Detached again – the Sequel

Since receiving many positive comments about the blog entry “Detached in Rockhampton”, I have been concerned about how to keep that level of excitement and interest in the blog given the lack of travel opportunities. So I have done what film producers do when bereft of ideas, create a sequel.

As I sit in the entrance of St Andrews hospital (last Thursday), I am reflecting that this blog entry was planned to wax lyrical about the marvellous progress I had made since my detached retina operation four weeks ago.  Alas, I am scheduled for more surgery in two hours’ time as the first round is failing. In spite of the great surgery, careful recovery progress, the bottom of my retina is detaching again and will continue to do so unless more radical surgery is undertaken. 

Our first checkup after four weeks saw us travel to the Queensland Eye Institute armed with a list of questions based the next phase in the recovery, when to swim, bicycle, travel etc.  It took less than a couple of minutes for Dr Shama to dissolve this plan after reviewing left eye scans.

Plan B: a rubber band and some 5W-20 or was it 10W-30 given our warmer climes? I believe that the technical term is a Left Vitrectomy, detached Retina with buckling. Yes they use a belt and buckle around the eyeball, what fun.

Seriously, as the gas bubble dissipated and was being replaced by natural liquid, the pressure was reduced and the retina has not stayed stuck to the back of the eye. The gas bubble works in 80% of cases, just not in mine. The planned option is to fit a silicone belt buckled around the eyeball and inject a silicone based oil then in place of the removed gas.  The oil will remain in place for up to six months before a further operation to remove the oil next year.  If successful, I should recover 30 to 50 percent of my left eye’s vision. I got all this news at 11am just before we were due to have lunch with friends. No eating and drinking allowed for me.  I just had to watch, as no food or drink for at leat six hours before surgery, while Anne and our friends tucked into a tasty looking lunch.

I think hospital wards must be a little like aircraft, the crews are always different as no one from my last operation four weeks ago is around this time in the same ward (2F). The paperwork is significant and duplicates all that I did four weeks ago. However it is to ensure I get the right surgery so no complaints here. 

I have the same surgeon and anaesthetist as last time so the team is all together again. Dr Sharma organised the people he wanted on the team again with little notice. A big thanks there.

I just hope the after party blues will not be as bad as last time. Sadly I have been told the procedure will be more uncomfortable than the first time. My discussion with the anaesthetist about how seedy I felt leads to a change in anaesthetic mix. I had been chatting with the anaesthetic nurse and she had enlightened me to all the mixing drugs and monitoring of the patient that goes on during the operation.  I just thought that the mask went on and then it was off to coffee for the anaesthetist. Must be all the old masters paintings I have seen where they anaesthetic was administered via alcohol or a piece of blunt wood.  Science has moved on, thankfully.

Let’s get this show on the road.

I am told I have wiggly veins in my hand so the cannula into my arm near the elbow. Sadly no more commentary as the lights go out pretty quickly so over to my photo team. 

Anne has asked that I include a warning this time for those of a more sensitive disposition. So here goes WARNING – DETAILED MEDICAL PROCEDURES ARE  INCLUDED IN THE FOLLOWING PHOTOGRAPHS.

The team hard at work to save my retina.
Look at the neat stitching.
Just pull the thread a little tighter.
Amazing the skill level to do this. (A Closeup)

Back in recovery and while I drift in and out of consciousness in the first few minutes I do not feel seedy as I did last time. The change in the mix of anaesthetics has worked and I feel good.

Back to my room in ward 2F and a quiet night’s sleep as there is very little elective surgery that day.  I am the only patient for eye surgery.

Taking it easy after a busy evening on the operating table.

Two new things I learnt in hospital this time, firstly some people have  this operation up to five or six times, not me I hope.  Secondly remember, while recovering from the effects of the anaesthetic,  the nurses adjust the bed up and down for treatment and when you get out of bed they have not shortened or lengthened your legs.

Safely home with Anne caring for me.
Day 6

So what’s next?  After a week on my back, opposite of the last time, and a further week of recovery, I return to the surgeon for a follow up.  I must wait for three to six months before the oil is extracted, yes another operation under general anaesthetic, but I am planning for this to be the last of the eye blogs. Again a big thanks to all involved in my treatment and this was all done in the space of 10 hours, two less than last time.

– Anthony

Detached in Rockhampton

Here we are again, another of Anthony’s medical emergencies to blog.  As I sit on this Qantas flight to Brisbane from Rockhampton, mask on of course, off to see another specialist with the likelihood of surgery this evening, I have time to reflect on the medical episodes that have occurred while travelling and those that were blogged from 2014. We have seen: 

“Himalayan Heart Attack” (Bhutan 2009)

“Helicopter tours of the Hunter wine region” aka “Medivac to John Hunter Hospital (NSW 2012) 

“Arrhythmia for Beginners” (Brisbane 2015)

“Crushed Ankle across the Andes” (Argentina/Chile 2015)

“Introduction to Nasal Tampons” (London 2017)

Nothing for three years, they all take planning you know, and I am as meticulous as Daniel Day-Lewis in my preparation.  But now, we are pleased to announce a new chapter  “Detached in Rockhampton” staring yours truly in another exciting medical adventure. I will write this as far as possible in real time to capture my feelings as this unfolds. Perhaps I should start at the beginning.  

After a night in Mackay, we planned a leisurely day heading to Rockhampton to stay with our friends Katie and Gus. During the journey, I had noticed an annoying irritation at the bottom of the left eye, like that you get when the eyelid can be a little inflamed.  Annoying but only impacting the very bottom of my vision.  It seemed to worsen slightly during the day and become more pronounced that night. While washing my eye out with saline solution Anne thought that it might be a detached retina and should see a specialist Thursday evening, but what would she know. A good night’s sleep is a great cure for many things, not this however. By morning, almost half my vision in the left eye is affected. 

Change of plans, the leisurely breakfast with Katie is out and at 08:20 I am outside a local optometrist, which seemed like a good starting point. I explain the problem and a quick examination by the very helpful optometrist, Lillian Beech of Lawrie and Taylor Optometrists, and a detached retina is diagnosed. Ouch, even though there is no pain, this is a serious problem.  

The eyes have it, well partially at 08:45 11 Sept 2020.

My limited understanding on detached retinas is that the quicker the surgery is done the better.  The length of time between detachment and surgery can impact recovery of vision.

The optometrist quickly makes some calls to see if a surgeon is available locally and also contacts my cataract surgeon from 2018, Dr Paine of the Queensland Eye Institute in Brisbane. A local specialist is available in Rockhampton, but there is an issue about where I would recover as the recovery process can require one to lie face down for two weeks!. Our Rockhampton friends are moving house in a couple of days and we have to get the camper van back to Brisbane early next week. 

I speak to Dr Paine and he is in the process of organising a surgeon to review me in Brisbane if I can get down today. Today is also a Friday and if we were to drive it would take two days to get back and I would not be able to drive so we would get back Saturday evening. Flight is the only way back, Qantas and Virgin both have flights and initially I am on Virgin, but then need to catch to the earlier Qantas flight which is full. I talk to Ben who is waiting to checkin and he agrees to take a later flight to allow me to travel on the 11am flight.  Thank you Ben.  Qantas do charge like a wounded bull, but the cost is insignificant compared with potential loss of vision due to delay. It is interesting even during the COVID-19 times that airline pricing and ticket change charges are unchanged.

Mr Cool en route to Brisbane.

I depart at 11am, leaving poor Anne to drive the camper van back to Brisbane over the next two days, it must be harder for her as she is out of the loop and we are not together.  An hour later, we are arriving in Brisbane.  We land on the new runway giving a new approach to the airport for me and taxi route to the terminal. Parked aircraft still fill the old cross runway and there is a much smaller number of aircraft in the terminal area, most for Queensland domestic routes.

Virgin Australia B737’s waiting return to lease holders.

New Taxiways off runway 01L/19R at Brisbane.

The terminal is strangely empty for a Friday afternoon, COVID-19 of course, but we have not flown since March so this is the new normal. Taxi to town and we are at the Queensland Eye Institute on time at 12:45. Not bad: diagnosis in Rockhampton at 8:45, in Brisbane some 700km away four hours later.

Dr Paine tells me he has arranged for an excellent surgeon, Dr Sharma, to give me a Left Vitrectomy and Laser, whatever that is.  He explains that the Retina has pealed from the top and is now hanging over the side of the eye blocking my vision. He also says this is delicate operation due to the nature of the retina and it can take a couple of hours.  

As I wait there for the paperwork to be prepared for the operation: it is a strange feeling, not physical but mental, as the retina continues to detach from the top on the vision in my left eye is now, at 13:30 is down to about 20%. 

Admission to the hospital, once I am past all the questionnaires and temperature checks, is decidedly manual, paper forms go backwards and forwards and they physically need both my credit card and medicare card. So much for reduced contact during COVID-19. I use my hand sanitiser to clean my credit card and Medicare card.  

As at 17:00 I am in my room at St Andrews Hospital, have had a succession of tests by a series of people who all look the same in their blue masks, well to me anyway. Vision in the left eye is down to about 5%. Wow the change has come on so quickly. I am so lucky that a surgical team has been assembled so quickly to operate at 19:00 this evening.

Waiting Waiting Waiting Room 15 Ward 2F St Andrews.

Anne has reached Maryborough for the night about halfway back to Brisbane. We talk but is is hard for both of us to be apart at a time like this.

An hour to go before surgery  The ward, 2F, is quiet.  It is the same ward I was in over 11 years ago for my quad bypass operation.  Hopefully they remember that although its a cardiovascular  ward, I am here for eye surgery. Having no food or liquid since 08:00 I am both thirsty and a little hungry. I wonder what the outcome will be and what impact it will have on future plans. I have just used the whiteboard and realised I have no perception of depth as I struggle to put pen to whiteboard and spill water from the jug over the table and not into the mug as planned, twice.

Wheeled down to Operating Theatre 14, a good banter with the team there and I get a nice warm heated blanket mmm… I think the banter helps me avoid thinking (too much) about the possible outcomes of the surgery – will I come through the other side, will I have sight back in my left eye.   We wait for our anaesthetist who is on a heart operation before mine. We should let him finish that first. The same questions are asked and I remember to mention I have restless leg syndrome.  It will be a GA for me. General Anaesthetic to those not it the know. This will stop any body movement while they work in my eye. 

Dr Sharma explains the operation will involve removing the vitreous, a gel-like substance that helps the eye maintain its round shape and repair the retina and insert a gas bubble.

I walk into the theatre, easier than wheeling the bed in, and another nice heated mat awaits me. A few drugs later and zzzzzz…

Dr Sharma and the team at work

Focus on the needle please.

All done. Disconnect the patient and send him to recovery.

Noise and light, seems like I am waking up from an all night party at midday. The recovery room.  Great to be awake but boy do I feel seedy. An uncomfortable night follows as the anaesthetic drugs work their way out of my system.

This what the after party feels like.

As I recover in the morning it is an interesting range of colours I can see out of my left eye. With only the left open, it is like a stained glass window with green and yellow predominant and vague shapes almost indistinguishable in the background.  With both open, my vision is overlayed with a oily liquid which reminds me of a toilet gel with purple specs.  While using the toilet, the bowl appears to fill up with this liquid to overflowing which is very disconcerting.

Dr Shama the surgeon comes to visit in the morning. He says the operation went well. They discovered five tears, four on top and one at the side. The gel was thicker than usual so as you age it the gel shrinks and can pull the retina off the wall. Normally 1:15000 risk now for my second eye 1:15 risk of it occurring – ouch. It may be months before we know how successful or not the surgery has been.

Oh what a night. A successful operation.

I was so lucky, from diagnosis to being wheeled to the operating theatre was about 10 hours, and 520 km by air apart. The gods were kind to me again.  A big thank you to all who made this possible in such a short space of time.  Anne got back to Brisbane at 10am the next day, in time to collect me from hospital with our friend Glen.

Two pieces of advice I can give is:  if you get a single spot that has the appearance of a black hole sucking in all light moving around in your eye or you start to loose vision, go see a doctor straight away. It is also important that your personal medical details, operations, allergies etc are up to date and handy. Mine are stored on my my iPhone but I realised I had not included all details such as restless leg syndrome which affected the method of anaesthetic they would choose.

Just another 24 hours on the road for the 2slowspeeds and now a few months of recovery. No more travel or blog entires I am afraid so the couch will have to go back in the cupboard till 2021.

– Anthony