Here are the things to avoid.  Do not get the implants that claim to offer variable focus.  The present one available here in the US is disappointing at best and many have been removed.  I have talked to several ophthalmologists about this as I have a cataract in progress from either my cancer or chemo.  Our place is where the doc's in town get their glasses so I get to pick the minds of the cream of the crop.

The goal of cataract surgery should be to replace the crystalline lens with an implant and restore the patient's distance vision to plano or no correction.  There are some doc's who want to offer mono vision in the process.  This is the condition where one eye sees far and the other near.  They promise no glasses in the outcome.  The drawback is that the patient loses depth perception.  This is a real problem for navigating elders in the case of driving, walking and negotiating stairs.  I feel very strongly opposed to this.  It can be overcome with distance only glasses to neutralize the effect, but I would rather have perfect distance at all times and use glasses for reading.  The patient is going to need glasses for something so it might as well be reading, rather than successfully getting around without crashing, tripping and stumbling.

Medicare pays for most all of the surgery, it is a universal medical condition and pretty much a standard procedure which Medicare is geared to facilitate.  Medicare also has a once in a life time benefit where the post op patient is entitled to get coverage for a complete pair of new glasses after surgery.  That is a new frame and a lens for each eye.  Surgery done on one eye, get a new frame and one of the two lenses is covered.  Second eye done and the new lens for that eye is covered.  The difficulty is during the time in between having the other eye operated on.  Old lenses will no longer be appropriate or useful. 

Most optical dispensaries will accept Medicare payments for the new glasses, but the benefit will pay most but not all the cost, unless you get the most primitive glasses.  Get what is needed, comfortable and make the patient happy and pay the difference.  More than likely these frames will be around for a long time.  You can change lenses in the existing frame as time goes on.  So choose the frame wisely. 

After the surgery, the eye's vision is unsettled for some six months and the new Rx given in the first few days is going to be pretty different from the one six months later when the patient usually goes in for follow up care.  So when buying glasses, find out what the store's policy is regarding Rx changes.  Stay away from the chains.  Most offices offer a 2 to 6 month window for a one time no charge replacement due to an Rx change or error.  You can find out by calling and make sure you get some written assurance.  This is also challenging for the patient as it does require a lot of running around and time to get things done.  But that's the way it is.  Also find out if the store can replace the lenses without your mom having to leave them behind during the wait while they grind the new lens..  Most should be able to order the lens and then she can go in and have it cut to fit while she waits in about a half an hour.  Stay away from places that do not have that capability.

So fear not about the surgery and don't allow it to be put off.  When it's done properly, it is an immediate quality of life improvement, in spite of all the running around required.  One of the first comments post op patients have is I can see the true colors again.  They are no longer looking through a cloudy yellow tinged lens.  So get your mom thinking about doing it and not putting it off.  When picking the ophthalmologist, the more experience the better.  Have your mom find out whose surgeries went well and whose went south.  I'm sure she has had some of those conversations already and that could be a factor in her hesitance to get it done.  But it must be done.  The alternative is a dog and a cane.

Hope this gives you enough to get the ball rolling.  Please ask me any questions that you may have as they come up.  No question is stupid or silly as you know. 

Researcher's labour of love leads to MS breakthrough

Link to article on the Globe & Mail web site.

Got me thinking of RedBill...

This could be a pain in the neck for you—

Musculoskeletal Disorder

Some people whose jobs involve intensive keyboard use have reported experiencing pain in their wrists, arms, and neck. This type of disorder has been variously categorized as regional musculoskeletal disorder (R-MSD), cumulative trauma disorder (CTD), and repetitive stress injury (RSI). These are "catch-all" terms that refer to a variety of soft-tissue ailments in the upper limbs such as tendonitis, tenosynovitis, rheumatism, and carpal tunnel syndrome, and are not specific medical diagnoses. Pain or discomfort that persists or impairs your normal activities should be evaluated by a qualified medical practitioner to define the precise nature of the disorder, institute appropriate treatment, and identify causal or aggravating factors amenable to modification.

In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis)...

The lumbar region is sometimes referred to as the lower spine. The five vertebrae in the lumbar region of the back are the largest and strongest in the movable part of the spinal column, and can be distinguished by the absence of a foramen in the transverse process, and by the absence of facets on the sides of the body. In most mammals, the lumbar region of the spine curves outward.

The actual spinal cord (medulla spinalis) terminates between vertebrae one and two of this series, called L1 and L2. The nervous tissue that extends below this point are individual strands that collectively form the cauda equina. In between each lumbar vertebra a nerve root exits, and these nerve roots come together again to form the largest single nerve in the human body, the sciatic nerve. The sciatic nerve runs through the back of each leg and into the feet. This is why a disorder of the low back that affects a nerve root, such as a spinal disc herniation, can cause pain that radiates along the sciatic nerve (sciatica) down into the foot.

There are several muscles in the low back that assist with rotation, flexibility and strength. These muscles are susceptible to injury, especially while lifting heavy objects, or lifting while twisting. A low back muscle strain can be extremely painful but will usually heal within a few days or weeks.

The lumbar portion of the spine bears the most body weight and also provides the most flexibility, a combination that makes it susceptible to injury and wear and tear over time. This is why low back pain is so prevalent.

Function: adjective
Etymology: New Latin lumbaris, from Latin lumbus loin
Date: circa 1656
: of, relating to, or constituting the loins or the vertebrae between the thoracic vertebrae and sacrum

Treatment of lumbar problems is very straightforward and follows a few anatomic principles...

What Makes People Better?
Time, knowledge, strength, body mechanics, braces, anti-inflammatories, specific steroid injections, surgery

What Makes People Worse?
Ignorance, prolonged bedrest, prolonged short acting narcotics and CNS depressants, surgery

Imaging
MRI-best screening test. Doesn't show stenosis as well as CT but covers conus to sacrum. Skip lesions are common in stenosis.  CT-radiation. Visualizes bone.  Myelography-new contrast agents relatively benign. Will occasionally elicit a lesion that is dynamic or positional missed by other tests. Best view of central stenosis.  Discogram-only test to show what hurts. Disco-CT scan is most sensitive test for disc abnormalities. l/lOOO infection rate. A pre-operative test usually for staging the scope of the procedure.  EMG-uncomfortable but very useful in following nerve damage, diagnosis of neural abnormalities.

Medications
Back problems often last a long time. Narcotics inhibit recovery in general, make people irritable, depressed, insensitive to body mechanics, lower pain tolerance and create occasional albatrosses. They are ok for a week or so. The same is true for CNS depressants like Valium. Tricyclics and heterocyclics very useful in the long run.  Non-steroidal anti-inflammatories sometimes help. Oral steroids not as effective as injection into the site of pathology but avoid the injection.

Hashimoto's vs. Hypothyroidism: What's the Difference?

A Look at Autoimmune Thyroid Disease and Underactive Thyroid Conditions
By Mary Shomon, About.com

Updated: June 18, 2009

Hashimoto's disease is a disease, and hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Here is more information to help understand the difference.

HASHIMOTO'S DISEASE

Hashimoto's disease, sometimes known as Hashimoto's thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis, is an autoimmune disease. In Hashimoto's, antibodies react against proteins in the thyroid gland, causing gradual destruction of the gland itself, and making the gland unable to produce the thyroid hormones the body needs.

Diagnosis

Hashimoto's disease is typically diagnosed by clinical examination that demonstrates one or more of the following findings:

Enlargement of the thyroid, known as a goiter
High levels of antibodies against thyroglobulin (TG) and thyroid peroxidase (TPO), detected via blood test
Fine needle aspiration of the thyroid (also known as a needle biopsy), which shows lymphocytes and macrophages
A radioactive uptake scan, which would show diffuse uptake in an enlarged thyroid gland
Ultrasound, which would show an enlarged thyroid gland

Symptoms

Symptoms of Hashimoto's can vary. Some people have no symptoms whatsoever, and will have no demonstrable symptoms of the underlying condition. For many Hashimoto's patients, the thyroid becomes enlarged, a condition known as a goiter. The goiter can range from slight enlargement, which may have no other symptoms, to a substantial increase in size.

Some people with Hashimoto's, especially those with a larger goiter, may feel discomfort in the neck area. Scarves or neckties may feel uncomfortable.

The neck may feel swollen or uncomfortably enlarged, even sore. Sometimes the neck and/or throat is sore or tender. Less commonly, swallowing or even breathing can become difficult if a goiter is blocking the windpipe or esophagus.

Hashimoto's typically involves a slow but steady destruction of the gland that eventually results in the thyroid's inability to produce sufficient thyroid hormone — the condition known as hypothyroidism. Along the way, however, there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto's disease. So, for example, periods of anxiety/insomnia/diarrhea/weight loss may be followed by periods of depression/fatigue/constipation/weight gain.

In some cases, the onset of Hashimoto's and elevation of antibodies will be accompanied by a variety of symptoms, including anxiety, difficulty sleeping, fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, and fertility problems, among others.

Treatment

If a goiter causes difficulty swallowing or breathing, or is a cosmetic problem, then thyroid hormone replacement drugs (i.e., levothyroxine or natural desiccated thyroid) will usually be given to help shrink the thyroid. If drug treatment does not work, or the goiter is too invasive, then surgery to remove all or part of the thyroid may be recommended.

Except in the case of a goiter, most endocrinologists and conventional physicians will not treat Hashimoto's disease, as diagnosed by elevated antibody levels, unless other thyroid function tests such as TSH are outside the normal range.

There are, however, some endocrinologists, as well as holistic MDs, osteopaths and other practitioners, who believe that Hashimoto's disease — as confirmed by the presence of thyroid antibodies — along with symptoms, are enough to warrant treatment with small amounts of thyroid hormone.

The practice of treating patients who have Hashimoto's thyroiditis but normal range thyroid function tests is supported by a study, reported on in the March 2001 issue of the journal Thyroid. In this study, German researchers reported that use of levothyroxine treatment for cases of Hashimoto's autoimmune thyroiditis where TSH had not yet elevated beyond normal range (people who were considered "euthyroid") could reduce the incidence and degree of autoimmune disease progression.

In the study of 21 patients with euthyroid Hashimoto's Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated. After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same.

The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto's disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto's disease, or perhaps even prevent development of the hypothyroidism.

In the area of nutrition, promising findings from a number of research studies have pointed to the value of the mineral selenium in helping to combat autoimmune thyroid disease.

Some studies have shown that selenium supplementation at the typically safe dose of 200 mcg per day can return elevated thyroid antibody levels to normal, or reduce them significantly, therefore warding off development of full autoimmune thyroid disease, and resulting hypothyroidism.

Ultimately, however, the autoimmune attack on the thyroid makes the gland slowly less able to function, and eventually, the thyroid becomes underactive. When hypothyroidism itself can be measured by blood tests, many practitioners will finally diagnose the hypothyroidism, and treat the patient with thyroid hormone replacement drugs.

Autoimmune Thyroiditis Atttacks

In some cases, the thyroid becomes particularly inflamed, known as a thyroiditis attack. Dr. Steven Langer, author of the book Solved: The Riddle of Illness, refers to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms are anxiety, panic attacks, heart palpitations, swelling in the thyroid area, problems swallowing, and frequently, problems sleeping.

"Thyroiditis attacks classically happen in the middle of the night," says Dr. Langer, which can be particularly troublesome in terms of the ability to sleep.

Dr. Langer suggests taking some calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation — buffered aspirin or ibuprofen — before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.

Reducing swelling is a key aspect of dealing with thyroiditis attacks, according to Dr. Langer. "Just as with arthritis, an anti-inflammatory pain reliever doesn't cure the problem, but it temporarily ameliorates the symptoms."

HYPOTHYROIDISM

Many people with Hashimoto's disease end up hypothyroid, the situation where the thyroid is either underactive or, eventually, totally unable to function. Hashimoto's disease is a disease, and is the leading cause of hypothyroidism, which is a condition. The other causes of hypothyroidism include, among others:

Graves' disease and hyperthyroidism treatments including radioactive iodine treatment (RAI) and surgery
thyroid cancer treatment, including surgery to remove all or part of the thyroid
surgical removal of all or part of the thyroid as a treatment for goiter or nodules
use of antithyroid drugs (such as Tapazole or PTU) to reduce thyroid activity
use of certain drugs, such as lithium
The diagnosis and treatment of hypothyroidism itself is a detailed topic, and you can read more about it here at the site:
Hypothyroidism Symptoms Checklist
HELP! My TSH Is "Normal" But I Think I'm Hypothyroid
How to Tell If You Are Hypothyroid
Quiz: Could You Be Hypothyroid?

REFERENCES

Thyroid, 2001 Mar;11(3):249-55, "One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit?"

June 2001 Findings of the 83rd Annual Meeting of the Endocrine Society, Denver, Colorado

Beckett GJ, Arthur JR. "Selenium and endocrine systems." J Endocrinol. 2005 Mar;184(3):455-65.

Oct. 2002, The Journal of Clinical Endocrinology & Metabolism, Vol. 87, No. 4 1490-1498