MKE Health Care Guide

When Doctor Becomes Patient
One local surgeon’s journey through cancer and back into the OR.

BY LORI ACKEN 

In 2010, just weeks before my annual mammogram, I found a lump in my breast that seemed to appear overnight. A few days later, ProHealth Care’s Dr. Kelli Pettit performed a biopsy and delivered news more than 1 in 8 women will hear in their lifetime: That “lump” was likely
breast cancer.

A few days after that, as I embarked on what would become a two-year journey, I got another call. Dr. Pettit would no longer be my surgeon. Because she too was facing a cancer battle of her own.

“That was interesting to have to say, ‘Hey, I’m sorry I can’t do your care. I have to take care of myself,’” Pettit says when I mention our connection, speaking not just about me, but the other women she was treating at the time. “It was a very surreal experience.”

Though Pettit had a deep pool of knowledge about what lay ahead, both from her own training and her mother’s breast cancer battle, she says her first reaction was exactly that of ever other cancer patient — shock.

What Knowledge Can and Cannot Do

Pettit says that, by virtue of that hard-won knowledge, “there’s a big part between the time of diagnosis to the time that you have a plan that is really scary for most people, because they don’t know. I knew what I would need.” But, she adds, “Mine was, in some ways, even scarier because I also knew the kind of cancer that I had was fairly aggressive.”

Pettit was diagnosed with a fast-growing, triple-negative cancer, a form of the disease more common in younger patients, African Americans, Hispanics and patients with a BRCA1 gene mutation. “Triple-negative” means that the three most common types of receptors (proteins found in and on breast cells that pick up hormone’s signals for cells to grow), which fuel most breast cancers — estrogen, progesterone and the HER-2/neu gene — aren’t present in the tumor. Since the majority of cancers are estrogen-receptor positive, common forms of treatment such as hormone therapy and drugs that target those receptors have little effect.

Triple-negative cancers do, however, respond well to chemotherapy, sometimes better than their more common counterparts. For Pettit, that was daunting news as she pondered not only her future as a daughter, wife and young mom, but also as a surgeon whose hands are her livelihood — a career she says is woven deeply into her personal identity. “A lot of people think about the hair loss and the nausea,” she explains of chemo’s most dreaded side effects. “But knowing that neuropathy, which is numbness of your hands and feet, or the potential to get another cancer down the road — that actually was scarierfor me.”


Dr. Kelli Pettit

And so she got down to the business so familiar to her patients: partnering with her care team to choose an appropriate treatment plan.

“Everybody who works in this field has the, ‘Oh, if I ever …’ thought or conversation,” Pettit says. “I remember, before being diagnosed, sitting around the office with other people and having that conversation. But when it happens, when you know the information, there was such a clarity as to what I would do. I outlined my plan within the first hour and I was on the phone with people and got things going.”

Perhaps a bit too quickly, she adds.

“I had my MRI a little bit quicker than most patients, so there was more artifact from the biopsy than we normally see,” Pettit explains. “That led to it being over-read. I realize, especially as I’ve treated people close to me, that you really want to go down the standard path — because there’s a reason we do things the way we do.”

Pettit also admits that her own plan and the one her oncologist suggested didn’t exactly sync up.

“He had thrown out — unexpectedly to me — doing chemotherapy before surgery,” Pettit says. “That was not in my plan. That wasn’t what I had arranged. So it took me by surprise and I really struggled with that for a while. Ultimately, we negotiated and I did do my surgery first, which, for me, ended up being good. But, that was a real struggle.”

One with a comforting outcome.

“After that, I decided I was just going to leave it in their hands,” Pettit recalls. “So that’s essentially what I did. … I realized that I couldn’t be in control anymore.”

Trust and Training

“Putting trust [in my care team], that was the part that was easy for me, because I actually knew the people that were taking care of me,” Pettit continues. “That’s actually one of the reasons that I became a surgeon was because, when my mom had breast cancer, I thought that that was just so amazing, that trust relationship that you have to put in your surgeon.”

Outside of the hospital walls, Pettit says her concerns were those common to all cancer patients — or those facing any challenging medical situation. “The financial part of not working, when all the bills come in and all of that — I don’t think we always think about that when we’re being trained,” Pettit shares. “And then there were three moments along the way [after the diagnosis] where it was the most emotionally challenging.”

The first was sitting in a business meeting where she had to tell her partners of her diagnosis, wondering if she would ever return to sit among them again. The second was ordering the wig she knew she might soon want to ease the shock of losing her thick, dark hair.

The third, Pettit says, cut deeper.

“My daughter just turned two while I was going through chemotherapy, and someone said, ‘Yeah, I’m just thinking about if I died today, my kids might not remember me,’” Pettit recalls. In that instant, she says, she changed how she approached the future, making sure that every moment held as much contentment and meaning as possible, rather than focus on years down the road.

Pettit says she only wore her wig (with which her daughter also used to adorn stuffed animals) when she didn’t want to talk cancer, and when she returned to work still figuring out how to broach being in her patient’s shoes even as she treated them. “It was kind of a struggle to figure out how to come back to work and be able to separate myself from my patients,” she says, adding that, especially when a patient wasn’t faring well, it stirred up phantom pains and worries that left her reaching for the phone for reassurance from her oncologist.

But as her recovery progressed and she settled back into a regular work routine, Pettit shared her experience when she saw that it could prove reassuring.

“I am very open,” she says. “I’ve never liked the term ‘This was God’s plan’ or something like that because, to me, my God would never put me through that. So there’s part of me that says, ‘OK, if I had to go through with this, there has to be a benefit.’ That’s my benefit, that I can stand there in front of somebody and say, ‘I can be that example for you. I can help you through this. I know where those struggles lie. I’m not you, but I can help you through it.’”

Family and Future

Outside of the office, Pettit and her husband began to eye a future in which cancer played a much lesser role, wondering when the time might be right to give their daughter a sibling. The pair had already delayed starting a family because of Pettit’s lengthy and arduous medical training. And now the possibility that her husband could become a single parent was real. “Ultimately, when I was about a year and a half out, we said ‘Yep, this is OK.’ We had another child and it’s all been good,” Pettit says, giving her husband credit for heroic patience and caregiver talents cultivated during that exhaustive residency. She also salutes friends and family who stepped in when, in the midst of Pettit’s treatment, he herniated a disc in his back, necessitating his own surgery and putting them both out of commission for some time.

With that insight, and as the years pass with no sign of her cancer returning, Pettit says she’s particularly careful to ensure that patients understand that part of cancer treatment is recognizing that the day may well come when the disease is in the rearview, possibly for good. “I really try to help people think that my goal is to make you cancer free and for you to live another forty years,” Pettit explains. “So, I want to make sure that, 10 years from now, you’re still happy with everything. That you don’t make a decision that is just a gut reaction. Because I know that when you’re done with the cancer, all your worries prior to the cancer start to come back — self-esteem, personal image, quality of life or whatever it is that’s important to you.”

And while Pettit elected to have both of her breasts removed, she assures her patients that, in many cases, it is unnecessary to their becoming and remaining cancer-free. “That is what I did, and I’m super happy that I did,” Pettit explains, “but my situation was very different in the fact that I have a strong family history, and my tumor-to-breast size, and that we were going to have more kids. So I try to help [patients] figure out what is it they want and why it is what they want. … Knowing all of those things that happen long after your diagnosis is so powerful before you make a permanent change that you can’t undo.”

Pettit says she’s heartened by new and evolving treatment plans that allow doctors to focus keenly on individual patients and tumor cell types, leading to more streamlined and effective therapies. But she knows now more than ever that a “successful” outcome goes far deeper than vanquishing a mass.  “Being a doctor, you always want to help others. That’s why you go into it — and having that successful outcome, particularly in the personality of the surgeon, is a significant drive,” Pettit says. “The difference for me is that I’ve realized that helping them is more than just making their cancer go away. It’s listening to them. It’s providing those emotional supports and resources, and connecting with the patients.

“Those kind of things that I can do now in a different way than I would have been able to,” she continues. “…I want be that mentor to all of my patients.” MKE


A Joint Effort
Local orthopedic surgeons break the stigma around hip and knee replacements.

BY NICOLE KIEFERT

creaking knee or minor limp are nuisances, but most people don’t give the discomfort much thought until it interferes with their day-to-day lives and their leisure activities.

I vividly remember strolling through Summerfest with my family a few years ago, looking over my shoulder and seeing my mom grimace as she limped through the throngs of people. She’d spent years enduring pain in her legs and feet, but her hip had begun to give her serious problems — to the point where she’d begun avoiding physically strenuous activities in an effort to avoid the oncoming pain. At just 45 years old, she scheduled a hip replacement, and though she still has some problems with her feet (due to several foot and ankle surgeries as a small child), she’s able to enjoy walking through outdoor festivals, continue playing in her summer sand volleyball league, walk her dog comfortably, and maintain a fairly active lifestyle.

Her story isn’t an unusual one. According to Dr. Donald K. Middleton, an orthopedic surgeon who practices at Orthopaedic Hospital of Wisconsin, there’s a misconception about joint replacements being strictly the stuff of aging or athletes. While it’s still incredibly rare, Middleton notes that it isn’t unheard of to have younger patients needing a joint replacement. “You think of joint replacements [as] being the problem of old people, but suddenly you turn around and there are people [in their 20s] who are having joint replacements.

“There can be some scenarios where people have a joint that’s destroyed for various reasons, but joint replacement surgeries are done younger and younger,” he continues. “Now, I’ve had patients in their twenties. It’s not an ideal situation, but compared to the other alternatives, sometimes you [have to] make that decision.”

While most joint replacements stem from the wear and tear of osteoarthritis, Middleton notes that physical trauma, congenital deformities and other complex situations may lead to joint replacements.

“Unfortunately, this can affect everyone,” agrees Dr. Thomas Parisi, an orthopedic surgeon and total joint replacement specialist of the Orthopedic Institute of Wisconsin. “There definitely is an activity component. In general, we also tend to carry more weight than we probably should, which can contribute to increasing arthritis. There is also a genetic component, although we do not yet have a ‘gene’ for arthritis.”

Whether joint pain is caused from the typical wear-and-tear or something more serious, Middleton says once that pain starts impacting your quality of life and your ability to function, no matter the age, it’s time to start considering a joint replacement.

Parisi says that most knee replacements are more of a knee resurfacing than an actual replacement.

“A lot of people, when they think [of a] knee replacement, think that we are taking off a significant amount of bone from the tibia and the femur. That, however, is not the case,” he explains. “What we do during a knee replacement is essentially resurface the ends of the bone. All of the areas that used to be covered with cartilage we replace with either metal or plastic.”

A hip joint resembles a ball and socket. During a hip replacement, the patient’s native “ball” is removed and replaced, and the socket is resurfaced.

Recovery from the two procedures is a bit different, though both Middleton and Parisi say that patients will be up and moving same day in both cases.

“[With] a knee replacement, I tell my patients that they will curse my name for three weeks and by three months we will be best friends,” Parisi explains. “Eighty-five percent of knee replacement patients are very happy when it is all said and done, but a high proportion of total knee replacement patients say that their knee replacement does not feel like a normal knee.”

Parisi and Middleton also agree that the recovery period is a little easier for patients who undergo a hip replacement.

“[With] hip replacements, people get up and go. They really do very nicely,” Middleton says, noting that studies have shown that physical therapy has little to no impact on a successful recovery. “Patients can walk right away. Patients can do stairs right away. The vast majority of patients are only in the hospital overnight, and some are leaving the same day. Hip replacement patients generally recover much quicker than knee replacement patients, and do not need nearly as much physical therapy.”

For younger people enduring discomfort and limited mobility because they fear that a joint replacement will wear out too soon, sending them back into the O.R., Middleton still recommends speaking to a doctor sooner rather than later.

“[Replacements] shouldn’t last for life — and that used to drive a phrase that we often heard: ‘Wait until you can’t stand it anymore.’ … If it wears out, you can go back and redo it,” he says.

Middleton adds that, though there are slight variations depending upon the type of implant, 90 percent of replacements are still going strong after 20 years. And Parisi notes that, after about 25 years,
“83 percent of replacements are doing just fine.”

“With that, you can see why we’re able to offer joint replacements for people in their 50s and 40s, and —when we need to — even younger,” Middleton says.

While picking a surgeon can be the most intimidating factor, it’s also one of the most vital.

“The most important [factor] is to pick the surgeon, not the approach,” Parisi advises. “You want to have a surgeon who does a large number of hip or knee replacements, and you want them to do it the way they do it all the time. Patients do better when they are treated by high-volume surgeons at high-volume centers.”

Though there are multiple different approaches and brands of replacement joints, Middleton notes that patients shouldn’t become overwhelmed, but rather find and trust a doctor with whom they truly feel comfortable. “The advice that I would give is that some people get bogged down in the details — ‘Which approach am I going to have?’” he says. “Along the same line, some people are very focused on which implant they have.

“With the surgical approaches, when we look at the results, we can’t tell people apart so much,” he continues. “So being focused on that is not so pertinent. When we look at the implants, yeah there are some differences — but there are a lot more similarities than differences. The best implant for you is the one that the doctor who you’re comfortable with picks with you.”

If your own joints are aching, take heart in knowing that the metro Milwaukee area is home to a tested, trusted and knowledgeable medical community.

“You’ll never find a surgeon who doesn’t think he’s ‘the guy,’ says Middleton. “But I think the reality is there are a lot of guys that are ‘the guy.’ … We’re very fortunate. We have a very strong medical community. We have great surgeons taking great care of people, and joint replacement is one of those very satisfying, successful things.” MKE


Nothing To Sneeze At
Local experts break down fact and fiction about why you’re sneezing and wheezing

BY LORI ACKEN 

Few of us escape the warmer seasons without a bout or two of rheumy eyes and a stuffy, sneezy nose. Blame it on new grass, blooming flowers and leafy trees early in the warmer months and ragweed come late summer and early fall.

But what if your sneezing or wheezing doesn’t go away when you go indoors? Or it gets worse. Is it allergies? Asthma? Or a combination of both?

According to the American College of Allergy, Asthma and Immunology, allergies are the immune system’s response to an environmental trigger such as pollen, dust, mold, pet dander or food. Symptoms include itching of the eyes, nose, mouth and/or ears; sneezing; a runny nose; a productive cough, wheezing or tightness of the chest; and hives or dry, itchy skin.

Asthma centers on inflammation of the lungs that constricts the muscles around airways, tightening bronchial tubes and resulting in wheezing, coughing and shortness of breath. Allergens also trigger most asthma attacks, but smoke, cold or humid air, intense odors and strenuous exercise can bring one on too. And yes, allergies and asthma can occur together.

We asked Walter Brummund, M.D., Ph.D., of Allergy & Asthma Centers, SC, and Gary C. Steven, M.D., Ph.D., CPI, FAAAAI, FACAAI, who founded Allergy, Asthma & Sinus Center, SC, to break down myth and reality when it comes to both afflictions.

Everyone is allergic to something.
False.
“Our best estimate is that about 20 percent of the U.S. population has allergies,” says Steven. “Most are mild and can be self-treated with increasingly more effective medications that are available over the counter. But it is also true that more people are developing allergies — and more people are developing more severe allergies.” About 5-10 percent of the population has asthma, adds Brummund.

If you consistently feel unwell after eating or being exposed to something, you are probably allergic to it.
Generally false. “It is VERY common for people to refer to pretty much anything that bothers them as an allergy, but ‘allergy’ means a very specific thing — the person is [making] allergic antibodies against a particular protein, such as pollen, dander, mold or food allergens,” says Steven. “In true allergies, encountering a protein against which a person is making allergic antibodies results in histamine release — which causes itching, redness, swelling, hives, wheezing or a drop in blood pressure. Other symptoms generally indicate intolerances. The classic example is the so-called ‘Chinese restaurant syndrome’ in which people sensitive to MSG get a headache. Headache is not a symptom of histamine release, so it is not an allergy. It
is an intolerance. … In true food allergies, people will react to even small amounts of the food, and can potentially have life-threatening reactions to the food to which they are allergic.”

Allergies and asthma are genetic.
True-ish.
“If each parent has an allergy or asthma, there is about a 1 in 2 chance that their child will have an allergy,” says Brummund. “If only one parent has an allergy, that chance is about 1 in 4.”

“Certain segments of DNA are more likely to lead to the production of allergic antibodies,” notes Steven. “But the development of significant allergic reactivity is actually a random event that comes from splicing DNA segments. Although family members might share several pieces of DNA that are related to the development of allergies, the right sequence of events might not happen by chance, so not ALL members of a family will necessarily be allergic.”

You can “outgrow” allergies or asthma. Or, conversely, develop them over time.
True on both accounts.
“Some allergies can be outgrown, others not,” says Brummund. “Infants with a milk, wheat, egg or soy allergy often outgrow these allergies, but less often outgrow peanut or tree nut allergies. Some children with asthma, even if it is severe, often have a dramatic improvement in or loss of asthma during their teenage years. It sometimes returns in adulthood, however. And in some individuals, asthma may begin in adulthood, often due to an allergy acquired later in life or following an infection.”

“Allergic sensitivities tend to change the most during periods of changes in hormones, especially puberty and adolescence, pregnancy, changes in thyroid hormones or menopause,” adds Steven. “And most people with allergies see their allergic sensitivities decrease after age 60, when our immune systems start slowing down with age.”

Allergies always equal antihistamines.
Depends on the severity.
“There are many effective ways to treat allergies, oral antihistamines being only one of them,” says Brummund. “Identifying what you are allergic to by allergy testing and avoiding that allergen is the most preferable way to treat an allergy. The identified allergen may also be desensitized with allergy shots or other immunotherapy. Other non-antihistimine medications can also help reduce allergy symptoms.” But, adds Steven, antihistamines remain the first line of defense against allergies. “The first step in an allergic response is to release histamine, which then causes all of the symptoms we associate with allergies. So the first step is to block the action of histamines with the antihistamines.” When those don’t work, the next step, says Steven, is steroid sprays, which deliver the needed amount of medication to the nose or lungs without exposing the entire body to steroids.

Asthma always equals an inhaler.
True.
Brummund stresses that identifying and avoiding your allergy and asthma triggers are always the first, best course of action. But, Steven notes, “When it comes to treating the inflammation of significant asthma, using inhalers to deliver small amounts of steroids to treat that inflammation in the lungs is the best way to go” to keep the total dose of steroids and their side effects to a minimum. Both men agree that even when asthma is well controlled with biologics, a quick-relief inhaler is recommended for emergent situations.

Stress and anxiety can trigger or exacerbate asthma.
True. “But sometimes it can be hard to tell if stress or anxiety actually triggers the physical changes in the lungs that happen in asthma attacks, or if people are simply getting short of breath [because of] their anxiety,” says Steven. “The best way to tell them apart is to have some tests of airway inflammation in order to make sure that the inflammation of asthma is well controlled.”

You can’t exercise or do vigorous sports if you have asthma.
False.
“If you can’t,” explains Steven, “your asthma isn’t well controlled. The entire point of the allergy specialty is to help people with allergies and asthma to control their disease, rather than let their disease control them. Although there might possibly be a few people so severely allergic that we can’t bring them under complete control, for the most part allergies and asthma can be controlled, through cooperation between the patient and their allergist.”

By taking proper care of yourself, avoiding your triggers, “taking appropriate medications and receiving allergen immunotherapy,” says Brummund, “asthmatic patients can perform vigorous exercise. With appropriate treatment, many star professional athletes with asthma perform at the highest levels.”

Certain climates are better for asthma and allergy sufferers.
False.
Neither Brummund nor Steven recommend that you pack a U-Haul in an attempt to leave your allergies behind.

“People think this because when they go on vacation to a different climate, they often notice that their allergies are better,” Steven explains. “But that is because one cannot become allergic to allergens to which they are not exposed. … A typical story goes that someone with severe pollen allergies at home in the Midwest goes on vacation to Arizona. Almost none of the pollens that cause their symptoms in the Midwest are present, so they feel great — so much so that they decide to move there. But they continue to be exposed to pollens native to Arizona not present in the Midwest. So after a few years of being exposed to mesquite pollen, they become allergic to it too.”

Mold allergies can get you indoors or out.
True.
“Mold is a bit unique among the common allergens in that it can be prominent in both indoor and outdoor environments,” says Steven. “Common indoor allergens like dust mites, pet danders and cockroaches are not present in significant levels outdoors, but mold can be found both indoors and outdoors.”

“Molds are frequently encountered indoors if the conditions are right, such as dampness and darkness found in a basement, a refrigerator catch tray or bathroom — or in areas where there has been damage such as from a leaky roof,” adds Brummund, noting that outdoor mold allergies are most frequently triggered “ in wet or swampy areas, forests, near lakes or in agricultural areas where there is sufficient organic material and humid conditions necessary for mold growth.”

Some pets are “hypoallergenic.”
Sort of.
But not in the way that most people think, the doctors say. “‘Hypoallergenic’ is a population-based assessment,” says Steven. “If you take a look at a large number of people, more of them might be allergic to one particular species of pet than another. So the term ‘hypoallergenic’ means that large numbers of people might be less likely to be allergic to a particular species of pet, but it doesn’t mean that a certain individual won’t become allergic to it. … It often
takes several months to become allergic to a type of pet to which you’ve never been previously exposed.”

“Smaller, non-shedding dogs tend to cause less of an allergic reaction than large, shedding dogs,” adds Brummund. “Having said this, if you have a pet allergy, it is best not to have a pet in your home, because even a ‘hypoallergenic’ pet will likely still cause some allergy symptoms — and they can magnify the symptoms of other respiratory infections such as a cold.” MKE


Brushing Up On Heart Health
Taking proper care of your ticker could begin with your teeth.

BY NAN BIALEK

Flossing and brushing your teeth daily makes your smile sparkle. And, as a bonus, those good habits may give you something else to smile about — a healthy heart.

“There absolutely is a strong connection between good oral health and heart health,” says Joshua Liberman, MD, FACC, preventive cardiologist with Ascension Wisconsin Cardiovascular Group. “We know that periodontal disease increases the risk for heart attack, and poor dentition is a risk factor as well for developing bacterial infection inside the heart, which can be devastating.”

Although medical research has not definitively established poor oral health as a direct cause of heart attack, many studies have indicated that people who have a history of gum disease have higher rates of heart attack and stroke compared to those who maintain good oral health.

Liberman notes that the cardiology community has known for decades that gum health and heart health are related. “Ultimately heart attacks are caused by a combination of cholesterol buildup and chronic inflammation,” he explains. “Any form of chronic inflammation, such as gum disease, autoimmune disease or arthritis, will therefore increase the risk of heart attack.”

The risk increases with age, Liberman says, largely because it takes years of chronic inflammation from chronic periodontal disease to lead to heart problems. It would be very rare, he adds, to see significant heart disease in young people simply because of poor oral health.

“Of course, that makes it even more important to encourage good dental health in young people so they can avoid this risk factor,” says Liberman.

So, how do you maintain healthy teeth and gums? Be sure to brush twice a day at a minimum, says Dale Rottman, DDS, of Successful Smiles based in Thiensville. Floss at least once per day with regular floss, or, even more effectively, with a water flosser. Consistent flossing prevents plaque from building up on the teeth and gums.

That plaque, notes Rottman, contains hundreds of kinds of bacteria. As plaque accumulates and calcifies on the teeth and gums, left unchecked it will eventually reach the root of the tooth and the jawbone. From there, the bacteria in the plaque can enter the bloodstream and affect the heart.

However, plaque that forms in the mouth is not the same type of plaque that forms in the arteries, resulting in coronary artery disease, says Liberman. “While they share the same descriptive name, the process of plaque creation and the composition of those plaques are totally different,” he explains.

Periodontal disease is not reversible, but it is manageable, Rottman says. “It starts with gingivitis, an inflammation of the gums,” he notes. “Once you have it, you have it. If it gets too advanced, you need surgical intervention.”

The risk of periodontal disease also increases with aging. Older people who take a lot of medications are at risk of developing it, because a side effect of many medications is a dry mouth — and lack of saliva contributes to the development of gum disease, explains Rottman.

To help prevent periodontal disease, have your teeth cleaned and examined by a dental professional every six months, Rottman says, or three to four times per year if you have been diagnosed with periodontal disease.

The most effective strategies to prevent heart disease involve improving your lifestyle, says Liberman. Those include:

“Any form of chronic inflammation, such as
gum disease, autoimmune disease or arthritis,
will therefore increase the
risk of heart attack.”

— Joshua Liberman, MD, FACC

• Adding more fruits and vegetables to meals and moving to a more plant-based diet

• Exercising daily

• Avoiding tobacco

• Avoiding sugar-added beverages like juice and soda

“As it turns out,” Liberman says, “these are the same strategies that can help you improve your oral health too.” MKE


 The Window to Your Health
Your visit with your eye doctor may tell you more than your new lens prescription.

BY NAN BIALEK

The eyes are said to be the “window to the soul.” They can also be an important window into the condition of your physical health. During an eye exam, an optometrist or ophthalmologist checks for common eye problems and may find signs of serious, but previously undetected, medical conditions.

“Some medical health conditions can present themselves first either with blurry vision, redness, eye pain, eyes not focusing [or] eyes not feeling good,” says Dr. Christina Petrou, a Glendale-based optometrist. Anything that can affect the body may be observed in the eye, Petrou adds, including diseases that impact the blood vessels and arteries, the immune system, the lymphatic system, as well as neurological conditions.

Cardiovascular disease commonly turns up while examining the eye, says Daniel Paskowitz, M.D., Ph.D., of Eye Care Specialists in West Allis. If there is a blocked artery in the neck, for example, small pieces of cholesterol may break off and get lodged in the eye’s blood vessels. He notes that although that does not cause pain, it does cause changes in vision, such as the patient noticing that part of a clock he or she is looking at seems to be missing.

“When we see a piece of cholesterol in the eye, that prompts us to evaluate the heart and blood vessels of the neck, and if that lets us find a problem early, we can sometimes even save people’s lives that way,” Paskiwitz says.

Strokes can also be detected during an eye exam. Paskowitz notes that strokes often do not cause obvious symptoms such as weakness or numbness, but can cause a blockage in part of the visual field. “If we see that the same part of vision is blocking each eye, that often suggests a stroke or another problem in the brain.”

Mark Freedman, M.D., of Eye Care Specialists points out that he often finds evidence of high blood pressure during eye exams. Sometimes the patient is unaware that he has hypertension; other times the patient has erroneously believed that his blood pressure was under control. If, after checking, the blood pressure is indeed high, the patient is referred to his primary care doctor for treatment to prevent stroke, heart disease or kidney failure.

Paskowitz says visual symptoms may also be caused by rheumatoid arthritis and lupus, “and it’s not infrequent that the first sign of a brain tumor is through abnormalities in vision.” Freedman adds that about 40 percent of multiple sclerosis patients are diagnosed because of an eye problem called optic neuritis, an inflammation that causes damage to the optic nerve.

Amy DeGueme, M.D., a board-certified endocrinologist with Madison Medical, says in patients with diabetes, high blood sugar levels can cause sugar to get into the eye’s fluid and cause blurry vision.

“This gets better once we can get the sugars controlled, which is reassuring for many patients who come to me with newly diagnosed diabetes and are concerned about permanent vision changes,” DeGueme says. “However, for diabetics with long-standing poor sugar control, we can start to see damage in the back of the eye, called the retina.” High blood sugar can cause blood vessels in the eye to degrade and bleed, or close, (a condition called retinopathy) while new vessels form. Those new vessels grow in areas of the eye that block the patient’s ability to see.

“This all can be prevented with yearly eye exams and good diabetes control,” DeGueme explains. Reasons to have an eye exam right away would be blurry vision or entire fields of vision that are missing. “It’s so crucial to find any damage early so that the ophthalmologist can treat it before it progresses to permanent vision loss.”

Freedman, who spends a good part of his day treating diabetic retinopathy, says, “We now have truly revolutionary treatments that can stabilize and preserve sight in 90 percent of patients and actually improve any loss of vision in 30 percent of patients.” The treatment is medication that is painlessly injected into the back of the eye. “Painless is the key word,” he adds.

Without good glucose control, patients with diabetes are also at risk for cataracts and glaucoma, DeGueme explains.

Treatments for retinopathy and other eye problems, says Freedman, “work best if we catch the disease at an earlier stage, rather than later.” MKE

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