Eye surgery experiences and painkiller advice needed.
February 19, 2015 10:14 AM   Subscribe

I have Salzmann's Nodular Degeneration. My worst nightmare is happening, and I will soon (two weeks) be getting surgery in which my cornea will be sliced open (with a blade) while I lie there, fully awake. Help me freak out less.

I've read (and reread) this helpful question. At this point, I am looking for further anecdotes about this kind of surgery, which I believe is called superficial keratectomy (I don't remember what the doctor called it, but the descriptions fit what she told me). Though my condition (Salzmann's) is fairly unusual, my doctor does this type of surgery all the time. She says it's best to peel the layer of scar-like tissue off my eye manually. Once she does, she's going to lay on a sponge with a chemical on it that helps keep the stuff from returning. Then I'll be put back together, with a contact lens bandage on top. My questions: What will I be able to see during this? Will my non-surgery eye be open? I'd rather be as unaware as possible, but I'll only be on Valium. I know the procedure will take about 10-15 minutes but that sounds like an eternity.

And, for aftercare: I have heard it will be very painful for several days. I had a bad reaction to the painkillers I got after a surgery 7 years ago -- my heart was racing and even though I was exhausted, I couldn't seem to let myself fall asleep; it felt like if I did, my heart would stop. I ended up having to take mega doses of ibuprofen which only partially dulled the pain. Has anyone else had that reaction, and did you find a painkiller that worked better for you? (Propofol worked great for me pre-surgery, but of course that's IV-only...)
posted by chowflap to Health & Fitness (20 answers total) 3 users marked this as a favorite
I have not had that particular procedure, but I have had a cataract surgery done while awake. (Open the cornea, remove the lens, put in a new - fake - lens, sew everything back up.) In my case, after I was sedated, they put a topical numbing ointment on my eye. My recollection is a bit foggy, but I don't think I was able to see much out of that eye - light, maybe, but the ointment made everything too blurry to comprehend.

I can't speak to the other parts, but these are things you could find out by calling the doc (or their office) and asking. For example, many eye procedures will be done with the rest of your face covered with a surgical drape, and you won't be able to see with the other eye; you could ask if that's how this is done. Your pain management question is also one they should be able to answer.
posted by spaceman_spiff at 10:39 AM on February 19, 2015

I suspect that the 10-15 minutes counts some setup and wrap-up and that the actual procedure part you describe is quite short. Usually the other eye is covered in an eye surgery like this. You typically will have topical numbing and maybe a shot of a novocaine-like numbing medicine as well.

By the way, propofol has no analgesic properties - if you experienced pain relief from it it's because it made you forget what happened (it causes amnesia).

Don't take mega doses of anything, you could end up with side effects or complications. If you need more pain meds after a maximum prescription dose of ibuprofen, try alternating with Tylenol. You could ask your doc to prescribe 800mg ibuprofen (assuming they feel that dose is safe for you) so that you only have to take 1 pill at a time.
posted by treehorn+bunny at 11:04 AM on February 19, 2015

Oh yes, the propofol was just to chill me out for a few minutes before putting me under. I think I was confusing using that for the surgery and for using it for pain relief. I took the mega-ibuprofen under doctor's recommendation, and I didn't go over what they prescribed (maybe 600 mg at a time?).
posted by chowflap at 11:15 AM on February 19, 2015

My impression from watching this kind of surgery in the past was that you would not be able to see anything from the affected eye, and the other one will probably have a drape over it to maintain sterility. I am not an ophthalmic surgeon - yours will be able to give you much more specific advice.

You might find this link reassuring.
posted by tinkletown at 11:18 AM on February 19, 2015

I've had various kinds of surgery on both my eyes. It's not pleasant, but it's not the Un Chien Andalou nightmare you're worrying about. For one thing, the Valium really does make you pretty spacy (it also tends to make you forget whatever you experienced pretty thoroughly, so you shouldn't worry about reliving the trauma over and over). From the bits and pieces I do remember, you mostly see BRIGHT--DARK--BRIGHT--DARK. You're not really seeing shapes or objects or anything like that (the operating room lights are aimed right at your eye, for one thing). Mostly, though, you're not really holding onto your train of thought very coherently because of the anti-anxiety meds, so you look at it all from a bit of a distance.

The main advice I'd have would be to talk to you doctors about this; tell them you're anxious about how it's going to go, and listen to what they have to say about typical patient experience. And on the day of the operation itself make sure the anesthesiologist knows you're worried and talk it all through with him/her carefully before the op.

Similarly, find out exactly which painkillers you were on that you reacted to so badly in the past and talk with the surgeon's team about getting a different class of painkiller prescribed to you, and maybe even having a back-up prescription available. There are quite a lot of options out there so you should be able to find something you don't react to--you just need to make clear to your team that you had a really serious reaction to whatever it was you were prescribed before.
posted by yoink at 11:34 AM on February 19, 2015 [2 favorites]

I had Laser surgery last year for glaucoma, and I was pretty freaked out about it. But it turned out to not be a BFD.

1. Valium. Take one early, they chill you out. They are the BEST! What's great is that even if you're uncomfortable, or afraid, you won't have that awful feeling.

2. The numbing stuff on your eyes. Works really well. You feel that something is happening , but you don't feel pain. Just let yourself stare at a spot on the ceiling, breathe in and out.

3. I found Morphine to be a dandy pain reliever. But do speak with your doctor about any meds you've had in the past. There are a LOT of things that can be prescribed, don't settle for something that makes you feel weird.

Good luck, it really is going to be fine. Don't fret.
posted by Ruthless Bunny at 11:44 AM on February 19, 2015 [2 favorites]

For one thing, the Valium really does make you pretty spacy (it also tends to make you forget whatever you experienced pretty thoroughly, so you shouldn't worry about reliving the trauma over and over).

Repeated for emphasis. I have not had eye surgery, but I had a root canal under similar circumstances, and even though I could hear and feel everything, I didn't feel any pain--and more importantly--I did not care. Apparently most people can't remember, but although I can remember the weird crunching noises and probing feeling, it was A-OK. It was all happening in an odd detached way, like in a dream, no pain, no horror, no emotion whatsoever except a vague pleasant feeling. Not at all traumatic. If your experience is anything like this, you'll be fine.
posted by epanalepsis at 11:59 AM on February 19, 2015 [2 favorites]

I have not had eye surgery but I have had surgery during which I was awake, and I strongly recommend self hypnosis for not freaking out. And pain control. They may even let you have ear buds during surgery if you ask. If not, you can practice a lot in two weeks.
posted by bq at 12:32 PM on February 19, 2015

I had eye surgery two weeks ago. Before surgery I had a bunch of numbing drops and a valium. (If you feel like your eyes are extra sensitive or something, feel free to ask for more numbing drops. Talk to the anesthesiologist.) It felt weird but did not hurt. I chilled out and listened to a relaxing playlist of music before surgery, which was pleasant. The valium really shuts off the panicky, fight-or-flight stuff.

The worst part was the fact that they laid a sticky sterile plastic sheet over my face, and removing that was kinda uncomfortable, like pulling a Band-Aid off your whole face. During the surgery I could sometimes see lights and blurriness, and sometimes I could just see darkness and stars. I mentioned each change to the doctor, and I was assured that it was all normal. He encouraged me to try to keep the other eye open (I think mostly to relax my face and keep me from squinching it up). They played top-40 radio during the surgery, and I was comfortable enough to actually listen to it.

Afterward I had what felt like a localized headache around my eye. Tylenol and ibuprofen took care of that pain. You're having a lot more done to your cornea (I just had slits cut in the side), so make sure you're in good communication with your doctors office. Don't be afraid to page the on-call doctor if you're having trouble afterward that you think is abnormal. They're there for you.

After surgery, do not send fighty and rude Memails when you still feel dopey because of the valium. Again, sorry about that.
posted by purpleclover at 12:48 PM on February 19, 2015 [4 favorites]

I recently had an eye surgery that's normally done awake. I explained to my surgeon that I was terrified of the prospect (and had had traumatic experience as a child) and we ended up doing it under general anesthesia. This was of course total overkill and majorly increased my risks during surgery but it was such a relief. I'm relatively young, healthy, and have always done well with general, so your mileage may vary, but if you find that you really can't let go of the terror, it's something to ask about.
posted by teremala at 1:46 PM on February 19, 2015

Teremala, they actually gave me that option -- to have it done under "twilight sedation" -- but it would have meant changing the date and location, and adding an anesthesiologist to the bill, so I told my doc I'd muscle through it. I think I will get through it without massively losing it (though there may be some crying).
Thanks to everyone who's answered so far -- it's helping!
posted by chowflap at 2:07 PM on February 19, 2015

I've never had eye surgery, but I've had Valium before dental work due to serious dental phobia, and I can absolutely co-sign what everyone else is saying. Due to some unusual nerve anatomy in my jaw, my dentist didn't get everything totally numb the first time through, and I could feel some pain while she was drilling. My thought process was like "Wow, that is DEFINITELY the sort of thing that under ordinary circumstances would freak me out. Like, it really would! Wow, that is so far out!" Just tell them that whatever the maximum dose of Valium they would recommend under this circumstance is, that's the dose you would like, please.
posted by KathrynT at 2:15 PM on February 19, 2015 [1 favorite]

My wife works for a pretty well regarded eye surgeon. I forwarded her your question, and got a lengthy response. I'm going to memail it to you, as it's a bit much for Ask.
posted by DigDoug at 2:16 PM on February 19, 2015

Hey, I have Salzmann's too! Although at this point, mine doesn't require anything other than regular exams to keep an eye (...heh) on it. But I'm keenly interested in how your surgery goes, since there's always the possibility that I may need it someday down the road.

My mom recently had cataract surgery, and was awake -- she said the Valium made her loopy enough that she really didn't care what was going on. She couldn't really see anything, and couldn't really feel anything either.
posted by sarcasticah at 4:04 PM on February 19, 2015

I had LASIK, which is much less invasive, but includes the "OMG they're doing weird stuff to my ratcheted-open eyes" thing. I mostly got through by reminding myself how quickly it would be over. I made it sort of a meditation, repeating to myself "it will be over soon." (This also helped me though childbirth, for what it's worth.)

Post-op (which again I recognize was not comparable to yours) I asked friends in advance to send me music playlists so I could spend a day listening to their tunes and feeling loved. One way to improve your pain management may be to think of what you want to do during that period that would be comforting.
posted by metasarah at 4:16 PM on February 19, 2015

Thank you to everyone who answered. Special thanks to DigDoug who sent me a MeMail with his wife's reply. I feel much better!
posted by chowflap at 7:22 AM on February 20, 2015

If you are typically an anxious medical person, one valium may not be enough, and you should talk to your doctor ahead of time about that. I had lasik surgery a few years ago, was given 2 valium pre-surgery. The dose was not nearly enough to keep me calm and able to hold still on the table.

The surgery itself was not at all painful, and they put a tiny little inner tube like thing on my eyeball to keep it from moving, which greyed my vision out entirely, so I couldn't see anything coming at my eyeball. But the psychological panic was overwhelming. The surgeon had to stop the procedure, give me 2 Ativan (on top of the 2 Valium I had already taken) and let me sit for 20-30 minutes for it to kick in.

The surgery went super smoothly after that, and I was high as a kite for hours afterwards. I remember the lady who checked us out of the office remarked that she heard I had a hard time. I said, "yeah but I'm sure it happens a lot" and she gave me the blankest look while saying, "no, it doesn't."

My data is extremely anecdotal, and I am prone to panic attacks about potentially painful things (fainted getting a tattoo and giving blood) but if you are at all similar I strongly suggest asking for more drugs up front. For what it's worth, despite my weirdo freakout, I would totally do it again if I needed to.
posted by nerdcore at 12:29 PM on February 20, 2015

I've had lots of surgery, including eye surgery, and I'm here to tell you that the nervousness you're feeling right now is honestly the worst you will feel. The Valium will be great and you'll feel so relaxed (even if in pain) that it's all over.

Best of luck!
posted by mgrrl at 4:29 PM on February 20, 2015

Two people in my life have had corneal transplants, a process which sounds at least somewhat similar to what you're going to have (peel off layer, add new layer). One person did it under Valium/local anesthesia, and one was so paralyzingly afraid that the only way they could talk themselves into doing it was by doing it general anesthesia.

The person who was awake for it - who has the kind of "don't touch my eye" terror that only someone who has eye problems can have - relates it as "Once the drugs kicked in, the doctor said 'I'm going to do surgery on your eye now' and I said *breathy voice* 'ohhh, ok, that's cool'." Needless to say this is not the reaction they would have normally had to such a statement. At all. It would normally have involved them losing their shit and bolting out of the chair. So...the twilight meds they give you are apparently pretty amazing.

They had small children at the time and according to what they remember now, they were able to be up and functioning within a few days with just some pain meds.

The person who did it under general had a tougher time; they woke up combative during that "body moves, but brain not really working yet" period, popped a stitch from the fighting, and had a much longer period of recovery and pain as a result.

Both people say that the big-gun pain meds were really important to staying sane during the first week (or more, in the case of the popped-stitch person). If one didn't work for you in the past, tell your doctor about it beforehand and ask for another. Post-surgical pain - any serious pain, really - is not something you want to be trying to beat back with just some Advil when there's better options available, for the sake of your own sanity.
posted by Hold your seahorses at 7:30 AM on February 21, 2015

Hi all, I thought it would be helpful to supply a post-surgery update! I had it done on a Friday afternoon, and was back at work on Wednesday -- but honestly, I could have gone in and worked on Tuesday. The actual procedure was weird, but to my surprise, the Valium really worked. I was super relaxed and just unable to get anxious about what was happening. It did take about an hour to kick in fully. When it did, they led me to the procedure room and I hopped up and laid down on the cot/table thing. They put a drape over my other eye, then the taped my eyelashes back before adding the plastic ring thing that keeps your eye open. Then they added numbing drops, which stung a little, and kept adding them until it stopped stinging. I was staring at a big light overhead which was a bit uncomfortable and I told them so, so they tilted it slightly. When the actual cutting and stuff was happening, it all seemed to happen in my peripheral vision -- I could still see the ring of the light above me. I felt absolutely nothing. At one point the doctor was explaining to someone observing that what she was doing was "like scraping gum off a sidewalk" which was... vivid. Again, I felt no pain, and even hearing them talk about what they were doing was just sort of fascinating and not scary. They put a contact lens bandage on, then I sat up and walked out. I looked at myself in a mirror, expecting to see some gruesomeness, but it looked like nothing had happened! Amazing.

We went home (do not drive yourself!) and I slept for a lot of the rest of the day. Over the next couple of days the pain actually increased, and peaked on Sunday night. It kind of feels like when your eyes are dry and burning, but more so. Not a stabbing, intense or focused pain. Keeping my eyes closed always helped a lot. I also tried taking Tylenol with Codeine, and though they gave me an anti-nausea drug as well, it still made my stomach churn. I just used ibuprofren and kept my eyes closed a lot (which meant a lot of napping). Monday morning, my pain was much, much less. I was happy to get the contact lens out the next day -- it just felt yucky, like a contact lens you've been wearing too long (heh). It's been a week and a half since the procedure, and my vision is still a bit blurry. It's annoying but not debilitating. Supposedly it will improve slowly over time. I am still on eye drops, ones that taste terrible. Did you know there's a little tube that goes from your eye to the back of your throat? Yeah. I looked it up online and found "one weird trick" that actually works for me: Put in the eye drop, then press, with a finger, the bony side of your nose right next to the corner of your eye. Gotta keep it there for a couple of minutes, then you're all set. It's worth doing, because the prednisone drops are pretty nasty.

So, there's my long story. Thanks again, AskMeFi!
posted by chowflap at 2:04 PM on March 17, 2015 [4 favorites]

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