Retinal Detachment

The retina is the light-sensing layer of tissue that lines the back of the globe of the eye.  Images that are focused onto the retina by the lens of the eye are sent to the brain via the optic nerve. In the most common type of retinal detachment, a tear or break in the retina allows fluid to get under the retina and separate it from the layer of blood vessels that provides oxygen and nourishment. A retinal detachment is so serious that it is considered to be a true medical emergency. The longer retinal detachment goes untreated, the greater the risk of permanent vision loss in the affected eye.

Risk factors.  Retinal detachments are more common in people who:

• Are extremely nearsighted
• Have had a retinal detachment in the other eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have had a severe eye injury
• Take glaucoma medications that make the pupil small (like pilocarpine)

Cause of retinal detachment:  The globe of the eye is filled with a clear gel called vitreous that is in direct contact with the retina.  "Floaters", the specks that float about in your field of vision, develop when this vitreous gel shrinks into more solid particles.  With aging, or due to some of the factors mentioned above, the vitreous can sometimes shrink and pull hard enough on the retina to create a tear.  Vitreous fluid entering the retinal tear separates it from the underlying layer of tissue resulting in a retinal detachment.

Symptoms of retinal detachment:  When the retina becomes detached, it does not function normally and vision becomes blurry. Other symptoms of a retinal detachment include:

• A sudden increase in size and number of floaters
• The sudden appearance of flashes of light
• Development of a shadow in the visual field  
• Seeing a gray curtain moving across the field of vision
• A sudden decrease in vision.

Treatment of retinal tears and detachments:  In a retinal tear, a hole has formed in the retina, but fluid has not yet entered the tear to cause a detachment. When this is the case, the tear can be treated by sealing the retina to the back of the eye with laser surgery (photocoagulation) or a freezing treatment known as cryopexy.  With laser surgery, small burns at the margins of the retinal tear scar down, sealing the tear and preventing detachment.  By applying intense cold to the margins of the retinal tear, cryopexy produces a similar result to laser photocoagulation.  Both of these procedures can generally be performed on an outpatient basis.

In addition to laser photocoagulation or cryopexy to treat the retinal tear, additional measures are necessary if the retina has become detached. Two of the most common surgical measures for retinal detachment are pneumatic retinopexy and placement of a scleral buckle. With pneumatic retinopexy, a gas bubble is injected into the vitreous which applies pressure to the area of the detachment.  The scleral buckle is a synthetic band that is attached to the outside of the eyeball which pushes the eye against the retinal detachment. The idea behind both of these procedures is to apply enough pressure to remove the fluid that accumulated beneath the retinal tear and allow the retina to reattach to the underlying layer of tissue. Both of these procedures may require a hospitalization and a period of absolute rest while healing occurs.

Results of treatment:  It cannot be overstated that a retinal detachment is a medical emergency and that medical attention should be sought with the first signs that this could be occurring. In the majority of cases, retinal detachment can be successfully treated, but treatment success if often related to how quickly treatment is initiated.  Any of the symptoms mentioned---increasing floaters, flashes of light, sudden decrease in vision, etc. ---warrants prompt medical evaluation to determine if this could be due to a retinal tear or detachment.

Sources for article:

Retinal Detachment from the National Eye Institute
Retinal detachment from Mayo Clinic
Retinal Detachment: What Is a Torn or Detached Retina? from the American Academy of Ophthalmology

If you have any questions about retinal detachment, please log into your account and send us your question. We are here to help.

Kent Davidson MD - Health Tip Content Editor

Exercise for those who do not like to exercise

The importance of getting regular exercise is so well known that there is little reason to rehash all of its benefits.  Likewise, most people are aware of the physical activity recommendations for overall cardiovascular health promoted by the American Heart Association (AHA) that encourages healthy adults to do:

• At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150

OR

• At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity

AND

• Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.

Nevertheless, there are many people who will not reach these goals because they simply loathe exercising. Today's Health Tip is particularly intended for those people who would like
to exercise, but find that the traditional methods (going to the gym, running on the track, swimming laps, etc.) are unacceptable. These people should be aware that some activity is better than no activity.  Some of the suggestions offered below may not meet the AHA guidelines, but could help someone to get their "feet wet" in regard to starting an exercise program.

1. Combine a hobby with exercise.  Outdoor photography typically involves walking while you scout out those "Kodak moments".  Parks, open spaces, zoos are great places to capture images with your camera. To keep things interesting, plot several walking routes and alternate them each day.  Another option is to consider geocaching. Geocaching, known as the "worldwide scavenger hunt&", requires use of a GPS as you to travel (hopefully by foot) from cache to cache.
2. Exercise while doing another routine activity.  How much time do most people spend reading the newspaper each day?  How about combining reading the paper with exercising on a stationary bicycle?  Treadmills, elliptical trainers, and stair climbers can also be fitted with a rack for holding the paper or a book.
3. Join an exercise class. There's nothing like peer pressure to encourage exercise.  Classes are great for people who like to exercise with others, who like music and rhythm, or who want the extra motivation and energy that an instructor and class provide.  A number of activities lend themselves well to the group format, such a Zumba, water aerobics, Pilates and yoga.
4. Dance your way to fitness.  Jazzercise is one of the best known dance-oriented methods of exercising. If this seems too much like traditional exercise, consider taking a dance class instead.  Swing, salsa, or even waltz can be a great way of exercising without seeming like exercise. Additionally, if there is a significant other that needs to "shake their booty", you may be able to get them moving also.
5. Take a walk in the woods or park.  In addition to being an excellent form of exercise, there is no better stress reducer than walking. Ideally, you would walk a fairly brisk pace to get your heart rate up, but if that seems too strenuous, just start with strolling along and see if your pace doesn't pick up over time.  If necessary add music or conversation with a friend to enhance your experience. 
6. For computer game junkies, combine your passion with exercise.  A number of exercise-oriented video games, dubbed "exergames", are now available. Eye Toy Kinetic from PlayStation 2 uses a small camera that allows you to view yourself while participating in a number of fitness games. In addition to cardio and strength activities, Wii Fit Plus offers a variety of mini-games that challenge your balance, stability and coordination. 
7. Use competition as a motivator.  Playing tennis, basketball, or racquet ball either on a team or in "pick-up" games may wet your competitive juices and maintain your interest in exercising. 
8. Trick yourself into exercising. Activities such as yoga or Pilates, which emphasize proper breathing and stretching, can also provide cardiovascular and strength benefits. Some types of yoga cycle quickly through poses resulting in an increased heart rate with aerobic benefit. Others require tremendous strength and concentration. One of the main benefits of Pilates is to strengthen the core muscles of the lower back and abdomen, and is particularly helpful for people with chronic back pain. But Pilates, particularly when participating in a "mat class", can also raise the heart rate, providing cardiovascular benefits.
9. Walk the dog.  Most dogs like (and need) to walk regularly. Let your dog provide the motivation to get you exercising.  That way, both of you will get a good workout. 

You don't have to be a marathoner or spend hours in the gym to reap the benefits of exercise. You just need to figure out some way of getting your body moving each day. Once you start, you're likely to find that you want to do more and more challenging workouts.  Someday you may even discover that you actually enjoy exercising!

Sources for article:
Recommendations for Physical Activity in Adults from the American Heart Association

Shingles---'Chickenpox Redux'

What is Shingles?  Shingles, known in medical jargon as herpes zoster, is an outbreak on the skin that is caused by the same virus that causes chickenpox — the varicella-zoster virus (VZV).  Following a bout of chickenpox, the virus retreats into nerve fibers and becomes dormant.  Shingles occurs when the virus becomes reactivated.  What causes the virus to become active again is poorly understood, but it is most often associated with aging, stress, or an impaired immune system.

What are the symptoms of shingles?  The first sign of shingles, even before the occurrence of a rash, is often burning, tingling, or itching, usually confined to a specific area on one side of the body. This is because the virus has taken up residence in the nerves that supply sensation to a dermatome (the skin that is supplied by that nerve). After several days to a week, a rash of fluid- filled blisters, similar to chickenpox, develops. The most common location for shingles is a band on one side of the trunk near the waistline.  The onset of the rash is typically accompanied by pain which can be mild or intense. The rash characteristically consists of red patches and small blisters (vesicles) that look similar to chickenpox.  After a few days, the blisters pop forming small ulcers that eventually dry and form crusts.  After 2 to 3 weeks, the crusts fall off and the skin heals.

How serious is shingles?  In healthy people, the pain resolves and the skin heals within 3 to 5 weeks. People with compromised immune systems-- from use of immunosuppressive medications such as prednisone, from serious illnesses such as cancer, or from infection with HIV -- are at special risk of developing shingles. These people can have repeated episodes of shingles or overwhelming skin involvement.  It is also possible for shingles to affect the eye which can lead to permanent blindness. It is recommended that people with shingles in or near the eye should see an Ophthalmologist immediately.

Perhaps one of the most devastating aspects of shingles is known as post-herpetic neuralgia. This complication affects up to half of those over the age of 60 who contract shingles and causes persistent pain, sometimes quite severe, after the rash has healed.  Severe cases of post-herpetic neuralgia can cause significant disability due to insomnia, loss of appetite and depression.

Is there any treatment for shingles?  In most cases, shingles will resolve on its own, and may not require specific treatment except for symptom relief, such as calamine lotion for itching or medications for pain. Several antiviral drugs have been approved by the FDA for treating shingles including acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir).  If started soon after the onset of a shingles, they have been shown to reduce the severity and duration the outbreak as well as offering protection against postherpetic neuralgia.

Is shingles contagious?  Shingles is considered to be "indirectly contagious". Unlike chickenpox, shingles can't be "caught" from someone else. At certain stages of the disease, a person with a shingles rash can pass the virus to someone (usually a child) who has never had chickenpox or received the chickenpox vaccine. In this case, the child will develop chickenpox, not shingles.  A person with chickenpox, however, cannot give someone else shingles.  Shingles comes from the virus hiding inside the person's body, not from an outside source.
Can shingles be prevented?  In 2006, the Food and Drug Administration approved a VZV vaccine (Zostavax) for use in people 60 and older.  Research has shown that giving Zostavax to older adults will cut the number of cases of shingles in half.  Furthermore, those who contracted shingles in spite of receiving the vaccine were noted to have milder symptoms and a lower likelihood of developing post-herpetic neuralgia.  Zostavax is not an appropriate treatment for active shingles or for post-herpetic neuralgia. It should also not be given to someone who is allergic to one of the components of the vaccine, pregnant women, or to someone who has a compromised immune system.

The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of the shingles (Herpes Zoster) vaccine for adults 60 years old or older whether or not they recall having had chickenpox. This is because studies have shown that 99% of Americans aged 40 and older have had chickenpox, even if they don't remember getting the disease. Furthermore, even if you have had shingles, you can still receive shingles vaccine to help prevent future occurrences of the disease.

Sources for article:
Shingles from Mayo Foundation for Medical Education and Research
Shingles Vaccination: What Everyone Should Know from the Centers for Disease Control and Prevention
Zoster (Shingles) ACIP Vaccine Recommendations from the Centers for Disease Control and Prevention

What is the difference in Type 1 and Type 2 Diabetes?

Most people are aware that diabetes is a disease characterized by having high blood glucose (sugar).  Indeed, an antiquated term for diabetes was "sugar diabetes".  But under the umbrella of the disease that doctors refer to as "diabetes mellitus" are really two entities, Type 1 and Type 2 diabetes.

Type 1 Diabetes was previously known as juvenile-onset or insulin-dependent diabetes (IDDM), while Type 2 diabetes was called adult-onset or non-insulin-dependent diabetes (NIDDM). These titles, however, did a poor job of describing either the underlying disease process or who was affected with the disease.

The great majority of diabetics have Type 2 diabetes, accounting for 90-95 percent of the total.  As its former name suggested, Type 1 diabetes does develop more often during childhood, but adults can have Type 1 diabetes too.  Likewise, increasing numbers of younger individuals are being diagnosed with Type 2 diabetes.

Insulin, the common denominator: Insulin, a hormone made in the pancreas, is involved in the development of both Type 1 and Type 2 diabetes. Insulin allows the cells in the muscles, fat and liver to absorb glucose from carbohydrates that we eat to be used for energy production.  The way that insulin affects the development of the two types of diabetes, however, is markedly different. Type 1 diabetes is considered to be an autoimmune disease in which the body's immune system attacks the cells in the pancreas responsible for producing insulin. Eventually, insulin production ceases and glucose is unable to enter the cells.  In Type 2 diabetes, insulin is still being produced but the body is unable to use this insulin effectively. This is called "insulin resistance." Initially, the body compensates for this by increasing insulin production but over time not enough can be made. In either case, the body is unable to convert sugar and other starches into energy and blood glucose rises, sometimes to dangerous levels.

How Type 1 and Type 2 diabetes are similar:

1. High blood sugar levels occurring in both types of diabetes produce similar symptoms. These include production of large volumes of urine (polyuria), increased thirst necessitating drinking more (polydipsia), and increased appetite and eating (polyphagia).

2. Both types of diabetes greatly increase a person's risk for serious complications. Persistently elevated blood sugar levels can damage the blood vessels, heart, nerve endings, kidneys and eyes. In the U.S., diabetes is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. Stroke and heart disease risk increases 2 to 4 times in adults with diabetes.  Well managed diabetes can significantly reduce this risk of developing complications.

3. Making healthy food choices, attention to body weight, controlling blood sugar and cholesterol levels, and being physically active are the cornerstones of treatment of both types of diabetes.

How Type 1 and Type 2 diabetes are different:

1. As an autoimmune process, no one is really sure why Type 1 diabetes occurs, nor can it be prevented. Development of Type 2 diabetes is primarily due to genetics and lifestyle factors. Risk factors for the development of Type 2 diabetes include: 1) a family history of the disease, 2) excess body weight, 3) low physical activity, 4) high blood pressure, and 5) abnormal blood lipids.

2. Type 1 diabetes usually presents as an acute illness with the sudden development of symptoms.  A serious complication of Type 1 diabetes called "ketoacidosis" often develops as its initial manifestation. In Type 2 diabetes, symptoms develop much more gradually. 

3. Before developing type 2 diabetes, most people have a condition known as "prediabetes". This means that blood sugar levels are elevated but not yet in the range to be diagnosed as diabetes. The U.S. Centers for Disease Control (CDC) reports that 86 million Americans have pre-diabetes with 9 out of 10 of these individuals being unaware that they have it. Prediabetes can often be reversed with as little as 10-15 pounds of weight loss along with 30 minutes of moderate physical activity.

4. Treatment of Type 1 diabetes typically requires the use of insulin which can be delivered via injections or an insulin pump.  In some cases, insulin may be used in the management of Type 2 diabetes, but most patients can be managed with some combination of oral medications.  

With one in three Americans having pre-diabetes, but most being unaware of their condition, the CDC has initiated a campaign to identify those who are at risk.  The Prevent Diabetes STAT program starts with a prediabetes screening test that can be found here.  Anyone with a risk score of 5 or above is encouraged to see their doctor to determine if additional testing is necessary.  Additionally, The United States Preventive Services Task Force (USPSTF) recommends screening for abnormal blood glucose in adults aged 40 to 70 years who are overweight or obese.

Sources for article:
Types of Diabetes from the National Institutes of Health
Diabetes Basics from the American Diabetes Association
Prevent Diabetes STAT from the Centers for Disease Control

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Recognizing Domestic Violence

The National Coalition Against Domestic Violence defines domestic violence as "the willful intimidation, physical assault, battery, sexual assault, and/or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another." Domestic violence can take on a number of forms including physical violence, sexual violence, psychological violence, and emotional abuse.

Estimates from the U.S. Centers for Disease Control set the annual number of victims of domestic violence in the U.S. at 1 million. The victims of domestic violence are primarily women, with 1 in 3 women experiencing rape, physical violence, and/or stalking by an intimate partner during their lifetime. Men can be victims of domestic violence also. Statistics indicate that 1 in 7 men have been severely physically abused by an intimate partner. There is no 'typical' victim of domestic violence with affected individuals coming from all economic levels, cultures, religions and education levels.

Sometimes the victims of domestic violence are criticized for not removing themselves from an abusive relationship. There are a number of reasons for this including fear of retribution, hope that the relationship will improve, religious or cultural influences, financial dependency, concern for children, low self-esteem, and lack of a support system. Abuse, however, is never the fault of the victim even though it may be difficult for them to end the relationship.

The abuser often minimizes the seriousness of the violence and blames their behavior on their partner's shortcomings, alcohol, drugs or stress. Characteristics of an abuser include: extreme jealousy, possessiveness, unpredictability, bad temper, controlling behavior, and antiquated beliefs about roles of women and men in relationships. The violence in the relationship most often relates to gaining power and control over their partner.

The following is a list of possible signs of abuse from the Office on Women's Health in the U.S. Department of Health and Human Services. You may be abused if your partner:

• Monitors what you're doing all the time

• Unfairly accuses you of being unfaithful all the time

• Prevents or discourages you from seeing friends or family

• Prevents or discourages you from going to work or school

• Gets very angry during and after drinking alcohol or using drugs

• Controls how you spend your money

• Controls your use of needed medicines

• Decides things for you that you should be allowed to decide (like what to wear or eat)

• Humiliates you in front of others

• Destroys your property or things that you care about

• Threatens to hurt you, the children, or pets

• Hurts you (by hitting, beating, pushing, shoving, punching, slapping, kicking, or biting)

• Uses (or threatens to use) a weapon against you

• Forces you to have sex against your will

• Controls your birth control or insists that you get pregnant

• Blames you for his or her violent outbursts

• Threatens to harm himself or herself when upset with you

• Says things like, "If I can't have you then no one can."

For more information about domestic violence and resources to help with breaking the cycle of abuse go to the website of  The National Coalition Against Domestic Violence or call the National Domestic Violence Hotline at 1-800-799-7233 or 1-800-787-3224.

Sources for article:

Violence Against Women, Am I being abused? from the U.S. Office on Women's Health

Signs of Domestic Violence from WebMD

What is Domestic Violence? from the National Coalition Against Domestic Violence

Risk Factors for Breast Cancer, Part: 2

Last week we looked at several factors that increased a woman's risk of developing breast cancer but could not be changed.  The purpose of this was to encourage women at increased risk to receive screening measures beyond those developed for women at average risk.  Today we'll look at a number of factors that increase the risk of developing breast cancer, but in some cases can be modified to reduce that risk. 

• Drinking alcohol--- Some studies have found that women who have two to three alcoholic drinks per day have a 20 percent higher risk of breast cancer than non-drinkers
• Being overweight or obese---- Before menopause, when the ovaries are producing estrogen, being overweight or obese slightly decreases breast cancer risk.   After menopause the ovaries stop making estrogen and most of a woman's estrogen comes from fat tissue. With excess fat related to obesity, estrogen production increases along with breast cancer risk.  Women who are overweight tend to have higher blood insulin levels also which is thought to increase breast cancer risk.
• Physical inactivity---Getting regular exercise appears to reduce the risk of developing breast cancer.  In one study from the Women's Health Initiative, as little as 1¼ to 2½ hours per week of brisk walking reduced a woman's risk by 18%.
• Having children---Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk overall. Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk overall.
• Taking birth control pills---Some studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them. This increased risk is thought to go away after being off of oral contraceptives for 10 years. 
• Receiving hormone therapy after menopause----Hormone therapy with estrogen or with a combination of estrogen and progesterone is used to help relieve symptoms of menopause and to help prevent osteoporosis. Estrogen therapy alone is typically used in a post-menopausal woman who has had her uterus removed (hysterectomy).  In post-menopausal women who still have a uterus, the combination of estrogen and progesterone was typically used. The use of estrogen alone after menopause does not appear to increase the risk of developing breast cancer. Estrogen plus progesterone increases the risk of both developing and dying from breast cancer
• Breastfeeding---- Research shows mothers who breastfeed for at least 6 months lower their risk of pre- and post-menopausal breast cancer.

In contrast to last week's list of risk factors for the development of breast cancer, several of the risk factors mentioned this week provide an opportunity to be modified in order to bring down one's risk of developing breast cancer.

Last week, the new breast cancer screening recommendations from the American Cancer Society for women at average risk were presented.  These deserve mentioning a second time to encourage every woman to discuss their risks for developing breast cancer and to undergo appropriate screening.

1. Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
2. Women should be able to start the screening as early as age 40, if they want to. It's a good idea to start talking to your health care provider at age 40 about when you should begin screening.
3. At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
4. Regular mammograms should continue for as long as a woman is in good health.
5. Breast exams, either from a medical provider or self-exams, are no longer recommended.

Sources for article:
Breast Cancer Prevention and Early Detection from the American Cancer Society
What Affects Your Chances of Getting Breast Cancer from Susan G. Komen

If you have any questions about breast cancer, please log into your account and send us your question. We are here to help.