Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Cataracts

Episode Date: October 14, 2014

Welcome to Sawbones, where Dr. Sydnee McElroy and her husband Justin McElroy take you on a whimsical tour of the dumb ways in which we've tried to fix people. This week: We squirt a little breast milk in your eye. Music: "Medicines" by The Taxpayers (http://thetaxpayers.net)

Saabones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth Hello everybody and welcome to saw bones a marital tour of Miss Guy the medicine I am your co-host Justin McElroy and I'm Sydney, my son. I'm not L.I. Not a great performance From your guy Eli Man yesterday on the old fantasy football team That that really hurts my heart to hear a big six points for the whole team From all the lie your buddy. I tried his best that really hurts my heart to hear. A big six points for the whole team, from all the Eli, your buddy Eli. He tried his best, I bet I'm sure he did. Well, I mean, he delivered some big points.

Now, it's worth pointing out that you insist that we include Eli Manning on the team every year. I really love starting, not just on there like a mascot, but like starting. No, I really love Eli Manning on the team every year. I really love starting, not just on there like a mascot, but like starting. No, I really love Eli Manning. I think that he is the better of the Manning brothers. He just, he hasn't tapped his full potential yet. What, what does he require to tap his full potential?

I mean, I've told you before, the main thing is that you have to believe in him. He's had a, it's been tough. Can you imagine what it's like being paid in Manning's little brother? Yeah. That would be, yeah, that would be really hard. And then you also decide to be a football quarterback. Right.

That would be tough. Yeah. And so the, you know, he's constantly doubting himself and questioning his abilities. And so he needs you to believe in him. He's like Tinkerbell. Okay, so you've got a clap and believe and he will for more keys.

We're believing in him yesterday. Obviously not hard enough. Maybe, okay, here I'd like to offer counter theory. Maybe you were believing hard enough and the blame lies somewhere else. Maybe it was those refs. That's what it was, it was those refs. Hey, ref, are you blind out there? Not my boy Eli, it was the refs. That's what it was. It was those refs. Hey, ref, are you blind out there?

Not my boy Eli. It was the ref fault. The refs, they've all got cataracts and they can't see what's happening on the field. Do you know what cataracts are? I can't see when Eli actually scored a touchdown. And cataract keeps you from seeing when he ran it in, like a big football hero that he is. Right. Cataract specifically present you from seeing touchdowns.

Yes. That's the thing they do. That's the thing that they do. Eli touchdowns specifically. Okay. I don't actually know what cataracts are or anything about them. I think Mandy Patinkin had to have one fixed ones because he had very dark sunglasses on it on an award show.

I vaguely remember seeing him in. That's your entire knowledge of cataracts. My some knowledge of cataracts. There it is. Well why don't I tell you some more about him? Hit me. First of all thanks to Ashley who sent us an email suggesting this topic pointing out that we've had a shortage of eye topics in general. Thanks Ashley. I don't know why that is. It's not intentional for sure. No. Although I will say we're gonna talk about cataracts and largely the history of cataract surgery.

So if you're one of those people that get squeamish with eye stuff, I'm sorry. Yes, you may wanna choose another of our fine episodes to enjoy. Sydney, obviously cataracts don't explicitly prevent you from seeing Eli Manning's touchdowns. I know he must have had because you believed in him so hard. So what what is a cataract? Basically a cataract is when you know your eye has a lens right just like a camera or microscope or whatever a lens that helps focus your vision

and the lens in your eye can get cloudy over time due to like the cross-linking of the proteins. Don't worry about it. The lens gets cloudy. There are lots of different causes, most commonly just old age, but it can be caused just genetics, trauma, there's some infections. But the result is at the end of the day, your vision gets cloudy because the lens itself is now cloudy.

So how do we address that? How do we even start? Well, the basic treatment for cataracts, even as we go back throughout history, has always been surgery. There's some other things I'll throw in there, but the main thing is been surgery. And it is probably one of the oldest surgical procedures,

which I think is kind of interesting that one of the first surgical procedures we which I think is kind of interesting that one of the first surgical procedures we decided to attempt involves sticking sharp things in somebody's eye. Yeah, let's just go ho hog. Yeah. Do you think it's because you can see a cataract from the outside, right? Yes. Do you think that's why? Because like we maybe could establish some sort of game plan because we could actually like see it, see the issue. That makes sense. That makes sense. It was worth the risk because we thought if we could just get to that white area that

we can so clearly see. Right. It's like when you have an eyelash and you think, well, I know the problem here except for cataracts. Except you usually don't use like a copper blade to remove an eyelash. I would not use a copper blade to remove an eyelash. Absolutely not. But everybody tried to remove cataracts.

The Egyptians, the Greeks, the Romans, there's an ancient Egyptian statue from like 2,400 BC that shows a priest where they have specifically like chipped a little white patch in one of his eyes representing cataracts. Huh. Do you know where the word cataract comes from? I do not.

As you almost certainly guessed. Yeah. At some time, you're're gonna have to surprise me and look this up ahead of time and then you'll just say yes. What a twist. It comes from the Latin for waterfall. Huh.

In the Greek word, it kind of means down rushing. So it references the fact that when water moves quickly, it looks white. Okay. So that's where that comes from. Oh, well, all right. That seems kind of indirect, but sure. I don't know. I mean, you know, all these Latin words, they had to come up with something

fancy. You gotta call it something. You can't just, you can't just say like white spot. White spot, eye white spot. It used to be believed that the cause of cataracts was fluid around your brain that flowed down into your eye and formed a little white membrane. As if these weren't already upsetting enough, we decided to postulate like the most upsetting theory of what could be causing the issue. This was later of course. Where was the optimism old time, if you will?

This was later linked to the humors, of course, and balance of the humors and different fluids, but in general, it was just thought that if we could get in there and get that little kind of dried patch of brain fluid out of your eye. I'm having trouble seeing it as common impediment to my day-to-day life. Oh, I know your problem. Your brain is leaking.

Oh, thank you. That's way better. I feel- No big deal. No big deal, just my brain linking? Awesome. No big deal. We'll just fix the brain leak, because we understand that. We think the earth goes around the sun,

but you go ahead up in there. You get up in there and fix that brain leakage. Now now, they weren't actually trying to fix the brain leak. They were just gonna remove the little bit of it that dried up on your eye. So, how did we try to address it? Okay, so let's talk about our first cataract surgeries. And remember, this was done with pretty much zero knowledge of eye anatomy.

Okay. Or any anatomy. Anything. I mean, just like, I don't know, I can see that white spot. Let's see how I- One get that. I'm gonna get to it. I'm gonna get it. So the first procedure was called needleing.

It's already awful. It's called needleing. It's very implicit. The Egyptians used this technique. They had flat copper knives. We actually found these knives in the tombs of buried Egyptian royalty. So I guess you would want those among your possessions

in the afterlife. Okay. I'll never want to forget this moment. That moment, when that doctor, that fake doctor stuck a flat copper knife in my eye. All my highlights, all my greatest hits are in here. So basically you would take this and you would slice into the edge of the cornea,

which is kind of the clear part that's in the front of your eye. And then you would wedge the lens out of place. You didn't know that's what you were doing, but you would push on the white spot until it moved. Okay. Now what you were doing, as I said, was you were actually kind of removing the lens from its supports and letting it just fall into the,

your eyes full of just this this gel this vitrius gel so you just kind of let it fall into that gel. I know I told you ask me if I can handle this before and I said oh it shouldn't be a problem big tough guy like I'm okay I'm all right and it made see the thing is once you did this you would think you'd been really successful because then that white area that you could clearly see the cloudy thing. Because you can see cataracts, when people have cataracts, you can look at them and you know that that's what they have. It would, you would move the lens out of the way so you wouldn't see the white area anymore.

So it looked like you fixed it, you know, from the outside. Now as the person with the eye that is being operated on, you now have, your vision is no longer cloudy, but it's completely unfocused. Because you don't have a lens. Right. Right. Right. as the person with the eye that is being operated on, you now have, your vision is no longer cloudy, but it's completely unfocused, because you don't have a lens. Right.

So it'd be like a camera if you took the lens away. Okay, and you just had your picture there opening and letting light in, right? Exactly, and it was very clear, but nothing's focused. This technique was later used in Japan, exact same procedure, but then they would try to suction out the old lens, suction out the white spot afterwards.

This was, as you can imagine, all very risky. Yeah, I would imagine. This does not sound safe. No, no. Obviously, there was a huge risk of infection. When you did this, there were no, we didn't understand sterilization techniques. So the copper knives that were being used, there's no reason to think that they

weren't covered in bacteria. You would almost certainly lose your vision. And in the worst case scenario, lose your whole eye. I can't believe people even attempted it. And they didn't stop there. Oh, good. The other procedure, which I say follows, but actually kind of was maybe concurrent to the needling procedure and then overtook it, was couching. And this is actually described in the Bible. Oh, yeah. Mm-hmm.

And what you, what you would call the apocrypha in Tobit. Okay. They described this procedure. This was also done in Egypt. It became really popular in China. I'm going to tell you how it's done, but I think this is interesting all the way until like the mid-1900s. It was popular.

So you use again like a flat sharp knife. And in this procedure instead of just kind of like trying to knock the lens loose, you actually try to dislodge it and shove it as far back in the eye as you can. Cool. After that, you want to, or while you're doing it, you want to keep rinsing the eye, irrigating it with breast milk. Okay.

A willing donor, hopefully standing by. Who's just ready to supply with breast milk to soak all over your eye that you just cut a whole in. And then once you've got the, once you've actually dislodged the lens and you can't see the white spot anymore, you want to have your patient blow his nose, but like just the one nostril. So if you're, if you're fixing the left eye, you want him to plug up the left nostril and blow out his right nostril.

To achieve. To blow out the white stuff that was in his eye. They thought it was some kind of flim. This is, you know, I talked about like the humor thing kind of overtook thing. That was some kind of flim and you could blow it out your opposite nostril once you've knocked it loose. I try to be inherently charred a little people. And so when we didn't understand a lot of disease and people would say, you know,

I don't know what's gonna fix this, but I'm gonna take a shot. I'll put a chicken on my head or put some poopy in a milkshake or whatever. I get it. But like, when the doctor's game plan is this shaky, but his opening play is, here's the, here's what I do know. We are definitely going to cut your lens off and shove it into your eyeball.

Beyond that, I'm not exactly sure. I'm going to be really faking it from that point on, but like that's the opener, that that's the opening play. Do you, are you so important for this? Is baffling to me? So, I mean, can you imagine that scene where you've got the doctor standing there with his knife that he's aiming at your eye?

And I don't know, I like to imagine that there's actually like a lactating woman standing there with a cup, like ready to express some fresh breast milk into a cup and then hand it to you. And then to top it all off, after he asks you to blow your nose, he's going to soak your eye in clarified butter. Delicious, succulent. That goes great with the breast milk you've already soaked your eye, and I can't.

Yeah, this is, we're like halfway to a tart now, an eyeball, an eyeball, an eye ball, apretif. They make the point that during this... Almost boosh. During this procedure, please try to avoid belching coughing, spitting, sneezing, or shaking. Or dying. If you could avoid dying from how much this all sucks,

that would be excellent there. I think it's a good rule of thumb that any time anyone has something near your eye, don't belch cough, spit, sneeze, shake, or move. Really. Breathing would be hard. This was actually paired later in China with acupuncture, and it was part of traditional

Chinese medicine, this procedure. It vanished for a while, but like I said, in the mid-1900s, it had a revival, because Chairman Mao really liked it. He really liked traditional Chinese medicine, and he was like, yeah, this is definitely something we should do. It's not practiced there much now. It's faded out again. That's good. There was a time period where this was one of the procedures that some of like the traveling like plaque doctors who sold their crazy medicines would do. So I'll throughout Europe, they would travel around, come in, do some couching procedures on some

people with cataracts and then high tail out of town, because they knew they didn't know what they were doing. They knew that it always ended up leaving people blind. They knew that people they did that and we're going to have trouble finding them. Yes. And so they got out of town before people could realize, like, oh, that was a terrible thing, and it didn't help at all. This is how handle was blinded in one eye. Oh, yeah. It did it help at all. This is how handle was blinded in one eye. Oh, man. It did it help at all. I mean, was there?

No, I mean, it looked nice, because now you look, I mean, you don't look like you have cataracts anymore, but your vision's completely unfocused. And likely you get a terrible infection and maybe lose the entire function of your eye in the process, but even if it goes right,

you still have completely unfocused vision. So, man, people must not be successful. I hate cataracts. Man, that must be annoying. The thought process behind people who would see the results of it, but then maybe, you know somebody you had it done and they would tell you, yeah, I still can't see. And then get it done. The idea was, depending on what your occupation was, let's say all you do is plow field.

You don't really need precise vision to do that. So there were people who were desperate enough to say, well, if this succeeds, while my vision will be completely unfocused, I won't have that cloud in the way that prevents me from seeing anything. So I can at least walk a straight line. And that was why people took the risk. That's rough. What else did? Well, before I tell you about that, it's that time of the week again, Justin. You're going to have to visit our billing department. Okay, well, let's, uh, let's take a quick break. Okay, so next, uh, next, next treatments, what else we got? Well, a lot of people

realized with these couching procedures, and this was at the time, you know, this, next, next treatment, say, what else we got? Well, a lot of people realized what these couching procedures says, and this was at the time, you know, this overtook anything else. This is all that was being done. If you're gonna treat your cataracts, you're gonna have a couching procedure done, that the lens itself, or what, you know,

we didn't know was a lens at the time, what the white spot could move around inside the eye, and could actually even, the, it could float back into your field of view. So the decision was made that they needed to find a way to remove it. Okay. Actually get it out of there. Get that lens out. So as suction devices were invented and physicians started using suction in like the surgical field, you know, to like suck blood out and stuff. They started trying to use those to remove the lens instead of just shoving it out of the way.

Oh my God. So they would take like a hollow copper tube or bronze tube and insert it into your eye. Can we not? To try to suck the lens out. And when I say suck the lens out, if you wonder what I mean by that, I will say that this is a quote from one of the medical texts, what do you need to perform this procedure? A large incision in the eye, a hollow needle, and an assistant with an extraordinary lung capacity.

Excellent. And I'm assuming the devil-make-haired attitude is implied. Just the willingness to really take it to the limit just really just go for it I like to think it's similar to that thing we we got to clean out Chuck's nose. Oh, yeah that that sucking tube To the bookers out of your kids. Oh, that's love. That's true love Although this is somebody else's eye that you're sucking it at work Yes eventually not at first. Still in theoretical stages.

This was in 1747, French surgeon, surgeon, Jacques Daville, performed it, and actually got the lens out of there. And then it was finally the technique was perfected in the 1800s so that they could remove it. Now, again, this doesn't really fix the problem, though, because we've identified that we've got this cloudy spot. We still at this point don't quite know what it is.

Now, we know how to dislodge it, and we know how to remove it. I mean, because that's what you would do. That's what we learned. You can't just go in there and suck it out of there. You kind of have to cut it away and then suck it out of there. So they figured out how to do that. But again, you're still left with completely unfocused vision. So the next step was we need to put something back there that will replace the lens.

And this obviously, before we were able to do that, we had to identify that, okay, this is the lens that we're removing. So that was the big breakthrough. Doctors figured out that the problem wasn't that there was white goo in your eye It was that the lens itself basically was intrinsically damaged. Okay, so if we're gonna remove the lens What can we put in its place? Well nobody knows like what is safe to put in an eyeball? Yeah Contact lenses because they just use those well, that wouldn't be strong enough I mean the the eye is completely unfocused. I mean think about it. You know, that's a powerful lens you've got in your eye,

and now it's gone. So we need something that goes back into the eye and it's the positioning too. You know, contact lenses are on the exterior. You need something that's actually in that, you know. Okay. Right. So, during World War II, there was an ophthalmologist in England,

Sir Nicholas Harrell-Bloyd Ridley. Sir Nicholas Harrell-Bloyd Ridley. Sir Nicholas Harrell-Bloyd Ridley, that's a heck of a name too. That's somebody who's bound for greatness, you can just tell. He noticed that pilots in the Royal Air Force who got pieces of shrapnel that were made of certain materials stuck in their eye, that it didn't bother them, that it never caused them problems. And this certain material is polymethylmethocrylate. Okay.

So now that you know that, hurry, write that down, I know you wanna memorize it. I'm just gonna say PMMA. There you go. But he noticed that it didn't seem to bother him. And so he thought- It didn't bother them? Well, I mean, you know,

I would probably speak up. They were pleased about it, like they weren't thrilled. I'm not super-gised about the PMMA stack of my eye, I mean, I would probably speak up. They were pleased about it. Like they weren't thrilled. I was super-gised about the PMMA stack of my eye, but I wouldn't say it bothers me. Well, it wasn't causing them constant problems. Okay. And so he made a lens out of it.

All right. And in 1949, the first lens transplant was successfully done. Excellent. And so at that point, the whole cataract surgery finally makes sense because removing the lens isn't very helpful unless you got something to put in its place. And so that kind of, since then, the evolution of cataract surgery has been refining that procedure, getting new materials to make the lens out of, finding better ways to remove the previous lens

and that's kind of, as I'll get to, that's the heart of cataract surgery now. Now, before I tell you what we do currently, though, I want to tell you about a couple other things that were attempted. Of course, Plenty had something to say about that. Had to get up in there. Had to have his say. You know, I was really disappointed because when I looked up his, his information on cataracts, it's kind of thrown in as an afterthought. He's really focused on the fig. And he's talking about all the great things that you can use figs for. And then he adds at the end like, oh, and the ointment can be used for cataracts. Just there's some honey in there. I see, figs and honey, I feel like he's just like recycling

his old material. I really feel like he's phoning it in at this point. It was really like a list. It was like, that could have been, that could have been for any of your dumb solutions, plenty. I think it was at the end of like his dissertation on the fig, like, ah, the fig.

Let us consider this delicious fig. I will say that, like, ground fig when it went with honey, sounds kinda yummy. In your eye. Well, no, not in your eye, just, you know, fig and having it. I love fig newtons, some honey. I think Pliny was just a scam artist

trying to con people out of figs. Don't eat it. Are you serious? Put that in my fig sack. I've got to go treat people for eye things. He turns a corn and is like, I'm not, I'm not figs. I love him. He's like a hamburger goler of figs. He's just trying to scam honey and figs away from people.

That's the healthier hamburger. Helping the other. Yeah, healthy hamburger. He loves figs. Some other natural treatments that I actually found these aren't ancient. These are things that you will read now online. If you're looking for natural treatments for your cataracts, pascalite clay, and an herb that's called Dusty Miller, which I do like the name of that herb, are said to you. I love Dusty Miller's hit country single.

These eyes aren't crying. It's just the rain. That will dissolve them. Okay. It won't. No, it won't dissolve them. There's also, of course, some homeopathic treatments specifically with Cepia.

But those don't work. But that doesn't work either. So don't do that. You can't dissolve a cataract and you certainly can't just with clay or herbs. There's some, there's always ongoing research, you know, is there a way to treat cataracts without surgery? Right now, there's not a reliable way. Maybe there would be, that would be great. But if somebody's telling you, oh, no, I got this stuff to put in your eye, it's gonna treat your cataract. I'd go see an ophthalmologist.

I thought this was really interesting. In the 1980s, there was an ophthalmologist, LR Croft, who suggested that cataracts may have been the reason that the dinosaurs became extinct. What, why? Well, his theory was that the world was getting warmer at the time.

There were increased temperatures, and it caused cataracts to form faster. And basically, all of the dinosaurs got cataracts all the same time, and they all went blind, and then I guess they died. I guess, I don't know. It wasn't really described past that. It was like, all of the dinosaurs got cataracts,

and then they were running into each other, maybe they're falling into volcanoes. Not again. I've put up this gate so many times. Please stop walking to volcanoes, my friends. He also thought that I thought this was just a side note that this is why the dinosaurs had horns on their faces. Why? Because they need to protect their eyes from the sun.

This guy is making this up. I don't buy this at all, sir. Yeah, I, um, as far as I know, that's not accepted. Again, I am not, this is another area where I am not an expert. dinosaurs. dinosaurs. Any animals really. Uh, so what do we do?

What do we do now? Any animals living or extinct, we're basically like our lack of expertise on animals is pretty wide spanning. If there is now a popular theory, if everybody is in agreement that cataracts made the dinosaurs go extinct, please let me know. Yeah. As far as I know though, that's still not true.

Now, so what do we do now? Tell me. Are you asking me? Yeah. What do we do now, Justin, for Cataract? Just get them out and then get something else in there. Right? Well, yeah.

Okay. Okay. Yeah, Cataract surgery is a very common surgery. It's done all the time. A lot of people have it done. Cataract are a very common surgery. It's done all the time. A lot of people have it done. It's very cataracts are very common cause of blindness worldwide. So basically what they do, they use something mainly, and they're different techniques, but the main technique is something called feco emulsification, where you basically use some ultrasonic waves and they break up the

old lens. So you insert a little device in there, it breaks up the old lens and then you suction it out, not with your mouth, not with your assistance slung capacity, but with a suction device. And you remove the old lens and then they have these teeny little foldable lenses that you can like slip through the tiniest low incision. It's really, I mean the surgery is incredible to watch. I watch some of them as a medical student and a resident and you insert the little foldable lens back into the eye and it pops open and now you have a brand new lens. It's amazing. And what's kind of cool and this was something I didn't realize until after I went to medical

school and I observed the procedure and then I started paying attention to this, you can kind of tell if somebody's had cataract surgery. If you, when they turn their head, the light will catch that lens and glint off of it in a certain way. Oh. So, if you ever notice somebody whose their eyes seem to twinkle a little bit more. Then they're Santa. Then they're Santa.

No. Or they've had. They've had cataract surgery. That's actually what I wrote in my outline. Then either they're Santa or they have cataracts Yeah, I just stole the joke from you guys. I saw it on the outline. Well, hey, hey, that's not fair Or you know what also you may be in love. Yeah You're in love with this old person It's a little less than a but they've had their cataracts fixed already

Thank you. Thank you for listening to our Program it is an exciting time. Did you know that Sydney? It is and is an exciting time to be a listener of max fun. It always is But if this is a big week for us. It's max fun week starting on Wednesday Where we're gonna be just celebrating this fine network that we call home. We got a full slate of activities lined up just to run through these real quickly. Wednesday is Max Fun trivia day. There's going to be trivia questions about Max Fun shows from the Max Fun HQ Twitter account.

October 16th is going to be a big effort to leave a review on shows that you enjoy for maximum fun Friday. You're going to be judged on Hodgman fans. We'll get to weigh in on on immediate summary judgment day Saturday. You can draw the adventures on adventures for a chance to win some stuff. That's our my brother, my brother, me, D&D podcasts. They're, they're, they're looking for artistic representation. Sunday, October 19th is max fun meetup day.

If you've got maximumfund.org slash max fun meetup, you can find a list of a ton of meetups for listeners of maximum fun. And they're all over the country and in the world. We've got Canada represented. We've got North Carolina. We've got Turkey, Germany, France. Not West Virginia. Not West Virginia.

I know, that's what I was looking for. Unfortunately, no meetups in West Virginia. You and I can meet up. Yeah, we'll meet up somewhere Our home at our house. No, don't come to our house We're doing AMAs read it asked me anything's There's a my brother my brother me one on Thursday October 16th, but those are happening all week On Monday October 20th is share your favorite episode day, where that's pretty self-explanatory. And then on the 21st, having a rocket coloring contest, where you can take a shot at filling in the max fun logo in an artistic fashion.

These are all at maximumfund.org forth-maxfunweek. You can find a whole list of activities and it's gonna be, it's gonna be a blast. And it's just a way for us to kind of say thank you to you and connect with you, find folks for listening to our programs and help us blow it out and help get the word out about Max Fun. We really appreciate it.

Thank you to Squarespace for supporting our show that is hugely helpful to us, and we sure appreciate you. Thank you to the taxpayers for letting us use their music Medicines for the intro and not you ever podcast and thanks for all your emails suggesting topics and sharing stories Yeah, we're so many to maximum fun. Or if you want to get in touch like that or you can follow us on Twitter at sobunds I think that's gonna do it for us for this week Until next Tuesday. I'm Justin McRoy. I'm Sydney McRoy.

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