Transcript

Speaker: [00:00:00] Today’s episode is brought to you by Microsoft Dragon copilot your AI assistant for clinical workflow, which helps to ease administrative burdens. I hate those. Lots of burdens. There’s the worst. Lots of burdens. Yeah. Automatically document care, streamlined workflows, and promote a more focused clinician patient experience.

I you love that, that Yes, I do. Learn about how Dragon copilot can transform the way you work. Visit aka do MS slash knock, knock high. Again, that’s. aka.ms/knock, knock high. 

Speaker 2: Hey, will, Hey. What’s up? I’ve been thinking the US healthcare system and needs some improvement. 

Speaker: Yeah, it’s, it’s, there’s room for improvement 

Speaker 2: for sure.

Yeah. It’s a confusing, scary place for everybody involved. 

Speaker: Absolutely. 

Speaker 2: Physicians, families, patients, everybody. 

Speaker: Everybody. And I’ve experienced it from both sides, right? I’m a physician, I’ve also been a patient, so I wanted to use my platform. To give people practical education. Really the only way that I know how.

By [00:01:00] making, so Dr. Glock Flecking, really fun and super uplifting Guide to American Healthcare is Out and it’s a free resource that includes all my videos from the 30 Days of Healthcare Series, alongside deeper explanations, also reliable facts. Emphasis on reliable. Yes. All right. Uh, uh, figures, uh, numbers, insights into how each of us can fight for a more humane, better healthcare system.

I. Also it has jokes. Did you mention the jokes? I did. I jokes. Okay. Yes, definitely jokes. Well, 

Speaker 2: this guide is great for anyone looking to learn more about US healthcare, but especially if you are experiencing it from the clinician side for the first time. That’s right. We really hope you’ll check it out.

Speaker: Get the free guide sent straight to your inbox by signing up for our mailing list. Glock and flicking.com/healthcare Enjoy.[00:02:00] 

Knock, knock,

knock, knock. Hi.

Hello everybody. Welcome to Knock, knock Eye with me, your host. Dr. Glock, flecking, you’re a one-stop shop for all things eyeballs. Welcome friends. I hope you’re having a wonderful day. Uh, I am having a great day. Had a wonderful day in the operating room. Even though our computer system went down, it’s that there’s nothing, you know, talking about the, I, I swear the pit needs to do an episode where all that crazy stuff happens.

During the shift, but also the computer system’s down. Just take it up to like 11. Just, just crank it up, crank up the stress, uh, as if that show is not stressful enough as it is. Uh, I, uh, the most recent episode of this podcast, of the Knock, knock Eye episodes, um, came out on YouTube and, uh, it’s, it’s by far.

[00:03:00] The most popular episode so far based on number of you who saw it on, on our YouTube channel at Glock Flecking. Uh, and I think it’s ’cause everyone is talking about the pit, and that was a part of what that episode was about. I gave a review of, of a, um, of a scene in the pit that, in, uh, that in involved eye trauma.

And so go and check it out if you want, but I, I love the comments, so I’m gonna address some of those comments. Uh, talk a little bit more about the pit. Uh. Here in a little bit. Uh, but first, uh, I, I wanted to, uh, usually at the start of these, knock, knock, uh, for those of you who are new, ’cause I feel like I might have some new people because a lot of you’re, uh, people are starting to find the podcast a little bit, which is awesome.

I love it. Um, here at the start, I, I try to do some kind of a, a, like a. Uh, current events type thing, like in healthcare, and I try to make it at least somewhat healthcare related. Uh, well, this time, uh, a couple days ago, there was a video that came out. [00:04:00] Uh, apparently there’s this, I think it’s a web series.

I’m not sure exactly what it is, but it’s called Surrounded, where they have an expert sitting in the middle. In this room, in this big room, they’re sitting at a desk in the middle. There’s like a timer. There’s, people are holding flags. I’m not totally sure how it works, but, uh, the whole idea is that the people that are, there’s people that surround the person in the middle in this big room, and these people take turns like racing to the center to debate.

This expert in something. Uh, so the only ones I’ve seen before, I saw clips of it, it was like Ben Shapiro, like the, the, the Republican guy. So I, I, I don’t, I don’t know. They must have, maybe they have like, you know, all kinds of different special or um, um, professions of people doing things, but it’s gotta be some kind of hot button topic, right?

’cause it’s a debate show. Well, uh, the, the most recent episode they put out featured Dr. Mike. [00:05:00] And he was talking about, uh, he was debating anti-vaxxers. So I’m gonna talk a little bit about my thoughts of this episode. Uh, but I really, really encourage you. It’s a long video on YouTube. You can find it on YouTube.

It’s over an hour. Um, but it’s, it’s, I think it’s, it’s, it’s interesting. It’s, it’s fascinating just to see the interactions so. As far as Dr. Mike goes, I, I’m a fan, I’m a fan of Dr. Mike. You know, when he, he, he first got started, you know, he was, he was like, the, the, when he first like, kind of blew up on social media, he was like the, the, the sexiest Dr.

Guy, right? That’s, he was on the Today Show and all this stuff. But if you’ve paid attention to his platform and with this podcast, the checkup, I think is what it’s called. Um. He has, he has really interesting conversations and he’s, he’s, he’s really using his platform well, uh, in talking about vaccines in particular.

And I, [00:06:00] so I, I applaud him greatly for even taking on this project because man, uh, the, the, the amount of vitriol and anger. Misinformation and politicizing around the idea of vaccines that wasn’t, that didn’t exist 30, 40 years ago, back when like polio, uh, uh, people were getting were was, I mean, it was long for further back than that with polio, but.

You know, before Andrew Wakefield and all the, you know, vaccines cause autism stuff. Um, you know, I I, I wasn’t around back then, but I, I can’t imagine there was this much anger and descent and, and, uh, uh, and, and just vitriol around this, this topic of vaccines. You know, you see the classic photos of, of kids with smallpox.

Pre and [00:07:00] post vaccine. It, it’s just remarkable what vaccines can do. Um, and then it goes on and on with polio and HPV and, and measles, mumps, rubella, uh, it, it just, you know, so anyway, but that, that, the point is I’m not trying to like, open up the whole vaccine thing, but, um, I, I’m so impressed by Dr. Mike.

Here’s what I’m impressed by. Just the fact that he did this. ’cause I, I mean, I don’t know if I could do it. Just, it, it’s, uh, it’s daunting to th to think about like, putting yourself in that position. Uh, and he did it gracefully. He, uh, he, he dealt with that, uh, with professionalism. He stayed levelheaded. He didn’t get angry.

He didn’t raise his voice. He showed all of these people compassion. And I like. Most of us in healthcare proponents of [00:08:00] vaccines, I, I don’t think a lot of us would’ve been able to stay as calm as he was throughout that time. And I, I, I did, I was able to connect with him about that. And he, he said that the, the taping was over three hours, like constant, like, like it was so much longer than the video show.

So there was a lot that was edited out. Uh uh, but, but, so that is. That, that is some, uh, per, per perseverance of being able to do that for that long and a lot of the interactions I. Were at least what we saw in the, in the, in the published post was, you know, there’s a lot of anecdotal things, you know, people talking about, um, you know, that they knew somebody that, you know, the, the kid got vaccinated and then they started having seizures or all, all these other issues.

A lot of kind of coincidental type things. And I, I, [00:09:00] I just, I got so tired of hearing all of that because that’s, that was a very common refrain. Uh, and that speaks to just people not really understanding, like what evidence means, what evidence-based practice means. We have a lot of evidence that vaccines work, um, and uh, um, and so there’s a knowledge gap there that was, was readily apparent.

Pretty much immediately, you know, a a as soon as they started the back and forth debating, and he tried his best, he really did. On, on trying to, to, to explain the difference, uh, you know, between a a, a coincident a thing, two things that happened relatively close to one another versus, uh, uh, like causality.

It’s like, you know, when I had a, I had a cardiac arrest back in. Uh, may of 2020 and the night before the cardiac arrest I had lasagna. [00:10:00] Was it the lasagna that caused my cardiac arrest? Do I think that other people should not be? I. Eating lasagna because it might cause a cardiac arrest. It’s like, it’s like that, that line of thinking, like that’s an extreme example, but I mean, this is all kind of extreme.

Uh, but it, but it’s, it’s that, that way of thinking that a lot of people are, were bringing to this, this debate. And, and at one point there was even a person that was, uh, Dr. Mike asked, which is a great question. He’s like, is there anything I can tell you I can say that would make you question or change your mind?

The person was like, no, nothing. You will say at that point, debate’s done. Like if I, if I was in that situation, and I’m glad I wasn’t because I, I would not come off looking as good. Uh, I would’ve just, I was like, okay, see ya and get [00:11:00] up and walk away. I mean, at that point, like, what are we even, what are we doing?

What are we doing? And. Do I think that this was a useful way to like, try to change minds? Probably not. I don’t think that’s a great format. I think it’s sensationalized, they, they, Mike didn’t have any control over the final edit of it. Right? So they could have edited it to take out some of his answers or include other things that other people were saying.

Uh, and so, and clearly it was, it was heavily edited. Um, you know, did it change minds? Maybe, you know, but. I, I, I posted about this on social media. I said, you know, I, I really am impressed by him because he, I think he represented the medical field well. People have so much distrust of physicians and, uh, right now, especially, like, I feel like it’s, it’s being stoked.

This, this like anger toward physicians. Um, [00:12:00] and, uh, and, and he. He had to present himself professionally in that situation. He couldn’t get angry at these people. It is really, it felt like a physician patient relationship and you can’t get angry in those situations. And so I’m glad he was the one that did that.

Uh, and I think he did a, a, a very admirable job. Um, and so what, how, how do we reach people on vaccines? I mean, I don’t think it’s gonna be stuff like this. I think it’s, it’s gonna be like real. Honest, like personal interactions, you know, in the exam rooms, uh, in your, you know, at family get togethers with friends over drinks.

That’s where it’s not gonna happen on social media. I really don’t think it’s gonna happen on social media. And so, uh, some, I, I heard some comments from people that were like, well, is it even worth it? Like, are we just platforming? These inappropriate [00:13:00] thought, not inappropriate, but these, these, this misinformation, these these arguments that don’t have any bearing, uh, that that, that don’t have any weight, that are not accurate, are we, why are we, are we just platforming misinformation?

And is that, is, is that just making it worse? And I pushed back on that because all of these anti-vaccine arguments, they’re out there. They’re, they’re prevalent, they’re everywhere. Every social media platform, everybody starts talking about vaccines. Maybe even in the comment section on this video, when it gets published, people are going to spout those same arguments and, and in the face of, of medical literature and of the evidence that we have that vaccines work.

Uh, and um, and so somebody has to be out there. Refuting this stuff there. Ha We people get their information on social media [00:14:00] now. We can’t just have the wrong information, not be challenged. And so I totally understand the criticism, like he shouldn’t have done it because it’s, it’s, uh, uh, it just platforms these people.

I, I get that. I get that. I just don’t agree with it because somebody’s gotta do it. Like we gotta combat it. Otherwise, you’re just gonna run rampant with no, and people are gonna believe this stuff. It’s gonna reach parents of babies, of young kids and they’re not gonna get their influenza or their, their, their hemophilus vaccine, their tdap, they’re, you know, whatever it is.

MMR. And, and then, and public health is gonna suffer for it. And so we gotta be on social media. And that’s what, uh, when I talk about social media usually it’s in the context of more health policy and health insurance companies. All the things I talk about a lot on social. [00:15:00] Um, I also make this point, I’m like, for the same reasons.

Like we gotta have somebody out there. I encourage physicians, public health professionals, people who know a thing or two about medicine. To have a social media presence. Talk about the things that you know a lot about, bring accurate information to it. Present it in a compelling, engaging manner. Tell your stories, include the evidence.

All that stuff can reach people. I don’t know, but I, you know, I, I think it’s important, but, and then it actually sounds like I, I just, I am, I’m. You know, uh, I’m going against what I, what I just previously said, how, you know, so can, I don’t think social media can actually change people’s mind on vaccines.

Maybe that’s true, you know? Um, I think it’s harder to do it on social media, but I, I don’t wanna live in the world where it’s [00:16:00] just one argument against vaccines that so many people see. We gotta have other people presenting a different point of view. So thanks to Dr. Mike. Uh, I honestly really appreciate that he did that.

And I, you know, also, here’s the other thing. He, he, he agreed to that knowing he was gonna get a tremendous amount of hate, an unbelievable amount, like more than any of us have ever experienced on social media. The guy’s got 15 million subscribers on YouTube. Like Dr. Mike is the biggest physician in the world.

In terms of popularity, in terms of the number of people in this world who know, who Dr. Mike is, like there’s not a doctor that people know more than, than him. And so to put his, his name out there and, and, and knowing he’s going to get lots of criticism, lots of hate on social media that [00:17:00] might even potentially like.

Get into his like real life too. Like that’s kind of scary to think about, but he did it anyway ’cause he knows how important this message is. And so we should all, all levelheaded people with a fully developed frontal lobe. Like we, we all need to be. Uh, we all need to, to recognize what, what he’s done and, um, and keep it going.

Right. We all, I could do a better job of talking about stuff like this. Um, and so, uh, yeah, thanks for setting the example there, Mike. All right, let’s take a break.

Hey, Kristen. Yeah. I’ve been, you know, grossing you out about these dex mites, although I’m not sure why they look like adorable. 

Speaker 2: Well, these are cute, but it’s the real ones that kind of freak me out a little bit. 

Speaker: Yeah. But I have some new facts to share with you. Oh, great. About Dex. 

Speaker 2: Alright. 

Speaker: These mites have likely lived with us for millions of years.

Oh. Yeah. Does that make you feel better? 

Speaker 2: No. 

Speaker: Like [00:18:00] they’re passed down through close contact, especially between mothers and babies. 

Speaker 2: Oh, wow. Such a special gift for our daughters. 

Speaker: They’re born, they live, they crawl around and then they die on your eyelids and in your lash follicles. Their entire life cycle lasts about two to three weeks, all spent on your eyelids.

Speaker 2: Well, thank you for that. This isn’t 

Speaker: helping, is it? 

Speaker 2: No. How do I get rid of them? 

Speaker: Well, it’s, it’s. It’s fun to gross you out, but we do have all of these, it’s really common, but there is a prescription eye drop to help with these now. 

Speaker 2: Okay. 

Speaker: That probably excites you. 

Speaker 2: That makes me feel better. Yes. 

Speaker: Any way to get rid of them, right?

Speaker 2: That’s right. 

Speaker: All right. 

Speaker 2: Sign me up. 

Speaker: Visit Mites love lids to learn more about Dex ble, which is the, the disease that these little guys. Mm-hmm. Cause mm-hmm. Sure. Again, that’s M-I-T-E-S. Love Lids, L-O-V-E-L-I-D s.com to learn more about Dedex and Demodex blepharitis and how you can get rid of it.[00:19:00] 

Okay, so we are back and I’m gonna, uh, go through a couple of comments on the, the latest YouTube video of this podcast. The title of the episode was The Pit. Is this the most realistic medical show ever? Which was, I don’t, I don’t come up with these titles. Uh, we, I have a, you know, the production team, my producers help, help, uh, you know, post all these things and come up with some of the copy editing.

They did a great job here. Uh, and because it was the most popular video, and I think it’s just the algorithm is latched onto the pit. Everybody’s talking about the pit. Great show I have not cut up to on all the episodes, but man, it is a gritty like. Like a white knuckle thrill ride. That’s what people describe it as, I think.

Um, and so I’m gonna read a couple of comments ’cause I talked about it the last episode or a couple weeks ago. Uh, so at Kim Alas said, I totally get that the pit may seem scary or [00:20:00] may feel like it’s too unflattering for the er, or too stressful or real. And the reason she said that is because in that episode I talked about some of the things that I had not really seen a whole lot of it at that point.

And I saw some people on social media, you know, obviously a lot of people praising it, but some people being like, it’s, it’s like it’s so real that it might actually like turn people off just off of emergency medicine ’cause it’s like too scary. Um, she goes on to say, uh, watching that show felt like getting punched in the face repeatedly with how intense it is all, all the time.

But. With that said, as someone who is hoping to go to med school but was dreading emergency medicine and surgery rotations, the pit actually helped me feel better about it. So, uh, I, I love this comment, uh, because I, I think there’s, there’s a lot of truth to this. I didn’t think about it from this perspective.

Like the pit is so [00:21:00] crazy. And it’s depiction of an emergency department that, um, if you can handle that, if you can watch that and think, oh yeah, like I, I see myself doing that. Well, there’s no way. Your job as an emergency physician is going to be that insane. In that much of a concentrated way. Yeah, you may, you may deal with all of those situations at some point in your career, but I mean, it, it is, it’s concentrated, right?

Like that doesn’t, not that many disasters doesn’t happen hour after hour after hour after hour. For like 12 straight hours. Like, but then, but they, they’re not gonna make a show where you’re like waiting for lab results for 45 minutes. So, so, so if you can, I love that perspective though. If you can see this, if you can see this show and still think, yeah, I could do that, then, then maybe that actually empowers you to choose emergency medicine as a field.

I love it. That’s great. Um. [00:22:00] At a screen eight. The biggest criticism I’ve seen from other ed docs across YouTube is not that each scene is wrong, but rather, most of these things are super bad and you just wouldn’t get all of these things in one shift. Yeah, exactly. Um, people are going nuts over this show.

That’s great. I, I think this is. This is the next big thing, right? I mean, this is, and I think a big part of it, a lot of people praising, uh, Noah Wiley’s performance and I mean, he’s got some experience, right? I encourage you guys to go, go look at when Noah Wiley was a. Was John Carter as a, as a, as a med student.

That’s great. Um, and so you see the, the incredible difference, uh, and so I, I’m gonna, I can’t wait to finish, uh, to keep watching the show because, um, it’s, uh, it’s wild. And seeing the, you know, when the, what I talked about was this eye. They had this retrobulbar hemorrhage. They had to do a, a lateral canmy can lysis.

Um, by the way, happy [00:23:00] to. Happy to, to, to consult for this, uh, makers of the show, writers of the show. If you need any more eyeball stuff, if you need me to, to show you, um, what exactly it’s like when an emergency physician sits down at a slit lamp and tries to remember all the, what all the knobs and buttons do.

Like, that’s me. I’m your guy. If you ever wanna depict, uh, a, an ophthalmologist, um, scared to death. As he walks through the emergency department trying to figure out where his patient is. I’m your guy. I, I can, I can show you exactly what that’s like. All right. I’ll be the actor in it. I’ll, I’ll coach whoever it is, whoever you wanna put in that role.

That’s I, I. Come, come talk to me. Okay, I’ll do it for free. I don’t even, you don’t even have to pay me. I’ll give you whatever you need. Um, somebody, uh, said, oh, here we go. At BD Fortes, Noah Wiley’s character is a hundred percent based on your emergency. I. Doctor character. Um, so I’m pretty sure they [00:24:00] should have credited you.

I disagree. I disagree because my character is based on emergency physicians. So, so it’s, uh, all credit to the actual real emergency physicians because I, I made my character based on all of you guys. Uh, and so, um, but they really, man, the, the acting on that show, the acting on the pit, just phenomenal.

Check it out. Um, thank you for all those comments. Okay, so, uh, I did have another comment that had some good eyeball related questions here. Uh, let me make sure I, oh, people talking about, uh, I, I mentioned the portable slit lamp and functioning slit lamps and, uh, how that’s not always the case. Portable slit lamps are expensive, so they, in the, the, the scene of the pit that I, I talked about, they brought out a portable slit lamp.

Those things cost about five grand. It’s very expensive. No emergency department’s gonna shell out that kind of money. Not whenever they could, they could buy like two more [00:25:00] ultrasound probes for that amount of money. No, there’s no way. They’re not gonna, they’re not gonna designate some of those funds for eyeball stuff.

You kidding me? A new eye chart. No new tono pin. Get outta here. Tone up in tips will be called eyeball Condoms. They look like condoms. Little tone up pen tips. Uh, where was I? I’m all of a sudden talking about condoms. Oh, some people, somebody said they were upset that, uh, no. Pharmacist and pharma, they say pharmacists are never shown in these, in these shows.

They need to have a pharmacy centric show. I feel like you could do a pretty good comedy based on like pharmacy. I dunno what you’d call it. I gotta, I gotta brainstorm some good names for a, for a pharmacy TV show. Pharmacy based comedy television show. That’d be a good one. Oh, here we go. At Xw bonehead said, I have so many questions for you.

Um, he said, why can we do crossed? I like, look medially, cross your eyes toward the middle, but not go [00:26:00] the other way. Abduction. How come your eyes can go together, but they don’t go well. There’s a functional reason why your eyes will, why you want your eyes to come together, why you have a neurologic pathway that allows for convergence of your eyes.

So we’re talking about a normal situation here where your eyes will converge. They’ll both move medially, and that’s because you wanna have binocular vision on things that you’re using with your hands. So you can have hand-eye coordination so you don’t miss things when you’re trying to eat or something like that.

Uh, or read something. And so, uh, we have this wonderful thing called binocular vision. We have two eyes for a reason. We want to use them together. And so yeah, that’s why we have this amazing ability to converge our eyes. Certain diseases will take that away from you, by the way. Certainly strokes, but also like Parkinson’s disease is a common one.

But the question is, how come we don’t diverge our eyes? Well, we do. We diverge them whenever [00:27:00] we’re converged and then we wanna put them back to normal. There’s no reason why we would want to be able to diverge our eyes further because that will take away our wonderful stereopsis or our wonderful binocular vision.

We wouldn’t have it anymore. We’d be chameleons. I don’t even begin to understand how that their, their vision works. Uh, and so, uh, we don’t need to be able to do that. But we do have pathways along our visual system that allows us to diverge our eyes and there is a thing called con divergence insufficiency.

Patients with that have this inability to diverge the eyes, and so they’re constantly converged. There’s a divergent and you can actually do end up getting surgery for that to, to help put your eyes a little bit further apart so they’re not, uh, if you’re watching on YouTube, I’m, I’m like moving my hands in and out constantly with convergence divergence.

Uh, so some [00:28:00] people have an inability to do the normal amount of divergence that our eyes have, that the ability to do. Um, uh, but that’s a, that’s a great question. Uh, another question was, oh, this, I love this one. It says, what’s the deal with retinal scans as a form of identification? Does it really work?

Will it still work if there are vascular changes, degeneration or other retinal diseases? I, I’ll be honest, this is something I never even thought about the idea. So you see all these sci-fi, you know, spy movies, whatever, like they’re trying to get into some vault or locked door. They get a retinal scan.

What’s that measuring? Well, we all have a unique retina appearance, so what it’s measuring when you see a retinal scan is your unique vasculature, the pattern of your vessels in the back part of the eye. It’s unique, just like your fingerprints, right? Nobody’s gonna have the same pattern of [00:29:00] vasculature.

No one’s eye is going to develop. The same exact way. So it’s gonna be a unique, a unique, you know, architecture back there. But what happens if you have. Diabetic retinopathy, or let’s say you have a central retinal artery occlusion or a branch retinal artery occlusion where you have narrowing of those arteries, or maybe you have retinitis pigmentosa, or you have significant arterial or narrowing, or maybe you have a branch retinal vein occlusion.

Basically just anything that could change the vasculature of the back part of the eye. You’d have to reset your retinal scan, wouldn’t you? I didn’t think about that. Like, man, that would suck. Like you’d, all of a sudden over time you just, things change. You got bad diabetes, you get, you, you, all of a sudden you have, you know, blood sugars for a few days over, over a 600 and all of a sudden you have a, a, a blown vein or artery back there and your retina scan doesn’t work.

You’re locked outta your vault. [00:30:00] End of the movie. Sad. That’s no fun. Uh, so yeah, you’d have to get a new scan if your, if your vasculature changes. I imagine they have to update those every so often. That’s great. It said, and will it still work? Another part of this question, will it still work if the eyes blinded by a Kraken disguised as a kitten, as in the case of Nick Fury from Marvel, um, obviously you have to be able to see back into the retina for a retinal scan to work.

Now other other scan types of scans. You can do an IRIS scan. We actually do that in ophthalmology. So we have certain lasers, um, that will register the position of the eye. I’m thinking mostly in doing LASIK or PRK or laser refractive surgery. Uh, it registers your iris, the architecture of your iris to determine.

How to orient the laser. So there’s Iris [00:31:00] registration. Uh, and, and because everybody’s iris is unique, just like everybody’s retina is unique. So we do have that kind of technology that we use in ophthalmology a lot. But things can happen to your iris, you know, you could have, uh. Uh, trans illumination defects with, uh, pigment dispersion syndrome where you have the lens behind the iris that chafes the back of your iris that chafes off a lot of the pigment that leads to.

What we call tis trans illumination defects. You have light that can get through the iris, that can change the architecture of your iris. You can get smoothing of the iris, you can get, uh, certain diseases. Um, Cogan, Reese there. There’s all kinds of stuff. So, uh, trauma as well that can change the architecture of your iris or your retina.

That’s really bad trauma. That’s no good. Uh, those are great questions. Uh, and then I do have one eyeball topic that I’m gonna get to. Um. We’ll take one more quick [00:32:00] break. We’ll come back, uh, with a, a real quick little eyeball topic.

All right, before we get to my eyeball topic, which is floppy eyelids, I think I’ve maybe talked about this before, but it came up on call. I just got off a week of call you guys. That’s why if you, if it sounds like I’m in a really good mood, it’s because I’m no longer on call. And yes, it’s private practice call.

And this was a particularly, I’m going to challenge the call gods right now. I can do that because I’m not on call for another, like four months. Uh, it was one of my easier call weeks. I got a total of six calls. Five of them were just patient phone calls. You know, what do I do with my drops? I didn’t get my drops.

I’m having flashes of lights. Uh. And it was like a come in, see me in clinic in the morning kinda situation. Uh, one call from an emergency department that I don’t take call for. Our practice doesn’t. So it was a mistake. [00:33:00] So, uh, shout out to all the wonderful emergency physicians in the area because I know there are a lot more eye patients that came in than you told me about.

I appreciate you, you do a bang up job. Wonderful. Some of you actually know how to use a slit lamp, which is awesome. Uh, and the, the, the calls I did get, um, um, you know, made sense, although there’s only that one, uh, still. It clearly did a good job, even though I don’t wanna take call there. Um, and so thank you, thank you for making my life easier.

I know that’s the goal of your job is to make me the private practice ophthalmologist, have an easy life. Um, so, but I, I did, I, I took a, a call from a patient who is, uh, ended up having some floppy eyelids, so I’m gonna talk about them in a second. But first, um, I, I need some advice from you guys. So I’m always trying to come up with new, like content strategies.

Other things I can do, because one thing I, I think I’m pretty good at is like [00:34:00] taking a relatively complex topic and somehow making it funny. You know, I do this with the healthcare stuff. I’ve been doing it with the New England Journal of Medicine videos, um, like, you know, some of these like. Some of these, uh, cardiology trials where you’re talking about like catheter ablation versus antiarrhythmic therapy for ventricular tachycardia, like that is not a funny thing.

So my job is to try to find some humor in it. Uh, and I’ve, I’ve gotten a lot of practice doing that, so I thought, okay, what else can I do? You know, I’ve been doing the trials. Um, what about just like general medical knowledge? What about like medical knowledge that. Maybe it’s, it can be for like med students and residents and stuff, but also just like the general public.

Well, the problem is I am an ophthalmologist. You guys, I could do those types of skits and make it about eyeball stuff, but I [00:35:00] don’t have a lot of expertise when it comes to like pneumonia or sleep apnea, which I’ll talk about in a second. Uh, or myocardial infarction. I, you know, or even like basic physiology, I just, I, I, I gotta remind myself all of this stuff.

So, you know what I did to this end? I bought the most recent edition of. First Aid, U-S-M-L-E. Step one, first aid. Uh, oh man. There are a lot of pages here. This is a, um, this is a five, 600 page book. This is, it’s going including the index. It goes to 800 pages. Is this, is this what’s in med students’ brains?

Like, you guys know all of this stuff? I how that, there’s no way, there’s no, there’s a lot of words. It’s, um, uh, I’ve never been more impressed with, with, uh, the next generation of physicians because my book [00:36:00] was not anywhere near this thick. So, uh, I immediately got discouraged in thinking like, I don’t know if I could do this.

I was like, maybe I could just like keep making videos over time. I’ll pick like some random topic, like after load. Cardiac, you know, after load and just like explain it in a skit featuring like, I don’t know, ortho and, and cardiology or cardiology and nephrology, and they argue about something. I don’t know.

Uh, but then I saw how thick this book was. Like I, that would take the, the rest of my career, um, uh, I, I would need like a, some kind of grant so I can quit my job and just focus on this. For the next 20 years anyway. I don’t know. I’m still playing around with it. What do you think though? I, I’d love to hear your thoughts.

Like, is this something, would you like to see, like just topics, random topics? Uh, uh, let’s, let’s, uh, choose one like, um, [00:37:00] some kind of, you know, like bile duct stones. I don’t know, just a random thing. Like, have me educate you about it, about a disease or a, something in physiology or an anatomical structure or something, and learn about it in skit format because I, I, the idea interests me because I like to push myself a little bit.

The, the New England Journal of Medicine, things have been really fun trying to make these really. Bland sounding trials into something fun and and engaging. And so it’s like, let’s do it for some like general medical stuff. So anyway, I have all the information I could ever need in this book. I think I just need, maybe what I need is some topic, you know, ideas from you guys.

Like what, what do you want to hear about in skit format? So please like. Help me out. Send me, send me some ideas, um, comment on the, in the YouTube, you know, comments here at Glock fl. Alright. And finally, I promised you [00:38:00] I’d give you some kind of eyeball thing, uh, floppy eyelids. So I saw a patient on call with floppy eyelids.

I. And, uh, floppy eyelids are, are they lead to dry eye? This is the biggest thing. So you have patients, they have like irritated, they have red eyes, they’re waking up. This is a classic. Patients who wake up with really dry sandy, like it feels like there’s a rock in there. Then it kind of, they can kind of get it better throughout the day, but then they wake up the next morning.

Same thing. One of the questions I always ask, these types of patients, and these are all like kind of vague, you know, non-specific symptoms, just irritated, oh my eyes feel. Sometimes they just feel heavy. Little bit of blurry vision, but generally their eyes like the vision’s. Okay. I always ask these patients, do you have sleep apnea?

Specifically? Do you use A-C-P-A-P? Or a BiPAP. This is, um, a, a [00:39:00] because obstructive sleep apnea has a strong, strong association with bilateral eyelid, malposition known as floppy eyelid syndrome. So what this looks like on exam is I can take my hand, my finger on the outer part of their upper eyelid, and I just lift it up.

And if that eyelid averts. If it turns inside out with, with just me trying to lift it up, if it turns out your eyelid should not turn inside out if you just lift it with your finger. But if it does, you got floppy eyelid syndrome and you might have sleep apnea. So honestly, you can see that if you have that issue, like get a, and you don’t know if you have sleep, you haven’t been diagnosed with sleep apnea, I encourage you.

Go see your doctor, get a get a sleep study, especially if you snore. You know, you might, you know, I, I snore and I don’t have sleep apnea. Um, but I did get a sleep study [00:40:00] because I had a cardiac arrest and they were like grasping at straws, trying to come up with any possible reason why I might have had a cardiac arrest.

But, uh, it, you know, snoring is another thing that goes with sleep, with obstructive sleep apnea. So anyway, this is, uh, and then so, so people, you know, I just put my eyelid very easy to diagnose this. You, you know, pull the eyelid up, it everts floppy eyelids. And the reason this is worse in the morning when people wake up is because often when, where, whenever you’re sleeping, well, first of all, when you, if you’re wearing a BiPAP or or CPAP, the air, often you don’t have a good, um, a good seal and that air can blow up into your eyes.

Cause worse. It’s just air blowing. Imagine air blowing directly on your eyeball, like that’s not good for dry eye. Um, uh, also, uh, people, if your, if your eyelids are so malleable and floppy, then if you sleep the wrong way, if you’re on your side, then you could actually sleep with your eyelids kind of pushed open and [00:41:00] averted, and so you’re just all night.

You just got your, your eyes just open, exposed to air. You’re gonna wake up with severe dry eye. Uh, and so how do we treat this? Well, the, the most conservative thing to do for this problem is over the counter ointment. Uh, so just aggressive lubrication. We wanna provide a barrier. Sometimes we have to give people what are called moisture goggles, basically like swim goggles almost.

Um, that you put a little ointment in the eye. You put a, a protective, comfortable pair of ggl goggles on that keeps the air from, from. Causing dry eye and blowing directly onto the eye. Um, another thing though can be you, this can be managed surgically as well. So our wonderful, in ophthalmology, we have wonderful, uh, physicians that are known as oculoplastics specialists.

And what they can do is a full thickness wedge resection. When you have [00:42:00] floppy eyelids, you just have too much eyelid. You don’t need all that eyelid. The, the tissue has been stretched out. It’s ex, it’s a redundant, you have redundant eyelid tissue, and so you can just take a wedge out of the eyelid and suture the ends together, shorten the eyelid, basically, and that will prevent the eyelid from having enough tissue to be able to just spontaneously avert with just a little bit of pressure.

Another thing you can do is sometimes you can do a, uh, what’s called a tar sophy. This is a terrifying sounding con, uh, procedure where you suture the eyelids together. Now it’s not the entire eyelid. We have lateral tars sophy. We have medial tar sophy. We do have complete tars sophy, where the whole eyelid is sutured shut.

Maybe another episode I can talk about why we might wanna do that. But in this situation, for floppy eyelid syndrome, a tar sophy can just provide a little bit more protection to the surface of the eye. [00:43:00] Because if you’re just, let’s say you just do like a lateral tar sophy of like a third of the eyelid opening, that’s, that’s a, that’s one third more coverage that you can provide to the cornea.

So you just close the outer part of the eye. You can still see. You don’t need the, the lateral part of the eyelids, you know, they can be closed a little bit and you can still see, do it to yourself. Close the lateral part of your eyelids. You can still see outta that eye. Alright. So anyway, we’ll do that for people to give them a little bit better coverage.

That’s typically when we do that. It can be a, a. A temporary thing, but often it becomes permanent because, you know, you can live a normal life. It might affect your peripheral vision just a little bit, but not enough that it, it’s prevents you from driving or doing daily tasks unless you’re like a firefighter pilot or something.

Uh, in which case you’re probably not doing that because I doubt they let people with obstructive sleep apnea become a fighter pilot. I don’t know. It’s like I feel like you have to be the picture perfect health. [00:44:00] Uh, the perfect, perfect picture of health, uh, to be a fighter pilot. That’s actually one of my go-to jokes for people is like, um, when people are worried that something is going to prevent them from being able to live their life normally, I always tell them, well, I.

You know, if you have macular degeneration, like you can’t be a fighter pilot, and this is like a 75-year-old woman I’m talking to. Right. And it always gets people to laugh a little bit. So, uh, it’s a good one. Anyway, um, so that’s, that’s just a little bit about, um, uh, floppy eyelids. So, you know, be aware of that.

And this is something that not even. You can look at this as a, as a primary care doc, as a, in the emergency department, you have someone with these types of symptoms that come in. I don’t know why they’re going to the emergency department, but that’s, that’s fine. Um, anybody can do this. It just eyelid pull it up if it, if it inverts spontaneously without, with [00:45:00] minimal lifting.

They got floppy eyelids, especially if they got a history of CPAP use. So you can do that, and then you can talk about obstructive sleep apnea. You can refer the patient for a sleep study. All that stuff, and then obviously send them over to your neighborhood friendly ophthalmologist. That’s it. That’s our episode for today.

Thank you all for listening. I’m your host will play. We also know as Dr. Glock and PLN, thanks to our executive producers, Aaron Corny, Rob Goldman and Shanti Brigg, editor engineers Jason Tiz. Our music is by m Omar Bensky, by the way. You guys like these episodes? ’cause I like making them like, can you give us like a nice, uh, happy review on like, wherever you get your podcast, apple, Spotify, Google I, wherever.

I don’t know. And like, tell people about it. It’s just, it’s, it’s fun. I like, like giving knowledge to people. I like talking about these things. Uh, and so tell people if they only want to learn about eyeballs, come on, check out Dr. Glock and FLS thing. Alright. Um, thank you all for listening. Knock, knock.

High is a human. In content [00:46:00] production. I will see you next week.

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