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Switzerland 2021


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Monday September 13, 2021
El Granada

Prologue




Totals for the trip:
12 rides
14 climbs
707.5 km cycled (half up, half down)
20114 meters elevation climbed

Eye summary:
First my eye got better, I could see nearly 100% clearly for a couple of weeks.
Then my eye got worse.
Then I needed surgery.
That was my fall 2021...

WARNING

Details of the problems with my eye below.
I'm trying to avoid gorier details, but there are details...

September

Tuesday September 14
I made an ophthalmologist appointment for Tuesday September 14, the day after I got home.
The doctor looked at me and told me to come back in 3 days when hopefully he'd be able to see something in my eye - too much stuff in my eye now, he couldn't see anything.
He did ask about the technique the doctor used in Davos.
She pressed a lens directly to my eye to examine it and to fire the laser into it, for all I knew this was normal, I have no idea what is and is not normally done anywhere.
My doctor here praised the work she had done in Davos, but he said he wouldn't have done it - I assume doctors in the US, or at least he, don't put lenses directly on your eye...
Guess I might have been stuck for days if I'd have needed to wait for treatment in the US.

Friday September 17
Three days later he was able to see my retina.
He advised more laser treatment someday, I said let's do it now.
He was happy I was so decisive, apparently many people need convincing for some reason.

He then started to blast me his argon green laser - 0.15s, 28Dens, 0.3-0.38 W
His laser was more powerful than the laser in Davos, each blast hurt.
Several blasts together really stung.
I got 142 more of them, 8 fewer than he estimated.

I got into the habit of requiring In-n-Out burger after an eye exam.
That was my reward for dealing.

Over the next few weeks, my eye slowly cleared up.
I had at least one follow up appointment, the doctor estimated my eyesight was around 85% recovered, I would have guessed a little higher by that point.

October

By early October I would have estimated my vision was 95% restored.
I was riding my bike fairly slowly on pavement.
I drove, went shopping, and met a friend for lunch.

Kathy and I planned to fly to Denver for a long weekend on Thursday October 21.
We drove to Oakland ParkNFly, parked, and rode the shuttle to the airport.
Right outside the door to the terminal I stopped to get my phone and wallet ready for TSA.
I put my Camelbak on my back.
I looked up.
In a few seconds I saw a large solid black sticklike object floating through my field of vision for a few seconds in my left eye - it looked more like a scene out of 2001 than anything else.
Poop.
We went inside and went through security.
My eye got cloudy quickly.
I wasn't going anywhere but to the doctor.
I was determined not to ruin Kathy's weekend any more than possible, I insisted she go ahead without me.
Robby came and picked me up from the airport and took me to Kaisar.
My blood vessel had ruptured a second time, a vitreous hemorrhage
Each time it ruptures, it will get worse, which is why I just went blind within an hour or so.
Now I get to do nothing at all, I need to let me eye clear as much as possible.
I need to sleep somewhat upright so my the crap in my eye doesn't settle on the back of my retina in my field of vision.

The doctor had mentioned a blood vessel between the two tears in my left eye many times.
I'm not sure he ever said that it had ruptured in Switzerland, I certainly hadn't understood that detail.
I knew I had to be careful, but I didn't know why.

I asked what the plan was - maybe in 6-12 months I'd be able to be active again.

Kathy ended up flying back from Denver Saturday a day early to help take care of me - she did get to see her parents, which was important to me and obviously her as well.

Over the next several days my eye didn't improve much if at all.
I had to lie to myself to tell myself that after a two weeks of clearing, it was almost as good as it was at its worst in September.

November

I had avoided doing any research on my eye because for a while everything was fine, I didn't need to know.
Then everything got worse... and I didn't want to know.

Tuesday November 2
Two days before my Thursday November 4 followup appointment I finally started researching treatment options online.
I saw there was a treatment option that was highly successful.
Fantastic!
I didn't research any further, ignorance is bliss....

Wednesday November 3
The night before my folllowup appointment I finally started to look at exactly what the procedure to fix my eye might entail.
Oh dear god no.....

Thursday November 4
At my two week followup appointment on Thursday November 4 the doctor still couldn't see anything and gave me an ultrasound.
At the end of the ultrasound he didn't say much, I knew that wasn't good.
A few minutes later back in the exam room he closed the door before he started to talk, I knew that wasn't good.
He said he thought I may never be able to see well out of this eye again without treatment.
I could continue to wait and see, or I could consider surgery.
If I wanted surgery, the soonest would be Monday, and I'd need to let them know by 10am Friday in order to schedule the surgery.
I asked a few hard questions - how many of these procedures has he done?
2500 over the last 20 years.
That answer alone should have been good enough, but I pushed him -
If you had to get this procedure done on yourself, who would you go to?
He said he'd perform the procedure on himself, he didn't seem to appreciate the question.
I pushed him a little harder, then realized I wasn't doing either of us any favors.
I decided 2500 procedures was more than good enough and told him I'd most likely decide yes, but I wanted to discuss with Kathy first.

We drove home and I emailed him within an hour - let's do this.

That same night I was watching tv and eating dinner on the sofa.
I wasn't happy that I needed surgery, but at least I had a plan and maybe I'd be able to see again.
I sat down on the sofa a bit carelessly and impacted my head on the back of the sofa, the nice puffy leather.
I don't normally keep my bad eye open any more because I can't see anything.
A while later I opened my eye and was horrified to see a large solid blob hanging across about a third of my field of vision
I was sure I had detached my retina only a few hours after I decided to get surgery.
I told Kathy and Robby what had happened then went upstairs to freak out about it quietly in bed.
I emailed the doctor at about 630pm that night, he responded within 30 minutes to come in Friday morning at 845am.

Friday November 5
Kathy's birthday.
Robby moved out of the house for good this morning, starting his drive to New York this morning via LA to see a concert with a friend.
For her birthday, Kathy got to drive me to the doctor where an ultrasound confirmed what we already knew, I now had a large superior retina detachment.
I now needed emergency surgery, today - a pars plana vitrectomy.

I asked Kathy and CJ to find me a massage table to sleep on since I would need to sleep face down for the next two weeks.
CJ found one on craigslist, went and bought it, and delivered it.

I got myself admitted, paid my $300 deductable for the procedure, got a covid test, then got set up in pre-op at about noon.
They couldn't find an operating room and staff until 4pm.
I had a few hours to contemplate my upcoming procedure.
Hooray.
They wanted to put the IV in right away, I managed to avoid it for a few hours since I wasn't going anywhere and didn't need a needle sticking out of me for an extra 4 hours.

The procedure itself wasn't awful.
It certainly wasn't fun.
You are completely covered - they put a metal shield over your remaining eye to protect it, and there's a gown over all the rest of you except your bad eye.
You can't see anything, but you are awake.
They give you just enough drugs to take the edge off.
I had a little more edge than I would have preferred at the beginning and begged for a little more whatever I was mainlining.
I felt a little better a little while after that.

From his notes:
Superior bullous detachment confirmed
Complete posterior vitreous detachment confirmed
Endodiathermy treatment
Cauterized and cut bridging vessel
50cc 15% c3f8 15mm injected into my eye
500mg diamox iv

I had 3 armbands when I left
White - hospital admission
Red
Green - "I have a bubble in my eye."
If you are given nitrous oxide, or you go above 4000' elevation, you increase pressure in your eye and you could go blind...

Saturday November 6
I had a followup visit Saturday morning.
Kathy got to learn how to put in my eye drops, and the doctor showed her what he'd done to my eye.
Kathy was on the floor at one point, she nearly passed out from seeing and hearing the details.
I couldn't see anything of my bad eye which was fine, just living with it was plenty.

I was told If I found that I had turned over in my sleep, all the air in my eye would escape, the procedure would fail and I could be blind forever - "it's all over"
I was given a very, very long list of possible side effects.
Almost anything unpleasant - itching, burning, pain, you name it - was considered normal and expected at this point except for stabbing horrific pain - I should call the doctor about that.
Anything else?
Normal, sorry - deal with it.

I was advised to do as little as possible, and to spend as much time as possible lying on my stomach doing nothing.
No reading, no computer, no iphone, no texting, no surfing the internet.
Watching tv or a movie is ok.
That's about it.
I asked which was the more important part - doing as little as possible, or lying face down, or were they both important?
Answer:
They are both important.
I should be doing nothing lying face down 95% of the time.
By this, he meant that for 5-10 minutes every two hours I should get up, eat, use the bathroom etc.
Other than that, I should be face down.
My next followup was scheduled for Thursday November 18.

Any time I moved, I could feel my eye - pressures changing, things moving.
It did not feel great.
If you've never noticed, both eyes always look the same place, so if you're using your good eye, you're using your bad eye too.
So using my good eye mad me feel like crap.
I would watch TV on Kathy's ipad while looking down
Some shows were ok, shows that moved too much were a bad idea.
I could go maybe an hour or so before I needed to rest both eyes.

I used a straw to drink so I wouldn't have to look up and loose my air bubble.

When I wasn't lying down, I was sitting looking down.
I did more than I should, but I almost never looked up.
Using my good eye or doing anything for more than maybe an hour at a time was pretty self correcting...
You start to feel pretty awful, and all you want to do is lie face down again with your eyes closed.

I've never been able to sleep face down... or on my side, I always sleep on my back... not anymore....
I could sleep face down for at most 3 hours a night, sometimes only 90 minutes a night - one REM cycle.
Few things are as reassuring when you're exhausted and trying to fall asleep... as knowing that if you turn over in your sleep, you could go blind.
Sweet dreams!

The first week was not great at all.

The second week was an improvement.

I woke up at 1030pm on my 11th night face up.
I hadn't been asleep longer than 3 hours at most.
I was almost relieved that I'd lasted until my 11th night before finding myself face up when I woke up.
My eye felt slightly different after that I think I could feel the air leaking around my eye back and forth.

Tuesday November 16
I started to notice a strange line at the top of my field of vision.
It was similar to the retina detachment, but it wasn't as large and it wasn't quite the same thing.
I was a little worried, but everything else seemed normal, so I let it slide as normal.
I mentioned it to Kathy.

Thursday November 18
At two weeks I was cleared by the doctor to look straight ahead again, but not much else.
I was told that the line is the bubble, remember?
No, actually, I didn't remember that at all.

Much of Kaiser was on strike today, my doctor was basically alone.
They'd cancelled nearly all the other appointments, mine was important enough to keep.
My doctor wasn't able to schedule a followup, thought.

When they came back from their strike, they now had to reschedule two days worth of missed appointments.
When I called to get an appointment, they didn't have anything.
When I called again, after 10 minutes or so they found one appointment before the end of the year - December 30. 
Why yes, I guess I'll take it since it is that or nothing...

I started sleeping on my side on the couch, which is much more manageable than sleeping on my front.
Within a week the air bubble shruink enough that I could see all sides of the bubble when I looked down.
I assumed this meant I'd be seeing clearly pretty soon.

December

Wednesday December 1
3-1/2 weeks after my procedure I went on an easy paved short bike ride.
I'd been very worried about depth perception, but I finally discovered depth perception matters much more up close than for distance.

Monday December 6
4 weeks after my procedure I drove to the post office.

I didn't look up the doctors notes on the Kaiser website until weeks after the procedure.
I didn't realize that c3f8 takes 6-8 weeks to fully clear out of your eye....

Wednesday December 8
My last eye drops.
I knew they had helped make a bad situation more tolerable.
I was worried that my eye would hurt or get worse without them.
Over the next few days I was pleased to survive with no eye drops.

Tuesday December 14
My eye is taking forever..
I'm nearly at 6 weeks and the bubble is shrinking very slowly.
My vision above the line has deteriorated considerably
I try not to worry about it, telling myself it is only gas bubbles.
Finally today I noticed the my vision above the air bubble line is shimmering just like the bubble itself and vision in the bubble has....
This confirms that the gas bubble is everywhere in my eye, which is great news since presumably I'll be able to see more clearly someday when it is gone...

Wednesday December 29
I'm scheduled to finally have another followup eye exam tomorrow - 6 weeks since last exam, almost 8 weeks since surgery.
The gas bubble is almost gone, but it is still significant.
I've decided there's no point in spending half the day at the doctor's office to have the doctor tell me what I already know - I still need to wait.
If I try to rush it, it will be a worse outcome and feel worse almost immediately...
I cancel tomorrow's exam and get a new one 2 weeks from now.

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Switzerland 2021


Previous
Monday September 13, 2021
El Granada

Prologue