Dr. Cheung’s Blog 6/24/2016

Dr. Cheung’s Blog 6/24/2016

June 24, 2016

Independence Day, 1776

Every year, I take a father and daughter trip with my oldest daughter, Claire.  The twins take up so much of my time and attention that it is easy to lose connection with a teenager.  This year, we went to the Big Apple.  We walked for miles through Central Park, window-shopped on Madison Ave, swung through several museums, and climbed to the top of Empire State Building.  We got to talk, argue and share the experience of being in the greatest city in the world.  The highlight of our trip was Hamilton.  This hit Broadway musical just won eleven Tony Awards and the genius of Hamilton composer, creator and star Lin-Manuel Miranda was definitely on full display during the show.  It traced the life of Alexander Hamilton as an orphan in the West Indies, how he immigrated to New York, studied law at King’s College (now Columbia) and rose to become the right hand man for General George Washington and a founding father of this country. The music was smart, clever and catchy with a fine mix of hip-hop, rap, rock and show tunes.  The cast was multi-ethic while the costumes and stage designs were appropriately 18th century with 21st century accents.   The overall effect, both visually and musically, rendered the story of Alexander Hamilton to be accessible, alive, relevant and highly entertaining.

Miranda apparently picked up a copy of the book Hamilton by Ron Chernow at an airport during a vacation break and was inspired to transform it to a musical.  I have never been a history buff and how Miranda could visualize music and dramas from the somewhat dry 800 pages book was beyond my imagination.  Nonetheless, I was inspired to learn more about the life of Hamilton and the founding of this country.  What struck me the most about Hamilton was his foreboding sense of self-doubt due to this humble upbringing and his immigrant status to the United States.  Instead of being crippled by it, his insecurity fueled him to work harder, try harder and always with a fierce urgency that he was running out of time. As an immigrant with modest parentage, I can certainly identify with that drive.  The show ended in a beautiful song “Who lives, who dies, who tells your story,” a meditation on legacy and time, still rings in my ear and mind.

Hamilton made me realize that history is not a static thing.  Looking at it from a fresh and contemporary perspective, it can be absolutely fascinating.   In a few short weeks, we will celebrate the 240th birthday of this country and in a few months, we will elect the 45th President.  Given the current political discourse, it is worthwhile to reflect on the ideals on which this country was founded and celebrate what unite us as Americans.  No celebration of July Fourth, however, is not complete without fireworks.  Have you ever wondered why we commemorate Independence Day with fireworks each year?  Apparently our second president started it.  In a letter to his wife Abigail on July 3, 1776, John Adams declared that that the signing of the Declaration of Independence should be a “great anniversary Festival” and “solemnized with Pomp and Parade, with Shews, Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.”  The next year, the Philadelphia Congress was all over it.  In the evening of July 4, 1777, the city of Philadelphia was beautifully illuminated with a grand exhibition of fireworks which began and ended with 13 rounds of rockets to symbolize the 13 states.  The tradition stuck ever since.  As much as I desire to unleash my pyrotechnic fixation as every other American on the Fourth each year, I am somewhat apprehensive of them because of their potential for eye injury.

Firework related injuries spike each year around July Fourth.  Of the 10,500 firework injuries that required treatment in the emergency rooms in 2014, as reported by The  U.S. Consumer Product Safety Commission , 70,000 (67%) occurred within the one month period between June 20 to July 20, 2014.

The hands and fingers were, not surprisingly, the most common body part to be damaged, accounting for 36% of all the injuries.  The eyes, were the second most common on the hit list – a whopping 19%.  The victims were mostly male (76%) and young (35 % were less than 15 year old).  A consortium of international studies also showed that bystanders were almost as likely (47%) to be injured as the individuals that set off the fireworks.

Ophthalmologists hate being on call on July Fourth as they are often swamped.  Corneal abrasions (42%) and contusions (26%) are what we most commonly see.  While they can be quite painful, they are fortunately temporary and patients generally recover without any long-term problems.  However, life-changing permanent damage such as rupture of the eyeball, retinal detachment, chemical and thermal burns, intraocular foreign body, can occur in up to 18% of cases.  Four percent of fireworks-related ocular trauma required enucleation (removal of the eye) – a chilling fact for a seemingly benign summer fun.

Firecrackers are the worst offender, causing 25% of all fireworks-related ocular injuries.  They blast off in unpredictable trajectory, with an uncanny ability to land on the eyes.  It is mind boggling to me why people will wear safety googles for house cleaning but they would not wear them to set off firecrackers.

In the same token, parents are more apt to let their children play with sparklers than to allow them to light their birthday candles.  Sparklers can burn at 2000 degrees Fahrenheit, 10 times hotter than boiling water.  Children holding them directly in front of their face are at high risk of thermal burns to their eyes.  Bottle rockets and roman candles are two other types of fireworks that have a high incidence of ocular trauma.

The American Academy of Ophthalmology advises that the best way to avoid a potentially blinding fireworks injury is by attending a professional public fireworks show rather than purchasing fireworks for home use.

For those who attend professional fireworks displays and/or live in communities surrounding the shows:

  • Respect safety barriers at fireworks shows and view fireworks from at least 500 feet away.
  • Do not touch unexploded fireworks; instead, immediately contact local fire or police departments to help.

For those who decide to purchase consumer fireworks because they live in states where they are legal, the Academy recommends the following safety tips to prevent eye injuries:

  • Never let young children play with fireworks of any type, even sparklers.
  • People who handle fireworks should always wear protective eyewear that meets the parameters set by the American National Standards Institute and ensure that all bystanders are also wearing eye protection.
  • Leave the lighting of professional-grade fireworks to trained pyrotechnicians.

If an eye injury from fireworks occurs, remember:

  • Seek medical attention immediately.
  • Do not rub your eyes.
  • Do not rinse your eyes.
  • Do not apply pressure.
  • Do not remove any objects that are stuck in the eye.
  • Do not apply ointments or take any blood-thinning pain medications such as aspirin or ibuprofen.

Alexander Hamilton died in a duel with then vice-president Aaron Burr.  He was 49.  He knew first-hand the risk of a duel – having personally attended the duel between Colonel John Laurens and General Charles Lee.   Hamilton’s first son, Philip, was also killed in a duel with George Ecker in an effort to defend his father’s honor.   Duels were commonly practiced for men to settle their disputes in Hamilton’s time.  He was honorable.  Apparently he didn’t even point his gun at Aaron Burr.  His death seemed absolutely senseless from a modern perspective.  History does not need to repeat itself.  Just because a practice is common does not mean that it is not senseless.  Losing eyesight from fireworks is equally senseless.  So, learn from history.  Have a safe and happy Fourth of July!