Barry’s Experience with our Health Care System
Many of you may not be aware that last April I suffered a detached retina and in the past year I have had four surgical operations performed on my eye and this year I am pleased to say that the eyesight in my affected eye was saved and at the present time is almost normal.
Last spring I was sitting in my backyard drinking a glass of water when I noticed that the water looked like it was full of little black things floating around in it. I quickly realized that it was not the water but it was my eyes. I seemed to have a multitude of tiny floaters whenever I looked at a surface with a solid background like the sky, a glass of water or a sink.
On the Monday following this revelation I phoned the ophthalmologist who had performed cataract surgery on my eyes in 2003 and 2004. After explaining my symptoms to his secretary, she informed me that I was no longer his patient and if I wanted him to look at my eyes I must go back to my family doctor and get a referral. I did this on the same day and was given an appointment for Thursday of the same week. My eyes, in the meanwhile seemed to be getting worse and my peripheral vision seemed to be diminishing. On Wednesday of that week I saw my optometrist, the person who usually just checked my eyes for general health and for prescriptions when I wore glasses. He asked me a few questions, examined my eyes and told me I had a detached retina and must go to Emergency right away. Any delay could result in the total loss of vision in that eye.
Many people may not be aware of the fact that although a regular eye examination by your optometrist is no longer covered by the Ontario Health Insurance Plan, any medical condition such as the one I had had, diabetic neuropathy, macular degeneration or even a corneal abrasion is covered with your Ontario Health Card and no payment is required. Not only that, they are a lot easier to see at a moment’s notice.
It is also important to add at this point that the secretary of the ophthalmologist who made me get a referral should have been aware of the symptoms of a detached retina and sent me to emergency right away. If she was unaware of these symptoms she should not have been working for an ophthalmologist in the first place. With so many people unemployed it is very unfortunate that some people who do have important jobs in the health field either have no consideration for the welfare of their patients or do not have enough knowledge to properly do their jobs.
When I arrived at St.Joseph’s Hospital in the emergency I was examined immediately by an ophthalmologist who told me that there were two retinal surgeons in Hamilton that could repair my eye, Dr.J.Martin and Dr.Arora. Having a great deal of knowledge about the horrible way Dr.Arora has treated his patients, I threatened to drive with one eye to Toronto unless Dr. Martin would look at my eye. A few hours later Dr.J.Martin examined my eye at the St.Joseph Health Care Centre in Stoney Creek and scheduled a procedure for the following morning.
The retina is located at the very back of the inside of your eyeball and I would liken it to a movie screen. In my case the cataract surgery that took place in one of my eyes disturbed the vitreous fluid in the eyeball. This constant jiggling over the years caused little tears to occur in the retina and one side was starting to peel down from the top as if it was old wallpaper. The goal of the retinal surgeon is to repair the tears and put the retina back in its place.
Cryopexy and Pneumatic Retinopexy
This was the first procedure done to my eye and it was actually the most painful. The first part, cryopexy involves applying a freezing probe along the outside parts of the eye to repair the tears and put the retina back in place. Although a local anesthetic is used, there is a tremendous amount of pain, swelling and redness in the eye. Also, as part of this procedure a laser is used to further attach the retina back into its previous position. These procedures are actually done in an office setting, not an operating room. When this is complete the surgeon injects a bubble of expandable gas directly into the eye. The purpose of the gas is to rise up and hold the retina in place and stop it from falling down again. As I said before the retina is like wallpaper and peels down from the top. The bubble of gas is supposed to rise to the top and prevent this action while the scar tissue heals from the laser and freezing.
As if this procedure was not painful enough, the restrictions after the surgery were even worse. I had to sleep in a sitting position because the gas bubble had to remain at the top of my eye. If I lied down the gas bubble could migrate to the bottom of my eye and the retina could peel down again. I could not travel in an airplane because the pressure at 37,000 feet could cause the bubble to expand and burst. I had to wear a special warning bracelet because if I need emergency surgery they had to know about the gas bubble in my eye that could cause a serious reaction with certain general anesthetics. I could not do any form of exercise because the surgeon wanted me as still as possible so as not to dislodge the surgical repairs to the tears in the retina. I was to remain a virtual couch potato for 3 weeks but I must have been too active because it did not work. During those three weeks, Dr.Martin saw me almost every day.
There are actually three different procedures to repair a detached retina. The most common is a procedure known as scleral buckling which involves making a silicone buckle that surrounds the eye and squeezes down on the eyeball holding the retina in place. This leaves the patient with nearsightedness (needing glasses for distance) and with a constant feeling of pressure in the eye. My retinal surgeon felt this was a last resort and other procedures should be tried first which could leave no after effects and a restoration of my 20/20 vision.
Vitrectomy is a procedure done in the operating room under local anesthetic. All the liquid from my eyeball was removed and the fluid that was in my eye was replaced with silicon oil which was a lot more viscous than the saline that was there. Once again the retina was lasered and all the tears were lasered and now my eyeball was full of this thicker fluid and the retina was securely in place. It remained like this for the whole summer until my baseball playoffs were over in September. It was a very bad year for me because my vision through the affected eye was very poor because it was like looking through jelly. There was no focus and with only one really good eye my depth perception was very poor. I also had to use three different types of eye drops that are usually used by people with glaucoma. That is because, just like a glaucoma patient, the intraocular pressure in my eye was very high because it was filled with oil rather than saline. The drops helped to maintain normal intra ocular pressure.
Finally on September 28th, another vitrectomy was performed. This time the oil was to come out and saline was going back in. Not only did Dr.Martin do this but for insurance he injected another bubble into the eye to make sure the retina stayed in place. Once again I had to sleep upright and refrain from physical activity but this time only for seven days.
This should have been the end of it but for some reason the pressure in my eyes was still high and my vision was still poor. It turned out that some of the oil did not come out and eventually attached itself to the lens of my eye and some of the surfaces of my eyeball.
To make sure this was the cause of the pressure in my eye, Dr.Martin sent me to a glaucoma specialist who eventually determined that I did not have glaucoma and the sole cause of the pressure was the oil.
Finally on March 1st, I had the last vitrectomy in which the surgeon removed most of the oil that was trapped behind the lens of my eye and as much of the other residual oil as possible. There is still a small amount of oil in the eye and I still have to use one prescription eye drop twice a day to relieve the pressure. My retina is totally secure and my overall vision is almost normal which means that I should be able to hit the baseball a lot better this year than last.
Many people complain about our health care system, the attitude of physicians, the long waiting times at emergency and for surgery and in my opinion there is really nothing to complain about. I received excellent treatment because I was proactive and did not just stand around and complain. Rather than accept the rude treatment from the secretary of my ophthalmologist, I went to my optometrist who diagnosed me immediately and was instrumental in saving my eyesight. Anyone who reads The Hamilton Spectator would have known about Dr.Arora and tried to avoid him at all costs. Because I had a genuine emergency and was in danger of losing sight in my left eye I was seen immediately. Physicians are people just like you and I and you must not be afraid to stand up to them and even question with them from time to time in order to determine your options.
Forty per cent of the people of Hamilton do not have a family physician but they could have one if they really made an effort. Without a family physician you do not have access to specialists and without specialists you are left to emergency treatment at the hospital.
Canada is a great country. If I were an American these procedures and countless office visits would have cost me more than $50,000 dollars. Even if I had insurance they could have refused me because people who have cataract surgery are 55 times more likely to get a detached retina. Which means that an American insurance company could have refused to cover me because I had an existing condition.
I would hope that anyone who reads this would never have to go through what I did with my eye. However, if it did happen, at least you are in a wonderful country that treats the health of all its citizens equally from their cradle to their grave.