Its official, I am done with all this snow. I've always been a lover of the four seasons. I have never been one to want to snow bird to the south for the winter months. But this year, I have just about had it. There is so much snow to shovel, and no one knows how to drive in it and I really have just gotten to my breaking point. We had snow the last two weeks. This week it started Sunday into Monday and I was late to work. Tuesday it snowed all morning. Wednesday it snowed all afternoon. And Wednesday night into Thursday we got another six inches. This morning I got up at 530 to dig myself out. I went back in an hour later to take a shower and get ready. I got a call at seven that the clinic would be opening at ten instead. I made a cup of coffee and went back out at quarter to eight to dig again. By 845 I had dug and tried to move my car approximately a billion times. It would just slide slightly, spin it's wheels and mock me. I dug and chipped away at the heavy,ice laden snow and nothing. Of course it was the one time my neighbor wasn't home and I had no ability to beg for some kitty litter. I had already gone through all the profanity I knew and at this point came the tears. I just couldn't hold it in anymore. I was going to be late to work again and I had no one to help me. All I needed was a push. And at that moment I realized how great a boyfriend would have been in this situation.
After a fifteen more minutes, dripping with sweat and my fingers about to fall off, I got out and headed to work. In the seven hours at clinic, I saw ten patients. And lost a lot of patience along the way. I'll make my trek home and fingers crossed my parking spot is still there or there will be hell to pay. I'm looking forward to moving into the city next fall. At that point I will really need to have a boyfriend, or at least a garage!
Thursday, January 27, 2011
Sunday, January 23, 2011
New but not scary
I'd like to say I'm a shy person. However, my friend Amanda once pointed out in laughter, that it was a pretty poor adjective to describe myself, as I would easily talk to anyone. I guess I'm not shy, but just because I cooly, calmly strike up a conversation with a new person, doesn't mean I'm not frantically trying to listen to what they say and think of the next thing to say. Sometimes I'm on, and sometimes I'm very very off. It's the inconsistency that has me normally nervous in new situations.
A patient came in the other day and noted blurred vision. When i was checking his prescription all of a sudden he say a, from behind the phoropter, ooh there is goes again, not I see double. That word brings panic worse than if you told me id need to put on spandex and be caged in with wrestling alligators... Not that anyone has ever threatened me with such a thing... Anyway, diplopia or double vision makes my stomach churn. I pull the phoroptor away and do a quick cover test, i get a rather large exophoria ( meaning his eyes are turned out a little more than average, but nothing too crazy) I check parks three step looking for a paralyzed ocular muscle. I got nothing. I put him back in the phoropter and check the ranges he can move his eyes in and out and all comes back normal. Ugh, my brain is moving a mile a minute and I've cast my reel into those great depths of knowledge, but really I'm just fishing for anything. Its probably a decompensating photos. He notes this don't happen all the time, but when he is driving long periods of time or reading for hours. Great. You know what worse than double vision? Intermittent diplopia.
So I leave work that Saturday, stomach churning, but I've forgotten about the double vision at this point, I'm making my way through the city to a tiny sushi place for a date. Ugh, first encounters make me so nervous. I like knowing what I'm getting into. I'm constantly afraid that the conversation will come to a standstill. Long pauses are the real world Diplopia's. I show up first, take a seat and hope for the best, scrolling through the NY times on my blackberry in wait. He shows up and a kiss on the cheek,half hug heists down. We order too much sushi, for which i later feel really bad, since I don't think he really likes it very much. But despite my nerves, things go well, and two hours later i realize its been perfectly fine maintaining conversation. Maybe I'm really not shy.
I hop in my car and head to a friends for the rest of the day, since we have an engagement party of friends to go to that night. I won't really know anyone there either, so I'll have to put my game face back on in a couple hours, but I think i've gained the confidence that i will make it. As far as my patient is concerned, I cant fix occasional double vision it with prisms and glasses because the times he is normal everything would be double in the other direction. I'm bringing him back for a more extensive binocular workup. As far as the date? Well, I guess I'd go out with him again too...
A patient came in the other day and noted blurred vision. When i was checking his prescription all of a sudden he say a, from behind the phoropter, ooh there is goes again, not I see double. That word brings panic worse than if you told me id need to put on spandex and be caged in with wrestling alligators... Not that anyone has ever threatened me with such a thing... Anyway, diplopia or double vision makes my stomach churn. I pull the phoroptor away and do a quick cover test, i get a rather large exophoria ( meaning his eyes are turned out a little more than average, but nothing too crazy) I check parks three step looking for a paralyzed ocular muscle. I got nothing. I put him back in the phoropter and check the ranges he can move his eyes in and out and all comes back normal. Ugh, my brain is moving a mile a minute and I've cast my reel into those great depths of knowledge, but really I'm just fishing for anything. Its probably a decompensating photos. He notes this don't happen all the time, but when he is driving long periods of time or reading for hours. Great. You know what worse than double vision? Intermittent diplopia.
So I leave work that Saturday, stomach churning, but I've forgotten about the double vision at this point, I'm making my way through the city to a tiny sushi place for a date. Ugh, first encounters make me so nervous. I like knowing what I'm getting into. I'm constantly afraid that the conversation will come to a standstill. Long pauses are the real world Diplopia's. I show up first, take a seat and hope for the best, scrolling through the NY times on my blackberry in wait. He shows up and a kiss on the cheek,half hug heists down. We order too much sushi, for which i later feel really bad, since I don't think he really likes it very much. But despite my nerves, things go well, and two hours later i realize its been perfectly fine maintaining conversation. Maybe I'm really not shy.
I hop in my car and head to a friends for the rest of the day, since we have an engagement party of friends to go to that night. I won't really know anyone there either, so I'll have to put my game face back on in a couple hours, but I think i've gained the confidence that i will make it. As far as my patient is concerned, I cant fix occasional double vision it with prisms and glasses because the times he is normal everything would be double in the other direction. I'm bringing him back for a more extensive binocular workup. As far as the date? Well, I guess I'd go out with him again too...
Wednesday, January 12, 2011
White Blood Cells/ White knights
So, you wouldn't put chapstick on your lips from a tube given to you by your mother-in-law would you? I dont think chapstick, or really any personal makeup/medications should be shared. That includes eyedrops.
I think I have written about this before... but EKC - epidemic keratoconjunctivitis is really an epidemic. It is killing me! Literally, my hands are raw from washing non-stop. I have had so many patients come in with it. The worst part, most of them have gone untreated, or wrongly treated for weeks. Many people with red eyes simply go to their PCP or ER. Well, its not that MDs cant diagnose different conjunctivitises, but they dont have the tools to. So, everyone goes home with erythromycin ointment or polytrim drops and end up spreading this eye disease to their entire family.
I woke up this morning, eyes white and quiet. I think Im most afraid of getting EKC myself... A big snow storm was due to hit New England and I was kind of hoping not to go to work. I got up at 730 since I had to be at work by 10. I went outside and there was only around 5 inches on the ground and my street was plowed, so I cleaned off my car, shovelled the porch and driveway and went inside for some hot coffee. I turned on the news and saw that where I worked was covered in a foot of snow and realized, if I made it off the island, I probably wouldnt make it back. I love the snow, but more so if I can be skiing. Stuck inside kind of stinks. So, I turned on my computer and parused facebook. And after all this time there it was. The ex and his new gf in photos of them on a ski slope. Its not that I suddenly wished to be that girl in the photo, but I was jealous of the happiness on their faces. The move here was exciting, but its still been so hard. Im not happy. It hit me harder than I had thought, but my eyes got red and watery pretty fast.
EKC is a virus. Like a common cold, it cannot be treated with antibiotics. Your immune system will eventually rid the virus, but here in lies the problem. Your white blood cells are like the white knights of the immune system. If a bug invades, they go nuts swords blasing. So, your cornea, or the clear part of the front of your eye. When it is infected with this super strong virus, the WBCs come in to fight it. They are white, literally, and form little spots called subepithelial infiltrates. So now your clear cornea is like a white spotted dalmation. Imagine how great it is to see through it. Yep - not good. Now these can go away, but sometimes they dont.
The reason I am so upset about this, is I keep getting patients who had really bad eye infections, werent treated correctly, and now Im the asshole telling them they prob wont see 20/20 again. A large part of treatment is actually giving them steroids. Steroids stop your immune system. It seems counter-intuitive, but you are trying to prevent them from going to crazy. Trying to prevent the SEIs to a degree, or hoping they break up and go away. So, the best recent patient came in and it was just her and her son. Instead of going to the doc, her mother-in-law gave her some drops she got in PR. So she and her family have been using them and just spreading the virus back and forth.
So my eyes welled up a little bit. But there were no white knights coming to my rescue. I dont think I'd want to use a drop to stop them from coming to my aid, but if loneliness was a virus, Id certainly appreciate a cure. After treating my patient and her son, I made her go make appts for her entire family to come in. Lets hope we can get their vision back! For all of us, the best treatment is time... and hope for the best outcome!
I think I have written about this before... but EKC - epidemic keratoconjunctivitis is really an epidemic. It is killing me! Literally, my hands are raw from washing non-stop. I have had so many patients come in with it. The worst part, most of them have gone untreated, or wrongly treated for weeks. Many people with red eyes simply go to their PCP or ER. Well, its not that MDs cant diagnose different conjunctivitises, but they dont have the tools to. So, everyone goes home with erythromycin ointment or polytrim drops and end up spreading this eye disease to their entire family.
I woke up this morning, eyes white and quiet. I think Im most afraid of getting EKC myself... A big snow storm was due to hit New England and I was kind of hoping not to go to work. I got up at 730 since I had to be at work by 10. I went outside and there was only around 5 inches on the ground and my street was plowed, so I cleaned off my car, shovelled the porch and driveway and went inside for some hot coffee. I turned on the news and saw that where I worked was covered in a foot of snow and realized, if I made it off the island, I probably wouldnt make it back. I love the snow, but more so if I can be skiing. Stuck inside kind of stinks. So, I turned on my computer and parused facebook. And after all this time there it was. The ex and his new gf in photos of them on a ski slope. Its not that I suddenly wished to be that girl in the photo, but I was jealous of the happiness on their faces. The move here was exciting, but its still been so hard. Im not happy. It hit me harder than I had thought, but my eyes got red and watery pretty fast.
EKC is a virus. Like a common cold, it cannot be treated with antibiotics. Your immune system will eventually rid the virus, but here in lies the problem. Your white blood cells are like the white knights of the immune system. If a bug invades, they go nuts swords blasing. So, your cornea, or the clear part of the front of your eye. When it is infected with this super strong virus, the WBCs come in to fight it. They are white, literally, and form little spots called subepithelial infiltrates. So now your clear cornea is like a white spotted dalmation. Imagine how great it is to see through it. Yep - not good. Now these can go away, but sometimes they dont.
The reason I am so upset about this, is I keep getting patients who had really bad eye infections, werent treated correctly, and now Im the asshole telling them they prob wont see 20/20 again. A large part of treatment is actually giving them steroids. Steroids stop your immune system. It seems counter-intuitive, but you are trying to prevent them from going to crazy. Trying to prevent the SEIs to a degree, or hoping they break up and go away. So, the best recent patient came in and it was just her and her son. Instead of going to the doc, her mother-in-law gave her some drops she got in PR. So she and her family have been using them and just spreading the virus back and forth.
So my eyes welled up a little bit. But there were no white knights coming to my rescue. I dont think I'd want to use a drop to stop them from coming to my aid, but if loneliness was a virus, Id certainly appreciate a cure. After treating my patient and her son, I made her go make appts for her entire family to come in. Lets hope we can get their vision back! For all of us, the best treatment is time... and hope for the best outcome!
Subscribe to:
Comments (Atom)