More Scleral Tools and Tips

Today marks ten years since I awoke from microvascular decompression surgery to left-side facial paresis. Well, paralysis at that time. Single-sided deafness as well. Fortunately over time I regained most of my balance and hearing and enough facial function that most people don’t notice anything amiss. My blink and tear function have never returned, so I have spent a decade finding a remedy for painful dry eye. The solution that has worked best for me is the combination of an implanted eyelid weight and scleral contact lenses. These large-diameter specialty lenses are expensive and require quite a bit of maintenance, but in my opinion are worth every bit of cost and effort.

In past posts I outlined the care routine that works best for me. Since then I’ve discovered a couple more items that make it more manageable.

Several months ago I had to have my collarbone plated following an auto accident. Something went wrong with the nerve block and for a while my left arm did not function. My insertion technique requires both hands – one to hold the inserter and lens, the other to hold my eyelid wide open. For the first couple of weeks my husband helped with the eyelid part. We were both relieved when I regained the minimal movement and grip necessary to hold the inserter relatively steady. It was frustrating at first. My left hand did not have the strength to hold my eyelids, so I could only use it to hold the inserter and lens. Fine for my right side, but very awkward for the left. It wasn’t what I was used to and I kept bumping into my nose moving my right hand across my face to open the left eyelids. The weakness in my left hand caused me to spill the solution quite often. I also had a hard time aligning the left lens in the mirror I used on the counter. I was back to needing ten to fifteen minutes or more just to insert my contacts.

I remembered seeing a scleral insertion system that incorporated a lighted stand, but remembered it as pricey. I also didn’t want to have to wait on shipping. I thought about my craft light box but couldn’t find it, so we went to Hobby Lobby to see what they might have. A store employee directed us to this:

I snapped it up with a 40% off coupon and it worked like a charm. All I needed to do was align the inserter so that I could see a little circle of light. This lasted for a few weeks before it died. I think that even though I blotted up excess saline right away, some made its way into the box and shorted its circuits. In retrospect, I should have put a square of glass or plastic over it to keep the liquid out.

No worries though – since the concept worked so well I wondered if combining lights with a mirror I had been using wouldn’t be any better. I started searching at Amazon.com and found this lighted compact:

I highly recommend this for people who have trouble inserting their lenses. I find that it helps immensely to align lenses properly, plus it’s inexpensive and small enough for travel.

Before I regained normal strength and dexterity in my hand, I reverted to using disinfecting solution rather than ClearCare. I did not want to run the risk of snapping a lens, even having moved to PROSE cases with their larger baskets. As soon as I was able, I switched back to ClearCare, but there is a drawback. I have two pairs of lenses that I switch between every other day. Because the hydrogen peroxide system doesn’t seal, when I travel there is a risk of spilling the solution out of the second case. Before our most recent hiking trip to South Dakota, I made an exciting discovery. The PROSE case exactly fits into an empty eye makeup remover jar. (The labels peel off easily.)

Make sure it’s the extra-large 120-count jar. The 80-count is too short for the PROSE case, but might work with a ClearCare case. While a little solution may still seep into the jar, it won’t leak out into luggage.

It amazes me to look back and see how far scleral lens technology and use has come in the past decade. I’m looking forward to seeing what the next ten years bring.

 

Safari Prep on a Budget

Having pulled the trigger on going on safari, I turned my attention to preparing for it. Whenever I plan to leave the country, I take out travel insurance, and this trip is no exception. I looked for a policy that would cover many contingencies of not being able to go, and maximizing lost luggage since I am taking expensive camera gear.

That done, I started googling safari gear. I had originally thought that I would be pretty well geared-up already, since Phil and I have been on many hiking excursions and I figured quick-dry gear is quick-dry gear, eh? However, the bold colors that make one easy to spot on a hiking trail also make one easy to spot by African wildlife, and not in a good way. Add in my post-accident weight loss, and suddenly I wasn’t so well geared-up after all, except for hiking boots.

The best colors for safari are desert neutrals: brown, beige, khaki, tan, olive drab. Besides the aforementioned bright colors that alarm the animals, black and navy blue draw tsetse flies, and who wants that? So . . . off to amazon.com! Unfortunately I soon discovered that 6L hiking pants are nearly impossible to find and quick-dry shirts have become quite pricey. Time to expand my shopping horizon, and explore alternative payment sources.

Our amazon.com account is linked to our Discover rewards, which I used to purchase a number of items for the trip, mostly related to technology (laptop sleeve, port dust plugs, MacBook port adapter, keyboard cover and such). We also have a policy of directing “found money,” such as product rebates and Ebates, into our travel fund.

We also have a Cabelas rewards charge card, which enabled me to order tan hiking socks, a khaki sun/rain hat, and a “Rite in the Rain” pen and pad – all with points.

eBay became my new best friend for safari attire. I was able to find five gently-used neutral-colored quick-dry shirts, two pairs of long-inseam pants (one new with tags), and a khaki travel jacket at prices ranging from $10-20. I was also able to purchase a Kata camera backpack with a laptop slot. One of my favorite eBay features is “Make an Offer,” where I explained to the sellers that I was going on safari on a budget. Almost everyone was willing to negotiate a lower price. (As a bonus, eBay participates in Ebates at a rate of 2%.)

I am still debating the merits of a travel vest and am watching prices.

Next up: camera gear.

 

Safari Bound!

I am going on safari in Tanzania next February, where I will see these majestic animals in their natural environment. I am so excited!

This trip has been a long-term dream that  started when I began following the work of photographer Jeff Cable. Among his extensive portfolio, he does amazing work shooting Olympic sports, portraiture, and of course, travel photography. The first time I saw him post about his safari excursions was probably 2015 or 2016. I had recently started a new job and it was just not feasible to take extended leave.

Several things happened in 2017 that made me realize that while no timeframe is going to be perfect, now is the time to follow dreams. One was a car accident in which I suffered a broken collarbone, with a subsequent surgery that resulted in an unexpected nerve injury with extended recovery. I also lost three “mother figures” — Arleene, a dear friend and former colleague, Aunt Grace, my beloved godmother, and Ann, my former mother-in-law. I’m sure that each of them would be honored to be an impetus behind this decision.

There is a lot of preparation for a trip such as this, and I anticipate multiple posts related to that in the near future. But for now I will revel in the decision to do this, and the anticipation of seeing my spirit animal, the giraffe, in its native habitat.

In an Instant, Part 2

It took some doing to get here, but today turned out to be a pretty special day.

October 22 – Little did I know, standing at the intersection of Academy Boulevard North and Jannie Drive in Colorado Springs as I gingerly explored the edges of a broken collarbone under my skin, what an ordeal recovery would become. The nice off-duty EMT who stopped at the accident site assured me that it was a common motor vehicle accident injury. As did the ER doc and the radiologist who made me raise my arm over my head for one of the views. (First major ouch.) I was released with an arm sling, a couple of prescriptions and a recommendation to see my own doctor for follow-up once I returned home.

Sitting through the soccer game and the hour or so van ride back to Denver wasn’t too bad, thanks to some heavy duty meds. Fortunately I was TSA Pre-Checked and sailed through security, although the sling probably helped. I converted my camera backpack to a right shoulder sling and draped my coat over my left shoulder and was good to go on the long walk to our gate. The agent who helped me switch out my exit row seat to one next to Laura also allowed both of us to pre-board. Unfortunately we had quite a bit of turbulence. It helped to put my right hand directly over my injury to keep it still, a little. (Second major ouch.)

October 24 – I see my regular physician. He says he thought the break would heal normally over the next six weeks, and prescribes a shoulder extender that he thought would be more comfortable. I visit two orthopedic shops and call several pharmacies only to find that it is a specialty item that will take several days to arrive. Frustrated, I text an orthopedic physician that attends my church, who makes room in his schedule the next day.

October 25 – I visit the orthopedic physician. X-rays show a 2cm displacement, on the cusp of needing surgical repair. He outfits me with a figure-8 brace (much better than the sling) and puts me on a two-week watch and wait with instructions to come back in if one of the bone ends starts protruding.

October 28 – I sneeze, violently. I feel it coming but am powerless to do anything other than throw my hand over my collarbone. I feel the ends of the bones rolling under the skin. (Third major ouch.) And just like that, one of the broken ends is much more prominent. Unfortunately it is Saturday morning, so nothing can be done but to get through the weekend.

October 31 – Another visit to the orthopedic physician. The followup X-rays show that the ends of the collarbone, previously overlapping, have moved apart and are no longer likely to heal properly on their own. He and his partner recommend that I see a trauma surgeon in Columbia.

November 2 – The first available consult with the trauma surgeon is November 28. Surgery will be scheduled shortly after. I am not at all happy about the delay. They later call back with a November 14 appointment. My orthopedic physician calls to see about a different surgeon, but they are both booked solid.

November 3 – A highly recommended local orthopedic surgeon is able to see me the following Thursday. The appointment is later moved up to Tuesday.

November 7 – The local surgeon tells me that he likes to do clavicle repairs within two weeks of the initial injury. I am just beyond that, so surgery is scheduled for the next day.

November 8 – The anesthesiologist recommends a brachial plexus nerve block for better pain control after the surgery. It is standard procedure, but one of the risks is a droopy face. This being my left side, I decline the block. The anesthesiologist, surgeon, and Phil all think I should reconsider, so I do. The surgeon tells us that he plated the broken ends, also having to screw together two additional bone fragments. I am sent home back in the sling. The nerve block should wear off over three days.

November 11 – My hand is still completely numb. Unfortunately it is once again a weekend.

November 13 – The orthopedic surgeon’s nurse tells me that I must have gotten a really good nerve block. I insist that something is wrong and get an appointment for the next day.

November 14 – The surgeon is pleased with my incision healing. He removes 15 surgical staples, replacing them with steri-strips. He examines my arm and what movement has returned. He thinks that I will eventually regain use of my wrist and hand, but it may take a while. Meanwhile he puts me in a wrist brace so that my hand is not flopping around, gives me some stretching exercises for my fingers and prescribes neurontin for the pins and needles. Then he sends me upstairs for an EMG. After that most enjoyable series of shocks and pricks, that doc says I have every reason to hope for the best, but again, when is anyone’s guess. He does say weeks rather than months. He does not think it was due to the block entering the nerve because there are so many non-responsive nerves, and instead calls it a “conduction event.” I discuss with both doctors the side effect of my pudendal block years ago as well as my neurosurgeon’s comments about my facial nerve during my microvascular decompression surgery. They both agree that I am not a good candidate for future nerve blocks.

November 16 – The orthopedic surgeon calls to discuss my nerve scan (EMG). The nerves are intact, but not conducting. Basically I wait and watch and stretch my fingers (which really hurts btw) and hopefully heal. On the plus side, I have some movement in my shoulder and elbow, and can curl my fingers slightly (although I can’t straighten them). I feel pressure, temperature, itching, texture and TONS of pins and needles. Today I noticed that the bruises on my breastbone and shoulder are really tender. That has to be a good sign.

On the other hand, loss of the use of my hand is really hard. Obviously, typing takes a lot more effort, and my job requires a lot of computer work. But there are so many other things that I took for granted. Phil has to help me put my contacts in. I can’t tie my shoes or floss my teeth. I am limited in my wardrobe choices. A colleague helped me put my earrings in; necklaces and bracelets are out of the question. So far I have not attempted to drive, though now that I am in the wrist brace I am thinking about trying to again. Everything is just harder and more tiring and takes longer and I am extremely frustrated and sad. Everyone has been incredibly kind and helpful, and while I appreciate it immensely, I still wish that I did not need the help. I am also angry with myself for not following my gut instinct to forego the nerve block.

I also nearly mistake a Smirnoff Ice for Gatorade. That could make things interesting.

November 17 – Gabapentin is an evil drug. I don’t even want to talk about its nasty side effects. We are going to try Lyrica, but insurance doesn’t cover much, so switching to Topamax. I seem to remember getting along all right with it back in my hemifacial spasm days.

November 20 – A friend who is a physical therapist gives me some exercises for my hand and says my scar looks good and I can peel off the steri-strips. I have a lot of brain fog and opening an envelope one-handed takes about 10 minutes. Frustrating.

November 21 – I am driving again. I hit the garage door with the breakaway mirror backing out, and it, well, breaks. I thought that wasn’t supposed to happen.

December 3 – I can uncurl my hand, but just once per day. Phil is camping and I have to call my brother over to open a paint can so I can do some touchup painting in our family room. It’s tricky but doable with one hand.

December 4 – I attempt some housework, but the feeling of wet laundry literally makes my nerves crawl. I spend fifteen minutes shuddering as the skin on my left fingertips executes a counterrevolt.

December 6 – My mother-in-law falls. At the emergency room I see a boy with a matching wrist brace and invite him to arm wrestle. He declines. I’m not sure why because he almost certainly would have beat me.

December 9 – My fingers have really opened up over the past week and the wrist drop has improved as well. I can pick things up and manage slightly heavier objects. Weakness is an issue though, for instance I can hold a toothpaste tube but can’t squeeze it. I can touch my thumb and each fingertip together but am neither strong enough nor coordinated enough to type. One new accomplishment for the week was tying the drawstring in my sweatpants. The first time took nearly 10 minutes but just like folding socks I have improved upon my technique so it is faster and the outcome is better. Shoelaces are still too fine to manage, but soon. I see the surgeon for a follow up Thursday so I hope to find out about physical therapy.

December 14 – My collarbone is 85% healed. The surgeon orders 6 weeks of hand PT/OT, but there are no openings until after Christmas. Still, there is progress! The surgeon warned me that my collarbone would ache in the cold. He is right.

December 28 – At my PT/OT evaluation I measure fourteen pounds of grip in my left hand, around 70 with my right. Our plan is twice-weekly visits to work on strength and dexterity.

December 29 – I see my optometrist to utilize my vision insurance benefits before they run out. He is very impressed with my LaserFit scleral lenses and thinks it would be great to bring them to mid-Missouri. I offer to put him in touch with Dr. Gemoules. I remove the lenses to be measured for a pair of eyeglasses, and have a routine numbing drop put in my left eye. Everything goes according to schedule with my right eye, but when it’s time to read the lines with my left, I can’t see anything. Literally nothing, and I panic. The good optometrist remains calm, assuring me that it is a reaction to the numbing drop. This is hard for me to believe since we have been doing the same thing for five years, but I agree to rest in the waiting room for half an hour. I think I actually waited longer than that, but by the time I returned to the exam room the corneal swelling has abated and we proceed with the exam. The optometrist asks me if I have been experiencing double vision lately, which I have. I believe it is due to the Topamax, along with some “jumpiness” in my vision. The doctor would like to add a slight prism to my lenses, and I agree. An appointment that I thought would take an hour actually takes four.

January 13 – In two weeks I have increased grip strength to 21! My therapist thinks I will have 35 in two more weeks. BTW therapy hurts. A lot. But it’s the good kind of pain, where you know it means you are getting better. We mainly work on strength, dexterity and desensitization in my fingers. My range of motion is really good now, and dexterity is way ahead of strength. The nerve sensitivity is now limited to my fingertips, with my thumb and forefinger ahead of the other three. I asked how long it typically takes to go away altogether. Of course, the answer is that it varies; could be a few more weeks, could be a few more months.

January 25 – My clavicle is completely healed! My surgeon is pleased with the progress of my hand and prescribed four additional weeks of PT/OT for my shoulder. As I’ve resumed typing, my left hand has started to exhibit symptoms of carpal tunnel syndrome, so we are addressing that in therapy as well. Saturday is my final day weaning off Topamax and while the weight loss side effect has been great, I won’t miss the brain fog or jumpy vision. I am also very happy that the Tylenol-only OTC pain relief restriction is lifted – my right knee has missed its naproxen. It may be months yet before the ultra-sensitivity in my fingertips and the tenderness in my breastbone resolve completely, but there is light at the end of the tunnel.

Which brings us to today, March 1 – I have been released from occupational therapy! Grip strength and pinch are back to normal in my left hand, and have even increased in the right. I have less sensitivity in my fingertips so I can type with both hands. I have much less numbness in my left hand and have every reason to hope that it was due to residual nerve irritation rather than carpal tunnel. I only had to utilize 17 of 41 prescribed visits.


There was that instant on October 22 when we were in the wrong place at the wrong time and my collarbone was broken in an auto accident. There was a second instant November 9 when I wish I had followed my gut instinct to forego a nerve block, but caved to the recommendation of others. In both instances things could have turned out worse, and I feel blessed to be where I am now. Thanks to everyone who has offered prayers and good thoughts, kind deeds and support. It’s meant the world to me.


Note: I have chosen not to identify health care practitioners publicly, other than Dr. Gemoules, whom I previously discussed in relation to my LaserFit lenses. Anyone desiring a recommendation is welcome to ask for a private recommendation.

 

In an Instant

It’s true that life can change in an instant. Even when you’re lucky.

Last October Laura and I traveled to Colorado Springs to see Kyle play soccer. We had also gone the year before, a quick, exhausting in-and-out trip to Denver that wore us both out and led to the decision that we should try a more extended, relaxing trip next time.

So we doubled our days from two to four. We arrived in time to tour Garden of the Gods.

We met up with Kyle, and later his family to see the first of two soccer matches.

We visited Pike’s Peak with Kyle’s family. Cold, crazy experience. I was so light-headed at the peak that I staggered into other sightseers. Not that they weren’t staggering too! Brrr.

Sunday morning, October 22, we decided to visit the zoo before Kyle’s matinee game. I was excited to see the giraffes. We checked out of the hotel on a lovely, clear morning. We left the hotel parking lot and headed toward the thoroughfare.

The next thing we knew, the car was no longer moving and full of airbags. I don’t remember feeling or hearing the impact. I asked Laura if she was all right; she was asking me the same thing. She did not want to get out of the car because we couldn’t see where we were and didn’t know if it was safe, so we stayed inside the car.

Within a couple of minutes someone was banging on my car door asking if we were all right. I said that I thought so. A man opened the door and we both exited on the driver side. Immediately I asked if the occupants of the other car were all right. The man told me that he didn’t know because the driver had taken off. I got a good look at the rental car, and it looked terrible.

The whole front end had been taken off and bits of Jetta were scattered everywhere. The windshield was broken on the passenger side and I began to worry that Laura had hit her head, but she assured me that she hadn’t. About this time an off-duty EMT stopped by and asked to examine us. Starting with me because I was driving, she asked me a bunch of questions, including who was president of the United States and how many quarters were in $3.50. Fourteen, by the way. I was correct and she stopped worrying about concussion. She asked me about pain and I realized that my shoulder was tender. We both touched it and found a bump on the collarbone – likely fracture.

She then checked Laura over, who had spent the intervening time contacting Kyle, his mom and Phil.

The first responders arrived and ordered an ambulance. The firefighters were great. They found our eyeglasses in the wreckage and loaded all of our personal gear in the ambulance, even the wine and hard cider we had bought for Christmas gifts, which was somehow still intact after the collision. They did say that one second further into the intersection and I wouldn’t have been walking away – they would have been extracting me with jaws of life.

The ambulance crew called to find out the least busy ER and we were off. Once there Laura and I were separated for our respective exams, which I found very stressful. I was taken to Xray, and was diagnosed with a fractured left clavicle. The Colorado Springs Police caught up with us at the hospital and interviewed us separately. The officer told me that they thought they knew who had hit us, that he had stolen his ex-girlfriend’s car and had fled the scene. Our hit-and-run was just one of many charges pending against him.

After Laura was interviewed by the police and released by the hospital, she was able to rejoin me. I called Hertz to report the accident. They asked me to contact them once I knew where the car was towed, and also asked if we needed another rental, but we would have to come back to the Denver airport to get it. Since that was our final destination anyway and neither of us felt like driving, we declined and told them that we would find alternative transportation to the airport.

Although the hospital staff originally told us that their goal was to get us on our 8:00 p.m. flight home, we were released in time to try to make Kyle’s afternoon soccer game. Laura called an Uber to take us there. October 22 turned out to be a big day: first broken bone, first ambulance ride, first Uber. We met up with Kyle’s family at the soccer field, loaded our stuff in their van, and headed to the game, missing only about 10 minutes. By this time my hospital meds had kicked in big time and I don’t remember much other than an egregious incident involving the other team pulling Kyle out of the box by his jersey with a resulting score that the officials let stand. Bummer!

After the game, Kyle headed back to South Dakota with his team and his family kindly drove us to the Denver airport. We left almost all of our luggage with them, and made it through security and to our gate with about 10 minutes to spare. Sadly, I had to give up my exit row seat with extra leg room because I was not physically able to open the exit hatch should it be necessary. But the gate attendance kindly sat me next to Laura, who took prodigious care of me during the flight. Just so you know, turbulence and broken collarbones do not make for a happy combination.

By about 11:00 p.m. we were home in Jefferson City, Laura ready to head back to Truman for the rest of her final semester, and me to deal with my fractured collarbone.

 

Noël Ensemble

I noticed several months ago that a quite a few musical artists had passed away this year, a trend that continued throughout the rest of 2017. My holiday selections this year have featured some of these artists who have enriched our lives. Today’s pick is a little different. Not only had I never heard of Johnny Halliday, I was unaware that there was a “French Elvis.” While I am not up to the task of translating the lyrics – the title means “Christmas Together” – we can count ourselves fortunate that music truly is the universal language.