Night blindness Archives - DSSurgery

Vitamin A and Wound healing

Dr. Ara Keshishian — Mon, 21 Dec 2020 17:37:11 +0000

We have discussed the importance of vitamin A and eyesight at length previously.

Night Blindness – Vitamin A Deficiency

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

A recent article discusses the types and function of vitamin A. As with the pandemic of COVID-19 continuous to stress our body and mind, we must stay vigilant with our nutritional status. Therefore, Vitamin supplements are critical in maintaining a robust immune system. For some, oral supplements are adequate; others may require injectable forms. If the oral supplements do not correct the vitamin A levels, please contact your primary care or our office to available vitamin A injections.

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Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

Dr. Ara Keshishian — Thu, 04 Sep 2014 15:08:00 +0000

Nycalopia or Night Blindness is a side effect of Vitamin A deficeincy. Vitamin A is a fat soluble vitamin that occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Beta carotene and other carotenoids, yellow and red carotenoid pigments, can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including immune mechanisms, maintenance of healthy epithelial tissues, facilitates the mobilization iron from stores to developing red blood cells, and most importantly, a function in the visual system. Vitamin A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. Zinc works with Vitamin A by converting retinol to retinal and also protects from toxicity of Vitamin A. Vitamin A deficiency can worsen Iron Deficiency Anemia. It has been shown that treatment for Iron Deficiency Anemia responds better when Vitamin A and Iron are supplemented together.

Vitamin A deficiency may also represent a decreased visual acuity, more specifically, night blindness. Night Blindness was found in a patient who reported that they were unable to read a particular sign at night while driving, but was able to read it during the day. The body uses Vitamin A to make retinal, part of a molecule called rhodopsin. Rhodopsin is found in the rods of the eye. The rods are the cells of the retina that allow you to see in low light conditions. Here is a video of a patient exhibiting the effect of night blindness.

Night blindness Video

If Vitamin A deficiency is left untreated at the stage of night blindness it can progress to Xerophthalmia. Xerophthalmia is also caused by Vitamin A deficiency. The symptoms of Xerophthalmia is lack of tear production which are the lubrication of the eye. This leads to corneal and conjunctiva inflammation and thickening. The cornea can become cloudy and foamy spots (Bitot’s spots) leading to scarring and damage that effect the sight.

Over the last few decades, the incidence of vitamin A deficiency in the general population of the United States has significantly decreased. It is only when a patient shows signs and symptoms associated with malabsorption of fat soluble vitamins that he or she may be diagnosed with a vitamin A deficiency.

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

When a patient is diagnosed with vitamin A deficiency, the treatment will require aggressive oral supplementation. Duodenal Switch patients will only respond to “Dry” water miscible form of Vitamin A, which is pictured below/right. This “Dry” water miscible form is a powder which is designed to dissolve in water without the addition of bile for absorption. When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” water miscible form of vitamin A. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.

For cases in which vitamin A levels do not respond to “Dry” water miscible Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage of vitamin A is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize the vitamin A level, as well as resolving the symptom of night blindness.

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Vitamins And Minerals

Dr. Ara Keshishian — Sat, 29 Mar 2014 17:26:00 +0000

Vitamins -Minerals	Function	Source	Problems with deficiency
B1 (Thiamine)	Carbohydrate conversion, breaks down fats and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, immune system	Pork, organ meats, whole grain and enriched cereals, brown rice, wheat germ, bran, brewer’s yeast, blackstrap molasses	Heart, age-related cognitive decline, Alzheimer’s, fatigue
B2 (Riboflavin)	Metabolism, carbohydrate conversion, breaks down fat and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, antioxidant	Brewer’s yeast, almonds, organ meats, whole grains, wheat germ, mushrooms, soy, dairy, eggs, green vegetables	Anemia, decreased free radical protection, cataracts, poor thyroid function, B6 deficiency, fatigue, elevated homocysteine
B3 (Niacin)	Energy, digestion, nervous system, skin, hair, eyes, liver, eliminates toxins, sex/stress hormones, improves circulation	Beets, brewer’s yeast, meat, poultry, organ meats, fish, seeds, and nuts	Cracking, scaling skin, digestive problems, confusion, anxiety, fatigue
B5 (Pantothenate)	RBC production, sex and stress-related hormones, immune function, healthy digestion, helps use other vitamins	Meat, vegetables, whole grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon	Stress tolerance, wound healing, skin problems, fatigue
B6 (Pyridoxine)	Enzyme protein metabolism, RBC production, reduces homocysteine, nerve and muscle cells, DNA and RNA, B12 absorption, immune function	Poultry, tuna, salmon, shrimp, beef liver, lentils, soybeans, seeds, nuts, avocados, bananas, carrots, brown rice, bran, wheat germ, whole grain flour	Depression, sleep and skin problems, elevated homocysteine, increased heart disease risk
B12 (Cobalamin)	Healthy nerve cells, DNA/RNA, RBC production, iron function	Fish, meat, poultry, eggs, milk and milk products	Anemia, fatigue, constipation, loss of appetite, weight, numbness and tingling in the hands ad feet, depression, dementia, poor memory, oral soreness
Biotin	Carbs, fat, and amino acid metabolism (the building blocks of protein)	Salmon, meats, vegetables, grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ	Depression, nervous system, premature graying, hair, skin
Folate	Mental health, infant DNA/RNA, adolescence and pregnancy, with B12 to regulate RBC production, iron function, reduce homocysteine	Supplementation, fortified grains, tomato juice, green vegetables, black-eyed peas, lentils, beans	Anemia, immune function, fatigue, insomnia, hair, high homocysteine, heart disease
Vitamin A	Eyes, immune function, skin, essential cell growth and development	Milk, eggs, liver, fortified cereals, orange or green vegetables and fruits	Night blindness, immune function, zinc deficiency, fat malabsorption
Vitamin D	Calcium and phosphorus levels, calcium absorption, bone mineralization	Sunlight, milk, egg yolk, liver, fish	Osteoporosis, calcium absorption, thyroid
Vitamin E	Antioxidant, regulates oxidation reactions, stabilizes cell membrane, immune function, protects against cardiovascular disease, cataracts, macular degeneration	Wheat germ, liver, eggs, nuts, seeds, cold pressed vegetable oils, dark leafy greens, sweet potatoes, avocado, asparagus	Skin, hair, rupturing of red blood cells, anemia, bruising, PMS< hot flashes, eczema, psoriasis, cataracts, wound healing, muscle weakness, sterility
Calcium	Bones, teeth, helps heart, nerves, muscles, body systems work properly, needs other nutrients to function	Dairy, wheat/soy flour, molasses, brewer’s yeast, Brazil nuts, broccoli, cabbage, dark leafy greens, hazelnuts, oysters, sardines, canned salmon	Osteoporosis, osteomalacia, osteoarthritis, muscle cramps, irritability, acute anxiety, colon cancer risk
Chromium	Assists insulin function, increased fertility, carbohydrate/fat metabolism, essential for fetal growth/development	Supplementation, brewer’s yeast, whole grains, seafood, green beans, broccoli, prunes, nuts, potatoes, meat	Metabolic syndrome, insulin resistance decreased fertility
Magnesium	300 biochemical reactions, muscle/nerve function, heart rhythm, immune system, strong bones, regulates calcium, copper, zinc, potassium, vitamin D	Green vegetables, beans & peas, nuts and seeds, whole unprocessed grain	Appetite, nausea, vomiting, fatigue, numbness, tingling, cramps, seizures, personality changes, heart rhythm, heart spasms
Selenium	Antioxidant, works with vitamin E, immune function, prostaglandin production	Brewer’s yeast, wheat germ, liver, butter, cold water fish, shellfish, garlic, whole grains, sunflower seeds, Brazil nuts	Destruction to heart/pancreas, sore muscles, fragility of red blood cells, immune system
Zinc	Supports enzymes, immune system, wound healing, taste/smell, DNA synthesis, normal growth & development during pregnancy, childhood adolescence	Oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified breakfast cereals, and dairy	Growth retardation, hair loss, diarrhea, impotence, eye & skin lesions, loss of appetite, taste, weight loss, wound healing, mental lethargy
COQ10	Powerful antioxidant, stops oxidation of LDL cholesterol, energy production, important to heart, liver, and kidneys	Oily fish, organ meats, and whole grains	Congestive heart failure, high blood pressure, angina, mitral valve prolapsed, fatigue, gingivitis, immune system stroke, cardiac arrhythmias
Carnitine	Energy, heart function, oxidize amino acids for energy, metabolize ketones	Red meat, dairy, fish, poultry, (fermented soybeans), wheat, asparagus, avocados, peanut butter	Elevated cholesterol, liver function, muscle weakness, reduced energy, impaired glucose control
N-Acetyl Cystein (NAC) & Glutathione	Glutathione production, lowers homocysteine, lipoprotein, heal lungs, inflammation, decrease muscle fatigue, liver detoxification, immune function	Meats, ricotta, cottage cheese, yogurt, wheat germ, granola, and oat flakes	Free radical overload, elevated homocysteine, cancer risk, cataracts, macular degeneration, immune function, toxin elimination
Alpha Lipoic Acid	Energy, blood flow to nerves, glutathione levels in brain, insulin sensitivity, effectiveness of vitamins C, E, antioxidants	Supplementation, spinach, broccoli, beef, brewer’s yeast, some organ meats	Diabetic neuropathy, reduced muscle mass, atherosclerosis, Alzheimer’s, failure to thrive, brain atrophy, high lactic acid

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Vitamin D And A -Dry (Water soluble) Formulary

Dr. Ara Keshishian — Sun, 25 Aug 2013 03:57:00 +0000

Vitamin A and D are fat soluble vitamins. This means that in order for them to be absorbed by the GI track, them need to be absorbed by fat globules (chylomicrons). These are then taken up by the lymphatics of the GI track and taken to the blood stream. With the anatomical changes of the Duodenal Switch, the fat absorption capacity is significantly reduced. This results in excellent weight loss. It also results in much diminished absorption of the Fat soluble vitamins A, D, E and K. It is essential to use Dry Water Soluble forms of Vitamins A, D, E, and K. Bio-Tech is a brand that is formulated in this manner.

The Biotech D3-50 has 50,000IU of Vitamin D.

We recommend specific dosages of dry (water soluble) Vitamin A and D. These are not available at most pharmacies. In fact when our recommendations are presented at most pharmacies they are incorrectly dispensed with the fat soluble variety with is worth less becasue it is not absorbed by the duodenal switch patients. It is also important to not that this type of vitamin should not be taken with any dietary fat. Fat can inhibit the absorption of this type of vitamin. When ordering online, please make sure that the “Dry” or “Water Soluble” formulary is ordered.

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Injectable Vitamin A and Vitamin D

Dr. Ara Keshishian — Thu, 20 Jun 2013 23:24:00 +0000

Injectable Vitamin A and Vitamin D can improve vitamin status post weight loss surgery. One of the common side effect of all weight loss surgical procedures is nutritional and/or mineral deficiencies. Patients undergoing weight loss surgical procedures are always instructed to supplement their diet with multivitamin, calcium, iron, vitamin D and other supplements or minerals. If you do not take your supplements regularly you can become deficient. The symptoms associated with vitamin A deficiency is night blindness. Chronic vitamin D deficiency may result in low calcium, osteoporosis and other health-related issues.

Vitamin A and vitamin D, both fat-soluble vitamins, are absorbed by duodenal switch patients only if taken and a dry formulation. An alternative to oral supplement, would be injectable form of these two vitamins. Both of these vitamins can be formulated and purchased from compounding pharmacies that are equipped and experienced with the interpretation of injectable vitamins and minerals. Your primary care WILL need to contact the pharmacy of their choice for the recommendations and be willing to make the injections available to you.

We will gladly be able to provide injectable Vitamin A and Vitamin D for patients whose data laboratory studies are available to us and see us in the office.Please be aware that these are compounded and are not covered by insurance.

We will not be able to provide prescriptions for injectable vitamins to be sent to your primary care or other physicians to provide the injections.

Vitamin D supplement has been discussed previously in my Blog .

The common dosing for the vitamin D is 600,000 IU, deep IM every 6 months till the levels are normalized. The patient then can take the oral supplements only.

Vitamin A supplements was also discussed in my Blog.

Injectable Vitamin D

The common dosing for the vitamin D is 100,000 IU, deep IM every 2-6 months till the levels are normalized. The patient then can take the oral supplements only.

Vitamin A supplements was also discussed in my Blog.

The common dosing for injectable vitamin A is 50,000 IU, deep IM every 6 months till the blood levels are corrected, and the patient symptoms are resolved.

Just as a reminder, we have no financial interest in any of the vendors that are recommended on our website. Also, note that this is not in any form or fashion a substitute for an evaluation by your primary care physician or your surgeon. This is for information only, and is not to be taken as a recommendation for any particular patients’ condition.

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Yearly lab and medication requests

Dr. Ara Keshishian — Mon, 17 Oct 2011 17:28:00 +0000

As the years pass, weight-loss surgery patients, like everyone else, will require routine screening for certain chronic conditions. What is important is ensuring your primary care team is aware of the need for specialty testing to monitor vitamin and mineral levels.

You should also check with one of the labs and your insurance company to make sure they are a contracted facility and that the order is covered under your policy. It is your responsibility to ensure that your insurance company will pay for the ordered labs. We are in no way responsible for verifying the benefits of the laboratory services we order.

It is critical that patients who have undergone weight-loss surgery receive continuous annual follow-up care and monitoring. It is critical that patients continue to receive yearly follow-up care, not only by completing their scheduled laboratory studies but also by attending an in-office follow-up exam. Patients are welcome to contact our office and schedule an in-person or virtual follow-up.

It is not in your best interest for us to receive lab results without first having the opportunity to get an update on your health. Due to medical, legal, and insurance issues, we cannot order yearly laboratory studies without first seeing the patient in our office. Some patients may choose to have their labs ordered by their primary care physicians; in that case, we suggest they review the information on our website. This is to ensure that we are not ordering tests for patients who will not follow up with us, and that the PCPs who ordered the labs will be able to review the results and make recommendations.

Over the years, patients have also requested that medication be prescribed solely based on lab results, even if they have not been seen by our office in years. We will not prescribe medication to any patient who has not been recently seen by our practice. An exception would be for patients or conditions whose treatment we have firsthand knowledge of, that are not new findings based on a patient’s long-term condition. There are cases when a patient calls our office 8 years after surgery asking for Flagyl to treat gas, which we will not prescribe.

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Vitamin A

Dr. Ara Keshishian — Tue, 17 May 2011 19:20:00 +0000

Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system. A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day

Over the last few decades, the incidence of vitamin A deficiency in the United States has significantly decreased. It is only when the patient shows signs and symptoms associated with the malabsorption of fat soluble vitamins that he or she may be diagnosed with a deficiency.

Vitamin A Deficiency Treatment

Injectable Vitamin A

When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.

When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” or water miscible form. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.

The post Vitamin A appeared first on DSSurgery.