Cataract surgery Attempt Failed

Well, I had a bad day yesterday. It was time for eye #1. I had also found out the other eye was virtually un correctable. but they still want to do it later. I had a bad high BP issue yesterday so they wouldn’t do the surgery. I had fallen and smashed my head and neck in October, so I was not feeling tip top anyway, but my BP had been just fine. It went up the day I fell, and was at the ER but once home it was ok. I read that spinal/cervical neck issues can also cause some BP problems. I’m seeing a doctor for all that late this month. He said that doctor was not sufficient for anything.
This clinic was frantic. They first told me to take no insulin for 12 hours, and I explained that ummm then I would be in the ER not eye surgery. I had a hard time getting my BG down, but apparently I was stressed. So, the anesthesiologist explained he could not do the procedure. Fine, I get it. I promised to verify my BP meds were working ok. But he made me sign a paper that only a Primary care doctor could evaluate my BP. My CDE, CNP has regulated my thyroid meds and BP for years. She’s got it figured out. He said she was unqualified. He would not accept anything from her.
So we have a Primary Care shortage here. My husband just lost three doctors in a row, waited months for a new one who told him since he has cancer, she wont see him (he was already there in front of her). She referred him to a different place, with a now five month wait. The local university health system has a one year wait. I reminded him of this and he wasn’t very nice to me. Insisting no other doctor but a primary will do, and I need signed documents from such a person or I am not allowed back in the surgery center. He also said no primary care doctor will turn down a diabetic and he thinks they are the only people a diabetic can trust with BP.
I intend to follow up with my CDE, and will be seeing the spine dr as planned. But now I’m thinking, maybe I need to try a clinic where they do anesthesia free cataract surgery. They do a tranquilizer and whatever. I got an appointment and it’s on my plan.
I don’t know how my plan will look at yesterday’s failed mess.

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I am sorry to hear what you have gone through. I can just tell you my husband just got cataract surgery about 6 months ago and they didn’t knock him out. We go to an eye center and one of the doctors there does the surgery at the hospital. But they just give you a calming drug and then paralyze and drug the eye while you are awake. An anesthesiologist was there to monitor everything. It took about 30-45 minutes. He didn’t even have to get clearance from anyone, just a visit to the same eye doctor before as a precheck. He’s not diabetic per se as he’s a controlled is/was type 2. For me when I had laser surgery on my eye (easy stuff) all he wanted to know beforehand was what my A1c was for healing purposes. My Dad when he had his cataract surgery years ago, they didn’t knock him out either.

This happed to me. Years ago about 14, I was scheduled for an test for endometrial cancer. The pre-op folks said take half the insulin meds the night before. I did so and none the day of the procedure. Get prepped to go in the surgery and the anesthesiologist canceled the surgery. I was very upset. Glucose too high. Had the scaping with no anesthesia in referring surgeons office. It was not bad. I do not know if I would re commend it. Currently I would go in at 150 BG, not stopping meds, and then disconnect pump and I would not go up or down much during the procedure.

I take olmesarten for bp. Take 25 a day, Had pretty resistant blood pressure.
Tis seems to work for me.’ Good wishes

It’s unfortunate that you live in an area with so little choice of body repair mechanics. I call most doctors repair mechanics because they couldn’t make a human body. They literally don’t understand how one works except at a superfical level. Like car mechanics , doctors aren’t uniformly competent. Unlike car mechanics, doctors are members of a guild that protects them from consumers.

It’s more unfortunate that you had no way before you needed a doctor to learn that the ones you need in your area aren’t competent in general medicine, let alone diabetes care. But you aren’t alone. Most people wait until they have a problem before meeting with a doctor, don’t find out what tne doctir is capable of until too late.

It’s not their fault that doctors don’t actually understand much, and what they “know” is mostly anecdotal information in the form of warnings from others who didn’t really understand what they witnessed. The “first do no harm” credo, taken literally, is to do nothing. It takes a special kind of bravery (ignorance or arrogance) to attempt anything when you don’t really understand how something works.

But ignorant medicine seems to have gotten worse with corporate medicine and siloed specialties. There they follow guidelines from committies and don’t directly talk to each other about individual patients under their mutual care - unless there’s an inquest.

Some of this can be excused because of the small number of doctors in the US. In 2016 for 320 million citizens, there were total 950,000 doctors (336:1) , 202,000 of them PCPs (1584:1), 45,000 opthalmologists (6670:1). For the 34 million PWD there were 8000 endocrinologists (4250:1 ).

To address this shortage there are now new regulated, licensed medical practitiioners. Every Certified Nurse Practitioner nurse in the US is licensed to diagnose, prescribe and regulate chronic conditions like blood pressure. Making you sign a form saying that only a PCP can assess your BP is illegal. I wouldn’t allow an anesthesiologist who did this participate in my care, but I would report them to the facility adminstrator.

I agree. I’m trying to visit other surgeons in my plan while my CDE CNP works on my thyroid dose and BP meds. With a severe shortage here, they ought to be smart enough to know that having a CNP who is already your prescribing person, has a greater chance of correcting things promptly.

If your endo or internal med doc refers you to a surgeon, he or she should be used to dealing with diabetics, or at least be a resource for the surgeon. I feel fortunate to have had an endocrinologist present when I had a surgery many years ago.
It was surgery to remove a cancerous tumor when I was just 26.

Maybe they went overboard back then. There was no cgm and they did finger sticks during the procedure. I was taking regular and nph at the time. I have no idea what insulin I took that morning, but I knew that I needed a tight range for the surgery.

Medicine is different now, to expect having an Endo present for surgery on a T1 sounds like a crazy extravagance, but I felt lucky to have him there.

If I need surgery again, I would be in a consult beforehand talking about specifics how they will deal with blood sugar and what the limitations are regarding range and what happens if it goes high or low during the procedure.

A decent surgeon should have a talk with you, I know they are all busy, but it’s in everyone’s best interest. This way you would know what your sugar needs to be when you get there, and not rely on a broad, take half your dose kind of boiler plate stuff.

I suspect I will need hand surgery in the coming years, so I’m already looking into who I might want to do it, and for certain it will be someone who understands type 1 and all the weird crap, like low blood pressure,very slow heart rate, which are rare in diabetics, but anesthesia slows your heart, and I want to know someone in the room understands the unique patient on the table.

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I’m thinking the reason my BP went so high is because when I hit my head in October, i started having what may be post concussion issues. I’m now trying to get to see a neurologist, but they are actually scheduled one full year out. I guess post concussion or whiplash can cause your system to do some funny things, including blood pressure changes/disregulation
I found a nice new cataract surgery place, and theyre good to go but I gotta get this whiplash or whatever, resolved…

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@Timothy Do not count on getting specifics dosing judged on you as an individual or at least what your preferences are. 7 years ago I was to have a surgery and checked with my endo for suggestions and she said take your normal basal. I dropped and ended up at 75 of what turned out to be a rather short surgery. I had another surgery a week later and my endo then said take half your basal the day of. She was a type 1 herself and it was just a standard response. I think the anesthesiologist might have given me a little glucose as I went in too high and slowly dropped to 150 and then went back up in the 200’s. I suppose at least I didn’t end up over 300 plus.

And to add, this was before I wore a CGM, when I talked to the anesthesiologist beforehand for the next slated 5 hour surgery, I asked how often were they going to test my BG level during surgery as I had dropped the first time and that I had reduced my basal more, but it was a concern what my blood glucose levels would do. He said they usually only do one test right before surgery. So I asked can you test me at least half way through and he said yes. It turns out I was tested 4 times during the surgery. I had the slow drop and then an increase. Maybe they gave me some glucose. That surgery was at a large university teaching hospital so I was surprised at the prior sort of nonchalance about my BG levels for a 5 hour surgery. They even have a anesthesiology department you meet with before who said address your concerns to the anesthesiologist before your surgery.

A month ago for a colonoscopy. I had been given instructions by the gastro doctor who knew I was a type 1 diabetic, instructions for surgery and anesthesia. Half insulin the day before and none the day of surgery. When the nurse handed me the instructions I said no way can I do none the day of surgery I will be over 300 in hours. She looked kind of shocked. In fairness there are not very many type 1’s on our island so they are probably only geared towards type 2’s taking insulin.

When the anesthesiologist asked about my insulin dose, I told him I was on a minimum basal rate I had tested, that the instructions had said no insulin but being a type 1, I could not do that. He said that it’s good that I could take my own initiative and make judgements as to what I needed. Hmm, that means some don’t?

But the other problem was my CGM. I had been running higher than I should have that morning and actually took extra insulin. It turns out it’s probable I loosened my omnipod pod running to the bathroom so much and I wasn’t getting my insulin completely. I went into the hospital at around 165 but shot up to 190 when I went into my cubbyhole. They did a hospital blood check and it said 158, I did a finger stick and it said 162, what is my CGM doing? It had been being accurate. So the anesthesiologist and me agreed to ignore the CGM. Which started working completely accurately again when I left the hospital. And still is on a restart. All I can think of is something at the hospital interfered with it. That doesn’t bode well to think it will be helpful in the future.
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I agee. Usually the anesthesiologist is the one most concerned about blood sugars. Surgeons of late have been reviewing A1c with me. Years ago, i did the boiler plate take half the insulin… and surgery was canceled due to high glucose

The eye doctor office told me to take no insulin for 15 hours. No wonder my BP was high. They started my stress in the pre op visit.

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@Laura_S The thing is they don’t want to worry about you going too low and the people they mostly see are type 2’s. Most doctors really aren’t that familiar with type 1’s. An endo might give you a generic suggestion, but at least it will be a generic suggestion for a type 1.

Love love Snoopy!

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