Hi Dr. Altman,
Are the eyes supposed to be equal after cocaine or if they are still unequal but both dilated from their original size, is that enough to say it's not Horner's and nothing further needs to be done? On the info her doctor showed me it said in Horners no dilation occurs, but I also read online that anisocoria greater than .8 mm post-cocaine and it is Horner's.
I wish we had taken pictures before and after .... I thought of that after I was there that I should have brought my camera.
Wow Ms Mack...
Thanx sooo much for the follow up !!!
First off, sorry for getting back to you so late
I just got back into town and am checking E-mails this morning.
Now some praise for you .
You have got to be the most informed mom I have met, or almost met...
In a good way, as many get 'online' and find spurious ,only somewhat accurate information
and begin concluding all kinds of silliness...
You on the other hand found 'THE' study on Cocaine and Horner's
Out of Iowa...and Randy Kardon's group....which is the gold standard
That any remaining anisocoria
(difference in the size of the pupils) after Cocaine (0.8mm , as you stated)
BUT...yes I said BUT...
in your baby's history/ story, clinically think I'm gonna have to now agree with your Peds Ophthalmologist
To say -
1.There are no other signs of Horner's...
2.The Urine tests were negative for Horner's...
3. The right pupil did dilate quite well...
...It is so so hard to truly /accurately measure pupil size in a baby
despite that, with the difference in pupil size so much less, This remains evidence against Horner's...
Now a question....Did he measure, or attempt to measure the post Cocaine pupil size in bright light,
or in dim light...when he gave you those numbers...? Both are good, but in the dim/dark light - may be better...
Again though - its so hard to get a great measurement in a baby
With the gestalt finding though that the pupils were relatively equal now, after Cocaine,
along with the other points mentioned above...
I think it is evidence against Horner's.
Now Ms Mack...we are not G-d nor are we prophets.
The only way to know for sure , is to image
(and truthfully, imaging is not perfect either !!!)
however, given the small risk of putting the baby thru that (general anesthesia...etc...)
and the very very small/unlikely chance of finding anything at all
I would agree to follow along carefully.
Wishing you and your family only the best of health and success
Michael Altman MD
Director Pediatric Ophthalomology
Krieger Eye Institute
Sinai Hospital of Baltimore
MOB 6th floor
2411 West Belvedere
Baltimore , MD 21215
W (410) 601-9084
F (410) 601-6606
Dear Dr. Altman,
Thank you again so much for your time - and I'm flattered, too, by your praise ;) I sometimes feel like doctors think I'm crazy, so it's nice to hear otherwise.
I feel better after receiving your opinion. I still may end up going to another doctor here to have him look at her if I start feeling really nervous about it. My only other question is wondering if I should ask for the "real" urine test (24-hour) - or do you think the spot test was enough, being that it was negative? I
I was hoping the cocaine would allow us to go on our merry way, stop worrying, and while it did make me feel better, it didn't erase the worry just due to the less-than-conclusive results.
Thanks again ~
yes, less than 100% conclusive results
But very positive...I mean good results for the baby....
and thats often the way medicine is...and life as well...
Ya got a really good idea, and youre confidant
however there always can be a wrench
On the other hand, it seems to me that all arrows point here in the right direction
You have to do what you feel is right
and what will help you sleep well...cuz your mom...
and peace of mind is very important.
You aren't wrong to go further
but my gut is with their's on this one.
Keep me posted
Always good to hear from you
(Gotta love gmail and the archiving of old emails!!)
Hope that helps and hope you get your answers! (((( Hugs ))))