Saturday, September 26, 2015

Every Rose Has Its Thorn and Capax Infiniti

Every Rose Has Its Thorn (2014) - RoneCapax Infiniti (2014) by Faith47
Left: "Every Rose Has Its Thorn" (2013) by Rone; Right: "Capax Infiniti" (2014) by Faith47. Located @ SW12th and Washington in  Portland. We were in Portland for one day and as we were heading to the Mark Spencer, we saw these two great pieces.

Buy the LiePortland Central Library domeTroy Lovegates and Paige Wright
Other Portland shots. Left: "Buy the Lie" sidewalk stencil on SE Division St. (cross street SE 30th Ave) Center: Portland Central Library dome. Right: Collaboration between Troy Lovegates and Paige Wright @412 SW 12th Avenue.

More shots of “Capax Infiniti”.
Capax InfinitiCapax InfinitiCapax Infiniti

More shots of “Every Rose Has Its Thorn”
Every Rose Has Its ThornEvery Rose Has Its Thorn

Wednesday, September 23, 2015

September Mural and Graffiti Grab Bag

A collection of images taken around Fremont and Greenwood. The most enigmatic is the "Stay Posted" found scribbled on the side of a dumpster. What does it mean?

Left: Fremont Alley Garage Door. Center: Dumpster in Fremont “Stay Posted”. Right: Greenwood Mason Lodge Mural (of Seattle).

Phinney Market Pub and Eatery North Wall
Phinney Market Pub and Eatery North WallPhinney Market Pub and Eatery North Wall

Random Tags in Fremont Burned Building
Random Tags in Fremont Burned BuildingRandom Tags in Fremont Burned Building

Monday, September 21, 2015

September Morn (Couch)

Early, on a crisp September morning we saw this couch in upper Fremont. It was humming:
September morn
We danced until the night
Became a brand new day
Two lovers playing scenes
From some romantic play
September morning
Still can make me feel that way

From Neil Diamond's 1979 album September Morn.
 

Tuesday, September 15, 2015

Hindsight

The fluorescent yellow and lime green walls of a Mexican restaurant in Ellensburg are forever etched in my mind. It’s mid-May 2015, and Mark and I are there on our way to officiate a wedding in Central Washington. While we wait for our food to arrive, we talk about what could go wrong in front of the 150 guests, and that I keep seeing little black spots in the periphery of my vision. We joke that the restaurant is full of flies, and we laugh it off as a case of overworked eyes. We tuck into our tacos, not understanding the warning sign that -- in hindsight -- seems as obvious as the glaring wall colors.

Early one morning a week after the wedding, I am standing in front of the bathroom mirror. My vision has steadily deteriorated to the point where I struggle to use a computer or read. In the gray light, I do something I've never done before: I check one eye at a time. I learn that what I thought was a general vision problem is really a problem with my left eye. Staring at my reflection with just my left eye, the right side of me disappears into a gray blob. Part of me is not there.

I mope around the house with my new discovery, but take no action. Mark though isn't having any of it; he sets up an appointment for a checkup with our optometrist. On the ship of my health, I'm not the captain, more a helpless deckhand. Writing this now, I want to reach back in time and slap myself.

The day of the checkup and the following ones blurred together in a series of doctors, waiting rooms, and dread as my eyesight worsened and we did not know the cause or prognosis.

On a Tuesday afternoon in early June, we are with Dr. Doan, a short, confident UW Eye Institute fellow. She specializes in diseases of the retina. The exam room is midnight blue, full of expensive equipment and a large model of an eye. Dr. Doan jumps around the room in her white coat getting me ready for an exam.

"Look to the right buddy," Dr. Doan says as she stares into my eyes with one her instruments. She calls me "buddy" and shoots from the hip. She uses the eye model to give Mark and I a 101-intro to the world inside our eyes, introducing terms like macula, fovea, and cone cells

I've come to believe that learning new vocabulary in a medical setting is rarely a good thing.

Dr. Doan describes the macula -- the prime real estate of the eye as she calls it -- as resembling an open book viewed from its bottom or top edge. The two sides of the macular book curve up and fall into the binding crevice. The area around the crevice is the fovea, which contains cone cells responsible for sharp central vision. My left eye looks like a book that someone left out in the rain, warped and wrinkled, not smooth and not functioning fully.

Left: An open book. Center: Cross section of inflamed macular area. Right: Retina with lesions.
An open bookCross section of inflamed macular area.Retina with lesions

Looking at a three-dimensional scan of my left eye, Dr. Doan delivers the news in a matter of fact way, as if she were perusing a menu: my cone cells are gone and are never coming back. A sick feeling wells up in my stomach, similar to the one several minutes later when she inserts a needle into my left eye to deliver antiviral medicine directly to my warped book.

Dr. Doan tells us a much as she knows. The black spots -- my flies on the wall in the restaurant -- are floaters, which are often immune cells clumped together, my body protecting against an invader. The damaged area of my left eye is the ground zero of the invasion. Dr. Doan can see the battlefield, but she doesn't know who the invader is. She is puzzled and curious, a detective at heart. She talks about what we can rule in and rule out. Even more sobering is her focus on "saving" my right eye. I feel more desperate than ever to find out what my immune system is battling inside my eye and to not lose any more vision. Why did I wait so long?
~~~

The detective calls two days later. She has an answer. The blood work she ordered revealed that we are dealing with toxoplasmosis. Toxoplasmosis is a parasitic disease caused by the single-celled organism Toxoplasma gondii. The etymology of the name gives clues to its look and history; toxoplasma refers to the crescent-shaped form of the cells, and gondii refers to the gundi rodent in which the parasite was first identified over 100 years ago.

Most people know toxoplasmosis as the pregnant-women-shouldn't-clean-cat-litter-boxes disease. The prevalence of toxoplasmosis in the U.S. is between 20 and 30 percent, with most cases being asymptomatic. Unfortunately, mine isn't.

I've been immunosuppressed and living on the edge for years dealing with ulcerative colitis. Onboarding this parasite, along with a host of other problems, has always been a possibility. I mistook my luck up to this point for invincibility perhaps. If I got something, I reasoned, I could beat it with modern medicine. Dumb luck or not careful enough, I ingested the parasite's cysts and didn't understand the symptoms until too late. Dr. Doan says my case is atypical, but that doesn't make me feel any better.

The treatments I've had up to the diagnosis focused on a viral cause. Toxoplasmosis is a parasite and doesn't respond to antiviral drugs. So I find myself once more on my back looking up and watching Dr. Doan bearing down with a needle, this time full of an antibiotic for my embattled eye. After she is done, I'm sweaty and white as a ghost. "Breathe buddy, breathe," she says. 

~~~

Since the toxoplasmosis attack, my change in vision dictates that I slow down and rethink daily activities like cutting fruit for breakfast, walking, working in the yard, and reading. The future includes long-term antibiotics, regular visits to check my eyes, protecting my good eye, and getting to know what to look for in the next possible outbreak. Yes, the parasite hunkers down, quiescent, in the scars bordering the battlefield and waits. No one knows what will trigger the parasite to resurrect and attack again.

Through it all, I'm puzzled why I waited so long to act. In fact, I didn't act at all. It was Mark who did, making the initial appointment that started the process of healing, or, more aptly, stemming the tide.

When I got the diagnosis, my engineering instinct kicked in to analyze sequences of events, assign probabilities, and counterproductively, assign blame. Did I prioritize my health too low? Did my doctors warn me enough about being immunosuppressed? Is there a flaw in my prioritization of what's important in life? Was I not educated enough to recognize the signs? Was I too cocky about my health?

I was mired in hindsight. As the urge to rewind the tape and replay the events fades, acceptance and foresight slowly replaces hindsight. I mentally prepare for a relapse of toxoplasmosis or threats from other serious infections such as from listeria or tuberculosis. I rehearse advice I've noticed I now give freely to others, which is this: don't wait to ask when it comes to something about your health.

When I wake in the morning now, I instinctively test my eyes. In my left eye, the gray spot shows up, fuzzy and dead center. Has it grown? Is my right eye okay? In the seconds it takes to run through these tests, a compressed version of those uncertain months -- from noticing the problem to halting its advance – passes through my mind. It’s but a glance in the rear-view mirror because my eyes are now squarely on the road ahead.

Tuesday, September 1, 2015

Amsler Grids

Isn't it funny how something you never heard of before can suddenly become a big part of your everyday life? That's what happened to me with Amsler grids.

It started on a warm Thursday morning, May 28, 2015. I was finishing up with my optometrist -- the first stop in a long journey to discover why I was losing vision. My optometrist was puzzled and referred me to a retinal specialist.  As I got ready to leave the office, a white-jacketed assistant handed me a few sheets of paper containing Amsler grids. I stared at them only for moment before realizing their purpose.

Named in honor of the Swiss ophthalmologist Marc Amsler (1891 - 1968), the eponymous grids test defects in vision, in particular, macular degeneration. The macula of your retina is responsible for central, high-resolution vision. Macular problems manifest themselves as warped or missing Amsler grid lines. To use an Amsler grid, you stare at it with one eye. If the grid lines misbehave and don't intersect at right angles, then you’ve got a problem.

Marc Amsler
A handful of doctors’ visits after my first encounter with Amsler grids, I learned that I had contracted toxoplasmosis in my left eye. My body mounted a fight and retinal cells in my macula were the collateral damage. If I had known about Amsler grids, would I have caught my vision problem earlier? Possibly. Detecting eye loss problems early is what the Amsler grids were designed to do.

On an Amsler grid, my vision loss manifests itself as a gray hole in the grid with minimal warping. The gray hole lives in most of the space from the center of vision of my left eye to my nose. My brain does the best it can without the information from the missing retina cells.

An Amsler grid is a sheet of graph paper. That's not to downplay the time Amsler likely spent testing and arriving at this simple diagnostic test. The genius of the Amsler grid is that it turns the subjective into objective. How you use it is what matters. The grid reminds me that checking my eyes is important: every day and everywhere. I see Amsler grids in mullions on windows and doors, stripes on walls and towels, fences. Even a telephone pole can work as a simple Amsler test.

Now that I know about Amsler grids, I routinely pull out a fresh grid and sketch the edges of my vision hole. Looking at grid results over time helps me keep track of what my vision is doing. If the warping changes or grows, then it may be that the toxoplasmosis parasite has awoken and is on the move.

The Ophthalmology Hall of Fame biography hints that Amsler may have been inspired to create the grid by fellow Swiss ophthalmologist Edmund Landolt (1846 - 1926). However, the biography doesn't give much more detail on how Amsler arrived at the grids. Likely, the complete story rests in private notes and correspondence somewhere, out of sight. All I have for now is the image of Amsler accompanying the biography. In the photo, bow tie askew and wearing a white doctor's jacket, Dr. Amsler smiles at us from the past. I imagine him saying, "Did you check your eyes today?"

Results of my Amsler grid tests showing loss of left eyesight.