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Medical Forum / General / Vision / November 2005Rough time with cataract
Hello to all. . .I had an atypically tough time with my cataract surgery. It has been 2 1/2 weeks and I still have only blurred vision in the eye that was operated on. I had the old-fashioned, non-laser surgery, with cutting and stitching, because I'm on the "poor people's health plan". I had general anesthesia because I'm very squeamish about my eyes. The reaction to the anesthetics was terrible - I vomited for a day and a half and couldn't even tolerate water. I had facial spasms and my eye watered non-stop for 24 hours afterward, but I was so busy throwing up that I hardly noticed.Many blood vessels in the eye ruptured and my opthalmologist had to give me a steroid shot in the corner of my eye to reduce the swelling. I am currently on three medicines: Tobradex, Voltaren and Alphagan. An exam today by a different opthalmologist revealed that the eye is still very swollen and the lens seems improperly positioned. She is not sure whether this will resolve after the swelling goes down. After hearing such benevolent reports about how easy a surgery it is, I was truly unprepared for the ordeal. I have had to miss an entire month of work because my eyesight as of today is no better than with the cataract. Opinions, prayers, thoughts. . .all are welcome. The waiting is the hardest part - waiting to see if the eye will heal or if I have to undergo the ordeal of another surgery. Best wishes, Melinda > I had general anesthesia because I'm very squeamish > about my eyes. The reaction to the anesthetics was terrible - I vomited > for a day and a half and couldn't even tolerate water. That's strange: TTBOMK with modern anesthetics you are on and off like a light with just a dulled sensorium for 24 hrs: my experience and the experience of everyone I have talked to. They didn't give you ether by chance? I would wager it is the cheapest anesthetic going. I had ether a few times as a child and vomiting for a day is about par. > Opinions ... welcome. Sure you wanted to say that? I would say the anesthetic is at the root of the whole wretched mess - is it that you are sensitive to modern anesthetics or that they gave you very bad anesthesia?  SignatureNicholas O. Lindan, Cleveland, Ohio Consulting Engineer: Electronics; Informatics; Photonics. To reply, remove spaces: n o lindan at ix . netcom . com Fstop timer - http://www.nolindan.com/da/fstop/index.htm On 11/18/05 5:31 PM, in article pfvff.1843$wf.1762@newsread3.news.atl.earthlink.net, "Nicholas O. Lindan" <see@sig.com> wrote: >> I had general anesthesia because I'm very squeamish >> about my eyes. The reaction to the anesthetics was terrible - I vomited [quoted text clipped - 13 lines] > you are sensitive to modern anesthetics or that they gave > you very bad anesthesia? No one uses ether anymore, as far as I know. It is highly flammable, and thus explosive and dangerous. > Hello to all. . .I had an atypically tough time with my cataract > surgery. I think the key word here is "atypical". I've had cataract surgery in both eyes, five years apart. The first one was a piece of cake. Unfortunately, the doctor retired and I got a new one. I was fine with her until the surgery. She didn't believe in tranquilizers. I missed three days work, versus the two days with the first one. I had some complications, perhaps because I was unable to stay still. She kept telling me to stay still, but I was literally shaking with fear and anxiety. This was three years ago. Fortunately, the outcome was excellent. I had eye surgery a few months back. It was much more major surgery (two hours working on the back of the eye). The anesthesia doctor assured me that they had lots of tranquilizers and would use them. It was another piece of cake. I was completely awake the whole time and happy as a clam (and about as lively). I was off two weeks, but felt pretty good. SignatureDan Abel dabel@sonic.net Petaluma, California, USA firstly, lasers are not used for cataract surgery for anyone. If you had a scleral tunnel, then your doctor came from the dark ages, no-one in backwards AUstralia uses scleral tunnels any more. Corneal incisions are faster, cheaper and faster to resolve. ANy blur you have is possibly related to sutures pulling your cornea out of shape. dr grant On 11/18/05 8:15 PM, in article 1132373704.483152.210850@z14g2000cwz.googlegroups.com, "CatmanX" <grantm@connexus.net.au> wrote: > firstly, lasers are not used for cataract surgery for anyone. If you > had a scleral tunnel, then your doctor came from the dark ages, no-one [quoted text clipped - 3 lines] > > dr grant There is still a role for scleral tunnels. If a rigid lens is required, rather than a foldable, a 6 mm optic requires such a large incision that clear-corneal really can't be used. Who needs a lens like this? Heparin-coated lens are used in uveitis patients occasionally. Bad diabetic may need a rigid lens. If a clear-corneal goes south, and an anterior chamber lens is needed, a scleral tunnel is a good, relatively astigmatically-neutral incision though which to place the lens. If you need to do an extracapsular cataract procedure due to a very hard cataract, for example, you can break the lens up into several pieces and get them out through a 6 mm scleral tunnel without making a traditional 9-10mm limbal incision, thereby closing up with 1 or no sutures. A limbal icision may requires up to 8-9 sutures. I use scleral tunnels about once a year. Thanks for thinking about this. But if the cornea is being pulled out of shape, can it be corrected without having to go under the knife again? Also, I notice my pupil is not contracting the way the other, healthy eye does. This makes it impossible to endure keeping the eye open for any length of time. Hope to hear from you again about this. Melinda > Hello to all. . .I had an atypically tough time with my cataract > surgery. It has been 2 1/2 weeks and I still have only blurred vision > in the eye that was operated on. I had the old-fashioned, non-laser > surgery, with cutting and stitching, because I'm on the "poor people's > health plan". Sorry to hear that. What health plan, where? Cutting is not old fashioned, as all cataract surgery requires it. Stitchless surgery (self sealing incisions) are the most modern, but sometimes even that type incision needs a stich or two. I had general anesthesia because I'm very squeamish > about my eyes. The reaction to the anesthetics was terrible - I vomited > for a day and a half and couldn't even tolerate water. I had facial > spasms and my eye watered non-stop for 24 hours afterward, but I was so > busy throwing up that I hardly noticed.Many blood vessels in the eye > ruptured and my opthalmologist had to give me a steroid shot in the > corner of my eye to reduce the swelling. Too bad you apparently were able to convince the surgeon to "put you completely out"! It certaintly isn't necessary in most cases. The versed they use during procedures these days is sufficient to keep you happy, even though not completely out... but it's past so I won't dwell on that. I am currently on three > medicines: Tobradex, Voltaren and Alphagan. That's pretty normal; I assume they are having a little concern about your eye pressure with the Alphagan. An exam today by a > different opthalmologist revealed that the eye is still very swollen > and the lens seems improperly positioned. She is not sure whether this [quoted text clipped - 5 lines] > hardest part - waiting to see if the eye will heal or if I have to > undergo the ordeal of another surgery. Best wishes, Melinda How is the other eye? What kinds of acuity do you have in each? w.stacy, o.d. (back from Cabo, sort of in recovery myself...) > I had general anesthesia because I'm very squeamish > about my eyes. > Too bad you apparently were able to convince the surgeon to "put you > completely out"! It certaintly isn't necessary in most cases. The > versed they use during procedures these days is sufficient to keep you > happy, even though not completely out... but it's past so I won't dwell > on that. I've posted this before, but the guy before me on my first surgery got a general. My doctor's exam room is right across from the waiting room. We're waiting there, and my doctor is just yelling his lungs out. I couldn't believe it, because he is very quiet and calm. So we're called in, and he apologizes. The previous patient was very deaf, and very stubborn. The doctor tried to talk to his wife, but she wouldn't even try to talk to her husband. The doctor wasn't willing to do the surgery with the patient awake since he had no clue what was going to happen, not to mention his being stubborn. While we were there, the doctor called and ordered a general for the guy. SignatureDan Abel dabel@sonic.net Petaluma, California, USA > I've posted this before, but the guy before me on my first surgery got a > general. My doctor's exam room is right across from the waiting room. [quoted text clipped - 6 lines] > not to mention his being stubborn. While we were there, the doctor > called and ordered a general for the guy. Sounds like taking the easy way out for the doc, at the expense of the patient's best interest. If he were that deaf, what's wrong with paper and felt tip marker? Hey, I just had my first colonoscopy and with the versed/fentanyl combo they put to me, I was out for the duration, but it's still not a general; I'd call it deep sedation with a little amnesiac thrown in. No trache tube, so little danger, and I walked out on my own 30 minutes later, no nausea, no nothing, clutching a color photo of the inside of my own, as it turns out, healthy gut. w.stacy, o.d. > > not to mention his being stubborn. While we were there, the doctor > > called and ordered a general for the guy. > > Sounds like taking the easy way out for the doc, at the expense of the > patient's best interest. I can't agree. I'm no doctor, and not even remotely connected to the profession, but they normally do cataract surgery with the patient awake for it. I've had a hernia repair, and a retinal detachment repair with vitrectomy, all wide awake (but heavily sedated). I was fine with that. This guy was just over the top. I could see him going ballistic during surgery. I can't blame the doctor, and I think that it was in the patient's best interest. SignatureDan Abel dabel@sonic.net Petaluma, California, USA >>>not to mention his being stubborn. While we were there, the doctor >>>called and ordered a general for the guy. [quoted text clipped - 5 lines] > profession, but they normally do cataract surgery with the patient awake > for it. No disagreement there. > I've had a hernia repair, and a retinal detachment repair with > vitrectomy, all wide awake (but heavily sedated). I was fine with that. [quoted text clipped - 3 lines] > I can't blame the doctor, and I think that it was in the patient's best > interest. OK I wasn't there, so maybe the guy was nuts, but maybe just deaf. I just can't imagine anyone going ballistic with enough valium and versed in them. I would not say that I was "wide awake" during cataract surgery, although I remember most of the details, including those little suggestions of "look over there" and "right there, good, hold steady", stuff like that, which if the patient couldn't hear might take away much of the advantage of local anesthesia in cataract surgery. BTW I also developed a peripheral flap tear of one retina and had it photocoagulated on the spot without any sedation at all. It hurt like hell and half way through I was offered a "block" and declined that, but I sure would have accepted a jolt of IV juice at that time. 15 minutes of sheer torture, but all is well now. w.stacy, o.d. > > This guy was just over the top. I could see him going ballistic during > > surgery. [quoted text clipped - 5 lines] > just can't imagine anyone going ballistic with enough valium and versed > in them. I wasn't really there either. The fact that his wife refused to translate spoke a lot, though. I have no clue what this "versed" is. This surgery was almost ten years ago. Did they have that back then? The wife wasn't exactly shy. She and my wife talked a lot in the waiting room, while our surgeries happened. His surgery was right before mine, and of course he spent more time in recovery since he had a general and I didn't. The wife didn't understand why her husband had a general and I didn't. I had to remind my wife of what had happened. SignatureDan Abel dabel@sonic.net Petaluma, California, USA Hey, I just had my first colonoscopy and with the > versed/fentanyl combo they put to me, I was out for the duration, but > it's still not a general; I'd call it deep sedation with a little [quoted text clipped - 3 lines] > > w.stacy, o.d. As you said, you may not not remember all the details of the procedure since there is an amnesia effect associated with these drugs. To wit, I had a long conversation with a friend who I talked to soon after the colonoscopy and she couldn't remember it later on in the afternoon. That's why they probably told you not to sign any important papers for a day or two afterwards. But they rarely mention the amnesia effect to patients for obvious reasons. George To wit, I > had a long conversation with a friend who I talked to soon after the > colonoscopy and she couldn't remember it later on in the afternoon. Er, I don't recall not remembering anything... > That's why they probably told you not to sign any important papers for a > day or two afterwards. But they rarely mention the amnesia effect to > patients for obvious reasons. Mostly they were concerened that I shouldn't drive. I was ready to go back to my office (walking distance) and do some paperwork, and asked how long would it be before I could drive. They said none at all that day. I thought that was extreme prudence, but for legal reasons I can understand it. So I just had my wife drive me home. Again, I don't recall forgetting anything, but I can't seem to locate my will... w.stacy, o.d. > To wit, I > > had a long conversation with a friend who I talked to soon after the [quoted text clipped - 14 lines] > > w.stacy, o.d. ROTFLMAO!!!!! Thanks for reminding me of something. The anesthesia not only induced vomiting for 2 days; it had strange, lingering side effects. One in particular was unsettling: when I was between sleep and waking for days afterward, I couldn't locate my limbs mentally. Now if I told them to move, they would do it, but I had to issue the command, and then my body would 'remember' where they were. It wasn't exactly paralysis; it was just that movement wasn't automatic. It had to be consciously ordered and executed. Needless to say, I'm going to find out what they gave me and studiously avoid it from now on. Melinda On 11/19/05 9:03 PM, in article AsTff.21025$q%.20180@newssvr12.news.prodigy.com, "William Stacy" <wstacy@obase.net> wrote: >> I've posted this before, but the guy before me on my first surgery got a >> general. My doctor's exam room is right across from the waiting room. [quoted text clipped - 17 lines] > > w.stacy, o.d. How can the patient follow directions during the surgery if he can't hear? The paper and felt marker may be fine for in the office to communicate, but won't work while he is lying under the operating microscope. Yes, in some cases, if they are very cooperative, it is possible to establish a communication "code" beforehand, as I did with one gentleman. > How can the patient follow directions during the surgery if he can't hear? > The paper and felt marker may be fine for in the office to communicate, but > won't work while he is lying under the operating microscope. I agree that inability to hear eliminates some of the advantages of local anesthesia, and may render the general mandatory. > Yes, in some cases, if they are very cooperative, it is possible to > establish a communication "code" beforehand, as I did with one gentleman. No doubt. As always, the skill of the surgeon is paramount, and communication skills are probably near the top of importance. w.stacy, o.d. >> I've posted this before, but the guy before me on my first surgery got a >> general. My doctor's exam room is right across from the waiting room. [quoted text clipped - 6 lines] >> not to mention his being stubborn. While we were there, the doctor >> called and ordered a general for the guy. The big-wooden-mallet solution would probably have been more fun for the spectators. > Sounds like taking the easy way out for the doc, at the expense of the > patient's best interest. If he were that deaf, what's wrong with paper [quoted text clipped - 4 lines] > on my own 30 minutes later, no nausea, no nothing, clutching a color > photo of the inside of my own, as it turns out, healthy gut. You should have asked for the movie! We got one in a mess of used VHS tapes from a yard sale. Fascinating -- especially the polyp-snippage, which is pretty damn crude. My mom had to be knocked out for eye surgery (two cataracts and a macular wrinkle/blister) even though it wasn't medically necessary -- she gets severe claustrophobia just from having the drape put over her face or lying face-down on her bed. Fortunately it hasn't caused any problems. SignatureCheers, Bev +++++++++++++++++++++++++++++++++++++++++++ Save the whales for dessert On 11/19/05 7:42 PM, in article dabel-E1687B.19420219112005@nnrp-virt.nntp.sonic.net, "Dan Abel" <dabel@sonic.net> wrote: >> I had general anesthesia because I'm very squeamish >> about my eyes. [quoted text clipped - 15 lines] > not to mention his being stubborn. While we were there, the doctor > called and ordered a general for the guy. Contraindications for topical anesthesia include inability to hear and follow directions, language problems that preclude following directions, as well as extreme nerves. Versed also does not work for everyone. I find that background jazz, coupled with keeping the patient updated as to where we are, and how it's going, is a better relaxant than the Versed. It is easy to get a little too much - the patient falls asleep and suddenly wakes up and jerks around, or even tries to get of the bed since he is disoriented. Or, the are so sleepy the eye is rolling all around and they can't control themselves. I had one poor fellow who we tried 2 prior times to operate under either topical or retrobulbar. He had spent the evening before surgery so nervious that he rubbed his forehead above the eye so hard with the finger that it was bloody. He was not a candidate for anything other than general (which I only do about once every year or two). > Contraindications for topical anesthesia include inability to hear and > follow directions, language problems that preclude following directions, as > well as extreme nerves. > > Versed also does not work for everyone. I find that background jazz, Jesus, do you ask first? Unless you're talking about Dixieland, the last thing I'd expect to keep me calm is crappy "sophisticated" jazz, which sets my teeth on edge whenever I'm forced to listen to it even in elevators. Just one more thing that's probably way more fun to do than to watch or hear. > coupled > with keeping the patient updated as to where we are, and how it's going, is > a better relaxant than the Versed. SignatureCheers, Bev +++++++++++++++++++++++++++++++++++++++++++ Save the whales for dessert My other eye shows no sign of cataract but it is very astigmatic and has been since childhood. I don't know my exact prescription. I am seeing the eye surgeon tomorrow and can get that information for you. Thanks, Melinda
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