Ocular Occlusion

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.

Relationship Between MMD and Spherical Equivalent

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.

Until Tomorrow

Mysteriously Missing Melatonin

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.

Until Tomorrow,

To The Moon

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.

Baby Luna
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
Stares Pouncingly

Luna inherited several attributes from her mother that made her one of the most adorable creatures I’d ever encountered:

  1. She was ridiculously fluffy, with a mane and tail that belonged to a Maine Coon
  2. She enjoyed, and even demanded belly rubs
  3. She was a lap-cat through and through
  4. She loved and trusted me implicitly

Sometimes she performed several of these feats simultaneously.

hedonist
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!
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
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
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
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
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
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
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
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.

Harvest Moon

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.

Rest well, Luna.

Lunar Quake

Two days ago, Luna’s health seems to have started rapidly declining. Jen noticed that she was standing next to the refrigerator and gently swaying for over an hour, and when I tried to pick her up, she yelled and bit me. I couldn’t tell if it was from pain or confusion, but I was being extremely delicate given that I know how old she is.

Even after that episode abated, she seemed unable to really walk. After a few steps, she flattens herself on the ground completely, as if she’s resting or simply too weak to continue. Given this was the case, I put her in my lap for the remainder of the day, and she never wandered away when I got up to leave my office. When the work day was finally done, she hid in Jen’s office behind a stack of books for the rest of the night. Salem even settled down nearby and kept watch over her until morning.

So I called our vet, concerned that she was finally on her way out after 21 and a half years. After seeing her, the vet told me a few things I already knew. Luna is too skinny because she doesn’t eat enough. She holds her head at a tilt most of the time, but the reason could be related to fluids under her eardrums or a tumor. But the vet thought that maybe some steroids could fix both of these problems, or at least give her one last chance to come out of the nosedive. So she gave Luna a two-week bolus of steroids, some fluid under her skin which I initially mistook for a cyst, and sent her back to me.

Luna was definitely hungry when she got back. She even started eating a hardened chunk of wet food she found under the dish while I was cleaning and filling it with a fresh can. But that hasn’t endured long-term. She didn’t eat once that can was gone and replaced with another later in the day, and despite giving her two different options this morning, both trays sit unmolested. Even if she had finished both cans, that’s not enough nourishment given she’s so scrawny now.

Still, she deserved the chance. There’s no reason to jump straight to putting her to sleep unless her quality of life has degraded to the point where she’s suffering. The vet said she didn’t seem to be in pain, and she still enjoys her long rests in my lap, so I’d like to continue those until she’s ready to let go.

Until Tomorrow,