Sunday, September 28, 2008

Natalie Adler blind three days out of six

A MELBOURNE woman whose eyes clamp shut for three days at a time - then open up for the next three - has baffled specialists.

Natalie Adler, 21, has been locked in the extraordinary routine for four years.

Doctors believe Ms Adler may be the only person in the world with her condition.

"My eyes are closed for three days and then open for three days," Ms Adler, of Caulfield South, said.

"Something happens overnight (on the third night). I go to bed and I can open my eyes, and then when I wake up the next day I can't.

"Nobody knows why."

Ms Adler has undergone hundreds of tests since her life dramatically changed in mid-year 11 at school.

"I woke one Sunday and my eyes were swollen. It was the day before an English exam," she said.

After a sinus and staph infection "I just never got better".

"My eyes started closing intermittently, really randomly, but within a few weeks they were closing for three days," she said.

Experts from the Royal Eye and Ear Hospital said Ms Adler's case was like no known other.

Associate professor Justin O'Day, head of the hospital's neuro-ophthalmology unit, said: "Natalie's a mystery.

"She's a one-off and we don't have a diagnosis."

Dr O'Day said a condition called blepharospasm - random muscle spasms forcing the eyes closed - offered some point of reference.

But he said there was no medical explanation for the strict consistency of Ms Adler's eye routine. He added: "It's unusual to see somebody with this degree of spasming and eyelid closure, especially at this age.

"There is no known cause."

The best-known treatment, Botox injections around the eyes, worked temporarily for Ms Adler.

For almost two years, her six-day eye cycle inexplicably changed to five-days open, one-day closed.

But Ms Adler, who also suffers unexplained fatigue and nausea, said Botox no longer worked for her.

During "closed-eye days", Ms Adler's eyes are completely shut, except for a small slit in her left eye.

On "open-eye days", they function normally, though the left eyelid can droop.

Ms Adler crams as much as she can into good days, which are marked months ahead in her diary. But some things can't be scheduled.

"On my 18th birthday, my eyes were closed, but on my 21st they were open, so I had a party," she said.

A big footy fan, she watched the AFL Grand Final live for the first time in three years.

"Not being able to go to the football or seeing my friends as much is what I miss the most," Ms Adler said. "It's the general day-to-day things that I used to take for granted."

Ms Adler's parents, Fred and Lillian, said they were proud of the way their daughter handled her lot.

"Natalie's always saying there are a lot of other people worse off than she is," Mr Adler said.

Natalie's next treatment will include electrical stimulation of the eyes, has not given up hope of a cure.

"The tests give me a glimmer of hope."

Horny goat weed could be better than Viagra

The soft green heart-shaped leaf of the horny goat weed could hold the key to a new drug for treating erectile dysfunction. Researchers say the Viagra alternative could be as effective as the famous blue pill, but have fewer side-effects.

Mario Dell'Agli of the University of Milan, Italy, and colleagues tested four plants which are used as natural aphrodisiacs in traditional cultures to establish their potential as alternatives to Viagra.

Viagra's active compound, sildenafil, works by inhibiting an enzyme called phosphodiesterase-5 (PDE5). Because PDE5 helps control blood flow to the penis, inhibiting PDE5 promotes male erection.

Dell'Agli and his colleagues tested the four plants in vitro to see how efficient they were at inhibiting PDE5. Just one – Epimedium brevicornum, also known as horny goat weed and Bishop's Hat – had an effect. This confirmed previous studies showing that icariin, a compound found inside the horny goat weed, is a PDE5 inhibitor.

The fifth compound

Sildenafil, however, is 80 times more effective at inhibiting PDE5 than icariin. Dell'Agli and his team extracted icariin from the plants, and produced six modified versions of it, which they also tested on PDE5. The most efficient of these, compound 5, "works as well as Viagra", says Dell'Agli.

A drug made from compound 5 could also cause fewer side effects than Viagra.

In addition to PDE5, sildenafil affects other phosphodiesterases, including some that are essential to sight and heart function. As a result, people who have heart problems are not advised to take Viagra and patients who do take the drug sometimes suffer disturbances to their eyesight.

Preliminary tests suggest that compound 5 does not affect other phosphodiesterases, meaning it may not have the same side effects as Viagra.

Eat your weeds

Compound 5 will now have to go through lengthy clinical trials before it can be approved as a drug. It could be 10 years before it reaches the market.

In the meantime, "if people eat horny goat weed, I think it can be beneficial because it contains icariin," says Dell'Agli. "But it will not be as effective as Viagra."

Horny goat weed is found in the wild in China, Asia and Europe.

The research was supported by private funds, but Dell'Agli declined to provide details.

10 ways to rediscover the joy of motoring


Too many people get irate at the sound of the horn, says Mr Vanderbilt, who spent three years examining driving habits around the world.

The horn's function could be entirely innocent, even benevolent. For instance, the honker could merely be pointing out that a fellow driver's petrol cap is loose.

"There's a tendency to want to go off at the first. Don't instinctively react to that noise. Try to think what the context is."

Drivers of convertible cars are less likely to use their horns than others, he says, because they don't have the anonymity of being enclosed and hidden.

Men honk more than women but women are most likely to be honked at, he adds.


You're on a motorway and the traffic has slowed to a crawl. Why do the other lanes always seem to be moving faster?

They don't really, says Mr Vanderbilt. They only seem to because of something called "loss aversion" which means our brains are more sensitive to loss so we tend to notice the cars that overtake us, not the ones we leave behind.

And changing lanes is counter-productive. It increases the risk of an accident, makes a driver more stressed and doesn't make much difference. When tested in Canada, the driver that changed lanes at every opportunity only made four minutes in an 80-minute drive.


Exchange glances as much as possible, especially with pedestrians at crossings, because it makes your intentions clearer.

Eye contact increases co-operation, he says, referring to a study which found that putting a photograph of eyes above an honesty box at a coffee machine made people give more money than if a photo of flowers was put there instead.

But the reality of driving means it's often impossible - not to say dangerous at anything over 20mph - to make eye contact with other motorists.


The idea that any sort of a commute is a good thing might sound odd, but drivers actually benefit from a short spell in front of the wheel twice a day - 16 minutes each way being the optimum time, says Mr Vanderbilt. For many it is valuable, personal time.

"If you commute, you're going to a job so your day is very hemmed in. You have your job and your home.

"People listen to music most frequently in the car so it's a space you can do what you want. You see people singing and behaving in a way that's not usually possible. There aren't many private moments in a day so people turn the car into a private space."

But there are limits. The enjoyment evaporates the longer the drive, and a commute that creeps past the hour mark will test the patience of even the most passionate petrolhead.


People leaving car parking spaces always take longer to do so when another car is waiting to get into the space.

This is because the space becomes more valuable, in the driver's eyes, when it is wanted by someone else.

The car is a private space in a public space, says Mr Vanderbilt, so motorists mistakenly think that once inside it, the land underneath is theirs as well. But there's no need to be territorial.


"For those of us who aren't brain surgeons, driving is probably the most complex everyday thing we do. It is a skill that consists of at least 1,500 'subskills'," says Mr Vanderbilt.

"At any moment, we are navigating through terrain, scanning our environment for hazards and information, maintaining our position on the road, judging speed, making decisions (about 20 per mile, one study found) evaluating risk, adjusting instruments, anticipating the future actions of others - even as we may be sipping a latte, thinking about last night's episode of American Idol, quieting a toddler or checking voice mail."

Because all this appears to be done so easily, experienced motorists treat driving like breathing. But problems arise if something unlikely occurs, because so much of driving is mundane.

The fragmentary nature of our attention was underlined in an experiment in which a video of people playing basketball was showed to the subjects of a study. Half of them failed to notice when a man in a gorilla suit walked through the players.

The lesson is to maintain concentration and don't slip all too easily into auto-pilot.


One of the biggest sources of road rage is late merging - when one motorway lane is going to end and the instructions are quite vague about when drivers should merge into the other lane. If a car doesn't merge straightaway, drivers in the backed up traffic queue get angry. In fact, those "selfish overtakers" are doing everyone a favour, says Mr Vanderbilt.

"People want to carry their personal idea of queuing into traffic and say 'That person is just [jumping the queue]' but why is there a lane anyway?

"More people will get through if drivers use both lanes to the end and then merge one at a time."


Tailgating accounts for 7% of road traffic accidents in the UK, says Mr Vanderbilt, but it's just another form of bully driving and it holds up the traffic.

"It increases your own crash risk and reduces the reaction time of the person behind you. If the person in front brakes, you have to come to a much faster stop and you have a chain reaction crash. Do you want to be reliant on the person behind you stopping in time?"


An experiment conducted in the UK discovered that drivers gave far more space to cyclists that did not wear helmets, than those who did.

The researchers concluded this was because motorists interpreted the helmet as a symbol of a more predictable and sensible cyclist, one less likely to veer into their path.


Racing car drivers accumulate more traffic tickets and take more risks in everyday driving than the rest of us, but there are certain things we can learn from them.

For a start, they have perfect driving posture, erect and alert, whereas others lean back.

And racing drivers always look ahead to where they are going, in order to speed through turns, which is something normal drivers would do well to adopt.

One reason for the high number of pedestrians struck by turning cars while crossing the road, says Mr Vanderbilt, is that drivers are not looking in the right place. They are looking at making the turn rather than where the turn will take them.

Tom Vanderbilt is author of Traffic: Why We Drive The Way We Do (And What That Says About Us)

Add your comments on this story, using the form below.

Some of these points should be taught and examined on the driving theory test - congestion and accidents could be significantly reduced. 'Zip'-style late merging is the quickest way for everyone to get through and it boils my blood that the vast majority of people think it rude, preferring instead to queue for miles past an empty stretch of perfectly good tarmac. I believe you get a ticket for this in Germany.
Tim Parris, Sheffield, UK

I agree with Mr Vanderbilt on all but one point, Late Merging. I have seen evidence where motorists in an out side lane that is blocked off have stream through despite warning and advice to merge further back have proceeded to merge at the last moment. This has caused the inside lane to come to a complete stop. Some even pull out of the inside lane to gain the advantage of a few yards. I also was in transportation planning and feel Mr Vanderbilt has got this wrong.
Richard, USA

There is an infamous junction in Edinburgh where a constant stream of traffic has to turn left into another constant stream of traffic. I discovered that if I wound my window down and caught oncoming drivers' eyes, I would get out quicker.
Andrew, Edinburgh

Caracas is one of the cities with more cars per person in the world, and the highways sometimes become huge parking lots. One of the things I do is listen to a good music and make exercise with my legs, arms and neck.
Max Trujillo, Caracas, Venezuela

I've noticed that if you make eye contact with someone they will nearly always let you pull out - a big smile helps too!
Liz, London

"4. LIMIT YOUR COMMUTE TO QUARTER OF AN HOUR" But that would mean stopping in the middle of a large roundabout and working from there?! I would probably be able to pick up a wifi signal and my mobile would keep me in touch with the office, but the traffic noise would be a distraction and there'd be nowhere to shelter when it rained.
Steve, Notts.

Drive an open-top car! When you are not sealed inside your own personal metal box, you feel more of a 'community' with other drivers around you, and feel more consideration towards them. Having the sun on your face and the wind in your hair makes you more cheerful too (when the weather allows!).
Richard Gosling, Aberdeenshire

I've found from experience on the A303 (where there can be stretches of single and dual carriageway) that late merging (point 7) is not OK once the volume of traffic is past a certain level. Once there is not a lot of room for the merging driver to get in at close to driving speed then both lanes slow almost to a stop (until onto the single carriageway after the bottleneck). If, at the higher traffic volume, drivers merge earlier then they can continue moving. At lower traffic volumes then late merging can be OK as there is more likely to be space to do so. Those sections of dual carriageway are only there for cars to overtake slow moving vehicles which also use the road but like any overtaking, if you cannot see the space ahead which you will pull back into, don't do it!
Nick C, Egham UK

Not convinced about all lanes in a traffic jam moving at the same speed, as a jam usually occurs suddenly the third lane hoggers come to a standstill, whilst the slow and middle lanes undertake them. I always figure the middle lane will have the most amount of lane changes so if I can do so safely I opt for the slow lane and pick a white van stuck in the fast lane as a marker. Usually this tactic works a treat - whoops there's the secret out!
Tim Fox, Beckenham

I disagree, late merging is NOT ok. Often you see warnings of lanes merging for several miles before an actual merge (typically for road works). Yet selfish drivers who wish to jump the queue drive along until the last minute pushing others out, despite there being plenty of time to get into the proper lane. If no one does this it will be faster for everyone as drivers at the front wont have to let these pigs in. I personally would never give way in these circumstances.
Paolo, St Albans