BS: Entropian (lower lid) Eye Surgery

Subject: BS: Entropian (lower lid) Eye Surgery
From: Rabbi-Sol
Date: 06 Aug 10 - 02:50 PM

My wife has a condition known as Entropian eyelid. Due to aging, the lower eyelid turns in towards the eye with the lashes iritating the cornea. The temporary fix involves lubrication drops and ointments to prevent the irritation as well as a tape which keeps the lower lid out of the eye.

She will need surgery by an opthalmic plastic surgeon, where an incision is made below the eyelid, excess tissue is removed, and sutures placed to keep the lid in the proper position. The procedure takes all of 15 minutes and can be done under local anesthesia injected below the eye, which in effect numbs the entire area.

The problem her is that the surgeons in this area have a racket going. Instead of doing the procedure in office, they send you to a day surgery center and make a whole production out of it. A major part of this racket is to enable anesthesiologists to bill medicare for their fee even though their services are not needed.

They are therefore insisting that my wife have IV sedation for the procedure which is totally unnecessary and which she refuses under all circumtances to have. She wants to be totally awake, alert, and aware of what is going on during the procedure. 2 years ago she had a major hip reconstruction and was on the operating table for 6 hours with only an epidural block and no sedation or general anesthesia whatsoever. She shopped around for over a year until she found a surgeon willing to do it her way.

There is no reason why a simple 15 minute procedure needs a patient to be sedated other than that the anesthesiologist comes as part of the package and has to make a living. The surgeon has all but admitted that this is the case. This is a total racket. They do the same thing with Carpal Tunnel surgery as well as podiatric procedures that are done with local anesthesia.

She will now be shopping around and is even willing to go out of state or out of country (Canada), until she finds a surgeon that will do it the way she wants it done.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Jack Campin
Date: 06 Aug 10 - 03:04 PM

In the UK it's legit for vets to treat human patients (but doctors are not allowed to treat animals - think about it, there are good reasons it's that way round).

Entropion is a common problem in cats, so you shouldn't have much problem finding a vet with experience in fixing it.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Kent Davis
Date: 06 Aug 10 - 03:28 PM

There is no need for this procedure to be done by a sub-sub-specialist ophthalmic plastic surgeon. An ordinary ophthalmologist can do it. Not all of them do it, of course. Mine does, and she does an excellent job. (I have referred many patients to her and they have been well pleased.) She is Brenda Jones, M.D., in Marietta, Ohio, and her office phone number is [phone].

Here is some information on entropian from emedicine, a well-respected source for medical information: http://emedicine.medscape.com/article/1212456-overview

There are different types of surgery for entropian and, of course, I do not know which type your wife needs, nor what complicating factors may apply in her case, so I couldn't say whether or not she truly needs general anesthesia. However, if her surgeon can't give a good reason for requiring general anesthesia, she should see a different surgeon.

Kent Davis

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Rabbi-Sol
Date: 06 Aug 10 - 03:36 PM

The only reason he give is that "this is the rule at the surgery center" and he has to abide by it. He does not make the rules but he has to follow them. There is a higher medicare reimbursment for an asleep patient and the center wants to collect every dollar that they can.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Q (Frank Staplin)
Date: 06 Aug 10 - 04:42 PM

Your description of your wife's condition is too incomplete.

I suggest you read this article, from a professor of ophthalmology at McGill.
Note that suture repair is not recommended.

Entropion

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: catspaw49
Date: 06 Aug 10 - 07:14 PM

I'm sure you can and undoubtedly will find someone closer but if you take Kent Davis' suggestion, Marietta is a lovely little city on the Ohio River and I'm sure both Kent and myself would be happy to meet you.

Spaw

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Rabbi-Sol
Date: 07 Aug 10 - 10:37 PM

Marietta is a 12 hour drive from where I live in Rockland County, NY.
If we can not find anyone closer who does it without sedation we will make the trip.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: GUEST,leeneia
Date: 07 Aug 10 - 11:59 PM

Consider this, Sol.

Suppose she's under local anesthetic, somebody's making an incision near her eye, and she coughs, sneezes or shrinks back in fear. Her eye could be injured.

There are procedures with two different reasons for anesthetic. One is to prevent pain, the other is that the patient must not move in any way - not even twitch. This could be one of those time.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Richard Bridge
Date: 08 Aug 10 - 03:46 PM

Entropion is common in pointers - the breed my late wife and I used to show. It is routinely fixed by vets (and the animal remains eligible to show but not for KC breeding). However, it is always done with the animal anaesthetised.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: SINSULL
Date: 09 Aug 10 - 10:02 AM

Try Mass General in Boston. Both the Morses and I have been pleased with the quality of service and genuine concern of the doctors.
Mary

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Rabbi-Sol
Date: 09 Aug 10 - 09:05 PM

Leenia,
       There are surgeons that perform actual cataract surgery which is IN the eye without sedation. My father in law had it done in Brooklyn.

The Entropian procedure is done OUTSIDE the eye under the eyelid. There is no reason to sedate a patient for such a procedure except to put $$$ in the anesthesiologist's pocket.

I can understand a child or animal that can not keep still. Not so an adult person such as my wife. She knows when she has to keep still.

Subject: RE: BS: Entropian (lower lid) Eye Surgery
From: Donuel
Date: 09 Aug 10 - 09:16 PM

Shop around. I share your grievence against medical/dental rackets in general.

Now from the left field of my imagination; About 6 months ago I posted some inventions that occured to me and one of them was a plastic surgury technique for the lower eyelid that involves putting several stitches frominside the upper mouth to the lower eyelid region which would then give the effect of an eyelift without a single incision. Untested and untried I could only assume that this procedure would have some kind of effect on entropian conditions, but that is of course souly my congecture.