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....
    

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