Sleep Apnea & Anesthesia When Having Surgery and Thank you

[Schnauzers 5]

C-pap and being under is the least of my worries. My eye specialists doesn't think surgery will help me. Without it in a year or less, and it will get worse until I am legally blind or worse. I don't want to wake up from surgery with the worst eye loosing/vision news. No one knows what tomorrow will bring, but I can't help but be afraid. Needless to say, being alone if the worst happens, my whole life will change and I would loose my home and dogs. And no income. I have seen group homes when I have groomed a patients' dog and they are full if people 20 yrs older than me and many senile. That would be a fate worse than death. I am also fresh food only vegan and I'd have to eat crap They give me. Sorry this is so negative.

[Schnauzers 5]

Okay, calm down. Firstly, there is nothing to worry about with apnoea and anaesthesia. Unless you are given a light shot to put you under, usually some version of valium or a more modern version of pentathol (there are so many now), which is possible, you are intubated, so there is no possibility of apnoea at all. Still, it is a good idea to mention it to the gas passer if they are thinking of doing a simple shot instead of a full narcosis. Either way, the amount of time you are under is very little, and to date I have not heard of any problems related to apnoea in this way, intubated or not, and looking through my gas-passer books on my shelf, I see no mention of this as a possible complication. So relax, mention it to whoever will put you out, and they will be ready for any eventuality.

Now as to the cataracts - a cataract operation essentially destroys the lens and replaces it with a plastic one, your pupil dilation shouldn't be a major factor, but if it remains fully closed, it will be very difficult to it, and it may be that they will not attempt it on that eye. If, on the other hand, your cornea is affected, the standard now is to essentially scrape off the cornea, use a laser to correct the faults of the underlying layers, and cover it up with a bandage contact lens until the cornea grows back, which is the only way air force pilots are allowed to have corrective surgery of any type on the eye. Lasik is not allowed. We are seeing a lot more people with eye damage years after Lasik operations - I honestly think it should be taken off the market.

I have never heard that. How can a cornea grow back? Why corneal transplants then? Why ever do Lasik if a scraping would work? OUCH, sounds painful. My doctor and his associate have credentials as long or longer than your arm. Why did he not tell me about it? More Lasik is not an option.

[DocWils]

I am sorry, I did not mean to confuse you here or get you worried. I was referring to a certain type of corneal surgery which might have been what you were indicating in your first posting. If you doctor hasn't mentioned it, it is because that is not an option. He is fully qualified and will judge the correct procedure for you, and you should trust him in all of this - your description in the posting is too general for me to make any real judgement and I did not intend to mislead you or worry you in any way. But I will elaborate on it to help you understand:

It is not exactly removing the cornea, it is scraping away the top layers of it. The PRK procedure involves use of an "excimer laser" to remove anywhere from 5 to 20 percent of the cornea -- no more that the thickness of three human hairs. A "polisher" is used to do that, and then the laser corrective treatment is performed. All of this is painless. The polisher part takes about five seconds. The laser procedure takes anywhere from 10 to 40 seconds. Then a soft contact lens is put on your eye, and you are done. The total time for the procedure is about one minute per eye. Healing is about a week. This may not be an option in your case, and certainly not if we are talking about a procedure involving the lens or the deep tissue of the cornea. However, Corneas can heal quite nicely under certain circumstances and do grow back given a scratch or the above described procedure. I might mention that PKR is a slightly older procedure than LASIK, but fell out of favour in the US mostly due to the cheaper and easier to use equipment of the LASIK system (and LASIK's excessively aggressive marketing). PKR is making a come-back, and I think for the better, since long term eye health seems better under PKR than under LASIK. The US armed forces offer both procedures for free to active soldiers, sailors and marines, but each branch has strong rules as to what type for what activity and they are very insistent on these rules - naval aviators are not allowed either type of surgery, air force pilots only PKR, and ground soldiers are allowed both (a lesson they have learned in Desert Storm about how useless contact lenses and glasses are in the sand combat). Since the armed forces actively track results of such procedures for the entire life to the patient (at least if they use the VET Hospital system after passing out), we should have effective long term data on both these procedures, but alas, long after you and I are beyond caring, I should think, since both of these procedures are relatively recent inventions, medically speaking.

Keratoplasty (corneal transplant) is done for a variety of reasons, all due to damage of the entire layer or most of the layer of the cornea: A cornea that bulges outward (keratoconus). Thinning of the cornea. Cornea scarring, caused by infection or injury. Clouding of the cornea. Swelling of the cornea. Corneal ulcers, including those caused by infection. Complications caused by previous eye surgery. In each of these cases, a corneal ablation is not a possible cure, so a transplant is needed. The operation is quick, done as an outpatient procedure, and is usually painless, with a very high success rate.

So, depending on your problem, a corneal ablation might or might not be recommended. Your doctor knows what is right for you in this case, so trust him. If that clinic commonly offers PRK for eyesight correction, then they have the necessary machines at hand. However the surgery you describe may be for a deeper problem of the cornea than an ablation could correct. And of course, in cataract surgery, the cornea is not the target at all; commonly, an incision is made to the side of the cornea - the lens is then ablated with a probe, and removed. A plastic lens, known as an Intraocular Lens (IOL) is then inserted, the incision stitched, a covering bandage of some sort affixed (varies depending on procedure and country rules) until the incision heals (around thee days to a week) and anti-biotic and dilation drops are given to you to apply to the eye during the healing procedure. There are various techniques, but the variance is minor and depends on the needed procedure and the established guidelines for that country (we do it differently here than in the UK, for instance, but the variance is minor - we put a covering lens on keep the incision clean, the UK doesn't). Your vision should correct itself over a week or so, and take around a month to stabilise, after which you may or may not need glasses, and a new prescription.

A variety of IOLs with different features are available. Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.

Some types of IOLs block ultraviolet light and other types of IOLs work like bifocals to provide multifocal vision — both near and distant vision. Your doctor will determine what is right for you.

Typically, during eye surgery, the sedative you will be given will leave you awake, but groggy, so apnoea is not an issue in such cases. Only certain types of eye surgery require full narcosis, and I do not know if that is going to be your case, but if it is, talk to the gas -passer about it first. If you are having an out-patient procedure (meaning you don't stay overnight), the likelihood is that you won't be given a full narcosis, since that is usually for more complex or severe eye operations that require you to remain in the hospital.

Typically, if both eyes need to be done, the surgery is scheduled a month or so apart.

Legally Blind is not the same as being blind. It means you have vision, but your vision is not sufficient to drive or operate machinery. It does not mean you cannot navigate or live a relatively normal life. Of course there are gradations in this, but it does not necessarily mean you will not see at all, and given time, you can adjust. I know a lady, now 76, who has had dry macular degeneration since she was a teenager - she sees only a sliver of world in a sort of circle, with the centre of the image blocked out. Yet she walks through the busy centre of Zurich with assurance and ease, reads (although she has to hold book up close and use a special pair of glasses), and even watches TV and is a regular opera goer (second row, four seats down from me). Legally she considered cane-blind (meaning she is supposed to use a cane to navigate, although she does not - but she does have a walking stick, and it confers certain advantages - all public transport is free, and any event she goes to she is given two tickets, one for her and a free one for a companion to act as "interpreter" and guide, which she doesn't need, but uses to her advantage). She lives a full and I think rather joyous life, we talk often and I am in full admiration at how well she gets on, but in all truth, what is happening is that the brain has adjusted to the point that it maps out her vision ins a way that allows her to make sense of the world. Given time that is what will happen to you as well - our vision is only what our brain makes of it - we have grown used to seeing a certain way, but when that is changed, our brain takes a wile, then adjusts its "interpretation" method to produce an image that makes sense to you. She doesn't see the world as I described, exactly, as a ring with a dark centre - her brain adjusts it to giver here a picture that makes sense to her.

So don't count yourself out just yet. Let your doctors guide you, they are very experienced in this and know what is best to do, and above all, don't panic. You are in good hands and they are trying to make sure you get the best care they can give you. I know it all looks grim at the moment, but the results are not in, just yet, and there is a lot of "magic" still to be performed before you are stuck with no more options, so try to relax and let your very qualified professionals help you.

[Sleepster]

If you have sleep apnea there is no better place to be than under the care of an anesthesiologist. You are being monitored by a professional whose only worry at that particular time is making sure that you continue to breathe.

And sleep!

Gosh, if only I could have one of them every night!

[Ugly]

C-pap and being under is the least of my worries.

OK I can't comment at the moment on the rest of your message but I had to think way back. When I had my vasectomy it was day surgery. I didn't stay in the hospital and didn't need my CPAP. And as for when I had brain surgery, I admit I was rushed to the big city by ambulance and my CPAP stayed at home. I had no real choice in the matter. Nowadays I'd hope somebody could bring it to me.

[aehjr]

I had foot surgery recently where they put me out. I made sure all were aware of my sleep apnea and brought my CPAP with me to the hospital. Anesthesiologist opted not to use it. I had apnea events during my surgery and ended up having to stay in the recovery room for significantly longer than originally advertised because I "had apnea events." If I had to do it again, I'd have made a bigger fuss about having sleep apnea.

[Schnauzers 5]

Docwils, Thank you for all the time you devoted to your reply.

#1 I am about a 2 on a scale of needing cataract surgery at this time. BUT the problem is:
The 1st and only doctor so far said he does not think he can give me a good outcome due to my Adies tiny pupil poses a big risk and then both corneas had the 1999 ( year done) voluntary for better vision, Lasik Now that thin layer done with cold laser has rippled like a rippled potato chip or worse. Put those two problems together and he doesn't think it would benefit me to operate when in about a yr or two outset I will need it. So my better left eye is my 20/30 and oddly told the right was 20/25 now 20/30. If at any time I saw letters at the exam that made the poor right vision 20/25 if must have been because I have memorized those damn letters! The first is A and the middle is O or P and the end is n. I told him he needs new letters ;I know all these by heart.

Corneal transplant by your explanation sounds good but not suggested to me. Monday I see a new guy elsewhere. Meantime the original doctors office or some asst. gal called and talked a long time explaining things as best she could. Bottom line, my pitiful right eye has a poor future and the good left? I dunno. There seems to be no good solution. I DO NOT WANT TO LOOSE THE VISION I HAVE NOW WHICH IS NOT ALL THAT BAD YET! I groom small dogs and trim nails and get up close and trim bangs all without any glasses at all. This can't last when these cataracts rippen and beyond. I will try to post a pic or two of paintings I did in the 70s. color and vision matter to me as would it to anyone. This is breaking my heart and I am I think justified to be afraid. Then, if all that isn't bad nuff', the guy who measures the eyes IF surgery on a lasik eye is done, won't do his collegues' patient. Does not accept state health ins. So I can't even see him cuz I can't pay out of pocket.

Only option now is the new guy. I also have distance / ride issue, if and when I ever have surgery, I need to be close to home for a ride to and from. I just want successful eye cataract surgery and for me that appears not to be possible. Disappointed is not the word....Devastated is. I am angry that the Lasik doc 13yrs ago knew this was my fate if I had the Lasik and never told me. I so so so regret having had it. I pray but have no hope for a good future. I want to keep my life as it is and no work? No home, no dogs, and all changes. Never expected this to happen. It is a lot to absorb, and I guess ultimately, accept.

Nothing more to say, I might know more Monday but we shall see. Funny, how "we shall 'see" expression means more to me than it used to. It is what it is.

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[Schnauzers 5]

5x7 Trompe'loeil watermelon. done in 70s, by me.

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[DocWils]

Firstly, very nice work there. I like the painting a lot.

Secondly, when you had the LASIK done there had not been enough time elapsed to have properly assessed the risks long term, to be honest, don't blame the doc, at the time the numbers looked good - blame the FDA for passing the procedure so quickly. It is also possible that hte LASIK is not the main source of damage (although I know several people with the same damage, and all had LASIK), that is for your oculist to determine.

On the whole, I think it is wise to get a second opinion, and go from there. Since one eye is a poor risk, I would probably not do that eye until there is really no other choice, since in the meantime, and this could be several years, new medicines and procedures could come down the pike. See what the specialist thinks, let him know of your fears, but present them as calmly as possible - write them down before hand so you can refer to them when discussing them and write out all your questions as well. It will help to organise the discussion, which could otherwise get easily side tracked. Try and get a timeline from him on how the problems you have will progress, and when it will be absolutely necessary to go under the knife (or laser, or whatever)

Above all, stay calm when with him. He can't help you if he is spending all his time trying to clam you and reassure you. He also needs time to think and asses the situation, so give it to him and follow your script in asking your questions and presenting your fears. He will do his best to find a good solution that gets you as close to your needs as possible. I have great faith that you will be helped and the outcome will be something you can live with.

BTW, I probably took more time formulating my long reply to you above than I spend with most patients.

[Schnauzers 5]

Firstly, very nice work there. I like the painting a lot.

Secondly, when you had the LASIK done there had not been enough time elapsed to have properly assessed the risks long term, to be honest, don't blame the doc, at the time the numbers looked good - blame the FDA for passing the procedure so quickly. It is also possible that hte LASIK is not the main source of damage (although I know several people with the same damage, and all had LASIK), that is for your oculist to determine.

On the whole, I think it is wise to get a second opinion, and go from there. Since one eye is a poor risk, I would probably not do that eye until there is really no other choice, since in the meantime, and this could be several years, new medicines and procedures could come down the pike. See what the specialist thinks, let him know of your fears, but present them as calmly as possible - write them down before hand so you can refer to them when discussing them and write out all your questions as well. It will help to organise the discussion, which could otherwise get easily side tracked. Try and get a timeline from him on how the problems you have will progress, and when it will be absolutely necessary to go under the knife (or laser, or whatever)

Above all, stay calm when with him. He can't help you if he is spending all his time trying to clam you and reassure you. He also needs time to think and asses the situation, so give it to him and follow your script in asking your questions and presenting your fears. He will do his best to find a good solution that gets you as close to your needs as possible. I have great faith that you will be helped and the outcome will be something you can live with.

BTW, I probably took more time formulating my long reply to you above than I spend with most patients.

I so appreciate your long answer and thought you put into it. It is so hard to get anyones' time these days I will write out all questions and topic I need to discuss. I will be as calm as possible.

Today here in Az it is perfect weather and I am enjoying the very green trees etc. I know I need to be still and know that he is GOD. Maybe I won't have to go down the worst path I fear. I do know I need to find a good home for and sell my male pup now over a yr old. I hardly have time for him and he needs affection from me, not just play time with his dog family on the patio. He is a very cute fella and someone would love to have him I am sure. Eventually I probably will have to find homes for all but my Sonora. If I can keep her I will. Breaks my heart but I know it is necessary eventually. Thanks again so very much for your time. S5

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