Putting off vision care leads to (surprise!) impaired vision

When you’re having problems with your eyesight, there are probably worse places to work than on a university campus that has just opened a state-of-the-art eye care facility.

And I’ve always had problems with my eyes.

Staring down the business end of the laser. (Photos by Kalani Simpson)

Staring down the business end of the laser. (Photos by Kalani Simpson)

I remember when I first realized my eyes were bad. I was an entertainment reporter for a small newspaper in upstate New York, and I’d been sent to review an opera.

To help the uncultured, the opera was translated via subtitles. As the mezzosoprano belted out the Italian aria, an English translation ran across a thin screen hanging high above the stage.

The problem? I couldn’t read a word. And no one around me was having any trouble at all.

To that point, I’d never realized I had a vision problem. Sure, things got blurry in the distance, but at some point, doesn’t everything? I never knew that my definition of “too far to see” was much closer than a normal person’s.

Still, no long-term effects. I got a pair of glasses, spent a week or so marveling at how crisp the lettering on stop signs was, and life went on.

Many years later, I was put on prednisone for a medical condition. The drug did what it was supposed to do, and I was pleased – but apparently, one of the possible side effects of prednisone is that it can cause cataracts.

The laser wasn't as frightening as I thought it would be. (Photos by Kalani Simpson)

The laser wasn’t as frightening as I thought it would be. (Photos by Kalani Simpson)

I began to realize something was wrong the following summer, when it became increasingly hard to see people’s expressions clearly — especially if they were facing me with bright sunshine behind them. (It was a problem most common in the late afternoon.) A trip to an ophthalmologist showed that I had what the doctor described as “classic” cataracts.

So two cataract removals later (I’m counting one per eye), I was fitted with a pair of trifocals and sent on my merry way, once more able to ascertain whether people were smiling at me after 4 p.m.

Oh, it wasn’t a perfect situation. To remove the cataracts, they also had to replace the lenses in my eyes.

I wouldn’t have cared, because quite frankly I was beginning to feel that my eyes had been letting down the team through the years – but in one area, they’d always been perfect.

There was a point of focus maybe two feet in front of me, right about the place you’d hold a book, where my vision had never wavered. But as a result of the surgery, that point of focus was lost. Now, to read, I would have to wear glasses. (And I read a lot.)

Dr. Gulati takes a photo of my repaired left eye.

Dr. Gulati takes a photo of my repaired left eye.

Still, I’m nothing if not adaptable. And the advent of Kindle, with its adjustable type sizes, has made reading super easy. So my eyes and I were going along quite nicely together, although let’s face it, I no longer trusted them.

Fast forward to this past year, when I began working at UNMC (and receiving health care here), and you find me interviewing a medical student about the VISION Clinic. In the course of the interview, we talked about how people often put off their vision care.

“They don’t realize how bad it’s getting,” UNMC medical student Matt Maslonka told me. “They don’t realize that their field of vision is shrinking until they start walking into things.”

Oh, (insert expletive here). As my colleague Elizabeth Kumru – who has a corner cubicle — can tell you, I walk into things constantly – particularly her cubicle as I’m turning the corner. I used to consider this a result of my preoccupation with deep and meaningful thoughts, such as “Is anyone ordering Jimmy John’s today?” Now, I was wondering if my evil eyes were letting me down again.

Stanley M. Truhlsen, M.D., right, and Dorothy Truhlsen

Stanley M. Truhlsen, M.D., right, and Dorothy Truhlsen

So, you may not have heard, but UNMC has this really big, really new Stanley M. Truhlsen Eye Institute, with state-of-the-art equipment and internationally known ophthalmologists and all sorts of cool stuff.

Even though I hadn’t had my initial eye surgery at UNMC, I decided to amble over to the new building one afternoon to see if our UNMC ophthalmologists could tell me what was going on.

The verdict: My left eye had some buildup – “capsular haze” was the term the doctor used – on the lens. Apparently, when you have cataract surgery at a young age, it’s common for the eye to try to repair itself even though a new lens is already in place. Laser surgery would be needed to clear away the gunk that had built up behind the lens. Speaking with Vikas Gulati, M.D., who is on the faculty at Truhlsen/UNMC and a glaucoma specialist, and who would be performing the procedure, I got the impression that it would be as easy as squeegeeing slush off a windshield – with lasers!

In reality, it was even easier.

For one thing, it was an outpatient examination, and the “laser-into-my-eyeballs” machine (actual name: Nd:YAG, or neodymium yttrium aluminum garnet laser) looked just like any other eye exam equipment. Dr. Gulati had me look through the machine – why do ophthalmologists always want you to look at their ears? – and a couple of bright flashes later, I was done.

Walking back to the 4230 Building from the Truhlsen Eye Institute, I was amazed at how quickly my vision had improved, and how much.

It was something, I realized, I should have taken care of much sooner. The improvement was almost frightening – just how bad had I let my eyes become?

Maybe this time, my eyes hadn’t let me down – maybe I’d let them down.

It's my M3 and I'll cry if I want to

A few years ago, Oregon Health & Science University Ph.D. candidate Katy Van Hook wrote a blog that struck a nerve. She called it Forget baseball, there is DEFINITELY crying in science.

Van Hook, who has since earned her doctorate, was talking about the fact that she was so stressed out by the life of a student at an academic medical center that she occasionally broke down and bawled in her mentor’s office.

I’ve cried in front of my boss, the director of my graduate program … countless friends, several thesis committee members, and a couple qualifying exam committee members if I’m not mistaken.

It was a brave admission, but the response was cathartic. The comments poured in, saying she was not alone:

first year ohsu grad student here: found myself sobbing alone in the bathroom today after a humiliatingly failed experiment, feeling like my life was unraveling before my eyes – your post really goes a long way to reassure me that maybe I’m still on track after all.

Have you, as a med student or grad student, felt the same way?

Well, chances are, you have, says a study (yes, an actual study!) done by Harvard Medical School, Crying: experiences and attitudes of third-year medical students and interns.

Sixty-nine percent of students and 74 percent of interns self-reported crying for reasons related to medicine. For both, the most common cause was “burnout.” … Seventy-three percent of students and 68 percent of interns thought discussion of physicians’ crying was inadequate.

One of the conclusions was: Trainees want more discussions of crying.

So here we go.

Here’s a blog titled First day in the OR, aka crying in public:

Here’s the confession: I totally cried.

I won’t go into the details, but suffice it to say that someone with more seniority than myself (not hard to achieve that level of seniority, by the way) made a mistake, and it was blamed on me.  And the scrub nurse was not happy. Not happy at all.

So I cried. I was so upset – I knew how unfair it was, and I knew it hadn’t been my fault, but still – someone was yelling at me, and telling me I had done something wrong.

Another blog:

In med school… wow, it happened a lot. After exams, before exams, just randomly in the locker room. I remember during my surgery clerkship, we were having a workshop on tying knots, and one student was having trouble with her knots and burst into tears. I still remember what she said: “I don’t even feel that sad. I’m just SO TIRED.”

So, go ahead. Let it out. You aren’t alone. Take advantage of the resources offered by the Counseling and Student Development Center. And share some of your own “crying in science” stories in the comments. We’ll all feel better.

Dr. Mathews, a man for all (sports) seasons

dr mathews sports medicine 002

Monty Mathews, M.D., assistant professor of family medicine, is on duty. He’s not wearing a white coat. He’s not wearing scrubs. He’s wearing a baseball cap, emblazoned with a Nebraska-Omaha Mavericks “O.”

The doc is on duty on a soccer sideline, Caniglia Field, on the UNO campus. He stands with trainers, with coaches, with players (the subs), looking out onto the field. On the green faux-grass, Division I college soccer is being played, bodies slamming, tendons straining, lungs screaming. Mastodons vs. Mavs.

In soccer, players often go down, and go down hard.

In soccer, players often go down, and go down hard.

A young boy, wearing a Jr. Mavericks soccer jersey, also was there on the sideline as a special treat. “I didn’t know sports teams had doctors,” the boy said.

As long as Dr. Mathews has anything to say about it, they do.

And he spends a good deal of his free time making sure that they do.

“It’s my passion,” he said. “My hobby.” His real job is here at UNMC, but this is how he spends his weekends and nights.

And thanks to the season we’re in, his volunteer workload is heavy on UNO men’s and women’s basketball and hockey.

But Dr. Mathews is also the team doctor for the Triple-A Omaha Storm Chasers baseball team. When they won the pennant, “I was out there when they were squirting the champagne,” Dr. Mathews said.

Dr. Mathews, along with a comprehensive med center team, worked the NORECA continental volleyball championship in Omaha.

Dr. Mathews, along with a comprehensive med center team, worked the NORECA volleyball championship in Omaha.

And when the minor-league football Omaha Nighthawks were in business, he was on their sideline, too.

He’s worked marathons and rodeos. He’s at every Brownell-Talbot football game.

These days, more and more sports teams are entering into partnership relationships with orthopedic clinics, and that makes sense. A good deal of sports medicine is knees and shoulders, ligaments and bones.

But then, a good deal of it isn’t. And it also makes sense to have a good old-fashioned primary care, family medicine doc there, too.

That’s why Dr. Mathews keeps showing up.

For instance, all this talk about concussions? “I feel very comfortable evaluating head injuries,” he said. Not every M.D. does.

He’s undergone special training to become a Credentialed ImPACT Consultant (CIC).

Dr. Mathews is not the only practitioner at the med center doing sports medicine. There’s a whole team, headed by athletic trainer Rusty McKune, The Nebraska Medical Center’s sports medicine program coordinator. And providers from UNMC, TNMC and UNMC Physicians have staffed national athletic events in Omaha, like the U.S. Figure Skating Championships, the USA Swimming Olympic Trials and the North, Central America and Caribbean Volleyball Confederation (NORCECA) Continental volleyball championship.

Dr. Mathews works closely with other practitioners, like UNO men's soccer trainer Philip Dennie (in black coat).

Dr. Mathews works closely with other practitioners, like UNO men’s soccer trainer Philip Dennie (in black coat).

They all work together, the way Dr. Mathews works with athletic trainers and orthopedic docs.

The Mavericks have a great training staff, in this case, Phil Dennie. Dennie and his fellow trainers could easily handle 95 percent of what might come up during the game. But that five percent left over?

“I can handle 90 percent of that,” Dr. Mathews said.

Meaning, he could initially evaluate, diagnose and treat nine out of 10 of the injuries the training staff would ask him to look at. Beyond that, he would ask for assistance from emergency personnel or other specialists if athletes needed to be transported to the hospital for central nervous system, spine, major bleeding or complex orthopedic injuries.

Luckily, at the soccer game, none of it comes up.

If you're at a sporting event in Omaha, there's a chance Dr. Mathews is there, too.

If you’re at a sporting event in Omaha, there’s a chance Dr. Mathews is there, too.

But it wasn’t his only appointment of the night. He also was set to be the team doc at the Mavericks’ hockey game down at CenturyLink Center. Would he have to hurry?

Doctors know better than to hurry.

“I’ll have to be efficient about it,” was the way he put it. And he was. After it was over, after the Mavericks had won 4-0, Dr. Mathews double checked with the training staff, to make sure there wasn’t anyone he needed to look at. Then he did the same with the visiting team. And then he was gone. Off to his next sideline. Off to make sure another sports team had a doctor in the house.