I got my second eye injection on Thursday, and so far the experience has been
roughly the same. My eye’s still a bit score and scratchy, but oddly enough, I
don’t seem to have gained any more floaters compared to the last injection. The
doctor says the bleeding under my macula appears to be receding and suggested I
may not need any further shots after this one. We’ll see in six weeks, I
suppose.
The most annoying part of the last injection is the slight scattering of dots
in my vision extending from the center to the bottom right edge, which slowly
fans out the further it gets away from the middle. What’s weird about them is
that they don’t move with my eye, so they’re not floaters, and they’ve been
there since I got that first injection. Still, despite this, it will be worth
it assuming my macula continues to heal and no further vessels form beneath it.
To me, the only remaining questions are regarding what steps I should take
regarding monitoring to ensure I’m not forming new vascular tissue in the
coming months and years. For both of my eyes, even though I’ve only had this
problem with one thus far. From what I’ve read, there are non-invasive scans
they can use for this. But how often should I go, given my high myopia and the
demonstrable fact I’ve already had one bleed?
This whole thing is a bit odd, really. I’ve found that I need more light to see
things clearly now, and it’s that same light that reveals all the new
imperfections in my vision. Aside from the blank spot in my central vision,
there really is quite an increase in several different distractions. There’s
some kind of dark haze that hangs out in the upper left quadrant, the
previously mentioned spray of dots in the lower right, multiple new and fairly
large oval floaters that swim across my vision like some kind of drunk amoebas,
and a stark black pinpoint in the lower left of center like the inverse of a
star in the night sky. It’s like trying to observe the world through an
aquarium that has long since been forgotten by the owner, and it’s slowly
becoming more filthy and opaque with each passing day.
I see all of this every time I take a walk to get some sun and exercise. Yet
it’s not a universal thing. My brain is trying valiantly to mix the disparate
signals from both of my eyes and erase some of these imperfections. The blank
spot in the center for example, merely becomes slightly blurry when using both
eyes. All the floaters are still there, but not as prevalent. The spray of dots
seems to be the only universal that doesn’t vary, and it’s much more obvious
under sufficient lighting conditions.
I suspect I’d need a vitrectomy to truly rid myself of all of the new detritus,
but because of my myopia, any kind of surgery vastly increases my risk of a
retinal detachment. Even these relatively minor injections can trigger such an
outcome, so I may have to end up living with it. It’s better than going blind,
either by allowing the macular degeneration to continue unchecked, or having my
retina detach. I vaguely wonder what my visual field will resemble once all is
said and done.
While I was vacuuming up some fur-based tumbleweeds around the house Sunday morning, I noticed that it seemed as if I’d stared too long into a light bulb. That misshapen blob that suggests light has seared an indelible purple smear into my vision until it eventually fades. “Huh, the bathroom lights must be brighter than I thought,” I thought to myself. I shrugged in annoyance and kept vacuuming.
But it didn’t go away. It didn’t fade. Confused, I tested by covering my right eye with my hand, and then the left. The discolored spot was only in my right eye. Worse, wherever I looked took on a pincushion effect, as if whatever I gazed upon was being sucked into a black hole, distorted, shrunken, and swirled. Given all of the warnings chanted to me by a ceaseless string of opticians, optometrists, and ophthalmologists, I immediately worried I was experiencing a retinal detachment.
Why would I worry about something that’s normally extremely rare? My eyes are bad. Awful. Terrible. You know that big E on the eye chart? If you can’t see that, your eyes are marked as -2.5 diopters. My eyes are around -14.5. Myopia is caused by the eye elongating and causing the visual image to fall short of the optic nerve, and in my case, my eyes are practically footballs.
That kind of stretching pulls the retina extremely thin, and as a result, raises the risk of it coming detached. Scared I was about to go blind, Jen and I called the local ophthalmologist, and her answering service suggested going to the local ER to make sure it wasn’t the worst case scenario. So we went.
After a bit of waiting, I was brought into the back room and given a quick triage. During this, they asked me to look at an eye chart, and even with my glasses on, I couldn’t make out the top line because the single letter E was engulfed in a thirsty black hole that distorted any sense of what the letter could have been. I knew it was the letter E, but I couldn’t see it; a far more important distinction.
So they called the ophthalmologist to get her opinion, and she actually agreed to come in on a Sunday to see me herself. Upon examination, she said it looked like the spot causing the distortion was “tenting” due to blood leaking between layers in my eye. So rather than retinal detachment, I’d incurred a wholly different malady: Myopic Macular Degeneration.
Based on what I’ve read, prescriptions as high as mine carry a roughly 95% or higher chance to experience this around middle age, and for similar reasons as retinal detachment. The bloated mass of the elongated eyeball requires extra vascularization, and these extra blood vessels are more likely to leak. It’s just a matter of when.
What I experienced on Sunday was merely my first symptom. So the ophthalmologist called a retinal specialist a couple hours away and conveyed my problem. He agreed to see me Monday afternoon, and so I went to bed unable to see through the middle of my right eye, hoping it wouldn’t get any worse by the time I saw him. I was also hoping this hadn’t progressed to a macular hole, because those require surgical intervention and carry a substantial decrease in visual acuity.
The visit itself was fairly uneventful. Apparently the doctor is extremely busy, and employed a kind of production line in his practice. One room for every major check, one person in each room at all times, patients in the waiting room until it’s their turn for one test or another. It was my “turn” about four times, until eventually he agreed that the tenting was being caused by blood between layers of my eye, and prescribed Anti-vascular endothelial growth factor (Anti-VEGF) therapy to prevent it from getting worse, and maybe eventually revert things back to some degree of normal.
That meant an injection of Avastin directly into my eye. Despite three applications of numbing drops and gels, I distinctly felt the puncture, and it left a dark black perfectly spherical hole near the bottom of my visual field. I can also see a few tiny bubbles where the injection disturbed my vitreous fluid. Still, if it works, it’s a small price to pay to avoid slowly going blind over the course of 3-5 years.
As of now I still have the visual warping distortion and it feels like I got punched in the eye by a particularly annoyed cat. I can barely read what I’m writing here, looking at the words obliquely so the dead spot in my visual field is temporarily displaced. I’m not sure how I’m going to be able to work long-term like this. It’s better than the alternative, but it’s hardly easy. I’m not even sure it’s viable long-term.
I see the retinal specialist in another five weeks, but I may have to ask him what I can actually expect so far as how well my right eye will be able to see when this is all over. Presumably the leaked blood will stop, and eventually be re-absorbed, but when? Can I expect any long-term issues from this occurrence? I’m going to be making a long list of questions for that appointment, especially if things haven’t cleared up by then.
What I find most odd is that every single eye doctor I’ve ever seen has warned me about retinal detachments, but not a single one mentioned MMD. Given the above chart, that seems patently ridiculous; I’m far more likely to experience MMD than retinal detachment (and sooner), even though I’m at high risk for both. What exactly happened there? Is it just that regular eye doctors don’t expect to see macular degeneration—a disease usually associated with older people—in younger populations?
Whatever the case, this is a new chapter in my life I was expecting, but hardly looking forward to. Here’s hoping it doesn’t interfere too much.
Well I just discovered something pretty interesting while watching a conference talk from Christian A Stewart-Ferrer. He’s a psychologist that seems to specialize in autism-spectrum disorders, and he spent roughly three hours outlining tendencies and dispositions of people with Asperger Syndrome.
At one point, he said something almost out-of-hand about melatonin production and quickly moved on. I’ve known about my Asperger’s for over a decade now, but I never really did much research afterwards, and it turns out that was probably a mistake. Apparently there are numerous studies and meta-analyses that suggest deficiency in melatonin production that can at least be somewhat alleviated with supplementary melatonin.
Why does this matter? Because I’ve never been able to sleep easily for as long as I can remember. Full day of playing outside as a kid? Can’t sleep. Kindergarten nap times? Forget it. I’m still convinced the other kids were just laying down and being quiet while not really sleeping. Winter, Summer, Spring, or Fall, no distribution of light made any difference.
I strongly recall either sleepovers or nights at a babysitter and listening to everyone’s breathing change as they fell asleep, while I simply lay there with my eyes closed waiting for my turn. One specific night I remember being told my mom would be picking me up soon if I just lay down and closed my eyes for a while. So I closed my eyes and waited, increasingly bored out of my mind. At the time I didn’t understand that the babysitter expected me to fall asleep, and most children probably would have.
About the only time I was capable of nodding off was before my heart surgery when my oxygen stats slipped so low that I blacked out. Little did I know that I merely needed melatonin. Decades of this, all because research in the area was—and still is, to an extent—in its infancy.
In my defense, I did try to use Melatonin once or twice in my 30s, but the studies suggest amounts of 500ug to 1mg rather than the vastly excessive 3-10mg normally available, and that best absorption is sublingual. Maybe if I knew I’ve been under-producing melatonin for essentially my entire life, I may have tried harder to make it work.
I’m glad at least that I stumbled upon the right solution one way or the other. I’ve been taking 1mg of melatonin about 1 hour before bed and I do seem to fall asleep easier than I recall in my past. I still have to find a way to fix the damage done by the Lexapro, but one thing at a time.
In late August 1999, a long-haired calico known only as “Mama kitty” due to her
numerous pregnancies gave birth to a litter of kittens in a garage on a farm
somewhere in Iowa. Winter came early that year and was not kind. The kittens
quickly succumbed to upper respiratory infections that eventually spread to
their sinuses and eyes, sealing them shut behind a wall of crust. They all
needed to see a vet, and fast.
I don’t remember how many actually survived, but it was at least three. I know
all of this because I had only recently graduated college and that farm just
happened to be the childhood home of my girlfriend at the time. I was visiting
for Thanksgiving and got to keep one of the kittens as an early Christmas
present. I named her Luna after a character in Lunar, Silver Star
Story that
captured my heart during the playthrough.
I had just brought Luna home.
Luna’s persistent weepy eye was the only reminder of her early brush with
death. Beyond that she was a healthy and vibrant kitten who delighted in
keeping me awake by yelling in my ear and licking my face. Soon after taking
her home, I moved into an apartment in Lisbon set above some shops on the main
street there. It was a sprawling cavern with a galley kitchen and nearby
bathroom, bookended by a master bedroom and the living room with a side room
in-between.
All of that room for a tiny little kitten, and she managed to strand herself in
the top shelf of my closet by climbing up my graduation gown on her first day
left alone. Her tiny cries for help were the first thing I heard when I got
home. Not too much longer after that, she took after her mother and started
going into heat when she was barely eight months old. I could have sworn that I
had at least a few more months before it was necessary, I rushed her to the vet
to have her spayed anyway.
And then? She was a cat and did cat things. I lived in a lot of apartments
where I didn’t think it was safe to let her outside, but she made the best of
it anyway. Eventually she grew up into an exuberant and extremely fluffy
testament to her species. And much playtime was had.
Stares Pouncingly
Luna inherited several attributes from her mother that made her one of the most
adorable creatures I’d ever encountered:
She was ridiculously fluffy, with a mane and tail that belonged to a Maine Coon
She enjoyed, and even demanded belly rubs
She was a lap-cat through and through
She loved and trusted me implicitly
Sometimes she performed several of these feats simultaneously.
I was her personal masseuse
Eventually I moved into a house where she could “spread her wings” so to
speak. It was a raised ranch set in a wooded enclave complete with fire-pit and
deck. The house itself was probably smaller than my first apartment, but it was
mine, and also hers.
I never begrudged her trips outside, and she knew to jump into the deck window
to alert me that it was time to come back in. I certainly enjoyed that more
than my childhood cat which jumped onto the screen door instead. Still, the
veritable forest in my back yard was like a wonderland to her. It wasn’t
uncommon for me to look outside and see her running head-first down a tree
either chasing something or just stretching her legs. Even the rain wasn’t
enough to dissuade her on occasion.
I don’t have a lot of pictures of this since my only camera was a “modern”
Kodak DC240; digital or not, it wasn’t exactly as convenient or ubiquitous
as a camera phone. It was still only 2004 after all. I regret both that, and
the fact I moved away from that house given how much Luna enjoyed it. She’s
been cooped up in Chicago and suburb apartments or homes ever since.
This is probably for the best in any case. In early 2008, Luna revealed she had
a heart problem not uncommon in cats. I
was actually ready to say goodbye to her even way back then, given such a
diagnosis usually brought death within a year. But she took well to the
appetite stimulants and heart medications and eventually got better.
This isn’t to say that she fully recovered though. It was pretty obvious that
she’d lost something in the exchange. She’d grown thinner, weaker, and less
active, and started matting more frequently. But she was still Luna, and still
sat on my lap while I messed with my computer or read a book.
And then time passed as it always does, and Luna continued to defy the odds.
One year post diagnosis became two, and then three. By the time we moved to a
sleepy college town it was already 2012 and I’d long since stopped worrying
about Luna’s health. Instead, it was time to consider her age.
I’m old, let me sleep!
She was 13 by then, and she’d long lost her ability to jump to 5-foot-high
window ledges. When we first moved into the house, we stayed at a nearby hotel
for the night so the moving truck could deliver everything the next day. When
we returned that morning, she’d somehow gotten onto the kitchen counter and was
yelling for our aid. We still don’t know how she got there, but it was an
isolated incident she never repeated. Instead, it was time to live the easy
life.
Looks comfy
Time marched on and the combination of her age and heart problems gave way to
some kind of seizure disorder. Though she always recovered from these
once-a-month bouts, each one left her weaker, stiffer, and tangibly older than
the last. Despite all of this, she was still my Luna. Still demanding my lap
any time I was sitting down, still coming to bed and resting between me and my
book before I went to sleep, still standing tall when she wanted to.
She’s still got it
But it also became increasingly obvious she was winding down. She was starting
to walk with her feet turned out and disliked having her hips handled, two
sure signs of arthritis. The seizures were lasting longer. Her sleeping more
frequent. Eventually even ascending the couch or bed became too difficult
at times, so we placed a wooden footstool nearby so she could always be with
us. Surely her time was coming soon?
A majestic sight
Instead, she’d reached some kind of fragile equilibrium. Her decline continued,
but she maintained her trips around the large ranch home. From the giant
LoveSac in the rec room to our bedroom on the complete opposite side of the
house, there was no nook, cranny, or hamper she didn’t impose herself upon. She
pawed at our legs for attention even then, insisting we never forget she was
there before Salem and Lorelei in 2014, and Ash in 2017. My lap was hers, and
hers alone.
Luna probably spent 1/3 of her life on my lap
And then Jen got a job in 2019 at a university further downstate in
anticipation of finishing her doctorate, so we moved for the first time in
seven years, Luna still in tow. By now Luna was extremely thin and her fur was
starting to look ratty and uneven no matter how often I combed her. Though she
still followed me around the house and imposed herself upon my lap, we’d
started feeding her wet food. It was the only thing she would consistently eat,
and she needed to maintain her strength. I’m pretty sure Fancy Feast Savory
Centers saved her life for at least the last two years.
Still beautiful
And then some time in 2020, it became blatantly obvious that Luna had dementia.
Instead of following me around the house, she was set in a kind of pattern. She
would go to a room where I was supposed to be, and if I wasn’t there, she would
yell at the top of her lungs in distress until I showed up to calm her.
Sometimes I just hadn’t gotten to my office yet, or was late going to bed;
she’d yell all the same.
When winter arrived, she began to actually prefer the furnace registers to my
lap, pressing her whole body flat into it for hours. A cat that old should be
under as little stress as possible, so I ordered a cat bed heated by a small
coil similar to a heated blanket. While Ash was the first to try it out, once
I let it reach operating temperature and introduced Luna to the warmth, she
rarely left.
She liked the warms
And then Luna began to die. It’s much easier to see in retrospect, but it was
as if the warmth of the bed finally allowed her to succumb to the years and
rest comfortably. She ate less, sat on my lap less frequently, and stopped
coming to bed to say goodnight in her special way. Eventually she only left
to eat and use a litter box.
When Jen found her gently swaying next to the fridge one afternoon, it was
obvious something was wrong. Her nearby food was untouched and she yelled when
I tried to pick her up. Eventually I managed to move her to her bed again,
but her breathing was hard and fast. I brought her to the vet the next morning
under the assumption I would be putting her to sleep. Despite her survival
nature, she was too old to weather a true health crisis.
The vet convinced me to give her one more chance since this could be transient,
and how could I refuse? So Luna received a two-week bolus of steroids to try
and encourage her appetite and maybe give her enough strength to defy the odds
once again. And for the rest of that day, things had improved somewhat. She
insisted on spending the rest of the day in my lap, and purred for most of it.
She happily chirped random meows that sounded encouraging. Then she went to her bed
for the night, and never really left again.
I think that was her goodbye; the last burst of energy the dying often have
when the end is truly near. I moved a water bowl one foot away from the bed,
and a food dish two feet. While she licked the food listlessly once or twice,
she never actually ate. She barely drank. And from Friday to Monday morning, I don’t
think she visited the litter box one single time. I could see how every breath
wracked her whole body, and picking her up to comfort her promptly resulted in
loud wheezing.
It hurt so much seeing her like that. I called the vet again Monday morning and
explained the situation. This time there was no argument; Luna deserved a
second chance, but it simply wasn’t enough. At twenty-one and a half, she was
about 102 in cat years, and sometimes you just die of old age. She spent her
last few hours in my lap, and then at 5pm, she went to sleep one last time
while I stroked her. I had the vet take a clay casting of her paw, and gave her
a few quick pets before leaving.
Finally Free
I honestly don’t remember the last time I cried—even thought myself incapable
at this point—but I did after we left. I’m even having a bit of trouble
writing this through tears, trying to do her life justice and missing her at
the same time. After 21 years, she was my daughter; old enough to have finished
college and vote. Old enough that I knew it was inevitable. Yet I’ll miss her
interminably.
She was the cat that would lay on her back for the full extent of my arm while
I held her aloft and rubbed her belly. She was the cat that navigated the
wooden rafters in our townhouse even though she was 11. She was the cat that
never bit or scratched me and purred seemingly without end. She was the cat
that defied the odds so often, I almost thought she’d tricked death into
forgetting about her. She was the cat that loved me above all else.
She was the cat that never left my side until she had absolutely no choice.
And she’s the cat that has left my life, but will never leave my heart.
I hope you can finally rest, Luna. You’ve earned it many times over.
Luna’s health doesn’t seem to be improving after her visit to the vet. If anything, she has gotten markedly worse. While the steroids did increase her appetite for the first day, she continued to weaken further over the weekend. Whatever benefit the steroids initially provided has been overwhelmed by her steadily waning constitution. It’s all she can do to walk two feet from her heated bed, so I’ve provided her with a bowl of water and a tray of food she won’t (or can’t) eat.
So sadly, I’ve called the vet this morning to have Luna put to sleep late today. I love that cat too much to watch her suffer; starving, laboring to breath, collapsed on the floor because she can no longer walk. I feel terrible she’s had to endure this long, and I want to minimize that as much as possible.
Twenty-one years is a long time for a cat to live, and if I’m being honest with myself, she wasn’t even really “all there” for the last year or so. But despite being a bit slow to move, she still got around the house OK. The heated bed really was the last sign, though. Once she started spending all of her time there, it’s as if she was using it for some long-needed relief. I suspect that maybe her arthritis was bothering her more than she was letting on.
Regardless, it’s time for her to rest. I’ve literally had this cat for half of my life, which is saying something at 43. She’s earned a break after all of that. Given that she went into heart failure back in 2008, she’s been a remarkable survivor until now.
