Menopause

Macular Hole Surgery: The Recovery

 

Bracelet

This post is long-winded and jumps around a bit, but I wanted to thoroughly chronicle the experience for others who may need to have eye surgery and then spend time face down. You can read the first two posts about my macular hole here and here. 

The hospital sent me home with this green bracelet. The bracelet was to remain on my wrist until all hints of the gas bubble in my eye were gone. If I needed emergency surgery, I couldn’t have nitrous oxide because that doesn’t mix with the gas, and I couldn’t be airlifted as that creates a change in pressure. I had to cancel a trip to a conference in the mountains later in the month after the doctor told me the restriction against changing altitudes. The results of not following these mandates can be extreme pain and blindness. Yikes!

The 45 minute ride home from the hospital seemed like ten minutes thanks to the lingering effects of the anesthesia. I kept asking Cliff, “Does this ride seem short to you?” I had no problem keeping my head down in the car since the time magically  flew. I was worried about neck pain, but I had zero trouble.

As soon as I got into the house, I began the serious business of keeping my face down for seven days. The doctor said the first few days were the most crucial, so I didn’t take many breaks during that time. After that, I did use the five to ten minutes allowed each hour. Luckily you are permitted to walk about as long as you keep your head down, so I made lots of circles around the downstairs of my house.

I soon realized that I liked the face support that hooks to the end of the bed the best. The chair I rented wasn’t especially comfortable to me for sitting long periods, and the face support system that works in the bed made me feel like I was sleeping on a ramp. You can see all of these products on the Comfort Solutions website.  The equipment rents for $150 a week, which I think is a very good price, especially since that includes shipping both ways. In fact, this was by far the cheapest part of my surgery.

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Although you are permitted to read, I found it difficult, so I listened to audio books and had a blast. I also put my phone on the ledge on the side my bed and watched three seasons of The Durwells in Corfu. Since I don’t watch much TV, this was fabulously fun. (The ledge of my bed is a little dull for photography, so I thought you might like to see our new headboard and one of the pillows that matches the duvet.)

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Sleeping was a challenge. I dozed some during the day, so I wasn’t super tired at bedtime. Once we turned the lights out, I put my head in the end of the bed face support. About halfway through the night, I cheated by sleeping on the bed itself with my head to one side.

The oddest thing is when morning comes. You think, oh good. I can get up. But you really can’t. You can get up just long enough to grab a hot beverage, and then it’s back down again.

My daughter Laura sent me sunflowers with a lovely note from granddaughter Emerson:

Friends visited and brought entertaining stories, food, wine, and flowers. If I ever popped my head up, they instructed me to put it back down again. Bossiness in friends can be good! I must admit it did feel strange entertaining guests with almost zero eye contact. Since my eye was red and somewhat closed, I have a feeling they were just as happy not to look at it.

Cliff took excellent care of me, and I greeted cocktail hour with gusto. A word of caution: wine is so delicious through a straw that it’s easy to over-imbibe.

On the day after the surgery, I saw the most incredible black and white geometric patterns in my surgery eye. I wished I could take a screen shot so I could later paint them. They were fleeting but amazing. This is the closest pattern I could find to the real ones:

Another time, I saw a bright red oval with brillaint silver tinsel all around it. Christmas in July!

I returned to the doctor the day after my surgery. They removed the bandage, checked my eye pressure, and examined my eye. The doc reported that things looked good. The eye was cloudy, so he couldn’t tell for certain, but he thought the hole was closing. (It starts to happen that fast.)

That day, I began a regimen of eye drops: a steroid and an antibiotic, four times a day for a week. Then the drops slowed to just the steroid, tapering off over a month. Cliff was my drop guy. After a while, I got more used to the drops, and learned to do better about not blinking, but there’ s just something about eyes that shout: “No! Nothing goes in here.” I bet people who wear contacts would have an easier time than I did. I’ve definitely gotten used to the eye pressure tests during the exams since they do this every time I go in.

After six days, the gas bubble began to shrink. At first I could see a small sliver at the top of my field of vision. Every day it got a bit lower. It seems like you’re mostly underwater with just part of you above.

My next eye appointment was a week after my surgery. This time they took films. I waited nervously for the results. The bubble was still obscuring enough of my vision that I had no clue if the hole was closed.

“It’s closing,” the doctor announced. He pointed to the picture.

“Yes! Please thank Dr. Manning for her fine surgery,” I said. “I’m so grateful.”

“I will,” he promised. “She ties fabulous stitches.”

Then I asked, “I’m blogging about this. May I take a photo?”

“Sure.”

I got out of the examining chair and snapped some photos of the screen. Below, you can my macular hole in  a photo taken before the surgery.

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In the photo below, you can see that the hole is closing at the top. The doc says it starts at the top and gradually closes in to the base. Macular holes tend to not reopen because the vitrious fluid that caused the problem in the first place is removed during the surgery.

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As the gas bubble got smaller, it felt like I was looking at the world through the giant bubble that transports Glinda in the Wizard of Oz:

After twelve days ,when the bubble grew so small I figured it would soon be gone, I spoke to it: “Thank you bubble, for healing me eye.” A few hours later, I realized the bubble officially was gone. It had become a buddy of sorts, so I felt a twinge of sadness.

I still had the stitches for company though: delicate black strings dancing across my vision. They were tons of fun to watch. They’d go away and reappear again like a ballerina coming back in from the wings. Now, eight weeks later, I see a tiny speck of black every now and then.

And eight weeks later, after two more trips to the doctor, I am celebrating my completely closed hole:

I never experienced any pain deep in my eye, but it did hurt some when I opened and closed my eye. I took Ibuprofen until that pain went away in about six days. My first foray into the world didn’t go well. Despite the super dark sunglasses they gave me at the eye doctor, the sun caused me to feel off balance and almost blinded. I stayed out of the sun for the next few days, and then  I was able to venture out with regular sunglasses.

Once the doctor gave us the good news that surgery had done its trick, we packed up my face down equipment, and Cliff took it to our local shipping store. Comfort Solutions really is a wonderful company to work with.

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My vision should continue to improve over the next three months. I can read print again, and work on Friend for the Ride without any visual distress.The weird jumping around that my eye did is gone. I began driving again after twelve days, which pleased me as I feared it might be a month or so.

The procedure causes a cataract, which is now forming according to my last check up.  I will need cataract surgery in the next year. I’m at increased risk for a detached retina, and I will forever fail the Amsler Grid. Parallel lines are still crooked. Some part of my central vision is now gone.

By the end of my face down time, I was going a bit bonky. I posted the old song I Am Slowly Going Crazy on Facebook. But all in all, this was not a bad experience. In some ways, it was like a personal retreat. I enjoyed the time to chill and listen to books and watch TV and chat with Cliff and friends. When you know you aren’t supposed to be productive, the time away from life’s pressures can be quite fulfilling.

And I don’t think wine has ever tasted so good as did through that straw!

Menopause

My Macular Hole: The Surgery


If you missed the first post about my macular hole, you can read it here.

The story continues!

This was the plan: During the surgery, the retinologist would scrape off the remaining vitreous fluid from my retina and inject a gas bubble into my eye. For one week, I would keep my head in a face down position that would force the bubble to press against my retina. This process would close and heal the macular hole. (You can see mine in the photo below.) The gas bubble would gradually dissolve over a few weeks, and over several months, my vision would improve. The surgery has a 95% success rate.

On July 8, two days before the surgery, the positioning equipment arrived: a chair, a device for your head that fits on the end of the bed, and a device that fits into the bed.

Cliff set everything up for me. He found that the written directions weren’t great, and he ended up watching the DVD included in the package, which was easier to follow. Cliff’s an engineer and highly mechanical. Just a heads up that the positioning equipment takes a bit of time to set up. The company, Comfort Solutions, is wonderful to work with though. Many thumbs up to them.

The night before surgery, Cliff took me out for an Italian dinner followed by frozen yogurt. I’d have my head down for the next week, so he wanted my last night to be festive, and it was!

We awoke at five the next morning. I needed to be at the surgery center by six-thirty. I’ve gotten braver since my surgery for endometrial cancer, and so I was fairly calm. Many people I told about the surgery cringed (politely). Some said, “There’s just something about an operation on your eye.” But I knew my poor eye needed expert help.

North Carolina Surgery at Wakefield is a great place. It’s new and  stylish. Best yet, you park right out front, and you’re in the door in two minutes. Amazing!

We registered at the front desk. About fifteen minutes later, I was escorted to the pre-op area. I put on a robe and took off, per instructions, my wedding rings.

One advantage to being the patient is that you get to rest comfortably while you await the surgery. I like to answer questions (easy ones), and so the long list of pre-op questions never bothers me.

The IV insertion went smoothly (or at least I thought it did). My nurse was wonderful, but she wouldn’t let me take her picture for the blog. I always like to ask the nurse a few questions. This time I asked,”Does anyone ever get up and walk out before their operation?”

She replied, “I’ve had people come close, but so far, no one has actually left.”

I didn’t meet my surgeon, Dr. Rebecca Manning, until a half hour before the operation. Imagine looking this pretty at eight in the morning and a few minutes later, tying minuscule stitches inside someone’s eye?

Just before they wheeled me into the operation room, I met my surgery nurses, who were also friendly and upbeat in their scrubs. One said, “You should start to feel a little woozy now, Barbara. We’ve added a relaxing medication to your IV.”

I didn’t. Not a bit. Hmmm.

“Are you almost asleep, Barbara?” a nurse asked once we were in the operating room.

“No,” I answered, firmly.

Like many of us, I’m terrified that surgery might begin while I’m still awake. This actually happened to my daughter Kath during wisdom teeth surgery.

“Let’s try the other arm,” I heard someone say.

I recall them moving very quickly. I hardly had time to anticipate the prick of that needle.

The next thing I knew, I was back in the prep room, propped up so the gas bubble could start to work its magic. A can of coke and a row of crackers sat in front of me. I suspect I requested them when given some snack options. I love Coke and crackers!

Phew. The surgery was over. I felt no pain or nausea, and soon Cliff came to see me.

The bubble had successfully been placed in my eye. I left with a huge plastic guard and gauze patch over my eye and instructions to keep my head face down for fifty minutes out of every hour for the next week, beginning with the car ride home.

Let the healing begin!

(The story will continue in a few days.)

Menopause

Eyes: My Macular Hole

I saved this cartoon to go along with an easygoing post about eyesight as we age. Wow. Life gives us twists, and now my eye issues aren’t so easygoing.

They began when I realized my cute over-the-counter reading glasses were no longer strong enough. I went to the eye doctor, a bit nervous abut the exam. My dad had glaucoma that came on in later life.

The doc pronounced my eyes fine, although I do need to be monitored yearly for glaucoma. I picked out cute blue glasses.

But in the time between my eye exam and picking up the finished glasses, I noticed that my eyes seemed to be jumping around. Using the computer became difficult. Letters were slightly out of place. I had trouble getting a comma where it’s supposed to be. Cliff pointed out typos in Facebook posts.

Although it was hard to determine definitively,the problem seemed to be with my left eye. It felt like it was running up a hill and couldn’t  catch up with the right one. I have an astigmatism and google told me that asigmatisms get worse with age. Could that be the trouble?

A few days later, I got my new glasses. Love how the magnetic sunglasses snap on as if by magic.

The glasses definitely helped me read, but the text still seemed jumpy. Friend and blog reader Stephanie works at my eye doctor’s practice. She quickly set me up for another appointment.I hoped they could simply tweak my prescription and all would be well.

At the appointment though, things went south when the technician said, “Mrs. Younger, I’ve tried a weaker lens and a stronger one. Neither works. The problem is with your eye.”

They dilated my eyes and took lots of pictures. The doctor asked me about my health, especially diabetes. I finally spoke about my deepest fear: “I’m concerned the problem could be neurological.” I knew that a lot of serious brain issues, such as tumors, first manifest themselves through failing eyesight

“The problem is definitely not in the front of your eye. We’ll start with the back of your eye and then go further back if we need to.”

“Further back” meant beyond my eye and possibly into my brain.

They took more pictures  on two different machines and found this. A hole in my retina.

It may sound odd to be relieved you have a hole in  your eye, but I was. The doctor was too.  “I’m glad we found this,” he said, looking at the film again. “I don’t like mysteries.”

Next step was a retina specialist.

The next day, at the specialist, they flashed a zillion lights in my eyes. Over and over again I was asked to look up, look to the high right, look to the side ride, etc. (My eyes were sore for several days afterwards.)

Next they gave me an IV and injected dye into my arm. This turned the world a lovely rose for a few minutes as they took more pictures. (I later read the dye tests for eye tumors and circulation issues. Yikes!)

When the testing was over, Cliff and I waited for the doctor in her examining room, Cliff studied the eye charts on the wall. “The eye sure is fascinating,” he said with enthusiasm. At that moment, I wasn’t so sure.

After the doctor spent a long time looking at my eyes, she gave me the official diagnosis: a macular hole. She said twice during the discussion, “You did nothing to cause this, and you could have done nothing to prevent it.”

As we age, the vitreous fluid pulls away from the retina. If you’re unlucky, it takes a bit of the retina with it. Read more here.

Here’s  a grid you can use to test your own eyes. I wish I had known about this six weeks ago. When I look at the grid with my right eye, the lines are straight. When I look at it with my left eye, the eye with the macular hole. they’re wavy.

I’m able to wait until after the family beach trip to have the surgery, which is called a “vitrectomy.”  The doctor will inject a gas bubble into my eye. Somehow, as the bubble dissipates, it causes the hole to close up. At least this works in ninety percent of the cases.

For a week after the surgery I’ll need to keep my head down for 45 minutes out of every hour. You can rent special equipment such as this chair to make the process more comfortable. This chair was NOT in my decorating plan for our new house.

The surgery may not restore my vision in that eye, but it should prevent the hole from growing and hopefully, stop my eye from jumping around. The procedure will cause the eye to grow a cataract, so a few months after the surgery, I will need cataract surgery.

I plan to blog about the experience just like I did my endometrial cancer. 

Keep your eyes open. More to come!