By Paul G. Donohue M.D. February 01, 2011 12:00 AM
DEAR DR. DONOHUE: Six years ago, my sister, 67 years old, was diagnosed with Graves’ disease, and it has affected her eyes. has there been any advancement in research with it? Where is the best medical facility for it?
Chalk up another illness to an immune system that turns against its own body. in this case, it’s the thyroid gland and the eyes. Graves’ disease is an enlarged thyroid gland (a goiter) that’s putting out too much thyroid hormone. The stimulation that causes the overproduction comes from antibodies made by the immune system. not only do they lead to excess thyroid hormone, they also lead to deposition in the orbit (the bone socket for the eyes) of material that pushes the eye outward and infiltrates the eye muscles. That, in turn, often produces double vision. The name given to eye involvement is Graves’ ophthalmopathy or orbitopathy.
Your sister has to protect her eyes by using eyedrops or eye lubricants. When outside, she should wear large sunglasses with side extensions that keep wind out of the eyes.
In the early stages, if eyesight is threatened from the pressure of the infiltrating material on the optic nerve, large doses of cortisone are given to shrink the infiltration. Often, time permits the swelling in the orbit to regress.
Six years from the start of her illness, your sister’s eyes are still a problem. she should be under the care of an ophthalmologist and an endocrinologist (a thyroid specialist). A number of surgical procedures can be done to enlarge the bony socket. If she suffers from double vision, eye-muscle surgery can correct that, or she can wear glasses with prisms that compensate for eye misalignment.
DEAR DR. DONOHUE: will you please explain a rectocele? Is surgery advised? I am 82 years old and concerned about surgery.
A rectocele (RECK-toe-seal) is a downward bulging of the rectum into the vagina. A similar bulge of the urinary bladder is a cystocele, and of the uterus, a uterine prolapse. all three are referred to as pelvic organ prolapse — “prolapse” meaning “falling downward.” The ligaments and muscles supporting these structures give way with aging and childbearing.
Surgery for a rectocele is advised if it causes symptoms like straining to evacuate, or is painful or causes loss of bowel control.
If you don’t want surgery, then try a pessary, a device that comes in many shapes and that’s inserted into the vagina to prop up the fallen organ. your doctor can suggest one best suited to your problem.
DEAR DR. DONOHUE: Recently, a testing service provided ultrasound tests for a reasonable fee. my arteries appear very good for a woman of 67. However, my gallbladder displayed many large stones, and my left kidney has a cyst. what can I expect to happen from my gallbladder and kidney? my doctor tells me not to worry. would you agree?
A single kidney cyst is a fairly common finding on an ultrasound scan. Often, it’s discovered exactly as yours was: A scan is taken for some unrelated reason, and the cyst is seen. A cyst is a round structure filled with fluid. It’s innocent. unless it’s pressing on the kidney and interfering with kidney function or causing pain, you don’t have to do a thing about it. If you’d never had the scan, you’d never know about it. Now that you know, you still can ignore it.
Silent gallstones — gallstones not stirring up any trouble — also can be ignored. in five years, one in 100 people with such stones will have a gallbladder attack; in 10 years, 1.5 people will have an attack; in 15 years, 1.8 will suffer an attack. The odds are greatly in your favor that nothing will happen.
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