Adventures in the OR

3 Surgeries

2009-06-04T23:25:00.001-07:00

Yesterday, I assisted in three surgeries.

First one was a membrane peel. We removed the membrane that was distorting this patient's macula and causing everything they saw to be crooked and curved.

Second was a macular hole. We peeled off the membrane and put in some laser where we saw 'tuffs' that could lead to a retinal hole.

Third, was a man I worked up this morning. He had a macula-off retinal detachment. We had to leave less pressure in there, because he's a rancher and has his house in a higher elevation.

5 Surgeries

2009-04-24T22:22:00.000-07:00

Today, I assisted in 5 surgeries. The first one was a lady who had to have a new lense put in from her cataract and then we did a membrane peel to fix a giant macular hole. Dr. JC said that the ICG was known to hurt some of the layer of the retina, so he was careful not to get it into the actual hole.

The second surgery was a membrane peel. The membrane had two layers, you could just see the ripples in the retina, even after we took off the membrane. It should settle down after 3-6 months. I guess I assisted in the surgery of the other eye back in October as well and boy did that membrane have so many layers, it was crazy! The vitreous wouldn't let go in spot and it caused some tears in the retina and even a small Retinal detachment. So she got some gas in her eye that will last 6-8 weeks.

The third surgery was the uncle of a girl optometrist! He had his cataract surgery done by another place and they put in silly sutures that caused the sutures to cut the iris like cheese cloth and caused some hemmoraging. We did vitretomy, but he had a previous retinal detachment, so there wasn't much after we put a new lense in, this time in front of the iris, because he no longer had a capsule to hold the new IOL.

The fourth surgery was a retinal detachment. I guess she had a brain tumor and it left her mentally retarded. We left her with gas, and it was originally a macula on surgery, but once we got in there, we discovered it was a macula-off RD.

The fifth surgery was a RD. They had already had one, but he developed another hole and so it detached again. We thought it would be a quick procedure, but it was the works. We not only took out his cataract, we had to put in a buckle, put in some laser, do a fluid gas exchange, etc. I had to leave early (thank goodness!) to work up some new patients--one CRVO, one with wet AMD, one with a dislocated IOL, and one with myopic eyes with a macular hemmorage. I really enjoy working up the new patients, because they have some really interesting diseases/cases. I also took pictures of each of these patients as well.

So it was a full day--from 7:30 am to 8 pm at night. And it caused me to not be able to go to Moab tonight and see my boyfriend who I haven't seen in what seems like FOREVER.

What the Inside of Your Eyes Look Like

2009-04-11T02:33:00.000-07:00

This picture is a good example of what you see as you look through a dilated pupil. Notice the optic nerves are towards the nose. Top picture is a right eye. The bottom picture is the left eye. I focused on the retina or back of the eye and not the front of the eye.

White Spot

2009-04-11T02:32:00.001-07:00

I took this picture of the periphery of the right eye. Patient has a curious white spot on the periphery of the retina. The technical term for this . . . "white spot".

One Good Eye, One Bad

2009-04-11T02:21:00.000-07:00

I took these. Can you guess which one is bad? Left eye is on top. Right eye on bottom.

Happy Easter Everyone--Result of Last Surgery Mentioned

2009-04-11T02:19:00.000-07:00

A few weeks ago, I assisted in a surgery of a man who was climbing a hill with his 4-Wheeler and it fell on the top of him. His eye was pushed out of the socket and with the help of many surgeons, his eye was repaired as much as humanly possible. Today the man doesn't look the same. One eye is lower than the other and the injured eye lids droop down. The man told me today that he doesn't dare look at his own face in the mirror. He avoids it.

As I think of Easter coming up in the next few days, I am reminded of what this time of year means. We celebrate Easter not for the colored eggs or the bunny, but of Christ's death and resurrection. Christ suffered for our sins in Gethsamane so that we could overcome spiritual death caused by our sins. But Christ also arose from the dead 3 days after he passed away. He was resurrected. His body and spirit which were separated at death were reunited in a perfect form.

I know that this man I saw today--that doesn't recognize his own reflection--will in fact be perfect again. He will not only one day see again, but his eye will be as it originally was in its perfect form.

I will forever be indebted to my Savior for His healing power.

4-Wheeler Accident

2009-03-19T23:27:00.000-07:00

Last Friday, I assisted in a surgery of a man who was riding his 4-wheeler up a hill and it rolled over backwards on top of him. It badly injured his eye. It split open the globe of the eye and caused a lot of bleeding behind and inside the eye. The globe of the eye was immediately stitched, but we didn't operate until 3 weeks after the accident.

We began by removing the old blackened blood from behind the eye. I pulled on the eye with silk ties around two of the four muscles around the globe. We removed all the old blood and then went inside the eye.

The eye was completely filled with blood. It look like cottage cheese. It was hard to see in, so much that we slowly made our way with the vitreotor chopping and sucking up the hemmoraging slowly. Eventually we got to the retina and it was splotched with old blood behind the choroid and newer blood. Damage was done to the macula, but it looked a lot better afterwards, clear of debris and old blood.

Two Surgeries, Two Different Surgeons

2009-01-13T22:38:00.000-08:00

So on Friday, I assisted on a surgery with Dr. Corey at Riverwoods Surgical Center. This patient had Eels disease. Before going into surgery, Dr. Corey didn't know what was wrong, because the blood in the eye didn't allow us to see. The said patient had some hemmoraging much like a diabetic, but this patient didn't have diabetes. So after ruling out the other diseases, Dr. Corey "chalked it up" to Eels disease. I'm learning that medicine is a process of ruling out diseases until you find the real reason.

For example, my doctors thought my numbness was M.S. or neuropathy and ended up I had neither! It was probably just a symptom of over-using my right hand.

Later, after taking photographs of a rare disease of a patient we had seen about every other day for the past two weeks, I ran to the operating room and assisted Dr. Carver. This surgery was to get rid of all the floaters in this patients eye and peeling the membrane off his retina and a whole bunch of laser. I don't mind spending my Friday nights in the Operating room if I know I can help someone in a significant way. Medicine is very fulfilling!

Operating Room Wednesday

2009-01-08T23:38:00.001-08:00

First surgery one of the cutest, happiest little old ladies yet. She has bruises all over her face from a car accident she was in a few days ago.

The pressure in her eye was too high, so we put a pump in the side of her eye and cover it with a little piece of a human heart and put the conjunctiva over it. I had to hold some of the conjunctiva up for Dr. Corey. It really makes you appreciate the steadiness of a surgeon. You barely move and you could make a vital mistake!

Second one was quicker. His cataract surgery had complications--another doctor let it slip and it landed on the back of the retina. In this surgery, we picked it up with tiny forcepts and took it out (it was tiny (smaller than my pinky fingernail!) We slipped in another and left it in front of the iris. It was gross, because part of the iris slipped out of the small incision, so we just tucked it right back in. Kinda crazy!

It was a hard day in the operating room, because everyone in the operating room lounge was talking about a 14 year old boy that died in the ER today. His parents saw him in the ER after his car accident only for him to pass away minutes later. Sad. Everyone was also talking about a young 14-year old girl who also past away. She had head trauma and had been in the hospital for two days.

It's different being on the other side with the doctors and nurses, who everyday save and improve lives, yet they are just human too. Yesterday I was reminded how human we all are and sometimes it's not within our control and the end result is ultimately up to our human limitations and the will of God.

Surgeries til 9 p.m.

2008-12-19T23:07:00.000-08:00

Today I worked til 9 p.m. My friend John gave me free tickets to Neil Diamond concert and I couldn't go, because of work. I worked at 8 a.m. and then took over for Jeremy in the operating room.

The first case was a man with neovascular glaucoma--he is now blind in that eye. We put in a pump to take away some of the pressure from his eye. So that the constant pain around his eye will go away.

The second case was a man with too low of pressure, the opposite of the first case. He had a Retinal Detachment and then the front of the eye by the iris fills the rest of your eye with fluid and it was "clogged" you could say, so it was literally flattening. His retina was flat which was great, but we filled the eye again. Hopefully it will stay at a constant pressure.

SX

2008-12-10T23:25:00.001-08:00

Doctor's files have a lot of shortcuts. But when it has to do with your health, there are no short cuts.

'Sx' is short for surgery. Sometimes I find myself wanting to use acronyms instead of real words these days.

Today I assisted in two sx's. One took an hour. Another took 3 hours. aka OD sx WF=1 hr. OS sx WM=3 hrs.

The first one was easy. A typical macular hole. The lady said some funny things under local anesthisea. She said the ICG was psychodelic.

I did work ups with a another lady this morning that had a macular hole sx a month or two ago. For a macular hole sx, they peel off the membrane on the retina by using tiny forceps after covering the macula with ICG (a green dye). After a few weeks, with the membrane no longer pulling the macula apart, the hole connects. This lady I talked to today remembers the exact moment the macular hole was filled and connected again. She was sitting on her couch and one minute she saw a black spot in her vision and the next moment she didn't. Today she sees 20/20. That was such a rewarding feeling. Even 6 years ago, these people lived permanently with this defect.

The second sx was much more complicated. I think the Dr. used everything on this sx. I helped him put in a buckle (a silcon wrap that encircles the scerla permanently). To put it in, you must identify all four muscles around the eye and place strings around them. Then I pulled the strings taunt for the doctor. My hands get tired after awhile. The eyeball looks like it's popping out. You twist the eyeball in all directions. It's amazing it stays in. But a buckle will do wonders for a retinal detachment. 3 hours later we were done.

I love everything that I'm learning.

Did I mention I LOVE my job?

Retinal Tumor

2008-11-09T11:22:00.000-08:00

Awhile ago, I told of a young man who found out he had cancer. This is a picture of the back of his eye and the tumor our doctor found.

I contacted the young man, who had the surgery done elsewhere, and he seems to be doing fine. There's a chance the cancer didn't spread through his blood and that it is contained.

Membrane Peel

2008-10-14T20:42:00.000-07:00

I assisted in on this surgery to remove the membrane from this patient's macula. There's actually two membranes--this is the craziest membrane I've seen.

In the operating room, the membrane just flapped like crazy. It wasn't hard to spot. We had to use ICG twice to dye the membrane, there was so much of it! Today the macula looks completely normal.

You may remember . . .

2008-10-14T20:36:00.000-07:00

You may remember my first surgery I ever witnessed. It was a man who works with safety glasses and got a piece of steel lodged in the back of his eye, i.e. the retina.

I was wondering what happened to him, but today I finally got to see him, even though his eye didn't look in that good of shape. Since the accident and initial surgery he's had two other surgeries both for detachments in his retina.

I took his pictures today. It was a fuzzy view.

Later I found out the white part above the optic nerve is the scelera (the outside of the eye). The Scelera is the white part of your eye you see. So the steel piece cut through all the layers to his scelera. Yikes!

ER

2008-10-14T20:33:00.000-07:00

Yesterday at family home evening I met a girl that works in the Orem Emergency Room. We both had the same excitement for the hospital. We both love diagnosing patients before the doctors does (and letting him tell them of course). We love working with the patients. We love asking a bizillion questions to the doctors and learning as we go. We were both so excited we were practically jumping up and down with excitement. I'm glad someone understands me!

Last Wednesday

2008-10-14T20:27:00.000-07:00

Last Wednesday, I assisted on a surgery to fix this detached retina. I took this picture and then assisted on the surgery. That small little tear in the left top corner (called the superior nasal area) is just a small part of the huge retinal detachment. This patient is lucky the macula is still intact.

Back Surgery

2008-10-05T10:44:00.000-07:00

On Friday while I was scrubbing up for another surgery, I could see into an adjoining operating room. It was a nurse at the hospital that was having a back surgery performed. She lay there butt naked and later when I scrubbed up again, I could see the cut into the lower portion of her back and on the screen on the wall, the bloody mess of her back. It was right out of the reality t.v. shows, but seen with my very own eyes.

Macular Scar & Wet AMD

2008-09-29T01:40:00.001-07:00

I took these pictures on Friday of some rare eyes diseases. The first is of wet macular degeneration.

The second is a macular scar.

After taking pictures, I headed to the Operating Room to assist Dr. Carver.

Photograph of Normal Eye

2008-09-13T16:17:00.000-07:00

This is picture of a left eye with no disease. The red color is from the blood vessels on the back of the eye called the Retina. You may have wondered where the red comes from when you have your picture taken--it's the red reflecting from the back of the eye.

You can see on the left the optic nerve that connects your eye to your brain. In the middle of the picture is the macula. This is the center of your vision. It has a slight dip in the middle of it. Light comes into your eye through you pupil and hits the macula and focuses the image.

I will post some pictures I have taken of some crazy diseases. But here's a normal retina for you to see to compare with!

More Than an Eye Full!

2008-09-13T16:02:00.000-07:00

So on Friday, I assisted Dr. Corey in the Operating Room. In the Utah Valley Hospital in front of the scrub sink is a large window into an adjoining operating room. Usually I just see two or three people over a body getting into the chest cavity. However when I looked through the window yesterday there was a man butt naked laying in "praying" position with his face down in a sheet. Dr. Corey came up next to me to scrub and I said, "I wasn't expecting this sight." He just said, "Yeah, we as doctors become numb to it, I guess."

Singleton asked me about my day yesterday and I said, "I saw a naked man in an adjoining operating room." I followed with, "I can't say I see a naked man very often." She replied, "So you're saying you see naked women on a regular basis?"

Buckle

2008-09-07T09:36:00.000-07:00

So on Friday, I assisted on four surgeries-one of a women who had an Retinal Detachment and needed a buckle. The buckle goes around the outer areas of the eye ball and held the retina attach to itself. The doctor took four corners of the muscles that keep the eye in place and he had me hold the strings tauntly. Meanwhile the eye was moving all around--it was freaky!