Before the Needle Although many people have heard about Botox, few people know what it actually is. So, what are Botox injections? Many people would be surprised to learn that it actually is a drug derived from a neurotoxin created by a specific bacterium, the Clostridium botulinum. This is the same toxin that causes botulism, a life-threatening form of food poisoning. When ingested in its natural form, Botox can cause paralysis that spreads through the body until it eventually works its way to the breathing muscles, causing respiratory failure. This is why it is important to educate yourself before considering Botox injections. Why Do People Get Botox? Although this is a toxin, it is safe to use in small doses for medical use. Doctors often use the substance cosmetically. It is probably best known as an anti-wrinkle agent used to treat fine lines and signs of aging. Most commonly, it is used to treat wrinkles in the neck or face. Some people also get Botox injections to minimize their forehead lines. [youmaylike] In addition to smoothing skin to give it a more youthful appearance, it serves other medical purposes. Some patients use it to treat severe underarm sweating, migraines, uncontrollable blinking, overactive bladder and strabismus (misaligned eyes). How Does Botox Work? Botox causes paralysis. While this can be fatal in large, targeted doses, it is the property that helps with treatment. It acts locally, upon the injection site where it will weaken or paralyze targeted muscles. This is done as the neurotoxin attaches to nerve ending and blocks impulses from coming through. Instead of contracting as normal, the injected tissues will remain relatively frozen. Reducing the pulling of the skin is what makes the skin look more youthful. This signal-blocking property is also assisted with the other medical applications of Botox. It is important to realize that these are not the same as a filler. How Long Does Botox Last? The effects of Botox do not last forever. After a while, the signals will begin to pass through again. Procedures are expected to have a visual effect that lasts three to six months. Botox will not lose its effect overnight. Rather, you will experience a gradual decline in results as the muscles slowly regain their movement. The effects of your first session will wear off faster than the later sessions. Your first session is expected to last around three months where the later sessions will gradually last up to six months. Is Botox Safe? Under controlled medical environments, Botox injection procedures are considered low-risk. Most procedures are carried out safely and effectively with little side effects. The side effects one does experience are normally what is expected from any sort of injection procedure. This would be some temporary redness, bleeding or bruising at the injection site. In rare cases, one may experience a headache in the first two days after the procedure or temporary drooping. With this being said, there are certain situations where you should avoid getting Botox injections. You should not undergo treatments if you: Are 65 years of age or older, or under 18 years old. Have breathing problems. Have bleeding problems. Are allergic to or have sensitivities to Botox products. Be sure to talk to your doctor about any medications or supplements you are currently taking as there may be some interactions that could be dangerous. If you immediately experience signs of an allergic reaction upon the treatment, seek medical help immediately. To reduce any of the potential complications, it is important that you thoroughly research the performing physician. You need to make sure you are going to someone who knows what they are doing and has an adequate environment to perform hygienically and legally. It is not worth the risk to seek other methods. Does Botox Hurt? Botox procedures use very tiny needles. While injections are associated with some pain, the size of the needles keeps this pain at a minimum. Botox injections are generally preceded by some sort of anesthetic treatment to numb the pain. This is often done with a topical anesthetic cream or a cold pack. Most people report minimal to no pain at all. The Cost of Botox The cost of Botox will vary greatly depending on the specifications of your procedure. Some facilities will charge you by the area covered, but more often they charge you per unit of Botox used. On average, you will pay about $20 per unit. As the average treatment is about 20 to 60 units on average, you will likely pay between $500 and $800. The number of units used in a session will vary greatly depending on the space that you want to be covered. The bigger the area, the more units you will need to pay to achieve results. When it comes to cosmetic procedures, insurance will likely not pay for any of the costs. You can talk with your insurance provider to find out if they offer financial compensation for non-cosmetic procedures.
Diabetic Macular Edema Explained
Diabetic macular edema (DME) is a complication of diabetes that occurs when excess fluid starts to build up in the eye's macula. The macula is the part of the eye that allows us to focus and see fine details, and it is located in the retina, which is full of blood vessels. High blood sugar levels can damage the retina's blood vessels. The damaged blood vessels then begin to leak fluid, thereby causing swelling and other complications. This damage is called retinopathy and generally develops over time.
What Causes Diabetic Macular Edema?
As earlier stated, DME usually occurs due to high blood sugar levels. Other factors such as high blood pressure and high cholesterol levels can also contribute to blood vessel damage. In other instances of diabetes, pregnancy may also increase the risk of developing DME.
Risk Factors
Since DME results from high blood sugar levels, it is common for people with diabetes, especially uncontrolled diabetes, to be at risk for DME. Additional risk factors that can lead to DME include:
- Poor blood sugar management
- High cholesterol
- High blood pressure
- Kidney disease (nephropathy)
- Sleep apnea
- Pregnancy
Associated Symptoms of Diabetic Macular Edema
In its early stages, there may be no symptoms. However, if you have diabetes, it is important to see an eye care doctor every year so they can examine your eyes for any changes. If you also notice any sign of retinopathy or DME, early treatment can prevent or restore vision loss. Let’s take a look at some of the common signs and symptoms of diabetic macular edema:
- Blurry or blocked central vision
- Distorted or "wavy" central vision (called metamorphopsia)
- Seeing floaters or strings of floaters in your vision
- Blind or dark areas or spots in your field of vision
- Difficulty reading at any distance
- Colors appear more washed out than usual
When to Call the Doctor
Call your eye doctor right away if you notice any of the above symptoms. Be sure to tell your eye doctor if you have any of the following symptoms:
- Blurry vision
- Seeing colors that look washed out
- Seeing more floaters in your vision
- Double vision
Diagnosis and Different Treatment Options
Diabetic macular edema can be diagnosed through a comprehensive eye examination. There are effective treatments available for DME. Be sure to talk to your doctor to find the right option that will work for you. If you have received a DME diagnosis, ensure that you start treatment quickly to help prevent long-term eye damage and vision loss. Your doctor can recommend any of the following treatments:
Laser Therapy
Laser therapy involves the use of tiny lasers to target damaged areas in the retina. This process seals leaking blood vessels and prevents abnormal blood vessel growth. Laser therapy is effective in maintaining your current vision level and helps prevent further loss of vision. You’ll likely need several laser treatments overtime to repair eye damage and may require additional treatments if more eye damage occurs.
Anti-VEGF Shots
When you have DME, your body tends to produce a protein called VEGF in excess. When this happens, your blood vessels begin to grow too quickly; so, they are weak and leak blood and fluid into your retina and macula.
There are three types of anti-VEGF medicines usually used for DME; they include aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis). These Anti-VEGF shots help to inhibit the effects of the VEGF protein. However, anti-VEGF shots may not be helpful for everyone and should not be used during pregnancy.
Focal-Grid Macular Laser Surgery
This treatment type works by sealing blood vessels in your retina to slow leaking and bring down swelling. If you have DME in both eyes, your doctor will treat one eye at a time, usually within a few weeks. In some cases, a laser may be used along with anti-VEGF shots if the shots alone are not helping.
Corticosteroids
These drugs are often called steroids and are used to target inflammation. They are usually prescribed to help lessen swelling in your retina. Steroids are usually not as effective as anti-VEGF shots, and they can cause other eye problems, like cataracts and glaucoma. They are not traditionally given as first treatment.
NSAID Eye Drops
Doctors sometimes use eye drops as a preventive measure for DME before or after you have eye surgery. These drugs are called non-steroidal anti-inflammatory drugs (NSAIDs) because they help fight inflammation like steroids but do not have the same side effects. Doctors usually prescribe NSAIDs to prevent or ease swelling.
Can Diabetic Macular Edema Be Prevented?
You may not be able to prevent macular edema if you have diabetes, a pre-existing eye condition, or have suffered an eye injury in the past. However, you can follow the nutrition and lifestyle recommendations from your health care provider to avoid developing diabetes in the first place. You will likely be advised to do the following:
- Keep your blood sugar level under control. Check your blood sugar level several times a day (ask your doctor exactly how often). The American Diabetes Association recommends people with diabetes keep their A1C levels under 7%.
- Stop smoking or do not start. Ask your doctor for help quitting. Smoking increases your risk of diabetic retinopathy, age-related macular degeneration, and blocked retinal blood vessels. All those toxins damage the eyes’ tiny vessels.
- Exercise often. Try not to go more than two days between exercising. If you do, the glucose-metabolizing effects of physical exercise will wear off.
- Eat healthy. Follow your doctor's nutritional guidelines but, in general, avoid junk food and fast food, and try to eat more fresh fruits and vegetables, especially dark, leafy greens such as spinach, kale, and collard greens.