episode


Allergy Testing Experience [Show Notes]

Allergy Basics

Anaphylaxis = an out of control allergic reaction that can be life-threatening if medical treatment is not sought immediately
EpiPens are a first-step self-treatment in the case of a major allergic reaction or anaphylaxis.

My Allergy Testing Experience

I got 33 injections!!

Allergy testing started with a serum test as a baseline – just to see how strongly my histamine reaction was.

The injections are sub-dermal (under the dermis layer of the skin).  It’s the same level if injection that a TB skin test is done (to see if you’ve been exposed to tuberculosis).

The next step was a prick-test or scratch test – these plastic claw things that poke down in my forearms.  This test required me to sit completely still for 20 minutes.  COMPLETE TORTURE!

A picture of my right forearm where the nurse performed my allergy testing prick testA picture of my left forearm where the nurse performed my allergy testing prick test

Numbers 1-20 are plants (trees, grasses, flowers).  C = cat. D = dog (Good news – I’m not allergic to dogs!) M = skin mites (don’t think about this one too hard). CL = cockroaches.  The other letters are household and common molds.

The skin pricks on my forearm was a preliminary test to determine how much serum she was going to inject of each in my upper arms. The mites injection hurt the worse of all of them, but i had minimal reaction.

Slowest tattoo EVAR!
An image of my left upper arm where nurse injected allergens for my allergy testing, labeled with letters. An image of my right upper arm where nurse injected allergens for my allergy testing, labeled with letters.

My Results

One of my higher reactions was to Fescue (this is the type of grass that Ken grows on the farm as hay to feed the cows!)
The one the nurse was most concerned about was Cocklebur.

They didn’t want me to wash the mold markings off until I go in for a delayed reading a few days later.

The next step that they prefer you do is allergy shots – 2 years of weekly injections of what you’re allergic to in hopes to desensitize you to those triggers.  NOPE!  Not doing it!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/


Eye Conditions 4 [Show Notes]

Eye Conditions (not) in ABC Order

Dry eye

48% of Americans over age 18 complain of dry eyes.  Caused by environment, genetics, health conditions, eye procedures, medications.

There are 2 reasons for dry eye:

  1. Inflammation blocks the free flow of fluid through the eye.
  2. Tear duct insufficiency – the ducts and glands don’t produce adequate moisture for the eye (can be solved by a tear duct stent)

If a medication dries up another part of your body, then it has the potential to dry out your eyes (antihistamines, medications for overactive bladder) – these medications can also lead to constipation. Many of the common diseases that many Americans deal with can cause dry eye – hypertension (high blood pressure), diabetes, obesity.

They light from electronic devices tricks your eyes into not blinking as often, therefore your eyes can dry out more easily (blinking is your eyes’ remoisturizing process).  The solution is to give your eyes long breaks from electronic light , especially late at night before sleeping.

Air conditions in hotels can make your eyes feel dry because they work to remove excess humidity from the air.

Hormones, whether in pregnancy, menopause, or during the use of prescription birth control products, can cause changes in the moisture content of your eyes.

The Solution: eye drops (either OTC or Rx)

Presbyopia

It means “old or elderly vision”.
Presby = elders
Presbyterian church = the church’s decision-maker was a group of people called Elders

This seems to happen somewhere around age 40.  The lens of your eye loses some of its flexibility.  The lens has to be really curved to see up close, and then flattens out a bit to see far away.  So, if the flexibility decreases, it means it can’t curve up enough to clearly see things up close.

The solution: wear reading glasses.

Stye

It’s an infected oil duct or hair follicle.  Looks like a zit.  **DO NOT TRY TO POP A STYE LIKE A ZIT!!**  They will usually clear out on their own in 6-7 days.  Not too troublesome other than being sore, swollen, and not pleasant to look at.

The Solution: warm compress for 15-20 min, then take a shower or wash your face, then leave it alone!  Can use drops or an ointment to help lubricate the eye.  Worst cases will require antibiotic drops or ointment from the doctor.

Corneal dystrophy

A genetic condition that causes the accumulation of protein material build up in the layers of the cornea (recap: cornea = the very front layer of your eye that starts to focus the light into the eye).  If this fluid gets cloudy with junk, then your vision gets blurry. No other symptoms really except worsening vision.  A surgical procedure can be used to clear out the cloudy liquid, but no cure.

This can lead to corneal erosion (where the layers of the cornea begin to separate = painful). Corneal erosion has to be corrected by surgery.  Erosion can also be a result of eye injury – either instant trauma or more gradual like an unhealed corneal abrasion (which can lead to ulceration and eventually erosion).

Take care of your eyes and treat them nicely!

Callback

Sleep

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Eye Conditions 3 [Show Notes]

Eye Conditions in (not) ABC Order

If something happens to your eyes that makes you want to ask the pharmacist if you should go to the doctor, the answer will most likely be “yes, go see a doctor.”  Even at emergency rooms, they will treat you and make you comfortable but always tell you to follow up with your eye doctor.

Photopsias

This is seeing things that aren’t really there, the visual cortex translates other sensations as “sight”.

  • Floaters: “shadows” that float around in your field of vision.  They *can* be a sign of a detaching retina, but that is usually not the case.  They are normal for most people.
    Inside your eyeball is a gel, called vitreous gel.  Throughout your life, that gel begins to liquify.  As it turns to liquid, it may have other bits of gel still floating in that liquid.  And you see “shadows” because they block light from reaching your retina.  Floaters may worsen with dehydration or exhaustion.  If you try to focus on them, they “float” away.
  • Flashes: “seeing stars” – when the vitreous gel/liquid combo gets shook up and sloshed around (i.e. head trauma).  You can also get “flashes” with Digitalis toxicity (Digoxin is a medication derived from the Foxglove plant and developed for arrhythmias.)  This is a medication that the doctor will test your levels for to make sure toxicity doesn’t happen.
  • Waves: looks like radiating heat; caused by spasms of the blood vessels in your eyes.  This may be one explanation of the “aura” that comes before a migraine.  If it happens and no headache follows, it’s caused an “ocular migraine”.

Glaucoma

It is the 2nd leading cause of blindness in the US and around the world.  Glaucoma is known for increased pressure in your eyes.  The fluid around the eyes typically have adequate drainage so nutrients can flow in and waste can flow out.  If that drainage becomes inadequate, the pressure builds up and it can put pressure on the optic nerve (the nerve that connects from the retina to the brain).  It starts with decreasing peripheral vision, and can become “tunnel vision” where a person can only see right in the middle of their field of vision. Medications are eye drops that control pressure and help open up drainage pathways as much as possible.  It doesn’t hurt, and it takes a while for the decreased peripheral vision to be noticeable.  It’s not reversible, but it can be slowed with medication.  Eye doctors have a way to check the pressure in your eyes each time you get your eyes checked.

(Macular Degeneration is the #1 cause of blindness in the US, Cataract is the #1 cause of blindness worldwide).

Nystagmus

Pronounced nigh-stag-mus.  It is the involuntary rapid eye movement side to side.  Caused by a neurological issue, either related to the eye muscles and nerves or the inner ear (one cause a vertigo).  The shaking seems to be worse when a person looks straight at something or someone.  For someone dealing with nystagmus, they usually discover they can tilt or turn their head to make their eyes slightly off center where the shaking wills stop – this is called a “null point”.  Strengthening eye muscles can help the shaking, but it still worsens with exhaustion or stress.

This can be a result of a stroke, multiple sclerosis (autoimmune).  Dilantin is a medication for seizures, and is another medication that has to be regularly measured because too much can cause temporary nystagmus.

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Eye Conditions 2 [Show Notes]

Eye Conditions in ABC order

Color blindness

It doesn’t mean that someone sees the world in black and white.
It’s technically labeled as Red-Green color blindness, which means the world is seen in shades of yellow.
The cones in your eyes (a certain shaped cells in your retina) are built to pick up different wavelengths of  light (think ROYGBV).  So the cones that would pick up reds and greens are absent or broken.
Found to be a Y-chromosome trait, so it is more prevalent in males.
Rarely Blue-yellow color blindness is a thing.

Conjunctivitis

pink eye = inflammation of the conjunctiva
conjunctiva = the layer that covers your whole eye

3 types:

  1. Viral: itching, watering, burning, light sensitivity, very contagious, lasts ~ 7 days
  2. Bacterial: green/brown discharge (aka “goo”), foreign-body sensation, contagious, can cause damage if untreated, requires antibiotic drop
  3. Allergic: triggered by allergens, histamine reaction, can accompany a larger, more general allergy reaction, anti-histamine eye drops can help

Corneal abrasion

A scratched or injured cornea.  Symptoms include redness, watering, light sensitivity, foreign-body sensation
Can be dramatic or traumatic like being hit in the face or eye by something, or something as simple as rubbing an itchy eye or getting something out of their eye.
* If you end up with something in your eye, the best option is to flush it out with water or saline
Bacteria on your hands or the thing that scratched your eye can lead to a deeper infection, but most of the time, if you use caution, it will heal itself rather quickly.

**Solution for light sensitivity:  wear sunglasses at night

Detached retina

When the retina detaches from the back of the eye.  Sounds awful but it doesn’t hurt.  The retina a web of nerves in the back of your eye that sends signals to the brain.

Closing curtain sensation is where part of the view of vision will become shadowed as the retina detaches gradually from one side to the other.  Floaters also show up if this is happening. (All floaters ARE NOT related to the retina.)

Sudden detachment can be caused by head injuries or sudden intra-ocular pressure drops (the fluid pressure inside your eyeball).  This sudden detachment is experienced as a flash of light and then sudden darkness.  Sudden or gradual detachment requires immediate medical attention and can be repaired with surgery and medical intervention.
Diabetic retinopathy do to chronic damage can lead to retina detachment.  *The risk of retina detachment occurring after an eye procedure (lasik surgery or cataracts surgery) is skewed for people with severe nearsightedness, possibly due to a genetic disposition of having a shorter retina.

Audience Question

Safe to use allergy eye drops long-term?
Answer:  Sure!  The only problem is that chronic use can lead to your body not responding to the same med over and over as well.  So, to avoid this, swap between drops and allergy tabs – based on if you’re experiencing “eye only” allergies or a wider allergy response that involves the sinuses too.

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Eye Conditions 1 [Show Notes]

Eye Conditions in ABC order

Your eyes work together so that the line of focus for each eye cross, and that is your most in focus image.  So as your eyes make tiny adjustments, you can focus on things close up or far away.

Amblyopia

If you have a lazy eye, the muscles don’t allow the eye to focus and coordinate with the strong eye.  This can lead to double vision or blurry vision.  I remember it because it sounds like “ambling” which can mean to meander or wander around.  Versions of this can be caused by torticollis, where a baby’s head is tilted or twisted due to positioning in the womb.  The eye can either compensate for the difference or it’ll just give up and let the dominant eye do all the work.  Correction of this issue usually involves patching the strong eye and making the weak eye do all the work.  The blurry or double vision can lead to headaches.  Overuse and fatigue (like long days at work) can make it worse.

Astigmatism

An astigmatism no a stigmatism.  It’s an irregularly-shaped cornea; think baseball vs football.  A circular lens (baseball) focuses light to a single point.  A football-shaped lens focuses light to a line, so that makes the vision blurry.  This is why people with astigmatism will squint.  Squinting is a way for your eyes to manipulate the amount of light coming in and alter the shape of the eye to clear up the image of what they’re looking at.

Lasix procedures can correct astigmatism – the laser does micro-damage to the eye and it heals more circular in the eye.

Blepharitis

Inflammation of eye lids.  Can result in dry eye.  It can affect the outside (eye lashes side) or the inside (lubrication gland size).  This is NOT a stye.  Caused by a chronic build-up of bacteria, skin flakes, dried eye lubrication.  Some skin conditions can make a person more susceptible to blepharitis – Rosacea (overgrowth of skin bacteria), severe dermatitis, including psoriasis.  It’s recommended to use really good eye hygiene before having a doctor intervene.  Using warm compresses to keep dried skin and “eye crusties” soft and glands open so they don’t get clogged.  Using clean cotton swabs or clothes instead of your hands to touch or wipe things out of your eyes, so you don’t transfer bacteria.  Doctor’s can insert a catheter into the tear ducts to keep it open and less likely to keep it clogged.  There’s not a cure to make it go away for good.

Cataracts

The lens of the eye gets cloudy due to proteins clumping up.  People have described trying to see with cataracts like trying to look through wax paper.  Risk of cataracts normally increases with age.  The risk for cataracts can be increased even more by chronic diseases (diabetes, high blood pressure), poor health habits (obesity, smoking, alcohol use), long-term use of certain medications (steroids, hormone replacement therapy).  The current treatment for cataracts is lens replacement.  The old treatment would be just removing the proteins, but depending on a person’s longevity, they may get cataracts again in their lifetime.

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Eye Vitamins 2 [Show Notes]

Remember: if a vitamin is good for one place in your body, it’s probably good for a lot of places in your body.  It’s a marketing ploy to call them eye vitamins.

Eye Vitamins

  1. Thiamine (B-1): thiamine is used heavily in your liver, to help metabolize alcohol.  Most well-known deficiency in alcoholics.  Thiamine also helps nerves produce several neurotransmitters, as well as protects your nerves from inflammatory chemicals (the chemicals in your body that trigger swelling and pain).  You don’t want inflammation in your optical nerves.  You also don’t want the signals from your eyes to your brain and back to be slow.
  2. Folic acid:  important for pregnancy women and fetal development, deficiency can cause a type of anemia.  It’s main job is to help make accurate copies of the DNA and RNA when cells are dividing and multiplying.  You don’t want typos in your DNA!  This is important for your eyes because the cells of your eyes is because they are some of the fastest reproducing and dividing cells in your body.
  3. Omega-3 Fatty acids:  Beneficial for heart health, found in oils.  Oils in your body are lubricating.  Omega-3 fatty acids are building blocks for the cholesterol that is build into cell membranes that keep the fluid and slippery. The body also uses O3FA to produce the natural lubrication in your eye.
  4. N-Acetylcystine (NAC): an amino acid (building block of protein).  Glutathione – your body’s naturally produced antioxidant.  NAC is used when the cells build and store glutathione.  Glutathione focuses mainly on oxygen-based free radicals.
  5. Alpha Lipoid Acid (ALA): another antioxidant.  Found in sources of natural oils – seeds and nuts.
  6. Lutein and Zeaxanthin: 2 nutrients that are found in red, orange, and yellow fruits and vegetables (and that actually cause them to be those colors in the first place).  Their main goal in your eyes are to prevent blue light damage.  Blue light is a short wavelength with a higher speed and energy than the lower colors of light.  This energetic light can damage cells in your eyes, so the orange nutrients blocks this energetic waves so you can still see the blue colors, but it’s more chill and doesn’t cause damage to the retina.  These nutrients concentrate in the macula.

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Eye Vitamins 1 [Show Notes]

*Disclaimer: most vitamins and minerals are good for ALL of your body.

Eye Vitamins

  1. Vitamin C: helps make collagen, allows iron to be absorbed, and acts as a neurotransmitter co-factor (helps in the process of creating and sending messages).
  2. Vitamin E: antioxidant, it traps up free radicals so they don’t damage cells in important organs.
  3. Beta-Carotene: a pre-cursor to Vitamin A (this happens in your liver). Vitamin A works with proteins in your eyes to create light-sensitive molecules to aid in color vision and seeing in dim light.
  4. Zinc: helps Vitamin A know where it’s needed in the body and helps it get there.
  5. Selenium: helps the body absorb Vitamin E.
  6. Calcium: vital for muscle and nerve conduction (think electricity).
No lone rangers here!
Many foods are fortified in modern countries and have vitamins added to them that may not be naturally occurring in the raw ingredients.  If you’re eating a well balanced diet and still deficient in something, take a supplement of the thing you’re deficient in, not a whole multi-vitamin.  If you’re getting regular check-ups with your doctor, they should be testing for many things, including many vitamin levels, to check for deficiencies.
Being “tired” isn’t always fixed by taking vitamins.

Bonus

Depending on what nutrient is missing to cause anemia, the red blood cells will have a certain appearance.

Some vitamins are fat soluble. They hang out in your adipose tissue, and can cause problems if you get them in too large amounts.

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Eye Anatomy [Show Notes]

Eyes

Your eyes are more complex than any camera on the planet!

Cornea:  a concave lens on the front of your eye that focuses light
Iris:  the colored part, a diaphragm that controls how much light comes in (the pupil is the hole the light enters = equivalent to the aperture of a camera)
Lens:  the “focuser”, uses a process called accommodation to focus near to far and make the image as sharp and clear as possible
Retina:  the sensor, and sends signals to the brain to translate light into an images

The retina has 2 types of sensors:

  • Rods – detect light intensity
  • Cones – color differentiation

Two special areas of the retina:

  • Macula – right in the middle of the retina, they place that detects the most detail (that’s why the center of your vision field is a clearer picture than the periphery)
  • Fovea – the center of the macula, it contains cones (color sensors) only to aid in the translation of very fine details

Support structures

  • Extra-ocular muscles – allows your eyes to move around in their holes
  • There are chambers of fluid that are between each structure of the eye, and that fluid helps hold nutrients that feed those parts, and remove waste
  • Choroid:  the layer that holds all the blood vessels that feed the eyes
  • Sclera:  the whites of your eyes, an outer coating that hold everything inside
  • Conjuntiva:  the mucus membrane that attaches the sclera to the eyelids; produces liquid for lubrication and trapping invaders

PSA

Please don’t vigorously rub or scratch your eyes, you could hurt them!

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Brainstem

An out of focus image of white and colored dots of light. The picture was taken this way, don't blame the out of focus on your brainstem.

Brainstem Basics

Your brainstem is the most basic area of the brain.  The area of the brain that we have in common with almost all other levels of the animal kingdom.  It extends right into the spinal cord.  A lot of other whole body involuntary reflexes come from the spinal cord – that’s another story for another day).

3 main parts

  • Medulla oblongata – rhythm center (heart rate, breathing, swallowing, vomiting and coughing reflex) – they’re all involuntary
  • Pons (not ponds) – the bridge between the cerebellum hemispheres and other brain regions, helps coordinate the right side and left side of your body for complex activities
  • Midbrain – sensory reflexes (also involuntary) – blinking, eye focusing, pupil dilation in response to light, visual and auditory startling reflex that kick-starts the “fight or flight cascade”.

Other eye focusing problems are not rooted in the midbrain. They are more likely rooted in the areas of the brain that control orbital muscles or in the areas that translate what your eyes are seeing, like a “lazy eye” or drifting eye or being cross-eyed.  There are therapies that doctors prescribe to try and strengthen the weak eye.  Blinking is usually a response to eye moisture.

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Blood Brain Barrier [Show Notes]

Basics

The blood brain barrier is the last layer of cells between what’s in your blood and the extracellular fluid around your brain cells.

You’re born with it!  It’s main job is filtration.

2 ways things get through the blood brain barrier:

  • Passive diffusion: small, neutral molecules (water, gases, lipid-soluble)
  • Active transport: glucose, amino acids, drugs (like a revolving door)

Permeability: how easily something can pass through a layer without work

Things that change permeability:

  • Inflammation – stretches layer and makes holes bigger (meningitis, injury)
  • Multiple sclerosis – an auto-immune disease that can degrade the BBB
  • Alzheimer’s – BBB becomes overwhelmed with antibodies and burns out

*Scary Section*

Rabies is a virus that is small and can get through the blood brain barrier but the immune system cells, antibodies from the vaccine, and medicines can’t.
HIV encephalopathy is caused when a mutation of the HIV gets into the brain and use brain cells to replicate (rather than the well-known T-cells of the immune system).  There is also a rare symptom of HIV called HIV-associated dementia.

Callback

microchimerisms – Pregnancy causes the permeability of many areas of the body to change, and this includes the BBB.

Test Yourself

Drugs that have central nervous system effects (good) or side effects (bad) cross the BBB.  See what you know of different medications and what job they’re supposed to do and what negative side effects they cause and see if you can guess if they cross the BBB.

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