Thursday, January 15, 2015

Real People # 1

In the coming months I will be sharing stories of others living with Stargardt's and other retinal dystrophies. These people have all inspired me on my journey and no doubt will inspire you too!

First up is Jenna!

Jenna Lawson, 22, Florida, United States

What is your diagnosis and how does it affect you?

In March of 2011, I was diagnosed with Stargardt disease, a type of retinal dystrophy. This disease impacts my central vision and, at this point, I have no central vision left. When I first began losing my vision and I was told that neither glasses nor surgery would fix my problem, I was very scared and upset. At that point in my life, I was a year out of high school, I wasn't going to school (even though I really wanted to), and I was trying to enroll in a dental assisting program that I thought would bring some direction to my life. I had successfully enrolled in a program and was due to start in a few days when I received the news about my eyes, so I had to withdraw from my classes until I figured out what was happening with my vision. In addition to feeling scared, I felt angry because all I wanted to do was get my life on track, but all of these events were preventing me from doing so.

I, thankfully, received an official diagnosis two months later, and I remember thinking: "This is my life now. There is no looking back." I was so relieved to simply know what I was dealing with that acceptance came very easily. I was so eager to pursue my life that something like Stargardt was not going to stop me. Funny thing is, Stargardt disease turned out to be one of the biggest blessings of my life because, not only did it enable me to attend school, but it helped me realize my true strength and tenacity. It's strange how something that, at first, seemed so negative turned out to be such a positive and motivational experience.  I definitely encounter challenges from time to time, but I have accepted my eyes for what they are and this alone has given me great peace.

Where do you currently work or study and how do you find it with your vision impairment?

Currently, I attend the University of Central Florida, and I'm pursuing a Bachelor's in Social Science Education. My goal is to become a history teacher. Before UCF, I attended Weber State University in Utah. When I lived in Utah, I walked three miles to the nearest bus stop, in the cold and the snow, and then rode the bus for an hour to school. I kept getting sick because of the cold and I hated the long commute, so I moved to Florida where I'm able to wear sandals and shorts almost everyday. I take classes online, and I also take classes at a location that is about three miles from where I live. I ride my bike to and from this location, rain or shine. School is my job, at the moment, but I spend a lot of time volunteering at an elementary school. I ride my bike there, as well, because it's close to where I live. If I have to go anywhere else, like the grocery store or the dentist, I have to have a friend or family member take me.

What hobbies do you have?

I love to paint and draw, write stories, read, spend time at the beach, hang out with friends and family, watch movies, travel,  study world history, and belly dance. I continue to enjoy all of the activities I did before I began losing my vision. I started belly dancing about a year ago because I wanted to improve the health of my spine (I spend a lot of time hunching over notes and textbooks because I have trouble seeing).

What has been the biggest hurdle you have faced?

The biggest hurdle I have faced has been transportation. Transportation has been the most persistent and frustrating problem. In the United States, there is sort of this expectation that anyone 18 or older should be largely dependent on themselves. Lack of transportation makes it so you have to depend a lot on other people, and a lack of transportation can also limit your access to job opportunities. Learning to accept a state of dependence is difficult, and it can sometimes feel demeaning when you live in a culture that places so much emphasis on independence and "finding your own way". Not being able to provide transportation for yourself also shows who your true friends are; those that truly care will undoubtedly find the situation tricky, at times, but they will be there to support you no matter what, whereas others will see you as a burden and will disappear from your life. I take this hurdle one day at a time. As far as relationships and job opportunities go, I have come to view my transportation issue as a filter. In other words, opportunities and relationships will continue to be in my life, regardless of my eyesight and the challenges I must face on a daily basis.

What's the best advice you'd give to others in this situation?

I have learned some very important things over the past few years that I would love to share:

  • Acceptance leads to success. Looking back on what used to be doesn't make things any easier, and it most certainly will not make you happy.
  • Be your own advocate. If you need help, don't be afraid to let people know. There are so many resources for people who are visually impaired. It's truly an amazing experience when you connect with people who are dedicated to your success and well-being.
  • Realize that things could be a lot worse. Honestly, I'm lucky to have Stargardt because, while I may lose an extent of my eyesight, I will never lose all of it. There are people out there who have suffered much worse and, amazingly, they have powered through it and come out on top. These people have been my greatest source of inspiration
  • Never let others minimize your frustrations, challenges, or experiences.
  • Pursue your interests and continue to live your life.
  • Honor your sadness, frustration, and fear, but don't allow these emotions to consume you.

Thanks Jenna for sharing. You have been an amazing friend and support from the other side of the world!

Here are some of Jenna's beautiful artworks. I've previously shared some of her work make sure to also check it out here.

If you want to connect with Jenna on Facebook click here.

Tuesday, January 13, 2015

Let's talk anxiety

I've brought this issue up previously, and I think it's time it comes up again. Mental health is something I am extremely passionate about and anxiety is something I have been dealing with now for years.

I experience panic attacks. For those of you who don't know or have never had a panic attack, it is probably the worst feeling you could ever feel. There was a study done with people who had experienced both a heart attack and panic attacks which found that panic attacks were far more frightening and disabling! I hope this puts it into perspective a little! 

When I have a panic attack, it feels like extreme fear, and my 'flight or fight kicks in'. I'm usually more of a flighter, I get out of the situation as soon as possible to reduce the feeling, but this only feeds the panic and makes it worse causing me to avoid.. well life. 

The physical sensations can vary but include dizziness, trembling hands and legs, numbness in the extremities, dry mouth, rapid heart beat, shallow breathing, blurred vision, churning sensation in the belly, rapid bowel movements - pretty much everything in the body is affected. 

My attacks got even more severe when I had to stop driving. I had lost my independence. I was holding on to that last bit of control I had, I couldn't handle being a passenger in the car and was always the driver. I wasn't venturing far from my home at the time. After I realised it was too unsafe to continue to drive I knew I had to stop. At the time I also quit my job because of my vision issues and anxiety. I decided that it was time for me to start from scratch, and so I hit rock bottom.

Rock bottom felt like a big, dark hole that engulfed me from every direction. All the light was sucked out and I was stuck, too scared to move forward. I got to the point where I could no longer leave the house and even looking out the window brought on an overwhelming feeling of claustrophobia and fear. 

I knew what I had to do, I had to face it. At the time I was studying a subject called Behaviour Modification (awesome subject) and was learning about desensitization. My avoidance was feeding the panic monster within and the monster was winning. I didn't want it to win. I wanted my life back.

So I started small, I would walk down my driveway (which is like a street in itself) and start down my street. At first I would only get ten houses or so down before I started to feel panic, then I'd turn around and come back. I kept doing this until it got a little easier and then went further. 

I was overwhelmed by the traffic on the busy road at the end of my street. There was too much for my failing eyes to take in and process and everything was a blur to me. It made me feel nauseous. So I would sit on the bus stop on the main road and force myself to breath and take it all in. Slowly I became more comfortable with the rapid movement and the little of it I could process. 

Next was getting in a car with someone else at the wheel. Now I'm a HUGE control freak, if I could control the weather I would! It was hard enough just to get inside the car with someone let alone actually drive somewhere. It also comes down to trust. I had to trust someone else to be my eyes. Miss Control Freak had to give up her control! Let's just say there was a lot of tears, screaming and emotions flying around when I tried to do this with my friends and family. It started with going 100 metres down the street and coming back. Anyone I go with is now a pro u-turner (as we say in Australia, 'chuck a u-ey'). 

This is a slow process and I am by no way back to normal. It tests your patience, your courage, your bravery and your belief. I am slowly working my way back, and I want to emphasise that this process is slow and draining. It doesn't happen overnight. There are always times when I feel like I'm going backwards but I need to keep positive and push through. Everybody has bad days and I know I need not take it to heart. Just get up the next day and try again.

Unless you have been through a similar situation, it can be hard to truly understand what it's like. Time and time again I've been told to 'just get over it', 'try harder' and 'just do it'. If it was that easy do you not think I would?! Mental illness is a REAL illness, it's not for attention, it's not anyone's fault and it is just as disabling as a physical illness, if not worse. Most importantly, it should not be something that we are afraid to share, after all, in Australia 1 in 2 people will experience anxiety or depression in their lifetime. Support is the key.

Having a double whammy of illness is hard. But you're not alone. There is help available and most of all support. I get a lot of emails saying that my blog provides 'inspiration', but it's everybody else who inspires me to keep going and keep fighting. Community is one of the strongest forces to produce change and ensure happiness.

Let's continue to stick together to make a difference and keep living our amazing lives!

Monday, December 1, 2014

Vitamin A and Stargardt's - Part 1

The only advice I was given when diagnosed with SD was that vitamin A was causing my vision loss and to not take supplements with Vitamin A. This totally contradicts the widely known fact that Vitamin A is essential for eyes. It's not that this fact is incorrect, it's that it doesn't wholly apply to SD. 

Since I love my science and research, I took it upon myself to spend my spare time reading every published article on SD and vitamin A to find out more about the mechanisms at play in the eye causing problems and what evidence exists to support these theories. The earliest article I found was published in 2008 and all used mouse models for investigations.

A paper published in Cell Death and Disease this year gives a good overview of the mechanism leading to vision loss and how Vitamin A is implicated. Essentially, SD is caused by an accumulation in the RPE of Vitamin A dimers (dimers are two molecules joined chemically), which are known as A2E (shortened version of the chemical name). Using an in vivo model, they found that increased A2E led to greater cell death. A word that always comes up when talking about SD is lipofuscin which is the yellow-brownish pigment deposits seen on a retinal scan used to diagnose the condition. Tying it all together, A2E derived from vitamin A is a retinal lipofuscin which is causing the damage and subsequent vision loss. These findings support earlier studies in mice such as articles n the Journal of Biological Chemistry and Investigative Ophthalmology and Visual Science which both looked at the effects of vitamin A, SD and mice demonstrating that higher doses of vitamin A led to increased lipofuscin development. 

Another paper in the Journal of Biological Chemistry also used a mouse model to investigate the effects of A2E and  also oxidative stress. It was found that A2E increased inflammation in the RPE, which is an important finding for prospective treatment solutions.
There are no studies performed in humans on the effects of vitamin A probably because it is not exactly ethical to get a group of SD patients and give them high doses of vitamin A and see whether they deteriorate! Despite this, the research is available to support that vitamin A is indeed causing damage in the eye and leading to vision loss. The continuing research has led to greater understanding on the different components at play and, no doubt, will help in the future to develop therapies. 

So now we know vitamin A is not our best friend, where do we go from here? Part 2 will discuss diet and vitamin A and how we can ensure not to overload vitamin A and contribute to the SD process.

Wednesday, November 19, 2014

Second chance for Mr Cane

I have been walking a lot more since unwillingly giving up driving. I have grown in confidence with walking alone but I still find road crossing difficult. I'd given the cane the flick because we just weren't getting along. I haven't used it in some months now although there has been a little voice in the back of my mind telling me to pull it out again and give it another go. 

Yesterday was the big day when Mr. Cane got his second chance to win me over. I must admit, he did a damn good job at it! I went for a walk with a friend who hadn't encountered anyone using a cane before so it was interesting for her to see how it was used and the reactions of others. 

One of the big issues I've been having is that when I'm walking, others have no idea I'm vision impaired and if I make a mistake crossing they will think I'm an idiot. I like the fact the cane is a way of saying "Hey, I don't see good, look out for me". This was evident when we crossed a main road, without traffic lights, but with an island in the middle (so we could go half the road at a time). This particular spot had been an issue for me because the road is so busy I can't simply rely on my hearing and limited sight. In a way the cane was like my indicator signal of a car. People knew to be mindful of me. We had a great experience, each time we crossed (we did it a few times!), when we were on the island, a person would stop the traffic to let us cross. It really was a testament to how kind people can be. These small gestures increased my confidence with crossing roads and also gave me more trust in those around me. 

We also noticed people's reactions when walking toward us. Each person we passed, even someone with a pram, moved off the footpath out of the way to let me pass. I don't know what I expected, that people would walk into me or make comments, but experiencing it first hand made me feel more at ease with the whole idea of using the cane and reduced the stigma to using it.

Mr Cane and I have gone on another date today, with similar success, and we are on the road to a happy and long partnership. Up until this point, I wasn't ready to accept the fact I may need extra help getting around and there is nothing wrong with that. Now is the right time for me and I will embrace it and continue to gain more confidence and independence. 

Monday, October 27, 2014

Update on Stem Cell Treatment

If you haven't already heard, results from the phase I trial using human embryonic stem cells for patients with Stargardt's Disease and Macular Degeneration have been published in the Lancet, and the results are very promising!

Nine patients were treated from each disease which involved surgical implantation of the stem cells into the retina of one affected eye. The main aim of phase I trials is to test the safety of the intervention, so whether there were an adverse events or complications from having the stem cells implanted, and in this case whether the stem cells 'stuck' to the eye. The investigators also looked at whether there was any improvement in vision.

Excitingly, the results were very promising - there was no major adverse events (although some patients with Stargardt's developed cataracts but this was treated surgically and didn't affect vision after treatment), no rejection of the implanted cells, no abnormal tumour growth and it looked as though the cells remained functioning at follow-up (which was up to two years after initial implantation). To top it off, there was also objectively reported improvement in vision in the treated eye!

To put it in perspective, this is still early days and we won't be running out to get stem cells injected tomorrow. Although it is definitely looking like a very possible treatment in the future and in our lifetime! The next step is to proceed to a phase II trial which will include a larger number of patients and find the best dose (number of cells to be injected) to gain the best results. Further evidence of the effectiveness will be developed to show how much vision can be restored, if it is permanent, whether the implantation needs to be done in the early stages of the disease and many other questions.

This is extremely exciting and shows how amazing modern medical science can be. It can give us all a little more hope that potentially in the future we may be able to see better, and if not us, the generations to come who will unluckily have to experience the hurdles we have faced. 

For more information here are the links to the results and news reports:

Wall Street Journal

The Lancet

Wednesday, September 3, 2014

Selling My Independence

This week was a big milestone in my journey of acceptance. I am actually quite surprised that I did it and finally let go of something I had been holding on to so tightly.

Probably slightly melodramatic, but I sold my independence this week, my beloved car. I had bought my car brand new almost five years ago to the day. After driving around in hand me down cars (including a red, seven-seater Mercedes Benz station wagon from before I was born), I had finally splurged on a shiny, fresh new car. I was very attached to my car, it had travelled with me through so many life events and it was like my solace where I could feel calm and even have a cry. Ok it does sound like I was in a relationship with my car but since I'd driven for 10 years I had really gotten used to having it.

I should have stopped driving a few years ago although I didn't stop (and I in no way recommend doing this). I continued to drive locally to and from work. As my sight deteriorated I realised I had to let go, I had to give it up. In March this year I made the decision that I was going to let go, I wasn't going to drive again and I was going to literally start from the bottom and learn to be independent in a new way. This caused me great anxiety and stress and by no means has it been easy or am I close to being entirely independent. I grew to rely on driving, I never caught public transport, so I'm literally learning how to do everything again with poor vision. 

I tried to find a reason to keep my car - someone in my family would drive it, I could give it to my brother, we could have a spare car, but deep down I knew it was pointless. I put it up for sale a month ago, grudgingly. 

As the weeks past I still tried to find reasons to keep it and more people came to look at it. Once I found a buyer, the few days before they picked the car up I started to think to myself I should just keep it and I didn't want to give it up. The morning they came to pick it up, I paced around the yard and my anxiety levels grew. I knew I had to do it and I knew that once I did I would feel stronger.

It was actually easier than I thought (possibly helped my a massive envelope of cash). It was even empowering. I was proud of myself. I had let go. I had let go of something I had been holding onto for many years. I knew I could do it, that I could face this new chapter. 

And here I am. Car-less, less independent perhaps but with a greater level of determination. Of the years I have been battling Stargardt's, this week definitely was a big step for me. Onwards and upwards!

Tuesday, August 12, 2014

Increased Senses

A common question I get asked is whether since losing my vision my other senses have increased. Generally I would answer no, but lately I've noticed that my senses have been changing and adapting. This is probably due to being more aware of what is happening around me and being more accepting of the need to use my other senses more in every day life.

I would not describe myself as having good hearing, quite the opposite especially since I had ear problems as a child which have continued into adulthood. Since learning how to use a cane to navigate, I have had to tune into my hearing more to help me cross roads. I think in the past I just didn't pay attention to what was going on around me on an aural level. The first time I tried to listen to determine whether it was safe to cross I felt overwhelmed and had no idea whether I should wait or go. I was also not accepting that I needed to be using a cane and my ears, and this also played a role in having so much difficulty tapping into the sense.

Another big help to me learning to tune into my other senses is practising mindfulness meditation everyday. I started learning about mindfulness to help with anxiety and I was instantly hooked on it. I was always interested in meditation, using it infrequently, but mindfulness really resonated with me. It teaches you about being in the present moment and to be aware of your body and your surroundings. 

My favourite way to practice mindfulness is to listen to the sounds around me. I was shocked when I first tuned in and heard at least five different birds, all in the middle of a big city! I had totally forgot the existence of the wildlife around me! I also can hear the traffic (which is surprisingly relaxing), the trains which are about a five minute drive away and the bats squabbling constantly. This probably sounds lame and like I have no life but I actually enjoy just listening! I've always been a person constantly on-the-go and always engaged in an activity but I've actually learnt to stop and just be, and it has helped with accepting my diagnosis and also in aiding my adaptation.

It truly is incredible what goes on around us and within us, and tuning into it has been a rewarding experience. I'm learning to embrace just listening, not having to rely on my eyes, to experience the world in a different way. You don't need to see every detail, you can combine what you see, hear, feel and smell and that is just as satisfying as being fully sighted.