Kathy's Home

something good

Thu, 06 May 2010 08:15:26 +0000

Oath I have taken
Help those who cannot afford
Value human life

I went to volunteer at Remote Area Medical. I heard about this program last year, and I'm excited to be able to participate this year. In this week long event, medical, dental, and vision care is provided to those who really need care.

We saw about 500 patients the day I went. We were really busy, so I wasn't able to take any pictures until the evening. The following pictures I managed to take when most services were finishing up their last patients for the day.

sports arena center from ground level. dental area.

vision area.

Here are a few cases that I want to document for myself...

-During my break, I talked to a man who just had his cavities filled by a dentist. I convinced him to get his eyes checked since he could not recall when he last did. He agreed, and was seen by another clinician. At the end of his exam, he came by to inform me that he was diagnosed with PDR and will be seeking treatment tomorrow. After talking to him some more, I informed him that he needed to control his diabetes. Otherwise, his condition will get worse and he will eventually lose his sight.

-A patient complained of having headaches and blurry vision for the past year. She was wearing thick glasses that were 3+ years old. She was found to have uncorrected refractive error, a significant amount of aniso, and Stage 2 HTN. These diagnoses combined are the reason why she has been having headaches. Ideally, contact lenses (instead of glasses) would help reduce her aniso, but cost is the limiting factor. I also informed her to see her PCP or go to a community clinic to help control her high blood pressure.

-A veteran came by to get his eyes checked. He had cataract surgery 10 years ago, and reported no change in vision since then. What was interesting about this case was that his refraction was +3.25 -6.00 x 180, but he was seeing just as well without glasses. That is because his EDS is 0. Using a slit lamp, we noticed a large (14mm, if I remember correctly) incision on the superior cornea. My staff doctor told me this incision was from an old technique used for cataract surgery. Apparently, this was a rare thing to see.

spring rain

Thu, 06 May 2010 08:17:49 +0000

This is the first year that I have really appreciated the beauty of spring. Birds are singing outside my window, and yellow mustard wildflowers are blooming everywhere. Jon and I are spending more time outdoors trying to capture this wonderful spring season on camera. And amidst engagement announcements from close friends, watching my nieces learn to walk, and playing video games with my little cousin, there comes the difficult part of life that I never look forward to - the death of a loved one.

I realize that as I get older, life and death intertwines... and that is how it will be from now on. I'm deeply sad for the loss of someone dear to me that I have known and loved for the past 9 years. But I also feel relieved because this person is no longer in pain and no longer trapped inside a dying body. My heart goes out to the grandchildren who lost their beloved grandmother, to the children who lost their mother, and to the husband who lost his wife of many decades. I was very close to my grandmother, and life just isn't the same without her.

Studies have shown that human relationships are a key to happiness. Quite true. I am happy to have wonderful and supportive friends and family in my life. I am also happy and fortunate to have so many grandparents in my life. And I hope to have children and grandchildren as supportive and loving as these grandparents have.

And after the rain, flowers bloom, even then.

Flaxseed oil vs Fish oil

Tue, 13 Oct 2009 05:15:18 +0000

Omega-3s are beneficial for health because it helps reduce the risk of heart disease, stroke, hypertension, depression, ADHD, arthritis, macular degeneration, and other ailments.

There are 3 important Omega-3 components – DHA, EPA, and ALA. While DHA is the most important type found in the brain, the human body cannot produce enough DHA on its own.

Both flaxseed and fish oil contain omega-3s, but only fish oil contains DHA and EPA. Thus fish oil is a good source of DHA for the human body.

Flaxseed oil instead contains ALA. In order to obtain nutritional value, the human body needs to convert ALA to DHA/EPA. When flaxseed is consumed, the human body converts only a small amount of ALA into DHA and EPA. In addition, some early studies have linked high ALA intake with a higher risk of prostate cancer, while high fish consumption will lower the risk of prostate cancer.

There is limited research on flaxseed oil to fully understand its benefits, but much research has been done to prove the benefits of fish oil, including reducing the risk of breast cancer.

In summary, fish oil is more effective because it contains much stronger and easily available omega-3s for the human body. As advised by many sources, men should avoid flaxseed oil until more is known about its potential link with prostate cancer.

Augustsson, K., Michaud, D., Rimm, E., et al. A Prospective Study of Intake of Fish and Marine Fatty Acids and Prostate Cancer. Cancer Epidemiology. 2003;12(64).

Brouwer, I., Katan, M., Zocck, Peter. Dietary a-Linolenic Acid Is Associated with Reduced Risk of Fatal Coronary Heart Disease, but Increased Prostate Cancer Risk: A Meta-Analysis. J. Nutr. 2004;134:919-922.

Burdge, GC., Calder, PC. Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults. Reprod Nutr Dev. 2005;45(5):581-97.

Kim, J., Lim, S., Shin, A., et al. Fatty fish and fish omega-3 fatty acid intakes decrease the breast cancer risk: a case-control study. BMC Cancer. 2009;9:216.

Schacky, C., (2003) The role of omega-3 fatty acids in cardiovascular disease. Curr Atheroscler Rep. 2003 Mar;5(2): 139-45

stressed out

Fri, 05 Sep 2008 02:38:28 +0000

so many things to do, so little time.
so many expectations.
so many things to keep track of.

please let me get by the next 9 weeks...

50% doctor

Wed, 11 Jun 2008 07:46:11 +0000

2 years completed, 2 more years to until graduation!

I am so glad second year is over - that is in my book the most stressful year I've ever had. I'm glad that Jon and I decided to postpone the wedding until after graduation. I can't imagine planning a wedding through all that chaos (though some of my classmates have successfully done so).

Reminder to self:
I may want to have a Chinese Tea Ceremony. A friend of mine did that for her wedding, and I think its a good idea to recognize my chinese heritage too. Besides, I like the idea of wearing a qi pao. =)

Although second year was busy, I enjoyed the many classes I took.
Here are some highlights:

-Systemic & Ocular Pharmacology:
I have a new profound respect for pharmacists. My friend and I created so many mnemonics to help us get by!

Some of my favorites:
"fatty GEM needs NIACIN but takes FEN-fen & Statins"
"Amiodarone is the smurf drug"
"Medrysone (HMS) is one 'Hell of a Mild Steroid'"
"Opioid stupor & no pooper"

-Ocular Disease:
is the most challenging class to date. I never knew there are so many things that can go wrong with the eye. To help us recognize many of these conditions, my professor described these as food! I guess it help me, but it certainly didn't help my appetite. (I won't go into details here).

-Contact Lens:
I am now proficient to prescribe and dispense rigid contact lens and soft contact lens. =) And, I now know how to modify an ocular prosthetic eye (aka artificial eye). I'm excited because I get to see these patients in clinic.

-Clinic:
Many hours of practicing to hone in our clinical skills.

Angela was nice enough to be one of my first patients!

I just got back from my 2 week summer vacation. Well, its more like 2 weeks of sleeping in and doing nothing. =P

Anyway, summer school just started and I'll actually be seeing a handful of patients every week. They say the key is to have confidence...

"No matter what happens, keep your head up and be calm and confident."

what i learned in pharm class

Wed, 02 Apr 2008 14:23:01 +0000

"If it looks like a duck,
quacks like a duck,
and walks like a duck,
it's probably a duck.

..but it might be a goose"

surviving...

Sat, 22 Mar 2008 08:37:05 +0000

I'm still alive.... just really busy with school this year. It has been said that 2nd year is the "toughest" of all 4 years because we are learning course material, how to use exam instruments, exam procedures, and clinical skills all at the same time. The last two quarters were filled with many exams and proficiencies. And in order to do well, I found myself staying late (11pm) at school to practice, going to school at 6:30am to study, and spending my free time at a local starbucks to study some more. Jon often sees me coming home with one pupil dilated (one pupil larger than the other). =P He's pretty fortunate that I haven't been using him as a guinea pig anymore.

I am happy to say that I have survived the past two quarters (not without difficulty), and to date I have passed all my proficiencies the first time around. =) See, I'm working really hard so I can finally say "Trust me, I'm a doctor" & truly mean it one day. Other things... I'm cooking more now and I'm making an effort to bring my lunch everyday. Its tempting to save time and money by purchasing a burger from a local fast food joint, but I'm trying to be both health conscious & thrifty.

The most exciting thing happened on 3/19/08. I saw my first patient! My staff doctor told our class that we will never forget our first patient.. I certainly won't!

I have given a handful of exams by now, but it was always during lab class, and my patients were my classmates. Obviously, there is some bias here... one of them is that my classmates know how to give the "right answer", and for this reason, they are the "perfect" patient.

My first scheduled appointment. My first "stranger" patient. And, I'm being watched by an upperclassman to evaluate my clinic skills! How did I feel? Well, its hard to describe but I was feeling ecstatic & nervous. I usually get a bit nervous before my exams and proficiencies, so I tried my best to shake it off.

So I walked to the front desk to meet my patient, and I took my pt to my exam room. The exam began something like this:

me: what brings you in today?
pt: my gf told me to get an eye exam

me: have you noticed any problems with your vision lately?
pt: no. i see great.

(Sounds like an "easy" patient so far. Probably a basic eye exam - the same drill I've been practicing on my classmates. But, I still need to get a Chief Complaint, so I questioned further)

me: do you have any eye concerns that you want us to look at?
pt: actually, i was told i might have some signs of iritis...

I was completely caught off guard. If I were to rate how nervous I was on a scale of 1-10 (10 being the max), I was probably at 11 with increased adrenaline concentrations in my blood. What am I suppose to do now? What follow up questions do I need to ask? Do I need to dilate my patient today? What if I run out of time?

Long story short, I continued with the exam, consulted with my staff doctor, did further evaluations, consulted with my staff doctor, then walked my patient to the check-out counter. In my mind, everything had occurred in slow motion.

In the end, I survived my first patient.

Lesson learned: I need to get some beta blockers.

El Salvador trip

Sun, 16 Sep 2007 03:22:28 +0000

So this past summer I had the opportunity to travel to El Salvador on a medical mission trip. I must say, El Salvador was by far the most meaningful experience of my life! It was a very humbling experience to see how much we take for granted – to see those people who truly have nothing.

We (the optometric group of 15 people) worked alongside other medical teams (medical students from the University of Virginia, primary care physicians, surgeons, dentists, pharmacists, and nurses to provide comprehensive healthcare for the underserved communities. We also visited an orphanage called My Father’s House International throughout the week to spend time with the kids. We also took a tour of archaeological sites in El Salvador to complete our trip!

We stayed at the Hilton in San Salvador, the capital of El Salvador. Each day we traveled to different locations throughout El Salvador to serve towns and remote villages.

Typical day
We saw about 500 patients during the trip.
6am Wake up
7am Breakfast
8am Travel to a village by bus
1pm Lunch
4:30pm Leave village

Stations
were set up for efficiency and to utilize manpower. During clinic days, we were able to rotate to each station:

Ocular health history
Autorefraction
Entrance Testing, Retinoscopy
BIO
Dispensing and Checkout

Ocular Health History Questions:
1. Would you like to see better in the distance?
Ve bien de lejos?

2. Would you like to see better for reading?
Ve bien de cerca?

3. Do your eyes feel dry?
Le dueden los ojos?

4. Do you experience watery eyes, itchy eyes, pain in your eye?
Tiene los ojos resecos, rojos, o le pican?

5. Are you light sensitive?
Pasa mucho tiempo en el sol?
Es sensible a la luz?
La molesta a la luz de sol?

6. Do you feel like there is something in your eye?
Siente los ojos arenosos?

7. Do you have diabetes?
Tiene asucar en lo-sangre?

Pase adelante!

Prescription glasses were given to those with more than a 20/40 VA. Sunglasses were given to all patients because the sun is very strong and most people are out in daylight. Topical medications (Systane, Vigamox, Patanol, Nevanac, Tobradex) were also provided.

Clinical cases:
This was definitely an eye opening experience. Never have I seen so many diseases in such a short amount of time. Its also a treat to see these diseases in real life instead of a textbook. The following is a list of observations:

1. Pterygium
– “a benign growth of the conjunctiva… requires no treatment unless it grows and covers the pupil, obstructing vision. Definitive treatment is achieved only by surgical removal. Associated with excessive exposure to wind, sun, or sand. ..Wearing protective sunglasses and using artificial tears may help prevent their formation or stop further growth.”

2. Dilation and Irrigation
-using a needle, and viewing through BIO

3. Hyperopic elderly man with walking stick
-He came in with a walking stick. Never had glasses before. I performed retinoscopy on him and obtained +2.00 OD, +10.00 OS. He was so happy that he can see... he handed his glasses to the next patient in line and told them they were "magical" glasses.

4. Bell’s palsy
– inflammation of cranial nerve VII (facial nerve) where it leaves the skull at the stylomastoid foramen. Causes facial drooping on the affected side. “Three times more likely to strike pregnant women… Four times more likely to occur in diabetics… Most patients recover completely within several weeks… others may be left with deficits of varying degrees.”

5. Pinguecula
– “a type of conjunctival degeneration in the eye. Common seen as a yellow-white deposit on the conjunctiva adjacent to the limbus. Most prevalent in tropical climates and is in direct correlation with UV exposure.”

6. Conjunctivitis
– aka “pink eye” … “an inflammation of the conjunctiva most commonly due to an allergic reaction or an infection.” May be treated or relieved with cool compresses, artificial tears, or topical steroid drops depending on the case.

7. Circinate ring
-Patient with diabetes had a blood hemorrhage on the retina. A circinate ring is formed from hard exudates (“extracellular lipid that has leaked from abnormal retinal capillaries… distinct yellow-white deposits”)

8. Traumatic cataract
– cataract (“a clouding of the eye’s lense that can cause vision problems”) caused by eye injury or physical trauma. This particular patient was poked in the eye when he was young, and eventually developed cataracts. His left eye is now turned in.

9. Corneal arcus
- due to trauma. This patient’s left eye has a corneal arcus (white ring) developed around the outer edge of the cornea. This is composed of cholesterol.

10. Infiltrate
Patient had an infection. Vigamox was given.

11. Hyperopia
Majority of patients were hyperopic (us American students are typically myopic). We quickly ran out of +1.00DS reading glasses.

12. Cataracts
Lots of cataract patients. During retinoscopy, I noticed that patients with difficult reflexes most likely had cataracts.

13. Abnormal reflex during retinoscopy
Instead of a circular reflex observed during retinoscopy, a “D” reflex was observed. (didn’t follow-up on this… will figure out later)

14. Diabetes
Patient with Diabetes had an Autorefraction of -1.25 OD, +1.00 OS. But retinoscopy showed +3.00 OD, +1.00 OS. (didn’t follow-up on this…. will figure out later)

In these communities, the lack of education, clean water, and healthcare in El Salvador are prevalent. I met a thirteen-year-old girl who just started to learn addition. At the end of each day, we donated our leftover drinking water for local villagers to use since clean water was scarce. In addition, a majority of our patients have untreated health problems because the government does not provide healthcare for those who are unemployed or poor. From these experiences, my personal hardships now seem irrelevant.

I absolutely fell in love with the children at the orphanage. They greeted us with smiles and laughter. It amazes me how these children – who were once abandoned or abused by their parents – had the courage to approach strangers with open hearts. A little boy name Jose gave me a handful of candy he had stashed in his pocket. A seven year old girl named Karla took me by the hand and showed me her coloring book. She later introduced me to her two older sisters, Karlita and Paula.

Other highlights from the trip include: riding in back of a truck, attending a quincenera, playing with the orphans, Mayan ruins, visiting an active volcano, taking touist photos with armed guards.

I’m so glad I decided to go on this trip… and to think, I almost skipped out because of financial reasons. I’ve learned so much about optometry, El Salvadorians, and what it means to truly help others.

El Salvador gallery

one year later...

Tue, 10 Jul 2007 16:40:25 +0000

Wow, a lot has happened since my last entry. I've been far too busy (and as a result, too forgetful) to keep up with my blog. My Gallery page better documents what I've been up to...

1. I graduated college.

These past 4 years passed by quickly. Boba runs at night, shopping at IKEA, buying a car, cooking on my own, part time job, etc. I'm growing up...

2. I'm attending Grad school at SCCO.

Yes, I am committing myself to 4 more years of school. I'm learning about the eyes and everything related to that - diseases and conditions that affect the eye, drugs used for treatment, vision therapy, etc. School is a lot of work (~2 exams per week), but a lot of fun. In the end, its worth it.

In fact, optometry was named one of the "7 Great Careers for 2007" in an article in April on Kiplinger.com. Authors state that these careers "provide an ideal combination of money, status, sense of fulfillment and good quality of life, and have good job market prospects for the foreseeable future." I can go on about this, but I won't go into details right now.

3. I'm engaged. =)

Photographer: Brad

You're witnessing the moment Jon proposed to me on Valentines Day 2007. I love this picture! And yes, I was definitely surprised... jocundly surprised.

4. Jon and I are new homeowners. We just bought a condo together.

This idea was proposed in Fall 2006, then we started house hunting at the beginning of 2007, found this condo in April, then spent a lot of effort remodeling, and we are currently unpacking all of our boxes. Yes, we're moving fast. =P

5. I went to Taiwan to visit family.

I was 3 yrs old the last time I went to Taiwan. So basically, I don't remember anything or anyone because I was so young. This trip - 20 years later - was definitely very memorable... I finally met my dad's side of the family, and also finally experienced Taiwan's hot + humid climate. =P My relatives were nice enough to show me around and introduce me to Taiwan... a TON of pictures are in the gallery if you're interested. Oh, and my skin is now a couple shades darker. =P

6. Next adventure: El Salvador!

to my friend, Alison

Tue, 04 Apr 2006 09:20:10 +0000

shock. disbelief.
then,
emptiness.

eyes swollen red. tears of sorrow.
memories of you
forever hold dearly in my heart.

i never thought this would happen
to any of us at this age.
i never thought you'd leave so soon.

i miss you.
rest in peace, Alison.
my dear friend.