Tag Archives: retinal hemorrhage

Pokes Galore

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I had my two-week BP follow-up last week. Like a good girl, I’ve been taking my Lisinopril every day, well, except for one day. I had a glass of wine and decided to skip it, but then I felt guilty for doing so. So I said, what the hay, I’ll have both if I feel like it. YOLO, right?

Doc asked me if I’d been taking my BP. He looked surprised when I said no. I don’t have a personal BP machine, nor do I plan to get one. It did cross my mind while I was at my “favorite” haunt, CVS, but I totally forgot to check it. I mean, why raise your blood pressure?

When he took it, I read 132/80. He was happy with that, but he wants to see me in three months. Which means I have to keep taking this little pink pill for three more months. And he wanted a slew of blood work, fasting. I usually stroll into the lab sometime in the early afternoon. This meant I had to get up early and go get bled before breakfast.

I’ve never been a morning person. I perk up around noon. The idea of rushing out of the house, sans breakfast, to go get needled wasn’t all that appetizing. It took me a few days to psyche myself up, and when I walked into the lab I knew why I go late in the day. It was packed to the rafters.

Two and a half hours it took for them to end up sticking me twice. That’s never happened to me. They always get it on the first try. But I was submissive and said nothing. No need to rattle the phlebotomist and cause her to stick me thrice.

What kept me calm was the ongoing thought that in a couple of days’ time there was going to be another needle introduced into a far more sensitive part of my body. I would have willingly taken a third needle to my right arm in place of that.

I knew two things when I walked into the ophthalmologist’s office. The sight in my right eye was better and I was going to get another shot.

The scan proved me correct. The blood settled by the retina was half gone. Vastly improved, but needing more treatment.

There was only one glitch. The cheaper drug he’d used before was not available, they’d ordered wrong or something. But, he had a sample of the designer drug, if I was of a mind. First, I asked if there was any difference in effect. They were essentially the same he said. It was a matter of dollars and cents for the pharmaceutical.

OK, how impacted would I be in the dollars and cents category? No impact at all, he said.

I mulled it over for a bit. We can order the other drug and you can come back, he said.

Did I need more anxious anticipation?

No. I’m here, prepped and ready I said. Just do it.

The immediate after effect was different. My eye was only slightly red, the sting was mild. I could open my eye, though it was sensitive to light.

I’d driven myself there figuring I’d sit in my car for a bit while the worst of it wore off, but I had no trouble driving home immediately after. I had almost no discomfort for the rest of the evening and night. The next day my eye was slightly pink and slightly sore, a result more than likely from the Betadine antiseptic. I used the artificial tears frequently and as he said, all was back to normal after a day.

The eye injection was definitely easier the second time around but I still don’t want to do it again, though I will probably have to. I did postpone the next appointment a few days past the four-week window as we won’t be in town. We plan to be in NYC celebrating our daughter’s 25th birthday. A quarter century. How did she get so old?

***YOLO = you only live once. I sincerely hope!

 

The Upward Slide

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I own a new adjective: hypertensive.

It’s been over a week since I had the eye injection and the sight in my right eye is somewhat improved. It could be coincidence. It could be that time was going to take care of the problem. It could be the Avastin. It could be both.

The reason I can tell it’s better is because when I look at a straight line, the dip in the middle is now minimal. When I follow the line, it undulates as the dip moves along my line of vision. It’s a phenomenon that makes me want to say: Far out, Man.

Before, the line had a steep downward curve past the midline of my vision field. One reason I could not read with that eye, the words were distorted and blurred in the middle. Now I can make out the words, though they are still a little blurred and slightly curvy in the middle.

My new ophthalmologist was immediately concerned about my blood pressure. Though no vital signs were taken at his office, he wanted me to have it checked out. The ophthalmologist I’d been seeing for years never mentioned my blood pressure when he diagnosed me with a retinal hemorrhage. All he said was let me stick a needle in your eye. But this new doctor was persistent and I promised I would.

My BP ran around 110/60 for years and years. Even on the busiest, non-stop days at work, I hardly broke a sweat. “How do you stay so cool?” the other nurses would ask me. “Why raise your blood pressure?” I would respond.

And now, now that I am retired from all those adrenalin rushes and working at something I enjoy when I feel like it, NOW I get high blood pressure? I suppose a contributing factor could be the sedentary aspect of “ass in chair” that writers suffer. Perhaps a standing desk over a treadmill is in order. You’d think all the years on my feet would have immunized me against hypertension.

It took a few years for it to trend up. First 120’s, then 130s and now 140s/80s. I can’t say I didn’t notice it. All the while I was being seen by a doctor every two months for over TEN years. But no comment was made by either one of us. Vitals are taken as part of the ritual. Something to document. Something to prove you’re still around, heart beating. It’s amazing how tunnel vision develops and you end up focusing on one big thing.

RA.

That’s all we saw, every two months. RA and RA-related numbers. The irony is that RA is probably complicit in these numbers as well. All along, my up-and-coming hypertension was hiding in plain sight.

I’m now on Lisinopril 5 mg daily. “It’s a little dose,” my doctor said. He wants me in the 130s. And he wants to check it again in two weeks. He retook my blood pressure himself, with a sphygmomanometer and a stethoscope, though the nurse had already taken it with the blood pressure machine. I liked that he did that. That’s how I started out taking blood pressures on my patients. The good old-fashioned way, where you can trust your own ears and not a mechanical object.

So, heads up: Learn your numbers and talk to your doctor about your blood pressure readings. Stay active and maintain a healthy weight. And if you love salt, cut it out! In all seriousness, I hope no one else has to worry about their BP.

 

Eye Injection

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I went to get a second opinion on the retinal hemorrhage in my right eye. This ophthalmologist said that if I didn’t have the injection within two weeks of the testing he’d have to repeat it. I don’t especially appreciate having dye injected into me, and since I doubt my insurance would pay for a third round of pictures just because I procrastinated, I did.

My son took the afternoon off and treated me to a pleasant lunch before heading to the hospital. The doctor’s office being in the medical arts building reassured me and relieved some of the anxiety.

It’s an office so large the elevator opens right into it and there’s a rope line where you wait to get to the front desk, sort of like at the movies just not as much fun. When I said I was in for a shot, they directed me to an area I’d never been to. That waiting room was full to bursting. My son pointed out the last empty seat to me.

After a moderate wait, I was called in and given information about the procedure plus a consent form to sign. The language reminded me of the long list of possible side effects recited after medication commercials and made me want to say, “I’m outa here.” The same words my son had used when we took him to see Ghostbusters when he was little. He stalked out of the theater without a backwards glance leaving us no choice but to follow him.

This time he would be following me, but I didn’t get out of the chair. Instead I took the pen and wrote my name. No turning back. Even though I still felt like bolting until the moment I was face to face with the doctor.

The assistant had instilled anesthetic drops, followed by a yellowish-tinged solution. “This might sting,” she said. It did and when asked what it was she said, “Betadine.”

“Betadine?” I responded. “In my eye!” Betadine is a brownish-yellow antiseptic solution that we used to prep for surgeries or other invasive procedures.

“Yes, to prep,” she said.

Of course, how stupid of me. I was there for an invasive procedure.

She then applied anesthetic gel all around my eye, in every nook and cranny. “Your eye might feel sticky,” she said. “I like to cover everywhere because he’s going to put a speculum in.”

I’d wondered how exactly he planned to keep my eye open, because there was no way I was going to be able to overcome the reflex to close it when there was a needle coming.

“Now you can go to the waiting room,” she said.

“The waiting room, really?” I thought I’d be left there till the anesthesia took effect.

“There’s two people ahead of you,” she said. “We need to give the anesthesia at least 20 minutes.”

“How long does it last?”

“Thirty minutes to one hour,” she said. “Keep your eye closed.”

I practically felt my way to the now half-empty waiting room. I wanted to check the time, but reaching for my phone seemed like a big bother. I decided to trust that they would get to me before the anesthesia wore off. I closed both eyes and rested my head on my hand. When you can’t beat it, give in.

I was called in again and the doctor was all business, but amiable, shaking my hand, answering my questions. He pushed a button and the chair rotated backwards till I was looking straight up at the ceiling. He put in the speculums, one under each eyelid, then bade me look left while he put in some drops. Then more drops. Then I saw, even though I was looking away from him.

I knew it was time. I felt the sting of the entry, but nothing more. It was a very slight sting, a nanosecond, but I was a trifle disappointed. I’d been told I’d feel nothing.

“You did great,” he said. He gave me instructions on when to call him. I went to check out and the burn began.

My son jumped up. “Your eye is all red,” he said, putting his arm around me. I looked in my compact mirror. Yep, tomato red.

The burn was fierce. I could not keep my eye open. When we got home, I used the artificial tears I’d been given, but they offered little relief. After a while the burn and the redness subsided and all I felt was the presence of a foreign body every time I blinked. It was probably inflammation at the entry site, but it felt like I had a two-by-four in my eye.

That was the worst part of the ordeal and it lasted for over eight hours. He said there would be a black spot at the bottom of my field of vision, and both after effects would be gone “within a day.”  And they were, but I have to say that black spot was freaky.

I’m to go back in four weeks for more pictures (no dye) and probably more medication, depending on how I respond. I’m not looking forward to it, but at least now I know what to expect. And I appreciate his wait-and-see attitude. The first ophthalmologist had told me flat out, “once a month for six months.” It didn’t exactly inspire trust in me as there is no cookie-cutter treatment that’s one-size-fits-all.

 

Gratified

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Ever since I was diagnosed with a retinal hemorrhage in my right eye seven weeks ago, I’ve been wondering what my rheumatologist would have to say about it. I requested that a copy of my test results be sent to him from the ophthalmologist’s office. The main things I ascertained with the ophthalmologist at that time was that, yes, I could fly, as I had two trips pending. And yes, there was a 50/50 chance that it would clear up on its own.

Though I’ve been seen by this group for years, I was not comfortable following through on their suggested treatment, intraocular injections. Perhaps it’s unfair of me to say so, but they didn’t inspire confidence in me, not the kind where I would willingly subject myself, and my eye, to their prescribed treatment.

Since I did have the upcoming trips, I decided to lay low, go on about my business and wait to see what would happen. I knew I ran the risk of it worsening. As the ophthalmologist stated, “You might end up doing the shots just to get back to where you are now.”

The fact of the matter is that I see almost perfectly, when my left eye is compensating of course. When I close the left eye, it appears that I am seeing through a smudged glass door, not the whole door is smudged, just the top center portion. And with my new glasses for distance, it’s like I’m seeing 3D, as I told my son making him laugh. But as the optometrist told me, “I can’t fix what’s going on with the right eye.”

My readers (expensive compared to the 20-dollar-over-the-counter kind) don’t seem to afford me better vision than the 20-dollar-over-the-counter kind. I find that they are great when reading on my tablet or my phone, but not so great when reading on my laptop. I use an old cheap pair for that. In fact any old cheap pair as I have a pair in every room of the house. I’m not sure why the difference, perhaps it’s the distance from the screen. Who knows?

But that is what is most concerning to me, my ability to read. When I close my left eye, the words are blurred at the top and clear at the bottom. It’s possible to read, but difficult. I can’t imagine not being able to read at all. I’ve always read. As far as my memory goes, I’ve read. I don’t live one day without reading, ever.

My rheumatologist was concerned about this development and asked if the ophthalmologist had mentioned it having any relation to RA. I told him he’d said that we’d have to “work real hard to find a connection between the two.”

He agreed that I should get a second opinion and referred me to a retinal specialist he knows. Since I trust my rheumatologist implicitly, I feel I already trust this new specialist without ever having laid eyes on him. But that’s a good start. We shall see what he has to say and go from there.

Of note, my labs were all normal with two exceptions. My CRP was slightly elevated, but that usually is. It bounces up and down depending on what I don’t know. My left wrist is still bothering me, though it’s not persistent RA pain. I know what that’s like and that’s not what’s happening here.

But there is definite swelling on the left side of the inner wrist. While examining it, he turned it this way and that, twisting my fingers into a pretzel and bending my wrist in all directions without it causing a bit of pain. But then he pressed down on the swollen part and yes, that hurt!

I’ve been on very small weaning doses of Prednisone for over two months, and I would think that the wrist would have gotten worse, and the CRP higher, but there’s been no effect on it whatsoever. It’s not worse but it’s not better, so I’m to have it x-rayed. Perhaps it’s osteoarthritis because it’s not acting like RA at all.

The other abnormal lab was my white blood cell count; apparently it’s high and he wants me to repeat it in a week’s time. I explained that while I was with Carmen she caught a cold and gifted it to me. It’s been ten days now with cold symptoms, but it does take me a while to shrug these things off.

He wasn’t to be swayed from repeating the lab test even after I explained the probable cause for the WBCs being elevated. So here we go, another needle poke, but at least I’m gratified to learn my immune system does work. Somewhat.

 

Retinal Hemorrhage

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Looks like I started the year with a bang, or an “explosion” as the retinal specialist stated.

On New Year’s Eve, I went to see the ophthalmologist one week ahead of schedule. I was due for a six-month follow-up. Since RA made its debut, I’ve had yearly or biyearly eye exams. This time he wanted to keep a closer eye on me, as it were.

Sunday the 28th of December, I woke up with a blur in my field of vision. I thought my reading glasses were smudged, but no, it was my right eye, not the glasses. It didn’t change for the better or for the worse, so Monday I called to move up my appointment.

I knew the news would not be good, so I was not quite receptive to all he said. Once I heard the word “hemorrhage” my brain went on overload. It didn’t really matter at the moment that he wasn’t going to treat it, that all he said was to come back for the specialist.

This past Monday, I went back and absorbed the news, even as my eye had not yet absorbed the blood that had leaked out of a retinal vein. At first, the retinal specialist called it a stroke and after that explosion sounded much better.

The ophthalmologist called it a “retinal hemorrhage” and he took the pictures to prove it. He also wanted to do a test where dye would be injected into a vein in order to visualize retinal circulation. It was the afternoon of December 31st. I wasn’t in the mood and I could hear the lack of enthusiasm in the tech’s voice when she said, “I’m the only one here.”

So it was done this past Monday. The tech told me it was a natural dye made of carrots and tomatoes. (?) I took his word for it and signed consent. When injected, it felt like a hot brick had been applied to the back of my hand and turned it a fluorescent yellow for 24 hours. The huge yellow spot on the back of my hand is now a purple/green bruise and four days later the site is still tender.

The specialist’s recommended treatment is monthly injections (I didn’t ask of what med, my brain was too busy receiving to analyze) for at least six months. He says I have a fifty/fifty chance of it resolving itself. And if I wait too long it could get worse and I’d be doing the treatments to get back to where I am now. Still, the thought of a needle in my eye . . .

The vision in my right eye is worse in the morning, as I have read it normally is due to the blood settling during sleep. As the day wears on, it’s hardly noticeable. It’s a small blurry spot right below where the twelve is on the face of a clock.

My one concern on Monday was flying. I have two trips scheduled in the next five weeks. When I asked if I could fly, he said, “Yes, you can fly.” It made me imagine myself with a pair of wings floating away and reminded me of the joke about the postoperative patient who asks his doctor if he can now play a particular musical instrument. When the doc says yes, he responds, “Good, cause I never could before.”

My other concern was computer time and that was given the green light as well. Today I see the optometrist. I’ve never used corrective lenses, other than reading glasses, and my vision is not 20/20. I think at this point my reading glasses could use some help, as I am doing a lot of reading and writing, and will be until all becomes a blur forevermore.

Has anyone done this sort of treatments? And if so, how did it go?