Thursday, June 19, 2014

Eye Caramba! or Undesired Adventures in Ophthalmology

My last tweet before something like a 5 month slacking on social media was this: Sometimes I look at my own handwriting and wonder when the stroke happened.

The handwriting has always been bad. But unaware at the time the joke was on me. At some point over the past few months I had some sort of a very small stroke in my left eye.

When I first started to notice the vision in my left eye wasn’t as sharp as it used to be, I thought nothing of it. I could still read things close up. Distances were difficult, but then again I am nearsighted. To be precise with regards to the change; picture a grid, vertical and horizontal intersecting lines, pinched toward a midpoint, and approximately 0.5 font sizes down from what the right eye would see (see Amsler Grid below). The avoiding part of me easily chalked that one up to the eye being challenged with its ability to focus sans updated glasses. I hadn’t had my eyes checked nor purchased new glasses in over 8 years. I thought maybe it’s just time for a new prescription.

Around the same time, at my day job in customer service at a physician association, I seemed to receive most of my calls from Ophthalmologists for various service needs. The pattern stood out. I also joked that maybe this was a sign.

I briefly took that notion of a sign seriously. I was curious why one eye was worse than the other. I did what one shouldn’t do, WebMD symptoms. The searches pulled up things like detached retina for which I was, for a quick moment, paranoid that I had it. In fearing this retinal detachment thing, I pictured the procedure as a medieval mode of going in the eye with microscopic needle and thread and stitching the Humpty Dumpty egg whites of my cracked eye like a crude sewing project.

My big worry was, once one eye goes, you only have one left. Down a spare, there goes whatever daredevil spirit resides within. What would reading be like with one eye, watching movies, looking at a painting or landscape? I feared the perspective could be flattened, narrowed. I looked up famous people with glass eyes and was comforted to find Peter Falk has one. He’s good company to be in.

But I brushed these notions into a hidden nook, as I was waiting for some new health and vision insurance to kick in and it was easier to think nothing of it. 

On Friday May 16th I went to see an Optometrist. She seemed to have difficulty nailing down the prescription for my left eye, so she dilated my eyes, had me sit in the waiting for 20 minutes while the drops kicked in and brought me back in to have a look in my eye. She noticed some swelling inside that left eye. She urged me to see an ophthalmologist rather soon. She gave me a recommendation and I made an appointment for that coming Monday. She assured me it wasn’t a detached retina, macular degeneration, a tumor or glaucoma. I did after all pass my glaucoma test, for which I was prideful like I had really accomplished something there.

Her insight with swelling inside an eye ball was that it was typically caused by stress or medication. Since I wasn’t on any medication, I assumed that I needed to learn how to chill out.

I didn’t WebMD anything over that weekend because I wanted to work on chilling out.

At the first visit to the Ophthalmogist, my eyes were again dilated. He looked inside them wearing a helmet fixed with a scope and a bright light. When he pulled away and I still saw orbs of red momentarily embedded in my eyes, he said “yeah that’s not normal, you had a small stroke in your left eye.”

I can’t really describe what I felt. It’s something akin to failing a test, or learning that you screwed something major up like leaving a loved one hanging when you forget an important anniversary, that devastating sinking feeling in your gut, only this feeling bobbed and pulsed as the fading red burn of light tried to fizzle from my vision. Then a series of photographs of the inside health of my eye were taken by a big machine where I looked at an Atari game looking grid and 7 minutes of some sort of infrared flashes checked to see if there was any leaking from the swollen part of my eye ball, back into my brain. I forget the results of this. I don’t think anything alarming was seen.

The next step was to see a primary physician. Check out systemic health. Make sure this doesn’t occur again, or on a bigger scale, like in the brain or heart.

So I went right away. I was feeling frazzled and panicked and incited enough to get researching the cause of that harsh word, stroke.  I learned that I have high blood pressure, for which I now get to take a low dosage ACE inhibitor.

Blood was drawn, and the news was mostly positive. In checking a wide gamut of tests, my counts came back normal and healthy, except in a couple of areas. My cholesterol and triglyceride levels were slightly higher than they should be, nothing a little more exercise and dietary changes won't help, but the key concern were the levels of a certain protein we all have that controls blood clotting. My levels were somewhat higher than they should be; nothing wildly off the charts, but enough to put me at risk.

I now get to take an aspirin a day. Now you may consider me an elder.

On June 5th, 2014 I got to have an injection in my left eye, which was probably one of my worst long standing fears. I’ve long been squeamish with needles, and with putting things in my eyes. I will never put contacts in there. The idea of a paper cut on my eye ball will make me shudder and cringe. This was a double whammy. For any of you faint of heart, picture this shot as the prong of a fork puncturing a wet hard-boiled egg. This nasty egg resides inside your head. Imagine this, feel this. This sort of, sort of sums up the queasiness I felt knowing this would be a thing about to happen to me.

My nerves wrecked me the day of, and when I arrived for my appointment I asked for some valium. They said they didn’t have any. Then I said any sedative will do. And they laughed and said I’d be fine. I just had to concentrate on deep breaths.

The ophthalmologist numbed the eye well. The strangest part was having my eye lids held open with a pair of clips like I was in A Clockwork Orange. The eye was washed with iodine. Then he used a little marker to mark the spot on my eye ball where he would give me the shot like it was a rounded little white board. I didn’t feel the marker and the shot maybe felt like some slight pressure, but nothing to make me cringe. When the plunger was depressed and the injection was released I could see a spread of faint liquid ripple in my field of vision. Then a little bead of dark liquid seemed to hover in the low center of my sight line and the optical illusion of it made it seem like it was floating out in front of me by a foot or two. If I could separate myself out for a moment from my squeamish pain, it was really quite beautiful. Projection plucked in a wet sort of tissue ball, like seeing a trippy thing up on the domed screen of a planetarium.

The worst part was at home later when the numbing drops wore off and the iodine that was still in my eye burned like I had been chopping 100 onions in a small space craft.

Then the soreness. My left eye was puffy and bloodshot the next day. I went into work anyway and really tried to hold some intense eye contact with people. Maybe share the squirming.

And what is my sight like post shot, after 1 week? The pinch is released, and the font size is back to about 92% of what it should be. I’m told the medicine continues to work up to one month. Hopefully within the month, font size will be keeping up with the right. If not, cue up shot number 2.

So why did all of this happen? Perhaps this was God’s punishment because I’ve choked some bishops. This is a euphemism. Playing with yourself leads to blindness, puritanical rumors have repeated.

My start to 2014 was a shit storm. Fresh off pneumonia, my strength was getting back on its feet after the blow of that battering ram of coughs. It took some time to get my lung capacity back. The pain of a break up from a long term relationship hadn’t yet healed. The disappointment of several sales opportunities at my previous job that didn’t pan out stirred up financial squeeze, and so I started a new job. Despite the relief of a new employer and steady salary, there was still the wonder if it would work out. In short, I was bathing in uncertainty. With the conditions of hypertension and blood clot risk already in place, the left eye had its equivalent of stumbling and breaking an ankle. The technical term for this eye stroke is BRVO. Branch Retinal Venous Occlusion.

I’m relieved to be standing here after flying on an airplane. While at the gate I had a sudden thought; what if cabin pressure is bad for my eye while working itself out with the medication? I didn’t think to ask if I should avoid such a thing. But the ticket had already been booked and I would’ve worried about the expense of canceling had they said, don’t fly. But it could also be an expense if my eye had popped open mid-flight and gushed as though stomped on like a grape, the inner ocular pressure just too much, some oozing and then the eye ball itself shrinking down as it loses its liquid. Then out it falls, tethered by a mesh of nerves and blood vessels, puss and plasma joining the pool at my feet. The mesh would recoil up and down, like skinny, oily curly fries wrapped in red, water-logged Ramen noodles, proud of their spring. I worried about this but it didn’t happen. Because if it did, even if it had long since healed, I would never revisit this in the form of tale. I would be twitching, institutionalized, forever haunted.

Memories were conjured recently of a seeming agenda at play to beat the shit out of my left eye. When I was young I experienced some bad blows and my left eye always seemed to take the brunt. I was maybe 5 when some friends and I were throwing acorns into the woods. One friend’s acorn bounced off a tree and hit me in the eye. I feel like there were a couple of instances in elementary school where some gym class ball hit me there. One time the throbbing was enough that I had to go sit in the nurse’s office for awhile. My mom had to come pick me up. At a friend’s birthday when I was 8, we were taking turns pushing each other on his tire swing. While he was on the swing, the spinning became unpredictable, and the heel of his foot made contact with my eye. At the end of the party his dad said “maybe next time you’ll be the hitter and not the hittee.” Stories like this are legion actually. My family joked that I had an eye magnet.

Always the left eye it seemed. Perhaps what was at play here was that eye had just had enough and tried to off itself.

Even well after the left eye had already begun with its vision issues this winter, there was incident while riding with my girlfriend. She took off her coat and threw it in the back seat. The weighty zipper flopped around and once again this left eye was bullied.

The lesson here is don’t bully eyes.

I know this all sounds serious and fucked up for a 30 year old to go through. The first ophthalmologist I saw, the one who diagnosed me, called this whole thing an eye stroke, but this was before the blood tests were ordered. The ophthalmologist who treated me, his partner, has been referring to it as a blood clot, which sounds less violent. When I first explained the eye stroke to my friends, it was met with a sort of “Jesus Christ Holy Shit” response. I’ve started explaining it as a blood clot in my eye that caused some swelling, and everyone I tell that to is like “okay” and it becomes a much simpler, smoother conversation.

But I’ll be fine. Some things were learned, for instance the blood clot risk, and is being treated. I’m getting a little more conscientious with my diet. I will no longer stock up on canned soups that have enough sodium in one serving to mummify a tiny bird. I’m getting a little more exercise. And most importantly I’m working on my karma so I don’t experience another harsh year transition as the one most recent. And if I do, I will remind my eyes to not take things so personally. Especially that left one, he’s sensitive and has a hard time taking a punch and stomaching a joke. And if this piece of writing is so bad that you want to throw fruit at me, please give me enough warning so I may cover up my face.