Diplopia
What follows was contained in an email sent to a number of people to explain my eye condition on September 28, 2019. The condition essentially reversed to perfectly normal vision over the course of four months with no medical intervention, more or less as Dr. Schepmyer, my neurologist, had predicted. Unfortunately it recurred on December 17, 2020. This time I am putting up with it and ignoring it as much as possible, on the premise that it is a repeat of last year's occurrence, and just another gentle reminder of mortality. I should note that at this time, and for as long as I can remember before, I have been on no medication of any kind. I smoked, mostly a pipe - intermittently - between the ages of 15 and 26, and the only times I have ingested prescribed drugs they were painkillers for very brief periods after traumatic injuries or surgery. Otherwise my only substance use is alcohol - in moderation (by my own definition😉).
The eyeball saga is a work in progress, and the diagnosis is "right cranial nerve six palsey", which may be terminal, but not serious. By terminal, I mean permanent, and not serious means I can learn to live with it. Work in progress means that I have been referred to a neurology clinic, which will confirm the diagnosis and determine if a remedy is likely or effective. The condition is called diplopia, and it turns out that Sarah's mother-in-law (Karen) has recently been afflicted with it as well, so I shall have to compare notes with her. Apparently she has been offered surgery as a possible remedy, but she has refused that. This is all second hand from Sarah - I have yet to talk to Karen.
My Thursday experience is something I should have taken the time to document during my seemingly endless experience of the VGH Emergency Ward, but lacking the appropriate device and environment at the time, it has had to wait until now. There are some useful lessons learned, which I shall get into later.
I may have mentioned earlier, the onset of my condition was on Sunday afternoon, while I was writing something at this computer. It must have been fairly sudden, but had no specific moment like a motion made or pain experienced. I must have first noticed it when I looked away from the screen, and I imagined it was a passing annoyance like other visual phenomena such as floaters. Later that afternoon, when I was requested to drive out to Surrey to pick up our house guests, I hesitated, but decided that I could drive, and made the trip successfully, closing one eye much of the time. I may have mentioned that my vision in each eye is perfect, just their coordination is screwed up; so aside from a loss in depth perception, closing one eye is a reasonable resolution of the double image. The two images are more or less side by side, with the right one slightly displaced downward, and they separate more on the right, being closer together and virtually merged on the far left.
Anyway, since I considered the condition non acute, I decided to try and sleep it off, and see if it improved in time. When it had not improved in a couple of days, I decided to consult my GP and made an appointment for early Thursday afternoon. I decided it was prudent not to bike over to Lynn Valley to the doctor (we lived on the North Shore when the kids were born - in the 1970s), and took busses. The GP did a couple of tests and wrote out an order referring me to VGH Emergency for further testing - presumably to check if I had suffered a stroke. I had a scenic trip to the hospital via three buses and a skytrain, and arrived at around 1600, checked in at the triage counter, and started my nine and a half hour "Emergency" experience. I should note at this time that the term Emergency for this unit is a complete misnomer, since it is principally a walk-in clinic with actual emergency patients being processed through it either for immediate additional medical intervention or admitting into acute care.
Had I had any inkling of what I was in for, I would have gone home at that point (lesson 1), but being still somewhat concerned about the possibility of a stroke, I took my place in the waiting room among the fifty or so "clients" with a variety of mostly non obvious symptoms. At this point, two comments may be appropriate. First, I think that there are huge inefficiencies and flaws with our health care system which have fairly simple and obvious solutions; and second, I think that effective communication on several levels might resolve many of those issues. I am sure we have all experienced those apparently endless waits as passengers, whether in aircraft or other conveyances, or in lounges or holding areas, when staff/authorities have offered no information as to cause or duration. An extreme example of this phenomenon was the killing of Robert Dziekanski by four policemen at Vancouver airport in 2007.
The "Emergency" holding area is segregated from the primary care area by a sliding portal, which is opened only by staff ID tags, and that door is served on the public side by a poor unfortunate staff person who does nothing but provide rapid access to ambulance paramedics with stretchers and other staff outside of late night hours. During my first few hours I discovered the only positive feature of the place: a public wifi system. I was also interviewed at one of the triage stations for the first of at least six sessions in which I related my symptoms, and I had an ID band put on my wrist after providing about five blood samples to a technician. Then after over four hours just waiting, I was called into the primary care area and put on a gurney with back raised in what seemed like a remote corner. This started my next wait period, which lasted another five and a half hours - with minor interruptions for an ECG, three physician interviews with two different doctors, including a blood pressure check and much the same "look at/follow my finger(s)" routine that had become repetitive. The one substantial break in this period was when I was taken, under my own steam, for a CT scan. During the third session, Dr. Kerry Walker provided me with a referral sheet to the Rapid Access Neurology Clinic, with a terse diagnosis written across the top. The whole ordeal ended around 0130, when one of the triage staff did a final blood pressure check and set me free. By this time transit services had stopper for the night, so the trip home was another adventure which I shall leave for another time.
Incidentally, the combined testing found no evidence of a stroke, although my last blood pressure test might have indicated a likelihood of one, having come in at 190 over 90. Dr. Walker sensibly refrained from prescribing me blood pressure medication, ascribing the high test results to a combination of white coat syndrome (there were virtually no white coats anywhere) and extreme frustration on my part. The frustration aspect provided me with a ready explanation for what I had initially considered a strange message at the triage counter...
The second, and more important lesson is simply this: never enter an Emergency Department unless you are the subject of a trauma needing immediate medical intervention: bleeding profusely, broken bone(s), cardiac arrest, etc. In short, if you can walk, you probably don't belong there, and other options are less painful. I'm sure my GP meant well, but had no idea of ordeal he was actually prescribing.
Sunday,
November 24, 2019
The
neurological clinic visit was substantially easier than my
“Emergency” experience, and involved minimum waiting. I was first
examined by a relatively young resident, working under the
specialist, who could hardly have been much over thirty himself, and
after the now familiar finger following routine, they both indicated
that the condition should correct itself in about three months, but
should be monitored by my GP and I should also consult my
ophthalmologist. That appointment took a while to arrange, and I
found myself seeing that specialist last Thursday. He was not
impressed with my progress, and suggested further testing – which I
am in no rush to undertake. Meantime, I am learning to cope, and
hoping that there will be more improvement over time.
A follow
up visit to the neurologist, Dr. Neville Shepmyer, in his Richmond
location, resulted in the diagnosis of “right cranial nerve six
palsy”, with a three month predicted duration.
2020
Dr.
Shepmyer's diagnosis proved correct and by the end of January normal
vision was restored, with no medical intervention.
Thursday,
December 17
At
virtually the same time in the early afternoon, under identical
circumstances to last year's event, diplopia struck again. This time
it felt so familiar, that I decided right away to do nothing and just
wait it out. I told Elaine about it later that afternoon, but
otherwise we will keep it to ourselves.
Monday,
December 21
Sarah,
Erik and Spencer came over to deliver anniversary flowers and visit,
and it didn't take Sarah long to spot my eyes weren't moving
correctly together. I had hoped to get away with it, as I had on
Sunday morning having coffee at Faubourg with Henry, but she is too
observant.
2021
As expected, the diplopia resolved itself within a few months, with no lingering after effects - except...
2022
Around the end of the first week of March, Diplopia struck again, but this time I am so casual about it, I don't even recall exactly when; so I expect it to resolve itself by midsummer. Meantime, Elaine has done most of the driving lately, but I drove myself to K3 at Kerrisdale on Tuesday, and did a pretty slick job of parking in a very tight spot.
2023
Around mid December another Diplopia session started, and currently continues through January 2024.
