In the pre-op prep area
Around 10:30 AM yesterday, we arrived at the St. Elizabeth SurgiCenter for my DALK procedure. After a brief wait I was taken back to the prep area where the nurses to sign papers, took my weight and temperature, and checked my vitals. I was hooked to an automated blood pressure monitor and shortly after, an IV. My wife came back to sit with me while we waited on some other patients who were getting Cataracts removed to go through Dr. Holland’s busy operating room. I asked the nurses if they could add espresso to the IV, but sadly, they couldn’t. (Attn: Starbucks – opportunity?)
Dr. Holland came in and said hi, verified it was my Left Eye we were working on (this is part of their quality control) and then marked it with a pen. I was asked at least 10 times which eye we were working on, which led to my earlier post.
The anesthesiologist visited, described the process for putting me to sleep for a few minutes during which they would be numbing my eye (called a “block”). I was glad to hear I’d be out while needles are around my eye (remember the childhood chant “cross my heart, hope to die, stick a needle in my eye”? I said bring on the loony juice for that, Doc.. He said they’d have me “sleepy” during the procedure but able to respond to questions, etc. He also said that should I feel anxious they can add some more relaxation to the formula. I asked him if I could get a doggy-bag with some of that for occasional home use (I am raising two teenagers, after all.)
Several doctors and nurses visited and asked me many questions, listened to my heart and lungs, and filled out many on-line checklists on the computer terminal. It was more boring than anything.
One of the doctors came in (I wish I’d gathered names) and pleasantly talked to me about my condition – and offered up much reassurance about what I already knew – Dr. Holland was renowned for his abilities in corneal grafting – indicating that the guy in the next room had flown in from Colorado for a transplant.
After a while, people gathered and it was time to get sedated (remember the Ramone’s song?). I remember them saying they were ready to start the ….. and that’s it – dial tone. Asleep instantly. I then woke to what felt like a flurry of nurses and my bed was being rolled into the OR, which was a well-lit room with Dr. Holland and his assistant. My left eye was in lockdown mode. Very strange.
Some of the things I remember from the surgery:
- The placement of the trephine on my eye and the sensation of Dr. Holland spinning it -whee. This was cutting a precise circular area of my cornea to a precise depth. Completely painless, but I recall thinking “there’s no turning back now.”
- The big bubble being inflated. This caused my blurry world to go snow white all of a sudden. Very strange.
- The dissection of the cornea – lots of blurry lights and a slow removal of the whiteness. Completely painless.
- Discussions between Dr. Holland and his assistant about a micro perforation of my Descemet’s membrane. *(More on what happened later – Dr. Holland filled me in in the follow up visit.)
- Dr. Holland requesting right and left handed scissors as he cut the outer radius of my cornea free.
- Dr. Holland requesting the donor cornea. This was a special moment that I knew was coming.
- The beginning of suturing. And some short-term pain that the anesthesiologist remedied on the fly.
- The application of a large contact lens – which is meant to reduce discomfort while the epithelium heals.
- Dr. Holland saying – “all done, beautiful job.”
Midway Through the Surgery, A Complication
I learned during my follow up that the surgery took twice as long as usual because of the microperforation of my Descemet’s membrane caused by the scar tissue that severe Keratoconus causes. At this point, many surgeons would have immediately converted to PK and done a full-penetrating graft. Dr. Holland’s skill in dealing with this (>50 DALKs per year) came into play and he was able to specially dissect around the perforation and save my Descemet’s membrane. The implications of this are faster healing time, near zero chance of rejections, and a graft likely to last the rest of my life. All of the work in finding Dr. Holland, the trips to Edgewood, and the homework paid off in those few minutes.
Because of the unexpected extension of the procedure, as suturing began, my anesthesia began to wear off (I’m notoriously resistant to anesthetics, my dentist has to shoot me twice as much as most patients.) I was so sleepy that all I could do was moan – Dr. Holland would apologize to me “Sorry about that.” After a couple of these, the anesthesiologist added more pain medicine to the mix and all was well soon – but not immediately.
It was pretty uncomfortable for a few minutes before that stuff got into my system. It didn’t last long, but I would like to have known some sort of signal other than vague moaning. Later, they said I should have let them know – but I was terrified of moving during surgery and disrupting the precise activity Dr. Holland was doing. So ask your surgical nurses or anesthesiologists what you should do if you feel pain during the procedure. For most people, this would never be an issue. I was just under the knife longer than expected for the drugs administered.
After the procedure. Shielded and Caffeinated
Dr. Holland’s words will echo for a while… “All Done, it went beautifully.”
After we were done, I was bandaged with a shield, taken somewhere to rest, and eventually transferred from a bed to a recliner in a room where Heather was waiting. It was nice to see her smile. I told her “they did the DALK successfully, it went well.” or perhaps I said “Led Zeppelin planted some Pansies on our Garage Roof” – hell if I know, I was flying high. I had poor balance and was pretty sore. I lost all track of time.
After missing my morning coffee or any Food for a while, I was also getting a caffeine / food headache. The nurses then offered me possibly the best tasting Coke I’d ever had in my life. They also gave me some medicine for my headache, and then I was led to the men’s room for additional relief. Soon, it was time to say goodbye, and, 3-4 hours after arriving, I was wheeled out to the van and we headed back to Lexington.
Get Ready for Some Discomfort, But It Doesn’t Last
After leaving, things got painful in and around the eye and I would have described it at the 8 out of 10 level for a short while. This should be expected – and you should plan on staying on a comfy couch or bed for the rest of the day. Have help around to bring you what you need. It stands to reason things would hurt: your eye was just stuck, sliced and sewn up. It was manipulated like it had never been. Manipulation includes the clamp that holds it open, tons of surgical instruments, endless poking, and several major injections. I wonder if the pain management could have been better perhaps with narcotics – but the nurses just told me to take Tylenol. Tip: Ask your nurses if you can have something stronger just in case.
But take some comfort. It felt far better after 5-6 hours of rest - and by the next day, the soreness was more irritating than anything. It is worth it and a small price to pay for long-term better vision. Just don’t expect this to be a cake-walk the first day.
My eyes are tired, so this post will end here. Next: My follow up.
Please make sure to read the entire diary and get the full story.