What's Going On Wednesday

Guess who's running a 5K on Saturday?

Me! Sweaty...

Last night I made these homemade oatmeal creme pies:

And look at the new billboard by my apartment:

My bosses watch over me at night

Gotta love it.

What I Do at Work part 2

There are 2 things that make the patient believe that the technician does all the work (and to that I tell them I deserve a raise). The first is the manifest refraction I described in the last post - "which is better 1 or 2?" The second is when I check the pressure in the eyes with a tonometer.

Not me, but you get the idea (source)

To do this I give the patient a drop of flucaine in each eye. It is a bright yellow numbing drop. Ironically, the drops sting when they first go in. I then hold the patient's lids open and  place the tip of the Perkins tonometer on the cornea. When I look through my tool, I am looking for a green line that I will align and use to obtain the measurement.

My View (source)

Can you see the faint green semicircles? Now imagine if the patient is sensitive and is squeezing their eyes shut. To get a good view, one must get up close and personal. Short fingernails and good breath are a must. When I have to give this test to prisoners, I get scared. Usually the patient is unaware that the instrument is touching the eye. Pressures between 10 and 20 are normal. Savvy patients, usually those with glaucoma will be very curious as to knowing their measurement. This method of measurement has replaced the need for the "puff of air" test in our office.

After checking pressure, I will instill the dilating drops. We use two types phenelyephrine 2.5% and tropicamide 1%. Because we usually instill these after the numbing drops, no pain is felt. This is different than when I worked in pediatrics and we just had to tell the kids that it would feel like soap is in their eyes. The dilating drops are important so that the doctor will be able to look into the back of the eye where the nerves and blood vessels are. To look inside, he will need to shine a light in. The dilation drops keeps the muscles of the eye from contracting and gives the doctor a more complete view. The drops can last anywhere from 4 to 24 hours depending on the individual. This will make it especially hard to read and the sunlight will seem very bright. We encourage our patients to bring a driver with them, however, if you've had them before and are comfortable driving then it may not be a problem.

In my next post I'll discuss testing like visual fields, OCTS and pachymetry.

What I Do At Work part 1

Have you had an eye exam recently? Then maybe some of this will ring a bell. I wanted to explain a bit more about what I do all day.

I call the patient back (sometimes seriously embarrassing myself with mispronouncing names). Some common techniques to deal with this are to
- make eye contact and ask "are you ready? come with me"
- call the patient by just their first name, or Mr. or Mrs. (last name) based on which is easier to pronounce

When I bring the patient back to the room I introduce myself as the technician. I still feel awkward calling myself a technician. I feel like I should be repairing a car or computer or something...

My job is to find out why the patients are here and get some basic measurements. To get a chief complaint I will always ask about blurry vision, pain, flashes, floaters and double vision and whether or not you use any eye drops. General medical history is also important - medications, chronic conditions, etc... This is when you get to find out how talkative the patient is. As they talk I fill out this worksheet:

And don't worry, electronic medical records are coming this year. I'm excited!

As a healthcare professional I deal with people all day long. As an introvert, this is a very tiring thing! But, the patients always keep things interesting and the majority are friendly. I am always amazed when I find myself telling my life story to random strangers - some people just know how to ask the right questions! 

I use a lot of equipment when I do my initial patient work-up. The first thing I will hand the patient is the occulder.

Me, back in the Doc Plot days (source)

Source

Every time we will start by checking your vision, Believe it or not people will complain that we have to do this. I'm sorry but even if you were just here yesterday we HAVE to make sure you can see, you're at the eye doctor!! I turn on the projector and have the patient read lines off the Snellen eye chart. When they can't got any further I have them use the pinholes which can sometimes help (like squinting). Up close, we use a Jaeger reading card:

Source

For patients who see an MD, I manifest refract the patient. That's when you look through the phoropter and I ask "which is better, one or two?" Patients get so nervous about making the right choice! In this post, an optometrist gives advice for refracting. I like his advice to call certain lines of letters "teeny tiny" or "for bonus points." This really works well for kids. Speaking of kids and babies, this video explains how pediatric eye exams are done (surprisingly entertaining).

Then I go on and check your pupils, by shining a light in your eyes and watching to make sure they are round and react equally. By shining my light from the side, I can check angles. Closed angles create shadows and that is part of a check for glaucoma. Then I will have you follow my light to check motility of the eyes. Your eyes should be able to move in all the directions. Finally we do a peripheral vision test. I have the patient cover one eye and look at my nose. Without looking at my fingers, I ask the patient to tell me how many fingers I am holding up in each of the 4 quadrants. 

Source

For older patients we check for cataracts by performing a test called the BAT (brightness acuity test) using a "big flashlight." I perform the glare test by having the patient look through the light and read the letters on the wall. If a patient has cataracts and they are advanced enough, the light shining in their eyes will cause a glare that decreases their acuity. For more information about cataracts, check out this site.

To be continued....

Quote of the Day

The patient looks over at me and says, "Oh you're expecting"


... um WHAT???
No no no no. It's just my large scrub top billowing out thankyouverymuch!!!

Sugar Cookies & Other Drugs

The Lumigan guy came by the office today with these cookies:

Something strange about eating a cookie advertising a glaucoma eyedrop... oh well, sugar rush!

"Miner" League Baseball

I went to my first Southern Illinois Miners game on July 17. It was the annual Kiwanis game meaning club members from all over Southern Illinois were invited. We also got a shout out on the big screen. It was a hot day, but our seats were in the shade. We had a fellow Kiwanian hook us up with good seats and a parking pass (just outside of the gate).

Love the couple behind us!

I was wearing a sweet Kiwanis visor. The park was really really nice. Although, in my opinion they could use some new mascot costumes. The Miner, TNT, Canary and the Gopher were a little rough around the edges. We had a great time. Especially, when the home team won in the bottom of the 9th, woo hoo!

The Marion Eye Center sponsored the eyeball race. I was rooting for brown but green came in for the win.

Hopping Aboard the Coupon Train

Today was a slow day at work, we had more techs than were needed. So I had a chance to practice my venipuncture skills some more. This time we did infusions (pushed saline into each other's veins). I'm getting better. Thanks to my brave coworkers! After that, my supervisior decided to send someone home and I was the lucky one :)

Brandon also had the day off so we spent the day watching world cup soccer. USA USA USA! I also made a wicked shopping list using all the coupons I've started collecting. When I went to Kroger I used 7 coupons at the register and saved $6.75. Haha. Yay! I'm almost an extreme couponer, lol.

For dinner I made BBQ shrimp, sweet corn and the disaster that was microwave mashed potatoes.

That's what I get for taking a short-cut I guess? Oh well.

It's been really hot here lately. But last night we had some torrential rain:

Gotta remember to take those summer storms seriously! (I was stranded for a good 20 minutes).

We're having a pot luck lunch at work on Friday. What should I bring?

Blood & Country Music

I had to work on Saturday. Actually, I was sent to class. A bunch of the techs from Marion Eye Center were sent to John A Logan to take Introduction to Phlebotomy. The course went from 9-4:30. While it was a long day, it was very informative and will prove useful in my career in healthcare.

We learned how to tie the tourniquet, palpitate for the veins, insert and remove the needle. Not as hard as you would think, but definitely not for everyone. We practiced on some dummy arms filled with water and then on our fellow classmates. I was able to draw blood on my second try. Our teacher, Van Hendrickson, was very informative and calm when we poked him in the arm :)

On our lunch break, many of us went to Arturo's Mexican Grill in Carterville. We had the lunch buffet which was a good deal for just $7.00.

When I got home, I found out that the plans for the evening were to go to the Williamson County Fair for the LoCash Cowboys concert. This was the first night of the fair. Can you believe it has been occurring annually for 155 years?! We went with Brandon's parents and his niece Kayla. We were able to get into the concert for free because Nancy is the childhood friend of Juli Ingram aka "Honey" from Z100's morning show Nut 'n Honey. Her son Ryan was going to be playing drums in the opening act Jared Thomas and the Vagabonds. Listen to their music on facebook.  They gave a good performance and the crowd seemed to be into them.

LoCash Cowboys followed them with lots of energy and excitement. They shot off red, white and blue confetti! But their loud base started shaking Nancy and we decided it was time to go, lol!

My Office

Since my 2 year anniversary of working as an Ophthalmic Technician has arrived, I wanted to do a couple of posts describing more about what I do on a daily basis. 

An ophthalmic technician is an eye doctor's assistant. My first job was with Dr. Plotsky in Bethesda, MD. I got that job through an ad on Craigslist. Luckily, I gained a lot of great skills with that job which made it easy to find a similar job when I moved to Illinois. I currently work for the doctors at the Marion Eye Center. My home office is Carbondale. I primarily work there but can be sent to other locations if needed. 

Step into my office:

This is just one of the 5 tech rooms. We take patients back to these rooms to get their initial work-up done. Each room has slight variations in size, equipment, furniture ... but the basic layout is the same. The patient will sit here:

Once the initial screening is done, we take the patient to the doctor's exam room. As you can see, it's got the good equipment ...

If the doctors rooms are full we seat the patients in the second waiting room.When I'm not in one of the rooms, you can usually find me back here, filing away:

Ophthalmology Lessons

So, I've been getting a lot of cool eye experiences lately. Yesterday, I assisted with a PRP and observed an Avastin injection. 

PRP is a laser treatment that zaps the retina multiple times in order to seal off leaky blood vessels. A big needle full of anesthetic is injected into the back of the eye before the laser so that the patient will only feel a dull pain during the treatment. This treatment is used for people with diabetes who are having complications with their vision.

Source

Patients with wet macular degeneration suffer from blood vessel growth and leakage on the retina and macula. Avastin is a medication that is injected into the eye that prevents blood vessels from growing. This procedure is a bit faster and less painful. A topical anesthetic is applied at the area of injection.

Source

My learning spree continued today at work when we had a staff seminar on canaloplasty. This meant free lunch from the drug rep, well in this case the procedure rep? 

This is a new procedure for those with open angle glaucoma. Glaucoma is high pressure in the eye that is normally treated with eye drops that must be used for the rest of the patient's life. However, with this procedure, patients have a chance of getting off drops for good. The rep really wanted us to learn all about the procedure since one of our docs is being trained to perform them. So she shared a video of the surgery. I almost considered posting a photo but they are a bit bloody and not for the faint of heart. See photos of the procedure here.

El Greco

It was a long, 9 hour day at work today. But, the payoff was that I got to see a cool in-office procedure: chalazion excision. A chalazion is another name for a stye, or swollen gland on the eyelid. Typically people will get them occasionally and they will last 2-3 days. However, the patient today had two, one which had been around for a year. The procedure was cool and a bit bloody. It was crazy to see how far the eyelid can be flipped back. This website does a really good job of showing what I saw.

For dinner tonight, I picked up gyros from El Greco in Carbondale. The restaurant was busy with a lot of people picking up orders to go. Next time I will call ahead! While I was waiting for my carry out, I checked out the t-shirts. Cute!

The best part was coming home and eating the delicious food!

This is the gyro platter which was the daily special today - you get the gyro, fries and a drink for $5.99. I had my fries upgraded to onion rings. Unfortunately, this was a bad choice. Although, the onion rings are homemade, they just didn't taste good - they tasted somewhat chalky, too much flour in the batter perhaps? The gyro meat was delish - a mixture of beef and lamb. The special sauce was also good, but it is sour cream based instead of yogurt. Brandon also enjoyed his meal and shared my feelings on the onion rings.

I have been posting my restaurant reviews on yelp.com. Not too many people use it out here but they should :)

Marion Cultural and Civic Center

Tuesday was an interesting day of work! We had the opportunity to attend a health department hearing at the Marion Cultural and Civic Center.

Source

Me and hundreds of my coworkers went in opposition to this exemption application...

E-001-11     Surgery Center of Southern Illinois, Marion

In accordance with the requirements of the Illinois Health Facilities Planning Act, Notice is given of receipt of a change of ownership exemption application (E-001-11 Surgery Center of Southern Illinois, 806 North Treas, Marion, Illinois). Cirurgia Centro, LLC is proposing to purchase a 100% interest in Marion Holding, LLC that owns 51 general partner interests and 9.6 limited partnership interest of Marion Surgical Center, Ltd. Upon completion of this purchase Cirurgia Centro, LLC will obtain control of a health care facility’s capital operation or physical plant and capital assets. The cost of the transaction is $1,512,500.

Basically, we do not want to give up our surgery center to the unethical lawyer - Ronald E. Osman. The hearing was definitely in our favor.  All of our MDs spoke and so did some patients. The best part was the beautiful setting:

Only an IDPH staff member and a court reporter were there to record the hearing. The case is scheduled to go before the State Board on June 28. I'll be sure to let you know if we get our way.

My Job

I thought it was time to introduce you to my place of employment - Marion Eye Center. I work at the office in Carbondale as a technician - the eye doctor's assistant. So, when you come in, you check in with the front desk and then I bring you back to check your vision, look at your pupils and give you eye drops if you need them. I also perform other tests like OCT and visual fields and in my down time I file charts and answer the phone.