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My DALK Corneal Surgery Day

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.

Surgery

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

Success!!

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.

 
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Posted by on March 10, 2011 in Diary Entries, Recovery, Surgery-Story

 

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Surgery update.

A full report will come soon with photos and lots of info, but this is just to let all know that things went very well.

 
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Posted by on March 10, 2011 in Diary Entries, Recovery, Surgery-Story

 

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Fix This One

Just about everyone I’ve talked to at the Eye Center have asked me which eye they were operating on.   I’m sure it’s part of quality control.  Anyway, I thought I might play a joke by arriving with this helpful note affixed.

Well, tomorrow is the day.

Developments today are minimal – verified that pharmacy had new prescriptions and asked nurse about migraine medicine and surgery.  I have gathered up my plungers and other supplies related to my scleral lens and will put those in storage after tomorrow.

All in all, I’m ready to go.

 
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Posted by on March 8, 2011 in Diary Entries, Pre Surgery, Surgery-Story

 

Pre-Op Activity, Weekend Stuff

Somewhat boring entry today…I had conversations with two staff at CEI Thursday, received directions and instructions for surgery day.   Also filled one of my prescriptions at the pharmacy, and blocked out my work calendar.  My office-mates and friends have been offering support and curiosity about what’s happening.

I can’t eat or drink after midnight on Tuesday night, and I need to wear a button-down, short-sleeve shirt to facilitate various wires and tubes.  I will take out my semi-Scleral lens for the last time upon arrival Wednesday AM.   I will call the pharmacy tomorrow afternoon to be sure they received prescriptions from CEI.

Both CEI staff asked me if it was the “left eye” that was being worked on.  I told them it was not a confidence inspiring question, and I might mark my left eye with a “THIS ONE->”  before I go in.  Hilarity all-around.

I sent a message to the staff today asking if they would be capturing video or photographs from the procedure.  If they do, I’ll share them with you in my diary entries.

I think my next post will be Wednesday morning.

 
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Posted by on March 6, 2011 in Diary Entries, Surgery-Story

 

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Thoughts on Organ and Tissue Donation

On Monday or Tuesday, someone is going to die.

A man, a woman, older or younger, black, white, Asian, Christian, Jew, Atheist, Gay, Straight…. someone will be lost.. Thanks to a 10 second investment, signing a donor card or answering a donation question, an eye will be harvested, sent to an eye bank and the corneal tissue delivered to Dr. Holland. The unselfish act of a total stranger will give me better vision, someone else life with a kidney, another dying person a heart or lung, perhaps.

I think that, if you are healthy and have not signed an organ donor card, you are committing a selfish act.

I was surprised to learn that 95% of Americans “support” organ donation, while only 38% are registered organ donors? I think it’s probably a combination of laziness, ignorance, paranoia and anti-scientific leanings. But mostly I think it’s the ridiculous opt-in system that we use in the US right now.

If you believe in heaven – donating your viable organs will look very good on your resume at the pearly gates check-in queue.
-Me

How many people die because people, rather than having some deep philosophical misgivings, simply forgot to sign their card? I’m a major advocate for opt-out organ donation nationwide and presumed consent.

Presumed consent, advocates argue, combines the principles of supply-side efficiency, respect for individual conscience, and individual’s positive, yet qualified, duty to promote the good of society.
-Organ Procurement and Transplantation Network

If someone is bothered by the donation of their organs, let them do the work of un-registering themselves. During that process, they will take an internal ethical journey, at each step justifying their position. I think many would reconsider after reflection.

More than 100,000 people are currently waiting for organ transplants, and close to 20 die each day because of organ shortages.
– National Institutes of Health

I’m also an advocate for preference of donors in receipt of organs/tissue should they need it. Excepting those with health issues that prevents donation, I think that when there are two people with equal need for a given organ, preference should be given to the one who has signed their donor card, such as it is in Israel

All major religions in the United States support organ, eye and tissue donation and see it as the final act of love and generosity toward others.
DonateLife

USA Resources:

www.donatelife.net
Created and maintained by Donate Life America, www.donatelife.net contains important facts and information about donation and transplantation as well as details on how to become a registered organ, eye and tissue donors in each state.

www.donevida.org
Donate Life America’s Spanish web site, www.donevida.org contains facts and information about donation and transplantation and addresses concerns that are specific to the Hispanic community. It also details how to become a registered organ, eye and tissue donor in each state.

www.unos.org
Created and maintained by United Network for Organ Sharing (UNOS), www.unos.org is the organ transplantation information resource for medical professionals and the general public. UNOS brings together medicine, science, public policy and technology to facilitate every organ transplant performed in the United States.

optn.transplant.hrsa.gov
Created and maintained by UNOS the site contains in depth national, regional, and state donation and transplantation data.

www.transplantliving.org
Created and maintained by UNOS, the Transplant Living Web site is the definitive information and education resource for transplant patients and their families.

www.restoresight.org
The oldest transplant association in the United States, the EBAA is a nationally recognized accrediting body for eye banks.

www.aatb.org
The American Association of Tissue Banks (AATB) is a professional, non-profit, scientific and educational organization. It is the only national tissue banking organization in the United States, and its membership totals more than 100 accredited tissue banks and 1,000 individual members.

www.aopo.org
The Association of Organ Procurement Organizations (AOPO) is the non-profit organization recognized as the national representative of fifty-eight federally-designated organ procurement organizations, serving more than 300 million Americans.

Interactive Body (opens in new window.)

I am seeking the source of the terrific illustration above so I can provide credit. Is it your illustration? Please email me so I can attribute it.
 
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Posted by on March 4, 2011 in Diary Entries, Pre Surgery

 

Corneal Transplant Countdown – 1 week to go

Springtime in Kentucky by Scott Clark

Springtime in Kentucky is Coming

It’s been a good week.  The signs of Spring are all around Kentucky.  If there is a more beautiful place to be in the Spring than Kentucky, I’ve not found it.  Soon foals will be visible in the plank-wood fields in the rural parts of the state and Lexington’s downtown will get busier during the day as people come out.

I bought myself a present – a new commuter bike, and to get it, I made a short 350 mile roadtrip to Indianapolis, listening to an Audiobook (“Shopclass as Soulcraft”).  Knowing I may not be driving much for the next couple of weeks, I thought it would be nice to go on a short mission.  I was right, it was fun – and I got a great deal on the bike!

I have had mostly good days with the semi-scleral lens, wearing it for 11-12 hours daily – my absolute max.  I’ve done well on watching the clock and not forgetting (easy to do on good days, when your eye feels great.)

But the calendar is ruthlessly counting down the days until I go in for my DALK procedure.   I’m apprehensive about it, but reason with myself that I’m already functionally blind in my left eye. It’s not as if I have great vision and am treating some invisible condition with a risk of losing what I have.  The overwhelmingly likely scenario is a successful procedure next week.   So, let the days come and I’ll check in again in a while.

 

 

The “7” photo to the left is by Alan Campbell.  The field is by me.
 
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Posted by on March 1, 2011 in Diary Entries, Pre Surgery, Surgery-Story

 

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Examples of Keratoconic Vision Simulations

I did a bit of searching for good examples of how life looks when you have Keratoconus… Here are the images I found.   Some images weren’t credited… so if you are the creator/artist/photographer and I have used an image you would like removed, please make contact with me.

Example 1 (click to zoom)

Example 2: Click to zoom

Example 3 - Click to Zoom (From Brian Williams' Excellent Diary - see blogroll)

Example 4 - click to zoom (Ghosting)

 
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Posted by on February 23, 2011 in Interesting Stuff, Surgery-Story

 

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2 Weeks To Go – Pre-surgery Physical

Had my pre-surgical physical today in Lexington at Baptist Family Medicine Clinic – with my long-time family MD. No surprises. I am healthy and should be good to go. Blood test, a few questions, and I was out of there. Scale was friendly – showing I’d dropped 11 lbs. Blood pressure was completely normal – nice considering my family history of high blood pressure.

The staff were quite interested in seeing the photos of my cone taken (previous post) the day before. Oddly, my physician was having trouble with dry eye, and I was able to give her advice and tell her about how semi-scleral lenses help with this – talk about role-reversal.

It is now 2 weeks from my surgery.   I’ve been studying the various means of anesthesia – as evidence on right demonstrates.

 
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Posted by on February 23, 2011 in Diary Entries, Pre Surgery, Surgery-Story

 

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Finally… Some Good Pictures of my Cone

Well, I set out today to take a good quality picture of my cone, and managed to do it (after 20-30 tries) with my iPhone4.    It’s not easy getting the alignment right.

Alas… you now see the culprit.  A ugly, lumpy cornea with a bulge at the bottom.   If you zoom these, the cone is really obvious.

Keratoconus - Cone visible from side

Keratoconus - Cone from side

Keratoconus - Cornea Covered by Semi Scleral Lens

Semi Scleral Lens Covering Keratoconic Cornea

Keratoconus - Cone visible from side

Keratoconus - Cone from side

Keratoconus - Cornea Covered by Semi Scleral Lens

Semi Scleral Lens Covering Keratoconic Cornea - Arrows show perimeter.

 
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Posted by on February 22, 2011 in Interesting Stuff, Pre Surgery, Surgery-Story

 

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Keratoconus and Eye Rubbing – Which came First?

Scott Clark on Motorcycle

Scott out making his eyes itch, among other things.

The idea that Keratoconus is caused by eye rubbing has been around a while.  I’ve talked with 5-6 corneal surgeons and they’ve had differing opinions on it.   There was consensus that one should be more safe than sorry and advise kids to avoid hard eye rubbing – and to treat the underlying condition.   My daughter’s itchy eyes are treated with Patenol, and I advise my kids to avoid doing it.  I asked them to report it to me when they have itchy eyes and I guaranteed to help them get rid of the symptom.  When I was a kid, I rode motorcycles a lot.  In the dust, dirt, mud, fields of corn, fields of grain, fields of dreams.  But I don’t recall rubbing my eye that much.. but why would I?

“For example, a case control study of 120 subjects with KC involved assessment of potential risk factors, including atopy, family history, eye rubbing, and contact lens wear. In the univariate analysis, there were associations between KC and atopy, family history, and eye rubbing. However, in the multivariate analysis, only eye rubbing was still a significant predictor of KC.” – Charles W. McMonnies, M.Sc., University of New South Wales, Kensington, Australia  (see more)

Here are some other articles/citations on the issue:

This quote from one physicians’ advice puts it in plain English:

Keratoconus has been associated with eye rubbing and eye allergies. Don’t rub your eyes!!! It is believed that eye rubbing can help to distort and thin the corneal surface. To help you with not rubbing your eyes you can use eye drops that lessen the symptoms of eye allergies. Some of these are available over the counter and some need to be prescribed. A good over the counter anti-histamine eye drop is “Zaditor”. Cool compresses help. There is also some evidence that using cooled tea bags and even cucumber slices help to calm the symptoms of eye itching.  – Dr. Jon Vogel

I may extend the list of links above if I find anymore.

Tomorrow:  My pre-surgery physical.

 
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Posted by on February 22, 2011 in Diary Entries, Interesting Stuff

 

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