Choroidal serous retinopathy

On 3 April 2018, I went to see my ophthalmologist. This is something I do regularly.

In 2005, I experienced an odd visual problem. Yes, 2005 was a long time ago, but I still remember it well. I was on my first teaching prac at the time. One evening, when I was trying to write up my day's notes and prepare for the next day, I noticed a strange spot in my vision in my left eye. There seemed to be a small ‘bubble’ distorting whatever I was looking at behind that spot. Something a little bit like this…

Ok, it's hard to draw. That's not quite right but it gives you some idea. Anyway, I put it down to my stress and tiredness (prac teaching is very hard work) and went to bed. The next morning it was still there, but it seemed to gradually fade over the following days.

Then a few years later, I noticed another interesting effect in the same region of vision in my left eye. A kind of wrong-colours and shimmering effect. You can read about this in a blog post I wrote in 2009, including another attempt to show you what I saw with an edited image. My ophthalmologist at the time (not the one I saw recently) suggested it was some kind of retinal pigment epithelium (RPE) defect, but wasn't sure what might have caused it.

Over the following few years, I noticed another patch appearing in my right eye, closer to the centre. The visual appearance changed gradually. Both eyes now have several spots with problems, some bigger than others. Let me try another vision-map like the one in this progress report blog post from 2011.

Ok, that's not perfect either, but again it should give you some idea. Notice that I've drawn this as I see it, which is actually opposite to how things are normally done in the medical field. Normally these things are done ‘as the doctor sees it’ looking at you.

The shimmering has now reduced but occasionally reappears; when it does, it usually lasts a few days. Colours are not right in these areas. Lines and shapes are distorted through them. I also see some reduced-contrast flare if there's direct sunlight falling across my eyes (eg. if the sun is rising or setting to the side).

Anyway, when I went back to the ophthalmologist recently, he made a suggestion about what might have been going on. He said it could be something called choroidal serous retinopathy (CSR). I looked this up and I think it does describe my symptoms. (Actually, most of what you'll find with a google search is central serous chorioretinopathy, which is basically the same thing only near the fovea, which is the part of the retina behind the centre of where you look—the + signs in my diagram above.)

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What evidence is there that this might be my problem? I'm glad you asked. Here's part of the OCT scan taken of my retinas at my ophthalmology appointment in April:

Ok, so maybe you don't know how to read one of these. I already had some idea since doing some research after my first OCT years ago, but reading this page helped enormously—go read it if you're interested in more detail than I talk about here.

1. These images are ‘standard’ medical imaging, so my left eye is on the right, and my right eye is on the left.
2. The small thumbnails at the top are retinal photos with lines indicating how the machine scanned my eyes. The middle row is a horizontal scan (cyan arrow in thumbnail). The lower row is a vertical scan (magenta arrow in thumbnail).
3. N/T in the middle row is Nose/Temple. Looking left to right, the right eye scan goes from temple (side of face) to nose (middle), then the left eye scan from nose (middle) to temple (side). The centre of the page shows the head of the optic nerve, corresponding to the blind spot. When you look for it in your vision, the blind spot appears towards the outside from the centre, but remember the image on your retina is inverted; the nerve is actually closer to your nose.
4. Similarly, S/I in the bottom row is Superior/Inferior, ie. top/bottom. That is, the top of the retina is on the left in the scan, and the bottom on the right. Again, remember that this is the opposite of what you see: the top of your retina sees the bottom of your vision, and vice versa.
5. Finally, the dip in the middle of each scan is the fovea. The centre of your vision has much higher resolution (actually ‘acuity’), meaning many more light detecting cells. The shape of the retina here is to make room for this.

Now we're ready to look for evidence. Here's the part of my left eye scan between the fovea and the optic nerve:

The highlighted sections (and maybe also the bit with a dimmer highlight) correspond approximately with where I see visual issues in my left eye, out from the centre towards the blind spot. The left-most section highlighted here certainly looks to me (a non-expert) like the OCT examples for RPE CSR from this page I linked to above.

And here's my right eye scans near the fovea:

Again, the highlighted sections correspond to my visual issues in my right eye, just outside and below the centre (so inside and above the fovea on my retina).

Whew! That was pretty technical.

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So what does this all mean? Well, interestingly, two potential causes stood out for me from my research: stress and steroids. (Actually, they're correlated with CSR, but not necessarily causal.)

Stress. My life is quite stressful. Teaching is stressful (and prac teaching, when I first noticed a problem in my vision, even more so). I'm also a middle leader at work (head of faculty). And I'm studying part time. Maybe I need to reduce my stress. But how—what should I change?

Steroids. I've been using corticosteroids for asthma since I was a teenager. I use corticosteroids to reduce my rhinitis. I also use topical corticosteroids at times to treat eczema and a variety of related skin problems. Probably not something I can easily avoid.

In praise of nurses

With Laetitia in hospital getting her heart valve fixed, I've been spending a lot of time in the company of acute-care nurses. And I'm struck by just what an amazing job they do. In the ICU it's busy and noisy 24/7, they do long shifts watching just one patient. Whatever needs to be done to keep you alive and comfortable, they'll do - no hesitation, no complaints, happy to serve.

Leah, Sophie, Steph - thanks for caring for my wife and speeding her recovery. You're amazing!

Asthma

Many, many years ago—long before blogging or Facebook—I was asthmatic. At high school I used to carry around so much medication in my pencilcase that I was called a walking apothecary. My triggers were a list of allergens including dust mites and cats, as well as vigorous exercise. I missed several weeks of school in Year 11, because I simply couldn't sleep properly; lying down exacerbated my asthma, so I spent all night and much of the day sitting more-or-less upright in a lounge chair.

As I left my teens behind, I gradually found I needed less medication. And then one day I read about the link between sulphur dioxide (additive 220, used as a preservative) and asthma, removed it from my diet, and what little asthma I had left stopped almost overnight.

Or so I thought.

Over the last ten years or so, I've had asthmatic symptoms maybe a handful of times. On most occasions a hot shower was all I needed, the warm moist air alleviating my discomfort within a few minutes. (And on every occasion I prayed!)

Until this year.

So far this year I have had several significant asthma attacks. So much so that during Easterfest in Toowoomba I  bought some Ventolin and I have actually used it more than once (for the first time in over ten years).

Apparently I'm not alone. I have read and heard from many others with allergy / hay fever problems that this year is a very bad year. The reason may be that due to the flooding that has broken the drought out west, there's a whole lot of plants (mostly grasses) that are suddenly flowering for the first time in, oh, probably at least ten years, releasing pollens to drift around the continent on the wind.

I'm not looking forward to August and the westerlies.

A visit to see the eye doctor

On Monday I went to see my old family ophthalmologist (a hard word to spell!), Dr Mark McGree. It was a check-up on my RPE defect which was diagnosed by Dr Kirkwood in Mackay. Dr Kirkwood told me to come back if things changed. Well, it's a bit difficult to go back to him now that we live in Brisbane, but I used to see Dr McGree before we went to Mackay, so I just went to see him instead.

The spot in my left eye's vision has grown a little. Hmm, let me draw a diagram instead of trying to find the right words:

In that spot, colours are wrong, especially if I blink quickly, and lines don't go through it straight. The shimmering I used to get when I looked at something really bright seems to have gone away. But the non-straight lines cause me some interesting issues, with spreadsheets and class rolls and other regular grids, but also with circular objects like protractors, mixing bowls and even circles I draw on the whiteboard. (They really don't look circular if the edge goes through that spot!)

I also seem to be getting a small odd spot in my right eye, just below my centre of focus.

Anyway, my eye doctors have traced it to a spot on my retina where I seem to have a drusen, a yellowish spot that seems to be between the RPE and the light-detecting cells in the retina. In Monday's OCT scan, you can see a small bump there:

68kg!

For most of my life I was 57kg. I got to that weight by about age 16, and stayed that way for years, regardless of how much I ate or what exercise I did (or didn't). Now 57kg is okay, if a little on the thin side for my height.

In 1997 I was living in the USA for a while, without my usual distractions to entertain myself, and with a nice friendly gym within walking distance. So I decided to join the local gym to see whether I could put on a little more muscle. For the first few months my weight stayed around the same 57kg (except of course I was measuring it in pounds), but I could feel the difference as my muscle tone improved. And then gradually, bit by bit, my weight began to rise. By the end of the year I was up to about 63kg…

And then I got sick in February 1998. I seemed to lose about 6kg in two weeks! (Yes, if you're wondering, that was the start of my new diet regime. Suddenly things I'd been eating all my life started making me sick.)

So I was back to 57kg. Fast forward several more years.

In 2006 I was in Brisbane, finishing off my studies in Education, and looking for a new job as a high school teacher. The job God provided was in Mackay. With the stress of finishing my uni course, moving to a new city, starting a new job, finding somewhere to live (not easy in Mackay), my first year of teaching… my weight started going down again. I was punching new holes in my belt (to make it tighten a little smaller). When I got all the way down to 53kg, I decided I'd better do something about it.

And I did. In August 2007 I joined the local gym.

Since then I have gradually been building back up again. Like the previous time, back in 1997, the first few months were more tone than bulk. But the weight gains did come with continued effort. Last year I celebrated with friends when I reached 60kg—it was, for me, a milestone worth marking. In the last couple of weeks I've been consistently over 68kg.

My goal is to be comfortably over 70kg. And I realise that I may not make it—the gains are getting harder and slower, I'm definitely fighting my body's natural inclination to stay thin. But I'm highly motivated: I'm fitter and stronger than ever before, I feel great, and my wife loves the improvement in my looks…

We need to move

One day in February this year, I came home from school during the day to find Laetitia having to hold herself up against the wall for support, and I knew then that this would be our last year in Mackay. It was time to move to somewhere less humid.

Laetitia's heart has a leaky valve, and with the high humidity here in summer (tropical monsoonal wet), each year she has found it a little harder to breathe than the last.

If it weren't for the summer weather (and the high cost of accommodation), we'd much prefer to stay in Mackay. We really like the people here: we've made good new friends, we love our church family, we've found clubs and hobbies we enjoy. I've really grown in skills and character through the support of my colleagues at work.

But now, it seems it's time to go.

Eleventh Anniversary

Dear Laetitia,

Thank you for spending the last eleven years as my beloved wife.

Thank you for loving me, cherishing me and honouring me.
Thank you for standing by me in times of trouble and distress, and in times of peace.
Thank you for comforting me when I have been ill, and cheering with me when I have been well.

Thank you for telling me the things I need to hear, which aren't always the things I think I want to hear. Thank you for forcing me to pay attention to details I might otherwise overlook. Thank you for reminding me of the things I forget. Thank you for encouraging me to grow.

Thank you for sharing your clever wit and humour with me. Thank you for playing your suave sax music for me, and for singing with your beautiful voice.

Thank you for being you, with me, for eleven wonderful years. I love you.

Ian xx

Retinal Pigment Epithelium Defect

I've been bothered by a funny spot in my vision lately. There's a patch in my left eye that has… issues. So I went to see the only eye doctor in Mackay, Dr Rod Kirkwood—who is a lovely, patient, gentle man who exudes calmness and confidence. And it appears (pun intended) that I have a retinal pigment epithelial defect.

People keep asking me what that means. I don't know, exactly. But I think the question they're really trying to ask is, what am I seeing? So I thought I'd have a go at describing it.

There's a small patch in the vision of my left eye where the image is distorted. The patch is a bit bigger than my blind spot, and near but not coincidental with it. The colours there are wrong—just a little bit. It's like I've just looked away from a light. And if I look at a bright area like the sky or a white wall, it shimmers, almost like a migraine aura.
Also, lines or edges passing through this patch do not look straight. Here's my attempt to fill out an Amsler grid. Note this is not a real Amsler grid; in fact my patch is just off the edge of the standard grid at its normal size (because my defect is away from the centre of my vision). I'm just trying to give you some idea of the way lines “bulge” outwards a little.
There you have it. Dr Kirkwood says he doesn't think it's anything to worry about, or that we can do anything much about. But he wants to see me again in a few weeks, just to check that nothing's changed. Apparently these things can sometimes be caused by a viral infection.

I'm just glad that with my skin's apparent attractiveness to all the fungus around here, I haven't become infected with this scary fungus.

Fungal Infections

So I've had a small itchy red spot on one arm for a couple of weeks. Today I noticed it had developed a characteristic small circular shape, a red ring around a clear centre: ringworm. What is it with Mackay? Laetitia's skin attracts the bugs, mine seems to attract fungus.

Yehudi Menuhin

I started reading Yehudi Menuhin's autobiography Unfinished Journey several years ago. Actually, I first found it in a library in Manchester in June 2003! I spent an hour or so browsing it there. But Manchester was a depressing place—it drizzled constantly, and there were basically no trees. So within days we had decided to hire a car and find someplace else to live.

But a few months later I found a second hand copy for sale for £2.50, and grabbed it. Yet I didn't get around to reading it until we'd been back in Australia for some time.

Two years ago, here's the brief review I wrote of what I'd read so far:

In accordance with the book's title, I have only got half-way through this book, and now it must be packed for our move to Mackay. Sigh. Worth reading, although I'm skipping quickly through some of it that I don't find interesting. I'd rather know more about his attitude to the violin (but he says he talks more about that in the latter half, which I haven't got to). I share his opinions of San Francisco (positive) and New York (negative).

Fortunately, he did talk more about violin playing, and music in general, in the latter part of the book. Technique-wise he puts great emphasis on flexibility. He gets a little carried away when he compares the violin to the piano! (“Who could lavish affection on a piano? Or cuddle it, or carry it in his arms, or put it to bed in silk and velvet?”) He also discusses the school he set up in England. He even mentions Suzuki, by whose method I first learnt to play the violin.

His cultural commentary makes very interesting reading. As a travelling performer he has been to many, many different countries around the world, in peace-time and in war. He makes remarkable cultural comparisons based on his experience, for instance in regard to individual performers vs team and chamber players, and the corresponding differences in sight-reading ability.

I especially enjoyed Yehudi Menuhin's stories about his music because in some ways my own musical journey has been quite similar. I also began with violin (though not as early), and later added viola. I also am careful with my diet and (as I get older) with stretching before I play. And I also was an ugly violinist who married a beautiful wife!

The prose is easy to read, although being topically- rather than temporally-organised the story jumps around a little in place and time. My edition includes an index, of mostly names of people and places.

Recommendation: Worth reading if you like biographies or music, especially if you play strings—but beware if your favourite instrument is the piano!

New Year's Resolutions

First, how am I going with last year's? Okay, I think. Viola practice didn't happen quite as often as I'd like, and there is nowhere in Mackay for me to do any rock climbing, but otherwise I think I made some progress.

Some personal goals for this year:

• Continue working on my drum playing
  
• Waste less time (and spend it on worthwhile pursuits instead)
  
• Lift my level of prayer, care and giving for missionaries
  

On a related note, as you may know, a long-time goal of mine has been to put on some weight. I'm pleased to report that my gym program (and carefully-planned diet) is working well, and I am now over 65kg! (That's more than ever before in my life!)