RADIATION THERAPY
These flashing lights are real
My patient is undergoing radiation therapy for head and neck cancer. She reports seeing flashes of light during treatment, even when her eyes are closed. She is disturbed by this because no one can explain to her what it means. Is this phenomenon unusual?-K.W., NEV.
No. Over the years, many patients undergoing radiotherapy to the head and neck have reported seeing unexplained light flashes. Many theories have been proposed, but only recently has a possible explanation been discovered. Using specially designed equipment, a team of researchers collected real-time data showing that during head and neck radiation therapy, enough light is produced inside the eye to elicit a visual sensation.1,2 The researchers say the light, which is very subtle, is generated within vitreous fluid when a radiation beam passes through it.
This discovery may have practical applications that could enhance cancer therapy in several ways.
* Giving patients a valid explanation for this phenomenon helps relieve treatment-related anxiety.
* Monitoring light emission from the eye could help clinicians determine whether radiation transects the eye. If the eye is a target of treatment, this helps confirm beam delivery. If the eye is not a target, monitoring light emission could serve as a safety check.
* Monitoring light emission could also help predict future vision loss. Published evidence has shown that patients who do not see light flashes during radiotherapy have a greater chance of vision loss after therapy concludes, the researchers say.
Reassuring your patient that the flashes she sees during treatment are common and normal should help ease her concerns.
REFERENCES
1. Tendler II, Hartford A, Jermyn M, et al Experimentally observed Cherenkov light generation in the eye during radiation therapy. Int J Radiat Oncol Biol Phys. 2020;106(2):422-429. [Context Link]
2. Scientists capture for first time, light flashes from human eye during radiotherapy. Dartmouth-Hitchcock Medical Center. News release. January 7, 2020. [Context Link]
EATING DISORDERS
What is diabulimia?
I work in a healthcare provider's office, where we care for several adolescents with type 1 diabetes (T1D). One patient was recently diagnosed with "diabulimia," which I cannot find in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Is this a legitimate diagnosis?-N.L., VA.
Coined in the media, "diabulimia" is a colloquial term for eating disorders in someone with diabetes, usually T1D.1 Increasingly reported in adolescents, it involves purposefully restricting insulin to lose weight. Some healthcare professionals use the term eating disorder-diabetes mellitus type 1, or ED-DMT1, instead of diabulimia.
Because diabulimia does not have a separate diagnostic code in the DSM-5, the diagnosis depends on the patient's eating disorder behaviors. For example, the diagnosis may be coded as bulimia nervosa if the patient is binging and then restricting insulin, or anorexia nervosa if the patient is restricting both food and insulin. Diabulimia can also be coded as "Other Specified Feeding and Eating Disorder (OSFED)."1
Seeking to avoid weight gain, teenagers with T1D are particularly susceptible to eating disorders. In one study involving 770 children and adolescents with T1D, more than half of adolescent girls with a body mass index in the obese range engaged in disordered eating behaviors.2
Treating these disorders is challenging. Early recognition and intervention is essential to prevent serious short- and long-term health consequences. To learn more about assessing and treating teens with diabulimia, visit the National Eating Disorders Association website referenced below.
REFERENCES
1. National Eating Disorders Association. Diabulimia. http://www.nationaleatingdisorders.org/diabulimia-5. [Context Link]
2. Wisting L, Froisland DH, Skrivarhaug T, Dahl-Jorgensen K, Ro O. Disturbed eating behavior and omission of insulin in adolescents receiving intensified insulin treatment: a nationwide population-based study. Diabetes Care. 2013;36(11):3382-3387. [Context Link]
SUICIDE PREVENTION
A new, shorter hotline number is in the works
When caring for patients who are depressed and possibly suicidal, I inform them about the National Suicide Prevention Lifeline: 800-273-TALK (8255). It is an excellent resource but remembering all 10 digits can be difficult for patients experiencing a crisis. Is a better option available?-P.A., MASS.
Not yet, but the Federal Communications Commission (FCC) is working to establish a 3-digit hotline number, 988, as mandated by the National Suicide Hotline Improvement Act of 2018. Easy to remember, the 988 designation "will help ease access to crisis services, reduce the stigma surrounding suicide and mental health conditions, and ultimately save lives," according to the FCC.1 Calls made to 988 would be directed to the National Suicide Prevention Lifeline, which has a national network of 163 crisis centers. In 2018, trained Lifeline counselors answered over 2.2 million phone calls and conducted over 100,000 online chats.1,2
The FCC is currently initiating a comment period to explore the technical challenges of implementing a new nationwide crisis number, so 988 will not be operational for many months. In the meantime, continue referring patients to the National Suicide Prevention Lifeline and similar organizations, such as Lines for Life (800-273-8255), which also offers a texting service (text "273TALK" to 839863).3
REFERENCES
1. Federal Communications Commission. FCC proposes designating 988 as national suicide prevention and mental health crisis hotline number. News release. December 12, 2019. [Context Link]
2. National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org. [Context Link]
3. Lines for Life. http://www.linesforlife.org. [Context Link]