Saturday, May 31, 2014
Second Sight
After the procedure on my eye, the protocol is to have the technician (or whatever she is called) put 2 different drops into your eyes and then you wait an hour in the office to have your pressure checked. The information sheet you are handed reads, in bold print, to "ALWAYS WAIT AT LEAST 15 MINUTES BETWEEN BOTTLES." The tech inserts a drop from one of the bottles and prepares to put in the other drop seconds later. "You're supposed to wait at least 15 minutes between drops," she says, "but I know you don't want to wait here that long." I'm scheduled to be there for at least another hour, so I say something like "Really?" Immediately her sunny demeanor turns cloudy, and she grudgingly concedes that she'll wait if I want to. I say never mind.
Thursday, May 29, 2014
SLT---for Me?
I underwent a Selective Laser Trabeculectomy yesterday. Ambivalent was not too strong a word to describe my feelings about it. And I'm still not sure if I made the right choice. How can we know if we're making the right medical decision, especially about any recent medical development where it is impossible to apply the test of time, at least an extended time?
Do we take the doctor's word for it, and assume he has our interest as the primary incentive for the treatment? It is certain that if you seek another opinion, or opinions, you will find one that differs from the first. In this case, the treatment, the SLT, is intended to lower the pressure within the eye so as to prevent damage to the optic nerve. Medically, high eye pressure can be a symptom of glaucoma, but it is also true that elevated eye pressure may have no relationship to glaucoma. Moreover, glaucoma can be present when the eye pressure is normal, or even lower than normal.
So the doctor senses that my low-normal eye pressure (IOP) may be too high for the continued well-being of my optic nerve, or maybe optic nerves. We haven't gotten that far yet. Whereas the usual treatment in such cases is a lifetime regimen of eyedrops, we find there is a new course of treatment, used for this purpose for about 12 years, but evidently in the practice I go to for only a few years. Possibly not even that long, because the option presented only last year, by another doctor in the practice, was eye drops. The present prescriber tells me that the SLT has none of the side effects of the drops, citing one of the drawbacks is that the drops can affect the heart. OK, I say, and schedule the procedure.
So I lean toward the SLT, over the drops anyway. I consider traveling to JH again, where a noted doctor told me he would not recommend any treatment, AT THE TIME, but that was a year ago. Could things have changed? I cancel the scheduled procedure, but do reschedule at a later date. I research as much as I can. Googling leads me to believe that the SLT is mild, almost without side effects, and is becoming the first line treatment in parts of the country.
But wait----I have another eye condition. How might that be affected by laser treatment. I go to my Foundation site. I already know that Lasix is dangerous and to be avoided at all costs. I find that lasers should also be avoided. I reschedule again, buying more time. I have an appointment with another of the doctors, for yet another condition. I mention my concerns, and he arbitrarily dismisses them, but in the process reveals he knows next to nothing about corneal dystrophy, a condition not treated in their office.
I leave the appointment in place, fatigued, and disappointed in myself for succumbing to the fatigue, and I show up early in the morning for the long-delayed SLT. I ask the tech if she sees many of the procedures and she says yes-------15 are scheduled for that day! I'm second, she says, and I feel like leaving. When Dr. W. shows up, right on time, I tell him I'm concerned about the SLT impacting on my other condition, and he reassuringly tells me that there are no studies linking the two. To me, that means only that there have been no studies, not no links. The SLT is very mild, he goes on, and only takes 2 minutes. So it's done.
The next step is the waiting room, a different one than I'd ever been in before, and its filled with the components of the select 15 SLT patients, and their wheelchair, canes, walkers. Each if us needs to have our IOP pressure checked one hour after the procedure, because the pressure can spike and then will need to be brought down. One woman is sent to the Clifton Park office for something, but we don't know why. My pressure is 13, fine, I'm told. I leave, still with misgivings....
Do we take the doctor's word for it, and assume he has our interest as the primary incentive for the treatment? It is certain that if you seek another opinion, or opinions, you will find one that differs from the first. In this case, the treatment, the SLT, is intended to lower the pressure within the eye so as to prevent damage to the optic nerve. Medically, high eye pressure can be a symptom of glaucoma, but it is also true that elevated eye pressure may have no relationship to glaucoma. Moreover, glaucoma can be present when the eye pressure is normal, or even lower than normal.
So the doctor senses that my low-normal eye pressure (IOP) may be too high for the continued well-being of my optic nerve, or maybe optic nerves. We haven't gotten that far yet. Whereas the usual treatment in such cases is a lifetime regimen of eyedrops, we find there is a new course of treatment, used for this purpose for about 12 years, but evidently in the practice I go to for only a few years. Possibly not even that long, because the option presented only last year, by another doctor in the practice, was eye drops. The present prescriber tells me that the SLT has none of the side effects of the drops, citing one of the drawbacks is that the drops can affect the heart. OK, I say, and schedule the procedure.
So I lean toward the SLT, over the drops anyway. I consider traveling to JH again, where a noted doctor told me he would not recommend any treatment, AT THE TIME, but that was a year ago. Could things have changed? I cancel the scheduled procedure, but do reschedule at a later date. I research as much as I can. Googling leads me to believe that the SLT is mild, almost without side effects, and is becoming the first line treatment in parts of the country.
But wait----I have another eye condition. How might that be affected by laser treatment. I go to my Foundation site. I already know that Lasix is dangerous and to be avoided at all costs. I find that lasers should also be avoided. I reschedule again, buying more time. I have an appointment with another of the doctors, for yet another condition. I mention my concerns, and he arbitrarily dismisses them, but in the process reveals he knows next to nothing about corneal dystrophy, a condition not treated in their office.
I leave the appointment in place, fatigued, and disappointed in myself for succumbing to the fatigue, and I show up early in the morning for the long-delayed SLT. I ask the tech if she sees many of the procedures and she says yes-------15 are scheduled for that day! I'm second, she says, and I feel like leaving. When Dr. W. shows up, right on time, I tell him I'm concerned about the SLT impacting on my other condition, and he reassuringly tells me that there are no studies linking the two. To me, that means only that there have been no studies, not no links. The SLT is very mild, he goes on, and only takes 2 minutes. So it's done.
The next step is the waiting room, a different one than I'd ever been in before, and its filled with the components of the select 15 SLT patients, and their wheelchair, canes, walkers. Each if us needs to have our IOP pressure checked one hour after the procedure, because the pressure can spike and then will need to be brought down. One woman is sent to the Clifton Park office for something, but we don't know why. My pressure is 13, fine, I'm told. I leave, still with misgivings....
Sunday, May 18, 2014
The night before (May 13) + The Appointment
I'm scheduled for the first anniversary visit of my knee surgery tomorrow. Last May 21 was the date of surgery on the right knee. I've not made a single call to the orthopedist's office, no questions, no requests for pain management, no complaints. The initial diagnosis cited the need for bilateral total knee replacement, but the unoperated knee stayed under the radar from the time of surgery, pain free. Until this spring. This morning when I brought the garbage cans from the roadside to the back of the house, my knee twinged, painful to walk. But later when I pushed the vacuum around the living room, it was fine. Then when I tried to clean the area outside the kitchen, where we keep the cat food, it acted up again. I don't know what I'll do or say at tomorrow's visit----just keep my mouth shut, I guess. I sure don't relish spending the summer recovering from another surgery. Especially since summers are at a premium now.......
The Appointment----May 14, 2014
I had X-rays of both knees. Dr. Congiusta said, "Right knee good; left knee not good." There is no cartilage, so bone on bone. It is the same as the other one was. "I'm surprised that you're not having more pain." I told him that I wouldn't expect the same results as before, since consensus seems that it was unusually successful. I told him the only issue was the discrepancy in leg length. The right leg had become very crooked when the cartilage wore away in the knee, and after surgery straightened the leg, it was almost half an inch longer than the other. He said the left leg is also crooked, and that the surgery would make them the same. He said he would expect the same results as before, assuming all is in order for the surgery, and he thought it would be.
It's up to me, as I knew it would be. There is absolutely no pressure to make a decision. All the risks involved with surgery are made clear. He did say he saw no reason why this surgery would be any different from the last. He said he would do it exactly the same way, using the Signature model. When he said it usually takes up to a year to get the full results of the operation, and I said I saw no difference after 2 months, he said that was very unusual.
--
The Appointment----May 14, 2014
I had X-rays of both knees. Dr. Congiusta said, "Right knee good; left knee not good." There is no cartilage, so bone on bone. It is the same as the other one was. "I'm surprised that you're not having more pain." I told him that I wouldn't expect the same results as before, since consensus seems that it was unusually successful. I told him the only issue was the discrepancy in leg length. The right leg had become very crooked when the cartilage wore away in the knee, and after surgery straightened the leg, it was almost half an inch longer than the other. He said the left leg is also crooked, and that the surgery would make them the same. He said he would expect the same results as before, assuming all is in order for the surgery, and he thought it would be.
It's up to me, as I knew it would be. There is absolutely no pressure to make a decision. All the risks involved with surgery are made clear. He did say he saw no reason why this surgery would be any different from the last. He said he would do it exactly the same way, using the Signature model. When he said it usually takes up to a year to get the full results of the operation, and I said I saw no difference after 2 months, he said that was very unusual.
--
Saturday, May 17, 2014
Manly
There are 30 doctors in the Ortho NY practice at the present time. None of them are women. I've read that orthopedists are mostly men because it takes a lot of physical strength to move bones and limbs around, sawing and hammering where necessary. This must be true and it's a scary thought.
Friday, May 16, 2014
Redux (May 11)
In three days I will have my annual knee check. I don't anticipate any problems with the operated (right) knee. The question will be what about the other knee. About seven years ago, when I first consulted an orthopedist about knee pain, I was somewhat surprised when, after viewing the X-rays, he quickly came to the conclusion that I needed bilateral total knee replacement. I didn't do anything about it at the time for a variety of reasons, first because I was taken by surprise, and, more to the point, I was still working and would not have been covered by insurance if I couldn't continue at my job. I remember the surgeon said to tell my employer that I had to be accommodated, but I didn't have that type of leverage and didn't even try to explain. He told me to call his office when I was ready and that I needed him more than he needed me. A heartless man, I thought.
So I limped along, figuratively and literally, for another six years, with varying degrees of discomfort, until the discomfort threatened to severely limit my mobility. This led me to my second orthopedist's visit, to a more kindly doctor, but one who still had the same diagnosis, the need for bilateral knee replacement. He suggested my thinking about it and talking it over with family, but I scheduled the procedure right there and then, with a date about six weeks away, which would have been in March. Of course, after the early bravado wore off, I postponed the surgery, for the reason I was tutoring a student who needed help to prepare for his June graduation. He really did need my help, but I do admit I was glad to have the excuse. There were so many cautions about total knee replacement that I was not anxious to go through with it; I think I may have postponed it indefinitely if my son hadn't made airline reservations to come home to help me. In face of all the advice and cautions, I had no idea what to expect in terms of how much help I'd need or for how long.
So, though not exactly forced, I felt compelled to honor my decision to have the surgery, and on May 21, old knee out, new knee in. Much easier than anticipated and way less traumatic than I'd been told to expect. I've never regretted it. Indeed, the outcome was so much of an improvement that my other knee was swept along with it, no more pain on walking and more stability. This happy state of affairs lasted into the fall and throughout the winter. But with the coming of spring came the beginning of forgotten twinges. My left knee doesn't react well to walking on uneven ground. It could be just strained because I've been outside this year doing a lot of the raking and yard work that I'd been unable to do for the past several years. I tell myself that. Yesterday, I walked a city block or so in Schenectady, and I'm pretty sure I got that old familiar feeling. Didn't I hear that clunking noise again?
I'm so much better off than I was a year ago that I'm reluctant to rattle the cage, as it were, but I also am not anxious to nullify my gains by allowing the other knee to deteriorate. The crux of the issue is that the knee doesn't hurt or ache if it's not being used. Neither did the right knee, not after the double set of cortisone injections administered by the first orthopedist. So if I can stop walking before my knee hurts, all will be fine, no surgery needed. I can wait to find out if pain will set in at rest. But then, if I need surgery, I'll be even older, and maybe, as I've been told, if the knee becomes more worn, the surgery becomes more difficult. I find myself on the horns of a dilemma. At Wednesday's visit, I will ask the surgeon what condition my left knee is in. Who knows, I've been using the stationary bike quite faithfully, so some muscles must be stronger, maybe enough to overcome the need for surgery. I don't kid myself, though, I know he'll say the decision is mine to make.
(May 12) Countdown to 2 days -----Testing 1, 2, 3
I walk across the yard to the end of the lot. I hear no sounds, but there is soreness, almost as if there is some sort of impingement. The pain stops when I stop. I have to take that as a good sign, and after all, the ground is uneven and moreover I walked around in Schenectady yesterday. I'm not sure I'll even mention my left knee at Wednesday's visit. There's no hurry anyway. I will be the only one affected by whatever I decide to do. Or at least I hope so.......I'll check again tomorrow, after my bike ride
So I limped along, figuratively and literally, for another six years, with varying degrees of discomfort, until the discomfort threatened to severely limit my mobility. This led me to my second orthopedist's visit, to a more kindly doctor, but one who still had the same diagnosis, the need for bilateral knee replacement. He suggested my thinking about it and talking it over with family, but I scheduled the procedure right there and then, with a date about six weeks away, which would have been in March. Of course, after the early bravado wore off, I postponed the surgery, for the reason I was tutoring a student who needed help to prepare for his June graduation. He really did need my help, but I do admit I was glad to have the excuse. There were so many cautions about total knee replacement that I was not anxious to go through with it; I think I may have postponed it indefinitely if my son hadn't made airline reservations to come home to help me. In face of all the advice and cautions, I had no idea what to expect in terms of how much help I'd need or for how long.
So, though not exactly forced, I felt compelled to honor my decision to have the surgery, and on May 21, old knee out, new knee in. Much easier than anticipated and way less traumatic than I'd been told to expect. I've never regretted it. Indeed, the outcome was so much of an improvement that my other knee was swept along with it, no more pain on walking and more stability. This happy state of affairs lasted into the fall and throughout the winter. But with the coming of spring came the beginning of forgotten twinges. My left knee doesn't react well to walking on uneven ground. It could be just strained because I've been outside this year doing a lot of the raking and yard work that I'd been unable to do for the past several years. I tell myself that. Yesterday, I walked a city block or so in Schenectady, and I'm pretty sure I got that old familiar feeling. Didn't I hear that clunking noise again?
I'm so much better off than I was a year ago that I'm reluctant to rattle the cage, as it were, but I also am not anxious to nullify my gains by allowing the other knee to deteriorate. The crux of the issue is that the knee doesn't hurt or ache if it's not being used. Neither did the right knee, not after the double set of cortisone injections administered by the first orthopedist. So if I can stop walking before my knee hurts, all will be fine, no surgery needed. I can wait to find out if pain will set in at rest. But then, if I need surgery, I'll be even older, and maybe, as I've been told, if the knee becomes more worn, the surgery becomes more difficult. I find myself on the horns of a dilemma. At Wednesday's visit, I will ask the surgeon what condition my left knee is in. Who knows, I've been using the stationary bike quite faithfully, so some muscles must be stronger, maybe enough to overcome the need for surgery. I don't kid myself, though, I know he'll say the decision is mine to make.
(May 12) Countdown to 2 days -----Testing 1, 2, 3
I walk across the yard to the end of the lot. I hear no sounds, but there is soreness, almost as if there is some sort of impingement. The pain stops when I stop. I have to take that as a good sign, and after all, the ground is uneven and moreover I walked around in Schenectady yesterday. I'm not sure I'll even mention my left knee at Wednesday's visit. There's no hurry anyway. I will be the only one affected by whatever I decide to do. Or at least I hope so.......I'll check again tomorrow, after my bike ride
The Office-MAY 14
I sit there waiting for my appointment. The waiting room is spacious and comfortable, not surprising since the building is new construction. There are close to a dozen people sitting there, some of them the patient's companion. No one waits for long, also not surprising because there are 29 doctors and almost as many PA's in the practice, with more in the process of joining. All but one of the other people present are wearing shorts. The day is warm, but not oppressively so. I speculate that maybe they want free access to their knees, though they can't all be there for that, and besides I see none of the telltale scars like the one concealed by my long pants, (chosen to be loose enough to easily slip up above the knee.) None of those present looks that good in shorts either, again not surprising as most are in the category where aging bones and joints have caused them to be there. The younger sports-injured patients presumably schedule their appointments after school or work hours, and acute injuries are treated at another facility. I have the thought that the doctors must derive much more satisfaction out of restoring use and mobility in the young where their orthopedic artistry has active use and longevity rather than being confined to the dust heap of eternity after a relatively short period of time. One patient I know who has a pair of artificial hips has said when she is cremated, she will bequeath the implants to her children, to be used as bookends; that is if they are not too badly charred.
Wednesday, May 14, 2014
May 14, 2014
It's early in the morning on the day of my appointment with Dr. C. I'm oblivious to the fact that I have knees. I feel nothing, though I have only walked as far as the bedroom to the kitchen.
One hour later, I go downstairs with laundry, and all is not well. Trepidation sets in as I leave for my appointment......
One hour later, I go downstairs with laundry, and all is not well. Trepidation sets in as I leave for my appointment......
Tuesday, May 13, 2014
May 13, 2014
At suppertime last night, it hurt to put weight on my left knee, but it's fine now at 2:45 a.m. I think it'll be okay. I've decided not to discuss whatever my decision will be until it happens. Everybody is too busy with their own lives, and old-people conditions are too deadly boring. I have a cousin who is the same age as I am, and I remember that her kids gave her and her husband a trip to Europe for their 25th anniversary. By then, their families were pretty much grown, and she and her husband only in their fifties. I feel like I'm in a time warp, so distressingly old, and my kids right in the hot and heavy midst of marriage and parenthood. It's an irony that what, by necessity, dominates our lives at the present time is anathema to those we are close to. Geriatric issues are the last thing anyone not personally facing them wants to address. If I announced that I was hatching a dinosaur egg in my cellar, it might generate a spark of interest, but health issues fall on deaf ears. Boring, depressing.
When I decided to have my surgery last year, I was distressed at the idea of being a hospital patient; my only in-patient stay had been for maternity which is a different type of deal. I totally resisted the possibility of a rehab facility. That idea doesn't seem so intolerable now; there's not that much going on in my life anyway. Tomorrow, Wednesday, I'll see what condition my knee is in, and maybe get an estimate of how long it's likely to hold up. Then I'll consult my actuarial table, and proceed from there.
When I decided to have my surgery last year, I was distressed at the idea of being a hospital patient; my only in-patient stay had been for maternity which is a different type of deal. I totally resisted the possibility of a rehab facility. That idea doesn't seem so intolerable now; there's not that much going on in my life anyway. Tomorrow, Wednesday, I'll see what condition my knee is in, and maybe get an estimate of how long it's likely to hold up. Then I'll consult my actuarial table, and proceed from there.
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