Knock Knock Eye: The Southwest Airlines Debacle: A Warning for Medicine?
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Welcome everybody to Knock Knock Eye with me, your host, Dr. Glockenflecken, your one-stop shop for all things eyeball, even though I am wearing my ortho cap right now. The reason I'm doing that is because I just got back from an orthopedic surgery conference last

I've been to almost every specialty conference at this point, doing a lot of speaking. Not all of them, but a good amount. I've seen the wide variety of different meeting types and events. I saw something at this ortho conference that I've never seen before. Pickleball courts in the exhibit hall.

They had three. They were having a pickleball tournament. Apparently in San Diego, there's like a the professional pickleball association, which is a thing I didn't know existed. I know you could play professional pickleball is their headquarters, I think, are in San Diego. And so they sent over a pro.

Uh, and, uh, I, I got to go and I recorded a little video, uh, with them and it was a lot of fun, but I've never seen that before. And I've seen everything. Like I went to an emergency medicine conference once and, uh, they had a donut wall. This was, this is pre COVID. There's like, like a peg board. It was a giant peg board. And, uh, on each peg was a donut. You can just go grab a donut off, off the, and there was like a ladder, uh,

I don't, I don't think that, I don't know if it was that tall in my mind, it was like a 40 foot tall pegboard of donuts, but it probably wasn't that big, uh, in, in reality, but I was very impressed by that. And so, um, a great job orthopedic surgeons on getting your, your, your physical activity done during, during your, I would expect nothing less from orthopedic surgeons, uh,

It was a great group. I had a lot of fun, and so I wanted to wear my ortho cap. This is the Ortho Women. Obviously, you've got to be watching on YouTube to see me wearing this thing. This is the one I wear in all my videos with ortho. It was given to me by somebody, I think, in Sweden. It was mailed to me. I didn't go to Sweden. I've never been to Sweden, but it was mailed to me.

by a woman in orthopedic surgery and it says ortho women. It has a picture of a hand with a drill. I love it so much. It's great. And so I try to wear this every single time I play the orthopedic surgeon. I'm wearing this thing. So thanks to all the ortho bros out there and ortho lady bros out there. I had a great time. So here's what we're going to do today. I'm going to talk for a few minutes about private equity.

I got some things to get off my chest when it comes to private equity. I always have something to get on my chest about private equity, but we'll do that. And then get into some questions you guys left for me on the YouTube channel, at Glockenfleckens. Some things to address, some great questions, some funny comments. So we'll get to that here in a bit. All right, first, let's talk private equity.

So first of all, this has been at the forefront of my mind because of what's going on with Southwest Airlines. RIP Southwest. I grew up in the Houston area. And so I'd say that's probably the most popular airline in Houston.

for for years and years because it was so easy to go houston to dallas i would go dallas to lubbock because i went to college at texas tech university uh austin is just that's it was so easy you know their hubs in dallas uh and so very easy to fly uh and i would always remember the the the one i get away that was my go-to whenever i had no money uh and the one i get away airfare i

I swear, I don't know if I'm just like misremembering this, but I swear to God, I would find like one-way flights for like $39. And this was like in 2000, probably 2007 or something. So a while back, I mean, it's been almost 20 years, but not like so far back. I still think $39 was crazy cheap. I don't know if I'm just making that up, but I really think that you were able to get super, super low fares.

That has since gone away. I think last summer they did away, or maybe a few years back, they did away with the want to get away, that type of cheap airfare. You got to go to Spirit for that. And now I think they have assigned seats now, maybe. I don't know. It was just...

Back when I was flying Southwest, you just, everyone, they started doing the numbered system, like you're a, you know, 30 or C 15. And so you'd line up based on that, but it was like, you're with your own, you're a cohort of C people. And so you'd all like go together and just kind of first come first serve on, on seats within your group.

But recently, it was announced that Southwest would do away with two free bags you could get. This was like, I haven't flown Southwest since I've moved out of that region. There's really no reason for me to fly Southwest. They don't come up to Portland, Oregon very often. But my parents...

Oh, they've been Southwest. In fact, I keep telling them, like, when you come to Portland, you can fly Southwest, but it's like double the time of the trip. But they're so insistent. It took them forever to try a different airline. People are very attached to their airlines. People in Texas, very attached to Southwest Airlines. And part of the allure is like, oh, two free bags. That saves you like $100. Yeah.

And so they went away from that. And so the question everybody's asking is why other than just, is this just a money grab? Well, yeah, of course it is. And so, and you know why? Because this is what I think, and this is probably the case is that about, I think a couple of years back, they received an outside investor, Southwest Airlines did.

of like 1.2 billion or something, from something called an activist shareholder.

which I had to look this up, but basically an activist shareholder is someone who buys a big stake in the company. It becomes shareholder status in a company with the purpose of being an activist, which in this context means influencing the company's direction and performance. So they get this big stake in the company. Maybe they're not a majority shareholder, but they've got a big enough stake that they can throw their weight around a little bit and, and,

and turn the company in one direction or the other. Well, this, which honestly, if you're thinking, it kind of does, it sounds like private equity. And then going further, these types of activists, they can be just individuals, they can be hedge funds, or they can be private equity firms. So I don't know if this particular group that bought this stake in Southwest Airlines is quote unquote a private equity firm, but they're acting like a private equity firm.

And what does that mean? That means you get a big stake in the company and then you just slash. They already had, they laid off a bunch of employees at Southwest. You do everything you can to try to cut costs and generate profit as quickly as possible. And so here you have it. And the reason I'm bringing this up is because how much more evidence do you need? And now I'm talking to people in healthcare.

I'm talking to physicians. I'm talking to administrators, executives. How much more evidence do you need to know that private equity ruins everything it touches?

There are no redeemable qualities about private equity taking over a company. It's slash and burn. It is short-term profit at the expense of everything else. The customer experience, the employee experience. Why would it be any different in healthcare? Why?

And what really irritates me is because I mentioned I go to all these conferences and this is not something that happened at this orthopedic surgery conference. I don't think, I mean, private equity is everywhere, but I don't even, I don't know if like ortho is even in the top 10 of specialties that have a private equity influence. Maybe they are because it's a surgical field. And so you're going to have a lot of private equity interest in high paying, high reimbursement fields.

But this is something I've seen in my own specialty, ophthalmology conferences, where you have a panel or a seminar that's like pros and cons of a private equity-owned practice. And the reason they have these types of events is because they do it for residents, for fellows, for young physicians trying to figure out what kind of practice they want to work in.

And, uh, and so of course, like private equity is like the big boogeyman, uh, for, for residents, for trainees, no trainee wants to be involved in private equity.

But still, you have these organizations that are putting on conferences, that are having events where you have private equity physicians, physicians that have sold to private equity. And you're giving them a platform to go in front of residents and say, there's some cons to private equity, but hey, here are some pros.

Now, you might think, well, what's the big deal? That's not like it's okay. They're showing the pluses and minuses. Well, my problem is that there are no pros to private equity in healthcare. We need it out of healthcare. So I don't want anybody sugarcoating private equity-owned practices as something that's just as viable of an option, that's just as good as

in some ways might be better, according to these doctors, as a physician-owned practice. They're not on the same level. In one, you have physicians owning a practice, physicians who got into medicine because they do have patient interests at heart. We take an oath. There's still some part of every physician that wants to do right by the patient versus private equity-owned practices that are just in it for profit.

Yeah, doctors want to make money. Doctors who own practices want the practice to make money. They want to keep their employees. They want to have a nice living. All right. And they do. But there's a difference between having a motivating, having motivation to do right by your patients and that central tenet, it influences the decisions you make.

Maybe you could do things, you could make a little bit more profit, but you don't make that decision because it's not right by the patient. Versus private equity. None of that matters. They are not in it. They're in it for short-term gain. They want to flip that practice to another private equity firm for profit. So I hate it when people...

just present the idea of private equity as, oh, there's some bad things, but there's also some great things. No, stop. There are no good things about it. It's ruining healthcare, just like it ruins every other industry it finds itself in. It takes over. And if it doesn't outright bankrupt a practice, which we've seen, emergency medicine has had private equity involvement, and we've seen those practices go bankrupt.

It's happened in the world of anesthesiology as well. And part of that's because those are specialties where you can't limit what type of patients you see, because that's a big calling card of private equity firms. They don't want to take care of the patients that have no insurance. They don't want to take Medicaid. All right, well, sorry, you got EMTALA with emergency medicine, so you're going to have to see everybody that comes in.

And that obviously makes it to where it's a less profitable venture for private equity firms. So they go bankrupt. They run it into the ground. And the thing is, in other specialties like ophthalmology, you don't quite have that because you can get away with not seeing Medicaid. You can turn Medicaid patients away. I think that's wrong. I think you owe it to your community.

to see any type of insurance someone can if they have a method a way to pay and in some cases even if they can't pay all right uh it i it's it's you have to do what's right by your community and so like in our practice we take all insurances we're constantly renegotiating with insurance companies to try to get what we're uh what we uh what we should make from them

And sometimes we have to threaten them that we're not going to take their patients anymore. And usually we almost always work it out. But you can't just, I've got a big problem with just blanket, like no more Medicaid. Like that's not the way to practice as a physician. I think it's harmful for your community, especially if you're a big practice. But it's the private equity thing. We need to be, every professional organization needs to just be

We should be on the same page with this. Like, it's bad. We need less of it. We need to try to create legislation and rules or whatever you want to go guidelines, something that makes it easier for physicians to own their own practices, to stay in private practice, to join private practices.

take away some of the reasons why physicians will sell to private equity. Sometimes it's just a money grab. You want to check out. You want to retire. Sometimes they don't have a choice. I get that. There's a different conversation to be had about the decision to sell to private equity. That's really not what I'm talking about right now because I don't want to litigate that at this point.

Because people have their reasons. Who among us would turn down a check for $8 million or something like that? I mean, that's a lot of money for physicians too. But it's the trying to sell, then go after you've sold, then to turn around and try to sell it to the next generation of physicians. That's what I have a problem with. We should not be platforming anybody like that. All right? You made your decision.

Great. Live with the massive boost to your bank account, but you don't get to tell other physicians, especially with your gigantic conflict of interest, that they really should consider joining a practice that's owned by private equity. There's some great parts to it. No. That's the opposite of what we need in healthcare. We need more

leadership and ownership in the whole healthcare system with, you know, we need it run by people who actually have patient care experience. All right, we need to get private equity out of it. Anyway, that's my soapbox. All right, let's take a break. We'll come back with some comments.

Hey, Kristen. What's up? I've been grossing you out about these little guys, Demodex mites, for months now. Yes, you have. Thank you for that. Well, good news. I have more facts to share with you. Oh, great. Yeah. These mites have likely lived with us for millions of years. Hmm.

Passed down through close contact, especially between moms and babies. That's very special. They're born. They live, crawl around and die on your eyelids and in your lash follicles. Lovely. The entire life cycle from egg to adult lasts about two to three weeks. That whole time, they live right there on your eyelid. That's making me itchy. Okay.

It is fun to gross you out, but we do all have these. All right. It's really common. It causes a disease when there's an overgrowth of these mites called Demodex blepharitis. It causes the eyelids to get red, itchy, irritated. You get this crustiness to the eyelids. But I have really good news. This is actually really good news. Okay. We have a prescription eye drop for this. Okay. That is great.

That does make me feel better. Visit MitesLoveLids for more information about demodex blepharitis and ways we can treat it. Again, that's M-I-T-E-S-L-O-V-E-L-I-D-S dot com to learn more. Okay, so I loved a lot of the comments that came in off of the most recent episode that was published.

That was posted, published. I'm a publisher now. No, posted, I'll say, which is where I talked about a number of things. One of them was rubella and getting the vaccine and the anti-vax movement, which seems to be just getting worse and worse every day. I had some great comments, so I want to share.

I want to share a couple of those. So at Amanda Bevan, 6331 said, my mom shared this with me recently when the news of the first death in Texas came out. By the way, there's been another death and there's just more. It's spreading, which is not surprising because rubella is, measles is just an incredibly common

infectious disease like just the what am i trying to say it's it's um contagious that's that's what that's the word i'm trying to say it's a very extremely contagious disease uh and so she said um she had measles as a child pre-vaccination probably in the 50s i didn't think anything of the comment about when i was talking about what i discussed with eye complications

But here's the quote from her mom who had measles back in the 1950s. I remember being ill when I had measles. Had to stay in bed for days in my room. It was totally dark. The light hurt. It can cause blindness. Our family doctor even came to the house to check on me. Really serious stuff and so contagious. You can catch it hours after someone who has measles has been where you are, which is absolutely true. It can just linger in the air for hours.

And so that just kind of hit me because as adamant as those of us in healthcare, the vast majority of us are, like 99.9% of us are in healthcare, about vaccinating, about getting the MMR vaccine. I can't even imagine what people must be thinking who...

had firsthand who had this disease who had a an entirely preventable disease and still clearly 70 years later all right this woman can recount exactly what that experience was like it shows you what kind of effect that has on people and so uh it just it makes me so angry you know i feel like i'm just airing grievances during this episode today but it's it's true and so uh um

I don't know. I don't even know. You know, I was asked at this past conference I went to, it was like, do you have any recommendations on social media for how to like reach people about vaccines? I don't.

I had no answer. I don't know at this point. I honestly don't know. I do know that storytelling is very powerful. It's very big. And people are, that's the way a lot of people are generating their content is through storytelling, either through comedic storytelling like I do or dramatic storytelling. Just that's how you reach someone on an emotional level. I don't know. A lot of us,

especially pediatricians, they've tried the stats. They've tried the studies. I mean, we have like dozens and dozens of studies featuring thousands and thousands of patients showing that there's no link to autism with the MMR vaccine. And yet we still have RFK juniors like, oh, we're going to allocate some funds to do a big study to finally put this question to bed. It's settled. It's science. It's there.

The data is there. What are we... And then saying that in the wake of the...

of dollars that's being cut from science funding and research funding by the Department of Government Efficiency. It's just none of it's making sense. It's depressing. It's awful. And I really feel bad. I feel like every day I see a new post of someone who had a research fellowship taken away from them, a grant that was taken away from them, a

And one, the one I saw today, it was someone who had a grant to study something about fibroids and, you know, just real things. These are real things.

topics that that need that's how we advance in society that's how we we stay ahead of other countries and be the be the be the forefront not that that's the end all be all but to to push science forward and and be um and set the example for scientific achievement that's that's going away clearly so anyway thank you for that comment

Oh, here's another. This is a great, great point here. At Passion at Propagator said, please point out in one of your episodes that rubella, one of the illnesses prevented by the MMR, can cause blindness in a prenatally exposed baby. It's a great, great point. In the 70s, I worked as an aide at the Oregon State School for the Blind. The deafblind unit was filled with rubella babies.

These kids have profound disabilities and would all need lifelong care. Congenital rubella syndrome is nasty.

Absolutely agree. Thank you so much for bringing that up. And so let's talk about it. Let's have that be our big eyeball topic of the day here. So congenital rubella is probably the most common cause of vaccine preventable birth defects. It's extremely common. The way you get this

through infection of the rubella virus during pregnancy, specifically the first trimester. And that increases the risk of getting this constellation of birth defects that constitute this congenital rubella syndrome. Obviously, lack of vaccination increases the risk dramatically. And

as, you know, even just a single dose of a rubella-containing vaccine, MMR vaccine is a great example, confers lifelong protection. So it's not hard to protect yourself from this, yet, you know, the vaccination numbers are, you know, lagging and people are questioning it. Let's see. So congenital rubella syndrome, um,

The most common manifestations that have to do with ocular disease would be, there's like four different ones.

All right, so there's pigmentary retinopathy. This is an inflammatory disorder of the retina, and it's found in probably about half of patients with congenital rubella syndrome. It can be unilateral. It can be bilateral. These babies have very classic appearance to the retina that we call salt and pepper retinopathy. So this is modeled pigmentation that occurs in the retina.

And that actually increases over time. And you end up getting atrophy of the posterior pole of the eye, which is where the most important part of your retina is, that what you use for your primary central vision, you get atrophy and pigmentation changes, and it just causes degradation of vision.

Um, so pigmentary retinopathy, another thing you see with congenital rubella syndrome is cataracts. So you get congenital cataracts, uh, that, um, there's a whole host of things that can cause congenital cataracts, but usually in the context of other findings and, you know, history of unvaccinated mother and all the, you can pretty easily put together a picture of congenital rubella syndrome. Um,

So for the eyes, basically you get these pearly white cataracts in the baby, and they're more likely to be bilateral in congenital rubella. And it's as high as like 89% of these patients have bilateral cataracts.

and obviously that's something that is very tricky to treat as a baby you know congenital cataracts when you do surgery you always have to decide how quickly you have to do surgery and you want to try to wait as long as possible to allow the eye to grow a little bit and to mature but sometimes you can't do that you got to do surgery pretty early to try to to save whatever vision you can but one of the more

Probably devastating findings that you can have, outcomes from a congenital rubella syndrome, effects, I should say, is microphthalmia. So microphthalmia occurs in a congenital rubella when the baby's eyes are less than 16 millimeters in diameter. That's a very, very small eye. And this occurs in about 10 to 20% of patients with congenital rubella.

And these eyes typically have very poor vision outcomes because of how small they are. There's a high degree of hyperopia. And sometimes with microophthalmia, the eye is just not developmentally a normal eye. Some of the structures don't develop properly, like the trabecular meshwork, the drainage system in the eye, which can lead to glaucoma.

And so sometimes you can get glaucoma as another complication of congenital rubella syndrome.

Uh, and so, and that part of that's just because that part of the eye just doesn't develop properly. So you can see there's a whole bunch of problems that is so that, that occur with congenital rubella. We didn't even talk about strabismus, uh, uveitis, which is, uh, you get inflammation inside the eye, uh, because of infection with this virus. Um, it's, uh, it's horrible. And it's, it's the worst part about it is just, it's so preventable. It's so preventable.

And so prognosis is not great. And I don't know if I've, I'm thinking back, even in my, I've probably seen a couple of kids that had it. I haven't seen any like newborns with it, but certainly going through my pediatric education and ophthalmology residency, we saw some kids that came through that had congenital rubella. And a lot of times they're blind. A lot of times they're deaf.

and um because it can affect the hearing as well so terrible horrible stuff uh and i wish i had a better answer to that person who asked me a question about how we reach people i just don't know anymore uh and it's um you know if someone has a great idea if you've had any success stories of how you've like changed someone's mind about vaccines please

like email me or leave them in the comments on the art on the youtube channel at glockenfleckens i will i will absolutely share anything i get because i would also love to know how to reach people about about getting them vaccinated about trying to explain to people how useful it is and how life-saving vaccines are and anyway anyway

So yeah, please reach out to me. I would love to hear people who do this a lot more than me because there are a lot of, you know, we don't talk about vaccines a lot in ophthalmology, but it doesn't often come up. Pediatricians,

primary care, family medicine. Like you guys do a lot more vaccine education than I do. And so I bet you have a lot more expertise on how to get people to understand the importance of vaccine. So please share that with me and I'll share it with all my followers. All right, let's, uh, let's take one more break. And then I've got a few comments, uh, related to the VA story I told last a couple of weeks ago. All right. So if you recall, if you haven't

If you didn't listen to this episode, please go and listen to a couple weeks ago. I talked about this story at the VA where the VA police and somebody actually commented, I didn't know what VA was because I don't live in America. And so it's Veterans Administration. So all the veterans...

military veterans they go to the VA to get their care and a lot of times it's either it's either free to them or not you know it's it's heavily discounted medical care it's government funded medical care and so

uh the story just the short version is the va police found what they call what they thought were vagina pictures uh basically pornographic pictures in in a in a physician office in the va they started opened an investigation to find out who's taking these photos turns out the photos were vocal cord photos from the ent clinic so uh the uh um

Money put to good use there.

So a couple of comments on that story at S.A. Maryless says, what I am surprised by in the VA story is that no one in the E&T department complained about why all their photos were getting stolen. Good point, which is why I made the caveat at the beginning of that story when I told it that it's a secondhand story. I don't know how the whole telephone thing got

How it's changed and the version that I'm telling you is, I think, the funniest version of it. And it's the version I heard. And maybe it's not the actual version of it, but, you know, it's probably pretty close. But good point. You think they would have noticed. But then again, there's like a lot of.

Like at this point, those photos are probably all like in the health care. Actually, I don't know if they're still if they're if they have that capability at the VA. But in a normal electronic record system, they would be all digital. So but good question. Here's here's this one made me laugh at Amanda to two four four said the the larynx thing literally happened to me when I was in college. I was in a speech anatomy class and

as a speech anatomy major and someone came up to me and told me I couldn't be studying that in the library oh man I like what do what do people think vaginas look like I I just to me the those vocal cord photos they look more like the xenomorph and alien than they do a part of the the female anatomy so I don't I don't get it I mean I guess I kind of get it but not really like I mean it's

People just are really, I don't know if it's like a problem with the education system in our country, but it's troubling to say the least.

Uh, it does remind me though, of being in the library, like being in like the general library, not like the medical library or being on a flight. And I'm like, you know, as a med student, um, or even as a resident, I was, you know, studying disease and I'm always like kind of self-conscious. Like when I pull up a terrible, uh,

you know traumatic open globe injury there's blood and iris coming out of the eye and it's there's a big laceration and basically an exploded eye i'm always like oh man i bet people are really hating like sitting diagonal across the aisle from me because i'm sure they can see this

At some point you just stop caring though. You just do it. But yeah, it wouldn't surprise me if people came up and be like, oh, can you turn your laptop a little bit or look at something else? I don't know. I've never done that to somebody. I would just not look at it, but whatever. That's just me. What else we got here?

seven oh this is old at old Dion seven months of investigation could have been saved by just bringing it up to the head doc the next day at least they took it seriously though good point yes uh I want to say they maybe just had some time on their hands and it was something that there's like oh something juicy we can really sink our teeth into and um really find uh someone doing some wrongdoing when yep could have just brought it up the next day good point

Oh, and then this is my last question because this might take a few minutes to explain. So at Catherine Hall 2780 is a great, great question. Okay. How do you tell if an ER will have an on-call ophthalmologist? A friend of mine went to the ER because his eyes, he had lost a vision, eyes were blurry and they did not have an on-call ophthalmologist. So just sent him home and told him to see his optometrist the next day. To be fair, that's like probably anything

75 to 80% of the patients with eye problems that come into the emergency department can be seen by an ophthalmologist or an optometrist the next day or the next business day or a few days later. He did get referred to the ophthalmologist from there, but I worry the delay may have reduced his chances of having a good outcome, particularly in his right eye. So like I said, we don't have to go in very often because a lot of stuff in ophthalmology is

People feel like it's more severe than it really is. And that makes sense because it's your vision. It's scary when all of a sudden you go really blurry in one eye or you start having eye pain. People don't want to go blind. It's very scary.

And so they go in to see the emergency department, but usually it's something that is more subacute. We've talked about pants patients. That's why I started doing these knock-knock eyes was to talk about pants patients. Maybe we'll revisit that and go over some of those again.

You can go back and listen to them though. And the pants patients are the true emergencies in ophthalmology. The things that will get me out of bed, make me put my pants on to come into the emergency department as an on-call ophthalmologist. Those things do exist. So if you are concerned about your vision or a new change, like it's okay to go in to see the eye doctor. If you are established with

either an optometrist or an ophthalmologist, particularly with an ophthalmologist, I would encourage you to start there with trying to figure out what's going on. Because any eye practice worth a damn will have somebody who you can talk to after hours, whether it's a nurse or a technician or at least somebody with some knowledge about eyeballs

who can triage what's going on with you. And so I really encourage you. And if your office, if you're seeing an ophthalmologist and they don't, nobody takes call out their practice, like honestly, unless that's your only option, like find a different practice because I don't think it's fair or appropriate to, to be a physician and not take call for your own patients. Like, come on, you gotta, you gotta make sure you're there for, for the people you take care of your community.

But to the question here is, how do you tell if an ER will have an on-call ophthalmologist? So any level one or level two trauma center hospital, if they're a level one or a level two trauma hospital, they have to always have an ophthalmologist on call.

That's going to cover all of your academic medical centers and most of your like big hospitals in an urban center. There's going to be, they're going to be at least level two, but you can Google it. You can search your hospital, your local hospital and find out what level they are, level one or level two. They will, in order to have that designation, which allows them to, to,

I don't know, get more funding. I don't know what the benefit of it is. You can have more residency training programs for sure and fellowships and things. But they have to have on-call ophthalmology coverage 24-7, 365. So you will be okay there. For smaller hospitals, urgent cares, especially you go further out into rural communities, it's much more spotty.

but they should have somebody that they can call. They might not have someone that can see you right away if you have something serious going on, but anybody, they can always triage it and they can call somebody to at least talk it over. And if you need to be seen at a level one or level two,

They'll transfer you over there. I've seen it. I've been the doctor taking those calls from rural communities and told them, okay, yeah, this is serious. This is a major traumatic injury with a tractor or something. Let's send them over. So anyway, I don't want you to be too worried about that, but

start with your local if you are established at a practice. They should at least help you out a little bit, guide you if they say, oh, this sounds really pretty bad. Go ahead and go see, go to the emergency department or everything's fine. You're having flashes. I'll see you in the morning. All right. So that's what I would do if I were having any kind of eye problem.

Good questions, you guys. All right. So send me yours again at Glock and Fleckens on YouTube. I go through all of these every week. And so I love hearing what you guys are thinking about and getting ideas. We didn't talk about some of you guys are very concerned about that spleens can explode.

I wonder if they can really explode. Rupture? I mean, that's kind of like an explosion. Anyway, give me your comments. I'd love to see those. Thanks to my producers, Aaron Corny, Rob Goldman, and Shanti Brooke. Editor and engineer, Zayson Pertizzo. Music is by Omer Binzvi. Knock Knock I is a human content production. I'll see you next time, everyone. Take care. Bye! Knock Knock, goodbye! Human content.