Medical Forum / Diseases and Disorders / Diabetes / March 2006
Laser surgery for macular edema, a few hours ago.
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Chris J. - 15 Mar 2006 00:10 GMT Well, just got back from the laser. It was not a bad experience at all. Actually, far less unpleasant than the flourecine angiogram.
I managed to get out of here (I was snowed in) early this morning. I left my 4X4 at my mother's house and took a taxi to the doc's office in a nearby town.(my Mother is out of town)
I asked about interocular steroid injections, but was told that those are more of a first line treatment when the edemas are in or near the focal center. So, I went ahead with the laser.
I had a total of nine (if I counted right) zaps, and the retinal specialist just had me look straight ahead. No device was actually placed in my eye, at all. Just dialating and numbing drops.
It was over in about two minutes.
I did ask about lowering Bg levels, and the retinal specialist's opinion runs contrary to my ophthalmologist's: he said that lower is better, and lowering my BG's won't hurt me at this point. He did however qualify his remarks with the comment that "you are, however, weird for a diabetic" Yes, he said weird, and I figured you would all get a chuckle out of that. :-)
What he was talking about was that my BG's are out of the normal profile, so I'm in an area not covered by studies of any kind. Therefor, it's extrapolation on his part (his words) that lowering my Bg's any further would do no harm.
At this point, given the conflicting advice, coupled with the opinion that I was already low enough for maximum benefit, I think I'm going to stay where I'm at.
He said my prognosis is good, as the inflammation is receding. He expects no visual loss. He did ask me to report any changes, but said I should be fine, and my next appointment with him is in June!!
I was told it wasn't needed, but I went ahead and scheduled a full dilation exam with my ophthalmologist in a month. It can't hurt, so I could see no reason not to.
The Doctor told me that I don't need to worry about exercise or lifting restrictions, even today. The nurse, however, told me to avoid heavy lifting or heavy exertions for two days. I'm betting the Doc is more likely to be right and the Nurse was just giving standard advice, but, to be safe, I'm avoiding everything but walking for the next two days.
My left eye was entirely unaffected today, as it wasn't dilated (only my right eye was treated). So, once I'd returned to my Mother's house, I hung around a few hours, and the dilation began to wear off, and I felt like heading home. After a few hundred yards, it's a dirt road from there to here, so no big deal. The only effects I had then (or now) is a bit of blurry vision in my right eye, just slightly out of focus, mainly for close vision, and distance vision seems fine.
So, all in all, I'm very happy.
What I am not happy about is that I've received, from two eye specialists, contradictory opinions on both causation, and recommendations for newly Dx'd. One says slower would be better, the other says faster is better. Ugh.
BTW, I'll have more time to ask questions at my next visit (I was a bit pre-occupied with my own case on this one).
Ozgirl - 15 Mar 2006 00:47 GMT > however qualify his remarks with the comment that "you are, however, > weird for a diabetic" Yes, he said weird, and I figured you would all > get a chuckle out of that. :-) You told him about the tofu then?
> He said my prognosis is good, as the inflammation is receding. He > expects no visual loss. He did ask me to report any changes, but said > I should be fine, and my next appointment with him is in June!! Good news it seems :)
Chris J. - 15 Mar 2006 09:31 GMT >> however qualify his remarks with the comment that "you >are, however, [quoted text clipped - 3 lines] > >You told him about the tofu then? Damn, Jan... Seeing this shook me up! You must be psychic! Seriously!!! A few minutes previously he'd asked me what I ate for breakfast, and he tried but failed to keep a straight face when I got to the tofu.... Or maybe it was the mustard and flax that caused him to crack up. And yes, he was grinning when he said "weird", and I think he was thinking of the breakfast as well as my Bg profile.
wmmckee@cox.net - 15 Mar 2006 00:57 GMT > He said my prognosis is good, as the inflammation is receding. He > expects no visual loss. He did ask me to report any changes, but said > I should be fine, and my next appointment with him is in June!! Sounds like a very good outcome, Chris. Congratulations! Prospectively, I hope all goes very well, and you have only good results to report from here on out.
Will, T2
Chris J. - 15 Mar 2006 09:31 GMT >> He said my prognosis is good, as the inflammation is receding. He >> expects no visual loss. He did ask me to report any changes, but said [quoted text clipped - 3 lines] >Prospectively, I hope all goes very well, and you have only good results to >report from here on out. Thanks! So far so good!
Uncle Enrico - 16 Mar 2006 23:03 GMT Chief - 15 Mar 2006 01:13 GMT > Well, just got back from the laser. It was not a bad experience at > all. Actually, far less unpleasant than the flourecine angiogram. [quoted text clipped - 62 lines] > bit pre-occupied with my own case on this one). > Sounds good Chris. Now for a quick check.
How many fingers are I holding up?
Quentin Grady - 15 Mar 2006 04:03 GMT This post not CC'd by email
>Sounds good Chris. Now for a quick check. > >How many fingers are I holding up? G'day G'day Chef,
Less than six if you kept on typing. <grin>
Best wishes,
 Signature Quentin Grady ^ ^ / New Zealand, >#,#< [ / \ /\ "... and the blind dog was leading."
http://homepages.paradise.net.nz/quentin
Chief - 15 Mar 2006 05:14 GMT > This post not CC'd by email > [quoted text clipped - 7 lines] > > Best wishes, You were peeking - again.
Chris J. - 15 Mar 2006 09:33 GMT >> What I am not happy about is that I've received, from two eye >> specialists, contradictory opinions on both causation, and [quoted text clipped - 7 lines] > >How many fingers are I holding up? ACK! I can't see!!!!!!!!!!!!!!!!!!
:-) BessieBee - 15 Mar 2006 01:56 GMT >I had a total of nine (if I counted right) zaps, and the retinal >specialist just had me look straight ahead. No device was actually >placed in my eye, at all. Just dialating and numbing drops. > >It was over in about two minutes. Glad to hear things went so well for you, Chris! Like in so many other things the reality is nowhere near as bad as the anticipation.
Are you absolutely positive nothing was placed in your eye? Sure? I also had the dilating drop and numbing drops. I've the procedure done on both eyes. For the first one I had no clue the doctor had slipped a little doohickey in to hold my eye open. The doctor's movements were swift and gentle, almost like magic.
I bet if you ask your doctor you'll find that you did have a doohickey placed on your numb eye, you just didn't feel it.
Anyway, glad to hear things went well!
BessieBee
Chris J. - 15 Mar 2006 09:38 GMT >>I had a total of nine (if I counted right) zaps, and the retinal >>specialist just had me look straight ahead. No device was actually [quoted text clipped - 4 lines] >Glad to hear things went so well for you, Chris! Like in so many >other things the reality is nowhere near as bad as the anticipation. Very true...
>Are you absolutely positive nothing was placed in your eye? Sure? I >also had the dilating drop and numbing drops. I've the procedure done [quoted text clipped - 6 lines] > >Anyway, glad to hear things went well! Hmmmm... You might be right, I'm not sure. The nurse did put out a thing that looked like a contact lens on one side and a pipe fitting on the other, but he didn't use it. He excused himself to get a "different lens" from another room. I never actually saw the new lens.
He was holding something up against my eye with his left hand. I assumed it was a half inch or so from it, as I thought I could still blink. I could certainly move my eye freely. I might be wrong about the unobstructed blinking, as my eye was numbed, but I can't be sure. I did blink right after each zap, and thought I was unobstructed. I'll ask next time I see him, as I'm very curious now.
BessieBee - 15 Mar 2006 17:58 GMT <snip>
>He was holding something up against my eye with his left hand. I >assumed it was a half inch or so from it, as I thought I could still >blink. I could certainly move my eye freely. I might be wrong about >the unobstructed blinking, as my eye was numbed, but I can't be sure. >I did blink right after each zap, and thought I was unobstructed. I'll >ask next time I see him, as I'm very curious now. Please let us know what you find out. I find it fascinating that the doctor could place a doohickey (maybe it was a thingamabob) in my eye and I never felt it. I hadn't even realized it's put it in. When I had the other done, a week later, I was more aware of what was going on and was aware he'd put the doohickey in. Still didn't feel it, though. That time I new the procedure was over when he removed it.
Are you having the other eye done?
BessieBee
W. Baker - 15 Mar 2006 20:49 GMT : <snip>
: >He was holding something up against my eye with his left hand. I : >assumed it was a half inch or so from it, as I thought I could still : >blink. I could certainly move my eye freely. I might be wrong about : >the unobstructed blinking, as my eye was numbed, but I can't be sure. : >I did blink right after each zap, and thought I was unobstructed. I'll : >ask next time I see him, as I'm very curious now.
: Please let us know what you find out. I find it fascinating that the : doctor could place a doohickey (maybe it was a thingamabob) in my eye : and I never felt it. I hadn't even realized it's put it in. When I : had the other done, a week later, I was more aware of what was going : on and was aware he'd put the doohickey in. Still didn't feel it, : though. That time I new the procedure was over when he removed it.
: Are you having the other eye done?
: BessieBee Whn you are all numbed up and all those bright lights are beign shimed into your eye adn the MD is apparantly, holding something up to your eye it may well be actually beign held by the eyelid, but you don' feel it. It is a different doohicky, to sontinue with this tech-term concept, than is used when they ar egiving you an intraocular injection. Then they eus something like a cross sction between a giant grasshoper and a paper clip (as it loks to my very blurred adn confused eyes) is used to , I guess, widen the amount of eye that is exposed, by pushing back the lids , which you can't feel. I can never see well enough when I am getting the treatment to actually check out what they are using. When I had the PDT, using a low level laser, they had one of those lens with a crew pipe tings that i do think ws ficed between the lids, leavign the MD 2 hands to work with.
This is my bes anaysis of someth8ng that is really hard to see.
Chris, I am glad it went wel and that you got an answer about the steriod vs laser. Given my past history, I think I woudl have gone with a steroid shot, what with having only one focusing eye left and being fractically fearful of burning lasers.
Wendy
Chris J. - 16 Mar 2006 04:04 GMT >Chris, I am glad it went wel and that you got an answer about the steriod >vs laser. Given my past history, I think I woudl have gone with a steroid >shot, what with having only one focusing eye left and being fractically >fearful of burning lasers. I can certainly see why you would!
I'd have gone with steroids, too, had they been wanting to laser anywhere near my focal center.
Chris J. - 16 Mar 2006 04:07 GMT ><snip> > [quoted text clipped - 11 lines] >on and was aware he'd put the doohickey in. Still didn't feel it, >though. That time I new the procedure was over when he removed it. I'll definitely check. I think I would have noticed, but I can't say for sure.
>Are you having the other eye done? No, as it looks like that one is ok so far.
Kurt - 15 Mar 2006 02:32 GMT > Well, just got back from the laser. It was not a bad experience at > all. Actually, far less unpleasant than the flourecine angiogram. [quoted text clipped - 61 lines] > BTW, I'll have more time to ask questions at my next visit (I was a > bit pre-occupied with my own case on this one). Glad to hear it went well, Chris, and that you are on top of things. Your diligence should pay off big time down the road.
Best, Kurt
Chris J. - 15 Mar 2006 09:40 GMT >Glad to hear it went well, Chris, and that you are on top of things. >Your diligence should pay off big time down the road. I hope so, and things seem to be looking up now. Thanks!
bantista - 15 Mar 2006 05:24 GMT > Well, just got back from the laser. It was not a bad experience at > all. Actually, far less unpleasant than the flourecine angiogram. [quoted text clipped - 61 lines] > BTW, I'll have more time to ask questions at my next visit (I was a > bit pre-occupied with my own case on this one). Hello, Chris J
You're happy; I'm happy. Everything sounds good. I don't know that its needed either, but if it was me, I'd feel much better with another eye exam as well.
By the way, we did get some snow the other day, and it was all gone by noon which didn't help much. Good that you still have some hanging around.
Best wishes to you, buddy.
rudy bantista@thuntek.net T2, last A1c 5.9, current bg 119
Chris J. - 15 Mar 2006 09:43 GMT >You're happy; I'm happy. Everything sounds good. I don't know that its >needed either, but if it was me, I'd feel much better with another eye exam >as well. The money for the extra exam is worth it to me just for the piece of mind, if nothing else. :-)
>By the way, we did get some snow the other day, and it was all gone by noon >which didn't help much. Good that you still have some hanging around. Sorry you didn't get more. I've heard about the fires in other areas of NM, and know you need more precip.
I'm expecting more this weekend, but this time, if I get snowed in, I can stay put and not worry about it. :-)
Alan S - 15 Mar 2006 06:47 GMT >Well, just got back from the laser. It was not a bad experience at >all. Actually, far less unpleasant than the flourecine angiogram. [quoted text clipped - 61 lines] >BTW, I'll have more time to ask questions at my next visit (I was a >bit pre-occupied with my own case on this one). Glad it went well. Keep us informed as things improve.
Cheers, Alan, T2, Australia. d&e, metformin 2x500mg
 Signature Everything in Moderation - Except Laughter.
Chris J. - 15 Mar 2006 09:44 GMT >Glad it went well. Keep us informed as things improve. Thanks, will do, and you too on the scan report!
Chris Malcolm - 15 Mar 2006 12:28 GMT > So, all in all, I'm very happy. Pleased to hear it.
> What I am not happy about is that I've received, from two eye > specialists, contradictory opinions on both causation, and > recommendations for newly Dx'd. One says slower would be better, the > other says faster is better. Ugh. I had a similar experience when my toilet kept clogging up. One plumber told me the problem was that the waste pipe under the floor was too shallow in slope, so the water was moving along it too slowly, and "stuff" was settling down and damming the pipe instead of being washed away in a faster flow. He was quite adamant that this was the problem. The reason it hadn't happened before was simply that I had been very lucky. The cost of rerouting the pipe was horrendous so I simply let him clear the pipe amd took my chances.
The next time a different plumber arrived who told me that the problem was that the pipe was too steep and the water was running away too fast, leaving the "stuff" stranded to dry out and build up clog the pipe. He was quite adamant that this was the problem. The reason it hadn't happened before was simply that I had been very lucky. Unfortunately the cost of making the pipe shallower was the same as the cost of making it steeper.
With this firm evidence that they were clueless, I investigated the problem myself. It took me five minutes to discover that the flush was broken, and only sending half the proper amount of water down. Replacing the nut which had become unscrewed and fallen to the bottom of the cistern was all that was needed, which took another five minutes.
That's why it's so useful to get two opinions from these tradesmen. Helps you to discover if they know what they're talking about.
 Signature Chris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/]
Anil - 15 Mar 2006 13:28 GMT Boy you are on the roll here today Chris. The moral of the story: Take more than one opinion of the experts to confirm that they are clueless many times! So you need to fix your toilet you need to get down and dirty! And most of the time the solution is simple.
I work with software. Designing solutions to complex problems is hard work. But most of the time after enough struggle you uncover a simple solution. Then you wonder how the obvious did not bubble up right away?
Well it does not. Part of the intelligent Design? :-).
Anil
Chris J. - 16 Mar 2006 04:13 GMT >> So, all in all, I'm very happy. > [quoted text clipped - 21 lines] >Unfortunately the cost of making the pipe shallower was the same as >the cost of making it steeper. ARGH! Well, the answer is simple: make the pipe both shallower and steeper. :-)
I've done a fair amount of plumbing, and I've never run into trouble from too steep a slope. Too shallow, on the other hand, definitely can cause trouble.
I once had a house that had a kitchen sink that kept stopping up. I found that they had cleverly run the drain pipe with a slight slope in the wrong direction.
>With this firm evidence that they were clueless, I investigated the >problem myself. It took me five minutes to discover that the flush was >broken, and only sending half the proper amount of water down. >Replacing the nut which had become unscrewed and fallen to the bottom >of the cistern was all that was needed, which took another five >minutes. I'd be willing to bet at least one of them knew that, and the re-piping was a "make work" project for them.
>That's why it's so useful to get two opinions from these tradesmen. >Helps you to discover if they know what they're talking about. Very true. I am what you would call an Estate Agent, so i deal with them very often. I do a lot of my own construction (everything from plumbing to electrical) so in most cases I know what to expect, but I've found it useful to pretend that I don't. I've had great fun yanking the rug out from under more than a few dishonest contractors that way. :-)
Alexander Arnakis - 16 Mar 2006 02:55 GMT >I had a total of nine (if I counted right) zaps, and the retinal >specialist just had me look straight ahead. No device was actually >placed in my eye, at all. Just dialating and numbing drops. > >It was over in about two minutes. Contrast this with the treatment for retinopathy: I had a total of about 2,000 burns in each eye, divided into sessions of 600-700 burns each. The first couple of times, I decided to tough it out without anesthesia, but I about reached my pain threshold. Afterwards, the doctor gave me a local anesthetic shot that deadened the optic nerve. I'll tell you, that was an amazing psychedelic display when that anesthetic wore off!
That was 20 years ago, and the retinopathy has been in check ever since, with no need for further treatments. (I'm expecting to have to have cataract surgery down the road, but that's another story.)
Chris J. - 17 Mar 2006 05:47 GMT >>I had a total of nine (if I counted right) zaps, and the retinal >>specialist just had me look straight ahead. No device was actually [quoted text clipped - 13 lines] >since, with no need for further treatments. (I'm expecting to have to >have cataract surgery down the road, but that's another story.) Ouch! That sounds like it would have to be Grid laser? I've heard that can damage vision. Is yours ok? Glad it's been stable for so long, though!
The burns I had were barely noticeable, but did seem cumulative, sensation wise, when in close proximity. Hundreds of them would sure be horrendous!
Alexander Arnakis - 20 Mar 2006 00:40 GMT >Ouch! That sounds like it would have to be Grid laser? I've heard that >can damage vision. Is yours ok? Glad it's been stable for so long, >though! The treatment that I had is called "panretinal photocoagulation." My usable vision is OK, but there are tradeoffs. The burns were all over the retina *except* for the central macular area. This stopped the retinopathy and saved my central vision, but at the cost of pretty much ruining my peripheral vision. It's a tradeoff. If I ever get macular degeneration (which my mother has), I won't be able to fall back on peripheral vision, and it might be seeing-eye dog time!
A side effect of the panretinal laser treatment seems to be a hastening of the cataract process. I'm developing cataracts at a younger age than is usually the case. The bright side is that cataract surgery has become almost routine, and has a high success rate.
>The burns I had were barely noticeable, but did seem cumulative, >sensation wise, when in close proximity. Hundreds of them would sure >be horrendous! That's why the doctor would stop after 600-700 burns in a sitting. The first few were like bright flashes of light, but after a while they really started to hurt. (This was during the times when I had it done without the anesthesia.) Even with the anesthesia, there was pain when the anesthesia wore off.
W. Baker - 20 Mar 2006 04:11 GMT : The treatment that I had is called "panretinal photocoagulation." My : usable vision is OK, but there are tradeoffs. The burns were all over [quoted text clipped - 3 lines] : macular degeneration (which my mother has), I won't be able to fall : back on peripheral vision, and it might be seeing-eye dog time! Don't feel tht way. There are now several treatments for macular deganeratin(wet), and more are soming ot every day. That is what I am fighting with currently and I, certainly, am readign beter than I was last May when I could not see te newsprint. You just have to know where to go.
Wendy
Chris J. - 20 Mar 2006 07:44 GMT >>Ouch! That sounds like it would have to be Grid laser? I've heard that >>can damage vision. Is yours ok? Glad it's been stable for so long, [quoted text clipped - 8 lines] >macular degeneration (which my mother has), I won't be able to fall >back on peripheral vision, and it might be seeing-eye dog time! Yipes... But, I know I'd certainly rather lose my peripheral than my central vision!
>A side effect of the panretinal laser treatment seems to be a >hastening of the cataract process. I'm developing cataracts at a >younger age than is usually the case. The bright side is that cataract >surgery has become almost routine, and has a high success rate. My Mother had that, and it was quick, easy, and very effective.
>>The burns I had were barely noticeable, but did seem cumulative, >>sensation wise, when in close proximity. Hundreds of them would sure [quoted text clipped - 5 lines] >without the anesthesia.) Even with the anesthesia, there was pain when >the anesthesia wore off. I did notice a very slight sensation of a dull ache behind my eye, later that day. It was slight enough that I wouldn't normally notice it, but I can just imagine what you must have endured. UGh. Sorry you had to go through that.
Alexander Arnakis - 21 Mar 2006 01:35 GMT >I did notice a very slight sensation of a dull ache behind my eye, >later that day. It was slight enough that I wouldn't normally notice >it, but I can just imagine what you must have endured. UGh. Sorry you >had to go through that. Better than the alternative. My retinopathy was caught at an early stage, before the growth of abnormal new blood vessels in the retina resulted in uncontrolled bleeding. When that happens, the eyeball fills with blood and the retina is in danger of detachment. At that stage, they have to do a vitrectomy, which involves the insertion of tubes into the eyeball, the pumping out of the vitreous, and its replacement with saline solution. Now *that* would be an ordeal. At least laser treatment is non-invasive.
BessieBee - 17 Mar 2006 18:54 GMT >Afterwards, the >doctor gave me a local anesthetic shot that deadened the optic nerve. >I'll tell you, that was an amazing psychedelic display when that >anesthetic wore off! Where did you receive the shot that deadened the optic nerve?
BessieBee
Ma¢k - 17 Mar 2006 19:46 GMT >>Afterwards, the >>doctor gave me a local anesthetic shot that deadened the optic nerve. [quoted text clipped - 4 lines] > >BessieBee Under the eyeball. You open your eye and look up and away from the doc and he takes this really long needle and inserts in through your lower eye lid or pulls your lower lid out of the way and inserts the needle under the eye in the eye socket and injects the med into the rear of the socket. I never felt a thing on the several occasions I had this done.
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Mary - 18 Mar 2006 04:34 GMT Yup, you're right, Mack. That's called a retrobulbar injection. Some docs use it when performing cataract surgery, although the latest thing is to only use topical anesthetic (such as the numbing drops used in the ophthalmologist's office) along with a bit of sedation. You described two different methods of giving the injection--either thru the lower eyelid, or pulling back the lower eyelid & upper eyelid and injecting in those two areas. All surgeons have their favorite method...
Many people describe the beautiful colors that they've seen during cataract surgery. Seems they're almost entertained by it...
Mary
>>>Afterwards, the >>>doctor gave me a local anesthetic shot that deadened the optic nerve. [quoted text clipped - 11 lines] > rear of the socket. I never felt a thing on the several occasions I > had this done. Alexander Arnakis - 20 Mar 2006 00:23 GMT On Fri, 17 Mar 2006 13:46:22 -0500, MaΆk <stopthespam@shootspammers.com> wrote:
>Under the eyeball. You open your eye and look up and away from the >doc and he takes this really long needle and inserts in through your >lower eye lid or pulls your lower lid out of the way and inserts the >needle under the eye in the eye socket and injects the med into the >rear of the socket. I never felt a thing on the several occasions I >had this done. That's exactly right. I would advise people not to look at the needle, because the idea of it is scarier than the actual shot. The effect is like a super version of a dentist's Novocaine. In a few minutes, your vision in that eye goes black and the entire eye is numbed. You get interesting visual effects as the anesthetic wears off and the optic nerve comes back on line.
bj - 20 Mar 2006 01:07 GMT > On Fri, 17 Mar 2006 13:46:22 -0500, Ma¶k > <stopthespam@shootspammers.com> wrote: [quoted text clipped - 8 lines] > That's exactly right. I would advise people not to look at the needle, > because the idea of it is scarier than the actual shot. At least I didn't have to be awake to watch when I had my throat slit (thyroid surgery) -- though some people do have it done with a local rather than general anesthetic. bj
Ricavito - 17 Mar 2006 04:57 GMT > Well, just got back from the laser. It was not a bad experience at > all. Actually, far less unpleasant than the flourecine angiogram. [quoted text clipped - 61 lines] > BTW, I'll have more time to ask questions at my next visit (I was a > bit pre-occupied with my own case on this one). Wow, that's great Chris. No visual loss!
Nicky - 17 Mar 2006 20:56 GMT > He said my prognosis is good, as the inflammation is receding. He > expects no visual loss. He did ask me to report any changes, but said > I should be fine, and my next appointment with him is in June!! I am so glad to hear that!
Nicky.
 Signature A1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg
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