OT: Cataract surgery questions

[tetragon]

worst part of the colonoscopy - by far- is the "cleansing out" the day before

That's what I thought, and had experienced, prior to my colonoscopy yesterday. That's when I encountered a doctor who uses a minimal amount of drugs in people with sleep apnea. Her response to my crying out in pain was to have the nurse push hard on the area that hurt and tell me to pass gas (it's so much easier without the scope in the way), and only increase the painkillers when that didn't help.

And as for my "night before" secrets: broth during the day; jello, fizzy water, and straws in the evening.

[Mirrasi]

They will likely sedate him with an IV. They want relaxed patients. .

[Pugsy]

They will likely sedate him with an IV. They want relaxed patients. .

Yep, we already knew that because he said he uses the "I don't care what you do to me drug cocktail".
Mainly we are working on the nerves he is having now during the waiting for the surgery date to arrive.
Hubby needs to have minimal time to "worry" about things.

[Slinky]

Tetragon, there is absolutely NO EXCUSE for your gastro to have been so heavy handed during your colonoscopy!! NONE! The sedatives they use are amnesiacs so these doctors get used to your being able to respond BUT NOT REMEMBER so they just work their way thru despite your pained response counting on your not remembering. I don't care how many scopes this jerk has done he is NOT skilled. Not at all.

http://www.e-health-questions.info/html ... lm=default

Endoscopy 2002 Jun;34(6):435-40

Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging.

Shah SG, Brooker JC, Thapar C, Williams CB, Saunders BP.
Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, London, United Kingdom.

BACKGROUND AND STUDY AIMS: Colonoscopy is generally perceived as being a painful procedure. Contributory factors are: stretching of the colonic wall and mesenteric attachments from looping of the instrument shaft, overinsufflation, the degree of torque or force applied to the colonoscope shaft, and patient pain threshold. The aim of this study was to determine the frequency of pain episodes experienced during diagnostic colonoscopy and the corresponding colonoscope configuration, utilizing real-time magnetic endoscope imaging (MEI).

PATIENTS AND METHODS: Consecutive outpatients undergoing colonoscopy were studied. Patients with previous colonic resections were excluded. Procedures were commenced with antispasmodics only, and patient sedation was self-administered whenever significant discomfort was experienced, using a patient-controlled analgesia (PCA) syringe pump. All "demands" were correlated with the MEI record, which was subsequently analysed.

RESULTS: A total of 650 demands were recorded in 102 patients. Seventy-seven percent of all demands occurred with the colonoscope tip in the sigmoid colon, 7 % in the descending colon, 6 % at the splenic flexure, 5 % in the transverse colon, and 4 % in the proximal colon. Ninety percent of all pain episodes coincided with either looping (79 %) or straightening of the colonoscope shaft (11 %); presumed overinsufflation being an infrequent cause of pain (9 %). Of the loops encountered during colonoscopy, the N-sigmoid spiral loop was associated with the majority of pain episodes (56 %). Looping was both more frequent ( P = 0.0002) and less well tolerated in women than in men ( P = 0.0140).

CONCLUSIONS: This study is the first to document pain at colonoscopy accurately. Looping, particularly in the variable anatomy of the sigmoid colon, is the major cause of pain, especially in women. Use of MEI may improve pain control by facilitating the straightening of loops within the sigmoid colon, and by enabling the endoscopist to target patient analgesia.

PMID: 12048623 [PubMed - indexed for MEDLINE]

Gastrointest Endosc 1996 Feb;43(2 Pt 1):124-6

Why is colonoscopy more difficult in women?

Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB.
Department of Endoscopy, St. Mark's Hospital, London, England.

BACKGROUND: In our experience colonoscopy in women is more difficult than in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in men.

METHODS: To investigate a possible anatomic basis for this finding, normal barium enema series from 183 female and 162 male patients were identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaware of each patient's gender.

RESULTS: Total colonic length was greater in women (median, 155 cm) compared to men (median, 145 cm), p = 0.005, despite women's smaller stature (p < 0.0001). Although there were no significant differences in rectum plus sigmoid, descending, or ascending plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and transverse colon between the sexes, but the transverse colon reached the true pelvis more often in women (62%) than in men (26%), p < 0.001.

CONCLUSIONS: Colonoscopy appears to be a technically more difficult procedure in women. The reason for this may be due in part to an inherently longer colon.

PMID: 8635705 [PubMed - indexed for MEDLINE]

Underlining is mine. I can vouch for both of these articles from personal experience. BY PERSONAL CHOICE I have most of my colonoscopies done W/O SEDATION. My gastro is caring and gentle and TAKES THE NECESSARY TIME to do a scope properly. I am a woman and we DO run into some pretty strong discomfort at the mid-transverse colon getting to and around the hepatic flexure but nothing drastic and it is short-lived, only during the action itself. I like watching the procedure on the monitor so unless I am really sick (I have Crohn's disease) I prefer no sedation..

[Elle]

Pugsy, I totally get your husband's anxiety while waiting. I told my ophthalmologist that I don't do "pending" well and he sent me to a hospital with a shorter waiting list to get it over with. It was still going to be months away (nov. - April) but they had a cancellation and I was given two days notice. I was so relieved to have the wait done with and now waiting for the second eye I am not anxious at all. I am surprised and happy to know that it was so easy. That won't really help your husband though. Many people (including a very helpful forum member here) tried to tell me how easy it was an although I loved hearing that I was still nervous.

I am sure it isn't easy on you either.

[tetragon]

Tetragon, there is absolutely NO EXCUSE for your gastro to have been so heavy handed during your colonoscopy!! NONE! The sedatives they use are amnesiacs so these doctors get used to your being able to respond BUT NOT REMEMBER so they just work their way thru despite your pained response counting on your not remembering. I don't care how many scopes this jerk has done he is NOT skilled. Not at all.

I don't think I was sedated. Even how differently my departure was handled suggests it. In Recovery, everyone else was being asked about who would pick them up and being told how long to wait before eating and drinking, while laying there out of it. I, instead, was sitting up, chowing down on the packs of cookies and licorice I brought with me, then left alone without any questions being asked (I hadn't even been given advanced enough notice to arrange for a ride (three days notice, I thought they were booking an initial consultation but the prep instructions they emailed me indicated otherwise (so, how many other people's instructions suggest mixing the prep with a couple shots of Cointreau))).

[Bobby269]

My Wife had one eye taken care of about 1 year ago. The other will be done in a couple of weeks. The most complicated part is keeping track of the drops that need to be given and the times.They give you a written game plan which helps.
Remind him that he has one tough Momma to help him.

[DoriC]

They will likely sedate him with an IV. They want relaxed patients. .

Yep, we already knew that because he said he uses the "I don't care what you do to me drug cocktail".
Mainly we are working on the nerves he is having now during the waiting for the surgery date to arrive.
Hubby needs to have minimal time to "worry" about things.

I think I'll make him some of my chicken soup! I don't know if you were here when there was a 10page thread about my chicken soup recipe, that was fun!

[STL Mark]

I wonder which common procedure/test patients dread the most.
A) colonoscopy
B) sleep study
C) cataract surgery
D) ______________

A) colonoscopy prep

I've had LASIK eye surgery both eyes and both of my parents have had cataract surgery on both eyes. Xanax or a similar drug can help with anxiety to do with that. But the dreaded colonoscopy prep, glad it is not very often.

[JeffL]

Elle - I can't believe you have to wait until June for the 2nd surgery I'd be a mental case if I had to wait that long with my eye's being so different, but maybe my vision was worse than yours.

As I told Elle before she had her first surgery, I found the experience more closely related to getting a hair cut, than getting a tooth filled.

I don't know if you've gotten this far in deciding what to do, but there are various lens options. Insurance will pick up the cost of the plain lenses, but if you have astigmatism, and want lenses that will correct that, you are on your own in paying for the lenses (not cheap!). That was the route I took. There are also "accommodating" lenses that will allow your eyes to focus after they are implanted. If you get those, you have a good chance of not needed reading glasses. They are even more expensive, and again, you are on your own in paying for them. I really wish I could have gone with the accommodating lenses, but at the time of my surgery, I was told that accommodating, astigmatism correcting lenses were still 2 years away from FDA approval. That was last summer, so I assume that they are still not available. I find the need to frequently put various strength reading glasses on and off kind of a pain. I've got dollar store reading glasses stashed away in all our cars, and every room of the house, as well as prescription "computer" glasses by the computer, prescription reading glasses on my night stand, and a pair of prescription bi-focal (reading, and for a little further away) that I carry around. Accommodating is the way to go if you are a candidate for them, and can afford them.

The colonoscopy isn't anything to worry about either. The prep is a pain, and it has the embarrassment factor that the cataract surgery doesn't have, but if they find and snip out something that can lead to cancer, you've saved yourself from a real pain in the a$$

[Elle]

JeffL, You helped a great deal toward decreasing my anxiety before the surgery and what to expect after. I really appreciate it. What did we do before internet?

I am hoping there will be a cancellation so I can go sooner for the second eye but my brain must be adapting to the different vision because I am not as dizzy and barely notice now.

Pugsy, I hope your husband is reading the thread.

[Pugsy]

Pugsy, I hope your husband is reading the thread.

OMG no, I hope not. He would have his macho image of himself sorely pinched to know his wife said he was being a big weenie about the whole thing.
I have just been telling him that "so and so says this or that"....to try to reassure him that he isn't the only person in the entire world (which is what he is acting like) to have to have this procedure done.

Today he went back to work..so I won't have to hear much whining till next weekend when he comes home. Then he will go back to work for a couple of days and be home the evening of the 12th..then have the procedure done the 13th.

Nothing I say to him really helps...he likes to wallow in things a bit . I can't baby him though...he would hate that even worse.
He has settled down a bit though. He actually didn't mention it at all today but of course we had other things pop up. Someone dumped a sick dog on us yesterday...and I bought a new kitten yesterday. So now I get to hear "that's the first time I have ever paid for a cat" thing....even though all I paid was a small rehoming adoption fee. So I got his mind off the eye thing.

[Elle]

LOL. I too acted like I was the only one to ever have it done.

I'm glad he is gone for a bit and I am also glad you have a kitten to snuggle with.

[Mirrasi]

Ya know, I'm 41 and I'm the surgery scheduler/tech. The doctor does about 10 cataract surgeries per week....and it would still freak me out too. They are his eyes, so he's going to freak out. That's totally normal. He will probably freak when hecreads the consent form too. But man, he will see so much better after!

[idamtnboy]

My husband has cataracts...both eyes...both needing surgery. While I am one tough momma...he is a big weenie (like most men)

Comments from those who have gone under the eyeball knife???

He'll have only one regret when it's all done - that he didn't have it done sooner!!! Cataracts are not a disease. It is a natural process of the lens in the eye getting cloudy and harder as one gets older. That's why most all older folks need reading glasses. Their eye lens lose their flexibility and so cannot focus like they do in youth.

I had both eyes done about 10 years ago in my late 50's. About 20 minutes in the OR and a totally painless procedure. I think it was about 60 to 90 minutes total from walking in the front door to walking out. What the doc does is he cuts a small slit in the cornea and the lens sac, then inserts a tool that emulsifies, or liquifies, the lens interior with ultrasonic vibrations. The lens is then vacuumed out. The plastic lens is small and has some small whisker wires on it to hold it in place. The whole thing is folded up like a burrito and slipped in through the slit. It unfolds and in a few days or weeks gets anchored in place by scar tissue or whatever.

I was severely near sighted, worse than 20/200, before I had mine done. Because of astigmatism the doc and I agreed to go for about 90% correction. I now am about 20/40 and see fairly well without glasses. As has been mentioned, you lose your natural focusing ability. I have two pairs of glasses, one trifocal and one bifocal. The trifocal is set for very close, ~8", mid-range for car dash, and distance. The bifocals are for reading and computer. I understand if one is not particularly near or far sighted before the lens implant then one has a greater depth of clear focus than I do.

Two things happened for me. It was about 4 or 5 weeks between doing both eyes. During that time I noticed that my world was about 10% larger with my 'new' eye than with my 'old' eye. I think the physics of the distance correction contributed to that. The other was color. I could look at a pure white paper with my 'old' eye, and a manilla folder with my 'new' eye and they were both the same color! My world had colored that much and of course there was no way for me to know that. Cataracts diminish the brightness of one's world, and colors it significantly.

My cataract surgery was the best thing medically I have ever done for myself. Well, maybe second best after my heart stents.

Tell hubby it's an easy, quick process that will dramatically brighten his life!