For those of you thinking about having strabismus surgery in the future, I just want you to know that while you'll probably want to lie around with your eyes shut the day of your surgery, day #2 is much better.
I actually woke up this morning feeling normal, except for a slight itch in my right eye. Actually,most of the itch was gone once I finally took the patch off.
I still had a slight headache for a while this morning, although 1 vicoden took care of that. Basically I've taken one vicoden every 4-6 hours today just to make sure my headache from last night, the one that felt like my head was going to implode or explode, from coming back. I don't know if I can handle that kind of headache again.
The neat thing was as soon as I took the patch off, and picked the yellow crusties out, or at least as many as I dared to try, my eyed popped open and I can see quite well. I still do have to do quite a bit of squinting, and I have my operated on eye shut much of the time (especially when I'm exposed to bright light) I can actually get around quite well.
Yet due to the vicoden, I am still a little woozy. Of course that could also be because I've spent the better part of the past 2 days sitting and lying around.
I have actually gotten quite a bit of writing done today. The computer screen must not be to bad for me to tolerate. Although I can see the words, they are still blurry, even if I look through my good eye.
So while I have a ways to go yet to get back to normal, I'm feeling overall quite good. I've been able to play with my kids a little, although it's a bit of a job to discipline them. So I've left that to the wifey poo.
So, day #2, so far, a good day. Although I have my fingers crossed it stays this way, as I can feel that monster in my head -- just barely.
Friday, July 02, 2010
Thursday, July 01, 2010
The strabismus surgery
The brain brain aneurysm started about 6:30 p.m., about 5:45 minutes after I woke up from the anesthesia in the recovery room. It felt as though a though there was an oxygen cylinder in my head and it was slowly leaking, causing my head to expand. The accompanying nausea made it worse, and forced me to toss and turn on the couch.
My 11-year-old son had a baseball game and my wife was just about ready to leave, and I made sure she gave me a couple more Vicodin before she left. I knew I just too 2 four hours ago, but the directions said every 4-6 hours as needed (PRN) and I was going to take advantage of it. She also gave me a phenergin pill for the nausea.
About 15 minutes earlier Crystal woke me from a nice 2 hour nap, which to me is not normal unless I worked the night before. I usually don't take naps because when I do I don't sleep at night when I'm supposed to. Yet today that surgery, and the effects of the anesthesia, was my excuse to snooze. She probably wouldn't have awakened me, but I said she could if KK, my 7-year old girl, wanted to stay in the neighborhood and play with the neighbor girl.
So here I was lying on the couch listening to the accustomed sounds of sub division: the yelling, the crunch of plastic bike wheels on pavement, the occasional slamming of a door, the occasional bark of a dog, and the whooshing of cars. And now that my wife was gone, and the house empty, my head was ready to explode.
The ironic thing was that while my right eye felt a little prickly and a tad bit itchy under the patch, I really didn't feel any pain there. The pain was the rest of the head. While the cause might have been the eye, I had a distinct feeling I was having a major hangover from the wearing out of the anesthesia. I lied on the couch, mostly on my left side so I didn't put pressure on my right eye, and placed a shirt over my head to block out light. Yet I just couldn't get comfortable.
It hurt so bad I couldn't snooze. I wanted so bad to get up and take another Vicodin, yet I didn't think I should -- or at least a phenergin.
My daughter came in about 8:00 as she was instructed, and I told her to take a shower and get ready for bed. Also said, "You have to stay inside and help me. Remember," I said, my voice barely audible as my mouth was dry as a cotton ball and my throat a bit raw from the intubation, "A few days earlier when you were sick I stayed up all night with you. Here's your chance to spoil your daddy."
"But daddy," she said, "I want to play with Alisha. He bed time is 8:30, so I'll come back then. Under normal circumstances this would not stand, yet these were not normal circumstances.
"Well, go ahead then!"
An hour passed and KK did not return. I wanted my wife, my own personal nurse, home. You know how us guys are when we're not feeling well: we like to be coddled. Yet what I really wanted was for her to come home and say it was okay to take another Vicoden.
The door opened. It was Crystal, "Well, Lany never stopped crying the whole first two innings. I felt bad for Jordan because I couldn't watch the game, I had to breast feed instead. So I figured I might as well come home."
"Why was she crying?" It was a rhetorical question
"Well, she didnt' get a nap today."
I think the real reason Laney was because babies have telepathy, and my Laney new I had a headache. After Crystal left and came back from picking up the boy, I strolled right to bed thinking I'd fall asleep. That never happened.
At 11:00 p.m. my personal nurse came in with some vicoden and a cup of water. She slipped in next to be and started rubbing my back.
"I never heard the kids come in," I said.
"That's because I told them to be quiet."
"That's rare that they listen," I said. It shows they can be good when they choose, I wanted to say, yet the words were stuckf floating among the air billowing around in my brain.
I arrived at the surgery center before my scheduled time of 9:30 A.M. and was immediately in with someone answering questions. Unlike our own hospital, they didn't ask me the same questions I was asked over the phone two days earlier. That was nice. And five minutes later my wife and I were lead to a recliner in the surgery preparation room by a young lady carrying a clipboard who said she was my helper. I do not remember her name.
She set the clipboard on the counter top to my right, and gave me a gown and told me to take everything off except my undies and "put on this gown." She left and I did as instructed. When she returned she picked up the clipboard and said, "So, it says here your RIGHT eye is being operated on. Is that right?"
She left and moments later a nurse's aid whose name I don't recall came in. The first thing she said was, looking at my wife, "Wow! When are we due?" After a brief chat she asked me tons of questions, ending with, "So, we are operating on your right eye?"
She took my blood pressure: it was 155/88, high for your humble RT. She took my blood pressure: 78, high for your humble RT, although in normal range.
Then anesthesiologist #1 came in to ask a few more questions. I don't remember her name either. She looked in my mouth, and I said, "Is this an LMA mouth or an ETT mouth?"
She said, "I'm not going to be taking care of you in surgery. Another anesthesiologist will do that. I'm just checking. "It says here you are going to have surgery on your right eye. Are you in agreement with that?"
A nurse came in next, and the first thing she said was, "When's the baby due?" Once again this set off a nice discussion, and it ensued until she was ready to insert my IV. "I'd rather have an ABG than an IV," I said.
"Really? I'd think ABGs would hurt worse," she said.
"I had an IV put in at the same time an ABG was being performed once," I said, "and I never even felt the ABG."
"We are operating on your right eye, right?"
Moments later anesthesioligist #2 came in. "We are operating on your right eye. Am I correct," she asked. He looked at my mouth. When I was finished, I said, "Are you going to use an ETT or an LMA?" She smiled in a way that indicated it was a question she never expected from a patient.
The doctor was next. "Are you in agreement we chose to operate on your right eye?" I agreed, and he took a black marker and marked over my right eye.
Another nurse came in. "I'll be your nurse during the procedure. We are operating on your right eye, right?"
"Just think right," I said.
Finally I was alone with my wife. White coat fever in full force, and my vitals proved it.
I walked to the cool operating room, and the doctor was sitting at the back of a bed all smiles. I do remember his name. There were 5 or so other's in the room. I hopped on the bed, was covered with a few warm blankets, and the anesthesiologist placed a mask a few inches above my head, "It's just oxygen," she said.
"Do you ever use gas to knock people out anymore," I asked, "or just IV stuff?
"We only use gas on kids."
"I remember that. In fact, I think that's what made my pukey after I woke up."
"You had this before?"
"Yes." I could feel the tingling now. I figured I'd be going out pretty soon. I would keep taking until I was out, which is out of character for me because I'm usually taciturn.
"And you have experience with nausea?"
"Yes."
"Have you ever had another surgery before. One not on your eye."
"Yes. I had this one three other times, and I remember being sick all three times. And in 1993 I had nasal septal repair. I did not get sick." My voice was starting to echo in my head. The medicine was working.
"Did you wake up nauseous for that one
"No."
"That's because for some reason when we operate on eyes and scrotums people tend to get nauseous."
I could hear my wife saying, "Don't say that to him." She wants me to get the big V.
That's my last thought before waking up. The blood pressure cuff was going off. I could feel the prick of my right eye. "What's the pain level," she asked. He name was Kathleen. I remember it, but only because I asked her 3 times.
"About an 8." It was purely subjective. I couldn't say 10, because to me 10 is so bad you can't sit still and scream. In fact, if you go by that measure, I was probably a five. Yet I didn't want her to be conservative with the medicine.
I could feel the blood pressure cuff squeezing my left arm again. When it was done I asked, "What was it?"
"Diastolic 100. The doctor said your young enough I can give you labatolol." She did, and the next time the cuff went off she said my blood pressure was 108/58. She said that was good, but to me it was low. I could really feel the tingling in my blood at that point, and as I tried to speak my words were drifting off.
"How long do I have to stay in this room." I was asking too many questions, although I was feeling great, like warm and tingly great. I could feel myself drifting off.
"Just until we have your blood pressure under control. I think it has to do with pain, so we have to get that under control."
"Take a deep breath," she said. Her voice coming from the distance. "Your sat is only 88."
I did, yet she repeated herself, "I need you to take in a deep breath. You probably know all about that."
I did. And I know that taking in a deep breath will only increase a sat while I'm taking in the deep breaths.
I felt no pain. And all the way home I felt no pain. I mean it felt awkward with a patch over my right eye, yet no pain. We stopped on the way home to pick up the kids from my mother's house, and I never even left the car. I had a blanket over my head, and all the meds in my body wouldn't let me move.
I heard a rap on the window. I waved, yet it was a feeble wave. I heard my 1 YO say, "Daddy, eye." The right home was abnormally quiet. Once home I felt great, and I was able to eat a couple pieces of toast.
The phone rang. It was 2:00. I picked it up. It was the doctor who poked my eye a few hours earlier. "Most people like to just lie around the first day," he said.
"I feel pretty darn good, considering. Although I don't have my hopes up based on my history."
"That's great. You can keep the patch on over night, if you want. I gave you antibiotis that should last 24 hours, so that should be okay.'
"I'll probably do that," I said.
"Your surgery went pretty good. Considering you had this done three other times, your muscle was still pretty intact. There wasn't much scar tissue. I think things went pretty well.
I took a nap, and when I woke up the oxygen tank in my head made it feel as though there was a herd of elephants in there.
Overall, I'd have to say I'm pretty impressed with the surgery, although it's only been 24 hours since my admission time yesterday. Other than the headache last evening, I've felt pretty good otehrwise. My eye feels a little weird, and uncomfortable, so I can see why a kid having this surgery might be a challenge as this guy wrote.
I had the surgery when I was 2, and my mom said I had a patch and was agitated by it. When I was 10 I had it, and I remember wanting the patch off, and the nurse took, it off, and then I insisted it be back on. I guess when you're uncomfortable you want to do something different, so this time I just left the patch on knowing it wouldn't feel any better with it off.
So, in this regard, I can see it's a much better expericne as an adult than as a child. Yet, I would highly recommend getting this done as a kid. Not being able to see properly can have its negative consequences. Whether you or your child as intropy or extropy types of strabismus, it's worth it to get the procedure done -- however annoying the post operation period is.
However, basically, you're loaded with so many good medicines the discomfort really isn't too bad. And it gives you an excuse to take a few days off and loaf around and sleep.
Overall I'd have to say it was a pretty positive experience. I was really impressed at all the people who saw me at the center, even while it was only a few moments for most. They all made doubly sure to recheck what I was having operated on. They all wore smiles. They all made what was a nerveracking experience not so bad.
Customer service is something Shoreline Medical works on with new employers, and then we are reminded in monthly meetings. Yet I imagine the screening tests we undergo before we're hired pretty much screens out the folks who wouldn't fit in.
And, as Kathleen noted, "Good customer service is probably a product of us all really enjoying our jobs."
My 11-year-old son had a baseball game and my wife was just about ready to leave, and I made sure she gave me a couple more Vicodin before she left. I knew I just too 2 four hours ago, but the directions said every 4-6 hours as needed (PRN) and I was going to take advantage of it. She also gave me a phenergin pill for the nausea.
About 15 minutes earlier Crystal woke me from a nice 2 hour nap, which to me is not normal unless I worked the night before. I usually don't take naps because when I do I don't sleep at night when I'm supposed to. Yet today that surgery, and the effects of the anesthesia, was my excuse to snooze. She probably wouldn't have awakened me, but I said she could if KK, my 7-year old girl, wanted to stay in the neighborhood and play with the neighbor girl.
So here I was lying on the couch listening to the accustomed sounds of sub division: the yelling, the crunch of plastic bike wheels on pavement, the occasional slamming of a door, the occasional bark of a dog, and the whooshing of cars. And now that my wife was gone, and the house empty, my head was ready to explode.
The ironic thing was that while my right eye felt a little prickly and a tad bit itchy under the patch, I really didn't feel any pain there. The pain was the rest of the head. While the cause might have been the eye, I had a distinct feeling I was having a major hangover from the wearing out of the anesthesia. I lied on the couch, mostly on my left side so I didn't put pressure on my right eye, and placed a shirt over my head to block out light. Yet I just couldn't get comfortable.
It hurt so bad I couldn't snooze. I wanted so bad to get up and take another Vicodin, yet I didn't think I should -- or at least a phenergin.
My daughter came in about 8:00 as she was instructed, and I told her to take a shower and get ready for bed. Also said, "You have to stay inside and help me. Remember," I said, my voice barely audible as my mouth was dry as a cotton ball and my throat a bit raw from the intubation, "A few days earlier when you were sick I stayed up all night with you. Here's your chance to spoil your daddy."
"But daddy," she said, "I want to play with Alisha. He bed time is 8:30, so I'll come back then. Under normal circumstances this would not stand, yet these were not normal circumstances.
"Well, go ahead then!"
An hour passed and KK did not return. I wanted my wife, my own personal nurse, home. You know how us guys are when we're not feeling well: we like to be coddled. Yet what I really wanted was for her to come home and say it was okay to take another Vicoden.
The door opened. It was Crystal, "Well, Lany never stopped crying the whole first two innings. I felt bad for Jordan because I couldn't watch the game, I had to breast feed instead. So I figured I might as well come home."
"Why was she crying?" It was a rhetorical question
"Well, she didnt' get a nap today."
I think the real reason Laney was because babies have telepathy, and my Laney new I had a headache. After Crystal left and came back from picking up the boy, I strolled right to bed thinking I'd fall asleep. That never happened.
At 11:00 p.m. my personal nurse came in with some vicoden and a cup of water. She slipped in next to be and started rubbing my back.
"I never heard the kids come in," I said.
"That's because I told them to be quiet."
"That's rare that they listen," I said. It shows they can be good when they choose, I wanted to say, yet the words were stuckf floating among the air billowing around in my brain.
I arrived at the surgery center before my scheduled time of 9:30 A.M. and was immediately in with someone answering questions. Unlike our own hospital, they didn't ask me the same questions I was asked over the phone two days earlier. That was nice. And five minutes later my wife and I were lead to a recliner in the surgery preparation room by a young lady carrying a clipboard who said she was my helper. I do not remember her name.
She set the clipboard on the counter top to my right, and gave me a gown and told me to take everything off except my undies and "put on this gown." She left and I did as instructed. When she returned she picked up the clipboard and said, "So, it says here your RIGHT eye is being operated on. Is that right?"
She left and moments later a nurse's aid whose name I don't recall came in. The first thing she said was, looking at my wife, "Wow! When are we due?" After a brief chat she asked me tons of questions, ending with, "So, we are operating on your right eye?"
She took my blood pressure: it was 155/88, high for your humble RT. She took my blood pressure: 78, high for your humble RT, although in normal range.
Then anesthesiologist #1 came in to ask a few more questions. I don't remember her name either. She looked in my mouth, and I said, "Is this an LMA mouth or an ETT mouth?"
She said, "I'm not going to be taking care of you in surgery. Another anesthesiologist will do that. I'm just checking. "It says here you are going to have surgery on your right eye. Are you in agreement with that?"
A nurse came in next, and the first thing she said was, "When's the baby due?" Once again this set off a nice discussion, and it ensued until she was ready to insert my IV. "I'd rather have an ABG than an IV," I said.
"Really? I'd think ABGs would hurt worse," she said.
"I had an IV put in at the same time an ABG was being performed once," I said, "and I never even felt the ABG."
"We are operating on your right eye, right?"
Moments later anesthesioligist #2 came in. "We are operating on your right eye. Am I correct," she asked. He looked at my mouth. When I was finished, I said, "Are you going to use an ETT or an LMA?" She smiled in a way that indicated it was a question she never expected from a patient.
The doctor was next. "Are you in agreement we chose to operate on your right eye?" I agreed, and he took a black marker and marked over my right eye.
Another nurse came in. "I'll be your nurse during the procedure. We are operating on your right eye, right?"
"Just think right," I said.
Finally I was alone with my wife. White coat fever in full force, and my vitals proved it.
I walked to the cool operating room, and the doctor was sitting at the back of a bed all smiles. I do remember his name. There were 5 or so other's in the room. I hopped on the bed, was covered with a few warm blankets, and the anesthesiologist placed a mask a few inches above my head, "It's just oxygen," she said.
"Do you ever use gas to knock people out anymore," I asked, "or just IV stuff?
"We only use gas on kids."
"I remember that. In fact, I think that's what made my pukey after I woke up."
"You had this before?"
"Yes." I could feel the tingling now. I figured I'd be going out pretty soon. I would keep taking until I was out, which is out of character for me because I'm usually taciturn.
"And you have experience with nausea?"
"Yes."
"Have you ever had another surgery before. One not on your eye."
"Yes. I had this one three other times, and I remember being sick all three times. And in 1993 I had nasal septal repair. I did not get sick." My voice was starting to echo in my head. The medicine was working.
"Did you wake up nauseous for that one
"No."
"That's because for some reason when we operate on eyes and scrotums people tend to get nauseous."
I could hear my wife saying, "Don't say that to him." She wants me to get the big V.
That's my last thought before waking up. The blood pressure cuff was going off. I could feel the prick of my right eye. "What's the pain level," she asked. He name was Kathleen. I remember it, but only because I asked her 3 times.
"About an 8." It was purely subjective. I couldn't say 10, because to me 10 is so bad you can't sit still and scream. In fact, if you go by that measure, I was probably a five. Yet I didn't want her to be conservative with the medicine.
I could feel the blood pressure cuff squeezing my left arm again. When it was done I asked, "What was it?"
"Diastolic 100. The doctor said your young enough I can give you labatolol." She did, and the next time the cuff went off she said my blood pressure was 108/58. She said that was good, but to me it was low. I could really feel the tingling in my blood at that point, and as I tried to speak my words were drifting off.
"How long do I have to stay in this room." I was asking too many questions, although I was feeling great, like warm and tingly great. I could feel myself drifting off.
"Just until we have your blood pressure under control. I think it has to do with pain, so we have to get that under control."
"Take a deep breath," she said. Her voice coming from the distance. "Your sat is only 88."
I did, yet she repeated herself, "I need you to take in a deep breath. You probably know all about that."
I did. And I know that taking in a deep breath will only increase a sat while I'm taking in the deep breaths.
I felt no pain. And all the way home I felt no pain. I mean it felt awkward with a patch over my right eye, yet no pain. We stopped on the way home to pick up the kids from my mother's house, and I never even left the car. I had a blanket over my head, and all the meds in my body wouldn't let me move.
I heard a rap on the window. I waved, yet it was a feeble wave. I heard my 1 YO say, "Daddy, eye." The right home was abnormally quiet. Once home I felt great, and I was able to eat a couple pieces of toast.
The phone rang. It was 2:00. I picked it up. It was the doctor who poked my eye a few hours earlier. "Most people like to just lie around the first day," he said.
"I feel pretty darn good, considering. Although I don't have my hopes up based on my history."
"That's great. You can keep the patch on over night, if you want. I gave you antibiotis that should last 24 hours, so that should be okay.'
"I'll probably do that," I said.
"Your surgery went pretty good. Considering you had this done three other times, your muscle was still pretty intact. There wasn't much scar tissue. I think things went pretty well.
I took a nap, and when I woke up the oxygen tank in my head made it feel as though there was a herd of elephants in there.
Overall, I'd have to say I'm pretty impressed with the surgery, although it's only been 24 hours since my admission time yesterday. Other than the headache last evening, I've felt pretty good otehrwise. My eye feels a little weird, and uncomfortable, so I can see why a kid having this surgery might be a challenge as this guy wrote.
I had the surgery when I was 2, and my mom said I had a patch and was agitated by it. When I was 10 I had it, and I remember wanting the patch off, and the nurse took, it off, and then I insisted it be back on. I guess when you're uncomfortable you want to do something different, so this time I just left the patch on knowing it wouldn't feel any better with it off.
So, in this regard, I can see it's a much better expericne as an adult than as a child. Yet, I would highly recommend getting this done as a kid. Not being able to see properly can have its negative consequences. Whether you or your child as intropy or extropy types of strabismus, it's worth it to get the procedure done -- however annoying the post operation period is.
However, basically, you're loaded with so many good medicines the discomfort really isn't too bad. And it gives you an excuse to take a few days off and loaf around and sleep.
Overall I'd have to say it was a pretty positive experience. I was really impressed at all the people who saw me at the center, even while it was only a few moments for most. They all made doubly sure to recheck what I was having operated on. They all wore smiles. They all made what was a nerveracking experience not so bad.
Customer service is something Shoreline Medical works on with new employers, and then we are reminded in monthly meetings. Yet I imagine the screening tests we undergo before we're hired pretty much screens out the folks who wouldn't fit in.
And, as Kathleen noted, "Good customer service is probably a product of us all really enjoying our jobs."
Wednesday, June 30, 2010
My eye surgery
I've been rolling around in my head what I can say to my doctor before he operates on my eye. Just something to spark a conversation, or get a laugh. Something like:
- I expect perfection
- I don't want to become a statistic
- It's my right eye, Doc. Just think right.
- I hope you didn't choose last night to start drinking.
- "I hope we're all republicans here." That was Ronald Reagan's line when he was shot.
- How come you're shaking this morning, doc.
- Don't give me a bloody lip (to the anesthesiologist)
- Don't chip my teeth (also to the anesthesiologist)
Although I've decided I might be better off saying nothing. I'm afraid if I get him to thinking too much while operating on me, he might just make me a statistic. I don't mean on purpose either.
Besides, I know how fun I get when I'm loaded with versed and vicoden. You might not be able to understand what I say, but I'm happy when I'm high. When I had an EGD a couple years ago I think I had the nurses rolling on the ground.
The unfortunate thing is I usually don't remember what I say, so chances are I won't be blogging about much of it. Obviously, if I do you'll be the first to know.
So I wrote this post yesterday while I was at work. This is being published while I'm on the operating table. I'm probably in lala land right now. Or perhaps the nurses are rolling on the ground, and my wife's face is red with embarrassment.
Tuesday, June 29, 2010
Deciding to go to the ER isn't an easy decision
I was having an email discussion recently with one of my asthma friends. She was telling me how she was reading my post, "Having asthma symptoms? Here's five tips to help you decide what to do," and started laughing when she read #3 on my list: go to the er if... you find yourself using your inhaler more than recommended.
I bet most asthmatics use their inhaler more often than recommended from time to time, and some of us more often than that. In fact, I think we asthmatics, along with some COPDers, and some cystic Fibrosisers, invented rescue inhaler overuse. And no, I'm not referring to abuse either. Yet, if you'd like, you can call us bronchodilatoraholics, which I wrote about here and here.
But, when you're referring to recommended, who'se recommendation are THEY talking about anyway. Are you talking about the recommendation of your doctor, or of the so called asthma experts or guidelines?
The asthma guidelines say if you use your rescue inhaler more often than 2-3 times in a two week period, your asthma is not in control and you should seek doctor consultation. Yet the guidelines also say that "control" may be different from one patient to the next. My doctor "recommends" I use my inhaler when I need it because I know my asthma better than anyone else -- which I do and always have (although I need it less often at the time being).
So, normal bronchodilator usage for me might not be normal for you. For example, I use my rescue inhaler 2-4 times in a day, while you might normally use yours 2-4 times in a two week period. So, by my definition, you should go to the ER if you are using it more than YOUR normal.
That was one of my better posts because I basically wrote that one to myself as well as other asthmatics. I don't find myself with bad asthma anymore, especially since I became a Gallant Asthmatic. Yet, I'm not really a Gallant Asthmatic -- I'm not perfect. Although what I am is the best asthmatic I can be. I oughta add that to the asthma types list.
It's funny how you could be an RT, a lawyer, an asthma expert, and whatever, and STILL have trouble making the decision to go to the ER. Yet being on the receiving end, working in an ER, I have never seen an asthmatic made fun of because he came in. Usually we herald asthmatics for coming in instead of waiting.
Although, my friend corrected me that the reason she hates going to the ER is because in her past she's been treated poorly. She said "made fun of" is a poor choice of words, that "whiners, or hysterics, or whatever" is more appropriate. She said many hospital workers treat everyone as though they are whiners and drug seekers and the like.
Although she did describe one vacation when she spent a night in a cabin near the small town I live in, and she had a good experience.
We do get our fair share of bad patients in the ER where I work. I would guesstimate that about 50% of patients don't need to be in an ER, and about 20% are whiners and hysterics and your drug seekers.
Although I couldn't imagine treating all patients as though they were. Yet sometimes it's hard to tell the normal folks from the whacky patients. Although if they're that bad in your ER, I guess I can understand why you wouldn't want to go there.
I'd like to think smaller hospitals would treat their patients better, especially considering we need to make money, and treating all patients like they are idiots wouldn't be a good way to do that. Larger hospitals have a steady flow of income that smaller hospitals don't have.
So why is it we have so much trouble deciding? I know: we're normal. Although by that philosophy, am I implying asthmatics who don't hesitate, who don't second guess themselves, are abnormal? Well, not really.
I bet most asthmatics use their inhaler more often than recommended from time to time, and some of us more often than that. In fact, I think we asthmatics, along with some COPDers, and some cystic Fibrosisers, invented rescue inhaler overuse. And no, I'm not referring to abuse either. Yet, if you'd like, you can call us bronchodilatoraholics, which I wrote about here and here.
But, when you're referring to recommended, who'se recommendation are THEY talking about anyway. Are you talking about the recommendation of your doctor, or of the so called asthma experts or guidelines?
The asthma guidelines say if you use your rescue inhaler more often than 2-3 times in a two week period, your asthma is not in control and you should seek doctor consultation. Yet the guidelines also say that "control" may be different from one patient to the next. My doctor "recommends" I use my inhaler when I need it because I know my asthma better than anyone else -- which I do and always have (although I need it less often at the time being).
So, normal bronchodilator usage for me might not be normal for you. For example, I use my rescue inhaler 2-4 times in a day, while you might normally use yours 2-4 times in a two week period. So, by my definition, you should go to the ER if you are using it more than YOUR normal.
That was one of my better posts because I basically wrote that one to myself as well as other asthmatics. I don't find myself with bad asthma anymore, especially since I became a Gallant Asthmatic. Yet, I'm not really a Gallant Asthmatic -- I'm not perfect. Although what I am is the best asthmatic I can be. I oughta add that to the asthma types list.
It's funny how you could be an RT, a lawyer, an asthma expert, and whatever, and STILL have trouble making the decision to go to the ER. Yet being on the receiving end, working in an ER, I have never seen an asthmatic made fun of because he came in. Usually we herald asthmatics for coming in instead of waiting.
Although, my friend corrected me that the reason she hates going to the ER is because in her past she's been treated poorly. She said "made fun of" is a poor choice of words, that "whiners, or hysterics, or whatever" is more appropriate. She said many hospital workers treat everyone as though they are whiners and drug seekers and the like.
Although she did describe one vacation when she spent a night in a cabin near the small town I live in, and she had a good experience.
We do get our fair share of bad patients in the ER where I work. I would guesstimate that about 50% of patients don't need to be in an ER, and about 20% are whiners and hysterics and your drug seekers.
Although I couldn't imagine treating all patients as though they were. Yet sometimes it's hard to tell the normal folks from the whacky patients. Although if they're that bad in your ER, I guess I can understand why you wouldn't want to go there.
I'd like to think smaller hospitals would treat their patients better, especially considering we need to make money, and treating all patients like they are idiots wouldn't be a good way to do that. Larger hospitals have a steady flow of income that smaller hospitals don't have.
So why is it we have so much trouble deciding? I know: we're normal. Although by that philosophy, am I implying asthmatics who don't hesitate, who don't second guess themselves, are abnormal? Well, not really.
Saturday, June 26, 2010
Super peripheral vision
My eye doctor told me during our last appointment that one of his past patients had the surgery to fix his wandering eye, and when he realized what it did to him he was pissed.
That's right, he got his eyes fixed and he was ticked off. That's because he was a football player, and he was a running back. Before his eye surgery he had super vision. While he wasn't able to focus in on what was right in front of him, he could see peripherally like a super hero -- like no one else.
After his surgery he lost this super peripheral vision, and it effected his game. I've noticed for quite a while I've had super peripheral vision, although I don't think I'll mind losing it. As of right now, I find that I'm unable to see in 3D like most people do.
In fact, the other day I was playing catch with my son and for the first time I saw double. I saw two Jordan's. This only happened because I worked the night before and was really tired -- yet I didn't like it. I had to quit. I didn't want to get donked in the head because I couldn't decide which Jordan was tossing the ball.
I'm working now, and I don't imagine I'll want to sleep much tomorrow. So I wonder if that double vision beast will return. To be honest, it's really not that big a deal. Although it's going to be nice once it's corrected.
At least writing positively like this gets my mind off the anxiety that I'm going to have my eye cut open. Believe it or not I actually watched the video of the surgery as you can see here. Eeek, don't watch it if you're actually gonna have this surgery like I did. It just ads to the anxiety of having surgery.
It's really not that big of a deal. I've had it done three times already, although the last one lasted 25 years. If this one lasts 25 years I'll be good to go. If not I'm gonna just deal with it, because this is the last time I'm going through with this. I've had enough interventions already in my short 40 years.
Basically it results in one day with my eyes shut with a good dose of phenergan and vicodin in my system. I had to ask for the phenergan because post op nausea is something that I've experienced in the past, and I think nausea was worse than actual pain or discomfort.
Pretty soon my super vision will be neutralized, and probably for the better.
That's right, he got his eyes fixed and he was ticked off. That's because he was a football player, and he was a running back. Before his eye surgery he had super vision. While he wasn't able to focus in on what was right in front of him, he could see peripherally like a super hero -- like no one else.
After his surgery he lost this super peripheral vision, and it effected his game. I've noticed for quite a while I've had super peripheral vision, although I don't think I'll mind losing it. As of right now, I find that I'm unable to see in 3D like most people do.
In fact, the other day I was playing catch with my son and for the first time I saw double. I saw two Jordan's. This only happened because I worked the night before and was really tired -- yet I didn't like it. I had to quit. I didn't want to get donked in the head because I couldn't decide which Jordan was tossing the ball.
I'm working now, and I don't imagine I'll want to sleep much tomorrow. So I wonder if that double vision beast will return. To be honest, it's really not that big a deal. Although it's going to be nice once it's corrected.
At least writing positively like this gets my mind off the anxiety that I'm going to have my eye cut open. Believe it or not I actually watched the video of the surgery as you can see here. Eeek, don't watch it if you're actually gonna have this surgery like I did. It just ads to the anxiety of having surgery.
It's really not that big of a deal. I've had it done three times already, although the last one lasted 25 years. If this one lasts 25 years I'll be good to go. If not I'm gonna just deal with it, because this is the last time I'm going through with this. I've had enough interventions already in my short 40 years.
Basically it results in one day with my eyes shut with a good dose of phenergan and vicodin in my system. I had to ask for the phenergan because post op nausea is something that I've experienced in the past, and I think nausea was worse than actual pain or discomfort.
Pretty soon my super vision will be neutralized, and probably for the better.
Monday, June 21, 2010
Strabismus: The case of the wandering eye
I have a post coming up on one of my blogs soon about how asthma is not just a disease of the lungs, but a disease that effects the entire body.For example, to go with my asthma I also been diagnosed with allergies, rhinitis, sinusitis, ear infections, conjunctivitis, GERD, deviated nasal septum, and even strabismus. In my case, as you can see from the picture, I have Walleyes. Actually, only one of my eyes appears to be out of alignment, and my doctor refers to it as exotropy (one eye wanders away from the nose).
Many of the above you can easily associate with asthma. The deviated septum is a greater stretch, although studies have shown asthmatics with allergies have a tendency to pick up sinusitus and rhinitis often, and the constant inflammation and irritation and rubbing often results in a nasal crease and, you guessed it, deviated septums.
Of course that problem was repaired long ago. Another problem that was repaired long ago and has made a comeback is strabismus. This is where my brain has lost contact with my eyeballs. My brain only has the ability to focus from one eye, and the other eye sort of drifts off, thus the common nickname wandering eye or lazy eye.
A better way of explaining it is to picture the front wheel bearings of a car. Your eyes, like your front tires, turn in unison as you move the steering wheel. If the left wheel is crooked, and you straighten it out, the right tire will be crooked. That's about how my eyes work.
The major problem with strabismus is the ability to focus. My doctor has actually said my vision for each eye is great for my age (20/20), yet I do not have the ability to focus. I have no depth perception. I have lost my ability to see in 3D. And, when I'm tired, I see double. This happened just last evening when I was playing catch with my son. I had to quit before I got donked on the head.
VisionRX.com describes strabismus in this way:
Strabismus is a functional defect where the eyes are misaligned and point in different directions. The brain’s ability to see three-dimensional objects depends on proper alignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the forms into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain. This causes loss of depth perception and binocular vision. The turned eye may be straight at times, and the misalignment may come and go. Strabismus occurs in about 4 percent of all children in the United States, equally in males and females, and is sometimes hereditary. The condition can also develop later in life.Actually, I find that I sometimes see double, especially when I'm tired. Yet I also see out of one eye at a time. This is probably because I have had bouts of strabismus my entire life. I've had surgery to correct it three times before now. (July 1, 2010, was my 4th corrective surgery)
In young children with any form of strabismus, the brain may learn to ignore the misaligned eye’s image and see only the image from the best-seeing eye. This is called amblyopia, or lazy eye, and results in a loss of depth perception. When an adult develops strabismus, double vision sometimes occurs because the brain has already been trained to receive images from both eyes and cannot ignore the image from the turned eye.
I first started noticing this a while back when I was doing breathing treatments and when I squirted the vial of medicine into the cup I kept missing the cup. Then one morning I dished out scrambled eggs, and I missed all the plates.
Harmless things, yet if your driving and all of a sudden you see a tree in the middle of the road, that's not so good. This occurs because while I'm looking at the road with my dominant left eye, my right eye is busy looking at the trees along the right side of the car. My brain picks up what both eyes are seeing, and thus the tree in the middle of the road that ain't there.
Now this has yet to pose a problem, as I just keep driving knowing the tree is not really there. Yet you can see how this might pose a problem. Plus what I just described is a rare and worse case scenario. Although it has occurred for split seconds.
Ironically, this has not effected my ability to draw blood gases. This is because as I'm getting ready to poke I concentrate hard and focus. My ABG success rate remains high until after 6 a.m. at which time it drops to a 90% success rate. At least that's how I've always explained it to my co-workers.
Now you might be saying: what is the connection between strabismus and asthma? Well, there is no proven link. Although from my review of historical text I've observed many asthmatics also have eye trouble.
Now this is not based on science, yet I would hypothesize as to whether all the bouts of conjunctivitis, and all the bouts of rhinitis (which is hay fever) have effected my eyes. Kind of like the way the deviated septum may have occurred due to constant rubbing of my nose, the crooked eye may be the result of constant rubbing of my eyes.
Despite my non scientific theory of what causes asthma, here is what strabismus.org has to say about the cause of strabismus:
"Many things and/or events can cause a strabismus. They include genetics, inappropriate development of the "fusion center" of the brain, problems with the controlled center of the brain, injuries to muscles or nerves or other problems involving the muscles or nerves. Surprisingly, most cases of strabismus are not a result of a muscle problem, but are due to the control system -- the brain."Of course I can't see this fact disproving my theory that rubbing of the eyes can cause strabismus. After all, rubbing is some form of "injury" to the muscles or nerves.
Or, according to lasereyecenter.com, it's caused by, "unequal pulling of muscles on one side of the eye or a paralysis of the ocular muscles." This definition also doesn't disprove my theory.
I remember when I was a kid having this same surgery when I was 2 in 1972, 10 in 1980 and 15 in 1985. I can't remember which eye was operated on those times, yet I remember parts if not all of them -- including when I was 2 believe it or not.
I remember my parents were not allowed to stay, and I remember having to sleep in a crib and I remember my parents saying goodbye. I also remember leaving the hospital in a wheelchair and my brothers saying, "Why can't I ride in the chair?"
Back when I was about 8 or 9 I remember walking with one eye shut all the time. Now, as an adult, as I do the same thing, I realize why I do this. It's the same as my tree in the middle of the road example above. When it's really sunny out, you focus on the ground before you, and face away from the sun as to not get the glare. Yet, while my left eye does this, the other is facing the sun. Hence, this eye is shut.I do this instinctively. I discussed this with my doctor, and he said walking around with one eye shut is the first sign of strabismus in kids.
In my review of this disease, I've learned that other famous people had it, including Abraham Lincoln. I knew he and I had to have something in common other than being great thinkers.
So, in a few weeks, I'm going to have this fixed for the 4th time. I'm not excited about it, although I'm looking forward to seeing right. So if I disappear from the blogsphere for a while in the first few weeks of July, now you know why.
Follow my strabismus surgery journey:
Saturday, June 19, 2010
Playing the game
I'm sure anyone who has asthma, including you, has heard of the game of asthma. The game, as I define it, goes something like this: You do what you can to be normal, and take the risk that you will be normal in the process.
The risks involved: the allergy and asthma beast might find you.
As much as we like to say it doesn't happen, asthma and allergies can and do effect our lives. Not as though it's that big a deal, but my mother invited me to spend the night at her home so all of her children could be together for one night.
In theory that would be awesome. It would be like old times. Actually, it would be like new times since we didn't sit and drink wine, whiskey and beer with mom and dad when we were kids, yet mom and dad and we kids are like chums now-a-days. It's neat how that happens.
I remember dad telling me that his best friend in his adulthood was none other than his own dad. They shared a business together, golfed together, and hung out together. It's just neat to come to the realization that the same has happened between me and my parents.
Yet just the thought of spending the night at my mother's home brings back memories of back when my asthma was not in control, and I'd wake up at night sniffling, sneezing and wheezing. It wasn't until I went to college and only had trouble on the weekends when I returned home for the weekend that I caught on that I just might be allergic to my mom's house.
So however nice it would be to be normal and just pack up my kids and go to mom's house, I don't think it's going to happen. I think it would be better just to stay home and sit out on the neighbor's back porch socializing and then return to my own bed when it's time.
We asthma experts often say that if you have your asthma under control you should be able to live a normal active life. Actually that's not totally true. You will have to make sacrifices. You will, as in the case with me, have to choose between whether you want to take risks or whether you want to stay in the confines of your own allergy proof home.
I think it was Bill Clinton who coined the phrase, "It depends on what the definition of is is." I think in the asthma world the correct phrase would be: "It depends on what the definition of normal is." What is normal?
To a male in my family, normal is socializing. Normal is sitting among friends, smoking a cigarette, and having a few drinks. Normal is packing up your things and visiting your brother when the opportunity strikes. Normal is playing sports. Normal is working in a factory, or in a car lot redolent of gas fumes, or....
So, after the lifestyle change that was necessary to get my asthma under control, what I have here in the blogosphere is the new normal. Yet it's not the normal. I'm happy and content in my new home, tucked in with my wife and kids, yet it would be even better if I could leave on a whim without having to worry about dust mites, and molds, and "do I have enough ventolin."
In a way it kind of sucks. It would be nice just to drop what I'm doing on a dime and just go somewhere. Yet when you have asthma, and worse allergies, you often have to think twice.
Unless you enjoy playing the game. The game, however, got old for me. I played it for many years, and I tired of it.
The risks involved: the allergy and asthma beast might find you.
As much as we like to say it doesn't happen, asthma and allergies can and do effect our lives. Not as though it's that big a deal, but my mother invited me to spend the night at her home so all of her children could be together for one night.
In theory that would be awesome. It would be like old times. Actually, it would be like new times since we didn't sit and drink wine, whiskey and beer with mom and dad when we were kids, yet mom and dad and we kids are like chums now-a-days. It's neat how that happens.
I remember dad telling me that his best friend in his adulthood was none other than his own dad. They shared a business together, golfed together, and hung out together. It's just neat to come to the realization that the same has happened between me and my parents.
Yet just the thought of spending the night at my mother's home brings back memories of back when my asthma was not in control, and I'd wake up at night sniffling, sneezing and wheezing. It wasn't until I went to college and only had trouble on the weekends when I returned home for the weekend that I caught on that I just might be allergic to my mom's house.
So however nice it would be to be normal and just pack up my kids and go to mom's house, I don't think it's going to happen. I think it would be better just to stay home and sit out on the neighbor's back porch socializing and then return to my own bed when it's time.
We asthma experts often say that if you have your asthma under control you should be able to live a normal active life. Actually that's not totally true. You will have to make sacrifices. You will, as in the case with me, have to choose between whether you want to take risks or whether you want to stay in the confines of your own allergy proof home.
I think it was Bill Clinton who coined the phrase, "It depends on what the definition of is is." I think in the asthma world the correct phrase would be: "It depends on what the definition of normal is." What is normal?
To a male in my family, normal is socializing. Normal is sitting among friends, smoking a cigarette, and having a few drinks. Normal is packing up your things and visiting your brother when the opportunity strikes. Normal is playing sports. Normal is working in a factory, or in a car lot redolent of gas fumes, or....
So, after the lifestyle change that was necessary to get my asthma under control, what I have here in the blogosphere is the new normal. Yet it's not the normal. I'm happy and content in my new home, tucked in with my wife and kids, yet it would be even better if I could leave on a whim without having to worry about dust mites, and molds, and "do I have enough ventolin."
In a way it kind of sucks. It would be nice just to drop what I'm doing on a dime and just go somewhere. Yet when you have asthma, and worse allergies, you often have to think twice.
Unless you enjoy playing the game. The game, however, got old for me. I played it for many years, and I tired of it.
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