St Croix River Road Ramblings

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Friday, November 11, 2016

I Can See Clearly Now, the Cataract has Gone

Cataract removal – left eye   Day 1  11/11/2016

At 7:15 am I checked into Mayo Clinic Gonda Desk 7 for my cataract surgery.  Some forms to fill out and then 15 minutes waiting.
  I visited with a woman, probably in her 40s who was having the first of two cataracts done.  “I can’t see well enough to drive now, and should have done this earlier, but was scared to do it.  However, Dad had his done recently, and he said it was wonderful, and pushed me into getting it done.”
Some of the pre-cataract surgery eye exam machines

Bed side monitoring machines

  A member of the surgery team then took be to the back to a small room—sort of a hospital bed room, but smaller.  I set in a chair that was both chair, hospital cart and hospital bed—my home for the next hour and a half.
After the id check (state your name and birth date) affixing a wrist band, connecting heart monitoring electrodes (the ones that stick over your chest hair and act as hair removers when they are detached), and an IV opening.  I had a few minutes alone, so got out of the chair and watched the heart monitor and blood pressure monitor.  Heart rate was 72, with an occasional skipped or abnormal beat (something I have had for 30 year and is considered normal), and blood pressure was 136 over 115.  The 115 is too high, and I can hear my family doctor rattling me about losing weight, exercising and taking some BP medicine when I see her in three weeks for my annual lecture on healthy living.  
Prepared for surgery with eye numbing gunk oozed into the eye and taped over to hold it there
The nurse who hooked up the IV tried the left hand for a vein, then the right hand, sticking me each time (these sticks are hardly noticeable as the needles are very small) and finally got one in the left arm.  Flabby veins or something like that was the comment.
The anesthesiologist came in, someone as old as I am, and got some more info and told me I was going to be given a local cream based numbing agent that would deaden the whole area around the eye, as well as a mellowing agent through the IV as I would be awake and somewhat alert during the procedure, but they didn’t want me too alert.
He said “I think I must have worked with you back in the 80s—at least Russ Hanson sounds familiar.”  I wasn’t quite in my best memory mode so couldn’t make the connection, but later realized that group I worked in at that time had one project to computerize the anesthesiology surgery record – and likely bumped into him then.  Still a little vague though.  I spent 25 years at Mayo and was in a lot of projects and am much more memorable to others than they are to me, as I was always involved in projects that brought change (computers) and folks were generally rather intimidated by changing to computers in those days. And things that happened 30 years ago are not quite as clear to me nowadays anyway.  
Dr. Kanna, my surgeon dropped in, now making about 5 folks in the small room and marked with a Sharpie pen a dot above the left eye to make sure the left eye was the right one to operate on.  Then he marked the orientation of the lens ---“have to get it in right as it has astigmatism correction—so there is a top, bottom, and angle to measure.”  More black marks around the eye  -- sort of like a bullseye with crosshairs (I actually couldn’t see them, but they may show up after I get the patch off).
The preliminaries all done, the chair was wheeled to the surgery area.  “How many cataracts in a day done here?” I asked. “About 24 today (three surgeons working today) and as high as 32 on busy days.”   I think they do two surgery days a week most of the time.    Scott, in the waiting room, said he watched a steady progression of folks going in with glasses and coming out with eye patches.
The Mayo building and the Gonda building are two buildings that appear as one inside.  Seventh floor on the Mayo side is the eye doctor side, and on the Gonda side is the surgery side.  Some of seventh is for urology, so I made sure the nurse pushing my chair aimed towards the eye surgery area.
The operating room was the size of a large living room, lots of instrumentation, and machines.  I was tilted flat, the chair becoming a bed, and the hovering folks began to hover.  One kept the IV (anesthesia) dripping and monitored my vital signs; a couple were the surgery assistants, and some others were there to save any removed parts in case of an autopsy. 
“If it is alright with you, I am going to video the procedure today.  Monday I am gving a talk to the folks in the eye area about cataract surgery and want to show them. Most of the staff never get back to the operating room,” said the surgeon. 
“Sure” I said, hoping I might get a copy of it for myself.  However that does not appear to be likely as I asked him about it after the surgery.  “Not even sure it recorded OK, and then we have to edit it before the talk.”  However, I will nudge him on this again in 3 weeks when I see him for the progress report.
My guess is he chose me for the model patient for the staff to see as my photogenicity is really quite high. 
As I had ask him to describe what he was doing during the surgery so I could understand it, and that fit with the video, I got the blow by blow details.  Although I was mildly sedated, I think I can remember the gist of it all.
I was in my street clothes, with only my glasses off and some blue paper shoe covers.  No removal of belts, shirts, or anything, but a hospital gown over my shirt. Then my head was completely covered with a blue tarp (not Menards), with a hole cut out so to the operating staff, I was an eye peering out of the sea of blue plastic.
The rest I am going to write as if the doctor said it, but as I was a little woozy and of course I can’t remember exactly, you have to accept there is likely some missing, added, and misstated parts.
“First we open a tiny hole in the edge of the eye to insert the ultrasonic probe into the lens.  Then, with my foot pedal (speed control?) I use the probe to make four pie slices of the round sort squashed spherical lens (think of a soft M&M candy).  Then I vibrate each slice into small fragments and use the vacuum part of the probe to suck out the fragments.  The lens is inside a lining so I carefully clean it out right up to the capsule that holds it and suck it all out.”
The ultrasound probe and vacuum made different musical tones based on speed or vacuum level (not sure which or maybe both).  “The sound helps me gauge the speed/vacuum levels so I can tell how the probe is working.”
I was able to ask questions and seemed like I was rational, and I asked “How do you get the big lens into the tiny opening, or do you have to make it bigger and swe it up?”  “The lens is sort of folded up and I can slide it into the empty capsule and unfolded it inside.  It is a flexible plastic, so it bends easily.  The opening is so small I don’t have to sew it up after I get the lens in.”
“Now I have the lens inside, and I have to get it oriented the correct way so your astigmatism axis is right.  There are several adjustments I do sliding it around until it is just where it is supposed to be.   After surgery it takes a while for it to get fixed into place and so you have to be gentle with your head movements and keep your fingers out of your eye so it remains lined up perfectly.”
“All done.  Everything went the way it is supposed to.   Looks good.  Now you can get unhooked and I’ll see you at 3:30 pm this afternoon.   Remember, it will look strange at first, and gradually get better and better over several months, although in a day or too should be usable.  See you this afternoon”  Don’t drive today, and let me know if anything seems abnormal.”   Abnormal was changes like flashes of light, worsening vision instead of improving, pain, etc. 
And I got unhooked, some more instructions on being gentle on the head and eye for a month or so, and walked out with Scott, my left eye patched with some gauze and a metal shield. 
Getting around with one eye, as I had already learned with Myasthenia Gravis in 2012 (I had to patch one eye for a few months to get rid of double vision), is sort of like dropping your vision level to 1/3 of what it was with two eyes.  Everything seems unreal and incompletely there.  And sitting in the passenger seat with Scott driving was clearly necessary as I didn’t think I would have felt safe to drive myself yet.
At home, I took off the shield to put in the two different kind of post surgery drops (5 minutes apart) and got really worried.  I could see through that eye, but everything was sort of like looking through a snowstorm and whatever came through the left eye was slanted about 30 degrees – like the TV screen was tilted that much—the whole world was.   Gee whiz, did the doctor get the lens put in rotated by 30 degrees?
Remembering the doctor and nurses said “your vision won’t be normal for a day or two, and then will keep improving for months” I refused to panic and turned to Dr. Google who assured me that as the numbing agent wears off, the slant should go away too.  At 1:45 pm, I tipped up the patch to look out and the world is level with both eyes, but the left eye sees a white fog over everything.  So I won’t panic yet, but keep waiting to see what happens.

Post surgery with temporary eye shield and still a little sleepy from the mellowing agents
Update:   4 pm day of surgery
The good news: went in for my post surgery checkup and took the eye patch off and I can see pretty good already with that eye. The doctor says it will take a few more days to get to normal, but everything looks pretty good. 

The bad news: My glasses are no longer any use for the left eye as it has been corrected. I can't really get new glasses until about 1 month when the vision is completely stable from the surgery. "All I have to do is remove the left lens from my old glasses and the distance vision will be good" I told the doctor.
"Don't you remember me telling you that doesn't work right with severe nearsightedness like yours?" he replied.
"Sort of, but remind me why again"
"Your right eye still has to use the glasses -- and for nearsightedness, the lens makes everything you see smaller. And your new left eye leaves them larger, like they should be. So you will see one big image on top of a small one. It will be enough difference it will confuse your brain"
"So can't I get glasses that will fix that?"
"No, you either have to shut one eye or patch one, or get your other eye done too. I knew you would need that, so if you want to go ahead, I scheduled it in 30 days on December 9th. That is as close to each other as we do the second eye."
So I am in that sort of between stage where my new eye sees much better, but won't work together with the old one. I already learned to read with one eye shut, and drive with one eye shut when I had myasthenia gravis double vision, so its back to that for a month.
The new eye lens gives me whiter whites, more colorful colors, but is still a little foggy -- sort of like a bar in the smoking days. That is supposed to clear away soon. Overall, I think it was quick, easy, painless, and likely to improve my life. However seeing folks more clearly may change some of my friendships.
In college, a girl friend always took off her glasses when I came to join her at the library or lunch table. "You are just vain and want to look better," I told her. "No I take them off so you will look better!"