Tough Choices

For those of you who don't know, an EMG/NCS is an unpleasant neurological test we do. It's to determine nerve and muscle function, and involves running electrical shocks through limbs, then sticking needles into various muscle groups. It's not horrible, but not fun, either. But it gives us a lot of useful information.

Anyway, a guy called in today to schedule one. His internist had ordered it.

My secretary explained the procedure to him, needles, shocks, blood, gore, etc. He didn't really care, but had very specific dates and times he could come for the study.

As the conversation went on it turned out that the dates and times he wanted the study done coincided with when his Mother-in-law would be at his house, and he felt the EMG/NCS was preferable to seeing her.

Another Fine Patient Quote

"I've had a rash for 15 years. It's everywhere. I mean, nobody can see it, because it's invisible. Sometimes I can see it, but doctors can't. But it's still a really bad rash. Like poison ivy, if that were invisible."

Today's Brainteaser

Today's guessing game was supplied by Mr. Mystery Patient, who called at 11:25 last night:

"Hello, mumble gargle patient of Dr. Grumpy's cough sneeze in my briefcase snap crackle pop pain medicine garble static mumble so I'll just call back in the morning."

More Allergy Fun

Today's patient quote:

"I once had a rash from Sulfa, so now I have to avoid all other Aspirin products."

Clarifying My Position

In the heat of being pissed over the FDA panels recommendations on Acetaminophen, I didn't really clarify my position, and so got all kinds of comments and email from both sides of the aisle.

To summarize my worthless viewpoints:

1. I stand by my point about regulating cars, pools, alcohol, and tobacco. The bottom line is that no amount of guidance, laws, and regulations will EVER protect people from their own stupidity and misuse (intentional or unintentional) of ANYTHING! People such as The Angry Pharmacist's "Cracky McCrackhead Addict" will continue to do whatever the hell they want.

2. I have no problem with regulating Acetaminophen (or APAP for short) to smaller doses and/or cutting out the combo meds. I'm not sure the APAP component really does much compared to the narc, and it falsely gives the impression these drugs are less addictive.

I understand the risks of hepatic toxicity (and, from a more practical viewpoint, rebound headaches), and have counseled patients about this for years. APAP is in a HUGE number of both OTC and prescription drugs, where it's existence isn't well listed. Many of these are "me too" crap, where the public buys them without reading the ingredients, and ends up unintentionally taking too much APAP. Getting half of this junk off the shelves would be nice.

3. Pain is a serious issue. Especially for people who are suffering from terminal illness. None of us want to die in misery. In a perfect world we wouldn't need pain medications. But we don't live in one.

And that's all, folks!

I'm Going to Throttle My Children

Our house was originally built in 1993. For no apparent reason the kitchen had a ledge put about 12 feet up on the walls. Since no one can see or reach up there, I assume it hasn't been dusted since it was first installed.

After getting back from the Independence Day Carnival at damn near midnight, and our kids waking us up at 5:30 this morning beating each other up over whether to watch Nick or Cartoon Network, Mrs. Grumpy and I really needed a nap.

When I woke after a very deep 2 hours, I discovered it had snowed dust bunnies in our kitchen. All over the floor, counters, sink, stove.

Apparently, while we were dozing, the Junior Legion of Home Terrorists began launching balloon rockets in the kitchen.

One of them didn't come down. So they assumed it was on one of these ledges. They got a ladder and climbed up, and with a broom swept 16 years of dust bunnies, spider webs, dead bugs, dog hair (how the hell does dog hair get up there, anyway?), and heaven knows what else, all over the kitchen.

The missing rocket, for the record, was lying in the hallway the whole time.

Stupid People At Large

Yesterday we went to an outdoor Independence Day carnival. At some point I wandered over to the snack bar and heard this great conversation:

Woman in line: "Do you have bottled water?"

Clerk: "Yes, we do."

Woman in line "What kind is it?"

Clerk: "Uh, the wet kind."

More Phone Calls

My office is closed today for the holiday, so my message says "Hi, my office is closed today for the Independence Day Holiday."

It's amazing how many people who call in feel this is something they need to leave a pointless message about (without a name or phone number, of course). So far today I've gotten:

"Oh, I forgot it was a holiday this weekend."

"I guess you're closed today."

"My regular doctor is closed, too".

"It's hot today"

"What time today will you be opening?"

"Since you're closed I'll call back next week."

"Are you completely closed? Or are you seeing patients today?"

Say That Again?

Working my way through some data research surveys about up-and-coming products. What do you guys think of this quote from one:

"Product M is not statistically non-inferior to Oxycodone in both relief and non-relief of pain".

An AWESOME Drug Rep

Oh, this was just a TERRIFIC way to end the work day. I couldn't have asked for something better.

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch today to the office, and there were a lot of leftovers.

So as I was leaving this afternoon I grabbed a big bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers into it, and headed out.

As I was passing a cardiologist's office on my way to the elevator, a pretty female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Prettyrep looking at me, horrified, with her jaw agape. "Excuse me?" I said.

Ms. Prettyrep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Prettyrep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "No name tag!. What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from our cardiology marketing division here".

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey from the cardiology marketing division looked even more horrified now then she had a minute ago. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

Tips for Patients

When asked "What brings you to see me?" the following answers are NOT acceptable, helpful, or desired:

1: "A car" (or bike, bus, or other method of transportation).

2: "My PCP said I should see you."

3: "My daughter drove me."

4. "The hospital sent me."

5. "My medical problems"

6. "The guy at the grocery store told me I should see a neurologist"

7. "Your name is on the referral".

8. "What kind of doctor are you?"

9: "I need a refill on the white pills with numbers on them"

10. "You were on my insurance plan."

Still Fuming at the FDA!

It should be noted that more people visit an ER and/or die, as a result of mishaps with cars, OR swimming pools, OR alcohol, OR tobacco, THEN AS A RESULT OF TAKING PERCOCET, VICODIN, OR OTHER TYLENOL CONTAINING PRODUCTS!!!

SO HOW COME YOU GUYS DON'T ALSO BAN CARS, SWIMMING POOLS, ALCOHOL, AND TOBACCO WHILE YOU'RE AT IT?!!!!!!!

Attention FDA!

Vicodin and Percocet don't kill patients!

It's the big pillow I want to smother them with when they ask for more Vicodin and Percocet that could kill them!

Neurotics at Law, P.C.

I had a deposition in my office yesterday. One of the lawyers showed up a few minutes late, set his briefcase down in the hallway, and we got started.

But after a few minutes he started squirming in his chair, like a little kid who had to pee. He looked very jittery and uncomfortable. So I told the court reporter to stop recording, and asked Mr. Attorney "Are you okay? Do you need some water, or to use a restroom?"

He said: "No, but I really need to get something out of my briefcase". Me and the other lawyer said fine, so he went out to his briefcase and opened it.

He came back in a few seconds holding a large rubber band. He sat back down and began playing with it, twisting it back and forth between his fingers. After that he was fine and calm for the rest of the meeting.