Macular Degeneration

Losing Sight

Age related macular degeneration usually affects older adults and results in a loss of vision in the center of the visual field.  It’s due to damage to the retina. Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.

Causes

• Aging: About 10% of people 66 to 74 years of age will have some evidence of macular degeneration. It’s 30% in patients 75 to 85 years old.
• Family history: For someone who has a relative with it, the risk of developing late-stage macular degeneration is 50%.  It is only 12% for others.
• High blood pressure plays a role in MD.
• High cholesterol, obesity, and high fat intake are associated with an increased risk of MD.
• Smoking increases the risk of MD by two to three times that of someone who has never smoked, and may be the most important modifiable factor in its prevention.

 Management

• Reducing fat intake:  This means cutting down greatly on red meats and high-fat dairy products such as whole milk, cheese, and butter, and eating more cold-water fish (at least twice a week); eating any type of nuts may help.
• Nutritional supplements: Some evidence supports increasing intake of two carotenoids: lutein and zeaxanthin.  Eating foods high in omega-3 fatty acids has been correlated with a reduced progression of early macular degeneration.
• Adaptive devices: These help people read and include everything from magnifying glasses to computer software.
• Audio books: are also helpful.
• Reverse print: Written material with white text on a dark background is easier to read for people with macular degeneration.

This article was originally published in Pathways Residential Care Journal - Issue 5.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

A Quick Review of COPD

A Progressive Disease

Chronic Obstructive Pulmonary Disease is a lung disease that causes a blockage or narrowing of the airways.  This results in decreased ability to move air in and out of the lungs. The disease has a slow, progressive course and is irreversible.

Statistics

COPD is the 4th leading cause of death in the US: 120,000 Americans annually.  It is expected that by 2020, COPD will become the 3rd leading cause of death worldwide.  Men are more likely to have COPD than women, and it usually occurs in those over 40 years old.

Types

There are three types of COPD and all of them require the patient to work very hard at breathing.

• Emphysema: Air sacs (alveoli) of the lungs are damaged and enlarged.  This reduces the amount of surface area for the exchange of oxygen and carbon dioxide.  Less oxygen can move into the body and less carbon dioxide can be expelled.
• Chronic Bronchitis: Inflammation of the bronchial tubes which can cause them to swell.  This can leave less room for air movement.
• Bronchiectasis: Permanent widening of the large air tubes which begin at the bottom of the trachea and branch into the lungs.

Causes

The most significant risk factor is, of course, smoking.  The American Lung Association estimates that 80% to 90% of people diagnosed with COPD are chronic smokers.  Secondhand smoke is also a major factor, causing 3,400 lung-related deaths annually.  Research also shows a link between air pollution and work-related exposure, such as coal mine dust, silica, cotton and grain dust.

Symptoms

Most symptoms include: breathlessness with any activity, chronic cough, increased sputum production, wheezing, chest tightness and frequent chest infections.

Other signs and symptoms may include swelling, weight gain and obesity, (which may be a side effect of medication therapy), a round barrel chest, coughing blood, and cyanosis (bluish coloring often seen around the mouth).

Diagnostic Testing

To make a diagnosis of COPD, a complete assessment must be taken including family history, environmental and occupational exposure and smoking history. Additional tests may include:

• Blood work such as arterial blood gases, hemoglobin and hematocrit levels
• Chest x-ray
• Pulmonary function tests
• Bronchoscopy
• Pulse oximetry

Treatment

The main treatments for COPD include medications (bronchodilators, expectorants, antibiotics and corticosteroids), oxygen therapy, pulmonary rehabilitation, and at the end of life, morphine to ease shortness of breath.