Sunday, 26 January 2014

 The Cheesecake Queen and the Professor

It sounds like a good title for a sitcom, don't you think? But it's actually about my opthamologist and our mutual love of cheesecake! I made him a raspberry swirl cheesecake when I had my most recent eye injection. But more about the cheesecake later. If you're just recovering from the thought of an eye injection - it's not as bad as you may think, especially when it's performed by someone skilled who has, as the receptionist said, 'a great bedside manner'.
Some background to my eye condition first. My mother was legally blind by around the age of 60. As far as any of us knew, she had macular degeneration, which is an age related deterioration of the macular. This causes distortion and ultimately total loss of  the central vision. I've known for over twenty years that I ran the risk  of developing AMD. My optometrist identified some early signs around the age of 30. In my  mothers case she had already experienced considerable distortion of her vision before it was detected, and in those days there was no treatment.  I was however placed on vitamin therapy which was having some success as a preventative measure. I have spent thousands on this over the last 20+ years. My mother grew up during the Depression and had a poor diet and no vitamins. So while I knew I was at risk, I was feeling fairly confident I'd be OK and if I did experience problems it would occur when I was much older.

My mum circa 1944

 About six months ago I happened to take the Amsler Grid test. It's a simple test (you can download it online) which you take to check for any signs of distortion. Had I known what I know now, I should have been taking it every week or so to pick up any changes early. I think I had been having troubles for up to 6 months when I finally realised. Because it is only in one eye for now, my other eye was compensating. I kept thinking my glasses were dirty. It wasn't until I picked up a grid while tidying my desk, and covering my 'good' eye, that I realised with great panic that my vision was quite distorted in one eye.
There were tell-tale signs over the past few years - I found a distinct loss of night vision and couldn't see in underground car parks, I couldn't see the lines on the road at night when it was raining. I kept telling my optometrist and he said maybe I should see an opthamologist, but never got around to referring me. But when I went straight in after the poor Amsler result, he said I had significant change in the eye and needed immediate opthamology. He warned me my 'AMD' may have changed from the slow moving but untreatable 'dry' type, to the potentially catastrophic (but treatable) 'wet' type, and that the treatment was an injection in the eye. Luckily a wonderful ophthalmic clinic was just upstairs and they had left for the day that day, but I spent several hours there the next day having many scans and tests, fluoriscene dye xrays, and was scheduled in for my first injection 2 days later.

My doctor is a professor  and so I just call him the "Prof". I had extensive neo-vascularisation he told me, and I didn't have AMD as such. My problem was genetic and no amount of vitamins would have helped it. But depending on my genetic markers, my prognosis could be quite different to my mothers. In the future he said I will need to have my genome sequenced (it could be sent over to China for about $2,500, however just last week a new machine was purchased here in Australia and we will be able to get it done locally for $1000. When you think it cost a billion just 10 years ago, we've come a long way, baby) and this will help in determining prognosis and treatment. He couldn't disguise it either - he seemed pretty excited to have someone to treat with this rare condition in amongst his mainstream clientele with AMD or diabetic retinopathy.


The injections themselves are of a chemotherapy drug. When I went home I scoured the internet and found that the therapy had only been given in England and the US for about 6 years, and had only been approved in Europe a few months previously. So it is still in the almost experimental stages and more is being learned as we go along. I like the idea that my journey can contribute to  learnings that can help others. But I found that on current data half of people's eyesight actually improves with the treatment, 40% gets slightly worse and 10% gets much worse.
So I had 4 injections at 1 month intervals, then this one
was an 8 week interval. I have responded well to treatment and next time is a 10 week interval. They are finding the maximum time anyone can go is 12 weeks before they relapse, although some have to go every 3 weeks. My eyesight did get worse sadly, and I think this is because I was fairly advanced when I started. When I started I could read with the bad eye to a reasonable extent, now I can not read at all, except for very large signs. But the Prof tells me if I hadn't started treatment I would probably be blind in that eye now, so I can't complain. And of course we will catch my good eye early when and if it also deteriorates. I have an 80% chance of that, regular AMD is around 50%. I was going to post a pic of an eye injection but decided it looked a bit confronting, but google it if you're interested, and in the meantime here's some raspberry puree!

So what does all this have to do with cheesecake? When I had that first shot I got some valium from my GP but was still feeling fairly shaky and apprehensive. The Prof started talking to me about cricket to distract me. Really? The cricket? Sorry, but I call the cricket "the boringness"! I come from a cricket mad family - my siblings and parents were all crazy about the cricket - watching it, playing it, talking about it. My mum, even when legally blind, sat in front of the TV watching from dawn to stumps as best she could, scrawling oversized calculations across copious notepads to tell us how many runs per over or ball they needed to average to win/lose. But sorry, I didn't share their enthusiasm and I did not want to be talking about the cricket at that moment in my life. But how Mum would have loved it if she had the chance!

So he changed the topic to dessert. What's you favourite dessert he asked. Cheesecake of course I said. Me too! he replied. He went on to tell me his favourite is the Cheesecake Shop strawberry flavour and he boasted he can eat a whole one! He also gave me permission to have dessert after my injection, a tradition I keep up.
At this point I wasn't even sure how many of these I would need to have. After it was over I asked the question - how long do I have to have these? He said well it's like this - until I die or you die. Mmm. Well I guess that means we are going to be a part of each other's lives then, and I cook for the people in my life. He says that even though I may not ever like the injections, I will 'make my peace' with them. I'm getting there. He said for someone who doesn't like them (er, does anybody actually like them?), I do very well.
So we have talked about dessert a few times, except for  the day he forgot and started talking about the cricket again!
I wanted to make the Prof and his many troops of nurses, doctors and radiologists a cheesecake for Christmas but didn't manage it in the rush, so took one today as a belated New Year offering. I made a no bake raspberry swirl which is not overly sweet but very creamy and delicious if you are fond of raspberries. He thanked me several times, proclaiming it his favourite. They were all planning to eat it for morning tea  the next day. I hope they enjoyed it!

All packed up and ready to go
250g butternut snaps
90 g butter
1/4 cup water
2 tablespoons gelatine
500g light cream cheese
1/3 cup lemon juice
1/2 cup caster sugar
1 1/4 cup cream, whipped
250g frozen raspberries
2 tablespoons caster sugar, extra
Line the base of a 22cmspringform tin with foil and brush with oil. Process biscuits finely and mix with butter. Press firmly onto tin base and sides. Chill while making filling. 
Beat cream cheese till softened, add juice and sugar, beat until smooth. Gently fold in whipped cream.
Process raspberries and extra sugar until smooth.
Sprinkle gelatine over water in a small bowl. Stand bowl in boiling water and stir until dissolved. Cool slightly.
Fold just over half gelatine mixture into the cream mixture, and the remaining gelatine mixture into the raspberry mixture. Swirl the mixtures together in the tin.
Refrigerate 4 hours or until set. Decorate with whipped cream and raspberries.
Tip - this cheesecake is quite tart, if you like sweeter cheesecake I suggest adding more sugar to the raspberrries.

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