Monthly Archives: April 2017

CBT for RD… WAPOS!

The emotional impact of retinal detachment is an issue which is frequently discussed in my online RD support group.  Recently it came up again, and there was some discussion of the role of various forms of counselling in helping people to deal with the anxiety and depression which are often associated with visual impairment.  It got me thinking about my own experience of CBT (Cognitive Behavioural Therapy) with regard to this, so I thought I’d scribble a few things down…

It was the Occupational Health woman at my workplace who referred me for eight sessions of CBT with a local provider.  This was back in September 2015, not long after my return to work following surgery number five to fix the detachment which occurred less than two weeks after my surgery to remove the oil.  Needless to say, I wasn’t in a great place.  Feeling distraught and depressed after my hopes had been crushed by the fifth detachment, I was riddled with anxiety about my vision and my future.  I was grieving for the sight I’d lost and insomnia was my constant nightly companion.  Furthermore, there was talk of yet more imminent surgery, which I was quite frankly terrified of.  Knowing that CBT had a reputation for being very effective in treating anxiety, I leapt at the opportunity when it was suggested to me by the Occupational Health woman.  In retrospect, I should have known better.  After all, this was the woman who had – the first time I met her back in July 2014 after my first detachment – brusquely demanded to know why I was worried as I’d had the surgery and therefore of course my retina wouldn’t detach again.  But I digress…

Off I went to my first CBT session, feeling nervous but hopeful.  As I had expected, the counsellor asked me to talk through the events which had brought me there and explain what I hoped to gain from the sessions.  I said that I’d like to reduce my anxiety, particularly regarding my almost obsessive need to constantly check my visual field for potential symptoms, and also that I’d like to improve my sleeping.  It became apparent within the first few minutes that she had no idea about eye issues (unless you count the ability to apply thick gloopy mascara), but she assured me that she would definitely be able to help me and so I left that first appointment feeling optimistic.

The next couple of appointments included an explanation of the function of worry, helpful and unhelpful thought patterns, and discussion of what she termed ‘catastrophising’.  ‘Catastrophising’ was the word she used to describe my fear of further sight loss and ultimate fear of complete blindness.  She made it sound as if this was an illogical fear with no foundation, and that I was being over-dramatic in entertaining it.  I explained that retinal detachment leads to sight loss if not successfully treated and that as I already had significantly impaired vision in my right eye due to multiple detachments and surgeries, and I’d had two large tears in my left retina, this had caused me to be fearful for both eyes.  Her pat responses delivered in artificially soothing tones together with familiar over-use of my first name made it obvious to me that she just didn’t get it.

At the next appointment we moved on to coping mechanisms, as she enquired what I did to try and reduce my anxiety.  I listed talking to certain people about my worries, chatting to my eye buddies via the online support group, and writing my blog.  I explained that I had attempted meditation/mindfulness techniques using an online app and I also told her about my ‘eye book’.  This is the little notebook I take with me to all my hospital appointments, in which to record the information.  If I’m worried about a specific issue between appointments, I often refer back to this book for confirmation or reassurance.   She voiced approval of the fact that I already had a lot of coping strategies in place, and I left that appointment with a lighter step, feeling that perhaps I wasn’t doing so badly after all.

Soon after this came a discussion of insomnia and what I could do in order to try and improve my sleep (or lack of).  She asked me if I’d tried a warm milky drink before bed, or tried reading or listening to music.  Instead of saying what I was actually thinking, which was: “Do you really think I’d be sitting in front of you now if I hadn’t already tried all that?!”, I nodded, with a certain weariness which couldn’t be attributed to lack of sleep, and added to the list of things I’d tried: burning lavendar oil, lavendar pillow spray, eating a banana or cherries before bed, meditation/breathing exercises, a warm bath…  She appeared entirely ignorant of the soporific effects of lavendar, bananas, and cherries, and went on to suggest a few of her own alternatives which I might try.  It was December by this point, so naturally she thought that if I couldn’t sleep, I might find it helpful to get up and put up my Christmas decorations.  When I told her that I don’t tend to decorate my house for Christmas, she faltered slightly but went on to suggest that I could do something else instead, like the washing-up or a bit of cleaning.  (Clearly she had never been to my almost freakily immaculate house.)  “I do all that before I go to bed”, I told her, doing my best to maintain a polite tone.  However, she was on a roll, and went on to ask me if I had any pets that I could get up and feed in the night.  Again, I crushed the voice screaming in my head, “You Have Got To Be Kidding Me?!”, followed by the more reasonable observation that if I had pets and their feeding timetable was dictated by my insomnia, they would probably be dead pets by that point, due to morbid obesity.  Instead, I just stared at her and told her politely that I didn’t have any pets.  My face must have betrayed me somewhat, as she laughingly observed that I was looking at her as if I thought she was mad.  “How very astute of you.”, noted my inner voice, icily.

About two thirds of the way through our sessions, she wanted details of all the various visual checks I do.  I obliged, and she proceeded to draw up an action plan whereby I could only complete the various checks a certain number of times a day.  I tried to explain that this simply wasn’t practical – if I think I see something different or worrying, I can’t ‘unsee’ it and I will obviously check it.  A certain amount of checking is helpful for reassurance, but this kind of thing can’t be set down in a prescriptive fashion.  She didn’t seem to understand, and told me that although it might be difficult at first, it was important to give it a go.  So off I went with my piece of paper, feeling immensely frustrated and depressed by her lack of understanding.  Over the next few days I became so wound up by what I was and wasn’t supposed to check and how many times a day that I made the decision that it had to stop.  I hauled my cross-cutting paper shredder out from the cupboard under the stairs, plugged it in, popped the piece of paper into the slot at the top and watched with satisfaction as it was greedily devoured by the sharp metallic teeth.

When my next session came around, I simply explained again what I’d told her before as to why I felt that her approach was fundamentally flawed.  To give her credit, she seemed to take this on board, saying that we would need to find another method and that (horror of horrors), our sessions could possibly be extended if we needed more time to work on things.  She then changed tack completely and announced that she thought I had too many support mechanisms in place and was confusing myself by flitting between them.  Instead, she advised, I should concentrate on just a couple.  I told her that I wasn’t in the least bit confused and that different mechanisms were appropriate for different issues.  I gave her a few examples but by this point it was glaring obvious that she, like me, had pretty much disengaged with the whole sorry process.  I almost skipped out of my final session, my sense of relief that it was over matched only by my frustration and anger that not only had the whole experience been incredibly unhelpful and a shocking waste of time, it had actually made matters worse in terms of increasing my anxiety.  I’ll leave it to the reader to deduce what the last five letters in the subject title of this post stand for…

 

Visual fields

Living with peripheral vision loss can be a tad embarrassing at times.  It’s caused me to let out a loud girly squeal whilst using the photocopier at work, when the Dean (no less) suddenly appeared on my bad side, seemingly out of nowhere, and boomed “Good morning!” at me.  It’s resulted in me leaping a foot in the air and bashing my knuckles on the hand-dryer in the loo at work, when a student materialised out of thin air at the hand-dryer alongside me.  It’s caused me to berate my good friend when she spotted me in the distance one day and ran to catch up with me, grabbing my right arm as she did so and thereby scaring the living daylights out of me.  I frequently jump violently and then swear with equal violence under my breath when a cyclist whizzes past me as I walk along the paths on campus.  After stumbling over students’ bags in the entrance to my workplace on several occasions, I now walk round and use a different door if I need to enter or exit at the time a lecture is due to start or finish.  Last but not least, I’ve acquired some interesting bruises on my right shoulder due to various minor mishaps.

The loss of peripheral vision in my right eye is due to the 360 degree laser surgery which was done in an attempt to stop the retina from re-detaching and to try and save my central vision.  I suspect the three retinectomies (where part of the retina which won’t lie flat is physically cut away) probably haven’t helped matters, either.  Of course, unless people have actually experienced loss of peripheral vision themselves, it’s difficult to expect them to fully understand.  I thought perhaps a visual interpretation might help, and therefore sought the assistance of my personal patient photographer, who happily doubled up as a person with properly working peepers.  (It’s such a shame that the ‘h’ in ‘photographer’ messes up the alliteration there; however, I digress…)  Our highly scientific peripheral vision experiments when looking at the fields just down the road from my house, followed by extensive jiggery pokery with photo-editing software, led to the following results…

The picture below shows the complete field of vision of a person with properly working peepers, with both eyes open:

Fields

The visual field of someone with ‘normal’ vision.

The following picture shows the field of vision of both a person with properly working peepers and myself, when our right eyes are closed (so looking only through the left eye):

fov-res-w

Visual field of left eye.

The next picture shows the field of vision of a person with properly working peepers, whose left eye is closed (so looking through the right eye only):

fov-les-w-a

Visual field of right eye of someone with ‘normal’ vision.

The final picture (below) shows the field of vision in my right eye, with my left eye closed:

fov-les-w-e

Visual field of my right (RD) eye.

If you compare the last two pictures, you can get some idea of how much peripheral vision I’ve lost in my right eye.  If you look at these pictures in conjunction with the images in my earlier blog post, Do you see what I see?, this gives the most accurate representation possible of my waffy vision as it is at the current time.  So with that in mind, if you could kindly avoid sneaking up on me on my right-hand side, that’d be just grand…

Note: Grateful thanks to the patient photographer for producing these images for me and putting up with extensive peripheral vision analysis in the process.

 

 

 

 

Rats and opera glasses

It was on a sunny Sunday afternoon a couple of weeks ago that I spotted the little blighter myself.  His huge hairy brown backside swayed gently from side to side as he sauntered brazenly down my garden path in the broad daylight; his tail trailing casually along behind him.  He didn’t even bother to take cover in the shrubbery.  “Great”, I muttered to myself as I sighed in resignation and proceeded to fire up the laptop and google ‘pest control, Canterbury City Council’.  My irritation increased as the web page informed me that the council no longer offered a pest control service, and advised me to search under several accredited bodies for a reputable private service instead.

I should probably explain at this point that rats have been recurrent unwelcome visitors to my garden throughout the ten years that I’ve lived in my little house.  When I say ‘recurrent’, it could be worse – the last time my neighbours and I had to call out pest control was about 2012.  However, about a year before that we had a most unpleasant episode when they burrowed down (the rats that is, not pest control) and got into my neighbour’s cavity walls and up into his loft.  That frantic sound of scrabbling in the walls is not one which is easily forgotten, and my skin still crawls at the memory.  So clearly we don’t want that to happen again.

After spotting The Intruder (it seems appropriate to use capitalisation here), I became ever so slightly obsessed with staring out of the window whilst clutching a hefty baseball bat, ready to rush out and whack it over the head the second it had the audacity to appear.  Okay, so maybe the bit about the baseball bat isn’t strictly true, but the first part certainly is.  I’d already undertaken a meticulous examination of my garden and spotted the exact place where I suspected it was making its unwelcome and illegal entrance.  (Maybe I should build a wall there, and get the other rats to pay for it…)  In the absence of Rat Cam, I had to rely on my own dodgy vision to track the blighter’s movements.

A couple of days later, early in the morning, I spotted a suspicious looking brown shape loitering in the middle of my lawn.  As it was so early, I wasn’t wearing my specs.  I therefore grabbed the closest instrument of magnification I could lay my hands on, which just happened to be a pair of antique opera glasses.  I raised them to my eyes with trembling hands and baited breath and spotted… the blurry shape of a blackbird, pecking about in the lawn.  I exhaled, and then set about trying to sharpen up the image seen through the opera glasses.

I figured that the glasses must have been at the optimum setting for my eyes pre-retinal detachment.  I closed my good eye and looked through them using just my bad eye.  The image was very blurry, but surprisingly I managed to improve it by turning the little dial to the right as far as it would go.  Obviously it was still blurred as I was looking through my waffy RD eye which has silicone oil in it; but it was better than I expected and certainly better than when I just have my specs on.  I then closed my bad eye and tried looking through my good eye without adjusting the settings.  It was horrendous!  In order to get it back into focus, I had to turn the dial almost all the way to the left.  I then closed my good eye and opened my bad eye again, but was back to a blurry mess once more.  I tried to adjust the opera glasses so that I could get a decent overall image whilst looking with both eyes, but it was impossible.

At this point, I had to stop as the experiment was beginning to make me feel a little dizzy and queasy.  However, it gave me a greater understanding of why the optometrist had said that my vision in each eye is so unbalanced that it’s impossible to fully correct it with glasses.  It also made me wonder whether this unbalanced vision, coupled with the fact that I’m still apparently right-eye dominant despite the vision in my right eye being extremely poor, is the reason for my frequent headaches, which are sometimes accompanied by a slight feeling of nausea.

Anyway, I’m hoping that Rat Man (aka pest control) will be able to do his stuff and dispatch The Intruder swiftly, in the same manner that Hamlet disposed of Polonius.  At the cost of two full-price return train tickets to Moorfields, the service certainly isn’t cheap, but I guess that’s to be expected when hiring a hit man…

Looking out on the garden through a pair of opera glasses.

Rat-hunting through the opera glasses