The Eyes have it Part 2

 

Following on with my two previous Eyes posts, namely. ‘The Eyes Have It – Introduction’ and ‘The Eyes Have it Part 1’. I now have another Part for you to read.Here is ‘The Eyes Have it Part 2’. These are my personal experiences and thoughts which I hope will be of interest and use to readers.

As an aside, thank you, for the comments and emails received with regard to my previous ‘Eyes’ posts. I know many readers have found them interesting and helpful.

When second and subsequent appointments are necessary at the hospital eye clinic the procedure may differ slightly as additional tests may have been requested by the Doctor. before you are seen again .

FIELD TEST
Part I referred to the Field of Vision test which may have been requested if pressures in the eyes appeared to be high or if there is a family history of glaucoma. In this case the patient may already have been tested by his/her own optician./ optometrist. The test used in my hospital is known as Automated Perimetry. This test evaluates your vision field by flashing random lights of different strength (generated by computer) in your peripheral vision field while your eyes are fixed on a source light straight ahead. The patient uses a button to indicate the presence of objects. There may be a blind spot if you fail to see objects in a certain portion of the visual field. This test requires the patient to be able to co-operate and concentrate and requires a certain amount of co ordination so is not suitable for everyone. There are other alternatives so don’t worry if there is a problem for you. I dislike this test because it appears to trigger my claustrophobia and makes my eyes water copiously.

A doctor I spoke to recently said that it was stressful because lights are shown which are outside the normal field of vision, and patients sense this is the case and feel anxious. because they have failed to register the flash. I don’t think it is ever taken as definitive in itself, – few tests are. It may be worth asking for it to be noted, however, if you have a headache or if your eyes are affected by hay fever or sinus problems. The Doctor will give you the result during your consultation.

OCT SCAN
It is also routine for an OCT scan to be requested. I have one almost every time I visit the eye clinic. OCT means Optical Coherence Tomography. This is a wonderful tool with many applications. It is a way of photographing cross sections of the retina in 3D, when used in ophthalmics. As well as its diagnostic uses it is also used to measure the success of various procedures and even indicate hazards which might occur in surgery. It can identify the areas where sub retinal fluid is present which means that injections or laser may be targeted more accurately in maculopathy and macular oedema.

The patient is asked to look into the camera. .Then it is just a matter of keeping the eyes wide open and not blinking while focusing on a central point for a few seconds. There is with the older machines a brief flash of light at the end but nothing else to disturb or alarm. Wheelchair users can remain in their wheelchairs for the scan. The results will be available on computer screens within minutes.

When I first began having regular OCT scans they were carried out by a skilled and experienced biometrist, then, a few years ago nurses were trained on the procedure. Some are excellent and there are no problems, but others find it challenging. Unless the image is clear it is useless. Occasionally the scan has to be repeated. The operator can examine the finished product and decide it is not good enough or the equipment senses that an error has occurred. I am so used to it all that I can tell with some accuracy when a retake is going to be necessary. It is usually because the focus wasn’t correct to begin with.

While searching for images I came across this in Netscape the American Ophthalmology magazine. Link here to article.

Also the images below show the scan in the top picture macular oedema while that underneath shows normal.

A very little experience, allows the patient to correlate the inconsistencies in vision apparent when tested on the standard eye chart with the images shown on the scans. Overlapping letters sloping and missing letters can all be matched to the irregularities on the OCT. I think my consultant is still trying to work out how I always know which eye is shown on the screen at any one time. I can only imagine the improvement in diagnosis and treatment which this amazing piece of technology has made possible while being so comfortable and non-invasive for the patient.

FUNDUS FLUORESCEIN ANGIOGRAPHY
The final test which may be advised for patients with diabetic eye disease is Fundus Fluorescein Angiogram commonly known as FFA [of course.] This procedure or the suggestion of it has been the cause of more anguish in my correspondence than any other. For a start to most people an angiogram means a coronary angiogram, they will never have heard it associated with eye problems. It is used to obtain more information about the blood vessels in the retina. It will show if there is leakage or bleeding and where treatment, if necessary, should be targeted. Patients – especially the newly diagnosed, are often terrified by the consent form they are asked to sign and the warnings they are given. The fact is that the dye used in this procedure, the fluorescein, yellow dye is not licensed to be used in this procedure, and was not developed for this purpose. It is however commonly used and very effective. The use of unlicensed substances is very common and something for which we should all be grateful. The hospital is obliged to tell patients of this and also to advise them of the risks involved in this procedure, for insurance reasons amongst others. Many people feel slightly nauseous for a few seconds after the injection, others may experience some slight allergic reaction on their skin afterwards, and very rarely, – one in about 25,000 patients will experience a more severe reaction which will be dealt with immediately by the emergency team. The benefits of the procedure are considered to far outweigh any risk.

I have had 3 angiograms and am still here to tell the tale! Before the procedure begins you will have your blood pressure checked and pupils dilated. You will be asked about allergies. There is a particular concern about iodine allergy so a bad reaction to shellfish would be something which must be disclosed. After your pupils have been dilated a cannula will be placed in a vein in your arm. You will be seated in front of a camera with chin and forehead rest and a series of rapid photographs will be taken. The dye is then injected via the cannula and this is the point at which nausea may be felt. I have only experienced this feeling once. On the other two occasions the officiating nurse believed that injecting the dye very slowly prevents nausea and this seemed to work.

More photos are then taken accompanied by more flashing lights, and after a while you will be allowed to rest for a few minutes. Then the final photos are taken. It is normal for the cannula, – now disconnected from the dye to be left in the arm until you are discharged, after about 30 minutes to allow you to recover and to check that no side effects occur. Some patients may need antihistamines for rash or redness at the cannula site. Tea and coffee is supplied in my clinic.

For 24 – 48 hours afterwards your skin and urine may appear orange or yellow, this is harmless and nothing to worry about. Drinking a lot of water should help to get rid of the dye. Then you are free to go. The doctor will generally discuss the results with you on your next visit. The only problem I have experienced apart from momentary nausea is with the insertion of the cannula. This very much depends upon the nurse. I have been very fortunate in having the same excellent nurse do this twice and it was totally painless. It is after all a very small cannula and a very fine needle used in this procedure. On one occasion a male nurse had seven tries in one arm and four in the other and was unable to insert the needle. It was excruciatingly painful. Having had a much larger cannula inserted by a paramedic on one occasion and a doctor on another I knew that the individual must be inept. Eventually I suggested that they try the wrist and this was successful. He had been suggesting a direct injection of the dye without the cannula but I was reluctant because I had no confidence in him by this time. I was later told that it is never a good idea to allow multiple attempts at inserting a cannula, or at drawing blood, as permanent and serious damage could be done.

I can‘t help but feel that it is the HCPs who ought to be aware of this and that the onus should not lie with the patient. In fact staff should be properly trained and proficient before being allowed to practice upon patients. I have heard from others that my experience is, by no means unusual or uncommon. If the cannula is not inserted properly and the dye escapes into the surrounding area it can cause burning which, while not serious, should be avoided if possible.

I have a great deal of sympathy for anyone asked to have an FFA shortly after diagnosis, I can well imagine the anxiety this would cause. I have had 3 FFAs in 3 years but this is unusual. It depends on the individual eye condition.

As with many tests and procedures the anticipation is worse than the experience. A newly diagnosed person may feel that this is only the beginning of a series of invasive tests but this is not the case at all. If you are a new patient and FFA is recommended it will certainly help in diagnosis and to pinpoint areas where treatment may be necessary. Most hospitals produce their own fact-sheets about these procedures, but these vary a great deal, and can  be misleading. I would advise anyone who is at all concerned to look at the information provided by several different hospitals which are usually available online in PDFs. This provides a fuller picture. Your hospital will always answer questions, but it is worthwhile doing your own research as it is very easy to misunderstand and not all hospital staff can be familiar with every procedure. Confusing and sometimes slightly uncomfortable as these tests may be it is worth while reflecting that not so long ago none of them were available and diagnosis and treatment would not have been possible until it was too late. It is much rarer for people to lose their sight completely these days and many new treatments are in the pipeline.

Next time I would like to share my experience of laser and eye injections .in the hope that they will be of interest and use to others. These are matters which worry many diagnosed with retinopathy

Kath

Posted in Diabetic complications, Living with diabetes, Support for diabetics | Tagged , , , , , , , | 1 Comment

Statins is the big con over? Catalyst: patients stop taking cholesterol drugs, says survey !

Huge numbers of people on potentially life-saving cholesterol medication have stopped taking it without consulting their doctor after watching an ABC television program, a survey of GPs has indicated. Up to 40 per cent of patients who were concerned by the Catalyst episodes had already gone off their medication, the survey found.
The two-part Catalyst series, presented by Dr Maryanne Demasi, claimed the causal link between saturated fat, cholesterol and heart disease was “the biggest myth in medical history” and cholesterol medications, known as statins, were toxic and potentially deadly. The second episode carried a warning that it should “not be taken as medical advice”.
Heart Foundation national director of cardiovascular health Rob Grenfell said the results were “frightening”.
The survey was commissioned by Merck Sharp & Dohme – which created the first statin in the early 1980s – and undertaken by market research company Cegedim, which surveyed 150 doctors.
It found 40 per cent of patients asking about statins had already stopped taking them, and the remaining 60 per cent wanted to stop.
About 58 per cent of those patients were considered to be at high risk of heart attack or stroke.
“These are people who should be on medications,” Dr Grenfell said. “If your risk is greater than 20 per cent – that is, you have a one in five chance of having a heart attack or stroke in the next five years – you should be treated.”
People with elevated cholesterol levels but a lower risk of heart attack because they do not have other risk factors such as diabetes or high blood pressure, should still take steps to improve their health. But Dr Grenfell said it was difficult for GPs to help people implement lifestyle changes, as many factors were out of their control.
More on this story here.
Eddie
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New blood glucose monitors sync to smartphones, send data to the cloud

This may be of interest to any gadget/tech loving diabetics who are reading…

A snippet…

“The latest offering in that space is Dario, a cloud-based mobile health platform that serves as an all-in-one glucose monitoring system. New York-based LabStyle Innovations plans to launch an iOS mobile app for the Dario on December 12 in the UK, Australia, and New Zealand, reports TechCrunch. A palm-size glucose monitor, with a lancet, strips, and a meter, is also part of the package, and will be commercially available in Europe after a soft launch in early 2014.”

More here

Paul

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Mark Sisson: It’s a way of eating and a lifestyle

A short video but worth a watch. Paul

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Low-carb diet gets more support from new analysis

I find so many of us have found the same to be true-A snippet from the article below…

“As people fire up their grills for barbecues over Labor Day weekend, a new analysis touts the benefits of a low-carb, meat-lovers’ diet.

A review of 17 different studies that followed a total of 1,141 obese patients on low-carb eating plans — some were similar to the Atkins diet — found that dieters lost an average of almost 18 pounds in six months to a year.

Overall, participants had improvements in their waist circumference, blood pressure, triglycerides (blood fats), fasting blood sugar, C-reactive protein (another heart disease risk factor) as well as an increase in HDL (good) cholesterol. LDL (bad) cholesterol did not change significantly.

“These improvements occurred during weight loss which is known to lead to some of these changes,” says William Yancy, an associate professor of medicine at Duke University Medical Center and a researcher who worked on the analysis. It’s being published in the journalObesity Reviews.

Yancy has done several previous studies on the Atkins diet, including some that were funded by the Atkins Foundation. A low-carb diet is a reasonable one to follow to lose weight and improve heart disease risk factors, he says.”

More from this article here

Paul

Posted in Diet and dieting, Fats, Low carb diet | Tagged , , , , , , , | 1 Comment

Dr. Jay Wortman: 2013 Low-Carb Cruise Lecture.

A must watch from our friend and fellow diabetic Dr Jay Wortman:
Graham

 

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Latest approach to diabetes, eat like your grandparents !

And we’re all familiar with the advice – get moving, lose weight, reduce fat in your diet. But one expert is suggesting that the solution could be a diet low in carbohydrates and high in fat. Professor Grant Schofield, from the Auckland University of Technology in New Zealand says that’s the conclusion of research last year in several countries including Tonga, Tokelau, Kiribati and Vanuatu. He found people in Vanuatu were healthier than in Kiribati and the difference was diet – a traditional diet.

What you see is contrary to what the regular health advice is, which is like you’re too fat, you need to exercise more and eat less and you particularly need to get your fat down. We’ve gone for the opposite approach which is just reduce the sugar and refined and processed carbohydrates, but make sure you do get some fat and protein and those sorts of traditional foods. And you see quite a good deal of success. So we’re not the first to do this. When the actual science has been done and proper randomised controlled trials that you see that these diets are actually highly effective in helping people lose weight and sort their diabetes out.

More on this story here.

Eddie

Posted in Diabetes news, Diet, Diet and dieting, Keto diets, Living with diabetes, Low carb diet, Low carb news, Low carb science, Low/Reduced carb food, Support for diabetics | Tagged , , , , , , , | 3 Comments

ACE inhibitor drugs linked to kidney damage !

Drugs prescribed commonly to diabetics could cause serious kidney problems and result in hundreds of deaths each year, a study suggests. Researchers found that ACE inhibitors and similar drugs, which are used to treat conditions such as high blood pressure and heart disease, especially in patients with diabetes, were linked to severe kidney damage.
  
The growing popularity of the drugs, which are now the second most prescribed medicines in the UK, has coincided with a significant increase in patients being admitted to hospital with acute kidney injury. Analysis of data from all English hospitals found that between 1007/8 and 2010/11, the number of patients being admitted for acute kidney injury rose by 52 per cent. Although doctors have previously raised concerns about the impact of the drugs on kidney function, the extent of any potential danger has remained unclear. Figures from the new study, published in the PLOS ONE journal, suggest that the higher prescription rate was linked to 1,636 additional patients being admitted to hospital for acute kidney injury over the three year period.
One in seven of all cases of acute kidney injury – which has a mortality rate of 25 to 30 per cent – could be a result of increased prescriptions of the drugs, they claimed.
More on this story here.  Full PLOS ONE paper here.
Eddie
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The Eyes have it part 1

This follows on my earlier post “The Eyes Have It – Introduction” and I hope readers will find it useful.

So, Gentle Reader, you have had your annual retinal photograph, you have survived the demon drops and – thanks to your sunglasses – the dangerous journey home afterwards.  Having almost been knocked down by an ambulance before I realised the necessity of wearing sunglasses after dilating drops WHATEVER THE WEATHER I am pleased to note that most opticians now recommend this to patients.

Now you must await the results. The all – clear received with a sigh of relief and then either a slightly smug feeling or a feeling of having “got-away with it” when any backsliding with regard to diet is recalled. The sobering feeling when you are told there are some slight retinal changes and the resolutions to do better after your 12 month reprieve.

Finally, for some unfortunates – the dreaded referral to the hospital eye clinic. The notification and appointment is received with varying degrees of anxiety. Some want an immediate appointment as they have heard that early treatment is vital. The appointment date seems ridiculously far away. Others seek an immediate appointment with their GP to demand further explanation. A great many others just panic inwardly and dread the whole process. but don’t know where to turn for advice.

Except for a few, the results of this first visit may well turn out to be an anticlimax. The fact of the matter is, that in the vast majority of cases, nothing much will happen as a result of this first visit. If possible, try to regard it as a follow up to the screening – a way of getting into the system so that you may be more closely monitored by the experts. Rather than worrying about it, think of it as a precautionary measure and consider yourself lucky. A few years ago you would not have been aware of any possible problem until your vision was affected. I can only speak from my own experience but I suspect most eye clinics are organised to a similar model.

On your first visit you are asked to bring a urine sample and your blood pressure is checked. This does not happen on future visits but applies to all new patients, diabetic and non-diabetic. A nurse will test your visual acuity on the usual chart – so you must also take any distance glasses you wear. On the first visit your near vision will also be tested. You will then have dilating drops and iodine drops instilled into your eyes, prior to your eye examination by a doctor. As with any eye drops much depends on the competence of the person instilling them. The iodine drops generally sting in any case, but if the correct amount is given, it’s merely a momentary inconvenience. I have had iodine split over my clothing on several occasions, however, so be aware that this is a possibility. It does wash out but doesn’t necessarily rub off easily.

It is the practice to test vision at every visit. I have certain reservations about this with diabetics, the success or failure of certain procedures is measured by as little as one letter on the chart. I know that my vision fluctuates with my blood sugar. I can guess my bg levels quite accurately by the state of my vision. In that case the only accurate measurement would surely be to have the test done at exactly the same time after having eaten exactly the same meal before each visit. Is this not taken into account? Unfortunately not. It is impossible to treat diabetic patients separately all the time, although a few diabetes clinics do endeavor to do so.

For the rest, it is the usual hospital practice of making several appointments at the same time and patients being seen in no discernible order. This doesn’t mean that there is no reason behind the order in which you are seen so don’t be upset or alarmed if others arriving later are seen first.

In the early days the visual acuity test does not need to be so precise and is probably a good general guide for purposes of comparison. It is only if you receive any sort of treatment that it may be worthwhile mentioning high or low blood sugar and other factors which might be affecting your vision.

When you see the doctor on the first visit you will be asked questions about your family and personal medical history and your diabetes and blood pressure control. Recently cholesterol levels have also become an issue. You will also be asked about your medication and the results of any self-monitoring your blood. The doctor will probably examine your eyes with what is called a binocular slit lamp – but again this may vary from place to place.

You will sit at one side of a table bearing the instrument and place your chin on the chin-rest with your forehead against a more flexible rest and your eyes will be examined with a bright light and/or lights of different colour. The pressures in your eyes may also be checked by means of a lens placed on your eye. An anesthetic drop will be given before this is done. The doctor will ask you to look in different directions and up and down, or to focus on a certain point during the examination. It is generally easier to keep both eyes open when one is being examined. As with everything else – some people can tolerate these examinations better than others and some practitioners are more skilled than others. Some manage to avoid causing discomfort from the glare, others don’t, so be aware that if you need another examination and it is different to the first, it is not a sign of changes to your retina – more likely a reflection on the skill of the examining doctor. Of course some people have more sensitive eyes particularly if they have other eye conditions or have had previous treatment.

At the end of the examination the doctor should tell you of his/her findings and of what will happen next. Unfortunately, I have been told by various people over the years that this does not always happen. It is up to you to ensure that it does. Bear in mind that an examination of your retina while your pupils are dilated using strong lights in a darkened room is likely to leave you a little blurry-eyed and disorientated. You may just want to leave. Don’t. Even if you are told that you will be given an appointment to return six months into the future that is not sufficient. You need to know the result of the examination.

You may be told that a letter will be sent to your GP. Your GP is not an ophthalmologist. As with everything else it is necessary to demonstrate that you wish to be involved in your own treatment. The doctor can confirm whether the scan results were borne out by the examination just completed. Can tell you if your eye pressures are within range and can explain what will happen next. Its not rocket science. They tend to err on the side of caution, which is good – so don’t panic if you are told that you will be recalled. This may even mean that there are very few signs of a problem but that they are going to see you again to double-check. If the pressures in your eyes are raised a little they may want you to undergo a field of vision test, especially if there is a family history of glaucoma. An OCT scan may also be mentioned, none of this is anything to worry about. It will probably be done on your next visit before seeing the doctor, or the field test may be done at a different time. It is possible if the doctor remains non-committal that he intends to seek a second opinion from a colleague, or superior, who is not available at the time and can’t give you a timescale for your recall. The doctors you see initially are not consultants of course. The consultants are also surgeons and therefore not always available while the clinics are in progress.  At least the ordeal – which may have taken a few hours, mostly waiting around, is over and you are free to go. Because people attend these clinics with various different conditions and because there is a great deal of waiting for eye tests for pupils to dilate, for scans to be done etc – there is probably a longer waiting time at eye clinics than in others. Unfortunately you must learn to be a patient -patient. Some are not, of course, but this generally proves to be counter-productive although the person may not be aware of it. On the other hand, I have always found the staff very willing to assist in genuine cases, and some will go out of their way to do so. The time spent waiting can be usefully employed in reading notices, speaking to other patients and generally familiarising yourself with the layout and the proceedings.

In my hospital’s clinic there is a great deal going on around the ophthalmology areas and often patients are confused by this. Waiting areas apart from the main waiting area are outside examination rooms. Many make the mistake of assuming that everyone in a certain area is waiting for the same procedure, or to see the same person. Some become very agitated if they think others are being seen out of turn. As most people are at least a little stressed this can become very irritating. If you are stressed and waiting in some trepidation to be seen you do not want to face an inquisition about how long you have been waiting, what time appointment had you been given etc as it has no relevance in this situation. The last straw came for me when I was practically pulled from a trolley while waiting to be taken up to the operating theatre by another patient who had been waiting longer. I suggested that notices be put up explaining the situation. This has been done in various clinics and day-care wards around the hospital and it is agreed that it has made a difference.

The procedure at my hospital is for appointments to be notified by post, so although you may be given an approximate date this will be confirmed or altered later. Even if you are not entirely reassured by your visit, or if you are now more concerned by the result of your examination and the prospect of further tests you will probably have realised that so much of the treatment and diagnosis of diabetic eye disease is a long slow process, and not in most cases a sudden trauma or something with an easy-fix solution. At least you will never face your first visit to that particular eye clinic again. Many will have paid their first and last visit to the clinic and hopefully everyone will have learned that blindness is not inevitable or imminent.

As ever, the above is just my own personal view from my own experiences as a patient. I have tried to address the main points which recur time and again in my correspondence with people on and off various places where diabetics gather. Some may seem petty and self-evident but these are the very things which cause most distress, purely because people are embarrassed to ask. I hope it is of help to anyone in this situation.

Next time I will write about the various tests and procedures which may be required before treatment.

In the meantime, as ever, you can best help yourselves by keeping those blood glucose and blood pressure figures under control. That means stable as well as low.

Kath

Posted in Blood glucose, Diabetic complications, Living with diabetes, Support for diabetics | Tagged , , , , , , , | 1 Comment

Tasty Saturday night pizza back on the menu ! Low carb of course !

Not my recipe but this recipe below looks absolutely awesome !
“These low-carb pizzas taste just like a Dominos takeaway to me. You can make them however you like as meats and cheese have negligible carbs. You can also make a lot of them and freeze them for cooking later to make some quick, easy meals for the future. A great addition to a low carb diet.
You can also make smaller versions with a lower carb count. This recipe is based on making four 9″ pizzas for 9.5g carbs per pizza.”

Serving Size: Makes 4 pizzas.
Carbs per serving: 9.5g
Tools: Bread maker

Ingredients:

  • 250ml bottled water
  • 2 teaspoons sugar (will be used up by the yeast)
  • 1 teaspoons salt
  • 2 tablespoons olive oil
  • 2 ½ cups CarbQuik flour (or any low-carb flour. Carb count will vary based on the flour you use. This recipe is based on CarbQuik.)
  • ¼ cup of white spelt flour
  • ½ cup of wheat gluten
  • 1 teaspoon baking powder
  • ¼ teaspoon garlic powder
  • ¼ teaspoon onion powder
  • 1 sachet of easy-bake yeast (7g packet)
  • 2 tablespoons cornmeal
 Method:
  1. Add ingredients (except for cornmeal) to machine bread pan in order as per manufacturer’s instructions.
  2. Set to “Dough” cycle.
  3. When the dough is done, separate dough into four balls.
  4. Roll out each dough ball to roughly 0.5cm thick pizza bases.
  5. Lightly grease a pan and sprinkle with cornmeal.
  6. Place dough in pan, then flip it over to cover both sides in cornmeal.
  7. Let pizza bases rest in pans for 10-15 minutes. (This is so they fluff up. Don’t miss this step).

Pizza Topping

Ingredients:

  • Mozzarella cheese
  • Pizza topping (I used Tescos own brand)
  • Any other toppings you like

Directions:

  1. Add a tablespoon of pizza sauce to each base and spread it around with a spoon in the centre of the pizza.
  2. Add toppings of your choice, then sprinkle with mozzarella.
  3. Bake at 350°F until done (approximately 15-20 minutes, depending on the thickness of toppings).

A massive thank you to the Low carb Chef for creating this mouthwatering looking pizza-check out this great recipe and others at http://low-carb-recipes-online.blogspot.co.uk/2013/10/low-carb-pizza-dominos-style-pizza.html

Paul

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