And while most of you are off at
Blogopolis (sob) is probably a great time to do it, as you'll all be too hung over to get to this for a few days and I can hide it behind a Sunday Sessions post. :)
Many of you will know I had follow up appointments with my Eye Specialists last week. I'd already seen 3 Opthamologists (all from the same clinics - there are 3, and the 6 or 7 doctors travel between the 3), and all had differing opinions about what had caused the
Branch Retinal Vein Occlusion and therefore the massive
Cystoid Macular Oedema.
The first felt certain that it was a condition caused by the high dose steroids I have been on for the past few months. His advice was to stop taking them.
The second felt that (due to the fact that this has happened 3 times now, each time immediately after cessation of steroid treatment and has resolved after restarting steroids) that I should actually be placed on an increased dose of steroids.
The third felt this was simply a case of diabetic retinopathy leading to BRVO and Macular Oedema (though he admitted it was a severe case, especially considering my near perfect diabetes levels of the past few months).
So, as you know, I'd seen my Rheumatologist finally and she felt confident that I did not have an auto-immune disease or vasculitis, and certainly not the Lupus that my GP and I were expecting. She has put my illness down to 3 things. 1)Fibromyaglia (Which I already knew I have. I was diagnosed 13 years ago); 2)Diabetes and 3) The Prednisone making me sicker. She also (rightly) pointed out that my weight is a contributing factor and she and my GP are at this point wanting me to consider some kind of surgery - the recommendation is for a Gastric Sleeve operation. More on that another day, I guess.
Her opinion, (and this is partly my fault, as I had not been clear) is that since I had only reported a 50% improvement in pain since the Pred started, that it wasn't autoimmune. Because the doses I'm on should have eliminated any joint pain.
Except. (And I didn't realise that we had gotten our wires crossed until I read the letter she sent my GP). My joint pain IS almost completely gone while on Pred, with the exception of my hip (which was dislocated a few years ago) and my hands in the worst of the winter. The rest of the main is muscle - easily explained by the FM.
So, while the blood tests for Lupus are negative, I'm not entirely sure her basis for ruling out AI is entirely sound, considering we got our wires crossed a little there.
The thing they were in agreement about was that we needed to get the Opthamologists to come to a consensus. I had gone from 2 years ago: (my last diabetic check) perfect vision in my right eye (in fact, better than 20/20 or 6/6 as it is now known - I think it was 20/10 or 3/6) and 6/36 in my left
(that eye has been the epitome of lazy since I was 8 and the opthamologist told my parents I was faking it. A whooooole other story!) and no signs of diabetic changes, to what I have now.
Which is Count Fingers in my left eye (could not see even the great big fat "E" and 6/36 in my right. Not quite legally blind, but pretty woeful. Several lenses etc were tried, most made no difference, a couple made it worse (Not sure why?). (This
link explains what the various numbers mean, but the gist of it is that with my best eye, I can see at about 6 metres what you can see at 36)
So. Enough to mean this. I can see. I can see you if we're talking. I can see colours, shapes, people. I can read my computer screen (though only for a few minutes at a time, it is exhausting and contributes to the headache I have had for 2 months now) when magnified to 200% (which is a PITA because you have to scroll almost 3 times to get across the screen).
But I probably wouldn't recognise you across the street (I've noticed this. I look at someone, and I suspect it may be them, but I really can't tell and I've gotten my own child wrong). I cannot read a normal book at all. I will never drive again (devestating, both emotionally and logistically for us). I can't see our 56cm TV well enough to make it worth watching (not a great loss, I realise, but I'm giving you an idea of where I'm at), but I can see better on my SIL's large screen TV.
Anyway. My Rheumatologist and my GP were insistent that from here on in, I see only the Opthamologist in charge, the Doctor who owns the 3 clinics. A lovely, older gentleman (with a spiffy bow tie that exactly suits him). He looked in my eye, looked back at the chart, looked in my eyes and hmmphed. He said that the pictures were clear, the oedema was terrible. But that he couldn't see any evidence of it in my eyes.
I found myself wondering if perhaps something was just wrong with
his, as obviously he was mistaken. My vision was no better, (in fact, my Visual Accuity test was slightly worse in my good eye). Of course the oedema was still there. Otherwise, why couldn't I see?
He said he really, honestly didn't know what to think. And that he was sending me to his colleague, a retinal surgeon. One of the best, he said. An appt was made for 2 days later. I left, let down that yet
again I'd paid a fortune for an appointment that provided not a single answer. (Also bear in mind that for each of these appointments, Joel has to take hours or a day off work. Eventually, even with a boss as wonderful as Alan, this is going to wear thin).
Showed up bright and early on Wednesday to meet this esteemed colleague everyone raved about (Well, ok. The Opthamologist, the Optitian and the receptionists. But that counts, right?). I should have googled him. That would at least have prepared me somewhat for the 12 year old that met me!
Seriously. he cannot possibly be my age.
(Except when I did google him later, I discovered that not only has he been practicing at one of Brisbane's best practices on Wickham Terrace - where all the 'good' drs are here in Brisbane - for 5 years, but that he'd spent years training at the Royal Victorian Eye and Ear Hospital, and then in the US working at the MAYO clinic and at New York Presbyterian Hospital & Columbia University Medical Centre, both kind of prestigious hospitals to have done fellowships at. And is now training other Retinal specialists. He's been a Specialist for longer than I've been married. I'm not kidding - he looks like he's 25).
Anyway. The point, I guess, is that this guy is good. Really good. And all he does is retinas, really. He sees my condition all of the time. He specialises in Diabetic Eye disease, macular and retinal disease and retinal and vitreal surgery. He's kind of the guy you want checking out your eyes, I guess when all of the others have shrugged their shoulders and said "Meh. Not a clue...".
And he was baffled. (Awesome, no?). First though, he did help a bit. He sat me down and explained better what the previous scans had showed, I guess in a build up to the blow he was going to deliver.
The pictures on the right of this image give you an idea of what we were looking at. The picture on the top right is what my scan looked like. He explained that the red was bad - indicated inflammation. And that the white is devestating. And I had a lot more white than red, similar to this picture here. My images now look more like the one on the bottom.
Ok. This is what my oedema looked like. (Although mine is a Branch Retinal Vein Occlusion, rather than a Central, the image looks identical). One massive pocket of fluid in the middle. And now, after 6 weeks of steroids, the bottom picture is what it looks like now. The swelling is completely resolved.
So that's an explanation of the scans. It gave me an indication of the severity of the oedema, and what we had been up against. It certainly showed why my vision had been so drastically affected.
He ruled out the conditions Dr#1 suggested. So this was NOT caused by the prednisone. Of that he is 100% certain.
He is certain that it has not been caused by an infection of any kind.
He is certain that it had not been caused by a trauma of any kind.
He is 90% certain that this is NOT caused by my diabetes (a surprise, I assumed they'd all be happy to palm off the fat girl and call all of it diabetes). He said that diabetes can absolutely cause what he's seeing. That it wouldn't be an unreasonable dx. EXCEPT. That there are almost no other diabetic changes in my eyes. Not nearly enough to have caused what has transpired over the past 2 months.
So he said while he isn't prepared to 100% rule it out he said he thinks it's highly unlikely and would be completely atypical.
He said if he absolutely had to put money on it, he'd be betting auto-immune or vasculitis. He said Lupus would be a perfect fit.
And I sit there stunned. After being told only 2 weeks ago that it couldn't be lupus, he's saying it's the most likely thing to have caused this and that he would be encouraging my Rheum to reinvestigate Auto-Immune or Inflammatory causes, because fibromyalgia absolutely can't have caused this.
He has ordered more blood tests, and MRI and an
MRA on my brain. He is concerned. He said he loves a good challenge
(is it wrong that a part of me wanted to tell him I'd be no challenge at all, all he'd have to do is keep wearing whatever that aftershave was????? No. I absolutely do NOT have a crush on my retinal surgeon. Shut up, Averil. You love your OB) and that this is certainly one of his better ones. Awesome.
So. Other than the bare facts, I'm processing. It's not the end of the world, I'm not blind. I can see. But, it's an enormous thing to me. It is not the result I was expecting. I thought that by the time the steroids had reduced the oedema (they have, completely. It is gone), my eyesight would return.
Instead, I have been left with Macular Ischemia, where those blood vessels have been blocked completely, allowing no blood to enter into the areas of the retina. This damage is permanant, and I've been advised that there is no available treatment (as the swelling is gone, and that is what they would have treated) and that I should not expect any improvement in vision. He likened the initial incident and my retina to a pure white brand new carpet. He said throw a few cups of hot black coffee on it. It's never, ever going to be completely white again. The initial (slight) improvement I got on my first 4 days on steroids is as good as it's going to get, as the following several weeks haven't brought any more.
As for logistics, we're really struggling. Getting Alexander to school is still by far our biggest challenge. Second to that is arranging and co-ordinating doctors appointments and tests for me. Trying to find days when someone can take me (when there are really almost no 'someone's available).
Those are the basics. There's more, emotionally mostly. I have fears about what will happen as we continue to taper the prednisone without knowing what caused this in the first place. When I'm off the pred, if it's an AI, will this happen again, taking out what is left of my useful vision? That terrifies us, and literally keeps us awake at night. I need the doctors to work this out before I get down to the single figure doses of Pred.
And there is what I have lost. I know that it, in the grand scheme of things, is nothing compared to what so many others face. But there is a sense of grief, undeniable. Mostly, I haven't let myself go there yet. But it's there, I can feel it bubbling away, and I imagine soon it'll find it's way out.
Enough of this. I'm going to go visit Thea and do a Sunday Sessions. If you got this far, I'm impressed. And grateful for your caring.