I’m Perfectly Healthy, Doc!

 

Without a doubt, all my challenging patients come to me on saturday mornings, when my day is booked, and double booked.  So of course, on a saturday morning, my office receives a call from a patient’s sister that reports that her brother, who is here in the US for vacation (from Brazil), woke up that morning and could not see out of one eye.  As any of my optometrist friends would do, I told him to come in ASAP.  About ten minutes later he was at my office along with two of his sisters.

My patient, the 47year old Brazillian Pediatrician tells me that he had LASIK about 4yrs ago and has had perfect vision since….until this morning, that is.  He woke up that morning and noticed that he could not see anything out of his right eye.  He reports that he is in “perfect health”.  His best corrected vision was worse than 20/400 (he couldnt see the big ‘E’) in the right eye and 20/20 in the left.  Looking at the way his pupils reacted to light told me that there was something seriously wrong.  So I went ahead with a complete dilated exam, with showed significantly swollen optic nerves and a lot of scattered hemorrhages.

At that point I put on my “detective” hat, and started asking more questions.  When asked when his last medical exam was, I was shocked at his response: “15years ago”.  So I brought out my blood pressure cuffs and checked it.  His blood pressure was 170/120.  So I explained my findings to the patient, and being an MD, he understoood the seriousness of it.  I sent him off to the ER, and told his sisters to go home and pack a bag for him, since he will be at the hospital for quite sometime.

The American Heart Association has recommended guidelines to define normal and high blood pressure.

  • Normal blood pressure less than 120/80
  • Pre-hypertension 120-139/ 80-89
  • High blood pressure (stage 1) 140-159/90-99
  • High blood pressure (stage 2) higher than 160/100

The swelling of the optic nerve are due to the lack of oxygen to the nerves.  Hemorrhages can happen because of the thinning of the blood vessel wall from the persistent pressure of the blood against the blood vessel walls.  My patient was in the hospital about 10 days before they were able to get his blood pressure under control.   He eventually regained most of his vision back after the blood pressure was brought under control.

Lesson learned:

  1. Make sure to go for your annual physical consistently.
  2. Annual Comprehensive eye exams are very important, including a dilated exam

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