I Can See Clearly Now...

 8 years ago, due to a congenital defect, I had surgery on the retina of my left eye. I had an excellent surgeon, and I'm confident that he did nothing wrong. Nevertheless, as he had cautioned me might happen following such an invasive procedure, shortly after the surgery I developed a fast-growing cataract on my left eye. Within just a few months of having the surgery, which was otherwise successful, the vision in my left eye had deteriorated to the point that I was unable to read the letter "E" on the eye chart.

Accordingly, 10 months to the day after the first surgery, I had a second procedure, performed by a different surgeon, to remove the cataract and implant an IOL (intra-ocular lens). For several years after that second surgery, I had enviable distance vision in my left eye, but eventually, I developed something called PCO, or Posterior Capsular Opacification.  As a result, the vision in my left eye deteriorated. I had difficulty focusing, and in the past couple of years I'd developed something called "ghosting", which occurs when you eyes see two slightly different images transposed next to each other. This meant that if I was looking at someone seated 8 to 10 feet away, instead of seeing their face I'd see 2 faces, one in front of the other, which was annoying to say the least, but also, due to this I was now finding it impossible to read road signs. 

PCO is the most common complication of cataract surgery, occuring in approximately 20% of patients. It's caused by a cloudy layer of scar tissue growing behind the implanted lens. This happens because when a cataract is removed, a small amount of tissue covering the lens, or capsule, is left behind to help hold the IOL in place. A PCO forms when the eye attempts to make a new lens using the material left behind. Different types of cells can cause the opacification, including migrating epithelial cells and residual lens cortex cells, but no matter what type of cell is causing it, when PCO occurs, although it's a natural part of wound-healing in the eyes,  it causes problems with vision.

In addition to everything else, I also have glaucoma in both eyes, so I see my ophthalmologist every 6 months for a thorough eye exam. He had noticed the increasing PCO over the new lens, and asked me about my vision. When I told him about the ghosting (by far the worst effect for me) he encouraged me to schedule a procedure to restore the vision in my left eye. This procedure is called YAG laser capsulotomy. YAG is short for yttrium aluminum garnet, which is the type of crystal located within the laser used for the capsulotomy. It dates back to 1982, and it's considered very safe and low risk for complications.

I considered going back to the surgeon who had removed the cataract and implanted the IOL, but when I learned that my ophthalmologist was one of the first doctors trained to do YAG laser in Texas, and has been doing this procedure weekly for almost 40 years, I decided to have him do it. 

From a patient standpoint, YAG laser capsulotomy is a simple, outpatient procedure. I went to my doctor's regular office. When I arrived, drops were instilled in my left eye to lower the pressure, and also to dilate my eye. It took about 10 or 15 minutes for the drops to take effect. I then walked down the hall to a different suite, where the laser was located. It's important to remain still during this procedure, so to help immobilize my head, after being seated, my head was positioned in the chinrest of a slit lamp microscope to which the laser was attached. A slit-lamp microscope is the thing where you sit in a special chair and then lean forward to rest your chin and your forehead on the device to position your eyes so they can be examined. When you go for your annual eye exam, your optometrist almost certainly uses a slit lamp microscope to examine the back of your eyes.

An assistant instilled numbing drops in my eye. She then placed a special contact lens filled with a gel-like substance on the front of my eye. Due to the numbing drops, I didn't feel anything. My ophthalmologist then performed the capsulotomy. Focusing on the posterior capsule, he "zapped" the PCO formation with the laser, which uses a wavelength to break up the tissue, first forming a hole in the central area of the lens and then moving in a circular manner around it. The zapped tissue falls off the posterior capsule and into the vitreous. The entire procedure lasted for just a few minutes, and there was no pain involved. 

Most patients experience increased intraocular pressure (IOP) as a result of this procedure, so afterward, another pressure-lowering eyedrop was instilled as a preventative. I then walked back to the inner office waiting room, where I sat for about 20 minutes before my IOP was again checked. It was at a healthy 18, so I was discharged.

Immediately after the procedure, my vision was blurred and I had some horrendous floaters, both of which are normal. It’s not unusual to see floaters for up to 3 weeks after this procedure. However, just 9 hours later, at 10 PM, although I still have some floaters, my vision is crystal clear.

General Info

You shouldn’t drive for the first 24 hours after having this done, so you need to arrange for transportation to and from the facility.

 

Financial Considerations

Medicare Part B covers YAG laser capsulotomy if it’s deemed medically necessary due to complications from cataracts and cataract surgery, but you’ll generally need a diagnosis of posterior capsular opacification for it to be covered.

Also, if you’re having YAG done, be sure to ask ahead of time if your surgeon charges a facility fee. Facility fees can range from modest to exorbitant, and you’re responsible for 20% of the facility fee even if Medicare covers the procedure, so be sure to ask about this ahead of time. My ophthalmologist didn’t charge a separate facility fee because he has a laser on site, but if I used the surgeon who removed the original cataract and implanted the lens, I would have had to pay a separate facility fee.

Old Friends...

 

Old friends, old friends

Sat on their park bench like bookends
A newspaper blown through the grass
Falls on the round toes
Of the high shoes of the old friends

Old friends, winter companions, the old men
Lost in their overcoats, waiting for the sunset
The sounds of the city sifting through trees
Settle like dust on the shoulders of the old friends

Can you imagine us years from today
Sharing a park bench quietly?
How terribly strange to be seventy

Old friends, memory brushes the same years
Silently sharing the same fears

Time it was, and what a time it was, it was
A time of innocence, 

A time of confidences
Long ago, it must be, 

I have a photograph
Preserve your memories; 

They're all that's left you

Paul Simon

I'd been thinking of a friend of mine, whom I hadn't heard from since BC (before Covid). I was feeling a little irritated at his not staying in touch, and thinking of calling him, but for some reason I decided to Google him first and when I did, my heart sank, because there it was: his obituary. He died, apparently peacefully and at home, perhaps in his sleep, late this past February. Not from Covid. This makes 4 friends who've died in the space of 16 months: none of them from Covid, but dead nevertheless. They ranged in age from 66 to 72. My 72-year-old friend had been sick, with Parkinson's and Lewy Body Dementia, but the other 3 deaths were totally unexpected, happening as they did to people who were relatively fit, with no known health issues. I remember my father (who lived to be 91) telling me it was so hard to outlive all friends and many family members. It's a weird feeling, to know these friends are gone. I miss each of them, and life suddenly seems much more precarious than it did 2 years ago, before this started happening.

Can You Hear Me Now?

I loathe and despise corporate America, and especially Big Banks, so after a recent fiasco with Bank of America, where I've banked for more than 30 years, I decided enough is enough and began the arduous process of switching to a smaller, friendlier, less expensive institution. If you live in a house, where you have a unique street number address, congratulations, because you've automatically saved yourself hours of work. But if, like me, you live in a condo (or an apartment or a co-op), where although your apartment or unit number is unique, you share the actual street address with many other people, plan to spend a couple of weeks downloading paper application forms which you'll have to complete the old-fashioned way and submit via snail mail before you're allowed to open an online account. When I asked why there's no provision to apply online unless you live in a house, I was repeatedly told this is a provision of The Patriot Act, "to prevent terrorism". I didn't realize terrorists only operate out of apartments or condos, but hey, what do I know? 

So today, approximately a month after I submitted the initial paperwork via snail mail, having jumped through all the initial hoops, I went online to activate my new checking and savings accounts. I'm retired and my only income is my Social Security check, so the first thing I did was go online to change that deposit from Bank of America to the new place. Today is June 8th; that change will go into effect in late August (!!!). I spent several hours online, attempting to update auto-pay sources. I use AT&T for my cellphone, and Spectrum for internet, and I was unable to change the info at either of those websites due to problems with the websites. Neither website provided any information that they were having problems. Instead, both websites allowed me to enter all of my information, including account and routing numbers, but after I hit submit a pop-up appeared with a message saying they were "unable to complete your request at this time, but please do try again later". Eventually, I was successful with AT&T but not with Spectrum. Tomorrow I'll try once more and if Spectrum still can't process my request, I'll phone customer service and try to get help that way. I find it ironic that the website that gave me the most trouble is my internet provider website. First world problems, I know, but I do have to solve this.

These Foolish Things...

Last night I went on my walk, but late. The day had been stiflingly sticky and hot, but once the sun went down, the air was pleasant, almost cool, so I decided to go further than I had planned. I followed one of my regular routes, which takes me through residential streets in my neighborhood, far removed from heavy traffic. 

Eventually, this route took me to one of my favorite streets, Glen Heather. This is a street with huge (for Texas) well-established trees, many of which reach from either side of the street to almost meet overhead, forming a beautiful green bower. I'd guess the houses on this street were built in the late 70s or early 80s. Every house is MCM (mid-century modern), with lots of wonderful sharp angles and big, floor to ceiling windows. Most of these houses are just one story tall, with a few exceptions, but whether one-story or two, every house on either side of the street is a duplex. I don't know what possessed the builders to construct an entire street of nothing but duplexes here in Dallas, where the soil is so abysmally bad that sooner or later, every house ends up with foundation problems, which I'd think would be horrendously complicated, legally, if you're sharing a slab with a neighbor. But foundation problems aside, the other unusual feature of this street of houses is that without exception, every one has a lovely enclosed patio. 

All of the patios are huge. Some run across the front of each house and then turn to go run along the sides as well. Each patio is enclosed by a brick wall of varying heights: some are just 3 or 4 feet tall, so that from the street one gets a glimpse of who or what's inside, but others are 5 or even 6 feet tall, providing complete privacy. I am so intrigued by these wonderful patios, that every time I walk down this street, I imagine different scenarios: I imagine having breakfast on these patios on beautiful days, sitting in a comfortable chair at a tempered glass table set with eggs and bacon and toast; a tray with croissants and jam and butter; glasses of freshly squeezed orange juice; cups of hot coffee with cream, hearing the softly rustling pages of a newspaper as it's held to be read, back in the days when newspapers were actually made of paper and delivered to one's door. I imagine lively cocktail parties, back when people still had cocktail parties, in the 50s and 60s. That was before these houses were even built, of course, and yet these enclosed patios beg for the presence of cocktail parties. If I close my eyes I can almost hear the laughter and soft tinkle of ice in glasses that need regular refills. I imagine having dinner parties on these patios. When I was a bride, in the early 70s, we and all of our friends had regular dinner parties for 6 or 8. I can imagine hosting dinner parties on these beautiful patios, drifting in and out of the house to bring more food and refresh drinks, the night air perfumed with the scents of the jasmine and honeysuckle and gardenias that grow freely along the patio walls. 

But in the entire 3 years I've been walking down this street, I've never seen a single soul out on any of the patios. Not in the daytime, and not at night. A handful of houses have strung lights which make the patios look festive at night, but despite the lights, the patios are empty. Instead, the windows of the houses occasionally flash blue, evidence of someone deep inside the house, watching television instead of hosting a cocktail party or dinner party on their lovely patio. 

The times we live in.

Happy Endings

On Sunday night, as I was cleaning up downstairs, I decided to clean the filter pump on my LG washer. My washer and dryer are located in a small laundry closet in my kitchen, and I try to clean the washer pump filter out as recommended, about once a month. I got a small basin and sat down on the floor and first drained the hose, then replaced that and removed the filter, which, as usual, needed cleaning, mostly because Chili has a heavy coat and sheds a lot. I removed what I could by hand, then rinsed the filter out in the sink until it was perfectly clean. Then, rather than sitting down on the floor again to carefully screw it back into place, I just reached down and put it into the slot and turned it a few times, to secure it.

 

Late Monday morning, I did a load of wash. An hour or so later, when I walked into my kitchen, I discovered the kitchen floor was completely flooded. I have 5' x 7' woolen area rugs with heavy felt pads in both the kitchen and the breakfast nook, and the rugs and pads were soaked, as were the wooden floors beneath. The rugs and pads weighed a ton soaking wet, so I dragged them one at a time out onto my patio, where it was raining heavily, but not having a garage, that was my only option. Inside, I first put towels all over the floor to soak up the water, and then spent some time figuring out what had happened. Once I was sitting on the floor directly in front of the pump filter slot, I could see that it wasn't all the way in, so most of the water used when the machine was on had ended up being pumped out onto the floor. On the plus side, front load machines use considerably less water than top loaders, but it was still a lot of water on wooden floors. I removed and re-inserted and secured the pump filter, then spent the rest of the afternoon moving everything I could out of the kitchen so the floor could dry thoroughly.

 

I don't think the rug pads can be saved, so I ordered new ones. The rugs are both inexpensive. The one in the pic is from IKEA. But I like them and wasn't sure I could easily replace them, so I decided to take both rugs to a laundromat with commercial sized machines. I was worried the rugs would be too big and heavy for those machines, but I needn't have worried: those machines are so big it was almost like washing potholders in a regular machine. I washed each rug separately, in hot water, and then dried each rug separately, which took forever. When I brought them home they were both still a bit damp, so I laid them out on my seagrass rugs in the living room to finish drying.

 

Both rugs were several inches too big for the areas where I was using them, which was a real pain because it meant I had to fold the edges under to the size they should be. So this morning I decided that since both rugs were now as clean as when they were new, I might as well take them to get them cut down to the right size. But when I laid them out on the floor to see how much needed to be trimmed, I discovered to my delight that both rugs had shrunk to the point that I no longer need to have them cut down. So there really was a silver lining to this mishap.

I Might Need A Victorian Fainting Couch (and maybe a new doctor, too)

About a month ago, as I was brushing my teeth and getting ready for bed, I noticed a rather large lump on the left side of my neck. Note: I know in the pic I've posted, it looks like it's on my right side, but that pic was taken in the mirror, so everything is reversed. I was going in for my regular 3-month diabetes check-up in a few days, and as I looked at the lump in the mirror, I thought I really should have my doctor check that out, but then I reconsidered. I currently have a doctor who, although he's a GP, prefers no physical contact. 

I'm old enough to remember when at the very least, every doctor visit included palpating your throat and jaw line for tumors, and once a year, there'd be a breast and pelvic exam, but those days are long gone. Several years ago, when I was still working, the health program at work was sending me regular emails reminding me I was overdue for a pelvic exam, so when I called to schedule my annual check-up I specifically requested a pelvic exam be included. But when it came time for the annual exam, my GP refused to do the pelvic. You would have thought I was asking him for a date. He told me I'd have to make a separate visit to an OB-GYN for that. So when I went in for the 3-month check-up, I didn't mention the lump on the side of my neck, and he didn't notice it. 

Fast forward 3 weeks to Mother's Day, when my son Chris, who happens to be a paramedic, came over to have lunch with me. After lunch he said, "Hey Mom, what the heck is that thing on the left side of your neck?" I said, "Oh, so it IS visible!" He replied, "Hell yes it is, and you need to get it checked out, right away." I told him I would, and that night, standing in front of the mirror before I brushed my teeth, I used my phone to take a picture of it. 

Two days later, I was back in my doctor's office, waiting for him to examine me. "What are you in for again?" he asked, even though I'd been very specific on the phone with the reason for my visit, and I'm sure it was written on my chart in front of him. I told him I'd found a lump on the side of my neck and wanted him to check it out. He looked at me and said, "I have to tell you, I can't see a thing!". I told him it was on the left side of my neck, and showed him where. Standing in front of me, he poked around a bit and said, "I can't feel a thing either! Do you think this is something that has just disappeared?" At which point I pulled out my phone and showed him the photo. His eyes got big and he said, "Holy cow! I can see why you called me! If you'd just sent me this picture, looking at this and considering your age I'd say oh yeah, that's probably CANCER! I can't see or feel it, but based on the pic, I'm gonna send you for an ultrasound, to rule out anything serious." 

After mentally giving him an "F" in bedside manner, I felt relieved that at least I was getting referred to someone who might be more interested in determining what this thing was. He specified on the order that he wanted an ultrasound for "lymphatics/venous/artery/jugular" and told me to be sure to show the tech the photo. The Imaging Center was able to schedule me for late in the afternoon the same day. To my relief, the technician had no trouble seeing the lump, and she spent a good 10 to 15 minutes mapping it with ultrasound. When she finished, she told me the results would be sent to a "neck specialist" who would write a report and send it to my doctor within 24 hours. I went home and against my better judgment, I Googled "ultrasound for lymphatics/venous/artery/jugular". Uh, yeah, not a good idea to do that. 

This morning I got a phone call from my doctor's nurse, reporting the results. It seems the lump is something called "A Prominence of the Jugular" (capitalization by me). Hahahahah! Does that sound Victorian or what? Thus my thought that I might need a Fainting Couch. If this was on the right side of my neck, a good doctor would be looking for signs of congestive heart failure, but apparently the prognosis is not nearly so grim when it occurs on the left side. I asked the nurse to send me the report, so I can read it myself and decide whether I want follow up. In the meantime, I'm thinking it may be time for me to find a doctor who's a little more interested in me as a patient.