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Six Bad Things That Can Happen If You Don’t Wear (And Care For) Your Contact Lenses Appropriately

Photograph: Richard Austin/Rex Features

I have been wearing contact lenses for about twenty five years. Overall, I’ve been very happy with them, and have found that they have improved my vision as well as my self-esteem. As a very nearsighted person, my glasses have the proverbial “Coke bottle” lenses. Even though I’ve chosen “ultra-thin” lenses, the refractory nature of the plastic causes my eyes to appear unusually small, giving me the appearance of a juvenile badger (they have pretty small eyes for the size of their heads – check out the photo).

Needless to say, I prefer wearing contact lenses – but I must confess that I’ve been somewhat non-compliant in wearing them according to my eye doctor’s instructions. I’ve learned a few things from my mistakes, and from interviewing optometrists Jason Pingel and Christi Clausson about other patients who have been naughty. I will summarize six of the most common mistakes that contact lens wearers make, and explain what the potential harms can be. You can listen to the full podcast of this interesting interview, here:

  1. Wearing Your Contact Lenses For Too Long – this was my biggest personal mistake. It’s tempting to wear your contact lenses beyond the recommended replacement schedule in order to save money, or for simple convenience. My contacts felt so comfortable that I’d wear them (don’t gasp in horror) for months at a time, even sleeping in them at night. But after a while my eyes started hurting when I took my contacts out, which just perpetuated the cycle of over-wear. In effect, I was depriving my corneas of oxygen for long enough to kill some of the superficial cells, so when I took my lenses out it was like removing a bandage from a wound. My corneas were sensitive to light, touch, and even the wind. This medical condition is called “superficial punctate keratitis” and although it’s reversible with eye rest, it is quite uncomfortable. If you wear your contacts for too long, this could happen to you.
  2. Using Tap Water To Re-Wet Your Lenses – Sometimes when a piece of lint gets in your eye or your eyes are feeling dry you may be tempted to rinse your lenses with some tap water. Although that seems harmless enough, tap water is not safe for use with contact lenses. Tap water is not sterile, and it can contain bacteria or even protozoa that can cause serious damage to your eye. Just as you would never drink salt water, you should never expose your contacts to tap water. The risk of eye discomfort, alteration of the lens, pH imbalances, or even infection is not worth the risk.
  3. Not Washing Your Contact Lens Case Regularly – At least a third of contact lens wearers report cleaning their cases monthly or less often. Obviously, mold spores and bacteria are not good for the eyes, so if you aren’t cleaning your lens case frequently you are putting yourself at risk for eye infection and allergies. Lens cases should be rubbed and rinsed with sterile solution recommended by your eye care provider, dried with a lint free towel or and allowed to air dry with both the case and cap(s) down before re-use.
  4. Not Changing your Contact Lens Solution – Dr. Pingel told me that many of his patients admit to “topping off” their contact lens solution or storing them in the same solution from the day prior. This increases the risk of bacterial growth in the solution and lens case. The way I think of it – it’s like having a surgeon simply wipe off her instruments on her gown between patients. It’s much safer for her to dispose of the instruments or have them sterilized before the next use, right? The same goes for contact lenses and their solution.
  5. Not Washing Your Hands Before Touching Your Eyes Or Lenses – Our hands are exposed to hundreds of different bacterial strains, molds, dirt, and chemicals every day. Not washing your hands with mild soap and water prior to touching your contacts is like touching your eyeball to a door knob. Why take the risk of introducing chemicals or bacteria into your delicate eye area? It’s very important to wash your hands carefully before insertion and removal of contact lenses so as not to increase your risk of infection, allergy, or chemical burns of the eye.
  6. Not Sharing Your Contact Lenses With Others (Or Buying Them Without A Prescription) – While that might sound like an uncommon practice, it actually becomes an issue around Halloween time. With cosmetic lenses that can make your eyes look like anything from a cat to a zombie, it is tempting to share lenses with friends. However, you should not purchase or wear cosmetic lenses without an examination by an eye doctor and a prescription to ensure they fit safely and comfortably. Delicate corneal skin can be scratched, irritated, or even infected by unclean or ill-fitting lenses. No one wants their real eyes to look scary, right? So please don’t buy lenses without a prescription or share your lenses with others.

For more information about safe wear and care of contact lenses, I highly recommend that you check out the Healthy Vision & Contact Lenses e-brochure. It is a terrific summary of all the most important do’s and don’ts of contact lens wear and care – perfect for double-checking on your safe use behaviors, or teaching your kids/teens about how to care for their lenses. Or you can use my blog post and podcast to badger them (pun intended), if that’s more convenient.

Disclosure: Dr. Val Jones is a paid consultant for VISTAKON® Division of Johnson & Johnson Vision Care, Inc.

Obama Administration Wants Patients To Report Physicians To The Feds

In another example of government over-reach, the NYT describes how the Obama administration is enlisting the help of patients to report physicians (whom they believe may have made a medical error), directly to the federal government. While there are systems already in place for such reports at the local hospital level, apparently the “under reporting of medical errors” has triggered AHRQ to pilot a program in which questionnaires are sent to patients to ferret out potential examples of errors caused by the following:

* “A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.”

* “A health care provider didn’t respect the patient’s race, language or culture.”

* “A health care provider didn’t seem to care about the patient.”

* “A health care provider was too busy.”

* “A health care provider didn’t spend enough time with the patient.”

* “Health care providers failed to work together.”

* “Health care providers were not aware of care received someplace else.”

So if a patient determines, for example, that a physician did not spend enough time with them, and they believe that resulted in a medical error (whatever that might be), they can/should report the physician to the federal government. Wow. One physician explains the potential hazards of such a process:

Dr. Kevin J. Bozic, the chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, said it was important to match the patients’ reports with information in medical records.

“Patients’ perceptions and experience of care are very important in assessing the overall success of medical treatments,” Dr. Bozic said. “However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.

“For instance, a patient may say, ‘I had an infection after surgery’ because the wound was red. But most red wounds are not infected. Or a patient says, ‘My hip dislocated’ because it made a popping sound. But that’s a normal sensation after hip replacement surgery.”

I believe that reporting medical errors is critical in the process of quality improvement, but that is most efficiently handled at the hospital level. There is no need to involve the federal government at the earliest stages of investigation, and the amount of bureaucracy required to support such an effort boggles the mind.

In the past when I encountered medical errors in the hospital setting, I found successful ways to report the incidents to the local administration. The result was a rapid correction of the problems and new processes put in place to ensure that it didn’t happen again. This is how medical errors should be reported and resolved. Soliciting patients for accounts of subtle lapses in social graces by their healthcare providers, and then reporting them to the government for it, is nothing short of Big-Brother creepy.

What To Expect If You Get The Flu

One of my dear friends just came down with influenza, and she asked me for some advice. Top of mind questions included – When can I go back to work? And when will I get better? So in a nutshell, here’s what I told her (borrowing heavily from the CDC website):

  1. The most common flu symptoms are: Fever or feeling feverish/chills; Cough; Sore throat; Runny or stuffy nose; Muscle or body aches; Headaches; Fatigue (feeling very tired)
  2. Adults shed influenza virus from the day before symptoms begin through 5—10 days after illness onset. However, the amount of virus shed, and presumably infectivity, decreases rapidly by 3—5 days after onset.
  3. Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.
  4. Uncomplicated influenza illness typically resolves after 3—7 days for the majority of persons, although cough and malaise can persist for >2 weeks.
  5. The 2011–12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010–11 vaccine. Annual vaccination is recommended even for those who received the vaccine for the previous season. Vaccination is the most effective prevention strategy available to reduce your risk of catching the flu.
My suggestions: Don’t go in to work (if you have the option) until 5 days after illness onset. If you go in earlier, you can wear a little face mask (and use Purell or other alcohol-based hand sanitizer) to prevent spread of the virus. Next year, get your flu shot early in the season.
As far as treatment is concerned, the Mayo Clinic recommends: LIQUIDS, REST, and TYLENOL or IBUPROFEN for pain. No vitamins or supplements have been shown to shorten the course of the flu.
P.S. My suggestions are relevant for “garden variety” flu sufferers. If you are immuno-compromised, elderly, or otherwise in a high risk category, please check out the CDC website for more information.

Motivation Is More Important Than Information At Reversing Obesity

I recently found my way to an interesting NPR podcast via a link from Dr. Ranit Mishori (@ranitmd) on Twitter. The host of the show interviewed a physician (Dr. Mishori), an obesity researcher (Sara Bleich), and a family nurse practitioner (Eileen O’Grady) about how healthcare providers are trying (or not trying) to help patients manage their weight. Several patients and practitioners called in to participate.

First of all, I found it intriguing that research has shown that the BMI of the treating physician has a significant impact on whether he or she is willing to counsel a patient about weight loss. Normal weight physicians (those with a BMI under 25) were more likely to bring up the subject (and follow through with weight loss and exercise planning with their patients) than were physicians who were overweight or obese. Sara Bleich believes that this is because overweight and obese physicians either don’t recognize the problem in others who have similar body types, or that their personal shame about their weight makes them feel that they don’t have the right to give advice since they don’t practice what they preach. While 60% of Americans are either overweight or obese, 50% of physicians are also in those categories.

Although it’s not entirely surprising that overweight/obese physicians feel as they do, it made me wonder what other personal conditions could be influencing evidence-based patient care. Is a physician with high blood pressure less apt to encourage salt restriction or medication adherence? What about depression, smoking cessation, or erectile dysfunction? Are there certain personal diseases or conditions that impair proper care and treatment in others?

Several callers recounted negative experiences with physicians where they were “read the Riot Act” about their weight. One overweight woman said she handled this by simply avoiding going to the doctor at all, and another obese man said his doctor made him cry. However, the man went on to lose 175 pounds through diet and exercise modifications and said that the “tough love” was just what he needed to galvanize him into action.

Dr. Mishori felt that the “Riot Act” approach was rarely helpful and usually alienated patients. She advocated a more nuanced and sensitive approach that takes into account a patient’s social and financial situation. She explained that there’s no use advocating personal training sessions to a person on food stamps. Physicians need to be more sensitive to patients’ living conditions and physical abilities.

In the end, I felt that nurse practitioner Eileen O’Grady contributed some helpful observations – she argued that the rate-limiting factor in reversing obesity is not information, but motivation. Most patients know what they “should do” but just don’t have the motivation to start, and keep at it till they achieve a healthy weight. Ms. O’Grady devoted her practice to weight loss coaching by phone, and she believes that telephones have one big advantage over in-person visits: patients are more likely to be honest when there is no direct eye contact with their provider. Her secret to success, beyond a non-judgmental therapeutic environment, is setting small, attainable goals. She says that if she doesn’t believe the patient has at least a 70% chance of success, they should not set that particular goal.

Starting goals may be as simple as “finding a workout outfit that fits.” As the patient grows in confidence with their successes, larger, broader goals may be set. Weight loss coaching and intensive group therapy may be the most motivating strategy that we have to help Americans shed unwanted pounds. Apparently, the USPS Task Force agrees, as they recommend “intensive, multicomponent behavioral interventions”  for those who screen positive for obesity in their doctors’ offices.

I think it’s unfortunate that most doctors feel that they “simply don’t have time to counsel patients about obesity.” Diet and exercise are the two most powerful medical tools we have to combat many chronic diseases. What else is so important that it’s taking away our time focusing on the “elephant in the room?”  Pills are not the way forward in obesity treatment – and we should have the courage to admit it and do better with confronting this problem head-on in our offices, and also in our own lives.

True Medical Detective Stories: A Great Little Book

I just finished reading True Medical Detective Stories, Dr. Clifton Meador’s personal collection of medical mysteries. Dr. Meador is a prolific writer and the former dean of the University of Alabama School of Medicine and professor at Vanderbilt School of Medicine. His 50+ years in the academic arena have exposed him to some delightfully rare and bizarre medical cases, and he shares his top 18 in this pithy little book.

Dr. Meador was inspired by Berton Roueché, a staff writer at The New Yorker, who helped to popularize the medical detective story genre in the 1940′s and beyond. Each vignette is between 3-5 pages in length, making for a very quick and entertaining read. In choosing to review this book I was very tempted to give away details of some of the cases in order to entice you to read it, but I have resisted the urge so as not to spoil the fun.

Broadly speaking, the stories include a rare case of intractable hiccups, a bizarre infection caused by sexually deviant behavior, and several examples of the power of the mind to inflict bodily harm on oneself and others. In each situation, the underlying cause of the symptoms or disease is uncovered through careful listening and analysis. Often, human shame and fear must be managed before the truth can bubble to the surface.

I highly recommend this book to healthcare professionals, skeptics, and anyone interested in a fascinating look at some of the most unusual medical cases described in one book. Perhaps we can all learn to become better listeners, or true “medical detectives,” from Dr. Meador’s stories. You can find his book here at Enjoy!

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