DEAR DR. ROACH: I just wanted to touch base with you about my diabetes. While my weight has stayed stable around 320 pounds, my sugar numbers have been increasingly hard to keep in line. I’ve maxed out on the oral medications we use. My latest A1c was 6.6. The doctor says it should be under 6 and that our next step is insulin. He asked me to try to lose 50 pounds over the next six months in order to get my sugar back under control.
I agree and want it to happen. I’m counting calories and cutting out carbs, and have started walking in the morning. I know I can’t run, with no discs in my bottom three vertebrae. But even walking is hard. I walk until my leg goes numb, but I don’t think it will be enough, and I may not even be able to keep that up. Even walking easy makes my hip hurt and leg go numb after about 20 minutes. — S.A.
ANSWER: I am surprised by your doctor’s advice, because it’s very clear now (from the ACCORD study) that an A1c (a measure of average sugar levels) of 7 percent has lower overall risks than an A1c of 6 percent for someone like you.
Exercise is always good, and my first thought is water. Getting in a pool will take pressure off your back, and you should be able to swim, walk in the water or do water-exercise classes to your heart’s content.
Readers: Start reaping the benefits of exercise the moment you begin. To learn more, order the booklet on Aerobics, Fitness and Abdominal Exercises by writing: Dr. Roach — No. 1301W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: What can you tell me about laser iridotomy for angle-closure glaucoma? What are the risks? What is the success rate? Any other things that would help make a decision? — J.K.
ANSWER: Glaucoma is increased pressure inside the eye. Without treatment, it damages the optic nerve and can lead to vision loss, even permanent blindness.
Angle-closure glaucoma is caused by abnormal anatomy inside the eye, where the lens blocks the pupil, “closing” the channels that allow fluid to leave the eye. In acute closed-angle glaucoma, symptoms include headache, a “halo” around lights and severe eye pain. This is an emergency, since permanent vision changes may occur within hours to days, so the surgery is done immediately.
Ophthalmologists can suspect the condition based on exam, and if confirmed, will recommend treatment to prevent this emergency. It sounds like that is what has happened in your case.
I resist making a recommendation of laser versus non-laser surgery. In my mind, you trust your surgeon to use the right technique for you. However, in this case, laser is the standard treatment. I have read effectiveness rates of 60 percent to 95 percent. Complications are uncommon but can include inflammation and “ghost” images. Repeat surgery is occasionally needed.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.