Complicated

“Complicated.” That’s the word Dr. Levine used again and again to describe the condition of my eye at our last appointment. After we thoroughly discussed my condition, the options, and the potential complications, he recommended, and I agree, that I wait on getting a lens implant. Yes, it is generally true that one needs a lens to see, but he thinks that the current shape of my eye will leave me very nearsighted but not exceedingly so, even without a lens. Between the accident and the buckle put on my eye to retain the retina, my cornea is now severely astigmatic (misshapen, not spherical) in a way that counters the elongation of my eyeball, potentially leaving me with vision that will be able to be corrected with glasses. Complicating the situation, my damaged iris may mean that I will need to wear a contact lens (tinted or printed with an opaque iris) to shield my pupil from too much light. Ideally, such a contact would also be a corrective lens, but my astigmatism may be too severe for correction with a contact lens, in which case I would have to wear glasses with the contact. In addition, my damaged eyelids may make wearing a contact lens difficult. So another consideration in waiting on a lens implant is that having one now might prevent me from getting a prosthetic iris implant in the future, if I cannot wear a contact lens or it does not prove sufficient. Once the silicone oil is replaced with saline (which Dr. Harris will do on Tuesday, March 19), we will be able to evaluate my vision and my light sensitivity without guessing.

And at the end of April, I will see Dr. Polonski to schedule further surgery for my eyelids.

At the end of my appointment, in order to avoid any more surprises like I had with my iris, I asked Dr. Levine if there was any other damage I didn’t know about. Here is a summary of the damage to my eye: My conjunctiva is scarred. My cornea is dry and severely astigmatic. My lens and capsule are gone, surgically removed. My sclera has a thin spot. My iris is ruptured, leaving my pupil wide open. The structures that maintain the balance of fluid in my eye (which are part of the iris) are damaged. My retina, especially the macula, is very scarred but no longer detached.

Yes, it is a miracle I can see. Hurray for miracles!

Thrown for a loop

I was caught completely by surprise yesterday when I learned that my pupil is permanently blown. All this time, I have been so focused on the damage to my eyelids and my detached retina that I never really looked at my eye itself in good light. Apparently, the blunt trauma from my mesquite missile also ruptured my iris, leaving barely any iris visible at the perimeter and no functioning muscle. This means that my pupil has no way of constricting, so it will always let in too much light.

None of my doctors has ever mentioned this aspect of my injury to me. Dr. Harris didn’t even know; at every visit, one of her techs has dilated my eye before she saw me. She saw me on Friday without dilation to assess the possible options for attaching my lens during my upcoming surgery (one option might have been suturing it to my iris) and realized that I never needed dilation: my pupil is wide open. Dr. Levine apparently knew of this condition, because he wasn’t surprised when I called him with the information, but he has never talked about it with me; I guess it was low on the list of damage to be dealt with. I have no idea whether Dr. Polonski knows; I think his assistant dilates me too, but I may be mistaken. (Karen had noticed my huge pupil when she was putting drops in but didn’t realize the significance and never mentioned it.) I will see Dr. Levine at the end of the week to discuss my iris and any implications for the surgery. Online research indicates that the only surgical options for actual repair of the iris (prosthetic iris implants) are still experimental. I am guessing that I will end up wearing a contact lens with an iris printed on it and a fixed clear pupil to limit the amount of light that can enter.

Up to now, my open pupil has not been a problem for two reasons: first, because my eyelid opens so little, the pupil is mostly covered; second, the silicone oil dims the light that does enter. I do notice some glare in that eye when I am sitting next to a lamp. Once the oil is removed, that will likely be exacerbated, and when I am outside, I will have to start wearing sunglasses regularly.

I am still adjusting to the information. The surprise of it so long after my accident has temporarily thrown me for a loop, but knowledge is power, and the more I learn about the condition (apparently known as traumatic mydriasis) and my options, the easier it is to accept it and proceed.

My next surgery

I postponed my next surgery so that I will be able to make work for and participate in the Tucson Museum of Art’s Spring Artisans’ Market, March 15–17. My surgery will follow on Tuesday, March 19, when the silicone oil in my eye will be replaced and a new lens will be installed. In preparation for that, I will have another laser procedure tomorrow, Tuesday, February 19, just to make sure that my retina is fully tacked down (this is the procedure I mentioned in my last post, postponed along with the surgery).

The March 19 surgery should be the last on my eye itself. Surgery on my eyelids will likely happen in May or even June. After a day like today, when, inexplicably, I could barely keep my eye open wide enough to let in light, I will be glad for that too. I don’t understand how or why my ability to open my eye can vary so much from day to day, but it does. A day like today is scary, but I trust that tomorrow (or the next day or the next) will be better.

In the meantime, I have just started the last piece in the series of commissioned work that has occupied me for so long. By the end of the month, I will be free to make whatever pleases me. Hurray for play!

New milestones

I have some new recent milestones to note.

First, last Monday, I drove solo for the first time since my accident. The weekend before, I practiced driving in a big empty parking lot and on the empty streets of an industrial park. I managed to park and corner and not run Karen over, so she granted me permission to drive myself to the dentist. I am using extra caution—my left-side blind spot really is a blind spot at the moment—but feel pretty good about being back on the road. I won’t be driving a lot or at night anytime soon, because I am not seeing well in low light and am not adjusting quickly to changes in light, as with oncoming and passing headlights, but it is good to know that I am not entirely dependent on others to get around.

Thursday, I finally finished the vessel I was working on when I had my accident. I epoxied it back together and filled the exterior cracks with turquoise inlay. It is now lucky number 13 in the commissioned series.

The vessel that broke and hit me, now repaired and finished.

The vessel that broke and hit me, now repaired and finished.

Another view of the vessel. I like that these sapwood patches look like eyes--and the left one (on the right in the photo) matches mine at the moment!

Another view of the vessel. I like that these sapwood patches look like eyes–and the left one (on the right in the photo) matches mine at the moment!

 

And on Monday, I started the first of the last four vessels in the series—from another highly cracked log. I used the wire guard on my lathe and wore my riot helmet for protection. The wire guard does interfere with seeing the curve I am cutting, so I probably will not use it for the final external shaping, but I will continue to use it for the rough turning of these vessels and while I hollow the interiors. I am pleased with the riot helmet. It is not too heavy. My head got a little sweaty, but that’s not a big deal for me.

Oh, and today, I used my chainsaw.

Finally, it appears that I will pass a major milestone at the end of February: Dr. Harris says the silicone oil in my eye can come out. She will perform another laser procedure next Tuesday just to make sure my retina is securely tacked down, and three weeks after that, she says, I can have the surgery. I was expecting to have to wait six months from the October surgery, but she says I am ready, or will be (it will be four and a half months by the time the surgery happens). My understanding is that she will replace the silicone oil with saline. I am hoping that this will improve my vision. When you compare photos of the retina in each of my eyes, the right is sharp and the left is dim and blurry, because of the oil. I still won’t have a lens, but I hope that what I can see will be a little clearer and brighter without the oil. And after I heal from that surgery, I can be measured accurately for a new lens, so maybe that will happen sooner than expected too. I don’t want to rush—I want to give my eye all the time it needs to heal as much as it can—but I am anxious to see better.

Healing aids

Over the course of my recovery, I have received a number of things from well-wishers to help me with my healing.

One of the first was a small jar of dirt from the chapel in Chimayó, New Mexico, el Santuario de Chimayó, where a miracle is believed to have happened some 200 years ago and where pilgrims continue to visit seeking healing. Karen and I visited it ourselves some years ago. The little jar, shared by someone who has also made me wonderful soup several times over the last few months, sat on the table next to me during the long weeks when I had to remain upright and remains close at hand. I will pass it on when my recovery is complete.

On loan since before Halloween is a small mascot, a stuffed zombie kitten made by a librarian colleague of Karen. I call it Cyclops. You cannot quite tell from the photo below, but its right eye is hanging out of its head. It is at once adorable, pitiful, and funny. It has helped me keep a balanced perspective throughout the ups and downs of this process.

Zombie kitten mascot, posed on the mesquite chunk that hit me.

Zombie kitten mascot, posed on the mesquite chunk that hit me. Notice how little solid wood was holding the vessel together.

One of my collectors gave me a turquoise Zuni fetish of a dancing bear. I call her Ursalyn. Bears are symbolic of vigor and health, and her smile and dancing make me smile. She reminds me of me. Turquoise is a healing stone and also happens to be my birthstone. She dances next to me while I watch TV or eat or work on the computer.

Ursalyn, view 1. Ursalyn, view 2.

Ursalyn, view 3.

Ursalyn, three views.

Another customer gave me a poem by Jane Hirshfield called “For What Binds Us,” written out by hand. It reads in part:

And see how the flesh grows back
across a wound, with a great vehemence,
more strong
than the simple, untested surface before.
There’s a name for it on horses,
when it comes back darker and raised: proud flesh,

as all flesh,
is proud of its wounds, wears them
as honors given out after battle,
small triumphs pinned to the chest—

Read the full text of the poem here. More than scars, it is about love. I reread it often.

The most recent healing aid is from my dear friends Pat and Darcey, who have been present at every step of my recovery. At my birthday, they put together a medicine bag for me, a small leather bag that contains a chunk of turquoise, a shell, a small bundle of sage, a shell, a feather, a sandstone rock, and a slice of mesquite. I wear it around my neck or keep it on the table next to me. Sometimes I unpack it to contemplate its contents.

These things all help. Beyond their respective healing powers, each reminds me that people care. They are my steady companions on an unsteady road.

Milestones

On Wednesday, I turned! My friend Art supervised me. I started with some spindle work just to see how it felt to be at the lathe cutting wood. It felt completely natural. I have not lost any muscle memory, and I didn’t notice any obvious challenges from my limited depth perception until I used the bandsaw to prep a blank and then, hardest of all, the drill press. Matching the tip of the drill bit to a marked center point proved to be the most challenging task of the day. I was nervous at the bandsaw, but I’m always on high alert at the bandsaw, and the extra nerves calmed as soon as I got the teeth into the wood.

After the spindle work, I played with shaping and hollowing an end-grain vessel and then moved on to turning a new face-grain bowl. Using a gouge felt easy and familiar. Oddly, it was a square-end negative-rake scraper, one of the easiest tools ever to use, that felt the most awkward. I had to remain extra aware of where the points were at all times. It is one tool that I tend to look back at as I cut. When I use a gouge or other tools, I am looking at the far edge of the wood, not at the tool; I think that is why my limited depth perception did not bother me. On the inside of bowls, I am cutting by feel anyway.

One shortcoming I did notice: I do not see detail as well as I used to. This, I hope, will improve when I get some new glasses. The pair I have been wearing doesn’t sit quite right on my face because of the plastic guard I wear over my injured eye. In addition, the remaining lens (the left one popped out) is badly scratched right across the center of vision. I didn’t notice some small areas of tearout until I was well into sanding. I had to go back to cutting a couple of times to clean up both the exterior and the interior surfaces.

Here is my first monocular bowl!

A small walnut bowl, my first since my accident.

A small walnut bowl, my first since my accident.

My second milestone is that I am no longer wearing an eyepatch during the day. I still cover my eye at night, with both a gauze pad and my plastic shield, but while I am awake, my eye is naked! I cannot keep it open very wide for very long right now, but that will come. Using my forehead muscles as well as my eyelid muscles, I can open my eye maybe three-sixteenths of an inch—just enough to see through. It quickly droops to an eighth of an inch or less, but I am working those muscles, blinking and looking as much as I can. My lower eyelid looks pretty good, considering. The graft has taken, and the lid is looking more normal. I have not detected any movement in it yet.

I still have a ways to go with my recovery, but these recent milestones leave me optimistic. Recent photographs of my retina made me realize that my visualization of its healing has been backward. I had been picturing the black spot in my vision being eaten away or erased. Now I realize that the black spot reflects a bare patch where the cells were damaged, so I am picturing instead some new seed-cells taking root and beginning to grow. Help me grow my retina garden by picturing it too!

Safety gear

For safety, I use the Uvex Bionic face shield, which I bought from the Sanding Glove, and a small 3M 7500-series half-mask respirator with P100 filters (other half-mask respirators did not come small enough to fit my face properly—true for most women, I think). Even though I wasn’t wearing my face shield at the time, since my accident, I have looked into whether I could improve that protection. (I also wanted to find out how much protection my face shield would have provided.)

One of the possibilities I considered was the Trend Airshield Pro, which is very popular among woodturners. I discovered, however, that it claims to meet only the “low energy impact” standard for eye protection (http://www.trendairshield.com/specifications.html) and its stated respiratory protection is also lower than what I already have (and it is not NIOSH approved).

The safety standard for eyeglasses and face shields is specified in ANSI Z87.1-2010, which includes general specifications and impact specifications. It is the general specifications that the Trend Airshield Pro meets. My Bionic face shield is rated for the high-impact Z87.1 specifications.

I did the math (see below) and realized that, measured in kinetic energy, the mesquite missile that hit me delivered about 30 times the amount derived from the high-impact Z87.1 specs. Surely, my face shield would have absorbed some of that energy, but I almost certainly would have been injured anyway. Polycarbonate isn’t supposed to break or shatter, but all that energy would have had to go somewhere. Could I have escaped with bruising and a concussion? Would my face bones still have broken? Would the impact have contacted my eye? Does anyone have any experience they can share?

Anyway, I went further with my research and looked into ballistic face shields. These are expensive and heavy and seem to me like overkill (they are also not readily available to civilians). But they did lead me to riot helmets and face shields, regulated under the NIJ 0104.02 standard, with about 15 to 27 times the impact resistance specified under ANSI Z87.1. I ended up buying the lightest one I could find, the Max Pro RD1002X; it weighs 2 lb 3 oz, just a little more than the Trend Airshield Pro. Others weigh 3 lb or more, which I thought might be a bit heavy for prolonged wearing. I should receive it in a week and will report on how it feels.

Max Pro RD1002X anti-riot helmet

Max Pro RD1002X anti-riot helmet

You may notice that the impact resistance of the riot helmet is still not equal to the impact I sustained in my accident; at best, it is 15% too low. I balanced the impact resistance against potential comfort (weight) and cost and also reasoned that damage to this helmet would still mean considerably reduced damage to me.

My intention is to wear my Bionic face shield with my respirator when turning most things (most of what I turn is small and light), but to wear the Max Pro with my respirator when turning heavier pieces, especially when working with cracked wood. I also installed the wire guard that came with my Jet 1642 lathe and will see how that feels. I have read that others don’t like using it, but I’ll try it to see if it interferes with visibility or tool use.

The wire guard on the Jet 1642 lathe.

The wire guard on the Jet 1642 lathe.

For the technically minded among you, below is a summary of the kinetic energy figures derived from the specifications and my calculations. I give the foot-pound equivalents for kinetic energy for those more familiar with the units used in ballistic specs.

KE Unit Accident Z87.1 High Velocity Z87.1 Penetration 0104.02 Impact 0104.02 Penetration
Joules 127 4 6 111 88
Ft-lb 94 3 5 82 65

Formulas:

  • velocity of falling object = √(2 × height from which dropped × acceleration due to gravity)
  • kinetic energy = .5 × mass × velocity²

My accident:

  • 1-kg piece from a 10″- (.254 m–) diameter vessel turning at 1200 rpm
  • velocity = (.254 × 3.14 (pi) × 1200) / 60 sec = 15.95 m/sec
  • 1 kg traveling @ 15.95 m/sec
  • .5 × 1 × 15.95² = 127.201 joules (93.82 ft-lb)

ANSI Z87.1 tests (Bionic face shield):

    High velocity:

  • ¼-inch steel ball (.001046 kg) traveling @ 300 ft/sec (91.44 m/sec)
  • .5 × .001046 × 91.44² = 4.373 joules (3.23 ft-lb)
    High mass impact:

  • 500 gm (0.5 kg) pointed projectile dropped from 50 inches (1.27 m)
  • velocity = √(2 × 1.27 × 9.81) = 4.99 m/sec
  • .5 × .5 × 4.99² = 6.225 joules (4.59 ft-lb)

NIJ 0104.02 tests (riot helmet):

    Impact:

  • 5.1 kg traveling @ 6.6 m/sec
  • .5 × 5.1 × 6.6² = 111.078 joules (81.93 ft-lb)
    Penetration (pointed striker):

  • 3 kg dropped from 3.00 m
  • velocity = √(2 × 3 × 9.81) = 7.67 m/sec
  • .5 × 3 × 7.67² = 88.243 joules (65.08 ft-lb)

This is a simplification, of course. The numbers don’t take into account air resistance, drag, pressure, or other factors. They just gives me a means of meaningful comparison.

Addendum

Australia and New Zealand have higher impact standards. (Their medium impact standard is close to the ANSI Z87.1 impact standard—at least for eyeglasses. Cannot find their face shield specs.) Their test for high velocity uses a 6.35-mm (¼-inch) steel ball traveling at 120 m/sec. This yields a kinetic energy figure of about 7.5 joules, compared to 4 joules under Z87.1. The Triton Powered Respirator meets this higher standard, and its shield is indeed thicker than that of the Bionic face shield. I did not check the helmet or respiratory standards for this device.

Oops! The Triton respirator may no longer be available: I can’t find it even on the Triton web site.

Ch-ch-changes

Dr. Polonski removed the stitches from my lower eyelid the day before yesterday, on my birthday. This time, for the first time, after looking at his work closely, he said, “Lynne, I’m happy.” I had a scare that night, though, thinking that the skin was slipping. He saw me the next morning and assured me that all is looking as expected and that I could expect the appearance of the graft to change and vary considerably over the next few months. I’m still nervous about the skin, but the rest of the graft seems to be holding well.

Surgery today

I go in this afternoon for surgery to reconstruct my lower eyelid. Dr. Polonski will use a graft of skin and cartilage from the back of my ear to make a lid that looks relatively normal (though it will lack eyelashes) and that will (fingers crossed) be able to function. Most exciting, when it heals I should be able to go without an eye patch. Exposing my eye may not look so pretty for a while, but it will give my eyelids more practice blinking, and that should strengthen both the muscle and the nerve (if nerves can be said to have strength) and get me a big step closer to having full vision again.

I will be under general anaesthesia for this. I was supposed to get a local, but that changed yesterday when I went in for an unscheduled visit with Dr. Polonski. I called him because my face has been swollen. At one point all the swelling had gone down, but in the past few weeks it has returned. Dr. Polonski says the lymphatic vessels are not draining the fluid properly, and he is going to try to help that during this surgery. He may also remove the tiny tube in my nose that has been allowing for drainage from my tear duct. I seem to be able to tear normally, so I think the tube is no longer necessary. These additional procedures will be painful, he says; hence, the need for general. I hope I wake up more easily this time.

Think of me blinking! Thank you all again for sharing with me your positive thoughts, prayers, energy.