We had decided that Mr R needed eyelid surgery to help him see better, so next, we had to consider where to do the surgery, and whether to do it under local anaesthetic or deep sedation. This would depend on his general health. If a patient is relatively young and healthy we do their eyelid surgery here in Clinica London, but if they are medically unfit and require special monitoring after surgery, then we do the eyelid surgery in the nearby private hospital.
Jane: Mr R, at age 78, what is your general health like?
Roger: My general health in the background is not very good. I have lots of problems in different areas of the heart and so on.
Jane: Are you under a cardiologist?
Roger: Under a cardiologist, indeed, who has looked after me since I had the stroke and various other problems that have occurred which I try to keep under control with diet and exercise and tablets.
Jane: Tell us a little bit about the tablets in general, what is it you have to take for your general health, your heart.
Roger: Since the stroke, I have been taking Warfarin, but I am now taking Apixaban which is for me a great step forward because it does the same thing, but I don’t need all the tests, and I don’t have diet restriction.
Jane: But it is a blood thinner and does make the surgery higher risk, doesn’t it, because of the risk of bleeding and bruising and then for risk to your vision with any surgery around the eyes?
Roger: Oh yes! Taking that form of the tablet helps the heart because I have got atrial fibrillation, and so the essential thing is that the blood is at the right consistency, so the heart is less likely to cause problems, like another stroke or a heart attack or whatever.
Jane: Did you have to stop your blood thinning drug before the surgery?
Roger: Yes. I always stop it before surgery.
Jane: How long before your eyelid surgery did you have to stop it?
Roger: I stopped five days before and six days afterwards.
Jane: Lovely, so 11 days without it. You feel alright, do you?
Roger: Absolutely fine.
Jane: That is great.
Roger: It always a bit nerve-wracking taking away what has been saving your life for the last 17 years.
Jane: It is a long time 17 years. So you were 61 when you had the stroke; that is young. Sitting in front of me you are looking very fit and well, and your eyelids are certainly looking a lot better one week after surgery. Because of your general medical condition, we decided that we would do your eyelid surgery at a local private hospital where you could be monitored medically, where they had an intensive care unit, should it be required, and fortunately it was not and also where you could stay overnight.