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Cataract Removal Experiences?
Misssy2
Posted: Tuesday, May 15, 2018 10:19 PM
Joined: 12/14/2017
Posts: 1677


My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.

I was wondering how many peoples loved ones have had the cataract procedure after being diagnosed with ALZ or demetia?

I was reading about the types of anethesia...as I know I don't want my Dad on any of that because it WILL worsen his symptoms...it is proven to worsen symptoms in patients with dementia for up to 10 DAYS.

I remember hearing the Dr telling my Dad today that the anesethestic would be topical...so that means he will have a loc region numbing...which is highly suggested by specialists in the area of dementia and ALZ for any dementia patient to have localized "anesthesia"...because how much effect it can have on someone with dementia.

Another study revealed that patients with dementia that have cataract surgery, recover very quickly with local numbing..and even signs and symptoms that were present prior to the Cataract surgery may substansually subside because being able to see...literally changes their whold prespective in life....from colors..to seeing clear...not fearing losing his eyesight but the surgery either eliminates or reduces the need for any glasses (farsighted)...does nothing for nearsightness.

I wanted to ask..since my Dad is having the Surgery in June..unter a local...I'm going to ask his Dr. what he thinks would be the best medication as a SEDATIV for this procedur?

I know his Dr. will say Lorazepam......Lorazepam is somthing I have in the house and it works wonderful....

I'm glad I'm figureing this out before his May 21 appointment with PCP..where I have a couple medication concerns for my Dad...

I would like to know if your loved one was sedated for any procedure?  I'm going to for SURE ask my Dads Dr...for what he thinks is best.....

But I wonder if anyone else has ever been in  similar situation with wanting to keep a loved one comfortable during a procedure...

But, not knowing what to do because of the unpredictablity of this illness is very, very hard.

 

 

 

 


dayn2nite2
Posted: Wednesday, May 16, 2018 12:04 AM
Joined: 6/20/2016
Posts: 1602


Who’s going to help him put the drops in on time afterward?  I can’t see your mother bothering to do the aftercare needed.
MissCory
Posted: Wednesday, May 16, 2018 6:07 AM
Joined: 6/14/2017
Posts: 109


Echoing day2night2 here...there is more than just surgery and sedation, ther are drops 4 times per day for 2 weeks. Another concern is agitation during the surgery. Both my mom and I have had this surgery. I'm not demented (in the sense of this site, at least) and the surgery was easy plus wow, the results!  But Mom...the first time anyone used the word "sun downing" to me was right after the surgery. I didn't think she had ALZ at the time, so chalked up her reaction to being part of her schizophrenia. (Wish I had known then what I know now...so many signs.) We did the surgeries in the morning, normally her best time. Each of us had mild anesthesia, not sure what kind. Here is mom's experience:

  • Before - Mom had to get her blood pressure under control first, which took weeks and many PCP appointments to ensure she was well enough for surgery. 
  • On the way there - quite nervous. She knew what was happening, but you can't fully understand it until you go through it once. 
  • During - the patient remains awake and can see some of what's happening. They must be able to lie completely still and calm down on command. 
  • Mom, only 79 lbs at the time, struggled so hard that two people had to hold her down while a third layed across her body to keep her still. Amazing the strength of tiny but determined people who think someone is hurting them.  She could have lost her eyesight completely or the entire eye. 
  • After - I stayed with her all day to make sure she didn't bend over and to put the drops in. She kept getting up to read the instructions, which she left on a table and would bend over to read. (Remember, I I wasn't aware of memory issues at the time. Makes complete sense looking back.) Bending over causes pressure on the eye. You can't do it. 
  • She napped a lot at first, but by evening was extremely agitated and trying to rub her eye, take off the patch, etc.  I nagged, begged, tried to calm her, but it got worse to the point she bit me while I was holding her down to put the drops in.  
  • My plan was to stay the night so I could take her to the follow up appointment at 7:00 am, but I was clearly making things worse, not better, so I had to trust that God had this one and whatever happened was supposed to happen. If she hurt her eye, at least she still had the other, even though with a very bad cataract. One of the hardest nights of my life, second guessing myself the entire time. 
  • Next day - picked her up for follow up appointment. Dr said it was a miracle it worked. We thought long and hard together about doing the second eye. 
  • We did choose to move ahead, and Mom was much better second time around, but I was a mess waiting for something to go wrong. 
  • The surgery CAN help nearsightedness if corrective lenses are placed in the eye. It CANNOT change the need for age-related reading glasses (farsightedness) unless very expensive bifocal lenses are placed, and many insurance companies don't cover that. 
Overall, the surgeries were successful and she was able to see much better, but it didn't slow the progression of her dementia or Parkinson's. Now she still thinks she need glasses, and constantly puts on reading glasses to walk around, because in her mind, she's always worn glasses. I had to swap out normal-glass (no correction) glasses so she has something on her face but can still see. 

 I sense that you want to manage the result by managing the type of sedation. That's understandable, but unless you are a medical professional, let the doctors confer together to come up with a plan. Make sure that the Dr managing the dementia is communicating directly with the ophthalmologist. 

If your Dad still enjoys reading and lots of activities where sight is the primary sense used, it might be worth it. If not, it might not. Cataract surgery will not slow disease progression. 


harshedbuzz
Posted: Wednesday, May 16, 2018 6:42 AM
Joined: 3/6/2017
Posts: 948


Misssy2 wrote:

My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.

Why was the procedure canceled 2 years ago? 

I was wondering how many peoples loved ones have had the cataract procedure after being diagnosed with ALZ or demetia?

I have been through this with my DH and a couple of friends who do not have dementia. While it is a simple day procedure for most, it requires significant care that would be beyond the abilities of most people who are impaired enough to be diagnosed with more than MCI. 

The initial evaluation for DH took about 90 minutes with the surgeon and his staff. He was asked to do certain tasks and to report how things looked and/or felt in great detail. The procedure itself is reported to be as a little "disturbing"; will your dad be OK with strangers prompting him and keeping him calm. 

Day of, the docs near me tend to do this assembly line style. Procedures are Tuesdays at the local hospital (for those who are sicker/older) and Thursdays at the freestanding surgical center. Appointment scheduling is random, so you might want to ask for the first slot in order that your dad gets in before it gets more chaotic. 

Then there are the drops. They start several days ahead of time- DH had 3 different medications; 4 doses of 2 kinds and 2 doses of the other ahead of surgery. Day of the surgery you don't have to do anything except keep the eye protected. Then you start with a reducing protocol of drops over the next 4 weeks. Keeping track of which drop when was a little challenging; DH's were a little different because one eye was much worse and needed an additional prescription. Someone will need to track these for him and instill them. The tips need to be kept clean. DH dropped one and we needed to replace it. It was the one with the $80 co-pay and no coupon. Be sure to ask the surgeon for coupons for the required drops which can lower your OOP costs. 

DH's doctor had him in safety glasses for 2 weeks after each eye and a protective shell at night for a week for each. DH was a chemist in his professional life, so he's great with safety glasses, the shell was difficult for him to tape on and sleep with. He was happy to be rid of it.

I was reading about the types of anethesia...as I know I don't want my Dad on any of that because it WILL worsen his symptoms...it is proven to worsen symptoms in patients with dementia for up to 10 DAYS.

I remember hearing the Dr telling my Dad today that the anesethestic would be topical...so that means he will have a loc region numbing...which is highly suggested by specialists in the area of dementia and ALZ for any dementia patient to have localized "anesthesia"...because how much effect it can have on someone with dementia.

You'll want to speak with the anesthesiologist directly. The surgeon may have an idea of what is used, but the anesthesiologist or nurse-anesthetist will be making the final call. DH had the numbing drops and Versed IV. My friend did as well. My BIL had general anesthesia because he tends to be an anxious patient (as many physicians are) and his surgeon wanted him out cold. 

Another study revealed that patients with dementia that have cataract surgery, recover very quickly with local numbing..and even signs and symptoms that were present prior to the Cataract surgery may substansually subside because being able to see...literally changes their whold prespective in life....from colors..to seeing clear...not fearing losing his eyesight but the surgery either eliminates or reduces the need for any glasses (farsighted)...does nothing for nearsightness.

You can get custom lenses to correct vision. Most people get the Medicare standard lens that corrects distance vision (myopia) and use readers. My BIL got a custom bifocal lenses. DH got the basic lenses and wears bifocals to correct a mild astigmatism and see close up. 

Did the study look at what stage of dementia their participants had? I could see where those with mild or early moderate stages would be helped, but not necessarily those who were already having vision issues related to brain changes. 

I wanted to ask..since my Dad is having the Surgery in June..unter a local...I'm going to ask his Dr. what he thinks would be the best medication as a SEDATIV for this procedur?

I know his Dr. will say Lorazepam......Lorazepam is somthing I have in the house and it works wonderful....

You do not want to give your dad any medication you have on hand ahead of time. The person doing the anesthesia should manage his meds. They may have some guidelines around whether he should take his usual prescriptions that day or even discontinue certain meds ahead of the procedures. 

He'll likely get drops to numb the eye and sedation of some kind. DH's got really mild sedation; we were out in about 90 minutes and went to breakfast both times. He was less out of it that he's been after some dental work he's had done over the years. DH does recall the procedure; he and the surgeon had a discussion about the history of cataract surgery during the left eye and the composition of plastic in the lenses during the right which DH recalled. 

I'm glad I'm figureing this out before his May 21 appointment with PCP..where I have a couple medication concerns for my Dad...

I would like to know if your loved one was sedated for any procedure?  I'm going to for SURE ask my Dads Dr...for what he thinks is best.....

See above. 

But I wonder if anyone else has ever been in  similar situation with wanting to keep a loved one comfortable during a procedure...

But, not knowing what to do because of the unpredictablity of this illness is very, very hard.

TBH, I would be consulting with the neurologist on this as well. You want to be certain he is in a stage where the benefit of the procedure is worth the risks and the before and aftercare that comes with. 

Who will be managing the drops? Unless your mom can be relied on, you will need to be there 4 times a day for a little over 2 weeks for each eye, then twice a day for probably another 2 weeks. He'll need to cooperate with eye protection and not touching his eyes which may feel irritated at first. 

Good luck.

HB

 

 

 

 



Misssy2
Posted: Wednesday, May 16, 2018 6:57 AM
Joined: 12/14/2017
Posts: 1677


dayn2nite2 wrote:
Who’s going to help him put the drops in on time afterward?  I can’t see your mother bothering to do the aftercare needed.
Yup...this is a HUGE problem for me...because 3 days before the surgery he has to use 3 different eye droppers and 3 times a DAY.....I will probably be with him the first time he puts the drops in each day...and then I told him I am going to call him the 2nd and 3rd time on those days to instruct him over the phone.
And the day of the surgery I will make sure I am with him 2 hours before to manage putting the drops in every 15 minutes as the lady said this is important to prepare for the surgery...
After the surgery...back to the drops 3x a day and I don't remember for how many days after the surgery he must do this...but both surgeries will have a follow up the very next day.
So to answer your question "I" am going to help him with the drops afterwards...But, this is where the elderly abuse comes in...because I don't think I trust that he can manage even with phone instructions...So, I'm going to have to confer with my Mother to see that she is going to help him the other two times a day...when she gets up at 5pm and before he goes to bed at 11...

Iamnumberfour
Posted: Wednesday, May 16, 2018 7:11 AM
Joined: 2/29/2016
Posts: 1135


An ophthalmologist recommended that my mom have cataract surgery a couple of years ago. I had many of the same questions and concerns you do. We ultimately did not do the surgery as my mom declined severely and suddenly before we could do more than just talk about it. At the time, I thought her vision was just fine; she could read the small print of the newspaper and she could see across the street. I don't think her vision has declined substantially since.

 While the procedure itself is quick and simple with a cooperative patient, the after care is an issue as MissCory points out. There are drops that must be put in, and it is important that the patient not rub at the eye or bend over as it can disrupt the surgical site. Had we proceeded with the surgery, I would have hired extra personnel to sit with her 24 hours a day.

It sounds as though your dad has a lot of time to reap the benefits of this procedure, and he does enjoy some social activities with you. Just be aware that ophthalmologists and eye surgeons are not dementia doctors and do not necessarily take all of the factors into consideration that we do as advocates for our LOs. Clear communication with the team is essential, and you will have to have an after care plan; it doesn't seem likely that your mom will ensure that the drops are in and the precautions taken.

My SIL had cataract surgery herself; she said it made a huge difference for night-time driving; this is not much of a concern for our LOs.


Misssy2
Posted: Wednesday, May 16, 2018 7:18 AM
Joined: 12/14/2017
Posts: 1677


MissCory wrote:

Echoing day2night2 here...there is more than just surgery and sedation, ther are drops 4 times per day for 2 weeks. Another concern is agitation during the surgery. Both my mom and I have had this surgery. I'm not demented (in the sense of this site, at least) and the surgery was easy plus wow, the results!  But Mom...the first time anyone used the word "sun downing" to me was right after the surgery. I didn't think she had ALZ at the time, so chalked up her reaction to being part of her schizophrenia. (Wish I had known then what I know now...so many signs.) We did the surgeries in the morning, normally her best time. Each of us had mild anesthesia, not sure what kind. Here is mom's experience:

 

  • Before - Mom had to get her blood pressure under control first, which took weeks and many PCP appointments to ensure she was well enough for surgery. 
  • On the way there - quite nervous. She knew what was happening, but you can't fully understand it until you go through it once. 
  • During - the patient remains awake and can see some of what's happening. They must be able to lie completely still and calm down on command. 
  • Mom, only 79 lbs at the time, struggled so hard that two people had to hold her down while a third layed across her body to keep her still. Amazing the strength of tiny but determined people who think someone is hurting them.  She could have lost her eyesight completely or the entire eye. 
  • After - I stayed with her all day to make sure she didn't bend over and to put the drops in. She kept getting up to read the instructions, which she left on a table and would bend over to read. (Remember, I I wasn't aware of memory issues at the time. Makes complete sense looking back.) Bending over causes pressure on the eye. You can't do it. 
  • She napped a lot at first, but by evening was extremely agitated and trying to rub her eye, take off the patch, etc.  I nagged, begged, tried to calm her, but it got worse to the point she bit me while I was holding her down to put the drops in.  
  • My plan was to stay the night so I could take her to the follow up appointment at 7:00 am, but I was clearly making things worse, not better, so I had to trust that God had this one and whatever happened was supposed to happen. If she hurt her eye, at least she still had the other, even though with a very bad cataract. One of the hardest nights of my life, second guessing myself the entire time. 
  • Next day - picked her up for follow up appointment. Dr said it was a miracle it worked. We thought long and hard together about doing the second eye. 
  • We did choose to move ahead, and Mom was much better second time around, but I was a mess waiting for something to go wrong. 
  • The surgery CAN help nearsightedness if corrective lenses are placed in the eye. It CANNOT change the need for age-related reading glasses (farsightedness) unless very expensive bifocal lenses are placed, and many insurance companies don't cover that. 
Overall, the surgeries were successful and she was able to see much better, but it didn't slow the progression of her dementia or Parkinson's. Now she still thinks she need glasses, and constantly puts on reading glasses to walk around, because in her mind, she's always worn glasses. I had to swap out normal-glass (no correction) glasses so she has something on her face but can still see. 

 I sense that you want to manage the result by managing the type of sedation. That's understandable, but unless you are a medical professional, let the doctors confer together to come up with a plan. Make sure that the Dr managing the dementia is communicating directly with the ophthalmologist. 

If your Dad still enjoys reading and lots of activities where sight is the primary sense used, it might be worth it. If not, it might not. Cataract surgery will not slow disease progression. 

 

Thank you for sharing this experience as it is helping me be more prepared...the eye dr did not mention a "patch" for afterwards...that will just be an added frigin stress to the whole thing...
Yes, as far as the sedation....We are fortunate to have an appointment with his Dr. and I will for sure be asking him what "they" should do as far as sedation...my Father himself told the eye Dr. that the one time he was sedated for a procedure he became very "combative" and that he is afraid of that happening again and moving and going blind....and the Dr. told him that he has lots of experience with people that become combative and for my Dad not to worry that they will be able to control his symptoms.
This Dr told my father that with the traditional surgery that he is having vs. the "laser" that cost 3500 dollars....the laser corrects vision 100% and there is no need for glasses either way.  My Dad said he did not mind wearing glasses and then the Dr said that he can have the traditional surgery that is covered by Medicare with a deductible of 312 dollars for each eye...and it will correct his farsighted vision to the point where his new prescription for glasses would be much better than his current and that the procedure will not correct nearsighteness at all...My Dad is fine with that.
I understand that this surgery is not going to slow the progression of the ALZ or Parkinsons but the research shows that cataract surgery does improve behaviors and mood and memory because of the new joy that is found in being able to see clearly....
So its not going to slow the progression....In my opinion this surgery will work something like the Aricept...for a period of time he is going to be elated about seeing....so therefore his mood is going to improve and he will surely benefit from this procedure.

I'm understanding from these replies that I am going to HAVE to recruit my Mother and possibly my sister upstairs in some form to make sure pre surgery and post surgery he is using the drops correctly.

With 3 of us being able to ensure he is using the drops...he should be ok.

I'm hoping and giving my Mother the benefit of the doubt that she will be helpful during this time.

My Dad yesterday in the appointment was very good...it was like he was a normal patient...asking questions after we watched the informational video on both the traditional and laser surgeries...He had appropriate questions for the Dr...so it seemed like he did not have dementia at all.

But, the first medication I listed on the medication list for the Dr to review was Aricept...and the reason documented for the Aricept is dementia...but I did not talk about this in the office...as I plan to talk to my Dads Dr about all this and either have him or myself call the surgical center to make sure they understand exactly what they are dealing with and how they should proceed with the sedation.

I said we have the Lorazepam at home because this is something his body is used to and I feel like he will have less complications if Lorazepam is STUCK to for his sedation and I am wondering if the Dr will tell my Dad to take a little bit more that morning...and of course we would let the surgical team know ahead of time as well what he has taken....Lorazepam was on his list of medications and they did tell him to take all his medications as usual.

My most concerning thing in your reply is this "patch" no one mentioned a patch was going to be applied to his eye....I'm wondering why the patch? The extra protection? Or to keep it from the light?  I wonder if sunglasses while awake would be just as good...I have to find out about this "patch".

Thank you!

 


Misssy2
Posted: Wednesday, May 16, 2018 7:33 AM
Joined: 12/14/2017
Posts: 1677


harshedbuzz wrote:
Misssy2 wrote:

My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.

Why was the procedure canceled 2 years ago? 

I was wondering how many peoples loved ones have had the cataract procedure after being diagnosed with ALZ or demetia?

I have been through this with my DH and a couple of friends who do not have dementia. While it is a simple day procedure for most, it requires significant care that would be beyond the abilities of most people who are impaired enough to be diagnosed with more than MCI. 

The initial evaluation for DH took about 90 minutes with the surgeon and his staff. He was asked to do certain tasks and to report how things looked and/or felt in great detail. The procedure itself is reported to be as a little "disturbing"; will your dad be OK with strangers prompting him and keeping him calm. 

Day of, the docs near me tend to do this assembly line style. Procedures are Tuesdays at the local hospital (for those who are sicker/older) and Thursdays at the freestanding surgical center. Appointment scheduling is random, so you might want to ask for the first slot in order that your dad gets in before it gets more chaotic. 

Then there are the drops. They start several days ahead of time- DH had 3 different medications; 4 doses of 2 kinds and 2 doses of the other ahead of surgery. Day of the surgery you don't have to do anything except keep the eye protected. Then you start with a reducing protocol of drops over the next 4 weeks. Keeping track of which drop when was a little challenging; DH's were a little different because one eye was much worse and needed an additional prescription. Someone will need to track these for him and instill them. The tips need to be kept clean. DH dropped one and we needed to replace it. It was the one with the $80 co-pay and no coupon. Be sure to ask the surgeon for coupons for the required drops which can lower your OOP costs. 

DH's doctor had him in safety glasses for 2 weeks after each eye and a protective shell at night for a week for each. DH was a chemist in his professional life, so he's great with safety glasses, the shell was difficult for him to tape on and sleep with. He was happy to be rid of it.

I was reading about the types of anethesia...as I know I don't want my Dad on any of that because it WILL worsen his symptoms...it is proven to worsen symptoms in patients with dementia for up to 10 DAYS.

I remember hearing the Dr telling my Dad today that the anesethestic would be topical...so that means he will have a loc region numbing...which is highly suggested by specialists in the area of dementia and ALZ for any dementia patient to have localized "anesthesia"...because how much effect it can have on someone with dementia.

You'll want to speak with the anesthesiologist directly. The surgeon may have an idea of what is used, but the anesthesiologist or nurse-anesthetist will be making the final call. DH had the numbing drops and Versed IV. My friend did as well. My BIL had general anesthesia because he tends to be an anxious patient (as many physicians are) and his surgeon wanted him out cold. 

Another study revealed that patients with dementia that have cataract surgery, recover very quickly with local numbing..and even signs and symptoms that were present prior to the Cataract surgery may substansually subside because being able to see...literally changes their whold prespective in life....from colors..to seeing clear...not fearing losing his eyesight but the surgery either eliminates or reduces the need for any glasses (farsighted)...does nothing for nearsightness.

You can get custom lenses to correct vision. Most people get the Medicare standard lens that corrects distance vision (myopia) and use readers. My BIL got a custom bifocal lenses. DH got the basic lenses and wears bifocals to correct a mild astigmatism and see close up. 

Did the study look at what stage of dementia their participants had? I could see where those with mild or early moderate stages would be helped, but not necessarily those who were already having vision issues related to brain changes. 

I wanted to ask..since my Dad is having the Surgery in June..unter a local...I'm going to ask his Dr. what he thinks would be the best medication as a SEDATIV for this procedur?

I know his Dr. will say Lorazepam......Lorazepam is somthing I have in the house and it works wonderful....

You do not want to give your dad any medication you have on hand ahead of time. The person doing the anesthesia should manage his meds. They may have some guidelines around whether he should take his usual prescriptions that day or even discontinue certain meds ahead of the procedures. 

He'll likely get drops to numb the eye and sedation of some kind. DH's got really mild sedation; we were out in about 90 minutes and went to breakfast both times. He was less out of it that he's been after some dental work he's had done over the years. DH does recall the procedure; he and the surgeon had a discussion about the history of cataract surgery during the left eye and the composition of plastic in the lenses during the right which DH recalled. 

I'm glad I'm figureing this out before his May 21 appointment with PCP..where I have a couple medication concerns for my Dad...

I would like to know if your loved one was sedated for any procedure?  I'm going to for SURE ask my Dads Dr...for what he thinks is best.....

See above. 

But I wonder if anyone else has ever been in  similar situation with wanting to keep a loved one comfortable during a procedure...

But, not knowing what to do because of the unpredictablity of this illness is very, very hard.

TBH, I would be consulting with the neurologist on this as well. You want to be certain he is in a stage where the benefit of the procedure is worth the risks and the before and aftercare that comes with. 

Who will be managing the drops? Unless your mom can be relied on, you will need to be there 4 times a day for a little over 2 weeks for each eye, then twice a day for probably another 2 weeks. He'll need to cooperate with eye protection and not touching his eyes which may feel irritated at first. 

Good luck.

HB

 

 

 

 

Hi HB...thank you so much...I think I gave the impression I was going to medicate my Dad...lol.....No...I am happy we have an appointment with his PCP ahead of time so that he can help decide how medication should be handled with my Dad...the Neurologist...well...she isn't very involved in my Dads "case" because there is nothing to "manage" with him except the medication and his PCP said that he will be the primary contact for continuing my Dads care with his ALZ...prescribing meds and progress...or lack of progress.
I felt literally DEFEATED when the mention of doing the drops 3 days ahead 3 times a day came about...The first time he uses the drops I will make sure I am there to see how he does...and I am thinking my Mother gets up at 5pm so she will HAVE to help him manage the drops at around 5 and before he goes to bed...that will cover the 3x a day for 3 days ahead.
Then...the day of..I will be there 2 hours ahead to administer the drops every 15 minutes...to prepare for surgery...and then again they said he will have to do the drops for 3 days after...3x a day again...which hopefully we will manage them as we do for the 3 days before the surgery.  Then repeat all this for the 2nd eye.
You are correct my Dad is in an early enough stage and cognitive enough to benefit from this surgery and i know his PCP is going to agree that my Dad can get thru this with the help of his family and benefit from it.
He has no other health concerns other than this darn* dementia...his blood pressure and heart are a ok....And his physical therapy for the time being has prepared him physically for this "mild" procedure.  I do think this is a mild procedure for most people without dementia...but I realize for him....in his condition and anyone with dementia this is a step up from a mild procedure and it has to be managed very carefully.
The study I read about did not mention the stages of dementia for improvement in behaviors and mood...but I think it is just common sense that this procedure would not be needed or good for someone that was not as active or cognitive about what is about to happen.
My Dad knows that this procedure is going to help him see better...he is cognitive enough to be nervous about it...because he has never been hospitalized or even to the Dr much and he is 79 years old...but he wants to SEE....So this is a gift for him that is certainly going to be chaos to manage...I think...but he is worth it.


Misssy2
Posted: Wednesday, May 16, 2018 7:38 AM
Joined: 12/14/2017
Posts: 1677


harshedbuzz wrote:
Misssy2 wrote:

My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.

Why was the procedure canceled 2 years ago? 


 The procedure was not canceled 2 years ago...my Father did not think he needed the procedure and since he never has been to the Dr in 79 years..except for annual visits to his PCP that started about 10 years ago....(where he refused every suggested preventative health exam like colonoscopy etc)....

So when they called him to schedule the cataract surgery that the eye dr recommended at the time...he refused the appointment.

When we were in the eye Dr. this time after he failed his eye exam for driving...she asked him why he didn't go to the scheduled appointment....He said no one called him to set up the appointment...and he really believes this.

My Mother told me two years ago that he canceled the appointment and she was mad at him for that at the time...so "I" remember that he canceled it....but I just go along with him when he says no one called him to go to that appointment.



harshedbuzz
Posted: Wednesday, May 16, 2018 7:39 AM
Joined: 3/6/2017
Posts: 948


Misssy2 wrote:
dayn2nite2 wrote:
Who’s going to help him put the drops in on time afterward?  I can’t see your mother bothering to do the aftercare needed.
Yup...this is a HUGE problem for me...because 3 days before the surgery he has to use 3 different eye droppers and 3 times a DAY.....I will probably be with him the first time he puts the drops in each day...and then I told him I am going to call him the 2nd and 3rd time on those days to instruct him over the phone.

Can he even do his own eye drops? Not everyone can self-administer drops. DH can't. He blinks. I had to do all of his drops. I'd ask him to put some saline drops in ahead of time to see if this is in his skillset. 

Will he be able to differentiate between the different bottles of drops? Warning, these are small bottles with impossibly tiny print even for those of us with intact cognition and good vision. 

If you can't be there to do all drops, I don't see this as a safe proposition for your dad. Some of the drops are to keep the eye comfortable and some are to prevent infection. 

 
And the day of the surgery I will make sure I am with him 2 hours before to manage putting the drops in every 15 minutes as the lady said this is important to prepare for the surgery...
 
After the surgery...back to the drops 3x a day and I don't remember for how many days after the surgery he must do this...but both surgeries will have a follow up the very next day.

The protocols vary a bit as per each surgeon. DH had drops 4x a day for 2 weeks and then 2x a day for another 2 weeks. His eyes were scheduled exactly 2 weeks apart- we did drops for a little over 6 weeks. DH also had additional aftercare checks with our referring optometrist at 2 and 6 weeks for each eye. 
 
So to answer your question "I" am going to help him with the drops afterwards...But, this is where the elderly abuse comes in...because I don't think I trust that he can manage even with phone instructions...So, I'm going to have to confer with my Mother to see that she is going to help him the other two times a day...when she gets up at 5pm and before he goes to bed at 11...

Do you really think your mother will cooperate? I mean, if you can't trust her your father will be more uncomfortable than necessary- at best. He could end up with a catastrophic  infection. 

 

 


MissCory
Posted: Wednesday, May 16, 2018 7:43 AM
Joined: 6/14/2017
Posts: 109


Missy, the "patch" is the same thing someone else called a "shield" (which is a better term).  It is a hard plastic eyepatch that has to be taped over the eye after surgery and replaced each time after putting in drops.  It protects the patient from scratching, rubbing, or irritating the eye, especially at night during sleep.  It has to stay on for about 24 hours after surgery, except when putting in all the drops.  I was advised to wear mine while sleeping for about 2 weeks, I think (it's been a while - might have only been 1 week.) 

I get that you are going for the joy of sight.  My mom was still living independently and walking herself to the store, so I'm sure being able to see helped keep her safer, and I think for a short time it helped her be more confident in walking  - she seemed more upright, not always looking down at the ground.  She frequently commented how nice it was to see.  But even then, when I didn't know all that was wrong, I found myself reminding her that she didn't need glasses anymore.  She put them on out of habit.  Looking back, I see she couldn't rationalize that her vision was 20-20 now.

So yes, the surgery improved her vision, her appreciation of sight, even her joy, but not her memory, at all, not even a tiny bit. 

I'm not saying don't have it, not recommending pro or con - there are lots of both.  Your family will have to get on the same page about who will help him consistently with the aftercare, so I'm glad to hear you think that can be managed.  Perhaps your dad is doing what you remind him of after phone calls.  My mom could not be counted on to follow through, sometimes out of "I don't have to do what people tell me, I'm an adult, dammit!" (even though she didn't say this to me out loud, except the day after the surgery when it was most important.)  But sometimes she didn't follow through on things because she probably already forgot after I hung up.  The only way to know for sure is to be there doing it, or have someone you trust there doing it.

What HB said about having the neurologist consult with the surgeon, and if possible, the anesthesiologist is great advice, especially if your dad is seeming like a normal patient at the eye doctor.  So many balls to juggle when we help our LO's successfully get through something like this!  Good luck to you and your dad.


Misssy2
Posted: Wednesday, May 16, 2018 7:47 AM
Joined: 12/14/2017
Posts: 1677


Iamnumberfour wrote:
An ophthalmologist recommended that my mom have cataract surgery a couple of years ago. I had many of the same questions and concerns you do. We ultimately did not do the surgery as my mom declined severely and suddenly before we could do more than just talk about it. At the time, I thought her vision was just fine; she could read the small print of the newspaper and she could see across the street. I don't think her vision has declined substantially since.
 

 While the procedure itself is quick and simple with a cooperative patient, the after care is an issue as MissCory points out. There are drops that must be put in, and it is important that the patient not rub at the eye or bend over as it can disrupt the surgical site. Had we proceeded with the surgery, I would have hired extra personnel to sit with her 24 hours a day.

It sounds as though your dad has a lot of time to reap the benefits of this procedure, and he does enjoy some social activities with you. Just be aware that ophthalmologists and eye surgeons are not dementia doctors and do not necessarily take all of the factors into consideration that we do as advocates for our LOs. Clear communication with the team is essential, and you will have to have an after care plan; it doesn't seem likely that your mom will ensure that the drops are in and the precautions taken.

My SIL had cataract surgery herself; she said it made a huge difference for night-time driving; this is not much of a concern for our LOs.

I love this board and all the information and all the support and YES the reason I post is to take the feedback from people who have been thru something or that just have general advice....
You said clear communication is essential...which is why I came here to ask this question as well..to make sure there is clear communication and cooperation with everyone involved and to make sure I don't "miss" anything.
Like I said..I am blessed to have already had an appointment lined up with my Dads PCP so he can be the leader on this team to listen to my feedback cause I know my Dad the best...and to instruct me or others on how to proceed during this cataract journey.
I do not want my Dad put under general anethesia and I'm going to do everything in my power to make sure that doesn't happen...I would rather have him take a large dose of Lorazepam which is what I am going to ask his Dr and the anesthesiologist about.  
Again, I'm telling his PCP...We know that my Dad tolerates Lorazepam well..he has taken it for many years...I do believe that a higher dose of the Lorazepam if it will knock him out enough for the procedure is safer than general anethesia....what I have read is that you never know with dementia how this general anethesia will render them afterwards..
where I am pretty confident that the Lorazepam can sedate him enough if he takes enough and I'm not worried about it changing his brain or causing the lasting effects that the anethesia can cause for up to TEN days....which is not true for everyone...but can be true for some...and I don't want to take that chance.
So I'm going to push really hard for the Lorazepam at a high dose...and my Dad is comfortable with Lorazepam and I feel it will also ease his worry vs. being told he is going to be given something that has made him combative in the past.
These drops...are a huge pain in the a**.

Misssy2
Posted: Wednesday, May 16, 2018 7:56 AM
Joined: 12/14/2017
Posts: 1677


MissCory wrote:

Missy, the "patch" is the same thing someone else called a "shield" (which is a better term).  It is a hard plastic eyepatch that has to be taped over the eye after surgery and replaced each time after putting in drops.  It protects the patient from scratching, rubbing, or irritating the eye, especially at night during sleep.  It has to stay on for about 24 hours after surgery, except when putting in all the drops.  I was advised to wear mine while sleeping for about 2 weeks, I think (it's been a while - might have only been 1 week.) 

I get that you are going for the joy of site.  My mom was still living independently and walking herself to the store, so I'm sure being able to see helped keep her safer, and I think for a short time it helped her be more confident in walking  - she seemed more upright, not always looking down at the ground.  She frequently commented how nice it was to see.  But even then, when I didn't know all that was wrong, I found myself reminding her that she didn't need glasses anymore.  She put them on out of habit.  Looking back, I see she couldn't rationalize that her vision was 20-20 now.

So yes, the surgery improved her vision, her appreciation of sight, even her joy, but not her memory, at all, not even a tiny bit. 

I'm not saying don't have it, not recommending pro or con - there are lots of both.  Your family will have to get on the same page about who will help him consistently with the aftercare, so I'm glad to hear you think that can be managed.  Perhaps your dad is doing what you remind him of after phone calls.  My mom could not be counted on to follow through, sometimes out of "I don't have to do what people tell me, I'm an adult, dammit!" (even though she didn't say this to me out loud, except the day after the surgery when it was most important.)  But sometimes she didn't follow through on things because she probably already forgot after I hung up.  The only way to know for sure is to be there doing it, or have someone you trust there doing it.

What HB said about having the neurologist consult with the surgeon, and if possible, the anesthesiologist is great advice, especially if your dad is seeming like a normal patient at the eye doctor.  So many balls to juggle when we help our LO's successfully get through something like this!  Good luck to you and your dad.

I'm not liking the patch....I'm thinking when I call my Dad about the drops (after I show him the first time)....
I am going to mark the bottles with the numbers 1, 2, 3 in black marker...
I will stay with him on the phone (this is if my Mother is not going to assist)...and I will say...put the phone down and put in bottle number 1....and so on....
For putting the eye "patch" back on?  I don't know about this...I'm hoping my Mother will do this...but if not...I will talk to my sister about this ahead of time and she is home and upstairs after 4pm as well....So either she will agree to helping with the drops at 5 and 10pm or she can run down and reapply the "patch" for him after I help him with the drops over the phone
Currently I help him do the calendar over the phone....He called me about Monday appointments cause they have changed to every other week is a different time...He called me confused....so I said...walk over to the calendar...find May 14th...and he would say "ok" got it...and then I would say write PT at 1130....and he would say OK done....

If I have to do this with the drops...I feel he can follow directions...If he struggles I will go over there and enlist those 2 (my Mom and my sister).

...UGH..this is a mess.  I really thought that we would have the evaluation yesterday...get the appointment show up have the cataracts removed..and go home...These drops and patches are complicating my life too much...LOL

 


Misssy2
Posted: Wednesday, May 16, 2018 8:06 AM
Joined: 12/14/2017
Posts: 1677


harshedbuzz wrote:
Misssy2 wrote:
dayn2nite2 wrote:
Who’s going to help him put the drops in on time afterward?  I can’t see your mother bothering to do the aftercare needed.
Yup...this is a HUGE problem for me...because 3 days before the surgery he has to use 3 different eye droppers and 3 times a DAY.....I will probably be with him the first time he puts the drops in each day...and then I told him I am going to call him the 2nd and 3rd time on those days to instruct him over the phone.

Can he even do his own eye drops? Not everyone can self-administer drops. DH can't. He blinks. I had to do all of his drops. I'd ask him to put some saline drops in ahead of time to see if this is in his skillset. 

Will he be able to differentiate between the different bottles of drops? Warning, these are small bottles with impossibly tiny print even for those of us with intact cognition and good vision. 

If you can't be there to do all drops, I don't see this as a safe proposition for your dad. Some of the drops are to keep the eye comfortable and some are to prevent infection. 

 
And the day of the surgery I will make sure I am with him 2 hours before to manage putting the drops in every 15 minutes as the lady said this is important to prepare for the surgery...
 
After the surgery...back to the drops 3x a day and I don't remember for how many days after the surgery he must do this...but both surgeries will have a follow up the very next day.

The protocols vary a bit as per each surgeon. DH had drops 4x a day for 2 weeks and then 2x a day for another 2 weeks. His eyes were scheduled exactly 2 weeks apart- we did drops for a little over 6 weeks. DH also had additional aftercare checks with our referring optometrist at 2 and 6 weeks for each eye. 
 
So to answer your question "I" am going to help him with the drops afterwards...But, this is where the elderly abuse comes in...because I don't think I trust that he can manage even with phone instructions...So, I'm going to have to confer with my Mother to see that she is going to help him the other two times a day...when she gets up at 5pm and before he goes to bed at 11...

Do you really think your mother will cooperate? I mean, if you can't trust her your father will be more uncomfortable than necessary- at best. He could end up with a catastrophic  infection. 

 

 

Great idea to observe him with saline drops ahead of time!  I will do that....And to differentiate between the drops I am going to mark the bottles with the numbers 1, 2, 3 in black marker...I did something similar to this for my boyfriends Mom..not for cataracts but for something else...cause your right they don't understand the bottles at all...

I do have all the instructions for the eye care prior and post..and his orders are 3 days before the 3x a day (3 bottles) and the same for 3 days after...not a week....3 days before, 3 days after...and the day of...he has the one bottle to put in every 15 minutes for 2 hours prior to the surgery.  I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help?  and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.

Of course this comes down to self survival for me...this is all about am I going to be able to manage to get him thru this...cause it appears I am all he has....but I hope I am wrong and that my sister and Mom will help out...

I "know" my sister will do whatever she can...she will...she just has a sick child to care for and a full time job and she also can't be in the same room with my Mother without a bunch of drama. 

I'm not really worried thou about my sister not cooperating..she has already assured me that if anything comes up with "Dad" that she can help with to let her know...

I completely feel like my Mother should manage this....but it is far away at the moment..June 11th....So I have time to talk to my Dads Dr...and my therapist...and you guys....to prepare for talking to my Mom....and to have this all figured out by the time the countdown starts for the procedure.



ExpressoTime
Posted: Wednesday, May 16, 2018 9:08 AM
Joined: 3/11/2018
Posts: 548


Hi Misssy, 

I  would be worried about a couple things besides just the drops. One is the bending over is not allowed post surgery, it causes pressure and strain on the eye and can damage the eye. This is a big problem because we know how long Alz parents remember things, sometimes 2 minutes before we are repeating ourselves again "Don't do that".  Who is going to be with him 24 hours a day making sure he doesn't bend over at the waist, look down at the table, look down at his feet when walking? 

Who is going to make sure he doesn't rub or itch his eyes? Who will be there if he has to have the patch on for the first day for 24 hours? Maybe you could take him to your house for one day? And then there's the being in a car issue. No bumps in the road after surgery coming home, no potholes, no slamming on the brakes. Riding in a car is something to be avoided for days. The ride home should be bump-free. 

Sorry, don't want to add more stress thinking about this, but these are all concerns I see. Hopefully your mother will step up and do her part. But when he's awake and she is sleeping, there will be nobody to watch him and remind him Do not look down, do not rub your eye, etc. 


harshedbuzz
Posted: Wednesday, May 16, 2018 10:05 AM
Joined: 3/6/2017
Posts: 948


Misssy2 wrote:

Great idea to observe him with saline drops ahead of time!  I will do that....And to differentiate between the drops I am going to mark the bottles with the numbers 1, 2, 3 in black marker...I did something similar to this for my boyfriends Mom..not for cataracts but for something else...cause your right they don't understand the bottles at all...

I do have all the instructions for the eye care prior and post..and his orders are 3 days before the 3x a day (3 bottles) and the same for 3 days after...not a week....3 days before, 3 days after...and the day of...he has the one bottle to put in every 15 minutes for 2 hours prior to the surgery. 

Just an FYI- DH's surgeon gave the prescriptions and instructions for the pre-op drops and the days immediately after. Then at the post-surgical visit, he laid out a new schedule for the next 2 weeks until the optometrist took over. The optometrist prescribed an additional 2 weeks of drops 2 weeks after he had the surgery. I asked the surgeon about this and he said it was to avoid confusing and overwhelming patients. Plus DH needed a different medication because one of his eyes needed more intensive work than most people have so I had to run out for an additional medication.

 I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help?  and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.

I would make sure you understand the bigger care picture. We went in knowing only about the first of four weeks worth of care. 

I completely feel like my Mother should manage this....but it is far away at the moment..June 11th....So I have time to talk to my Dads Dr...and my therapist...and you guys....to prepare for talking to my Mom....and to have this all figured out by the time the countdown starts for the procedure.

You can ultimately control your own behavior- not your mom's. If you can't trust her, you can do all of the care yourself, hire someone to do the appropriate care or pass on the procedure. 




jfkoc
Posted: Wednesday, May 16, 2018 10:11 AM
Joined: 12/4/2011
Posts: 15470


I had both eyes done...a year apart since the first was such a big improvement. Drops before, appointment that afternoon not next day...patch at night for 3 nights, and drops for  a period of days. Followup appointment in a week and then in a month.

With a local I would worry about movement during the surgery! I think I was in some kind of restraints. I do not think I would do well knowing what was going on.


RanchersWife
Posted: Wednesday, May 16, 2018 11:15 AM
Joined: 3/14/2018
Posts: 90


Our cataract story goes like this

Early November - surgery on right eye.  LO spoke fluent Spanish during procedure. She studied Spanish in college.  We were just starting to learn the extent of the dementia. 

December - LO spent month with relatives.  Not a lot of oversight with meds, drops or personal care

Late December - Came home with eye infection.   Preservatives in antibiotic drops massively inflamed cornea.  Inability to completely close eye (delayed effect of previous eyelid surgery) caused dry patch on surface.  (We are still treating this condition)  we've had to eliminate any eye product with preservatives.  

Early January - fell and broke hip, had UTI.  Hospital increased antibiotic drops and nobody put moisture drops in eye or patched her eye closed at night. Dry patch got worse.  Not able to get to eye dr.  

We might have this under control.  However they dialated LO's eye yesterday.  Aweful!  I will argue hard against that again as it really hinders her ability to function. 

So while the surgery was to lower fall risk, we had a fall and are still dealing with eye issues 6 months later.  I think we may be getting out of the forest.  It was a long complicated thing.  However her sight was 20/40 yesterday.  I'll take it.  

 


BadMoonRising
Posted: Wednesday, May 16, 2018 11:26 AM
Joined: 4/22/2017
Posts: 235


Oh, my. Here's my experience for both me and LO. (LO had AD at the time of the surgery).

LO had to have drops instilled presurgery, I did not. This is the surgeons' preference.

Nothing by mouth after midnight.  (The surgical team was ready to cancel my surgery because I was chewing gum to relieve dryness. Oops)  Thus, no pills, tablets, capsules, etc.

 Schedule the earliest surgery time possible. Nothing quite like having an afternoon surgery when you've had nothing to eat or drink since midnight. See a pattern here? 

I've never heard of general anesthesia for cataract surgery. A sedative administered via IV will relax your father. This is why anesthesiologists are paid the big bucks.

Cataract surgery is important. If the cataract becomes too dense, the docs can't see what the hell is going on behind the cataract. There are age related ocular diseases, such as macular degeneraton, that cannot be seen through a dense cataract. 

Questions regarding the surgery and what to expect need to be addressed by the surgeon, NOT the PCP.  Each surgeon has their own preferences regarding the procedure and of course, will be the ones calling the shots. Around here, the PCP will make sure the preop exam, as ordered by the surgeon, is completed. 


JustLikeMom
Posted: Wednesday, May 16, 2018 11:53 AM
Joined: 2/7/2012
Posts: 425


I’m following this post and replies closely as my mother’s optometrist is recommending cataract surgery.   I have serious misgivings about it: 

1) She was made aware of the issue well over ten years ago (when still competent) and chose not to pursue surgery all that time. 

2) When in the optometrist’s exam room, she readily agrees to scheduling the procedure, but when I broach the subject again as the day goes on, her “yes” turns into “maybe” which turns into a definite “NO!”

3) She can’t keep her hands away from any injury.  When she had shingles, she ripped her skin apart.  When she had a bruise on her arm, she kept at it until it was an open sore then kept picking the scab apart so often it couldn’t heal.  If she has the surgery, it won’t matter how many reminders she’d get, her hands WILL go straight for that eye shield and won’t leave it alone. 

4)  Having the surgery won’t result in any physical pain — just the continued diminishment of sight — a shame but not physically painful. 

Am I right in thinking this surgery isn’t a good idea for her? 


jfkoc
Posted: Wednesday, May 16, 2018 2:55 PM
Joined: 12/4/2011
Posts: 15470


IV sedative? I don't think I had that and everyone I know "wakes" up in recovery. Also you can not lift anything for about a week.
Imnbed
Posted: Wednesday, May 16, 2018 4:15 PM
Joined: 5/27/2017
Posts: 17


I’ll throw my two cents in. I have gone through this with myself, husband and mother. 

One may be allowed to take their usual morning meds with a sip of water. Depends on anesthesiologist and what the meds are.

IV sedation, like Versed, may be used to relax person. It will be light, but sufficient. See next paragraph. It may also block any memory of the actual procedure. It’s a handy and desired side effect. The eye drops given at the hospital do a great job of numbing the eye. (There are many doses of different drops given in the OR holding area about every five minutes.)

General anesthesia is rare for cataract surgery. The doctor wants the patient awake since there is a point in the surgery where directions are given and patient cooperation is needed. Nor do they want you to dose off and startle awake.

The patch is not a patch at all. It is a plastic shield with multiple perforations for air and vision. It does not obscure vision. It is taped to the face and worn until next morning, then at night for a few days. The patient must leave the tape and shield on to prevent incidental rubbing of the eye. My mother had the surgery before her Alzheimer’s was advanced. Now at stage 5-6, she is a “face picker” and probably would not tolerate something on her face. (She had a facial skin cancer removed and had pulled the pressure dressing and skin graft off by nightfall ...return trip to doctor.)

The eye may feel a little itchy for day or so. The eye drops help with this sensation or any pain. There are also steroid drops which prevent scar formation the first few weeks. Scar formation is common even if drops are done correctly. Both my mom and husband had to have a small scar removed on one eye at six months in the office with laser. The other drops are to prevent infection.

All three of us saw immediate improvement in our far vision. Husband no longer needs glasses to drive. It is a great payback for a very quick procedure. If your father has the surgery, you will find that you are hardly comfortable in the waiting room chair before you are told that you can come back to the postop room. I waited for my husband for NINE minutes! It is an assembly line of sorts for the doctor. He did 16 on my day.... another reason to get there early to be at the head of the line!

I hope we have helped with your decision. You see that different people have different experiences. The experience for someone who has dementia adds another level of needs, depending greatly on the person. It will definitely be stressful for you all. Something as simple as eye drops become a big deal. My father undergoes this operation next month. We will have to “double up” with caretakers for him, since Mom cannot be left alone when he is at the hospital.


SelEtPoivre
Posted: Wednesday, May 16, 2018 5:30 PM
Joined: 3/8/2018
Posts: 482


I will add another perspective. My mom is legally blind from end-stage glaucoma and only sees shapes and shadows. Because she doesn’t see well, she doesn’t have any of the visual cues that would have helped her recognize objects and reinforce memory (ie, if you can’t see it, it’s harder to remember)

I can’t leave a list for her, or a calendar. If she puts something down in the kitchen, walks away and forgets about it, she can’t find it later, and that can get her agitated.

Visual input is so very important, I would take all preparative steps and get the logistics set up for day before, day of, and aftercare so he can have the procedure with as few glitches as possible


Misssy2
Posted: Wednesday, May 16, 2018 8:36 PM
Joined: 12/14/2017
Posts: 1677


ExpressoTime wrote:

Hi Misssy, 

I  would be worried about a couple things besides just the drops. One is the bending over is not allowed post surgery, it causes pressure and strain on the eye and can damage the eye. This is a big problem because we know how long Alz parents remember things, sometimes 2 minutes before we are repeating ourselves again "Don't do that".  Who is going to be with him 24 hours a day making sure he doesn't bend over at the waist, look down at the table, look down at his feet when walking? 

Who is going to make sure he doesn't rub or itch his eyes? Who will be there if he has to have the patch on for the first day for 24 hours? Maybe you could take him to your house for one day? And then there's the being in a car issue. No bumps in the road after surgery coming home, no potholes, no slamming on the brakes. Riding in a car is something to be avoided for days. The ride home should be bump-free. 

Sorry, don't want to add more stress thinking about this, but these are all concerns I see. Hopefully your mother will step up and do her part. But when he's awake and she is sleeping, there will be nobody to watch him and remind him Do not look down, do not rub your eye, etc. 

What I am finding kind of confusing is that everyones experience is a little different, with number of days, infections, pre op instructions, post op instructions....seems an awful lot for a 15 minute procedure.....lol.
I will manage the post op...but I have to get thru the pre op first..
As far as rubbing and itching is eyes...hopefully he doesn't...after all these responses...I think that the day of the surgery...I will wake my Mother up when we get home and give her the list of instructions....
But it may be a good idea to line up a caretaker from the time he gets home until he goes to bed that night....I don't even know how to go about that...but that would cover the bases.

Misssy2
Posted: Wednesday, May 16, 2018 8:46 PM
Joined: 12/14/2017
Posts: 1677


harshedbuzz wrote:
Misssy2 wrote:
 

Just an FYI- DH's surgeon gave the prescriptions and instructions for the pre-op drops and the days immediately after. Then at the post-surgical visit, he laid out a new schedule for the next 2 weeks until the optometrist took over. The optometrist prescribed an additional 2 weeks of drops 2 weeks after he had the surgery. I asked the surgeon about this and he said it was to avoid confusing and overwhelming patients. Plus DH needed a different medication because one of his eyes needed more intensive work than most people have so I had to run out for an additional medication.


 I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help?  and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.

I would make sure you understand the bigger care picture. We went in knowing only about the first of four weeks worth of care. 

I completely feel like my Mother should manage this....but it is far away at the moment..June 11th....So I have time to talk to my Dads Dr...and my therapist...and you guys....to prepare for talking to my Mom....and to have this all figured out by the time the countdown starts for the procedure.

You can ultimately control your own behavior- not your mom's. If you can't trust her, you can do all of the care yourself, hire someone to do the appropriate care or pass on the procedure. 


 Thank you for all the help today, I think I'm getting a pretty clear picture of the pre and post care...and I am just going to do the best I can for my Dad.

Your eye Drs office sounded like it was in the middle of a shuffle while your Husband was going thru his surgeries...

This office we go to is very efficient with their process...the top in our State...and we do already have the pre drops the 3 bottles for the 3 days before and the one bottle for the day of surgery. We picked up the drops today and my father insisted that he has to put them in today....OMG...lol 

We know that we are getting more prescriptions the day after the first eye is done and then the 2nd eye will be done a week later....they told me they could do the 2nd eye a DAY later, a week later or 2 weeks later they said they leave that up to the patient after the first eye is completed......and I said if all goes well we would like the 2nd one done the following week and the Surgeon agreed.

You gave me a good idea to look for a backup caregiver for the day of the surgery..I am going to prepare him in the morning....and take him and bring him home getting him thru the post op etc....I am thinking of asking my Dad if I can have someone come stay with him from when he gets home until he goes to bed...and if he can pay that person....

Today he said that he is NOT SURE if my Mother is going to help him with the drops and he said he doesn't know how to put drops in his eyes and that he never has...I told him no worries...we will figure out the drops...He said how?  And what i got from YOU on this site was the ANSWER...We will practice with SALINE

 




Misssy2
Posted: Wednesday, May 16, 2018 8:50 PM
Joined: 12/14/2017
Posts: 1677


jfkoc wrote:

I had both eyes done...a year apart since the first was such a big improvement. Drops before, appointment that afternoon not next day...patch at night for 3 nights, and drops for  a period of days. Followup appointment in a week and then in a month.

With a local I would worry about movement during the surgery! I think I was in some kind of restraints. I do not think I would do well knowing what was going on.

OMG if they try to put restraints on my Dad he will not have the procedure I know that for a fact....
Yea, the procedure didn't seem like a big deal....my Dad told the Surgeon he was afraid he would move...and the Surgeon said that HE was NOT worried about my DAD moving and he told my Dad not to worry about it.....that the anesethiologist would be there and they have done thousands of patients and told my Dad with a smile...."We will get thru this and you will be ok".
His time and kindness really comforted my Dad and he convinced my Dad to do the Traditional procedure vs. the one that costs an extra 3500.....So to me...that just means during that brief meeting he earned my Dads trust and I hope everything goes as smoothly as the Surgeon made it sound.

Misssy2
Posted: Wednesday, May 16, 2018 8:54 PM
Joined: 12/14/2017
Posts: 1677


RanchersWife wrote:

Our cataract story goes like this

Early November - surgery on right eye.  LO spoke fluent Spanish during procedure. She studied Spanish in college.  We were just starting to learn the extent of the dementia. 

December - LO spent month with relatives.  Not a lot of oversight with meds, drops or personal care

Late December - Came home with eye infection.   Preservatives in antibiotic drops massively inflamed cornea.  Inability to completely close eye (delayed effect of previous eyelid surgery) caused dry patch on surface.  (We are still treating this condition)  we've had to eliminate any eye product with preservatives.  

Early January - fell and broke hip, had UTI.  Hospital increased antibiotic drops and nobody put moisture drops in eye or patched her eye closed at night. Dry patch got worse.  Not able to get to eye dr.  

We might have this under control.  However they dialated LO's eye yesterday.  Aweful!  I will argue hard against that again as it really hinders her ability to function. 

So while the surgery was to lower fall risk, we had a fall and are still dealing with eye issues 6 months later.  I think we may be getting out of the forest.  It was a long complicated thing.  However her sight was 20/40 yesterday.  I'll take it.  

 

This is a very sad story....ugh...I'm praying for none of this...no infections..no falls..no extra burdens for him or for ME...and I'm sorry that your LO did not have the care she needed at a very fragile time...I'm going to do everything in my power to ensure my Dad does have the "oversight".
Thank you for sharing your story

Misssy2
Posted: Wednesday, May 16, 2018 9:01 PM
Joined: 12/14/2017
Posts: 1677


BadMoonRising wrote:

Oh, my. Here's my experience for both me and LO. (LO had AD at the time of the surgery).

LO had to have drops instilled presurgery, I did not. This is the surgeons' preference.

Nothing by mouth after midnight.  (The surgical team was ready to cancel my surgery because I was chewing gum to relieve dryness. Oops)  Thus, no pills, tablets, capsules, etc.

 Schedule the earliest surgery time possible. Nothing quite like having an afternoon surgery when you've had nothing to eat or drink since midnight. See a pattern here? 

I've never heard of general anesthesia for cataract surgery. A sedative administered via IV will relax your father. This is why anesthesiologists are paid the big bucks.

Cataract surgery is important. If the cataract becomes too dense, the docs can't see what the hell is going on behind the cataract. There are age related ocular diseases, such as macular degeneraton, that cannot be seen through a dense cataract. 

Questions regarding the surgery and what to expect need to be addressed by the surgeon, NOT the PCP.  Each surgeon has their own preferences regarding the procedure and of course, will be the ones calling the shots. Around here, the PCP will make sure the preop exam, as ordered by the surgeon, is completed. 

 

We did get the earliest times for the surgery on both days...Mondays and one after the other.

We did ask the Surgeon a lot of questions yesterday and he made this whole process seem very simple with the exception of the drops!  
When I asked him about sedation choices...He did say that the anesthesiolgist will discuss what type of sedation on the day of the Surgery...
So that is why I am glad I am seeing my Dads PCP on the 21st before the Surgery on the 11th...because since we don't have access to the anesthesiologist until the DAY of....
I want the PCP to make sure that he advises me on what type of conversations to have with the anesthesiologist the day of the Surgery...or to let him decide if he should talk to the anesthesiologist.....Whoever does the talking or plays the role of decision making is getting MY input and....my Dad will have the safest sedation possible for his condition.

Thank you for your help and responding to the post.


Misssy2
Posted: Wednesday, May 16, 2018 9:06 PM
Joined: 12/14/2017
Posts: 1677


JustLikeMom wrote:

I’m following this post and replies closely as my mother’s optometrist is recommending cataract surgery.   I have serious misgivings about it: 

1) She was made aware of the issue well over ten years ago (when still competent) and chose not to pursue surgery all that time. 

2) When in the optometrist’s exam room, she readily agrees to scheduling the procedure, but when I broach the subject again as the day goes on, her “yes” turns into “maybe” which turns into a definite “NO!”

3) She can’t keep her hands away from any injury.  When she had shingles, she ripped her skin apart.  When she had a bruise on her arm, she kept at it until it was an open sore then kept picking the scab apart so often it couldn’t heal.  If she has the surgery, it won’t matter how many reminders she’d get, her hands WILL go straight for that eye shield and won’t leave it alone. 

4)  Having the surgery won’t result in any physical pain — just the continued diminishment of sight — a shame but not physically painful. 

Am I right in thinking this surgery isn’t a good idea for her? 

I think that this is your Mom and if you feel the surgery is not right for her...than she should not have the surgery.....I think my Dad would be ok without the surgery because he thinks he can see fine.....But the eye Dr. can not give him a new prescription because his cataracts are so bad...So now my Dad and I joke back and fourth when I talk about the surgery and he says he doesn't need it....LOL...I just say ok...DAD...I know...you see fine...but you could only see the 3 foot letter E on the chart and nothing else!  
But your Mom...if she is not complaining of seeing and you think of this as being a hazard to her well being and your stress level....than I think it doesn't sound like a good option for her.

Misssy2
Posted: Wednesday, May 16, 2018 9:13 PM
Joined: 12/14/2017
Posts: 1677


Imnbed wrote:

I’ll throw my two cents in. I have gone through this with myself, husband and mother. 

One may be allowed to take their usual morning meds with a sip of water. Depends on anesthesiologist and what the meds are.

IV sedation, like Versed, may be used to relax person. It will be light, but sufficient. See next paragraph. It may also block any memory of the actual procedure. It’s a handy and desired side effect. The eye drops given at the hospital do a great job of numbing the eye. (There are many doses of different drops given in the OR holding area about every five minutes.)

General anesthesia is rare for cataract surgery. The doctor wants the patient awake since there is a point in the surgery where directions are given and patient cooperation is needed. Nor do they want you to dose off and startle awake.

The patch is not a patch at all. It is a plastic shield with multiple perforations for air and vision. It does not obscure vision. It is taped to the face and worn until next morning, then at night for a few days. The patient must leave the tape and shield on to prevent incidental rubbing of the eye. My mother had the surgery before her Alzheimer’s was advanced. Now at stage 5-6, she is a “face picker” and probably would not tolerate something on her face. (She had a facial skin cancer removed and had pulled the pressure dressing and skin graft off by nightfall ...return trip to doctor.)

The eye may feel a little itchy for day or so. The eye drops help with this sensation or any pain. There are also steroid drops which prevent scar formation the first few weeks. Scar formation is common even if drops are done correctly. Both my mom and husband had to have a small scar removed on one eye at six months in the office with laser. The other drops are to prevent infection.

All three of us saw immediate improvement in our far vision. Husband no longer needs glasses to drive. It is a great payback for a very quick procedure. If your father has the surgery, you will find that you are hardly comfortable in the waiting room chair before you are told that you can come back to the postop room. I waited for my husband for NINE minutes! It is an assembly line of sorts for the doctor. He did 16 on my day.... another reason to get there early to be at the head of the line!

I hope we have helped with your decision. You see that different people have different experiences. The experience for someone who has dementia adds another level of needs, depending greatly on the person. It will definitely be stressful for you all. Something as simple as eye drops become a big deal. My father undergoes this operation next month. We will have to “double up” with caretakers for him, since Mom cannot be left alone when he is at the hospital.

I'm pretty sure it is like an assembly line procedure with this Surgeon as well.....at least the waiting room for consultations was running like an assembly line and a very efficient one at that...they did the testing...then move to the next room for more testing...then moved to another room to talk to the Surgeon and then to the last room for instructions, prescriptions and insurance information...all cookie cut processes....the same exact process for everyone.
The concern I have now is this patch....because he has not had ANY procedures I think he may be more willing to follow directions....He is a very honest and rule abiding citizen...so he has respect for the Drs and if the Surgeon tells him to leave the patch on or how long he has to leave it on...it is most likely that he will comply.
But, I'm concerned about this after care...I will need to find out what my Mothers involvement will be....will it be paying a Caregiver or chipping in...Cause just taking him to the Surgeon and being with him 2 hours before....doing the drops...etc....and getting him home....is going to be enough for me....that day.
Since it is on a Monday my sister is working...so it is up to my Mom or a Caregiver...I will have to have that conversation with her soon...but I want to wait until I see his Dr on the 21st so that if I have any other information for her...I can tell her all at once.

Misssy2
Posted: Wednesday, May 16, 2018 9:17 PM
Joined: 12/14/2017
Posts: 1677


SelEtPoivre wrote:

I will add another perspective. My mom is legally blind from end-stage glaucoma and only sees shapes and shadows. Because she doesn’t see well, she doesn’t have any of the visual cues that would have helped her recognize objects and reinforce memory (ie, if you can’t see it, it’s harder to remember)

I can’t leave a list for her, or a calendar. If she puts something down in the kitchen, walks away and forgets about it, she can’t find it later, and that can get her agitated.

Visual input is so very important, I would take all preparative steps and get the logistics set up for day before, day of, and aftercare so he can have the procedure with as few glitches as possible

....legally blind and dementia...the poor woman...thank God she has you....I know we are doing the right thing by my Dad having this procedure because he is still trying to read labels in the market....the newspaper, his organ music....the hymns at church...and most of all
He is ready for this surgery...It took everyone (me and the Drs at the eye Drs) to convince him that this is going to be easy, safe and effective and he will be happy to see again.
So the fact that his spirits are up now about the procedure and he is not as fearful is another good sign that he will do well.

JustLikeMom
Posted: Wednesday, May 16, 2018 11:15 PM
Joined: 2/7/2012
Posts: 425


Misssy -  Would you consider responding without copying the other person’s post ?  Maybe just refer to them by name in the first line of your reply instead (or similar) if you want them to know you’re replying to them? All the copying and recopying  makes it hard to get through this thread to the new replies.  Thanks for understanding!
Misssy2
Posted: Thursday, May 17, 2018 8:53 PM
Joined: 12/14/2017
Posts: 1677


JustlikeMom...good idea to reply to the persons post....with the name...it IS annoying to scroll all the way thru these threads....

I don't think the site has very many options for posting....its harder to use than most sites I use...but I can adapt....anything to make life easier


harshedbuzz
Posted: Thursday, May 17, 2018 9:22 PM
Joined: 3/6/2017
Posts: 948


Misssy2 wrote:

Your eye Drs office sounded like it was in the middle of a shuffle while your Husband was going thru his surgeries... 

Not sure why you leap to that conclusion. The office staff were great. Even when DH picked up a stomach bug that left him with severe projectile vomiting after his first surgery. We got the aftercare handout that said he wasn't allowed to lift so I was really worried he;d need a 2nd surgery. The doc called me several times the day after to arrange his follow up- he ended up clearing out his office and staying behind with a single RN to check DH. After we left, they scrubbed the place down. He was late for dinner that night for sure. 

DH's eye surgeon is a professor at one of the top teaching hospitals in the country. I'm pretty persnickety about vision. I took my late father's detached retina issues to Bascom Palmer Eye Institute in Miami. My mother sees a researcher at Boston's Eye and Ear Infirmary for her macular degeneration. DH's surgeon is affiliated with Wills Eye Hospital in Philadelphia. 

I would ask the surgeon to lay out the protocol for aftercare; many reveal the care required going forward as it becomes needed to avoid confusion. My father had a bad outcome from cataract surgery and lost vision in one eye which impacted his depth perception and balance to a significant degree. 

That said. Depending where they are on the dementia journey, sometimes vision problems are a function of brain damage rather than physical issues with the eye.

 

 





 
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