Cataract post-op follow-up

Cataract post-op follow-up

Due to a snow storm on January 7th, I had to reschedule my follow-up with Dr Song to today.

Happy that mother nature cooperated and people remembered how to drive today.  I arrived 15 minutes early for my appointment in Waltham.  The office was busy, but things were moving along.  Around 2:45, my name was called and one of the medical professionals brought me over to one of the eye machines where she performed some tests (glaucoma).  I was then whisked away to another room where I was given an extensive vision test.  Upon completion, I was handed over to Steve, who brought me to another examination room where he checked peripheral vision.  

I had not used (or don't recall using) those machines.  One had me looking into a toilet bowl-like opening and needing to use a clicker to identify when I saw various flashes of light.  Very similar to counting stars, one eye at a time.  I'm sure I missed a few since some looked like floaters, so I hesitated registering those.  There's no way of knowing how well I did since I didn't get any audible sounds from Steve other than, "We are almost done."

I was given some drops and was asked to wait for the doctor in yet another examination room.  While waiting, Steve was explaining the advantages of having a barber use a straight edge for a real close shave.  All this while we were wearing masks.  He seemed to recall that I had a 'pringles-style' mustache.  Oh, the impressions we make on others. He was called away and I sat waiting for Dr Song.

Dr Song arrived and after exchanging pleasantries, he indicated that my glaucoma test was good and things looked OK, but he was concerned with a high pressure reading in my right eye (the one that had the cataract surgery first in 2016).  He told me the reading, but it didn't mean anything to me, but the two numbers were far from each other, meaning one eye had higher pressure.  He took more measurements and said his reading was higher than the test I had earlier.  He said, 'We are going to prescribe eye drops'. He went on to say that Timolol was a gel-like drop that I would be using every day on my right eye.  He said that sometimes insurance doesn't cover it.  If that's the case, he would prescribe a different drop that needed to be taken twice daily.  So I said, this is probably something I'll be taking going forward?  He said yes.  [It is what it is.]  He asked if I had any questions to which I responded, yes: Why? and How?

He said they were good questions.  He indicated (and he mentioned this before) that the eye has a drainage system and mine isn't working well enough.  The eye drops will reduce the pressure.  I asked what are the long term consequences of the pressure if not addressed?  He indicated that the pressure over time will cause the retina to get thinner until I lose portions of my vision.  He also said that it's not reversible.   [For joy].  I asked why this eye and not the one just operated on?  He said that he suspects that the same problem will eventually happen on the other eye.  [For joy X2].

He called in the prescription to Walgreens.  He said he would see me in 6 to 8 weeks.  On the way out I got an appointment for March 28th.

When I got home I had a message from Walgreens saying the prescription was out of stock and will be ready tomorrow.  I checked my online account and saw that a price was not listed yet.  So we'll see.

I have my Cystoscopy schedule for tomorrow, so more to come!

Omicron Found Me

Omicron found me

I finally got notification on Sunday that I had tested positive for Covid-19.  Already in isolation since mid-week, there was nothing for me to do other than wait it out.  Fortunately for me, my symptoms were mild.  I had a sore throat one day then runny nose and bouts of coughing.  I've been sleeping about 10 hours a night, mostly uninterrupted. I took a day off from singing and performed a set of instrumentals for a live-stream.  Eventually I eased back into singing.  A little scratchy, but happy to be able to.  I believe my isolation period is over and I'll just need to mask up (something I do anyway).  A friend of mine dropped off a home testing kit that I will take, but since I'm still home-bound, I'll wait until I plan to go out in public.  It's been brutally cold and I've skipped a few days of taking my walk.   Hoping to resume.

Cystoscopy

Dr Ingham's office was able to schedule a cystoscopy at St Elizabeth's, Brighton for January 25th.  Given the current state of affairs, they require a PCR test 24 hours in advance with a negative finding.  They were insistent that a home test would not suffice.  The scheduler said that she was looking at hospitals in my area (and in their network), but she indicated that there were no appointments.  She asked if I could go there on 1/24.  I informed her that I currently have Covid and would not prefer to go to Brighton, just to test and turn around home.  She said she'd get back to me.  I'm hoping that Omicrom will wind down enough to have me tested 'up here'.

So at this point, my sister Leslie agreed to take me to my procedure.  It's a 10:15 check in and 12pm procedure.  It generally takes about an hour.  Dr Ingham indicated that he may find and scrap out a nodule that showed up in the MRI.  I really, really hope that I don't have a catheter.  But, I pray that once he's in there, his feelings are validated on how to proceed.  Please, not radical treatment!

More to come!

Well 2022 isn't starting off so well

Well 2022 isn't starting off so well

Was supposed to have a tele-health follow-up with Dr. Ingham on 12/27.  Got a notification that it needed to be rescheduled.  I could have sworn the scheduler said Friday 12/31, but I was wrong.  It ended up being today.

According to Dr Ingham, the MRI looked OK and there was no concerning findings.  However, the doctor did say that on one of the 'views' it looked like I had a 6mm nodule near the juncture of the diverticulum and the urator.  He said that it was only seen on one of the views, so it could be something, or maybe not.

The next steps (and this was planned), I'm going in for an operating room cystoscopy, where the doctor can get in there and look around.  He said that if he does see the node, he'll scrape out and send it to pathology.  Because this procedure requires my being sedated, I'll have to have someone drive me in and drive me home. I was concerned with the need for a catheter and he said he doesn't think it will be needed.  But if I do need it, he'd make arrangements with Dr Hurley's office to have it removed so I don't have to trek to Brighton.

Unfortunately due to the current omicron surge, there are staffing shortages and elective procedures will have to wait.  He said this is non-elective, so it's a matter of fining a slot.  So I wait.

I did have a follow-up cystoscopy with Dr Hurley, but Dr Ingham said to cancel that seeing I'll be having one (hopefully soon)

On another front, I was notified that I have been exposed to Covid.  I was advised to get tested.  Conveniently for me the Aamvets down the street was having a walkin-in clinic.  I went yesterday and waited outside in the cold for nearly 3 hours.  I haven't heard any results yet.  However, I have been experiencing a runny nose, slight sore throat and sporadic coughing.  I'm generally fatigued.  I don't have a fever and I can smell and taste.  I've been in isolation since Wednesday.

There is also a nasty cold going around so it could be that.  I'm vaxxed and boosted, so I'm hopeful it will be mild if I do have it. Scary times indeed.  And I've always been safe and haven't attended any live performances except one.  It was only me and another and we are both vaxxed.  We used our own mics and wore masks, however there were a few times that I forgot to put it back on.

More to come!

So Glad I'm Not Claustrophobic

So Glad I'm Not Claustrophobic

Since my tele-health follow-up call with Dr. Ingham, I was scheduled for an MRI at St. Elizabeth's in Brighton today (12/15/21) with a subsequent tele-health follow-up on December 27th.

I've been following the weather hoping for a 'weather-free' day (meaning no wet or frozen stuff) for my 8:30 AM appointment.  Given the unpredictability of Boston traffic, I set my alarm for 6AM and was out of the house by 6:30AM.  Traffic was busy, but moving along with the exception of the regular slow spots. Sunrise looked beautiful and they had predicted a warm spell.  I'll take it.  Once in the 'tunnel' it gets a bit tricky with exit ramps competing with incoming traffic.  Although I had my GPS on, I managed to get off at the wrong exit, but was able to get back on track quickly.  Mass Pike was busy, but moving.  The exit from the Pike in Alston/Bright is very confusing and there is no time to think with all the aggressive drivers trekking to work fully caffeinated.  But, with a few stumbles, I made it to Cambridge St. and was bale to get to the hospital parking deck by 7:45.  Not bad, considering.  Unlike my last visit, there was plenty of parking and no drama.

I arrived at the main building and was provided with very good instructions on how to proceed to Radiology.  The guy/greeter was very friendly.  In fact, everyone I dealt with was very courteous.

Arriving at Radiology at 7:55, I was given the obligatory SAT paperwork to complete.  I'm sure there's a reason, but they ask the same questions in different ways.  I wanted to write in 'see answer to #4", but I was a good boy and provided the same info on the different sheet of questions.  I handed in my assignment and was rewarded with a hospital bracelet.  I was directed to the next waiting room.

There were only a few patients waiting in Zone One.  But it appeared that all others were being called before me.  I was about to inquire about my status when my name was called at 9:05.  I was now graduating to Zone Two.  The technician, checked my answers and asked a few more questions.  I passed.  I was brought to a changing room where I had to put on two johnnies  (front and back).  Not long after I was called to enter Zone Three.  Whoa, this is happening.

I followed the technician to the MRI room and managed to get onto the slab.  A bit of 'scooching' was required and I was sternly told "do not move".  Also, I was told that it was going to take about 45 minutes including 'shots' with contrast.  I crossed my arms and I was given a bulb to press if I needed help.  [Wouldn't that be moving?]

The technician gave me some ear plugs and said that it gets loud.  She was nice to ask if I need a blanket.  I certainly did and was appreciative.  She then said she would start the first round and it would take about five minutes.  She left the room, but not before saying, "Don't Move!"

Shortly after, the slab began to pull me into the void.  Although it didn't really bother me, I could understand how some with claustrophobia might find this difficult.  There's not much room to move even if you had to.  The sides were pressing against my elbow bones and it began to get quite uncomfortable.  I guess I was trying to gently adjust when I heard a voice come through the speaker saying, "You moved." [Sorry]

It was noisy, got a bit warm, rattled, shook, vibrated and beeped...a lot.  The voice said, I'm coming in to give you the contrast.

The technician asked if I had a preference on which arm to use.  She was on my left so I said, "Left". Not sure, but she couldn't get what she wanted after a few jabs and decided to go through my hand.  Not painful, but uncomfortable.  She then said the next test will take about 5 minutes.  More of the same, then she said, "We are done".  [YAY]

She assisted me off the slab and insisted that I sit up for a few minutes so I wouldn't be dizzy.  I'm a good patient, so I did what I was told.  I got back to changing room and got dressed, then left.

No issues getting out of the garage and basically no traffic going home.  Took me a bit more than 30 minutes to get home.

So now I wait until 12/27 for the doctor to review the results and determine the best treatment.  Dr. Ingham did say that he did want to preform another Cystoscopy and I expect that to happen in January.  As the season progresses, there's always that chance for a weather incident to gum up the works.  But, you deal.

More to come!

  

Feeling Thankful

Feeling Thankful

I received a call at 4PM from Dr. Ingham's office just verifying that I would be available and to ensure that my insurance or other things haven't changed.  I was told that the doctor would call me after he was done with his in-person patient.

 

At 4:20 Dr. Ingham called.  I was all set for him with pen and paper to take notes. He got right into it after thanking me for having the scans done (up my way).  

He said:

- Scan of lungs look normal.  No masses or enlarged lymph nodes were seen.

- Scan of abdominal and pelvic area showed no metastatic growth.  (Meaning there is no sign of cancer spreading). No lesions were found in the kidney.  The drainage portion looked fine (it shares some of the cells of the bladder). The diverticulum (the outer pouch where the cancer is) looked less prominent than what the ultrasound showed. He was concerned with some thickening of the wall, but he indicated that sometimes it's not that clear with these scans.

The scans did show some cysts in the kidney, but he said not to worry about that. He did indicate that my aorta was slightly enlarged and suggested I let my vascular surgeon know.  [I know after my AAA repair, the sac was enlarged and was slowly beginning to shrink.  I have an appointment in a few months.  I'll mention it then.] Also, he said I have a hiatal hernia.  I had mentioned that I had a discussion with my primary care physician once I noticed this in my chart.  Dr. Ingham said it may be related to my GERD (reflux). I have a wellness appointment in a few months, I'll mention that.

He was, however,  concerned with a few things, and wants me to have an MRI.  After a review, he did indicate the need for another cystoscopy so he can have a better view of the anatomy.  From his latest observation the opening of the diverticulum is very close to the urator.  The proximity will define the surgery I'll be having.

Both the MRI and Cystoscopy are out patient.  However, the cystoscopy will require my being in the operating room.  I'm waiting for his office to contact me on scheduling.

More to come!

So It Starts

So It Starts

Dr. Ingham had ordered CT scans of by Lungs and Pelvic area.  I had requested that these be done 'up here' versus my having to drive to Brighton.  I was pleased to only have to go on the other side of town to the Merrimack Valley Holy Family Hospital.

It was a beautiful day.  Sunny and close to 70 degrees.  I arrived at 11:15 for my appointment at 11:30.  My check-in was easy.  Having been here before, I knew where Radiology was located and got there at 11:20.  I was asked if I had lab work (blood work) in the last three weeks.  I had not.  So I was directed to the lab down the hall.  There were two ahead of me, so I sat and watched The Price Is Right until I was called.  I had to sign-in and my being tall didn't help my penmanship on the sign-in sheet taped to the wall.  When it was my turn the phlebotomist paused and said, "Is there someone here with a name that begins with an 'R'?"  That's me.  I did glance at the sign-in sheet and because of the angle I wrote, it did look like RIJ.  So I gave her my paperwork and we proceeded to the lab.  While she entered info into the computer and printed out some labels, I prepared myself by rolling up my sleeve. When she walked over, she seemed happy that I was ready.  She was good.  Really no pain and barely a pinch.  I was done.

I arrived back at Radiology.  I was given some paperwork to complete.  By the time I was done, the attendant had taken a break (or lunch) and someone else was covering.  Four people came in after me and they were all taken as I waited, for almost an hour.  All I could think of is my having to leave for lab work made me lose my place.  I wish I knew I had to have that done, I would have come earlier.  Oh well.

By this time nature was calling, but I was afraid to leave in case I'd lose my place again.  By this time the first attendant had returned and saw me standing.  She said, "Oh they haven't called you yet?"  Nope.  But I did ask where the rest room was.  I was instructed to walk down the hall and it would be on my right.  No sooner did I finish and walk out, a technician called my name and asked that I follow her.  Perfect timing.

Entering the CT scan room, I was instructed to hang up my coat, lay on the slab and pull my pants down to my knees.  She was nice enough to give me a blanket since it was chilly in the room. She told me that I would have a stint and would be given and IV of saline and then some dye.  I offered up my same arm used for the blood test and she inserted the needle but soon said  that my 'valve' wasn't working.  [What?  You have valves in your veins?].  I suggested she use the other arm.  By this time another technician arrived and assisted.  She was good.  Barely a pinch and she said the valve was working good.  So she 'flushed' me and I was told that I needed to extend my arms (so they stayed straight and out of scanning chamber).  I was told that I would take a few passes, then they would inject dye and I'd have a few more passes.

I've had scans done before and they may have been a different kind, but each pass only took a few minutes for this.  The machine told me when to take a deep breath, hold, then exhale. After the first round, the technician said that I would feel warm as the dye was injected.  It was a very weird feeling, but not painful.  I made a few more passes and she said, "You're done."

The stints were removed and I was told to get dressed.  She said have a great day.

So the images will be sent to Dr. Ingham and I have a tele-health appointment scheduled for 11/24 (day before Thanksgiving).  Now the waiting and hoping for a clear path for treatment.

More to come!

Here we go again!

Here we go again!

Dr. Hurley had referred me to a urologist that specializes in bladder cancer.  I had an appointment today at St Elizabeth's in Brighton with Dr. Matthew Ingham.

My ride into Brighton on this first Monday after the time change was fairly uneventful (thankfully).  I gave myself an hour and a half for travel.  I arrived at the hospital parking garage about a half hour before my appointment.  My luck, the garage attendant was setting up 'garage full' sign right in front of my car as I waited to enter.  I asked where should I park.  He instructed me to go to valet parking.  I'm not a fan.  So suggested that I wait until someone left the garage.  He thought it was a good idea so he asked that I move off to the side.  Other people behind me weren't too happy and some heated exchanges took place, as if the attendant had anything to do with the garage being filled.  One guy, recklessly back his truck up almost hitting my car then left rubber as he exited. I had pulled over so  I had clear sight of the attendant and could make eye contact when a vehicle left.

Not too long after, a car was exiting.  I got the visual cue to proceed.  Not knowing how things worked and hopeful that no one else would beat me to the opportunity, I drove up to the gate and was hoping he would lift it.  He walked up to me and said I needed to take a ticket so I could pay upon exit.  I told him I'm not with it today, and he was very pleasant and said no worries.  He pressed the button and gave me the ticket.  I'm in!   I went slowly looking for that elusive spot which happened to be on the top level.  I still had time.

I figured out which building I needed visit.  The directory in the lobby had the doctor's name and which floor/room he was in.  I rode the elevator to the third floor and looked for 303.  I couldn't find it, so I walked around looking for 303.  There was was no order, but I did find the room.  I checked in and was given my obligatory SAT's to complete.  I just started when my name was called.  I was directed to an examination room where the medical professional took my vitals.  She was having trouble with the blood pressure cuff and tried a few times.  She said she would return with another.  [She never did].

I sat and continued to complete my paper work and a doctor (didn't get the name). [Masks make communication challenging].  He asked some questions about my medical history, as well as family members.  After harvesting the information, he said Dr. Ingham would be in to talk to me.

Not too long after, Dr Ingham arrived.  After my health history monologue, he added that he did see some imaging (and apparently Dr. Hurley captured some during my TURBT procedure).  He did say that he needed more data and images. Because of how and where the cancer is.  He said he needed more data to define the best course of action.  Like Dr Hurley, he sketched out my condition and described the three possible action plans, but he did not commit to any and won't until he has more data. He wrote in my care summary the following:  [my comments and understanding will be in brackets]

"I am going to refer this patient down to Saint Elizabeth's Hospital for urologic consult concerning this diverticular bladder cancer. [The 'pouch' that has grown out from the bladder is very similar to diverticulitis in that it's not a normal structure and many times things grow there.  In my case cancerous tumors.] The fact that he has high-grade cancer invading the lamina propria in a diverticulum is somewhat concerning. [ In the doctor's sketch he indicated that there are layers around the bladder wall, scaffolding; muscle and fat.  Without imaging he is not sure of which layers may be with the pouch.]There is no muscularis propria behind this so I am unsure of whether or not how invasive this is. [ There is concern that the cancer may have spread.] Whether or not he can get away with may be a repeat fulguration with BCG instillation versus a diverticulectomy versus a radical cystectomy is difficult to say at this point and I need confirmation from of other urologist expert in this disease." 

That last statement sums up the three possible plans of action.  The repeated fulguration with BCG, pertains to the scraping, cauterizing and 'chemo-like' medicine.  Diverticlectomy is the removal of that bulge.  Radical cystectomy is complete bladder removal. 

There was a discussion about life altering radical cystectomy and the need for an ostomy bag.  The most common (based on my age) is creating an outlet for urine that empties into a bag.  At a high level, a piece of the small intestine is fashioned as a new drain that attached to a urine bag.  I also discussed the possibility of a neo bladder.  Although being an option, it's generally used on young men.  But he did say it's not off the table.

Next Steps

He wants imaging done (CT scans of plevic area and the lungs).  I asked why the lungs?  He said that if the cancer spreads, it's most likely to go there.  [HOLY SHIT!]

I asked if these imagings can be done locally, to which he said, yes.  I was informed later that they will be done at Holy Family.  [Waiting to hear back.]  He said that if I do need an MRI, based on other images, that would need to be done at St. E's.

No new news, but a better understanding of what's going on.  

More to come!