You may or may not know this: For 9 years we’ve followed the faculty of Northeastern State University’s Oklahoma College of Optometry around the country to give advanced procedures courses. The first half of the course covers local anesthesia, radiofrequency ablation, oculofacial biopsy, chalazion management, suturing, injections, and so on. We usually arrive after this part of the course is over, so we can setup equipment for the next day.
The second half of the course covers therapeutic laser procedures, including selective laser trabeculoplasty (SLT) for open-angle glaucoma, YAG capsulotomy to remove a cloudy capsule after cataract surgery, and laser peripheral iridotomy, etc. TelScreen typically supplies one or two slit lamps for gonioscopy, and imaging systems for the slit lamps and lasers. Learning is faster when the instructors and all attendees can see what’s going on.
During mid-COVID we were asked if we would help bring the course to London, England.
It didn’t take but a millisecond for me to say “Yes!” to that idea!
Why? Well, I’ve been looking for an excuse to go to London since 1985, and there happens to be about 16,000 optometrists in the UK. That’s good enough for me!
I was fascinated to learn that in the UK, entrance into the Optometric profession begins with a Bachelor’s degree, followed by practical exams that allow one to see patients. Beyond the basics, there are post-graduate qualifications to be earned in areas such as Ocular Conditions, Glaucoma, Independent Prescribing, Medical Retina, Diabetic Retinopathy screening, etc. It seems like every little thing has its own certification, so Optometry is a very fine-grained profession. Maybe 10% of those in the UK are practicing at the very highest level, with the others practicing at the limits of their current certifications.
Anyway, the movers and shakers in UK optometry decided it was time to add another layer of post-graduate training. They were ready to offer education and certification for laser procedures, as well as some minor surgical procedures. These thought leaders contracted with NSUOCO faculty to bring the Advanced Procedures course across the Pond, because they recognized that Oklahoma Optometrists have had advanced procedures privileges for 20+ years, and thus have the most experience.
That’s how we received the invitation to support the course in London. That was the easy part. From the day we said Yes, until we left London, we had a grand series of adventures.
The first adventure was getting there. Because it was during COVID (December, 2021) I was tested 4 times in 8 days. One swabber at a UK clinic was particularly thorough. Home Court advantage notwithstanding, a Personal Foul should have been called!
The second adventure was getting the equipment there. How much equipment do we bring? What will they supply? What’s the lowest risk of damage? This led directly to the next adventure…
…coordinating with local equipment suppliers and being thankful I brought 5 times the equipment we were asked to bring.
The fourth adventure involves blowing up the internet between Instagram + WhatsApp.
The fifth adventure turned into a lesson on discovering how many Ellman RF ablation units it takes to fry a transformer.
The sixth adventure involves the Shettler Flash, fish & chips, and football/not football.
All of these adventures are detailed in the podcast.
The adventure with the greatest olfactory impact was discovering the number of Ellman units it takes to blow up a UK electrical circuit.
The adventure with the equipment was more of a challenge. The original plan was for Birmingham Optical to provide two Nidek lasers and a green laser. But just like everything COVID-related, they were at the mercy of the supply chain. When the time came, they could only get their hands on one Nidek laser. Frankly, I think they repossessed it from a customer for the weekend! They couldn’t get a second one and they couldn’t get a green laser. So they ended up bringing in one Nidek laser. The “Andrews” from Carleton Optical brought two slit lamps, two YAG/SLT combo lasers, and a last-minute green laser. Unfortunately, the video setup on the lasers suffered from considerable blooming.
I was prepared, though! Although they were counting on me for one set of non-recording imaging equipment, I brought four sets of cameras & optics plus a complete Diamond system. There were enough cameras to make a course happen, even if no one else had working video equipment.
Ideally, the role of a good technical person is to be invisible. If you can make everything run so smoothly that no one sees you do anything, that means you were successful. All of the equipment arrives on schedule. Everything is setup well before it is needed. It performs flawlessly during the workshops, and you magically disappear into the background. That would be perfect.
In the spirit of Murphy, it didn’t exactly happen that way.
The surgical part of the course uses an Ellman radio frequency generator and wand – a handpiece with interchangeable tips for various applications for cutting and for removing unwanted tissue and such. Because it involves cutting or removing something from a human it’s a surgical procedure, and this instrument makes clever use of RF energy to accomplish that.
The workshop y had a separate room with three Ellman units and a vacuum to evacuate the smoke. When you’re slicing and ablating practice steaks, there is a “grilled meat” smell that needs to be dealt with. Otherwise, the smoke alarms might go off.
For those who don’t know – when you travel internationally, it’s important to understand voltage and power. Most electronic devices, such as computers, have what’s called an “International” or “wide-ranging” input. If the supply voltage is between 100 – 260 Volts, and the frequency is between 47 – 63 Hertz, you can plug that in almost anywhere in the world. As long as the plug fits, the power supply will work, and your device will work. The power input module converts the input power into whatever the electronic circuits require.
It turns out that the North American version of the Ellman Units are 120 volt only. If you were to plug that into a UK 240 volt wall socket, very bad things would happen, in dramatic fashion.
So the organizers provided some transformers that would convert 240 volts from the wall into 120 volts for the Ellman Units. About 5 minutes into the workshop, I got a call. “Hey, Wes, could you take a look at this black box that smells like burning plastic?”
So I looked at it, took a whiff, and said, “Yeah, that smells like burning plastic alright. What happened?”
They said, “Well, we just had it plugged in and then these things stopped working.”
Three Ellman units and a vacuum were plugged into one transformer. They had plugged in the third unit and that’s when the burning smell was noticed. They unplugged that third unit and were getting ready to swap in the backup transformer and continue the workshop.
Right about now you’re thinking – wait! They want to plug in the only backup unit after burning out the first one?
Yes. Yes, they did. Workshop rotations, 3 groups, must preserve the Shed-Joule (schedule), can’t encroach on Tea Time! This is why we have a backup, isn’t it?
I called a quick Timeout, and asked for a little patience while we figure this out. Let’s look at what we’ve got plugged in here.
We have 3 Ellman RF units. How much power does each of them take? Nobody seemed to know.
We looked on the back panel. Two of them gave no information and one of them was labeled … in cutting mode: 120 watts.
Now we calculated: 120 times three is 360 watts. The capacity of the transformer is 300 watts. This means we’re 20% over capacity, but it might still work since most engineers give you some headroom over the listed spec. (Things we learned from Star Trek, right?)
It’s probably not melting because of 3 Ellman units. What about the vacuum? 10 amps 120 volts. Well, it’s a motor, so the current and voltage are not exactly in sync. But even with a reasonable Power Factor, it’s somewhere in the neighborhood of 1000 Watts.
After a bit more calculation, we determined we can plug in up to three Elman units and statistically be fine (not all Elman units will be in cutting mode all of the time). However, as soon as we plug in the vacuum, which runs continuously, we’re going to blow up the next transformer, too – probably in about five minutes!
What can we do? Well, we found a floor fan. So we put the floor fan up on the table and had it blow the smoke and smell from the burning meat toward the door, where it can disperse throughout a larger volume. The primary goal is to keep the fire alarms from going off!
Ingenuity, quick thinking, and a basic understanding of electricity and power saved the day. Yes, we managed to keep two Ellman units running. We decided to not risk the third one. Leading us to ultimately say… the course didn’t suck, because we created the Ellman Blow! Not exactly the way it was drawn up on paper. For the next course, they’ll either have a 1500 watt transformer or they will get the UK version of the Ellman surgical units & vacuum. That won’t be much of an adventure though, since they are designed to run on 240V – just plug it in and go.
So no, we didn’t burn the building down or set off the smoke alarm or make everyone evacuate. Perhaps we will be remembered, though, for saving the expensive equipment and preserving the workshop.