Friday, 30 December 2016

Cataract surgery - the operations

This is the second in a series of posts by my husband following his cataract surgery in late 2015, hopefully it will be of use or interest to someone going through the same experience. You'll find the first post, about the consultation process, in my sidebar.

It took about a month for my surgery date to come through and it was a month later, 11 November 2015. After the uphill struggle to reach this point it suddenly became very real.

On the day of the surgery I took some diazepam tablets that my GP had given me. I had been told at the first pre-op assessment that if my blood pressure was high then they wouldn’t operate. Since I have high blood pressure coupled with white coat syndrome and the added stress of surgery it was considered wise to take something to try to calm me down. As it happened all it did was give me a blinding headache and make me sleepy.

On arriving at the hospital I was shown to a waiting room with seats around the walls. It was quite small and close to the operating theatre. I would spend most of the afternoon in this room. Paperwork was checked and double checked, I had an arrow drawn on my forehead to make it obvious which eye they were operating on and then my wife was told that she would have to leave.  

Whilst I waited for my turn I chatted with the other patients. They were all a lot older than me, having the surgery at the more usual time of life. Some were in for their second eye so were able to reassure the rest of us that it was painless and quite simple. When my turn came I was put in a wheelchair and taken through to the anaesthetic room adjoining the theatre. Once you are transferred from chair to bed it's suddenly VERY real and there is no going back.

Looking back the anaesthetic and nerve block are the worst parts of the whole procedure. An injection first to nub the outside of your eye. Relatively minor but needles do freak me out a bit. The nerve block was the traumatic part. You are already anaesthetised but you can feel the pressure as they push a small tube into your eye socket and around behind your eye. It feels like its being pushed into your brain and all you can think is “Are you not there yet?” Once they reach the desired spot they use a syringe to push the nerve block into place and you feel increasing pressure in your eye socket. It seems to take an age. After everything I’ve had done to my eyes I’m fairly robust and not squeamish about eyes but this was really very unpleasant.

I have to say that the nurses appear to appreciate that you are having a really bad day and are very sympathetic. Having a total stranger hold your hand and talk about the mundane really does help.

When its time to go you are wheeled through into the theatre. Its surprisingly small in there and really quite cold. I appreciated the low temperature as its easier to cope with than being too warm in these situations.

A drape is placed over your face which has a hole in so that only the eye to be operated on is visible to the surgeon. It's adhesive and sticks to your face around your eye. At this point you can see light and dark and some vague movements with the anaesthetised eye. I asked Ms Bailey to talk to me and give me a running commentary so that I had something to concentrate on and it gave me an idea of how far through we were. She was very good and her calm voice throughout put me at ease. She asked me not to talk back to her as this would make my eye vibrate slightly which, when viewed through the microscope she was using, would make it difficult for her to be precise.

A small incision is made with a scalpel and then the old lens is removed with a small suction device which crunches up the lens as it goes. It makes a fair noise and its probably best not to dwell too much on what its doing at the time. It takes a few minutes and then the new lens it ready to go in.

There is no change in your vision as the new lens goes in as your eye is still frozen. I had a few injections of an anti-inflammatory around my eyeball as I suffer from iritis and inflammation is always a risk.

A large cotton wool pad and a hard plastic protective cover are taped on and then you are wheeled out, back to the waiting room you started in. 

I was lost as the patch arrangement made it impossible for me to put my glasses on and with a -14 prescription I couldn’t see anything without them. Fortunately, I was able to work a mobile and call my wife to collect me.

I had a large bag of drops to take home with me. There was an antibiotic drop to keep it clear of infection, a dilating drop to keep all the muscles relaxed and an anti-inflammatory to ward off the iritis. They all needed administering at different intervals so Rachel had to draw up a chart so that we wouldn’t miss any.

Next morning was the moment of truth, the big reveal. It's quite daunting that you have to do this by yourself at home. There is little concrete guidance given. You may be able to see, or it may take a while for your vision to clear. At this point how do you know if it's been a success?

We sat in the en-suite and carefully removed all of the surgical tape securing the patch to my eye. Gingerly we removed the patch. I kept my eye shut whilst Rachel bathed it with some cooled boiled water to loosen the crust of tears and blood. It wasn’t a gory mess fortunately as Rachel “doesn’t do eyes”.

When I opened my eye I was very relieved to at first see light. There is always a worry in your head that you will open your eye and just see darkness. What I could see was blurry but straight away I noticed that the colour temperature of what I was seeing was much colder. With my right eye (as yet untouched) everything had a warm yellow tinge to it compared to my new eye. What the true colour should be is anyone's guess but my new world seemed brighter.

I went back for a check-up in a week and all looked good so I was able to start tapering the drops. My vision started to noticeably improve at this point with the vision in my new eye improving steadily. It was a new experience for me to be able to see without glasses as I had been first prescribed with glasses at the age of five and been dependant on them for many years.

Waking up and being able to see without the usual fumble on the bedside table for my glasses was quite exciting. Being able to see in the shower was quite liberating. Previously everything had to remain in the same place as there was no way of me telling shampoo from conditioner from shower gel once in the shower. Now I could see, albeit at arm's length.

I had wanted to keep working as much as I could (I work from home) so I optimistically removed one lens from my old glasses so that I could theoretically see with both eyes at a distance. This really didn’t work as the images (as I had been told they would) were very different sizes and it made me feel quite sick. 
It's surprisingly difficult to buy an eye patch without resorting to a fancy dress shop
I resorted to using either my good eye with an eye patch over the other, or covering my left with a cotton wool pad when I was wearing my glasses.  I had some +1 reading glasses from before the operation that I used when wearing contact lenses. I found these worked reasonably well for computer screen distance. I also bought some +3.5 glasses off the shelf from Sainsbury’s which I could read with although they did feel a bit strong as I had to hold whatever I was reading quite close.

With a combination of  glasses I managed to get around and to work, watch TV etc. although I did decide that this was a suitable point to stop driving. I had been driving up to this point as legally you only need to be able to see out of one eye. My right eye was good so the left gave me some peripheral vision if not clarity.

I was given strict instructions not to bend over, do anything strenuous or exert myself.  Anything that might increase the pressure in my eye was outlawed and Rachel strictly enforced this. It's surprising how little you can actually do if you stick to this regime. I don’t idle well but potential blindness is enough of a motivator to ensure compliance. On the day of the first operation I was given the appointment paperwork for the second cataract operation which was four weeks later.  After a very slow start it appears that once you are in the system things move along quite quickly.
Sometimes the obvious solution is the best
On the day of the second operation I was familiar with the set up and it went as it had before. We didn’t congregate in the waiting room this time but in one of the day wards on the floor below. We had more room but this also meant that we didn’t really speak to each other.

Once upstairs the anaesthetic block seemed to take longer and be even more uncomfortable that it had the first time. In the theatre it all proceeded as it had before and I was quite relaxed. Whilst I was waiting for them to prepare the new lens, after they had removed my old one, I started to feel a bit uncomfortable. I couldn’t put my finger on it but something didn’t seem right. This feeling got worse once Ms Bailey started to put the new lens in place. I could feel her manoeuvring it. The lens goes in through a small incision folded and then has to pop back to its normal shape once its in the lens pocket. I could certainly feel her trying to get it to reshape and settle.

Conscious of the previous instructions to not say anything I gritted my teeth and was pleased when she announced that it was in and all done. As I breathed a sigh of relief Ms Bailey administered the injections of anti-inflammatory into my eyeball.

I definitely felt that and gave an involuntary jump.  She noticed and asked if I could feel it. She was concerned when I confirmed that I could and I had been feeling for some time.  Another splash of local anaesthetic and she finished the injections and bandaged me up. I never did find out if she had subsequently had a few choice words with the anaesthetist but she wasn’t too happy.
All done
I left with a now familiar bag of medication to return in a week for a check-up.

The start of drops in my right eye coincided with the end of drops in my left. Unfortunately, my left eye took this as a sign that now was an ideal time for an outbreak of uveitis.  It’s a painful auto-immune condition which leads to an inflammation of the front of your eye. It is treated with the same drops as I had had post operation so the hospital gave me yet more of these and I started a different regime of drops into my left eye. This was familiar territory though.

At my check-up everything was proceeding well except that I was developing PCO in both eyes. PCO or Posterior Capsule Opacification is where, following cataract surgery, the rear wall of the lens pocket becomes clouded. The symptoms and effects are very similar to cataracts themselves. The treatment is to use a laser to cut a hole in the rear pocket wall which is so simple an operation that it's done in clinic as an out patient.  Ms Bailey said that once the inflammation in my eyes from the surgery and uveitis had settled she would do this before discharging me. So, I went into the Christmas holiday optimistic that the worst was behind me. How wrong I was.

The next post in the series will be up next Friday and will cover what happened next...

Friday, 23 December 2016

Cataract surgery - the build up

If you're a frequent visitor to my blog, you'll know that we had a bit of a difficult time at the end of 2015 and start of 2016 following my husband's cataract surgery. At the time I asked him to make notes, so that when I go through the same experience, I'll know what to expect.

I then thought, why keep it to myself? As it was a fairly drawn out experience, I'll serialise it over a few blog posts. Hopefully someone will find it of interest. I'm a bit eye-squeamish (unsurprisingly less so after the last year or so!) so hopefully if I can read the posts to edit them, they won't make you feel too queasy either! Now over to my guest blogger...

Rachel has asked me to write a piece for her blog to detail my recent treatment for cataracts. The first thing people usually say is “You’re a bit young for cataracts aren’t you?”  Being in my mid 40’s I’m no spring chicken but I don’t fit the usual profile for cataract surgery. 

I have always been extremely myopic. I started wearing glasses for reading when I was five years old and my sight has got progressively worse. When I was in my mid 20’s I had a detached retina in my right eye.  As it was explained to me, due to my elongated eyeball the retina was stretched pretty thin and had developed a tear. This tear allowed aqueous humour to get behind the retina and, like water behind wallpaper, it caused the retina to start to detach.  The treatment I was given was a silicon explant / buckle on the back of the affected eyeball (designed to push the wall of the eye in towards the retina) and also laser surgery to “spot weld” the retina and seal any tears. At the same time they performed pre-emptive laser on my left eye to try to prevent this being similarly affected.

What they didn’t tell me, and to be honest it would have made no difference if they had as it was vital surgery to save my sight, was that a common side effect of the laser surgery was premature cataract formation.

So fast forward twenty years to February 2015 and I find myself in the optician’s chair being told that my cataracts had developed to a point where corrective lenses couldn’t bring my sight up to any reasonable standard. I would need to be referred to a hospital for surgery.  It had been a steady decline over several years so I was aware it was coming but it was still a shock that I was going to need surgery.

The initial referral was to my GP.  Due to NHS bureaucracy opticians cannot refer direct to hospitals. I was warned that my GP would probably want me to see them for a discussion about treatment before referring me on but that it would all take place in about a week. After a fortnight of not hearing anything I chased the practice and all they could tell me was that they had received the referral letter but that nothing had been done with it. I chased a couple of times more, getting the same answer each time, until I received a letter through the post in mid March 2015 inviting me to “choose and book” my appointment. There were a selection of hospitals to choose from and I selected the Bristol Eye Hospital (the 'BEH'). Apart from my history of myopia and detachment I also suffer from iritis, an autoimmune condition which causes inflammation in the front of the eye. I assumed that it would be safer for me to attend the hospital that would have a detailed history for me rather than starting afresh somewhere else.

Unfortunately, the BEH is very popular due to its specialist focus and it wasn’t possible to get a date for an appointment and instead I received a “you’re in the pile” type of acknowledgement. Understandable but still not terribly helpful. After hearing nothing after a month I rang choose and book and was told I should hear soon. The next time I rang them (a couple of weeks later) I was given the details of the hospital team to ring and also advised of process for complaining to the Patient Liaison team at the hospital trust. 

I spoke to the appointments team at the BEH who were very rude. It was now May and I wanted to know when I would hear something and at least get an appointment date through. The lady I spoke to said, “I haven’t got an appointment to give you, what do you expect me to do?”.  Anticipating that NHS lack of resources would be involved somewhere, what I had specifically not done was to demand an appointment now / soon, I had just asked when I would hear what was happening.

Disappointed by the lack of compassion or understanding I reluctantly complained to the Patient Liaison Service. I didn’t want to make things worse for the Hospital but I was left with nowhere else to go. My written complaint was regarding the lack of communication and transparency. Little did I know that this would not be the only time I had to formally complain. I was initially contacted by someone who asked me what I wanted to complain about. I explained and her response was “What do you expect me to do about it, I can’t make you an appointment”. I was surprisingly, and somewhat uncharacteristically calm (I don’t suffer poor service well) but was constantly met with a negative attitude from someone who was obviously responding to the complaint they expected me to make rather than the one I was making. I had no choice but to escalate my complaint. This was already feeling like an unnecessary waste of time and effort and was having a detrimental effect on my blood pressure but I was left with no other option other than wait indefinitely for a response.

I next received a phone call from the newly appointed appointment booking manager. He sounded as though he was just coming to realise the magnitude of the task before him and I was just the tip of the iceberg.  We had a long conversation and he was very candid. The hospital was struggling to find qualified clinicians to fill the posts required to fulfil all the requested appointments. A backlog had built up and it was now at the point where if they did find the suitable staff then facilities would be the limiting factor. He was obviously doing his best but couldn’t practically schedule sufficient appointments to stay on top of the ever growing waiting list. His plan was to find some locum clinicians to concentrate on the backlog and just do the best he could. He couldn’t prioritise me as although effectively blind in one eye now, it wasn’t life threatening. To be fair, I didn’t want priority treatment, I just wanted to know that something was happening and it would eventually be resolved.

True to his word an assessment appointment came through in early June. I had a lot of questions and I thought this would be my opportunity to ask them. I had a complex history and given how important my eyes are to me and my work and the pressures on the NHS I wanted to ask whether I should be thinking about going privately and potentially looking at a multi focal implant. It would be expensive but a price worth paying for something so important. It was also important to me to know when / if they would operate on my right eye. It wasn’t yet at the point that it needed the surgery but it was well on the way. 

The assessment clinic was packed and we had a long wait past our appointment time. This is just something that one comes to accept with the NHS. When we got to see the consultant he looked at my eyes and said “You need to have these cataracts seen to.” I was a little stunned, that was why we were there… “So what next?” I asked. A pre-op assessment was the answer. I asked my other questions and was told that he had no idea and couldn’t comment as he was just a locum and didn’t work at the hospital usually. With that we were shown out. I’d waited four months to have an appointment with a locum who could give me no information on my possible treatment but correctly identified the reason why my optician had referred me in the first place. At least I was now in the system…

In July 2015 I had my pre-op assessment. I had been told that this would be with a consultant but as it happened it was with a nurse. The first thing she did was ask me to take my glasses off and then read letters off the chart. My prescription was -14 so without my glasses I’m doing well to see the chart let alone read anything. She seemed amazed when I couldn’t read anything and actually asked me, “can you see me?” and waved her arms.

They then put me on a machine that scans your eye and assesses what strength of lens you need to give you perfect sight following the operation. This is for distance only as you will need reading glasses for close up. It's all automated and apparently can’t be influenced by human error which was a relief as the nurse seemed confused by the results she was getting.

She couldn’t answer any of my questions so I left again not really knowing what was going on. I asked when I would see a consultant who could answer my questions and was told that it would be on the morning of the operation. I was not going to wait until that late stage to get answers so I complained to the Liaison Service again. After my previous experience I also went to see my GP. This process had dragged on so long that I now lived fifty miles from Bristol and had changed GP. The GP was brilliant though, assuring me that I wasn’t being a fussy bugger and that my questions were not only not unreasonable but he would definitely recommend me getting them answered before I proceeded. He said he would write to the consultant named on my GP records.

A week later I had a second pre-op assessment, this time with a doctor. He wasn’t a consultant but he would, I was told, be able to answer all of my queries. He had a copy of my complaint in front of him and he went through each point. Some of his resolutions were a little vague and along the lines of, “I’m sorry but there’s nothing we can do now” but one thing he did clarify was what would be needed for my right eye. Wearing strong glasses makes the image that you see smaller than uncorrected vision. He was very clear that I could not operate with only one eye treated as the images from each eye would be different sizes. I would definitely need both eyes done in quick succession but that the NHS would not, under any circumstances, do this as I could still see out of that eye. I needed to arrange a private consultation and surgery on my right eye.

When we got home from that appointment there was an appointment letter waiting for me with a consultant. This was as a result of my GP’s letter. As I was under the impression that I had already received the answers and clarifications that I sought I cancelled this appointment. The consultant was Ms Claire Bailey and having googled her she had an excellent reputation and an expertise in retinal medicine. For this reason I made a private appointment with her to discuss my right eye. She was on holiday so I couldn’t see her until early September. By coincidence I received a surgery date which was later the same week so it felt like things were coming together.

When I met Ms Bailey in early September and recounted my tale she was shocked and frustrated. It turned out she was due to take a more senior role at the health trust and would be responsible for overall clinical performance. She was most upset by the advice I had been given that I would need the second eye done privately. She stated that as I could not operate with only one eye done then the NHS had an obligation to do the second eye as well. She thought it wise if I was treated by her personally and so I cancelled my upcoming surgery with another consultant and awaited a new operation date with Ms Bailey.

The next post in the series will be up next Friday and will cover the operations...

Saturday, 3 December 2016

November round up

Frost across the fields
There goes November and all of a sudden we're in December. It's really felt like it over the last couple of days, freezing cold but I can't complain when it looks beautiful outside with frost across the fields.

Work has been fairly quiet but it's starting to get more stressful as we approach Christmas, with lots to do before the break. We've had two new members of staff start in our northern-most office and I've changed the firm of accountants who look after us. We'd been with our previous accountants for sixteen years, but they merged with a firm I used to work for and I simply didn't want to put any money in their pockets. This is why you should always look after your staff!!

Puppy school is going okay, Barney has good days and bad days, but overall I think we're making progress. He's still very excited to see all the other dogs, but will generally do what is asked of him. He's also getting a little calmer at home, not jumping up so much and waiting slightly more patiently. The next Kennel Club Good Citizen gradings are in February, I'm just hoping he may be ready for the bronze level by then. Fingers crossed!  

In other Barney news, we visited the puppy school's dog show in aid of Children in Need, you can read about it here. Barney won waggiest tail and came second in puppy agility, I was very proud!
Staying still for sixty seconds contest
He also went for his first proper haircut and came back looking like a dog rather than a puppy. Luckily after a couple of days of running around, he got his scruffy puppy look back again.
Neat and tidy, even if it wasn't for long
We've been talking about getting a new cooker since we bought the house. One of the rings didn't work, the oven seemed to cook too hot and the temperature scales had long since rubbed off the dials. We eventually had our replacement delivered this month. It has an induction hob which is taking a little getting used to, but overall it's a huge improvement on its predecessor. We can now choose what temperature to cook at, rather than likening the dials to clock faces and cooking things at 7 o'clock! We'd also noticed that out mattress was rather sunken, more than we'd expect as we only bought it last year. We emailed the supplier and had a free replacement delivered without a quibble. Great service from Dreams! We've also been discussing games consoles for ages, and finally bought an Xbox One, so far we've only really played Tomb Raider, but the graphics are amazing and it's keeping our brains busy!
It works!
I met up with a friend in Malmesbury at the start of the month. We ate amazing pizza and had a great evening catching up and putting the world to rights. She's currently working her notice at a firm I used to work for and considering options for afterwards, which is a good place to be. I'm looking forward to seeing her again soon to hear what she's decided upon.

We also repeated our meeting up with another friend at Westonbirt. The weather was a little kinder this time, but I wasn't going to take a chance, fully wrapped up in wellies and padded waterproof! Barney was well behaved off lead, which is always a big relief, although I think it had a lot to do with the sheer quantity of treats that Andrew was putting into him!

Finally, we had my parents and brother over last weekend. It was my parents' birthdays and due to Barney they decided they'd rather come to us, than us go there. We cooked an enormous lasagne and followed that with birthday cake. They commented that it was the best birthday they'd had in a long time, they certainly had no shortage of attention from Barney!

Now onto my progress against my plans for the year...

Read sixteen books
No progress in November, I'm afraid. I think reading ten books over December to hit my target may be a challenge too far!
Find one hundred geocaches
We're still at 534 finds, 46 for the year to date. Whoops.

Meet up with an old friend
I've known the friends I met up with this month for about ten years, we don't meet up often but it's good when we do. 

Blog once a month
I've had a bit of a blogtastic month, as well as my blog about the dog show, I wrote about a couple of our frequent dog walking locations at Lydiard Park and Coate Water, a post about Barney's progression from puppy to adolescent and a Photo an Hour post.  

Watch a new film once a month
With the arrival of the Xbox and probably more due to the start of I'm a Celebrity... (my husband's favourite programme), we've not watched any films this month. They have been a good group on I'm a Celebrity though!
Take six day trips
No progress on this one, I think this may need to wait until next year, but you never know!

December looks as if it will be pretty stressful work-wise and busy out of work. Christmas visiting with Barney will be interesting this year, I'm just hoping it goes better than when we visited my in-laws with him earlier this year, when he pursued their dog and then weed on the rug. Wish me luck!