“DR. BEN, IT’S the chameleon again!” exclaimed my younger colleague as he stared into the lady’s eye with the ophthalmoscope. For a brief moment I was at sea. What’s he talking about - a chameleon in the eye?  I quickly came to my senses. He must be speaking figuratively. As he completed his examination, he looked at me as if he had discovered something worthy of a Nobel Prize and repeated with pride, “It is the chameleon. I saw her for the first time yesterday morning. I was completely baffled when she gave me her story. Nothing she had said prepared me for these findings. As a matter of fact, I was thinking of something completely different.”

My thoughts went some miles ahead trying to work out the various eye conditions that could behave like a chameleon. Chameleons are fascinating creatures. There are about 160 different types in nature. Three things are peculiar to them all. The first is the chameleon’s eyes. Each eye can rotate in a different direction. The second feature is their long tongue which is about 1 ½ their body length. Imagine a 6-foot person, having a 9-foot long tongue! The third and perhaps the best known feature is the ability of the chameleon to change its colour.

Which of these three features has aroused the interest of my colleague? The lady’s eyes are fixed. I can see them! Her tongue looks nothing like the chameleons and neither can she change the colour of her skin! At least she hasn’t looked any different since I have been in the room over 15 minutes. The feature therefore must be in the inner recesses of her eyes. My anxiety was further heightened after he had taken the lady’s intraocular pressure and he exclaimed, “Dr. Ben, the pressures are within normal limits.”

What then can he be talking about? Glaucoma is usually associated with a higher than normal intraocular pressure. Just as it would be right to say you cannot have hypertension without a raised blood pressure, it would be unusual to have glaucoma with normal pressure! I couldn’t stand the suspense anymore. “Doctor, what is it then if it is not glaucoma?” I asked in a voice that conveyed my disenchantment for keeping me anxious about his findings.

“Dr. Ben it is glaucoma! She has glaucoma!” Now I am even more confused. He saw my bewilderment and explained further, “She complained of blurring of vision when reading. She had no problem seeing distance clearly and no other symptoms. She is 45years old and her symptoms are typical for normal people of her age. Since there are no specific symptoms attributable to chronic glaucoma in the early stages, patients with glaucoma often present with misleading irrelevant history.”

“How then did you come about the diagnosis of glaucoma?” I probed further. “For a diagnosis of glaucoma, at least two of three things must be present. There must be evidence of damage to the nerve at the back of the eye. Secondly there must be a higher than normal intraocular pressure for that eye. Thirdly there must be functional evidence to explain the structural change observed within the optic nerve.”

I looked at him and I could see that he was passionate about the subject. But I wasn’t done with him yet. “Which of these three things you have mentioned are present in this lady?” I asked. “I have two of three,” he replied. “No! You have only one,” I interjected. “First I can see evidence of structural damage to the optic nerve at the back of the eye. Yesterday morning, the intraocular pressure was 10mm Hg. This is the lower border of normal but this afternoon it is 20mm Hg. That is clearly double! I am certain the test of function of the optic nerve we call visual field will show damage consistent with my findings to meet all three criteria.”

It is not always easy to make a diagnosis of glaucoma especially in the early stages. Quite often it behaves like a chameleon. Painstaking examination is required to make a diagnosis in the early stages. Fortunately there are newer and more accurate structural tests that can be done to ascertain presence of the disease before serious damage occurs.   

Is your family a functional or dysfunctional one?

THE FAMILY IS THE basic unit of the society. Its basic function is to provide the natural framework for the emotional, financial, and material support essential for the growth and development of its members.

Functional (or healthy) families

These are families whose members enjoy mental, physical, social, psychological and spiritual (or religious) well being and are free from “infirmity”.

They are characterize by healthy  communication, personalautonomy,flexibility,appreciation,supportnetworks,family times and Involvement, spousebonding,growth,spiritual and religious values.

Functional families encourage and provide the followings:

Respect

Respect is the Holy Grail of functional families. All people in the family, brothers to sisters, mothers to fathers, parents to kids must be respectful as consistently as possible. Being considerate of each other is the tie that binds, even more than love. Too much emphasis is put on love in general. Many atrocities are done within families in the name of love but not in the name of respect.                                                                                                                

An emotionally safe environment

All members of the family can state their opinions, thoughts, wants, dreams, desires and feelings without fear of being slammed, shamed, belittled or dismissed.

A resilient foundation

When relationships between and amongst people in a family are healthy they can withstand stress, even trauma, and, if not bounce back, at least recover. Resilience starts with encouraging sound health, eating and sleeping well, and physical activity.

Privacy.

Privacy of space, of body and of thought. Knock and ask permission to enter before going through a closed door. All family members are sensitive regarding personal space and aren’t insulted if someone needs a wide berth.

Accountability

Being accountable is not the same as planting a homing device on your kid or abusing the cell phone to track her whereabouts 24/7. Being accountable is  respectfully and reasonably informing people in the family where you are and what you are doing so they can grow trust and not worry.

An apology.

It’s sad when people hold out for an apology on a point of pride, never acknowledging their part in a dispute .A functional family will have conflict. It’s very cool when we can have an argument and get to the other side of it still friendly and satisfied with the outcome. Sometimes we say things that we regret. If we can feel and show remorse for our part, quickly apologize, ask for and receive forgiveness, no harm is done. You may even become closer for it.

Allow reasonable expression of emotions

It is good  to teach the children to state their anger in a managed manner and  not to fly off the handle when they did.

Allows people to change and grow

 A functional family lets people define themselves. Individual differences are appreciated even celebrated. It also lets the kids become independent when it’s appropriate and come back to the safety of the family when they need nurturing.

The adults in the family need to be allowed to grow as well. A mother may want to get a graduate degree, or a father may decide to retire early and start something new. These changes merit discussion on how they will affect everyone in the family.

-To be continued