Godzilla 2014 and my Visceral Hatred of its Choices

WARNING: *Spoilers*

As I mentioned before, I saw Godzilla (2014) in 3D with my son in the movie theater. At the time, I was disappointed with the story choices they made regarding killing the father off early on.

I saw the movie again on BluRay with the entire family, and I felt felt a strong, visceral hatred of the storyline- made worse by the fact that everyone was board. My girls fell asleep. My son was on the laptop Googling Minecraft stuff. My wife was into the movie at the start, but after the Hawaii sequence (the one right after he dies), she started shopping on her phone! I had to tell her to look up every once in a while so that she wouldn’t miss a nice shot, like when the son jumps out of the airplane or when Godzilla opens the mouth of the female monster and breathes fire into her. (“Why didn’t he just do that at the beginning instead of destroying the city,” she said.)

I just wasted my family’s entire evening! It was a gigantic waste of potential in exploring the divide between a father and son after the death of the wife/mother as well as the decisions military commanders and scientists make. After the father dies, I no longer care about the human story and keep looking at my watch waiting for the monsters to fight so we can get this movie over with.

I will propose ways the story could have kept me entertained, but first let me go beyond my visceral response and repeat and expound logically about the flaws in the story of Godzilla (2014):

…the Godzilla movie left me emotionally unsatisfied for 3 reasons:

  1. I thought the movie was about the father, but then they take a turn, and I guess we follow the son the rest of the movie even though the father had all the emotion in the first act.
  2. Everyone knows you don’t kill the mentor until the end of the second act.  If the father isn’t going to play the hero, then I guess he is the mentor.  They kill the father in the early second act.
  3. Fine, you kill the father early on, but you’re not going to let us see any catharsis with the father and son? Seriously, the closing image should have been the son at the father’s grave or something. Emotionally I want to see the son reconcile with his father.

Further, killing the father eliminated the only character I cared about. He’s the only character the story explored, and they don’t even reference him at all the rest of the film! His death meant nothing to anyone, not even his own son as far as we can tell.

The son is just a punk who barely says anything. He’s too quiet. Sure, he’s got a wife and kid and just came back from the Sand Box, but big deal. Why should I care about him when I just watched his father close the blast door on his mother.

Also, the filmmakers missed a great promotional opportunity with Dr. Ishiro Serizawa, played by Ken Watanabe. In every scene, he should have been carrying a bottle of Jack Daniels (or whatever brand of alcohol that would pay the most to be in the film). That’s the best way to explain his character’s broodiness.

The Problem with Godzilla (2014)

I took my son to see Godzilla in 3D on opening night. It was great that we shared the experience, but the Godzilla movie left me emotionally unsatisfied for 3 reasons:

(Spoilers ahead)

 

  1. I thought the movie was about the father, but then they take a turn, and I guess we follow the son the rest of the movie even though the father had all the emotion in the first act.
  2. Everyone knows you don’t kill the mentor until the end of the second act.  If the father isn’t going to play the hero, then I guess he is the mentor.  They kill the father in the early second act.
  3. Fine, you kill the father early on, but you’re not going to let us see any catharsis with the father and son? Seriously, the closing image should have been the son at the father’s grave or something. Emotionally I want to see the son reconcile with his father.

Anyway, other than not being emotionally satisfying, Godzilla 2014 was…fine.

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.

Flurisafe Review

Flurasafe
This yellow diagnostic drop is the new black.
Flurisafe comes in a 6 mL dropper manufactorered by AL-ROSE Enterprises and is composed of Fluorexon disodium with benoxinate. Fluorexon’s heavier molecular weight makes it “safe” for use with soft contact lenses since it won’t permanently dye it yellow like fluorescein will.

If you don’t use Flurisafe, then you should try it out. I’m confident that you and your patients will like it better than fluorescein sodium/numbing drop combinations (benoxinate or proparicaine).

Here are my reasons:

  1. My patients report less stinging with Flurisafe compaired to FluorBenox and especially proparicaine.
  2. The mild stinging from Flurisafe seems to have a few seconds delay after installation, so that allows me to get the drop in both eyes easier for the little kids.
  3. Most older patients report NO stinging with Flurisafe.
  4. I can use it on any patient and not worry about rinsing it out with eyewash if they happen to want to try soft contact lenses later.

On the downside, it is a little more expensive than FluorBenox, but not significantly more. Also, I turn up my light level a little more using the blue light compared to using a Fluorette or BioGlo Strip; however, Flurisafe still lights up nicely while using a yellow Wratten filter (my slit lamp has one integrated; I just lower a pin.)

I get mine from Wilson/Hilco, but your usual ophthalmic supply company should have it also.

Try it! You’ll like it.

Disclosure: I have to financial interest in any companies or products mentioned above, and to date none of them have ever given me any free stuff.

Bad cord management on Sonogage Corneo-Gage Plus 1AS

In my original review of the Sonogage Corneo-Gage Plus 1AS, I neglected to mention one of my pet peeves. First, please look at this picture closely.

Bad cord management on Sonogage Corneo-Gage Plus 1AS

It shows an unwound cord while the probe wrests on 2 black, plastic deals. It is very tedious to manually unwind the cord.

Vacuum cleaner companies long ago invented a way for cords to be quickly unwound by turning a knob that allows the cord to be released. Please, Sonogage, follow their example and put a turny-knob-thingy on one of the deals that holds the probe so I can quickly release the cord. The more I use this thing, the more I hate spending the extra 3 seconds to unwind the cord.

Review of Sonogage Corneo-Gage Plus 1AS

In my first review for Optoblog, I’ll focus on the most recent equipment addition to our clinic, the Sonogage Corneo-Gage Plus 1AS. There are a couple different versions out there, the “1” and the “2.” We somehow got the 1AS. I’m not sure what the AS stands for, but it might have something to do with not having a printer. Sonogage’s website isn’t clear on the different models available, and the complete set of features they list are only available on the “2.” We chose not to get one with a printer because. . .what’s the point? Just write the numbers down in the chart! A few years ago, the docs that used to work in my clinic chose to staple into the chart note the little printout from our ARx/AK instrument. The ink has faded beyond recognition, so in my opinion the optional printer is a waste of money, and I’ll detail another reason why later.

We’ve had our Corneo-Gage Plus 1AS 6 months, and it hasn’t required a recharge on the battery. In fact, the battery level indicator still reads 100%! Truthfully, we only been using it 1-2x per day on average, but still, the battery life is pretty impressive.

The probe has 50 MHz transducer, which is a big selling point because it’s supposed to be more accurate than lesser frequencies. Available on the “2″ is the ability to measure epithelial thickness. Sonogage states they are currently the only pachymeter that does this. Also, the “2″ has feature of automatic IOP correction instead of having to look at a paper table.

On the downside, the most glaring inconvenience is that the Corneo-Gage Plus requires pressing buttons 3 different times in order to turn it off. Sure, I can see how you wouldn’t want to accidently turn it off, but requiring two button pushes would be sufficient. Three is overkill and a nuisance.

Picture of Sonogage Corneo-Gage Plus 1AS

While the cord from the instrument to the probe is 4’10”, that isn’t long enough to reach from my counter to the patient in the exam chair. Actually, I could get one eye, but the other is too far away. Many doctors will not have this problem, though, since my exam lane is probably wider than average. I just have to set the pachymeter on my stool during testing.

I can’t imaging they can’t make the Corneo-gage form factor smaller, especially for those of us who didn’t get the extra printer option. After all, the Pachmate DGH55 is a little larger than a big pen. I assume the bulk of the Corneo-gage form factor is from the battery inside. (I’d love to open it up, but that would void my warranty.) Despite being shoe-box size, it is completely portable between our 4 exam lanes.

Now, I will explain why the printer option is a completely useless option that is a total waste of money. The Corneo-gage Plus is continuous read, so you put the probe on the cornea and stay there until you here 5 beeps. Then go to the other eye. In the end you would have 10 readings, the first 5 are for the first eye, and the last five are for the second eye. For each eye, you automatically throw out the first and last readings. The lowest of the middle three readings is the corneal thickness which you record. No averaging is required. That is why I see no point in getting the printer models because you only have to write down (or hopefully type) one number per eye in your chart.

Some might say that not having a “Right” and “Left” button for taking readings is undesirable. I answer that it’s easy to listen for 5 beeps then switch eyes. No fuss with having to press extra buttons. It’s a time saver, really.

So, why did we choose to buy the Sonogage Corneo-Gage Plus 1AS sight unseen and without a demo? Thomas and Melton, of course. Those two guys’ word is optometric gospel. In fact, to all the drug reps out there, don’t even bother coming to my office. If you want me to use your product, you need to convince Thomas and Melton- not me. Anyway, they endorse this pachymeter, and that’s good enough for me.

One of their selling points was a free table for corrected IOP from corneal thickness. I would expect it to come with any pachymeter, so it’s not a real selling point. Also this is information available for free from many sources, including Melton and Thomas’s website. Another selling point is that they used this pachometer in some study. Big deal. Other pachometers were used in other studies, and any ophthalmic instrument maker can donate a several thousand dollar instrument to some poor study. (By the way, we paid ~$2,500 for our pachometer. That’s the government price. It’s hard to believe they’re worth that much, but selling to ECPs is kind of a small market.)

Some very useful information came with our Corneo-Gage Plus. The instruction booklet was very clear, helpful, and comes with a handout entitled “Pachometry Reimbursement Codes” to help you know how to bill. The guideline for billing pachometry is if there is “a reasonable expectation that the outcome of corneal pachometry will impact decision-making in the medical management of the patient.” So, every glaucoma suspect in your office needs this, and they will allow anyone with a c/d over .3 or elevated IOP to be a candidate for pachometry.

While following corneal disease, like Fuch’s, bullous keratopathy, or corneal edema, you may bill for every pachometry reading as long as you documented in your original plan of care the need for repeat pachometry. Reimbursement assumes a bilateral procedure, so don’t try to bill for one eye at a time. Just plan on always taking readings from both eyes. Medicare only reimburses a small amount (~$12) and only once in the lifetime of the patient with glaucoma.

So, your pachometer is not a money-making machine, but it is standard of care now. We should all have one, unless you are satisfied to be practicing like a commercial optometrist in the back closet of an optical shop whose only care is to sell more glasses. (Seriously, I interviewed for an optical chain which shall remain nameless. They had several locations all within one state. When I asked where the visual field machine was, he said none of the 16 locations except one had a visual field instrument. So then I asked how much disease they see. He replied something like, “Oh, the people who come see us don’t have much disease.” Right. Or maybe it’s just that you don’t look because your 10-15 minute exams don’t allow enough time to find any problems. And what’s the deal with having an exam “room” the size of a thimble and a curtain instead of a door? What are you- the wizard of Oz?)

Anyway, thumbs up for the Sonogage Corneo-Gage Plus 1AS (no printer). If I did a lot of LASIK co-management (or CRT?), I would opt for the “2″ for it’s epithelial thickness measuring ability. If fact, I would tell everyone to opt for the “2” anyway because it has the feature where you press a button on the selected measurement, and it tells you the adjustment number to find true IOP.