Aging, Eye Problems And The Changing EMS World

The last few weeks have been interesting to say the least.

I have not really written much on my on health in the past but it seems as I age that my health is trying to get my attention. In December of 2016 I required surgery for multiple meniscus tears and a strain of a ligament in my left knee. This was a surprise as I always referred to the right knee as my bad one and had awaited with much trepidation the day it would finally "go." So I was actually caught unawares as I hit the bottom step at home and the left knee gave way totally without warning.

Needless to say, I was hobbled for about a month. All in all, I bounced back pretty quickly although I am still unsure as to when I will be fully ready to hike or backpack again.

Fast forward to last week. It was a Monday. I had spent the day before moving furniture, boxes and assorted other heavy items. I had been at work for about thirty minutes and was sitting in another manager's office having a discussion when I saw a bright flash of light, then intermittent flashes that looked like lightening in my right eye. After about three hours of this and the development of "floaters" in my vision (I am calling them a floating ball of dancing snakes), I finally went home thinking it could be a migraine. I tried sleeping it off and it did not work. 

I got up and went to teach the next to the last night of my paramedic class (Respiratory and Cardiology) and noticed something different. There was a definite blackened crescent in my vision in the affected eye whenever I looked to the left, along the peripheral edge of my vision. The lightening was now more pronounced and the floating snakes were more distracting than before.

After class, I had to go pick up my son. I was starting to do the paramedic self-diagnosis thing and kept coming back to the fact that Retinal Detachment could not easily be ruled out without an exam. Retinal Detachment has to have surgical intervention quickly or you lose sight in the affected eye. I texted my mentor, a trusted ER physician, with an ambiguous "asking for a friend" type text. He saw right through my guise and had me go to the emergency room. It was approaching 9:30pm by the time my wife found out and took away my driving privileges, driving me to the ER.

Around midnight, the attending ER physician came to the same conclusion as I that the worst case scenario could not be ruled out. He called the on duty ophthalmologist. He wanted an exam first thing in the morning and I was to sleep only on my left side for the remainder of the night.

Me and my snake-filled right eye complied.

The morning came. I called. They wanted me there in fifteen minutes. I complied.

Quick tomography and a thorough exam revealed that it would be better news than expected. I was already preparing to have my eye dissected in a free-standing eye surgery center when I found it would not be needed.

The night before at the emergency department I was staring at tropical fish in the tank there wondering if my sight would potentially be limited to one eye. You know, the things we never think about because we take sight for granted. I had spun a lot of prayers out the night before and in the morning.

So... it turns out that it all has to due with aging (and activated potentially by heavy lifting). As we age, the vitreous fluid in our eye becomes more gel-like. When it does that and you increase ocular pressure (like with lifting), that gel can separate from the interior surface of the eye. This condition is called a Posterior Vitreous Detachment.

So, I had PVD... and two small hemorrhages; one on the interior surface and another on the retina. 

The good news. No surgery required. I am thankful. Needles inserted in the eye do not appeal to me (or anyone I think).

The floaters are manageable and depending on what source I listen to regarding prognosis, they may never go away. The flashes have decreased. I have a follow-up visit in three weeks.

During all of this, I am still a medic. During the past week I have had to go to Indianapolis to take a Handtevy Pediatric Instructor Course (best course EVER by the way), given a paramedic module final exam and chaired an Indiana EMS Commission Meeting and had a stretch of six days where I had less than 20 hours of sleep. Such is this life.

At the start of this week, I have already noted road rage against an ambulance doing exactly what ambulances are supposed to do, I have been on what I can only say is the most violent scene I have seen in my EMS career... and this week is not over.

Tomorrow, my son graduates high school. Again a hectic week.

With aging comes change. As I age, I am noticing that the world of EMS is changing quicker than what I age.

Violence on EMS scenes is increasing. The violence we are exposed to is increasing. The importance of intubation is decreasing. Children ARE little adults. We must train like we fight. Cardiac Arrest medications probably, rarely, if ever work. Quality CPR and staying on scene to work the medical and pediatric cardiac arrests produces better outcomes. Supraglottic airways are coming of age and produce great outcomes and less complications as they evolve. We now have smartphone applications for EMS protocols. Long spine boards are bad and response times rarely matter. Tourniquets are good again. Curricula is behind the eight ball before it even hits print.

When I started as an EMT in the early eighties I never dreamed we would have an automatic defibrillator or that it would ever be public accessible. I never dreamed I would be a paramedic either. 

And now we pack wounds with gauze containing clotting agent.

It's all good. We will adapt. I will keep on learning and keep on teaching. Good stuff is coming.

And I will do it all as my mind teaches me to ignore the snakes in my eye.

It is good that the brain adapts to that...

They are now in the left eye too.