Top Ophthalmic Issues

Ophthalmology includes sub-specialities which deal either with certain diseases or diseases of certain parts of the eye. Some of them are: Anterior segment surgery; Retinal ophthalmology, which emphasizes such things as laser treatment of the retina and actual retinal surgery; Cataracts — not usually considered a subspecialty per se, since most general ophthalmologists perform cataract surgery; Cornea, ocular surface, and external disease; Glaucoma; Medical retina, deals with treatment of retinal problems through non-surgical means; Neuro-ophthalmology; Ocular oncology; Oculoplastics & Orbit surgery; Ophthalmic pathology; Pediatric ophthalmology/Strabismus; Refractive surgery; Uveitis; Immunology; Veterinary Formal specialty training programs in veterinary ophthalmology now exist in some countries; Vitreo-retinal surgery, deals with surgical management of retinal and posterior segment diseases and disorders. Medical retina and vitreo-retinal surgery sometimes together called posterior segment subspecialisation.

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Colonoscopy Without Going To Sleep? Is It Possible?

A recent article published by Gastroenterology & Endoscopy News detailed an increasing number of physicians implementing sedationless colonoscopies. New technologies have enabled patients to have more options for how they want their colonoscopy to proceed and have given doctors more room to come up with procedural methods that make colonoscopies available without going to sleep while still remaining relatively pain free.

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The option of sedationless colonoscopy has been around for about 10 years or so, after a study performed by Douglas Rex, MD and others who found that specifically older men in good health could be good candidates for colonoscopy without sedation. The techniques and procedures for sedationless colonoscopy are still under development and require the use of variable- stiffness and pediatric colonoscopes in order to have a comfortable procedure.

There are still many elements that need to be worked out and Dr. Howell, a physician who had been performing sedationless colonoscopy for about 12 years now, has developed a method for determining which patients would fare well and which would struggle with the sedationless procedure. The screening process developed by Dr. Howell eliminated those who had previously required significant medication during a colonoscopy, those with a body mass index (BMI) below 20, women who had pelvic surgery, have a history of endometriosis, those who have undergone radiation, or those who suffer from chronic pelvic pain.

He found that when using this pre-screening method only 10 percent of patients who underwent colonoscopy while they were awake made additional requests for pain medication. Further their study looked at over 600 patients and found that, not only were the majority of patients able to complete the exam effectively, but also eliminated those patients who would not benefit from sedationless colonoscopy.  Once again Dr. Howell found that the best candidates were middle aged to older men, who often do not face many of the problems used as eliminating criteria. Using his screening process he performs sedationless colonoscopy on about 30% of women and 50% of men.

Sedationless colonoscopy offers several benefits; most importantly in the eyes of Dr. Howell is how cost efficient it is. Without the need to go to sleep you no longer have to pay for an anesthesiologist to monitor and perform the sedation. Additionally, it allows patients to get in and out of the office without needing someone else to drive them and with relatively fewer side effects. Finally, sedationless colonoscopy is commonly used in many countries without major complaints of patient discomfort. It is important that both you and your physician speak about your specific situation before deciding that this type of colonoscopy is right for you.

Vitamin D Shown To Raise Cancer Survival

Vitamin D is often referred to as the “sunshine vitamin” because the first step in making it occurs in the skin and is stimulated by the ultraviolet light in sunshine. This produces a preliminary form called vitamin D3, which is one of the common forms of vitamin D found in food and in supplements. The next step occurs in the liver, with a final step to make fully active vitamin D occurring mainly in the kidneys. The form made in the liver goes by the scientific name 25-hydroxy-vitamin D. This appears to be the storage form of the vitamin, and is also the form of vitamin D measured in blood tests for the vitamin.


Blood levels of vitamin D in people living in northerly countries such as Canada and the Scandinavian countries are measurably much lower in the winter than in the summer. This led medical researchers in Norway to investigate whether this difference could be related to various measures of health – and it was. Among other associations, they saw that people diagnosed with cancer of the breast, colon or prostate gland had a 15% – 25% lower risk of dying if they were diagnosed in summer or fall, compared to those diagnosed in winter or spring. This led to many more studies around the globe looking at vitamin D and cancer, and again higher levels correlated with better outcomes for many patients.


The latest study of this type comes again from Norway and it looked at vitamin D levels in patients diagnosed with cancer of the breast, lung and colon, as well as the immune system cancer called lymphoma. A strong point of the study was that over 650 people with these cancers were followed for a long time, from 1984 to 2004. Their vitamin D levels were tested within 90 days of their diagnosis. The researchers adjusted for the seasonally varying levels of the vitamin in their statistical analysis of the outcomes. For example, a value of ‘70’ in the winter might be equivalent to 100’ in the winter.

Over the twenty year study period, over 300 people died of their cancers, while others died from other causes. The researchers found that those having a vitamin D level below a value of ‘46’ at the time of their diagnosis had significantly higher death rates from their tumors than those with levels above that value. The higher the level, the fewer cancer deaths were seen. When compared to the 25% of people in the study with the lowest vitamin D levels, those in the top quarter had a 65% reduced chance of dying over the entire study period. This is likely to be a true result because it falls in line with previous studies of a shorter nature.


Of course vitamin D is also essential for bone health, and was discovered on the basis of its need in preventing the childhood bone disease called rickets. Foods that contain relatively high levels of the compound include alfalfa, mushrooms, and fatty fish such as catfish, salmon and tuna. It is also added to some foods, such as milk. As mentioned, vitamin D3, the intermediate form, is available as a supplement. However, since the vitamin is stored in fatty tissues, it is possible for it to accumulate to toxic levels in people taking “mega-doses,” such as 50,000 international units [IU] (1,250 micrograms) per day or more. Safe standard doses of supplemental vitamin D3 are in the 1,000 to 5,000 IU range. Those with an over-active parathyroid gland may be more sensitive to overdoses. They as well as pregnant or nursing women should consult with their physician about their optimal dosages of this very important nutrient. is a comprehensive information network for individuals seeking to learn more about colorectal concerns. Whether in need of standard or virtual colonoscopy, users can find local gastroenterologists and medical providers to link up with and seek further advice.

Is Coffee the Answer to your Colon Conundrum?

A recent study, which occurred at the University Hospital Heidelberg in Germany, found that drinking coffee significantly reduces the time needed to recover from bowel obstruction following abdominal surgery. The study lead by Dr. Sascha Müller looked at more than 80 patients’ recoveries from surgery and divided them into two groups. One group was given 100mL of water 3 times a day while the other group was given 100mL of caffeinated coffee 3 times a day. The patients all faced surgery for a variety of reasons with the majority (56 percent) suffering from colon cancer. Another 28 percent of patients suffered from diverticular disease, a type of condition wherein there are structural problems with the colon; 13 suffered from inflammatory bowel disease and the remainder had various conditions. The patients were of comparable health, age 61 on average and were 56 percent male. These conditions allowed for the trial to look at a variety of responses by patients.

According to the study, those who received the caffeine treatment had their first bowel movement a full 14 hours before those who had only water. The first bowel movement occurred at 60 hours for those on caffeine versus those who did not have caffeine who had their first bowel movement at 74 hours. Similarly, those who had caffeine were able to have solid food at around 49 hours while those who had only water were only able to keep solid food at 56 hours.

Finally, those with caffeine treatment were able to pass gas on average 5 hours before those who did not have caffeine, as they only required 41 rather than 46 hours. However the length of hospital stay was the same for both groups of patients. Interestingly, there have been previous studies that have ruled out the influence of caffeine and even found that decaffeinated coffee had some beneficial effects.

This study, however, will need to be followed by further research. There is more to be determined about the reasoning behind why coffee makes bowel movements come sooner. Furthermore, this trial only had a small number of participants necessitating studies with a larger sample size. Finally, it is important to realize that, as with any type of surgery, there are numerous risks, which must be discussed with your physician before undergoing any treatment. Before undergoing any type of surgery on your colon, whether for cancer or resection (removal of part of the bowel), the use of caffeine following your surgery should be determined by your physician. This study is hopefully the first of many advances in colon treatment.

Laxative-Free Colon Examinations Making Slow Progress

Doctors recommend all those 50 year of age or older to be screened preventatively for colon cancer. There are three distinct ways of doing this: colonoscopy, sigmoidoscopy and ‘virtual colonoscopy.’ The first method is the most involved and still appears to be the most sensitive approach. Sigmoidoscopy is simpler but only surveys the last one-third of the colon (large intestine); however, over half of all colon cancers are in this area, so it is still considered a valuable exam. Both these methods involve the insertion of a flexible viewing scope past the anus and into the colon.

Computed Tomography

The ‘virtual colonoscopy,’ however, is non-invasive: pictures are taken from the outside. It is actually the technique called computed tomography (CT) applied to the colon. Computed tomography – sometimes called computer assisted tomography, CAT – can be described simply as a more accurate version of traditional X-rays, though there are various technical differences. So far, the CT method seems to be somewhat less sensitive than a real colonoscopy, yet can be a partial substitute for it in patients who are too sick or weak to tolerate a colonoscopy and the sedation it requires.

Abdomen Computed Tomography

Both colonoscopy and it’s virtual counterpart require a patient to not have solid food the day before the procedure, and also to drink literally a gallon of a laxative solution. This thoroughly cleans out the intestines and makes for the best visibility of any potential tumors or pre-tumors, which are called polyps. Unfortunately, a minority yet substantial portion of people find they just can’t stand getting through this preparation routine. The sigmoidoscopy, on the other hand, is usually done without any laxative – but isn’t as thorough as the other two techniques.

Now a team of doctors primarily from the Massachusetts General Hospital has tested the accuracy of a virtual colonoscopy performed without any laxative preparation ahead of time. They have found that these are almost as good as standard colonoscopy for detecting the largest polyps. These are defined as one centimeter (cm)(10 millimeters) or more in width, half the diameter of a penny. They did both types of exams on over 600 patients undergoing screening, and calculated that for these largest polyps the sensitivity of CT was 91% while that of the traditional colonoscopy was 96%. They also looked at the number of false positives each technique gave, called the specificity of the test; fewer false positives means a higher number for the specificity. Here too, colonoscopy was just a little bit better than the virtual type: 89% versus 85%. On the other hand, the experiences of the patients were rated much more positively by them for virtual than for real colonoscopy, as might be expected.

Abdomen CT Scan

That was the good news. The less good news? Both the sensitivity and specificity of the laxative-free virtual colonoscopies were significantly lower with smaller and smaller polyps. For example, for polyps 0.8 cm wide (8 millimeters), colonoscopy was 88% sensitive but CT sensitivity was only 70%. For polyps 0.6 centimeters wide (6 millimeters) the sensitivity of true colonoscopy was 76% while the virtual variety was only 59% sensitive. Differences in specificity were very similar, namely always better with true colonoscopy. These results indicate that those who absolutely cannot tolerate the large volume of laxative – for either personal or medical reasons – can still receive screening that has some value to it, even if not the full value of true colonoscopy.

As doctors continue to improve their technologies and their techniques, preparing for colon cancer screening may become somewhat easier. In the meantime, those who are able to prepare for a full colonoscopy are still encouraged to do so. It’s a little unpleasant to prepare for, but in exchange for that, a patient can be assured they’re getting the most sensitive and accurate exam possible.