2-month post-op update - addendum

Dr. Rumery called me back to ask that I come back in so he could test the pressure in my eye (a quick and simple test) so we coordinated and somewhat sketchily / awesomely met up at the Dean Clinic on the West Side after hours to get me checked out before he went on vacation (thanks again, Dr. Rumery, for being so flexible and awesome!)

For those interested, after a numbing drop, Dr. Rumery used a hand-held applanation tonometer, which I find to be vastly preferable to the puff of air method:

It didn't look exactly like this one, but this picture was too awesome not to include

Anyways, good news:

• left eye: 8 mmHg (the one of interest)
• right eye: 11 mmHg

Background on this measurement and why it matters from the Ocular tonometry wikipedia page:

Tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma.^[1] Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).

2-month post-op update

Ok, it's not quite 2 months, but due to scheduling stuff, I had my 2-month post-op with Dr. Rumery today.

Stuff we discussed:

My current meds

1. Tobradex Ophthalmic ointment - 3x/day, this is for comfort and as an antibiotic
2. Atropine - 1 drop daily before bed, this is to keep my eye dilated*

*Why are we keeping my eye dilated? Great question! This helps to prevent synechia. Basically, after surgery or other eye trauma, it's possible for your iris to become sort of stuck to your lens (in my case) or cornea. This is bad because it can cause pressure that can led to glaucoma. Keeping my eye dilated means my iris is a bit more withdrawn from the lens, at a position where it's at a slight distance from it and therefore less likely to become stuck.

My vision

Pretty good! With glasses for correction, my right eye is at 20/20, which is expected. My left eye is still not back at 100%. I've been worried about this, but this visit reassured me a bit.

You're probably familiar with an occluder (see image below), even if you don't know it by name: it's the thing you use to cover one eye so you can use the other for a vision test. They had a nifty one at my eye doctor that had a flap that rotates into place over the eye of interest, adjusting the opening from a Sacagawea dollar-sized hole to a series of pinpoint openings. This is awesome because it reduces the amount of light entering your eye. Meaning...

*drumroll please*

It simulates your eye in a non-dilated state! In other words, looking through the occluder with this flap engaged meant I was seeing as I would if my eye weren't dilated. And hearteningly, this improved my vision a LOT. While I'm not at 20/20, I'm close. This alleviated my worry that maybe I wasn't recovering well, or that my cataract was already brewing.

Fancy occluder

My retina and overall eye health

Pretty good! Nothing in particular of note, in either direction.

My cornea moisture

After putting a drop and some yellow (fluorescein?) dye in my eye, Dr. Rumery examined it using blue light, with which the dye is most visible. The idea is that the yellow dye attaches to areas of lower moisture on the cornea, meaning those areas are dry and perhaps indicative of poor corneal health or recovery. Good news: while I had a couple of areas that showed up under the blue light, they were small and faint. This isn't worrisome.

Bonus: for those who looked at the surgery pics, there was one where I was not at all sure what layer was sewn shut. Well, mystery solved: it was the conjunctiva, which is a layer on top of the white part of your eye (the sclera) that helps with lubrication. It doesn't normally extend over the iris/cornea, but was stretched to do so during the time I was wearing the plaque (apparently). Anyways, ♪♫ The more you know! ♫♪

I've gone back and updated the photos post with this info, too :)

Aftermath

IT'S OUT!

The surgery went well. Here's what's next:

• I wear a much smaller patch (lead-free) until Wednesday morning
• Starting Wednesday, I begin using drops:
• Dilating drops nightly (to ease pressure)
• Antibiotic drops 4x daily
• I fly home to Madison Thursday evening
• I begin being able to see well sometime next week ish
• I can drive again in one week
• I can lift 25+ pounds, resume strenuous activity, etc. in two weeks
• The stitches in my eye dissolve in the next 4 weeks, at which point my eye will begin looking better (less red / swollen)
• I see my referring physician for follow-up examination etc. in 2 months and 4 months
• I get results of genetic testing (to determine likelihood of metastasis) in 8-12 weeks

So that's it! More details on all of this (hopefully including photos!) in the coming days and weeks.

Almost there...

I've almost made it! The surgery to remove this thing from my eyeball is scheduled for 12 PM Eastern tomorrow and I can't wait.

I've spent the time since the first surgery doing...not much.

Turns out it's pretty uncomfortable to read or do anything that requires eye movement; my left eyelids are sewn shut on top of the plaque, meaning when I move my left eyeball it moves underneath the eyelids and sutures. Sometimes this is uncomfortable; occasionally it's painful.

It's also uncomfortable to be near bright lighting. Such as...the huge [seeming] windows in the restaurant at breakfast. This screen, even with the brightness turned way down, is kinda bright. So yeah, that's why I haven't blogged much :(

Anyways, I've caved and have been taking the Tylenol with codeine as well as Aleve...the discomfort is real.

I'm looking forward to having nothing sewn to either eyeball! And to having this patch off and being able to shower all of me, not just neck down!

After pics + update

Here's the update; it'll be a series of bulleted lists because I can't really see very well :(

• I went into surgery around 12 PM and got out around 1 PM
• I hung out in recovery for a half hour before I was ready for my mom to visit and to eat food (food = grape juice, pretzels, and fig newtons)
• After another half hour they took the IV out and I was able to get dressed
  
• By 2:30-ish, we were in the hotel room at the Hilton Garden Inn on 11th and Arch
• Mom got me a chocolate chip cookie at Reading Terminal Market and luckily also picked up some milk :)
• We ordered room service for dinner

More lists below, since I like list making :)

I have prescriptions for the followig meds in case I need them:

• Tylenol with codeine - for pain
• Ativan - for anxiety (e.g. itchiness / "get this sh*t off my eye" sort of feelings)
• Zofran - for nausea

Apparently day one is the worst, and if you can avoid taking the meds, you'll be happier, so I haven't even filled these scripts yet. They said if you have a decent tolerance for pain, this should be doable, and I do have a high tolerance for pain; I've taken some regular Tylenol so far but not much more.

Here's the plan:

• Thursday (post-surgery - apparently the worst, pain-wise)
• Had a doctor visit to check in
• Sleep recommended, so that's what I've done until like 6 PM
• I put a contact in my right eye (glasses have no hope of staying on; see below for  a pic) so I could watch some TV
• Likely going to bed around 10 PM Eastern
• Friday
• Will have another doctor visit before noon
• My plan is to watch TV, read, do some internets, maybe listen to some music or podcasts, etc.
• Saturday
• Will have a doctor call to check in
• If you're in town, text or call me or my mom to coordinate a visit!
• If you're pregnant, you're not allowed
• Otherwise, you can come over and hug or touch me once or twice, then stay 5-6 feet away
• Otherwise, same TV/reading/listening plan
• Sunday
• Will have a doctor call to check in
• Otherwise, same TV/reading/listening plan
• Monday
• I'll be on an 8 AM shuttle back to Wills Eye for the plaque removal surgery

I'm radioactive!

Fashionable lead shield (under the gauze)

Roller coaster of emotions

TL;DR: surgeries are happening as scheduled!

Details:

I spent much of Monday on the phone. The short version is below (believe me, it could be longer...as my notes prove, because I'm a note-taker). Hit the jump for the blow-by-blow.

[My thoughts will be denoted thusly]
 

Home, James, and don't spare the horses

I'm now at my parents' place in Maryland; landed tonight.

The plan (stay tuned as there's a finite, significant chance that this will change - more on that later):

• 4/25 - Drive to Philadelphia tonight; stay overnight
• 4/26 - 
• Get ocular testing (examination, ultrasound, photos, etc. - same as in Madison and as last time I was in Philadelphia) - this is needed because I wanted long enough after my biopsy that things may have changed
• Drive back to MD in the evening
• 4/27 - 
• Take the train to Philadelphia in the evening, or maybe the next morning depending upon surgery timing
• 4/28 - First surgery
• 4/29 thru 5/1 - Stay in pre-determined hotel and be a bit bored
• 5/2 -
• Second surgery
• Take the train back to MD
• 5/3 - 5/4 - chill in MD
• 5/5 - Fly back to Madison

The reason this is subject to change is that based on conversations I had with various parties last Thursday and Friday, as well as this morning, I do not anticipate getting a prior approval for either Tuesday's tests or the surgeries themselves before they're set to occur.

So it's likely that I'll be flying back to Madison on Monday or maybe Tuesday night, rescheduling this all for 1-2 weeks from now.

Scheduled!

Plaque implant: Thursday, 4/28
Plaque removal: Monday, 5/2

I expect this time period to be very boring :)

Details & plan

The exact wording the pathologist used was that the results of the biopsy are "suspicious for melanoma."

He therefore recommends plaque radiotherapy. Not sure what that is? It goes something like this:

<Philadelphia>
On a Thursday: I have surgery to have a radioactive piece of metal ("plaque") sewn to the surface of my eyeball over which I'll wear a lead patch (!)
On the following Monday: I have surgery to remove the radioactive plaque
</Philadelphia>

<Recovery>
Week 1: no driving
Week 2: no strenuous activity (no lifting anything more than 25 lbs), pools, or saunas
</Recovery>

I may have blurry, doubled, or distorted vision right away; I also may have flashes or floaters. These should subside as my eye heals from the radioactive intrusion.

I'll have follow-up appointments:

• at 2 months: here in Madison
• at 4 months: back in Philadelphia

Then, over the next year:

• I will develop a cataract
• I may develop cornea damage

I'll do a post on the science of plaque radiotherapy later (maybe). Nerds out there, this will have to suffice in the meantime:

• Radioactive Plaque Therapy
• Eye and Vision Sparing Radiation Therapy for Intraocular Tumors