3-15-11 Tuesday  + 4 ½  months

Your comments are so clever and uplifting.  Laughter is indeed the best medicine.  I frequently have to administer eyedrops, which involves a whole routine of getting Kleenex, lying down, taking my glasses off.  Several times I can’t find where I laid my eyeglasses, only to discover I had already put them on.  I laugh at myself each time.  Thank goodness there’s some humor in all of this.

Status:  Dry eyes aren’t quite as troublesome as dry mouth, but fortunately I saw the ophthalmologists today.

Events: First seen by a technician who took me through the regular exam: visual acuity, colorblindness tests, ocular pressures checking for glaucoma.  Then seen by a Fellow, who did more extensive tests: viewing retina, cornea, and conjunctiva, and a special exam called Schirmer’s test, in which they place paper strips against the lower eye for 5 minutes to see how much tear production you have.  I had none, which officially documented my dry eye problem.

  Next came the attending physician and two doctors from Brazil, visiting the famous Institute for educational purposes – everybody got a look see.  After confirming that GVH was responsible we talked about a solution.

 Chronic GVH damages your tear glands (the same phenomena that occurs in my salivary glands and subsequent dry mouth) and decreases tears.  My immune system sees my tear glands as foreign and attacks them.  The treatment is two-fold, one is to use immune blocking eyedrops, in this case Restasis (you’ve probably seen their ubiquitous TV commercials), which is an optical solution of the anti-rejection drug cyclosporine.  Cyclosporine was the breakthrough that made early kidney transplants possible.  Hopefully that will stop the immune attack and allow the tear glands to work.  The second is trying to keep the eye moist by plugging up the drain and not let whatever tears are made runoff.

  If you look in a magnifying mirror at the inside of your lower eyelid nearest to your nose you’ll see a little hole called the punctum.  That’s where tears drain down the tear ducts and outlet through your nose (the reason your nose runs when you cry).  You also have the same puncta (remember your plural Latin) on the upper lids, but they’re hard to see.  They inserted tiny plastic plugs to keep whatever tears are made where they are.  The ophthalmologists were informative, considerate, and caring.  It’s a nice clean job, and patients are invariably grateful.

Comments:  Talked with my oncology team today about the lesions in my lung.  They want to know exactly what they’re dealing with (a common fungus resistant to the anti-fungal I’m on, a rare fungus, or maybe something all together different).

   So tomorrow I get up very early to see the pulmonologists and have a bronchoscopy.  A bronchoscopy is accomplished by putting a tube down into your lungs and taking a look and perhaps snipping a sample of tissue.  It’s done while you’re awake, and I’m not looking forward to it.  But it’s the only way to know what we are doing.  The moles keep popping their heads up.  I’ll probably be pretty spent by tomorrow afternoon, but I’ll try to let you know how the day went.  I do keep laughing at how many orifices they’ve found.




7 Responses to “”

  1. Lynn Oliver Says:

    bronchi, lacrimal ducts–anything left to intubate? hopefully “they” won’t think of anything
    laughing with you too and loving your posts, as always
    you continue to inspire
    good luck tomorrow–may they find nothing fungal

  2. judy moss Says:

    Although I haven’t commented in a while, I have read and enjoyed each and every one of your posts. We continue to keep you in our thoughts and prayers. Larry and I had dinner with Terry tonight and talked a lot about you. I had asked him about your education and jobs through the years. Very, very impressive!!! No wonder you are such a big help to the doctors in your recovery. We hope and pray that all of the side effects and problems that you are suffering from will go away and that you will be back to 100% again very soon.
    Love, Judy (and Larry)

  3. Margot Says:

    Bruce, I hope this day goes well and goes by as quickly as possible. I always learn something – I thought the tears came out of those holes – not drained into them! I have to say that I squirmed a bit over the plugs but then your next paragraph brought my perspective back! Thank you for continuing to inform and always make me want to learn more – even when I am well out of my comfort zone. XXO

  4. Victoria Cushey Says:

    Darling Bruce,

    My thoughts and prayers of love are with you — it’s been a tough time for sure. Please let us know how things progress tomorrow. I’ll be thinking about you and sending you my love and hugs.


  5. Espranza Says:

    Don’t remember if they did that bronchoscopy on me before my lung surgery so many years ago (you graduated medical school that year) I think, maybe. Doesn’t hurt anymore. Love you!

  6. Donna Hill Howes Says:

    All positive thoughts for you today w your bronchoscopy. Know you are in the very best of hands. Also know that your “army of supporters” goes with you. Love and more love, Donna (your favorite eye nurse!!) Know the great folks at Wilmer are doing their best for you too. CO

  7. joel steinberg Says:

    Good luck on your bronchoscopy. We await the results. Joel and Margaret S.

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