Ptergium surgery - Concerns about it

[Tessa]

My dear friends, queridos amigos.

I am confused and worried. I was told by my eye specialist that I have two ptergiums in each eye...
(A Pterygium is a raised, cream colored growth usually on the nasal side of the white of the eye. They sometimes get yellowish or reddish. Before the growth extends onto the cornea it's called a Pingueculae. When it extends onto the cornea it's called a Pterygium)
More info: Surgery

On my last visit to the specialist, I have been told that I should undergo surgery...She told me to think about it and to return when I have decided the surgery... Well, in fact, I am having problems (blurred vision, reddish eyes, extension to the cornea and near the centre of the eye...)and I should not wait for it to get to the iris...

Besides having to confirm with the specialist that the surgery will be modern... I mean, not only removing the ptergium but also filling the gap with a trasplant of tissue to avoid the 50% probability of it to grow again sooner and larger if not transplanted...I have a big problem with the local anesthetic. and being on Medrol....

I am sure that you remember my bad reactions to Novocaine and Nitroglicerine...

I know that as it is a minor surgery with local anesthetic and because I have adrenal insuf. (plus being on Medrol) I should have 100 mg. IV of Hidrocortisone before the surgery, plus a special care of Blood pressure and heart rate during the surgery process... (any other comments about this are welcome)

But what about the local anesthetic?
I have had a very bad reaction to an infiltration of a local anesthetic some years ago. It was novocaine and I also had a similar reaction to Nitroglicerine...

I am concerned about it.

I have an appointment on Monday at the specialist for food allergies. yes, food allergies and they do not like to talk about anything else that you were invited to... But I wonder if I can try and mention the surgery and my concerns about the local anesthetic... Wayne, I am sure that you remember that the specialist was not very helpful at that Department last time and that the tests for drug allergies were carried out following a "completely" unaccurated protocol... But... what else can I do?
I am worried about the possibility of having a reaction at the surgery...

What do you all suggest?
Could I have a reaction to eye anesthetic drops?
Do they cause hypotension....?

Any idea how to approach this?

Thanking you beforehand for all your suggestions, comments and help. (Personal experiences are also welcome).
Love,
Tessa

[tex]

Hi Tessa,

I'm sorry to hear of your problem, and I hope that you can find a safe way to resolve it. I am not very familiar with Pterygium, but I believe that it has two common causes:

1. a combination of sunlight, heat, wind, dust or sand, low latitudes, etc., (it's more common near the equator)

2. immune system suppression

I am guessing that both conditions may have contributed in your case. Did you know that the American TV star, Farrah Fawcett had this problem two years ago, (after her immune system was suppressed, by chemotherapy used to treat her colorectal cancer? In your case, the Medrol, (methylprednisolone), has probably suppressed your immune system, allowing the Pterygium to grow much faster than it would have, otherwise.

What local anesthetic would they use? In this country, I believe that proparacaine and tetracaine are commonly used as a local anesthetic, for the eye. I don't believe that either of them would be a problem for you, unless you happen to be allergic to them, for some other reason. You might need to test them, before the date of the surgery, to be sure.

Yes, I remember your disappointing experience with the specialist, and to be candid, I doubt that he will be much help to you in this situation. I doubt that he would know anything about the surgery involved, let alone know anything about the anesthetics used during the surgery, and even if he did know anything, I don't believe that he would be willing to offer any advice about it. I'm not sure that his advice could be trusted, anyway, even if he were to offer it, since that has nothing to do with his area of specialty.

In order to be able to make any valid decision about the safety of the local anesthetic that might be used, you will need to know the name of the anesthetic that your doctor plans to use during the surgery, and what else will be used with it. For example, the two local anesthetics that I named here, should be safe, however, sometimes they are used with adrenaline, (to dilate the eye), and adrenaline can sometimes cause hypotension during eye surgery. I see no reason why the pupil of the eye would need to be dilated, during surgery, (or just before surgery), but that does not mean that your doctor might not use it anyway, for some unknown reason, so you need to have that information, in order to rule out the use of adrenaline during the surgery. Does your optholmologist normally use adrenaline to dilate your eyes, during a routine exam. If so, it's possible that it might not be a problem for you, but I believe that it is the use of either proparacaine or tetracaine, in combination with adrenaline, that causes the primary hypotension problem with local eye anesthesia, during eye surgery.

Remember, though, I'm not a doctor, and it's almost impossible to predict individual reactions to various drugs that haven't been personally tested, previously.

Love,
Wayne

[Tessa]

Hi Tex
You are always so helpful and ready to give your personal opinion.
Thank you for your time my dear friend.

You are right regarding the causes of the Pterygium. I am afraid that both conditions have contributed to it. You know that our immune system has not been very "steady"...And taking Hidrocortisone (now Medrol + Hidrocortisone), I agree that it has accelerated the growing of the tissue...

Thank you for mentioning the local anesthetics they could use. At least it is a start to investigate them...
To test them before... How can I test them? Do you mean at the eye specialist?

You are right. I have to know the name of the anesthetic that they plan to use during the surgery... This is not going to be easy...

Do you have an idea how the medical cover works in Spain?
In brief, it is a system where we are paying the health cover (because they deduct an amount from our salary every month. The deduction is compulsory for those who work).
Then we have clinics and hospitals who belong to the system (known as Social Security).
You go to your nearest clinic for your GP. You do not have to pay for the visit, for the tests, etc. but you rely on his decision.
Your GP sends you to the specialist if he/she believes you need it.
You get an appointment with a specialist at a special clinic... But on your next appointment for that speciality it is very likely that you will be seen by a different person (not the same doctor)...
You do not pay for the tests, surgeries, visits, etc. But you cannot decide where to go or the specialist you want.
when you have to go to surgery, the specialist decides it but you do not see the surgeon until the day of the surgery (in fact, they do not know who will be surgeon until that day)...

I just wanted to give you a rough idea on how the system works. But I am talking about the bad side of it... It has many advantages. Maybe it sounds bad for you but it is known as one of the best systems in Europe.

Of course, most of the doctors working for the Social Security believe they are "Gods". Patients never reply, they do not ask, they do not question they decisions...

I am with you that I have to know the anesthetic he will use, as well as any other kind of drugs...

All the optholmologist I have seen have never dilated my eyes. Therefore, they have not used adrenaline (at least, not yet).

If so, it's possible that it might not be a problem for you, but I believe that it is the use of either proparacaine or tetracaine, in combination with adrenaline, that causes the primary hypotension problem with local eye anesthesia, during eye surgery.

Excellent information, Tex. Thank you.

I know that you are not a doctor, Tex.
But you are my best help and you have given me many good ideas to follow and ask doctors... I have a lot of work to do... I will tell my husband too. We will have to start by asking an app. with the Ophtolmologist and tell him or she that I´ve decided for the surgery but... that we have to talk seriously about all this... Oh, my God.
This is not going to be easy... But I have to do it.

Last Saturday morning I was very scared when I woke up and tried to look for the time... My vision was completely blurred and I could not see the numbers of the clock...

I have been told not to wait for it to grow more or it could blind me and the surgery would be much more complicated...
Love,
Tessa

[tex]

Tessa,

Your country's system for health care sounds as though it should work quite well for most people. People with special needs, though, (such as allergies and intolerances), are at a big disadvantage with such a system, unless most doctors take special care to be aware of such issues, and carefully review the patient records, every time they see a patient. That would require that they would all have to be carefully trained, and extra-careful when dealing with such patients.

Testing ahead of time may not be possible, (and might not even be safe, outside of a medical setting, where the proper assistance would be available, in case an adverse reaction should occur). Ideally, when such surgery is done, where there is a chance of an adverse patient reaction, (which is always possible, for many patients, though the risk is low), the doctor would be prepared for a hypotensive event, by having the facilities readily available, so that he could quickly administer treatment, (possibly even an IV infusion, such as a saline solution), in case it were needed.

It's a complicated situation, because adrenaline, (epinephrine), is mostly used to help a patient to recover from respiratory distress, cardiac arrest, and for purposes such as prolonging the effectiveness of anesthetics. It can save lives, when the chips are down, and something has to be done "right now". Most doctors should be very, very familiar with the uses of adrenaline, though, so your doctor should be able to recognize the signs, if something should go wrong, and he should be able to respond appropriately.

I've never had that type of surgery, so it's certainly possible that they are always prepared for such a reaction, and the doctor may be quite capable of handling it, very quickly. After all, one never hears of someone dying, (or almost dying), during eye surgery. Compared with other types of surgery, it's quite safe.

Also, there is a good chance that even if a combination of local anesthetic and epinephrine were used, you would not have a hypotensive problem because of it. The main thing is to be sure that the doctor doing the procedure, (an optholmologist, I assume), is aware of all your issues, before the surgery. I'm sure that he or she will do everything that they can, to prevent anything bad from happening.



Love,
Wayne

[Tessa]

Hi Wayne.
Thank you for your kind and helpful answer. Sorry for not posting before, but I had a bad episode on Friday night and have been feeling unwell since then...

I woke up at about 4 am with a light chest pressure but it quickly turned to be an accute chest pain that irradiated to the back. I also had sweats and could not breath easily because of the pain... I had to take some extra hidrocortisone but it took a long time before the pain started to fade away and I could sleep again...
It scared us. It was so painful...

Thank you for the information provided. I hope to feel better in a few days to answer your comment more carefully. I just wanted to let you know that I am aware of your answer and that I will answer as soon as I feel better to stay longer typing.

Love,
Tessa

[tex]

Tessa,

I'm sorry that you had such a bad episode. That does sound scary, and I hope it doesn't return.

Don't worry about not being able to respond, sometimes. I understand the issues that you are having to deal with, and please don't feel that you have to respond quickly - always wait until you feel well enough to be comfortable.

Love,
Tex

[Tessa]

Thank you for your answers, Wayne. They are always most helpful.
I am better now, thanks God.

i have an app. on Monday with the eye specialist to tell him that I´ve decided to go on with the surgery.
I am writing down all my allergies, reactions, dx., etc. to inform him.
I hope that they will respond and accept the information that I will provide as well as inform me about the procedure and drugs to use.

will keep you informed.
Thank you,
Love,
Tessa

[tex]

Tessa,

Thank you for the update. I hope that the appointment goes smoothly, and the specialist addresses all of your concerns, mi amiga querida.

Love,
Wayne