Busy day on Monday
Two appointments on the same day, an hour apart but also seven miles apart! Starting in Bingley with a check up from the diabetic nurse, followed by a trip into Bradford to see the Opthalmologist. I can’t drive after seeing the eye specialist and not enough time for public transport so hd to enlist the services of my chauffeur!
Nurse consultation
Started off with the usual questions about health in general, weight, smoking (not for over 20 years) and drinking (still too much) and exercise. Fortunately I am in good health generally and resonably fit and active. Despite this my blood pressure is always high whenever I see the nurse. This is strange as I can measure at home and get nice low readings. Recently I also had an operation on my hand, due to Dupuytren’s contracture. Just before going in for surgery my BP was 131/66! If you are interested in Dupuytren’s you might like my other blog on this topic – www.thevikingfist.com.
After taking a couple of blood samples, for HbA1c and general blood screens, it was time for the feet. Blood flow in the feet and ankles is routinely measured using a doppler ultrasound device. It is quite reassuring to hear my blood flowing well in both feet! This was then followed up by testing the sensitivity of the soles of my feet. For this simple testthe nurse uses a plastic prod (officially a monofilament) to touch various part of the foot, with the instruction to close your eyes and say yes if you feel anything. Again, happy to say I passed the test.
Foot monitoring is important as diabetes can severly affect the blood flow to the feet which, besides peripheral neuropathy, can lead to other complications including poor healing of any skin damage. Serious cases can lead to amputation. Statistics from Diabetes UK show that diabetes leads to 184 leg, toe or foot amputations every week. Put another way that’s 26 amputations a day or 1 every hour. More information on foot health can be found at https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/feet/what-can-i-expect-at-my-annual-foot-check. Looking after your feet is really important.
I was a bit surprised to be asked if I moisturised my feet. Apparently this is often recommended to diabetics to help maintain health skin. I dont moisturise, full stop, so had never considered doing my feet. Fortunately I have such good skin that I don’t need to!
Opthalmology clinic
So into the car and off to the Macula Centre in Bradford. Fortunately the traffic wasn’t too bad so we arrived in good time. After checking in at reception it was a case of going through the various stations. First up, an eye test. The usual rows of letters of decreasing size. I managed the bottom row with my right eye but had to admit it was a bit blurry with the left, just about doable but probably not a good test as I could remeber the letter sequence! In the same room i had my eyeball pressures measured before pupil dilating drops were administered.
The top image is my oedema on my previous visit to the clinic shown as a heat map. Green is normal retinal thickness, yellow to red for increasing thickness and the white are being the maximum thickness. The numbers in the grid give an average thickness in each section. Note the retinal thickness is measured in micrometers, there are thousand micrometer in every millimeter. This gives some idea of how thin and delicate the retina is.
The middle image shows the oedema on my recent visit. Happily it has shrunk considerably and hopefully this will continue until it disappears.
The lower image shows the change between the two.
My thanks to Ms Shetty, the opthalmologist for taking the screen shots for me.
What now?
The opthalmologist was very pleased with progress since my last visit and treatment. The expectation s that the oedema will continue to shrink as the steroid implant continues to do its job. The implant lasts 3 – 6 months so plenty of time left yet. So no further treament required at this stage.
I’ll have another appointment in around 8 weeks time. As explained, the oedema may come back at some point so there will have to be regular monitoring. Some patients require multiple rounds of treatment. The important thing is to keep good control of my diabetes as this will greatly reduce the chance of recurrence.
