@optotrician: Sunwear in Jewelry?

Guy with thick accent (Indian?) holding up $9.99 sunglasses: Do you have anything cheaper than this?
Optician: Over in jewelry there are more sunglasses.
Guy: Yes. Cheaper?
Optician: I don’t know for sure, but probably a few might be cheaper.
Guy just stands there.
Optician pointing to jewelry: Over in jewelry.
Guy: Where?
Optician: Look right over there. Jewelry.
Guy: Sunglasses?
Optician: Yes, a different selection over in jewelry.
Guy: Cheaper?
Optician: You’ll have to look and see.

I did an eye exam almost 3 years ago. The patient paid their copay. A couple weeks later the insurance paid the rest, a whopping $15. Almost three years later the insurance said their payment was made in error, so I have to remit to them a check for $15 or else a future EOB would have $15 deducted.
Whatever, they can deduct it, but I ain’t sending a check. Do they expect me to send the patient a statement for $15 for an exam from three years ago? Never mind the patient has probably moved, and even if they haven’t, they will probably shrug off the statement like I did from the insurance.
A month later the insurance takes $15 from one of my EOB payments. Luckily I don’t bother billing the patient because a week later, they sent me a check for the same patient’s three-year-old visit!
Make up your mind, insurance company!
[UPDATED: Today BCBS sent me ANOTHER letter saying that they overpaid me for this patient when they repaid me! Eat poop, BlueCross!]

I had a patient who has a really big head and his regular size glasses were making an indented, red scar in front of his ears. Of course I recommend the largest style frame we have called FatHeadz. He finds one he likes, and it fits his head perfectly. The optician enters the order, but the lab calls and says they can’t make it. It turns out he has a small PD; therefore, they don’t make a lens blank large enough for his combo of large frame, small pd. Poor guy.

@optotrician: Nice Soup-strainer!

There is a different vaccine nurse at the table in front of the V.C. every day!

I observed a guy with the biggest mustache I’ve ever beheld. Imagine walking around with a dresser comb under your nose all day. Then, later the same day I saw another guy with what is now the biggest mustache I’ve ever seen! Just think of a blond Yosimite Sam.

It is my experience that youth who have trouble with the NCT and dilation drops tend to be unsuccessful at learning to insert contact lenses. But a teenage boy surprised me recently when after 20 minutes of trying, I had him take the contacts home to practice. He returned for a followup being successful!

This week I had a day where 100% of my exams were contact lens patients! Crazy! (It’s usually ~50%.)

Atkins/Paleo/VLC Diets in AMD, DES, and other Eye Conditions

I would like to propose that someone perform a series of studies regarding living a low carbohydrate/high fat diet and its effect on inflammation-related eye disease.

I read The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Drs. Stephen Phinney and Jeff Volek. An interesting conclusion is how our bodies become carbohydrate intolerant as we age, which pushes many people into metabolic syndrome, diabetes, and hyperlipidemia. It turns out that carbohydrates, by taxing our insulin response, cause inflammation.

Hence, the American Heart Association’s war on fatty food is misguided (see Good Calories, Bad Calories by Gary Taubes) because dietary fat is only bad in the presence of too much carb intake.  While there are some high omega-6 oils which increase inflammation, it is easy for people on Very Low Carbohydrate (VLC) diets to intake the good fats like olive oil, canola oil, high-oleic safflower oil, butter, animal fats, and coconut oil. In VLC diets, your daily Caloric intake is approximately 80% fat, 15% protein, and 5% carbohydrate.

Recent research, CE lectures, and trade articles have been advising us to tell our patients to increase their omega-3 fatty acid intake via Fish/Flaxseed oil pills.  With the latest research coming from Dr. Phinney et al, wouldn’t it be more responsible to educate them regarding the New Atkins/Paleo/VLC diets?

VLC diets are already proven to tighten diabetes control which we know decreases incidence of diabetic retinopathy. Logic tells me that Atkins/Paleo/VLC will soon be proven to reduce incidence and/or severity of macular degeneration, dry eye syndrome, and any eye condition related to inflammation.

So, anybody want to do some studies?

I’d start by visiting this helpful website and reading these books:

DISCLOSURES:

Dr. David Langford before-after 50 weight loss (6'0"- 221 to 170)
With all the lost weight, I have the energy to carry other things! 😉
In 2010 I lost 35-45 pounds using the hCG diet, but could never keep off the last 10 lbs, so in 2012 I switched to the New Atkins. Now I easily maintain a 50 lb weight loss (221 to 170), and my body doesn’t even crave things like pizza and popcorn.
Also, if you click on the links above and actually buy a book, I get a tiny referral bonus from Amazon.
David-Langford-weight-loss-history
Dr. Langford’s weight loss history.