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Posts tagged ‘St George’s Hospital Tooting’

Post-op surgery care

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Throwback Thursday 1

As was organising my writing files, I came across several other articles that were also unpublished – so I’m going to update and post them over the next few Thursdays. 

I was born with a fairly unusual eye condition called keratoconus. It affects about 1 in 5,000 people and causes the cornea to become misshapen. Some people with the condition eventually need a corneal transplant.

I have now had a second transplant in each eye. The first two surgeries were over 25 years ago. My last two transplants were carried out in 2016 and 2017. Most my outpatient care has been at Moorfields Eye Hospital in London. My surgeries took place at St George’s Tooting. My surgical care was fantastic. The nursing care, sadly, was not as good as it should have been. I’ve blogged about this previously.

When corneal transplant surgery takes place, minuscule stitches are used to anchor the graft in place. Over time, as the eye heals, some of these stitches come loose and start to feel very uncomfortable. The sensation is like having an eyelash in your eye. The eye can become sore and painful too. I wear scleral lenses, and over the last few weeks I’ve been very aware of discomfort in my left eye once I’ve taken out my lens. 

On my last appointment at Moorfields, my consultant was away. So I saw his registrar. We decided that because I only had some slight discomfort in my left eye, he would leave the stitches until my next follow up appointment. So I was fairly certain that last week’s visit would include stitch removal. 

Mr Romesh Agranawalah is a highly skilled surgeon who specialises in working with patients who have complex corneal conditions. I am extremely fortunate to be under his care. I present a challenge to eye surgeons, not just because my corneas are badly affected by keratoconus, but because I’m also allergic to local anaesthetic. I’ve previously had stitches removed under general anaesthetic. Removing stitches without anaesthetic is unusual and rarely done. Also, it is sometimes difficult for me to position my head appropriately without being in a great deal of pain. Romesh, we’ve got to know each other well over the past few years, is patient and understanding of my needs. Manoeuvring my wheelchair in the tiny clinic spaces isn’t easy either!

So getting organised and settled prior to being examined is quite a performance. But, as ever, Romesh is unruffled and still finds time to ask about my other health issues. Having examined me, the decision is obvious, two stitches need removing, and a third trimmed. I’m fine with having the procedure. I have trusted this surgeon to repair my vision; he has done this and more. My vision has actually improved from my baseline pre-surgery levels. 

Once Romesh returns with the equipment needed, he makes sure I’m in as comfortable position as possible, and begins his delicate task. Despite having no local anaesthetic, I hardly feel anything as each stitch is cut and then gently removed. I get a break whilst Romesh gets some new scissors. Now, for the last task. It’s slightly disconcerting to see the scissors reflected in the mirror of the slit-lamp, but all I feel is a light brushing sensation. He trims the ends of the stitch. The tricky procedure is over. As always, I thank Romesh. He has literally changed my life by giving me my vision back. I can drive and therefore have freedom.

I can now put my scleral lenses back in and drive to Synagogue in time for the Friday night service. I am grateful, not only for the skill of my surgeon, but for the NHS. We must never forget how important it is that the NHS remains a public service, free at the point of need.

Surgeons like Romesh Agranawalah are the people who make our NHS the envy of other countries. Each day when I put in my lenses, my vision goes from blurred to crystal clear. Almost six years after my last surgery, I’m still amazed at how much I can see. I will fight for the NHS as long as I have breath in my body.

Update: 

In April 2020, during the first UK lockdown, I felt that familiar pricking sensation in my eye, which meant I had another loose stitch. Having had a check-up phone call from the Contact Lens Clinic, they arranged for me to go into A&E at Moorfields and get the stitch taken out. We agreed a date and time so the surgeon on call was aware I was coming in. 

The streets were deserted and remarkably, we had a choice of where to park. My carer drove me, just in case I couldn’t put my scleral lens back in for some reason. We waited outside for about 10 minutes as they were limiting the number of patients in the A&E department, as part of their Covid precautions.

Once inside, I was called to see the consultant within 20 minutes. That was a record! Moorfields is usually so busy that on clinic days. I’m usually there for at least 2 hours and I’ve waited even longer to be seen at A&E. 

I met the consultant, he inspected both my eyes and told me there were two stitches needing removal. He was a little taken aback about my local anaesthetic allergy, but I assured him I was fine without anaesthetic. 15 minutes later everything was done, and we chatted for a few minutes more whilst the nurse went to pharmacy to collect my antibiotic eyedrops. I was on the way to the car within an hour of my arrival. 

As always, I’m so grateful for all the expertise of the consultants who do such amazing work.

Corneal Rejection Update

I went back to Moorfields last Friday for my check-up. This was to find out if there had been any improvement in my graft or whether the rejection diagnosed four weeks previously had continued. When I saw the Registrar he confirmed what I had thought, there was no improvement and I would need to have a re-graft. My previous graft on that eye was 22 years ago, so I guess it’s done me well.

When the Consultant came to discuss the surgery with me, he explained that not only would he be giving me a new corneal graft but that he would also be removing the cataract which is also growing on my right eye. I didn’t realise that it was possible to do both procedures at the same time. He reassured me, but did remind me that the chances of graft rejection are higher when having a second graft. I completely forgot to ask if he will also implant a lens, but I’m due to see him a couple of weeks before the surgery, so I will remember to check with him then.

The surgery will not be until September. That was partly my decision, as my daughter was abroad when I had the partial re-graft on my left eye last year, and she very much wants to be with me because of the poor nursing care I had last time. She will not be home until next month and I also need the time to try and get my care package increased for my postoperative period. All of this is complicated by the fact that I will have to been in hospital overnight again as I will be having a general anaesthetic. I have previously had severe reactions to local anaesthetics.

I’m not worried about having a general anaesthetic, but am very concerned about my post-operative care, as last time nursing staff did not understand my need to use my wheelchair for all mobilisation, that my balance is poor and that I have restricted movement and poor grip in my left arm. So I need help transferring from bed to wheelchair and back again.

Because of my concerns, I spoke to Jasmine, the lovely Specialist Nurse at Moorfields and she has given me contact details for the Specialist Nurse at St George’s Hospital in Tooting, South London, where my operation will take place. This will enable me to talk through my needs and hopefully meet with ward staff so that they understand how I should be nursed. Even though my daughter will be at the hospital with me, I don’t want her to have to be battling with nursing staff to ensure I get appropriate care.

Following my partial re-graft surgery last year, my surgical care was excellent, but nursing staff had no idea how to care for someone using a wheelchair who also needed help with many activities. All of this was complicated by the fact that my operated left eye is the one in which I have most vision, so immediately post surgery I had very little vision, which the nurses failed to take into account when they wanted me to do things, such as going alone to a room at the end of the ward that I couldn’t see well enough to navigate to. Also, despite telling staff I was Jewish, the breakfast I was offered was a ham sandwich!! It seemed very difficult to provide me with anything more appropriate. My letter of complaint did not get a particularly re-assuring response, hence my apprehension.

But until I have my surgery, I will be enjoying the lovely summer weather and spending as much time as I can getting out and about.

I would also be interested in hearing from anyone who has had both a corneal graft and cataract removal at the same time.

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