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Old 03-29-2012, 06:53 AM   #1
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Severe Eye Pressure and options

MIL has glaucoma in one eye and has gone blind in that eye 3 years ago due to this. She has been doing the drops, however, the eye pressure is causing alot of pain. The eye doctor has given her two options: One is to take out the cataract and do something that helps with the ducts to allow the fluid to drain. The second option is to take her eye out and give her a fake eye.

The problem with the cataract removal plus is that they just numb her locally and she has to sit still for an hour and a half. I know she can't do that. If they remove her eye, that calls for sedation which he didn't want to do.

If they remove her eye, do they have to give her a fake eye? She's 88 and I know you have to take those out to clean them. I can't see her putting up with that. Can't she just wear a patch or have them just sew it shut?
I can't find any good info on the internet. Thanks for anybody's input.

 
Old 03-29-2012, 07:54 AM   #2
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Re: Severe Eye Pressure and options

Mitsy, I would have a long discussion with her general physician and the eye specialist that is doing the procedure. Explain to the eye specialist the complications of her dementia. Let them know that she is incapable of sitting still for that long. The big question is....Is there a level of sedation that will give her comfort for the cataract plus surgery? That would definitely be my first option. Sedating her is not the same as anesthetizing her. If there is a possibility of saving the eye that is what I would chose... if there was an assurance that they could sedate her to the point that she would not be fearful. But I am also seeing problems there because it is going to take somebody constantly reassuring her and not sure even that would work... what a quandary you have! You also need to ask the specialist about the option of no eye at all.... the benefits due to her dementia and the possible draw backs. Then you also have to consider the effects of the anesthesia. There are different types of anesthesia and you need to discuss which one is best with the anesthesiologist. There are types that are not as detrimental to the elderly cognitive function. I have probably brought up all the things you have already thought about but I do believe your best bets is to have an honest discussion with her doctor's related to her dementia and other health problems.

Love, deb

 
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Old 03-29-2012, 08:10 AM   #3
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Re: Severe Eye Pressure and options

Thank you Deb,
I was asking my husband all these questions, and I was asking him several questions and he's like 'I didn't think about that' and I didn't know that. So hopefully that will help him ask questions to the siblings, etc. It's never just black and white. I wish all the siblings got along and could sit together in the doc's office and listen to what he says and ask questions together, but we know that is rare. I've not read alot about this happening in eye issues. I do know that the type of glaucoma she had was a result of an eye stroke due to her HBP. The family still doesn't understand that one. Thanks again for your insight.

 
Old 03-29-2012, 10:31 AM   #4
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Re: Severe Eye Pressure and options

Mitsy,
I am sorry your MIL has eye problem. Like what Deb said, it is more complicated given dementia. My Mom didn't have dementia diagnosed yet so she was able to do the cataract last year and it worked out fine for her. Now she can see and pass the driving test.

With dementia, it is more difficult. I am not sure taking off one eye is better. That big change may cause more trauma. Yes, the doctor should be consulted.
I think the cataract is worth doing. But ask the doctor if they have a way to calm her down with some pills and do it for her with local anesthesia.

I personally would not remove the eye but it is up to the doctor if it is neccessary.

Hugs,
Nina

 
Old 03-29-2012, 10:42 AM   #5
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Re: Severe Eye Pressure and options

MIL started off with just a cataract a couple of years ago. She never did anything about it and then she went blind in that eye. They doctor said that she probably had eye stroke(which is sudden pressure in the eye) and it damaged the eye. She's been on several different drops but now at this point her eye is in extreme pain. In order to save the eye they need to do cataract removal and also creating a drainage hole with the use of a small surgical tool. This new opening allows the intraocular fluid to bypass the clogged drainage canals and flow out of this new, artificial drainage canal. He said that would take 1 1/2 hours and she'd have to stay still. Not sure why they can't sedate somewhat for this. I'm sure that's a question that needs to be asked.

 
Old 03-29-2012, 08:36 PM   #6
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Re: Severe Eye Pressure and options

An eye stroke is actually like any other stroke but it occurs in the eye. It can cause swelling and pressure as well. If the eye is extremely painful something needs to be done that will make her comfortable. That is my criteria to determine if something is necessary. If it is creating pain that makes them uncomfortable then let's do what is needed to eliminate pain.

Yes, it is more difficult when the siblings can not all sit down and discuss Mom's care. Perhaps using e-mail or a social networking private group site would help. Then they can sit in the comfort of home. At least questions can be ask and opinions put forth. At least if it is all there in black and white nobody can say they didn't know or were not ask The rounds of one on one when there are more than two just don't work out well.

I do hope something can be worked out for Mom's sake

Love, deb

 
Old 03-30-2012, 06:30 AM   #7
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Re: Severe Eye Pressure and options

The doctor said that she needed to make a decision within the next week. The caregiver is trying to talk the dr. in letting her be in the room to calm her. He's saying no. I'm not sure why a family member isn't trying to do this. Also, I'm sure dr's worry about the liability. So we'll see what happens.
For those that wonder why I don't step in, is because the family doesn't like any of the inlaws input. I can steer questions for them to think about and I can talk to my husband and one of his brothers plus his wife. There's already a big rift in the family because one brother has imagined that we're all out to get him. I think he has mental issues and depression. Problem is he influences his mom and tells the caregiver how we're out to get him all day long. If anyone comes over, he runs out the back door. Very dysfunctional.

 
Old 03-30-2012, 07:44 AM   #8
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Re: Severe Eye Pressure and options

Quote:
Originally Posted by mitsy View Post
The doctor said that she needed to make a decision within the next week. The caregiver is trying to talk the dr. in letting her be in the room to calm her. He's saying no. I'm not sure why a family member isn't trying to do this. Also, I'm sure dr's worry about the liability. So we'll see what happens.
For those that wonder why I don't step in, is because the family doesn't like any of the inlaws input. I can steer questions for them to think about and I can talk to my husband and one of his brothers plus his wife. There's already a big rift in the family because one brother has imagined that we're all out to get him. I think he has mental issues and depression. Problem is he influences his mom and tells the caregiver how we're out to get him all day long. If anyone comes over, he runs out the back door. Very dysfunctional.
Does this doctor understand dementia at all? My husband was able to be with his Dad for his microwave therapy treatment and my FIL was not sleeping at all during the whole process and he also begged his son to stop it and etc. It was only about 20 minutes. Maybe the doctor wants a family member, not the hired caregiver. But I am sure our caregiver would be allowed to do that. One reason was that my FIL was very sick with Alzheimer's and he was at least 90.
Frankly, if family cannot be in the room, it is better to do it if she is totally sleepy so she won't make a fuzz. I am not sure how far is her dementia, but if no one is there to comfort her and no sedatives, the op. will fail to complete anyway. If no one is allowed, I am not sure how the doctor can tell her what to do. It may work out if she likes the authority. It is hard to explain; sometimes the person with dementia listens to the one with authority such as a doctor.

I am not sure why there are 2 solutions in conflict at the same time - cataract and eye stroke for taking off the eye. It is the same eye, right? Maybe it is top priority to stop the pain, blind or not. She has another eye that is working?

Hugs,
Nina

Last edited by ninamarc; 03-30-2012 at 07:48 AM.

 
Old 03-30-2012, 08:15 AM   #9
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Re: Severe Eye Pressure and options

I know the dr understands the alzheimers and that is why he doesn't want to sedate her but he also understands that she is an hysterical person and sitting still for 1 1/2 hours even with a family member or care giver is near impossible. The eye that has the cataract is the one that she had an eye stroke and glaucoma causing it to go blind. The other eye is still somewhat ok. I just don't know enough about eye problems to know why they just can't do none of the above and just try to moderate the pain. Texas doctors don't like liabilities because they are sued so much, that's why I think they don't like people in the room during procedure time. That's all I can think of. I don't have any authority to speak to the dr., so I can only reach out here for people's advice, which I truly appreciate

 
Old 03-30-2012, 08:21 AM   #10
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Re: Severe Eye Pressure and options

I do remember your dysfunctional family Mitsy. It is a shame how we end up tip toeing around one dysfunctional member which throws it all out of kilter.

Shook my head at the doctor saying NO to the care giver. They told me NO I could not go in the CT room with Dad... but 3 minutes later I was there and stayed until the CT was done. The CT operators didn't have a clue what they were in for because they didn't understand dementia. The next time I happened to have a CT operator that knew dementia and he ask me to stand right there where I could see and come quickly if needed. But he had a knowledge of dementia and handled it well. I would assume the doctor is not "educated" in dementia which is going to make it difficult for Mom to be awake and cooperative because he is probably going to bark orders she doesn't understand and then wonder why she doesn't do as he says. As we all know, the success of an adventure with dementia involved is 25% the loved one with dementia and 75% those around them.

Does your husband have the authority to call and talk to the doctor? If so he should do so and ask his questions not going through the others to help him make his decisions. I just hope they can come to a decision with the best interest on your MIL in mind.

Love, deb

 
Old 03-30-2012, 08:24 AM   #11
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Re: Severe Eye Pressure and options

The doctor missed a point. When a patient is nervous, a family member or a familiar person can help a lot. The person can tell her what is going on and tell her to trust the doctor. the person can explain what is happening since the doctor won't bother to talk for comfort as he is working on it! My FIL was in IL. It has nothing to do with liability if the family or caregiver is in the same room! Cannot believe this! It is common for family to be there because the patient is incompetent.

If the doctor knows that, maybe he will go for the surgery for removing the eye...

I understand your position because you are not the son. Me too. We can only talk. We cannot sign anything... I guess you just have to let the doctor do what he wants and finds out what he can do for your MIL.

Hugs,
Nina

 
Old 03-30-2012, 09:54 AM   #12
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Re: Severe Eye Pressure and options

I definitely understand the standing on the sidelines. At least I feel that I can talk here and gain some understanding what others have gone through. Sometimes I feel the biggest problem with Alz is the constant family dysfunctions and the lack of understanding with the medical profession. I do feel that doctors are treating all patients this way in all cases whether you have AZ or not. They are bogged down trying to see as many patients in such a short time to earn money. I literally have to block the door for my orthopedic dr. to take the time to talk to me. Several doctors that I've seen are like this. I also see alot of geriatric doctors make patients come in continually when the patient doesn't need anything... ugh...

 
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Old 03-30-2012, 05:40 PM   #13
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Re: Severe Eye Pressure and options

Mitsy, you are absolutely right. There needs to be a wave of awareness in the medical community and general public concerning Alzheimer's and dementia in general. I am pushing the local Alzheimer's Association chapter to have education courses for the hospital staff and local doctor's offices. I also want a wrist band which indicates dementia just as they have wrist bands for fall risk and other medical situations. We each have to be loud and strong in our advocacy for awareness, especially in the medical community.

To that end I have conversations with administration every time I hit a stumbling block in the ER, Hospital, or Doctor's Office. I have actually insisted on Alzheimer's training for the ER staff in lieu of reporting an incident to the state.... with verification through the Alzheimer's Association that it occurred. I raised such a fuss about Mom's unfortunate episode in the ER three years ago that when I walk in now, somebody knows who I am I have also ask for a change in nurses or doctors for one that had knowledge of dementia.... and quizzed their knowledge.

I will say my last trip to the ER a couple of months ago was much better. The doctor was aware of the problems associated with dementia and the CT tech was a dream. His father had Alzheimer's and he truly understood.

So be loud and strong in your advocacy for Mom

Love, deb

 
Old 04-02-2012, 06:33 AM   #14
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Re: Severe Eye Pressure and options

Deb, you are so right. Also, just having observed my MIL in the hospital setting, it's important for the family to be there. I see doctors having to communicate to someone with AZ and no one is there to make anyone aware that they are talking to someone that has no clue or 5 minutes later won't remember what was said to them.
I think your idea for an Alert Bracelet is an excellent one!

 
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