Holidaying on the Greek island of Rhodes in May 2011 was the turning point and the end of my pre-CLIPPERS existence (if that doesn't sound too dramatic). Below is a short account of the time between first overt symptoms and being admitted to hospital for investigation.
Double Vision
The week after I got back I was watching television when I noticed that the peripheral vision on my right side was going slightly double. It was worse the further away and the further over to the right I was looking (by moving my eyes not my head). As the doubling was slight and only affected the edge of my vision I wasn't too concerned at first. Also I wear contact lenses for short-sight and get my eyes checked out twice a year so I knew there wasn't anything that got flagged up at my last eye exam. I could watch tv without a problem and get to work OK albeit with that weird feeling that there's something happening in the corner of your eye that you can't quite see.
The week after I got back I was watching television when I noticed that the peripheral vision on my right side was going slightly double. It was worse the further away and the further over to the right I was looking (by moving my eyes not my head). As the doubling was slight and only affected the edge of my vision I wasn't too concerned at first. Also I wear contact lenses for short-sight and get my eyes checked out twice a year so I knew there wasn't anything that got flagged up at my last eye exam. I could watch tv without a problem and get to work OK albeit with that weird feeling that there's something happening in the corner of your eye that you can't quite see.
Over the next few days I noticed it more and through experimenting at home realised that if I covered one eye or the other my vision was fine; the problem was with using both together. Against my better judgement I then scared myself by looking up double vision on the internet. I found it can be a sign of all sorts of nasty things but can also be "one of those things" which self-resolves eventually. I also read that "double vision should be treated as a medical emergency" in the first instance and so decided to get some professional advice. I also found out the correct medical term for it - diplopia.
Moorfields
One of the advantages of working in and round London is the access to excellent specialist medical services. I walked into Moorfields Eye Hospital Accident and Emergency on the 1st June 2011 complaining of double vision. I was seen promptly and assessed for eye damage (I think detached retina is one of the main concerns for emergency treatment) and passed to the Orthoptics department. They established that the double-vision was horizontal (images side-by-side) rather than vertical and related to a problem with the tracking in the right eye and measured the size of the “shift” causing the doubling. I was told I had a palsy affecting the right eye movement and that it was quite common and might well self-resolve over a period of months. I was issued on the spot with some corrective glasses with a prism lens over the right eye designed to shift the right view back into line and told not to worry. The glasses were quite effective (if not very flattering!) and my corrected vision returned to near normal.
One of the advantages of working in and round London is the access to excellent specialist medical services. I walked into Moorfields Eye Hospital Accident and Emergency on the 1st June 2011 complaining of double vision. I was seen promptly and assessed for eye damage (I think detached retina is one of the main concerns for emergency treatment) and passed to the Orthoptics department. They established that the double-vision was horizontal (images side-by-side) rather than vertical and related to a problem with the tracking in the right eye and measured the size of the “shift” causing the doubling. I was told I had a palsy affecting the right eye movement and that it was quite common and might well self-resolve over a period of months. I was issued on the spot with some corrective glasses with a prism lens over the right eye designed to shift the right view back into line and told not to worry. The glasses were quite effective (if not very flattering!) and my corrected vision returned to near normal.
Over the next few weeks nothing changed suddenly but I had a suspicion that the double vision was slowly worsening. I get the train to and from work and coping with the station environment was one of my benchmarks. Essentially looking at people down the length of platforms where they are all confined to the central portion of the field of view remained quite good whereas increasingly I noticed that looking across to people on adjacent platforms (which extended left-to-right across my field of view) gave very bad results. In addition the distance at which the doubling kicked in started to reduce. I had been warned that things might get worse before they got better so I went back to Moorfields to get my glasses upgraded on 13th July. They confirmed that my vision had changed and also flagged a warning as I was atypical of the sort of person expected to present with this problem. Apparently if I had been some combination of over 70 years old, obese, diabetic or hypertensive it would have been less surprising but a reasonably fit, 44 year old was unusual. So they promptly booked me an appointment with their Neuro-Opthalmology clinic to investigate further.
Balance
This was starting to feel serious. On 1st August 2011 I attended the clinic where I was first seen by a neuro-opthalmologist who then brought in a neurology colleague. A comprehensive history and assessment of neurological symptoms was taken and my eyes were carefully examined and found to be functioning normally (for vision). I was told I would be referred on for in-patient investigation at the National Hospital for Neurology and Neurosurgery including imaging. Since visiting Moorfields the last time I had started to have problems with balance and walking coordination which I initially put down to my vision problems. Walking from A to B in a straight line or climbing up and down stairs was OK but situations that involved rapid adaptation, for instance to negotiate a crowded concourse or recover from stumbling on uneven ground were starting to become more daunting. In addition the ends of my fingers had a numb/tingling feeling to them as did parts of my face from forehead to chin and the whole picture was becoming more worrying. Another symptom that I initially put down to anxiety was the feeling that there was a tight band around the front of my rib-cage which would occasionally clench - uncomfortable rather than painful.
Balance
This was starting to feel serious. On 1st August 2011 I attended the clinic where I was first seen by a neuro-opthalmologist who then brought in a neurology colleague. A comprehensive history and assessment of neurological symptoms was taken and my eyes were carefully examined and found to be functioning normally (for vision). I was told I would be referred on for in-patient investigation at the National Hospital for Neurology and Neurosurgery including imaging. Since visiting Moorfields the last time I had started to have problems with balance and walking coordination which I initially put down to my vision problems. Walking from A to B in a straight line or climbing up and down stairs was OK but situations that involved rapid adaptation, for instance to negotiate a crowded concourse or recover from stumbling on uneven ground were starting to become more daunting. In addition the ends of my fingers had a numb/tingling feeling to them as did parts of my face from forehead to chin and the whole picture was becoming more worrying. Another symptom that I initially put down to anxiety was the feeling that there was a tight band around the front of my rib-cage which would occasionally clench - uncomfortable rather than painful.
Googling a Diagnosis
My in-patient bed became available quickly on August 10th reinforcing the potential seriousness of the symptoms. In the mean-time, and against my better judgement, I had done some more Googling and although I had excluded a lot of nasty conditions, I kept coming back to Multiple Sclerosis. My presentation was slightly atypical (slightly older than usual but not unheard of) but as MS is a relatively common disease I thought it perfectly possible. My previously ignored rib-clenching symptom also fit quite well with descriptions of the so-called MS-girdle and it was tempting to make the connection. It was almost a relief as MS seemed less scary than some of the common brain-tumours and less likely to kill me anytime soon. The bottom line is don’t Google this stuff though as many conditions have similar symptoms and there are many discrepancies and exclusions and special cases. There are also many possibilities for a diagnosis that are hard to find on Google (like this one) so it's also possible to get a false sense of security.
In-Patient Admission
On August 10th I was admitted to the National Hospital in a mixed neurology ward. The people in my bay were mostly "walking wounded" like myself and either in for investigation or treatment. I wasn't told how long I would be in for exactly but was told it would be for "a few days" depending on what was discovered. So I figured it would be about a week and tried to be relaxed about it. A short account of the month I then spent under investigation and treatment in hospital will follow.
Read other articles in this series at Living With CLIPPERS.
Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
