It's the End, the End of the 70's

(for those of you who recognize the title, congratulations!)

WARNING: THE FOLLOWING POST IS NOT FOR THE SQUEAMISH. I MEAN, IT'S NOT AS BAD AS THIS STORY FROM MY ESTEEMED COLLEAGUE ERP, BUT IT AIN'T GOOD EITHER. SO STOP READING NOW IF YOU THINK IT'S GOING TO FREAK YOU OUT, OR IF YOU'RE EATING.

Before Viagra and it's cousins, there were some other methods of waking Sheriff Woody. They're still out there, for those who have issues with Viagra.

One of them is Caverject (or Alprostadil for my pharmacy fans). This is fairly effective at getting it up for special occasions. They have to be pretty special, though, because Caverject has to be injected directly into the side of your winkie for it to work. What fun.

Because it came to market before the era of direct-to-consumer celebrity advertising, we were fortunately spared TV ads featuring Eric Clapton singing (to the tune of "Cocaine"):

"If your lady is hot
Just give yourself a shot-
Caverject."

But I digress.

I have a patient who's been using Caverject for years. For whatever reason he can't use one of the newer drugs. He's kind of an aging, swinging, disco guy. In the 70's he was swinging, single, wearing gold chains, and picking up babes at the disco. In 2009 he's still swinging, still single, still wearing chains, and now picking up aging babes at the disco.

A few weeks ago he had a small stroke (he's fine now), and as a result he's now on Coumadin, a potent blood thinner. This gives new meaning to "Stayin' Alive".

So last Saturday he was out getting his boogie on and picked up Ms. Agingdiscoqueen. They went back to his place for some wild times. He shot himself up with Caverject and the fun began.

And abruptly ended. Apparently she got on top, and while she was riding the disco pony, blood began squirting out the side where he injected Caverject (thanks to Coumadin). Seeing blood flying all over those dark areas killed the mood fast. She ran out, and likely went home to douche with bleach.

He's been visiting me and his cardiologist today, to discuss stopping Coumadin.

Thus endeth the 70's.

No Shit, Sherlock

A drug rep brought my staff a jar of mixed nuts today.

On the label, I swear, it says:

"Allergy information: This product is packaged in a facility that handles nuts."

Uh, Oookeeeeeeeeeee.................

I saw a guy this morning who was in ER over the weekend, and he brought in the generic preprinted instruction sheet they gave him. I glanced over it, and noticed this line:

"If you've been given suppositories for your condition, do not store them above room temperature or unwrap one before you are planning on using it. If you haven't been given suppositories for your condition, don't".

Words Fail Me

This morning the hot water heater for my office was on the blink. So I called maintenance to let them know.

The 12 year old answering the phone kept telling me someone would be over "in 5 minutes". So after 3 hours of nothing happening (except for my staff getting pissed off) I called again, only to reach the same 12 year old.

I asked her when a realistic idea of a repair would be:

Ms. Twelveyearold: "Look, I really don't know. Um, do you live near here?"

Dr. Grumpy: "Yes, why?"

Ms. Twelveyearold: "Then why don't you just go get some?"

Dr. Grumpy (not sure I've heard right): "Excuse me?"

Ms. Twelveyearold: "Why don't you go home and fill up some tupperware with hot water? Then you could store it in your office or fridge or wherever until you need it, while we try to get someone up there to fix it."

Okayyyyyyyyyyyyyyyyyyyyyy.

So Much For My Nap

I saw a lady on Friday for a tremor, and put her on a drug called Inderal for it. She gratefully called today to wake me from my Saturday afternoon nap.

Dr. Grumpy: "Hello, this is Dr. Grumpy."

Ms. Ruinedmynap: "Hi, I'm calling because I woke up this morning with a small bruise, about the size of a dime, on the left side of my forehead. Maybe I bumped my head on the night table during my sleep. Can Inderal cause a bruise like that?"

Dr. Grumpy: "No, it shouldn't".

Ms. Ruinedmynap: "Good. Because I haven't started taking it yet, but wanted to be sure before I do."

My Readers Write

Okay, gang, today I am going to hit the email bag! One of you writes in:

"Hi Dr. Grumpy,

Hello! I am a staff pharmacist for an evil chain pharmacy, and had an interesting moment while working today. We received a fax for a prescription for a patient, but the date of birth didn't match our records. When we called the office to verify the prescription, the nurse said that the prescription wasn't supposed to be for that specific patient, and she didn't know who the prescription was for. I guess WE'RE supposed to figure out whose prescription this is? Anyway, I was wondering if this happens in your office.

Thanks!

PS."


Well, PS, I gotta say that we have our share of prescription confusion on this side of the trench, too. I'm not infallible, and am sure me and my staff have (unintentionally) given a pharmacist cause to apply Rogaine. On the other hand, we honestly do try our best to play nice with you guys. I mean, we need each other, right?

We do get a lot of patient voice messages like "Hi! I need my medications! Thank you.", with no useful information. Or "Dr. Grumpy wanted to know how many of the brownish-white pills I take, and it's three." And Annie's favorite "Hi, I saw Dr. Grumpy back in 2005, and he said there were pills that might help whatever my condition is, and I'm ready to take them now."

To answer your question, though: that physician's office appears to have staff from a planet where mind-reading skills are everyday norms, and expect no less from those who fill prescriptions. Many of my patients are from the same place. So, since it appears that you are as incompetent as I am at reading minds, I'd have to say we will both continue to get such odd calls.

The physician's office should have known better then to suggest you solve the problem with your mind-reading skills. Since they originated the script, somebody there should get off their butt and go ask the doctor what he REALLY meant, although he may not know, either. In fact, for all you know it was sent by a chimpanzee playing with his fax machine.

Get a Life!

I was trying to help a patient find a pharmacy on his plan today.

His insurance lets him go to Local Grocery, but they don't all have pharmacies in them. So I typed a few words into Google to find the Local Grocery with a pharmacy in it that was closest to his home.

I somehow ended up on one of these sites that reviews local businesses, with reviews written by random anonymous people who have nothing better to do with their time then write reviews.

The top review about Local Grocery was great:

"I love this store! They are super-duper friendly, and they all know me. I go there 2-3 times every day to buy lottery scratch tickets and Fritos."

ATV Danger!!!

The following is a public service announcement from Grumpy Neurology, Inc.

While I always strongly recommend NOT having anything to do with those modern deathtraps called ATV's (I see way too many young people with brain and spinal card injuries from them) a new ATV danger has recently come to my attention.

When going water skiing at Lake Sewage with your buddies, ALWAYS remember to bring your water skis. Having them makes water skiing much more enjoyable, not to mention possible.

If you've forgotten your skis, and are too drunk to use common sense, IT IS NOT ADVISABLE TO TRY USING AN ATV IN PLACE OF THE SKIS!!!

Extensive studies of physics (Newton, Einstein, Hawking et al) have shown that the ATV will likely sink like a stone, or float upside down with it's wheels at the surface. Whether it has 3 wheels or 4, or how fast you drive the boat, are irrelevant. Revving the ATV's engine will not change this outcome, and it will shut down upon immersion, anyway.

Medical studies have also shown that having a blood alcohol content well beyond the legal limit WILL NOT lessen the chance of this being an unsuccessful attempt at discovering a new watersport.

Trying to argue with the neurologist who was called to see you for your head injury will NOT alter the laws of physics and buoyancy. While I can understand why the consumption of alcohol might have led you to believe that the ATV would run fine on water (hey, it did great on snow last winter! And that's water!) it most assuredly will not.

This has been a public service announcement.

Inside Voices, Please

I'm sure this post is going to make my pharmacy readers cringe.

I went to my local pharmacy today for my Sarcasma refill (without it I'd have no patients, or friends, or staff).

Local Pharmacy was hopping. Very busy. Long line, only one poor pharmacist with dark circles under his eyes was working. Looked badly understaffed and overworked (I later found out they had 1 pharmacist and 2 techs call in sick today). And the pharmacist was frantically trying to keep from tearing his remaining hair out.

Finally there was only one elderly lady ahead of me, and I patiently waited my turn. Suddenly the cashier turned around and yelled "I need the pharmacist to counsel over here!" The bleary-eyed pharmacist actually was holding a phone receiver to each ear when this happened.

He paused for maybe 5 seconds, put one of the phones on hold, glanced at the computer screen next to him, and then yelled across the room: "Verapamil, uh, might make you constipated, or make you lightheaded!"

Thank heavens it was only for blood pressure pills.

Date Night

So on Saturday night Mrs. Grumpy and I actually found a (drumroll please) babysitter! Date Night! Woohoo!

So we went over to La Enchilada Grande. There was a large van in the parking lot, but I didn't pay much attention to it.

When we got inside the place was almost full. There was a large group at a big table in the center. We got a booth and began perusing menus and munching chips.

To my horror, I belatedly realized that the large group was a dinner field trip from La Casa deMentia, a local Alzheimer's home. And many of them were my patients.

Gotta love these people. They can't remember how to tie shoes, count money, or who their family members are, BUT THEY SURE AS SHIT CAN SPOT AND RECOGNIZE THEIR FREAKING NEUROLOGIST FROM ACROSS THE ROOM IN A BUSY RESTAURANT!!!

As a result our dinner was frequently interrupted by varying patients wandering over to say hi, help themselves to our chips, and/or ask directions to the bathroom. And since they have Alzheimer's disease they didn't recall doing so. One lady (with mismatched shoes and her blouse on inside-out) came over 3 times in one hour to tell me I looked familiar and to ask if we'd met before. One of them announced to her table (and the restaurant) that I was either her doctor or her grandson. Another asked me if I had any samples of "those memory pills, I forget what they're called".

We went elsewhere for dessert. Mrs. Grumpy noted the van's license plate for future reference if we see it in a parking lot again.

Get Your Butt Out of my Hospital, Loser

So I got called to come in to the hospital this Saturday morning. 21 year old woman who woke up this morning, completely paralyzed from the waist down. While driving in I turned over the possibilities: spinal card tumor, multiple sclerosis, big herniated disk, etc.

So I saw the patient, and as advertised she couldn't move either leg. There were some things about her story that didn't add up, but certainly she needed further work-up.

While I was out at the nurses station dictating a note she walked out of her room to ask where the smoking patio was.

As soon as she saw I was still there she ran back in and laid down on the bed.

What Does a Neurologist Do?

Many of you have written in to ask what I do, anyway.

Everyday a neurologist has to deal with many serious medical questions. My nurse Annie and I exchange email all day concerning critical patient problems and other important issues.

Here, for example, is an excerpt from an email that Annie and I recently exchanged on a patient who called in for urgent medical advice.

(click to enlarge)

Gee, Thanks for the Demo

I'm seeing a grizzled old cowboy this morning (boots, belt buckle, big ol' hat) for coordination problems, and am trying get an idea of what his limitations are.


Dr. Grumpy: "Do you have any problems combing your hair?"

Mr. Oldcowboy: (lifts up hat): "I ain't got no hair".

Dr. Grumpy: "Any trouble brushing your teeth?"

Mr. Oldcowboy: (pulls out dentures): "Ain't got those, either".

Feeling Special

I ordered some med samples (Axert) because Ortho-McNeil finally canned my incompetent drug rep. They came with a cover letter saying "Dear Dr. Grumpy, thank you for taking the time to order Axert samples, yadda yadda yadda."

Attached to the letter was an invoice of what was in the box.

Notice the circled item on the invoice: "Personalized Thank You Letter"

This just makes me feel SO appreciated.

(click to enlarge)