General

EYES and ears and mouth and nose

Posted 8 June 2024 by saralynn143

June 2 marked sixteen years since microvascular decompression surgery for hemifacial spasm left me with left-sided facial paralysis. I intended to post a 15-year update, but sadly my mother passed away last year and I did not feel up to writing one. Although it’s a little late, changes over the past year make this an opportune time for an update.

At the time of my surgery, I was still in my 40s. Now that I am a wee bit older, I find it helpful to leave myself reminders, such as sticky notes on the bathroom mirror or alarms on my phone, so that I don’t forget appointments. And both morning and evening, I run through the line “Eyes and ears and mouth and nose” from the children’s song, Head, Shoulders, Knees and Toes, to make sure I’ve completed all of the daily routines necessitated by chronic facial paresis.

This post will focus on eye care, by far my biggest challenge. I have posted extensively about my eleven years of experience with scleral contact lenses, the mainstay of my visual health. I alternate between two pairs of SynergEyes VS lenses. I also have several pairs of LaserFit lenses that I keep as backups. I wear prescription progressive readers with prism correction over the scleral lenses.

I had hoped to use this year’s vision benefit on an updated pair of distance glasses for when I’m not wearing contacts (in conjunction with ointment to keep my left eye moist). But — and this is a big, fat, unfortunate but — I learned that even my right cornea is too irregular to correct vision with glasses. This hit me hard. Before I thought of myself as having complicated vision, now I feel visually impaired. This might change someday after cataract surgery, but I have no idea when that will happen or even how it can happen on my left eye that does not blink or produce tears. For now, I will have to rely on wearing scleral contacts any time that I want to see clearly. This cloud does have its silver lining: my optometrist says that I am the epitome of medical necessity for scleral lenses as vision insurance companies scramble to tighten the definition.

A combination of factors has recently caused me to make changes to my nightly routine. Over a long period of trial and error, I learned that my left eye does best with an ointment with a high ratio of mineral oil to petrolatum. With the ongoing RefreshPM shortage and the recall of comparable store brands, I have found it difficult to make do with alternatives. Either I would wake up during the night in discomfort and needing to reapply this product or my optometrist would caution me against using that product long term. After a series of ointment failures, I tried Celluvisc gel drops with a pair of dry eye goggles prescribed after my surgery. The first night went well, and I was cautiously optimistic. The second night I woke up in the wee hours needing additional drops. The next morning, I noticed that the foam lining was separating from the goggles (not surprising after 16 years). Following a little research at the Dry Eye Shop and Amazon, I ordered iVIZIA gel drops, eye bandages and a new pair of goggles. The night after they were delivered I tried the drops with an eye bandage. That combination was fantastic — the thick gel drops kept my eye moist all night and the bandage was much more comfortable than goggles.

Best of all, my vision was crystal clear from the moment I inserted my scleral lenses, which eliminated a huge longstanding challenge. I have a photography trip to Peru scheduled for this summer, and since it’s not really a viable option to ask an entire group of people to wait for me several times each morning while I try to clear up my vision, this new regimen is a huge improvement. I have yet to decide if I am comfortable wearing an eye bandage on an overnight plane trip, but maybe the goggles will work for that.

This is my packing list — I’ve added links where possible. Most items are available from either the Dry Eye Shop or Amazon, and many are available from Walmart, Target, grocery stores and pharmacies.

Daytime:
• Nutrifill preservative free solution
• iVIZIA Sterile Lubricant Eye Drops
• Peeps glasses cleaner

Nighttime:
• ClearCare Triple Action (travel size x2)
• Saline for Sensitive Eyes (Target or Walmart store brand)
• Boston Advance Cleaner*
• iVIZIA Lubricant Eye Gel
• Adhesive Eye Patches

Other Supplies:
• 0.9% Sodium Chloride 5 mL (Addipak, Modudose, etc.)
• Antihistamine eye drops
• Steroid eye drops (from pharmacy)
• Cotton swabs
• Eyelid cleaner
• Drain cover
• DMV vented inserter
• DMV removal plunger
• Cleaning sponges (cut into quarters and pretreated with cleaner*)
• Anti-fog goggles

Just to complicate matters, this has been a terrible year for allergies in the midwest. I had allergy symptoms in my eyes for the first time in my life, with redness, itching and absolutely disgusting stringy discharge. It is much improved and I am weaning off antihistamine eye drops that I have been using for over a month. I was on steroid eye drops for five days during the worst of it. I have an appointment for allergy testing scheduled in August.

Over the next few weeks I will post updates about ears and mouth and nose. And who knows … head, shoulders, knees and toes might make appearances as well.

Scleral Lens Emergency Kits

Posted 19 September 2022 by saralynn143

I maintain two scleral lens emergency kits — one in my handbag and one in my car. I check them every couple of months and swap out solutions as necessary.

*Scleral care kits for handbag and car.*

I use an old cell phone dry box for my handbag kit. I like that it will keep any potential spills contained as well as its thin profile. It’s easy to move from pocketbook to daypack or airline personal item, even a pocket if need be.

Handbag kit contents:

Flat contact case
Sterile saline vials
Remover and inserter tools
Cotton swabs
Alcohol wipes
Ointment tube
Small mirror

I don’t often have occasion to use the kit, but it is invaluable when needed. Since this kit is indoors most of the time, I don’t worry about the solutions overheating. None of the solutions have expired so there are no changes needed at this time.

My car kit is housed in another waterproof box. This one is from Coleman and I believe it originally contained a first aid kit. I have only used the car kit once, during a weekend trip when I inadvertently left my scleral supplies at home. Because I did not have a large case for H2O2 disinfection, I bought Boston Advance cleaning and disinfecting solutions to use with a flat contact case, augmented with sterile saline and nighttime ointment from the kit.

I’ve recently discovered new products and figured out a way to use a small ClearCare case for disinfecting scleral lenses in emergency situations, enabling me to modify the contents of my car kit.

Updated car kit contents:

Modified ClearCare case
Aplicare H2O2 packet
Sterile saline vials
Flat contact case
Remover and inserter tools
Cotton swabs
Alcohol wipes
Ointment tube
Small mirror

One Aplicare packet contains enough H2O2 to fill a ClearCare container three times. I included a tiny binder clip to fold and seal the packet if opened.

With a little bit of stacking and manipulation, it all fit, although I had to jettison an eye patch that was getting old and discolored and had never been needed anyway. I am at the point in my scleral journey that I don’t really need the mirror, but it still fits so I left it in, although if it’s lost or broken I probably won’t replace it. Since it has been a couple of months since I last checked the kit, I did replace the sterile saline vials.

The small dry boxes that I use are ideal for tucking into my bag and glove box, but emergency scleral supplies can be kept in any type of container. A TSA 3-1-1 plastic bag would work very well—and hold additional supplies—but also requires more room to store it.

Prefilled scleral emergency and travel kits are available from the Dry Eye Shop.

In Case of Scleral Emergency…

Posted 12 September 2022 by saralynn143

Edited to add: I wrote this post when I wore LaserFit lenses, which are marked with dots to differentiate right from left. Due to insurance, I have switched to another brand of lenses, which are not marked. If I were to use this emergency hack today, I would separate the lenses into two cases and mark them for left and right lenses.

As I packed scleral supplies for a recent airline trip, my mind was preoccupied with the panicky thought, “What if my scleral supplies are confiscated?” It’s a long shot, but WHAT IF???

Most of the supplies in my scleral care kit are replaceable…with the notable exception of a large diameter lens case for use with hydrogen peroxide disinfection solution. Of course, I could substitute a different RPG cleaning solution in a flat case. However, my eyes are much happier with hydrogen peroxide disinfection.

So…I began seriously contemplating some WHAT IFs. What if I am flying and my supplies are confiscated? Or what if my scleral case breaks? Or what if I am unexpectedly caught away from home overnight? My emergency kits—purse or car—do not include disinfecting solutions.

I live in the United States, so most of the places where I might be stranded would have access to a Walmart, Target, or grocery/pharmacy/convenience store of some variety. Again, if necessary I would purchase some kind of RGP solution with a flat case, and rinse the lenses to within an inch of their lives with saline the next morning. Then again, I might be able to procure ClearCare (or equivalent generic), but not have a scleral case. What then?

I have read that some scleral users have successfully disinfected their lenses by carefully centering them within a ClearCare case. In fact, I began my scleral journey that way…until suffering my first lens break. Other users leave the baskets ajar rather than closing them over the lenses. But every time that I practiced a dry run of this technique, one or both of the baskets snapped shut upon insertion into the jar, in which case a lens might also very well snap.

So, I took another look at a ClearCare case, and came up with a emergency use solution that I feel is workable for those of us with larger lenses. I tested this using old lenses, and although I haven’t yet tried it on current lenses, I am confident that this approach would be safe for emergency use.

The case used here is from ClearCare. However the steps would be the same for generic store brand equivalents.

Step 1. Remove the lens baskets from the basket assembly.

Step 2. Snap the basket assembly off of the lid. Why? It is much easier to place the scleral lenses into the solution with the neutralizing disk and lens basket assembly inserted in the jar, but the lid removed. Note that there is a flange remaining on the underside of the lid. Leave it there. Why? Stay tuned…

Step 3. Fill the jar with hydrogen peroxide cleaning solution up to or just a little over the line on the jar. It will need to completely cover the lenses.

Step 4. Place each lens in an opposite side of the lens basket assembly. Add more H2O2 solution if necessary, but keeping the level below the top of the lens basket assembly will help prevent it from floating.

Step 5. Center the lens basket assembly/neutralizing disk in the jar and screw on the lid. The flange left attached to the lid will keep the lens basket assembly from floating as well as centered within the jar so there is not a gap for one of the lenses to sink between the side of the jar and the neutralizing disk.

Step 6. After at least six hours of disinfection time, scleral lenses may be retrieved, rinsed, and inserted as usual. I used a suction cup removal tool, but the basket assembly could be carefully raised until the lenses can be taken out.

This is probably the appropriate place to insert a disclaimer: I offer this as an emergency approach to disinfecting scleral lenses. I do not recommend it as a long-term solution for using less ClearCare than a PROSE case as I have no idea what potential harm long-term contact with the neutralizing disk might have on scleral lenses.

Next week, a review of my handbag and car emergency kits.

New Scleral Travel Finds

Posted 29 August 2022 by saralynn143

My husband and I are headed to Las Vegas to visit our middle daughter over the upcoming Labor Day weekend, and we’re trying out a discount airline for the first time. Given that I am allowed a personal item only for a five-day trip, I need to minimize what I pack in all areas, including scleral supplies.

I had originally intended to take a PROSE case and five Aplicare 1-oz. hydrogen peroxide packets for disinfection. But after booking, I happened to notice a Facebook post on the Scleral Lens Education Society page about what appeared to be a smaller scleral lens case. When I was unable to find a place to purchase it, I Googled the original poster and contacted him through his clinic. He sent me this link.

I also ordered a DMV Versa combination inserter/remover, because that’s one less thing, right? It is available from the Dry Eye Shop or Amazon.

*Scleral Lens case for H2O2 disinfection* *and DMV Versa Remover/Inserter*.

I have performed a trial run of both products. The only downside to the Versa device is that it is solid rather than hollow like the Vented Scleral Cup inserter I am used to. The suction cup side is exactly like the DMV Ultra Hard Contact Lens Remover that I generally use. The Versa doesn’t save that much space, though, so I don’t know that I would buy it again.

I am cautiously optimistic about the new scleral case. As you can see in the photo below, it falls in size between the PROSE case and the ClearCare case. Some time ago I measured the amount of ClearCare that it takes to fill a PROSE case (1 ounce) compared to a ClearCare case (⅓ ounce). The new scleral case takes ½ ounce. The jar is shorter than the PROSE case and designed with slots that the lens baskets slide into, so the diameter can be smaller and require less fluid. The lens baskets are large enough to accommodate my 19mm LaserFit lenses. However the baskets (particularly the clips that keep them closed) seem fragile and I don’t know how well they will stand up to repeated use. I may reserve it solely for travel.

*PROSE case, Scleral Lens Case for H2O2 Disinfection, ClearCare Case*

Since the new scleral case requires half as much fluid as the PROSE case, a single travel size ClearCare bottle will last the duration of my upcoming trip. I will also take a backup pair of lenses in a flat case. I have just enough Nutrifill vials to last through this trip. I am also packing a few normal saline IV flush syringes for rinsing, the Versa inserter/remover, a few alcohol prep pads, nighttime ointments, a cleaning sponge saturated with cleaning solution, and a drain cover. This all fits nicely in a 3-1-1 size bag. I think I’m ready!

Traveling with Sclerals: 2022 Edition

Posted 8 August 2022 by saralynn143

It’s been a minute or two since my last post about traveling with scleral lenses, so it’s probably time for an update with new products, insights, tips, tricks and strategies.

I’ve done a bit of traveling in the past year, by plane to Seattle, Las Vegas and Scotland/Ireland, and by car to Minnesota, the northeastern states for fall foliage, California to visit Joshua Tree National Park, Indianapolis and Valparaiso, Indiana, a cargo van road trip to Las Vegas, and a hiking trip in the Arcadia, Missouri area. No matter where I go or how I get there, I have to plan supplies for my scleral contact lenses. I need to wear these specialized lenses because I have left-sided facial weakness due to a surgery for hemifacial spasm that resulted in seventh cranial nerve damage (click here for more information). While I have experienced a good bit of recovery, my left eye still does not completely blink or produce tears. Without intervention I am in continual pain (think sand in your eye). I can deal with the pain by applying ointment to that eye, resulting in blurry vision. But add a scleral lens—plus a pair of progressive reading glasses with no distance correction—and my vision is nearly normal with no pain. I cannot overstate the improvement this treatment approach has made to my quality of life.

The trip to Scotland and Ireland was the most extensive and required the highest level of preparation, so most of this post relates to that trip. These are the supplies I packed (in addition to a pair of prescription progressive readers worn in conjunction with scleral lenses and a second pair of prescription glasses with distance correction for use without the contacts):

*Contents of my carry-on scleral care bag for Scotland and Ireland.*

Solutions:

For filling: I am one of the fortunate individuals for whom it makes no difference whether or not the preservative-free sterile saline I use for filling my lenses is buffered. Generally I use the more economical 5ml nebulizer saline vials, such as Addipak or Modudose. However for a two-week trip abroad, I decided to take Nutrifill solution because I had read that many scleral wearers find it more comfortable and that it helps with fogging. I also liked the 10ml size — twice that of the nebulizer saline vials. I took sixteen Nutrifill vials in my carry-on and sixteen more in my checked bag. (I always overpack filling solution because preservative-free saline is not readily available in most areas.)
For cleaning: Who doesn’t love a good sudsy cleaner for their scleral lenses? I used Lobob ESC for many years until is was discontinued. Currently I am using Naturalens GP Cleaner, but it also appears to have been discontinued. I packed my last bottle in my carry-on. I’m not sure what I will use once this bottle is depleted, but I am open to suggestions.
For rinsing: At home I rinse my lenses with neutralized ClearCare solution from the PROSE case, supplemented by any leftover saline. If my lenses occasionally need additional rinsing, I keep a supply of Target brand saline for sensitive eyes on hand. When I travel, I throw a large bottle in my checked bag. Recently, however, our mail order pharmacy mistakenly sent a 90-day supply (360 syringes) of IV flush saline rather than nebulizer saline. It was just before changing insurance plans, and in order to avoid a potential ordeal trying to return the order, I opted to keep them. The website indicated that the flush saline is preservative free, but erring on the side of caution, I decided to use them for rinsing. I packed 16 syringes in my carry-on and a bunch more in my checked bag.
For disinfecting: My preferred method of disinfection is ClearCare Triple Action (or equivalent Target generic) in a large PROSE case. Shortly before I began preparing for the trip, I started seeing posts about the discontinuation of travel-size ClearCare, and decided to see if I could find any. Walgreens #1 — out of stock. Target — out of stock. Walmart — out of stock. Panic starts to set in. Walgreens #2 — out of stock. HyVee (a grocery store where I seldom shop) — one lonely bottle on clearance! Score! My local pharmacy — never stocks. Gerbes West (my usual grocery store) — out of stock. A second local pharmacy — out of stock. Well, at least I have one bottle for my carry-on bag. Schnuck’s (a grocery store where I occasionally shop, usually on “Wednesday Wine-day”) — six, count ’em, SIX, bottles. Not on clearance, but I buy them out. And decide that I have enough not to head to the east side of town in search for more. I packed two travel-size ClearCare in my carry-on plus a large bottle of Target brand hydrogen peroxide cleaner in my checked bag.
For nighttime lubrication: As I first began recovering from my microvascular decompression surgery and needed round the clock eye protection, I tried every type of eye lubricating drop, gel or ointment that I could find. The one that worked best for me was RefreshPM ointment. Even after I began wearing scleral lenses, I used it on my left eye at night. During a prolonged shortage of RefreshPM, my optometrist had me switch to Muro 128 ointment. After RefreshPM was available again, I discovered that a combination of the two ointments worked best for nighttime eye comfort. I took a tube of each in my carry-on bag. I also packed a few vials of TheraTears nighttime eye drops in case my right eye was feeling dry at night. Fortunately this seldom happens.

Additional Supplies: All of these were packed in the carry-on scleral care bag pictured above.

DMV vented inserter and suction cup remover.
PROSE scleral lens case for hydrogen peroxide cleaners with a neutralizing disc.
Jar from Almay 120-count eye makeup remover pads. A perfect fit for the PROSE case, it minimizes solution spills while traveling.
Contact Lens Accessory Pads, small green sponges used in conjunction with cleaning solution. I cut them into quarters because I find it easier to clean the interior of my lenses. Plus they last longer. I packed eight quarters (two sponges).
Two spare pairs of lenses in small cases filled with Bio-True solution. I also carried a travel-size bottle of Bio-True in my carry-on.
Silicon drain cover. More than once this has saved one of my lenses from going down a drain with no stopper. (In the future I will also include a small suction hook so that I can hang the drain cover on the bathroom mirror to dry.)
Travel size fragrance-free and lotion-free hand soap.
Lens cleaner and microfiber cloth for cleaning my glasses. Also handy for camera lenses.
Travel size package of cotton swabs.
Alcohol wipes.

Most of the products noted are available online from Amazon or the Dry Eye Shop. Many may be available locally from Target, Walmart or Walgreens — the exceptions being the large PROSE case, DMV inserters and removers, and preservative-free saline solution. The latter may be available from a local pharmacy with a prescription, but I have always resorted to Internet purchases.

Whenever I fly, I also carry a letter from my optometrist explaining that I need to take medically necessary fluids for scleral lenses in excess of the 3-1-1 TSA limits. I keep this with my COVID vaccine record and passport.

Check back next week for my top 10 scleral lens travel tips and tricks. Meanwhile, remember that there is no reason to let scleral contact lenses keep you at home. Happy travels!

Photo of the Year 2020-21

Posted 24 January 2022 by saralynn143

The COVID pandemic wreaked havoc on the Jefferson City Photo Club schedule, causing the cancellation of fifteen consecutive meetings. One result of all these postponements was rolling contest themes forward, another was combining 2020 and 2021 contest winners in the Photo of the Year contest.

I have been pushing myself to enter images in every monthly contest, and had one or more winning entries in seven of the eight contests. Out of those, I placed first in two categories.

Color Print

This photo originally took first in Color Prints in June 2021 for the theme of Boring. Charlie is an extremely photogenic cat.

Open Print

This image also took first in June 2021 in the Open Print Category for the theme of Boring. Archive photos taken more than one year in the past may be entered in this category.

First Solo Photo Exhibit

Posted 17 January 2022 by saralynn143

Artists Helping Artists, a wonderful community organization that encourages artists of all types to express their creativity, meets every week at Faith Lutheran Church. Late last year, the group initiated a series of public exhibits in the main stairwell at Faith, an airy space with lots of natural light. The first exhibit, in October/November 2021, featured paintings by local artists Caryl Collier and Jan Sonnenberg.

I was thrilled to be asked to assemble a photography exhibit for the next timeframe, December 2021 – January 2022. I decided to feature my favorite images from a Tanzania safari taken in February 2019. I also chose to mount the photos in reclaimed vintage frames (this will be the topic of a future post).

By the time this weblog is posted, the exhibit will be nearly over. Next time I will be more proactive about announcing the exhibit in time to see it in person, but showing the chosen images will have to suffice for this one.

Upper Level (Choir Loft)

A group of elephants frolicking at dusk.

The ever-popular “roaring” lion cub, who is actually yawning.

Upper Landing

Another crowd favorite, I often use this image for wedding cards.

Adorable mother and baby monkey.

Main Level (Sanctuary)

Two young bull elephants skirmishing at dusk.

Lovely zebra with some nice tail switching action.

Lower Landing

My favorite safari image — I still feel the exhilaration of locking eyes with this regal lioness.

The tour guides gave me the nickname of “Mama Twiga” due to my love of giraffes. This shot showcases the symbiotic relationship with ox-pecker birds.

Lower Level (Fellowship Hall)

This elephant was kind enough to pose with an ubiquitous acacia tree.

These young male zebras are competing for the attention of the female. They engaged up and down the flamingo-laden coastline for quite a while.

Please feel free to contact me for more information about Artists Helping Artists, Jefferson City Photo Club, or M&M Photo Tours.

I’m a Muse!

Posted 10 January 2022 by saralynn143

This is a post that I intended to share more than a year ago, but time slipped by and so did my inspiration. Recently something happened that spurred me to action.

First, some background. In August 2019, Norbert Haupt, a guest at the photo club presentation about my Tanzania safari, was inspired to create a painting from one of the featured landscape shots. No only that, he wrote about it in his own blog.

This is a sausage tree, so called because its fruit resembles a sausage. An interesting fact about this photo is that it was taken from a “Loo with a View” following an early morning hot air balloon ride over the Serengeti.

Artist Norbert Haupt chose to move the hill in the background to better highlight the tree as subject. I have no problem with that decision. Had the loo to the right been vacant, this is how the photo could have turned out.

What caused me to write about this now? A couple of days ago, I received a large package. A very large package containing, as you may have guessed, this very painting. Many thanks to Mr. Haupt for his generous gift.

One of my next framing projects will be for an enlargement of the photo that inspired the painting.

2022 Here I Come!

Posted 3 January 2022 by saralynn143

I’m trying to wrap my head around a new normal. For the past few years Phil and I have been operating within an overall life plan that included my working through 2022. However due to increasing stress caused by significant changes, both at the workplace and in my personal life, we made the decision that I would leave my job at the end of 2021.

Just a few days into the new year, I am already at peace with our decision. I plan to spend the 40+ additional hours per week wisely, and look forward to:

Spending time with family — it’s going to be a big year for the Hartmans. Granddaughter Lillian turns two next month, and is growing and developing so fast! We would love to spend more time with her, Hanna and Ryan. Laura will graduate from vet school in May and will be moving into a new chapter of her life, location yet to be determined. Joseph is on schedule to graduate from his master’s program in December, at which point everyone in the Hartman family will have an advanced degree! I am also happy that I no longer need to stress over taking time away from work to take my mother to67 doctor appointments. She’s working on regaining strength and skills to return to her home; if and when that happens it will also take more time.
Health — I need to take better care of myself, both physically and emotionally. Last year I started using my Fitbit to remind me to get up and moving during the day, and hope to continue to meet movement and step goals on a daily basis. I also plan to start taking yoga classes again, include fewer processed foods in my diet, and drink more water.
Travel — Phil & I hope and pray that our twice-postponed 25th anniversary trip to Scotland and Ireland will finally take place this June. Hanna, Lillian and I are looking into a spring trip together. Although it’s unknown at this point where Laura will end up practicing (she loves the Rocky Mountain states), I want to be available to help her move and settle in, wherever it may be.
Photography — digital photography has bubbled up as my favorite hobby over the past few years. I definitely want to improve my skills, which takes practice, which takes time. I plan to enter each Jefferson City Photo Club monthly contest and to spend more time taking photos and trying new techniques.
Home — our house has been neglected over the past few years with both of us working plus the added responsibilities Phil has faced as executor of his parents’ estate. As that (hopefully) wraps up, we have plenty of projects of our own. We are already starting with replacing our picture window and storm door. I also plan to switch rooms for my office/craft space to one of the larger bedrooms. We have some plumbing problems, plaster issues, floorboards, and general touch-ups to address. Plus — and this is a biggie — we want to significantly pare down the volume of possessions in our own home so as not to leave a mess for our children and grandchildren.

This may be a rather dull weblog post for others, but I am hoping that it serves as my inspiration to refocus the use of my time this year to meet these goals and aspirations. Toward that end, I plan to return to posting weekly weblogs as a means of keeping on track.