Chronic Angle Closure Glaucoma

That's the title for today since it was the last patient I saw before my practice management test. this morning started off uneventful enough in specialty pediatrics with only one patient. YAY! Not that I don't like the patients.. most of them are adorable. It's the random completely un-disciplined ones i have issues with. Today's patient was a very adorable, well behaved, four year old hispanic boy. He only spoke spanish and we had a great time. While he was dilating he insulted my drawing ability and we had a good laugh. Apparently my drawings of dogs in chalk "esta malo".

I was scheduled for three patients in glaucoma clinic this afternoon and somehow wound up with four. Fortunately, my friend Stephanie helped me out and took the fourth one when she saw how long the third one was going to take (it wasn't a straight forward primary open angle case).

First two patients: easy IOP checks.. drops doing they're thing.. Go Xalatan !

Third patient: Is handed to my by and attending as I'm wondering to the conference room to finish assesments on my first two patients. She's a referral from this morning from family practice. Her IOP in her left eye is 42. For those of you NOT eye docs.. 42 is BAD !!

When I greet this patient and her daughter-in-law it's clear the patient has been crying. She's also been waiting since her family practice appointment, through lunch, til 115pm when I pick her up. (almost three hours) Hopefully she got lunch in there before I saw her, I forgot to ask. :(
This patient also speaks no English. All I have to say is.. if you live in the south and plan on being in health care.. TAKE SPANISH !! Screw French, German, and Latin. NOT useful !! I'm SO glad I did. I never have to wait an hour for the translator to show up (since our school only has one and she's mainly the insurance biller)

My poor patient's ocular angle is synechied shut from chronic inflammation. she's not in pain right now, but she has been off and on for FOUR YEARS !! In the meantime, this woman has had cataract surgery in mexico and apparently no one mentioned to her, or never looked into the fact that this woman has REALLY BAD GLAUCOMA !! So now, at 65 she's legally blind in her left eye. Almost no peripheral vision. her C/D's are 1.0 in all but one quadrant. BAD BAD BAD !! Poor thing is in pain and had no idea what was going on. I'm just REALLY glad she finally came in. I felt so bad for her. I wish someone had told her what was going on before she went blind. If we can't get her pressures down with drops.. she'll have to get a filter.. since laser surgery won't correct for her mangled angles. She was very appreciative, gave me a HUGE hug when she left, and thanked me for helping her stop her pain and taking the time to explain her problem. (diagrams never hurt anyone) ;) Days like that make me feel really good about what I do.. even though i was almost too late to help. She's still 20/100 thank goodness.. if you saw her nerves you'd be shocked she sees that well.

After all this.. practice management tests seemed like a joke.