Tuesday, October 20, 2020

You Gotta Love Frozen Peas

Yay! The bandage is off, and to my great relief, my eye is not stitched shut, so I can see out of both eyes again. Depth perception is BACK!

 

The dark long line beneath my eye in the pic is surgical thread, which appears to be anchoring the tiny stitches in the graft, which was taken from the outside edge of my eye. I feel much better now, but at about 3 AM this morning, with my face hurting quite a bit, I decided to open the Swiss Eye Masks and attempt to get some relief by cooling my eye through the bandage. First of all, I've gotta say, whoever thought that printing the instructions for a mask to be used after eye surgery in pale grey ink in a tiny font on a shiny white background should be fired. When I finally got one of the mask packets open and picked it up to put it on over the bandage, I realized why I was told I could "just use a bag of frozen peas" instead. The masks are SLIMY and totally disgusting, to the point that I'll pass on using them.

 

I like peas, but in a lifetime of eating peas, I've never been so happy to see a bag of frozen peas in my freezer at 3 AM as I was last night. The bag of frozen peas inside a clean wash cloth provided some instant relief from the pain, even through the bandage, so that's what I'll be using to ice my eye for the next two weeks.
 

I Survived!

I was at the facility from 11 AM until 4 PM. The two surgeries (removal of the BCC and then reconstruction of my eyelid) took just over 2 hours. I had a general anesthesia during this time, which included insertion of a breathing tube. They told me to expect a sore throat. The recovery room nurse asked me if I've ever been diagnosed with asthma. Yes, when I was in my early 50s, and for about a year I took Singulair, but I’ve never had a severe asthma attack, so I discontinued that and just keep rescue inhalers on hand, which I occasionally use. Apparently, I had some problems tolerating the breathing tube, and she appeared to be a bit alarmed with my perfectly normal (for me) post-op cough, so she sent me home with an inhaler. I was told I have deep stitches, which will dissolve on their own, and surface stitches, which the surgeon will remove in a couple of weeks. Dunno what they look like though, because I have what appears to be a MaxiPad covering my right eye. I’ll remove that tomorrow. Some people who've had this surgery said they had no pain, but I’m not gonna lie, my eyelid and the area below it HURTS…really hurts. I was told to take Tylenol for pain, and I took 2, which haven’t have any effect whatsoever. They also sent me home with something called "Swiss Eye masks", which are currently cooling in the refrigerator and which I've been instructed to use for treatment of pain and swelling, or, if I don't like those, I've been told I can use a bag of frozen peas. I also received an antibiotic ointment which I'll start using tomorrow, once I have access to my eye.

 

I’d fasted before the surgery, of course, but I wasn’t really hungry afterward. Nevertheless, I was instructed to eat something, so when I got home I heated up some Trader Joe’s tomato soup, and had that and some ginger ale, after which I brushed my teeth, inserted a new set of Invisaligners, and went to bed, where I slept soundly for a couple of hours. I'm so relieved the actual surgery is OVER.

 

Oh, and one other thing. I'm not driving (of course). I'm writing this using my left eye, in which I have an IOL (intraocular lens) for distance only. So I must wear eyeglasses to be able to see anything up close, like my laptop screen. But another effect of having just one eye to use is that my sense of depth perception, which has been on shaky ground since the 2 surgeries on my left eye anyway, is just pretty much gone for now. Attempting to put toothpaste on my toothbrush really illustrated this for me, because when I tried to load my toothbrush, I discovered I was nowhere near it. I actually laughed out loud when I realized the toothpaste was going all over the sink. Sheesh.

 

 


 

Thursday, September 17, 2020

Results: Basal Cell Carcinoma

This afternoon the surgeon called and told me that the results of the biopsy showed that I have BCC, or Basal Cell Carcinoma of the eyelid. BCC is the most common form of skin cancer, and although a cancer diagnosis is never good, if one has to have some form of cancer, this is one of the best forms to have, because it's rarely life-threatening and is generally quite treatable. BCCs can become locally invasive and can cause disfigurement and permanent skin damage if left untreated, though, so prompt treatment is important. The only tricky thing about this BCC is the location: it's on my eyelid. That sounds so innocuous, doesn't it? When the PA at my dermatologist's finally agreed with the self-diagnosis that I'd made almost a year ago, I didn't understand why she immediately referred me to an oculoplastic surgeon. So when I got home, I Googled "lower eyelid cancer surgery" Images. Oh. Well then. OK. I see the need for the referral to an oculoplastic surgeon, because basically, the oculoplastic surgeon has to reconstruct the eyelid after the tumor is removed. 

I'm trying to balance out the positive and negative aspects of this. One of the negative things is that I've had this growth for well over a year, but one of the positives it that it seems to be nodular rather than flat and diffuse, and I think that's a big plus in terms of removal. Because I've had this so long, apparently it's more likely to recur, however, now I know what to look for. I'm grateful that I live in a place where I have access to excellent doctors who have experience doing this type of procedure.

I've been going to a dermatologist's office for annual skin cancer checks for over 20 years. I've just learned that eyelids are one of the most common sites for skin cancers to occur in fair skinned people, but not once in the 20+ years I've been going for skin checks has anyone thought to examine my eyelids. You've seen the pics of my eyelid. This BCC is just a tiny, pearly lump on the surface of my lower eyelid. It never bled or crusted over. It didn't hurt. The 2 main symptoms for me were loss of eyelashes where the tumor was growing, and a noticeable blood vessel going to the center of the tumor. It looked so innocuous that even when I made a special appointment 2 months after my annual visit and said the reason for my visit was that I'd been a bad patient and spent time on the net and was pretty sure this was a skin cancer, no one took me seriously, and it took 7 more months for anyone to believe me and biopsy it and confirm that it was indeed a BCC that must be removed, and the sooner the better. So, please, monitor yourselves.

Biopsy


15 September 2020 - So today I had the biopsy. I was told they'll have the results in approximately one week, at which time if it’s benign, I can decide whether I want it removed (YES) and if it’s malignant, there's no choice, I’ll be scheduled to have it removed.

 

I drove myself to and from the biopsy with no problem. For the biopsy, I did not wear the contact lens which I normally wear in that eye for reading. I was given an ice pack to hold against my eyelid for about 5 minutes before I went into the room where the procedure was done. Both eyes were then numbed with an anesthetic eye drop, after which the surgeon administered an anesthetic injection into my lower right eyelid. That stung a bit, but the eyelid became numb almost instantly. Then, keeping my eyes wide open, I had to stare up and to the left the entire time the biopsy was being done. That was actually rather difficult to do, because it meant that the very bright light which the surgeon wears on his forehead to do the procedure shone directly into my eyes the entire time. He had to go in twice to remove enough tissue for the biopsy. There was a slight stinging and tugging sensation as the tissue was removed, but really the most unpleasant part of the procedure was after the biopsy was over, when he cauterized the incision, because I could feel the heat and smell my flesh burning as that was done. Ugh. But the whole thing was over very quickly: 30 minutes from start to finish. Immediately afterward, my eye felt dry and my eyelid was so sore that I didn't even think about putting my contact lens in for the rest of the day. I turned down an eye patch, preferring the incision to be exposed to the air to heal. After I got home, I instilled Systane preservative-free dry eye drops in both eyes whenever they felt dry. Fingers crossed for the results.


Oculoplastic Surgeon Visit 1 2020.09.09

 

I like the oculoplastic surgeon. I met him on September 9, 2020. He asked me to state in my own words why I was there. He then carefully examined the lump on my eyelid and gave me some good news: he said it may not be BCC after all. He said it’s right on the borderline, in terms of characteristics. He said, “If this isn’t malignant, I won’t be surprised. But if it IS malignant, I also won’t be surprised. That’s why it’s got to be biopsied." I was momentarily surprised to hear this, because the Physician's Assistant at the dermotologist's office had FINALLY diagnosed it as Basal Cell Carcinoma. But then I thought back to when I'd worked as a clinician in pediatric psychiatry, about all the patients sent to us by other psychiatrists who had diagnosed them as Bi-polar, but whom we determined, after we'd examined them, had been misdiagnosed, and I realized that until a biopsy is done, diagnosing skin cancer by simply looking at the physical characteristics of the growth isn't really any different from that. So I’m going back on September 15th for the biopsy, but in the meantime I’m feeling optimistic.

 

Friday, August 21, 2020

Beware of bumpy eyelids

 

Sometime last year, I developed a small bump almost in the center of my lower right eyelid (see selfie above). At the time I thought, "Damn. I'm getting a stye, and I HATE styes!" I was so sure it was going to turn into a stye that I checked my medicine cabinet to be sure I had some ointment specifically for treating styes, which I did. 
 
But it never turned into a stye. It didn't get red, or sore. It was just this tiny pearly bump, right on the surface of the eyelid, almost at the center. When it didn't turn into a stye, I thought maybe it was a blocked Meibomian gland. Can you tell I worked with a bunch of ophthalmologists at an eyecare company for 10 years?

Being fair skinned and living in Texas, I have a standing annual appointment for a full body check for skin cancer every December. It's supposedly a "thorough" skin check. The PA even goes through the hair on my head, to examine my scalp. But she's never examined my eyelids and I didn't call her attention to the bump at that visit, so she didn't notice it. I've since read that a thorough skin cancer check should always include careful examination of the eyelids, which are a common site for skin cancers. 
 
In early February, two months after my annual visit, when the bump still hadn't gone away, like all bad patients I looked it up on the internet and learned it could be skin cancer. "Nah", I thought, "no way!" But to be on the safe side, I called the dermatologist's office and made another appointment. At that visit, on February 26th, I mentioned that I was worried it might be skin cancer. The PA scraped the bump. She did not take tissue for a biopsy, but said she didn't believe it was skin cancer, but thought it was some sort of milia cyst. She sent me home with instructions to treat it with warm compresses, assuring me it would go away.

I did as instructed. But it didn't go away. And my eyelashes stopped growing in that area. And if you looked at it closely, in a 10x magnifying mirror, like I did at least once every day, you could see a rather fierce looking, spidery red blood vessel, like a flower stalk, going to the center of it. 
 
So in early July I called to make another appointment. Asked for the reason for the appointment, I told the receptionist that a bump on my eyelid for which I'd been seen in February hadn't gone away, had in fact grown, and that I believed it might be skin cancer. None of which impressed the receptionist. Mid-August was the first available, she said. I took it. 
 
At the August appointment, which was on a Monday, the PA examined the bump again. This time, she noticed the missing eyelashes and the blood vessel, two tell-tale signs of BCC. She measured the bump and said it's 3 mm across (tiny, right?). But she looked rather somber when she said, "This appears to be a BCC (basal cell carcinoma)". She referred me to an oculoplastic surgeon, and then, brightening up, she said cheerfully, "He'll remove it and put in a couple of stitches", leading me to believe this was no big deal. She did say if I hadn't heard from the oculoplastic surgeon's office by Friday, I should call them. She also said if they couldn't see me right away, I should come back to the dermatologist to have it removed.

Uh huh.

On Friday, not having heard from the oculoplastic surgeon's office, I called them. They told me the reason they hadn't contacted me was simple: they hadn't received the referral. In fact, they hadn't received any referrals at all that week from my dermatologist's office. The woman who took my info was very nice. She said, "The way it works is your dermatologist will remove the BCC, and then you'll see the surgeon for reconstruction of your eyelid." That was the first time I'd heard the word "reconstruction" regarding any of this. It sounded rather ominous, but also, that was not what I'd been told, and I said so. I told her that the PA had told me that the oculoplastic surgeon would remove the BCC and repair the eyelid. She paused for a moment and then said, "OK. Well, that means it's either too big, or in too critical a location for the dermatologist to remove it. But don't worry. Dr. A does this all the time. You're in good hands here." First available appointment was second week in September. Needless to say, I took it.
 
To be continued.





Saturday, June 15, 2019

Orthodontia for Boomers!

I'm 69 years old. When I was a kid, my family was poor, and by poor, I mean no car, no indoor plumbing, bread-and-dark-Karo-syrup-for-dinner poor. So of course, no doctor visits unless you were dying, and nothing so luxurious as a dentist. My dad had almost no teeth, and my mother had false upper teeth, due a car accident in which she lost her upper teeth when she was young. 

When I was a kid, none of my six siblings owned a toothbrush. When I started school and became vaguely aware of dental hygiene and asked for one, I was told, "Go eat an apple; it does the same thing." 

When I was 8, we moved to town. For the first time, we had indoor plumbing, and I was enrolled at an elementary school where twice a year the teacher expected to see proof that each of her students had seen a dentist. We didn't have money for fillings (of course), so at my first dentist visit, two permanent molars which needed fillings were pulled from my mouth.

You get the picture. Eventually, I began taking good care of my teeth, but by the time I realized I needed to do this, there was a lot of damage to deal with. So for my entire adult life, although my gums are in great health, I've had a mouth full of fillings. In my 40s, I had all the silver amalgam fillings replaced with white composites, which have lasted well on my back teeth but not so well on my front teeth. Also in my 40s, I switched to a very expensive cosmetic dentist, who recommended a "smile makeover", but I couldn't afford the cost estimate of over $30,000, so I didn't do it. From time to time we did discuss the possibility of just putting veneers on my front teeth, but veneers are also incredibly expensive, specifically, I was advised that "to get a good result" I'd need a minimum of 6 veneers on top, at $1500 per tooth, "but 8 would be better".

20 years later, as a sexagenarian, I'm hardly in my cavity-prone years, but even without hard use, old composite fillings deteriorate, with the result that in the past 10 years I've had the composites on my upper central and lateral incisors redone close to a dozen times, each time losing a bit more tooth structure. Eventually, the very expensive, highly rated cosmetic dentist I'd been seeing retired, so I switched to a highly rated general dentist in my neighborhood.

The first time I went to see Dr. G, she looked in my mouth and said, "What's going on here?" "No dental care as a kid," I responded. "Yes," she said, "I can see that, but why on earth do you have all these composites on your front teeth? Hasn't anyone suggested crowns or veneers?" 

After reviewing my x-rays, she advised me that in her opinion, I had so little intact tooth structure that I'd be better off with crowns than veneers. Then she dropped the bomb, and asked, "Have you ever considered getting braces? Because look how your fillings and even your intact teeth are worn. If you don't correct your bite, you'll continue to have problems with any additional dental work." My teeth LOOK straight, that is, my central and lateral upper incisors are lined up as they ought to be, but after that, things get a little crazy. The permanent molars that my childhood dentist pulled so many years ago left gaps on opposite sides of the top and bottom of my mouth, so when my wisdom teeth came in (and I have all 4 of those), the gaps filled in, permanently changing the alignment, and not for the better. In the bottom of my mouth, my teeth have been moving sideways ever since, with the result that my lower teeth have not been remotely aligned with my upper teeth for years. In my upper teeth, one pre-molar is totally turned sideways and in addition to the cosmetic aspects of this, my entire adult life I've had an open bite on the left side of my mouth: my top and bottom teeth on that side don't meet by close to half an inch. I haven't had the headaches that plague some people when their bite is off like this, but for years I've periodically bitten the inside of my mouth due to this malocclusion, and more recently, as my teeth have continued to shift, I've worn down the enamel on my upper teeth, to the point that the bottom of my left lateral incisor is now crescent shaped. So rather than be put off at the suggestion of braces, the thought that all of this could potentially be corrected, even at my advanced age, THRILLED me.

Dr. G recommended Invisalign, a system of clear, plastic aligners that you wear 22 hours a day: you take them out and clean them while you eat, but the rest of the time, including when you sleep, you're wearing them. They're then changed each week until your bite is corrected. I could have gotten Invisalign through Dr. G, but after doing some research on the internet, I decided I wanted an orthodontist, and specifically, someone who had Invisalign's Top Provider rating and who could plan my treatment after scanning my mouth digitally with Invisalign's iTero 3 D Scanner.

Three of my four children had braces, but the thought of spending thousands of dollars out of pocket on straightening my own teeth at age 69 seemed incredibly self-indulgent to me. Also, when I'd mentioned that I was considering this option to 2 of my kids, although I know they love me, their reaction was "Really Mom, at your age?" But I kept thinking about the fact that if I didn't do it, I would just be setting myself up for more problems with whatever future work I had done on my teeth. I'd learned there was no charge (and no obligation) for the initial consultation with the orthodontist, so one Tuesday in May I called the office of the local orthodontist whom I'd decided I'd want to do the work, and 2 days later I was in his office for my free evaluation. "I guess I'd probably be your oldest patient", I said nervously, but he just smiled and said his current oldest patient is in his late 80s. He said he was intrigued by my open bite, which would be something of a challenge to correct. Nevertheless, there was no pressure to sign up for the treatment. One of his assistants provided detailed information on the interest-free payment plan, which required $500 down and then monthly payments of a little over $300 a month (no interest) for the next 15 months. That was doable financially, so I handed over my credit card and signed on, after which my mouth was scanned and a follow up appointment was made for one month later, at which time my first sets of aligners would be ready for me.

At the follow up appointment, I was excited but also nervous about putting in the aligners. I was worried they would hurt, but (so far at least) they don't hurt at all. I was nervous about being able to put them in and remove them, but that's easy to do. I was worried I wouldn't like the way they feel in my mouth, but they feel fine. My treatment plan is for 26 aligners, to be worn for 1 week each, or 6 months of treatment. The orthodontist explained that because of my open bite, it's possible that at the end of 26 weeks, I may need additional treatment to close that bite, but there are several options if that happens, and of course it may not happen at all.

So I picked up 13 of the 26 aligners and 2 orthodontic retainer boxes and made a follow up appointment for September, when I'll be halfway through treatment, and headed home. So far, so good!