Management of acute endophthalmitis requires a rapid diagnosis and appropriate treatment or referral. Most cases of endophthalmitis are managed by vitreoretinal specialists who will take a sample of fluid from the eye for culture and inject antibiotics or antifungal agents into the eye on an emergent basis. In cases of light perception vision only, vitrectomy is recommended in addition to culture and antibiotic injection. Cases of endophthalmitis can lead to a complete loss of vision and even the eye if not treated rapidly. However, it is possible to retain good vision if treatment is timely and successful.
I am five days from completing my microtaper off of Klonopin and have done very well over the past 18 months of tapering. For anyone who wishes to get off of any psych drug (AD, benzos, anti-psychotics, opiods, etc.) PLEASE consider doing a liquid titration microtaper. Your body will thank you!! Most all of the suffering I have seen in others (including myself and the family member) has been due to a taper that was too fast. A microtaper gives the brain time to heal during the taper. If minor w/d symptoms are experienced during a microtaper, the daily reductions can be put on hold until w/d symptoms subside. It’s really that simple. Such a taper can be speeded up for those who can handle it, but, in my opinion everyone should assume the worst and start off with a microtaper, rather than find out the hard way that their body can’t handle a faster taper and may not be able to reinstate and start over. Be very careful in the first place, not later.
“In a patient with Cushing’s who has had successful removal of the tumor, either pituitary or adrenal, the patient should be hypoadrenal (adrenally insufficient). This is because the high levels of cortisol caused by the tumor will have suppressed the normal hypothalamic-pituitary-adrenal axis. To test for adrenal insufficiency after surgery while preventing symptoms of adrenal insufficiency, we give a small amount of a glucocorticoid (cortisol compound) called dexamethasone, which will not interfere with our ability to test the axis. A small amount of dexamethasone is given in the post-operative period (typically less than 1 mg/24 hours) and tests of serum, urine and late night salivary cortisol are performed. If the tumor has been completely removed, these results will be very low, and the patient said to be “cured” or “in remission”. If the levels are not very low, the tumor is likely still there, or, a longer time period may be needed to assess the person’s axis, because in rare cases, the cortisol levels fall more slowly. If the cortisol level is very low, the patient is adrenally insufficient and must take a small amount of a glucocorticoid (such as prednisone or hydrocortisone) every day to be healthy. The goal is to give enough cortisol replacement so that the patient does not have adrenal insufficiency, but not so much that the system is suppressed. There are no biochemical tests to indicate the best dose for an individual patient; this is determined by talking with and examining the patient.