Diabetes is a growing disease in America. Almost 96 million Americans are followed for diabetes in 2024. If you are followed for diabetes, your physician will stress the importance of a comprehensive eye examination. This is because uncontrolled diabetes can cause changes in your vision and the development of cataracts. The most severe complication is diabetic retinopathy.
What is Diabetic Retinopathy?
Diabetic retinopathy causes damage to the blood vessels of the retina, which is the back layer of the eye. One in 12 people with diabetics have diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness for people under the age of 60.
Diabetic retinopathy can develop in anyone with type I or type II Diabetes. The longer you have diabetes, the more likely you are to develop diabetic retinopathy. Most often patients will not have symptoms of early diabetic retinopathy. As retinopathy progresses, you may develop blurred or fluctuating vision, floaters (spots in your vision that may appear like black or gray specks, strings, or cobwebs), a quick change in your vision, dark spots in your vision and even blindness.
In this example of how people with normal vision see, there are no visual symptoms of floaters or damaged blood vessels.
This is a simulated example of how someone with diabetic retinopathy may see. As retinopathy progresses, individuals may begin noticing blurred vision, dark spots, and floaters.
Early Diabetic Retinopathy
In early diabetic retinopathy, the walls of the retinal blood vessels are weaker. The small blood vessels will leak fluid and blood into the retina. Large vessels will dilate. As retinopathy progresses, more vessels become blocked causing more blood in the retina. Sometimes, the macula, which is the center of portion of the retina, will develop a buildup of fluid. This will cause a dramatic decrease of the vision.
Severe Diabetic Retinopathy
In severe diabetic retinopathy, new blood vessels will leak into the clear jellylike vitreous which fills the center of the eye. Scarring of the retina can even cause a retinal detachment.
How Eye Doctors Diagnose Retinopathy
It is very important to have a dilation during the eye examination. This means that your eye doctor will instill eye drops to enlarge your pupils. With a slit lamp and other specialized equipment, your eye doctor can thoroughly examine the retina. Photography or scanning may be performed to look for macular or retinal edema. If there is significant fluid or bleeding of the retina, a consultation will be scheduled with a retinal specialist.
Managing Risks
The loss of vision from diabetic retinopathy can be significant. The risk of diabetic retinopathy increases with poorly controlled blood sugars, high blood pressure, high cholesterol and tobacco. Careful management of your diabetes is the best way to prevent vision loss. Is very important to see your eye doctor for a yearly eye examination with dilation, even if your vision is fine. In addition, healthy eating and physical activity are important to control your diabetes.
If you have questions regarding diabetic retinopathy, consult your eye doctor. He or she will advise your physician of the appearance and progression of diabetic retinopathy.
Dr. Jackson joined Lakeview Clinic in December 2003 and enjoys providing comprehensive eye care for all age groups. She also fits contacts and sees patients for emergency eye care.
Decrease drinking alcohol- any amount of alcohol increases your risk of breast cancer. At the very least try to drink less than three drinks per week.
Be active!! Move your body every day, especially after meals!
Control your weight- women after menopause who are overweight have an incrementally increased risk of breast cancer.
If you have been taking a combined estrogen/progesterone medication for more than 3 years discuss the risks of this with your doctor.
Can I detect breast cancer early? YES!!!
It is possible to detect breast cancer before it is even Stage I! This type of cancer is called DCIS (ductal carcinoma in-situ). These changes can be detected on mammogram even before the cancer leaves the lining of the duct of the breast.
How can breast cancer be detected early?
If you are a normal risk woman, get your mammogramevery year starting at age 40. 3-D mammograms are available at many healthcare facilities, including Lakeview Clinic. If 3-D mammograms are available in your area, get one! It is better at detecting small changes.
What if my mammogram report says I have dense breast tissue?
Having dense breast tissue makes self and physician breast exams important. If you notice any change when feeling your breast tissue, see your doctor. Depending on other risk factors, such as strong family history, you may be a candidate for other types of imaging including ultrasound or MRI.
Can I have mammograms more than once a year if I am at increased risk for breast cancer?
No, but you could be a candidate for other lab tests, imaging tests or even medication or surgery to decrease your risk. Other factors (besides having breast tissue) that put you at increased risk include if you have had certain cancers before, family history of breast, ovary or pancreas cancer, history of radiation treatment to your chest, biopsy of breast tissue in the past showing atypical cells or lobular carcinoma in-situ (LCIS), or a genetic mutation of BRCA 1 or 2.
Wow! That is a lot of information.
Can my doctor help me determine my risk? YES!!
As early as the age of 25 your doctor should be asking you questions about you and your family history to determine if you have an increased risk of breast cancer. Based on the answers to these questions, you may need to start your mammograms before age 40 or have other image testing such as MRI.
Source: NCCN (National Comprehensive Cancer Network) More information is available on their website nccn.org.
General Surgeon, Dawn Stapleton, MD
Dr. Stapleton’s practice includes surgical and endoscopic services. She has special interests in cancer surgery and robotic surgery for cancers and benign conditions including hernia repairs. She also performs colonoscopies.
Dr. Stapleton is the Cancer Liaison Physician for Ridgeview Medical Center and monitors cancer care quality at the hospital.
Everyone says you should exercise. Exercise should continue throughout your life. In fact, as we age it becomes even more important. According to the Physical Activity Guidelines for Americans, 2nd edition, published by the Department of Health and Human Services, there are both immediate and long-term benefits of exercise.
The immediate effect of exercise can be an improvement in sleep. Moving your body and breaking a sweat can also help ease anxiety and improve blood pressure.
The long-term benefits of exercise affect your whole body. Certainly, exercise can help to burn calories to help with weight management and reduce blood sugars and diabetes risk. In addition, exercise keeps our heart healthy, decreasing our risk of heart attack and stroke. Your doctor may also ask you to walk to improve your bone health. Recent data suggests that regular exercise can also reduce the risk of dementia.
Exercise helps to improve strength and remain strong and independent. Adding strength exercises has been shown to reduce the risk of falls. Strong muscles help with balance and allow you to catch yourself if your trip or walk on unstable ground.
Cancer prevention is another area of benefit. Regular exercise has been shown to help prevent eight different types of cancer, including bladder, breast, colon, endometrium, esophageal, kidney, lung and stomach. Certainly, there are other contributing causes of cancer, but exercise is one way to decrease your cancer risk.
How much exercise is needed to reap these benefits? For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. What is “moderate intensity” versus “vigorous intensity” exercise? A person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorous-intensity activity cannot say more than a few words without pausing for a breath. In addition, ideally, muscle strengthening activities are encouraged twice weekly.
The effects of aging can result in arthritis or other ailments that may affect movement and flexibility. If you cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, set a goal to be as physically active as your abilities and conditions allow. Start slow and gradually increase activity. Exercise components should include balance training as well as aerobic and muscle strengthening activities. It may be helpful to work with a trainer or physical therapist. Options for exercise are endless. Grab a pair of walking sticks and hit the trails or sidewalks. Check out the community center for Pilates or yoga. Get in the pool to swim or try water aerobics. Remember that all activity counts. Raking leaves, pushing a lawn mower or gardening are all great forms of exercise. Carrying groceries would count as a strength option.
If you have questions about exercise options, particularly if you have health issues, please ask your physician for guidance. Set your exercise goals to move your body every day. Our goals may change as we age, but in general, try to move more and sit less. Remember, every step counts.
Check out these resources to help increase your physical activity:
Dr. Beulke joined Lakeview Clinic in April 2003. She provides the full spectrum of family medicine, including gynecology, pediatrics and geriatrics. She has special interest in women’s health and diabetes care. Dr. Beulke serves as Lakeview Clinic’s Medical Director and is active on several committees which aim to promote quality and reliability in health care.
Annual well-child visits are an important part of your child’s overall health and development. While the first years of life are full of many doctor visits, it is important for older children to continue seeing their medical provider throughout adolescence. Well visits are a great opportunity to annually check your child’s overall health and wellbeing and are beneficial for both kids and teens.
Well visits will include screenings such as vision and hearing screenings, evaluate social and emotional development, monitor for specific health conditions/risks, and ensure your child is up to date on immunizations. For older children and teens, they provide a great opportunity to address concerns such as birth control, STDs, and mental health issues such as substance use, eating disorders, anxiety, or depression.
Sports physicals
Some parents take advantage of free or discounted sports physicals for their children, which are convenient, but it is important to remember that sports physicals are not a substitute for your child’s annual wellness visit! Sports Physicals are designed specifically for clearing an athlete for sport participation but are not a comprehensive exam.
Staying on track
Life is busy and it is easy to get off track with routine wellness visits for your child. Children ages 0 – 3 will be seen frequently during their first years of life, seeing their doctor 12 times for well-child visits alone. Children should then be seen annually when they are 3 – 18 years of age. The American Academy of Pediatrics (AAP) has a complete well-visit schedule available on the healthychildren.org website.
Tips to stay on track with your child’s visits.
Remember annual visits are important for adolescents of ALL ages. (Ages 0 -18 years)
Schedule infant – toddler next visits while you are still at the clinic. Your provider or their nurse will let you know when your child is due. Schedule online or stop at the front desk and schedule before you leave.
For older kids, set a repeating annual reminder to schedule for the same month each year.
Create easy access to your child’s record of appointments and immunizations with Lakeview’s Patient Portal (for children under 13).
Consider your child’s school and activity schedule.
If needed, have your child’s sports physical done during their well-visit to eliminate extra appointments.
In addition to annual well visits, we recommend annual eye exams beginning at age 3. Good vision and ocular motility are vital to your child’s success.
Childhood Immunizations
No one enjoys getting shots, so it is easy to understand why this can cause anxiety in our children. It is helpful to remember that even many adults have a mild to severe fear of needles. Don’t dismiss your child’s concerns but be honest that it might hurt a little, like a pinch or scratch, and that it is very quick. Let your child know that there is a possibility of receiving an injection at any of their visits, but don’t dwell on it too much. Every child is different. Some children do better if they have time to mentally prepare, but for some it simply increases their worry and stress over the upcoming visit. In the end there is no perfect way to ensure shots cause no anxiety at all for our children.
It is important to remember that receiving vaccines is an important part of keeping your child and others healthy and safe. If you know your child has a heightened fear of needles, it is helpful to let their medical provider know in advance. Click here for the CDC’s complete adolescent immunization schedule. If you need to access your child’s immunization records, click here for instructions. Your child’s care team is also a great resource and is happy to help you stay on track with well visits and immunizations. You can contact them via Lakeview Clinic’s Follow My Health Patient Portal, or by calling (952) 442-4461.
Pediatric Care Team
Lakeview Clinic’s pediatric team sees children of all ages, and pediatric appointments are available at all four Lakeview Clinic locations. Our team consists of eight pediatricians and a physician assistant. CLICK HERE to learn more about our team!
June is Alzheimer’s & Brain Awareness Month providing the perfect opportunity for a discussion about what Alzheimer’s disease is, how it is treated, and what to expect if you or a loved one is diagnosed with the disease. Many of us know someone or have cared for someone with this devastating illness. Understanding the disease can help us navigate caring for loved ones with the diagnosis.
What is Alzheimer’s Disease and how is it diagnosed?
Alzheimer’s disease occurs when certain proteins deposit into the brain causing the brain to shrink and cells to die which leads to dementia. Symptoms of dementia include memory loss, behavioral changes, difficulty swallowing, changes in sleep patterns and difficulty with other activities of daily living including eating/feeding oneself, walking, and talking.
Diagnosing Alzheimer’s disease uses a multifaceted approach including a thorough history and physical/neurological exam, lab testing to rule out other causes of symptoms, neuropsychological testing, and an MRI or PET scan of the brain. There are other tests including a spinal tap to test the level of proteins and a blood test to measure beta-amyloid level in the body. These are more commonly used if someone is displaying symptoms at a young age or is having a very rapid progression of symptoms.
How is Alzheimer’s Disease Treated?
There is no cure for Alzheimer’s disease, but there are some medications that can help with memory loss. Cholinesterase inhibitors (donepezil/Aricept, galantamine/Razadyne, rivastigmine/Exelon) can help with behavior of those with Alzheimer’s disease. These are normally first line treatments and are most useful in those with mild to moderate disease but can be used at any stage. Side effects are common and can include nausea, diarrhea, vivid dreams, loss of appetite/weight loss.
Memantine/Namenda is another medication in a different class but can be used with the above medications and is used for moderate to severe dementia. The goal of this medication is to slow memory loss. Side effects include headaches, dizziness, hallucinations, agitation, and constipation.
A newer medication called Lecanemab is an IV infusion that decreases the amyloid in the brain. This was approved in 2023, so long term data is limited.
Multiple medications can be used to target symptoms of agitation in Alzheimer’s disease, including brexpiprazole. Many of these medications do, however, come with a black box warning as they can increase the risk of death in these patients.
What are the stages of Alzheimer’s disease/what can I expect?
Early/mild disease stage: This stage is exhibited by word finding difficulty, forgetting appointments/where valuables were put, trouble with planning/organizing, and remembering names. Individuals in this stage can usually still perform most ADLs independently.
Middle/moderate disease stage: Middle/moderate stage disease presents with mood changes, difficulty remembering personal history, trouble with social events, confusion about where they are or what day it is, changes in sleep patterns, wandering/getting lost, trouble with bowel/bladder control. These individuals tend to need some help with ADLs.
Late/severe disease stage: This stage is manifested by the loss of communication, difficulty swallowing leading to potential aspiration pneumonia, difficulty with walking, weight loss, decreased responsiveness. These individuals will require 24-hour care and are eligible for hospice services as this is end-stage disease.
Is there any genetic testing available?
Genetic testing is available and may predict one’s susceptibility to developing Alzheimer’s disease. In most cases of disease there is not one single cause. Rather, it can be multiple genetic factors along with environmental and lifestyle factors. A variance in the APOE gene has been linked to early onset Alzheimer’s disease. There is genetic testing available; however, testing positive for the genetic variant does not mean the individual will develop the disease in the future. It simply means the person is at higher risk for disease development than someone that does not carry this variance. It is important to weigh the pros and cons of testing and meet with a genetic counselor to discuss results if testing is completed.
Is there anything I can do to prevent Alzheimer’s Disease?
Increasing physical activity, eating a nutritious diet, not smoking, limiting/avoiding alcohol, managing other chronic illnesses such as diabetes or high blood pressure can all help prevent Alzheimer’s disease. Challenging the brain with puzzles and staying socially active can be helpful as well.
Alzheimer’s disease is incredibly challenging, but there are still ways to help those suffering the disease remain functioning at the peak of their ability throughout the disease course. The medications listed above may help with disease progression, while keeping these individuals socially active and mentally stimulated will feed their mental and emotional well-being. It is important to contact your primary care provider if you notice any cognitive changes as early detection will help you come up with an individualized plan of care.
Erin Dahn, NP-C, is a Lakeview Clinic nurse practitioner specializing in the geriatric population. She works at various long-term care facilities with a home base of Lakeview Clinic – Waconia. Her special interests include palliative care and management of chronic diseases including hypertension, heart failure, diabetes, and dementia.
