As we close out the day, we would love to hear your reflections about what you heard today, given everything you know about British Columbia and social and emotional learning. And maybe we start just back at the very beginning, which is what is our ultimate goal as we came here together. Well, you know, so first of all, I just have to first thank all of you for staying so late, because I know it's been a long couple of days, so thank you. There are so many of you still here. And also, just to thank you to the Ministry of Education who's helped put this together. They've done just such a fantastic job, and I think we should be so grateful for being a place in the world, in which puts an emphasis on this. So I really think it's reflecting on that. You know, really thinking about the various speakers that we are in a very special place and a very special time. You know, I think Mark Greenberg was mentioning this idea that we have this bottom-up, tap-down approach that's already occurring. So I think that we should think about what we've done so far and also to say we have a lot of work to still do. So I think that that, in reflecting that, I think we've learned a lot. But I think many of you now want to know, okay, what are we going to do next? What's going to be our plan and strategy as we move forward? So I think that that's one thing to really think about as we move forward, what people are going to do. And before we step forward, though, as you say, just to maybe take stock from your perspective of what's happening in British Columbia now, how did we get to where we are now in the area of promoting mental health and well-being, promoting social and emotional learning? So I have to graph it. So there's been actually, this actually says five courses, but I've added a sixth one. You don't have to see what it is. But it has tipped our scale. We look at, I love what Monique talked about, this idea of educating the heart. Or we call it social-emotional learning that has now become ingrained within our province, educating the heart and taking about social-emotional learning mental health promotion. And I think we first had one of the things that we've seen is policy change. And policy change in itself is not sufficient, but it places a huge space in which to have this happen. If there's no policy, if this is an integrated with the redesigned curriculum, with the new physical health and education curriculum or mental health and well-being are discussed, that policy change has really helped move that forward. The next one is really about teacher preparation. And I first have a quick question for you. How many of you have gone through a teacher preparation program? I went through to become a teacher. You have to just look. Okay, how many of you had a course on social and emotional learning when you were in your teacher education program? Okay then. Oh, there you go. There's some of there.  There, so good, I have to ask. How many of you had a course on systems leadership? Okay, good, oh there's some. I love that, I see how some. What we're finding is one of the ways to move forward is we really need to have this notion of mental health, social and emotional learning integrated within teacher preparation. One of the barriers for us moving forward is how many people who are currently in our system, how many educators actually know in depth about this. At UBC, we've started a teacher preparation program with a focus on SEL about eight years ago. We now have a master's program in the human development learning culture program that has a focus on social and emotional learning in particular, but we know that that is one way we have to tip the scale to move forward. We also have assessment or data that we now, as you heard, there was a whole data team who talked about all the different data we're collecting here in British Columbia that's not just about academic achievement. The data with the early development instrument, with the middle years development instrument, with the student learning survey, with the adolescent health survey, with the childhood experiences questionnaire. We have much data that's now being collected and we need to know how to use that. But that is one, we're ahead of the game in that way. We also have the science, the research of social and emotional learning. And I have to say, in many places I've traveled abroad, there's no other place I've ever been where there was such an interest in the science and the research for so many people. We're really interested in learning about the research that we're influenced by knowing about the social and emotional learning. I mean, it was even just interesting Mark talking about the meta-analysis that showed an 11 percentile increase in academic achievement among students who had social and emotional learning. And I got a sense that many people already had heard that. Yeah, and even the young student from SASE this morning who was talking about her prefrontal cortex, that would not have happened five years ago. So this notion of incorporating the science was so important. We also know that it's in schools that I would say there's probably a very few schools within our province where if you walked in the door and said, what are you doing to promote wellbeing in students or social and emotional learning that the majority would say, show you something that they're doing already. So this idea that we're seeing it integrated into schools, into classrooms and much is already happening. And I think also to me what's gonna tip the scale now as we move forward is systems leadership. We need to have, in order to move to system-wide change, we need systems leaders. Ones in which who actually are able to understand the system, able to use tools to be able to identify what's not working, where to move next. Leaders who, if you really think about what is a systems leader, I'm really trying to think of someone who it leads and it could be all kinds of leaders, there are, but those leaders who are able to have those social-emotional skills who are self-aware, who are socially aware, who can make responsible decisions, who can have good relationship skills and also who have self-management. And I think also, and I actually, it stuck with me with President Ono from UBC. I believe a systems leader is also able to be vulnerable and be able to be okay with that, to be able to be authentic and vulnerable at the same time as taking that leader to a bold model of that vulnerability because if I think forward about what one of the barriers might be, is because when we talk about mental health, or mental illness, and social-emotional, is that it's different than talking about math or science. There's a certain, we all have experience with something that's just happened and our hearts are vulnerable to it. And so we really have to have that compassion leadership to understand that if people don't buy in, you can't say, well, they're not coming in, but it actually might have to do with their own vulnerability. And courage. And courage, exactly. We have to have courage to be vulnerable. And I think, has anyone heard of Brene Brown? I guess, and a few of you have. I think that's something that we can bring forward. So this list that you've just shown us, or the teeter-totter that you just showed us, that again, just describe what are you telling, what's the story? So the notion is that in order to tip the scale, so to speak, to move forward to a system-wide change, you need multiple lenses, and you need multiple approaches. And really, to think about all of these is all the different parts of the system. Now, this is a very simple depiction of that, but the idea is that how you have to have these multiple layers, from leaders to schools, to having the research basis, but also having policy and assessment and teacher preparation, that you need all of these together to make, to tip the scale, to move forward. And that's generic, but this you're specifically saying, in so many ways, is British Columbia. It is British Columbia, yeah. It really has been, and I would say, in terms of thinking where we are with those, there's probably ones that are more advanced than others. Teacher preparation area, I think now as we saw many, if I would have asked that question five to 10 years ago, I don't know if the hard-pressed if anyone would have raised his or her hand. So I think we've made great strides. So you actually have, some of your students have actually looked at school districts across the province at their websites to see in fact what shows up. So this is a depiction of what's happening in the Big Picture in BC, some pieces stronger than others, but tell us about that piece of work, the scan. So it actually was Kate, where's Kate? Over there, there's Kate, who has started to do a scan, just so you know, you probably don't even know of district websites. To begin to say how many of your websites and your school, your district plans have actually intentionally mentioned anything related to systems leadership, mental health, well-being, social and emotional learning. And so far, and Kate, I'll see if I have this right, of the 30 that have been reviewed so far, I'm not finding out, the majority have some mention of one of those, one or more of those. So this again is showing that so much is already happening in British Columbia. This is not like a start from zero and we're moving forward. There's so much already happening. There's so many initiatives that are happening and we really need to think about how now to take this, I mean, that's why we're trying to step back and say, what do we mean about a systemic approach? Because there's lots of things happening, but are we doing it in a system way? What do you mean by when you talk about it, Mark talked about it through his models, but for you, how do you think about it? About the system approach. I think the idea of system-wide, well, I always think it has to be in the floors and the floors and the doors and it has to be so integrated within that approach. And we think about how, it's like the elephant metaphor. It was perfect, Tracy. It was wonderful to have that right beforehand because the idea is that many people are in the system and they're seeing this piece of it. Even students, even parents, even that, and how do we make sure we get to understand that elephant, so to speak, from those different perspectives and realize that each one is valuable. It isn't one correct way in saying like, oh, well, it's really this, but how we can only move to a systemic approach if we involve all. And you have a graphic that you use to look at the different elements of, well, isn't that a coincidence that you happen to have that here? There we are. There we go. So one thing, you've heard Mark Greenberg talk about the 10 indicators of school-wide social and emotional learning that include SEL in the classroom, programs, infusion into the curriculum, a safe and caring environment, adult well-being, school discipline, family school partnerships. And a couple of years ago at HELP, we created this infographic about a systemic approach to school-wide social and emotional learning. And I have to say, when I talk about SEL, I'm talking about mental health promotion. So keep on thinking of those as being interchangeable. And what we talked about is these three dimensions, and I think I could put up the long list of 10 indicators, but I think that these three, if you think about, so first of all, there's a social and emotional learning of the students, and that would involve some evidence-based programs and be infusion into the curriculum, but it also would be about students having a voice and youth engagement in those kinds of things. And then you move to the learning context. And the learning context is about the school climate, the school discipline approaches. It would be about even assessment, like what is being collected. And it also includes families and community. And I have to say, there's no way we're gonna get this accomplished unless we involve parents, unless we invite families and community to be a part of the system, to be a part of the journey. And then the last one I wanna click on, but I really wanna emphasize it in a big way, is the social, emotional competencies and wellbeing of the educators. I know there's lots of research Mark compellingly gave us those data, but they are part of the system and their wellbeing is so much a part of the system. So really thinking that, if you think about this as like a three-legged stool, first of all, the circle indicates kind of interconnectedness among all three. They overlap and go together. But then if you took away one of these, it would fall over. And the idea that you really need to have these three dimensions, as I said, multifaceted in combination in order to move forward. And I think, and the one thing I do wanna kind of just mention, one of the things we haven't talked about as much as the adult climate in the schools. So on the one hand we could be focusing on adult wellbeing and I think Mark alludes to this idea of the system so it doesn't blame me teachers it's about the systems that support teacher wellbeing. But I also have to make mention of the adult system within the school. And I often find that the children and their belonging is a barometer of how the adult climate is working. So we have to think about it for moving systems. How do you create that positive adult culture? There's Tony Breik and Barbara Schneider who talked about something called relational trust in schools. And they did a study and they have a measure to look at what is the relational trust among all the adults in that building and how they can, it's about creating that climate of adults that is so important. So I just wanna say these systems, as you start unpacking it you see that it becomes so complex. And so I guess the complexity just to say there's no easy answer. There's no magic bullet or silver bullet or whatever kind of bullet which I hate those kind of words and that kind of language. It's also aggressive. But anyway, there's no magic sauce. Yeah, what about the trust? What does that trickle down to describe a little bit more about that? What does it look like? What does it look like when it's not there? And what does it have to do with mental wellbeing of the students? It's so interesting. So I'll tell two little stories. So first of all, that relational trust is about how much you feel like you can rely on someone else. And when there was a survey done several years ago, teacher stress, if you know the number one most frequent stressor that teachers reported was not getting the respect of their colleagues. That was so interesting. And I think that idea of what is it like if you don't get that respect? And what does it mean if you don't feel that trust and you can't rely on the person next to you in the classroom? Maria, could you just come and watch my class real quick or having those, or the staff room? And you can't be vulnerable, that's for sure. Well, I know, the staff room, so I'm gonna tell a story. Okay, so some of you might know I was a teacher before I went back to graduate school and I was teaching, my first teaching job was seventh and eighth grade French in Oak Park, Illinois, near Chicago. And I was a brand new, I just graduated, I was like a long-term sub that was like a substitute teacher, PTOC, they're called now, I think. And so six months. So I go into the staff room. I'm there, I have seven days, graders. I go into the staff room the first day for my lunch. No one says anything to me. I go sit on the chair and have my lunch. Second day I walk into the staff room. No one says anything to me. By the fifth day, I was kind of sitting in my corner, having my sandwich. I decided to go, I just felt like, and I realized that I could have been more outgoing and could have gone up to people and said, oh, hi, my name is Kim and I'm here for a long-term sub, but I just, I didn't do that. So what I did do was I went back to my classroom that was empty during lunchtime and just sat in my classroom and had my lunch because I did not feel any connections. But do you wanna hear the wonderful thing that happened? So my students, because my classroom was like on a corner and it had windows that was on the first floor, my students started seeing me eating lunch by myself in my classroom. So those sweethearts, they would come to me and go, we saw you eating lunch by yourself when we wanna come join you. So by the end of a week, I had like 20 students in my class joining me. But again, you think about how do we create that adult, that compassionate culture in that school, in that district? How do we welcome people? How do we create that caring, that circle of caring in a way that everyone is included? So that helps give a good example.  Why wouldn't that just automatically happen? Why wouldn't that just automatically happen? So now from now on I'm gonna be thinking, what's the mental model behind that? But one of the things that you've done is research the impact of that teacher whose well-being is ill, ill-being, the impact of that teacher on the students. And Mark alluded to it. So we also wanted to know, so there's research, I feel I'm gonna tell you some bad news, so be prepared. It's stress contagion. Now some of you've heard me speak about this before, I'm sure, but just so you know that like stress is contagious. Emotions are contagious, but stress is contagious. So even if you're not stressed, but you're among a small group of people who are highly stressed, you will actually get the negative physiological symptoms of being stressed yourself.  You could feel it creep into your bones. So we did a study wondering if stress is contagious in the classroom. So think about the classroom as another system. So in this way we went to the teachers grade four to seven and we asked the teachers to complete a measure about their own stress and burnout. You know how much they were stressed, how they felt burnt out. And then to get the stress levels of the students, we were really interested in kind of getting biological data, like some indication of their stress through something called cortisol, which is a stress hormone. And we all have cortisol, it peaks about a half an hour after awakening and a healthy pattern is at declines throughout the day. And to get cortisol, does anyone know how to get cortisol? Blood, no, we didn't get blood. Saliva, spit, spit. So just so you know, grade four to seven students, love giving you their spit. No, they do, they really loved it. They loved learning about the stress in their brain, kind of like the kids do. They love the brain stuff. Yes, the university hill, yes. So what we found was fascinating. We found that those classrooms in which the teachers reported the highest levels of stress and burnout were the classrooms in which the students had the highest levels of cortisol indicative of high stress. Now, again, we don't know if it was students coming into the classroom from families that were highly stressed and those kids were coming in and the teacher was catching that stress. If the teacher was stressed and burned out and was handing it over to the kids and the contagion was there or some combination of the two. But again, we have to think of that complexity of the system and that system and that stress. And, but the good news is, guess what? Happiness is also contagious. Joy is contagious. So in the same way we can redirect that to create these joyful and optimistic and happy classrooms. Don't dogs also get? Yes, oh right. That's the oxytocin. So just so you know, oxytocin, which is not oxy-cotton, which was a warning us about not fixing them up.   Oh, is that right? No. Well, that's good though because we're talking about wellbeing. So one of the things we talked about today on the data panel is how would you collect information about teacher wellbeing? So do you know anybody doing that? What would you, how would you do that? Because you're indicating that it's really important. It is very important. And there are surveys certainly that we have done. I'm working with Dr. Ava Oberle, who is doing a study right now, actually in Vancouver School District on teacher wellbeing and teacher stress. I think there's a number of surveys to really look at it. I think the important point here is how much not that we wanna blame the teachers in their stress and burnout. We have to look back at the system and see is there something in the system of by which these teachers are feeling stressed and it really makes me think that as you move forward, I don't, do any of you have any stressed teachers in your schools? You think about it and you think about here's all this amazing new things you're learning you wanna bring back and what sometimes the reaction will be even if it's the best things and sliced bread. Is that like a really old saying? Oh, it's because I'm one of the elders. That's right.  So how do you go about trying to make system-wide changes that mental model when already everyone's feeling so put on and I think to think about how do we create a system that has that wellness at the fore as an intentional focus and actually I'm going out where's Greg Smith? There he is over there. Sorry, Greg, I told you, I kinda warned you I would call you out but I know Greg Smith, the superintendent of Port Alberni has really had as a system leader has really put an intentional focus on well-being through the entire district so that school plans have to, and I see if I have this right, Greg, I might be totally messing it up, but with the focus on well-being. So everyone is already giving an intentional focus on how do we create cultures of well-being that support everyone. And what you need to have system-wide changes think about the relationships among all the different initiatives and how they work together. Or maybe some of them don't work together very well and you have to think about what doesn't fit in. But I think the schoolhouse really depicts that idea, and I think two things I wanna emphasize here. One thing, this is not so new. There's probably many things you're already doing. It's kind of that Wizard of Oz, that you're already doing many of those things, but that it might be not coordinated or systemic. Do you think we have about five minutes left? Do you think we can do your five takeaways? Yeah, I wanna do that. I just wanna say data is one of my points, but you'll get to it. This is Alberni School District. This is from the Middle Years Development Instrument asks fourth grade and seventh grade students, how many adults at your school are important to you? You see here is that you see that of those grade sevens in 2013, 2014, 34% said there's two or more adults at my school who are important to me. 14% said there's at least one adult at my school who's important to me. And just, I won't go into the whole literature, but science and resiliency shows the importance of at least one significant adult. 53% of students in grade seven in Fort Alberni said there's not one adult at the school who's important to me. I think that shook them up. They said, what can we do as a system to change these data? So it's using both data to instigate and catalyze action, data to collect across time to see if they made a difference. They put an intentional effort to say how can we be connecting with our students? I don't know the details. I'll send you to Greg if you want to know. The next year, they changed significantly from 51% of students now saying two or more to decreasing to 38% of students saying no one. And then they went further and continued to show this change. And this is a great example of how data in itself isn't meaningful. It's the interpretation of the data. And who you talk to about it. And who you talk to about it. Wouldn't it be interesting if you took these data and you said what makes it go to grade fours and sevens? This was grade seven. What makes an adult important to you at school? What do they have to do? Like, has anyone had that conversation with their students? Think about it, asking what do people who are important to you, what are they doing? What are their characteristics? What are their qualities? And wasn't, didn't you ask early in one of your studies, you asked students how do you know somebody cares about you in school? Right, in the high school we asked what are some things that teachers do to show they care? What do teachers do to show they don't care? And the number one most, by kids at risk, kids at honor roll, the most single most important thing was the teacher says hide to me in the hallway by my name. Cause it's you see me, you know my name there. They're shocked that someone knows their name. They often feel invisible. And it goes back, even if the work on school dropout that most kids who drop out of school, it wasn't because they have poor academic achievement, is they say no one cared. And there's a whole literature on push out versus drop out and things like that. So has anyone ever heard of Seymour Saracen? He wrote a book called The Predictable Failure of School Reform. So he talked, he actually was talking early on in the 80s and 70s about system, system wide change and system leadership. And I love this quote and it really is gonna emphasize the key points. To the extent that the effort of change identifies and meaningfully involves all those who will directly or indirectly be affected by the change. To that extent, the effort stands a chance to be successful. So you have to think about if you're trying to do system wide change using system leadership, who are all those who will be affected and how do you involve them in the conversation? Okay, now it's my five. No way? Okay. Do you wanna ask me with the five key messages? One of your five key messages, Kim? Okay, let me see. Okay, I have to remember these. Okay, this is, and so what I did is I kinda listened carefully and I know there's so many important things that have been said over the last two days and I wanna apologize in advance if I missed something really critical and I just wanted to have five things because I could have 30 but I figured we'd be here much longer but I'm hopefully encapsulated some of the key things that also resonate with you. What I've listened to is this starting with a strengths-based approach. Starting with a survey, maybe I've already what's happening that focusing on the system. So the idea of focusing on what we're already doing instead of saying like, here's all the things we're doing wrong and we have to go and fix this and go and fix that. Look for, use that appreciative approach. Use an approach that really looks for those things that are going really well and try and understand those as well. Use a collaborative approach. I've heard that over and over again from so many people that we need collaboration and this includes all voices including educators, staff, community, families and students and during those times to make sure you have time for reflection, that time in, I really love that phrase, the time in the idea of being able to be reflective, to be able to think about how you come together and get everyone's voice in an authentic way. The third one, and this is a really important one and I think really goes to the idea of mental health in schools. And I'll tell you what I've been to many meetings over many decades now, I guess it's been. And when you talk about mental health, when we talk about mental health in schools, my experience has been it often focuses on mental illness. Me too. That's what I mean.  And do you know back when I was in graduate school when I was doing a study on mental health, do you know how I measured mental health? Depression and anxiety, and if you were low on those, you had mental health. No, it was true, that's what it was. Okay, they're mentally healthy because they're low on depression and anxiety. We really had a paradigm shift in the idea that things like joy and happiness and optimism and hope, these things are what constitutes positive mental health. And so we really have to think about when we talk about mental health and we use that mental health in schools, we're not just talking about mental illness. And so I tried to create, and I know Mark talked about Kathy Schwartz mental health assist. It involves three dimensions. Promotion, which would be universal approaches to promoting social and emotional learning, positive mental health. That's about a universal approach about prevention. And I would say something like mental health literacy is a focus on prevention by getting kids to understand the language around mental illness. And then of course intervention for those young people or even adults who already have a mental health problem. So think about, when we talk about mental health in schools, think about all three dimensions, not just the mental illness. And I think it's gonna be one of the barriers as we move forward as we even go into conversations that assist them and use that phrase mental health in schools, that we do have to be really clear about the definition and not make those assumptions, which I think with those systems tools really help you with those. Well language is, that's where all kinds of assumptions happen. But I wonder when you stay on this one, here we're talking about social and emotional learning, mental health literacy just mentioned and trauma informed practice. You've mentioned that they're in three different tiers, but are there common, are there commonalities? There must be some base that's the same, even though they fall into different categories of care. If I think about they are this multi-tiered approach of thinking about, so for example, mental health literacy actually requires that you have some self-awareness. Like if you think of the social, emotional competencies, self-awareness, you have to be aware of how you're feeling. Mental health literacy is also being socially aware, being aware of other people's, having relationship skills to go and find the help you need. So I would say that mental health literacy, that you need these social, emotional learning competencies in order to have good mental health literacy. They're kind of a foundational, necessary, but not sufficient condition. And then trauma informed practices, again, should underlie everything because you never know who has experienced trauma. But it's, to me, if I had a way to phrase trauma informed is really a compassionate approach to everyone, not making assumptions about what people are and being really sensitive to the experiences that others in trauma might experience. And not to have the mental model that it's only those kids who are from lower socioeconomic status areas that have those traumas. Yeah, I've been reading a little bit about that. There's some literature now, if you just Google trauma informed care plus compassion, there's an idea about shifting the language even around that just because it should be there, that should be the basis for all care. Yeah, and there's actually, there are some debates about even calling, still continue to call it trauma informed practices. And I think it's important to think about that. I go to number four. Yeah, cool. Aren't you just waiting to see what number five is? Okay, sorry. Use data as a way to instigate collective conversations and system-wide reflection and catalyze positive change. So data, as Peter said, data itself is meaningless, but use the data in a way that instigates these collective conversations with a curiosity. Because sometimes we go right away to interpret things, but the idea is that, oh, well, that's so interesting that so many kids say there's no important adult in their school, or that's so interesting that we're seeing that. I wonder what that is, what can we do to further investigate it. So it's about that open-mindedness and being able to approach the data with that rather than right away going to try and find solutions. And just to say that there's, sometimes at that point, one of the investigations is, what does the science say about? What does the science say about anxiety, as with the University Hill students, right? Exactly, to go for that science and to say, what do we know, so, for example, we know just, you know, as children enter adolescence, you see it's a typical pattern of seeing declines in motivation, increases in self-consciousness, increases in importance of the peer group. Those are, the research will tell us those are sort of trajectories that we see that we can expect. So, for example, if you're doing a survey of data from fourth to seventh grade, and you see that kids are staying the same, and you might say, oh, they should be getting better. Actually, them staying the same is a good thing, because typically the pattern is they go get worse. So, if they're staying the same, it's an interpretation of the data based on the science. Yes, right, so you need that triangulated in. And number, drum roll please. I hope, now I'm trying to remember what it is. Oh, yes, compassion. Building a compassionate system leadership and compassionate systems. Really, through an indigenous lens, again, I have to keep on saying how that idea of bringing love to the fore. Enjoy. Enjoy. And think about what inspires us to be happy. How can we move forward to always have that compassionate lens in which we see another person and interpret their behavior through that compassionate lens? Do any of you have any annoying students? Well, if you think about it, how can you start as a compassionate leader in the classroom, in your school, in your school district, to try and understand that other person? And I'd say a student or a colleague, I don't know if any of you have annoying colleagues. But to start interpreting their behavior from that, not knowing what pain or suffering they've been through. And compassion, again, I wanna just emphasize the difference, why I'm saying compassion and not empathy? So, empathy is when you are feeling with another person. You see that person's pain and suffering, and you actually could experience that same pain. Compassion is really different than empathy. In a sense, it's not just feeling for another person, it's being moved to move to action to do something to alleviate death suffering. And so that's why we have to really go about compassionate systems, which is about creating that circle of caring and responding to others in that way and really having that compassion. And I think at the very fore, and it started with the first activity. Yes, that's right. The whole circle. The relationships of thinking about the relationships that really inspire us, that really have the catalyze our action. Jeff, can I tell that story? Go ahead.   Well, I wanna say so it's so interesting. So why am I here now having spent 40, whatever, years of my life focused on this topic of mental health promotion, social and emotional learning, having been a teacher, working with teachers in districts for many years. And I think back, when you were asked a question with a teacher, I thought to my grade eight language arts teacher, Mrs. Hepperly, who I knew very well. She was someone who saw me, believed in me, but she did something very interesting during Christmas break, my grade eight year. Before Christmas break, she came to us and said, well, holiday break. She said, I want to ask some of you in this class if you would like to come over to my apartment over Christmas break to make some cookies and then go spend a day in a local mental institution where there are inpatients who have no families and no one visiting them. And she talked about these people who would not have, and I have no idea how she knew how she got.  And all of us raised our hands and said, yes, yes. Of course, because she had really told us about how we'd be making a difference in their lives. So here it is, Mrs. Hepperly who broke the system. I don't know how many teachers have a group of eighth graders over to your apartment to make cookies. First of all, we all came there and then went and spent the day spending time. And none of us were afraid, none of us were apprehensive because she had created the system of support. And to this day, many years later, that idea of how you can make a difference in someone's life, how at that grade eight, that transformational year which you develop a sense of purpose, could use that in an opportune time to catalyze our change. Because I think, I believe that we as a student benefited much more than the people even that we were helping from now. Kim wanna say thank you to you for being here and closing out this conference for us with your unique Kim-ness. So I'm sure you wanna thank Kim for that. Thank you.


Thanks for checking out this unboxing and it's time once again to do the box of dread one of two boxes that I'm Continually getting I might add a box of something else here or there, but for now. I'm just doing box of dread I'm doing the band box This is the want to remind everyone if they don't remember or they've this is the first time They're seeing this $20 box very cheap definitely for horror fans. I've liked the items in there thus far So we'll have to see how this July one is Yes, July and we got it in July which it's been one of my biggest pet peeves with a lot of companies when you don't actually get the box in the month or even close to the month that it's supposed to be for so Box of dreads been good. I Think the only time that I did one of these unboxings for box of dread late is when it was my fault because I was on vacation And just couldn't get to it. All right, so here we go. Mm-hmm. Sorry shaking everything So they have been doing posters which I'm not huge on posters But the ones that they've been putting in here fortunately have been kind of cool So they have been doing posters. We'll see if they do another Expect that they will since the last two months have been But last month they had a poster for the howling comic book which has come out already Which I need to get my hands on because I love the howling and you check that out And the one before that was like a page out of the Necronomicon from like Ashford's Evil Dead and Ashford's Army of Darkness all that stuff Or army darkness. All right a little bit of packing on top Oh, I think we got another DVD. We got a little Yeah, okay Just like a little Cyclops thingy Looks like kind of Ray Harry house and ask Focus a little bit better. Yeah, I Probably won't keep this These things I'd rather than just kind of not throw in you don't really need to just save you Saved the money on you know, these little type things. I don't really need it Not some on that Is there another one? There's there's another one. Oh, this one's actually way cooler though This is a this is like a psychotic clown with like His guts hanging out. I don't know if you really see any kind of see it And I can't even like see okay. Well, hopefully hopefully you could see it well enough, but reminds me a tad bit of um Violator, you know the clown guy from spawn Sorry if you're my cat yelling in the background. I just got home and she wants attention Quiet All right So those are done. I think we got all right. Oh No, not all right I was thinking it would just be like a mystery mini from Funko. So they're switching it up, which is fine They're doing a Titan vinyl figure, which honestly, I don't like the look of these Titan vinyl figures especially because you'll see they have like Nor like much larger heads than their bodies and their bodies look kind of realistic And then just their bodies look weird like the head-to-body proportion is just odd to me And I don't really like that about these plus. This is Buffy the vampire slayer No, a lot of people like Buffy so I can't really blame them for putting a Buffy thing in here, but I Don't really care about Buffy. I mean I'll open this up and take a look in a minute, but Just don't I'm just not a Buffy person I do love Joss Whedon though. So maybe I should watch it at some point because I'm a Joss Whedon fan. So next one I think this is yeah, okay. So DVD Epic another epic one which figures because they're now, you know epic bought boxed dread And this one is Day of Reckoning and it says how will rise Take a look at it first and then all day of reckoning looks like pterodactyls and stuff maybe and It says 15 years ago the world suffered a horrific global disaster will make millions of demon-like creatures ascended from the bowels of The earth swarming the entire planet and feasting on mankind for one full day Now due to a lunar eclipse they have returned for 24 hours to purge the earth's population once more Okay, I mean I'll check it out. I'm always down to get DVDs because I Like checking out new horror movies. So that's always fine with me Next Letter from the kill crew Oh, I've got all these things in here about stuff Well, I'm not gonna read too much of that at the moment just to make sure if there's spoilers or something for what else is in here Okay Little trial thing for shutter, which actually I use the last one Which I'm on at the moment. So Shutter is a good service. I think if you're gonna pay for it Honestly, it's only like 50 bucks for like an entire year. So I subscribe to it now Because of Box of Dread actually so there you go shutter. It's paying off. I like it. You can get plenty of movies So that's totally sweet Yes, oh, yes, yes, I'm very excited about this so they basically tease this Bag and boarded comic book. It's the number the one number one issue I'll slip it out of here for because of the glare The howling comic as I was just saying to everyone. I gotta get a hold of the howling comic Yes, Box of Dread. Thank you so much. Oh, that's exciting. I love it. So, yeah I've gotten big into comics within the past few months and I've just been tearing through comics. So Thank you so much. That's so awesome. Ah, so glad about that comic and then a Box of Dread sticker Cool, I'll just put it on like my beer fridge in the basement. All good. I guess I should open this fluffy Is there anything there are some? Some rare ones, which is cool One in two that are one and forty two that are one and twenty and three that are two and twenty Yeah, I don't know. I'm not gonna be able to figure out what that is Looks like it might be that would spike. Is that who this is? Yeah spike two and twenty, you know pretty common Yeah Look everybody it's spike in his hands move his arms move That's fine. I mean whatever I just don't like to look at these things. They're weird. Like look at how like Mischaping their bodies are it's like It's like they don't have necks or anything.  I don't like it. I don't like these things I'm just not a fan of the design. So I like the idea of putting like mystery box or mystery bag things in for these But like, you know horror mystery maze like funko mystery minis or pint size or like anything like that I just I don't like to tighten vinyl things Um, maybe some kid robot stuff. They have to do some cool stuff All right. So there's a letter from the kill crew. So I don't know if there's Okay, so they they do have they're now putting like on the back of this thing Like what is in the box and like a little bit of an explanation what's in there? So that's I mean, I don't really need that. I'll just open it and look at the stuff But I guess it's cool for some people. They want that kind of stuff, but um, oh my gosh Well, there's a lot to read in here. So I don't think there's anything we're not allowed to kind of share so honestly what I'll do I'm not gonna read this whole thing. I'm just gonna show you Here so you can like pause on it if you want to and then over here Do See Yeah, you're probably not gonna be able to read that but anyway, overall Box is fine. I mean, this isn't my favorite of their boxes. It's probably my least favorite of the boxes. I've gotten Um, mainly because of this thing. Uh, yeah, but I am very excited About the howling comic very very excited about that. So that And this make I mean basically make it worth it. It's a $14 box with $6 shipping. So $14 For these two things fine like Values there no problem. And that's the thing one of the things I really really like about this box I feel like it's very low risk for how little you're paying and Um, how how many things you are getting you're gonna like something or a few things Even if you don't like something like this or like these little things like There's gonna be something at some point and it's You know worth 20 bucks a month to just take a gamble in my opinion But I like it. I mean, even though this hasn't been my favorite At least I got you know, I'll check out the movie for sure and I'm very very excited about the comic. So We're good. Um box of dread keep doing what you're doing. John One guy handling box of dread. So I know it's a lot of work, man Really appreciate it.  I forgot one month we're in In the unboxing for august Maybe I'll tell you if there was anything important that was in here, you should know But anyway, thank you for checking this out. Look for my next unboxing, which I don't know what it'll be But until next time keep it brutal


Well, well, well, here's Mama Bloom's brood. We look in on Papa as he sits in his office at the Excello Pictures Corporation in Hollywood. For the moment, he's alone. Then the door opens and... Huh? Oh, hello, Mama. Yeah. Yeah, I'm very busy. When you're busy, do you always sit with your feet up on the desk like that? Oh, Mama, my feet are tired. I was walking around all morning trying to see what was going on. But what's going on, Drake? I don't know. 50 miles, I walked to find out what was going on. I could have walked a million. I still know as much as I do now. Shitness as we are in production on the big picture. That's very nice. I'm glad to hear you say that, because I wouldn't be knowing if it is or not. Don't Sidney and Harold know it is? Sidney and Harold? Sidney and Harold? All they can say is terrific. Then it must be good. Mama, they say that so much during the day, I don't know what is good and what ain't. The day the lunch was terrific. Yesterday the weather was terrific. It's only afternoon the train. Well, the boys can't help the weather. They hear them talk about themselves. You'd think they've got everything to do with the weather and everything else. They're very smart. Maybe. Didn't they think up behind you for the picture? I'm afraid of that. Drake, the trouble that's true is this. You got, but are you listening? Yeah, yeah, yeah. Then why you got your eyes closed? I listened with my eyes.  And it's very, very bad manners to sleep when somebody is talking to you. Mama, look, what you're going to say I could hear in my sleep. You're going to tell me that the trouble with me is that I don't have young ideas like Sidney and Harold.  A mind reader. You ain't it. I ain't a mind reader. I'm only very tired and very busy. What have you got to do? Sidney says I've got to sign the production okay. They think up what I've got to spend, then I sign the checks in the report. So, when I think I shouldn't be spending some money for something that I think is foolish, I don't say. And you shouldn't. Yeah, I shouldn't. The only trouble with that is that when I talk to Sidney and Harold, they talk me into signing. Then I get ahead of it. Well, just remember, Dick, in any business there's a headache. In this business, I got two of them with names, Sidney and Harold.  A movie? Mama, I make movies. I don't go to see them. Never mind. You should take it soft for a couple of days and then you'll feel better. But I can't leave the office today, Mama. Why not? Why not? There's a man coming to see me.  I don't like to go alone. When I go alone, I haven't got nobody to tell me what the pitch is about. You haven't got the... Yeah. All right, Mama, I'll tell you what. You read a book and they'll love me, huh?  Now, look, Mama, I'm not wanting to go to a movie. I'm telling you the... You're already talking. Hello, Papa. Hello, sirs. How are you? Say, where's Sidney? Any in the office? Nope. I just left there. Wasn't around anywhere. Oh, no. I gotta walk around again until I find him. Papa, you should sit still if you're tired. Say more. Let you and I take a walk along the boulevard. It's such a lovely day. Well, if you don't need me no more, Papa. Mama, I'm so busy, I'd be glad if you and Sarah would go for a walk. You shouldn't try to push yourself that way. That's all right. They'll go for a walk. All right, Mama. I'll see you this evening. Yeah, yeah. Come home early, Papa. I'll come home just as soon as I find out what Sidney and Harold did today. Yeah. I mean, I'll come home if I'm able to walk after I do find out. All right, darling. Goodbye. Goodbye, Papa. Goodbye, Sarah. Goodbye, Mama. Goodbye. Goodbye. Come on, Ma. We'll go across this way and come right out on the boulevard.  There. See? Just a couple of steps. We're out on the boulevard. Yeah, yeah. I don't know what to say. So we'll walk slow and enjoy it. Sure. It's a gate, Ma. I can see it, Sarah, darling. There we are. Let's walk out on the Strip. Strip? Strip of what? Just a Strip, Ma. Oh, so we're on a Strip. Even though Strip's got to have a name. Well, that's what they call this out here. This is part of Strip Boulevard, where all the fancy shops are and the night clubs and, well, they call it the Strip. So they got to give it a funny name. It's ain't a Strip. It's got to be a Strip. Oh, look, Sarah.  What's the matter? Oh, look over there, Ma. That's fine. See? The Swami Yogashandra, psychic reading. It tells your name, your address, and telephone number.  That's in case you get lost, huh? Oh, no, Ma. He doesn't... Well, I can't explain it to you exactly, but he tells you those things. Well, so without policemen, if you've lost... Oh, you still don't understand, Ma. That means he's psychic and can tell you those things without asking any questions.  Your name is Sarah Shipman, and your address is... Oh, Ma. Listen, Ma, just for the fun of it, let's go in. So, what's fun about knowing where you live? Oh, you still don't get it, Ma. He tells the past, the present, and the future. Who tells him? Nobody, Ma. He just looks in a crystal ball or whatever he uses and tells your fortune. But that's very foolish. How does he know what's going to happen tomorrow? How does he know what's happening to me yesterday when he don't even know me? Well, that's it, Ma. He tells you those things without knowing. Somebody's talking foolish, and it ain't me. Oh, let's go in, Ma. Maybe we'll have a lot of fun. Can't hurt anything, and we've got lots of time, and it'll be fun to talk about later on. Come on, Ma. Well, all right, so we'll go in. And then if I'm finding out what I'm going to do tomorrow, I won't have to do it. I'll just be able to go past tomorrow without even coming to it.  Oh, this is going to be fun. Yeah, yeah, maybe, maybe. But remember, all this is not gold, it's jewelry. Oh, look, Ma. All these autographs of movie stars who've been here. They already know what they're going to do the next day. They're going to hack. So why did they come here to find us? Oh, it's a doorbell. Why, there doesn't seem to be any. Maybe this swimmer can tell us where the bell is. It's swarmy, Ma. For heaven's sake, don't make any breaks like that when we're in there. Sarah, use the knocker on the door. Maybe that's why it was put there. Oh, I see it. Okay, here goes. I'm getting a big kick out of this already. I got... It sounds like somebody's coming to the door, Ma. Oh, what's the matter? Do we have to be just quiet a couple of moves? They ain't be allowed to talk? Oh, D-Ma, doesn't anything ever impress you? Sarah, when you get as old as I am, you won't be getting excited over finding out what your name is. Even my address and telephone number shouldn't make me nervous. Oh, look. Please, Anna. Has he got a headache? That's a turban. Oh, thank you. We wanted to get our fortune, so... The swarmy does not tell fortunes. He reads the psychic vibration. You have, of course, an appointment. An appointment? For what? The swarmy is very busy. Oh, he's busy. Well, we'll come back in a few days. We're not anxious to know our names. Ma. Come on, sir. No, we didn't have an appointment. Ma, you see, we were just walking along this tribe and be seeing the signs that we came in. Oh, I see. Wait here one moment, please. What name shall I say? Our names. Ma. I beg your pardon, madam. What's he saying? But I must present your name to the swarmy. Why should you be making him a president of our names when he's nice to them already? Oh, ma, for Pete's sake. We would like to see the swarmy. Thank you. You'll wait here, please. In case the swimmer gets stuck, my name is Bloom and this is my daughter. Oh, ma, you mustn't act that way. Sir, I'm not acting any way. You're saying the man will tell our names without saying anything or asking us. But this man's asking our names right away. Oh, gee. I hope he tells us something exciting. Maybe we're going on a long sea voyage or something like that. Sarah, why don't you tell me you're going away? You shouldn't be keeping secrets from your mama. Well, I meant he might tell us that. Why should he? Oh, ma, you're impossible. Maybe he'll tell us what's going to happen tomorrow or the next day. Sarah, what difference is that making? Why should you be wanting to know? Don't you like surprises? And if Papa wouldn't over here, he'd be having a fight. I know Papa. He'd be having a fight. Maybe only with himself that he'd have it. Where'd the man go? I don't know. Back in the other room someplace. Sarah, we should get out of here right away. What's the matter now? There's something boiling. I smell it. Oh, that's incense. Come to that little idol on the mandal there. I don't know what you're talking about. This is all foolishness and it's going to cost money. And besides that, I knew I smelled something boiling. Oh, ma, that was a good one. Oh, that was a gong. Swami will see you now. This way, please. Go ahead, ma. No, no, no. You're going first, Sarah. Well, all right. Come on. One at a time, please. What's the matter? Couldn't the swimmer be telling two names at once? Very well. He may both come in. The Swami will give you a double reading. Still it costs more. The Swami has one price. What is it? Oh, ma, please. Don't worry. Nobody charges. Shh. Never mind that now. Come on, ma. In this room, please. Be seated, please. Please. What's the matter? Can't you afford to pay for the electric lights? The vibrations on this psychic plane need no light. Go. Shh. Can't we see him? What is it you wish to know? Nothing. But, ma'am, sir, you must want to know something. Swami shouldn't have an argument. We'd like to know a lot of things. Tell us. Wait a minute, ma. We just wanted reading. Ah, yes. Very well. It, uh, it appears that you are going on a long trip. Again? We just had one. Please, ma'am, sir, I must not be interrupted. But we just have a trip. Why should we be taking another one? Oh, ma, please. That is nothing. I, I say that you are going on a long trip. You cannot stay in one place long. For 25 years I stayed in New York. Maybe 25 years ain't long, huh? Madam, I must ask you to be quiet. Please concentrate so that I may tune myself to your vibration. Look at the drapes. Cheap materialities in New York. I could get it for 150 a yard. Maybe one dollar if Papa's cousin still voices the news. Madam, concentrate a little more. Concentrate more. I am, sir. I am. Ain't I got my eyes shut? No, I shall. Oh, I just happened to remember. Ah, something is troubling you. Something that may be cleared up by the aid of the astral forces. Sir, what are you talking about? I mean you have a problem inside. One that has troubled you for a long time. I'm telling you that I... Madam, you should be happy that you have come to me. Your problem will be solved. Smooth over in due time. For this problem that ain't quick enough. More. Have you got something on your mind? It comes to me now. Yes, it comes to me. Sarah, we got to get out of here. Ah, the solution has come to you through me. I am pleased that my humble powers have been able to solve your difficulties. Yeah, yeah, that's nice. Okay, come on, Sarah. One moment, please. The reading will be five dollars. Five dollars? You shouldn't joke like that. Madam, the price will be five dollars. I solved the problem I cannot give my services. There's no use arguing about it, Mo. Ah, ah, but if Papa was here, do you know what he would say? Fui. Five dollars the man charges so that I should be reminded to go home and point the stove off under the potatoes.


Thanks for coming out, everyone. I know dry eye is not necessarily the most sexy topic.   But the thing about dry eye is that it's been kind of pigeonholed into this narrow definition where people think that the only manifestation of dry eye is that my eyes itch, burn, sting. When really the biggest manifestation, and one that is overlooked a lot, is visual fluctuation. So the first thing that the light entering your eye has to go through is the tear film.  It's the tear film. So if the tear film is junky, what you see, the image on the back of your retina that's formed is going to be junky as well. And we know based on a internet search that the practice that I work for is one of the biggest, most asked questions that led people to our site is why does my vision fluctuate? And a lot of people think that it's due to their focusing system, the lens inside their eye, what we call the accommodation. But more often than not, that's not the case. It's actually the fluctuation of the tear film. And that's kind of why I wanted to talk to you guys about this topic because I want to set the record straight and explain a few little things about it. And then we'll talk about some things that we can do pallatively to help increase the quality of the tear film and decrease those visual fluctuations, that itching, burning feeling, and get you doing better with your eyes. So first thing we're gonna start with is basically a little bit of anatomy as far as the tear film goes. So this is a relatively simple schematic of the tear film. Much more complicated than this, but for the sake of today, we'll just kind of go with this. The first layer at the top, that's the lipid layer, okay? This lipid layer is composed of, can anybody guess what it's composed of? Lipids, fats, cholesterol, those kind of things. And what it does is it acts as an anti-evaporative agent for the aqueous layer, the watery layer underneath. So if you guys can imagine putting water in a glass and then putting olive oil on top, the amount of evaporation you get is going to be much reduced if you have that olive oil. The water's not gonna be able to evaporate. Same thing happens with the tear film. That lipid layer protects the aqueous layer, the watery layer from evaporating. So the muco aqueous layer used to be that we thought it was the mucin layer and the aqueous layer, and those are two totally separate things. Now we're finding more that the two are so intimately connected that we can't really think of it as two separate layers. It's more of a matrix that we have. So these little squiggly lines that I drew in there are the mucin components, the proteins that basically attach the aqueous layer to the corneal epithelium. The corneal epithelium is just like any other epithelium on your body. It regenerates from basal cells, but the cells themselves are not inherently photo, are inherently photophobic. So you need these mucins to kind of connect the two, the cells in the aqueous layer. So this is what it looks like when we have a healthy tear film. Everything is nice and uniform and distributed uniformly as well. So where do those substances come from is the next question. And so we'll start with the lip, since we talked about the lipid layer first, we'll talk about where they come from. And those come from the mybomian glands. So these mybomian glands that we have in our eye, we have about 20 to 30 on the upper and the lower lid. And those are designated by the black lines up there. And so they sit just behind the tear, or the lid follicles. So where your lashes come out, these mybomian glands sit right behind there. And when we blink, we have muscles in the orbicularis oculi that basically squeeze those mybomian glands. So every time you blink, it's excreting a little bit of that lipid layer that coats the front surface of the eye, okay? So that's where the lipid comes from. Now the lacrimal gland is located in the superior temporal portion of the upper lid. And what it does is it creates the aqueous layer, so that watery layer that mixes with the mucin and attaches to the front of the cornea. So what I always tell my girlfriend is that I have a lacrimal gland over activation because that's why I'm crying during the sad movies, but that is true that the lacrimal gland is the portion that makes your tears when you cry, emotional tears. Then we have these third kind of little things that are interspersed in what we call the conjunctiva, the clear layer on the outside of the white part, which is the sclera, and that produces that mucin, that connecting block between the epithelium and the aqueous layer, okay? So that's the normal anatomy that produces a normal tear film. So let's get into this relatively simple schematic of what causes dry eye here. There is a group called T-Fos, a tear film and ocular surface society. And if there's any worse society to belong to, I don't know what it is. But they basically spend millions of dollars every year to come up with this report and develop cool schematics like this that no one can really read too well if you kinda look at it and squint, maybe that works out. But what I think we should do is kinda distill all of this down, and if you read through their reports that are thousands of pages long, you end up getting to a more easily read schematic, which is the one that I've developed that it will kinda go through step by step. Okay, so in the first 100 pages of this T-Fos report, it basically tells us that the loss of tear film homeostasis is the cause of dry eye, okay? That's all you guys need to know. You're 100 pages in, you're in good shape. So why do we lose this homeostasis? What is it that causes these feedback, positive and negative mechanisms to break down and for us to lose the structure of the tear film? Well, the first thing is we get these internal and external factors, obviously very specific, but we'll go through those in a little bit. But those can lead to two problems. And those two problems are primarily first, an unstable lipid layer, okay? If you have an unstable lipid layer that front surface, you're gonna get an increased amount of evaporation in that tear film. So imagine how we were talking about with a water glass and olive oil on top. Now we're thinking more of oil on top of a lake. It's all spread out, splotchy, patchy, things like that. There's not an even surface over the water to prevent that evaporation. So all the spots where that oil is broken up, that's where you're gonna get that increased evaporation. The second problem that we run into with these internal and external factors is a potential reduced production of aqueous. So that lacrimal gland is no longer producing the aqueous layer like we would like it to. And that comes from another number of different issues that we'll get into, but both the unstable lipid layer and the reduced production of aqueous lead to an increased tear film osmolarity. So that means there's more dissolved in the water than there is water, essentially, or aqueous, I should say. And that increase in osmolarity is the hallmark. This is what this TFOS group in their dues report said is the hallmark of any dry eye disease. Any at all is this increased tear film osmolarity. And we can measure that clinically with a few different instruments, but what that leads to is an increase in ocular surface inflammation. So we get all of these inflammatory factors released that causes basically this giant feedback loop of inflammation and leads to a decreased quality of these tear components that are produced. And it can work both ways. It's kind of a two-way street in that an increase in ocular surface inflammation, it can be caused by systemic issues, can then increase the tear film osmolarity by producing these inflammatory factors. And that's how you get an increase in the tear film osmolarity. So it kind of works both ways and they feed each other and it's a bit of a vicious cycle. So let's get on to the infamous factors, the internal and external. I was gonna put an animation, but I couldn't figure out how to do it, so you guys just get all of them. It's no surprise here. First is environment. They're not in any particular order. Diet is another big one. Hormone level systemic disease and systemic and topical medications also factors that we can talk about. But today we're really gonna focus just on the top four because our goal in looking at health in an ancestral way is to use diet and movement and all those kinds of things to reduce the number of systemic medications and topical medications that we are dependent on. We use them when we need to and they're very important, but we want to try to first build a base just like Tim was saying in his earlier lecture on auto-immunity, build a base of these other behaviors that we can do, changing the environment, changing the diet in order to increase our ability to need the systemic and topical medications less. All right, so now we're gonna get interactive. I want you guys to just kinda shout out things that are different between the photo on the left and the photo on the right. Just give me, just doesn't matter what you say, you'll be right. There's no right or wrong answer. Okay, good. Computer, good. Positive ions, okay. That was not what I was expecting, but that's good. Location, light, good. Sunlight. Focal distance, that's a good one. Sitting, good. Yeah, you guys nailed it. 100%. I was not expecting focal distance, but that's a good one. But we'll talk about a few other ones before we get into that. So humidity level, okay. Most of the time we're in air conditioned environments. We might have a desktop fan, something blowing on our face. Bad news for dry eyes, okay. That's just gonna exacerbate things because it's increasing that evaporation that takes place. Altitude can have an effect on it. These, we don't know where the guy in the desk is, but can have an effect on things. Temperature, higher temperatures, higher rates of evaporation. But really the biggest thing that it comes down to is, yes, this focal distance. What are we looking at during our day? And why that's important is because it changes how we blink. And it sounds a little weird, but how we blink is one of the most important things when it comes to dry eye, okay. And so the reason how we blink is so important is because there are rate of blink changes and our completeness of blink changes, okay. When we are just sitting out watching the sunset tonight over the mountains here in Bozeman, we're blinking at about 15 blinks per minute, okay. And that's the variation. There is some variation, but it's not that large. But when we start doing things on the computer or reading books, our rate goes down and it becomes much more variable. So we don't get as consistent of a blink pattern as we get when we're out looking at something. And actually as we talk to people as we're having a conversation, the blink rate skyrockets. So we go from 15 to about 26 to 30 blinks per minute. So just talking to people, having conversations instead of being stuck in an office is actually gonna increase your blink rate, which is interesting. The second component is the completeness of the blink. So what we find is when people are just out running around, most of their blinks are complete. That means the eye, the two lids come down, touch each other and then release. When we start to use computers and read and everything like that, the variation in the amount of complete blinks is hugely influenced. So the way that we spread to your film across our eye, if my arms are my eyelids, I have a tear reservoir that's created from those glands right here. It sits on the lower eyelid. It's called the lacrimal lake. And what happens is that upper lid comes down and it actually acts like a windshield wiper, but in reverse. It actually picks up those tear films and spreads them vertically over the eyeball. So if you have an incomplete blink, here's what happens. You don't pick up that lacrimal lake. The lid goes up and there's no spreading of that tear film uniformly across your eye. So this completeness issue is a huge one and we're just starting to finally get some clinical devices that help us measure and quantify this. So what happens when we have these incomplete blinks? Well, on your guys' left, that's a picture of healthy mybomian glands. You can see those black arrows pointing to these little orifices where the mybum comes out. On the right, we see these clogged or these caps on the glands as we call them in the clinic. And what happens is when you don't have those complete blinks, it doesn't get excreted and it becomes kind of like when you don't put the cap on the top of your toothpaste, it gets hard and anytime you fully blink, then you're not getting that expression of the mybomian glands. You're not getting a good quality lipid. And it's not only from blinking, there's a number of other things we'll talk about with this quality, but it's a huge, huge component of it because every time you blink, that's what's causing that expression of the mybomian glands.  Helps with symptoms, but it doesn't fix the problem, which is the poor mybomian gland function and the incompleteness of the blink. So what can we do with our environment? We can blink better, we can blink more often, so I want everyone to do blink exercises with me. These are literally things that we prescribe to our patients.  And what some of you might have felt or might feel is after you've done that big blink, you might feel like your eyes are a little bit watery and that's because you had this massive excretion of that lipid layer and so just remembering to do that. People sit on computers for eight, 10 hours a day and if they're the three blinks per minute person, they're gonna be pretty uncomfortable pretty quick. Other things, like I said, limit direct fan use. You can use a desktop humidifier if you're in an office to help increase the amount of moisture in the air, decrease the amount of evaporation and just don't work as much. Just don't be on the computer, right? We all can tell our bosses that I just wanna work less. I only wanna be here half the day. And the tongue in cheek with that is that as you increase the cognitive demand of what you're doing, you're going to decrease the amount of blinking you do. So if you're reading comic books, maybe not the most cognitively demanding thing in the world, you're gonna be blinking more than you would be staring at Excel spreadsheets that you've made so small to fit as much as you can in that you're trying to squint to see what you're trying to do. So things you can do is increase font size just to reduce the amount of stress that you have cognitively. So now we have another one. All right, let's hear some things about what's the difference between the left and the right picture. Delicious, that's a good one. They're both delicious, I agree. Process and non-process, good. Seed oils, carbs, good. Good. Can I hear dairy? That's good, I love dairy, so I'm good with that. So you guys are all right, you know, refined carbohydrates, refined sugars, really high gluten content in the pizza crust versus a lot of natural stuff. There's some nightshades on the plate on the left and some people obviously have problems with that, but on the whole, pretty low as far as obvious inflammatory foods. But the biggest, the reason I put the picture on the left up is because it contains omega-3s. And omega-3s have been this kind of holy grail of dry eye for a long time. That's where everybody focuses their research when it comes to dry eye. So if you just type in dry eye omega-3 on the university that I was previously working for, you get 2,500 peer reviewed, full text online papers. Half of them say that omega-3s are awesome, they work perfect, let's do it. And half of them say they don't work at all, they don't do anything. So we've spent all this time in this money trying to figure out what it is, why is it a conflict? What's the issue with omega-3 versus not omega-3? Well, I think the answer lies somewhere in the fact that the mechanism of action of the omega-3 is that it reduces, it's an anti-inflammatory, which it is. But if you're just putting on a substance that's slightly anti-inflammatory onto a bunch of a huge population that you don't know how much inflammation that they have to begin with, how are you going to be able to control those variables in order to say this works or this doesn't work? We have no understanding of what is going on inside of them systemically. All we're telling them to do is keep eating McDonald's, but just use these omega-3 supplements. So is there a tie then between what we eat, our gut, and this dry eye? And I believe that there is. And so there's a couple of studies out there, they're pretty few and far between, because like I said, dry eye, not a very sexy issue in the world. But we find that people with irritable bowel syndrome tend to have objective, so lower tear quality and subjective, higher amounts of complaints about burning, itching, those kind of thing, visual fluctuation. And people are, it's higher in those with IBS than those without IBS. And thank you. In folks who have shogrens, which is an autoimmune disease, and it's one of the primary complaints of that is dry eye, we find that 70% of them have a low level of gut inflammation. So we look at, we see as an optometric community shogrens as this autoimmune disease that you can't do anything about, so let's just mask the symptoms. But what we find is probably that by changing some of these environments in these diets, we could actually lower the amount of symptoms in these shogrens patients by decreasing systemic inflammation. So what can we do to manage this with diet? We can remove inflammatory foods, that's different for every single person. I'm not gonna say we need to cut this or add that or anything like that. You guys are all smart enough to know that it's a complex issue and it's an N of one. So you need to find what works for the N of one, you, and remove those foods and reduce that inflammation. Maintaining hydration is kind of an easy one. There's been, believe it or not, there's been studies that have cost a lot of money where people go in and say, you should drink, if you drink more water and you don't drink as much water, do you get more dry eye or not? The people who drink more water, as it makes sense, get less dry eye. And then I still recommend omega-3s and that's because it's something that they can do that will reduce inflammation. And the reason that it's become controversial is there's a big issue. They had a big clinical trial where they said they did a omega-3 supplement and an olive oil supplement and they found that there was no difference between the two, but they both increased comfort and reduced symptoms and increased quality of objective markers. So we know that omega-3s themselves are not this holy grail, but there's something going on there that we need to look further into. So I still get folks on that just because in some patients it really does help.  So anyways, you guys tell me what's the difference, what's kind of going on between these two images here. Yeah, sedentary, active, both patients are a little bit older, okay? And so what we find is that those glands, the mybomian glands and the lacrimal glands are highly, highly influenced by these androgens. Testosterone, estrogen, progesterone. Those are highly, highly specific targets of these androgens. And what we see is as we get older, there is, it's an undeniable fact that those levels will start to get out of balance and be decreased. And so what we see in postmenopausal women and men with andropause or low T is this huge increase in dry eye. And that's simply because the glands are not being stimulated enough, okay? We're not getting that signal to produce high quality and the amount of tear components that we need. So what can we do about that? Well, there's some evidence in the literature that resistance training can kind of balance those levels. It's not gonna, you're not gonna, by doing resistance training, get back to where you were at 20 but it's going to help. You can prioritize sleep. We know how important sleep is in our life with getting all our androgens and cortisol and everything like that straightened out. And then we can supplement if needed. Like I said, there are cases where we can't get those levels back to where they need to be. So we need to do some supplementation or even topical supplementation. Some of our patients are on topical steroid creams on their eyelids that actually increase the quality of their tears and production of the tears. So the whole goal with what we talked about today is to get folks out of here. So at every big box store, Walmart and everything like that, there's an entire aisle dedicated to artificial tears, eye drops, things like that. And there is a huge need for these. Don't get me wrong. I have patients use them every single day but I think we're putting the cart before the horse a little bit. I think there's other things that we can do before we just go, hey, your eyes are dry, go pick up some artificial tears and use them four times a day and then everything will be great because that's typically not what happens. We're just masking symptoms instead of getting at the root cause of everything. So we wanna get everyone here. We wanna get them to the point where they can be happy, be healthy, have consistent vision and not be burdened by these kind of annoyances of this dry eye. So thank you guys very much for listening to me today and I'm happy to answer any questions you guys have. And those are references. A dry eye is my number one health problem. So I'm glad you're here. I'm interested in the mechanism of when you have an allergy, like to me at Desert Flowers, why does your eyes dry up? I don't understand why that would occur. So it comes down to that increase in osmolarity or at least part of it does. When you have a reaction to those allergens, you get a bunch of anti-inflammatory cytokines, things like that released onto the ocular tissue and that increases the osmolarity, increasing the potential for evaporation. And then it also, anytime you have inflammation or anything like that, you're going to get that neurosensory feedback. And so it's partially that evaporation component and partially just that the inflammation is causing pain, which is experienced as dryness, itching, burning that kind of thing. Yeah, I can take an antihistamine and boom. And it's fine, right, exactly. Yeah, you have antihistamines, you have mass cells that are broken, releasing more histamine. So oftentimes if that is the source of the dry eye, we hit it with exactly that an antihistamine because there's just not much we can do. Cool compresses is a palliative treatment just to reduce that overall inflammation, but. So you recommend staying away from our artificial tours, tears, if you can? If you can, but it's certainly, like I said, it's something that I recommend to my patients all the time as long as it sounds like you are the kind of person who has your health pretty straight, your diet pretty straight, your exercise. There's 98% of the population who doesn't have that. So if we can get folks doing that more, and as the whole conference is here to talk about, those increase all kinds of health markers. If we can get them doing that first to help their dry eye, then sometimes patients are like, oh yeah, I have, I'm obese and have diabetes, but I'll get in shape because I want my eyes to be less dry. Thanks. Yep. Steve, nice talk, a couple of comments. One is the research that showed these kids, particularly like in India, for example, they're living mostly on rice and they're extremely vitamin A deprived and that's how they lose their vision and they usually die as a result and just really small amounts of vitamin A will recover their vision and save their vision and now this is purely anecdotal, but when I learned about Weston A Price and I started the first time I ate liver, my dry eye problems resolved and I recommended this to scores of people since and every single one of them has had either complete or moderate relief from dry eyes just from increasing their vitamin A consumption in a natural way, usually some kind of liver or maybe even fish eggs and so I would just encourage any or all of you to consider that and try that. Like I said, that's totally anecdotal. I couldn't find any research that is good support for that but we all know that vitamin A is critical to tear production and then my other comment is, I just wanna make a comment about the Omega-3 supplementation is that the Omega-3s are polyunsaturated fatty acids and they're unstable and they oxidize really easily as soon as you pull them out of the natural food that they're eating so when you put them into a bottle or into a pill they're going to oxidize and this contributes to our consumption of oxidized polyunsaturated fatty acids and I say, this is my recommendation is, get it from the food, get it from the fish, I think is the best way to go, go to the fatty fish and avoid the capsules. Yeah, thank you. That's just my performance. Thank you Chris, I appreciate that and that's one thing that I forgot to kind of really dig into is I feel the exact same way on the Omega-3s with you as far as prioritizing, making sure you're getting those oily fish, the sardines, if you can stomach on which some people can't, I force myself to and that's really the best way to do it and I think would, everyone here would agree as far as looking through it from an ancestral way that the food would be the best way to get those Omega-3s. Hey there, hey there, thanks, that was great. Love the pictures. Oh sure. So when I read the blurb for this talk, I thought I'd mentioned something about blurriness as well as dryness and that caught my attention because that caught my attention because the past few months, sometimes I'll get a little bit of blurriness for no apparent reason, just randomly, it'll be there for a second, I'll blink and it'll go away and I'd never experienced that before but I don't recall that you mentioned anything about that, does that fit into this conversation? Totally, and we kinda got into that a little bit right at the very beginning of the talk. And I would submit it a little bit. But that's totally fine. So imagine you have a nice uniform, if you're in your car, you have a nice uniform, thin layer of water over your windshield. That's not going to distort the image that you see the road in front of you, the signs or anything like that. As soon as it starts to evaporate or you get what we can, you know, you would say rainfall, something that's irregular, irregular water distribution across that surface, things are gonna look a lot blurrier. So that's what kinda happens on our eyes but happens with evaporation. If we don't have that uniform, that nice uniform thickness of tear on the front and you have this increased evaporation, it's gonna get really, the tear film's gonna get junky and that's what image you're gonna see because the light has to go through that junky tear film before it gets to the back of your eye. So what you're seeing is junky and that's why it looks blurry. Yeah, because the tear film is not uniformly distributed on the surface of your cornea. And is that always correlated with the eye drying with the evaporation? Or could there be another reason for a blurriness? We kinda talked about that. There can be some issues with your accommodative system and that's what help us see up close when we're young. We can bend and stretch the lens inside of our eye and that can account for some blurriness but typically almost never when we're looking out in a distant environment, farther than about 10 feet, almost all of that kind of visual fluctuation comes from that tear film breakup or that junkiness in the tear film. Yeah, because I'm not experiencing the feeling of dryness, just the blurriness but maybe just because that's what I'm sensing. Right, oftentimes it probably is happening. Yeah, oftentimes the blurriness or the inconsistent vision, the visual fluctuation is the first sign of dry eye and then as it gets more a bigger problem then you start to actually expose tissue to the air and bring in friction forces that actually cause that itching burning feeling. Right, okay, thank you. Sure, sure, of course. What would be your recommendations on doing those exercises that you talked about?  So every 20 minutes, look in the distance, 20 feet for at least 20 seconds and there's some more information coming out that it needs to be probably longer than 20 seconds, maybe a minute or two and during that time, you can do those blink exercises. So a couple of times an hour, I forget. So I try to, if I get them once every hour, once every 45 minutes, then that's kind of where I'm at. Sure.


You need a financial advisor with the freedom to focus on your specific needs. Whatever your goals, Reed Potter can create a game plan tailored to you. Call Reed at 432-0777 at Pikeville, Kentucky to learn more. The Pikeville Community Kitchen gives out blessing bags throughout the community every month. Today we were given out blessing bags. We give them out every month. Every month hundreds of blessing bags filled with food are picked up at the United Methodist Church in downtown Pikeville. We see joy. I've had people cry. I've had them say, you don't know what this means to me. You don't know how much we rely on this. Some people actually, you know, I received a phone call last night. And the lady, because of weather, you know, we was concerned about being able to have it. And the lady just said, you've got to, we depend on these. We have to have them, you know. Each giveaway is a walk up or a drive through system starting at 11 a.m. and lasting until the last blessing bag is picked up. We're just thankful that we've been doing this going on six years serving the community. And everyone has just been so good to us. And we couldn't do it without the sponsors, without the people, United Methodist Church, and without our volunteers. And I want to thank God for letting us do this. And the community is, we love our community. Reporting from Mountain Top News, I'm Ethan Miller.