The Kender Report — Surgery Dog Edition

Yesterday afternoon I saw an older man and a little girl walking down the sidewalk next to a busy street.  He had a walking stick with him, a little more than waist-high, with a leather loop hanging about halfway down.  He moved slowly but steadily along in his yellow jacket, just out for a stroll.  The little girl had fallen behind him a ways.  She was reaching up over her head to a broken tree branch that was dangling just above her outstretched fingers.  I could see the thought in her head, that if she could just reach that branch, then she’d have a cool walking stick like Grandpa, and then she could catch up.

I saw these two by the side of the road as I left the hospital with Kender.  It really caught my eye and made me think of the cycle of life, these two points, connected yet on the opposite sides of the circle, one heading up, one heading down.

Kender had his first exam under anesthesia since we brought A’Kos home.  A’Kos and Kender both did fantastic.  A’Kos was a little nervous about being in the new place, with all the new noises and smells, but he settled into his job just fine.

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Kender and A’Kos in the waiting room at Beaumont Hospital Children’s Surgery Center

Kender’s behavior and attitude was completely different from the last few times we’ve been there.  We only take him in every six months for these exams, but the regular nurses all remember us.  Every single one of those long-timers commented on the changes in Kender, from how calm and cooperative he was to how talkative he was.  No fuss getting on the scale, get his pulse-ox taken, getting his clothes changed, getting his temperature taken.  Not only no fuss, but he was doing things himself with my direction, instead of me needing to handle him like a baby who happens to be big.  He even wore the silly surgical cap…sort of…

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Kender kept pulling the cap down over his face!

We ended up having to wait nearly an hour past his scheduled surgery time.  This isn’t uncommon; Dr. Trese schedules everybody for an uncomplicated exam under anesthesia with fluoroscein angiogram, but if he then finds something that needs fixing, whether it needs a simple laser cauterization or a full-out membrane peel and vitrectomy, he just does it right then while the patient is already asleep.  Obviously this can throw the schedule off a bit!  But I think most of us have been “that patient” at least once, so we just wait it out.  Kender waited it out in style this time.

Kender and A'Kos waiting for go time.

Kender and A’Kos waiting for go time.

When it was time to go back, the nurses offered Kender a blanket.  When he said no, they gave it to A’Kos instead.  Then they pulled up the rails and took both A’Kos and Kender into the OR.  I never heard a peep out of Kender, nothing like the crying I used to hear from down the hall when it was time for them to take him away.  I chatted with one nurse while I waited, and another nurse brought A’Kos back to me once Kender was asleep.  Such a good boy A’Kos was to behave even when his momma was away!

It's go time!

It’s go time!

Kender’s eyes checked out good, no changes since his last exam, so all we had to do was wait for him to wake up from the anesthesia.  As soon as they called me back to post-op, A’Kos got back into bed with Kender.  Whenever Kender would start to fuss or try to take something off too soon, A’Kos was there with a “lap” command and a paw to calm him down.  Post-op was the only place where we got anything resembling a negative comment, when an adult patient just waking up across from Kender asked what a dog was doing in there.

A'Kos keeps Kender calm as the nurse takes out his IV.

A’Kos keeps Kender calm as the nurse takes out his IV.

Again, even though he was still groggy as he woke up from the anesthesia, Kender was so much more responsive, helping to get himself dressed and anxious to get off the bed.  He tried to walk to the car, but he was pretty wobbly still!  The hospital makes everybody leave in a wagon or wheelchair anyway.  Kender asked for pancakes for lunch, so we headed up to the Original Pancake House where both A’Kos and Kender took a nap while we waited for the food.

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Anytime is a good time for a nap!

A’Kos was such a good boy for the whole day.  Once we got home, though, it was like another dog had come to visit.  A’Kos wanted to run and chase and play fetch for hours!  He got an extra special peanut butter treat, too.

A'Kos got peanut butter in his kong toy, a very special treat!

A’Kos got peanut butter in his kong toy, a very special treat!

We are so incredibly grateful for all that A’Kos is bringing into Kender’s life and into our family, and for all the help that we received to help bring him home to us!

Borderline

Everything medical in our lives (except for Kender!) seems to be borderline.  The boundary line (ohai Loki!) between “clinical” and “not a problem” is not always a happy place to live.  Being on the boundary line means that medical treatment almost always can help, but doctors won’t diagnose or treat anything until it crosses that line.  Being a family full of medical “zebras” doesn’t help anything, because the doctors rarely think to test for the conditions we actually have.

My hypermobility syndrome has ridden that line my entire life.  When I was a kid, I constantly sprained my joints, but the dislocations were never severe enough or lasted long enough to get medical attention.  I’m not completely rubber-jointed. My skin already shows the fragility my mother and grandmother faced but doesn’t stretch like elastic. My eyes are bad, but they’re correctable.  I get orthostatic hypotension and cardiac arrythmias, but never bad enough to actually pass out or predictable enough to show up on a formal test.  I have IBS, but not severe enough to land me in the hospital.  Pain medications don’t work on me, local anesthesia frequently fails or works only sporadically, and even general anesthesia doesn’t work quite the way it should.  My platelet and hematocrit counts are frequently low enough (150,000 and 12, respectively) that I can’t donate blood or platelets, but not low enough to set off any flags when I have CBCs drawn, not low enough that I ever actually bleed out.  I have pain, headaches, neuralgias, symptoms of carpal tunnel and sciatica, but I manage to keep functioning through all of it so it must not be something that needs fixing, right?.  Even my vitamin B levels when checked last year were low (B1 measured 8 on a scale of 8-30), but not low enough to be clinically deficient.  All of these things affect how I feel, and I feel so much better when any of them are fixed or brought back up into the middle of the normal range, but getting anybody to treat these things is usually more trouble than it is worth.  I can see signs of the same syndrome in almost all of my children, but again the symptoms are borderline, and when a diagnosis for them will require traveling to another state to see a specialist who may not be covered by our insurance, I have to wonder if it is worth the trouble at this time.

With the kids’ eyes, until Kender was born everybody was riding that borderline between “normal” and “Houston, we have a problem.”  It was always just a little off, just a little tweak here and there, nothing to worry about, we’ll just get stronger glasses, have a couple of surgeries to tweak the muscles, do some patching, nothing to see here, move along.  I had a growing suspicion for most of the triplets’ lives that there was something more, that there was something genetic in there, that they seemed too different, but it was never different enough to make anybody look further than ROP and lazy eyes.  When Kender was born blind, the FEVR diagnosis for everybody became obvious, but they had never thought to look for it before.

My hypoglycemia is barely clinical.  In real life, I never actually pass out.  I probably never drop below 65 or 70 mg/dL…low enough to make me feel like shit, but not low enough to be clinical.  So I got passed around from doctor to doctor with these vague “I don’t feel good” symptoms and got labels like “psychotic”, “atypical painless migraines”, “atypical petit mal seizures”, and even AIDS (once…before they tested at least), with nobody even thinking to check my blood sugar.  When they finally gave me a glucose tolerance test, I dropped down to 30 or 35 and made the diagnosis obvious…but they had to think to give me that test first.

Brenden’s cold urticaria rode that line for a long time, making it difficult to diagnose.  He only reacted in certain situations at first, like swimming in the Mason High School pool or eating iced shrimp (surprise: he’s also allergic to shrimp!), and we struggled for a long time to try and figure out what the connections were that were making him break out in hives.  Once a doctor thought to put an ice pack on his arm, the diagnosis was obvious, as it would have been had he started out reacting as badly as he did in 2011 and 2012.  Instead, he rode that boundary line with the cold, and he continued to ride it when tested for the full spectrum of allergies a few years ago.  Every single allergen in the test caused a small reaction, just enough to make it positive but not enough to show symptoms in everyday life.

Autism is another one of our boundary lines, with most of us having symptoms and capable of being diagnosed when tested, but also not being severe enough generally to make anybody think of testing us.  I first heard about Asperger’s Syndrome when an acquaintance shared her concerns about her son.  He sometimes wet his bed, he would go to school and forget to brush his teeth or hair, he had trouble making friends, he wouldn’t look people in the eye, his language and math abilities were off the chart but he had trouble in school.  I told her to quit worrying, I had had all of the same problems growing up and I was just fine.  Then he got diagnosed with Asperger’s, and at about the same time we started seeing signs of it in Caitlin.  I’ve had every differential diagnosis in the DSM for Asperger’s at one point or another and most likely should have that diagnosis, but I was never severe enough to warrant somebody else thinking of it when I was growing up and it hasn’t been worth arguing over as an adult.  Caitlin also presented as borderline, so much so that her diagnosing psychiatrist at first said there was no way she was on the spectrum…but she tested positive for Asperger’s on every test he gave her.  Some of my other children probably would have the same diagnosis if they were tested, but as with me it hasn’t been worth the trouble to seek out the diagnosis.

A story about PANS this morning brought all this back to the front of my thoughts.  It’s not the first time I have heard of PANS or PANDAS, and I know people personally with this diagnosis.  It always makes me think of Liam.  When he was a baby and toddler, he was such a happy little boy.  People would comment on how sweet he was, how happy and kind.  When he was two, all that changed.  His near-constant smile turned into a near-constant frown.  He would actually growl like an animal and lash out at the slightest provocation, biting and clawing.  He didn’t want to cuddle anymore.  All those comments about “What a nice boy,” went away.  It was severe and sudden enough that we took him to the doctor, where we were told that it was all because we had moved and were expecting a new baby.  He never “got over it,” though.  Another odd thing that happened only last year was the discovery that giving him regular pain medicine, something as simple as Advil, seemed to change him back into that happy, smiling boy that we’ve missed for so long.  We also found out that he could have a condition that ought to cause intense pain, like an abscessed tooth, and not show any sign of it.  Yet with all of that, Liam continues to function.  He does his schoolwork, he learns new skills, he is not speechless and hysterical…he is subclinical.  He is riding that borderline.  And I am almost certain that some diagnosis and treatment, something more than “He’s just depressed about moving” would make a difference…but it is possible to get that?

How do you go to doctors again, for what seems like the ten-thousandth time, and say, “Listen to me this time, we have another invisible zebra that needs treatment.”  I know that doing something would help, but when the problem is borderline and my life is already so packed, it’s way too easy to just let it slide, to say it’s too much, it’s not worth worrying about.

The Kender Report

Kender has had a busy week. On Monday, he went under anesthesia for an eye exam, which showed nothing new. Dr. Trese said we could start backing off one of the three eye drops Kender takes every day, which is happy news.

The bigger event was Wednesday, when Kender went under anesthesia again, this time for dental work.  At five years old, Kender has never had a successful dental exam. Until just last year he wouldn’t even let us clean his teeth regularly. Since we started using a spin-brush and singing a song, he lets us brush his teeth so well that the dentist could find no fault with our cleaning job.

The damage of years past was already done, though. Dr. Meyers gave Kender eight filling, four caps, and one baby root canal. The root canal in particular means he’s probably been in pain from his teeth for who knows how long. How exciting that we found and fixed yet another source of pain for him, and sad that he was in pain at all.

Two surgeries in one week were a little rough on Kender. He was droopy for a couple of days, much slower to wake up than usual, and one evening he even ran a brief fever. Today he seems to be back to his usual self.

I am so excited about the potential developmental leaps Kender may make now that his teeth are fixed, much like the incredible progress he made in 2012 after his eye pain was relieved. I want to say I see changes already, longer speeches and more paraphrasing replacing straight mimicry. In reality, it’s probably too soon to see any definite improvement, and I need to sit back and relax. A hard thing to do sometimes!

Regrets

“Regrets. I have a few.  But then again, too few to mention…” — Frank Sinatra

I’m going to mention some, though.

I regret not being more forceful in trying to figure out what was wrong with Caitlin’s and Jarod’s eyes before Kender was born.  Ever since Jarod was a baby, and his eyes seemed to be going down the same path as Caitlin’s, we knew there had to be something genetic going on.  Obviously Caitlin’s eyes weren’t just the result of ROP and cerebral palsy.  I remember in the two weeks before Kender was born, we had an appointment with our pediatric ophthalmologist.  I sent Brian, both because I was in pre-labor and not really up to the all-day trip required, and because I thought Brian, with his better communication and people skills, might finally be able to wring an answer to this question out of her.  Even Brian could only get, “I don’t know.”  I still don’t know how, after more than 2 years of looking into Jarod’s eyes every 4 months, she never once saw that he had a retinal fold blocking his bad eye.  There are so few pediatric ophthalmalogists around here, though, that we never sought a second opinion.

I regret trying to patch Jarod’s eyes.  Although we now know that he has stage IV FEVR in his bad eye, and that it would never be able to just magically get stronger, at the time our ophthalmologist said it was just lazy eye.  We tried patching, but he fought and screamed and hollered every time we put the patch on.  (Obviously…we were effectively blindfolding him!)  Since just patching didn’t seem like it was going to do any good with a child who was essentially throwing a hissy fit the whole time, we tried using atropine drops, which dilate and blur the vision in the good eye to force the child to use the bad eye.  Remember, that bad eye had Stage IV FEVR, with a retinal fold that covered more than half of his lens capsule.  That eye was blind. But we put drops in his good eye to force him to use the bad one.  I know that we were only operating on the knowledge we had at the time, but dear gods I regret that more than anything else I did to my children in the name of medicine.

I regret the two surgeries that Caitlin had before receiving her FEVR diagnosis.  They kept insisting that she just had some strabismus because of her cerebral palsy, and if they just went in and snipped a nerve or a tendon here and there, they could straighten out her eye.  Caitlin has Stage III FEVR in her bad eye, with a peripheral retinal fold and a dragged macula.  These days, she is still losing vision in that eye, with active disease along the fold that is worsening the dragging and decreasing her vision.  The first surgery she had didn’t do the trick, so they wanted to do a second one, and I went along.  Again, I was only operating (no pun intended) on the knowledge I had at the time.  But those unnecessary surgeries are probably near the top of my regret list.

I deeply, terribly, horribly regret that I waited so gods-damned long to force the issue of Kender’s eyes, and his autism.  With his eyes, in his bad eye he has had a vitrectomy, a retinal membrane peel to pull a fold off his lens capsule, and a lensectomy after a cataract developed in response to the first surgeries.  Then the disease in that eye continued to progress, and he blew the pupil out (uveal ectropion).  Then he developed a bleed, along with glaucoma.  The blown pupil removed his ability for his pupils to contract in response to light.  If you’ve ever had your eyes dilated for an exam, and then walked outside into the daylight, imagine that NEVER GOING AWAY.  That’s what he lived with for 2 years, from the time he was 18 months until he was nearly 4, before I started investigating pain as a contributor to his developmental delays.  We finally got him started on atropine drops a year ago.  Atropine is a dilating drop, which seems counterintuitive (after all, he’s permanently dilated).  However, the problem with his bad eye is that, even though the pupil is blown and can’t contract, the muscles are still there, and they still respond to the light stimulus.  Even though that eye is now effectively blocked by the remnants and scarring from the last bad bleed, it still responds to light, forcing the muscles of the pupil to try to contract.  But they can’t, and so they cramp.  He was in constant pain. The changes we saw in him once we started the atropine drops were nothing short of phenomenal.  It was like he’d been stuck as a baby, and suddenly he started to progress.  He went from constantly being in a little ball, not interacting with anything or anybody, to finally exploring the world.  Gods, do I regret those 2 years.  What did we cost him?  What pathways in his brain might have solidified in immaturity, or atrophied from disuse?

I regret that it took so long to get Kender’s autism diagnosis.  Part of that was the confounding factors of his blindness, and the delays caused by the chronic pain.  However, I suspecting the autism from the time he turned three, and I took him to the psychologist who originally diagnosed Caitlin with Asperger’s.  That…that man…had the gall to look me in the face and tell me that my child was just stubborn.  That it was impossible for an autistic child to show affection for his mother, or to play games, or to explore a room.  I wish I could face him now, although I don’t know what I would say.  We have the diagnosis now, which gives us new tools to work with in helping Kender.  But that man…I trusted him, because he first looked at Caitlin and said, “No way,” but then he tested her and admitted that she was absolutely on the spectrum as Asperger’s, that her condition was initially clouded by the fact that she was a triplet with NT triplet siblings.  I trusted him, and so even though I felt in my heart that he was wrong, I waited almost another year before seeking out another opinion.  A whole year wasted, waiting, when we could have had his dog already by now, we could have known.  Maybe not my biggest regret, but it still makes me mad.

Yeah.  I have a few regrets.  Maybe some of our doctors should have them, too, although they probably never give me and my children a second thought.  One day, I know, I’ll get over it.  The PTSD from the triplets’ birth has faded after 13 years, although it is not gone entirely.  This will pass, too.  Someday.

FEVR Conference

Better late than never. It’s always so crazy around here. Here’s my summary of the FEVR conference we had here in Michigan last month:

If you’ve been reading this blog regularly, you know that our ophthalmologist, Dr. Michael Trese, is the world’s leading pediatric retina specialist. People come from all over the world to see him and his colleagues, Drs. Capone and Drenser. Last month, their office, Associated Retinal Consultants, together with ROPARD, held a conference for families affected by Familial Exudative Vitreo-Retinopathy (FEVR), the disease causing the blindness in our family. It ended up being a two-day event, with social opportunities the night before and lectures given by the doctors on Saturday.

For many (most?) of us there, it was our first opportunity to actually meet other people and families with this disease. FEVR is so rare, most doctors will see at most one case of it in their entire careers. Our local low-vision specialist flat out told us that he didn’t even study this disease in school because he never expected to see it. Many of us have been through misdiagnoses and mistreatment from our local “specialists” who just didn’t realize what they were dealing with. The opportunity to share our stories was priceless.

Friday night, ROPARD helped organize a dinner at the hotel we were staying in. We all ate in one of the hotel’s conference rooms, and then there was time to hang out and chat. Paula from ROPARD brought some items to display, special toys and things. One blind gentleman she brought with her brought a Mountbatten brailler for us to check out, and I brought a box of Braille and tactile books. Thanks to how the child-care situation ended up not working out, there weren’t many children with us, but there were a few.

I was a little embarrassed, because people kept coming up to me and saying, “Oh, it’s so nice to finally meet you, you always seem to have so much information!” Of course I’ve met people online before, but usually just one or two at a time. This was a little weird!

One thing happened after dinner Friday evening that was just so amazing, I keep telling everybody I know about it. I’m always a big advocate for mobility in young children, and I kept telling everybody I spoke to that they needed to get canes into their children’s hands, no matter how young, no matter what the schools or anybody else said. While we were standing around chatting, a little boy came up to Brian. The boy looked to be about Kender’s age, with a little better vision than Kender. He grabbed Brian’s cane, curious, and I whispered to Brian to let the boy have it. This little boy, who had never held a cane before, took off with Brian’s cane around the room, using it in a completely appropriate manner, finding all sorts of obstacles with it. You couldn’t ask for a better demonstration of how natural cane use is for these children when they start young, and how easy it can be.

Later, a bunch of us parents got together in the hotel lounge and hung out until the bar closed down, chatting and sharing stories. Brian got to talk with some other fathers who also have FEVR, although none of them were blind and all found out about it as adults. There were other families there with 3 and 4 children with FEVR (although none with six childrens altogether!), and even a couple of families from Michigan! Max Bodnar and Brian really hit it off, and started making plans to set up another “conference” next year, mostly as a get-together for the parents and children this time.

Saturday was the official conference. The morning was taken up by presentations by Drs. Trese, Capone, and Drenser. There were two major revelations presented. The first is that they no longer believe they can identify FEVR patients with a routine dilated exam of the retina. Some Stage I patients have been slipping through this screening, only to show leakage or exudates when given flourescein angiogram. Because of this, they now are planning the fluorescein angiogram to be the standard diagnostic tool, and will be using this to screen family members once a patient has been diagnosed. This will be easier than it has been for older people (say, over 10 years old) because the doctors are acquiring a new machine that will make it easier for them to do these angiograms in the office and still get a good look at the periphery of the retina. For us, this news means that Brian’s parents need to get rechecked, especially in light of his dad’s newly-diagnosed macular degeneration and cataracts, which could be exacerbated by FEVR. The doctor down there in Texas does not do angiograms, so they will have to wait until they can come up to see Dr. Trese to get that done, but they will be able to get their blood drawn so they can be included in Dr. Drenser’s genetic study, and that should show if they are carrying the same FZLD-4 mutation Brian and the kids have. It’s important for us to find this out, because if either of his parents turn out to be carriers, Kevin’s family will need to be checked.

The second big news was that the doctors are having much better “success” rates over the last two years with preventing rapid deterioration in their FEVR patients. They have taken a very aggressive approach to laser cauterization of the retina, lasering areas with exudates, blood leakage, avascular retina, and capillary dropout. We’ve seen this in our own family, where it seems like somebody gets fresh laser every few months. This aggressive treatment has resulted in many fewer cases of what they called “surprise” leakage and exudates, where previously-quiet eyes suddenly showed massive changes on the next exam. This could be very good news for children like Tamara, Caitlin, and Jarod, who may now be at less risk than we previously thought of losing their remaining vision.

Finally, Dr. Drenser gave a very interesting and detailed description of the current understanding of the genetics and chemistry behind FEVR. There are several different known mutations that cause FEVR, as well as more that are unidentified. All the different mutations disrupt the same basic chemical process linked to the growth of new blood vessels in the retina. This process is very complex, with many known receptors at the beginning and end of the reaction chain and what Dr. Drenser called a “black box” of reactions in the middle that have not yet been fully identified. Messing up any link in the chain leads to the emergence of FEVR. Having so many different places where things can go wrong means that FEVR shows all of the known inheritance patterns (dominant, recessive, and sex-linked), and because the expression of these known genes can be up- or down-regulated by other unknown genes, the expression of the disease in two people (say, siblings) with the same mutation can be very different (like Tamara and Kender). It was really fascinating to see how much they know (and how much they don’t yet know) about how this disease works. We also got to get a sneak peek at the new genetics lab that the doctors have set up this year for further research into FEVR and other pediatric retinal diseases.

Saturday afternoon was given over to a presentation by Dr. Ference, a low-vision specialist who works out of the same building as Dr. Trese et al., and who is very highly recommended. She may be highly recommended, and I’m sure there are some advantages in her style, but Brian and I personally were very disappointed in her presentation. It came off as a 2-hour advertisement for herself, and several times she gave the impression that she could effectively “cure” somebody’s blindness through eye exercises! Many of the things she said nobody else does were things all of our ophthalmologists and low-vision specialists have done, and many of the “treatments” she prescribes are things that any child with an active parent and an engaging environment will do naturally. I’ve got notes from the presentation, and I’ll break down my criticisms in another post, but Brian and I (and really our TVI, who came along Saturday for the fun of the presentations and learning) came away very disappointed.

All in all, though, it was a wonderful 24 hours, and we can’t wait to do it again. We spoke with Dr. Trese, and we will be working with the surgery schedulers to set up a week or two next summer that can be set asides for the practice’s FEVR patients. We’ll get everybody out-of-town to schedule their annual/biannual/whatever checkups for that time, and over the closest weekend we’ll book a group of rooms at the hotel and plan some family events. We want it to be a kid-friendly get together this time, so all the kids can meet and talk and socialize. As parents, we got a lot out of just that aspect of it, and we think the kids will, too.

Eyeball Update

Things are going much better on the eyeball front. Caitlin had her office visit with Dr. Trese, and he said she looked better and could wait until that Friday for the exam under anesthesia (EUA).

Thursday afternoon they called to say we needed to be at the hospital at 6:30 a.m. This hospital is an hour and a half away, so we had to get up at 4 a.m. to get there on time. Ugh.

Kender was first. His pressure in his right eye was 17, so he will continue on all three eyedrops (Cosopt, Xalatan, and Alphagan). Everything else looked good, so he gets to wait until September before going back.

Tamara looked okay, but there were areas where Dr. Trese had previously lasered that he said didn’t take, so he did more laser in both eyes on her. Otherwise, she’s good, and can come back to the office in October.

Dr. Trese found the bleed in Caitlin’s left eye, and had to do quite a bit of lasering to cauterize it. He thinks he got it, though, and he didn’t see any sign of retinal issues, so she just stays on light activity for now and goes back in the office in a few weeks. She also says that she doesn’t see any difference in her vision now that the bleeding has cleared up, so that is great news!

More Eye Issues

It took longer than usual last night to get a call back, even considering it was after office hours, but Dr. Faya called us back and said to bring her in to the Royal Oak office in the morning, NPO in case anything needed to be done. (I am so thankful to be living so close to them that we really can bring the kids in at the drop of a hat!)

So we got up and left at the butt-crack of dawn to make sure and get to the office when they opened. Dr. Luo (? I think? haven’t seen/met him before) looked at her, and said yes, she has quite a bit of bleeding in the left eye, so he left to call Dr. Trese (who wasn’t actually in that office today) to see what to do. Dr. Trese said that he wouldn’t be able to do anything today as far as laser cauterization, because there is so much blood floating around in her eye now that they can’t get a clear shot of where it’s coming from. She’s not actually seeing curtains or blank spots, so they don’t think there’s any active detachment. They put a shield patch on the eye and ordered her to low activity and sleeping upright, in the hopes that the exudates will start to precipitate out and clear the vitreous. We go back to the office on Tuesday to follow up; if she is having no signs of detachment and the vitreous seems to be clearing, we will go ahead with her previously-scheduled EUA with fluoroscein angiogram next Friday the 22nd (along with Tamara and Kender), and just expect that she will, at a minimum, get fresh laser cauterization at that time. Of course, if she shows any signs of incipient detachment, we’ll go back immediately and I guess he’ll do a vitrectomy to clear things out so he can reattach the retina and cauterize the bleed.

Three trips in 8 days. I’m glad we live close, but in my 12-passenger van, crossing half the state still ain’t cheap! Not to mention we are NEVER going to catch up on our school work if this stuff keeps happening.

On the positive side: ATLAS SHRUGGED opens today! Happy Tax Day (or what should have been Tax Day) and TANSTAAFL everybody!