Windows to the Soul

They say our eyes are the windows to our soul.  More importantly, they are the windows to our outside world and if something goes wrong with them, our lives can change drastically.

As we age, millions of us will struggle with some form of eye disease.  For those over the age of 40, it could come in the form of cataracts or glaucoma.  Out of the millions of people in that age group, approximately 25 million of them have cataracts, and more than 2.5 million have glaucoma.  Also, for those over the age of 50, more than 2 million of them suffer from age-related macular degeneration (AMD).

Cataracts are small clumps of protein that can form in the lens of the eye, causing it to become cloudy.  This causes a loss of vision which cannot be corrected with eyeglasses or contact lenses.  As a matter of fact, there is no cure for cataracts.  The only effective treatment, at this time, is surgery

During the procedure the surgeon will make a tiny opening in the cornea (which is the front part of the eye) insert a tiny high-frequency ultrasound, and use it to break the "cloud" into fine particles.  He then removes the particles, using a vacuum method, and inserts an artificial lens.  Prior to the procedure, the surgeon will ask what type of lens the patient would like.  They have the option of a basic monofocal lens that allows them to see clearly up close or at a distance; a premium lens that can correct astigmatism; or a multifocal lens that has the potential to restore full vision without having to use corrective lenses (eyeglasses or contacts). Now this may all sound pretty painful to most readers, but the surgeon will give the patient anesthetic eye drops or injection  and a tranquilizer to help you relax.  The entire procedure can take as little as 15 minutes to complete.  Laser-assisted surgery may soon take the place of the ultrasound but it is currently being evaluated for safety and advantage.

Macular degeneration (AMD) occurs when the maccula (a tiny area near the center of the retina) of the eye become damaged.  This damage causes a loss of central vision, but the side vision (peripheral) remains clear.  This loss of the center of vision makes simple tasks like sewing on a button, seeing someones face, and driving, extremely difficult- if not impossible.  Several factors play a role in the development of AMD: family history, smoking, and sunlight.

There are two forms of AMD: wet and dry.  The dry form develops gradually over a period of years.  About 10 per cent of dry cases will progress to wet.  Wet AMD occurs when new blood vessels form under the macula and begin to leak blood and fluid.  Wet AMD is more aggressive and can cause severe loss of vision in just a matter of weeks or months.

In order to treat wet AMD, the patient may be given antibodies to help prevent the growth of the leaky blood vessels.  This is not a cure, but supplements of high levels of antioxidant minerals and vitamins could slow down the progression in someone with moderate to severe AMD.

Glaucoma, if left untreated, can cause blindness.  It was originally thought that glaucoma was caused by increased pressure in the eye.  It has now been discovered that it is more of a neurological disease caused by the degeneration and death of nerve cells in the brain.  Eye pressure continues to be a factor in the development of glaucoma but it is not the sole contributor.

Only half of the people who have glaucoma know they have it.  There are usually no early symptoms and it progresses slowly, affecting peripheral vision first.  By the time they notice anything wrong, it may have already progressed enough to affect central vision.  Once the damage is done, it cannot be undone.  The best they can do is try to prevent further loss of sight.

Eyedrops to reduce pressure are usually given to the patient and are the most common form of early treatment.  In some cases, surgery may be performed to improve the flow of fluid out of the eye to control the pressure.

There is another condition of the eyes that becomes more prevalent as we age- "floaters", as they are called, can be a sign of a more serious condition but are more likely to be just an annoyance more than anything.

Floaters are caused by the breakdown of the gel-like substance in the eye called the vitreous.  As we age, the vitreous, which normally acts as a shock-absorber for the retina, starts to sag and weaken.  As it breaks down, it becomes more watery and bits of the gel begin to peel off and float around inside your eye cavity.  These bits cast a shadow on your retina, causing you to see floaters.

It is common to have a few floaters but if a sudden increase in floaters along with flashes of light or a "veil" over your vision occurs, you should seek prompt medical attention.  This could be a sign of retinal detachment which can cause permanent loss of vision if not treated promptly by surgery.  This can also be caused by inflammation in the back of the eye from an infection, bleeding from injury or diabetes, or complications from cataract surgery.  The best way to differentiate between a serious retinal detachment or a less serious condition is by seeking prompt medical attention from an ophthalmologist who will check your eyes with a dilated eye exam.

To keep your eyes healthy, be sure you wear protective UV sunglasses while out in the sun, don't smoke, maintain a healthy weight, control your diabetes, keep your blood pressure and cholesterol within normal limits, eat a healthy diet and exercise regularly.  For those who are between the age of 40 and 54, you should have eye exams every 2-4 years, for ages 55-64- every 1-3 years, and for those 65 and older- every 1 to 2 years. 

Words

They can make you feel like a king or a queen- or they can make you feel like a criminal. They can make you feel like a winner- or they can make you feel like a loser. They can lift you up, they can bring you down. Sometimes they can mend a heart- sometimes they can break it. I have been the one to use them and I have been the one that receives them. They can hold a person captive- or they can set them free. They can be filled with mountains of lies- or they can speak with oceans of truth. They can be short- or they can be long. Two or three of them put together can speak volumes in one utterance; or a combination of many of them can echo in silence. When they are shared with love, they can calm a storm- when they are held back in angry silence, they can create one. They can strengthen relationships or they can be the catalyst that causes them to fail.

They are words. They were created as a means of communication. Since the beginning of time people have tried to come up with ways to express what they want to say. They have been written and they have been spoken. They come in many styles and languages. How they are interpreted is in the heart of the one hearing them. How they are said is in the heart of the one speaking. They can be as abrasive as sandpaper, and they can be as gentle as a breeze. By combining them, many have written beautiful stories and poetry; and many have torn people, families, and nations apart.

We can’t escape them. They are and always have been a necessary part of communication. What we can do, however; is make sure we use them in a way that will help, not harm. By focusing on what others are saying with their words instead of being distracted by thinking of what we want to say next, we can build up relationships. If we are the ones doing all the talking and none of the listening, we can destroy relationships.

We are defined not only by our words, but also by our actions. Our words and our actions must come from the same place, our hearts, in order to be believed. The most interesting thing about words, you see, is that they can be spoken beautifully and in a way that draws people close; but with just one small action, those words will be forgotten and the memory of the action is all that will remain. In the Bible, Mark 7:15, Jesus says, “Nothing that comes from outside can defile that person; but the things that come out from within are what defile.” So let our words and our actions not be merely noise and simple gestures that come only from the outside, let all that we say and all that we do come from the inside -where our heart is.

Osteoperosis

Osteoporosis is a bone disease that is common to older, post-menopausal women but can occur in men as well.   As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.  It is caused when bone density decreases which leaves bones brittle, fragile, and prone to breaking.  It is not only bothersome, but it is actually quite dangerous and can make life miserable.

Osteoporosis is strictly an internal disease.  For this reason, it is often difficult to recognize its signs and symptoms.  It is, however, extremely important that it is recognized so those who suffer from it can make lifestyle changes.

 Having a bone break in a situation where it shouldn't have broken (such as while turning over in bed) is the most common symptom of osteoporosis.  This often happens later in life when there is an increased risk of tripping and falling.  There is a good chance that, if you break a bone from tripping while you were walking, your bone density has decreased due to osteoporosis.  This is known as a "fragility fracture".

Another common symptom of osteoporosis is the collapsing of the vertebrae in the spinal cord which is known as a "compression fracture".  It usually leads to shorter height and the inability to stand up straight.  A compression fracture will often cause nerve pain so sudden back pain is another symptom to be aware of.

Due to the fact that there are not a lot of symptoms with osteoporosis, knowing some of the risk factors can help you recognize the possibility that you may develop it.  As mentioned earlier, osteoporosis is most common in females and more so in those of advanced age.  This is due to the decrease in hormones that aging brings which lead to lower bone density.  As in many diseases, family history plays an important part in your chances of developing osteoporosis.  If you have a parent or grandparent that suffered from osteoporosis, there is a higher chance that you will as well.  Being of small, thin stature is also a risk as is being a white or Asian woman.

As we know, our age, sex and genetics cannot be changed but there are some risk factors that can be changed and prevented.  People who are overweight or obese have a greater risk of developing osteoporosis.  Also, people who drink alcohol, smoke, or drink carbonated beverages excessively have a greater risk than those who do not.

The right amount of exercise and muscle strengthening can help prevent osteoporosis but too much of both can do more harm than good.  Diet also plays an important role in prevention.  A diet rich in calcium and vitamin D is a very good way to help prevent the disease.  Vitamin D helps the body to absorb calcium so taking them together is most important.  It is recommended that:

• Adults under age 50 should have 1,000 mg of calcium and 400 - 800 IU of vitamin D daily.
• Women ages 51 to 70 should have 1,200 mg of calcium and 400 - 800 IU of vitamin D a day; men ages 51 to 70 need 1,000 mg of calcium and 400 - 800 IU of vitamin D a day.
• Adults over age 70 should get 1,200 mg of calcium and 800 IU of vitamin D daily.

A bone density test using a DEXA scan can help your Primary Care Physician (PCP) monitor your bone density to see if it is decreasing, predict your chances of developing osteoporosis and, if you already have osteoporosis, it can monitor how well your medicine is working.

In order to prevent breaking a bone if you are at risk for or have osteoporosis, you should take the following measures: 

• Do not take sedating medicines, which can make you drowsy and unsteady. If you must take them, be extra careful when you are up and about. For example, hold on to countertops or sturdy furniture to avoid falling.
• Remove household hazards, such as throw rugs, to reduce the risk of falls.
• Leave lights on at night so you can see better when walking around your house.
• Install and use safety grab bars in the bathroom.
• Make sure your vision is good. Have your eyes checked once or twice a year by an eye doctor.
• Wear shoes that fit well and that have heels. This includes slippers. Slippers that do not have heels can cause you to trip and fall.
• Do not walk outdoors alone on icy days.

There are medicines available to treat osteoporosis and they can help prevent future fractures.  Unfortunately, spinal bones that have already collapsed cannot be reversed but surgery can be performed to ease the pain caused by a compression fracture.

Suitcases

I once knew a couple who planned on taking a vacation to Australia as an early Golden Wedding anniversary celebration. Their 50^th wedding anniversary was in a couple of years but they were concerned that they might not be healthy enough to make the trip then.

They planned their vacation for over a year. They bought the tickets, reserved the hotel, got their passports, and had everything set long before their trip was scheduled. The only thing left to do was pack their suitcases. Little did they know that less than a year before they were due to leave, he was diagnosed with a terminal illness and died just a few short months later. She also became ill and died within nine months of his passing.

I am quite sure at least most of us have done something similar. We spend a great deal of time and effort planning our vacations, leaving nothing undone. We then feel we can relax and just wait for the day to come, knowing that everything is in order. The only thing we will have left to do is pack our suitcase. 

If we would only put as much effort into planning for the trip we will be taking when our life ends. We go through each day of our life as if there will always be a tomorrow. The only time we may think about our own mortality is when someone close to us dies unexpectedly. We realize- for a time- how short life can be. We think about it, we talk about it, and then, we once again forget about it.

Yet, the most important trip to plan for is just that one. But how do we plan for it? What can we do differently each day to make sure we have “everything in order”? That is probably the most difficult part. We can say “I will do this” and “I will do that” but then we soon get caught up in life once again and our good intentions are soon forgotten. 

The fact is, none of us know when our final trip is scheduled for departure or how to prepare for it. The best we can do is have our suitcase ready and hope that we have filled it with the right things. Just as we make sure we pick out the right things for wherever our vacation is, we must pick out the right things to pack in our “spiritual suitcase”. 

And what exactly are those things? They are the prayers you have spoken in conversation with God. Prayers that are not only for yourself, but for others. They are those times when, in spite of being overwhelmed yourself, you took a moment to comfort someone else who was going through a difficult time. They are the times you have truly forgiven someone else for the hurt they have caused you or a loved one. They are the times you have said, “I’m sorry” and asked for forgiveness; the quiet times you have spent alone with God; the times you have given thanks to God after recognizing the little blessings he constantly sends you. They are the sacrifices you have made to visit the sick, feed the hungry, clothe the naked… the list goes on and on. 

Unlike the suitcase you pack to take on vacation, you will never run out of room in your spiritual suitcase. As a matter of fact, the fuller your suitcase, the better your trip. Keep adding things to it each day and that way, when it’s time to take that final trip, you will be prepared.

Caring for Your Kidneys

They may be small (each one is about the size of your fist) but they play a very important role in the functioning of your body.  Your kidneys are responsible for maintaining just the right balance of water and other substances inside your body.

The kidneys, in spite of their importance, do not let you know something is wrong with them until it's too late.  Often, by the time you feel sick from kidney malfunction, the problem is serious and irreversible. 

Your two kidneys are located on either side of your spine in the middle of your back.  They are reddish, bean-shaped organs and their main job is to filter your blood.  Each kidney is made up of about a million tiny filters that are able to process about 40 gallons of fluid each day.  That is about enough to fill up the hot water heater in your house.  As blood passes through the kidney, these filters sift out the harmful wastes and the extra water and nutrients and send them to the bladder to be flushed away as urine.  They will hold on to the nutrients and much of the water that your body will need. 

Kidneys are also responsible for producing several types of hormones.  The hormones they produce help to make red blood cells, activate vitamin D (important for keeping bones strong), and control your blood pressure.

As we age, the kidneys lose a little of their function.  Many people have been known to survive with only one kidney after donating one to a friend or family member.  There have also been several cases where it has been discovered, by a random radiology test, that a person has lived most of their life with only one kidney because they were either born with only one working kidney or lost the function of one kidney at an early age. 

Although, as mentioned, it is normal for the kidneys to lose some of their function as we age, if loss of function is caused by an underlying kidney disease, it causes great concern.  The toxins and extra water that the kidneys would normally filter out and get rid of can build up in the blood.  In addition, if the hormone levels begin to fall because of poor kidney function, other problems can occur.  There are about 20 million people nationwide (that is 1 out of every 10 people) that have some signs of kidney damage.

Most kidney diseases affect both kidneys at the same time by causing harm to the tiny filters (nephrons) thus reducing their filtering ability.  If this damage happens quickly, such as from injury or poison, it's called "acute" kidney injury.  The more common type of disease, however, occurs slowly and it can take years or even decades before the injury is discovered.  This is known as "chronic" kidney disease.  Chronic kidney disease often shows no symptoms until it is well advanced.  Sometimes as much as three-fourths of kidney function has already been lost by the time it is discovered.

Although chronic kidney disease can strike people of any race, African Americans are at highest risk; possibly because they tend to have high rates of diabetes and high blood pressure which are two of the leading causes of chronic kidney disease.  Also, as in many diseases, family history of kidney failure (a severe form of kidney disease) and heart disease are also high risk factors.  Because of this, if you have any of these risk factors, you should be screened for kidney disease.  This is often done by two simple lab tests- a urine test and a blood test. 

The urine test checks for proteins called albumin, which is not usually present if kidneys are functioning normally.  The blood test checks your GFR (glomerular filtration rate) which measures your kidneys filtering ability.  If your GFR is below 60, it is a sign of chronic kidney disease and if it is below 15, it is a sign of kidney failure.

Chronic kidney disease cannot be cured, but its progress can be slowed down if caught early enough.  If treatment is not received, the disease will often become worse.  People who have a GFR of less than 15 may feel tired, weak, nauseated, have vomiting and itching.  If those types of symptoms are experienced, it may be time for a kidney transplant or dialysis.  If you are diagnosed with kidney disease, it is best to learn about these two options before they are needed as this will give you time to learn about and understand your options before it becomes necessary.

Obviously, the most desired treatment would be to have a kidney transplant but the timing for this is so unsure due to a long waiting list and finding a matching donor. 
Dialysis treatment filters the wastes and excess water from the blood which helps the patients to feel better and live a near normal life.

To avoid or delay kidney failure, the best thing to do is control your blood pressure.  Healthy living that includes physical activity and a diet that is heart healthy can do much to bring blood pressure to normal and slow down kidney disease.  Cutting back on salt intake (less than 1500 mg/day) is very important to good kidney function and, if you have been diagnosed with kidney disease, you may be required to watch your protein intake.  By eating more fruits and vegetables and whole grains, and by choosing lean meats and low-fat or fat-free dairy products to reduce fat intake, you will help your kidneys handle their workload.

Your primary care physician (PCP) may have additional changes they would like you to make to your diet.  If lifestyle changes don't help slow down the progression of kidney disease, they may give you medications that will bring down your blood pressure, control your glucose levels, and lower your cholesterol. Also, if you are overweight, you should take steps to shed the excess pounds and if you drink alcohol or smoke, you should take steps to quit.

If you have any of the risk factors for developing kidney disease, take the first step and talk to your PCP about taking necessary measures to keep your kidneys healthy.  Also, ask them if you should be tested for kidney disease.