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Dr. Sipperley Consultation
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Re: Dr. Sipperley Consultation
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stringyeye
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Nov 13 11 6:00 AM
Hi All,
I am back in St. Louis after seeing Dr. Sipperley yesterday. Since many of you want to know about after care, I'll first relay what I learned on this topic. The surgical scheduler said there's a 24-hour recovery from surgery, and after they check you the day after the surgery, you are good to go and they do not see you for a couple of weeks. She said you can go back to work after the bandage is removed from your eye. I asked her how I would be seeing at that point, and she said my vision should be back to normal! She said that would be the case even if he had to peel membranes (I think that would include PVD induction). I would assume that they will provide emergency phone numbers just in case there are any issues within the 24-hour recovery period, but I didn't specifically ask about that. I really got the feeling that they their patients typically don't have any issues post surgery. I would definitely have the surgery on Tuesday rather than on Friday so that I could see the doctor on Wed. rather than having to wait until Monday.
My primary concern is with the post-op care after I return home. I learned from the doctor's office here that the surgery and post-op visit are billed to the insurance company as a package. Right before I left for AZ, the doctor's office gave me the codes that they recommended including with the vitrectomy code to show that Dr. Sipperley would not be doing the post-op visits and that my doctor in St. Louis would be doing them. Well, it turns out that Dr. S. will not co-manage post-op care with out-of-state doctors. The surgery scheduler suggested that I check back with the Dr. here to see if they would code the post-op visits as follow-up visits instead, but I'm not sure what the difference is between the two. I will call the doctor here on Monday and try to make more sense of this. My concern is that I would be starting all over again paying ala carte for care if I had a complication. Of course, if my retina were to detach, it's an emergency that I'd have to have repaired in my hometown--I wouldn't have the luxury of hopping a plane to Phoenix to have it fixed!
This, plus a few other factors, has me questioning whether I'll choose to have surgery with Dr. Sipperley. As I mentioned, I had my questions written out, and the first thing he said was, "You sure have a lot of questions." Then he turned to the tech and said, "They all have the same questions, all the people from the blog." I assumed he was speaking of this forum. Then he said, "We should probably post the answers somewhere." Well, that would be helpful!
Also, I was counting on his willingness to use sutures if I wanted, but he was adamant about not using them unless the incisions are leaking as he's wrapping up surgery. He told me that it is best not to ask a surgeon to alter his technique. Rather it is better to find a surgeon that uses the technique that you think you want. He also said that sutures can actually cause infection.
Additionally, I asked him what he does to prevent vitreous wicking, and he said the vitreous is what helps plug the incisions. I had read that Dr. Charles thinks vitreous wicking can be a cause of endophthalmitis, so that's why I asked what he does to prevent it. I was hoping for stitches and something about his using trocars that open and close inside the incision to help keep vitreous from wicking, so I didn't really like what I heard. On the other hand, I did like hearing the fact that he injects subconjunctival antibiotics after the surgery. He also said that the kenalog that he always uses make to sure he can visualize the membranes helps to prevent infection.
Then I asked him about how much vitreous he removes, and when he said he leaves some behind the lens to prevent cataract formation, I told him I was concerned about the remaining vitreous degenerating, and he was rather dismissive of my concern. I asked if he would consider a clear lens extraction-vitrectomy for someone my age (almost 50), and he said no because the recovery time is so much longer--about two weeks.
In any event, I will check with the doctor's office here about the follow up situation on Monday and will post what I find out. One thing that was very helpful to me was hearing from Dr. Sipperley that I have PVD in both eyes and looking at my OCT (unfortunately after I saw the doctor when I asked for my records), which showed the membranes being detatched on both sides of an indentation that I think is the optic nerve insertion point. So now I'm wondering if my Weiss Rings are still attached. I don't see them and the doctor here in St. Louis couldn't see them either, and that's what he uses to diagnose a complete PVD. After the exam, I asked Dr. Sipperley if he thought my PVD was complete, but he said he wouldn't know until he was looking through the microscope during surgery. Does anyone know, if your membrane looks like a V coming out from an indentation, if that indicates that the membrane is still attached around the optic nerve with the Weiss Ring? And if that's the case, how much trauma would be caused during surgery due to the surgeon's having to tease the Weiss Ring off the retina?
Thanks,
Stringyeye
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