Why Your Eyes Betray You Over 40 (It's NOT Just Age)

What the heck is going on with our eyes in midlife? Like, who warned us or who didn't warn us about this reading thing about we can't see things and all of a sudden we need big reading glasses or we have to put our phone or things way out in front of us. And what about dry eye? Why is that popping up more and more? And then what about cataracts? Is that something just our parents had? Do we need to be taking that seriously? And let's talk about migraines. Is there a connection with migraines and our eyes eyesight? Today on Midlife Conversations, I cannot wait to have this conversation with Dr. Ronnie Banik. We are going to go all into eye health, what's happening and what we can actually do about it. Thank you so much for being here today.

Oh, thanks so much, Natalie, for having me.

I have so many questions. I don't even know where to start. I'm going to start with a general one. What the heck is going on with our eyes in midlife? It's like we, if we don't have enough things going on with the hair change and the body change and the. What's going on with our eyes?

Yeah, you know, it's. It's a period there where there's a lot of change between our 40s and 50s, a lot of things can happen to our eyes. And many of them you mentioned, like trouble reading up close where you kind of have to hold things further and further out. It's my arms aren't long enough syndrome. That's what I like to call it. Then there's dry eye. Then there's just general blurriness, cataracts, glare, light sensitivity, and migraine aura. That can happen. So there's a lot that happens. Some of it is due to changes inside the eyes as we get older, and other changes can be due to hormones. You know, the shifting hormones that we all love and, you know, wish that we could avoid, just skip past the stage in life. But those hormonal shifts can definitely affect our vision in very, very deep ways. And I think, you know, so many women out there suffer with these eye issues, yet they don't really get the support they need. So I hope that I can share some helpful tips today to help people navigate through this time.

I can't wait. I don't even have an order to this. I have so many questions. So I'm going to start with the one that's most pressing to me personal, because. And all my friends and my husband, and that's this Whole reading thing, like, why we cannot see things. And. And I've been fighting it. You know, I have the reading glasses in every room, but I still fight it. And I'm like, no, I can do it. I can do it. I don't need them. What is that? And should we be fighting it, or do we just need to embrace the reading glasses?

Yes. I have to say, this is something that happens to everyone as we get older. Different times. You know, some people may notice the symptoms as early as their late 30s, 30s, where they have trouble reading. Other people maybe not into their late 50s or even early 60s, but everyone goes through it. And as you said, both men and women can be affected. And it's a change that happens inside the eye. Now we have a lens inside our eye that helps us to focus. And that lens is constantly changing shape. So if we're looking at something at distance, it has a thinner shape. If we're looking at something up close, it gets a little bit wider in the middle. So it's constantly adjusting its shape to allow us to focus. Now, as we get older, the lens becomes stiff. And imagine like, you have this tree trunk that's very malleable when the tree is young, but then as the tree gets older, it becomes really hard, and it's just not very flexible. And so when the lens can't focus that well up close, that's when we have trouble seeing. And a lot of people mistakenly think that this is some kind of, like, a muscle weakness or something like that. It's not the muscles inside the eyes. It's really just the lens becoming stuck differ. Now, how can we avoid it? Well, you know, there's some early research that shows that certain foods and even nutrients may help us to kind of delay this process. And the foods that are most important are foods that have anthocyanins. Now, you may have never heard of this term before, but they're nutrients that come from, like, deeply colored fruits and veggies, like berries, for example. So if you're struggling with presbyopia, I would say bump up your intake of berries and see if that helps you a little bit with that eye strain, helping to focus up close. Then there is a host of other things people can do. You mentioned a couple of things like basic reading glasses. And I have to say, Natalie, like, there's no shame in wearing reading glasses. I know we don't like to. They're bulky. You know, they forget where you put them. You have to have multiple pairs. But if you really need them to see Especially like fine print. Like let's say you're reading like a medicine bottle or you're reading like really, you know, like in ingredient label. You may want to reach for your reading glasses nowadays. There's actually some other options out there. There are drops that are FDA approved to help with presbyopia. There are two ones that just came out this year. Yeah, there was one that came out a few years ago, not so popular. But the two new ones are really exciting. So you're going to be hearing a lot more about them. One is called Closi Qlosi and the other was called Viz V I Z Z. So kind of a catchy name. You're going to be hearing a lot more about that coming up. So there are some prescript encryption drop options and then there are various types of glasses, even contacts. So personally I've been wearing contacts for presbyopia for years.

And is that the monovision where one is closer and one's not?

You could certainly do that where one eye is for distance, one eyes for reading. Or you can do what's called a multifocal, which is kind of like wearing bifocals in your contacts, yet nobody knows that you're wearing bifocals. So that can be really, really effective. Just try out different ones with your eye care provider, like get some samples. If you wear contacts, then just ask for some samples or get fitted and see what is the best solution for you. And then finally there's the option of surgery. If things get really bad, you can have a surgery to correct for this presbyopia. But I would say that's kind of like the last resort. Try all of these other things first, like nutrition, you know, just lifestyle, just adding some more light, you know, giving yourself that, you know, that help that it's, you know, accept the help. Don't, don't try to fight it. So increase the font size on your phone. You know, there's so many things we can do.

I have a question about the exercise comment you made. You said at the beginning, you said there's a lot of people that think you can fix it through exercise or it's a memory thing, or is there any truth to that? Is that. And I know I actually interviewed somebody a while back that had a whole thing about doing eye exercises. My husband even started trying it. But is that something worth trying to play with and experiment with or what's your thought as a doctor here?

I think you could. Absolutely. There's near far exercises. So basically you pick a point in the distance, you focus on that. Then you pick a point, kind of intermediate distance, and you pick a point like something really close, and you just keep shifting your focus. You can certainly do that. It may help your endurance when reading. It's not going to turn around the process though, because that stiffening is still going to happen. But certainly, yes, you can do those exercises. And sometimes it takes a while to see the results. Like, you may not notice. It may be actually really tough in the beginning when you're those exercises. So you have to give yourself some time and let your eyes kind of adjust to it and see if it really helps you. But really the bottom line is if you're struggling, if you really can't see properly to see your phone or read, you know, read a newspaper, read a magazine, get the help you need. Just ask your doctor, what are my options? Am I a candidate for those contacts? Or maybe one of the drops or, you know, again, maybe it's the surgery that you need.

Let's talk about cataracts. That's another one of the favorite topics. And I when I ask you about cataracts, I want to understand what they are, but also about the sun. And there's a lot of divide around the sun, like whether it causes them, whether it helps them. If you could help clear up some thoughts as a doctor yourself, around your thoughts on cataracts and then also the sun in general with our eyes.

Sure. I love this question because there's a lot of talk on social media about getting sun exposure, especially early morning sun exposure. And yes, it's great for our body. We need to get that early morning sunlight that has blue light. It helps us set our circadian rhythm. It helps with our vitamin D. So all of that is true. But one thing I'll tell you that there's a misconception about this is that when you go outside in the morning and you're getting that sun exposure, please don't look directly at the sun. Because when you gaze straight at the sun, when you stare at the sun, it's called sun gazing, by the way. It could potentially do harm. Not only do you get blue light, but you get all the potentially harmful UV rays, uva, UVB rays that can do a number on our eyes. So please, please, please, if you're going to do early morning sun exposure, expose your face, but close your eyelids. Let the sunlight get through your eyelids. Don't stare directly at the sun. I've actually seen patients who've stared at the sun and they've gotten burns in their Retina, which are like irreversible. So you don't want to risk something like that by staring at the sun for too long. Now, in terms, I want to pull out my little show and tell here to explain about the cataract question. So here's our friend, the eyeball. And when we look at the eye, we just typically just see like the front part of the eye, which is the white part, and the colored part, which is the iris. But I'm going to give you a little sneak peek inside. When I open this up, you see there is a lot going on inside the eye. So let me break down your question about what's a cataract and what can we do about them? So sunlight or any kind of light comes in through the front of the eye. It first goes through the cornea, which is this clear dome shaped structure. Then it goes through the hole in the iris, which is the colored part of the eye. This is the pupil right here. Then it goes through the lens and then it hits the back of the eye to form an image. This is the lens. Now this is a natural lens. We all have this lens. This is the same lens that we use for focusing what we were talking about before. This is the same lens that gets stiff when we get older. Now in cataract, what happens is you can see that this, in this model, it's clear, it's transparent, like you're looking through a window. When we get older, this lens starts to become opacified. It starts to get a little yellowish, a little darker, a little orangey. And then in the worst case scenarios, it can become completely white and opaque, or it may even become black in the worst case scenarios of cataract. So whenever the lens changes color, that's called a cataract. And imagine what would happen. So imagine this was yellow, or let's say a light yellow. And light is trying to get through the front part of the eye and it's getting scattered by this yellowish lens and it's not getting focused properly onto the back of the eye. So imagine like it's looking through a dirty window. Like you used to have a clear window, transparent, crystal clear. You can see everything outside perfectly. But now that window is opaque, and that's what a cataract is.

Do you think people even, do they notice that things start looking dingy and opaque? Or is it one of those, like once they have them removed, they're like, whoa, I didn't realize how clear everything is.

That's a great question. Usually it's very subtle. And people don't know it because it's so slow. It happens over years to decades. And so most people don't even realize that it's happening. Like, imagine something slowly getting, like, dimmer and dimmer and dimmer. And colors may look a little bit dull and washed out or faded, so you may not notice it. But this is why it's important to go get an eye checkup at least once a year. So this is my, I guess, my public service announcement. If you're above the age of 40, especially if you're a woman, go get your eyes checked once a year, even though you think, oh, my vision's Perfect. I have 2020, I can see just fine, I can read, I can drive. Go get your eyes checked because things may be developing back there that you don't know about. And the only way to know about it and act on it early is to get it checked out and get the diagnosis.

When you get your eyes checked, is there a specific type of eye doctor you suggest? Because that's also confusing. Like, a lot of people will just go to the lens store or like. Any thoughts around that and why one versus the other?

Yeah. So there are two types of eye care providers. Actually, there are many more than two, but two main ones. Ophthalmologists, who are medical doctors like myself, trained in everything related to the eyes. Glasses, prescription medication, surgeries, everything. And then optometrists, who are trained in optometry school. They're also doctors of optometry, and they prescribe glasses. And depending on the state, they may be able to prescribe medications, diagnose, et cetera. So you can go to either one, either an ophthalmologist or an optometrist. Just make sure that it's not just for a glasses check. Make sure that you're getting the complete eye exam, that you're getting the dilating drops. I know a lot of people don't enjoy getting those. Yeah, we don't love that because they make your vision blurry and, you know, it's inconvenient and you're light sensitive. But get that dilation because that's the only way to pick up if you have cataracts, if you have diabetes. We can diagnose over 200 medical conditions based off of a dilated eye exam. So we can see and we can find neurologic conditions, we can find inflammatory conditions. So get that dilated eye exam. And yes, it's a little bit of an inconvenience for a few hours or maybe half a day. But it's worth it. Absolutely.

I think this is important because I think what I want everyone to realize too, and I didn't know this either, a lot of the glasses stores that you just walk in and they say, oh, the doctor there. So it is nothing against optometrists, but really what those stores are doing is selling glasses. So they're there literally just looking for the vision change. And then do you need new frames? Do you need this? So I know when I've gone into those, they typically don't do what you're saying. So I would personally agree with you that it's an ophthalmologist with the MD that's going to do more of that. But like you said, it's state to state and it varies depending on who that person is and what they're doing.

Yeah. And one other thing I'll, I'll add is yes, you can go to your local, you know, lenscrafters or optician and they may just say, okay, we're not going to do the dilated eye exam. We're just going to take photos. So that'll kind of serve as like a substitute for it. You can do that. That's better than getting nothing. But honestly, the dilated exam is the best. So good to know.

Push for it, ask for it.

Yeah.

What about sunglasses? While we're on that topic of the sun, are you for them, against them? Because there is that also that whole thought. I mean, there's a whole again, social media that it's good for you or not good for you. So what do you say to that with people?

So being having been an eye Dr. For 20 plus years to almost 25 years now, I can tell you that I've seen the havoc that UV rays from the sun can cause on people's eyes. They can get so many things. I talked earlier about burns. They can get growths on the surface of the eye. People may have these growths that kind of grow over the cornea, sometimes even cancers that are directly linked to UV damage. So I'm a huge advocate of sunglasses. Maybe not entirely known, maybe not the whole day, but I would say between the hours of 10am to 4pm Please wear your sunglasses because they will protect you against some of these chronic eye conditions and also cataracts. So cataracts can be directly caused by too much sun exposure.

Wearing the sunglasses will help to decrease that risk.

Now, what just came to my head when you said that is that I wear a baseball cap and pull it down. Is that sufficient? If you're not looking at the sun or do you really have to put sunglasses with it?

Yeah, that's great. If you don't like to wear sunglasses, wear a hat, like a wide brimmed hat or a baseball cap. Make sure that your eyes are in the shade and they're getting protected. Not to mention the UV damage that can happen around our eyes. Like a lot of people will have kind of like sagging skin, loose, wrinkly skin that can all be from some sun damage, also even cancers of the eyelids. So wearing either UV protection or a wide brimmed hat is really, really helpful. Now you were talking earlier, Natalie, about, you know, this controversy about sunglasses. And the thought that comes up, what I've seen on social media is this concept that sunglasses are endocrine disruptors. Yeah. And I don't know if you've heard.

That before, but basically, yes, all the time. And I'm guilty of sharing that too. So help us understand.

Yeah. So the thought is that if you wear sunglasses that your eyes are being affected negatively because they're not able to absorb blue light, which may lead to decreased melatonin and affect your circadian rhythm. So that's where this whole endocrine disruptor concept came into play. The truth is when we're outside, even if we're wearing sunglasses, there is so much stray light that's getting in from around the sunglasses, even on our skin, our bodies, our eyes know what time of day it is. You're not going to be able to block, block out all of that sunlight to affect your melatonin levels. There's no study to show that melatonin levels are adversely affected or, you know, the circadian rhythm is thrown off because of wearing sunglasses. So I would say more so from late time screen use, you know, late night screen use, but not so much from wearing the sunglasses. So even if you wear sunglasses, it should be fine.

It's very confusing for a lot of us, especially those of us that are not doctors and didn't like, you know, it's very confusing because you especially with so much different information and I even had, you know, the doctor that introduced us is the one, is one that taught me that about the sunglasses and endocrine disruption. So it's confusing. And then I've also heard, and again it's very confusing for us listening to know which thing to believe and what but about the idea that if you have direct sun in your eyes, it helps you regulate so you don't get burned. Have you heard that one?

I mean, burns on your Skin.

Yeah. Is there any. Have you heard people talking about that one?

But so what I'll tell you, Natalie, is that first and foremost, sight is most important to me, is protecting someone's sight. That's my goal, that's my mission in my career, in my life, to help people protect their vision. And would you rather have a burn in your retina or a burn on your skin? You kind of have to weigh that. Like, what's more important to you?

I agree with you.

Preserving your vision or preserving your skin? Now, of course, we don't want either one. Right. We want our skin to be healthy. But if you get a burn on your skin, eventually it will heal. But if you get a burn in your retina, it will not heal, and you've lost part of your vision forever. And again, I've seen some of the worst case scenarios. I don't want to scare anybody, but, you know, things that could have been avoided had people worn sunglasses, even. There are even cases of glaucoma. Now, glaucoma is a disease that affects the nerve in the back of the eye, but it also has to do with what's going on in the front of the eye. And so too much sun exposure can potentially cause damage to those delicate ocular structures that may ultimately lead to certain types of glaucoma. So I, again, I've seen the spectrum, and my. My recommendation is still to wear those sunglasses. I do. I. I always do. And.

And I think you've convinced me now. It's very. I. I mean, I am just as guilty because I interview a lot of people, I ask a lot of questions, I'm very curious, and I'll get swayed. I. Oh, well, does that make sense to me? Oh, that makes sense. And I think my advice to myself and anyone listening is you just really have to be your own detective. Like, you ask the questions, you learn, and then you have to go with what really feels right to you. So what you're saying is resonating with me, and I think you've answered my question on that, so I feel better about that.

I want to just add one more thing. So just for fun, one time, you know, because of this myth going around about sunglasses and endocrine disruption and blocking light, I actually used a light meter on my phone to go outside and measure, like, what was the luminance from the sun just coming through my phone, and I forget the numbers, so forgive me for that. But it was very, very high in the thousands of lux. And then I put my phone's camera up against my sunglasses and I measured it again and it only went down by a few hundred lux.

Wow.

So still, it was still in the thousands and it only went down by a little bit. So honestly, if you're wearing your sunglasses, it's not decreasing the amount of light coming into your eyes by anything to really affect your hormones.

So if I'm hearing you correctly. Yeah. And you didn't sound anti sun to me at all. I mean, if I'm hearing you correctly, you were still a fan of get out in the morning, just close your eyes and get that on you. So you, you're a fan of all that. And you even said a baseball cap or a wide brim hat over if you don't want to wear glasses. If I'm hearing you correctly, it's just about the looking direct at the sun or really like not being aware of that and not thinking that you have to force yourself to do that.

That's really what it is. Please expose yourself to sun. Absolutely. Get out there. Early morning sunlight or late evening sunlight is fine too. Just don't stare. Don't stare at the sun. You know animal species that stares at the sun like, there's no animal out there that just looks and enjoys the sunlight for hours at a time. It's just not natural, it's not normal.

So, but they also don't wear sunglasses or hats or.

Sunblock. So there you go. So no animal does that either.

With a lot of these, they do end up like dogs and cats end up with cataracts and really? Yeah, yeah, absolutely. Yeah, same thing.

What can we do about cataracts if we have them? Is it require a surgery to remove it? Is it an easy surgery or are there other options?

So first of all, not all cataracts need to be operated on. Right. So if you have like a mild cataract and light is still getting in, even through a slightly yellow lens, if your vision's still 2020, or if you're still able to do everything you need to do, you can still read, use your phone, you can drive, watch tv, see faces. If you can do all those things, leave it alone. There's no reason to jump into any surgery. And eventually, yes, things will progress. It's going to become more and more opaque at some point. If it affects your vision, then talk to your doctor about considering getting surgery. It's not for everybody, but have a discussion with your doctor. And it is a pretty straightforward surgery. It's actually one of the most technically complex procedures. But so quick and so effective. It takes about 10 to 15 minutes. It doesn't take long at all to take out a cataract. And what we do is we remove the. Imagine this is like a yellow lens. We remove the lens, we put an implant in its place, and that implant stays inside your eye. It sits behind the iris. You don't even see it, and it helps you focus and it blocks UV light. So then you already have internal kind of sunglasses in your eyes after that implant. And that lens stays with you for the rest of your life. So it's a very effective surgery. Now, a lot of people will ask me, like, is there anything I can do to prevent the cataract or dissolve the cataract? Like, there are these drops that are marketed called can C drops. You may have heard of them. C A, N, C I think is what it's called, and it's L. Carnosine is the active ingredient in it. I've had patients who've used them for years and, you know, they've stayed stable. I've had patients who've used them and they still progress. So I don't really have any evidence to say that it really works. But if you want to try it, you can certainly try the drops to prevent cataract progression. Diet is really important for cataracts also. So making sure you're getting lots of fruits and veggies with vitamin C, vitamin A, vitamin E, all the antioxidants our bodies and our eyes need to stay healthy can help to reduce, reduce the prevalence of cataracts. So have a healthy diet and also if you're diabetic, try to maintain better blood glucose control, because we know that when sugars are high, cataracts will progress very, very rapidly. So that's important to look at also.

Oh, that makes sense. And I've definitely heard anyone I know that's had cataracts also had type 2 diabetes. So that makes sense. That aligns.

Yes. Type 2 and especially type 1. Almost all type 1 diabetics will get cataracts early. Yes.

Wow. Okay, good to know.

So, yeah.

Okay, now let's get into some of the really common ones. Dry eye. Dry eye seems to be common any age, but really in midlife.

Yes. Okay, so I'm going to pull out another. Another show and tell here. So let me just explain. First, the front of the eye, the cornea is what gets dried out because most people think that, oh, they're not producing enough tears, and the tears are just, just, you know, not there. But the truth is most people produce enough tears, but the Tears evaporate too quickly. And when they evaporate too quickly, then people have symptoms of dry eye. And there's actually a root cause of dry eye that people need to be aware of, especially women. And that root cause goes to. Speaks to this. Now let me explain what this is so you can see. This is someone's eyeball. It's a picture of someone's eyeball. And this here, this is someone's eyelid pull down like this. So imagine I'm pulling down my eyelid and you're seeing the inner surface of the eyelid here. And this is taken with the special infrared camera. These little finger like kind of white things. Projections are glands. We have glands inside the eyelids that helps to create oils. If the glands are not working properly, the oils are not formed properly and then the tears just evaporate. And that's what causes dry eye. So in 85% of people with dry eye, it's a problem with the glands.

So what you're showing on that picture is that where like, think about when we were younger and we put eyeliner on the inside of our eye. Is it that ledge there or is it the inside of your eyelid that you're showing me? That's the ledge where you would draw eyeliner, basically.

So the ledge is the openings of these glands. So if you look really close, if you pull your eyelid down, you look in a mirror, you look really close, you see these little dots on the inside of your lashes, like just behind our lashes. Those little dots are the openings of these glands. And when you tight line, when you put eyeliner right over those glands, you're blocking them. You're literally blocking them from being able to secrete their oils.

So no to that. Do not go back to 1980s eyeliner.

Yes. So that's a common, common thing. And I see it all the time on social media. I see all these tutorials, people putting eyeliner right on their waterline. And it just makes me cringe because if you, you keep doing that chronic, you can do it for special occasions, like once in a while, it's totally fine. But if you're doing it day in, day out, you're blocking those glands, the glands, ultimately. So this is someone with healthy glands. We have about 25 to 30 glands in each eyelid. This is someone who's had some gland loss. You can see that there's patchy areas. This is about maybe 30% gland loss. But here you see how these glands just don't look healthy. They look really kind of congested and like disorganized. So this is because the glands have been blocked. And then this is someone with very severe gland loss. So this is like 80 to 90% gland loss. And one thing I'll tell you is once the glands are lost, we can't grow them back. The eyelids can't grow them back, so they're gone forever. So you want to maintain the glands. And the other really important thing for especially women in midlife to recognize is that there are hormone receptors on these glands. So you would think, oh, there's estrogen receptors, progesterone receptors, but more importantly, there are testosterone receptors on the glands. So all three sex hormones start to go down in midlife. And when they go down, you start to get gland dropout. So it's so important to be able to support your health from within. Maybe you're doing some kind of bioidentical hormone replacement or maybe traditional hrt. I'm actually working on something where we can deliver those hormones directly to the glands themselves. So stay tuned for that.

Oh, that's exciting.

A product that can directly, you know, basically manage dry eye and also support the cosmetic changes under the lids by providing hormonal support. But think about that. When you're thinking about dry eye, it's not just about putting in, like a lot of people will just put in drops, like over the counter drops and think, oh, if I just lubricate, it's going to be fine. You need to support the glands. So hormone support. Also hot compresses can be really effective. I have lots more show and tell if you'd like to see it, Natalie.

If you want to. And I also want to know, I understand the drops won't fix it, but are they bad? Are they. Is it. If it just helps you get comfort, is it okay to use those?

Absolutely. Yeah. I'm not against drops, but it's just putting a band aid on the problem. And the effect of the drops is very transient. Like if you put a lubricating drop in, it may last you for like an hour, hour and a half. And then kind of you have to put another drop in.

Yes.

Versus treat the underlying root cause, which is the glands are not functioning properly. And so support the glands, provide heat to get the oils flowing and open up the pores, let the oils be able to be expressed. So I actually recommend like a trio of things for eyelid hygiene for dry eye. Now, a lot of people remember, like we do dental hygiene. You know, we brush, we floss, we rinse the same thing with your eyelids. If you do these three things for eyelid hygiene, you'll help support dry eye, you'll prevent styes, and you'll keep those glands healthy. So the three things are. You want to do a hot compress? I like this type of hot compress. It's a. I don't know if you can hear inside. Yeah, let me see. There are some like medicated beads in here. Okay. So you heat this up in a microwave about 10, 15 seconds, you put it on your eyes, it heats up the glands and then it loosens all any clogged glands. The second thing I like to do is to use a cleanser wipe to get rid of any debris along the edges of our eyelashes and our eyelids. So I like to use a cleansing wipe which has tea tree oil in it. And tea tree oil helps to stabilize the ocular surface. There's actually a microbiome for the ocular surface. Many people have heard of like the gut microbiome. There's also an ocular surface microbiome. So the tea tree oil wipes. Wipes can help to clean off things. And then finally.

And tea tree doesn't irritate your eye. I would think tea tree oil would irritate it.

Yeah. So this is a really dilute amount. So you can't use like full strength tea tree oil. This is, I think this is like.

Don'T do your own, don't make your own. It's not a DYI.

No. Unless you're really diluting it to less than 5% or even less than 2.5%. You can do a DIY, but it has, has to be dilute enough that it's not going to sting and burn if it accidentally gets in your eyes. Because you don't want that. It will really, really hurt if you get tea tree oil in your eyes.

So if dry eye is caused from that kind of, that damage over time, like you're showing where that water line is, why do we then like feel it more? Like I live in the desert, Like, I would feel it more here than when I lived in San Diego. I feel it more in Arizona now. Or like when people get allergies, is that still related to that or is that like a completely separate reason you would have dry eye?

It's, it's related because if you think about your environment and the humidity, so if you live in, you know, a drier climate, those tears are just going to evaporate very, very quickly versus if you're living in a more humid environment. Like if you're in like Miami, for example, or southern Texas, where it may be more humid, there's just more moisture in the air, so the tears will last longer. So it does all go back to, like, tear stability and how much your glands are supporting your. Your tear film by producing healthy oils.

It's now, I kind of like us.

Like a covering, like a film that keeps the tears in place. So if the, the oils are, like, not healthy, if they're breaking up, then the tears will just evaporate.

Hey, there. If you're finding value in this episode of Midlife Conversations, I would really appreciate it if you would hit that, like, button, button and subscribe. And when that little bell pops up, you want to hit that. That way you are notified of all new episodes so you don't miss a beat. Also, you subscribing and liking helps others find this content, and this allows me to keep growing, keep getting amazing new guests for you and to keep sharing. What about, like, I know I had Lasix years ago, and many people that had Lasix developed dry eye after that. Is that. That's a different area of your eye, though. They're not touching that water line. So is that a different reason that you get dry eye after Lasik?

Yeah, that's a great question. So I'm glad you brought it up. So the cornea, which is again, in the, in the very, like, front part of the eye over here in Lasik, what the your surgeon's doing is they're actually cutting into the cornea. They're making a flap, they're putting the flap aside, they're ablating the cornea, they're flattening the cornea, and they're putting the flap back. Now, when you cut the cornea like that and you're cutting this flap, you're cutting the nerves to the cornea, and the cornea has lots of nerve endings. Those nerves can take some time to regrow. And until they regrow fully, people may have worse dry eye. So it's slightly different mechanism than the tear film because the nerves give a lot of growth support, like a lot of growth factors to the cornea, the surface of the eye, to keep the cornea healthy. So when you're directly cutting those nerves, you're directly affecting the healthy substrates for the cornea. And sometimes it's just like six months, and then people kind of go back to normal after having Lasik. Other times, rarely, it may persist even after that. Where people have kind of chronic dry eye after having had Lasik surgery.

I remember when I had Lasix and I Had dry eye. The doctor put that stupid plug thing in, and I wanted to kill him. It's like that. They put a plug in, and I was like, nope, not doing that. Nope. Not to that. Why did they do that?

Yeah. So we have. The whole tear system is actually quite complex. The tears are produced by a gland up here. Then the oils are secreted to keep the tears in place, and then the tears drain out of. We have this tiny little drainage system on the inner part of our eyelid, and they drain into our nose. So if your doctor thinks that you're draining too much and they want to keep more tears on the surface of your eye.

Oh, that makes sense.

Plug up your gland right here. Now, for some people, these plugs are. You know, they don't even notice that they have them. But for some people, like you. And I knew too, because I tried it too, and I could not tolerate it.

No.

You feel like there's, like, a grain of sand in your eye. Yeah. And then some people even have to have those plugs removed because they're just uncomfortable. So it's not for everyone. Yeah.

Mine came out, like, two hours later. I was like, absolutely not. This is not gonna work. Yeah. If you're highly sensitive, you're not alone.

Not alone for sure. Yeah. Yeah.

Okay, let's. I want. Before I get into migraines, which I have a lot of questions about, I want to. You mentioned waterline makeup and why that would be bad. Can we talk about eyelashes for a minute and eyelash extensions? And I want to get your thoughts. And now I. I don't have eyelash extensions on, but I am guilty of wearing eyelash strips. But I want to talk about all of it. Like, I want to get your real unfiltered stuff about your thoughts around eyelash extensions and just. Just in general, wearing false lashes.

Yeah. So I think the trend has kind of. Kind of come down a little bit. I think maybe like four or five years ago, it was really, really trendy to get the. The two week, three week, like, extensions. So back then, we saw a lot of complications from these eyelash extensions. The glue that they used, a lot of salons would use this glue that was formaldehyde based, so it would cause irritation of the. The skin, and sometimes it would even make people's natural lashes fall out. So the glue is really a no, no in my mind. And then a lot of people even got styes because the glue was plugging up those glands because it would kind of seep, you know, kind of like spread and Then go where it's not supposed to go and block the glands. So glue is in my opinion, a no. No. But if you want to wear lash extensions, the kind that I love, and again, this is not for everyday use, but you know, if you're going out for a special occasion, absolutely, you can do this. I love the magnetic lash liners. So it's basically, it's like liquid eyeliner, but it's got magnetism in it. And you put it just on the outside, so not on the waterline but on, just on the outside. And then the lashes clip onto that because it's all magnetized and it's just.

So that's healthier for you, the glue line with that than using even your own natural glue. And, and like that's what I do right now. I do the strips and the glue, but I take them off every day. And you're saying, no, the magnet's gonna be better.

You can do that. It just depends on what's in the glue. Like you'd have to look at the ingredients and make sure that they're not gonna cause like damage to your lash follicle and make your lashes fall out. I love the magnetic ones because you wear it, it literally snaps in because it, you know, magnet to magnet snaps in, you take em off, you just remove the eyeliner with makeup remover and then you're done.

It's so funny. I used to actually wear Mac. I used to actually wear and promote magnetic ones years ago. But I thought, because I used to think the opposite, I was like, oh, well, the magnet might not be good for our eyes, but I hear what you're saying. You'd rather that than the chemical part because the magnet's going to do way less damage than the other part. Interesting.

Yeah.

And is there truth that people.

It's tinted. Like when you're wearing the magnetic eyeliner, you can see where it's going. Right. So you can be really see like making sure it's not getting on your waterline. And if it does, you can clean it off. You can just be more proactive with it.

Any truth to some of the viral videos from lash extensions about getting like bugs in your lashes and stuff like that because you're wearing them for three weeks. Was that, is that all a myth or is that true?

So I'm assuming when you mean bugs, you mean mites.

Yeah.

Have you seen those? Yeah, so. So there are these mites. And I know it may sound a little bit gross and creepy, but it's, it's a Fact of life. We have, you know, different microbes living on our bodies. And there are these eyelash mites that live inside our lash follicles. They actually. They're tiny. They're microscopic. They live inside. And almost everyone has them. Oh, wow. You know, almost everyone has them to some extent. They live on your lashes. They live on your eyebrows. Like a bacteria Sometimes. Yeah. And sometimes they overgrow. And when they overgrow, that's when you'll see, like, deposits at the base of your lashes. Kind of like crusty, like dandruffy, like deposits that could be a sign of mite overgrowth. And this is again why I like the tea tree oil. Because the tea tree oil wipes have been shown to decrease this mite infestation. It won't get rid of them completely, but it will decrease their count and decrease the inflammation that goes along with it. And eyelid mites can also cause dry eye because they're directly impacting the quality of your glands and your tear film and all of that. So it kind of all goes together. So if you're practicing, again, good eyelid hygiene, hopefully you'll keep those mites at bay. There's also, like, for people who have really bad eyelid mite infestation, they really have a lot of, like, irritation of their lids. If their lids are red and, like, really thick and, like, uncomfortable. There's a drop on the market now. There's a prescription drop that is designed specifically to treat eyelid mite. So you can ask your eye doctor about that also whether you're a candidate for getting like a. It's a six week course of treatment with that drop.

It's just so funny. Listening to you like, tick tock is so sensationalized. It's so funny. Like, you're like, people are showing these videos of lash extensions with bugs, but what you're saying is, like, literally everybody has mites on their eyelashes and this is like a sensationalized thing. Like, oh, yeah, I guess it makes sense. They're gonna close up and you're having an overreaction and you have lash extensions. But it's not that that the lash extensions necessarily cause them. We all have it. So it's just. It's just funny.

I mean, like, I guess you could say that, you know, if you wear them all the time, that you could have an overgrowth of these mites. It's possible.

Yeah. But it's not because of the lashes.

Right? Exactly. It's not that the lashes brought the mites. The mites Were already there.

Wow. Okay, that's. That's wild. So don't believe everything you see on TikTok. What about migraines? You mentioned, you said there was a connection with migraines and eyes, and I had never heard of migraine aura before. I actually had a vasovagal episode happen to me on the airplane with a headache, but I'd never heard of that before. And I've heard that that's a similar thing. So can you help educate us there? Like, what is a migraine aura and what. How is this connected to our eyes?

Yeah, this is one of my favorite topics because I'm a neuro ophthalmologist and I deal with migraine a lot in my practice. So migraine, first of all, just back up and explain migraines. Not just a regular headache. It's a neurologic condition and it can affect our vision. It can cause dizziness, it can cause vertigo, it can cause nausea, vomiting, GI upset even. It can affect our urination, it can affect our stool. So it's a complete neurologic condition. And the way it affects our eyes. The most common symptom that people with migraine will have is actually light sensitivity. Almost everyone with migraine has different variations of light sensitivity. Not just when they're having a migraine, but even in between migraine attacks. People can be a lot more light sensitive. But the second most common thing is the migraine aura that you were talking about.

Wait, before you answer that part about the migraine aura, elaborate on light sensitivity. What does that mean? Does that mean in regular daylight? Does that mean at night, all light? Like, what does that mean?

It can be exquisite. Sensitivity to any kind of light, whether it's sunlight, whether it's indoor lights, and particularly fluorescents are a problem. So, you know, like those long, like if you go to like, you know, a grocery store, you see those long fluorescent overhead or an office setting, those really, really trigger people's migraines because people don't realize those fluorescent lights are actually flickering on and off, on and off at a very, very high rate. And our eyes may not be able to detect the flickering, but our brains can detect it. And sometimes that can actually trigger a full on migraine attack. So anyway, and even screens can trigger light sensitivity. So we're all on our screens all day long. So the blue light that's coming from our screens, it's also flickering at a really, really high rate and that can trigger migraine. So if, you know, maybe now this is kind of piecing together for Some of your listeners out there, like, oh, yeah, when I'm in a grocery store, I can't tolerate those lights. Or when I'm at my computer for a long time, I can't. I have to look away or get a screen filter. So definitely there's a very strong connection. And actually light sensitivity is one of the diagnostic risk criteria for migraine. Light sensitivity and sound sensitivity also are two diagnostic criteria for a migraine. But moving on to the aura. So this is a very scary symptom if you've ever had it. And when I'm going to describe what it's like, and if you've had it, you will know exactly like, yes, that happened to me. I was there. I, you know, I was scared, you know, terrified that I was having a stroke. So what happens with aura is that initially, if you catch it at the earliest onset, that it's kind of like a gray spot in your vision. A tiny little gray spot. So let's say you're trying to look at someone's face and all of a sudden their nose is missing or their eye is missing because of this gray spot. And then that gray spot starts to enlarge. And as it gets bigger, it starts to shimmer. So its edges will be kind of like shimmering, kind of like zigzags. And sometimes they'll even have like geometric shapes to them. So imagine this gray spot, it can expanding and it starts to shimmer like this and it takes on like a C shaped appearance. So this whole aspect of your vision is shimmering, kind of like a kaleidoscope. Like it's shifting geometric figures. It's colorful, it's very bright and you can't see. And it's kind of like you're having a stroke or a seizure. But it's a migraine aura. And the way you know it's a migraine aura is that eventually this C shape will get bigger, bigger, bigger, and then it will drift off and the whole.

So that's different than the tunnel vision. Like the tunnel. Like I, I know I had an experience recently with the tunnel vision where it was like closing in, which was called, I learned was basal vagal. Is that different than this?

It's slightly different, yes. That's where kind of like everything is closing in. From the. Yes, from the periphery to the center. This is more like different than the world center. And it's expanding out.

Got it.

And the whole episode from start to finish, if you catch it like at the gray spot, when it just starts, the whole thing usually is anywhere from five to 30 minutes.

Okay.

Typically 15 to 30 minutes.

I have migraine and I have aura. The very first time I had one of these was when I was in medical school. I was stressed out studying in the library, like, you know, lack of sleep, too much caffeine. And I had one of these. And even being a medical student, I did not know what it was. I thought I was having a stroke. It's so scary. But then afterwards, after it passes, your vision eventually goes back to normal. And by the way, this happens in both eyes at the same time.

So now is your head pounding while this is happening? Are you having an actual headache while this is happening?

Not yet. Not yet.

Okay.

So it starts actually after. So this is the interesting thing. Usually the aura happens first, and it's kind of like a prodrome, like it's the precursor to the migraine headache. And then the headache starts. And usually the headache is on the opposite side. So if your visual symptoms were all on one side, the headache will be on the opposite side. Sometimes, like right behind the eyes, sometimes in your forehead, or sometimes it just kind of radiates, like all the way down, even into your neck and shoulders. But it's typically the opposite side of where you saw the visual disturbance.

And then there are some people who just get the aura and never get the headache. And I consider them the lucky ones because they don't get the full blown migraine. But that's just called migraine aura or visual aura. But no headache. But definitely, if it's your first time, get it checked out. Don't just assume, like, oh, yeah, I think I get those. Just get it checked out. Because we don't want it to be something more serious. Get an eye exam, have your doctor take a look at you. And if it's just migraine aura, then you just have to think about, okay, what may have triggered this, like, what was going on in my life that may have triggered this whole neurologic thing to happen? Was it because I was dehydrated? Was it because I was exposed to too many bright flashing lights? Was it because I was hungry and I hadn't eaten in a long time? Was it because I had too much caffeine? That's a big one. Like, too much caffeine, sometimes even too little caffeine. Like, if you're used to having a lot of caffeine. And then there's one day you, when. When you don't have that much caffeine, that may trigger it also. But a lot of the triggers for migraine and Migraine aura are lifestyle based. You just kind of have to do a little detective work and figure out what may have triggered it. And so then you know, next time to try to avoid that thing from being a trigger in your life.

Now, is managing migraines, does it really come down to that, where you can figure out the trigger and do that, or is it something that you would need medication to manage them? Cause I've heard both things. I've heard, heard people say they have to avoid certain things for migraines. And then I've also heard people, they take like a pill, there's something they take when they, when these are coming on.

Yeah. So it really depends on how much migraine is affecting your life. So if you get a migraine like once every six months, you don't need to take a pill, you know, to prevent it. It's happening, you'll manage it as it happens. But if you're someone who has more chronic symptoms, like for example, I have patients who get migraines like four or five days a week. And if you ever had a migraine, you know like how debilitating that is. Right. So imagine you're getting attacks like four or five days a week for people like that. Yes. They need to be on a medication to prevent it from happening so that they can be migraine free during most of the month. So it all depends on your symptoms, the frequency, the severity. But a lot of people who have this like episodic migraine, like once in a blue moon, really, it can be managed. I'm a strong believer if you figure out what your triggers are, you can manage it and you can prevent it. And you don't have to go on medications. A lot of people, there'll be foods that are triggering it, for example. For a lot of people, including myself, I know that certain types of alcohol like red wine will trigger a migraine or certain fermented foods like cheeses or other types of fermented foods may trigger a migraine. So do a little detective work, figure out what it is and try to again eliminate it from your life.

Can you have migraines without the aura?

Yes, and actually most people do. The aura is only about, in about 30% of people. So the vast majority of people just get the full blown migraine attack. They never have the aura. Now, I described a visual aura. Other people may have other types of auras. Sometimes people will have, and this can be a little scary also where they'll have tingling or numbness down one half of their body. And for that they definitely need to get that checked out to make sure it's not a stroke, to make sure it's not a seizure. But that may just be their type of migraine aura. And the, you know, if the workup is all negative for everything else, it could just be their migraine aura. Some people will have speech difficulties, and this can be, again, really, really scary where they're trying to say something and the words are not getting out. And that could be a precursor to migraine. Or sometimes people will smell things. Like they may smell something that's not really there, and that will be their aura. Their. It's col. Like an olfactory aura.

So an aura is really just the precursor to that. It doesn't mean it doesn't have to be the visual one. It could be what you're feeling in your body. It could be a lot of different things, but it's the precursor. Basically, the commonality is you get this thing, and then you get the headache. Is that what I'm hearing correctly? It's like this comes on and then you get a headache.

Yes, yes. So migraine actually has four phases. So like the. The prodrome, the migraine phase, and then the post postrome, and then kind of like the inter migraine phase. And so not everybody gets the aura, though. And even after the migraine has subsided, again, there's this post trauma phase where you kind of feel like you have this brain fog going on. And if you have migraine, you probably know exactly what I'm talking about, is the headache may be gone, but you don't feel like yourself. You still feel like something's not right. Like I can't think straight, I can't function. Right. That's postdrome migraine, kind of like a hangover, like a migraine hangover. And that's also something that can last, like a few hours to a few days. And again, migraine is not your typical headache.

What's the difference between. How does somebody know, like, the difference between a headache and a cluster headache and a migraine? I think people use a lot of these interchangeably. Like, I've heard people say they have severe headaches or they have cluster headaches or they have a migraine. Like, what is the actual difference between them all?

Yeah, so there's actually diagnostic criteria, and I won't bore you with all the details, but for migraine, it has to be. I'll just share a couple of things. It has to be at least four to 72 hours. The attack.

Okay.

Usually you have to have again like light sensitivity or sound sensitivity with it, maybe nausea or vomiting with it. You have to have, it's pretty severe. So it's not just like a mild kind of annoying headache. It's really severe. It stops you from doing what you want to do. And usually you have to have at least five episodes before we call it migraine.

Okay.

So if you had just one episode, it may not be like full blown. You know the diagnosis of migraine, you have to have, have at least five distinct episodes for it to be called migraine now. Cholesterol.

Yeah. And I've definitely heard people, they have like these, these things were like it's like seven there. It's like a three day situation and they have to go get away from light. So it's the more severe I'm imagining. Like that's what.

When you describe that, it's exactly it. We just want to like go into a dark room, crawl under the covers, not talk to anybody, not do anything. That's migraine most likely. Got it. Because if you just had like a tension headache, most people can still do things if they have a tension headache. Actually sometimes when they, or they're more active, their tension headache goes away. If they do some kind of activity versus migraine. If you try to do some activity, it makes it worse. You don't want to do anything when you have a migraine. It just makes it worse. Now cluster is slightly different. It's along the spectrum of the same nerve that causes migraine is affected in cluster, but cluster is more like a stabbing kind of pain. And it's like someone's like trying to drive an ice pick. And usually it's behind the eye like in your eye socket or in your forehead just on one side. And cluster is where you get these bouts like several days in a row where you know, maybe you don't have it all day long, but you're sleeping and all of a sudden it wakes you up from sleep. Yeah, like 5am it wakes you up from sleep because it's such as a severe pounding headache. And then it goes away and it comes back the next morning. Like that's cluster. So it's a little bit different in its time course because it's more like kind of regular. Like you can kind of predict it's going to happen.

Now when is it an urgent, like there's also really severe like where you have an aneurysm or it's something really dangerous. Like what. And then I think what happens now is some people actually do have life threatening things like that. But they think, oh, no, it's just this. When is it actually urgent? How do you know? Like, like, wait, this is not normal. This is. I need to go to the er. This is more serious.

Yeah. So there's a couple of red. Red flags or warning signs. Number one, if it's the worst headache of your life, don't take chances. Just go to the er. Like, if it's. If you've never had a headache like that, just go get it checked out. Make sure it's not something like an aneurysm, like you said. Also, if you have any, like, unusual neurologic symptoms, like I mentioned earlier, like numbness, tingling, trouble with your. Your speech, get that checked out, too. Yes. It could just be migraine, but you don't want to miss, like, something more serious like that.

So worst headache of your life. Like, like, you're. Without a doubt, you're like, I've never felt this experience. Or you have real other slurring, weakness.

Things like that, or weakness, numbness, balance problems. Like, if you can't walk straight, go get that checked out. If your face is weak on one side with a headache, get that checked out. Or if you've lost. Lost vision. Like, let's say you think, oh, maybe this was an aura, visual aura. But now my vision's still not back to normal. It's been like two hours. Get that checked out. Because that's not migraine. Like, if you've, like, your vision's not coming back, go get it checked out.

You know, it's. It's funny. I'm interviewing you and asking all these questions, and I'm thinking of everyone I interview and how do we not become a hypochondriac in midlife? Seriously, there's so many. Like, there's. It just. The ailments start piling up as we age. You know, it's like everything is like. Like it starts compounding.

Do you.

Do you notice that? And I can speak as 54 all of a sudden, it's like these things just start piling up. And I think it's challenging for midlife women to know, like, what's just me right now versus what's like, really something serious.

Yeah. My advice would be. I mean, I'm 54 too, and I. All kinds of things have popped up, you know, through the years. Like, recently, I. I'll share this with you. I had this really, really scary symptom where I was having pins and needles on one entire half of my body. Like, literally, you know how when you, like, Your leg falls asleep and you feel like there's pins and needles. It wasn't numbness, it wasn't like weakness, but it was pins and needles. And I was like, oh my goodness, like something is wrong. Yeah, right. And yes, I have migraine. I was like, this is not my usual migraine. So, you know, kind of establish for yourself what your baseline is like. Okay, I know. My body. I know. Okay, this is. I do have like these little aches and pains here and there or. Or this particular thing is bothering me. I have these GI issues. That's your baseline. If anything's beyond your baseline, don't just wait on it. Don't just describe it to. Oh, it's just menopause or perimenopause or it'll just go away. You deserve it to yourself to get that checked out. And even though, yes, we all have busy schedules and it's hard to get to go see a provider. Just do it because it will give you peace of mind. So. So I ended up going in, getting an MRI for this crazy symptom I was having. I thought for sure I had a brain tumor. I thought for sure it was Ms. I thought sure I had a stroke, like something. Of course, being a doctor, I always think like the worst possible.

Did you ever piss nerve things?

That can happen. Yeah. So I have some cervical disc disease. And what was I doing? I was doing sit ups the night before. Right. Wow. And you think that, okay, you're doing something healthy, you're trying to like, stay healthy, you're exercising, doing something good for your body, but then you cause something to happen. But the good news is just disc disease. I can do some physical therapy. I'm already getting better. Like, it's not bothering me so much, but it's just the peace of mind to know that, okay, it's not something serious. I got the test done, I'm okay. And now I know what the real diagnosis is. Now I can deal with it.

I knew what you were going to say because I had a disc replacement in my lower back. And then when I started, I started having tingling on my lower left side and same thing. And it was just. It's just like a. Your neck can do that. So, like. And I think as we get older, we definitely have spine issues.

And.

And I'm really learning a lot more. I hope other listeners are too. And I'm sure you are as what for what you do. There's just such a big connection between our spine, our brain and our gut and our vision. Like, they are it's really all connected. Something really weird you might appreciate as an eye doctor. I don't know. Before my back surgery, my left eye was blurry, and I couldn't figure out why. I had this blurry left eye. I had my disc replacement between L5S1. I've not had a blurry eye since. And I thought that was so strange, but my neurosurgeon said it's actually not that strange. He said it's just all connected.

It is all connected, you know, so the eye is a direct extension of the brain, and the brain is connected to the spinal cord, and they're all bathed in the same fluid, cerebral spinal fluid. Right. So if something's going on even down in your lower back, it may actually manifest as some kind of eye issue. Definitely get it. You know, if you have blurry vision, get. Get it checked out. But things can be connected in ways that we don't necessarily connect them. So I love that you brought that up. It's really, really important to think of the body, like, more holistically and not to think of the eyes as. As part of. As like in a silo. They're not. They are part of our bodies. They can detect things early. Like, we can really list. Find out so much from eye exams. Listening to our video vision, like, what's going on? Could it be a sign of something else? One example is diabetes. So we talked about diabetes earlier, but I've diagnosed countless people with diabetes over the years because they've had this fluctuating vision. Their vision goes blurry in and out, in and out, and they're really not sure why. It's not a glasses problem. It's not dry eye. And it ends up being that their sugars are high. And so when our Sugars go above 200, our vision, our lens inside the eye will swell up and it'll make our vision blurry. And then when the sugar comes back down, the lens will go back to its normal shape. So, you know, things like that. Something that your eye doctor can be really instrumental in helping you with your health journey. Make sure your team.

We are all science experiments of one. And it's so. It's so interesting. And we're also. We all have to be. I really advocate for midlife women. You have to be your own health detective. You really have to be your own health detective. And I just think. And I'm working on this too, in this season, we have to. There's a fine line between being a health detective and learning and being a hypochondriac so it's like we got, it's like all the things, right? So you have to listen. And I love your advice that you just gave. Like, check in, know what your norm is. Like what's my norm? And then you know, when you're really out of norm or it's just a minor thing that's different. So it's just like, what's my norm? And then where's something really concerning. And I'm definitely not afraid of, and I think listeners should not be afraid of going and getting things checked out when you need to. There's no harm in getting an ekg, getting an mri, getting whatever it is you need. If you have this little thought, like, you know, I don't know, just get it checked out. And I also love, and I with recent interviews recently, I really think we do need to get back to really doing the full body check every year. So, like when you're going to the gynecologist, you also should be making your dentist appointment. You also should be making your eye examination. But do it all around your birthday, whatever it is, but don't skip, don't just go to a general practitioner. You need to go to specialists and really that know those areas to really understand what's going on. You've answered so many questions today, I could talk to you forever. Where can people learn more? How can they? And where are you located? Can they go to you as a patient? And how do they find more?

I'm based in New York City, right in Manhattan, so I do have a practice here. If anyone's local or they'd like to come to New York for a visit to come see me, definitely welcome that. And you can find out about my, you know, my work on my website, drronniebanek.com and I do a lot on Instagram as well. So please follow me there. I have a few books, I have a few courses online and I also have a supplement line. So you can find out all on my website. Thank you.

And I'll link all of that in the show notes. Thank you so much for being here today.