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.

I'm back

It's been a while (ok, a few years!) but I've decided to come back here. I've been doing so much reading, for my studies. And I've been doing so much consuming—maybe even too much. I've deactivated my Facebook account for now (gasp!) to stop myself wasting so much time there. Instead, I want to create. I need to get better at essay-style writing (for my studies) and the best way to get better at that is to practice: that is, to write.

I don't know how much time I'll be able to set aside for writing. But I want to do more. I want to write more.

Land ownership

Today was settlement day: We now own 4+ acres of vacant land in Logan Village!

We started looking back in April. Our weekends for a few months there consisted of going out looking at various houses and blocks. Almost every place we saw had something wrong with it: house too small, land too swampy, neighbours too close. We found one place we liked in Logan Village, but God had other ideas: We were outbid by another buyer. We found another place in Logan Reserve, but the land was a bit sandy and we would have had to do some work to the house as well (building in underneath).

We kept going back to this one vacant block, on the hill on the eastern side of Logan Village. And in the end, we decided we should just buy it and build our own house. So that's what we're doing.

It's a steep block (about 26°). But the views are fabulous, out to Flinders Peak.

So now we just have to clear the lantana and other weeds, build some fences, design a house, get Council approval, …

A busy semester

Well what can I say? Sorry it's been so long. It's been a very busy first semester.

As I wrote earlier, this year I'm teaching Year 11 and 12 Maths A, and Year 10, 11 and 12 Physics. The Physics classes are going much better this year, since it's now my second time around—especially since the start of term two (I only started teaching Year 12 Physics in term two last year). My revised and extended Year 10 Physics unit is definitely an improvement. I'm even collecting and marking the assignments electronically now. I wonder if I can figure out a way to get them to do their exams online too…?

I am missing the Year 10 Prep Maths A, though.

Other than that, I enjoyed my lecturing at CHC, although it was a lot of work. That's finished now; I didn't even have to create a supplementary exam! (Which is not the same as saying that all the students passed…)

So far this semester has been much less stressful. I hope it stays that way.

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:

Not living next to the school

Well, I think it has been a successful year. Not living next to the school this year has meant that I have been much better able to separate my work and home life. I didn't go to school on the weekend even once! :-)

(Quite a change from when we were in Mackay, living 10m from the staffroom over the back fence…)

Quilt Extravaganza

Today Laetitia took me to a quilt show in Cleveland. It was held at the Redland Performing Arts Centre (in the same place, I think, as my Senior Dinner back in 1991). Some of the quilts were amazing—intricate details, creative ideas, all kinds of sizes and patterns. My personal favourite was one made by a mum for her son. It had these fantastic comic strips with the boy being a hero, along with exciting designs of space travel, dragons, and fishing (apparently the five-year-old boy likes going fishing).

But an additional highlight of the day for me was seeing there an old English teacher from high school, Anne Green. (Hmm, and here I need a Shakespearean quote about teachers or teaching. Ideas?)

Reflections on Easterfest 2010

Laetitia took me to Easterfest this year. She's a regular goer, since before it changed its name, and has been wanting to take me along for years. This year I finally let her take me along.

We camped with friends from Mackay, in a borrowed tent. Well, when I say “we camped”, actually only Laetitia camped in the tent. I found on the first night that I was getting an allergic reaction to something in the tent, so I spent the nights in the car instead. But it was good to be in the midst of hundreds of tents, with many friends around. I especially enjoyed the discovery directly across from us of the tent of Benoir (I hope that spelling's right), one of the leaders on the year 9 camp I went to not long before Easter!

I also enjoyed running into so many friends walking around at Easterfest—old friends, new friends and students. With special thanks to Lily for the warm welcoming greeting within barely a minute of entering the gate!

But the point of Easterfest is the music, so I'd better say something about that, hey?

First let me start with what I didn't like: Too much noise without musicality, mostly from one tent in particular. But there were plenty of very good alternatives. I liked Sons of Korah, of course, and Newsboys on the main stage (even though there's only one Aussie left, and he's apparently not an original member either). Also enjoyed some of the other groups on the main stage (though not all of them). But I think my favourites were the “smaller” (lesser-known?) artists in venues like the YWAM Chai Circle, with its lovely relaxed atmosphere and intimate setting, and the jazz in the Hammered Silver tent. Bel Morrison and her band made some awesome music in the YWAM tent—and I'm not just saying that because she's my friend! They played really well together, with delicacy and musicality and, well, just actually listening to each other and playing as a group instead of trying to drown each other out like so many others.

I also enjoyed sessions by Jeff Crabtree and Steve Grace in the Vision Arena. Steve Grace in particular inspired me to think quite differently about how to be generous with some of my gifts.

So, overall, a positive experience, but I'm still not sure I want to go back next year. Cold, crowds, and uncomfortable nights are less than enticing.

It's been a while… Sorry.

I've been so busy. And I haven't written here for ages. But my head is buzzing with ideas—not just for here, but also for my photography blog. And although I'm still vacillating, I think I really do want to sell my photos.

School has been … full-on. I'm now teaching year 12 Physics (in addition to the year 11 class) instead of year 7 PE. Which I think is an improvement! I'm enjoying the rotation through the classes in year 10 Science; I'm getting to know all of the year 10s (well, three classes so far, and the last class next term).

I've also enjoyed being a leader on a Scripture Union camp over the winter holidays. And last weekend Laetitia and I went up to Mackay for the Student Festival of Fashion—and to see old friends. Catching Bel Morrison at our church there was a special surprise!

Should I write more detailed posts about any of these? Let me know…

Term 1 at a new school

Phew! Term 1 is finished.

My new school is quite similar to the one I left in Mackay: both Christian, about the same size, K-12. If anything, the students here are more obedient, although not necessarily less lazy.

I'm teaching Physics and Maths A in year 10 and 11, plus an odd mix of other things - year 9 ICT and Christian Foundations, and a year 7 PE class!

I'm not sure what else to talk about here, so feel free to ask questions…

Renting a house in Brisbane

To all those well-meaning people who told me that the rental market in Brisbane has become “pretty bad”, and that it is now “quite hard” to find a place to rent, I have one thing to say: With all due respect, you have no idea!

I went to Brisbane for a few days last week, to look for somewhere for us to live in 2010. I spent most of my first day there, Wednesday, driving around Kingston, Loganlea, Waterford and Loganholme getting rather demoralised because the only place I managed to see the inside of had mouldy ceilings (we're trying to escape all that!). Nevertheless, on Thursday I started in Eagleby, and I found three places that would suit us very well and a handful of others we could live with, scattered around these suburbs. On Friday I saw yet another really nice house.

So we put in applications for our favourite four to three real estate agents, and I flew back to Brisbane on Saturday with a reasonable hope that we'd be approved for at least one of them. Today (Wednesday) we were approved for the place I saw on Friday, in Loganlea. We've just signed the lease (by email-print-sign-scan-email back, because the quality is better that way than by fax).

Seriously: If you want to experience a hard rental market, move to Mackay. It took us two months to find a place to rent here, and in the end we only got this house by word of mouth, not through real estate agents or advertising. (And if you want to see just how bad renting can get, try Moranbah, where a three-bedroom house costs at least $600 a week.)

However, I am glad I went to look during the week. On Saturday morning I inspected a house in Loganlea. We had to go through in groups of three because the tenants were still there. I was in the second group. There were still people driving up when I came out! (In comparison, when we first moved to Mackay, Laetitia was going through rental houses in groups of about ten, and there would be at least four such groups looking at each place.)

Thank-yous after three years

Perhaps one really does have to leave to get people to actually say “thank you”. Certainly I've received more thanks than usual at the end of this year.

My fellow maths and science teachers signed a card for me, and pooled contributions to get me a gift of a couple of games: Tantrix and Rush Hour. The former I'm enjoying already; the latter I plan to use in my classroom. Both are about building logical and spatial reasoning skills.

I also received many thank-you cards from students. I thought I'd share a few of their nice comments. They have honoured me greatly with their kind words.

In first term this year I taught Maths B in year 11, but then the classes were reorganised and I switched to teaching Maths A instead. There were a few students in that Maths B class who I continued to help with their maths in after-school tutoring—and many other times when they asked! It seems some of them still think of me as their maths teacher:

I was a private maths tutor to one student since the end of last year. In our tutoring sessions, as well as working on maths, we discussed many topics including dealing with stress, time management, careers and life after school, … and we prayed together.

When I was studying to be a teacher, I was warned that I wouldn't see some of the best fruits of my work for years. Here's (part of) a lovely letter from one student who I first taught two years ago, and then again this year:

But I will finish with a short note written for me at the end of the last day of school. Rushed, unprompted, but so meaningful to me:

On practicum during my studies, my mentors and lecturers were always commenting on my apparent passion for my subject. I really wanted them to be commenting on my love for my students. But it's very hard to build up that kind of relationship in the context of a four-week prac. Now, three years into my teaching, and with God's constant help and guidance, it seems I'm finally getting somewhere.

Thank you, Father, for an amazing three years. Thank you for all that you've taught me about being a good teacher. Thank you for the lovely encouraging words from my students. Thank you for allowing me to be such a big part of their lives, and for encouraging and growing their passion for and enjoyment of learning through me.

Ian's core values

Funny how some things don't change—at least, not in a hurry.

I've been going through old stuff in preparation for our move to Brisbane, and it's providing me with a good opportunity for reflection on my first three years of teaching. This afternoon I rediscovered some notes I'd made during one of my teaching pracs. At that time I decided my core values for my classroom were:

• Respect for others and self
• Build others up
• Self-discipline
• Follow God's leading

These lead on to a similar number of simple classroom rules, but that's not the point here. This is: in the last three years, these core values haven't changed. I wrote these up before I started teaching full-time, and in the mean time I have imbibed, digested and regurgitated my school's own philosophy and value system. My teaching skills and strategies have grown from almost nothing to—well, perhaps I can now call myself a teacher, although not yet one good at managing a large class of thirteen-year-olds. My opinions on many aspects of teaching and learning have changed as my ideas have been challenged, bruised, mangled or proven downright absurd through daily testing at school. But in the end, I still think these four statements sum up what I feel should be valued most highly in my classroom.

Interesting, no?

(PS- For my teacher friends, a challenge for you to think through. What are your core classroom values?)

I have a job!

Next year I will be teaching at Calvary Christian College. No, not the one in Townsville; we're trying to escape from the humidity, remember! This is the one in south-east Queensland, at Carbrook, just north of the Logan River. I will be teaching senior Physics, and some combination of Maths and Science.

Making dinner

I enjoy cooking.

Today I came home already feeling a bit run down, the shopping wasn't done yet, lots to do, gotta go out at seven, time is short… One of those days. Oh, and since Laetitia's going to do the shopping, I have to make dinner too. And there's almost nothing in the fridge to make it with.

Rummage around for ingredients. Change my mind a couple of times about what to make, based on what I (don't) find. Oh, and when the shopping comes back there'll be things to put away, too.

But once I actually start cooking— I dunno, I just start to feel better. Is it the smell of the spices? The frying garlic? The soothing action of stirring the pan? The sound of the onion sizzling in the warm oil? Actually I think it's as much the creativity: God the Creator has made me in his image, and I thrive on making something out of—well, not out of nothing; out of the raw ingredients that God has made.

And by the time dinner is ready, I'm feeling much better. I enjoy cooking.

Invited to dinner

Twice this week, Laetitia and I were invited to dinner by friends from church.

On Tuesday we spent the evening with Miranda and Lawrence and their three children. Miranda cooked us a delicious meal including a fabulous white cake for dessert, in spite of her nervousness about cooking for our special diets. We met their dog Boaz, ate outside on the back patio, and finished the night by watching Shrek the Third on their (rather large) TV.

On Saturday we spent the evening with Fiona and Craig and one of their children (Brandt). Now Fiona once ran a catering business. She (and Craig) cooked up a veritable feast! There was so much food! She had gone to some effort to prepare menus for us and all, printed on fancy paper:

(I've scanned the back of Laetitia's menu at the side, so you can see the back of the fancy paper.)
We took some photos of all the food too:

Over dessert we played 500 (teaching Brandt how to play in the process). Oh, and we also met their dog Tess, their new puppy Electra and their cat Sonic.

Thanks Miranda and Fiona for fabulous meals and great company—and for taking such care to feed us so well.

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.

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.