Tuesday, November 30, 2010

Justifiable homicide

I was seeing a new patient, and as usual had a can of Diet Coke on my desk. Yesterday afternoon, for variety, it was the kind with lime.


Mr. Manners: "It hurts when I climb stairs, and... Hey, how is that lime-flavored Diet Coke? I've never tried it."

Dr. Grumpy: "I like it, I go back and forth between it, regular Diet Coke, and..."

Mr. Manners reaches over, picks up my Diet Coke, and freakin' DRINKS SOME!

Mr. Manners: "Hey! That is good! I'll have to buy some."

Dr. Grumpy: "Uhhh, you can keep that one."

Mr. Manners: "Really? Thanks, doc! Anyway, sometimes the foot goes numb and..."

34 comments:

yay said...

My diagnostic money's on the frontal lobe!

S.M.O. said...

so did you investigate the foot numbness, or did you focus on the distractibility and behavioral disinhibition, or did you find a single diagnosis that fits both?

Not House said...

@ Yay - Bwahahahaha.

@ SMO - I think Hickman's Razors applies here (the opposite of Occum's Razor "Patient's can have as many diseases as they damn well please"). In this case, it sounds like some sort of neurological condition, with the unfortunate combination of being a dolt.

Grumpy, M.D. said...

Well, Treponema Pallidum can cause both disinhibition and foot numbness.

But you usually can't get it from a Diet Coke can. Of course, that depends on where it's been.

Anonymous said...

That's nothing. I once had a man I had just met stick his finger into my ice cream cone and then lick his finger in order to take a taste.

Jackie said...

LOL that's... *shakes her head* I hope you had a back-up can!

xx
Jaxs

Julie said...

well done on not killing him ...

The Mother said...

He's probably one of those folks who steadfastly refuses to believe in the germ theory of disease.

Or gravity.

C said...

Don't touch my stuff!! I'm usually saying that to the heathen though. Sigghh...

Queen of Crafts, Current Events, and Such. said...

Dr Grumps, The other night at work I had a cardiologist tell me that Diet Coke was like putting formaldehyde in your brain...What do you think?...being a neuro doctor and all.....lol

Anonymous said...

i guess from now on, you will try not having any food/drink on your desk when seeing a patient :p

23 Skidoo said...

What an Asberger....!



http://southgeek.blogspot.com/

Anonymous said...

He is not a numb foot , he is a numb nuts.

Jobs that involve interaction with other people really are the best kind ...........to avoid at all cost.

Anonymous said...

You see patients in your office (not in an exam room)?

Joe said...

@ yay

I was going to suggest a MRI w/ focus on the frontal lobe, too.

Phathead said...

Soooo technically you go to first base with him right?

Wunderwoman said...

That not only calls for homicide, but torture beforehand.

Anonymous said...

Sometimes his social ineptness so embarrasses his foot that it refuses to talk to him.

Anonymous said...

I ONCE had a friend try to take food off my plate, when I jabbed them with my fork, word spread quick that I don't share food/drink!!!

Dave said...

"Dr Grumps, The other night at work I had a cardiologist tell me that Diet Coke was like putting formaldehyde in your brain...What do you think?...being a neuro doctor and all.....lol"

There is some truth to it. To make aspartame you take the two amino acids aspartic and phenylalanine (which is why PKU people can't have diet coke) put them together and then tack on a methyl group. It's the methyl group that leads to what your cardiologist is referring to. Basically, when aspartame is initially broken down it forms aspartic acid, phenylalanine, and methanol.

Methanol is quickly turned into formaldehyde or formic acid (both are bad and are the reason why methanol is so toxic). However, aspartame is very very sweet and not a lot is used, so the dosage is quite low (and quickly eliminated from the body).

For example, a can of diet coke contains 125 mg of aspartame. Aspartame is 294.3 g/mol. So diet coke contains .000424737 moles of aspartame (and thus contains the equivalent amount of methanol when broken down). Methanol weighs 32.04 g/mol so you have .0136 grams of methanol in a diet coke.

Turning that into milliliters (methanol's density is .7918 g/cm3 and 1 cm3 = 1 ml ) yields .017 ml.

To put this in perspective, it takes a full 10ml of pure methanol before you have to start worrying about blindness occurring. Federal guidelines allow workers to be exposed to about 5-6g of methanol a day (or roughly 368 diet cokes). Alcohol (particularly wine/port) and fruits (oranges, apples, tomatoes, etc.) contain some methanol. For example a glass of tomato juice is thought to contain .085g (over six times more than what is in a can of diet coke!).

So its unlikely that diet coke will kill you through methanol/formaldehyde poisoning. That said its always possible for someone to be particularly sensitive to aspartame and/or methanol and have issues associated with diet coke.

Jeralee said...

You just say, "No problem, I don't think I backwashed in that particular can."

pharmacy chick said...

And this very well could explain why she is seeing a neurologist..tho perhaps a psychiatrist might be more appropriate...

the observer said...

Good God!

That's all I have...

Liked Anon 3:17 too.

Earl said...

Dave! Where were you when I took freshman chemistry. I am dazzled by your units conversion.

Anonymous said...

I would have told him that it was my spit can from the previous day. But that's just me.

mjay said...

I'm sorry that may have been my mother trying to be sneaky. shes been adicted to the stuff for years...

Helen said...

I went out for sushi with a relatively new friend a while ago, and the couple at the table next to us made a comment about her interesting-looking entree. So she PICKED SOME UP IN HER HAND AND OFFERED IT TO THEM.

Anonymous said...

Also dazzled. Molar mass to mass in grams per mL. Now I'm impressed. Best comment ever?

Anonymous said...

Dave, Dave. Oh, Lord. I was hoping to never see some of that again. Here's hoping this sort of thing doesn't keep you up at night, or cause inability to return to peaceful slumber.

Ragged Warrior said...

he doesn't need a neurologist,I doubt that he has too much going on in his brain anyway. He is definitely in the double digit IQ.

I love this blog.

You have strange patients, I have strange neurologists.

Anonymous said...

Maybe his foot goes numb because people stomp on it after he drinks their drinks? I'm not a doctor, but I'd check for trauma-induced nerve damage..

Anonymous said...

You see patients in your office (not in an exam room)?

Grumpy, M.D. said...

Both

kate said...

After having my lunch break cut short by patient appointments, I stashed a bag of Doritos at my desk to munch on throughout the afternoon...one patient walked up, said "YUM! CHIPS!" and reached across my desk and into the bag to grab one. I quickly offered the rest to him.

 
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