Knock Knock Eye: Dr. Mike vs. Anti-Vaxxers: What Went Down on Surrounded?
50:54 Share

This episode is brought to you by LifeLock. It's tax season, and we're all a bit tired of numbers. But here's one you need to hear. $16.5 billion. That's how much the IRS flagged for possible identity fraud last year. Now here's a good number. $100 million. That's how many data points LifeLock monitors every second. If your identity is stolen, they'll fix it. Guaranteed. Save up to 40% your first year at LifeLock.com slash podcast. Terms apply.

Today's episode is brought to you by Microsoft Dragon Copilot, your AI assistant for clinical workflow, which helps to ease administrative burdens. Those...

Lots of birds, lots of birds, automatically document care, streamline workflows and promote a more focused clinician patient experience. I love that. Yes, I do. Learn about how dragon copilot can transform the way you work. Visit aka.ms slash knock, knock high again. That's aka.ms slash knock, knock high. Hey, Will. Hey, what's up? I've been thinking the

The U.S. healthcare system, it needs some improvement. Yeah, there's room for improvement. Yeah, it's a confusing, scary place for everybody involved. Absolutely. Physicians, families, patients, everybody. 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 making jokes. So Dr. Glockenflecken's 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. Figures, numbers, insights into how each of us can fight for a more humane healthcare.

better healthcare system. Also, it has jokes. Did you mention the jokes? I did. Jokes. Yes, definitely jokes. Well, this guide is great for anyone looking to learn more about U.S. 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. Get the free guide sent straight to your inbox by signing up for our mailing list, glockenflecken.com slash healthcare. Enjoy. Oh,

Knock, knock, hi!

Talking about the, 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 as if that show is not stressful enough as it is. I, the most recent episode of this podcast of the knock, knock I episodes came out on YouTube and it's, it's by far the most popular episode so far based on number of you who saw it on, on our YouTube channel at Glock and Fleckens. And I think it's because 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, uh, that involved eye trauma. And so go and check it out if you want, but I, I love the comments. So I'm going to 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 your people are starting to find the podcast a little bit, which is awesome. I love it. Here at the start, I try to do some kind of like a current events type thing, like in healthcare. And I try to make it at least somewhat healthcare related. Well, this time, a couple days ago, there was a video that came out. 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 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. So the only ones I've seen before, I saw clips of it. It was like Ben Shapiro, like the Republican guy. So I don't know. They must have, maybe they have like, you know,

All kinds of different special or professions of people doing things. But it's got to be some kind of hot button topic, right? Because it's a debate show. Well, the most recent episode they put out featured Dr. Mike. And he was talking about, he was debating anti-vaxxers.

So I'm going to talk a little bit about my thoughts of this episode. But I really, really encourage you. It's a long video on YouTube. You can find it on YouTube. It's over an hour. But I think it's interesting. It's fascinating just to see the interactions. So as far as Dr. Mike goes, I'm a fan. I'm a fan of Dr. Mike. When he first got started, he was like the...

When he first kind of blew up on social media, he was like the sexiest doctor guy, right? He was on the Today Show and all this stuff. But if you've paid attention to his platform and with his podcast, The Checkup, I think is what it's called, he has really interesting conversations. And he's really using his platform well today.

in talking about vaccines in particular. And I, so I, I applaud him greatly for even taking on this project because man, the, the amount of vitriol and anger and misinformation and politicizing around the idea of vaccines that wasn't, that didn't exist before.

30, 40 years ago, back when polio people were getting, I mean, it was further back than that with polio. But before Andrew Wakefield and all the vaccines cause autism stuff, I wasn't around back then, but

I can't imagine there was this much anger and dissent and just vitriol around this topic of vaccines. You see the classic photos of kids with smallpox

pre and post vaccine. It's just remarkable what vaccines can do. And then it goes on and on with polio and HPV and measles, mumps, rubella. So anyway, but the point is I'm not trying to open up the whole vaccine thing, but I'm so impressed by Dr. Mike. Here's what I'm impressed by.

Just the fact that he did this, because I mean, I don't know if I could do it. Just it's it's daunting to think about like putting yourself in that position.

And he did it gracefully. He dealt with that with professionalism. He stayed level-headed. 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 vaccines,

I don't think a lot of us would have been able to stay as calm as he was throughout that time. And 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,

perseverance of being able to do that for that long. And a lot of the interactions were, at least what we saw in the published post, was there's a lot of anecdotal things, people talking about they knew somebody that the kid got vaccinated and then they started having seizures or all these other issues. A lot of coincidental type things.

And I just, I got so tired of hearing all of that because that's, that was a very common refrain. 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. And, and so there's a knowledge gap there that was, was readily apparent pretty much immediately, you know, as soon as they started the back and forth debating.

And he tried his best. He really did on trying to explain the difference between a coincidence, two things that happened relatively close to one another versus causality. It's like when I had a cardiac arrest back in May of 2020. And the night before the cardiac arrest, I had lasagna.

Was it the lasagna that caused my cardiac arrest? Do I think that other people should not be 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.

But it's that way of thinking that a lot of people were bringing to this debate. And at one point, there was even a person that was, 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? And the person was like, no, nothing you will say. At that point,

Debate's done. If I was in that situation, and I'm glad I wasn't because I would not come off looking as good, I would have just said, okay, see you and get up and walk away. At that point, what are we doing? What are we doing?

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. And so, and clearly it was, it was heavily edited. You know, did it change minds? Maybe, you know, but,

and 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 right now, especially like, I feel like it's, it's being stoked to this, this like anger toward physicians. Um, and, uh,

And he had to present himself professionally in that situation. He couldn't get angry at these people. It really 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. And I think he did a very admirable job. And so how do we reach people on vaccines? I mean, I don't think it's going to be stuff like this

I think it's going to be real, honest, personal interactions in the exam rooms, at family get-togethers with friends over drinks. That's where it's not going to happen on social media. I really don't think it's going to happen on social media. And so I heard some comments from people that were like, well, is it even worth it?

Like, are we just platforming these inappropriate 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 that just making it worse? And I pushed back on that because all of these anti-vaccine arguments, they're out there.

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 in the face of medical literature, of the evidence that we have that vaccines work. And so somebody has to be out there refuting this stuff. We...

People get their information on social media. 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 get that. I get that. I just don't agree with it because somebody has got to do it.

We got to combat it. Otherwise, you're just going to run rampant with no, and people are going to believe this stuff. It's going to reach parents of babies, of young kids, and they're not going to get their influenza or their haemophilus vaccine, their Tdap, whatever it is, MMR, and public health is going to suffer for it. And so we got to be on social media. And that's what, 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. I also make this point, like for the same reasons, like we got to 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 think it's important. And it actually sounds like I'm going against what I just previously said. I don't think social media can actually change people's mind on vaccines. Maybe that's true.

I think it's harder to do it on social media, but I don't want to live in the world where it's just one argument against vaccines that so many people see. We've got to have other people presenting a different point of view. So thanks to Dr. Mike. I honestly really appreciate that he did that. And you know, also, here's the other thing. He agreed to that knowing he was going to 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 name out there and knowing he's going to get lots of criticism, lots of hate on social media that might even potentially get into his real life too. That's kind of scary to think about, but he did it anyway because he knows how important this message is. And so we should all...

all level-headed 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 Demodex mites, although I'm not sure why they look like adorable. Well, these are cute, but it's the real ones that kind of freaked me out a little bit. Yeah, but I have some new facts to share with you about Demodex. Oh, great. All right. These mites have likely lived with us for millions of years. Oh, wow.

Yeah. Does that make you feel better? No. Like they're passed down through close contact, especially between mothers and babies. Oh, wow. Such a special gift for our daughters. 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. Well, thank you for that. This isn't helping, is it? No. How do I get rid of them? Well, 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. Okay. That probably excites you. That makes me feel better. Any way to get rid of them, right? That's right. All right. Sign me up. Visit MitesLoveLids to learn more about demodex blepharitis, which is the disease that these little guys cause. Sure. Again, that's M-I-T-E-S blepharitis.

Love Lids, L-O-V-E-L-I-D-S.com to learn more about Demodex and Demodex blepharitis and how you can get rid of it. Okay, so we are back and I'm going to go through a couple of comments on 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 come up with these titles. I have a production team. My producers help post all these things and come up with some of the copy editing. They did a great job here because it is 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 caught up on all the episodes, but man, that is a gritty, like a white knuckle show.

thrill ride. That's what people describe it as, I think. And so I'm going to read a couple of comments because I talked about it the last episode or a couple of weeks ago. So at Kim Adler said, I totally get that the pit may seem scary or 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, watching that show felt like getting punched in the face repeatedly with how intense it is all the time. But with that said, as someone who was hoping to go to med school but was dreading emergency medicine and surgery rotations, the pit actually helped me.

feel better about it. So I love this comment because I think there's a lot of truth to this. I didn't think about it from this perspective. The pit is so crazy in its depiction of an emergency department that if you can handle, if you can watch that and think, oh yeah, like

I see myself doing that. Well, there's no way your job as an emergency physician is going to be that insane in a, 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

But I mean, it is, it's concentrated, right? Like that doesn't, that many disasters doesn't happen hour after hour after hour after hour for like 12 straight hours. Like, but they're not going to make a show where you're like waiting for lab results for 45 minutes. 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 maybe that actually empowers you to choose emergency medicine as a field. I love it. That's great. At A Screen 8, 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. People are going nuts over this show. That's great. I think this is...

This is the next big thing, right? I mean, this is, and I like a big part of it. A lot of people praising 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'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 lateral canthotomy cantholysis um by the way

Happy to consult for this, makers of the show, writers of the show. If you need any more eyeball stuff, if you need me to show you what exactly it's like when an emergency physician sits down at a slit lamp and tries to remember what all the knobs and buttons do, that's me. I'm your guy. If you ever want to depict an ophthalmologist scared to death

As he walks through the emergency department, trying to figure out where his patient is. I'm your guy. 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 want to put in that role. That's I, I,

Come talk to me, okay? I'll do it for free. You don't even have to pay me. I'll give you whatever you need. Somebody said, oh, here we go, at BD Fortes, Noah Wiley's character is 100% based on your emergency situation.

doctor character. Um, so I'm pretty sure they 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, that the acting on that show, the acting on the pit, just phenomenal. Check it out. Um, thank you for all those comments.

Okay, so I did have another comment that had some good eyeball-related questions here. Let me make sure I... Oh, people talking about... I mentioned the portable slit lamp and functioning slit lamps and how that's not always the case. Portable slit lamps are expensive. So in the scene of the pit that I talked about, they brought out a portable slit lamp. Those things cost about five grand.

It's very expensive. No emergency department is going to sell out that kind of money. Not whenever they could, they could buy like two more ultrasound probes for that amount of money. No, there's no way they're not going to, they're not going to designate some of those funds for eyeball stuff. You kidding me? A new eye chart? No. New tonal pin? Get out of here. Tonal pin tips will be called eyeball condoms. They look like condoms, little tonal pin 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 pharmacists and pharmacists. They said 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 don't know 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. He said, why can we do crossed eyes, like look medially, cross your eyes toward the middle, but not go the other way? Abduction.

At the same time, 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 want to 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 or read something. And so 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 we're converged and then we want to put them back to normal. There's no reason why we would want to be able to diverge our eyes further because that would take away our wonderful stereopsis, our wonderful binocular vision. We wouldn't have it anymore. We'd be chameleons.

All right. I don't even begin to understand how that their their vision works. And so 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 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 help put your eyes a little bit further apart. So they're not, if you're watching on YouTube, I'm like moving my hands in and out constantly with convergence, divergence. So some people have an inability to do the normal amount of divergence that our eyes have that, the ability to do. 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 though, 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 going to have the same pattern of vasculature. No one's eye is

is going to develop the same exact way. So it's going to be a unique 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 where you have significant arteriolar 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. Well, 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, it's 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 600. And all of a sudden you have a, a blown vein or artery back there and your retina scan doesn't work. You're locked out of your vault.

End of the movie. Sad. That's no fun. So yeah, you'd have to get a new scan 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 eye is blinded by a kraken disguised as a kitten? As in the case of Nick Fury from Marvel. Obviously, you have to be able to see back into the retina for a retinal scan to work.

Now, other types of scans, you can do an iris scan. We actually do that in ophthalmology. So we have certain lasers that will register the position of the eye. I'm thinking mostly in doing LASIK or PRK or laser refractive surgery. It registers your iris, the architecture of your iris to determine how to orient the laser. So there's iris 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, transillumination 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 TIDs, transillumination 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 a certain diseases, um, Kogan Reese, there's all kinds of stuff. So, uh, trauma as well, that can change the architecture of your iris or your retina. It'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 going to get to. Um, you know what? We'll take one more quick break. We'll come back with 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 kind of situation. One call from an emergency department that I don't take call for. Our practice doesn't. So it was a mistake. So a 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. And the, the, the calls I did get, you know, made sense. Although there's only that one still clearly did a good job, even though I don't take call there. 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. So,

But I did, I took a call from a patient who is, uh, ended up having some floppy eyelids. So I'm gonna talk about that 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 think I'm pretty good at is like 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, um,

Some of these cardiology trials where you're talking about catheter ablation versus antiarrhythmic therapy for ventricular tachycardia, that is not a funny thing. So my job is to try to find some humor in it. And I've gotten a lot of practice doing that. So I thought, okay, what else can I do? I'm doing the trials. What about just 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 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 got to remind myself all of this stuff. So, you know what I did to this end? I bought the most recent edition of, uh, first aid USMLE step one, first aid. Uh,

Oh man, there are a lot of pages here. This is a, um, uh, this is a five, 600 page book. This is going, including the index. It gets to 800 pages. Does 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,

I've never been more impressed with the next generation of physicians because my book was not anywhere near this thick. So I immediately got discouraged in thinking like, I don't know if I can do this. I was like, maybe I could just like keep making videos over time. I'll pick like some random topic, like afterload, like cardiac, you know, afterload and just like explain it in a skit featuring like, I don't know.

and cardiology or cardiology and nephrology. And they argue about something. I don't know. But then I saw how thick this book was like, I, that would take the rest of my career. 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'd love to hear your thoughts. Like, is this something, would you like to see a,

like just topics random topics let's let's choose one like um some kind of you know by like bile duct stones uh just a random thing and like have me educate you about it about a disease or a something in physiology or anatomical structure or something and learn about it in skit format

Cause 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 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. Comment on the, in the YouTube, you know, comments here at Glock and Fleckens. All right. And finally, I promised you, I'd give you some kind of eyeball thing, floppy eyelids. So I saw a patient on call with floppy eyelids and floppy eyelids 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 and then it's 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 is,

And these are all like kind of vague, you know, nonspecific symptoms, just irritated. Oh, my eyes feel, sometimes they just feel heavy, a 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 CPAP or a BiPAP?

This is 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 everts,

If it turns inside out with just me trying to lift it up, if it turns out your eyelids 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 us 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 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 because I had a cardiac arrest and they were like grasping at straws trying to come up with any possible reason why I might've had a cardiac arrest. But 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 lid very easy to diagnose this. You know, you pull the eyelid up at everts floppy eyelids, uh,

And the reason this is worse in the morning when people wake up is because often whenever you're sleeping, well, first of all, if you're wearing a BiPAP or CPAP, the air often you don't have a good seal and that air can blow up into your eyes and 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 you're, 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 everted. And so you're just all night. You just got your, your eyes just open, exposed to air. You're going to wake up with severe dry eye.

Uh, and so how do we treat this? Well, the most conservative thing to do for this problem is over the counter ointment. Uh, so just aggressive lubrication. We want to provide a barrier. Sometimes we have to give people what are called moisture goggles, basically swim goggles, almost, um, that you put a little ointment in the eye, you put a protective, comfortable pair of goggles on that keeps the air from, from causing dry eye and blowing directly onto the eye. Um,

Another thing though, this can be managed surgically as well. So our wonderful, in ophthalmology, we have wonderful physicians that are known as oculoplastics specialists. And what they can do is a full thickness wedge resection. When you have floppy eyelids, you just have too much eyelid. You don't need all that eyelid. The tissue has been stretched out. It's 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 evert with just a little bit of pressure. Another thing you can do is sometimes you can do what's called a tarsorophy. This is a terrifying sounding procedure where you suture the eyelids together.

Now, it's not the entire eyelid. We have lateral tarsorifice. We have medial tarsorifice. We do have complete tarsorifice where the whole eyelid is sutured shut. Maybe another episode I can talk about why you might want to do that. But in this situation for floppy eyelid syndrome, a tarsorifice can just provide a little bit more protection to the surface of the eye. Because if you're just, let's say you just do like a lateral tarsorifice of like a third of the eyelid opening.

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. All right. You don't need the lateral part of the eyelids. They can be closed a little bit. You can still see. Do it to yourself. Close the lateral part of your eyelids. You can still see out of that eye. All right. 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 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 prevents you from driving or doing daily tasks unless you're like a firefighter pilot or something, 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

the perfect picture of health to be a fighter pilot. That's actually one of my go-to jokes for people. It's like when people are worried that something is going to prevent them from being able to live their life normally, I always tell them, well, 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 it's a good one.

Anyway, that's just a little bit about floppy eyelids. So be aware of that. And this is something that not even, you know, you can look at this as a primary care doc. 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 fine. Anybody can do this. It's just eyelid problems.

Pull it up. If it inverts spontaneously with 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 Platt, and we also know as Dr. Glockenflecken. Thanks to our executive producers, Aaron Corny, Rob Goldman, and Sean Duprick. Editor and engineer, Zayson Pertizzo. Our music is by Omer Abinski. By the way, you guys like these episodes because I like making them.

Can you give us a nice, happy review on wherever you get your podcast? Apple, Spotify, Google, wherever. I don't know. And tell people about it. It's fun. I like giving knowledge to people. I like talking about these things. So tell people if they want to learn about eyeballs, come on, check out Dr. Glockenflecken's thing.

All right. Thank you all for listening. Knock Knock High is a human content production. I will see you next week. Bye. Knock Knock. Goodbye. Human content.