ORBITAL SOCIETY

Patient Testimonials

Thyroid Eye Disease Graves Disease Double Vision secondary to sixth nerve palsy Medical Blepharoplasty Grave's Ophthalmology

Thryoid Eye Disease – Testimonial

“I had Grave’s disease and very puffy eyes for about 15 years. At one time I had double vision as well. Then out of the blue I began to lose my vision…

I first noticed that there were very blurry patches in my vision when I was looking out our window at a very familiar big bushy plant in our garden. Day by day, as if using the bush as my own eye chart at home, I realized that gradually over a period of only 1-2 weeks, I could no longer see the shinyness of the sun on the leaves, and could only see the outer edges of the bush clearly; the rest was very dark and I was unable to distinguish the individual leaves. I became alarmed when I realized that my eyes could no longer see what they had seen clearly just two weeks before. At the same time, my eyes were very itchy, red, and watery, and there was an extra liquid and swelling built up in the outside corners of my eyes.

I went to an optometrist and was diagnosed with dry eyes. He put plugs in my tear ducts and sent me home. A week later the dark area in my vision was a lot larger. I could only make out the outer edges of the bush I had looked at before. So I went back to the optometrist, but saw a different doctor in the same office. He immediately detected a significant loss of vision and referred me to Dr. Cockerham. He insisted that I contact her that same day.

She scheduled an appointment with me the following day, squeezing me into what must have already been a completely full schedule at UCSF, and scheduled me for emergency surgery for the following week. I was amazed and very grateful at how quickly Dr. Cockerham was able to coordinate my surgery with her co-surgeon, especially since it was the Christmas and Hanukah holiday week.

She explained that I had thyroid eye disease (TED) which can cause the muscles and fat in the space behind the eyes to expand. TED was also the reason for my puffy eyes and double vision. When the muscles and fat expand and there is not enough space in the orbit (the bony compartment for the eye,) the optic nerve can be compressed. This can cause a permanent loss of vision, if not corrected. The purpose of the surgery would be to remove a window of bone in the orbit to create more space for the eye and take pressure off the optic nerve. It would take two surgeries to complete this. The first would be done with a Ear-Nose-Throat (ENT) co-surgeon where he would perform an endoscopic procedure through the nose. In the second surgery, Dr. Cockerham would remove bone from the other side of the orbit. I was completely confident to go forward with both surgeries because I trusted Dr. Cockerham due to her professionalism and the thorough explanation she provided me as to how the surgery could possibly help to restore my vision. She also stated that I might need radiation treatment after the surgeries, which I did require for ten days.

I distinctly remember thinking as I walked in to the hospital on the morning of my first surgery, that I desperately wanted to go through with the scheduled surgeries and the radiation, so that I would always be able to see the expressions on my six year old son's face as he grew up on his way to becoming a young man. I would have missed seeing his radiant smile that always uplifted my spirits the most, had I lost my vision. By that point, I had to hold on to my partner's arm in order to feel more secure in judging and maneuvering the step down over the curb to walk safely and quickly across the busy intersection to enter the hospital. I remember that I took one last long look at the blue sky and the clouds before I entered the hospital, trying to soak up its' beauty, feeling grateful that I could still see it, and hoping that after completing the surgeries and radiation, I would be able to see everything in its' exquisite detail again.

Thankfully, after the two surgeries and the ten successive days of radiation, my vision was completely restored. The healing process from the surgery took time, approximately six weeks, but in combination with the radiation treatment, it worked and it was completely worth it to regain my full sight! My eyelids are still a little puffy, but I can see beautifully and that’s all that matters to me. I trusted Dr. Cockerham from the first appointment I had with her. She referred me to an excellent radiologist and she has taken care of my eyes ever since. She is an absolute pro and I recommend her unhesitatingly to anyone with thyroid eye disease.

If you are a person with TED and you notice any subtle vision loss whatsoever, I urge you to seek professional help immediately, because in my case, the vision loss progressed so quickly that had I not acted, it might have been permanent and would most likely have continued to deteriorate. I might not have been able to see my son score his first three pointer as an eleven year old, continue to work full time, bicycle across the Golden Gate bridge with my family, see the myriad of colors in my partner's elaborate flower garden outside our mountain home, nor get back to living life to the fullest!

In my opinion and from my experience, the current cutting edge care that I am receiving from Dr. Cockerham and from each and every expert professional to whom she refers me, is thorough, conscientious, and stellar. I know that if there is any procedure available that will help to maintain my vision or lessen the discomforts of TED, Dr. Cockerham will keep me informed, and I will always entrust the health care needs of my eyes to her professional expert care."

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Do You Believe in Second Chances?

When I was diagnosed with Grave's Disease in 2003, I had no idea what the disease was, nor was I prepared for the trauma and hardships that I would face. Some of the advice I received led me to make the wrong decisions which exacerbated my condition. After radioactive iodine (RAI), I had conflicting thoughts and ideas about how to combat this illness and I had serious misgivings about the doctors who were treating me. Those doctors told me it would get worse before it got better. I had no idea how prophetic those words were. It's amazing how a little gland like the thyroid can trigger a tremendous number of symptoms and problems when it goes awry. It’s a cruel disease.

“If you get any symptoms of Grave's Ophthalmopathy, (Thyroid Eye Disease,) you have more than an 80% chance of it worsening due to RAI.” In my case, I was rushed into RAI without being informed of any other treatment available. This was the worst thing that has ever happened to me. I was robbed of making a choice because I was never given any options. I endured all the ill effects: swelling, broken blood vessels, redness, dry eyes, and tearing. Most worrisome, my eyes began to protrude to the point that my eyelids would not close. Radiation therapy was prescribed in 12 painstaking sessions but this only compounded the problem, and my eyes protruded more than before treatment. I was prescribed steroids in the hopes that it would remedy the problem in time, but it didn't.

As months passed, my once beautiful face and striking brown eyes were unrecognizable. I tried eye exercises, icing my eyes, using eye drops and ointments, taking flaxseed oil and vitamin B, and monitoring my diet in the hopes of improving my condition. Comments like “What’s wrong with your eyes?” “What happened to your face?” “You used to be so beautiful,” and looks of pity and non-recognition steadily deteriorated my confidence and self-esteem. Now, with a hypothyroid condition, I felt fat and ugly. When I told my endocrinologist, all he could say was that I had to accept that I was getting older. He failed to understand it wasn’t a matter of getting older, but that Grave's Disease had impacted my appearance and disfigured my face so that I could not see any resemblance to the person I was. I shunned posing for photographs, withdrew from family and friends, and became a recluse as I suffered in silence. For two years, I depended on my partner and son to drive me to work and appointments. I memorized my route to and from home those few times that I could drive with one eye cupped, and I put my life and those of others at risk. My single vision was replaced with diplopia (double vision), and I lost my depth perception, peripheral vision, and night vision. I could not see bumper-to-bumper traffic on the highway (while being driven around), and I could not see cars driving toward me when I walked down streets. I had to turn sideways to see one image out of one eye. I lost nearly all visual acuity and color sensation, and I was sensitive to bright lights and sunlight. I could not pick people out of a crowd, I could not catch a ball, I easily became dizzy and nauseous, and I was always fearful.

On the recommendation of my doctors at Kaiser I waited three years for my eye disease to plateau. They squelched any hope of orbital decompression surgery because there were others on the waiting list with more severe conditions than mine. The following year, I signed with a new carrier. I researched the web until I found Dr. Cockerham’s website. I delved into her background and education, read all the patient testimonials, and studied all the “before and after” pictures. Now it was time to meet her in person. I was nervous and unsure of what to expect, and brought my photos and medical records with me. On my initial consultation, I found the office and staff inviting and friendly. I met with Dr. Chan, the practice's optometrist, who gave me my first thorough and complete consultation and examination. I noticed framed awards, certifications, and photos in every room, along with accolades and patient testimonials.

I found Dr. Cockerham to be personable, friendly, compassionate, and sympathetic---the complete opposite of the doctors I had experienced before. She quickly disarmed me, listened to me, and let me cry. She studied my photos, went over all the data and analysis, and reassured me that I wasn’t losing my mind. By the end of our visit, she had charted a course of action. My first surgery for an orbital decompression was scheduled for February 2009, strabismus (Double Vision) surgery was scheduled for August 2009, and eyelid retraction repair was scheduled for February 2010.

This process has been a journey that has taken seven years of my life and nearly cost my life. I suffered a multitude of physical problems and psychological stress as a result of bad advice. However, all that changed when I met Dr. Cockerham. She is the most amazing woman and I owe her a huge debt of gratitude for saving my life and giving me a second chance. I am finally able to look at myself in the mirror. I am the person—the face---I used to be before Grave's Disease, and more importantly, she has given me the gift of my eyesight. God has performed miracles through her ability to restore my vision. Every surgery she has recommended has been the right surgery for me, and I have not been disappointed at any of the outcomes. I have a full life again, my face and eyes are as beautiful as before, if not more, and I have regained my confidence.

Dr. Cockerham is nothing less than a miracle, a godsend, and the most caring, sympathetic, attentive, understanding, and passionate physician who is a consummate professional and perfectionist. I am a living testament to her ability and expertise in the field of medicine, and I thank God for her every day!

My thanks to Dr. Kimberley Cockerham, Dr. Stephanie S. Chan, and the entire office staff, as well as my anesthesiologist, Dr. Lee, and the El Camino Surgical Center.

2003 (before GD) Age 43 130 lbs. – sz. 2	2004 – Pre RAI 119-120 lbs. – sz 1/3 Eyes begin swelling, suffering from dry eyes and broken blood vessels.	2005 – Post RAI Painful, can’t close eyes to sleep, eyes starting to protrude badly and suffering from double vision, and vision irregularities.	2006 – Post Chemo Radiation treatments Peripheral, depth, single, and night vision gone, losing control of eye movement. Hair falling out, facial burns surfacing, teeth moving.
2007 Weight out of control, lethargic, adjusting meds to find right T-levels. Will it ever end?	2008 Orbital Decompression research starts 179 lbs. – sz. 12	2009 – Post Orbital Decompression Started steroids and prisms for vision to n/a	2010 - Present day 131 lbs. – sz. 2 3 surgeries later - Success fully vision restored!

 

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Double Vision

Dear Clients of Dr. Kimberly Cockerham,

About 3 months ago I woke up one morning with double vision. I could not bring the two images from my eyes together. It was very unnerving to say the least. Thinking it might be a short temporary thing, I didn’t go to the doctor for 2 days. Since it was not getting better, I went to my eye doctor who believed that I had Sixth Nerve Palsy and that it would take months to correct on its own if ever. He first referred me to Dr. Cockerham to confirm his suspicion & to get me further help. He also had me start wearing a patch over one eye. It helped, but I lost depth perception & felt disoriented most of the time & dizzy occasionally, but it allowed me to drive and function more comfortably. However, I still felt disconnected from the world for the most part. Most importantly, for me anyway, was that I did not feel comfortable riding my motorcycle which is one of my biggest stress relievers. All sorts of things ran through my head about having to change everything I did in my life. That thought truly saddened me.

After meeting with Dr. Cockerham for the first time, she started to rule out all the possible “bad” causes for this condition and after some blood work & MRI it was determined that I probably had a “mini” stroke from unknown causes. She then assigned some eye exercises and gave me the option of having Botox injections. She informed me that the amount of Botox to use would be guess work, and it may take more than one injection. So, two weeks later, I went for my first injection. The preparation (i.e. no vitamins, ibuprofen, etc.) was much worse than the actual procedure. I was in and out within 2 hours with no discomfort whatsoever. I was amazed that immediately after surgery, I could already tell that my vision was somewhat better, even though it takes about a week to be fully effective. After that first week, I returned to Dr. Cockerham and it was determined that one more shot would be required. So, two weeks later, I returned for my second injection and 7 days later, saw the doctor for another evaluation. She felt that no more injections were needed as my eyes were now tracking more evenly. I eliminated the patch to see how I would do. I was able to function with only a little difficulty. Now it has been another month or so & I am back to doing everything I had done before the onset of this condition. I am riding my bike, bowling, hiking, and trying to improve my life style which needed changing anyway. I am not quite 100% but that, I am told, should come back in time. Do not live with this condition if you have it, there are too many good options to correct it. Dr. Cockerham will explain your options in a friendly & intelligent manner. Thank you Dr. Cockerham.

Sincerely,

Ed Ramsauer

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Blepharoplasty / Ptosis Repair

Dear Dr. Cockerham,

Thank you, for the great experience with you, your office staff – and of course the results from my operation! You exceeded my expectations! Everyone has complimented by on my new look. I will be recommending you to anyone thinking of this procedure.

Warm regards,

Joseph

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"Me And TED And Dr. KPC":
A True Story Of Vision Lost & Found

This is a brief recounting of how, thanks to the caring and expertise of Dr. Cockerham, I went from someone with bulging eyes, double vision and a compressed optic nerve whose life was on hold, someone too disabled for 18 months to even seek employment, back to being a detail-oriented technical writer who enjoys seeing straight and the life around him.

Bloody Eye At The Dentist Office

In March 2006 I arrived at my long-time dentist office for a routine cleaning. Both the dentist and the hygienist, noting my left eye looked somewhat bloody and was twisting outwards, insisted I have Urgent Care check it out. I had also noticed, and been disturbed by, the appearance of my left eye but since no actual vision changes were yet apparent I'd been stubbornly ignoring it.

Urgent Care took a blood test and referred me to a good local opthamologist. The blood test came back showing hyperthyroidism.
Not only that but the CT scan that the opthamologist had me take showed proptosis/exophthalmos (bulging eyes), another classic attribute of Grave's Disease, also known as TED (Thyroid Eye Disease), or Grave's Opthamology.

Vision Lost

Within a couple months I acquired two other miserable, and classic, Grave's Ophthalmology characteristics: double vision (strabismus) and a compressed optic nerve in my left eye. A difficult 11 week regimen of taking Prednisone© stabilized the situation but didn't improve it. There was still a noticeable loss of vision in my left eye too; it saw with maybe 70% of the brightness and clarity with which my right eye saw.

More than a year was to go by wherein my life stood still. I was unemployed, on California Disability, felt alone and miserable and was treading water. Reading was difficult and painful; using the PC likewise. I only did some lightweight editing, replied briefly to email and watched TV. I was also becoming a burden and a drag on my roommate. Walking to and from the ocean at West Cliff was the one big consolation prize.

I went through various stages of denial and then had an important realization: no matter how bad I wanted to, I would never see as well as I had, or in the way that I had, before developing Grave's.

I saw my ophthalmologist regularly, every four weeks at the most. He ran tests which showed that the vision in my left eye wasn't worsening but, not being an expert in Grave's Disease himself, referred me to specialists at Stanford for consultation on what might be done to improve my vision.

He also brought up Orbital Decompression surgery, noting that it was the one treatment that would likely have me seeing best "five or ten years down the road" and that, though it was a major surgical procedure, I was "young enough to recover."

I met with a neuro-ophthalmologist at Stanford in January 2008. She instructed me to occlude (cover) my left eyeglass lens with scotch tape in order to ease the disconcerting affects of the double vision. Occluding one eye did provide some relief but my existence, visual and otherwise, remained just that, an existence, and uncomfortable.

The neuro-ophthalmologist noted that, given the degree of my visual impairments, something would eventually need to be done; she mentioned surgical options as well as radiation treatment. I was reticent to explore the surgical options until I'd checked out the other, less invasive, alternatives so a referral was set up for me with Stanford's Radiology Department to see if radiation treatment, which could remedy the compressed optic nerve, was appropriate. I eventually decided to pass on the treatment because it wouldn't address the bulging eyes and double vision, only the compressed optic nerve.

A few months later my life was still on hold and I overcame my misgivings about surgery enough to at least arrange an initial consultation regarding it. I met with Dr. Cockerham for the first time on the day before my 52nd birthday, May 12 2007.

Vision Found

Dr. KPC had only to examine me briefly before informing me that I was a good candidate for the definitive treatment -- the Orbital Decompression surgery I'd been hoping to avoid. She unequivocally stated that this surgical procedure was the only treatment that could, and would, address all three of the visual impairments that Grave's Disease had left me with: the proptosis, the double vision and the compressed optic nerve.

I first agreed to schedule the surgery within four weeks, noting how miserable I was. But then I got cold feet and put off scheduling it. Fortunately for me, Dr. Cockerham didn't let me off the hook! I received a follow up phone call and an email from her with two direct statements that were to change my mind, and my life, for the better:

"You have a compressed optic nerve. You need surgery." and "You'll never regret restoring your vision."

The Orbital Decompression surgery took place at Stanford in August 2007. It eliminated the bulging and fixed my compressed optic nerve. The recovery was neither easy nor brief but going through with the Orbital Decompression was the key to me getting my life back to live. Within a few days of the surgery, my brain and my entire being experienced a profound and tremendous sense of relief at no longer having a pinched nerve painfully transmitting inadequate visual signals to my brain. Not only that but I could see properly out of my left eye again and the bulging was gone too!

"Trouble with you is The trouble with me Got two good eyes but we still don't see..."

-- Casey Jones, words by Robert Hunter, music by Jerry Garcia.

I still had double vision however, as Dr. KPC expected would likely be the case. In early October 2007, I had successful strabismus surgery (a brief outpatient procedure), again performed by Dr. Cockerham, this time at Dominican Hospital in Santa Cruz. My eyes began to fuse shortly thereafter, no more double vision. Fun! Another few weeks of inexpressible post-surgical relief ensued and I still give daily thanks for, and never take for granted, the blessing of being able to see straight.

So today, thanks to the surgical expertise of Dr. Cockerham and Dr. Winston Vaughan, the sinus surgeon who teamed up with Dr. KPC to do the Orbital Decompression work, and to Dr. Cockerham's insistence that I not deny myself definitive treatment, I'm back on my feet and chasing technical writing contracts in Silicon Valley.

Recent Observations Of A Dental Hygienist

The other day Mia, my friendly long-term local dental hygienist, glad to see the vibrancy back in me after its long absence, observed: "Yeah, you were just treading water there for a while." Another day I stopped in at my regular opthamologist's office to say "Hello" to a couple members of the office staff. Rosalie looked me over and noted "Now there's even a gleam in your eye!"

Thanks for listening and, if you're having Grave's Opthamology issues, I hope my experience encourages you to pursue the definitive treatment offered by Dr. Cockerham.

Alan Mark Levinson
Technical Writer / Editor
web site: http://mindrunner.org

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