What to do for a scratched eye (corneal abrasion)

When someone talks about “scratching” their eye, they are usually referring to an injury to the cornea. The cornea is the clear dome-shaped structure that covers the front of the eye.  The cornea protects underlying eye structures (iris, lens, etc.) from injury and helps to focus images on the light-sensing portion of the eye (retina).  A cut, scratch, or scrape to the surface of the cornea is known as a corneal abrasion.
  
How do corneal abrasions occur?  Some of the most common ways that the cornea becomes injured include:

• Particles such as sand, sawdust or insects getting into the front of the eye beneath the lid 
• Poking the eye with a fingernail or tree branch.
• Being hit with a piece of projectile metal.
• Caustic chemicals splashing into the eye.
• Leaving a contact lens in too long or injury from a poorly-fitting contact lens.
• Lack of protection to the eye while under general anesthesia for surgeryry

What are the symptoms of a corneal abrasion?  Symptoms of corneal abrasion include pain, sensitivity to light, blurry vision, and the sensation of something being in the eye.  Often the eye becomes bloodshot along with excessive tear production. Because the cornea has a dense
concentration of sensory nerves that are important in its role in protecting the eye, corneal abrasions can be extremely painful.

How are corneal abrasions diagnosed?  A common way that doctors use to visualize abrasions is to instill a drop or two of a dye called fluorescein into the eye. The dye will pool in the corneal defect and glow bright green when a cobalt blue light is shined on the eye.  A magnifying instrument called a slit lamp is sometimes used for more thorough evaluation of the injury.

How are corneal abrasions treated?    Most corneal abrasions turn out to be fairly minor injuries. Nevertheless, it is important that a suspected corneal abrasion be evaluated by a health care professional.  This allows the seriousness of the injury to be established as well as determining the most appropriate treatment. While patching the eye has been a traditional treatment for corneal abrasions, more recent research indicates that most can be effectively treated without the use of a patch.   Depending on the size and general health of the cornea, most abrasions heal in 1-5 days. In certain instances, the use of antibiotic eye drops or ointment may be advised to prevent an infection. Contact lens wearers should not put in lenses until the abrasion is healed or the problem caused by the contact lens is resolved.

What should you do if you suspect a corneal abrasion? As mentioned, it is best to seek medical attention if you suspect that you have a corneal abrasion.  Prior to seeing a doctor you should:  

• Rinse the eye with clean water or saline solution using an eye-cup or small drinking glass. Many schools or work site have an eye-rinse station for this purpose.
  
• Blink several times to help remove small particles of dust or sand.
  
• Pull the upper eyelid over the lower eyelid. Your lower eyelash may be able to brush away something stuck to the underside of your upper eyelid.
  
• Refrain from rubbing the eye after an injury since this can worsen a corneal abrasion
  
• Avoid the use cotton swabs or other instruments to try to remove an embedded foreign object

To prevent corneal abrasions it is recommended that protective eye-wear be worn when working with tools, chemicals, or playing sports that could cause an eye injury. Contact lens wearers should make sure that the lenses fit properly and are used as directed.  The great majority of corneal abrasions heal without long-term consequences.  More serious scratches or abrasions that are not appropriately treated, however, can lead to serious complications such as corneal erosions or scarring of the cornea.

Traction for a "Slipping" Memory

There are many causes for people’s memory to “slip”.  These include medication side effects, dementia, depression, medical conditions, and unhealthy lifestyle choices. By addressing the underlying cause, it is possible that memory can be improved. For example, if a medication is responsible, discontinuing or changing that medication can have a beneficial effect. 
While normal aging can cause some forgetfulness, it does not lead to dramatic memory loss. When memory loss cannot be attributed to a specific cause, or normal aging appears to be responsible, the following measures can help provide traction for a “slipping” memory.

1.  Challenge your mind.   The saying “use it or lose it” applies equally well to the mind as it does to our muscles.  The more you work out your brain, the better you’ll be able to remember information. One scientific study showed that older Americans can improve their memory by instituting a memory-improvement plan that included regular mental exercises, such as working crossword puzzles.  A second study found that elderly individuals who frequently engaged in leisure activities such as reading, playing board games, playing a musical instrument, or dancing were less likely to develop dementia in the future. The best brain exercising activities challenge you to develop and use new brain pathways. Activities that appear to be particularly helpful include those that are new or unfamiliar and those that take some mental effort to perform.
   
   
2. Learn “tricks” to help boost memory.  Here are a few examples:
    
• Put frequently misplaced items, such as your wallet or purse, keys, and glasses in the same place each day.
   
• Use a date book or electronic organizer to keep track of appointments, telephone numbers, or “things to do”.
   
• Repeat the names of people when you meet them. For example, if you’ve just been told someone’s name, use it when you speak with him or her: “So, John, what line of work are you in?”
   
• Use mnemonics to help you remember. In a name mnemonic, the first letter of each word in a list of items is used to form a name of a person or thing.  For example, using the first letter of the colors of the spectrum (red, orange, yellow, green, blue, indigo, violet) makes the name, Roy G. Biv.
   
• Visual association operates on the principle that to remember a new piece of information, it helps to associate it with something else. For example, to remember that Robert’s last name is Green, you could visualize him wearing green clothes while putting a green ball on a golf green.
   
• “Chunking” breaks a long list of numbers, such as a telephone number, or other types of information into smaller, more manageable chunks. A common example involves breaking down a 10-digit telephone number in to three sets of numbers.
   
• Remembering by “not trying”. Sometimes trying to remember too hard can inhibit memory. Performing a relaxation technique, such as deep breathing, or just thinking about something else can help bring a buried thought to the surface.
   
• Rhyming is one of the oldest methods in memorization.  The rhyme “30 days hath September, April, June, and November...” is a well-known example of this technique to remember the number of days in each month.
    
3. Improve your lifestyle.   A strong memory depends on the health of your brain.  Controlling stress, exercising regularly, getting enough sleep, eating a good diet, and cutting down on alcohol are some of the important lifestyle adjustments you can make to help promote brain vitality and protect your memory.
    
• Exercise.   Research has found that aerobic exercise helps to maintain short-term memory, which is the type used extensively in recalling names, directions, and telephone numbers.  Additionally, people who exercise regularly are less likely to develop Alzheimer’s dementia.
    
• Get plenty of sleep.  This is the time that the brain “files away” newly acquired information for later retrieval. In addition to affecting memory, sleep deprivation compromises your problem solving ability, creativity, and critical thinking.
    
• Eat “memory foods”.  Evidence is accumulating regarding the benefits on brain health of eating foods containing omega-3 fatty acids.  Examples of these include cold water fish (salmon, tuna, sardines, and herring), walnuts, flaxseed oil, and soybeans.  Foods high in antioxidants, in particular colorful fruits and vegetables, may also help in maintaining memory.
   
• Manage stress.  Chronic stress can affect an area of the brain called the hippocampus, where memories are stored. There is evidence to support the role of meditation in helping to reduce stress and improve memory. Yoga, exercise, massage, prayer, deep breathing, visualization exercises, and listening to soothing music are other healthy ways of managing stress.
   
• Avoid excessive alcohol consumption   Alcohol can produce detectable impairments in memory after only a few drinks. These impairments are usually reversible in the occasional drinker.  In alcoholics, alcohol-induced damage to the brain can lead to permanent memory deficits. 

The belief that age-related memory loss is inevitable can become a self-fulfilling prophecy. By not accepting this cliché, and practicing memory-preserving measures, you have a much better chance of avoiding cognitive decline and keeping your mind sharp.

April is Autism Awareness Month

Autism, currently and more accurately referred to as Autism Spectrum Disorder (ASD), is a developmental disability that includes autistic disorder and Asperger’s syndrome. ASD is caused by changes in the brain that appear to occur during its early development. There are no distinguishing physical features of autistic children and at least early in life, they may behave the same as “normal” children. In many cases, this has led to a delay in the recognition of this disorder. What becomes more evident during the social and emotional maturation of an autistic individual is that there are differences in the ways that they behave, learn, communicate, and interact with others. ASD is a life-long disease, and the earlier that recognition and intervention occurs, the better the outcome.

The Centers for Disease Control & Prevention (CDC) has estimated that the prevalence of ASD in children is 1 in 68. This represents a startling 30% increase from previous estimates reported in 2012. While a single cause has yet to be determined, evidence is pointing primarily toward a genetic cause. This is evidenced by the marked increased in risk for the development of autism among identical as well as fraternal twins.  Other likely influences on its development include premature delivery, birth trauma, and exposure to environmental chemicals during pregnancy.  What has now become almost irrefutable is that immunizations are not involved in its causation. An interesting article in the New York Times from neuroscientist, Sam Wang, does a good job of separating fact from hearsay in regard to the suspected causes of autism.

ASD can often be detected by attention to the general development milestones in children. These milestones include the ways that children act, learn, play, and speak. Along with screening for general development milestones, the American Academy of Pediatrics recommends that children be screened for ASD using a standardized assessment method at 18 and 24 months or whenever a parent or provider has a concern. Parents can also play an important role in detecting autism and other developmental disorders by looking for important milestones in their child’s development. The CDC’s “Learn the Signs. Act Early” initiative provides information on many of these important milestones in a child’s development. Signs such as not babbling, waving or grasping by 12 months, not saying single words or two-word phases by 16 and 24 months respectively, or loss of language or social skills at any age, are “red flags” for the possibility of ASD and warrant further investigation.

Features of ASD that may be evident in children or adults include:

• Not pointing at objects to show interest (for example, not pointing at an airplane flying over)
   
• Not looking at objects when another person points at them
   
• Having trouble relating to others or not having an interest in other people at all
   
• Avoiding eye contact and wanting to be alone
   
• Having trouble understanding other people’s feelings or talking about their own feelings
   
• Preferring not to be held or cuddled
   
• Appearing to be unaware when people talk to them, but responding to other sounds
   
• Being very interested in people, but not knowing how to talk, play, or relate to them
   
• Repeating or echoing words or phrases said to them, or repeating words or phrases in place of normal language
   
• Having trouble expressing their needs using typical words or motions
   
• Not playing “pretend” games (for example, not pretend to “feed” a doll)
   
• Repeating actions over and over again
   
• Having trouble adapting when a routine changes
   
• Having unusual reactions to the way things smell, taste, look, feel, or sound
   
• Losing skills they once had (for example, not saying words they were once using)

To learn more about ASD and its recognition, go to the CDC’s ASD home page or to the web page sponsored by the Autism Society. 

Toning upper arm “flab”

An eDoc client recently wrote in asking about ways to reduce excess fatty tissue in the upper arm region that she referred to as “chicken cutlets”.  Several factors should be taken into consideration in regard to firming the upper arms:   

1. Is overall weight reduction needed?  If general weight reduction is needed, improvement in overall weight will also be reflected in the upper arm region. To lose fat anywhere on your body you need to burn calories by following a program that involves both cardiovascular
   training and weight training. In doing so, you will decrease fat stores throughout your entire body, including the problem areas. Sometimes following a significant weight loss, people have problem areas that won't go away despite aerobic and toning exercises. In these cases, consideration may be given to body contouring plastic surgery.
    
2. It’s hard to fight genetics.  You have to consider the effects of genetics on your body composition since it is very difficult to change something that has been genetically programmed.  This means that some people may carry more fat in certain locations that they would like even with overall weight loss.  And unfortunately, “spot reduction”, or losing weight in a specific area of the body is almost impossible to achieve. Sit-ups, for example, will definitely strengthen your abdominal muscles, but sit-ups alone will not get rid of the layer of fat that is covering the muscles.  Everyone is a structured differently, and achieving a “movie star” physique may simply be unrealistic.
    
   
3. Exercise to help “tone” the upper arms.  As mentioned previously, exercising a specific area of the body in order to decrease the amount of fat just doesn’t work.  Nevertheless, there are benefits to performing strengthening exercises, both for the body in general, as well as for the upper arms. “Toning exercises”, those that typically involve lighter weights and higher repetitions, can easily be performed at home with improvement in upper arm strength and endurance. Strengthening exercises can also help with overall weight reduction and in maintaining bone density. Here are a few example of  simple upper arm exercises:

• Triceps kickbacks---Use a small dumbbell or some substitute (such as a can or bottle). Bend over at the waist, resting your hand on a chair, so that your back is flat. Grasping the weight in the other hand, bring your bent elbow up to your side and keep it there. This is the start position. Now, keeping your elbow close to your side, extend your arm back until the elbow is straight, then lower and repeat 12-15 times. Do two to three sets. As this gets to be too easy, increase the weight.
  
• Standing Biceps Curl with Dumbbells--- Stand with your feet shoulder-width apart and knees slightly bent, or sit in upright position. Grasp the dumbbells with an underhand grip (palms facing forward), arms hanging down at your sides. Flex at the elbows and curl dumbbells up to approximately shoulder level. Keep elbows close to the side throughout movement. Pick a weight that allows you to complete between 8 and 12 repetitions.  Perform two to three sets of each exercise before moving on to the next exercise.
• Lying Triceps Extension with Dumbbells---Sit in an upright position on a flat bench. Rest the dumbbells on each thigh. Then lie on your back and bring the dumbbells to your chest. Press up so they are directly over your shoulders with your palms facing in. Lower dumbbells toward your forehead by bending elbows to 90° with the elbows remaining pointed forward.
• Bench dips---Sit up straight on the edge of your bed or a sturdy chair with your palms planted on each side of your hips and your feet flat on the floor.  Move your feet slightly forward so your buttocks just clear the edge. Use your arms to lower yourself until your elbows are at 90 degrees and your upper arms are parallel to the floor. Then push yourself back up to starting position. Continue to raise and lower yourself 12-15 times for two to three sets.

While “spot reduction” of excess fat in the upper arm region is unlikely to be successful, overall weight loss and toning exercises can make a significant impact on the upper arm “jiggle factor”.