Tuesday, 10 January 2017

December round up

How can it be 10th January already? I'm sure Christmas can't have been that long ago. 

December was a nice month, not just because of the long break at the end of the month, but that helps! Maybe everyone is just in a much better mood in December.

We caught up with a couple of friends who we hadn't seen for a few years at the start of the month. They've recently moved back to the UK from the Falkland Islands so we thought we should make the most of being half an hour apart, not 13,000 miles! We went out for lunch at their local, the food was good as was the company. I'm looking forward to doing it again.

Barney had a trip to the vet, he was neutered and had a couple of retained puppy canine teeth out at the same time. I felt awful putting him through it but he bounced back (literally!) really quickly. He was sent home with a cone of shame, but he couldn't cope with his head being so much wider that usual and kept clouting things, and my shins were starting to suffer, so we got him a recovery suit. He was much happier!
Sad puppy
Happy puppy!
I left Andrew and the recovering Barney alone for a couple of hours to meet a friend for lunch. She had a baby just over a year ago, but this was about the second time she's had some time to herself apart from to work. We spoiled ourselves with a trip to Pizza Express and have resolved to do it more often. 

Work was fairly quiet, which makes it a good time to catch up with admin. We had our Christmas lunch which was really nice. We always exchange Secret Santa presents over lunch, they varied from the useful to outrageous. Mine was a, "Leave me alone, I'm only talking to my dog today" top. How well they know me.

We had to miss one week of puppy school after Barney's op. He had been making good progress, but after being under virtual house arrest whilst he was recovering, he was like a thing possessed when we took him back. We're taking a month off in January as we're so busy and hopefully he'll calm down a little with being a month older!

On the whole, I really enjoyed Christmas this year. We spent Christmas Day at home, much as Andrew rolled his eyes at me buying presents for Barney, he enjoyed unwrapping them and adopted each of his toys in turn as his new favourite. We had a nice lazy day, got up late, did presents with a few snacks, threw some balls for Barney and then a mid afternoon Christmas lunch. What's not to like?!
Barney's Christmas robin already looking a little worse for wear
I'll only wear these antlers if I can have a biscuit, okay?
I can't even see now, my price has gone up to two biscuits
We went to see Andrew's family the following day. Barney got to meet Andrew's aunt and his sister and brother in law the first time. He's still not getting on brilliantly with Andrew's parents' dog, but things went slightly better than last time. He was very excited to meet all the new people, but at least he didn't disgrace himself. Andrew's father managed to wind him up by shaking a biscuit tin at him for longer than was strictly necessary, but we're trying to forget about that! We all had plenty of presents and were thoroughly spoiled and well fed.

By the 27th, it was time to see my family. Barney had met my parents and brother before, there were no other dogs and no-one shook a tin at him, so it all went very well. He injected just the right amount of fun into the day and he's been invited back, so he must have done well.
Can you tell I helped Mum unwrap her presents?

Now onto my final summary of progress against my plans for the year...

Read sixteen books
No progress in December, I'm afraid. I have almost finished my audio book I've been listening to for six months though. That gives me a final count of 6/16. Whoops.
Find one hundred geocaches
We're still at 534 finds, which leaves us at 46/100. Whoops again.

Meet up with an old friend
I met up with a number of friends over the year, it's been great and can just hope to find the time to do the same next year. 

Blog once a month
I published a couple of posts penned by Andrew about his cataract surgery saga. If you are interested, you can find them here and here.

Watch a new film once a month
We've been rubbish with films, but I can recommend a couple of good XBox One games! We watched 12 over the year though, so on average we hit target.
Take six day trips
No progress on this one, it's fair to say that Barney has changed how we spend our spare time quite significantly!

I'm already thoroughly enjoying January, so I'll keep up with my monthly updates. If nothing else, I quite enjoy looking back at what I've done over the month. I've not set any resolutions or the like for 2017, but am already hitting the gym with a vengeance and enjoying it. Fingers crossed that continues!

Friday, 6 January 2017

Cataract surgery - the retinal detachment we weren't expecting

This is the third 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 and the second about the operation in my sidebar.

Travelling back from my in-laws on 27th December I started to get flashes of light when I moved my eye. Due to my previous retinal detachment I knew this wasn’t good news, so early on the 28th we were in A&E at the Bristol Eye Hospital. Due to the way Christmas fell that year this was a Monday but was the Boxing Day Bank Holiday. The place was deserted of staff but quite full of patients.

When we finally got to see a doctor she looked as if it was all she could do to keep her eyes open. She looked like she was hanging. She barely looked at me, got confused about which eye she was talking about and sent me home saying she could see no problem but that I should come back in a fortnight for a review. I knew there was something wrong but what can you do.

Over the next couple of days I still had my flashes and then the ominous black shadow appeared. On New Year's Eve we were back in A&E which was thankfully better staffed. We saw a doctor (coincidentally the one who had dealt with my complaint several months earlier) who quickly issued a verdict – “Go straight to theatre, do not pass ‘go’ do not collect £200.” I had a retinal tear and detachment.

That was how I found myself on New Year's Eve lying in bed in a private room waiting for my slot on the emergency surgery list. Apparently there had been a number of emergencies come in that day so it was a full list. Between patients the surgeon came to see me to assess what he had coming through. I asked him at what point would I get bumped to the next day's list as it was too late to operate. His reply was that his theatre team weren’t going home until all the patients on the list had been seen to. For all the faults within the NHS you have to admire the dedication and professionalism of the clinical staff.

It was late, I don’t remember how late, when I was wheeled back to my room. I was lying on my right side which is a position in which I would spend most of the next few months. The operation performed consisted of sucking out the vitreous humour and replacing it with a gas bubble. They then laser around the tear to “spot weld” it back in place. The bubble will hold the retina in place whilst the blood vessels reattach hence the posturing to keep the bubble in the correct place. This was the simpler of the two options and was performed under local anaesthetic and block. My original detachment had been treated with a silicone buckle stitched to the back of my eyeball and was performed in a lengthy operation under general anaesthetic.

As an added bonus whilst they were in there they cut away the rear lens capsule thus treating my PCO in that eye. Apparently it gives better results to do this surgically rather than laser but is too invasive to do alone.

Once back in my room I had to lie face down for an hour and a half, I assume to prioritise pressure direct onto the area around the optic nerve being the most critical area to get attached securely. At this point my lovely wife went home. She had been through a lot, always by my side and now she had to get to bed. For the first time since we met we saw in the New Year separately.  Rachel was asleep and I was too until woken by the fireworks at midnight.

I woke in the morning hopeful that I was going home.  They had said I would only need to be in for one night and I wanted to escape as soon as possible. My eye had other ideas though. When they removed the patch I could see absolutely nothing. Not light and dark, not movement – nothing. The consultant couldn’t see anything either and this was potentially not good news.  I had a clot in the front of my eye that was obscuring all attempts for him to see the back of my eye and whether the surgery had been a success. Added to this the pressure in my eye was also very high. “We can’t send you home like this….” This was a real kick in the guts.
The morning after
I was now started on hourly drops for the pressures and antibiotics. Doing this from 6am to 2am meant I had very little sleep despite spending 50 minutes out of every hour lying on my right hand side. 

At 2am in Friday night / Saturday morning the nurse came in for my hourly drops to find me rocking on my bed in agony. I begged her for whatever pain relief she could give me. A dose of paracetamol as well as codeine was given and still didn’t take it away. It helped though. My pressures had gone through the roof. I don’t know what the scale is but under 10 is “normal”, 10-20 is cause for concern and I was over 30.

The next morning I started a regime of regular tablets to take the pressures down. These had an adverse effect on kidney function so now I needed daily blood tests as well. I also had an oral steroid to take the inflammation down but this attacked the stomach lining so I had a third tablet to protect my stomach. In my sleep deprived state I was starting to lose track of it all and just resigned myself to their care.

I was kept in for a few more days.  At this point the pressure had come down but they still couldn’t see into my eye and I couldn’t see out. It is very scary when they shine a light in your eye and you can’t tell. They still couldn’t tell if the operation had been a success but there was little to be gained from keeping me in so I was released back into the wild. Being at home helped my morale greatly and after a couple of days I started to see light and dark and then colours. A few more days and I had shapes and could count my fingers.  Small things become great achievements.
Our homemade drugs chart
As I started to see more I became aware of the bubble in my eye. It consumed about 90% of my eye so the interface between bubble and aqueous humour (which slowly displaces the gas) was a dark shadow across the top of my vision. As images are inverted in the eye and then corrected by the brain this was at the bottom of my eyeball.

Depressingly as my left eye vision started to improve my right eye started to deteriorate with the PCO. It's not major but it takes the clarity away.

A week after release and I was back at the hospital for a check-up. Progress, I am told, is good. They can see in and the retina looks flat. Pressures are down but the inflammation is still there along with the clot. It's now a waiting game.

The steroids I took gave me terrible indigestion but have to be reduced gradually. I hadn’t really thought about how serious a medication they were. To be honest at the time they started I was in so much pain I would have taken anything they gave me just to make it stop. Every time I decreased the dose I was taking I had terrible withdrawal symptoms. I was absolutely wiped out each time and had stomach cramps. Googling it revealed that the steroids reduce the production of adrenaline and it can take up to four weeks to start again after you stop taking them. Knowing this didn’t make me feel physically any better but it did reassure me that there wasn’t something else amiss.

The horizon in my vision gradually dropped as the gas was absorbed. It was very off-putting because when you move your eye the fluid / gas “sloshed” in your eye and the horizon breaks into waves. It can make you feel quite sick. The gas was supposed to be completely absorbed in 4-6 weeks. Six weeks after the operation I was back at the hospital for a check-up and was discharged despite still having the bubble remaining. We didn’t see the consultant and weren’t filled with confidence by the doctor we saw but I was due to see Ms Bailey again, so wasn’t too concerned.
Gas bubble in the eye means no flying
9 ½ weeks after the operation the bubble finally disappeared. The final bit went quite quickly and then one morning it was gone completely. 

Mid March I saw Ms Bailey again and was given the all clear. She performed the PCO laser on my right eye and finally discharged me. From first operation to discharge ended up being four months. From Optician referral to discharge it was thirteen months.

At the beginning of April I had my long awaited post operative eye test. I could have done it earlier but I had to wait in order to get an appointment with an optician I trusted. I’ve had so many bad eye tests over the years that I am very selective about who I see as it is a complete waste of time if they don’t do it properly.

The results were good. I was given the all clear to drive without glasses. My official distance prescription is now +0.5 in my left eye and 0.0 with slight astigmatism in my right. This is a hell of an improvement over -14 in each eye. Ms Bailey said she was aiming for slightly short sighted in each eye but that it was difficult to predict exact results. I was very pleased. My reading prescription is +1.75 mid distance and +2.25 for close reading. I was prepared for it to be in the +3-3.5 range so I was again pleased. I got some “Office” glasses which are amazing for computer use. They are a bifocal split between the mid-distance and reading prescription so I can see computer screen and papers. I also got some standard varifocals. These took a bit of getting used to and the first pair had to go back and be adjusted as the vision zones were in the wrong places and I couldn’t see anything out of them. After the adjustment they were much better. I don’t like them for reading (a book or magazine) as the reading zone is so small but for reading labels etc. they are ideal.

So roughly fifteen months after being referred I can see again and get on with my life. It would be easy to say the whole experience was unnecessarily stressful and took too long but that would be too broad a generalisation. More specifically, the administrative side of the NHS is too bureaucratic and it's an uphill struggle to get anywhere. The clinical staff from consultants and nurses to porters and caterers are a fantastic and dedicated bunch. They work hard under difficult circumstances and I think we probably take them for granted. The NHS is undoubtedly under-funded. If extra funding went straight to the front line then I would happily pay more tax to support it. However, too much is absorbed by the administrative hierarchy and more is wasted in non-critical areas.

It's easy to get annoyed and exasperated by the NHS but remember that it isn’t the nurse in front of you who is to blame. She’s doing her best to treat your ailment and make you feel better.