Glaucoma Disease » Glaucoma Surgery

States weigh covering obesity surgery

admin — Tue, 19 Apr 2005 00:00:00 +0000

Question:

>It can also cut down on the long-term cost of medications, he said. >"The surgery pays for itself in under three years," he said. "There is no >question that there are cost savings."

If there is no question, then there’s no need for legislation. Does anybody believe that if this saved insurance companies money that they wouldn’t already cover it? But I think what would probably happen is that many more people would opt for the bypass surgery if it was covered, thus throwing any cost savings projections out the window.

Response:

States weigh covering obesity surgery Risks, costs debated in several states HARTFORD, Connecticut (AP) — Jacqueline Ezell says she felt as if she were drowning when she was rushed to the hospital four years ago. At 288 pounds, doctors had already diagnosed her with diabetes, glaucoma and high cholesterol, all side effects of obesity. She also had heart problems. "I couldn’t breathe," Ezell said. Doctors gave Ezell two options. She could seek a heart transplant, or have gastric bypass surgery. She chose the surgery. The Preston woman recently told Connecticut lawmakers that she went from a size 26 to a size 6. The surgery also helped lower her cholesterol, and she was taken off a heart transplant waiting list. Now, the only medications she needs are for her heart condition. "There’s nothing I can’t do now," she said. A proposal is before Connecticut lawmakers that would require insurance companies to cover the surgery for people with a body-mass index of 30 or more if a doctor deems the surgery medically necessary. The BMI is a widely used formula based on height and weight. The Connecticut proposal may not get off the ground this session because lawmakers are struggling to define under what medical conditions the surgery should be covered, said Sen. Joseph Crisco, a Woodbridge Democrat who chairs the legislative committee looking at the issue. Benefits vs. risks The debate is not unlike others across the country. Georgia lawmakers are considering a similar bill this year. And in Louisiana, 40 state employees were chosen last year from 1,200 applications to get the surgery on the state’s dime. The standard surgery, which can cost between $20,000 and $35,000, involves using staples to separate a small pouch at the stomach’s top from the rest of the stomach, greatly limiting the amount of food that can be eaten. The procedure also involves bypassing much of the small intestine so that less food is absorbed into the body. Blue Cross and Blue Shield of Alabama recently stopped paying for the operations while it decides how to handle claims; Blue Cross and Blue Shield of Florida has also decided to stop paying for the operation. In Connecticut, many major plans offer coverage only for large numbers of employees. Others are considering offering the coverage for an additional charge. "What we’re starting to see is an increase in what we would consider at best, unnecessary, and at worst, unsafe, surgery," said Keith Stover, a lobbyist for the Connecticut Association of Health Plans. "Many plans decide the best course of action simply is to exclude coverage." But many physicians say the long-term benefits of weight loss surgery outweigh the risk. Gastric bypass surgery can help cure obesity-related health problems such as high cholesterol, high blood pressure, sleep apnea and even diabetes, said Dr. Jonathan Aranow, director of the Middlesex Hospital Center for Obesity Surgery. It can also cut down on the long-term cost of medications, he said. "The surgery pays for itself in under three years," he said. "There is no question that there are cost savings." Last year the federal government opened the door for Medicare coverage of gastric bypass surgery. But some lawmakers and insurers are also worried about risks. State Rep. Anthony D’Amelio, R-Waterbury, said noted two people in his district died after having the operation. Complications strike as many as 1 in 5 patients having the surgery, and it is believed that for every 200 patients, 1 to 4 will die. Estimates are that more than 100,000 people will have the surgery this year. "I would rather see people try to do it the harder way, exercise and eating properly," D’Amelio said. "I know it’s a struggle … I think it’s the safest route." But for some patients, the hard way hasn’t worked. Deborah Sicaras, 36, of Wethersfield, has tried Weight Watchers, Jenny Craig, diet pills and liquid diets; she also teaches ballet, tap and jazz four days a week. "I’m one of the fortunate ones who will be able to have this surgery in the very near future," she said. "I can’t do this by myself. I need assistance. I’ve dieted my whole life."

Response:

Do MRI scans interact with the metal plates installed during shunt (tube) Glaucoma surgeries

admin — Wed, 30 Mar 2005 00:00:00 +0000

Question:

Hi John, MRI would only be a problem if glaucoma shunts were made of metal, which they are not. All glaucoma shunts are plastic and/or silicone, except for the Ex-Press glaucoma minishunt, which is not commonly used anymore. Those are metal, but I believe they are not magnetic. Hope that helps. –Rick Cohn, MD Glaucoma Specialist

Response:

MRI machine operators usually question people closely about possible metal fragments remaining in eyes after accidents; presumably because MRI can move these metal fragments around. Wouldn’t the same apply to the metal plates installed in "shunt" glaucoma surgery? — particularly in "brain" MRI scans? I started wondering after having lower spine and pelvis MRI’s today. I did not think to mention my two shunt surgeries, which was probably just as well. Thanks for any comments. John

Response:

"John" wrote in message

news:bpck41dao2gbubk88gcj756f74jj94trvn@4ax.com… > MRI machine operators usually question people closely about > possible metal fragments remaining in eyes after accidents; > presumably because MRI can move these metal fragments around. > Wouldn’t the same apply to the metal plates installed in "shunt" > glaucoma surgery? — particularly in "brain" MRI scans? > I started wondering after having lower spine and pelvis MRI’s > today. I did not think to mention my two shunt surgeries, which > was probably just as well. > Thanks for any comments. > John

It would depend on the type of metal. I have a titanium implant in my arm. It is a non-errous metal which is not magnetic. I would imagine your shunts are non-ferrous metal too, but you might check with your Dr.

Response:

Vitamin C

admin — Sat, 08 Jan 2005 00:00:00 +0000

Question:

I have been taking massive doses of Vitamin C recently. I have read several studies suggesting that Vitamin C is very good for your eyes and for lowering IOP. Your eye has about 25 times higher concentrations of vitamin C than your blood serum. Can anyone post more studies or information?

Response:

I took high doses of Vitamin C a few years ago. I slowly built up to 12 grams/day. It did seem to reduce the IOP by about 2-3 mm, but there were a few side effects such as occasional diarrhea (which is sometimes expected) However, a bad side effect was that I developed a kidney stone which I was fortunately able to pass without surgery. In my case, this was bad enough of a side effect to make me stop taking it – I occasionally take up to 1 g/day if I feel a cold coming on. "Tom" wrote in message

news:RJ6dnR9cwryIMH3cRVn-pg@comcast.com… – Hide quoted text — Show quoted text ->I have been taking massive doses of Vitamin C > recently. I have read several studies suggesting that > Vitamin C is very good for your eyes and for lowering > IOP. > Your eye has about 25 times higher concentrations > of vitamin C than your blood serum. > Can anyone post more studies or information?

Response:

"Sav Sood" wrote in message

news:T%cFd.25655$b64.706786@news20.bellglobal.com… – Hide quoted text — Show quoted text -> I took high doses of Vitamin C a few years ago. I slowly built up to 12 > grams/day. It did seem to reduce the IOP by about 2-3 mm, but there were a > few side effects such as occasional diarrhea (which is sometimes expected) > However, a bad side effect was that I developed a kidney stone which I was > fortunately able to pass without surgery. In my case, this was bad enough of > a side effect to make me stop taking it – I occasionally take up to 1 g/day > if I feel a cold coming on. > "Tom" wrote in message > news:RJ6dnR9cwryIMH3cRVn-pg@comcast.com… > >I have been taking massive doses of Vitamin C > > recently. I have read several studies suggesting that > > Vitamin C is very good for your eyes and for lowering > > IOP. > > Your eye has about 25 times higher concentrations > > of vitamin C than your blood serum. > > Can anyone post more studies or information?

It is a fallacy that vitamin C causes kidney stones. Apparently there is the argument that Vitamin C can either acidify your urine or turn it alkaline. Some people are susceptible to kidney stones if their urine is either too acidic or alkaline. But vitamin C can either be taken as ascorbic acid or sodium ascorbate so this is not an issue. I find it interesting that vitamin C lowered your IOP. Does anyone else have similar experiences? It is very disturbing that the stock of B & L went up two points after news on their glaucoma medication. It seems that corporate profits may be leading to insufficient research into safer treatments that dont involve huge corporate profits.

Response:

Non-Penetrating Glaucoma Surgery

admin — Tue, 21 Dec 2004 00:00:00 +0000

Question:

Possibly, but it depends on the type of bleb (drainage bubble under the upper eyelid) is obtained as a result of your surgery. With "non-penetrating" surgery, one should not have a very large, elevated or thin bleb like in a standard trabeculectomy. If that is the case, then contact lenses would be safe to wear. If there is a thin or elevated bleb, contact lenses are risky, increasing the chances of a bleb infection. This all depends on how you heal and whether the surgery is truly non-penetrating. In non-penetrating surgery, a flap is made in the wall of the eye, but the anterior chamber is not entered by making a hole at the edge of the cornea under the flap. Rather, a communication is attempted between Schlem’s canal, the natural drain from inside of the eye, and the flap. This is a very tricky dissection, and some surgeons end up entering the anterior chamber of the eye inadvertently. Many surgeons have given up on "non-penetrating" surgery because they feel that it does not last as long or work as well as a standard trab. In addition, the dissection of the flap is very precise and tedious work. Hope that helps. Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

"Ruth" wrote in message

news:41c8aacc$1@news.012.net.il… > Is it still possible to wear contact lesnes (either soft or hard) after a > successful non-penetrating glaucoma surgery?

What is non-penetrating glaucoma surgery? Don

Response:

Is it still possible to wear contact lesnes (either soft or hard) after a successful non-penetrating glaucoma surgery?

Response:

Chronic Sinusitis Article

admin — Sat, 27 Nov 2004 00:00:00 +0000

Question:

I found the following article on www.medscape.com I saved it to my hard drive, but I don’t still have the URL to point to. Since the article is not so long, I will post the whole article below. ———————— Approach to the Patient With Chronic Sinusitis First, it is imperative to take a careful history and review past medical records, with special attention to treatment options that have been used in the past, including antibiotic and corticosteroid use, past sinus surgeries, history of nasal or facial trauma, and past subspecialty consultation (eg, allergy and otolaryngology). Next, a thorough physical examination is important, and baseline fiberoptic rhinoscopy can be very helpful to delineate the patient’s anatomy. In addition, a baseline limited sinus CT scan will help document the extent of disease and clarify any other anatomic abnormalities, such as a deviated nasal septum. An allergy evaluation is also very important, since a failure to adequately address allergen triggers may cause a relapse of the disease after initial treatment. The patient should also be evaluated for associated asthma, since a significant portion of patients with chronic sinusitis may have associated asthma. Finally, a baseline absolute eosinophil count may be helpful, since persistence of eosinophilia despite medical treatment portends a less favorable response to more aggressive measures such as surgical intervention. If there is suspicion of immune deficiency (eg, history of recurring otitis media, bronchitis, pneumonia, or recurring infections with encapsulated organisms), then humoral immunity may be evaluated with IgG (total and subclasses), IgA, IgM, or specific immune responses. If there is suspicion of allergic fungal sinusitis (by CT scan or clinical presentation), then appropriate referral to a specialist for that evaluation should be done. Once the disease has been adequately staged, as noted above, the patient should receive "intensive medical therapy." This would consist of an antibiotic for 30 days, simultaneously started with prednisone for 8 to 10 days (see dosages below), nasal saline irrigations, intranasal steroid spray twice a day, and an (optional) oral decongestant (assuming no contraindications exist for these medications). The patient should then be re-evaluated and restaged in 1 month. Antibiotic choices should be guided by sinus cultures whenever possible, and the use of broader single antibiotic agents should be considered with or without the addition of anaerobic coverage with clindamycin or metronidazole. Antibiotic therapy should usually be given for 7 days after sinusitis symptoms have completely resolved. This may take 4 to 8 weeks. If symptoms recur soon after treatment is stopped, or fail to resolve with the above program, then an alternative antibiotic may be needed. Treatment failures occur more commonly in chronic sinusitis, compared with acute sinusitis. In general, patients who fail a prolonged course of combined prednisone and broad-spectrum antibiotics should be referred to an otolaryngologist for surgical consultation. There are only limited data to guide the treating physician on proper dosage of prednisone (used in conjunction with antibiotics) for the treatment of chronic sinusitis. A number of the symposium participants indicated that they had used different dosage schedules in this setting. One possible dosage regimen was suggested as follows: prednisone 20 mg orally twice a day for 4 days, followed by 20 mg orally every day for 4 days, then stop. It should be noted that the addition of oral corticosteroids to an antibiotic regimen for treatment of chronic sinusitis is a significantly different approach than those used in the past. Preliminary data suggest that it may be a very useful adjunct in this setting. However, patients and physicians alike need to be aware of the possible side effects of systemic corticosteroids. These must be weighed by the possible adverse consequences of chronic unresolved infection, risks of sinus surgery, etc. These judgments can only be made after close consultation between the treating physician and the patient, while taking all these factors into account. Topical intranasal steroids are also recommended, especially if the patient has a history of nasal polyposis. Intranasal steroids have been shown in several double-blind, placebo-controlled trials to improve nasal congestion and reduce the size or rate of growth of nasal polyps. Postoperatively, they have also been shown to help prevent the recurrence of nasal polyps after surgical polypectomy. Summary Management of chronic sinusitis presents a number of challenges to the treating physician. It is now becoming clear that, in addition to infection, inflammation may play a key role in the persistence of chronic sinusitis. If the inflammation that leads to mucosal thickening and sinus ostial occlusion is not addressed, it is much more difficult to successfully treat this condition. Further studies are needed to better clarify the role and proper dosage of both systemic and topical corticosteroids, when used alone or in combination with antibiotic therapy, in the management of chronic sinusitis. It is critical to identify allergen triggers to minimize the chance of future infections through effective allergen avoidance, etc. If patients fail to improve while on an intensive medical program, then referral to an otolaryngologist for surgical consultation may be indicated. References 1.. Hamilos DL. Resistant sinusitis: what to look for when usual measures fail. Program and abstracts of the American Academy of Allergy, Asthma and Immunology 60th Anniversary Meeting; March 7-12, 2003; Denver, Colorado. 2.. Slavin RG. Resistant sinusitis: What to look for when usual measures fail. Program and abstracts of the American Academy of Allergy, Asthma and Immunology 60th Anniversary Meeting; March 7-12, 2003; Denver, Colorado. 3.. Berrettini S, Carabelli A, Sellari-Franceschini S, et al. Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors. Allergy. 1999;54:242-248. Abstract 4.. Emanuel IA, Shaw SB. Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg. 2000;123:687-691. Abstract 5.. Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg. 2000;123:S1-S32. 6.. Kaliner MA, Osguthorpe JD, Fireman P, et al. Sinusitis: bench to bedside. Current findings, future directions. J Allergy Clin Immunol. 1997;99:S829-S848. Abstract Copyright

Stubborn migraines, Unsympathetic Dr's…

admin — Thu, 09 Sep 2004 00:00:00 +0000

Question:

Hi, I’m 27, and have suffered from migraines since I was in grade 6. My migraines have always been bad but as of this spring they started to get much worse. I now get them at leats 5 times a week…. I’ve tried almost every drug on the market and also tried other forms of pain management but with no success. I am currently in school and as it stands, I WILL flunk out of school this year if something doesn’t change. My problem, is that even though I’ve tried everything, and am currently seeing a specialist, nobody will give me painkillers… I am well aware of the risks and problems they can and will cause, but I currently have no other option. My options are either painkillers, or suffer in pain, and flunk out of school. I couldn’t even hold down a job if I left school… I’ve talked about all this to both my normal Dr and my specialist, and they both tell me to get the painkillers from "the other Dr". They’re basicly pushing me off on eachother back and forth like garbage while my future goes down the toilet… What the hell am I suppose to do? BTW I am in Toronto Ontario Canada if anyone has any specific suggestions for my area. I’d rather have a medically supervised dependancy then spend the rest of my life in a welfare appartment in agony… to bad the Dr’s think the welfare/pain option is better for me…. Thanks

Response:

hi, thanks for all your responses. I have told my school and they are helpful, but they can only bend so far… Even if they gave me all the time I needed, there would still be a final date that the marks had to be in by. I have tried Imitrex, cafergot, and many others. I wish I could remember them all, but there have been so many over the years. I also just recently tried novo-pranol which I think is a Triptan. Heck, I remember way back when they were giving everyone beta blockers… I also have tried the intervenous drugs that you can get in Emerg with no success. I’m not sure why my migraines are so subborn, but they always have been. I was told by 1 specialist that I’m in some sort of 5 or 10% bracket of people who current drugs don’t seem to work on… As for the usefulness of painkillers, I know they don’t work great, but they do at least let me function. I would guess that they take away about 30-50% of the pain. Enough for me to function, but obviously I would much prefer something that totally removed the problem… I know these Dr’s are just trying to save me from a dependancy, but whats the point if I spend my life in pain and without a job or a future? I’d rather become dependent on the drugs and then come off them later if something is ever found that works on me… I even hear they have something now called "rapid detox" that cleans you up in a matter of hours…. I’d even pay for that. It would be worth it if I could finnish school and have a job… I really don’t understand why this is such a hard concept for a Dr to understand. Thanks

– Hide quoted text — Show quoted text – You don’t say precisely what "every drug on the market" means, but as a lifetime migraineur, I have found that pain relievers, per se, have never relieved my migraine pain. At the frequency you note (5 X a week) you should be on some kind of preventive regimen. There are many preventives on the market, & new ones coming out all the time, so you may not have tried them all. Probably none of them actually prevent migraine, but they can & often do help to reduce severity and/or frequency. As for pain relief, most people have better results with abortives than with pain relievers. I have had reasonably good luck with cafergot and Imitrex. The problem is that no migraineur is exactly like another & what works for me may not work for you, but as others have said, you first need a cooperative doctor. Good luck & welcome to ASHM & migraine world.

Response:

There’s a remarkable number of people, not just doctors, who act hostile towards those suffering from serious pain problems like migraine. All they’d need is to develop a pain situation of their own and they’d understand as simple as that. I have had a persistent and worsening headache problem for almost 15 years. I’m prescribed Zomig, which is non-narcotic. I am considering trying accupuncture, which is said to give very positive results in situations like these. You may want to investigate that, yourself.

Response:

You don’t say precisely what "every drug on the market" means, but as a lifetime migraineur, I have found that pain relievers, per se, have never relieved my migraine pain. At the frequency you note (5 X a week) you should be on some kind of preventive regimen. There are many preventives on the market, & new ones coming out all the time, so you may not have tried them all. Probably none of them actually prevent migraine, but they can & often do help to reduce severity and/or frequency. As for pain relief, most people have better results with abortives than with pain relievers. I have had reasonably good luck with cafergot and Imitrex. The problem is that no migraineur is exactly like another & what works for me may not work for you, but as others have said, you first need a cooperative doctor. Good luck & welcome to ASHM & migraine world.

Response:

I totally understand. I’ve been in college since ‘98; first working on the bachelor’s degree and now on two masters. It takes a lot of time, dedication, and suffering sometimes just to manage the deadlines. I remember one night after being in the ER with a terrible episode, coming home and writing a paper that had to be turned in. Amazing what we can do even when we want to die. Have you gone through the preventive list they post on here? Also, have you tried the antiseizure meds like Topamax, Tegretol, Zonegran? Just wondered. If you’re in a cycle like that, have they tried to kill the cycle with steroids or DHE; in patient care? Are you in the US, if so have you tried one of the good in-patient clinics? Just some more ideas. I totally understand and sympathize. I know school can only go so far and they all usually have some sort of disability statement as well and will make accommodations, but as you say, grades have to be turned in at some point. I have two classes this semester, I’ll be praying for you. Michelle

– Hide quoted text — Show quoted text – hi, thanks for all your responses. I have told my school and they are helpful, but they can only bend so far… Even if they gave me all the time I needed, there would still be a final date that the marks had to be in by. I have tried Imitrex, cafergot, and many others. I wish I could remember them all, but there have been so many over the years. I also just recently tried novo-pranol which I think is a Triptan. Heck, I remember way back when they were giving everyone beta blockers… I also have tried the intervenous drugs that you can get in Emerg with no success. I’m not sure why my migraines are so subborn, but they always have been. I was told by 1 specialist that I’m in some sort of 5 or 10% bracket of people who current drugs don’t seem to work on… As for the usefulness of painkillers, I know they don’t work great, but they do at least let me function. I would guess that they take away about 30-50% of the pain. Enough for me to function, but obviously I would much prefer something that totally removed the problem… I know these Dr’s are just trying to save me from a dependancy, but whats the point if I spend my life in pain and without a job or a future? I’d rather become dependent on the drugs and then come off them later if something is ever found that works on me… I even hear they have something now called "rapid detox" that cleans you up in a matter of hours…. I’d even pay for that. It would be worth it if I could finnish school and have a job… I really don’t understand why this is such a hard concept for a Dr to understand. Thanks You don’t say precisely what "every drug on the market" means, but as a lifetime migraineur, I have found that pain relievers, per se, have never relieved my migraine pain. At the frequency you note (5 X a week) you should be on some kind of preventive regimen. There are many preventives on the market, & new ones coming out all the time, so you may not have tried them all. Probably none of them actually prevent migraine, but they can & often do help to reduce severity and/or frequency. As for pain relief, most people have better results with abortives than with pain relievers. I have had reasonably good luck with cafergot and Imitrex. The problem is that no migraineur is exactly like another & what works for me may not work for you, but as others have said, you first need a cooperative doctor. Good luck & welcome to ASHM & migraine world.

Response:

- Hide quoted text — Show quoted text – Hi, I’m 27, and have suffered from migraines since I was in grade 6. My migraines have always been bad but as of this spring they started to get much worse. I now get them at leats 5 times a week…. I’ve tried almost every drug on the market and also tried other forms of pain management but with no success. I am currently in school and as it stands, I WILL flunk out of school this year if something doesn’t change. My problem, is that even though I’ve tried everything, and am currently seeing a specialist, nobody will give me painkillers… I am well aware of the risks and problems they can and will cause, but I currently have no other option. My options are either painkillers, or suffer in pain, and flunk out of school. I couldn’t even hold down a job if I left school… I’ve talked about all this to both my normal Dr and my specialist, and they both tell me to get the painkillers from "the other Dr". They’re basicly pushing me off on eachother back and forth like garbage while my future goes down the toilet… What the hell am I suppose to do? BTW I am in Toronto Ontario Canada if anyone has any specific suggestions for my area. I’d rather have a medically supervised dependancy then spend the rest of my life in a welfare appartment in agony… to bad the Dr’s think the welfare/pain option is better for me…. Thanks

hi there, I’d request seeing a neurologist and get some paperwork from the doctor saying you are ill, pass it to the school so they know your working on the problem, kick and scream if the school bitches and moans, your sick, its NOT your fault and don’t let them screw you over. I know that’s no help but been there in my youth as well, migraines are much better understood now and go see the schools’ councilor and such and tell them what is going on, disabilities are not something they can laugh off. and chronic pain is a disability. try changing doc’s if neither will help, I know that’s a bitch to, but you got to do what you got to do, and you have to function. maybe someone else in the group from Toronto might know a local doctor who understands migraines and such and I wish you the best of luck btw often awake 3 am or 3pm with a migraine so you need someone to scream at use my email ANYTIME. vent, whatever, anyway I can help, speak up. Robert

Response:

hey there. if you’re in Toronto, try John Edmeads at Sunnybrook. he’s very nice, though i don’t know where he stands on the painkiller issue. i saw him only once (since i’m now down in the states) but he was very sympathetic. when i had a migraine on a camping trip (absolutely WORST place to get one), a friend gave me a Vioxx. it really helped. i haven’t asked my Dr about it, but maybe it would help you too…? as for your school problems, have you talked to anyone there about getting an extension or making up lost assignments? i find that even between headaches i’m unable to focus or concentrate (and computer screens and fluorescent lights are terrible!). your performance at school could be suffering even when you don’t have a headache. if you see Edmeads, be sure to tell him if you’re having "cognitive difficulties" between your headaches. it’s weird because some people say "oh, a headache. big deal." what they don’t understand is how it affects every part of your life, every single day. it sounds like you’re getting even more stressed out, which is probably not helping. can you take a sick leave from school? maybe you need a few weeks to chill out, slow down, convalesce. good luck and let me know what happens. -RM – Hide quoted text — Show quoted text – Hi, I’m 27, and have suffered from migraines since I was in grade 6. My migraines have always been bad but as of this spring they started to get much worse. I now get them at leats 5 times a week…. I’ve tried almost every drug on the market and also tried other forms of pain management but with no success. I am currently in school and as it stands, I WILL flunk out of school this year if something doesn’t change. My problem, is that even though I’ve tried everything, and am currently seeing a specialist, nobody will give me painkillers… I am well aware of the risks and problems they can and will cause, but I currently have no other option. My options are either painkillers, or suffer in pain, and flunk out of school. I couldn’t even hold down a job if I left school… I’ve talked about all this to both my normal Dr and my specialist, and they both tell me to get the painkillers from "the other Dr". They’re basicly pushing me off on eachother back and forth like garbage while my future goes down the toilet… What the hell am I suppose to do? BTW I am in Toronto Ontario Canada if anyone has any specific suggestions for my area. I’d rather have a medically supervised dependancy then spend the rest of my life in a welfare appartment in agony… to bad the Dr’s think the welfare/pain option is better for me…. Thanks

Response:

This document is one I post from time to time on alt.support.headaches.migraine. I would suspect you are already familiar with most of the ideas on the list, but please scan down it anyway; it is surprising how often people wha have been through the mill, as you have, have nevertheless missed one or another promising prophylactic measure. This was compiled with the help of participants here. Migraine Prophylaxis On alt.support.headaches.migraine (ASHM), we frequent

lensectomy – no impant

admin — Thu, 13 May 2004 00:00:00 +0000

Question:

I also have a larger irregular pupil in my bad eye. Can this cause doublw vision by itself? eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … – Hide quoted text — Show quoted text -> czar…@cox.net (Craig) wrote in message … > > Are you saying the block(which I had in all 3 surgeries to numb the > > head) could be the cause? **yes** > Will patching the good eye help strengthen > > the muscles > > in my surgerically repaired eye? **no, but it will temorarily eliminate double vision.** > If it is related to the block, can > > that be > > temporary? **yes, but it may take weeks or months to resolve.** > My eye muscles track normally, just the bad eye is off > > alignment. > > My optometrist mentioned about seeing a muscle specialist when my > > vision > > improves a little more(it only about 20/100 now). He also mentioned > > vision > > therapy as an option. What do you think? Seeing an eye muscle specialist (a pediatric ophthalmologist) would be a good idea. Vision therapy is crap. > –Dr. C

Response:

There is a possibility oof accommodation to the difference, perhaps. I have had one nearsighted and one far sighted eye all my life, and have never had double vision etc. Sometimes a contact is usedforpeople in one eye, also. Or, are you saying the lens status under discussion is a much greater discrepancy? Carolyn – Hide quoted text — Show quoted text -Rick Cohn, M.D. wrote: > loo…@firstpobox.com (Looker) wrote in message … >>eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … >>>… Glasses won’t work for you because you now have a very >>>significant difference between your two eyes. >>Why won’t glasses work, since there is a lens for each eye? >>Looker ( a glaucoma sufferer) > Because through a minus lens things look smaller and through a plus > lens things look larger. If an image looks too different in size > between two eyes this will cause double-vision and headaches. > –Dr. Cohn

– A contented malcontent. http://www.equalizers.org

Response:

Carolyn Schwebel wrote in message … > There is a possibility oof accommodation to the difference, perhaps. I > have had one nearsighted and one far sighted eye all my life, and have > never had double vision etc. Sometimes a contact is usedforpeople in one > eye, also. Or, are you saying the lens status under discussion is a much > greater discrepancy? > Carolyn > Unlikely one will accomodate to this…the reason your difference between your two eyes doesn’t bother you is explained in your own comment: you’ve had this all of your life. It is much easier to deal with different refractions between two eyes if it has been since childhood…it’s entirely different if this is created as a result of surgery in adulthood.

–Dr. Cohn

Response:

On 23 May 2004 19:20:02 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: >—-Boy, I don’t respond for a day or two and you guys sure get >huffy!!!

Yeah, and we want our money back! Oh, wait. Leigh — Consequences, shmonsequences, as long as I’m rich. - D. Duck

Response:

eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … > … Glasses won’t work for you because you now have a very > significant difference between your two eyes.

Why won’t glasses work, since there is a lens for each eye? Looker ( a glaucoma sufferer)

Response:

loo…@firstpobox.com (Looker) wrote in message … > eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … > > … Glasses won’t work for you because you now have a very > > significant difference between your two eyes. > Why won’t glasses work, since there is a lens for each eye? > Looker ( a glaucoma sufferer)

Because through a minus lens things look smaller and through a plus lens things look larger. If an image looks too different in size between two eyes this will cause double-vision and headaches. –Dr. Cohn

Response:

I had a baseball related trauma to my right eye back in August 03. See "High IPO from Silicone Post" for details. I had my lens removed and after 3 surgeries,everything seems to be stable. My surgeon elected not to implant a lens when my oil was removed on 4/22/04. His thought was to leave the eye alone because everything was stable and he did not want to risk any setbacks by going back into the eye. I have worn contacts my whole like(age 41) and natively have 20/300 in both eyes w/o contacts and correctable to 20/20 w/contacts before the accident. My surgeon said because I am so nearsighted that my lens probably was not doing much for me. My question is other than a super strong contact lens I will need, what else could I expect with my vision without a lens? If I put on reading glasses with +3.25 my vision in my bad eye clears up dramatically, but when I put on my precription glasses it make it worse. I would have thought my glasses would also improve my vision somewhat. Any ideas out there?

Response:

I wouldn’t get too excited about this guy’s "huff" … he’s talking about double-vision in a forum about glaucoma. Methinks he has more to worry about than his vision …. — This message and all attachments have been scanned by the most current version of McAfee virus protection software. "Rick Cohn, M.D." wrote in message news:54e8377c.0405231820.67740b4b@posting.google.com… – Hide quoted text — Show quoted text -> > ANY IDEAS OUT THERE???????????? > > > Ok, I just went to the optometrist and I am a +6(like I thought in my > > > surgically repaired eye). I am a -10 in my good eye. We have > > > encounterred > > > another issue. Double vision was expected because of a larger image > > > in my +6 > > > corrected eye, but the double vision is not over the same focal point. > > > The image is left and lower that the image in my -10 eye. The > > > optometrist > > > is thinking it is either my muscle in my eye(although it tracks > > > objects with no problem) from the surgeries or it is because the eye > > > has not been asked > > > to be productive in 9 months that it may have to be retrained. Any > > > ideas > > > out there? E-mail if you would like more detail. > —-Boy, I don’t respond for a day or two and you guys sure get > huffy!!! > Anyway, yes, your optometrist is correct. Diplopia, or double vision > may result from a muscle imbalance (somewhat common if you had a > "block," an injection around the eye to numb it up right before > surgery) but, as you mentioned, the eye may have drifted from > underuse. You may need prism in your glasses on top of the contacts. > Also, covering one eye should remove the double vision, which can be > done during important tasks like reading. > –Dr. Cohn

Response:

czar…@cox.net (Craig) wrote in message … > I also have a larger irregular pupil in my bad eye. Can this cause > doublw vision by itself? >If you close the other eye and you still have double vision, then you

have what is called, "monocular diplopia," which is NOT due to a muscle imbalance. Monocular diplopia is always refractive in nature, coming from a cataract, an opacified membrane behind the lens implant, or light hitting the edge of the lens implant. The latter is often the case in patients with dislocated lens implants or in situations where the pupil is irregular and stays dilated. This may be what is going on in your case, but I couldn’t say without looking at your eye. Hope that helps, Rick Cohn, MD

Response:

On 26 May 2004 20:23:07 -0700, eyegu…@aol.com (Rick Cohn, M.D.) wrote: >czar…@cox.net (Craig) wrote in message … >> I also have a larger irregular pupil in my bad eye. Can this cause >> doublw vision by itself? >>If you close the other eye and you still have double vision, then you >have what is called, "monocular diplopia," which is NOT due to a >muscle imbalance. Monocular diplopia is always refractive in nature, >coming from a cataract, an opacified membrane behind the lens implant, >or light hitting the edge of the lens implant. The latter is often >the case in patients with dislocated lens implants or in situations >where the pupil is irregular and stays dilated. This may be what is >going on in your case, but I couldn’t say without looking at your eye. > Hope that helps, >Rick Cohn, MD

It sure does help. John

Response:

Are you saying the block(which I had in all 3 surgeries to numb the head) could be the cause? Will patching the good eye help strengthen the muscles in my surgerically repaired eye? If it is related to the block, can that be temporary? My eye muscles track normally, just the bad eye is off alignment. My optometrist mentioned about seeing a muscle specialist when my vision improves a little more(it only about 20/100 now). He also mentioned vision therapy as an option. What do you think? – Hide quoted text — Show quoted text -"PoP" wrote in message … > I wouldn’t get too excited about this guy’s "huff" … he’s talking about > double-vision in a forum about glaucoma. Methinks he has more to worry about > than his vision …. > — > This message and all attachments have been scanned by the most current > version of McAfee virus protection software. > "Rick Cohn, M.D." wrote in message > news:54e8377c.0405231820.67740b4b@posting.google.com… > > > ANY IDEAS OUT THERE???????????? > > > > Ok, I just went to the optometrist and I am a +6(like I thought in my > > > > surgically repaired eye). I am a -10 in my good eye. We have > > > > encounterred > > > > another issue. Double vision was expected because of a larger image > > > > in my +6 > > > > corrected eye, but the double vision is not over the same focal point. > > > > The image is left and lower that the image in my -10 eye. The > > > > optometrist > > > > is thinking it is either my muscle in my eye(although it tracks > > > > objects with no problem) from the surgeries or it is because the eye > > > > has not been asked > > > > to be productive in 9 months that it may have to be retrained. Any > > > > ideas > > > > out there? E-mail if you would like more detail. > > —-Boy, I don’t respond for a day or two and you guys sure get > > huffy!!! > > Anyway, yes, your optometrist is correct. Diplopia, or double vision > > may result from a muscle imbalance (somewhat common if you had a > > "block," an injection around the eye to numb it up right before > > surgery) but, as you mentioned, the eye may have drifted from > > underuse. You may need prism in your glasses on top of the contacts. > > Also, covering one eye should remove the double vision, which can be > > done during important tasks like reading. > > –Dr. Cohn

Response:

Ok, I just went to the optometrist and I am a +6(like I thought in my surgically repaired eye). I am a -10 in my good eye. We have encounterred another issue. Double vision was expected because of a larger image in my +6 corrected eye, but the double vision is not over the same focal point. The image is left and lower that the image in my -10 eye. The optometrist is thinking it is either my muscle in my eye(although it tracks objects with no problem) from the surgeries or it is because the eye has not been asked to be productive in 9 months that it may have to be retrained. Any ideas out there? E-mail if you would like more detail. – Hide quoted text — Show quoted text -Carolyn Schwebel wrote in message … > There is a possibility oof accommodation to the difference, perhaps. I > have had one nearsighted and one far sighted eye all my life, and have > never had double vision etc. Sometimes a contact is usedforpeople in one > eye, also. Or, are you saying the lens status under discussion is a much > greater discrepancy? > Carolyn > Rick Cohn, M.D. wrote: > > loo…@firstpobox.com (Looker) wrote in message … > >>eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … > >>>… Glasses won’t work for you because you now have a very > >>>significant difference between your two eyes. > >>Why won’t glasses work, since there is a lens for each eye? > >>Looker ( a glaucoma sufferer) > > Because through a minus lens things look smaller and through a plus > > lens things look larger. If an image looks too different in size > > between two eyes this will cause double-vision and headaches. > > –Dr. Cohn

Response:

- Hide quoted text — Show quoted text -> ANY IDEAS OUT THERE???????????? > > Ok, I just went to the optometrist and I am a +6(like I thought in my > > surgically repaired eye). I am a -10 in my good eye. We have > > encounterred > > another issue. Double vision was expected because of a larger image > > in my +6 > > corrected eye, but the double vision is not over the same focal point. > > The image is left and lower that the image in my -10 eye. The > > optometrist > > is thinking it is either my muscle in my eye(although it tracks > > objects with no problem) from the surgeries or it is because the eye > > has not been asked > > to be productive in 9 months that it may have to be retrained. Any > > ideas > > out there? E-mail if you would like more detail.

—-Boy, I don’t respond for a day or two and you guys sure get huffy!!! Anyway, yes, your optometrist is correct. Diplopia, or double vision may result from a muscle imbalance (somewhat common if you had a "block," an injection around the eye to numb it up right before surgery) but, as you mentioned, the eye may have drifted from underuse. You may need prism in your glasses on top of the contacts. Also, covering one eye should remove the double vision, which can be done during important tasks like reading. –Dr. Cohn

Response:

- Hide quoted text — Show quoted text -czar…@cox.net (Craig) wrote in message … > I had a baseball related trauma to my right eye back in August 03. > See "High IPO from Silicone Post" for details. I had my lens removed > and after 3 surgeries,everything seems to be stable. My surgeon > elected not to implant a lens when my oil was removed on 4/22/04. His > thought was to leave the eye alone because everything was stable and > he did not want to risk any setbacks by going back into the eye. I > have worn contacts my whole like(age 41) and natively have 20/300 in > both eyes w/o contacts and correctable to 20/20 w/contacts before the > accident. My surgeon said because I am so nearsighted > that my lens probably was not doing much for me. > My question is other than a super strong contact lens I will need, > what > else could I expect with my vision without a lens? If I put on > reading glasses with +3.25 my vision in my bad eye clears up > dramatically, but when > I put on my precription glasses it make it worse. I would have > thought my > glasses would also improve my vision somewhat. > Any ideas out there?

Yes…if you were a high myope (very nearsighted), then your old prescription glasses contain thick concave lenses (the lens is shaped like an hourglass…thicker at the edge than in the center). With no implant in your eye, you are now a hyperope (farsighted), which means you need a plus powered lens which is convex (shaped like a magnifying glass…thicker in the center than at the edge). Readers, like plus 3.25 are convex, although most people who are aphakic (have had a lensectomy with no implant) need more like +8.0 to +12.0 to clear their vision. Glasses won’t work for you because you now have a very significant difference between your two eyes. The only way to correct your vision well for both eyes together would be to wear a contact in your surgical eye (or both eyes)…one will be plus powered and one will be minus powered. Good luck. –Rick Cohn, MD Glaucoma specialist Winter Park, FL

Response:

ANY IDEAS OUT THERE???????????? – Hide quoted text — Show quoted text -czar…@cox.net (Craig) wrote in message … > Ok, I just went to the optometrist and I am a +6(like I thought in my > surgically repaired eye). I am a -10 in my good eye. We have > encounterred > another issue. Double vision was expected because of a larger image > in my +6 > corrected eye, but the double vision is not over the same focal point. > The image is left and lower that the image in my -10 eye. The > optometrist > is thinking it is either my muscle in my eye(although it tracks > objects with no problem) from the surgeries or it is because the eye > has not been asked > to be productive in 9 months that it may have to be retrained. Any > ideas > out there? E-mail if you would like more detail. > Carolyn Schwebel wrote in message … > > There is a possibility oof accommodation to the difference, perhaps. I > > have had one nearsighted and one far sighted eye all my life, and have > > never had double vision etc. Sometimes a contact is usedforpeople in one > > eye, also. Or, are you saying the lens status under discussion is a much > > greater discrepancy? > > Carolyn > > Rick Cohn, M.D. wrote: > > > loo…@firstpobox.com (Looker) wrote in message … > > >>eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … > > >>>… Glasses won’t work for you because you now have a very > > >>>significant difference between your two eyes. > > >>Why won’t glasses work, since there is a lens for each eye? > > >>Looker ( a glaucoma sufferer) > > > Because through a minus lens things look smaller and through a plus > > > lens things look larger. If an image looks too different in size > > > between two eyes this will cause double-vision and headaches. > > > –Dr. Cohn

Response:

Thanks, as I suspected.. carolyn Rick Cohn, M.D. wrote: > Carolyn Schwebel wrote in message … >>There is a possibility oof accommodation to the difference, perhaps. I >>have had one nearsighted and one far sighted eye all my life, and have >>never had double vision etc. Sometimes a contact is usedforpeople in one >>eye, also. Or, are you saying the lens status under discussion is a much >>greater discrepancy? >>Carolyn >>Unlikely one will accomodate to this…the reason your difference between your two eyes doesn’t bother you is explained in your own comment: you’ve had this all of your life. It is much easier to deal with different refractions between two eyes if it has been since childhood…it’s entirely different if this is created as a result of surgery in adulthood. > –Dr. Cohn

– A contented malcontent. http://www.equalizers.org

Response:

czar…@cox.net (Craig) wrote in message … > Are you saying the block(which I had in all 3 surgeries to numb the > head) could be the cause? **yes**

Will patching the good eye help strengthen > the muscles > in my surgerically repaired eye? **no, but it will temorarily eliminate double vision.**

If it is related to the block, can > that be > temporary? **yes, but it may take weeks or months to resolve.**

My eye muscles track normally, just the bad eye is off – Hide quoted text — Show quoted text -> alignment. > My optometrist mentioned about seeing a muscle specialist when my > vision > improves a little more(it only about 20/100 now). He also mentioned > vision > therapy as an option. What do you think? Seeing an eye muscle specialist (a pediatric ophthalmologist) would be a good idea. Vision therapy is crap. –Dr. C

Response:

I have no IOL and my vision in binocular diplopia. My IOL wont be done until 10/04. My surgeon wants me to wait. I see out of my bad eye images to the left and lower, My choroidal folds(which are getting better) are distorting things a bit(tilt with some wave). This were due to the hypotony that was there before my iris was repaired in 1/04. Silicone oil was removed 4/04. So it is either my eye muscles or the nerve blocks*like you said earlier, or maybe something else such as what I was asking. I am just trying to cover all of my possibilities. Any more thoughts? eyegu…@aol.com (Rick Cohn, M.D.) wrote in message … – Hide quoted text — Show quoted text -> czar…@cox.net (Craig) wrote in message … > > I also have a larger irregular pupil in my bad eye. Can this cause > > doublw vision by itself? > >If you close the other eye and you still have double vision, then you > have what is called, "monocular diplopia," which is NOT due to a > muscle imbalance. Monocular diplopia is always refractive in nature, > coming from a cataract, an opacified membrane behind the lens implant, > or light hitting the edge of the lens implant. The latter is often > the case in patients with dislocated lens implants or in situations > where the pupil is irregular and stays dilated. This may be what is > going on in your case, but I couldn’t say without looking at your eye. > Hope that helps, > Rick Cohn, MD

Response:

Econopred

admin — Sun, 18 Apr 2004 00:00:00 +0000

Question:

Don wrote in message … > I just had cateract surgery along with a TRAB. The Dr. has me on > Econopred every hour. The original instructions were for a drop every > four hours but was changed to every hour. What is the purpose of this > medication? I won’t see my Dr. until next week and am curious what it > does. The instructions that came with it has a warning that prolonged > use can cause glaucoma which has me a little concerned as well. > Don

Econopred is prednisolone acetate, a steroid, which is used postoperatively to decrease inflammation and to help slow healing after a trab (you don’t want the flap to heal down or it will stop the outflow of fluid, thus raising the eye pressure). The reason your doc may have increased it to a more frequent dosing regimen may be that you had a little more inflammation than expected when your eye was seen in the office after surgery. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

I just had cateract surgery along with a TRAB. The Dr. has me on Econopred every hour. The original instructions were for a drop every four hours but was changed to every hour. What is the purpose of this medication? I won’t see my Dr. until next week and am curious what it does. The instructions that came with it has a warning that prolonged use can cause glaucoma which has me a little concerned as well. Don

Response:

sort of OT: new trend – eyeball jewelry

admin — Sat, 17 Apr 2004 00:00:00 +0000

Question:

Funny? I’d like to hear from an eye doctor what kind of eye problems these people are opening themselves up to. I don’t believe there’s any such thing as "minor" surgery. For example, you’d think tongue-splitting was harmless, but I’ve read it can cause a lot of complications, like infection. On Sat, 17 Apr 2004 16:27:52 -0400, Leigh Melton wrote: – Hide quoted text — Show quoted text ->I found this rather funny. Most of us here would probably prefer not >to have our eyeballs operated upon, and these people do it for the >heck of it! >http://msnbc.msn.com/id/4685961/ >(There’s a picture of the installed jewelry at the above URL.) >Updated: 4:00 p.m. ET April 07, 2004 >AMSTERDAM, Netherlands – Body piercing and tattoos make way. The >latest fashion trend to hit the Netherlands is eyeball jewelry.

Response:

"Steve" wrote in message … > Yikes! > My retinas like to detach after cataract surgery, so I have scleral buckles > in both eyes. Nobody told me of this risk. How great is it? What happens > if it happens? > — > Steve > sc…@pacbell.net > Extremely rare…I’ve seen hundreds of patients with buckles over the years and only two with any buckle erosion problems. Don’t worry about it. A buckle can always be removed if need be.

–Dr. C.

Response:

Yikes! My retinas like to detach after cataract surgery, so I have scleral buckles in both eyes. Nobody told me of this risk. How great is it? What happens if it happens? — Steve sc…@pacbell.net as can occasionally – Hide quoted text — Show quoted text -> happen with scleral buckles after retinal detachment surgery. Seems > like a colossal waste of time and money. These doctors should be > ashamed of themselves. > –Rick Cohn, MD > Glaucoma Specialist > Winter Park, FL

Response:

Laura wrote in message … > Funny? I’d like to hear from an eye doctor what kind of eye problems > these people are opening themselves up to.

I would guess the most common possible complication would be scleritis, inflammation of the sclera (outer wall of the eye), either of an infectious nature or secondary to chronic pressure or rubbing on the eye tissues. There would be a mild risk of extrusion (the implant working it’s way through the conjunctiva), or erosion through the sclera (having the implant end up inside the eye) as can occasionally happen with scleral buckles after retinal detachment surgery. Seems like a colossal waste of time and money. These doctors should be ashamed of themselves. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

I found this rather funny. Most of us here would probably prefer not to have our eyeballs operated upon, and these people do it for the heck of it! http://msnbc.msn.com/id/4685961/ (There’s a picture of the installed jewelry at the above URL.) Updated: 4:00 p.m. ET April 07, 2004 AMSTERDAM, Netherlands – Body piercing and tattoos make way. The latest fashion trend to hit the Netherlands is eyeball jewelry. Dutch eye surgeons have implanted tiny pieces of jewelry called

Diagram please of eye drainage / glaucoma

admin — Mon, 23 Feb 2004 00:00:00 +0000

Question:

"Reason" wrote in message

news:C%j_b.72365$Wa.5466@news-server.bigpond.net.au… > Hi everyone, > I have not yet seen any diagrams that clearly show how the eye drainage > mechanisms work. > Can anyone post a URL? > Maybe also diagrams of how a trab, lazer surgery, etc are used. > Thanks, > Stephen

For the eye drainage, what you are looking for may perhaps be found in: http://wills-glaucoma.org/aclose.htm . As for the other diagrams, try google search for image. Sun Chong Hong

Response:

Hi everyone, I have not yet seen any diagrams that clearly show how the eye drainage mechanisms work. Can anyone post a URL? Maybe also diagrams of how a trab, lazer surgery, etc are used. Thanks, Stephen