Where Am We?

Introduction: Mr. Fried, a pleasant refugee of the 60's (think Reverend Jim, from "Taxi"), saw me 8 years ago, when he used to live here. He then moved away, but recently moved back and came in to re-establish care. Please note the state names have been changed to protect the identities of myself and the states. Mr. Fried needs no protection, as he has no idea who he is anyway.


Dr. Grumpy: "Good to see you again, Mr. Fried."

Mr. Fried: "It's good to be back in Minnesota, Doc".

Dr. Grumpy: "We're in Oregon, sir."

Mr. Fried: "Yeah, that's what I meant."

Dr. Grumpy: "So I last saw you in 2001, before you moved to Alabama."

Mr. Fried: "I didn't know you moved to Alabama. I was living there, too."

Dr. Grumpy: "No, I was here in Oregon the whole time. You moved."

Mr. Fried: "I know. I miss Minnesota already."

Dr. Grumpy: "How are your headaches?"

Mr. Fried: "Are they why I moved to Alabama?"

Dr. Grumpy: "I have no idea."

Mr. Fried: "Do you know if I had them when I lived in Minnesota?"

Dr. Grumpy: "Mr. Fried, I've never lived in Minnesota."

Mr. Fried: "Neither have I."


It was a really long hour.

Life in Retail

(Annie's daughter, Evie, started working at Target this week. Today Annie sent me this email about how she's doing)

"This is Evie's first retail experience. They have her managing lingerie.

"Yesterday, they had a corporate head guy come through at 10 am. The store manager told her at 8am there was to be this surprise inspection at 10 and unfortunately the night crew had left 5 full carts of merchandise in her department to be tagged and shelved. He knew it was not fair, but he needed it done.

"She got it done, but just as the head guy was coming to her department here comes a woman with 5 unruly kids. Knocking over the racks, grabbing the bras and screaming "look mom I have boobs". Horrified store manager got the bigwigs to move on while kids continued to destroy department. Mom of the kids went into melt down and started beating them all with both her purse and one she grabbed off a rack.

"An hour later, while trying to help an elderly woman on a cane, who could not find the type of bras from her day... Evie innocently asked 'well could you try and describe it to me so I can help you find something like it'. The woman lifted up her shirt to show her the bra she wanted.

"Welcome to retail."

Helpful Radiology Results

This report came over the fax today:

"Impression: When compared to the previous study of January, 2009, the right carotid artery stenosis has significantly worsened and is entirely unchanged."

I'm Impressed

My 9:00 patient this morning called at 8:45. Said she was having "car trouble", and asked if she could reschedule to later in the morning. So we moved her to 11:15.

She shows up at 11:15, with her forehead and arms darkened, smelling strongly of smoke.

She apologized for not having had a chance to shower, but by the time she gave up on trying to put out the car herself, and the fire department left after doing so, and she found a friend to give her a ride here, she just didn't have time.

Two points:

1. I am in AWE at your devotion to me that you only moved the appointment 135 minutes, instead of to next week or month.

2. When the fire department is putting out your car, I consider that beyond "car trouble". I'd have been running in circles & screaming, and likely wouldn't have bothered to call my doctor about the appointment under the circumstances.

Mary's Desk, September 16, 2009

Mary: "Dr. Grumpy's office. This is Mary."

Mr. Needshelp: "Hi! I need to make an appointment to see Dr. Grumpy!"

Mary: "Okay. When would you like to come in?"

Mr. Needshelp: "Um, I don't know, you mean to come see the Doctor?"

Mary: "Yes. You said you wanted to make an appointment?"

Mr. Needshelp: "I do, but, um, I don't think I'm quite ready to actually schedule it. I'll call back another day. Thank you!"

Public Service Announcement

If you (hypothetically, of course) get a can of Diet Coke that has lost some taste due to sitting in a garage for too long, DO NOT pour a packet of sweetener into it.

The resulting reaction will cause the soda to foam up wildly, going all over your desk, keyboard, pens, MRI reports, notes, and anything else.

The tissue box on your desk will likely not have enough in it to stop it from pouring on the floor.

The patient across from you will be of no help whatsoever, and may post about it tonight on grumpypatientblog.com.

Again, this is a purely hypothetical situation.

Thank you.

What Does a Neurology Exam Involve?

Several of you have written in to ask what a neurology exam involves, and how it differs from what your regular doctor may do.

Neurologists learn to do very detailed exams, studying reflexes, strength, coordination, and many other systems. These involve great skill in noticing important, sometimes subtle, details.

To give you an example, today I was reviewing some notes from a neurologist across town. Here is a detailed complete neuro exam from her note:





Obviously, it takes years of training, and a great deal of time, to notice things like this.

To give you a more thorough picture, here is another very detailed exam by the same doctor on the same patient, done 1 month after the initial visit. Notice how she carefully documents changes in his condition:





So that's what a neurology exam involves.

Because We're Nuts, That's Why

Yours truly was asked to write a guest post over at "Ask an MD" about why neurologists are so strange (good question, too).

So to see my answer (which really boils down to "I have no freakin' idea"), click here.

Drug Rep Sunshine

Ms. Sunshine: "Doctor, Fukitol is the most prescribed drug in it's class."

Me: "Fukitol is the ONLY drug in it's class!"

Ms. Sunshine: "Um, yeah."

Welcome to McGrumpys, May I Take Your Order?

"Hi, I'm on my way there for an 8:00 appointment. Anyway, I didn't have time to eat breakfast, and am hungry. Do you guys serve food in your office? And if you have bagels, what kinds?"


WTF? Am I a Marriott?

Take Her Down, Helmsman

People use different phrases to mean the same thing. Case in point: migraines.

Some patients say "I have migraines". Others say "I get migraines". Occasionally one will use the odd phrase (at least to me) "I take migraines" to mean the same thing (I always want to ask who they're taking them from).

But today I had a lady who used a more, uh interesting, phrase.

When she gets a migraine she has to go lie down in a dark room (which is common). So, for whatever reason, she uses this act to refer to the migraine.

In other words: when she gets a migraine, she calls it "going down".

It is remarkably hard to keep a straight face when the young lady across from me says things like:

"I went down 3 times last week."

"July was awful. I spent the entire month going down".

"I went down on Saturday. I had to do it in front of my kids, too."

And, as she was leaving, she said, "I feel another one coming on. I just know I'll be going down tonight, but have to wait until my husband gets home."

No comment.

Monday Morning, 1:18 a.m.

Tap tap tap tap tap tap tap tap

"Mmmm... whuzz......."

Tap tap tap tap tap tap tap tap

"mfffff... Craig..... What do you want?"

"Dad, I have a question."

"mfffff..."

Tap tap tap tap tap tap tap tap

"What?"

"If I peed in my pajamas while I'm sleeping around now, will they be dry by morning?"

Today's Test

Okay, Grumpyites. Get out a #2 pencil and a piece of paper. We're going to have a pop quiz.

Everyone ready? Okay, you, in the back. Please put the comic book away. Thank you.


Question: You are a 63 year old man. You wake up just after midnight with vertigo, double vision, and imbalance. You need help, so you call:


A. Your wife, who's asleep across the hall because your snoring keeps her awake.

B. Your grown son, who lives 2 blocks away with his family.

C. 911

D. Your 88 year-old mother, who lives across town, but still has a car and comes over to pick you up and drive you to ER, and wakes up your wife when she rings the doorbell at 1:35 am.


If you answered D, it was a pleasure meeting you and your Mom this morning, and dude, you have some issues you need to work on.