Desert Health News - March-April 2024

. www.DesertHealthNews.com March/April 2024 Medical News The Valley ' s Leading Resource for Health and Wellness 9 www.desertvasclarassociates.com Personalized quality care delivered with compassion and integrity Anna Gasparyan, MD, FACS Vascular Surgeon Desert Vascular Associates 760.902.1511 74000 Country Club Dr. • Suite G-3 Palm Desert CA 92260 DesertVascularAs ociates. Special Interests: Varicose Veins/Venous Insufficiency Carotid Artery Disease Aortic Aneurysms Peripheral Vascular Disease (PVD) Endovascular Interventions Dialysis Access IVC Filters Chemotherapy Port Insertion Accepting new patients and most major insurance plans www.myhealthmyadvocate.com Our goal is to improve patient experience and outcomes by ensuring clients understand and receive appropriate treatment, quality care, and accurate billing. • Talk with doctors on your behalf • Review treatment plans • Unravel medical billing • In-hospital bedside care • Assist with hospital discharge to home or other facilities • Wellness visits O ering 30 years of experience navigating the health care system. Tammy Porter DNP, MLS, RN-BSN, CPHQ, CCM (760) 851-4116 myhealt .co Serving Coachella Valley, Riverside, San Bernardino, surrounding areas, and nationwide virtually. A Nurse Advocate Your Trusted Guide Through the Health Care System T Simply Caring For You Although rare, a cataract lens implant can dislocate after surgery. Dislocations can occur in the early post-operative period of cataract surgery or even several years later. Any weakness to the zonular support structures or capsular bag that holds the lens implant can place a patient at risk for lens dislocation. Symptoms of this condition include oscillopsia (jiggling vision), rapid shifts in focus, light sensitivity or photophobia and sudden loss of vision. Some patients even experience seeing the moon shape edge of the lens implant drifting out of their field of view. Besides trauma or previous vitreoretinal surgery, other risk factors include specific conditions, such as pseudoexfoliation syndrome, Marfan syndrome, Ehlers- Danlos Syndrome, high myopia and retinitis pigmentosa. Over the past two decades, there have been remarkable advances in surgical techniques to repair and manage patients with dislocated lens implants. If a lens is only partially out of position, or subluxed, we can surgically reposition and recenter it. Sutures may be needed depending on the status of the capsular support bag. If the capsular support bag is healthy, the lens implant can be captured inside the capsule without sutures. However, when there is poor capsular support, internal sutures are required to lasso the lens implant and anchor it securely inside the eye. When the implant is completely dislocated posteriorly to the back of the eye by the retina, the surgical management is more complex and often staged with the help of a vitreoretinal surgeon. First, the damaged implant is lifted off the retina and explanted by a retina surgeon with careful attention to avoid potential for retina damage. Then, a new artificial lens implant can be placed as a secondary procedure. Over 20 years ago, I remember working late into the night in surgery with Gregg T. Kokame, MD with his haptic externalization techniques to suture secondary lens implants in aphakic patients. The Kokame technique was revolutionary for its time, but it would take several hours to perform with tedious internal suturing inside and outside the eye. Later, in the early 2000s, I worked with Howard V. Gimbel, MD, who at the time, published multiple surgical techniques of capsule fixation, optic capture and internal suturing that laid foundational concepts for further developments in the repair of lens dislocations and secondary lens implants after trauma. Other surgeons expanded on these concepts, and new techniques were popularized over the intervening years, including iris fixation, glued IOL (Agarwal, et al) and corneal-scleral (Hoffman) pockets. These secondary lens surgical techniques were challenging to perform. Some surgeons would resort to older style surgical techniques of implanting an anterior chamber lens implant (ACIOL). Although using an ACIOL was a less complicated surgery to perform, it did require large incisions, multiple sutures and resulted in high post-operative astigmatism. Furthermore, the ACIOL techniques had increased rates of complications, such as corneal failure, chronic inflammation and UGH syndrome, that would often result in the need for additional surgeries. In 2017, Shin Yamane, MD described a novel technique using small incisions and transscleral haptic fixation that revolutionized the field of secondary lens implant surgery. It is often performed without sutures and can be executed in less than an hour. This allows for much faster surgical times, lower complication rates and an easier recovery for patients. For these reasons, the Yamane technique is the preferred way to manage secondary lens implant surgery in patients with complete dislocated lens implants. As for lens implant dislocations, the best advice is to avoid the problem altogether. Ensure that your eyes are safely protected when there is any potential risk of eye trauma. This is especially important when playing sports such as tennis and pickleball. An active, healthy lifestyle is an important part of living life to its fullest, and sports goggles should be a part of this too. Dr. Tokuhara is a cataract surgeon with Desert Vision Center in Rancho Mirage and a member of Desert Doctors. He can be reached at (760) 340.4700. Formore information visit www.desertvisioncenter.com Cataract Lens Dislocation By Keith G. Tokuhara, MD Long-term care (LTC) is a topic many of us would rather not think about, yet understanding your LTC coverage before you need to use it is an essential step in securing your future health and financial well-being. LTC encompasses a variety of services and support to meet health or personal care needs over an extended period. It can be provided at home with caregivers or in a facility for rehab or assisted living. Early understanding affords you the time to research and decide the type of care you prefer. As we venture into an era where people live longer, the probability of needing some form of LTC increases. In addition, a sudden illness caused by a fall, stroke or heart attack can prompt an unexpected change in your living situation. Here's a guide to help you navigate and understand your LTC coverage in advance, ensuring you're prepared when the need arises: Cost of care • Know whether your policy includes in-home care, assisted living facilities, nursing home care or all three. • Personal care at home – hourly caregivers range from $25 - $40/hr (more if you want/need a licensed nurse). Most agencies require a minimum of four hours/day. For 7 days/week, that is $700 - $1,120 per week or $2,800 - $4,480 per month – just for four hours of help a day! • Assisted living apartments or a room in a Board and Care home can run $3,500- $7,500/month and higher. Elimination Period • Look at your policy’s “Elimination Period” (30, 60, 90 days). This is the time between when you become eligible for benefits and when you start receiving them. This will be your share of the cost that is not reimbursed. Plan for how you will cover costs during this period. If you have to pay for the care I just mentioned above for 90 days, do you have access to those funds during this waiting period? Understanding Your Long-Term Care Policy By Tammy Porter, DNP, MLS, RN-BSN, CPHQ, CCM Continued on page 20 It’s important to understand your long-term care insurance policy before you need it.