Wednesday, February 15, 2017

Cataract Surgery, South Canterbury Eye Clinic & Timaru Hospital

During 2016, Leah's eyes were painful, so she visited her Fairlie GP who said she had cataracts & needed to see an ophthalmologist. There was a long waiting list for ophthalmologist appointments at Timaru.

Breadwinner teacher Leah needed good eyes at Lake Tekapo School, St Joseph's School, Fairlie, working with private students at Fairlie & lecturing Specific Learning Difficulties topics at Seabrook Mackenzie Centre, Christchurch.

Leah's 3 year teaching contract ended at Lake Tekapo School, so at year's end we moved to Pleasant Point, after Leah got a Resource Teacher Literacy post at Timaru. Leah would need good eyes to commute daily by car from Pleasant Point to Timaru. Her new job also needed good driving eyes to South Cantebury schools from Timaru to Waimati southwards, Peel Forest northwards & Twizel westwards, requiring her regularly visiting & advising 40+ South Canterbury schools.

Wed 15.02.17. South Canterbury Eye Clinic appointment: Over 2 hours, Leah was seen & tested by 2 ophthalmologist nurses & an ophthalmologist to assess her for placement on the 4 month waiting list for cataract surgery at Timaru Hospital. Leah was told NZ state would pay $3000 for cataract surgery in one eye.

If Leah wanted cataract surgery in the other eye she would have to go through the whole bureaucratic nonsense again, seeing staff at South Canterbury Eye Clinic again to get on another waiting list for cataract surgery in her other eye. Or if we had the money, opt for cataract surgery by a private surgeon & pay his private fee. Meanwhile without cataract surgery on both eyes simultaneously, Leah's sight would be marginal & glasses defunct, while waiting for surgeries in separate eyes several months apart.

South Canterbury Eye Clinic gave Leah a handout - CATARACT SURGERY INFORMATION - PUBLIC which read:

Cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and helping to produce clear, sharp images. The lens is contained in a capsule within the eye. Over time the lens changes, making images blurred or fuzzy.

For most people, cataracts are a natural result of aging but can also be caused by certain medications or injury to the eye.

In cataract surgery, the clouded natural lens is removed and, in most cases, a permanent intraocular lens (IOL) implant replaces the natural lens.

Eye tests at the Eye Clinic

The nurse puts drops into your eyes to make the pupils bigger [Leah's pupils became as wide as blackberries] so that the Ophthalmologist can examine the eye. He can advise you of possible risks and outcome you can expect from the surgery. He will get you to sign a consent form for surgery.

The nurse checks both your distance and reading vision and questions you to determine how your reduced vision is impacting on your life. Your eyes are measured on two different machines to obtain the exact lens strength required. You may also have had the operation explained to you and have been given written information. The nurse will also ask you questions about any other health issues, medicines you may be using, medication allergies and whether you have been in hospital before.

The office staff will get you to sign a form to give your permission to put your name on the waiting list. The office staff will get contact details for you and your next of kin for the Hospital.

You will be given a prescription for the post-operative eye drops, Please get this filled when you get your surgery date. Inform staff if help is required for the post-operative drops.

You have been placed on the list for cataract surgery. The Hospital Booking Office staff will notify you of the date when your surgery is scheduled. You will be sent admission information. Read the hospital information and the fact sheet and keep them.

If you take Warfarin you will be asked to have a Blood Test prior to surgery. Cataract surgery is usually done as a day case meaning you will be discharged from the hospital on the same day as your surgery.

Smoking

You are advised to stop smoking at least six weeks before your operation as smoking causes anaesthetic complications, can damage the eye's blood supply and impairs the body's healing ability. Eye Clinic or Hospital staff can refer you onto quit line. Please contact them prior to admission if you wish to take advantage o this service.

Discharge planning

Arrange for someone to take you to and from the hospital and to the post-operative appointment. You won't be able to drive yourself. You should either arrange to stay with someone, or have someone stay with you on the first night in case of unanticipated problems. [Like what?]

Food

* You will be advised by the Hospital or Ophthalmologist, but normally if your surgery is under local anaesthetic you will eat a light meal prior to admission.
* If you are having a General Anaesthetic or sedation you will receive fasting instructions from the Hospital. / Anaesthetist.
* Take your normal prescribed medication as usual unless told otherwise. Diuretics (water pills, e.g. Furosemide) may be omitted. You will be advised if there is any alteration for diabetic medication. Remember to take all your medications with you. The hospital will advise you about Warfarin according to INR results.

Do not wear any make-up (other than moisturiser) or nail polish.

On the day of your surgery

Go to the Day Patients on Level 4 of the Hospital. You will be seen by the Ophthalmologist performing your operation; you will sign the Consent Form, if it has not been signed, for the operation and a mark is placed over the operative eye.

You will also be assessed by the anaesthetist; and asked to sign Consent for the Anaesthetic. The Anaesthetist decides the type pf anaesthetic most appropriate for you - local anaesthetic - numbing of the eye before you have your operation, you may require light sedation or a general anaesthetic.

About one hour before your operation, drops will be placed in your eye to dilate the pupil. [Blackberry wide again]. Once you are taken to the operating theatre, other drops will be placed in your eye to numb the surface, and any other Local Anaesthetic will be given before the operation. If you are having a general anaesthetic you may not require these numbing drops. You will be asked your details and the operation you are having several times during your hospital stay - this is called 'Safe site surgery' and is recommended by the WHO (World Health Organisation).

During the operation

[Two pics of a plastic lens being folded into place with a surgical instrument behind the iris. Caption: Inserting the new lens].

The theatre nurses will make you comfortable on the theatre table.

You will be given a constant supply of oxygen during surgery and the clear, light, plastic, sterile drape will be lifted off your mouth and nose.

The procedure will be explained to you and you will be asked to warn them if you need to move or speak. It is important that you don't move any part of your body or talk. The ophthalmologist has instruments inside your eye and any unexpected movement you make could therefore result in damage to your eye. [Why not use a head brace?] He can usually stop and remove his instruments from your eye, or let you know when it is safe for you to move or cough.

The actual operation usually takes about 10-20 minutes per eye. so that is the only time you will need to be still for.

The time from when you arrive at hospital to the end of your surgery, will be subject to differing circumstances which cannot be controlled. [Like what?]

After the operation

You will return to the day ward with a cover over the eye which stays in place until the next day. After a light snack you will be free to leave.

The nurse will give you:

* an instruction sheet with contact phone numbers (in case of problems). [Like what?]
* eye drops should be collected prior to returning home, so the eye drop regime can be commenced when the cover is removed the next day - these drops will help settle inflammation.
* if the eye is uncomfortable, take Panadol (not Asprin or Disprin) [Why?] to relieve the discomfort.

Don't be alarmed if clear vision does not return immediately following your cataract surgery. In some cases this can take several days. [Why?]

If you have glaucoma: you may be given Diamox tablets to take morning and evening for 3 days. Restart glaucoma drops the day after surgery unless instructed by the ophthalmologist. You will be given an appointment for 1 week after surgery to ensure the eye pressure is normal.

After the surgery

You will be phoned by the Eye Clinic nurse the morning after your surgery.

Tinted glasses will be more comfortable outside as the eye will be light sensitive. Either sun glasses, or prescription tinted glasses will be suitable.

It is quite normal to feel a slight sensation of something in the eye for a while after the operation. This is part of the healing process.

Wear your own glasses if they help, they may not. The Eye Clinic in Timaru will see you again for the follow-up after the operation and will advise you whether to change your glasses at that stage.

You do need to be aware that normally the artificial lens placed in your eye during the operation is for distance vision, so you will require glasses for reading. [Misinformation. See later information].

Contact the Eye Clinic on ... if you experience any of the following problems:

* Pain
* Worsening of vision after initial improvement
* Discharge / Infection

Do's

* Use your common sense. If it hurts don't do it.

* Follow the instructions of your eye drop regime.

* Carry on with normal activities as you feel comfortable.

* Avoid dusty or dirty environments.

* If working, expect to be off work for up to 2 weeks.

* Driving will depend on the vision of the other eye, how quickly the operated eye recovers, whether you need glasses and your own self confidence.

Don'ts

* Don't rub the eye.

* Don't use your handkerchief to wipe the eye. Remember the wound is not yet healed and could provide an easy entry for infection. [Blame the patient for crap surgery].

* Don't get water in your eyes for three days after the surgery, refrain from washing your hair yourself for 3 days, as again the wound is not healed and could become infected [What about wet tears, blepharitis, etc?]

USE of EYE DROPS

It is very important to always wash your hands first, as infection in the eye may be disastrous

PUTTING DROPS IN YOURSELF

Method: [11 bulleted steps, how to put drops in your eyes].

IF SOMEBODY IS PUTTING YOUR EYE DROPS IN FOR YOU

Method: [7 bulleted steps for somebody].

FREQUENTLY ASKED QUESTIONS

 If you have any questions that are not covered here, please call the clinic.

WHEN CAN I DRIVE?

This depends on the individual. After your post op assessment, we will tell you for sure. We take into account, e.g. the vision of your other eye, whether you need glasses adjusted. [Costly].

CAN I READ OR WATCH TV?

You should avoid reading for the first few days. TV is fine.

CAN I WEAR MY GLASSES?

You can wear your old glasses in most cases until your follow-up.

WHEN CAN I HAVE NEW GLASSES MADE UP?

After your eye drops are completed. If it is on your licence to wear glasses to drive, you must ensure you get your licence changed if you no longer need them.

CAN I WASH MY HAIR?

Yes after a few days, but please don't get dirty water in your eye.

I FEEL LIKE THERE IS SOMETHING IN MY EYE

Some mild discomfort is common in the first few days, but may continue for some time. Please contact us if concerned.

WHEN CAN I FLY AFTER SURGERY?

Please avoid flying for at least two weeks. If you must fly, ask us for advice first.

POST CATARACT EYE DROP REGIME

[A 4 week table with daily tick boxes, to be ticked 4x/day when using Prednisoline eye drops].

POST CATARACT DROPS

DO NOT TOUCH YOUR EYE ON THE DAY OF THE OPERATION

Prednisoline 4 times/day for 4 weeks commencing the morning after surgery

IF THERE ARE ANY SUBSEQUENT (GLAUCOMA) DROPS WAIT FIVE MINUTES BETWEEN DROPS.


Mon 22.05.11 Leah went for a pre op appointment at Timaru Hospital. She waited most of 3 hours in a waiting room to intermittently see a cataract op nurse, doctor & anaesthetist. They were apologetic about her long wait. Leah reported there was adequate parking at Timaru Hospital, unlike poor parking at Christchurch Hospital.

Leah was given a South Canterbury District Health Board, Patient Information Booklet, Cataract Surgery which read:

Please understand that your surgery may be cancelled at short notice due to unforeseen circumstances or emergencies.

NOTES...

Please report to Day Patient Services Level 4

Timaru Hospital Admission

for...

Please confirm you can attend surgery by phoning the Booking Office on the highlighted number on the next page and leaving a message as soon as possible.

BOOKING OFFICE CONTACT NUMBERS...

INSTRUCTIONS TO PATIENTS NEEDING ANAESTHESIA

NB: LOLLIES AND CHEWING GUM ARE NOT TO BE CHEWED OR SUCKED

FASTING INSTRUCTIONS

a) If your operation is in the morning, do not eat anything after midnight. You may drink WATER ONLY up until 6am.

b) If your operation is in the afternoon, you may have a light breakfast (toast or cereal, NOT a cooked breakfast) before 7.30am. You may drink WATER ONLY up until 11am.

PREPARING FOR YOUR SURGERY

This checklist is to assist you and the team caring for you before, during and after your stay in hospital.

NB: Methicillan Resistant Staphylococcus Aureus (MRSA)
- have we asked you if you have been in hospital the last 6 months? If you have let us know as soon as possible.

If you have a cold, or any other infection near the day of surgery, please inform the Booking Office without delay as it may be necessary to postpone your admission until you have recovered.

OWN MEDICATIONS:
Take your usual medications on the morning of surgery, using a sip of water to swallow pills except - do not take pills for diabetes. Ignore instructions on your medications to take with food, take with water only.

You may also be given special instructions regarding:

* Insulin
* Anticoagulants (e.g. Wafarin, Pradaxa, Clopidogrel)
* Anti-Inflammatories (e.g. Aspirin, Voltaren)
* Diuretics (Water tablets)

Please bring all your medications with you to hospital.

SMOKING:
Smokers develop more complications than non smokers. It is in your interest to stop smoking 6 weeks before your operation, but if your operation is arranged at short notice, you should not smoke for at least 48 hours before operation.

PRIOR TO YOUR ADMISSION

* Remove all makeup, especially lipstick and nail polish before arrival st Day Patient Services.

* Please arrange to have a capable person stay with you for 1-2 days after discharge if possible. [Me].

* It is a good idea to have some quick meals prepared and household chores up to date so you can spend 1-2 days resting and recuperating in your home after your visit to hospital.

* Please have a bath or shower on the morning of your operation.

WHAT DO YOU BRING TO HOSPITAL WITH YOU?

* Your current medications
* Glasses or lenses
* Hearing Aids and Case (if required)
* Walking Stick (if required)
* Dentures

You will require a brimmed hat and sunglasses to wear when you go home and please wear comfortable clothes on the day of your operation.

As a precaution against loss, we suggest that you have clothing clearly marked and DO NOT bring valuables or large sums of money with you.

WHO SHOULD ACCOMPANY YOU ON THE DAY OF SURGERY?

* You should be accompanied by a capable person who will be responsible for your transport home. [Me].

* Due to lack of suitable space for waiting, we ask that the person leaves their contact details with staff so that they can be notified when you are ready to be discharged. [Poor planning & inadequate facilities for the patients' family / post op carers].

ON ADMISSION

* Please report to Day Patient Services, Level 4 at your reporting time.

* A gown will be provided for wearing during your operation. [A gown for an eye operation?]

* A Nurse will outline your procedure to you.

* If you haven't attended a Pre-Admission Clinic you may be seen by the Anaesthetist or House Surgeon.

REMEMBER
You are responsible for your own belongings while in Day Patient Services. They will be locked away while you are having your surgery.

WHAT HAPPENS AFTER YOUR OPERATION?

* After your operation you will be returned to Day Patient Services.

* You will be given something to eat and drink.

* When the Nurse decides it is appropriate you can get dressed. [A humiliating gown's essential for an eye operation huh?]

WHAT HAPPENS ON DISCHARGE?

* When you are ready to be discharged your nominated person will be contacted.

* In consultation with you and your family any services required by you after discharge will be arranged. If you or your family have any concerns please tell the staff as soon as possible.

* You will be given a written discharge summary.

* Commence your eye drops as instructed.

* You will be given a follow up appointment if necessary.

COMPLAINTS

Should you or your family wish to make a complaint, you can do so by using one of the following ways:

* Talk to the Staff concerned

* Contact the General Manager Clinical Governance...

* Contact the Patient Advocacy Service...


FACTSHEET                                                         South Canterbury District Health Board

INSTRUCTIONS TO PATIENTS FOLLOWING GENERAL ANAESTHESIA OR SEDATION

1. DO NOT drive any vehicle or operate any machinery, for at least twenty four (24) hours after general anaesthesia or sedation.

2. You should arrange for someone to take you home from hospital.

3. You need to have a person to stay with you overnight.

4. DO NOT drink any alcohol for at least twenty four hours afterwards. It would be advisable to avoid any social engagements for this period.

5. AVOID any activity which requires the use of skill or judgement - e.g. delicate work, cooking or similar activity for twelve (12) hours afterwards.

6. DO NOT make any important decisions or sign any important papers for at least twelve (12) hours afterwards.

Thurs 25.05.17. Leah had the cataract op on her right eye. Day 1 after the op, Timaru Hospital phoned Leah at home. Leah told the nurse her eye was red. The nurse said that was normal post op.

Days later while recovering at home, Leah found the local anaesthetic took a while to flush from her body. The post op, anti inflammatory, eye ointment ("eye drops" below) left her eye teary & gritty & her body whoozy, with flu like symptoms & nose bleed. Leah soon stopped using the hospital ointment in favour of self medicated, homeopathic tablets, thuja & ferrum phos. She trusted her homeopath more than hospital iatrogenic quackery. There were plastic bottles of hand antiseptic for public use all over the hospital! Leah was allergic to antibiotics, so her post op reactions to conventional medicines were expected.

Leah said the op soon improved her colour vision, things looked brighter, but it took several days for her visual discrimination & focussing to improve. She would need a cataract op on her left eye before she could get prescription glasses, which was inconvenient for Leah a teacher.

Cataract surgeons only did one eye at a time due to possible complications.

Facebook chatter with friends: One said his dad had cataract ops, both eyes at different times, no problems. Another had a cataract op on her eye, which years later needed correctional laser surgery, before another cataract op on her other eye.

Post op info from Timaru Hospital:

Post Cataract Surgery Eye Drop - [Prednisolone AFT Ey 1% (Pre)]
Day of Surgery

Commence eye drops as instructed on your discharge summary.
Commence eye drops the next morning and remove your eye shield as well at this time.

Information Sheet

Points to report immediately any of the following symptoms:

* Redness
* Pain
* Headaches
* Sudden deterioration of your vision on operated eye

Please instil one drop as per instruction sheet to your operated eye only. For one month. (The regime is on the backside of this sheet).

[Wow! Regime: One squeeze of Prednisolone AFT Ey 1% (Pre) ointment 4 x per day = 112 doses in one eye per month. Leah disregarded the one month "eye drops" regime after 2 days, due to the whoozy / exhausted body reaction the "eye drops" created. She was convinced the corticosteroid anti inflammatory was poisoning her. The one month corticosteroid regime was a "better safe than sorry" medication from Timaru Hospital, which didn't take Leah's aversion to toxic drugs into consideration, despite Leah telling hospital staff at the pre op appointment, about her allergic reaction to drugs, like penicillin.

Five days post op Leah phoned Timaru Eye Clinic & told the nurse she had stopped using the anti inflammatory ointment due to side effects. The nurse replied OK, but would check with the surgeon if Leah's non compliance was OK. Hours later the nurse phoned & told Leah the surgeon said it was OK to stop the drops. One of the side affects was that the ointment could actually cause sub capsular cataracts!].

Wear dark glasses after your operation and a wide brim hat when outside.

You can wash your hair 3-4 days post operation.

Notes for patients with glaucoma:

* If you are prescribed drops for your glaucoma use them from the morning after your surgery unless the surgeon tells you differently.

If you need advice please contact Timaru Eye Clinic - 68 High Street, Timaru, Phone...

Copyright Mark JS Esslemont.

See South Canterbury Eye Clinic

See Timaru Hospital

See Prednisolone AFT Ey 1% (Pre) sterile eye drops suspension



Thursday, February 2, 2017

Southern Cochlear Implant Programme Assessment, Costs, Communication

1. Background: In Durban I wasn't born deaf. As a 30 year old adult, I started going nerve deaf in Durban, after working on noisy onion packing machinery at Kibbutz Grofit, Israel in early 1982. In Dec 1982, the loud noise of my shooting a run over dog in Durban aggravated my nerve deafness. In 1983 I taught biology & was boss of the general science department at Glenwood Boys HS, Durban, where I started going deaf. I battled to hear boys' questions, had vertigo & loud noises were painful. Intermittently, I had good hearing days & deaf days, sometimes lasting weeks or months, then a series of good hearing weeks or months.

My nerve deafness worsened over the next decade, while I continued teaching at Durban, Kleinzee, QwaQwa & East London & doing a 3 year stint of DeBeers personnel work at Kleinzee & Koffiefontein mines. With my vertigo I started having blackouts & nystagmus. In desperation I saw doctors, ENT specialists & audiologists in Durban, Kleinzee, Bloemfontein, Port Elizabeth, East London. They all made megabucks out of my deafness, examining me & telling me my deafness was worsening & I must buy expensive hearing aids. I bought my first analogue hearing aid in Bloemfontein in 1987. I found analogue hearing aids painful & useless.

My last 6 teaching years were at Selborne College, East London, where my deafness worsened. 1994, my last teaching year, I couldn't hear a thing. I bluffed my way through teaching, lip reading & persevering with my useless analogue hearing aid. 1993, from East London I applied for NZ residence. My deafness was passed in my medical by NZ Immigration Service.

Before emigrating from East London, South Africa to NZ, I bought expensive Starkey in-the-ear, analogue hearing aids. My family & I arrived in Christchurch NZ in 1995. The Starkeys proved painful with loud noises & useless. The Starkeys broke & after a year I asked my East London audiologist for a refund. After evasions he repaid some of my money.

In Christchurch NZ I stopped teaching as I was too deaf. I'd tried retraining as a NZ teacher at the end of 1995, but dropped out of the teacher retraining course as I couldn't hear school kids nor teachers properly, even with my analogue hearing aid. In 1996, I read a post grad horticulture diploma at Lincoln Uni. I dropped out after a semester as I doubted the diploma would find me work. Thereafter I did labouring / clerical work in Christchurch for a couple of years before stopping & going on the dole. Teacher wife, Leah became breadwinner while our 2 sons grew up in Christchurch.

Over the next 2 decades in Christchurch I saw NZ audiologists, doctors & an ENT specialist. (Never mind NZ doctors milking WINZ for deaf & depressed Sickness Beneficiaries, a long story). They couldn't cure my nerve deafness. Early days, an audiologist gave me 2 Phonak, shop soiled, analogue hearing aids. Useless. I acquired another pair of  Phonak analogue hearing aids after a deaf friend died. Useless. I bought a Widex digital hearing aid which proved adequate in quiet environments over the next 18 years. It was useless with any background noise like at restaurants. I didn't buy 2 expensive Widex digital hearing aids, as I'd had so much trouble with analogue hearing aids.

Once our sons settled into their Christchurch jobs, after 3 years of Christchurch quakes, Leah got a 3 year teaching contract at Lake Tekapo School. We moved to Fairlie & 4 days a week Leah commuted to Lake Tekapo School. One day a week she taught at St Josephs School, Fairlie. During that time my old, Widex digital hearing aid played up, with intermittent, loud, beeping noises which disturbed me, my family & anyone else within hearing aid beep range. In mid 2016 I took the Widex to a Timaru audiologist for hearing aid repair. (Other hearing aids I had had also needed expensive repairs over the years). The audiologist looked at my old Widex, gave me the usual audiogram, beep test, pronounced my profound deafness & gave me 2 Bernafon digital hearing aids, an improvement on the Widex.

She said as my deafness was so profound, I was eligible for one Cochlear Implant, via the Southern Cochlear Implant Programme.

At the end of 2016 Leah got a teaching job in Timaru, advising 40+ Southern Canterbury schools about literacy resources. We moved from Fairlie to Pleasant Point for Leah to commute to Timaru.

2. Southern Cochlear Implant Programme Assessment:

For rich folk the Cochlear Implant Assessment costs $750. I didn't pay, as I was referred by the Timaru audiologist.

In Dec 2016, I received a letter from the Southern Cochlear Implant Programme, based at St George's Hospital, Papanui, Christchurch, informing me of my Cochlear Implant Assessment which would take place over 2 days in January 2017. The letter incl a claim form stating I could only claim travel & accommodation costs after 6 visits to Christchurch. That meant stiff petrol, car wear & tear & motel costs for us, just to tell me once more I was profoundly deaf & needed a Cochlear Implant.

Despite my new Bernafons, as I lip read Leah well, Leah attended the following appointments with me as my interpreter:

Thurs 19.01.17. St George's Hospital, morning appointment, 2 hours with an audiologist: She spoke clearly in her quiet office, but I needed Leah to interpret quite a lot, as the audiologist was a UK expat with a Pom accent. She listened to my deafness story, gave me the usual audiogram beep test & pronounced my profound deafness. (Duplication of my Timaru audiologist's audiogram). She emphasized a Cochlear Implant was expensive, that the waiting list was about 140 & the Cochlear Implant Programme only had annual funds for 20 Cochlear Implants per year. She later posted me a copy of her assessment report & audiogram, recommending I needed a Cochlear Implant.

Thurs 19.01.17. St George's Hospital, afternoon appointment, 1.5 hours with a rehabilitationist who would oversee my rehab if I had a Cochlear Implant. She spoke clearly & eloquently in her quiet office. I heard her well. Like me she wasn't born deaf, but went deaf later on. She'd paid for her 2 Cochlear Implants by mortgaging her house. Fine if you had a house to mortgage. I didn't.

Like the audiologist, she emphasized that Cochlear Implants were expensive, that NZ govt only provided one Cochlear Implant for each deaf person on the programme, annual funding was low, that the waiting list was long & I'd have a long wait for a Cochlear Implant. She said as I was now on the Cochlear Implant waiting list I would never be bumped off the waiting list, which happened with other state medical waiting lists.

She suggested I write to my MP & Minister of Health to enquire why state funding was scarce for Cochlear Implants? She gave me a grant application form to apply for a Cochlear Implant grant, but emphasized there was no guarantee I would get a grant soon & should apply every year. (Rigamarole of getting annually inflated quotes). Maximum grant was $45000 per Cochlear Implant & surgery. (Eight years ago the grant max was $25000, showing inflation & troughing service providers). If I ever got a Cochlear Implant via SCIP, later on I could apply for peripherals, like repair or replacement of processor, repairs after warranty, consumables & spare parts. Cumbersome funding for dubious hearing benefits. I told her I was sceptical of the SCIP.

As I'd found in the past in South Africa & NZ, medical people used deaf people to milk money for themselves & not for deaf people. In the Southern Cochlear Implant Programme office at St George's Hospital there were was a receptionist, clinical coordinator, doctors, audiologists, rehabilitationists (for adults) & habilitationists (for children) all slurping salaries from the deafness trough, even before I saw an ENT specialist.

Fri 20.01.17. Specialists at Nine, Caledonian Rd, afternoon appointment, half an hour with an ENT specialist. In his quiet office he didn't speak clearly & Leah had to interpret most of what he said. He went through ENT mumbo jumbo I'd heard before in SA & NZ that I was deaf, I had wax in my ears, that he must check my ears while I lay on his couch... He showed me a Cochlear Implant device & a plastic ear model with a Cochlear Implant. He answered my questions & reiterated state Cochlear Implant funding was scarce. The Cochlear Implant operation would take place at Forte Health, Kilmore St. Post Christchurch quakes, Forte Health was built, a private clinic funded by doctors with shares in Forte Health.

The Cochlear Implant was glorified trepanning where the ENT specialist drilled a ledge on my skull bone, planted the implant on the bone ledge, short circuited my perfectly normal outer & middle ear with an implant electrode wire covered in plastic which he inserted into my cochlear to stimulate my auditory nerve. He then stitched my skull skin closed. About a month later, after skin & bone healed, the implant processor hanging on my outer ear & attached to a magnet in my skull implant would be activated. The audiologist & rehabilitationist would enable me to use the device.

Snag: The ENT specialist wanted to place my Cochlear Implant in my "good" ear, which enabled me to still hear with my Bernafon digital hearing aid. The rationale was that my "bad" ear would take longer to rehabilitate with a Cochlear Implant. If the ENT specialist botched the implant operation, or the implant malfunctioned, there was no going back to my digital hearing aid.

The ENT specialist gave me a Cochlear Implant Advice Sheet which read:

Usually takes 1.5-2.5 hours under a General anaesthetic:

The anaesthetist will assess you on the ward before your surgery. I will see you on the ward or occasionally at the anaesthetic room.

Steps once asleep and practical points to know:

Antibiotics given through the drip

Reduces likelihood of wound infection or the rare complication of meningitis. [Complication huh? After drilling a hole in my skull!] Should have vaccine prior to surgery date.

Hair shave behind and above ear

Will grow back.

Site for Receiver Stimulator marker

For bilateral or second side implantation every effort to be made to align the implants symmetrically. However due to the curvature of the skull and the healing process they do not always end up at the same level on the skull e.g. different height above ear.

Incision made behind ear

Top of ear may feel numb afterwards. Usually recovers within 3 months.

Bone drilled to expose 2 nerves

Taste nerve:   may have metallic taste. Usually recovers within 3 months.
Facial nerve:  rarely weak face post op. If present it is usually temporary.

The inner ear / cochlea is then entered

Balance may be affected. Common in first 24 hours, may last a few weeks.

Electrode wire inserted

Full insertion is usual but rarely insertion is incomplete. "Device failure" is when the electrodes don't all function. Occasionally some electrodes need to be turned off. The audiologist will adjust the MAPing for these situations.

Hearing may go completely in that ear. Ringing / tinnitus may sometimes increase as nerve endings die off. This usually improves over time. [Sounded dodgy. Cortical cells destroyed to accommodate electrodes which may or may not work!]

Wound closed

Hidden stitches used. Do not need to be removed.

Head bandage applied

Stays on for 48 hours.

You will be in recovery for 1-2 hours

I will ring your contact person if you wish.

On the ward:

You will receive 2-3 doses of antibiotic. You will have an X-ray the following morning to document the position of the implant. You may be discharged from hospital afterwards. A prescription for pain relief will be supplied. Most people remove the bandage themselves the next day (as well as the underlying dressings). However, if you would prefer, you can see your GP practice nurse or come back to the ward to have it removed.

After you go home:

You should keep the wound dry. A family member or friend may wash your hair if you hold a cup over your ear and use a hair dryer to dry any water that gets on the wound. You should see your GP in 1 week for a wound check. If you are from Christchurch I can see you at this time. It is normal to feel a small bump behind your ear.

"Switch on" is usually 2-4 weeks after surgery. The implant programme will organise this with you. My secretary will organise an appointment with me around this time also.

3. Costs: After seeing the ENT specialist, Leah & I went back to St George's Hospital to enquire about costs for a Cochlear Implant. Days later, I received an email giving costs of Cochlear Implant devices & long term maintenance costs, but wanting me to email around for estimated Radiology, Anaesthetist, Surgery, Hospital costs, as follows:

*Radiology pre op CT Scan: Cost unknown, no quote given by SCIP, surgeon, radiologist
*Post op X-ray:                         $101.60

*Anaesthetist 3 hours in theatre: $1800.00

*Surgery pre op visit:                $114.50
*Surgery:                                 $4700.00

*St George's Hospital theatre time (120 mins): $2290.00
*Medical Supplies:                                        $4500.00
*Recovery:                                                    $350.00
*Accommodation per night                            $655.00

Medical costs were sick.

The Southern Cochlear Implant Programme supplied the following costs, administered by deaf troughers & tax minions, wanting their cut from the deaf before any Cochlear Implant:

Please find below our charges and fees. All prices are GST inclusive and may change without notice. These charges are subject to our Terms and Conditions:

Prices

Prices provided here are accurate as at 25 November 2016 but may change at any time. [Inflated by manufacturers, retailers & wholesalers slurping the deafness trough]. For implant prices and fees, please request a formal quote valid for 30 days. [Making any quote request a waste of time & energy].

Equipment Manufacturer

Our programme offers the choice of 3 equipment manufacturer's systems, Cochlear Limited, Med-EL and Advanced Bionics. Selection is done in consultation with you and clinical staff. Your personal preference may not be available under some circumstances based on clinical grounds - this will be made clear to you at the time of consultation.

Invoicing and Payment

Payment should be made against our GST invoice at the time of consultation. All SCIP related services and equipment (Assessment Fees, Cochlear Implant equipment, Consultation Fees, Spare Parts, Batteries and Repairs) are payable on invoice at the time of consultation.

For initial implant system charges only, 10% deposit at time of confirmation is required. [I wasn't confirmed, just on a nebulous waiting list]. Balance can be paid in 3 monthly instalments, with the first payment required prior to surgery. [I must invest in more Lotto tickets]. After the first 2 years, follow up appointments at SCIP are invoiced at the hourly rate quoted and payment should be made at the time of consultation. [A money making factory for SCIP paid by CI recipients, similar to deaf troughing audiologists, audiometrists & WINZ doctors].

Payment for all other specialist services (ENT Fees, Hospital Fees, Anaesthetist Fees and Radiology Fees) [Above] is via the specialist or provider concerned, subject to their own Terms and Conditions. The SCIP is not responsible for costs, prices, or the Terms and Conditions of other providers. [SCIP just flogs Cochlear Implant devices, support equipment, consumables, captive audiologists & rehabilitationists / habilitationists].

Speech Processor Upgrades

Your speech processor will need to be updated at some stage in the future. Currently the approximate life of a processor is 7-8 years. [As opposed to my cheaper Widex hearing aid which needed major repair after a couple of years & lasted about 15 years before going bung over the next 3 years].

Warranty

The Cochlear Implant, speech processor and consumable parts are warranted against defect and failure. Please consult the relevant manufacturer's terms and conditions for specific warranty terms.

Travel and accommodation assistance

Patients who fund their own Cochlear Implants are therefore also required to fund their own travel and accommodation costs. Please be aware, that when you come to Christchurch or Lower Hutt [Northern Cochlear Implant Programme] for your Cochlear Implant appointments you may need accommodation. You may also need to stay in Christchurch two - three days after surgery following discharge from St Georges Hospital (this is dependent on recovery) and another two days at time of switch on. [The ENT specialist's Terms & Conditions I read & signed wanted my surgery at Forte Health, another deaf troughing, money making factory].

Bilateral Patients

Simultaneous Cochlear Implant Procedures

Some patients who are provided a Ministry of Health funded Cochlear Implant system may elect to fund a second simultaneous implant system at the same time.

Please be aware that only those costs associated with the publically funded procedure will be met out of Ministry of Health funds. Any treatment costs, including unforeseen costs, [botch ups?] not associated with publically funded procedure must be met by the patient. [Sounded dodgy].

As part of the pre-implant assessment process the clinical staff will, on clinical grounds, recommend an ear for unilateral implant. This recommendation will be done prior to surgery. This ear will then be deemed the funded ear; the other ear will become the private ear and any treatment costs associated with this private ear must be met by the patient. [Would my hearing coordinating brain then become part funded, part private too?]

Sequential Cochlear Implant Procedures

Some patients with an existing Ministry of Health funded Cochlear Implant system may elect to fund a second (sequential) implant at a later date. [After cortical cells were buggered by the first deaf troughing op].

Please be aware that any costs associated with the privately funded ear must first be met by the patient and the Ministry of Health funded services cannot be used to subsidise private procedures. [Resulting from botch ups by SCIP surgery].

This includes the cost of travel and accommodation to attend appointments for treatment procedures associated with a privately implanted system.

Any treatment costs, including unforeseen costs, [dodgy] not associated with the publically funded procedure must be met by the patient.

[The above SCIP Terms and Conditions avoided the fact there was little funding from the Ministry of Health for Cochlear Implants].

For questions regarding our Terms and Conditions please consult either the Finance Administrator or the General Manager. [Hopefully they lobbied MPs & the Ministry of Health for the long SCIP Cochlear Implant waiting list].

Cochlear Implant System - Equipment only

                                                                    Cochlear            MED-EL     Advanced Bionics

*Implant system (implant & speech processor)  $30190.00          $30190.00   $POA
Bilateral system (sequential or simultaneous)           $25357.50
Applicable to patients with existing Cochlear Ltd device - valid until February 2017

My wife recently bought a second hand, 1300cc, Toyota Vitz for $6000, incl h.p. to commute daily from Pleasant Point to Timaru. Go figure, as evidently profoundly deaf people were ripped off by Cochlear Implant pricing, hospital care, anaesthetists, surgeons & radiologists. Cochlear Implant & MED-EL Implant pricing being identical, looked like monopoly pricing. Over 3 years ago when I went to my Christchurch audiologist & GP about my wavering Widex hearing aid, neither mentioned the SCIP, but both encouraged me to buy expensive hearing aids.

Worse:

Consultation Fees - Audiology, Habilitation / Rehabilitation

Cochlear Implant Candidacy Assessment (Audiology, Rehabilitation) $750.00 [Ripoff. Described above].

"Meet and Greet" pre op discussion [ENT surgeon described above]. No charge. [He got his cut from his whopping surgery fees, above].

Post implant Follow-Up (Audiology, Habilitation / Rehabilitation)

*All appointments first 2 years post switch-on               $5400.00 per implant
After 2 years post switch-on                                       $200.00/hour per implant

A 40% discount on consultation fees is offered for simultaneous recipients on the second ear.

[And the SCIP wanted me to lobby NZ govt MPs for funding. A Google search showed that SCIP troughers had asked CI candidates like me to lobby MPs for years].

On-going Equipment and Spare Parts - representative costs

Below are representative costs for some consumable items that may be necessary for on-going maintenance of your Cochlear Implant system:

Cochlear                                  Med-EL                                       Advance Bionics

Std Rechg Battery      $315       Battery pack frame      $465          Please Enquire
Battery Holder           $205       Coil with magnet         $800
Coil                          $212       Coil cable                   $165
Coil-cable                 $127

Med-EL spare parts cost more than Cochlear spare parts.

Other consumables:

Disposable Batteries 10 pk  $32
Dri Briks 3 pk                   $18 [Ripoff - silica gel in plastic packages for use in a plastic jar].

Speech Processor Repairs

Cochlear                                   Med-EL                                      Advance Bionics

Warranty period     5 years         Warranty period     3 years            Please enquire
Warranty repair      No chg         Warranty repair      no chge
OOW repair          $488.75        OOW repair           $592

Med-EL processor repairs cost more than Cochlear processor repairs.

Speech Processor Upgrade                  Cochlear          Med-EL             Adv Bionics

Usually required after 7-8 years             $8360.00         $11040.00         $POA

Med-EL processor upgrade cost more than Cochlear processor upgrade.

Cochlear Implant device & Med-EL Implant device cost the same, but Med-EL spare parts, processor repairs & processor upgrade cost more. As both Cochlear Implant device & Med-EL Implant device cost the same, why were Med-El's maintenance & repair costs more then Cochlear's?

None of the above costings showed any cost of failure of the Cochlear Implant in my skull, nor cost of surgery failure.

Totaling *asterisk costs, bare minimum costs for the Implant device, surgery & 2 year follow up, the grand total $50101.10 exceeded the $45000 grant.

$50101.10 single Cochlear Implant cost exceeded Leah's gross annual teacher salary.

Medical expediters needed to pull finger to reduce astronomical costs for Cochlear Implants.

4. Communication: 13-14.02.17. After posting a grant application for $50101.10 for one Cochlear Implant to the SCIP at St George's Hospital, I emailed the following to the National Rangitata MP, Jo Goodhew & National Minister of Health, Dr Jonathan Coleman:

Cochlear Implant Funding - Southern Cochlear Implant Programme.

I am a NZ resident of 22 years, emigrated from South Africa in 1995. I have over 20 years' full time experience as a teacher & personnel officer in SA. I wasn't born deaf, but gradually went profoundly deaf over 30 plus years due to Grofit kibbutz farm machinery noise in 1982 causing my deafness. Analogue hearing aids proved inadequate & I stopped teaching on arrival in NZ. Digital hearing aids are still inadequate for my profound deafness.

Presently I live with my wife at Pleasant Point. My teacher wife is breadwinner, commuting daily to Timaru. My two adult sons, ages 30 & 25, live and work in Christchurch.

After referral by my Timaru audiologist, last month at St George's Hospital, Christchurch, I was assessed by the Southern Cochlear Implant Programme, which found me eligible for a single Cochlear Implant. I was informed the Cochlear Implant waiting list was 140, but there was annual funding only for 20 Cochlear Implants.

My Google search found there were Cochlear Implant funding shortages for years, as well as astronomical rising costs for Cochlear Implants, surgery & Cochlear Implant maintenance & repairs thereafter.

With the present status quo, I must wait years for a Cochlear Implant. Recent quotes give costs about $50101 for a single Cochlear Implant, done via the Southern Cochlear Implant Programme. Our family cannot afford to pay for a private Cochlear Implant. Never mind expensive, ongoing repair & maintenance costs.

A Cochlear Implant would greatly improve my hearing & quality of life. My wife has had a deaf husband for 34 years of our marriage. My sons have always had a deaf father.

Please let me know why there is so little NZ government funding for Cochlear Implants?

Thank you.

Mark JS Esslemont

P.S. More info about Cochlear Implants & the Southern Cochlear Implant Programme Assessment & Costs can be found on my Woza Wanderer blog...

17.02.17. I received a form letter from the Clinical Coordinator, SCIP, dated 14.02.17, which read:

You were recently seen by our Centre for a cochlear implant assessment by our Clinical staff.

The results of the assessment indicate that you meet the candidacy criteria for a cochlear implant. This means that you are likely to derive more benefit from a cochlear implant than your current hearing aid or hearing aids.

Although you are a suitable candidate, public funding for cochlear implant surgery is limited and is therefore prioritized. [How?]

Based on your clinical assessment, you do not meet the threshold [Profoundly deaf not deaf enough huh?] for a publically funded implant and as a result are referring you back to your local provider with advice for management of your hearing loss. [A waste of resources as my new digital hearing aids were useless with any background noise]. This may include a review of hearing aids [done over more than 30 years of deafness] referral to a hearing therapist, [trougher] the provision of assistive devices such as FM systems [risibly expensive] and other community supports [already sussed over many years: trougher orgs; deaf culture sign languages; loop systems in cinemas, courts, churches, lecture halls; amplified telephones; caption telephones; TV captions...]

While you don't meet the threshold for a publically funded implant at the moment, you remain on the programme. If there is an increase in funding and you meet the threshold [what?] at a later date, we [who?] will advise you at the earliest opportunity. If your circumstances have changed since your original assessment and you feel you warrant a review of your clinical priority [what?] please contact our clinic. A change in circumstances may include:

* A significant change in your hearing. [My hearing changed to profoundly deaf over many years].
* Increase in difficulty hearing at work [don't work, deaf for years] in education [I stopped teaching after leaving SA & couldn't hear lectures at Lincoln Uni in 1996 despite my analogue hearing aid] or at home. [Without hearing aids I'm completely deaf].
* Caregiver responsibility [N/a. Leah & sons were my unpaid interpreters].
* The effect of your hearing loss on your quality of life and mental health. [Crap. Huge financial, social & emotional costs. The bulleted points were discussed at my SCIP assessment, rendering them repetitive & patronising in a form letter].

A request for a review of your clinical priority should be supported by information from your GP or other health care provider. [Troughers. e.g. In 2011, when I saw my GP & Bay audiologist in Christchurch about getting new digital hearing aids via WINZ, they were both duplicitous: checking my blood pressure, referring me for blood tests, referring me to the GP's unqualified wife for hearing aid advice, or trying to dupe me to buy mega expensive digital hearing aids. Neither GP nor audiologist referred me to the SCIP in Christchurch].

You may proceed with a cochlear implant at your own cost through our private service at any time. [$50101.10 for one implant. Cough]. Please contact us if you wish to pursue this option. [SCIP screened & solicited both state & private patients simultaneously. No separation of SCIP state & private costs. e.g. private ENT specialist on SCIP milked either state or private patients with exorbitant costs].

Please do not hesitate to contact us if you have any questions about this [sick] letter....

Copy: Audiologist... Timaru.

The risible thing about the letter was that the SCIP's audiograms showed me more profoundly deaf then my Timaru audiograms done a few months ago. i.e. SCIP's audiogram curves were lower than my Timaru audiogram curves. A significant change in my hearing.

Letter dated 20.03.17 from the Southern Hearing Charitable Trust Grants Committee:

"Thank you for your recent application to the SHCT Charitable Grants Committee.

The Committee received 15 individual applications and had $50 000 to allocate from a single benefactor. The Committee met on 1 March 2017 to consider all applications.

The limited availability of charitable funds means that the Committee was unable to approve all applications and on this occasion your grant application has been unsuccessful.

The Committee would like to thank you for taking the time to apply. In the event that further charitable funds become available at a later date then we will notify you of this and you may apply again."

Busy work for bureaucrats who expected waiting listers to apply year after year for a grant which presently only covered one Cochlear Implant as above. What a farce! Cochlear Implant candidates were also expected to lobby current MPs for funding to enrich said bureaucrats & medical staff.

After sending my lobbying email (above) to Jo Goodhew my National MP, a lackey replied asking whether my email could be sent to Dr Jonathan Coleman, Minister of Health. I didn't reply as I'd already sent my lobbying email to Dr Coleman.

19 April 2017. I received the following email form Nicky Wagner, Associate Minister of Health. Despite her National govt praising verbiage, she avoided answering my email question above.

Thank you for your email of 18 March 2017 to the Minister of Health, Hon Dr Jonathan Coleman, about cochlear implant funding. I am responding as the matters you have raised fall within my portfolio of responsibilities as Associate Minister of Health.

The Government recognises the positive effect that cochlear implants have on people's lives. As a consequence, in 2013 the Government invested in improving the provision of cochlear implants by doubling the number of implants delivered each year to adults and continues to consider additional funding for implants alongside other health and disability priorities. [Meaning the National govt had funded about 3 CI per N Island & 3 per S Island in 2013].

[Despite 2017 being an election year, Nicky didn't say whether National's funding / numbers for cochlear implants was doubled for 2018. Considering ex PM John Key's $26m wasteful, 2016 flag referendum, $26m could've paid for 520 cochlear implants, today's prices, wiping out the waiting list].

As you know, the Ministry of Health currently contracts two trusts to deliver cochlear implant services nationally. [Enabling trust lackeys to siphon govt money for trust expenses instead of actually doing cochlear implants. The 3 SCIP staff who assessed me for a cochlear implant all said funding was low]. Each trust is contracted to provide 20 implants for adults each year. [At 2017 quoted prices above, roughly $1 000 000 cost per N island & $1 000 000 cost per South Island. A risibly low amount]. These trusts are also contracted to provide implants for children. The trusts can reprioritise funding to provide additional implants for adults if there is less demand than anticipated to provide for children's implants [Er what about trusts' waiting lists for children & adults Nicky?]

The Government acknowledges that there is growing demand for adults to access cochlear implants [due to limitations of digital hearing aids & referrals by audiologists, like Bay Audiology] and that there can be long waiting times for some people. [So provide more funding for cochlear implants!] Priority is given to people with the greatest need and ability to benefit from an implant. [Codswallop!] If you consider your circumstances have changed and your need for a cochlear implant has become more urgent, you can contact the clinical assessment team at Southern Cochlear Implant Programme and request a review of your needs. [Busy work for bureaucrats when the need is obvious - I'm profoundly deaf & hearing aids are useless in noisy environments, assessed thus by audiologists in RSA & NZ for decades]. The programme can be contacted on freephone... or email...

Thank you for sharing your concerns.

Yours sincerely...

My lobbying proved that National MPs Dr Jonathan Coleman, Nicky Wagner & Jo Goodhew were slippery buck passers & circumlocutioners.

21.02.17. I emailed the SCIP rehabilitationist who'd assessed me:

Thanks for the interview last month. We are now settled in Pleasant Point.

Regarding my CI, I have done the following:

Got quotes, applied for a grant, done a blog post, emailed MPs Jo Goodhew & Dr Jonathan Coleman asking why CI funding was so scarce?

My question:

Should my CI fail (body rejection, botched operation, failed processor needing repairs...) would I be able to use my Bernafon hearing aid again on my implanted ear?

Thanks and regards...

No reply from the SCIP rehabilitationist.

Meanwhile I contacted my audiologist in Timaru & asked the same question. Audiologist's reply: I wouldn't be able to use my Bernafon hearing aid after cochlear implant surgery, as the surgery could damage cochlea hair cells when the implant wire was shoved past hair cells in my cochlea. I said I would then have to rely entirely on lip reading, as hearing aids & cochlear implant would be useless to me.

Copyright Mark JS Esslemont

See Cochlear Implant

See Med-EL Cochlear Implant

See Nicky Wagner's tweet attitude to NZ disabled (The Press / Stuff Co)