So, I was really looking forward to today’s appointments. First, I had the opthamologist appointment this morning. This was one of the those “wait two hours for a 5 minute appointment” stories. My eye has healed well, and I haven’t any any infections, so the Dr. Squires congratulated me and showed me the door. (He said that I could come back in one year for a checkup, but didn’t seem all that motivated to say that. He seemed to prefer that I come back when my right eye needs a surgery — which will probably be in 20 to 30 years!)

Diana had told me that on her last visit to an opthamologist, the doctor said that a patient may be better off at with an optometrist for getting eyeglass prescriptions, because an optometrist has better equipment and fits lenses all of the time. Thus, I had scheduled an afternoon appointment with Dr. Eddie Chow. Dr. Chow is a family institution, since he fitted me with my first contact lenses around age 17. (He also fitted my sister Jeanne and brother Ben). He’s also the one who prescribed ortho-k (i.e. wearing hard contact lenses while sleeping) for Adam.

For the past few year, I’ve had three pairs of eyeglasses: one for long vision (e.g. driving), one for reading, and one for computer work (i.e. intermediate distances, with Zeiss multifocal lenses so that I can look at some paper documents without changing glasses). Diana and I stopped by Superb Optical on Friday night to look at a fourth set of frames. I thought that I would change the left lens in the three old eyeglasses for when I’m not wearing the contact lens, and would then need new frames for working on the computer when I am wearing the contact lens.

I was surprised today when Dr. Chow said that computer and reading eyeglasses could only be fitted above my wearing the contact lens in my right eye. When the difference between two eyes is so wide, glasses won’t work. (I guess I might have suspected this, from popping out the left lens from my old glasses!) The other unattractive options are:

• get a contact lens for the left eye — correcting the eye that just had surgery(!) with a multifocal prescription;
• get LASIK on the right eye to fix the myopia — uggh!; or
• have a cataract surgery on the right eye — which definitely isn’t covered by provincial health care, and is purely elective, because I really don’t need it — at least for a few decades!

I’m not used to wearing contact lenses from waking up to going to sleep, so my first response was denial. Dr. Chow wrote me up a prescription for multifocal eyeglasses (both for computer work and reading), and told me that I’d have to figure this out for myself.

I went out front to Superb Optical, and immediately saw Edmond, the optician. (He’s another institution!) I asked how long it would take for the multifocal lens, and he said that it would take a week to get one from Zeiss. As an alternative, he suggested that I have separate eyeglasses for computer/intermediate work, and for reading. These lenses would then be all single-vision, and he could make them up while I waited. One consideration was that single vision lenses are relatively cheap, so it’s more practical to try this way first, and then order the multifocal lens in the future if I really felt I need it. I gave him the two newer eyeglass frames that I already had, and he put the new lenses in. It was $50 for four lenses, which seems cheap compared to the history of eyeglasses I’ve had in the past.

While I was having this discussion with Edmond, Dr. Chow walked by, and insisted that I really should have the multifocal lens! (I know that he uses them himself, because he uses optical equipment while seeing patients, and then has to read and write on paper). Edmond says that the optometrist doesn’t always know the best way. I’m usually all intermediate distance — 8 to 10 hours per day on a computer — or all reading — checking the newspaper in the morning, and then maybe studying some academic texts later. I’m picky about my focus — I think that I’ve spent too many years in photography! — so I’ve opted for two pairs of eyeglasses. This is ironically better than my past 3 years carrying around three pairs of eyeglasses!

There is some good news about my condition. I’ve been wearing hard (gas-permeable) contact lenses for 30 years, so in the grand scheme of changes, my having one in my right eye isn’t such a big deal. Dr. Chow said that he has older patients that would benefit by doing as I am, but they can’t get used to wearing a contact lens, and things don’t work out. For me, I can’t warm up to the idea of elective eye surgery, so the single contact lens is the answer. I wonder if I’m going to have issues when my eyes water up in hayfever season, though ….

Yesterday, my surgery was scheduled for 1:35 p.m. Diana and I went the requisite 2 hours early, and checked into the day surgery clinic (on the fifth floor at St. Michael’s Hospital). It’s been designed as a welcoming place — some benefactors must have spent some time there! — with a wood panel reception area. We were directed down a very long hall — the place is huge — and were given a cubicle large enough for a reclining chair and two guest chairs. The curtain was drawn in front, and I was given the usual hospital gown (actually designed with a side slit) and a very large white terry bathrobe. I removed my street clothes, and was down to underwear and socks under the bathrobe. The nurses went about to correct the attendant who had brought me down: for cataract surgery, they’re only interested in the head, so I could actually have kept my pants on. I opted to stay in my underwear, because it’s about as comfortable as being in my shorts at home.

A nurse came in to do the usual medical history, and put a catheter in the back of my right hand for the anaesthetic. Diana and I chatted for for about 45 minutes until the intern came. At that point, I handed over my glasses to Diana, so I wasn’t seeing much, either out of the left eye with the cataract, or my normal myopic right eye! I was wearing little booties over my socks, and the staff decided that I might as well walk down to the operating room (rather than take a wheelchair).

As the operating staff introduced themselves — it was impossible for me to make them out without my glasses! — I got up onto the operating table. They put a folded towel under my head, and then — rip, in a sound like a roll of Scotch tape! — they wrapped a strip of tape over my forehead and under the operating table. I remarked that this seemed primitive, but obviously functional. The staff bundled me up in warm towels, including a little tunnel for my left arm. I remember the nurse introducing herself, as she must have connected the catheter in my right hand to the anaesthetic. I remember the intern telling me that he was going to clean my left eye with three swabs of cleanser, counting 1 … seeing yellow … counting 2 …. and then … I don’t remember much.

In the pre-admission visit, the doctor had said that cataract surgery calls for a light anaethetic, because the patient has to be awake to respond to requests to move the eye. I can imagine that I was awake, but I really don’t remember anything. I do remember a few voices as they were working through the surgery … it sounded like they were having a little difficulty getting out my cataract, and I heard when they said that the artificial lens was put in … but everything else is pretty much a blur. I barely remember them taking off all of the blankets, getting down off the operating table, and then getting wheeled down to the recovery area. The surgery probably took about an hour.

The nurses asked me for Diana’s name, and she got paged to join me. (She doesn’t get called as Diana Ing very often). The nurses took my blood pressure, and gave me a turkey sandwich and apple juice. (It was annoying to be fasting since midnight the night before, but I was the last surgery of the day). I wasn’t feeling any real pain, just a slight sensation of a dry eye. I put on my street clothes, got in a wheelchair pushed down to the front door, and Diana and I took a cab home.

At home, I had some soup (I was on a cooking spurt on Saturday, having found tarkeys on sale for half price on Friday!). I watched tv in bed, and put in eye drops every hour. I guess that I fell asleep about 6:30 p.m., for a few hours. When I woke up, I decided to pop out the left lens from my glasses, which seemed to show that I had normal vision in the left eye, but I really couldn’t get my right and left eyes to line up. I had some cereal, watched some more tv, and went to sleep.

This morning, I had a shower, and decided to put in my right contact lens so that I could wear sunglasses to my post-op appointment. (It’s actually a rainy day). I actually haven’t worn contact lenses since last June, because my optometrist then said that glasses would allow more light into my left eye. Now, however, a contact lens works best. There’s no disparity, as with a pair of glasses with only the right lens in. One thing that I do notice is a slight colour difference between my eyes: the right eye has a slight yellow tinge in it, as I guess my natural lens is getting old.

Diana drove me over to the eye clinic. As we were passing over the Richmond Street viaduct, it’s interesting to observe how blind I was in driving with the cataract in one eye. Sure, I could see, but it was pretty much tunnel vision. With two eyes this morning, I could see traffic, the building, the trees. It was an amazing, joyous feeling.

At the eye clinic, the intern saw me first. He looked into the eye, and said that the lens was perfectly centered. I read the eye chart, and he said that I have 20/20 vision. I asked about the lens that they put in yesterday. He said that my eye is about 6, and they put in a lens to correct to 8. Of course, the downside is that I’m now farsighted in the left eye, so I really need reading glasses. The intern said that the human brain will adapt, so I’ll probably start reading more out of my right eye. He also said that my left eye is still dilated, so my vision should improve over the next few days. He was a bit concerned about a bit of pressure in my eye, but Dr. Squires, joining us, mentioned that the pressure was there before the surgery. I asked what I can and can’t do until the final checkup in three weeks, and Dr. Squires said no jumping up and down — so there goes badminton — no heavy lifting or exertion — so there goes bicycling — but otherwise I can live pretty normally (including showering!)

I’ll get fitted for glasses at the appointment in three weeks. In the meantime, my long vision is great, but with drops in my eye from this morning’s exam, it’s hard for me to judge what life will be like over the next three weeks. In a reversal of the condition before the operation, I can see long distances well enough to drive, but have found newspaper type to be illegible. I’ve been playing with the font sizes on Windows XP, so I can be functional on the computer — albeit with less screen real estate!

[Blogging note: I' behind maybe 6 posts on multiple blogs, so I'll be playing catch up over the next few days. Wordpress has a feature that enables changing posting dates, so the entries on Fuschl, Finland, Manchester and Hull will still appear in correct date order.]

I find the hospitals, like most public institutions in Canada, to be interesting reminders of citizenship. Generally, the health care professionals are more than capable. Public services are an equalizer. Priorities (e.g. emergencies) are mostly driven by need, rather than social status (i.e. money doesn’t usually help jump the queue). In the best demonstration of Max Weber’s machine bureaucracy , pretty well everyone gets the same level of care and treatment. It’s likely that in the perverse Canadian way, the more a person raises his or her voice, the more he or she will be flagged as someone annoying. (In either the American or French culture, it’s probably a way of “getting noticed”).

The pre-admission facility at St. Michael’s Hospital, from a business perspective, seems pretty well thought out. On the one hand, it provides efficient pre-op services. The patient stays in a little room. Then, a nurse comes to take a medical history, various technicians come through (e.g. the blood technician takes a sample), and a doctor does a physical exam. From a function of bedside manner, however, the facility also seems to be on the path towards reducing anxiety in the patient. There’s a standard video that is played. (I was entertained by the shots of not doing anything requiring motor control on the day of anaesthesia, which not only included driving cars, but also cutting vegetables in the kitchen!) The doctor answers any final questions that the patient may have. I suppose that this is a last opportunity to back out, if the patient has any second thoughts about elective surgery!

One personal downside of the medical system is, though, that western medicine doesn’t seem to recognize Chinese medicine. When I commented about my resting pulse changing from 84 to 60 in the past month, the doctor seemed to think that was normal. He said that a person’s pulse can change walking across the room. This feels a bit too much like denial of symptoms, and a potential blindness in a western philosophy of medicine.

The pre-op took 90 minutes, meaning that I was finished just in time to dial into a teleconference call. I’ve been taking the subway and bus to get to work, and getting on the subway would mean that I would miss much of the conference call. As a tactical decision, I confirmed with the subway fare collector that the College/Carlton/Gerrard streetcar runs to Main Street station on the Danforth line. From the Main Street station, it would be a few subway stops over to Warden, where I connect to the northbound bus. Thus, I could take the streetcar as a wending alternative to the subway, and continue to receive a mobile phone signal.

Thus, I got onto the Yonge Street subway at Queen, and went two stops north to College Street. I dialed into the conference call, and in 10 minutes, the streetcar pulled up. The right route … but a sign in the front said that the streetcar wasn’t following the prescribed route, and would turn south at Parliament and go across to Kingston Road and Victoria Park. Without more information, I decided that moving east was better than not moving at all, so I got on the streetcar.

It was a good idea to be on the conference call — there’s all sorts of minutiae that turns up the day before a conference starts. About 30 minutes later, I was at Kingston Road and Victoria Park. I got off. The streetcar went around a loop and returned westbound. I was still on the teleconference, but there’s no TTC service that connects at that point!

After walking around in circles for 10 minutes, I decided to take a taxi to a subway station. (The conference call went on for another 15 minutes after I got there!)

As a downtowner, we make jokes about being in Scarberia (i.e. the depths of Scarborough), but I usually don’t take the TTC there. This is probably more than I wanted to know about the transit system in Toronto.

I was assessed as needing the surgery on February 17.  From February 17 to May 11 is 87 days.  (This didn’t include the span from December 1 until February 15, which was how long it took just to get the consult with the optometrist!) 

I had previously commented on the Ontario wait time web site.  Here’s a snippet from scorecard, most recently and with some history.  (In addition the measures for all hospitals and St. Mike’s, I’ve included Don Mills Surgical Unit, which I see on the list as a privatized alternative).

Although there’s some that might believe that privitization might fix the wait time issue, it looks like Ontario’s implemention of it doesn’t seem to make things much better.  

My wait time appears to have been within the ballpark, not only for St. Mike’s, but for the province.  I wonder why there’s variability month by month.

I’ve been under the care of Dr. Lam since 1996. He’s dean of the Institute for Traditional Chinese Medicine, the oldest teaching school of its domain in Canada. Dr. Lam was a pediatrician in a hospital in Shanghai, and has the advantage of being able to explain symptoms and problems in the contexts both of western and eastern philosophies. Since I’ve had eczema and allergies since childhood, I know that western medicine doesn’t have any answers. For most maladies, I generally prefer to see Dr. Lam and get some herbs. They seem to clear things up in a few days.

It was a nice day, so I decided to bike over to Dr. Lam’s office. It’s in the Dupont / Bathurst area, all the way cross town, so it’s ride over to the university and then beyond, about an hour in traffic. Dr. Lam is used to seeing me show up on a bike, and I could use the exercise, since I didn’t feel up to playing badminton on Sunday.

Dr. Lam asked about my symptoms. He first said that I must have a cold, and that a lot of his patients are coming in with colds because the winds have shifted. As we discussed more, he started the usual exam. The first step was taking my pulse. I don’t know how to read a pulse Chinese style — it’s a three-finger assessment on the right wrist and then the left wrist. Dr. Lam seemed to be taking a longer time on my right wrist. He then checked my left wrist, and said he wanted to check my right wrist, again. He opened up my file (which he usually doesn’t do).

On the last two visits, my resting pulse has been 84 beats per minute. That sounds about right, as the pulse I’ve had my entire life. Today, Dr. Lam said, my pulse was 60. This measurement was taken 5 minutes after bicycling for an hour. My energy is so low that it’s had systemic effect on my pulse!

The one thing that’s really unusual right now is, of course, the cataract in my left eye. Diana has pretty well taken away the keys to the car, and even drives Noah and me to badminton when we go. I’m not much in the mood to go out, and have been spending lots of time on the computer. I’ve taken the opportunity of staying at home to catch up on e-mail, and update my personal web sites, so I’m probably on the computer even more than usual. It’s productive, but since my left eye is a total blur, all of the information is coming through my right eye. I guess my body doesn’t like that. I assume that western medicine would say that there’s no connection between the cataract in my eye and my pulse. Diagnoses like that are why this is the third visit I’ve had with Dr. Lam since the beginning of the year.

If you’ve seen me at breakfast, you know that I usually have little canisters with lot of little pills — the modern way of taking Chinese herbs. I usually take an hour every two weeks to portion out the pills, because it’s annoying to count 8 of this, 5 of these, etc., every time. With this condition, however, I’m sticking close to Dr. Lam’s prescriptions, where I take some pills three times per day, and some pills four times per day.

Here’s what Dr. Lam has prescribed, this time.

wuchaseng eleutherococcus senticosus:

Dr. Lam says that this is a pseudo-ginseng. It’s not Korean Ginseng (that increases energy, but also increases heat massively), nor Chinese Ginseng (that increases energy and increases heat a lot), nor even Canadian ginseng (which would probably work, increasing heat while cooling). Wuchaseng is also known as Siberian ginseng, with an “anti-fatigue effect … stronger than that of ginseng” and published results in Soviet research showing positive results countering “heat, noise, motion, work load increase, exercise, [with] increased mental alertness, work output and the quality of work both under stress-inducing conditions and in athletic performance“.

dangshen and astraglal tablets

Since I had a “moss” on my tongue, Dr. Lam prescribed these for energy and digestion, reducing phlegm. Dangshen “promotes production of body fluid and blood circulation“. Astragali “warms the muscles and strengthens the striae as well as invigorates qi“.

semen ziziphi spinosae

I’ve been sleeping about 3 to 4 hours less each night, so Dr. Lam has prescribed this to dissolve the cycle of insomnia and fatigue. The herb “[nourishes] the heart to tranquilize the mind, promoting generation of body fluid and arresting sweating“.

qin qi huatanwan

Dr. Lam has prescribed this to take away my phlegm. It’s supposed to “clear heat, eliminate phlegm, redirect rebel qi“.

zhang yian ming

Dr. Lam suggested that these would nourish the eye. I think it’s less for the eye with the cataract, and more for the one that’s taking all of the load. (When I’m tired, that one gets blurry, too!)

cataract vision-improving pills

It seems a bit late for this, since I’m ready for surgery, but it “contain[s] mother of pearl, a calcium source, [and] blood building herbs … improve energy and circulation“.

I asked about the other herbs that I usually take, and Dr. Lam said that I should lay off them, until I get over this.

The primary symptom of being cold seems to have abated. I’m waiting for my energy to pick up.

On the other hand, research published in the Journal of Clinic Investigations suggests that nitroglycerin may do nothing for me if I run into heart issues.The more intelligible Globe and Mail, today, says that nitroglycerin probably won’t work for me.

Few heart drugs in the world have been prescribed as often as nitroglycerin has. Canadians filled 2.1 million prescriptions last year. Yet new research from China offers startling numbers to bolster [Toronto cardiologist] Dr. Liu’s observations: 30 to 50 per cent of East Asians might carry a genetic trait that blocks the body’s ability to process the drug, rendering it useless.

The mechanism is so striking that scientists at Fudan University in Shanghai suggest doctors reconsider prescribing nitroglycerin to East Asians.

The newspaper article continues, suggesting where my response to drinking comes to play.

Tests to detect the genetic trait are not widely available. But [Fudan University] Dr. Li Jin noted there might be an indirect way to identify carriers: “This particular mutation also results in blushing after drinking alcohol.”

The research report (not the newspaper) says that 30% to 50% of Asians potentially have this issue.

This article appears to be part of trend turning away from “universal” cures for humans. It should make sense that medicine should have variations related to ethnicity, if not genetics.

Now if we can get explanations about why non-drowsy allergy medications put me right to sleep, and aspirin gives me insomnia.

I tried 5 different contact lenses in the first half of 2005, until my optometrist said that the prescription was correct, but I had opacity in my eye. I returned to wearing glasses — something I haven’t done constantly since teenage years. By November, the vision was getting worse. It’s now definitely been diagnosed as a trauma-induced cataract, but I have to first get an official opinion from an opthamologist.

From early December, the first available referral was in April. A second try was in March. I decided to phone the St. Michael’s Hospital Foundation — I have actually donated (small amounts) of money to the eye clinic, because Diana had a nearly-detached retina some years back. They got me onto the cancellation list for the eye clinic, so I have an appointment on February 12 — next Tuesday. This is just the consult, not the surgery.
In a movement in the right direction, the Province of Ontario is now monitoring wait times, and cataract surgeries are one procedure they monitor. Here’s what I think I’ll have to look forward to, after Tuesday.

I usually work at about 150% — that means that I can do my day job, and other volunteer stuff and graduate studies — but now I seem to be operating at about 80%. I may have to look to short-term disability. This is when it’s good to be working for a big company.

Well, I guess I’ve found my limits.

The combination of a return from a two-week non-vacation, jumping back into a consulting engagement two weeks underway, two appointments for dental restoration, plus a request for a referral to an opthamologist — that has resulted in my doctor requesting a physical, and ordering blood work that may have had complications — put me into bed for most of the weekend.

It looks like I’ll have to take lifestyle change seriously, and this includes spending less time on the computer (and maybe more on exercising).

Thus, I’ve done enough blogging to understand a lot of the dynamics of technology, and have obtained a learning of how it works. I’ll be sticking to Wikis!

(by David): It looks like I’ve really maxed out on stress. My colleague in my day job said that I always look like I’m not under stress, but I guess I hide it better than most. I know when I’m tired, and try to watch out. On Thursday morning, when I drove into the office, I pulled into 3 parking spaces, before I decided to choose one. I got into the client office late — after making a stop at our downtown office to pick up printouts — and the remaining parking spaces were pretty tight. Since I was tired, I decided that I shouldn’t take any chances, and gave up on 3 parking spaces before I found a space that wasn’t so tight.

On Friday, in packing, I seemed to lose sense of time. I know that it usually takes 4 to 5 hours to pack for a trip of 2 weeks to Finland, if I don’t do any packing in advance. I got up late (having stayed up until 4 a.m. finishing up a report, and then puttered away at things that needed to be done: re-registering on the company’s medical plan (on the last day of registration), and checking in with DLH (since people in Finland will ask about him).

Diana picked up Mary — they were planning to go shopping out the direction of the airport, after dropping me off — and I was still packing. With a 5:15 p.m. flight, I had planned to leave around 2:30 p.m., knowing that if I left around 3:00 p.m., that I would probably still be okay. By 3:30 p.m., I was throwing things into the suitcase, and we were rushing to leave.

And … by 3:30 p.m., we were hitting rush hour traffic. I’ve been doing the trip to the airport almost every day for the past 8 weeks — the client office is right across the street from the airport — and Mary said that it was clear that I was taking all of the right side routes to get out of traffic — but it still took about 40 minutes to get airport. When I got to the Air Canada counter at about 4:30, the check-in clerk said that I was arriving about 20 minutes after the flight had closed, and that I would have to rebook.

I walked across to the ticket desk. In line, I phoned AmEx, and they said that the alternative flight at 7:15 to Frankfurt was full, so I might have to go the next day. When I got to the ticket counter, the check-in clerk was very nice, and said that I could get the last seat on the flight to Munich. I’ve taken that route before, so I said yes. She checked with some other reservation clerks, and put stickers on my tickets. Since I was booked on Air Canada for the whole trip — yes, the Germany-Finland legs are actually Lufthansa, but they’re Air Canada codeshares — she said that Air Canada usually charges for ticket changes, but that she wouldn’t charge me today. I thanked her profusely.

At the other end, Annaleena was scheduled to pick me up from the airport, but when I looked at my PDA, I hadn’t updated her phone number from when she was in Sweden. I phoned DLH, and asked if he could call Annaleena. At that point, since the time would have been past midnight in Finland, DLH said that he would phone Annaleena.

As soon as I got on the Toronto-Munich leg of the flight, I put on the eye shades, and went right to sleep. (The plane was full, so I was in upright seating). On the Munich-Helsinki leg, I tried to do some reading, but still fell asleep.

When I arrived at the Helsinki airport, Annaleena wasn’t there. I phoned her, and she said that she had come to pick me up for the original flight, but I wasn’t there. (Sorry). I took a taxi to the hotel, instead.

I’ve been definitely stressed out this past week. I know that DLH has been pretty stressed out recently, but I guess that I was so stressed that I forgot that, and he probably miscalculated the time zones to speak with Annaleena. These are signals that everyone is just too busy.

Postscript, adding injury to stress: As the flight was landing in Munich, the overhead door flew open, and someone’s laptop fell onto my lap. The top of my left thigh hurt initially, and then was okay. After sitting on the Munich-Frankfurt flight, my thigh started to hurt again, and I’ve been walking with a limp. It could have been worse … it could have hit a bone ….

(by David): Flu shots are free to residents of Ontario, and the advertising push is on again. We’re used to the lineup at Gerrard Square, but they’ve been transforming that mall, so flu shots aren’t there this year. Since I try to prevent catching or giving the flu to people on the trans-Atlantic flights, I decided that I needed to go to one of the earlier flu clinics. Diana and Ryan will have to schedule a time for themselves.

The lineup at the Eaton Centre for a 6 p.m. shot was probably about 40 people. There must have been a dozen nurses there. Line up, get a shot, have a seat for 10 to 15 minutes, and leave.

While I was in the Eaton Centre, I thought that I would check out the price of scarves. I had bought two microfiber scarves at Target a few years ago, when I was working on a U.S. gig. Diana had given one to the boys, and they lost it. Then, in packing for Adam’s trip to China, she gave him my scarf. This isn’t quite a traumatic as losing my scarf, but it’s an annoyance. Since I won’t be going to Target anytime soon, I should find a substitute nearer to home.

I went to Sears, and saw a plain acrylic scarf for $12.50 — probably about what the Target scarf cost, but not as nice. I then went to H&M — I’ve never been to the one in the Eaton Centre, although I’ve been to the Big Apple branch in Espoo, Finland! — and found a plain polyester scarf with a velour finish for under $8. The Target scarf was much better finished, but this is cheaper, and will do ….

I hope Adam brings my Target scarf back from China when he returns.