The Eye Hospital

I went to the Eye Hospital today as a follow-up to my retinal scan a few months ago. The doctors were concerned that my eyes showed ‘diabetic changes’ so wanted to investigate further. The initial part of the appointment was very much the same as having a retinal scan – drops in eyes to dilate pupils to the size of dinner plates, wait for them to take effect, then have retinal photographs taken. Having your pupils dilate like that has the inevitable consequence of making everything seem exceedingly bright, and also makes it impossible to focus on any text smaller than large billboard size.

Imagine my surprise, therefore, when I realised that the waiting room was liberally spread with reading matter of all varieties – a bookshelf, stacks of magazines on a table, and an extensive range of pamphlets covering a broad spectrum of physical ailments, their symptoms and treatment. Looking around at the other patients it was clear (even through blurred eyes!) that none of them was capable of reading any of this without the aid of the Hubble Space telescope! I don’t think they had quite thought this through…!

Now you’ve had your drops, please go and sit down,
Before long they will call out your name…
You just need to wait whilst your pupils dilate
And your retinas start to inflame!

But let me just show you, for it may be some time,
Our library of books old and new!
We’ve novels and thrillers, and can’t-put-them-downs,
There’s bound to be one to suit you!

Or if you prefer, there’s a fantastic range
Of magazines to flick through and browse!
There’s fashion and cars and gardening and golf,
Or farming if you’ve a passion for cows!

If that’s not to your taste, take a look over here
At our leaflets displayed in this rack!
There’s all you need know about things ‘down below’
Or ways you might injure your back!

In an EYE hospital nurse? Have you quite thought this through?
It ought to be no big surprise
For the reason we’re here is abundantly clear –
We’ve got something wrong with our eyes!

Running the Southampton Alps!

Cobden-Mousehole-Peartree

I’m starting to get into a bit more of a routine now with the running, with three runs in the past four days. I had to take yesterday off as my legs were a little on the sore side from Thursday and Friday’s runs. It seems I may be getting a little addicted to the challenge of big hills at the moment. I could have gone for a relatively fast and flat run through the park alongside the river this morning, but I had a route in my mind that was an extension of last weeks ups and downs, but without the unintended loop back due to the map inaccuracies. This would take me on a wider loop, which turned out (as you can see in the pictures) to be almost heart-shaped!

Why all this determination to get back running again? Well, apart from the fact that I have the Great South Run to run in October, I got a bit of a shock the other day. A week ago I went for my annual diabetic retinal scan. After they’ve taken the pictures you have to wait to see if they will send you a letter. Getting the letter is not good news – at my hospital they only send you one if they have found something of concern. Unfortunately, on Thursday, I got the letter. It said that I have ‘moderate diabetic eye disease’, which is a worsening from the ‘background retinopathy I was told I had last year. My first thoughts were that I was going blind and I’ve only been diagnosed two years – how can this be happening to me? My HbA1c has been practically perfect since I got things under control, with numbers of 11.8, 6.8, 5.2, 5.4, 5.6 and 5.6 (the frist number was diagnosis, the one after about six weeks later). What do these numbers mean? Well, ideally, the HbA1c should be below 6.5 in order to minimise the damage that diabetes can do to the small blood vessels – particularly those in the eyes and kidneys. With my numbers I am well under that figure.

So, why has my retinal scan shown deterioration? The answer is more than likely the high blood pressure I have been suffering for several months now, as this is also a big factor, alongside diabetes, in determining how healthy or otherwise your eyes are. So, it’s a warning to me that I have to get the BP down so no further damage is done. As things stand, it is unlikely that I will need treatment, just more regular eye checks. The problem may even improve if I start looking after myself better. So, that is my aim – I already have very good blood sugar control, now I need to take every possible step to make sure my blood pressure is perfect!

Cobden-Glenfield

A lot of the steps I will be taking currently seem to involve running up huge hills! I’m happy to say, though, that I have seen a rapid improvement already in my pace around these hilly courses. Thursday’s run was 11 min/mile pace, and Friday’s 10 min/mile pace over the same route. Today’s run was slower, but I’m building more distance already, so now up to 3.1 miles (5k). I’m sure I could have managed a much quicker and longer run if I had opted for the flatter route! Main thing is not to get injured. My legs are not as young as they used to be, so can take a little longer to recover – I need to resist the cravings for endorphins and make sure I take rest days. Might not be too difficult, given the weather that is being forecast!

Background Retinopathy

I got a letter yesterday from the hospital, following up on my retinal scan that I had back in July. It came as a bit of a shock to read that I have something called ‘background retinopathy’. This is where the effects of diabetes have caused small blood vessels in the eyes to rupture and bleed onto the retina. At first, this sounds dreadful, and all those stories I had heard about diabetes being the major cause of blindness came flooding back! I read on, and was relieved to see that this was a condition that didn’t require immediate treatment, just extra monitoring in 6 months rather than waiting the full 12 months to my next scan. Consulting others on the forum reassured me that this form of retinopathy would not affect my sight, and may never progress. As long as good control of my blood sugar levels is maintained, then there is very little chance it will get worse and progress to the much more serious ‘proliferative retinopathy’, which can be sight-threatening.

I think I was upset chiefly by the unexpected nature of the letter. My control has been excellent since diagnosis, with my average BG levels (as measured by HbA1c tests) at non-diabetic levels – currently 5.2%. There is a possibility that the changes may have been caused by the rapid fall in my HbA1c levels after diagnosis – it reduced quickly from 11.8% to 6.5% within a few weeks, and background retinopathy can be caused byt this sharp reduction. I also have slightly raised blood pressure levels, and this is something that I am going to work on reducing as this can also contribute to the microvascular damage seen on my retina. I suppose another upsetting aspect is that this is really the first concrete evidence of diabetes having a negative effect on my health. The good news is that I am being closely monitored with the latest equipment, and, should the worse come to the worse, there are now laser treatments available which have proved very successful. These days, it is highly unlikely for someone as recently diagnosed as me to lose their sight because of diabetes, or indeed even if you have been diagnosed for 20-30 years!

So, I will be cutting out the alcohol and getting plenty of exercise to try and reduce that blood pressure. I might even discuss increasing my BP medication with my doctor, as I’m currently on the smallest dose. I’m less averse to taking medications now than I was a year ago – I think my body tolerates them better now that I am fully recovered from my initial illness and weight loss.

For anyone interested in reading further about diabetic retinopathy, I’d recommend the following site:

http://www.diabeticretinopathy.org.uk/

Oh dear! What can the matter be?
I’ve just found out that I have retinopathy!
That’s got to be worse than being locked in a lavatory
And nobody knowing you were there!

Let’s just calm down and read again properly…
The letter says, ‘you have got background retinopathy’,
‘This doesn’t need treatment’ – so that’s not the end for me,
It doesn’t mean I’m going blind!

This form of the changes is often just temporary,
And forms from the rupture of tiny capillaries,
Amongst diabetics it happens quite frequently,
But may not get worse through the years.

Now the hospital will keep a six-monthly check on me.
So it doesn’t become proliferative retinopathy,
That’s the kind that could end with me not being able to see,
And I certainly don’t want that, no siree!

Wide-Eyed World

I went for my annual retinopathy scan this morning. One of the serious complications of diabetes is when the blood vessels in the eyes grow or rupture. This can affect the macula, a tiny region on the retina that is hugely important for vision. The scan involves taking photos of the retina with a special camera. These photos can then be examined for any changes that may need further treatment. In order for the photos to be of the best quality, it’s important to dilate the pupils of the eyes as much as possible – and often this is achieved with special eye drops. These can sting a little at first, but the biggest consequence of having them is that your pupils remain enlarged for several hours afterwards, so even the dimmest and dullest of days can feel like bright sunlight! You feel like you have the light-gathering power of an astronomical telescope for those few hours!

Welcome to my wide-eyed world!
Where lurid fires around me swirl,
And dullish clouds that clothe the skies
Are floodlit in my lucent eyes!

Do I perceive the reddish glow
Of far-off galaxies that grow
Beyond the sight of beasts or men?
My universe expands again…

And distant stars will live and die,
Imprinted on each gazing eye,
Where sunlight spells out double trouble –
Blinding me, the Human Hubble.

Oh curse the Sun, the Moon, the stars!
The planets and the plains of Mars!
Please lock me in a darkened room,
Where all is black, and all is gloom!

This once-a-year spectacular
Preserves each precious macula,
So I’ll endure the searing light
And cherish this, the gift of sight.

Eye Noon

One of the scary ‘complications’ of diabetes is retinopathy, which affects the sight and can lead to blindness. As I understand it, poor blood sugar control causes the tiny blood vessels in the eyes to become narrowed and rupture. The human body being the remarkable thing that it is, new vessels are then formed to ‘re-route’ the blood. Unfortunately, these can then affect an area of the eye called the macula, and it is this that can cause the blindness. If caught early enough, the condition can be treated with lasers, preventing further deterioration. For this reason, all diabetics in the UK should go at least annually for a retinopathy scan – I’ve got mine due in a couple of weeks. A special camera is used to photograph the retina, and this can then be compared to previous scans for any changes or progression of problems.

So, this poem is a bit weird, and a bit allegorical – hopefully it’s not too difficult to work out what it’s all about!

Now, Eyeball was a mean old town,
A perilous place to be!
An evil trio ruled the roost –
The Rhettin Hopper Three!

They ran the bar ‘The Sugar Vole’
And challenged any man
Who dared to drink their whisky sour
To see straight if he can.

Across the road was Inn Sue Lynn,
Whose business once was fine,
Run by a gal called Pam Creeyass,
Now sadly in decline.

The sheriff of that sorry place,
A man called Mack Yoolar,
Was powerless to uphold the law,
Despite his sheriff’s star.

And then one hot and dusty day,
A stranger came to town,
Confronted by the Hopper gang,
Who laid the challenge down!

‘Don’t listen!’, cried out Pam Creeyass,
‘Their drink affects your sight!
It’s cheap and nasty syrupy stuff
That turns the day to night!’

The sheriff stumbled across the road
And took the stranger’s arm.
‘I’ll lock you in the Beta Cells,
To keep your eyes from harm!’

The stranger shrugged the sheriff off
And drew aside his coat.
The crowd all gasped, they knew the score,
His chances were remote.

He walked into The Sugar Vole
And scrutinised the scene.
He saw the jars of whisky where
The soft drinks should have been…

Rhettin Hopper taunted him,
‘No stranger frightens me!
As long as we have whisky here,
This town will ne’er be free!’

The stranger drew his gun real fast,
And in a flash of light,
Each vessel stored behind the bar
Was blasted out of sight!

‘You’ve saved us all!’ cried Pam Creeyass,
‘And now that we are free,
There’ll be no future in this town
For the Rhettin Hopper Three!’

And so, the stranger married Pam,
And they became sheep farmers,
They reared some tiny Andean sheep,
Called micro-vascu llamas!