Tuesday, April 12, 2011


How does the saying go? If you want to give god a good chuckle, make some plans.

I had planned to post up the first part of a series on the use of antibiotics in food animals this week. But things didn't work out as planned.

I woke up last Friday morning with something wrong with the vision in my right eye. Things were clear in the left, blurry in the right. Not terribly blurry, but enough to bother me. The right eye felt full, too, almost as if someone had popped me a good one and given me a shiner. In the mirror, though, there was no black eye, no swelling. As nearly as I could tell, both eyes looked normal. But the blurry vision persisted, seeming almost like I was looking through a nearly transparent curtain.

As the day progressed, the eye stayed pretty much the same, but toward evening I started seeing fleeting shadows and bright spots in my peripheral vision. There was no pain, and only the fairly mild symptoms I described above. Maybe I was just tired, I thought. With the onset of calving I’d been putting in a lot of hours.

Saturday morning brought no change, however. The eye was no worse, no better. I decided to give it another day. No change Sunday morning. I managed to muddle through the weekend, but by Monday morning I knew I needed to get it checked out. So off to Cheyenne.

I’m blessed and fortunate to be able to get my medical care through the Veterans Administration system. I called ahead, talked to a nurse, and reported to the emergency room at the VA Medical Center.

Almost before I could take a seat in the waiting room, I was whisked in to see the ER doc, then quickly whisked upstairs to ophthalmology. Within a few more minutes the eye doctor was putting drops in my eyes and conducting a thorough examination. When she completed the exam she said that there were signs of swelling at the optic nerve in my right eye. My symptoms and the swelling, she said, were consistent with Giant Cell Arteritis (GCA), also called Temporal Arteritis. GCA is an immune disorder, related to Rheumatoid Arthritis (RA). The cause of GCA, just as in RA, is unknown. The pathology of the disease – how it affects the body – is the formation of so-called giant, multinucleated cells in the lining of medium and large arteries, commonly those in the head. The giant cells are a form of swelling, and the swelling reduces the flow of blood through the affected arteries. In my case, the swelling was probably reducing blood flow through the optic artery, which supplies the eye, she said.

If the blood flow to the eye is reduced for long enough, or interrupted entirely, the eye doctor said, it would lead to loss of vision in the eye. Blindness, in other words. This is why, she quickly added, that she would treat my symptoms as a medical emergency. The important thing is to quickly reduce the swelling, she said, and for that they would give me intravenous steroids for 24 hours.

So back to the ER, where I was punctured for lab work and an IV. Within a few minutes the crack ER staff had administered 250 mg of an IV corticosteroid. Over the next 24 hours I received three more doses of the steroid at six-hour intervals. By the time I had the second dose, the feeling of pressure in my eye was easing, though the vision remained blurred.

On Tuesday morning the eye doctor put me on oral steroids and scheduled me for an MRI on Wednesday, to take a close look at my eyes and at the vasculature of my head. “Hmm,” I thought, “maybe there’s something in there after all.”

The eye doctor also scheduled me for a biopsy of my right temporal artery on Friday. The only way to confirm the diagnosis, she said, is to look at a piece of artery under the microscope and see if the giant cells are present.

While this turn of events has been sudden and has come as something of a shock, it looks (as I write this) like we caught the problem soon enough to give me the chance of an excellent outcome. Only time, and a few more tests, will tell.

One thing is certain, though. The care I continue to receive through the VA system is absolutely top-notch and state of the art. The staff of the Cheyenne VA Medical Center are simply wonderful, from top to bottom. They do a tough job and see an enormous number of patients. They are always busy. Yet they take the time to treat each patient as an individual, and go out of their way to treat each veteran as an important person. At some point, nearly every staff member I’ve met has thanked me for my service. The level of concern and quality of care shows that those are much more than empty words.

Regardless of how this thing turns out, I’ll never be able to adequately tell the Cheyenne VA staff how very much their care and dedication mean to me. And by extension, since you taxpayers foot the bill, how very grateful I am to each and every one of you.

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