[onsmash http://videos.onsmash.com/v/L7gNvKWambv1Hlim]

Al tipo le falta un ojo. Prueben taparse un ojo y agarrar al bjeto cercano. Cuesta un poco mas no? Eso se debe a q perdomos la profundidad de la 3era dimension o algo asi. Bueno, volviendo al gato, pense q por ahi le cuesta mas treparse a los árboles, paredes, etc. y sólo se dedico a la buena vida... comer, domir y...

An eye for an eye saves the other eye.

Now you can have anti-aging and priming benefits in one product! TimeWise® Age-Fighting Lip Primer creates healthier-looking lips by fighting fine lines and wrinkles while light-diffusing microspheres decrease their appearance. Use it on lips, inside and outside your lip line, to extend lipstick wear and prevent lipstick and lip gloss from feathering and bleeding. Based on a 12-week clinical study, a dermatologist saw 100 percent of the panelists had an improvement of fine lines on lips.

Satin Lips® Lip Mask contains miniature buffing beads that gently exfoliate dead surface skin cells that cause lips to appear dull and lifeless.

Satin Lips® Lip Balm helps moisturize dry, rough lips. Clinical results show that a single application of Lip Balm moisturizes lips for at least six hours.

TimeWise® Firming Eye Cream - Ninety-six percent saw an improvement in the overall appearance of the skin around their eyes.* Experience the results for yourself!  Just imagine a luxuriously rich eye cream so advanced it firms, brightens, provides intense moisturization, plus minimizes fine lines and wrinkles. With new TimeWise® Firming Eye Cream, you can have it all. It delivers more benefits for the younger-looking eyes you want to see.

Indulge™ Soothing Eye Gel - Revive a tired-looking appearance with this cool, soothing gel. Contains botanicals reported to tone, firm and reduce the appearance of puffiness in the eye area. Can be used as a mask or a leave-on product.

SHOP NOW

KAMILA SALAZAR

My vision is supposed to continue to get better and stabilize in the next few weeks, but already I can see unaided. I'm still reeling over it. Yesterday I was walking around on cloud 9, smiling and saying "hi" to random people on the street. I have a few burst blood vessels in my left eye, so I look like I have pink eye or something. Those are supposed to go away in the next couple weeks.

Rheumatoid arthritis (RA) is a common disease that affects about 1% of the population worldwide. Women are affected almost 3 times as often as men. The prevalence increases with advancing age, and 4% to 6% of the white population older than 65 years may have RA. Although the cause is unknown, evidence suggests an association between severe RA and HLA, particularly to alleles coding for a shared epitope on the HLA-DRB1 molecule.

Major features of active disease include symmetrical polyarthritis with joint swelling and tenderness and morning stiffness lasting for an hour or longer. Subcutaneous nodules, presence of rheumatoid factor (in about 80% of patients with RA), and radio graphically evident erosions or juxta-articular osteoporosis in or adjacent to the involved joints are further characteristics of RA.

The onset and clinical course of RA are variable. Gradual onset is most common. About 20% of patients will have a monocyclic course, which will abate within 2 years, whereas the rest will have a polycyclic or progressive course.¹ The long-term prognosis of patients with abrupt onset of disease is similar to that for patients with gradual onset of disease.²

Rheumatoid arthritis is one of the most common causes of disability. After 12 years of disease, more than 80% of patients with RA are partially disabled, and 16% are completely disabled.³ Life expectancy is shortened by an average of 7 years in men and 3 years in women, an outcome equivalent to the increased mortality of patients with Hodgkin disease, diabetes, and stroke.⁴ Factors contributing to the poor prognosis include the presence of extra-articular disease and infections, as well as complications of treatment such as gastrointestinal (GI) toxic effects of nonsteroidal anti-inflammatory drugs (NSAIDs).

MANAGEMENT PRINCIPLES

The goals of therapy for RA are to alleviate pain, control inflammation, preserve the ability of the patient to function in activities of daily living and work, and prevent joint destruction. Appropriate and timely therapeutic intervention after accurate diagnosis diminishes not only the symptoms but also the progress of RA. The primary care physician has a crucial role in this process by early recognition of the symptoms of RA, leading to its diagnosis and use of the resources necessary to establish a successful treatment program to achieve these goals, and by participating in the ongoing management of the patient with RA.Early in the course of RA, education on the disease and vocational, lifestyle, and family counseling must be provided. Patients are best served by a multidisciplinary team that includes a rheumatologist and other specially trained medical personnel, including nurses and occupational and physical therapists skilled and knowledgeable about RA. Physical modalities such as joint protection, orthotics and other adaptive devices, and exercises improve the symptoms, function, and well-being of the patient. Adequate rest reduces the fatigue associated with active RA, and resting the involved joints lessens the symptoms of inflammation.

THERAPY

Nonsteroidal anti-inflammatory drugs reduce inflammation and help relieve pain but seldom completely eliminate signs and symptoms of active arthritis. They inhibit 1 or both types of cyclooxygenase (COX). Cyclooxygenase-1 is constitutively expressed in the GI mucosa, kidneys, platelets, and vascular endothelium. Cyclooxygenase-2 is functionally expressed and promotes the elaboration of prostaglandins in inflamed tissues.

Selective blockage of COX-2 may lead to an improved safety profile for these agents. Celecoxib and rofecoxib are the first such agents available in the United States that selectively block COX-2. Rofecoxib is withdrawn from the market due proven increase in cardiac risk.  Of importance, the efficacy of these COX-2 inhibitors does not differ substantially from that of conventional NSAIDs. Their putative advantage is principally because of a reduced rate of adverse events, especially upper GI bleeding.⁵ Cyclooxygenase-2 inhibitors should be considered in patients at high risk of GI bleeding, including those older than 65 years and those with a previous history of GI bleeding. Despite advantages, these drugs may be associated with important adverse reactions, including allergy and fluid retention, and like other NSAIDs should be used with caution in patients with renal insufficiency.

Glucocorticoids are the most potent suppressors of inflammation and may be needed to control severe polyarticular disease until disease-modifying antirheumatic drugs (DMARDs) have been added and become effective. At that point, the glucocorticoids should be tapered and discontinued. Glucocorticoids should not be used alone in the management of RA. Oral prednisone or an equivalent is given in dosages typically ranging between 2 and 15 mg/d, often in divided doses (eg, 2 mg twice a day). A split-dosing regimen is frequently necessary because the anti-inflammatory effect is relatively short. It is preferable, but often not possible, to avoid long-term glucocorticoid therapy in patients with RA because of the well-appreciated adverse effects of these drugs. Systemic extra-articular manifestations such as rheumatoid vasculitis may require treatment with initial prednisone dosages of 40 to 60 mg/d, tapering according to response.⁶ Intra-articular injection of glucocorticoids is an effective means for reducing pain and inflammation in individual recalcitrant joints.

Disease-modifying antirheumatic drug therapy is associated with reduced morbidity and mortality in patients with RA.⁷ It should be used when the diagnosis of RA has been established and before erosive change appears. Disease-modifying antirheumatic drugs are usually given with NSAIDs and glucocorticoids, if needed. The DMARDs currently in use are listed in Table 1. The mechanism of action of most of these agents is diverse and to a variable extent overlapping. For many of the agents, the mechanism of action is defined incompletely, whereas for some, including the new class of tumor necrosis factor (TNF) blockers, it is better understood.

For patients with mild disease, hydroxychloroquine is often the first drug of choice because of ease of use and its favorable toxicity profile. Retinopathy due to hydroxychloroquine rarely develops when appropriate dosages are used. The onset of antirheumatic disease activity occurs in about 3 to 4 months in almost 50% of patients, although 6 months may be needed for the full benefit to be realized. For patients with moderately active or severe newly diagnosed disease, methotrexate or sometimes sulfasalazine is a preferred initial choice. In patients with continuing active established disease, methotrexate may be used in combination with other agents including hydroxychloroquine, sulfasalazine, or both or cyclosporine, azathioprine, and the more recently available DMARDs.⁹

For patients with acute and severe disease, a combination of DMARDs, prednisone, and an NSAID may be initiated; the dose of prednisone should be tapered during the ensuing weeks to months as disease control improves.

Because of its favorable efficacy and toxicity profile, methotrexate is regarded by many rheumatologists as the anchor therapy for RA. The initial dosage is usually 7.5 to 10.0 mg/wk, titrated upward to an average dosage of 12.5 to 15.0 mg/wk, although dosages of 20 to 30 mg/wk (if tolerated) may be necessary to realize this drug’s therapeutic potential before the response is deemed “inadequate.” Methotrexate may be given in tablet or liquid form; the liquid form is substantially less expensive than tablets, and injection may be associated with less stomatitis and GI upset. Appropriately managed, methotrexate can be used effectively for long periods to control RA. Although generally well tolerated, methotrexate can cause GI upset and hepatotoxicity including liver fibrosis and cirrhosis. Concomitant alcohol use is an important risk factor for methotrexate-related hepatotoxicity, and thus alcohol should not be used by patients taking this drug. Methotrexate can also cause a syndrome of pulmonary hypersensitivity manifested by dyspnea, cough, and fever and should not be used in patients with hepatic or renal insufficiency or severe lung disease. Supplemental folate (usually 1 mg/d) seems to reduce the occurrence of other adverse effects, including stomatitis, hair thinning, and bone marrow suppression. In patients taking methotrexate, physicians should avoid prescribing antifolate drugs such as sulfamethoxazole for sinusitis or cystitis, which may precipitate pancytopenia.

Use of DMARDs has substantially improved disease control and the long-term outlook for patients with RA. Their use may be associated with a lower incidence of extra-articular disease manifestations such as systemic vasculitis. In a series of more than 3000 patients monitored for up to 20 years, patients who had received DMARD therapy had a 30% reduction in long-term disability and improvement in survival compared with patients who had received NSAIDs alone.⁷ Despite these successes, major challenges exist. For example, DMARDs are becoming more accepted among practicing physicians and their patients¹⁰ however, adverse effects or failure of the drug to produce long-term disease control often leads to a change in DMARD treatment.

To improve disease control, therapies that contain combinations of DMARDs are often used. About 50% of patients with RA treated by rheumatologists are prescribed combination therapies with either 2 or 3 DMARDs. The combination of methotrexate, hydroxychloroquine, and sulfasalazine is among the most popular regimens. Methotrexate is often combined with other DMARDs including cyclosporine, but many other combinations of DMARDs have also been used.

In addition to hydroxychloroquine and methotrexate, other traditional DMARDs include penicillamine, gold, and sulfasalazine. Sulfasalazine was among the first drugs to be developed for the treatment of RA and may be chosen as the initial DMARD for patients with no allergy to sulfa, rather than hydroxychloroquine or methotrexate. The use of gold or penicillamine is seldom recommended because of the limited efficacy and the pronounced incidence of adverse effects associated with these drugs.

Three to 6 months may be needed before agents such as gold, hydroxychloroquine, and even sulfasalazine are effective. If the response is inadequate after 6 months of treatment, a second DMARD should be added or the DMARD regimen should be changed.

In the past year, 3 new DMARDs, etanercept, infliximab, and leflunomide, have been approved for the treatment of patients with RA.^11,12 Etanercept and infliximab are TNF-α antagonists that have powerful anti-inflammatory effects in patients with RA. Tumor necrosis factor is a potent inflammatory cytokine expressed in increased amounts in the serum and synovial fluid of patients with RA. It promotes the release of other proinflammatory cytokines, particularly interleukin (IL) 1, IL-6, and IL-8 and stimulates protease production. Etanercept consists of fusion monoclonal antibody composed of 2 identical chains of recombinant human TNF-α receptor fused with the Fc portion of human IgG1. In vitro it binds to soluble TNF. About 70% of patients receiving subcutaneous etanercept at dosages of 25 mg twice a week have substantial improvement in the extent of joint inflammation, often within 1 to 2 weeks after initiation of therapy. This improvement can be enhanced by combination with methotrexate. Adverse effects of etanercept are influenza-like symptoms and reactions at the injection site, which usually abate after the first few injections. The efficacy of infliximab, a recombinant TNF receptor fusion protein, seems to be roughly equivalent to that of etanercept. Infliximab is given intravenously once every 8 weeks, a regimen that may be more convenient for some patients. Potential long-term risks of these TNF-α antagonists have not been established. Infliximab may be associated with development of autoantibodies such as antinuclear antibodies. To date, neither drug has an increased risk of malignancy, autoimmune disease, or infection, issues that are the subject of ongoing postmarketing surveillance. The cost of these drugs is about $10,000 to $12,000 a year, generally higher for etanercept than infliximab. The available TNF-α antagonists should be considered in patients with recalcitrant disease not controlled by methotrexate.

Leflunomide is a pyrimidine synthesis inhibitor with clinical efficacy generally equivalent to methotrexate.¹³ Adverse effects reported include rash, alopecia, allergy, weight loss, thrombocytopenia, and diarrhea. Diarrhea often occurs early in the course of treatment and may abate, but discontinuation of the drug is necessary when the diarrhea cannot be ameliorated with dose reduction or concomitant use of antidiarrheal agents.

Serious extra-articular disease manifestations including vasculitis, scleritis, and recalcitrant serositis generally require systemic glucocorticoids and may necessitate the use of immunosuppressive agents such as cyclophosphamide. In my opinion, the only indication for cyclophosphamide in the treatment of RA is severe extra-articular disease, especially vasculitis.

Of importance, the decision about the use and aggressiveness of DMARD therapy should not be based solely on the presence or absence of the rheumatoid factor. Early in the course of RA, the rheumatoid factor may be absent, whereas in patients with established poly articular arthritis, absence of the rheumatoid factor is not invariably associated with mild disease and good disease outcome. Treatment must be tailored to the disease manifestations and needs of the individual patient. Consultation with a rheumatologist is helpful for patients who are pregnant or considering pregnancy because many antirheumatic drugs have severe fetal toxic effects including teratogenicity. Management suggestions for several clinical scenarios involving patients with RA are listed in Table 2.

When the symptoms of RA are well controlled, the glucocorticoids should be tapered, and the NSAIDs may also be tapered or used as needed. As a generalization, DMARD therapy should be continued indefinitely; however, if the patient does well and has no signs of active disease for at least 1 year, DMARD therapy could be carefully tapered. With combination DMARD therapy, one of the DMARDs could be tapered if the patient has been in remission for at least 6 months. Methotrexate can be considered as an “anchor” therapy and generally continue this drug for the longest period. Of note, less than 5% of patients with bona fide seropositive RA remain in long-term disease-free remission.

Rheumatoid arthritis is a serious disease. Follow-up early in the course of disease and in patients with poorly controlled disease should be every 2 to 6 weeks. Patients with well-controlled disease may be seen every 3 to 6 months. The primary care physician has an important role in the management of RA and can effectively guide and monitor routine therapy, with periodic consultation by a rheumatologist as needed. Assessment of disease activity and treatment efficacy is enhanced substantially with serial use of standard outcome measures, including duration of morning stiffness, severity of fatigue, presence and degree of joint pain and stiffness including joint counts, global and disease-specific health assessment instruments such as the modified Health Assessment Questionnaire, erythrocyte sedimentation rate, and radiographs of involved joints.

Appropriate medical care for patients with RA includes immunization and prompt treatment of infections. Patients with RA have a high risk of infections even if they are not taking DMARDs but particularly when they are taking immunosuppressive drugs. Several medications used to manage RA, including NSAIDs, cyclosporine, and glucocorticoids, may cause or exacerbate hypertension. Rheumatoid arthritis is associated with an increased incidence of pulmonary disease, and patients who smoke have an especially high rate of lung disease. In patients at high risk of GI bleeding, including elderly women and those with a previous history of GI bleeding, prophylaxis is achieved with agents such as proton pump inhibitors and misoprostol. As a general principle, use of NSAIDs should be avoided when possible and certainly discontinued when symptoms diminish. Virtually all patients with RA have or develop osteoporosis as a complication of the disease or its treatment. Adequate intake of calcium (1200-1500 mg/d) and vitamin D (400 IU/d) is important. In all patients receiving long-term corticosteroid therapy, including men, an antiresportive agent such as bisphosphonates or calcitonin should be considered. In postmenopausal women, estrogen replacement therapy or agents such as raloxifene may be considered. Finally, mouth and eye moisturization is necessary for patients with sicca complex symptoms.

Understanding the relationship of disease susceptibility and severity with genetic factors may provide an avenue for individualized treatment of patients with RA in the future. It may be possible to treat patients lacking genetic markers of severe disease with milder agents, while those with markers of severe disease may be treated more aggressively. More than 80 drugs are currently being developed for treatment of RA; thus, further advances in the management of the disease are forthcoming.

Questions About Treatment of RA

1. Which one of the following would be an acceptable therapeutic program for a patient with early mild RA?

1. Hydroxychloroquine with an NSAID
2. Hydroxychloroquine, methotrexate, and an NSAID
3. Methotrexate and prednisone at 5 to 15 mg/d
4. Etanercept and prednisone
5. Leflunomide and sulfasalazine

2. Which one of the following regimens would be appropriate for a patient with RA and new-onset systemic vasculitis?

1. Azathioprine, hydroxychloroquine, and prednisone at 10 to 15 mg/d
2. Prednisone, 20 mg/d, and methotrexate, 25 mg/wk
3. Prednisone, 40 to 60 mg/d, and cyclophosphamide
4. Cyclosporine and prednisone at 20 to 30 mg/d
5. Prednisone, 40 to 60 mg/d, and immunoabsorption column treatment

3. Which one of the following situations is not a relative contraindication to the use of etanercept?

1. Patient with history of tuberculosis exposure
2. Patient with history of lymphoma
3. Patient with active chronic infection
4. Patient with newly diagnosed RA
5. Patient with established RA receiving hydroxychloroquine and methotrexate

4. Which one of the following statements about the clinical course of RA is false?

1. The median life expectancy of patients with RA is the same as that for the general population
2. Most patients with RA have some disability after 12 years of disease
3. Predictors of poor outcome in patients with RA include the extent of radiographic erosions, female sex, and functional class
4. Patients in whom the rheumatoid factor is present have a worse prognosis than those with seronegative disease
5. Disease-free remission is unusual

5. Which one of the following statements about COX is true?

1. Cyclooxygenase-1 is constitutively expressed in the gastric mucosa, kidney, and platelets
2. Use of the currently available selective COX-2 inhibitors is safe in patients with renal failure
3. Currently available selective COX-2 inhibitors have been proved in multiple clinical trials to be safe in patients who are taking warfarin
4. Cyclooxygenase-1 is functionally expressed and promotes the elaboration of prostaglandins important in the inflammatory cascade
5. Selective COX-2 inhibitors are not associated with risk of GI bleeding Correct answers: 1. a, 2. c, 3. e, 4. a, 5. a

REFERENCES

1. Masi AT. Articular patterns in the early course of rheumatoid arthritis. Am J Med. 1983;75(suppl 6A):16-26.
2. Jacoby RK, Jayson MI, Cosh JA. Onset, early stages, and prognosis of rheumatoid arthritis. BMJ. 1973;2:96-100.
3. Sherrer YS, Bloch BA, Mitchell DM, Young DY, Fries JF. The development of disability in rheumatoid arthritis. Arthritis Rheum. 1986;29:494-500.
4. Mitchell DM, Spitz PW, Young DY, Bloch BA, McShane DJ, Fries JF. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum. 1986;29:706-714.
5. Wolf MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999;340:1888-1899.
6. Matteson EL, Conn DL. Extraarticular manifestations of rheumatoid arthritis. In: Weisman MH, Weinblatt ME, eds. Treatment of the Rheumatic Diseases. Philadelphia, Pa: WB Saunders Co; 1995:52-67.
7. Fries JF, Williams CA, Morfeld D, Singh G, Sibley J. Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies. Arthritis Rheum. 1996;39:616-622.
8. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum. 1996;39:723-731.
9. Borigini MJ, Paulus HE. Rheumatoid arthritis. In: Weisman MH, Weinblatt ME, eds. Treatment of the Rheumatic Diseases. Philadelphia, Pa: WB Saunders Co; 1995:31-51.
10. Ward MM, Fries JF. Trends in antirheumatic medication used among patients with rheumatoid arthritis, 1981-1996. J Rheumatol. 1998;25:408-416.
11. Weinblatt ME, Kremer JM, Bankhurst AD, et al. A trial of etanercept, a recombinant tumor necrosis factor recepton:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med. 1999;340:253-259.
12. Moreland LW, Baumgartner SW, Schiff MH, et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. N Engl J Med. 1997;337:141-147.
13. Mladenovic V, Domljan Z, Rozman D, et al. Safety and effectiveness of leflunomide in the treatment of patients with active rheumatoid arthritis. Arthritis Rheum. 1995;38:1595-1603.

Ever get the feeling that you're being watched?

There was this one day during elementary school where my mom came to say hello to me. I was so embarrassed.

How could she do this to me? I ignored her, threw her a hateful look and ran out. The next day at school one of my classmates said, 'EEEE, your mom only has one eye!'

I wanted to bury myself. I also wanted my mom to just disappear. I confronted her that day and said, ' If you're only gonna make me a laughing stock, why don't you just die?'

My mom did not respond... I didn't even stop to think for a second about what I had said, because I was full of anger. I was oblivious to her feelings.

I wanted out of that house, and have nothing to do with her. So I studied real hard, got a chance to go abroad to study.

Then, I got married. I bought a house of my own. I had kids of my own. I was happy with my life, my kids and the comforts. Then one day, my Mother came to visit me. She hadn't seen me in years and she didn't even meet her grandchildren.

When she stood by the door, my children laughed at her, and I yelled at her for coming over uninvited. I screamed at her, 'How dare you come to my house and scare my children!' GET OUT OF HERE! NOW!!!'

And to this, my mother quietly answered, 'Oh, I'm so sorry. I may have gotten the wrong address,' and she disappeared out of sight.

One day, a letter regarding a school reunion came to my house. So I lied to my wife that I was going on a business trip. After the reunion, I went to the old shack just out of curiosity.

My neighbors said that she died. I did not shed a single tear. They handed me a letter that she had wanted me to have.

'My dearest son,

I think of you all the time. I'm sorry that I came to your house and scared your children.

I was so glad when I heard you were coming for the reunion. But I may not be able to even get out of bed to see you. I'm sorry that I was a constant embarrassment to you when you were growing up.

You see........when you were very little, you got into an accident, and lost your eye. As a mother, I couldn't stand watching you having to grow up with one eye. So I gave you mine.

I was so proud of my son who was seeing a whole new world for me, in my place, with that eye.

With all my love to you,

Your mother.
By : Sarfaraz amani

Its tough being a parent.  Even when you know something is going to be good for your child it can be a hard decision to put them through the discomfort of the situation.

As I sit here in the waiting room, I can't help but reflect that our Father in heaven has similar moments.  He puts us or allows us to go through times of heart ache and pain in order for us to grow and understand Him more deeply.  It is for our good and He knows this perfectly, but I can't help but think that where I was unable to go to the surgery room with my daughter, He is always there holding us up as we go through our valleys.  I am comforted by that fact.  Lauren is out of my reach at the moment, but she is still in the palm of His hand and He is much more capable of taking care of her than I am.

The surgery should not be long, so I am hoping to see her within the next hour.  I will keep you all posted later today and I am appreciating your thoughts and prayers.  Hey .. I see the doc... gotta run.

It has been lovely to have Robyn at home in the holidays but its nice now to be back in a routine. As I type Anthony is still asleep and Katie is playing in her cot really happily after a lie in. I must admit I'm enjoying having the time to myself down here!

Anthony has been poorly with his eye. Its a recurring problem and was referred to the eye clinic at the hospital yesterday. He saw 3 specialists and all of them are a bit baffled. One of them declared his eye to be "weird!". We have to go back to hospital tomorrow and again on Monday to see a different specialist. Hopefully we'll get some answers as to what is wrong. In the meantime he has 2 different types of tablet to take,1 lot of eye drops and some eye ointment too.

His eye is very bloodshot, very achy, very light sensitive and the iris is swollen. I'm just very glad that its being dealt with now. Its gone on for a long time on and off. At our last doctors he was always fobbed off with "Its conjunctivitis" which it so obviously isn't!!!!

I am at the point where trying to keep count is losing any meaning - its not like I can sit down with the next doctor or surgeon and detail all the procedures she has been through.  I will just have to point them to the mountain of paperwork that follows her from hospital to hospital and from doctor to doctor.

The thought of her facing another surgery does not bring fear because my wife and I have come to terms with the fact that God is in control and His Will is sufficient for us.  I do feel like Tom Hanks from Joe Versus the Volcano where he talks about how the lights suck all the energy from his life. That's how I feel about hospitals.  They drain me.  I have spent too much time there just waiting and I know Lauren isn't any more enthused about it than I am... and for better reasons.

The good thing is that this will be out-patient and we will be home in the afternoon, at which point, I will turn around and take my youngest daughter to see the family doctor for a cough that isn't getting any better.  It may just be her allergies acting up.

Here's the thing... isn't it a blessing that we have such good doctors and health care here in the United States?  There are many places in the world where my eldest daughter would have never survived a day let alone 15 years and where my youngest daughter would suffer her allergies with no relief.

God has been good to us.

Remember us in your prayers that would we would be good witnesses of God's provision as we get to talk to nurses, doctors, and other patients.

Your friend.

They care caused by small, benign inclusions in the vitreous.

They increase with age and may be permanent once present.

The sudden appearance of numerous floaters is a whole different ball game and may suggest retinal detachment.

Source

Tasman, W. et al. Duane's Ophthalmology. Lippincott Williams and Wilkins. 2008.

One thing that those people at TLC need to do better is explaining the post-procedure care. The directions are way confusing. For example:

Zymar:
1st 24 hours - One drop every two hours while awake
2nd 24 hours - One drop four times a day (at meals and bedtime) for an additional 6 days

Xibrom:
Use one drop two times a day for two days

Pred Forte:
1st 24 hours - One drop every one hour while awake
2nd 24 hours - One drop every two hours while awake
3rd Day - One drop four times a day (at eals and bedtime) for an additional 7 days

Refresh Plus:
During the first week, use at least every two hours. We prefer you use the preservative-free vials during the first week, and then you may switch to Optive. These drops should be used at least four times daily for the first few months.

Ridiculous, no? The "while awake" business--does that mean that if I go down to take a nap, I don't need to set an alarm for two hours? And the "for an additional 6 days" for Zymar, is that 6 days after the 2nd 24 hours or 6 days including the 2nd 24 hours?

I realized that I looked slightly down. It also ment that I didn't hold that person or that picture to the same level as I am, meaning that Ii held that person "above" me and thus lowering my status. I need to correct that habit. It will be tough but practice saying "Hi" to people while holding eye contact and you'll get over that habit. Knowing is half the battle as well, doing is more demanding but stick with it!

Blood travels 30 crore Km/day

Hair grows 0.425 cm/day

Mouth Speaks avg 4800 words/day

Average eye blinks 42 lakh times/day

Regular eye exams are not just about obtaining optimal vision through the right eyeglass or contact prescription but can also help detect early warning signs of disease that can affect your eye health and general health.

Since an eye examination can help detect many health problems, eye care practitioners often work in conjunction with internists and general practitioners to help empower individuals on their health and wellness journey.

Many doctors offer new technology, such as digital retinal eye scans, that are quick and comfortable and produce a computerized picture of blood vessels in action. This new technology effectively provides information on eye health and certain systemic health conditions, such as diabetes and glaucoma.

With more than 50 million “prediabetics,” 65 million hypertensives and 5 to 10 million Americans with high pressure in the eyes, a regular eye exam is important for your eye and overall health.

Taking the following steps, according to the experts at LensCrafters, can help keep your eyes healthy:

1. Begin a regular routine of eye exams with an optometrist or ophthalmologist once a year or as often as the doctor recommends.

2. During the exam, talk about what the doctor is doing during the various procedures and ask for a health and wellness summary.

3. Ask the doctor how soon the next exam should be scheduled. The advice will vary depending on several factors, such as the patient’s history of health and disease, age, and use of contact lenses or other corrective lenses.

4. Make sure you explore all your options. Ask your doctor about new technologies that can help you see better. For example, Advanced View Progressive (AVP) lenses available at LensCrafters are one of the latest technologies in multifocal eyeglass lenses.

5. Like other regular health exams, set up your next appointment before you leave the doctor’s office and ask if they can send you a reminder.

6. Finally, remind your friends and family members. Make sure they also know about the importance of regular eye exams.

For more information, or to schedule an eye exam appointment with the Independent Doctor of Optometry next to LensCrafters*, visit www.lenscrafters.com.

*Eye exams available by the Independent Doctors of Optometry at or next to LensCrafters in most states. Doctors in some states are employed by LensCrafters.

A regular eye exam is about more than getting a stylish new pair of glasses. It can help keep your eyes healthy.

Power yoga yesterday, 2 times this week.

Early morning: left eye senses a blind spot coming on.