Marching Along

March Madness

The first week of March was an eventful one. My husband had his second cataract removed on the 1st. Both of his surgeries went well, and he is able to see without glasses for the first time since he was a boy. The next day was his birthday, so after taking him for his follow up appointment with the eye doctor, we went to one of our favorite local restaurants for dinner. We saw another couple from our community there, so we joined them at their table and had great food and conversation.

Friday night we went out to eat with our next door neighbors as one of them was having a birthday on Saturday. We celebrated the two birthdays with a nice meal, followed by dessert at our house. I was told one of my neighbor's favorite desserts was Bumbleberry Pie. Needless to say, I was intrigued. What in the world is a bumbleberry? As it turn out, there is no such thing and it's just a fun name Canadians put on a mixed fruit pie. I decided to make one, and it is a lovely pie. Not too sweet, but not too tart either. I served it with vanilla ice cream, and we all enjoyed it.

Bumbleberry Pie

Saturday afternoon I played in my fist Queen City Pickleball League game. My husband and I are both on the team, though neither of us was scheduled to play yesterday. One of the women needed a sub, so I said I could come. Each team had 6 players, consisting of three men and three women. I played a game with each of the women on our team as well as one with each of the men, for a total of 5 games. It was outside, and the wind was definitely a factor. It was a lot of fun, and our team ended up winning 8 of the 15 games. Not too bad for our first time playing together. Jim and I both play next Saturday against a different team.

Today we were supposed to go kayaking with a group of people in our neighborhood. But the wind gusts are up to 25 mph, so I think we are going to pass despite the nice temperature. I think I will take my electric bike out for a ride instead. I've been trying to ride 6-7 miles each day, and I have been pretty successful in doing that. Ride on...

Update on the Eye Issue

This morning I was to have the YAG procedure performed on my right eye. It was an inconvenient date and time as our daughter was visiting us from Los Angeles for a long weekend, and I was looking forward to spending her last day here doing fun things. Thinking the right eye was going to be taken care of on September 12th, I was not anticipating this conflict. See my previous post for more on that.

When I got to the office today for my 10:00 appointment, I explained that my left eye just is not right. So again they sent me upstairs to have an eye exam done, fitting me in around patients who were already scheduled for such activities. Obviously I was screwing up the schedule of not only the surgi-center but the regular office as well. Dr. Pepose said this time there is not any filament or stray cells on my lens. Instead it is my astigmatism in the left eye that is causing the problems.

My vision with both eyes together is 20/20, and I have tried to explain that I am happy with the outcome in terms of what I can read. However, it is the quality of what my left eye sees that is the problem. Everything is slightly blurry. My frustration comes from the fact that I paid (a lot!) for the enhanced intraoccqular lenses to be implanted during the cataract surgery, and also for my astigmatism to be corrected in the left eye. The lenses and correction were not covered by my insurance, so that was all out of pocket. So to be told now that the astigmatism still exists came as a shock to me.

Apparently my astigmatism was corrected to a certain point, which is obvious as I was reading 20/50 with that eye before surgery and it is now 20/30. However it was still not as good as my right eye, which is why I am seeing the difference between the two eyes. My choices are 1) live with it, or 2) have an additional procedure know as Limbal Relaxing Incisions (LRI) done to further correct the astigmatism. The downside is that I may lose a little near vision, but what I do see will be clear. What a choice!

While I have tentatively scheduled the procedure just to secure a spot on the calendar, I'm not really sure what I'm going to do at this point. One decision became clear to me, however. I am definitely not going to have the YAG done on the right eye at this point. I'll be leaving well enough alone on that one for the time being.

More Eye Issues

eye ball

Yesterday I went back to the eye surgeon to have the same surgery performed on my right eye that had been done on the left last week - the YAG laser procedure. But that is not what ended up happening. After I got checked in and before the nurse put the dilation drops in my right eye, I mentioned that the left eye was still cloudy. In fact, I think my vision was worse in that eye than before I had the laser done. That proclamation resulted in her talking to Dr. Pepose once he came out of the surgical suite he had been in, and he decided he wanted me to have a thorough exam done on my eyes before proceeding.

The bottom line is that they determined I had a filament that was still covering my left eye, and he wanted to go ahead and take care of that first. So the YAG was repeated on the left eye, and the right eye was rescheduled for Monday.

I'm not convinced the left eye is totally cleared up yet. I'm going to see how things look in the morning, and may give the doctor's office a call. At this point I'm not even sure I want to have the right eye done, because I certainly don't want to have it turn out like the left eye.

All of this is pretty disappointing as my vision was better before I had the darn cataracts removed!

Eye Yi Yi

creepy eyes

This morning I had the YAG laser capsulotomy performed on my left eye to remove the cells that were forming on the back of the new lens that was inserted following my cataract surgery in June. Essentially it was as if I was looking through a window that had finger prints on it. That is not exactly the result I was hoping for after bucking up for the expensive replacement lenses. My surgeon noticed the problem when I was in for my one month follow up appointment. In fact he said the right lens had some cells on it as well, but that the left eye was more prominent and the cells should be removed.

My insurance company insisted that I wait 3 months post-surgery before they would approve the YAG procedure, which is why I didn't have it done before now. Fortunately for this I could drive myself to and from the appointment. I arrived at the surgical center about 8:50 for a 9:00 appointment. I signed the appropriate paperwork, and at 9:15 was taken in the back to have my eye dilated before returning to the waiting room. Shortly after 10:00 I was again taken back, this time for numbing drops, and then seated before Dr. Pepose in front of what looked like the normal machine they use to examine your eyes. He placed a clamp on my left eye to keep me from blinking, and as I kept my chin and forehead pressed against the machine, he zapped my eye with the laser. In less than five minutes it was all done.

The assistant rinsed my eye, and then placed Lotemax drops in my eye. Lotemax is an anti-inflamatory steroid drug, and one of the three drops I had to use in both eyes following cataract surgery. For this, I need to place one drop in the affected eye three times a day for a week.

I asked Dr. Pepose if I could go ahead and schedule the right eye since my deductible and maximum out of pocket expenses have been satisfied for the year, which for us ends on September 30th. He said absolutely, so I will get it done next week. I also told him about the fact that my left eye has a bit of discomfort still. I asked him if he ever wore the hard contact lenses. I got my first pair of those before my sophomore year in high school, and they were extremely painful to get used to. You had to build up a callus on the back of your eyelid, and that is sort of how this feels. He suggested I try taking fish oil pills twice a day, as that has proven to help some patients with dry eyes. Otherwise the option is for me to use prescription eye drops like Restasis. I'd like to avoid that if possible, so I'll give the fish oil a go and pray for the best. My left eye has seemed a little better the past few days, so perhaps I am turning the corner on that problem anyway. Of course, having the laser treatment done may change all that.

In all, I was at the office an hour and twenty minutes. They had warned me to be prepared to be there two hours, so getting out early was a bonus. Hopefully next Wednesday will go just as smooth.

Left Eye Cataract Surgery Follow Up

My one week follow up appointment for my second cataract removal was yesterday morning. When I woke up yesterday, my left eye was bothering me a bit. It sort of felt like something between a scratch and having something in my eye. The prescribed eye drops did nothing to alleviate the sensation. As I was heading to the doctor for my appointment, it seemed fortuitous that it began to bug me that morning.

A check of my eyes revealed the eye pressure was 10 in the right eye and 11 in the left, both well within normal ranges. My vision has continued to improve, and in fact I could read the eye chart and the text sheet they handed me better with my left eye than with the right. At home I very rarely have to slip in reading glasses, so that is fantastic.

Dr. Pepose said the left eye looked really good, but in light of my complaint he had the technician run dryness tests on both eyes. As both came back being too dry, he feels that the discomfort in my left eye is due to dryness. It is hard to fathom considering I am putting three drops in each eye three times a day, but there you have it. He suggested that I get an over the counter eye drop called Retaine. He also said that there is an ointment I can use in the eyes each night in case the day drops don't do the trick. Just what I need - more things to put in my eyes!

Retaine eye drops

Stopping at Schnucks, I found that they do not carry Retaine. After looking up the product online to see if I could substitute one of the other 30 brands of eye drops on their shelf, I found that Retaine has a proprietary ingredient that no one else has. Off I went to Walgreens to look for the elusive drops. Even there with the 60 brands of eye drops on the shelf, I had a hard time finding Retaine. After Googling it to see what it looks like, I saw that it comes in a square box with single-serving tubes inside, while I had been looking for a box that would contain a bottle. I finally located the drops, and was dismayed but not all together surprised to find that the price was $26.99 for the 30 drops. Yikes! No wonder a lot of older people don't take care of their eyes - it is so expensive to buy all the different kinds of drops you need! On the plus side since it was the first Tuesday of the month, the clerk asked if I was a senior as I could receive a 20% senior discount. Since their age requirement is 55, I'll take that as a compliment. Here's to senior discounts!

I have used the drops a few times now, in both eyes as directed. The immediate relief in my eyes is great, but about 5 minutes later my left eye feels scratchy again. If the situation doesn't improve in a couple of days, then I'll go pick up some of the ointment to use at night. It seems odd to me that there was no problem until six days post-surgery. Maybe there is just something in the air as the allergens have been high lately. We'll see what happens - bah!

Cataract Removal in Left Eye

left cataract removal

Yesterday morning I had the cataract removed from my left eye. I was a little less anxious since I knew what to expect. They did give me a little more of the sedation drug since I had told them I didn't experience anything the last time, and it certainly didn't relax me for the surgery. I can't say that it did anything for me during the second surgery either, but boy did it affect me after the fact.

The surgery went well, and before I knew it I was being wheeled out with my juice and pretzels to meet Jim. I was quite hungry as I had nothing to eat or drink after dinner Tuesday night, and it was now 11:15 on Wednesday. I remember finishing the pretzels and my drink in the car, and then bam! I was out like a light until Jim pulled into our drive. After he helped me in the house and I ate an English muffin, I crawled into bed and slept for 4 hours! Apparently that sedation drug impacts me after surgery if not during. I can't remember the last time I have napped that long. I was afraid I would not be able to go to sleep that night, but it was no problem.

Today I had to see Dr. Pepose at 7:45 in the morning. Jim drove me as I still had to wear the plastic shield over my eye. I definitely would not want to drive looking through it. The doctor looked at both eyes, and the pressure in my right eye has dropped to 9, which is excellent. The left eye was 20, which is high but not unexpected. Dr. Pepose seemed very pleased with my progress. Like last time, I am on limited activity until he sees me next Tuesday, and I only have to wear the shield when I am sleeping.

designer shades

Having the brightness and clarity in both eyes now is quite remarkable. My eyes are a bit sensitive to the light, but that should calm down in the next couple of days. My uber-expensive, designer (hah!) sunglasses help outside at least. I can't wait to see what my reading level will be next week when I go in. Hopefully the reading glasses will be a thing of the past, or at least only be necessary in low light/small print situations. Speaking of small print, I find it extremely ironic that the writing on eye drops is so minuscule. It is impossible for people with poor eyesight to make out, and once you add the first drop to you eyes, forget about it. While the lids are different colors, it is not helpful if I can't read the sheet that tells me which eye drop to use next.

Anyhoo, it is great to have this experience behind me. It was inevitable that I would get cataracts since both my parents and at least one of my siblings had them, so hopefully I will have a lot of years ahead to enjoy my enhanced vision.

Cataract Surgery Update

This morning was my one week follow up appointment, and this time I actually saw the surgeon who did the procedure. The last appointment was with a doctor I had never met before. My eye pressure dropped from 21 to 16, which is great news. Anything under 20 is good. The left eye measured 13. I can easily read the 20/32 line on the eye chart, but certain letters on the line below that are not crystal clear, specifically the "C" and the "O", which look alike to me.

The bottom line is that I am still slipping on reading glasses more often than I hoped to, though there still should be some continued improvement in the vision in the right eye. Taking all of that into consideration, I opted to go with the enhanced lens in my left eye next week. It makes sense to have a matching set. Dr. Pepose will correct my astigmatism in that eye at the same time. Interestingly, the enhanced lens will be ordered to the specifications to fix the astigmatism in my eye.

eye shield

Overall, everything is looking good with my right eye. I no longer need to wear the plastic shield at night, and I can resume all activities except for swimming. Even pickleball - color me happy! I can also wear eye makeup again, though I will only do that when I'm going out since I still have to put drops in three times a day. Of course next Wednesday I begin the whole process over again, but for a week I'm footloose and fancy free.

Postmortem on the Cataract Surgery

While it might seem odd to have the word postmortem in my blog title, since the usual definition means an examination following death, people have come to use postmortem to refer to any examination or discussion that takes place after an event. As my natural lens has been removed and tossed away, I think postmortem works in this context.

My first cataract surgery took place on Wednesday. Beginning on Monday, I had three eye drops to put into my eye, three times a day, including one of each in the eye before heading out for surgery. There was to be no food or drink after I went to bed Tuesday night. We were told to arrive at the surgical center at 7:30, where I completed enough paperwork to apply to a PhD program. As I was instructed to bring nothing with me except for my ID and insurance card, I didn't even have my reading glasses with me for assistance. But I could clearly see the young woman in the waiting area scarfing down a bag of potato chips. My stomach gave a disgruntled rumble.

About 15 minutes after arrival I was taken back to a surgical waiting area where I was told to lie down on a gurney. You get to leave on your street clothes, so that's a bonus. Two other beds were already occupied with patients, which gave me some sense of my wait time. My vitals were taken and I had to give my height and weight (ugh!) for the anesthesia, I presume. Multiple eye drops were placed in the right eye in preparation for surgery.

I was nice and toasty under a warm-from-the-dryer blanket when the anesthesiologist came to talk to me. I'll admit that I did not realize ahead of time that anesthesia would be administered. When I had my LASIK done 14 years ago, I was given a "happy pill" while sitting in a recliner in a dimmed room to relax me before walking into the surgical room. When the technician talked to me at my last appointment, all she said is that I would be given "better stuff" than what I had gotten previously. I assumed (my bad) that it would be a stronger pill.

About 8:20 the nurse came to administer the anesthesia. It was in liquid form, shot under my tongue with a needle-less syringe, where I was told to hold it for 60 seconds before swallowing. As the first thing I had to drink in 11 hours, let's just say it didn't taste like Kool-Aid and leave it at that. At no time did I ever feel the effects of whatever they gave me - before, during or after surgery - so I'm not sure exactly what it was supposed to do for me. It certainly didn't relax me like the LASIK pill did.

It was 8:42 when the nurse wheeled me into the surgical room. That was not a moment too soon as the man who was waiting in the bed next to me was just starting to tell the nurse about the online video he had watched on cataract surgery. Some things I just don't want to know ahead of time. More numbing drops were placed in my eye, and then a white plastic sheeting was placed over my face. They told me that they were blowing oxygen under it so I could breathe. A hole was cut in the sheet over the right eye, and a clamp was placed on the eye so that I couldn't blink.

When the light was maneuvered overhead, the doctor told me to stare at the light. There were three glowing orbs, and he said I could look at any of the three. Then he began the surgery. I can't say that I felt any pain, only pressure. But I was braced for the pain as I have a weak (or is it strong?) tolerance for anesthesia. Often during my skin cancer removals I will have to stop the doctor as I can feel him cutting. During dental procedures I usually need an extra shot. And I felt them removing the most recent breast biopsy. Ouch! But this time there was no pain, thank goodness. I just wanted it to be over with, as it is rather scary to think about what the doctor is doing.

rocking the pirate look

The procedure took about 15 minutes, then the draping was removed, more drops put in my eye, and I got a sexy eye shield to wear. I was wheeled to a the recovery ward, where I was rewarded with orange juice and pretzels before being helped into a wheelchair for dismissal. Jim brought the car around to the front, and we were off.

For the first day I was to leave the shield on, raising it only to add eye drops. I could watch t.v. but there was to be no reading or computer time. I had minimal discomfort in the eye, only a headache which a couple of Tylenol fixed. Yesterday Jim had to drive me back to Pepose Vision for my first follow up. They said the eye was healing nicely, though my pressure is a smidge high. Fortunately it was not so high as to necessitate additional eye drops. The shield now only has to be worn at night and if I take a nap. But I have to use these eye drops for 42 days! And that is just for this eye.

For the first week, there is no lifting over 20 pounds, no strenuous exercise (no pickleball!) and no bending over. You don't realize how often you do that until you are told you can't. I'm getting really creative in how I get things that are down low. My hair looks like crap as I always bend over to fluff it each morning. I also cannot wear eye makeup, which is a big deal to me. I feel naked without my eyes done.

It will be worth it in the end though. I can already see better with the right eye than I see with the left, and my vision should continue to improve in the surgical eye. The one thing that I've noticed the most is that the surgical eye sees everything much brighter. It is so obvious since the left eye has not been done yet. Although people had told me that would be the case, I wasn't expecting it to be very drastic for me since my cataracts were still in the early stages of development. It's amazing, for sure.

On Tuesday I will drive myself to the last follow up appointment for this eye, and hopefully get the news that I can resume all my activities. Especially pickleball. At least until May 30th when I get the second eye done, and start the process all over again.

Horsing Around in Shannon County

Wild horses of Shannon County

Last weekend we photographed the wild horses in Shannon County, Missouri. But I almost didn't get to go. Wednesday afternoon I was working away on the computer when it seemed that my left eye was not focusing correctly. When Jim and I went for a walk that night, I noticed that it had gotten worse, and I was seeing a blob out of the left eye. It was moving like a floater, but it was rather large and shaped like a vertically squished circle. But then I saw some white flashes like lightning on the left side of the eye, and that was very disconcerting.

The American Academy of Ophthalmology website lists these things as possible indicators of a torn or detached retina. It further warns that if prompt attention isn't paid to the eye, blindness can occur. Well, that certainly sounded scary. The next morning I called my ophthalmology practice and explained what was going on. They agreed I should have it looked at, and scheduled me with the retina specialist at 12:40. I skipped my morning pickleball just to be on the safe side. After thorough testing, the retina doctor said she could see what I was referring to, but my eye pressure was good and there were no signs of any tear or detachment. She explained it was just a big old floater, and that each eye will most likely have something like this. The average age is 67 when it occurs, but she added that nearsighted people get them earlier. In 85% of the cases they disappear on their own. If I am one of the unlucky 15%, I can decide if I want to live with it or have it removed by laser surgery. Unfortunately it cannot be removed when I have the cataract surgery done. So, bottom line was good news and a clearance to make the drive to Shannon County the next day.

For Christmas Jim had given me a gift certificate to attend a workshop about photographing the wild horses in Shannon County, Missouri that was offered through the Academy of Nature and Wildlife Arts. As background on the horses, it is believed that the herd formed after residents left their livestock behind during the great depression. Though there was an effort by federal officials to remove the horses in the 1990s, local protesters intervened and petitioned the National Park Service office in Shannon County. Legislation was passed to protect the animals, with the condition that the herd remain at 50 horses. When the number grows, the Missouri Wild Horse League rounds up some of the younger stallions, who are tamed and then adopted by local farmers. The herd roams free on land located in the Mark Twain National Forest.

Echo Bluff State Park

On the way to Eminence, where our base would be for the weekend, we stopped at Echo Bluff State Park. A project of SWT Design, I had heard about the park for years and had seen many pictures of it during and after construction. But I had not yet seen it in person. Missouri's newest state park opened in 2016, so everything is still pretty new and sparkly. It will take time for the added vegetation to mature, but in terms of camping or glamping, the park has something for everyone. Tent campers will find themselves on wooden platforms, the campers and RVs are on a nice concrete pad with good facilities nearby, the main lodge offers rooms and a restaurant, and cabins built for singles and large families are also offered. The lodge is located near the echoing river bluffs, from whence the park got its name. The park has been so popular that reservations need to be made a year in advance for weekends or any day during the summer. It has also become a wedding destination, which was not something that was anticipated. It is a wonderful park, and I appreciate how they kept several of the old structures from when the property was Camp Zoe.

Following lunch at the lodge, we got back on windy, hilly, narrow Highway 19 and made our way to Alley Spring. Located in the Ozark National Scenic Riverways, Missouri's 7th largest spring discharges 81 million gallons of water each day. The grain mill at the site was constructed in 1893, replacing an earlier mill that had been built in 1868. It was a wheel-less mill, operating instead on a turbine system. The mill closed in 1918. It has been preserved by the National Park Service, along with a one-room schoolhouse that is located nearby.

Alley Spring

By late afternoon we made our way into Eminence and checked into the Riverside Properties. Located on the Jack's Fork River, the choice of accommodations includes the motel or cabins. Some cabins are located along the river while others are across Highway 19 from the motel. We could have stayed anywhere around Eminence, but the workshop instructor had a room at Riverside and would be having meetings with the group there. We opted for one of the cabins along the river so we could have some cooking facilities and the ambience of the river out back. The cabins went under water when the river flooded last year, so they were touted to be recently renovated. The decision to stay in the cabins ended up to be a cause for concern that evening when turbulent weather rolled into the area.

Riverside cabins along the river

Stay tuned...

The Eyes Have It

My annual eye exam was in January, and I anticipated that the test would reveal what I already knew - my eyesight was worse than the previous year. Though I had passed the driver's license cursory eye exam in October, I know that I am slipping my reading glasses on more frequently. Still, I was unprepared for the ophthalmologist to suggest a prescription for glasses. Huh? I had LASIK done on both eyes in 2004 to eliminate the need for glasses or contacts. I was expecting the doctor to suggest a "tweak" of my previous surgery, not offer up glasses.

When I told him I would like to discuss an enhancement, he explained that he would need to do a more in-depth test for cataracts before we could consider that. If cataracts are present, then LASIK is not a choice. Instead, the option is cataract surgery. As my mom, dad and sister all had cataracts, I knew it was a matter of time before they showed up on my eyes. And sure enough, the additional test revealed the beginnings of cataracts. On the plus side, insurance covers basic cataract surgery, while LASIK is considered an elective procedure.

Before it could be determined if my cataracts were far enough along, additional tests needed to be run. I had a two hour appointment this morning, which entailed multiple tests on my eyes, a discussion with the doctor after he performed an eye exam, a followup test as the optic nerve in one eye was a little enlarged and they wanted to rule out any problems, and then a meeting with the scheduling department.

The bottom line is that I am approved by the insurance company to have surgery on both eyes, and the optic nerve issue is one they believe I was born with and nothing to worry about. The biggest consideration is what type of lens I want to have placed during surgery. Insurance will cover just the minimum lenses, which most likely means needing glasses the rest of my life. They also will not cover the correction for the astigmatism in my left eye, which seems stupid but there you have it.

The next step up in lenses would be similar to what I had done with the LASIK surgery. One eye was corrected for distance, and one for nearness. That has served me well for the past 14 years, with the exception of using reading glasses in low light and with small print. The doctor is concerned, however, because of the fact that I am a writer and a photographer, the lenses might cause problems for me in one area or the other. It is not an exact science, and while it worked well following my previous surgery, those were my own lenses he was working with and not man-made ones.

The final option is using extended depth of focus lenses. Relatively new on the market in the United States, the lens provides improved near and intermediate visual acuity while maintaining comparable distance visual acuity. Sort of like what our eyes were like when we were young, I suppose. As you might imagine, because they are state of the art they are very pricey.

If I was quite a bit younger, the pricier lenses would be a no-brainer. If I was quite a bit older, going the basic route would be a no-brainer. But here I am, stuck in the middle... When Jim gets home tonight we will discuss the pros and cons of the options, along with the associated costs. Although I met with scheduling today, I cannot set up the first eye surgery until a lens decision has been made. The second surgery will take place two weeks after the first, as they want one eye healed before they work on the second. Following surgery, there is no lifting or vigorous exercise for a week. Weeks without pickleball?

Eye, caramba!