Category Archives: Personal

Jello in a spirit level

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I decided that rather than try to describe what my vision has been and currently is, I would post some images. You may find this hard to beliee, but these images are not from a biology textbook; I drew them myself.

First, this is what normal vision (sort of) looks like:

Each of your eyes see its own image of this odd-looking dog with the odd-looking gait. They are slightly different, but your brain seamlessly merges them into one coherent image. You are normally not aware that there are two separate images in the overlapping area, but the differences in the images are what allows you to perceive the different distances to various objects that you see.

After my surgery, the vitreous in my right eye was replaced with sulfur hexafluoride (SF6). The optical properties of SF6 are different from that of the vitreous, and the eye can’t focus an image through it. That means that my right eye’s image was blurry, and objects in my field of view seemed to be in a different place from what my left eye was reporting. This yielded an image kind of like this:

Imagine that I was looking at a table. My left eye saw it clearly, while my right eye saw a blurry, displaced images. My brain couldn’t figure out how to merge these images, so it basically didn’t. It just gave me two different images at the same time. This made it essentially impossible to read or to drive. Since I spent Thursday afternoon after the surgery through Sunday with my head down, reading was about all I could do. I solved this problem by closing my right eye.

As the body absorbed the SF6, the bubble shrank. For several days, this is what I saw with my right eye:

The very top of my visual field was clear, while all of the rest was blurry. There was not enough clear vision to allow my eye to focus at normal distances, so I still had to close my right eye to read, and I couldn’t drive.

Eventually, the bubble shrank to the point that it was beneath almost everything I needed to see, leaving something like this:

This image is from what I imagine driving though the foothills of the Sierras would look like.

And this is what my vision is like as I write this on Saturday night. I can look up where I’m writing and can see the mess of objects on our dining table, and, most importantly, i can tell where they are. I can reach out and touch the salt shaker without making several tries. Unfortunately, if I look down, I am looking through the bubble and I have no depth perception. A Walmart employee had to help me put my credit card in the reader tonight because I kept missing the slot

If I look straight down, I can see the entire bubble as a circle filling maybe 80 percent of the entire field of view. The bubble jiggles when I shake my head, like a bowl of Jello. When I look up, the bubble reminds me of the bubble in a spirit level, finding its own level as I move my head around.

But, you are wondering, if this is a gas bubble within an eyeball otherwise filled with fluid, why is it floating at the bottom of my eye rather than the top? That’s an astute question, and I’m glad you asked. I wondered about that myself for a while, and then I remembered that the image the eye’s lens projects on the back of the eye is inverted; it’s upside down. The brain perceives it as right-side-up. Since the bubble is at the top of an upside down image, the brain thinks the bubble is actually at the bottom of my eye, thus fooling both itself and me.

Since I am still recuperating, I continue to spend a lot of time reading on my phone. Looking down still moves my bubble up (actually, down) into my field of view, so it’s still a real distraction. My solution now is to put blue masking tape on the right lens of a cheap pair of reading glasses.

I can still see the bubble in my right eye; in fact, in a lighted room, I can see the bubble with both eyes closed. But I can do a pretty good job of ignoring it. Right now there is a ghost image of the bubble covering about the bottom third of my laptop’s screen. It’s somewhat distracting, but much less than it would be without masking tape on my glasses.

There is one discouraging development. At my post-op appointment, while waiting for the doctor to come into the examination room, I discovered that I could focus on an object very close to my eye. I put a medical alert bracelet I was wearing up close and could read the fine print. It seemed to me that the blind spot and distortion I had been experiencing were gone. That made me very happy. Unfortunately, I have since determined that I still have a blind spot and distortion at my fovea. If I look at a straight line, I see something like this:

The images is blurred and distorted, and whatever is at the very center of the fovea is not visible. If I look directly at a small object, it disappears and is replaced by whatever surrounds it in my visual field. A small stone on a concrete surface disappears, and where it should be looks like more concrete. The effect might not be quite as bad as before my surgery, but it’s still there.

I have read that one’s vision after a vitrectomy can continue to improve for up to six months, so maybe it will get better. If it doesn’t, I suppose, and hope, that my brain will accomodate that deficiency and begin to ignore the blurring and distortion, replacing it with the better image from my left eye.

Things fall apart

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As it turns out, Leah and I are the things that are falling apart.

Leah has continuing issues with pain; balance; and, I’m sorry to report, cognition. She has what is apparently a stress fracture in her right heel. I say “apparently” because when the medical people ask how it happened, we can’t point to a particular time, place, and event. They say, “Aha! Its a stress fracture,” because those can happen over time from overuse, or unconditioned use. In any case, her right heel, or driving heel, is fractured and it hurts, strangely enough, in places other than her heel. The orthopedist thinks she has some nerve disfunction that is preventing her heel from hurting as much as it should. As a result, she is using it more than she should.

The doctor also says the bone in her heel has apparently lost some density. He suspects she may have osteoporosis in other bones as well.

This was on top of her chronic pain from arthritis and some residual pain from her pinched nerve and the subsequent surgery to correct it.

The balance problem has been increasing for months. She is falling fairly often now, usually on her left side. She scrapes the skin off of her arm, and just about the time it has healed, she falls and scrapes more skin off. She is supposed to use a walker, but she usually leaves it some other place.

That is partly the result of her cognitive decline. Her memory is fading fast. She remembers things that did not happen, and doesn’t remember things that did happen. She asks the same question several times, minutes apart. I will tell her something (I hesitate to use the word “explain”) and she responds with, “You used to be able to explain things so that I could understand.” When we watch a television show, she has trouble following the plot and remembering the characters. It’s getting harder for her to find something that she is interested in. One of the worst parts of this is that she is aware of the decline.

The center cannot hold.

Only in this case, the problem is that the center is holding all too well. A couple of months ago I started noticing an annoying after-image in my right eye when I blinked. It got worse, and my vision started to blur. I made an appointment with my eye doctor, and he did some imaging that showed a distortion in the macula. He referred me to a retina specialist, who told me I have vitreomacular traction (let’s call that VMT). That means that the vitreous (people in the eye business use the word as a noun. I can’t help seeing it as an adjective, as in “vitreous gel,” the clear fluid in the eye. But, as I was saying, ) shrinks and doesn’t let go of the macula like it should. They (mainly google) tell me that the vitreous shrinks as we age, normally without symptoms or harm, but in some cases, it refuses to let go of the macula, with which it has been in intimate contact for many years. When that happens, it pulls the macula away from its proper position, causing visual distortion, blind spots, and eventually tears in the macula. The tears may actually be responsible for the blind spots; Google is silent on that issue. I now have a blind spot in the exact place that normally has the highest resolution. You know, the part you read with.

I have eye surgery scheduled for October 5 in Chattanooga, TN, about an hour and a half away from our home, depending on traffic. It would be hard enough if it were in our town, since Leah is not driving now. I am expecting to be gone a minimum of five hours, possibly more. Leah can’t drive now, possibly ever again, and I cannot leave her alone that long. Even if I could, she can’t handle Zoe, our big dog, and I will need someone to drive me home, and then back to Chattanooga again the next day for a post-op checkup.

My aunt has found a friend of her son who says he can drive me. He will soon learn that he will be driving Leah and two dogs as well. That’s the only solution I can think of to take care of her and the dogs. Fortunately, the weather should be cool enough in October that they can stay in the car for a while. I checked the surgery center on Google Earth, and it looks like there are shaded parking spots.

In addition to my VMT, I have a cataract in my left eye, which is now my good eye, but which used to be my not-good eye. It’s having to do double duty, seeing for itself and filling in the details that my right eye is missing. Unfortunately, the cataract is causing a slight bit of double vision, just enough to be annoying when i’m driving at night. So, soon after I get over the VMT surgery, called a vitrectomy, because they take out the vitreous, I will need cataract surgery. It seems that everyone my age has had cataract surgery, and it’s a breeze.

A vitrectomy is not quite a breeze, but it is a relatively short procedure. The recovery involves maintaining a face-down position for up to a week. That’s because the surgeon will inject a gas bubble into my eye intended to press against the macula and try to convince my body that the macula is supposed to be attached to the back of my eyeball. The gas bubble does no good if it’s pressing against the front of my eye, so I will need to be face down to keep it pressing against the back of my eye. The gas will eventually be absorbed by the body, and the eyeball will be filled with some sort of fluid that the body will generate. We all hope.

Various eye specialists, speaking through Google, tell me that the surgery has a reasonably good success rate. The first time I saw my specialist, he said if the VMT is caught early, surgery is 99 percent successful. The second time I saw him, he said it had an 85 percent success rate. I will not ask him again.

And, of course, success depends on your definition. The result of a successful vitrectomy is a gradual recovery in visual acuity. Although Google refuses to commit to a particular level of recovery, the strong implication is that my vision will never be as good as it was before VMT.

Google also tells me that if a person has VMT in one eye, the probability that they will have it in the other eye is greater than 50 percent.

It’s just barely possible that I have already had VMT in at least one eye, possibly my “good” eye. About two years ago I started noticing the after-image when I blinked. It was annoying but I didn’t worry too much about it. It gradually went away, and I didn’t even notice when it did. Was that VMT? I do not know. All that I know is that it was almost identical to what I experienced with a diagnosed VMT, and that in some cases VMT can spontaneously resolve without surgery.

Health issues are generally depressing. And, as anyone who has dealt with the cognitive decline of a loved one knows, that can also be depressing, and quite stressful. That’s one reason I have not been able to generate enough momentum to actually do anything lately, including write new blog posts. Maybe a few things will come back together in the not-too-distant future. Things not falling apart would be a nice change.

Divisible by five

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My brother Henry died five years ago on the day this posts, April 6. He would be 75 years old now. My mother would be 100, and my father would be 105.

It’s been long enough for me to get used to my family not being here, but I haven’t. I feel like they are somewhere over there, in some reality next door to this one. There has certainly been enough going on in this reality over the last few years to make me think there must be a better one somewhere.

I no longer think to myself that I need to tell one of them about something that has happened, or something I did around the house, or, more important, a question that I would like to get an answer to. That phase ended a while ago, but the need did not.

As Snoopy* once said, “You never miss the water till the well runs dry.”

So here I am, still with a lot of questions that need to be answered. I don’t know whether they would be able to answer them, but at least the questions would be there, out in the open.

By the way, if you are wondering whether you look old, you know the answer when someone sees you walking your dogs and asks you how old you are, and then congratulates you on being able to walk a dog. “Thank you. Still working at your age, eh?”

But here I am, still breathing. There is a bit of cosmetic damage, and some internal parts are not working as well as they once did. My mind seems to work almost as well as it did, let’s say five years ago. But then, maybe I wouldn’t know.

But I was talking about asking questions.

No one warned me that I would get old, and still not be wise. In fact, no one said a god-damned thing about that, and I want to know why. I thought we were supposed to be able to figure things out about life, the universe, and everything when we got this close to the end of it. Was I standing behind the door when wisdom was handed out? Maybe I was looking out the window, daydreaming, and I missed hearing my name called. Maybe they ran out of wisdom; it does seem to be in short supply today.

However it happened, here I am, needing questions answered. There is no one to answer them, and I’ll be damned if I can answer them myself. Is it like that for everyone?

This is the way I think of my family.

I don’t know when this photo was taken. It looks like the early 1990’s, possibly a little earlier than that. I don’t know where I was, or who took the photo.

Maybe that’s the way they look now, in that other reality.

* I’m pretty sure Snoopy said it once, but the only citation I can actually find was Franklin’s grandfather.

A doctor visit

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First things first; so what have the dogs been up to?

Dogs like Cheetos. In fact, I’m pretty sure this dog likes Cheetos more than we do.

Sam likes thumbs from leather gloves. I caught him before he ate the whole thing. I’m not joking about eating it; either he ate the thumb, or he’s really good at hiding stuff.

We had some light snow back in December. Some canid not a domestic dog left its tracks on the road. I suspect a fox. Look at the shadow to Zoe’s left. It’s not Zoe’s shadow. That’s Sam, best known for blue eyes and big, erect ears.

We had some nice days, too, sunny and warm, but not too warm, well suited for lounging for a few minutes. I hardly ever sit down in the grass of our front yard, so Sam was a little concerned. He also wanted pets.

Zoe invited a few Doberman friends over for a friendly game of poker.

Dobermans do not play poker. This is an image generated by an application called wall-e 2, which uses some kind of AI to generate images based on a simple instruction. The instruction for this image was “doberman pinchers playing poker in the style of Normal Rockwell.”

Actually, Zoe does play poker, but for her, poker means “poke her”, which she plays with the cat using her nose.

Speaking of weather (or were we?), something woke me up just at dawn a few days ago and I was able to see the sunrise. It was nice.

I hear that the sun rises almost every day, and often it’s quite picturesque. Maybe some day I will go to bed early enough to get up and see more of them.

Afternoons can offer nice skies, too.

Look at the evidence of wind shear, waves going two different directions. The sky over the parking lot was about all that our local Walmart had to offer, given the continuing supply chain problems.

Oh, about that doctor visit.

I went to my vascular specialist on Thursday of last week to talk about pulmonary embolisms, or blood clots as I don’t like to call them. Since my clots were not explained by any of the normal causes or risk factors, the various physicians I have dealt with have mentioned that cancer often causes blood clots. My vascular specialist repeated that, and added that in 10-to-20 percent of cases of unexplained pulmonary embolisms, cancer is diagnosed within two years.

I went home after that because it seemed like the best place to go. I considered not telling Leah what the doctor said, because I knew she would worry. I was right about that. I told her not to worry, and that, while I was considering potential courses of action should I be diagnosed with cancer, that was not the same thing as worrying. I spoke to my primary care doctor the next day, and he was more reassuring. He said that a cancer that was advanced to the point of causing blood clots would almost certainly be causing other symptoms, of which I had none.

The main concern at this point was that imaging of my chest right after my blood clots had found a nodule in my lung. Doctors said that it was small and did not show some typical features of a cancer, so it was probably benign. But not definitely.

I told Leah that we should hold off on the worrying until I saw the pulmonary specialist on Thursday of this week. I had a CT scan last Friday in preparation for that appointment to see whether the nodule had grown, which would be bad, or was the same, which would be good. The pulmonary specialist told me it had not changed in the six months since the previous CT scan. So, good news. In fact, he said it was probably not really a “nodule” but rather an enlarged lymph node possibly from a past infection, or something.

He said, “You do not have cancer.”

But the mention of an infection causing the enlarged lymph node made me wonder. About 10 years ago I had some heart function problems that were potentially pretty serious. A few months after that was diagnosed, my heart functions had recovered to the point that one of the two cardiologists I had seen discharged me. I asked what had caused my problem and why had it essentially cleared up. The cardiologist said he didn’t know, but that it might have been some kind of infection. So I asked my pulmonary specialist if the enlarged lymph node could have been caused by the same thing that caused my heart problem. He said it certainly could have been.

The doctor wants me to have another CT scan in a year, just to be sure, although the radiologist who read the CT image said there was no need for more imaging.

When I drove back home I felt as if a weight I didn’t realize I had been carrying had been lifted from my shoulder. I felt pretty good. When’s the last time you felt that good after leaving a doctor’s office?

Excitable dog they all said, plus an update

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Our dogs love to go for car rides. I don’t know why. The only place they ever get to get out of the car is at the vet’s. But they get excited when they figure one of us is leaving.

Zoe gets excited enough for both dogs, with some left over for a third dog, should we ever decide to get one. She knows what the door handle is for, although not how to use it, and she knows where her leash is. She thoughtfully points out both to me, just in case I have forgotten.

She is extremely sensitive to whatever signals we send unconsciously when the possibility of an inkling of an thought surfaces about taking the car somewhere. She seems to know we’re going to go at just about the same time I do.

She ran over Leah’s foot in the last clip. Leah is expected to make a full recovery.

I usually remotely open the sliding side door on our van before I let the dogs out. This is about the only time I ever let Zoe go ouside off leash. She runs directly to the car and jumps in. Sam, ever the polite dog, runs to the door and then stops. He needs to be invited before actually jumping in.

I don’t let Zoe jump out of the car off the leash. The last time I did that she led Sam down the driveway and up the street for a vigorous 15-minute workout.

I have forgotten where we went on this particular trip, but it’s the same routine for every ride.

And now the update on the as-yet-unresolved story of my lungs. I saw a vascular specialist on June 23, then a pulmonary specialist the next day. They were all reassuring. Everyone is reassuring. So far.

The regular practice for lung nodules such as I have is to watch them to see whether they grow, assuming there are no immediate indictions of malignancy. That’s what they are doing to me. I had a CT scan on July 14, about a month and a half after my hospital stay, when I had the first CT scan. I have heard nothing from it, so I assume there is nothing urgent. I don’t see the pulmonary specialist again until August 30, a month and a half after the CT scan. Is that a good sign? Someone tell me that’s a good sign.

Aside from whatever may be happening with my nodule, I seem to be OK. I’m walking with no shortness of breath, but neither the dogs nor I feel like going very far. I think Zoe’s feet may hurt because of an allergy of some sort. I am sure my knee hurts because it’s worn out. I expect to get a new one before long, but not before I find out what’s happening, or not happening, with my nodule.