Knock Knock, Hi! with the Glaucomfleckens

I just wrapped my second call week of the year, and honestly, getting older has made overnight pages so much harder than they used to be. At 30 I could wake up from a dead sleep and immediately have a coherent medical conversation, and now, ten years later, I basically have to be walked through who I am and what hospital I'm even at before I can function. I also tell the story of getting completely lost in a big Portland hospital after hours, which honestly just confirms the stereotype that ophthalmologists get lost in hospitals.

Then I get into something a lot more serious: my latest deep dive into hospital administrations behaving badly, this time at Asante Rogue Regional Medical Center in Medford, Oregon. Nine neonatologists, an incredibly stable, highly skilled group who'd been building this NICU program for two decades, were told in January they were being let go, with shifting and frankly contradictory explanations from the hospital. I walk through the timeline, including the hospital's decision to bring in a private equity-backed locums staffing company, a VP's misleading public comments about the firing, and the deleted panel video that followed once I called it out. I explain why I keep making these videos, even when people ask what the point is, because these decisions affect real patients, and communities deserve to know why their care is changing.

Takeaways:

Turns out being a doctor and getting woken up at 3 AM hits different in your 40s than it did in your 30s.

Asante Rogue Regional Medical Center fired all nine of its neonatologists in January despite the group having no departures since 2021 and meeting national quality benchmarks.

The hospital's stated reasons for the firings shifted over time and were contradicted by a hospital VP's own public comments about ongoing retirements.

Locum staffing companies are typically meant to bridge short-term staffing gaps, not replace an entire well-functioning department, and often cost hospitals significantly more per hour than the doctors they're replacing.

Physicians who raise patient safety concerns internally can face professional and legal pressure that discourages them from speaking publicly, even after losing their jobs.

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

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If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15

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A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

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This week Kristin and I get into "Ozempic face," which has been all over social media, and I break down what's actually happening medically when people lose facial fat quickly on GLP-1 medications. Kristin gets grossed out the moment I bring up orbital fat, so we go down a whole rabbit hole about fat pads, blepharoplasty, and why your eyes need that squishy cushion behind them. I also share something newer in ophthalmology: GLP-1 medications are now considered a rare but real risk factor for a type of vision loss called ischemic optic neuropathy.

Then we get into a story from a Cake concert I took our kids to while Kristin was out of town, where our teenage daughter and her friend somehow knew every word to a Black Sabbath cover better than half the adults in the crowd (genuine proud dad moment). After the break, I keep working on my medical Spanish with more phrases sent in by a listener, and Kristin does her best to correct my pronunciation.

Takeaways:

"Ozempic face" refers to the hollowing and sagging that can happen when someone loses facial fat quickly on GLP-1 medications, it's a side effect of rapid fat loss, not a direct effect of the drug itself.

Facial fat loss on GLP-1s can also affect the fat pad behind the eye, which may contribute to a more sunken appearance around the eyes.

GLP-1 medications are now considered a risk factor for ischemic optic neuropathy, a rare condition involving reduced blood flow to the optic nerve, though the overall risk remains very low.

Orbital fat plays an important structural role in cushioning and supporting the eye, and its loss or migration can contribute to changes like under-eye bags or a sunken appearance.

Learning key medical Spanish phrases, even imperfectly, can help physicians communicate more effectively with Spanish-speaking patients.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects.

Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

To get your Henson Razor go to ⁠hensonshaving.com/knockknockhi⁠ and use code knockknockhi to receive 100 blades for free with the purchase of a razor.

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I've got a love-hate relationship with research, and this week I finally get into why. I'll read a study, I'll watch a talk, I genuinely enjoy learning about it, but performing research myself has never been my thing, and I get into the whole story of how I ended up doing it in med school anyway purely to check a box. Then I break down the newest NRMP match data, and the numbers are insane. We're talking applicants matching into ortho and neurosurgery with over a hundred research experiences and dozens of publications, and I explain why I think this whole system has turned into a predatory arms race that has very little to do with becoming a good doctor.

After that, I get back to some actual eyeball content. I dig into a fascinating study out of Portugal on wind instrument musicians and their eye pressure, and it turns out playing high-resistance instruments like trumpet, oboe, and French horn can cause real spikes in intraocular pressure, potentially even mimicking a condition called normal pressure glaucoma. I walk through some of the older research on this topic too, and honestly, it's the first time in ten years of practicing ophthalmology that I've even heard about it. If you're a serious wind player, this one's worth a listen.

Takeaways:

The number of research experiences, abstracts, and publications reported by matched medical residency applicants has climbed to levels that go far beyond what's needed to become a good clinician.

Doing research as a medical student is not a requirement for becoming a skilled doctor.

Wind instrument players, especially those using high-resistance instruments like trumpet, oboe, and French horn, can experience measurable spikes in intraocular pressure while playing.

Chronic pressure spikes in musicians could potentially be misdiagnosed as normal pressure glaucoma if a patient's musical background isn't factored into their history.

Professional musicians who play high-resistance instruments at a high level may benefit from routine glaucoma screening.

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects.

Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

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This week Kristin and I start off with something I've been wanting to work on for a while, my medical Spanish, because we're opening up a new location and I want to actually be able to communicate with my Spanish-speaking patients. Kristin was a Spanish major, so she helps me practice phrases sent in by a Spanish-speaking listener named Gabe, and let's just say it does not go great.

Then I give Kristin a real update on my acting class, which has become my midlife crisis hobby of choice after bouldering nearly took out my elbow and beekeeping felt like too much commitment (and too much risk of me acidentally killing a bunch of bees). What I didn't expect going in was how much I needed something that has absolutely nothing to do with healthcare. Something else I really wasn't expecting: making actual friends who have nothing to do with our kids, which apparently is possible even after 30. If you're looking for a sign to take that random class you've been thinking about, this is it.

Takeaways:

Trying a hobby that's completely unrelated to your career, especially in healthcare, gives you a real mental break and can be genuinely good for your well-being.

It is possible to make genuine new friendships after 30, even ones that have nothing to do with your kids' friends' parents.

Learning common medical Spanish phrases, even imperfectly, can help doctors better communicate with and care for their Spanish-speaking patients.

Learning a brand-new skill later in life, and simply being bad at it for a while, can be a rewarding experience on its own.

Shared proximity and shared experience, like being in a class together, are two of the biggest drivers of forming new friendships as an adult.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15

As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects.

Check out FIGS on social platforms: @wearfigs

--

A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.

Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off.

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I wanted to start this one off talking about Sydney Towle, a 26 year old TikToker who documented her stage four cholangiocarcinoma diagnosis with so much humor and honesty that it genuinely impacted me, even though I never knew her in real life. Her passing hit hard, and it brought back a lot of what I went through with my own testicular cancer diagnoses at 26 and again at 31. I talk about how isolating it is to get a cancer diagnosis as a young adult, how most of the research and attention goes to kids and older adults, and how organizations like First Descents helped me find my people when I needed them most.

Then I get into some actual eyeball stuff, because that's still what this show is for. I break down a fascinating case out of Ireland, the country's first ever transorbital neuroendoscopic surgery, where surgeons went through the eye socket to remove a meningioma pressing on the orbit. I get into how that surgery works, why the orbit is basically an obstacle course of tiny structures, and why neurosurgery always takes precedence when ophthalmology, ENT, and neurosurgery are all in the room together. I also can't resist going down a history rabbit hole on ice pick lobotomies, which were done through the eye socket, and I even throw in a random fact about the Bayeux Tapestry and a king who allegedly took an arrow straight to the eye.

Takeaways:

Young adult cancer patients often feel isolated because most cancer research and support resources target children or older adults.

Organizations like First Descents and Stupid Cancer exist specifically to connect young adults facing cancer with a supportive community.

Ireland's first transorbital neuroendoscopic surgery used the eye socket as a pathway to remove a brain tumor pressing on the orbit.

Neurosurgery typically takes precedence in multidisciplinary trauma cases because saving a patient's life comes before preserving their vision.

Ice pick lobotomies, performed through the eye socket, were still being done as recently as 1960.

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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If you want more information on models I use:

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