Had an early morning appointment

with my ophthalmologist, Dr Kielar, today.  I started seeing him twice a year several years ago because I had a little ocular hypertension--not glaucoma, or even high enough for drops, but the pressure in my eyes was just a bit too high.  He also follows me to see if there are changes in my retinas or eyes due to my diabetes.  This was just a brief exam--no field of vision test or picture of the optic nerve this time.  They basically numbed my eyes with these yellow drops and did the pressure check, after just running me through a quick exam to make sure I was seeing well.

He said the pressure was a little higher, but not enough for drops as if it gets too high and I'm put on the drops I'll be on them the rest of my life.  But apparently, it reads a little higher anyway because I have thicker corneas, which is genetic.  He said that's better than if they were thinner as they'd have higher pressure than the readings.  He also gave me some tips on my contact wearing (which I knew, and which I follow, thankfully, except sometimes I'm a little over my monthly wear, and so I've started changing them at the beginning of the month to be sure I don't go too long).  But I don't sleep in them or swim or shower in them at all; I even take them out for naps.  I usually do take my contacts out when I get home, which he encouraged, as 12 hours is about the limit of what they should be worn.  We also discussed amoebic and bacterial infections and what happens when they infest the eye (apparently it's extremely painful and takes 6 months just to kill amoebae, and then there may be scarring and a need for a corneal transplant.  I first was made aware of them by my optometrist, Dr Zent, who stressed drying hands thoroughly after rinsing or washing them with tap water, as any wetness could allow the parasitic infection.  Dr Kielar said you should not rinse your case with tap water, but use solution, and if you can, have two, so you have one drying at all times.  I don't use tap water on mine.  I actually just ordered a multi-pack of the solution I use, Bio-True, from Costco yesterday (that was what I needed but wasn't going to go in-store for because of my ankle).  It has two full-sized containers, one travel one, and a couple of cases.

Speaking of my ankle, I'm feeling pretty decent.  I did wear my boot today while I was out, and I remembered the secret to getting the thing on without stress. 1) Put your foot into the inner lining. 2) Put that with your foot into the plastic/rubber case. 3) Line up the bladder with the hole on the cover.  4) Lace the straps through their loop and fasten.  It makes it so much easier than trying to just put your foot in the whole thing at once.  Also, I wore short capris today, which was a mistake, and I must remember to wear long pants rather than a skirt or shorts or capris.  I have a pretty large calf and the velcro only closes in a sort of 'v' shape, leaving part of it unattached.  It doesn't hurt as far as the fit and the use, but it does rub against bare skin unless I have some cloth there.  That is not good for someone who is diabetic at all.  So again, lesson learned.  I'm glad I have till Monday to work out the kinks before returning to my job.

Okay, it's late morning and I haven't eaten anything. I'm going to go have some cereal. :)

Today's 'ewww' story

So YKWIA called me at work and asked me how long I keep my contact lenses in at a time. I told him just the day, that technically I'm supposed to be able to to sleep in them, but I don't, and I take them out each night and clean them overnight. Mine are disposable, and I throw them out after a month or so of wear. I also do not shower in them, etc. Why did he want to know, I asked.

Amoebas devour girl's cornea after contact lenses stay in for 6 months

Student goes blind after keeping her contact lenses in for six months and microscopic bug EATS her eyeballs

Once the lenses were removed, doctors discovered that her corneas had been eaten away by the amoebas. The girl had not taken her contacts out at all in six months, including while swimming and bathing, and contact with dirty water can cause the amoebic infection. The lenses, which reduce oxygen and act somewhat like a bandage, created the an excellent breeding ground for the amoebas. This is being used as a cautionary tale by doctors to remind contact lens wearers to practice good hygiene, especially in the summer months, as that is the most likely time for them to become contaminated.

So if you're tempted to keep your lenses in for more than a month at a time, and think it's a bother to change and clean them, then 1) remember this story and 2) contacts probably aren't for you.

You have to be pretty desperate to seek an organ donation

and in many cases, it comes out as a miracle cure. And then there's this sort of thing...

Brain Amoebas. Organ Transplants. Brrr.

The CDC’s weekly bulletin today describes that nightmare scenario come true. Last year, four people received the kidneys, heart and liver of a 4-year-old boy who died in Mississippi of encephalitis that was assumed to be a rare reaction to flu infection. Weeks after the transplant, the two kidney recipients developed neurological symptoms — spasms, seizures, visual disturbances — and were hauled back to hospitals for evaluation. MRIs showed ring-shaped lesions in both their brains. That sent investigators back to re-examine the boy’s death — and revealed that while he did have encephalitis, it wasn’t because of flu.

It was because he was infected with a newly recognized pathogen, Balamuthia mandrillaris, a species of amoeba. It had passed to the four recipients via his organs, and grew in them with an assist from the immune-suppressing drugs they were taking to prevent rejection.

First of all, the deaths and illnesses of recipients were the only real clues that anything was wrong. Two clusters are described in the article, with a total of five people dying (including the two donors). The only real treatment was to put the others on a regimen of drugs that includes one not available in the US except under direst emergency.

This shows that 1) any time you deal with human tissue--even tissue that's been carefully scruitinised--you run the risk of passing along a pathogen, because the possibilities, while not quite endless, are there, although in practice it's thankfully rare that something fatal gets through, 2) there are pathogens we know very little about and don't occur much (this one has only been found in about 200 human cases), so they don't get studied much, and 3) there's just something terrifying about an organism that you know so little about that the authorities THINK it might be caught from inhaling amoeba cysts in dust. Yeah. Breathe in. It's things like that that make us hypochondriacs insane. Oh, and the kicker? The little boy was from Kentucky and it's unclear as to whether he caught the amoebic infection here or in Mississippi. Yeah. They could be anywhere, hiding in dirt. Here's to hopefully strong constitutions.

Oh, and here's a nice fact from Wikipedia (which needs some updating in some areas of the article, but this was nicely attributed*):
'Balamuthia is most easily identifiable in a brain biopsy performed on an individual suffering from Balamuthia meningoencephalitis. The amoeba cannot be cultured on an agar plate coated with gram-negative bacteria because unlike most amoeba, Balamuthia mandrillaris does not feed on bacteria. Instead the amoeba must be cultured on primate hepatic cells or human brain microvascular endothelial cells, or HBMECs, the cells that constitute the blood-brain barrier.'

Um. Am I reading that right? It eats brains cells? Well, I guess something other than zombies have to, but yuck!

*Martínez AJ, Visvesvara GS (March 2001). "Balamuthia mandrillaris infection". J. Med. Microbiol. 50 (3): 205–7. PMID 11232763.

Ew

Lake amoeba can kill swimmers

It sounds like science fiction, but it's true: Killer amoebas living in lakes can enter the body through the nose and attack the brain, where they feed until you die.

Though encounters with the microscopic bug are extraordinarily rare, it is known to have killed six boys and young men in the United States this year; over the decade ending in 2004, the yearly average was 2.3.

The jump in cases has health officials concerned.

Someone once brought me a clay masque from New Zealand and said that she'd gone to the hot springs it came from but you coudn't put your head underwater because of this same amoeba (yeah, that makes you want to use a product from there, doesn't it?) I had no idea they lived in the US--mostly the South--as well. I've swum in one lake in my life. I don't think I'll be returning to the water any time soon--just give me a pool. I don't want my brain eaten by amoebas, even if it is really, really rare.

That's up there with the faceless man who was infected by a fungus, who in order to save him they had to remove his eyes and most of his nasal area. (Don't watch this if you're squeamish. Just imagine living without a face. And although it's extremely rare, you never know when that statistic will be you.) YKWIA showed me this on months ago.