Transcript

Will: [00:00:00] Knock, knock,

knock, knock. Hi.

Hi everybody. Welcome to Knock, knock. I with me your host, Dr. Glaucomflecken, and this is your one-stop shop for all things eyeball related. I’ve got a really fun episode for you today ’cause we’re gonna be, uh, doing a lot of questions, uh, lately, last couple episodes that have gone up on our YouTube channel at Glaucomflecken.

I mean, these episodes, they, they go up everywhere, anywhere you want to get your podcasts. But for comments, I, I just, I like to, to just see what people are talking about on the YouTube channel. So you don’t have to watch me there. You can listen to me on Spotify or wherever, wherever the hell you wanna listen to podcasts.

But, um, if you wanna leave a comment. Go over to the YouTube channel at Glaucomflecken. That’s where you find all these episodes, the video episodes, and that’s where [00:01:00] I, I read all those. And so I, I’ve gotten a lot of great comments. I’ve got some corrections to, to issue about some, uh, things that I’ve said that were not accurate.

Uh, and so, uh, we’re just, that’s mainly what we’re gonna do today. I do have a couple of eyeball topics that have come up in the comment section too. Uh, so just a little hodgepodge, popery of lots of different things. But, uh, bef, uh, right now here at the top, um, I, I wanna talk about, uh, the state of medical comedy a little bit in general.

I think it’s in a great place. I think, man, I, I still remember when I started doing, I don’t wanna make it sound like I like invented medical comedy, ’cause I didn’t, there were, there were people, you know, there have been funny doctors, like for a long time. Um, but, you know, social media was the first time I think that, you know, people started to realize, oh wait, there are some funny doctors out there.

Um, and so when I started doing Glaucomflecken there, there wasn’t much out there. And I [00:02:00] was nervous enough about it, about telling jokes like with my face, with my name, that I was anonymous for. Like four years because I was like, I’m gonna get fired if people know that I have a sense of humor.

I’m a physician with a sense of humor. I can’t let people know that, which is ridiculous in hindsight. Like I didn’t need to hide myself. Patients actually love it when their doctors are funny. They really do. Um, so, but, but I was, I was scared. I was nervous about it. There wasn’t a lot of people. I didn’t have a framework to follow someone to.

To, you know, to, you know, it was, there was, there were the Gomer blog guys, and they’re incredibly funny. Most of them were posting under pseudonyms though. Uh, no one wanted to put their name to, to their comedy. Uh, and so it was just, it kind of felt like a new path, trying to figure it out. But now fast forward, you know, that was back in 2016 when I started Glaucomflecken now, you know, eight, nine years later.

You go on TikTok and man, I, I’ve recently, the [00:03:00] algorithm has just been feeding me all these brand new content creators, which is great. I love seeing what these healthcare professionals who are, who are starting to make content. Most of them are young, you know, med school residency, fresh outta training, um, seeing what they’re doing and, and the, the education they’re giving, the advocacy.

And yes, the humor. A lot of people, they’re telling jokes, jumping on trends, uh, memes, all, you know, all these things. Uh, and in general I love it. But there’s one, one little thing, just a, a tiny thing that I’ve learned over the years not to do that. I, I feel like people just need a bit of a reminder and I don’t wanna go into these people’s comments section and be like, Hey, you shouldn’t be doing this.

Because I, I, it’s like, I feel like coming from me that might like. Burst the bubble a little bit. I don’t, I don’t wanna discourage people from creating content as a healthcare professional, because in the end, I think it’s actually a [00:04:00] good thing that we have people, especially those of us who are, who are actually giving like, you know, accurate medical tips and education and, and talking about diseases and a way that’s evidence-based and treatments and all these things.

So we need more of that. So I don’t, I don’t wanna discourage anybody, but. The thing that’s, that’s a little bit concerning to me about some people and what they’re posting is when you make fun of patients. Now this is like an area just, maybe it’s just me, but Oh, I have everything I tell people not to do on social media.

Whenever I give keynotes or whatever it is, it’s because I’ve made the mistakes. I’ve been doing this for a while on social media, and so I, I know like what’s, what’s not a good thing to do as far as like your reputation is concerned and the biggest one. Is when you put content out there, that’s, it’s kind of like [00:05:00] making fun of patients.

It’s always the same stuff too. It’s like, um, some, you’re, you’re jumping on some trend where you, you’re talking about, uh, you know, the patients, they come in, they have a viral illness and they, but they’re demanding antibiotics. You’re trying to manage that there’s like, you know, people who have a thousand allergies, making fun of that.

There’s, uh, people that, you know, just are, are, you know, have, anyway, there’s, there’s a lot of things that frustrate medical professionals that patients do, but it does take it to a different level when you go on social media and just blast that out to everyone because one thing you gotta realize. With patients is when they do some of these things, when they raise their voice, when they get frustrated, sometimes when they get angry.

Now, obviously nobody should be violent or verbally abusive. Like I’m not talking about there’s a line that patients should not cross, and that’s, it’s [00:06:00] fine to call people out for that kind of behavior, right? That’s not, that’s not okay to be abusive toward medical professionals. But often it’s j when, when patients are frustrated.

Uh, it’s coming out of a place of fear because the medical system, our medical system in particular, in the us it’s scary. It’s hard to navigate, it’s time consuming. It’s expensive. That’s gonna raise your anxiety level a little bit. That’s going to cause lots of fear and, and, uh, people. Oh, they’re just, sometimes they’re just scared and that comes out for, for people in different ways.

And so, um, I just, I, I would hope that everybody just keeps that in mind before you go on social media and make a piece of content that, yeah, it might be funny, but, but what is that message sending to your patients, not you, specifically [00:07:00] medical professional, making these types of jokes? What message is that sending to patients about other, the, the people that do what you do?

And so like my personal, I have personal boundaries I’ve set for myself with my content that I will not do, and one of those is making fun of patients. I rarely, if ever, have a patient character in my content. I do that purposefully because I don’t want to post something either purposefully or accidentally.

That will undermine the public’s trust in physicians, which is already dangerously low. I don’t wanna make it worse. And I do feel like there’s a lot of people that are gonna see content like that. Even if we all know it’s a joke, they’re gonna see it and they’re, they’re, they’re going to react to it negatively.

And it’s, it’s going to. To shade [00:08:00] their impression of, of what medical professionals do. And the the empathy that that we have toward our patients, it’s gonna take a hit. And it’s not just that person, it’s the whole enterprise. All of us take a hit when people post jokes like that, and it’s just. You could make the argument.

It’s like, well just take a joke. Why can people take a joke? It’s different. It’s different when it’s coming from a physician who, or, or anybody. It’s actually, it’s not even just physicians. I see it from PAs, nps, dentists, you know, when healthcare professionals are people put their trust in, in us to a, um, a to a unique degree.

And I’m saying us generally. ’cause no one’s gonna put their, no one’s putting their live life in my hand as an ophthalmologist. But you get the point. People are trusting us to a level that’s, [00:09:00] that doesn’t exist in most other places in society. That we have a, a, a very unique place in society as people that, that receive that trust from the public.

And, and so that requires us to maintain a level of professionalism that other people don’t have to worry about, right? Like I, I’m against the people that weaponize professionalism. That’s why we had people like me who were anonymous on social media. ’cause I was afraid that my actions would be viewed as unprofessional even though they weren’t.

I’m not talking about that. Like, that’s okay. I, I encourage people to, to express themselves. Tell jokes, use your sense of humor, but there’s certain lines you, we really shouldn’t be crossing. And the big one is when that humor tips over into patient care, you [00:10:00] know, how we react to what patients are saying.

It’s, I don’t know. I’m not a fan. I’m, I’m just not a fan. And, uh, and I would encourage people just stay away from that. There’s so many things to make fun of in the healthcare system, uh, each other make fun. That’s why I, all the videos I do, it’s like specialty to specialty arguments. Yeah. I make fun of other physicians, all right.

I, I stay away from patients. Like it’s, you don’t need to, you know, if you wanna vent your frustration about something a patient said or did. Do it privately. Do it privately. ’cause we all have those frustrations. Patients have frustrations about us on the, some of the things we do. Alright. It goes both ways, but some of it just doesn’t need to be out to the public.

Alright? Just keep it to yourself, keep it to keep on a private setting. Uh, if you need to blow off some steam, but man, I just, ugh. [00:11:00] I see it. I just cringe a little bit. I don’t like it, and I wish it would, um, wish people would realize. And, and, and it’s, this is something that, I know I’ve talked about this before, but it needs to keep being said because there’s new people every year coming into this profession and, and now.

Being a content creator is being accepted as like, this is just what you do. This is a, a, a, you just, you’re a medical professional. You have this expertise. You’re learning all these amazing things. You’re doing all these incredible things that most people don’t get to experience. So let’s talk about it on social media.

I love it. It’s great, but just there’s that level of professionalism we gotta maintain. Right. It’s not even a high level. Right. Just like you just can’t go below that. Anyway, that’s, that’s my little. Soap box, diatribe, whatever you wanna call it about, um, medical comedy. Oh. ’cause we need, we need a lot of, I, I love the jokes.

I love the jokes. Just be careful. All right, let’s [00:12:00] take a break.

Hey, Kristin. Yeah. There’s this podcast that’s every clinician should listen to. Ooh, what is 

Kristin: it? Yeah. It’s 

Will: called the Sepsis Spectrum. 

Kristin: Mm. 

Will: It’s all about sepsis. Mm-hmm. Which is a really important topic. It 

Kristin: sounds like a big deal. 

Will: It is. And, and it’s, it’s not just like fluff and, you know, your typical ce. 

Kristin: Mm.

Will: Uh, this is, it’s like gripping narratives. Ooh. 

Kristin: I love a gripping narrative. Yeah. 

Will: Fascinating to listen to and, and so you’re having fun listening to it and learning. 

Kristin: Gripping narrative and ce. Yeah, you don’t hear those two things often. S sepsis together. The 

Will: SSIS spectrum by sepsis alliance and critical care educator, Nicole Kic.

You can listen to the sepsis spectrum wherever you get your podcast or watch it on Sepsis Alliance’s YouTube channel. To learn about how you can earn free nursing CE credits just by listening. Visit sepsis podcast.org.

All right, let’s jump into some, some q and a here, uh, with [00:13:00] some, some eyeball topics thrown in. We’ll start with the, I love, see, I, I love the random, the random, um, uh, comments that come in on on YouTube. It’s, it’s fantastic. And this is, uh, coming from. The episode that was posted where I, the, the problem with alternative medicine, uh, where I, I, I railed against, um, homeo, homeopathy, homeopathy, whatever you wanna call it, and the, the, the terrible products that come in and how it’s portrayed on social media and all this stuff.

Uh, and so, and you guys really came out with the comments on the, on this episode, but, uh, here’s, here’s a random one. So at Mary Beach said, I like cutting onions, but why does it do that? Why does it make you cry? It also seems to clear my sinuses. Uh, this is a great, uh, a great question, a great eyeball topic.

And so the, the thing with, um, with, with, with onions is it actually contains these sulfur compounds [00:14:00] that whenever they get released into the air, it, it comes into the, and into contact with the surface of the eye. It’s a noxious stimuli, and when you have noxious stimuli, whatever it is, it could be like a pollen in your eye.

It could be a foreign body. It could be you are mowing your yard, you get grass in your eye, you could get, you get a dog hair. I’ve seen almost every object in somebody’s eye at one point or another. Um, it’s gonna cause tearing, and that’s, you get that reflex tearing, which is constant tearing, and it’s gonna make your nose run.

People think it’s clearing your sinuses, and maybe it is, but your nose runs because that’s where your tears drain. They drain into your nose, so that’s why when you cry, your nose runs. That’s all that is. Um, and so, yeah, but it’s the sulfur compounds that, uh, your eyes are reacting to that gas that contains those sulfur compounds.

Uh, and you know, you can rinse your eyes out. Um, uh, but really you just gotta clear the air, right, you [00:15:00] guys. But there’s also something called onion glasses. Do you guys know about this? And you’re, if you’re asking like, what on earth are onion glasses? Well, you better believe I have myself a pair of onion glasses right here.

You would think that there’s a thing called onion glasses that I, as perhaps one of the most famous ophthalmologists on social media don’t have them. Like, look at these. Uh, so you gotta look on YouTube because you just look at me wearing these things. They’re the most hideous. Awful looking glasses, but they’re, they’re just, and this is not an ad for onion glasses.

I’m just, I’m an if it’s, if anything, it’s just an ad for people protecting their eyes from sulfur compounds contained in onions, and I’m willing to look, however, whatever I need to look, whether it’s silly, stupid, I don’t care how you describe it. These will protect me from onion cutting. All right. So, um, I, I’m all for, I love the innovation.

Of protecting your eyes [00:16:00] from onions, using onion glasses. So go check on, you can get yourself a pair of onion glasses and if there are any, uh, people that sell onion glasses that wanna sponsor this podcast, please be in touch. I’m not paid by the onion glass lobby, but I’m willing to ’cause I like what you’re doing.

I love it. All right, so that’s onion, glasses, onion, uh, they don’t even call ’em glasses. They’re goggles, but I mean, they’re, you could, I don’t see why you can’t put a prescription in these things though. So you can, you can see clearly while you cut them. That’ll protect your fingertips and protect you from the noxious chemicals.

Uh, okay, let’s keep going. Uh, somebody asked about, and I don’t have the comment in front of me, but somebody asked about sticklers stickler syndrome, uh, not sticklers stickler syndrome. So this is something I haven’t talked about. Stickler syndrome is fascinating. I first came across this in, um, in residency.

There were, um, there’s a couple of families at Iowa that, [00:17:00] like everybody had stickler syndrome, uh, and um, this is a genetic disorder that affects connective. Tissue. So it leads to a, a lot of different problems that impact the eyes, ears, bones, joints, um, and uh, the eyes, what I’m gonna be focusing on. But people are more prone to, ’cause it’s a collagen disorder and you have collagen everywhere in your body.

So you get a mutation in these genes that have to, that make collagen. I’m not remembering if it’s like, I think it’s collagen, type two, I wanna say. Type one or type two. I don’t, don’t quote me on that. Alright. But maybe somebody else knows. Um, but, uh, the point is though, you have, you have, you have these types of collagen throughout the body.

Alright? Now with the eyes, the most common symptom that we see is people have, have severe nearsightedness. ’cause the eye just has a, if you have weak collagen, what happens is. The normal pressure that you have in your [00:18:00] eye, it’ll cause the eye itself to enlarge that pressure kind of stretches out that weak collagen in your body, uh, causing you to have a larger than average eye.

And when I say larger than average, I’m talking large. Like I I, some of these stickler patients they have, their eyes are, they’re 27, 28, 29, 30 millimeters. A normal size eye is about 23 to 24 millimeters, and that, that increase in size will give you severe myopia. Once you get to an eye that’s like 30 millimeters long, uh, you’re talking about like a minus 12 or higher prescription.

So it’s a big deal. Um. These patients also have some mid facial deformities, like, uh, underdeveloped, um, uh, midface, uh, sometimes cleft palate. [00:19:00] And, um, in addition to the, the eye, the, the myopia, because, and we’ve talked about this before with, um, with severe myopia, what that does is it stretches out your retina because the bigger your eye is, the more.

Surface area, you have in the back of the eye that the retina has to cover, and so you’re stretching out that retina, it’s gonna be much more prone to braking, having tears, vitreous, detachment, retinal detachment. So these patients, unfortunately, are very, very high risk. For, for retina problems. And so some of ’em have had multiple surgeries.

Uh, sometimes they just go blind because they just can’t keep that retina attached. So that’s probably the biggest problem they can get early cataract formation as well. Um, and uh, you know, it’s genetic so it runs in families. Uh, but uh, these collagen [00:20:00] disorders, uh, can be really, really tough. And I’ve been thinking about like.

Diseases like this and why I wanna talk about this disease, because there was a, a, a recent news article where the, the, they did the first like gene editing in vivo, gene editing. I’m not, I can’t remember which country this was in. I think it was, maybe it, it might’ve been China. But, um, they did, uh, the first, uh, the first patient.

Was, had, had, it was a baby, had gene editing to remove like a, a, a, a mutation that results in like 50% fatality. And so far that the, the baby like shows no signs of the disease. And so this has sparked a lot of, a lot of, uh, a, a, a lot of conversation. People thinking, saying, oh, this is, this is [00:21:00] amazing and it is amazing.

It’s incredible. We can do that. And then some people are like, this is eugenics, this is a, a slippery slope toward Gatica. You guys remember that nineties movie Gatica? We just watched it in our house not too long ago. I love the movie. It’s great. But basically like they can, you can choose what you want your baby to be, right?

If you have enough money. And so I think people have that in mind when they think about like. This idea that we can like edit out defective genes and I, I, I see both points of view, right? You could totally see how if we get really good at this gene editing thing where we can edit genes for any disease, but also any like feature right eye color, uh, hair color.

Personality. I, I don’t know, like Right. You can see how, especially in the us like someone’s gonna try to make a ton of money off of this. Like, that’s, [00:22:00] that’s, that’s just how things work in this country, right? So someone’s going to, to take this and use it for unethical things like you, you know, like stuff in Gatica.

So, so I understand that point of view. That, that’s so far off. And I’m not saying that’s never, that would never happen, but like it’s, that’s so far off. I think it’s, it’s important to like celebrate these like breakthroughs that we have because you also have the other side where it’s like you have, maybe you have a family with, with a stickler syndrome, right?

Where they have a defective gene that causes collagen problems. Well what if like, right, like as a newborn, they can edit that out. So the baby doesn’t have to deal with a lifetime of, uh, joint issues and, and retinal detachments. And so, you know, I don’t know, it’s, woo, these are questions and ethical, ethical questions that we’re gonna have to [00:23:00] ask ourselves as this type of technology becomes more possible.

Anyway, that’s, that was all about stickler syndrome. Everyone we’re getting into. And I’m not an, I’m not an ethics, uh, you know, uh, professional or something. I, I try to be an ethical person, but there’s a lot I don’t know. So I’d be interested to hear what other people think about that. If you heard about that story.

I didn’t explain that very well ’cause I don’t have it in front of me. But, uh, so someone else maybe has more information about it than I do. Uh, okay. Stickler syndrome. Uh, that was, so thanks for that question. Uh, whoever you are, I’m sorry I don’t have your comment right in front of me. Uh, people. Let’s see.

Oh, this was, um, this was really, uh, uh, something I have to correct. So in the last episode I talked about, or a couple episodes ago, I talked about the story where. Someone was having cataract surgery and died [00:24:00] because, um, the, like monitors were turned off. It turns out they weren’t ble uh, breathing. There was a, some kind of musical jukebox game being played in the, or basically distracted or personnel.

And, uh, it, it ended up with a death. Which is extraordinarily uncommon for cataract surgery, so it is very scary. Definitely made the rounds in the ophthalmology community. I had a couple of great, uh, good comments from it. During that conversation, I discussed how we do sedation. Typically in cataract surgery, it’s like one to two milligrams of versed, and then I also said, uh, 50 to a hundred milligrams of fentanyl.

That is not correct. That would potentially kill a horse, much less a normal human. Normal human, any human, what am I talking about? But, uh, it’s, it’s, it’s, it’s, uh, micrograms. We’re on the microgram scale when it comes to fentanyl. Not, not, don’t let anybody ever give you [00:25:00] 50 milligrams of fentanyl. You will not be breathing after a very short period of time.

Okay? So anyway, I just wanted to issue that correction. I do know the difference. I just misspoke. At least I, that’s what I’m telling myself. Okay. Oh, another comment that, uh, a great comment about that story. One person said that they had a c-section and when they woke up, they heard like the, the, the staff joking around and.

And, and, you know, having a good time and uh, uh, you know, just, just talking about whatever to each other. And that was actually reassuring to the patient. ’cause part of what I talked about in cataract surgery, people are awake, right? And so they can hear anything you say. And if you just chit-chatting with each other, which sometimes we do in the operating room, um, maybe, you know, that could put patients, uh, um, make them a little bit nervous, like we’re not paying attention to the surgery.

But this person, this comment. [00:26:00] Was the opposite side of things. They’re like, actually it made me feel more calm. ’cause if they’re just talking about their day, that means that everything’s going right and that they were no, none, none, no complications. Nothing bad happened because everyone’s just enjoying the, they’re, they’re very relaxed.

You could tell that the staff was relaxed. I never thought about it from that perspective. That’s, that’s a really good point. So thank you for that comment. Uh uh, and, um. And so, you know, I don’t know, everything in moderation. I guess. Like we do just talk with each other in the operating room, but we’re all very focused on our jobs and there are a couple of points during cataract surgery that I definitely do not talk.

I wouldn’t even be able to pay attention to anybody saying something to me during those steps because they’re very delicate. I have to have complete focus. Alright, la Last thing I wanna, uh, talk about here. We did a little bit of eyeball stuff, right? Did I do enough? Did I do enough eyeballs? Because we’re gonna, I’m, I was [00:27:00] about to go to like a, a, a slightly different ball, my Testa ball.

Um, and oh, it was at Tanya Groaning. That’s who it was. Talked about stickler syndrome and eye complications. Yeah. So thank you. Thank you for that. Uh, okay. So in that episode, uh, I talked a lot about, about. How I feel when I haven’t had testosterone. And, um, a lot of people related to this, not, not specifically, I mean, some people with the testosterone or they’re on testosterone, but, uh, just with hormones in general, like hormones are crazy.

They make you feel like insane. Like either they’re really good or really bad. You wanna be right there in the middle. Uh, so, and that’s what I talked about in the episode, was just like the rollercoaster that testosterone has, has left me with. Um, and that I had, I had years where I thought I was just [00:28:00] lethargic and sleepy because I was going through medical training residency.

But turns out I think I, I was just low on testosterone for a long time and, um. I, I got some great comments, people talking about their own experiences, you know, going through hormone replacement. And I had somebody, um, who was curious about why it was, uh, why it’s a urologist that I see that handles my testosterone replacement and not, um, an endocrinologist like this is a, a, a great comment and, um.

One that I was actually totally unaware that I should be going to a urologist for this. And lemme tell you why. So the first testosterone replacement I was on was after my second orchiectomy. So I had my second testicle removed and um, [00:29:00] and so I was left with, if you’re keeping count zero testicles. I had zero testicles, zero endogenous.

Testosterone production, so I definitely needed some replacement. Started on gels. I hate the gels. They’re greasy, they’re awful. They’re just, no one can touch you for a while. Afterwards, it just, it, I don’t know. It gets all over the place. It’s it. I hated it. I hated it. So I was on that for maybe a few months and I was like fed up with it.

Can’t do it. And it’s hard to get your levels right. They’re very, lots of fluctuation with your levels. You had to do it every day. It’s really annoying. Then I went to injections and it was about this time that I did see an endocrinologist, and so the endocrinologist started me on supinate, which is a once weekly injection.

Started me on like a very traditional dose that helped, but not enough and just kept me doing. I was doing that for like a couple years. Just seeing the endocrinologist, never even thought, Hey, maybe I should go see a urologist for this, because in my mind I’m [00:30:00] like, I have no balls. What do I need to see a urologist for?

They’re gonna look at my ballish scrotum and they’re gonna be like, what the hell are we gonna do? There’s no balls here. Go to go to some, go see someone else, buddy. All right. Get your, get your ballish ass out of our clinic. All right. Go asses. Don’t have balls. You get what I’m saying? So anyway, um, I, so I was just seeing the endocrinologist and.

I was doing okay, but you know, I was having to inject myself like once a week. And sate, which is a very basic, just hormone replacement, you know, it’s just a liquid. You do like, you know, a half a milligram, um, you know, at, at a time or up to one milligram and, uh, um, not milligram mil, half a mil to a full mil.

It. D don’t, the dosage is not important. Alright. So, but [00:31:00] anyway, I was injecting myself like, ha uh, once a week. And, um, I was having just wild swings. It was like, I, I was feeling good like for like a day or two after my injection. And then toward the end of the week I was getting so low, getting really fatigued and irritable, and then I give myself an injection.

I didn’t like the rollercoaster aspect to it. It wasn’t until I went to a urology conference as Glaucomflecken to speak to a keynote that I realized better forms were possible, better things were possible. Let’s take a break and then I’ll elaborate on that.

Hey, Kristen. Hmm. I know I like to talk to you about the little dex mites. Mm-hmm. And little tiny guys. Mm-hmm. Thought we could give that a break. Oh. And just talk about the, the eyelid disease that they cause when there’s an overgrowth of Dex. 

Kristin: I like that idea. No mite talk. 

Will: So Dex blepharitis it, it gets missed, it [00:32:00] gets misdiagnosed, uh, because a lot of the symptoms overlap with other eye conditions.

Kristin: Mm. Okay. So what are the top symptoms that people should be looking out for? 

Will: Itching, swelling, irritation of the eyelid margin, redness. 

Kristin: Yeah. That kind of sounds like it could be allergies or something else. Exactly. 

Will: It could be a several different things. But the key is if your doctor spots little crusties, that’s, they’re called collarettes, but you know, they like little crusty technical term.

Exactly. Uh, then, um, uh, that’s dex Blepharitis. You just know it. 

Kristin: Mm. I like that there is a clear sign to know. 

Will: Yep. And once you’re diagnosed as a prescription eye drop treatment. Available for Dedex Blepharitis. Whew. 

Kristin: That is good to know. 

Will: To learn about the common symptoms of Dedex blepharitis and more visit mites love lids.com.

Again, that’s M-I-T-E-S-L-O-V-E-L-I-D s.com To learn more. This ad is brought to you by Tarsus Pharmaceuticals.[00:33:00] 

All right, so here we go. I’m at this urology conference and I just kind of joking around. I was, I was, I, I was, I was talking, it was this, this cocktail hour and I had a group of urologists and urologists are great people. They have a wonderful sense of humor ’cause they have to, and, uh, uh, it’s, I, I was sitting there talking to ’em.

I was like, yeah, I’m on these, uh, weekly injections and I made some kind of joke about it. And um, and then they looked at me very concerned, and they’re like, why, why, why is that? That’s, that’s what you’re on. That’s all you have. And I was bewildered. I was like, well, I mean, I’m seeing an endocrinologist like that.

This, this is what they have me on. I are there other options? I just didn’t even look into it myself. And they told me, he is like, oh, it’s. It’s like a, a, a magical world of testosterone replacement out there. And you’re on like a, like the, you could be on like a Rolls Royce of testosterone replacement.

Instead you’re driving a a to to a Toyota Previa minivan from the 1990s. And, [00:34:00] and, and, and I’m like, I was like, oh my God, what, what’s, what’s going on? So they told me all about these different options, different formulas of testosterone, and they taught me about test appel, which is this new thing. It’s just a series of pellets that you get in the clinic that go into your, into your, into your butt.

And I would not have known this was even possible unless I talked to a group of, of urologists. What I realized is like, yeah, endocrinologists, they’re great at what they do, but they also, their, their attention is spread out to all the different hormones, right? Like they’re doing cortisol, they’re doing.

The, uh, they’re doing, uh, you know, testosterone, estrogen, progesterone they’re doing, you know, so, uh, all the, I’m just not, I’m struggling to even think a DH what, what are the other hormones? [00:35:00] You can tell I’m just like blanking on hormones. Anyway, there’s like a, like 20 hormones and endocrinologists kind of deal with all of them versus a urologist.

Most of their patients do still have testicles, but they’re really only focused on a couple hormones. And so they’re going to know a lot about those hormones and how to replace it. So it actually, when you think about what the specialties do, it actually makes sense. Thyroid, that’s another hormone I couldn’t come up with a should.

Right? I’m an ophthalmologist. Um, so, so it makes sense for, for urologists to know. So much more about testosterone than any other healthcare professional out there. And that has borne out to be true because the first appointment I got with my urologist, they just talked me through all these different options.

And ever since I finally got, and that’s a whole other episode, is like how to get how I got insurance to cover Testopel, because that [00:36:00] was a, it was a struggle. Uh, I can’t tell you how many times we had to tell him, no, I don’t have testicles. I can I send you a picture? I, I could show you the incisions I have from both ectomies.

Like there I do not make my own testosterone. It’s honestly, I was like, I was so close to just taking some very explicit photos of myself to send to the insurance company. Um, but they’re the ones that got me on this, finally got it approved and I’ve never felt better. So, so at that, yeah, I, I understand it’s so hard to figure out like what doctor does, what thing it, it was hard for me to figure that out and I’m, I’m a, I’m like in it, right?

I’m a physician. I should know, but I didn’t, and it took me years to figure out I should be seeing a urologist. So I, I don’t know if that’s gonna be an option for you. You know, I, I, I’ve heard a lot from the trans community as well, people who are on testosterone replacement as a gender affirming care. Uh, and, [00:37:00] um, and so I understand people, some, some people have commented there.

They’re frustrated by, you know, how difficult it is to get testosterone, and I think it probably depends on what state you’re in. Um, and so, you know, I, I can totally sympathize, uh, with you because it is a pain in the ass to try to literally and figuratively a pain in the ass to get testosterone. And so, uh.

Um, you know, I’ll keep talking about it. I can go over all the health insurance issues like that might be a little special episode where I go through all the, the insurance things that I’ve encountered on the patient side as opposed to the physician side, um, and how difficult that was. But anyway, it’s been a long road trial and error, trying different things.

Eventually found something that, that does work. Um. And that’s it. That’s all I got from Knock-Knock. I almost said knock-knock. I knock, knock. I, uh, so leave a comment. Let me know what you think of the [00:38:00] episode. Do you have any questions about eyeball stuff? Sorry we didn’t do more eyeball stuff. We’ll get back to like, we can do, we could do anything you want.

You need to do some deep. Dives into different parts of the eye that we haven’t done yet. Uh, we haven’t talked much about the uve a or the sclera or the optic nerve. A deep dive into the optic nerve might be quite fascinating for somebody out there. Uh, so let me know. Go to the YouTube channel at Glaucomflecken, leave a comment.

Thank you for listening. I’m your host, Will Flanary also knows Dr. Glaucomflecken. Thanks to my executive producers Aaron Corny, Rob Goldman and Ashanti brick editor engineer. Jason Ties. Our music is by Omer Ben-Zvi, night, neck, eye and Night. Neck Eye is a human content production.

Thanks for watching the episode. You can find more on that playlist over there If you prefer to listen or you just had your eyes dilated, you can binge [00:39:00] full episodes wherever you get your podcast or join the party over on Patreon where you get early access episodes. Hang out with us, get lots of exclusive bonus content, help you subscribe, leave a comment below, let us know what you think.