There are few situations that are intolerable for me as a seasoned crime, disability and “medical procedures” veteran. However, a recent experience increased my empathy for the clients I serve with blindness or visual impairment. I also naively thought I had seen it all when it came to medical bureaucracies and treatments. Oh how wrong I was!
There I was, minding my own business recently when amid the sometimes shower of little black floaters common after cataract surgery, a “black half moon” appeared and persisted in my lower field of vision. The next day I left work and went to my optometrist for what I thought was a routine check. Upon examination he was quieter than usual. I knew something was up!
He said, “You have to go to the hospital and have surgery TODAY, you have a detached retina.” Retinal detachment repair is eye surgery to place a retina back into its normal position. The retina is the light-sensitive tissue in the back of the eye. Detachment means that it has pulled away from the layers of tissue around it.
Whoa! What? Where, When? Why? No matter, I had to do it. However, thinking you could be examined and have surgery the same day is pure fantasy in the world of healthcare. Local surgeons were either operating or on vacation. I scrambled to find a solution. Searching my mental Rolodex, we contacted a surgical practice I had visited once after my cataract surgery. Being single with no other family member to turn to, I felt guilty to have to impose upon my mother who has so selflessly dedicated her time for years to all of my medical endeavors. At 82, she did not deserve this one either! This amazing woman, after the initial shock, took it in stride and told me it was her job as a mother. We knew we would do it together.
Although I work for one of the best agencies for the blind in the country, no one was familiar with the recommended medical treatment I was required to do. It was kind of cool for me to educate my colleagues on a vision related issue for a change.
- After many twists and turns due to other medical emergencies, and high volume in these mullti-physician practices, I was evaluated with several diagnostic tests and found to have a significant tear from 11 o’clock to two o’clock.
- As it turns out, different ophthalmologists recommend different treatment procedures, depending upon the advanced nature of the problem.
- If holes or tears in the retina are found before the retina detaches, the eye doctor can close the holes using a laser. This procedure is most often done in the doctor’s office.
The Anatomy and Procedures:
- Pneumatic retinopexy (gas bubble placement) is most often an office procedure
- The eye doctor injects a bubble of gas into the eye.
- You are then positioned so the gas bubble floats up to the hole in the retina and pushes it back into place.
- The doctor will use a laser to permanently seal the hole.
Although my detachment was caught early, it was severe and required surgery in a hospital. I insisted it be done with general anesthesia – while totally asleep.
- The scleral buckle method indents the wall of the eye inward so that it meets the hole in the retina. Scleral buckling can be done using numbing medicine while you are awake (local anesthesia) or when you are asleep and pain-free (general anesthesia).
- The vitrectomy procedure uses very small devices inside the eye to release tension on the retina. This allows the retina to move back into its proper position. Most vitrectomies are done with numbing medicine while you are awake.
- According to the National Institute of Health, most retinal detachment repair operations are urgent. A detached retina does not get a supply of oxygen. This causes the cells in the area to die, which can lead to blindness. The surgery should be done the same day if the detachment has not affected the central vision area (the macula). This can help prevent further detachment of the retina. It also will increase the chance of preserving good vision.
Back to my Story
It was a nightmare to accomplish all of the procedures required in our time crunch to prepare for surgery from filing for temporary FMLA medical status at work, to arranging an emergency pre-op physical which I had just done a little more than a month ago, to moving to my mother’s home. And, as we learned the hard way, arranging for the green monster. We thought that the doctor’s office would arrange for the miracle contraption, but no, we had to do it, or rather I had to. It was incredulous to me that I was still madly making medically related phone calls and doing paperwork up to the morning of surgery day! This should not be! I am the patient!
My description of the green monster is a glorified massage chair with several pieces that detach some for nighttime sleep on your stomach while maintaining your face in the doughnut hole. It includes an inverted mirror such that if placed strategically, in front of the family tube, you may watch TV, only in this manner to your heart’s delight. Misnomer – this is anything but comfortable, particularly when you already have a physical disability!
- It is vital that you mount this chair like a horse jockey, face down in a “doughnut hole” for up to 7 hours per day (or decreased as advised by your MD) with only 10 minute breaks. Most people have to endure this for 7 to 10 days.
- You may not, be in an upright position with your trunk, or your head; You may not be on your back. You may not read indulge in social media or do any activity that compromises this position.
- In the meantime, you are not so patiently waiting for the gas bubble that appears as a big black bubble in your eye. It gradually subsides depending upon your body chemistry, and your body’s ability to heal. I was fortune in that I “my time on the chair was reduced after the first day from 7 hours to 3.5 hours. However, I did lots of extra (What else was there to do?) thinking that more was better. The physician assistant told me that being on the chair, has no effect on how the gas bubble subsides.
- During subsequent exams, I miserably failed the eye test the day after surgery with the bubble at 90%., then 55% the next week, then near normal visual acuity on the third visit. This was combined with a regime of three kinds of eye drops several times per day. and “careful showering.”
More on the “Green Monster “and Medical Necessity-
- Amid numerous calls as I scrambled to acquire this chair, I learned that such positioning chairs, whether Comfort Solutions brand or otherwise, is considered a medical necessity for the best outcome by physicians BUT, is not covered by any insurance company in the tristate area. Therefore, I was billed $300.00 on my credit card for a 7 day rental and $21.00 for subsequent days.
- Although the chair was initially delivered to my Mom’s home, a 75 mile trek one way near the New York border. This company expected the customer to dismantle this heavy chair , pack it precisely into a tight cylindrical box, label it, load it into your car and drive it to a UPS store, or find a pickup commensurate with your time frame! This was very unrealistic given our situation. Therefore, we insisted that they return to pack up and retrieve the chair. Suffice it to say, I am out a few hundred, although they did offer a small discount.
- On the one hand, you cannot put a price on your vision. On the other hand, this is so wrong as it is classified as a medical necessity.
The Office of the Healthcare Advocate-
- Residents in the State of Connecticut are very fortunate to have an option to the injustices encountered in healthcare. This state agency is known as The Office for the Healthcare Advocate. They assist in navigating the system, communicate with insurance companies, physician offices and other entities in an effort to file appeals and “win justice” again. Applicants are responsible for furnishing as much documentation to “make the case” as possible. I have worked with this office once with good results. The caseworkers are RN’s and are skilled in the bureaucratic procedures necessary to get justice. It is a challenge to get through at times, It may take several weeks to months, but as people know, I am a “pit bull” about such things. I have full confidence that my case worker will help me not only in reimbursement, but most importantly, to pave the way for others such that they don’t have to endure what we did and to change the classification of coverage with insurance companies.
Timing is Everything!
I was told numerous times, had I not gone to my optometrist immediately, there is a good chance I could now be visually impaired or worse, a very devastating thought!
I was really nervous that my long-term plan to fly to my home in Myrtle Beach in September would be foiled by this latest, and hopefully last medical event! You cannot fly in an airplane in a pressurized cabin if you are fresh from this surgery! I was cutting it very close, “too close for comfort,” as well as potentially losing $200.00 to change my reservations. Could I heal in time?! Yes, I could and I did!
Studies say…” there is a 20% chance that I could experience a detached retina in the other eye.” I prefer to think of the 80% positive.
Why did it happen? Who knows. I did not injure my eye. I did not fall. I did nothing to cause this event. Speculating, perhaps there was always a congenital weakness in my retina and it “chose to rear its ugly head” now. Suffice it to say, I learned many lessons. With all that has occurred in my life, if I questioned why, I’d never get out of bed! LOL
The Most Important Question to my Doctor – Going forward, how do I tell the difference between, “just floaters, and the real deal – retinal detachment.” He said, “if you see a black curtain coming down, closing in on your visual field, that’s detachment.” Black Curtain Indeed!