ask a doctor anything come on in...

[JohnL]

This thread was automatically split due to performance issues. You can find the rest of the thread here: http://archive.reefcentral.com/forum...44#post7787044

[Muttling]

Originally posted by Nina51
if Debi needs a cane, you might as well shoot her.

Dang....You're harsh.

[Nina51]

Originally posted by Muttling
Dang....You're harsh.

oh now that's just flat out not fair. thread gets split and you misquote me and now it looks like i really that and i swear by all that's holy debi, i did NOT say that. do you believe me? or are you gonna believe HIM ^??

[dc]

Originally posted by Nina51
oh now that's just flat out not fair. thread gets split and you misquote me and now it looks like i really that and i swear by all that's holy debi, i did NOT say that. do you believe me? or are you gonna believe HIM ^??

Who would believe Mutt?

[Muttling]

Originally posted by Nina51
oh now that's just flat out not fair. thread gets split and you misquote me and now it looks like i really that and i swear by all that's holy debi, i did NOT say that. do you believe me? or are you gonna believe HIM ^??

You love me and you know it.

[Nina51]

Originally posted by Muttling
You love me and you know it.

i do and i do?

[Stephany]

You can't make her use it even if it's like.. practically a danger to herself NOT to?

Like making a person wear their glasses while driving.

Somebody should be able to make her use a cane while walking.

Being able to walk isn't in the bill of rights, is it?

[Nina51]

Originally posted by Stephany
You can't make her use it even if it's like.. practically a danger to herself NOT to?

Like making a person wear their glasses while driving.

Somebody should be able to make her use a cane while walking.

Being able to walk isn't in the bill of rights, is it?

LOL steph, i haven't read the bill of rights recently but i seriously doubt there's anything in there about canes OR wearing glasses while driving.

seriously, you have no options unless you wanna admit her to the 5th floor of the lounge and we'll keep the ole bag in a straightjacket.

[Stephany]

*Le Sigh*

[Wolverine]

Originally posted by Stephany
You can't make her use it even if it's like.. practically a danger to herself NOT to?

Like making a person wear their glasses while driving.

Somebody should be able to make her use a cane while walking.

It gets worse. Not only can you not make them use a cane, you can't make them stop driving.

If I see a patient who has been driving, but has fallen below the legal driving limits (which vary significantly by state, and are somewhat arbitrary to begin with), all I can do is tell them that. I tell them they no longer meet Michigan driving criteria, and that they should not drive. I document that conversation in the chart, and that's the end of it.

If I notify the secretary of state that this person no longer meets criteria, I have broken the law. The best I can do is refuse to fill out the paperwork for them to get a renewal after they fail at their next renew date (which can be several years away in some cases).

Dave

[skippy2]

Wolverine:

Last week I started seeing black spots in front of my right eye. Lasted a couple of days on and off. Yesterday, it started again. Only it's not spots. It looks like some type of wiggly line maybe an 1/8" long. It's quite annoying as at first I thought there was a bug in front of me. Anything I should do about this or will it go away on its own? My left eye seems fine.

[Wolverine]

she went to Russia, and Italy for experimental eye injections that she feel slowed down her vision loss.

Unlikely; how recently was this. There has been some anecdotal stuff with stem cell injections, and some injections with newer medications (as in just released in the last 2-3 years), but none of it is anywhere close to proven or even widely acknowledged.

Decades ago there were some people doing melanophore hormone injections, which basically turned out to have no beneficial effects.

We now know that vitamin A in high doses (with avoidance of high doses of vitamin E) slows vision loss in some RP patients. Of course, those can both be taken orally.

But she says she doesn't want a seeing eye dog, because she doesn't want people to look at her funny.
Not that: a) she could see their looks anyway, and b) people already don't look at her funny when she bumps into everything

That attitude is unfortunately tremendously common. I've heard these people described as "80-year-old beauty queens". We see people, for example, who go to Bingo weekly, but they'll stop going because they can't see the regular cards anymore. They'd rather not go than use the larger print cards and have people know they can't see well. It's a shame because for many of them things like this are a very good social outing. IME, there's really not a whole lot you can do to change that view.

Dave

[Wolverine]

I almost forgot, in Russia in the early 80's doctors started giving injections of ribo-nucleic acid to treat RP. They do not believe that they work, but feel it is more humane to treat patients with a worthless placebo than offer no hope at all.
That's obviously different than the view of most American doctors, who don't feel that false hope is a tremendously beneficial thing (hope is, but not false hope).

Because RP is slowly progressive, it's easy for patients to convince themselves at any given stage that it's stabilized, even when that's not the case.

Dave

[Wolverine]

Originally posted by skippy2
Wolverine:

Last week I started seeing black spots in front of my right eye. Lasted a couple of days on and off. Yesterday, it started again. Only it's not spots. It looks like some type of wiggly line maybe an 1/8" long. It's quite annoying as at first I thought there was a bug in front of me. Anything I should do about this or will it go away on its own? My left eye seems fine.

It's a good idea to get it checked out, and I'm fairly certain that it won't go away. Here's a synopsis of the lecture I give patients on this with a few caveats: (1) it's a little easier when I can show people what's going on with a model, (2) some of what I say is not completely physiologically accurate, but it makes it much easier for people to understand the concept of what is going on.

Behind the lens, the eye is filled with a jelly called the vitreous. As we age, the vitreous liquifies and essentially shrinks. At times you can get small condensations of vitreal fibers into little clumps that we see as floaters.

The vitreous is firmly attached to the retina at certain points (around the frontmost part of the retina, at the optic nerve head, and along vessels). As it is shrinking, it can pull away from these points, it's not atypical to have a the part attached to the nerve head suddenly separate and cause a noticeable floater.

The floaters on their own are annoying, no question about it (I have some also, so I understand), but in and of themselves are no danger to your eye or your vision.

That's the good news; here's the bad.

As the vitreous separates from the retina, at times it is too firmly attached at places, and can create a hole in the retina. Further traction lifts that hole and allows the liquified vitreous to flow through the hole to get underneath the retina. As an analogy think of water getting under a laminated floor and lifting it up. This is a retinal detachment, and that's a big deal that's on a clock for good successful treatment.

If there's a small hole, and not a lot of fluid has gotten under it, it can be treated with a little laser in the clinic, which is a lot easier than surgery, and something most general ophthalmologists can handle. If it's bigger than that, then it will likely need surgery.

Overall the process takes about a month. So typically we see someone when they call, usually in the first couple of days after it starts, and then again in 4-6 weeks. There is a warning that goes along with it, if you start seeing more floaters, get in right away; if you start seeing flashing lights, like lightning or fireworks in one eye, get in right away; and if you see a shade or curtain blocking part of your vision, get in right away. With my patients I tell them "right away" means when they notice it: days, nights, weekends, holidays. Since we're in Detroit, and our system has someone available 24-7, that's easy to do. I don't know how easy it is in SW MI.
(As an aside, the flashing lights come because that's all the retina knows how to do. There are no pain sensors, and any stimulus, such as the vitreous tugging on part of the retina, is interpreted as light)

As for the floaters themselves, surgery that is done for other reasons (retinal detachments, diabetic hemorrhages, etc) will remove the floaters, but we don't do it for that reason (except in extraordinarily rare circumstances), because it's a fairly involved surgery for something that is merely annoying. Expect that they will always be there. Over the course of months, your brain learns to ignore them most of the time. They'll be more noticeable in bright light, and against white/off-white backgrounds and light blue backgrounds. They'll also be more noticeable when you're thinking about them (like mine are as I write this thread).
Since they're in the vitreous, and it's sort of jelly-like, sometimes they can float out of the way so they're not in the more sensitive center part of your vision, and so seem to come and go.

Now, in diabetics, it's not uncommon to get some bleeding into the vitreous, and that can show up as floaters as well. There are various othe problems that can show up as lines/black spots, like wet macular degeneration, ischemia, MS), but it's not really worth listing all of those right now.

If I had heard about this yesterday, I would have told you to get it checked out today, since I know the clinics would have been easily available. Weekends there might be harder. It wouldn't be a bad idea to see if you can get ahold of a local ophthalmologist on call, and see if they want to check you out tonight or tomorrow. If you call around to the emergency rooms, you can just ask for the number for ophtho on call. Most likely, at this point, they'll see you next week some time, but I definitely wouldn't go longer than that. If you were more in our area, we'd tell you to come down tonight, then you would tell us there's no way you're driving into the center of Detroit in the middle of the night, and we'd say "fine, come in tomorrow then" (that's the typical conversation for people in the suburbs here).

Dave

[Nina51]

Originally posted by Wolverine
It gets worse. Not only can you not make them use a cane, you can't make them stop driving.

If I see a patient who has been driving, but has fallen below the legal driving limits (which vary significantly by state, and are somewhat arbitrary to begin with), all I can do is tell them that. I tell them they no longer meet Michigan driving criteria, and that they should not drive. I document that conversation in the chart, and that's the end of it.

If I notify the secretary of state that this person no longer meets criteria, I have broken the law. The best I can do is refuse to fill out the paperwork for them to get a renewal after they fail at their next renew date (which can be several years away in some cases).

Dave

in my experience, about the only way you can pull a license from an elderly person, unfortunately, if she causes an accident. sometimes, when renewal comes around, the driving examiner will fail them but even at that, it seems to take a major infraction before it happens.

[dc]

Originally posted by Stephany
You can't make her use it even if it's like.. practically a danger to herself NOT to?

Like making a person wear their glasses while driving.

Somebody should be able to make her use a cane while walking.

Being able to walk isn't in the bill of rights, is it?

Some people are just stubborn. My Mother refuses to wear her oxygen(COPD) half the time, to the point of falling. My poor sister fights and nags her to the point she can hardly be in the same room with her. My Mother says she can do any dang(not the word she really uses) thing she wants to, including fall. Then she calls up my other sisters and complains that all my sister does is complain! She really deserves a medal!

[skippy2]

Thanks very much Dave. I will definately call my eye Dr. on Monday.

[AcroSteve]

Originally posted by joeychitwood
It could be a Morton's Neuroma, which is a nerve growth that occurs near the metatarsal-phalangeal joint. Though it usually occurs between the third and fourth toes, it can occur between others. See Google.com for more details.

Joey,
I have a bulging disc that causes very frequent discomfort in that same leg. Any change they are related? Or is it just a coincedence?

[joeychitwood]

Originally posted by AcroSteve
Joey,
I have a bulging disc that causes very frequent discomfort in that same leg. Any change they are related? Or is it just a coincedence?

It's a possibility, I suppose, but usually radiating disk pain isn't that easily localized or so specific. Is the foot tender to palpation? If so, it wouldn't be due to the disk problem.

[Stephany]

Originally posted by Wolverine
Unlikely; how recently was this. There has been some anecdotal stuff with stem cell injections, and some injections with newer medications (as in just released in the last 2-3 years), but none of it is anywhere close to proven or even widely acknowledged.

Decades ago there were some people doing melanophore hormone injections, which basically turned out to have no beneficial effects.

We now know that vitamin A in high doses (with avoidance of high doses of vitamin E) slows vision loss in some RP patients. Of course, those can both be taken orally.



That attitude is unfortunately tremendously common. I've heard these people described as "80-year-old beauty queens". We see people, for example, who go to Bingo weekly, but they'll stop going because they can't see the regular cards anymore. They'd rather not go than use the larger print cards and have people know they can't see well. It's a shame because for many of them things like this are a very good social outing. IME, there's really not a whole lot you can do to change that view.

Dave

I know that the injections were done directly to her eye, and that she had to bring her own needles, because they re-used their needles over there... and they became dull after a while, and were quite a bit more painful unless she brought her own.
She said that when she went to the clinic, they just came out to the waiting room... and did the injections right there.
She had to get permission from her state senator to travel to Russia, as we weren't in the best of relations with them at the time. I'll get the time span of years that she traveled to Russia (and later Italy) for the treatment.
She did read a study done by a twin that had received treatment in Russia vs. his brother that didn't, and the one that received treatment had lost significantly less vision... but I have to look back at a research paper I did to see if I cited it.

I can't believe you say that attitude is common... that's really unfortunate. I mean, the woman is brilliant... peruses the entire newspaper every day with a magnifying glass.. very interesting to speak with about anything.... But than angry woman will yell at her husband 10 times a day for not telling her something was in her way and she bumped into it. Everything is his fault...

[Wolverine]

Originally posted by Stephany
I know that the injections were done directly to her eye, and that she had to bring her own needles, because they re-used their needles over there... and they became dull after a while, and were quite a bit more painful unless she brought her own.
She said that when she went to the clinic, they just came out to the waiting room... and did the injections right there.
She had to get permission from her state senator to travel to Russia, as we weren't in the best of relations with them at the time. I'll get the time span of years that she traveled to Russia (and later Italy) for the treatment.
She did read a study done by a twin that had received treatment in Russia vs. his brother that didn't, and the one that received treatment had lost significantly less vision... but I have to look back at a research paper I did to see if I cited it.

That probably doesn't mean anything. You can often just have 2 twins do the exact same thing and get completely different outcomes in cases like this. There are so many variables in something like that that even twin studies are iffy (especially with only one set of twins).

The RNA injections were given into the eye, so I'll bet that's what she was getting. If that's the case, in the US that treatment is considered unethical on multiple grounds.

The method is also obviously different from how we tend to inject things in the eye here (which is definitely not in the waiting room).

I'd bet two things. One is that the medication didn't do anything positive (because there's nothing from that time period that did), and the other is that you'll never convince her of that.

I can't believe you say that attitude is common... that's really unfortunate. I mean, the woman is brilliant... peruses the entire newspaper every day with a magnifying glass.. very interesting to speak with about anything....

IME, this attitude seems to have nothing to do with intellect, level of education, ethnicity, financial situation, etc. It's just a part of the personality, and some people refuse to allow others to consider them blind. They would rather be considered clumsy.

Dave

[Stephany]

Originally posted by Wolverine
That probably doesn't mean anything. You can often just have 2 twins do the exact same thing and get completely different outcomes in cases like this. There are so many variables in something like that that even twin studies are iffy (especially with only one set of twins).

The RNA injections were given into the eye, so I'll bet that's what she was getting. If that's the case, in the US that treatment is considered unethical on multiple grounds.

The method is also obviously different from how we tend to inject things in the eye here (which is definitely not in the waiting room).

I'd bet two things. One is that the medication didn't do anything positive (because there's nothing from that time period that did), and the other is that you'll never convince her of that.

IME, this attitude seems to have nothing to do with intellect, level of education, ethnicity, financial situation, etc. It's just a part of the personality, and some people refuse to allow others to consider them blind. They would rather be considered clumsy.

Dave

She was diagnosed in 1980, her doctor said matter of factly that she was going blind and there was nothing she could do.
She started travelling to Russia for treatment shortly after she had researched and cleared the red tape.
Do you have any idea what they were doing in Italy? After going to Russia for approximately 8 years, she continued treatment in Italy from 1989 to 1998 to get the treatment...

[KING OF THE REEF]

i have a hard time getting cramps worked out of my right leg. i keep getting them about 5 times a day in the same spot on the right leg. could this be heritary or just a problem with my blood circulation? im about 6 feet tall white male with red hair and brown eyes. i say that because i am wondering if my background might have anything to do with it

[minh_han]

King, I would have your doctor consider checking your electrolytes, as some things that are out of balance such as Mg, P, Ca, Na, and K might cause muscle cramps. Also, you could do a muscle enzyme test called a CPK to see if you're breaking down muscle.

[Orangeman]

Got another eye question for anyone...

Since I was a teenager, I've occasionally gotten weird colorful test patterns that appear crescent shaped. It begins in the center of my vision and slowly moves to the outside. If I had to desribe it it would be this:

Hold your right hand in a crescent moon shape about 1 ft in front of your nose. Instead of seeing your hand, your see constantly moving colorful geometric patterns pulsing with color. Slowly move your right hand from in front of your nose to your right ear. The effect usually lasts for about 5 minutes.

Never any headaches assocoiated with it and I have 20/20 vision.