Thursday, April 30, 2015

The "PRACTICE" of Medicine

I am always saying: if you have an eye problem, go to an eye doctor. The jack-of-all trades primary care doctors really don't know what to do with you. Just as another recent example of this, I was just sent a "picture quiz" from one of my medical apps. It detailed the case of an adult who had pain, redness and light sensitivity for weeks, despite using prednisolone (steroid) eyedrops (no word on how he got them, whether some other doc Rx'd those to him or he had them from some previous problem or he bought them OTC in Mexico or what). Here's the picture quiz with the multiple choice answers. The green check shows that I chose the correct answer (click the screenshot for a larger view): The biggest takeaway here is that given that rather obvious history and picture, still only 45% of medical docs made the right call. This is an app that almost all medical doctors and students have because it is specifically designed for MD's, so the vast majority of people taking this quiz are MD's. There are a few DDS's & OD's like me, but not many. This quiz is MOSTLY taken by MD's. So less than half of the respondants got the correct answer. That's pretty scary, especially given that there is really only one thing in medicine with that specific appearance of "dendrites". Nothing else even closely approximates that appearance, certainly not "keratoconjunctivits sicca" (dry eye) or "staphylococcal corneal ulcer" (bacterial infection). THE ONLY condition that causes dendrites like the ones in that picture is herpes simplex. So once again I say: IF YOU HAVE AN EYE PROBLEM, GO TO AN EYE DOCTOR. I kind of wished one of the answers had been "pink eye" because then I bet even less people would have chosen the correct answer. MD's can't stay away from a diagnosis of pink eye, haha. They did put "corneal abrasion" on there which is the other overly-diagnosed eye condition!

Wednesday, April 29, 2015

GPC GPC GPC GPC

It's rampant right now, mostly b/c here in East Texas we have had an unusual amount of winter/spring rain and the pollen is high high high. The allergist tells me its a 25 year high for pollen count. So even some people who have "never had allergies before" are having them this year. I have blogged on this 3 other times (here, here and here), and they are 3 of the most commented-on posts on my entire blog. It's a hot topic because it's a common problem that's very often misdiagnosed. And even when it's diagnosed correctly it's often treated improperly. Add to it that there is very little information on the internet about it and that the symptoms sound (to a regular doctor) like those of "pink eye", and you can see how this can snowball quickly. This has all been hashed out in gory detail on this blog before, but just to hit the high points again: 1) if you're a contact lens wearer with chronic red eyes, it's almost assuredly not "pink eye" that you're "catching over and over" 2) if your contacts used to fit fine but now they "move around a lot" or even "pop out", that screams GPC, no matter what your PCP says 3) don't go to a PCP for eye problems anyway 4) if you're young (under 40) and your contacts bother you it is probably not "dry eye" 5) if you have confirmed GPC, stop messing around with Rx's for Pataday. The real, long term fix is switching to DAILIES. 6) freshly-diagnosed cases of GPC who are miserable need Lotemax. Not FML or pred or dexamethasone or worse: crolom (6.5 if your doctor suggests crolom, find a new doctor). I actually read on Wikipedia (bad source, I know) that diphenhydramine (Benadryl) is often prescribed for this, and that brings up a point that I have been meaning to blog about. NO ANTIHISTAMINE PILL will do anything for your eye problems/symptoms. Yes, I know it says on the Benadryl and Zyrtec boxes that they treat "itchy, watery eyes". But it is my experience that it doesn't work well at all. Its "too far": swallowed, deposited in your stomach/digestive tract, absorbed into your bloodstream, metabolized by your liver, then travels AAAAAAAALL the way to the VEEEEEERY end of the capillaries on the surface of your eye...then delivers a dose of antihistamine that is potent enough to stop itching and watering? I think that's just a taaaaaad optimistic. How about apply the antihistamine (or better yet Lotemax) right to the site and get immediate results with the full potency directly to the area of the problem? Yeah that's more like it. It is my opinion that if you have itchy, watery, red eyes, NO PILL will work to give you relief. You need eye drops. What else? Please post new GPC questions here. Trying to find your new question amidst the literally hundreds of comments from 2009-2011 is really quite difficult. WHEN ASKING A QUESTION THAT YOU WANT A REPLY TO: always be the last comment. Don't "reply" to an OLD comment that's in the middle of a bunch of other old comments...that makes your question very hard to find and answer.

Monday, April 27, 2015

Wednesday, April 22, 2015

"Please Install BT Notifier in Smartphone" Error, part 2

With Lollipop OS now reaching Galaxy S4 users this week, I expect more than a few people are going to be having trouble making their RWATCH work. Never fear! I've blogged about this before but let's cut thru the junk, huh? HERE ARE THE FILES TO MAKE YOUR RWATCH M26 AND U8 WEARABLES WORK AGAIN ON LOLLIPOP: FOR M26 CLICK HERE and FOR U8 CLICK HERE. If you have questions, feel free to comment! Have fun out there, Android Wearables people!

Friday, April 17, 2015

Getting a Bonded Title for a "Classic Car' in Texas

So as I recently blogged I bought a "classic car" with no title. It's a 1972 VW Type 3 Fastback. I bought it as a hobby, just something else to do, as if I don't have enough. I probably don't have the time or money to fully "restore" it, for now I just plan on making it run and making it look presentable. The car has no title. It was lost literally multiple owners ago. So I began the process of trying to get a title for it before I dump any money into this thing. 1st I Googled how to do this, and I printed out multiple forms: VTR-130 SOF "Bonded Title Application or Tax Collector Statement of Fact", VTR 131 "Application of Title Only", Request for Pencil Tracing, 130-U "Application for Texas Title", VTR-270 "Statement of Physical Inspection", and VTR-275 "Request for Texas Motor Vehicle Information". I carefully and neatly filled out all of this paperwork before I even went to the country tax office. So I go in there on a Fri morning and wait in line. When it's my turn I greet the super smiley, very personable and cheery (are you catching my sarcasm here?) person and tell them I have purchased a classic car with no title and I need to apply for a bonded title. She curtly informs me that she cannot help me, and instead I need "line 4", not the line I'm in (line 6). OK off to line 4. Here I am met by an equally cheery man who after he says "NEXT!" in the manner of Jebidiah Atkinson from Saturday Night Live, listens to me quickly explain that I need a bonded title for an old VW. He takes all of my paperwork, looks it over and starts frowning. "You don't need THIS or THIS or THIS...or THIS. You only need THIS (Request for Pencil Tracing) and THIS (130-U "Application for Texas Title"). He hands all of these back to me. "Send those to the office in Waco. The address is on here" and he hands me a packet of all the same forms. OK so at least I have made a little progress. I know what forms to send and where to send them to. So that same day I send just the pencil tracing and the Application for Texas Title, along with a check for $15 to the Waco office. Two weeks go by. I get a letter in the mail from the Waco office! It says that I need to send in all the forms: VTR-130 SOF "Bonded Title Application or Tax Collector Statement of Fact", VTR 131 "Application of Title Only", Request for Pencil Tracing, 130-U "Application for Texas Title", VTR-270 "Statement of Physical Inspection", and VTR-275 "Request for Texas Motor Vehicle Information". Haha! BRILLIANT! I have officially wasted my time based on the wrong facts from the county tax office. Hooray! Knowing this would not be a fast process and knowing what dealing with a government entity is like, I am not too fazed by this. I already have all those forms, I just made more copies of them for my records and sent ALL of the forms to the Waco office. Yesterday (about a week later) I receive a letter saying that they "cannot" issue a title because there is no "properly assigned evidence". This is actually VERY GOOD NEWS. It means they did a search for the title and title owner and came up empty, which means I don't have to worry about trying to contact the old owner and now I am free to apply for a bonded title or "surety bond"! Yay! This was what I was hoping would happen! I am now going to call my buddy who owns an insurance company and have them sell me a surety bond and then I can have a title. There are services that do this online, but I want to give my buddy some business (unless they want to charge me an arm and a leg haha!). So I'm calling them next week, probably. It's Friday afternoon and I am not assuming anyone will start this today anyway. Hmmm maybe I'll call him today. Yeah, what the heck let's get this party started! EDIT: Called my insurance guy, he said "no problem, we do this all the time", had me scan and email him the "no properly assigned evidence" letter, which is apparently the Golden Ticket, along with a copy of my bill of sale, and he says they will charge me $100 which is exactly in-line with what I have read that the online companies do it for. So...the process has been officially OFFICIALLY started! I'll get the surety bond then apply for a bonded title and I should get it! THEN the real work begins...overhauling this thing to make it run and look decent haha

Wednesday, April 15, 2015

The Golden Age of Contacts?

It always makes me chuckle when someone complains to us about the cost of a box of soft contact lenses. Soft contacts are the cheapest and best they have ever been in history. There was a time in the 80's & 90's when optometrists were making a killing selling non-disposable soft contacts for $200+ each from their office, and even selling "contact lens insurance"...a $30 or so fee that guaranteed you a replacement at reduced cost (not a free lens, mind you, just the promise of a CHEAPER replacement!) if the lens was lost or ripped. This was before disposables and "before the dark times...before the EMPIRE!", the "Empire" being 1-800-CONTACTS. Right now as of Tax Day April 15th 2015 our office "makes" about $4/box selling contacts. WHOOOOO where are we going to spend all that extra dough? I'll tell you: $4 a box is not even enough to pay for the staff to order the lenses or call you when they get here, etc. Our overhead swallows up that $4 lighning fast. 1-800-CONTACTS brought the cost of a box of contacts so far down that it made contacts a commodity. We lose money selling you contacts. This is why we all charge that pesky "contact lens fitting fee" that patients hate so much and insurance companies mostly refuse to pay. So why even bother with contacts? A lot of doctors don't. But those of us docs practicing here in the real world know that glasses have their limits and not everyone is a LASIK candidate, and so contacts are a great, cheap alternative. Very cheap. Cheaper then they have ever been...and they're about to go up. Multiple manufacturers have announced plans to institute "unilateral pricing policies", which are going to drive the cost of a box of contacts up for the first time in 25 years. The age of dirt cheap contacts is coming to an end, mostly brought on (ironically) by 1-800-CONTACTS...the same people who slashed the prices years ago. Coming up soon the oldest, cheapest brands are probably going to be discontinued, replaced by more expensive premium lenses like Dailies Total 1 by Alcon (the best lens on the market right now IMO). So I guess the point is: if you're complaining about the cost of a box of contacts today, you are probably in for a rude awakening in the next few years. Don't look a very cheap horse in the mouth...you're very likely going to be forced to buy a thoroughbred.

Thursday, April 9, 2015

Alcon, B&L, J&J: WE NEED MORE HIGH CYL OPTIONS!

Practicing in East Texas we have a large hispanic population, many of whom need high - astigmatism or "high cylinder" contact lenses. Our options for these patients have been woefully poor for my entire 15 year optometry career. Until a few months ago the ONLY disposable soft lens that came in anything over -2.25 cylinder was B&L's Soflens Toric, now a 25 year old product. I like it ok, except that it's plastic and 90+% of the rest of the world who are not wearing dailies (also not avail in high cyl) are wearing silicone. Any Rx over 3 diopters of astigmatism gets the dreaded CooperVision Frequency 55 Toric XR for $85/box, or the Coopervision Proclear Toric XR (XR stands for "entended range"), both also over 20 years old and both also made of plastic. We need a disposable silicone toric in high cylinder Rx's. This cannot be THAT difficult. Alcon, B&L & J&J have exactly ZERO products available in ANY material for high cyl patients, and Coopervision only has $85/box 20 year old designs. Now I understand the manufact's traditional comeback to this complaint: "there are not enough of these" (i.e. low demand). The reps will also tell us how we can "mask" a diopter of cyl, which I often do. But in the age of silicone dailies (DT1, the best lens on the market right now and the lens I choose for my own family), can we really feel good about "masking" that much cylinder or telling these folks they have to wear a lens design from 1994? I mean I have 2 of these patients a day, so it can't be that rare. I'm selling more high cyl torics than I am multifocal dailies, and multifocal dailies are made by multiple manufacts. Come on, contact lens industry. We need for you to step up now. It's past time. As the band INXS once said: "21st Century's YESTERDAY!" (from "Need You Tonight").