Tuesday morning, 2:18 a.m.

"Hi, can someone call me back? I saw you in 2005, but changed to another doc because I didn't like you. Anyway, that doc just moved away, and I'm out of Vicoden. Can you please call some in for me until I can find another neurologist?"

Tonight's health tip

While I don't have any large-scale, double-blinded, placebo-controlled studies to back it up, I'm going to go out on a limb with this recommendation:

IT IS NOT, UNDER ANY CIRCUMSTANCES, A GOOD IDEA TO SHOVE LIT FIREWORKS IN YOUR ASS.

This has been a public service announcement from Grumpy Neurology, Inc.

Today's quiz

This picture:

A: Shows why you shouldn't pass out drunk when your friends have magic markers lying around.

B. "OMG grandma, I told you not to use the discount tattoo place!"

C. Is the latest innovation from Apple, the iBrain. The flash drive is planted right under your skin, and connects in your gums via Bluetooth.

D. Is from an ad for a new type of brain scan.


The correct answer is D. Really!

Weekend reruns

Dear Dr. Worthless,

Thank you for your note on my migraine patient.

I've tried several medications for Mrs. Hedhurtz, including Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn, all without success.

I've done MRI's, MRA's, and a spinal tap on her. I sent her to an ophthalmologist.

I was frustrated. She was more frustrated. I wasn't having a lot of success helping her. And she seems like a nice lady.

So, since you advertise yourself as a neurologist who specializes in treating difficult headaches, and cite your 2 years of headache subspecialty fellowship training, I decided to refer her to you. You opened up shop near me last month, so I thought I'd give you a chance to earn my referral business. Your marketing person dropped off some cards here 2 weeks ago.

And yesterday I got your faxed note about her.

At the beginning of your note it says that "I've reviewed Dr. Grumpee's notes and tests in detail." That was your second lie (your first lie is in calling yourself a headache specialist, or even a doctor). I also loved the fact that you spelled my name wrong.

Your note ends with the following, which I've paraphrased.

"Impression: Mrs. Hedhurtz suffers from chronic headaches. She's previously failed trials of Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn. I suggest she be referred to an ophthalmologist. A spinal tap should also be considered.

For future treatment, I suggest she be started on a medication that she hasn't previously tried before. I've referred her back to Dr. Grumpee's care to follow my recommendations.

Yours truly,

I. M. Worthless, M.D."


Thank you SO much for your helpful advice. I'd normally say "thanks for nothing", but what you've done doesn't even amount to that much.

As my late grandfather would have said, "this is the second time I've sent you a patient. First and last."

Sincerely,

Ibee Grumpy, M.D.

July 28, 1909

The Waratah wasn't a fancy ship compared to the giants that crossed the North Atlantic. She was built for mixed-use (both freight and passengers) but still had fashionable features to keep her travelers comfortable. She worked the long (6-8 week) voyage between England and Australia, serving stops in South Africa along the way.

And 103 years ago today she disappeared. Without a trace.

211 people vanished with her. She'd stopped in Durban, South Africa, where one passenger disembarked as he felt she was top-heavy and unsafe. She left port later that day, never to return.

Cruising along the South African coast on July 27, 1909 she was passed by (possibly) 3 other ships, though identification was difficult. The Waratah, like many other ships of the era, didn't carry the newly invented telegraph equipment.

The area is known for monstrous freak waves, which can overwhelm and badly damage ships. One steamer reported seeing a ship coming up quickly, possibly on fire (though it could also have been a brush fire on land, which were common). A police officer patrolling the Transkei coast thought he saw a large ship offshore being battered in huge waves, finally rolling over and sinking.

She was expected to reach Cape Town on July 29, but never made it.

The Royal Navy quickly launched a search with 3 cruisers, without success. One of them (HMS Hermes) was so badly damaged by huge waves that she required extensive drydock repairs upon return.

Further patrols were sent out, both private and government sponsored. All together they covered 14,000 square miles of water of South Africa. Without any evidence of the Waratah.

Not a single verifiable trace has ever been found. A few sightings of what may have been bodies floating off the coast afterwards, or a non-identifiable chair cushion bobbing on the waves. All seen from passing ships, but no one stopped to get a better look. For all we know they were seaweed or aquatic objects.

Leads have come in sporadically over the years. In 1925 the pilot of a plane reported seeing a large vessel on the bottom, but searches of the area have since been unsuccessful. Similar searches of the offshore area where the officer reported seeing a ship sink have also found nothing.

Twice it was thought her wreck had been found, but on investigation they turned out to be other lost ships. One was a freighter sunk during World War II.

What could have happened?

The answer remains a mystery. She was considered a safe, well-built ship, and had received top ratings from government inspectors and insurance companies.

A great deal of investigation time was spent on descriptions of her stability, but in the end a board of inquiry was unable to find any clear evidence of her being unseaworthy.

103 years later and we're no closer to finding her, or learning the fate of 211 voyagers, than we were in 1909. Like U.S.S. Cyclops, this is a mystery I'd love to see solved.

But I'm not optimistic.

Patient quote of the day

Mrs. Young: "I like to walk a lot, but not hike. I prefer streets. I like to streetwalk. Um, that didn't sound good, did it?"

Magic

Dr. Grumpy: "Have you lost or gained any weight since starting Fukitol?"

Mrs. Pound: "I don't know... I don't have a scale at home."

Dr. Grumpy: "Okay, then let's go over to the scale. I need to know what your weight is on the drug."

Mrs. Pound: "No, you don't need to."

Dr. Grumpy: "I'm sorry, I do."

Mrs. Pound: "No, I'm not going to. A good doctor should be able to tell my weight just by looking at me."

Drug rep swag

Since January 1, 2009 drug reps haven't been able to give us any of their goodies like pens, post-notes, calendars, or pretty much anything.

However, my colleagues in non-human medical fields are exempt. So veterinarians still get their bountiful, yet bizarre gifts. My colleague Webhill recently received this gem, which she kindly sent:

What the hell is that? A rubber cat? A hurkle? (no, wait, it has 4 legs, not 6) A Pokemon?



Nope. It's a flash drive.

Because, let's face it. Nothing could ever make your day like having someone ask, "Hey, doc, why do you have a blue cat's butt sticking out of your computer?"

Do not try this at home. Or anywhere.

Gee, I wonder how much he won?

Thank you, Brick!

Odd numbers

Dr. Grumpy: "Any major illnesses in the family?"

Mrs. Trilateral: "My Mom has had breast cancer 3 times, once on each side."

Heroism

My deep sleep is shattered by hysterical screaming of the psychopath-with-a-butcher-knife-has-broken-into-the-house-and-is-about-to-kill-me sort coming from Craig's room.

I go flying down the hall.

Dr. Grumpy: "Craig! Are you okay?!!! What's wrong?!!!"

Craig: "THERE'S A LIZARD ON MY WALL!!!"

Dr. Grumpy: "That? For crap's sake, Craig, it's 2 inches long. They eat bugs. It's not going to hurt you."

Craig: "IT COULD CLIMB UP TO THE CEILING AND GET OVER MY BED AND DROP ON TOP OF ME AND CRAWL IN MY MOUTH AND I COULD CHOKE AND IT WOULD KILL ME IN MY SLEEP!!!"

So, in order to protect my children from a dangerous, potentially-lethal, 2-inch-long bug-eating lizard, I got a yardstick and tupperware container, and gently captured the menacing beast.

It's now out in the yard, where the bug hunting is likely better, anyway.

Sancho Panza, where are you when we need you?

I guess he's sort of a modern-day Don Quixote.

Thank you, Tanya!

Sunday re-runs

On the side I do survey work for various market research companies. They ask me what I think of ad campaigns, or medications, or whatever.

So last night I was doing a phone interview with one, and was asked this great question:

"Doctor, have any of your patients ever stopped taking their Alzheimer's medication due to death?"

Random Saturday pictures

First off, we have this:

 

Because nothing says "handmade by skilled craftsmen" more than prepackaged pizza dough in a plastic tube, made by a huge food conglomerate, and stacked en masse on shelves in every grocery store in North America.



Next is this picture, taken on approaching Atlantic City. Where, apparently, the casino buildings are always standing erect and ready.

Back to the artisanal crap, we have this generic package from a generic warehouse club, where they apparently can't decide if their generic cookie of the month is blueberry, cranberry, or macadamia. Unless it has all three.

Of course, there's always artisanal salt to put on your artisanal food:

And then there's Australia, where you can build an entire pharmacy from artisanal components!

And  lastly, we have this non-artisanal, but remarkably bad, juxtaposition of news headlines:

Friday whatever

Mr. Webster: "My internist says my blood pressure is erotic."

Dr. Grumpy: "You mean erratic?"

Mr. Webster: "Whatever."

Assumptions

Mary: "Is there a problem, ma'am?"

Mrs. Ink: "Yes. I don't like having to fill out these forms with a pen tied to the clipboard."

Mary: "I'm sorry, but before we started tying them on we were losing 2-3 pens a day. That adds up."

Mrs. Ink: "Ridiculous. You get pens for free from drug companies, anyway."

Mary: "We used to, but that was banned effective January 1, 2009. So now we buy our own office supplies like everyone else."

Mrs. Ink: "Everyone knows doctors are rich. I can't believe your cheap boss just doesn't buy more pens."

The evening news

By a quirk of fate, I have not 1, but 2, items to share tonight.

1. Sometimes you may be better off to just stay in jail.

2. I don't know what to say.

Why? Why? Why?

Dr. Grumpy: "How are you doing?"

Mr. Colloid: "Fine, except this morning I was hacking up some seriously disgusting greenish-black caked mucus gunk."

Dr. Grumpy: "I'm sorry."

Mr. Colloid: "Here's a picture of it."

Steve Austin. Asstronaut. A man barely able to sit comfortably.

Technology. Bringing us the internet, iPads, digital music, MRI's, the International Space Station...

And, most importantly, the world's first BIONIC BUTTOCKS!

Thank you, SMOD!

Life on the edge

Dr. Grumpy: "Do you take anything for the panic attacks?"

Miss Old: "I don't want to. They're pretty much the only excitement I get."

Sunday night, 9:05 p.m.

Mrs. Nerve: "Hello?"

Dr. Grumpy: "Hi, it's Ibee Grumpy, calling to give weekend check-out to Dr. Nerve."

Mrs. Nerve: "He's in the bathroom."

Dr. Grumpy: "Okay, can he call me back when..."

(muffled male voice in background)

Mrs. Nerve: "He says he wants to talk to you, hang on..."

(muffled male voice in background)

Mrs. Nerve: "He wants to know if Mr. Smith is still in the hospital?"

Dr. Grumpy: "He went to the rehab floor, but Dr. Nerve will need to check his follow-up CT..."

(muffled male voice in background)

Mrs. Nerve: "Hang on, he says he's out of toilet paper."

Dr. Grumpy: "Look, I'll just call back in..."

Mrs. Nerve: "No, it's okay. He asked if the Jones girl had any more seizures?"

This is Karl

I don't know him personally. I wish I did, as he seems like a helluva nice guy. He's a hospitalist, and in our occasional communications by email or blog comments seems to be pretty cool, and a damn good doctor. He's the kind I wish worked at my hospital.

In addition, Karl is also a great cook from what his family tells me. Every year he single-handedly whips-up some sort of major-league Mardi Gras feast. Never having been to Mardi Gras I have no idea what he's cooking, but if I was invited, and lived near you, Karl, I'd definitely come over (but I'd have to draw the line at crawdads- crustaceans just ain't my thing).

As you can see in the picture, Karl's sister was also kind enough to make him a Dr. Grumpy cooking apron for Christmas.

He's also built his own wooden boat. Not a model, but a real boat. Which is way beyond what I can do. My boat-construction abilities are limited to inflating a raft for the pool.

Unfortunately, for all the fact that Karl is a good person, doctor, and cook, he's been diagnosed with brain cancer, has been through chemotherapy, and is now home on hospice.

So, Karl, this post is dedicated to you. I'm sure you helped plenty of patients and their families over the years who never had a chance to thank you.

Not to mention helped patients of other neurologists, and because of my field's inherent lack of social skills, I suspect my neurobros didn't thank you either.

Since you're now on the other side of the bedrail, I want to thank you on all of their behalfs and wish you and your family the very best at this difficult time.

I also want you to know what an awesome sister you have, and how much she loves you enough to put me up to this. Your wife is in cahoots with her.

Thank you, from all of us out here in cyberspace.

Ibee Grumpy, M.D.

July 13th rerun

His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working without a net for the first time is terrifying. I'd survived 4 years of medical school, 4 years of residency, and 1 year of fellowship to get there. This is the goal I wanted. And when it finally came it scared the crap out of me.

There was fear in medical school, starting classes and later starting clinicals, and even more in residency. But in both those cases there was always a back-up system- more senior people who actually knew what they were doing. There was also a herd-based support system: You were with plenty of other people, all sharing the same challenges.

But here, after 9 years of training, it was just me and Girard. Even though his case was simple, it's pretty damn scary to realize that YOU are the attending, and if you screw up there's no one else to blame.

I remember another patient that day started the visit by saying "I came to Humungous Neurology because I heard you guys are the most experienced." My inner voice said "you probably don't want to know this is my first day."

Throughout medical school you saw the attending physicians as omniscient giants. Suddenly you're one of them, and realize that they don't know everything. And you aren't a giant.

Like everything else, after a while it becomes routine. But trying to remember that first day still helps to keep you on your toes.

I don't remember how many patients I saw that first day. A handful compared to what I see now. One of them is still with me. I think I told her a few years later she was on my first day. I even got a hospital consult, a lady who'd obviously had a stroke. I got lost in the hospital trying to find her room, then sat in the MRI control room to see images, terrified at the thought that if they were normal I'd have no idea what was going on.

I've now spent an estimated 4,650 days of seeing patients in one place or another, with a lot more to go. But the first one was the scariest. And hopefully always will be.

To all who are starting this July, good luck.

No, I honestly don't

"Doc, because, sometimes I get headaches, and I also have trouble remembering things, and it's like when your foot hurts, or you've just slept with a bunch of girls and don't want to get tested, or you just got a new car and repaired the roof. Do you know what I mean?"

Not tonight, I have a headache

Yes, folks, tonight is (drum roll):

I'm not joking. This is a somewhat bizarrely-named drug-company sponsored educational event where doctors can (remotely) listen to lectures about migraine pathology and treatment.

Personally, I think this could have been better named something like "Migraine Symposium." Because the current name sounds like we should all be sitting in the dark with icepacks on our heads in solidarity. And I sure as hell wouldn't want to join that.

But it's for a good cause, so let's all break out the triptans and party (no red wine or chocolate)!

I suppose one has to grateful such events aren't held for Viagra, Detrol, or Imodium.

Annie's desk, July 9, 2012

Mrs. Gemini: "Hello?"

Annie: "Hi, Mrs. Gemini. This is Annie, from Dr. Grumpy's office. He wanted me to tell you your brain MRI was fine."

Mrs. Gemini: "REALLY! That's incredible. I'm so happy to hear it. I mean, I was pretty sure I had another one in there."

Annie: "Another one?"

Mrs. Gemini: "Well, I read this thing at the supermarket checkout about how this lady had, like, her unborn twin inside her head, with teeth and hair and everything, and I figured that's what I had."

The set-up

Frank: "DAD!"

Dr. Grumpy: "What's up?"

Frank: "Can you come help me?"

Dr. Grumpy: "Where are you?"

Frank: "I'm in your bedroom, by the dresser."

I run into my bedroom and find...

  Clever little bastard.

Today's criminal tip

When trying to rob a convenience store, don't take your Mom along.

Thank you, PH!

Friday morning

Dr. Grumpy: "What can I do for you?"

Mr. Words: "I'm having balance problems. Like my liquoribrium is off."

Burnin' down the house

Dr. Grumpy: "What can I do for you?"

Mr. Prolixin: "My arms are on fire!"

Dr. Grumpy: "You mean they feel like they're on fire?"

Mr. Prolixin: "NO! THEY'RE REALLY ON FIRE!"

Dr. Grumpy: "Okay..."

Mr. Prolixin: "CAN'T YOU SEE THE SMOKE AND FLAMES?"

Dr. Grumpy: "Well, no."

Mr. Prolixin: "Ya know, neither can my psychiatrist."

July 4, 1939

"Fans, for the past two weeks you have been reading about the bad break I got. Yet today I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and have never received anything but kindness and encouragement from you fans.

Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure, I’m lucky. Who wouldn’t consider it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrow? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I'm lucky.

When the New York Giants, a team you would give your right arm to beat, and vice versa, sends you a gift — that’s something. When everybody down to the groundskeepers and those boys in white coats remember you with trophies — that’s something. When you have a wonderful mother-in-law who takes sides with you in squabbles with her own daughter — that's something. When you have a father and a mother who work all their lives so that you can have an education and build your body — it's a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed — that's the finest I know.

So I close in saying that I might have been given a bad break, but I've got an awful lot to live for. Thank you."


-Lou Gehrig, terminally ill at age 36 with ALS (aka Motor Neuron Disease), in his retirement speech. He died less than 2 years later.

This post is dedicated to Spiritcove and Roy, facing ALS as best anyone can. This is likely the worst disease in neurology, if not all of medicine. It's been almost 200 years since the first published report on it, and effective treatment remains a mystery.

If you're looking for a cause to give money to, consider the ALS Association.

Things I wish I could take back

Dr. Grumpy: "So at your last visit the medication was causing impotence, and we stopped it."

Mr. Pill: "Yeah."

Dr. Grumpy: "So where do things stand now? I mean, uh..." 

Mr. Pill broke out laughing.

Things that make me grumpy

I say "epilepsy." What do you think of?

Did you think of someone drooling in a dimly lit institution? Or someone so sedated on their seizure medicines that they aren't capable of working?

Think again.

Yes, there are some patients who still fit that description. But they're rare. You want to know what most epilepsy patients look like? They look like YOU!

Yes, folks contrary to popular belief, epilepsy patients are out there living normal lives. And there's a lot of them. It's a disorder that affects 1% of humans. So imagine the Rose Bowl stadium in California. When sold out it holds roughly 90,000 football fans. And statistically speaking 900 of them have epilepsy. Some may even be playing on the field.

Current epilepsy patients in my practice include 7 teachers, 3 doctors, 5 nurses, 1 judge, 2 veterinarians, and a lot of other responsible professionals.

Very few diseases have been as maligned over time as this one has. The majority of early cultures attributed seizures to demonic possession. I'm sure many innocent epileptics were killed in horrible fashion because of this. Others saw it as an intentional punishment from the gods. The great Dr. Charcot, founder of modern neurology, reported that in 19th century France epilepsy patients were locked up in the same dark building used to house the criminally insane and mentally handicapped.

Detail from "Transfiguration" by Raphael (1516) showing a child possessed by demons. The boy's posture and eye deviation are typical of partial-complex epilepsy.

You don't have to look too far back in American history to find laws on the books that banned epilepsy patients from marrying or having children. In the mid-90's I even trained under a doctor who still believed that horseshit, and told young adults, just starting out in life, that they should never, ever marry or raise a family. That's a pretty damn devastating thing to do to someone.

Vilifying any person because of an illness is wrong, whether it's diabetes, hypertension, or cancer. But epilepsy is one in my specialty, and I'll make a stand for my patients.

I probably fight harder for the rights of my epilepsy patients than any other group. Several times a year I have to write a letter to a divorce attorney saying that a well-controlled seizure patient is perfectly capable of being a parent, because the ex is saying that it makes them a danger to kids. Or I have to reassure a family that a patient can drive, or work, or travel on a plane. Obviously, there are laws restricting some things, like driving, but the majority of patients follow them and are perfectly good drivers. Hell, they're likely a lot safer than many non-epileptic people behind the wheel.

So what brought on this rant?

Last week the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (AKA Obamacare). Now this post is NOT about the PPACA. I know a lot of people feel strongly about it in both directions, and if you want to fight about it, go to a website where you can. Because it's not what I'm talking about, or giving an opinion on.

What pissed me off was the reaction of a radio talk show host (who's not a medical doctor).

U.S. Chief Justice John Roberts has epilepsy and (under treatment guidelines) is likely on medication for this (I'm not his doctor). Big deal. So are a lot of other people.

But, as usual, there are some who'd rather smear than respect an opinion. Conservative commentator Michael Savage went on record last week as blaming Roberts' vote on - surprise - his epilepsy treatment (!) saying his writings showed "cognitive dissociation." He noted that drugs used for epilepsy "can introduce mental slowing, forgetfulness, and other cognitive problems."

Yes, Mr. Savage, they can cause these problems. You can also find similar side effects listed for most blood pressure medications, statins, and many other drugs (which, given your age of 70, I suspect you take at least one of) yet I'm not going to say your comments are due to medications. The side effect list of any drug is HUGE. But that doesn't mean everyone who takes it gets them. Quite the opposite.

My point is this: You're certainly entitled to your opinion. But just because you disagree with a man, don't go blaming it on his medications or health. It's a step backwards for all the epilepsy patients out there trying to lead responsible lives in the face of biases like yours. And, I suspect, if he'd ruled the other way you'd never have made such comments.

Since you apparently don't feel people being treated for seizures are capable of making rational decisions or serving in a responsible capacity, I'm leaving you with a list of people who have (or are highly suspected to have had) epilepsy. Perhaps you've heard of some.

Tchaikovsky
James Madison
Napoleon Bonaparte
George Gershwin
Bud Abbott
Julius Caeser
Harriet Tubman
Vincent van Gogh
Neil Young
Lindsey Buckingham
Edward Lear
Prince
Alfred Nobel
Danny Glover
Socrates
Lord Byron
Hugo Weaving
Dostoevsky
Joan of Arc
Florence Griffith Joyner

Last, I should also mention former congressman Tony Coelho, who has the disorder. He was the primary sponsor of the Americans with Disabilities Act (1990). As a young man he wanted to be a priest, but was banned from such by his epilepsy. He also lost his driver's license and health insurance because of the diagnosis.

During his first run for congress (1978, which he won) his opponent tried to paint him with the same insulting brush, asking voters how they'd feel if their representative was at a White House meeting and had a seizure. Mr. Coelho responded, "I knew a lot of people who went to the White House and had fits. At least I’d have an excuse."

Sugar: beats alcohol

Yes, yet another strange news item.


Thank you, Carol!