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Edited on Sun Jun-20-10 08:23 PM by iverglas
And: if you have cataract surgery, be aware of possible complications.
Both my co-vivant and I developed cataracts before the age of 55, statistically young. He's diabetic and a heavy smoker; I'm female, brown-eyed and a heavy smoker: statistically higher chances.
My surgeries were disasters. First, my PTSD makes sedation ineffective. After the first eye was done, I had a reaction to the local anaesthetic and my iris went into spasm and I was in agony for a couple of hours. For the second, extra sedative and no local anaesthetic, and I was in distress and pain for the whole thing. The pressure in my eye went sky high post-op from the steroids, the drug to bring it down sharply made my hands go numb, I was left with a stew of floaters in my eye and pseudophakic cystoid macular edema - a swelling on the back of my eye - and the ophthalmologist kept telling me everything was progressing fine. I had lost confidence in him and the $50 cabfares to his office were killing me, so I stopped going, and the swelling finally disappeared (the spot in my vision disappeared) after about 9 months.
A year later, an optometrist did the quick glaucoma test, picked herself up off the floor and sent me to a new ophthalmologist. I have glaucoma, from the post-op steroids. He referred me to a retinal surgeon for my other complaints; he operated last September, redoing the lens implant, removing scar tissue from my retina and doing a vitrectomy to clear all the crud out of my eye. And finally, a few weeks ago, the new opthalmologist, in response to my demand that he tell me what he'd been showing the med student, explained that I was missing the "spokes" that connect the lens capsule to the "coloured part of the eye". Yes, duh, the iris and (I now know) the zonules that hold the lens capsule in place. The ophthalmologist who did the original cataract surgery should have called in a surgeon right away, I have since read, when my absence of zonules became apparent (although maybe it didn't). I'm a rare bird.
Anyhow. The co-vivant's cataract surgeries (done by the top ophthalmologist he sees regularly because of his diabetes) were the walk in the park they are supposed to be. And he isn't as concerned about knowing everything that's going on, so he was happy.
Last night, I got home latish and proceeded to start making mushroom spinach quiche. He wandered into the kitchen complaining about not being able to see the computer monitor. I queried his symptoms. I said it sounded like a detached retina. What does that mean? he said. It means we go to the hospital right now, I said. He insisted on eating first, and I told him to go google in the meantime, and he decided that was what he had.
So. We arrived at the ER at the local hospital campus just before midnight. He was seen by a doctor within a few minutes. The doctor paged the ophthalmologist/retinal surgeon (not sure) on call and waited for a reply, as to whether we should go to the eye care clinic then or next morning. When no call back came in half an hour, the co-vivant lost patience and we left, at 1:00 a.m.
Next morning, 10 a.m. was just too early for him, so the eye care clinic said to come in by 11. It's in a fabulously beautiful hospital built a few years ago. He was seen immediately by an opthalmologist who examined every aspect of his eye and vision. (Then I horned in and got him to check my eye pressure while we were there, and I was right, I need to see my ophthalmologist sooner than scheduled, and he was quite insistent about that.) He told us to take a walk and come back in a little under an hour to see the surgeon, before 1:00.
The surgeon repeated some of the exams and explained to us at length what had happened and what had to be done: he confirmed my diagnosis of retinal detachment, which calls for a scleral buckle, sealing of the tear, a vitrectomy and replacement of the vitreous fluid with a gas bubble (mine was saline) to hold the seal in place. Odds of success are 9 in 10, with the 1 in 10 needing surgery again. He's done 9 in the last three weeks ... One of his patients, who had had the surgery two days before, was in the waiting room, and he asked him (out of our hearing) to come in and let us see how he looked and tell us how he felt, and we chatted with that couple afterward in the waiting room.
The co-vivant is a "young man", as the surgeon put it, for the purposes of retinal detachment, so his retinal tear is associated with the cataract surgery and the floaters in his eye after that surgery, which ordinarily develop naturally in old age, in everyone.
The young doctor took us down to Admitting, where the co-vivant presented his Ontario health plan card and his hospital ID card (from when he was admitted twice a year ago in diabetic ketoacidosis ... and nearly died). Admitting directed us up to the ward, where the co-vivant was to have a semi-private room (two beds instead of three) since that was all that was available, although we don't have the supplemental insurance to pay for it and weren't paying extra out of pocket (as I did once to get a private room when I was in for three days for a biopsy). We presented ourselves at the nursing station, where they didn't know quite what to do with us, since they weren't used to people walking up and checking themselves in, but then they figured out who he was and they were expecting him. He reclined on his window-side bed, and they called the pharmacy for his insulin. His nurse then took blood and made five tries to get his IV thing in place, but his delicate little veins blew each time; I believed her that she really was the best one on the floor at doing it, though. Another nurse came in and he got it in one.
We waited, and occasionally wandered outside for a smoke. (They'll give him a patch when he gets out of surgery.) At 1:30 there had been two people ahead of him for the one OR open on Sunday -- he's an emergency, but every other emergency in the world, usually Caesarian sections and car crashes, bump him. So at 5 when I left, he was still waiting. I called at 7:30 and the nursing station said he was on his way for it right then. So at about 9:00 now, he may be finished!
He'll almost certainly be discharged tomorrow, and then will see the surgeon the next day, and a couple of days later. If he's like I was, he'll see the surgeon once or twice more before follow-up is turned over to his own ophthalmologist. He'll be out of commission -- in his case, because of the location of the tear, he'll be lying around and sleeping semi-upright (some have to sleep on their side, etc.) -- and no lifting and all that jazz for weeks.
And my point, which of course I do have. ;)
This is yet another tale of the complete care provided by our provincial health plan at zero cost.
Not quite zero -- since we don't have supplemental insurance (usually employer based and cost-shared, covering drugs, dental and eye exams and glasses), we'll pay for the post-op drugs, probably three (an antibiotic and two anti-inflammatories), which I recall being about $50.
I had a crap experience, possibly because of poor care by the opthalmologist who did my cataract surgery, but I'm coming to the conclusion I'm just a case of if it can go wrong, it will. My dental experiences are the same ... nobody else goes from a toothache to root canal to two broken teeth to an interminable infection from the crown on one tooth to having the bridge to replace the other tooth fall out ...
But that makes 6 eye surgeries in our household in less than 4 years, plus two hospitalizations for near-death diabetic complications last year, plus of course regular attention for our various conditions (hypertension me, diabetes him) at our chosen community clinic. Promptly (my first cataract was, of course, a bizarre one that went from zero to virtually blind in 6 weeks, and I had surgery scheduled within a month, delayed slightly because it was Christmas) and at no direct cost: no insurance premiums, no deductibles and no co-pays, and no extras while in hospital.
I say none of this to garner sympathy -- or to excite jealousy. Just more tales from the front, in the Canadian health care system so much ill is spoken of south of the border. ;)
And just a heads up for anyone having cataract surgery -- be mindful of the possible later complications. Symptoms of retinal detachment, in particular, call for immediate attention.
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