned about.
I did not fully accept this, but felt as though I was committed to seeing the entire planned regimen through to the end. What shape was I in to make decisions? By this time, I was seeing the world through a brownish red have of blood and wanted to get O’Brien’s green light for Negrey to perform the cataract surgery that promised to clear up that problem.
O’Brien put me under the laser again on 7 December. He waited until the 18th for the next exam. I endured another PRP session on December 21st. The holidays, presumably, delayed the next exam until 4 January 2010.
I had wanted it all done by that time.
I had lost my life to helplessness. I had told O’Brien that I had wanted to be up and running by Christmas. That deadline came and went, sliding unseen through the ruddy haze.
On the 4 January exam, after five PRP sessions, O’Brien lit the green light for the cataract surgery. That green light looked a sickly brown to me, distant and dim in the fog, but I still reached for the light.
Negrey’s office scheduled he cataract surgery for 25 January, 2010.
Addressing reader concerns:
Comments are welcome. Anyone who feels that their thoughts shouldn’t be pubic for any reason are free to privately e-mail me. E-mail links are common on my kozzi.us page.
Light sensitivity is a standard complication of diabetes. I have found no internet mention that the dilated light tests are a probable cause. A good part of the blog’s intention is to get my crazy theories out there. I don’t think they’re all that crazy. They need to be out there to be considered. We live in a country where healthcare is a capitalist venture. Doctors will run every test they can get paid for, as often as they can get paid for them. From my experience they are not forthcoming in volunteering potential risks or side effects. More scarey, some doctors will deny the risks and side effects even when asked. My GP is big on that. He often just brushes off specific concerns as me being a difficult patient rather than discussing the my concerns.
I understand that doctors do not want to discourage anyone from having treatment they need, but too many will give more treatment than needed if there’s a buck to be made. I am a strong believer that patients need to be fully informed to enable the best decisions. Whether it’s minor light sensitivity or something major, such as Cialis and Viagra causing a massive stroke or hemorrhage in the eye, the patient should be told of the risks so he can make his own decision. Patients should not have to independently research things . Doctors should not rely on pharmacists to prevent drug interactions.
I have always believed that, and the experiences that conveyed on this site show the importance of patient knowledge and dire consequences of their ignorance.
Shame on doctors who do not cover every detail of these risks. Relying on the patient to ask is not appropriate. If a patient has never heard of something cannot ask about it.
The same reader was unsure of my statements about the "retina weld" as a benefit of PRP surgery. Not every site I have researched to fact check lists it. More than one did. Instead of calling the benefit a "weld" I’ll qualify it that it can retain the retina’s contact to the back of the eye. There is NO benefit of PRP surgery that even approximates re-attachment of a retina that has begun to separate.
I do aim for accuracy, especially when trying to make complicated terms and procedures more understandable than many doctors would prefer.
Tomorrow, back to my procedures in January 2010. It should be as entertaining as watching a blind guy walk into a ladies’ room because his roommate can’t tell the difference between "first door on the right" and "first door on the left."
Yes, that happened today. My apologies to the women in there when I left the stall. They weren’t there when I went in.
And I think I left the seat up.
I understand the natural questions that come about from some of my past decisions concerning my health. The post "Braying to a new God" begs the question, "How can you be so >censored< stupid to not have PP surgery after you were told that you would be blind in six months?!"
The answer may clue in a lot of people who often just shake their head at me with complete incomprehension.
I was an average sized child when the diabetes struck at age 4. Upon entering first grade at the age of 6, I was 45 pounds. Upon entering third grade at age 8, I was 45 pounds.
My mother would see me just glance in the direction of a stray Oreo, and she would warn me "If you eat that, the doctors will have to cut your toes off." Sometimes, it was "If you eat that you’ll go blind." The problem with that was that I had neither gone blind nor had toes cut off when I did secretly seize a stray Oreo. I already knew the scare tactics were untrue.
My parents were not well educated in diabetes care. The family pediatrician was an old stout German woman who wore too much perfume and had a remarkable inability to color in the lines when it came to her lipstick. She gave most kids lollipops to keep them from hating her. As I couldn’t have candy, every visit I got a crumpled brown bag filled with plastic "toys." These "toys" were the long caps of the plastic guards for the needles that she gleefully jabbed into terrified children, and I was expected to be appreciative that the old bat "got something special" for me. She did not want my parents ever taking us kids to the hospital local to us because she was not affiliated with them. My parents followed the lead of this woman who saw no reason to share control of her patients.
Throughout the first eight years or so of diabetic living, I was seen only by the old world pediatricianl whose management of diabetes remained simple: starve the child to keep the sugar low. Unintentionally, this created a context that needing more insulin was bad and special treatment for diabetes unnecessary.
I can only assume that she saw a patient who neither gained even one pound in two years nor died of starvation as a success.
Growing up diabetic for me was an existence of denial and limitations in an atmosphere that diabetes needed no care beyond that of a "healthy" child. Scare tactics saw favor over more complicated things like discussion. I’m not inclined to believe any authority "because they say so."
I’ve eaten Oreos and have lost no toes.
On my own, I do not remember the details of the 1998 examination. I remembered where the office was, but not the name of the practice or the attending doctor. I remembered only broad strokes.
The detailed recollection came after a search through old file folders. A letter from Dr. Arthur Geltzer thanks Dr. Krosschell’s office for the referral and provided a recap of the exam. I haven’t looked at it in years, maybe not since cramming it in the file.
I do independently remember that Geltzer asked general health questions and I stated I was healthy. I remember his response, this declarative statement said in the tone of a commandment. "If you’re a diabetic, you’re not healthy."
I also remember Geltzer’s prognosis. I’d heard the same prognosis word for word eight years before. If I didn’t have the PRP laser surgery ":you will be blind in six months."
Actually, I lied. It wasn’t quite word for word. When I heard it from the quack at Vision World in 1990, he had said "If you don’t have that surgery, you will be blind in six months.
Geltzer’s warning was an imperative laced with God Complex. "If I don’t do this surgery, you will be blind in six months."
I suppose I should have dropped to my knees and prayed to the exalted doctor Geltzer. He would strike with his holy lightning as red lasers burning into the back of my eyes and he would cure me.
His God Complex was so bad, that he extended his plan for living in his Godly image. "You need to quit your job and get one with health insurance or you need to save your money so I can do this surgery."
He did not mention that preexisting clauses in health plans would have disallowed his laser surgery at a new job for 6 to 18 months after the deadline had faded to black.
He did not mention that clinics at some of the hospitals would do the same procedure at a fraction of the cost.
He did not refer me to any social service program.
He had simply commanded me to marshal whatever forces I had to so he could do the PRP treatment.
That’s what I remember.
The letter I found puts things differently. It states that he found no rubeosis (the growth of abnormal blood vessels on the iris.)
It was Geltzer’s "impression" that I had "neovascular diabetic retinapathy from longstanding diabetes mellitus."
Maybe I’m too jaded, but his having "the impression" doesn’t quite sound the same as a conclusion based on careful examination.
In this letter, Geltzer "also suggested that he, in all likelihood, will need laser in the not-too-distant future."
Maybe I am too jaded. These experiences helped make me that way.
I did hear that "blind in six months" threat once after this. By that third time, it didn’t produce angst. My reaction: "oh, this again."
Small vitreous hemorrhages do occur in the natural course of diabetic retinapathy. The sites I reviewed describe them similarly.
The hemorrhage comes from newer or weaker abnormal vessels. Those vessels bleed a little and the discharges enters the vitreous gel that fills the center cavity of the eye.
Because the vitreous gel has no nerve cells, it feels no pain or pressure. The sufferer of hemorrhages related to diabetic retinapathy alone see dark matter, sometimes tinged red, but usually black or grey. The floaters appear as tiny spots, or flecks of stuff, or in small masses of stringy cloud such as spider webs, the type found in corners, not the ornate stretching ones.
None of the sites I reviewed again in researching this blog describe a vitreous hemorrhage caused by diabetic retinapathy as a massive outlet of enough blood to fill both the venter of the eye and a cataract. All describe diabetic retinapathy caused hemorrhages as minor, even if the patients suffers recurring hemorrhages. None that I encountered describe a diabetic retinapathy hemorrhage as making the patient see bright crimson.
The massive blood letting I watched in my eye was a flow. I saw it start as I woke and I watched it spread throughout the eye in a matter of seconds, like the effects in cheesy horror movies when they end the opening credits with a falling wave of dripping blood.
I bring this up after some conversations about the blog and reviewing medical records from 1998. Dr. Kroschell did not think the isolated 1998 floater was necessarily related to retinapathy.
The doctor he referred me to listed the floater as a vitreous hemorrhage. In his examination, Dr. Arthur Geltzer used a specific phrase that I had heard before....
There’s an old saying that a good excuse is one you can use over and over. That might be true, but not every excuse used over and over is a good one. The diabetes is in the second category.
Today I went to an urgent care center about a foot and ankle that has been sore and swollen for about a month. Nothing’s broken, so it amounts to staying off of it more than I have been. I didn’t think anything was broken by range of movement and other quirks, but it’s good to know for sure. Part of the ongoing concern that sent me to the E was that the prolonged swelling could be symptom of or cause circulation problems in my diabetic foot.
I asked the attending doctor about a cortisone shot. She said they didn’t like giving shots to diabetics because of the increased risk of infection.
Yes. I heard that right and you read it right.
They don’t like giving SHOTS to DIABETICS because of the increased risk of infection.
This does not decrease my cynicism of modern American medicine.
Don’t get me started on the profiteering of unnecessary finger poking for blood sugar testing, up to and including television commercials that show lazy women too self sacrificing to disturb her husband and kids by not getting up off the couch to wash her hands before jabbing her finger. I’m sure that it was simply oversight that the commercial did not show the woman two weeks later having her grossly infected finger amputated. That whole subject will wait for future posts.
With the way blogs sort by month and the way I’m rambling in the narrative, seems like a recap is in order
This blog documents one guy’s slow and ongoing descent into blindness. Being diabetic is an underlying factor but not the direct cause.
I have been blind in one eye since 2003 due to diabetic retinapathy being opportunistic of a striation injury to the right eye. Since then, I lived with pretty much full function despite this handicap and meticulously saw retina specialists to chart any potential changes in the good eye. The doctors found no changes in comparative exams.
I went through a couple doctors. Some tried scaring me into immediate PRP laser surgery even though the left eye showed bleeding or signs of active or ongoing retina damage. (Yes, there was old damage as all diabetics will develop just by nature of the disease’s side effects.) Other doctors failed to report factors or conditions that should have wider documentation, or they demonstrated clear unwillingness to communicate with their patients. While I acknowledge that I may get disillusioned by doctors or other "authority figures" if they do not live up to the responsibilities that come with their "power," O see no reason to tolerate bad service or willful failure to communicate (or outright lies, even if "only" by omission) from doctors. This is especially true as I am a self pay patient.
For the first time in my life I saw with rose colored lenses and that was just a vitreous hemorrhage suffered in October 2009. This filled the cataract-debilitated eye with blood. The hemorrhage happened less than 24 hours after I took a Cialis (a Viagra or Levitra type boner pill drug) but did not "take advantage" of the drug’s purpose.
I am not blogging for any call for sympathy. I am making the complicated situation available to those who are usually too polite to ask in person (who’da thunk I even knew people like that.) The blog writing is a step I need to take in the course of accepting that this is my new permanent status quo, until it gets even worse. I have been told by "some" people that I have been an incredibly stubborn ass in the acceptance part. Just because I can do things like drive to the supermarket or use power tools such as chain saws does not mean that I should. Some people yell or lecture when I’m going to do things like that. Other people want to watch.
Yet the most important purpose of this blog is to get information publicly available. This information will include things from my experience that other people, especially diabetics and boner pill users, should know. Things their doctors won’t tell them.
If masturbation can make you go blind, those boner pills can get you there a helluva lot faster.
