Hiccups during surgery

Yesterday was my surgical day. My last case of the day, a cataract patient, got the hiccups during the surgery. Under the operating microscope, it was like a series of earthquakes. It made for an interesting few minutes until the anesthesiologist could give him enough sedation to put the hiccups to sleep. The patient looked great this morning, except that the hiccups woke up after the surgery and are still there.

Subspecialty Day at Hawaiian Eye

Today was the first day of the conference -- sort of. It officially starts tomorrow, but they've started having a one day specialty conference, so we all went to that today. Mel and Emilly did remarkably well following the talks. Russ, not so well. I'm kidding. Actually, Russ was thinking and making some good connections.

The first section was on Oculoplasitic and Aesthetic Surgery. It focused on Botox and Dermal Fillers. I've enjoyed this part of my practice since we started doing Botox two years ago. I'd like to be doing more, but we just don't have the demographics on Saipan -- people who are concerned about their appearance and who have disposable income. They included a live demonstration. Here, a patient is going to get injected with Botox and Juviderm filler. It was interesting to see Dr. Steve Yoelin's technique. Steve is the country's leading Botox injector and the person who taught me to inject Botox. He lives in Beverly Hills. Now that's the kind of demographic where you can thrive doing this.


The second section of the day was on Controversies on Perioperative Pharmacological Therapy. Sounds fascinating, doesn't it. Actually, the information in this section resulted in me making a few changes to the regimen of drugs I use around the time of surgery (that's what the word "perioperative" means). I'm switching from Ocuflox to Zymar, using the Zymar for two weeks post-op instead of one week. I'm not patching the eye after surgery, but instead using Zymar every 15 minutes for the first hour, and every two hours thereafter for the first day. And I'll be checking the wound with fluorescein at the time of surgery. Finally, I'm going to develop a good method to automate the extended use of NSAID's in our diabetic cataract patients.

Anytime I end up doing something differently as a result of a conference, I consider it a good conference. Knowledge is useful, but clinical practicality is the key.


The final section was on the use of implanted intraocular lenses to correct presbyopia -- the loss of near vision that occurs in the early 40's. This is the new trend in ophthalmology, because unlike LASIK, it can correct both the near and distance vision simultaneously. I've tried introducing this to Saipan, but there seems to be very little interest, again due to demographics. The lenses and the extra work cost a lot more than regular lenticular surgery. (Note to self: this year, the best IOL combination is Crystalens in the dominant eye, and Restor in the non-dominant eye. Micro RK/ARK and CK can be useful for over/under corrections.)

Tomorrow is the start of the conference. It's the lifestyle day, and the keynote speaker is the guy upon which the movie "Pursuit of Happyness" is based.

Mental Preparation for Surgery

I'm in the operating room right now, between cases. Having been on vacation, it's been about three weeks since I've performed surgery. The most common procedure I perform is cataract surgery, and I have four scheduled today -- two down, two to go.

Even though I've done cataract surgery like a gazillion times, and it's pretty much an automatic thing for me, I still sat for a few moments last night and just went through the procedure in my head. Incision with the 15 degree blade, intracameral lidocaine, Viscoat, incision with the 2.75 mm keratome, capsulorhexis, hydrodissection, rotation of the nucleus, insertion of the chopper and phaco tip, chop, spin, aspirate, chop, spin aspirate, chops, spin, aspirate, chop, spin aspirate, switch to I/A, aspirate cortex, insert intraocular lens into cartridge, fill chamber with Viscoat, insert intraocular lens, aspirate Viscoat, check the incision.

I find this mental preparation, especially after an absence, to be very useful. There are studies that show your brain doesn't know the difference between mental visualization and the actual act, so visualization can serve as a means of giving you "experience" and getting you back into practice.

One of the things that still surprises me during surgery is how much of an artistic act it has become for me. Sure, it's a linear sequence of steps, requiring the left brain to be on top of things, but once that is mastered, and the left brain is doing its thing in the background, I seem to switch over to right brain mode. Time sort of stands still. I can't talk during surgery because it requires my right brain to turn off. Some surgeons like music during surgery. I need the operating room silent. It's one of the most enjoyable things I do.