Knock Knock Eye: United Healthcare Is A Wealth Of Content
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Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken. This is your one-stop shop, all things eyeballs. Just fresh off my surgery block, ready to talk eyeballs with you guys, some little ophthalmology. I've got some great topics. It's been an interesting last few clinic days. I've had some exciting, some terrifying things come into the clinic, and I'm excited to share some of those things with you, including a pants patient.

We're going to harken back to the beginning days of Knock Knock Eye when I was telling you all about all the different pants patients. Well, I have a pants patient to tell you about today. But first, before we get into the eyeball stuff, I want to dedicate this episode to a familiar foe for all of us. This episode is dedicated to UnitedHealthcare.

They will not stop giving me content ideas. It's I like, I appreciate it. I really do. I wish it didn't come at the expense of like making people very angry and, and, and potentially like, you know, having people die or become financially devastated because they can't get the treatment that they need. I wish that wasn't the case, but yeah,

On a content side of things, I do appreciate that they keep just stepping in it and giving us lots of ways and things to make fun of them about. And the latest thing is basically there's a few articles have been out there about this. They recently hired... Well, actually, before we tell you exactly what they did, let's just... I want to set the stage. How did we get to this moment? So...

UnitedHealthcare, for years and years and years, decades, they've been operating in the shadows, right? They don't want people to know what they do because it is so harmful and so profit-driven. They don't want all of us to know how much we hate UnitedHealthcare. They don't want us talking to each other. They don't want us to come to this grand conclusion for all of society that UnitedHealthcare is terrible.

And that's the way they've been operating. They've been doing all these little things, you know, vertically integrating, you know, automated claim denials, using artificial intelligence to automatically deny claims. And, and, and, and just that being the default, like we're not going to pay for this care, abusing the prior authorization system, making us do peer to peer reviews with people that don't have our level of expertise talking as a physician and,

And surely UnitedHealthcare is not alone in doing this. The other companies do various parts of these things as well. But UnitedHealthcare, I think, is the worst offender. And then, so they were chugging along, doing their nefarious corporate malfeasance. And then their CEO was killed. All of a sudden, everybody's paying attention.

Everybody, I think the reaction to the killing, which I've talked about on this podcast already a lot, I really do think it caught UnitedHealthcare with their pants down. I don't think they expected the reaction that they got, which was pure vitriol and lack of sympathy for UnitedHealthcare, for this company.

I don't think they were expecting it. I think they were somewhat surprised. I don't know how you could be surprised by that. Like, look at you. Look at what you do. That should not be surprising to anybody. But it was, I think, surprising to them. And so all of a sudden, because of the shooting, like everybody is talking about UnitedHealthcare, pointing out all the, oh, look what they did to my family. Look what they did over here. All of a sudden, everybody's paying attention.

which is not what a company like UnitedHealthcare wants. They want to operate in the shadows. They want to generate enormous profits under the surface where we can't really see or understand, really comprehend what it is they're doing or why. But now they weren't able to do that, right? And this has been going on now. It's been, what, three months, something like that? Well, the latest thing, which brings me to why I'm even bringing this up now, is because they hired...

A high powered law firm that deals with like defamation lawsuits with the expressed, you know, reason being to go after people on social media who are, quote, like lying about UnitedHealthcare.

And one of the things that kicked this off was that there's a physician on social media who talked about being pulled out of the operating room to be told that the patient she was operating on was not going to have her post-op hospitalization approved by insurance. She talked about this and she made videos about it. Healthcare sent a letter saying basically cease and desist, don't tell lies, this is not appropriate, kind of threatening legal action.

really despicable letter that was also shared on social media. Thank goodness. And, uh, and then, and then this is how United healthcare has, has, has dealt with that. It's like, okay, fine. We're going to start coming after all you people just for the record. They have not come after me yet. If they ever do, if United healthcare ever comes after me, which I don't think they will, because if I was just like saying things like I am now into a camera,

and talking about UnitedHealthcare. And that was like the main thing that people knew me for. Like maybe I'd be a little bit higher risk, although that's kind of what I'm doing now. But everything I'm saying is true. But because I do it in comedy form, in satire form, I have some level of legal protection for freedom of speech. At least that's what I tell myself. So nobody's come after me yet. I've done some pretty like...

I've gone hard on all the insurance companies, but mostly United healthcare. So am I a little surprised that they haven't said, sent me anything? Yeah. Am I a little bit disappointed? I mean, kind of, it's like, what am I not? Maybe I just need to go harder. Maybe I will. Um, so no, I have never been approached, uh, with any kind of cease and desist from a, from a health insurance company, despite what I do on social media. Um,

But it's stuff like this that UnitedHealthcare is doing, like hiring this legal firm to threaten people and to not talking shit about UnitedHealthcare. Come on. You're making it worse for yourself. Obviously, public image is very important to this company. They don't want their company being synonymous with hurting the public. But that's what's happening. And then doing stuff like this

It's just making it so much worse. If they ever did come after me, you better believe I would start... Oh, man. I would make...

I would make so much ruckus on social media about it. Like you would not hear the end of it. And maybe that, that, that factors into their decision on not sending me anything. I don't want to give myself too much credit, but I do have a large audience. And so maybe that's part of it. But I will tell you one thing that happened really, and not even, no, they didn't, the insurance company didn't send me anything. This was Aetna. One thing that Aetna did back in 2022 was,

was they decided to institute this policy where they required every single cataract surgery to get a prior authorization. So prior authorization required for all of their customers who needed cataract surgery. And let's see how much you've learned on Knock Knock Eye so far, folks. Who gets cataract surgery? Everybody.

Everybody gets cataract surgery. If you're over 60, you have cataracts and eventually you will get cataract surgery if you live long enough. And guess what? People are living longer. Everybody gets cataract surgery. 4 million cataract surgeries performed every year in the US. Most common surgery out there. And so you can imagine this was, there's a huge deal in the world of ophthalmology, big regulatory burden, especially in practices that had a lot of Aetna patients.

Um, and so I, of course I made a video about it. And during that video, I, I, I put up a piece of paper on my wall cause I like to make little posters and show them in videos sometimes. And this one, it was about the, what the Aetna mission statement was. And it just, I used Aetna's logo on this poster and underneath it, it just said, be evil period.

So I put that out there. A couple of weeks later, I get a message from somebody, one of my followers on social media, who's well-connected and new people in the C-suite at Aetna.

And what they said was, what this message said was the company CMO, the chief, in this case, it was the chief marketing officer, but someone in the C-suite. The company CMO saw the Glockenflecken video on Prioroth and held a huge internal meeting about it. The CMO was angry about how the company was portrayed and wanted the video taken down.

Not how the internet works, everyone, just in case you didn't know. The PR folks told the CMO that they couldn't take the video down. And so the company decided to review their policies, though no one internally seems to believe there will be significant change. The point is that these videos are having a big impact and are more likely to bring about change in healthcare. Getting that message blew me away because that taught me that

These companies, they pay attention to social media and it matters to them, you guys. It matters. They care that people are complaining about their company. And it's not just one or two people. It's widespread. Public opinion matters to these for-profit companies. And so it may seem like we can't do anything to fight back against these billion-dollar corporations, but

It matters. All the stories, all the anecdotes, all the comments on all the videos talking about UnitedHealthcare, like that stuff matters. You don't have to have a big audience. You don't have to dress up in costume and record yourself as different characters in medicine.

It helps. You don't have to. But just putting yourself out there and talking about these things, it really does. It adds up. It adds up. And the company, if nothing else, what that message to me showed is that at least I'm making them angry. And I think we need to be making them angry. Because that means we're...

eating away at them. And, and then we can use that momentum to help actually create real change and scaling back PBMs and, and prior authorizations and, and just the cost of healthcare. I don't know. So it's, uh, I just, I shook my head when I heard about United Healthcare hiring this company, because it's like, what are you trying to, are you trying to make it worse for yourself? Cause I think that's what they're doing. Uh, because nothing people are saying is false. Like,

These outrageous things that I'm putting in my videos, yeah, the interaction between the characters are fictional, but it's all real. These things are happening to real people. Go to ProPublica. Google ProPublica UnitedHealthcare or health insurance and just read all the in-depth reporting that they've done over the past two years about all the insurance companies, but mostly UnitedHealthcare.

That's how we know about Evacor, the hilariously named company external to UnitedHealthcare called Evacor, E-V-I-C-O-R-E, which is a company that UnitedHealthcare, they export their claim denials to this company, not their claims, their claims to another company in order for them to deny them.

So it's like a way to deny claims more efficiently is hiring this external company called Evacor. So anyway. All right. That's the end of my rant. All right. We're good to ophthalmology stuff. 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. Yeah.

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 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. 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. All right, now I'm fired up, you guys. I'm ready to go with ophthalmology. All right, I got to tell you, I got a couple of main things that I want to talk about. The first is this. I told you about that. I had a little little pants patient incident. And this also goes back to one of my videos, one of my personal favorites, which was

The doctor getting a phone call from somebody, another doctor, and says, hey, you remember that patient you saw last week? I had one of those moments. I had one of those moments. One of my partners who was on call for our practice sent me a message saying that a patient that I had done surgery on about a month ago all of a sudden had an eye pressure of 70%.

but it was in the non-operative eye. So the eye I did not do surgery on and my stomach just dropped. I was like, Oh no, this, uh, that's, that's awful. I, you know, what are we going to do? Turns out it was angle closure glaucoma. So this patient ended up being seen at the university, um, before we even got wind of what was going on. They were, they already showed up to the emergency department and, um, with angle closure glaucoma, just to give you a quick recap. So, um,

The eye is constantly making fluid and draining fluid. Think of the eye as like a bathtub. You got two bathtubs in your face and the eye, you know, the faucets turned on and the drain is open. So you have this steady state of fluid inside the eye. Well, if the drain closes and there's lots of different reasons you can get a drain to close the eye drainage system, which is right at the edge of where the cornea is.

touches the iris. So right on the edge of the white part of your eye, right where you start to get to iris, that's where your trabecular meshwork is. That's where your drainage system is inside the eye.

So sometimes it gets plugged up because, or it gets closed. It closes off because you have, you know, a scar tissue that's closing the angle or you have abnormal vessels, what we call neovascularization of the iris that causes neovascularization.

the angle to close. We see that sometimes with patients with severe diabetic retinopathy, or they've had a retinal vein occlusion and started to develop neovascularization because the eye is so ischemic, it's making all these really fragile little blood vessels to try to increase the vascularization of the eye. Sometimes the eye is just small.

And as the lens in the eye, as it gets larger when you develop a cataract, well, that lens in the eye is taking up more amount of space in the eye. So as that lens fattens up, gets bigger, it starts to push everything forward and narrows that angle, narrows that trabecular meshwork, and it can narrow it enough to where it just, boom, closes off.

All of a sudden the drain is closed, but the faucet still works on your bathtub eyeballs. And then the eye just fills with fluid. You get this really high pressure. We know from monkey studies decades ago that if you increase the pressure enough in the eye, it'll decrease the blood flow. And then if you decrease the blood flow to the eye long enough, then the optic nerve dies out.

And so it's kind of a race against the clock. That's why angle closure glaucoma is one of the true pants patients in ophthalmology. Like really, that eye pressure, you got to do everything you can to get that eye pressure down as efficiently, as quickly as you can. So one way, so that's what this patient came in with. She already had a small eye.

So it was about 21 millimeter eye. I'd say normal size is like 23 to 24 millimeters. And so a smaller eye, everything's a little bit more crowded. She had a cataract. I was planning on doing the cataract surgery coming up pretty quickly. Unfortunately, she went into angle closure glaucoma. So the drainage system closed off. The fluid was building up in the eye. And in the acute setting, there's two ways to try to fix this.

Patient comes in the emergency room, pressure 70, acute angle closure glaucoma. What are you going to do? Well, one option, the conservative option would be just to pound that patient with eye drops. So we have lots of different classes of pressure lowering eye drops that sometimes they try to open up the drainage system. You can't really do that with angle closure because it's closed. It's not opening up.

So the other way to do it is to turn off the faucet. And so we have numerous medications, temolol, dorzolamide, carbonic anhydrase inhibitors, that the way they work is turning that faucet off inside the eye. So the eye stops making fluid. And it can be very effective. We also have oral inhibitors.

carbonic anhydrase inhibitors, acetazolamide. That works really well. It's one of the strongest things we have to try to decrease the production of aqueous inside the eye. Whenever I've seen patients in the emergency room with angle closure glaucoma, that's the first thing I start doing immediately. As soon as I know that that pressure is high and what we're dealing with, I'm just

blasting that patient with eye drops. Like every 10 minutes, every 30 minutes, I'm putting in another round of these pressure. We got to get that faucet turned off. But that's only a temporizing measure because we can't obviously keep a patient on that amount of eye drops like forever, right? So we got to do something else. And for angle closure glaucoma, for an acute episode like this, one thing we'll try to do is create a separate pathway for fluid to drain.

And so one part of the problem is that fluid that's being produced by the ciliary body inside the eye, it doesn't have a way to get around the iris and reach the angle of the eye where the drainage tubes are. And so what we can do is create a small hole, a small opening in the iris. We just take a laser like asteroids. We just shoot that hole through the iris and all of a sudden you have a new path

for fluid that's trapped back there behind the iris, you have a way for that fluid to now come forward and reach the angle. And it's super cool when this works because you do the laser and then you create that opening and all of a sudden like the eye, the iris, which is it's in something called iris bombay. It's like being pushed forward because of all the pressure behind it. All of a sudden it just relaxes.

and the pressure goes down and it's just it's a beautiful thing when it works that well in an ideal world unfortunately this patient my patient and i didn't do this laser this is probably done by one of the residents over at the university um this patient uh uh whenever the eye pressure has been high for too long the cornea starts to get cloudy it starts to get swollen

And you need a clear cornea to see what you're doing with a laser for the laser to even get to where it needs to go on the iris. So there was a valiant effort done by the resident to get the pressure to do the, what we call laser peripheral iridotomy, but it wasn't enough. There was not a good enough view to the iris to get that done. So it was aborted trying to do the laser.

And so what are you left with? Well, just pounding with drops. Just keep doing the drops. And it worked. The pressure got down. It got down to under 20, which is fantastic. But then what do you do? Well, you got to figure out a way to just for the long term release, open up that drainage system. And one of the best ways to do that for someone who has a big cataract is cataract surgery. So that's what I did today.

I found out about this patient yesterday morning and I worked with her, their schedulers to get the patient to come in today during my surgery block. Did the cataract surgery. It went great. Pressure is going to be fine. It's almost impossible to get an angle closure glaucoma from that thick lens like we're talking about after you've had cataract surgery because the thin, the artificial lens we put in the eye is so much thinner.

So we've basically eliminated that patient's risk for angle closure glaucoma, assuming nothing else happens in the eye, knock on wood. So I think she's going to be okay. We'll have to see if there's any permanent vision loss during the time when she had that 70 pressure.

Good chance that there's going to be some peripheral vision loss, but I'm hoping that it doesn't affect the center of her vision. Fortunately, her other eye went great 2020. So kind of remains to be seen, you know, what effect that's going to have on her vision going forward. But I feel good about the care that she received. There's good communication between the emergency department and

The resident who saw that, who contacted our doctor who was on call, who got in touch with me right away. And then we got her in for the surgery that she needed. So sometimes when the medical system works the way it's supposed to,

It's a beautiful thing. So, uh, um, I, I just, I really appreciate all my, all my partners. Cause it's a scary thing. It's scary for the patient. It's scary for us because, um, you know, that's, this is one of the, the, the nightmare scenarios sometimes is this high pressure is angle closure glaucoma. You don't see it often, but when it happens, it's, um, it's a big deal. So anyway,

um, try to give updates laid down, down the road. All right, let's take one more break. I have some comments to address and then a segment I'm calling difficult conversations. All right, we are back. So a few quick comments on the YouTube channel. So, um, uh, these are on our YouTube channel at Glock and Fleckens. All the podcast episodes are there. Uh, it's where I get all of these comments. So if you watch, leave a comment, you know,

question thoughts jokes i don't care what it is you know if it strikes my fancy i'll read it on these episodes so we have a few what the first one is at vance underscore tang said wait knock knock i and knock knock hi are two different series laughing face uh

I think, uh, hopefully you're joking, but if case you're not, I realized I should probably address this. Yes. We have two different episodes. Once a week, we do an episode where me and Kristen, sometimes we're just like talking to each other and, um, just like, like, uh, you know, married couple who works together does. And we talk about things in society or just weird things that happen in our daily life. Sometimes we have interviews with people. We just recently interviewed a, um,

uh one of the um uh like the biggest names in canadian hockey and if you're a hockey fan uh go check it out uh and then once a week i have one of these knock knock i so it's like one episode of eyeball stuff one episode of just random things uh with me and kristin lady glock and flecken so yes they're both on the channel by the way so check it out uh let's see at norn iea

This is a good one. Topic for conversation. Risk of NAION from using Ozempic. So this is a really good topic. I may have talked about this once before, but there has been a study. It was published. I probably didn't talk about this because it was published in 2024. Well, it was in July, so maybe I did address it. So there's this disease called non-arteritic ischemic optic neuropathy.

N-A-I-O-N. Basically, you just lose a little bit of blood flow to the head of the optic nerve that causes you to have vision loss. And we have an observational study of something like 16,000 patients who were taking Ozempic.

And what this study showed is that there was a higher risk of NAION in patients prescribed semaglutide compared with patients prescribed non-GLP receptor agonist medications for diabetes or obesity. So yeah, it's a little bit alarming. Now, this is an observational study, right? It did show that there was a higher risk

of an ION, but it's not a prospective study. So you got to look at the level of evidence here. And although it is, it's certainly something that would benefit from a prospective trial looking at this. So whenever, you know, any study, their conclusions, like more studies are needed, absolutely more studies are needed to look at this because an ION can be a pretty devastating disease. Um,

in our neck of the woods and but you have to like life's all about risks and benefits right so like yeah they're on ozempic or whatever it is munjaro and um uh their life their health gets better because they're losing weight they're they're you know decreasing their amount of insulin they have to use and just there's so many benefits that we're seeing to this do those benefits outweigh

What's most likely a very, very small risk of developing an AION? That's a hard question. That's why informed consent is just so important with stuff like this. Like you, you, you just, you talk about it with your patient. And I would say I haven't gotten into the habit of bringing this up for patients who are taking AION.

taking one of these GLP-1 agonists. Maybe I should. I haven't done it yet. I'm not sure what the data, how to address it really with the amount of data we have, this observational study. And it does, I mean, these medications are like life-changing for people. And so, you know,

I don't want to scare people and I don't want to say, I don't think it's my, I can tell people like, yeah, there's this study that show there's an increased risk of this ischemic optic neuropathy, but then how do I accurately assess that risk for somebody without

Just making them like nervous that they're going to go blind, you know, because a lot of times people just think in black and white. Oh my gosh, this is, I might go blind from this medication. Well, it's helping you in all these different ways. And the risk based on what we have, the data we have is very, very low, like less than a 0.05% or something like that. So anyway, I, I don't think it's like a, this, like this bombshell thing.

type of thing, like we can't be prescribing this because we don't have the data to back that decision up. So anyway, I am watching it and I am appropriately concerned while acknowledging that these medications are really good for a lot of different things, just might not be great for your optic nerves.

So I don't know. There remains to be seen. I'm interested to see what's going on about this, you know, in the next year or two and see if more data comes out about it. But good question. All right, let's do a couple more. Okay, here's one. At S.A. Mary Liss says, when I heard about people cutting their eyelashes, that was the last episode I talked about that, that trend on TikTok. I immediately thought of that house episode.

where the patient had used toenail clippers to trim their nostril hairs and ended up getting some kind of foot fungus in their brain. I would be worried about doing that kind of stuff near my eye. You'd have to have sanitized blades.

Good. You know, anytime we can relate a dangerous thing on social media to house, I'm all for it. I've got to, I have not, that, that episode does not come to mind, but it's, it's, it's an interesting thought. Yes. I don't know. What are people trimming their eyelid? And it's really close to your eye. That's close to a mucus membrane. And mucus membranes are prone to getting infections by, from things because bacteria love moist things.

hot environments. Although your eyes aren't as hot as other mucous membranes. This is kind of getting into a kind of a gross conversation, but a couple of the things about eyelashes that I think people were wondering about when you cut eyelashes, they grow back in like two weeks. So very quickly, as opposed to like plucking your eyelash, which don't do by the way, or eyelashes to just fall out at the follicle. Those take like six to eight weeks to come back.

So, um, even if you do, for some reason, decide to try this trend where you, you trim your eyelashes, I mean, they're going to grow back in a couple of weeks, but just like, why, you know, why keep them, just keep them. All right. And the last thing I want to talk about before we wrap up here. Oh, difficult conversations. Okay. This is something that's come up a little bit in my life recently is like, what are the, and I've been thinking about this, like, what are the most uncomfortable things

awkward conversations I as an ophthalmologist have to have with patients. There's two big categories for me. One is talking about weight, a few circumstances where we have to do this. All right. So like telling patients like what, what's going on is because they've gained weight or they're overweight or obese. And so one of them is with the disease, idiopathic intracranial hypertension. We've talked about it on this podcast before and,

um, basically increased pressure around the brain. That's, um, a big risk factor for it is being overweight. And so that's always a kind of a, like can be a little tricky conversation to have with someone. Obviously you tried to do it respectfully, but, uh, it's, um, it's a, uh, that could be, it could be tough, tough to hear, tough to bring up, um, to say that, you know, it's your weight is a big part of, of what is happening here. And so, um,

You know, trying to work with them and, you know, their primary care doctor, whoever would be better at talking to someone about ways to lose weight is that can be a challenging conversation that I've had to do a little bit, a couple of different times over the past month, I would say.

Another one with weight is with Plaquenil. Now this is actually the opposite. It's kind of a weird thing because hydroxychloroquine, one of the big risks of it, and it's not even a big risk, it's a small risk, is that medication carries a risk of permanent vision loss, which is why with the Plaquenil, the hydroxychloroquine craze with COVID, it was just like, okay,

just driving ophthalmologists up the wall because it's like, this is not just a, this medication is not benign. Like it, it's, it has risks to it. One of them being that you could permanently lose some of your photoreceptors in the center of your retina. And she had big blind spots in the middle of your vision. Nobody wants that. And so,

you know, a few times a week, I'll get patients that are on hydroxychloroquine and we have to do an evaluation to make sure they're not showing any signs of maculopathy, what we call it. So toxic maculopathy from Plaquenil is pretty rare. You have to be on the medication for years before you even have a somewhat significant risk of developing it. So if you just started that medication, you've been on it for just a few years, like your chances are you don't have it, but your risk goes up

the higher the dose and the lower weight you are. It's a weight-based risk. So the way to mitigate this risk for Plaquenil is to be on a dose that's less than five milligrams per kilogram per day. And so patients who are overweight or obese, they're much lower risk of developing toxicity.

But it's the opposite if you're very thin. We don't want you on a large dose if you're thin because it's a weight-based risk. And so your milligrams per kilogram is much higher if you're very thin and you're taking what's considered like a normal average dose of hydroxychloroquine. So that's another situation where I have to talk about weight as an ophthalmologist. It doesn't happen often. And I'm not the best at it just because it's not a big part of my job.

The other difficult conversation that I have to have from time to time is when patients come in with uveitis and I have to somehow tell them that we need to check for syphilis. I still haven't quite figured that one out. I don't optimize. We don't do a lot of sexual history taking. I still remember and somewhat mortified the time in med school, the first sexual history I had to take on a patient in my internal medicine rotation. I had to ask someone if they'd been having anal sex.

I don't remember the details, something about a UTI. I don't know, but it traumatized me. Maybe part of the reason I became an ophthalmologist, but here I am still occasionally have to go and do it a little bit about the sexual history stuff. So having to tell it's okay. This is just one of the things we always have to check. People with uveitis have inflammation in their eyes. It could be

So we went to check for that. Who knows? I've learned to stop saying it's probably going to be normal because honestly, you never know. And I have been fooled in patients who ended up having neurosyphilis. But I never feel that's hard for me. It's hard for me to do the sexual history stuff.

It's just so far outside my normal day-to-day conversations with patients. So anyway, I think I'll leave you guys with that. Let's see. How about one more YouTube comment from at end root? I, for one, enjoy not having blood infections. I will keep my spleen unless it needs to be removed. Thank you. I love the spleen apologists.

Um, you know, it's great because some of these comments I get, cause I check them about a week after the, the episodes published. And usually it's about two weeks after I record that episode. When I read the comments, sometimes I like, I learn from you guys. What are the things that I said in this, in, in the video? I forgot, like, I don't remember going on a rant about the spleen, although I am, I am, you know, I do that from time to time.

So it's kind of funny. He's like, oh, I must, I guess I did talk about, about my hatred for the spleen. It's all in jest, right? Although I do think we would be a little bit better having two livers, but it can't, you know, I can't argue with evolution. I don't know. I'm sure there's a reason. Something to do with bloodborne infections. I don't know. I'm an ophthalmologist anyway. You know, end root, keep your spleen. No one's going to take it out of you. All right. We're not paying people for organs yet.

So I'm just saying it's a thought experiment. What organs would be better if we had two? I mean, two eyes are great. Two kidneys. Awesome. Two spleens. Why? Two livers. That makes a lot more sense, doesn't it? Anyway, what other organs would you like having two of? Let me know in the comments.

That's it for Knock Knock I. Thank you for listening. I'm your host, Will Flannery, also known as Dr. Glock and Flecken. Thanks to my executive producers, Aaron Corny, Rob Goldman, and Shanti Brook. Editor and engineer is Jason Portizzo. Music is by Omer Binzvi. Knock Knock I is a human content production. We'll see you next time, everybody. Bye. Knock knock. Goodbye. Human content.