Knock Knock Eye: The Bizarre VA Investigation That’ll Make You Facepalm
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Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken. This is your one-stop shop for all things eyeballs. And for today, also a few non-eyeball related things. I always touch on some eyeball adjacent topics like the nose. Now, that's terrible. I'll keep that joke in, but it's not good. That's like the type of humor people always ask me, like, what kind of humor do you have?

Like in the exam room with patients, like, do you, are you, are you like a standup comedian to your patients? Like, no, I'm not. I like to tell jokes because it does make people feel at ease, especially when you're talking about eye surgery, if you can make them laugh. So I do, but it's like, it's dad jokes. Like that joke I just told is like a dad joke. And so people really like it. I'm not Dr. Glockenflecken though in the exam room.

But anyway, I'm happy to have you join me today. We're talking about, I've got a few different topics. The first thing I'm going to do is tell you a story about government efficiency, pertinent to the news recently. And then we'll take a break.

i want to address a few of the comments on uh my most recent post particularly regarding the spleen and a little bit about united healthcare and then we're going to wrap things up with an eyeball topic the topic of today which is measles we're going to talk about measles and the eye another thing that's that is very relevant to society and things that are happening right now in this country so first

My, the story about government efficiency. So this is a, this is something that, um, actually I've never told this story on any of my channels, any video, any podcast episode, um,

For a couple of reasons. One, it has some adult themes to it. It's a, and I do try to, to keep ever since I had somebody at a conference, bring their, their kids up to me and they acted out one of my skits in front of me at on that day, I decided, okay, I got to keep this somewhat family friendly. Be like, in terms of my social media presence, because I,

I think it's really cool if families, if parents are connecting with their kids over these characters and the pediatrician and the radiologist and the ortho and all this stuff. So anyway, I, I've tried really hard to keep things, um,

you know, PG 13 at, at, at worst. Um, so this story does have some adult themes. Uh, and so if you'd like to listen to this podcast with your family, maybe like skip ahead about 15 minutes. Um, and,

But it's not that bad. It's just a little bit different than my usual content. So that's one reason why I haven't talked about it in anything I do publicly. But also, it's almost impossible to believe. It's a true story. At least it's true in that I heard this story secondhand. So it didn't actually happen to me, but someone I know was very involved in all of it. And so I believe that it was all true.

But you're going to hear it and you're going to think there's no way that that story is true. So, hey, just take it from me, but it's secondhand. So who knows? Maybe there's some embellishment. But anyway, regardless, it's a pretty damn good story.

And it's about government efficiency. And so I've been thinking about this story quite a bit over the past couple weeks as we keep hearing about Trump and Elon and the Department of Government Efficiency just basically holding funding from things like NIH research. And just yesterday, the House resolution bill, which would cut Medicaid services by $800-something billion. And now here's where I stand on all of this.

Like, is there a waste in government? Sure. Okay. Yeah. There's going to be waste. Like we have a deficit for a reason in this country that's been there my entire life. Um, there, uh, for sure is, is some, uh, the government could be more efficient with how they do things. I think, and most people are going to agree with that.

I think the disagreements come with how they're going about finding what to cut and how much to cut. And this whole thing about Medicaid is a bit alarming, especially as someone who practices medicine. I, we see all insurances at my office, including Medicaid. And so we have a good amount of people who have Medicaid who come see us and yeah, Medicaid doesn't pay very much. It doesn't pay us. We don't get as much money through Medicaid, but yeah,

These are patients that don't have a lot of money that still need eye care. And so whatever, it's fine. Like we'll, we'll still see these patients because they need eye care. And we're the biggest game in town in Oregon and in the Portland area, aside from the university. And so, and so anyway, we see Medicaid pay a lot of patients. And so hearing about like a potential $800 billion cut to Medicaid, it worries me for my patients. And, and so again,

I don't know the best way to go about making the government more efficient. Maybe this is the best way. It doesn't seem like it because it seems like it's really making a lot of people anxious. It's hurting a lot of people, which a lot of people are going to be hurt if we're trying to make cuts in different places. So I think we can argue about how best to do this, whether you do it a little bit more deliberately or just really just take a hacksaw to the government budget.

I don't know. I don't know what the right answer is, but I am alarmed by the news about Medicaid. And so it's got me thinking about this story. So here we go. This is a...

It relates to my experience in government health care, which for anybody who goes through med school and residency, your experience is going to be tied to the VA. That's where we, for the first time, most of us will experience government health care.

And I personally, I love the VA. I do. I love the patients. I love the people that work at the VA. It's a much more laid back experience. It can also be very frustrating.

Yeah, they're using a record system, CPRS, that was, I think maybe now it's updated. But back when I was in the VA, it had been around since like 1978 or something. And so there are certain things it does. Everything moves very slowly at the VA. Wait times are very long to get in to see doctors. There's a lot of frustrating things. But in the end, they're taking care of veterans.

and um at little to no cost to the veterans and that's i think that's a wonderful thing so this story has to do with the va police so the va police they're just they're police officers that they patrol the va they keep everybody safe they help deal with like de-escalation of angry people or family members or mental health crises they're there to just just keep people safe

As police officers do. And so they're during the day, you can see them. They were walking around. Well, they also make rounds at night. And so the story goes, I'm not going to tell you which VA this was. It doesn't matter. But the VA police were doing their rounds at night and they were in one of the physician work areas. I don't know why. I guess, I mean, that's what they do. They just walk around. They just make sure everything's in order. No one's acting, acting up or stealing things. I don't know.

But they were in a physician work area and they came across quote unquote pornographic photos. And they were alarmed by this, granted. And so they confiscated these photos that were in, again, a physician work area. And they decided they were going to open up an investigation. They weren't going to bring this to the attention of the physicians who work in that area. They wanted to try to figure out what these were. Because what they look like, we're not just like,

pornographic magazines or something it looked like they were they were photos actually taken in that department by somebody and uh of uh you know of a sensitive nature and so they confiscated the photos and they opened up an investigation the investigation took about seven months and every so often they'd go back to this area of the hospital this this department and every week

Every month, there were more photos, more of these pornographic photos that would show up. And they were very concerned by this, obviously. And so they collected more data. They collected more evidence. And then finally, they brought this treasure trove, these dozens and dozens of these pornographic photos.

They brought them to the head of the physicians at the hospital, so like the medical director of the hospital, of the VA hospital. They had a big meeting, very serious, very serious. They said, listen, doctor, we want to show you what we found in one of your physician workrooms in this department. And it's very sensitive in nature, but we want you to know that somebody has been taking what they called vagina photos.

of patients. We have dozens and dozens of these. We have evidence. Here they are. They laid all of these, what they were referring to as vagina photos. Never really heard that term or what exactly that meant, but they laid them all out, said, look, this is what we've been, this is what we've discovered in our rounds at night. And the medical director looked at the photos and they asked the VA police, where did you find these?

The VA police said, in the otolaryngology department, ENT. The medical director said, congratulations, you've found photos of patients' larynx. You have found laryngeal photos, which is a thing that happens in the ENT clinic. They were mistaken by someone with no medical education or training as vagina photos. So right now, if you don't know what I'm talking about, go Google otolaryngology.

image search larynx photos to see what I'm talking about. I guess you can kind of, and then come back because, uh, I guess you could kind of like see how they could maybe think that that looks kind of like a, a vagina. Um, of course this story, I heard it from, from somebody who, who knows who was like higher up in the VA, this story, just like wildfire. Like I,

I was surprised to get picked up by the national media. It's so funny and outrageous because obviously it was just normal medical care that was being given, but they were determined to get to the bottom of who was taking photos of people's larynxes. I have to assume it's a true story. It's far-fetched, but not so far-fetched that it can't actually happen. Oh, man.

I've been sitting on that one for a while. And so anyway, that was, that's my, that is so, so whenever I hear people talk about government efficiency, I do think about that story now. And I don't want to generalize this to like all of the VA, like police. That's not, that's not the point here because this was, this is just like one hospital, one group of people that, yeah, they made a pretty big,

big mistake i mean seven months of investigation into this that's a lot of man hours used to to find like normal photos um how do you interpret that as a vagina anyway uh but uh so this is this is not like indicative of everything that happens at the va obviously v is a wonderful place but it's just it's a really funny story and um i i assume that you find it funny too i don't know

I always like it gives me a little smile whenever I think about it. So anyway, let's take a break. Hey, Kristen. Yeah. I've got some friends I'd like you to meet. I see that. You seem a little too friendly with them. I have to say. Aren't they cute? Sure. With the little beady eyes and their little hands.

The hands, the claws. I don't know. Appendages. Okay. How about that? That works. Anyway, they just like, they'd like to say hi. Okay. They'd like to say hi. Okay. Wonderful. They're not, they, oh, look, the one's sticking around. It sure is. Right on my mic. These little guys are demodex and they live on your eyelashes. Yep.

And they can cause flaky, red, irritated eyelids. See, that's not cool. That's a party foul. You just kind of want to rub them. You're not welcome here if you're going to do that. And it's caused sometimes by these little guys. Yep, that's rude. Demodex blepharitis. But you shouldn't get grossed out by this. Okay. All right, you got to get checked out. Yes, get checked out. To find out more, go to eyelidcheck.com. Again, that's E-Y-E.com.

L-I-D check.com for more information about these little guys and Demodex blepharitis. Have you ever spotted McDonald's hot, crispy fries right as they're being scooped into the carton? And time just stands still. All right, now you can invite your children back to listen to the rest of this podcast.

I also think it's funny to think about knock-knock eye as a family gathering activity. Gather around like you're gathering on the radio. Let's listen to the eyeball, the comedian eyeball man. Talk about congenital rubella or measles conjunctivitis or crazy stories that happen in the VA. All right. So real quick, let's go through some comments on the most recent episode because I got some good ones here.

So this is on the episode, UnitedHealthcare is a wealth of content. And in this episode, I talked about, I mentioned the spleen. I debated whether or not two livers would be better than a liver and a spleen. I still think it's obvious that we would benefit from two livers. Why not? The liver, it does amazing things. It cleans your blood, has two circulations. It probably does other things as well.

It breaks down like chemicals. It breaks down certain things that would be harmful to you otherwise. So anyway, and so I posed a question on the comment section. Again, the YouTube channel is at Glockenfleckens. I posed a question. I said, do we really need the spleen? Let me know if your team's spleen or not. And here are some of the comments. At Lid, Jagillers said, it seems important. Fair enough. Very practical. Yes.

But maybe not as important as you think. At Castle 42 said, I want many accessory splanes. The big splane fan.

At Enroot said, multiple spleens is one of the most common anatomical variations. So I knew this was the thing. I didn't realize. I didn't know much about this. But he says, about 10% of people with accessory spleens, about 10% of people have accessory spleens. Sometimes if your single spleen gets exploded, get this, it will heal as multiple spleens. See, I knew this was a possibility. It's a thing called splenules, like these little tiny spleens that you get.

I didn't put it into the context of if your spleen explodes, what happens? Can you get basically where your spleen tissue lands, you grow more little tiny spleens. And are they functional? I don't know. Do they have a blood supply? Well, they must if they're turning into something. And it also makes me think what other organs would be advantageous if it exploded for some reason?

that you would make like a whole bunch of baby organs, like the kidney. That'd be kind of, I think it'd be kind of cool, right? What if your kidney exploded and the exploded tissue turned into like dozens of little kidneys? We'd never hear it from the nephrologist. They'd be done such a high horse, just holier than thou, so much better. They'd have something on the cardiologist because if the heart exploded, you're dead.

I don't think you'd have time to form dozens of new hearts before you're dead. But so the kidney would be kind of cool. Adrenal glands would be cool. Testicles, I don't think it would be useful to have like dozens of little testicles. Actually, it would have been very useful for me. If I had one instead of cancer in my testicle, if one of my testicles exploded, then I could have my other testicle taken out when I eventually got cancer the second time and I'd still have dozens of little baby testicles.

are still able to function somewhat. I don't know if it would work that way. Anyway, let me know what you think. What organ would you love to, if it exploded, you'd have a whole bunch of? The brain, obviously, but that goes along with the heart. If it exploded, you'd probably be gone before you developed dozens of little tiny brains. Okay, here's one. Here's a great comment. At Acure Jacobs says, no opinion on the spleen.

I love this. I don't care what you're talking about. Here's my thoughts on something else. But I'd vote for multiple skins. This is interesting, you guys. Wouldn't it be cool to molt every couple of years? Maybe each new skin would have different melanin content and we'd need mandatory vacations. James? Oh, yeah, he's having his 10th molt and it's a big one. He'll be out of the office for a month.

Then we'd be calling for more representation of public molting. People would post pictures of it. Yeah, I think it would be a bigger problem than you think. Because on the one thing, if something happens to your skin, say you get a big scar you don't like, well, then you just molt it and you get a new skin. That would be cool. So I think for people with skin diseases, yeah, it'd be awesome just to get rid of that one. You get a new one. But yeah, people would leave their molts everywhere. Yeah.

You just like nobody who throws them away. They're just on the sidewalk. You walk, go into the bathroom. Someone's left their old skin and, uh, it just, and then like practical jokes would be out of control. People leaving their skin up somewhere and you think it's a person, but instead it's just molted skin. I could see, I could foresee a lot of problems.

I mean, think about how many skins that would be. We'd have to figure out what to do with all the molted skins. There are 400 million people in this country, 6 billion people around the world. Like what would we do about every two months? We have 6 billion skins. What would we do with that? There would have to, we'd have to be a figure out a way to, to use it for alternative energy. I think like that would be, that would be the thing to do.

Um, but then like if you burn hair, it stinks really bad. So it wouldn't smell good. I don't know. I just, we have to figure that out. Some kind of alternative energy. There's maybe use them for as like a, like a windmill. They can catch your skin could catch the wind. I don't know. Anyway, if you guys got ideas of how we can use our molted skin in this alternate universe to generate energy that could be sustainable, um,

Please let me know in the comments. In reaction to that comment, at TractorChick1950 said, I don't know what it was about your comment, but I think I just puked a little in my mouth. I'm sure a lot of you are probably feeling that way as well.

Great comments. All right. Here's another good comment from that episode where I talked about UnitedHealthcare and their dedication to defamation lawsuits, right? That's a thing now. Anybody who speaks ill of UnitedHealthcare, they hired a defamation firm. They're going to come after everyone. Well, this comment from at Stephen McGinnis, 5789, because I talked about how I

as a comedian and with my skits it's satire so i'm protected through freedom of speech uh from them coming after me which is probably why they haven't yet this point he said um in the same way so he talked about the the strisand effect a little bit which is where if you if

point something out that you don't want people to talk about, but by pointing it out, you're going to make people talk about it kind of thing. Like when Barbara Streisand, there was a drone that took pictures of her house and she made a big deal about it, which all of a sudden brought it to the attention of the entire world. In the same way, there is a concept in defamation law called being defamation proof. This is an individual organization whose reputation is so bad that it cannot possibly be harmed. I would suggest that

that in the, the implication being that United healthcare is, is in this category of company, which I think you're onto something like, honestly, they're so powerful. Like what could we possibly make fun of them about that would knock them off their pedestal that would make them less powerful. Yeah. It'll make people not like them. It'll make people not like United healthcare, but it's going to remove their power. Not right away, but this is why I keep talking about United healthcare because I

eventually enough people will be pissed off that will actually enact laws or increase regulation that will strip away some of the power of these billion dollar insurance corporations. So I wouldn't go so far as to say they cannot be harmed, but their reputation is already in the tank. So like, what do they care if people just make fun of them? We all, it would be better, honestly, just like you're suggesting to just ignore it

If I'm going to give them, as someone who's had a lot of angry comments levied against them over the years, it's best to just ignore this kind of stuff and not hire a defamation firm to go after them, kind of like Drake did with Kendrick Lamar. All right. Anyway, great comment. There's another one here. Yeah, people saying satire is free speech. Hilariously, YouTube has decided to pair this episode with ads for UnitedHealthcare. That keeps happening.

But I think it's kind of funny. You're not going to convince anybody on any of my videos. So by all means, give me money, UnitedHealthcare, in the way of you buying ads from YouTube. But you're not going to get anywhere with my audience, UnitedHealthcare. All right.

And just for the record, I have never, I would never, I have never, and I would never accept any money from Optum, from United Healthcare, from Cigna, from Blue Cross, any health insurance company. You're not going to see any of that shit from me. Never going to happen. I can promise you that. And then finally, last one here at John C4403 said, I could really do with an extra appendix. John, you don't, you don't need an extra appendix. We take them out for a reason that all they do is cause trouble. You don't need one.

Um, he said they took mine out a decade or so ago and it's one of those organs. I don't have a spare for you. Don't need one. Trust me. There's some organs. You just don't need an extra one of some people would argue. You don't really need an extra kidney for some reason. They got one in the liver did. So I don't know. Uh, all right. So let's talk about, let's take a one last quick break and then we will come back and I'm going to talk about Rubyola, otherwise known as measles.

I'm ready for my life to change. ABC Sunday, American Idol returns. Give it your all, good luck, come out with a golden ticket. Let's hear it. This is a man's world. I've never seen anything like it. And a new chapter begins. We're going to Hollywood. Carrie Underwood joins Lionel Richie, Luke Bryan, and Ryan Seacrest on American Idol. Season premieres Sunday, 8, 7 central on ABC and stream on Hulu.

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To find your next pair of glasses, sunglasses, or contact lenses, or to find the Warby Parker store nearest you, head over to warbyparker.com. That's warbyparker.com. All right, here we go, folks. So, measles. Measles and the eye. So...

Measles has, it's in the news, there's an outbreak in Texas. And actually, I just heard today as of this recording that the first death as a part of that outbreak has occurred. Very sad. And you can see this coming, right? With so much...

misinformation, so much negative publicity surrounding vaccines that you're kind of waiting for stuff like this to happen, unfortunately. And so let's talk about measles. It's

been worldwide for a long time a leading cause of childhood blindness and unfortunately it's re-emerging in developed countries so in 2023 worldwide over a hundred thousand mostly children died from measles around the around the globe that's according to the world health organization

And then here in the United States in 2024, 285 cases required hospitalizations. So it's one of the most contagious diseases out there. And it's airborne. It can linger in the air for several hours. And most, 89% of the people who develop measles had not been vaccinated against the disease.

The measles vaccination works, folks. It works. It can save your life like so many vaccines. You're not going to hear any anti-vaccine stuff on this podcast. Very much pro-vaccine in this house, in the house of glock and plucking. So blindness, let's talk specifically about blindness, though. It's a very real threat. As many as 60,000 children are estimated to develop measles-related blindness per year

in low-income countries, countries that don't have high vaccination rates. So let's talk about exactly how it can affect your eyes. So the most common way that we see the manifestation of the eyes that we see with measles is conjunctivitis.

So you get pink eye, you get this red, watery, irritated eyes. It's really the hallmark of this, of this with a, along with fever, cough, runny nose. And then from there it transforms into the telltale measles rash, you know, the red splotchy rash. And then what's the treatment for it? Well, there's none, right? You got to let it run its course. Unfortunately with the eyes, the,

you can develop more severe ocular involvement. So the conjunctivitis can spread to keratitis. So the conjunctiva, conjunctiva, conjunctiva, however you want to say it, either way is acceptable in the world of ophthalmology. The conjunctiva is like a translucent, it's like the skin of the eye. It doesn't molt either, by the way.

It's a translucent covering that covers the white part of the eye. So that when you look at someone's eyes, the white of the eye is actually the sclera. That's the tough fibrous outer wall of the eye. That tough fibrous wall is covered by this translucent tissue called conjunctiva. And that's where a lot of the blood vessels are. So when your eyes get real red, like you have an infection, you have pink eye, it's because the vessels in the conjunctiva

are, are, are inflamed. The virus is infecting the conjunctiva and you need that conjunctiva because if, if it gets deeper, the infection gets deeper into the sclera, well, then you're at risk of losing the eye because that, and then the infection can spread into the, through the sclera into the eye. And so the conjunctiva is really, it's a, it's a, it's a protection among other things, but it does protect the eye.

And the cornea obviously is the clear translucent covering of the eye. And so keratitis, which is inflammation of the cornea, is a very serious manifestation of a corneal infection. So symptoms, you get pain, you get tearing, you get severe light sensitivity when you have inflammation of the cornea. And

The danger with any kind of corneal infection is that

it can scar and lead to permanent blindness. And that's where the vast majority of blindness from measles occurs is when you have a severe enough infection on the conjunctiva that it starts to affect the cornea and you get haziness to the cornea, you get scarring of the cornea that causes permanent vision loss. The conjunctiva, pink eye, conjunctivitis, that heals. Your conjunctiva is fine. Like that'll heal up just fine.

the cornea does not heal up the same way that's why we take contact lens wear so seriously and why we really hit it hit any kind of contact lens related corneal ulcer we hit it so hard with steroids i'm putting patients on every one to two hours of topical uh antibiotic not steroids sorry we hit it with topical antibiotic because if you want to get rid of that infection as quickly as possible or it'll scar so unfortunately

in measles epidemics measles outbreaks you can get inflammation significant inflammation of the of the cornea that results in scarring and permanent vision loss and so basically those corneal ulcers that are developing as a result of this infection it just starts it kind of melts into the cornea and it's very painful it's filled with the virus and that can also

increase the chance of developing a secondary bacterial infection on top of the measles virus infection. So you can get multiple different infections on the eye and it all started with measles. Any virus can do that too. Herpes simplex virus, zoster, usually don't see it with just like rhinitis, like rhinovirus, new typical common cold viruses. But then those ulcers eventually will heal, but they scar over inhibiting vision.

Now, there are a couple of much more rare...

examples of blindness caused by measles and these are like reportable like you could publish it in a journal one would be retinopathy so very rare but they're dog definitely documented cases where measles virus destroys the retina it gets into the back of the eye and it infects the retina and causes inflammation and just the retina is very sensitive tissue and so if you that happens

you're it's toast, you know? And so I, I did, I found a, an, an article about bilateral macular retinitis as a presenting feature of a measles complication called subacute sclerosing panencephalitis, which is a delayed neurologic complication of measles. I don't know the pathophysiology of, of, of, of how that works, but, um, you get, uh,

On neuroimaging, you'll see panencephalitis, so inflammation of the brain, of the spinal cord. Well, guess what? The retina, that's brain tissue that is connected to your brain. And so there have been cases where that subacute sclerosing panencephalitis, that delayed complication of measles, it migrates forward into the retina and causes blindness. Horrible, horrible things.

And in the same way, in the same vein, you can also get optic neuritis. So that's inflammation of the optic nerve, which obviously very important, relaying signals from the eye, what you see to the brain. So you get inflammation of the optic nerve that causes degeneration of the nerve and you just, you lose your vision.

So conjunctivitis, corneal scarring, retinopathy, optic neuritis, and all of these things can, they can all lead to blindness. And so like, what's, what's the, what's the takeaway here? Like don't get measles, like protect yourself, protect your kids, get vaccinated against measles. Uh, it's, uh, don't put yourself and others at risk. That's it. That's it. Um, that's measles in the eye, everybody.

We could do, there's so many different infectious diseases we could do still for knock-knock. Oh, someone told me in a comment, they said, I just realized we haven't done a don't do that eyeball tip of the week in a while. I'm so sorry. You are absolutely right. So your don't do that eyeball tip of the week is avoid the MMR vaccine. Don't do that. Not good for your eyes and presumably other parts of your bodies as well. Other parts of your body as well.

All right. That's your don't do that eyeball tip of the week. I'll try to bring that back. I just keep, I just have forgotten for like two months. Sorry. I've got so many good eyeball tips for you guys. So that's our episode. That's knock, knock. I thank you so much for joining us. Us as if I actually am here with my dog. Milo's in the back. He's sleeping. You probably seen him throughout the episode. He's just laying there farting at the storm. He's a stinky boy.

All right. That's Knock Knock Eye. Thanks to my producers, Aaron Cordy, Rob Goldman, and Shanti Brooke. Editor-in-chief Zayn Supportiz. Our music is by Omri Benzvi. Just another reminder, go check out the YouTube channel at Glockenfleckens. Leave a comment. I see all of them. I'll read your comment if it's a good one. If it's pertinent to anything I want to talk about, if you have an eyeball topic,

Let me know. Something I haven't talked about. I'll even repeat some because I've been doing this for like a year now, it seems like. Maybe not that long. But I'm happy to revisit certain topics as well. So let me know. Give me your suggestions. In the meantime, take care of your eyeballs. Knock, knock, I is a human content production. See you later.