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.

Let Me Prove It

I get your emails. Some of you write in that I must be making this shit up.

You write that there's no way people can be that stupid. Or crazy. Or whatever.

I'm not going to name any names (hell, I don't even know your real names, anyway). But you guys know who you are.

Therefore, as an exhibit for Dr. Grumpy's defense, I ask you to direct your attention to the remarkable site People of WalMart. After perusing their stunning collection of photos, and the fact that they encompass all corners of the continent, I think you'll come to the correct conclusion that there are more people of this type out there then you realize.

The defense rests.

AAAUUUGHH!!! MR. PHONE JUST CALLED BACK!

He left a message asking if it's safe to take the multivitamins his ex-girlfriend bought him last month.


I am not returning his call. Dr. Notoncall can deal with him on Monday.

Weekend On Call- The Phone Calls

Dr. Grumpy: "This is Dr. Grumpy, returning your call".

Mr. Phone: "Um, yeah. I see Dr. Notoncall, and she has me on Aspirin 325mg once a day for a stroke, and, um, I was wondering if I can change it to the baby Aspirin 81mg size once a day instead?

Dr. Grumpy: "Are you having stomach problems or bruising, or another problem with it?".

Mr. Phone: "No."

Dr. Grumpy: "Then why do you want to change it? If Dr. Notoncall told you to take 325mg I assume she had a reason."

Mr. Phone: "Cuz my buddy, Phil at the paint shop, told me he thinks the 81mg is gonna be better for me. Ya see, my girlfriend bought me the bottle of 325mg after my stroke, but she and I broke up yesterday, and I'm not gonna see her again. So Phil pointed out that since she's the one who got me the 325mg size, maybe now that she's left it's not a good idea for me to be taking them, and so I should change sizes to something she didn't buy me".

(Long pause)

Dr. Grumpy: "Sir, I think you should stay on the 325mg pills. It's what Dr. Notoncall told you to take."

Mr. Phone: "Is that safe? Cuz my ex-girlfriend bought them, and Phil said..."

Dr. Grumpy (interrupting): "If it's that important to you, then you can buy your own bottle of the 325mg and get rid of the one she bought you."

Mr. Phone: "Am I allowed to do that?"

Dr. Grumpy: "Yes."

Mr. Phone: "Okay, but I'm gonna go to a different store than she did."

Mr. Jackass- The Sequel

For those of you who've already forgotten who I'm talking about, click here. It's also only been 3 days, so you should probably go see a neurologist.

So his appointment was at 10:00 today.

10:00 - No Mr. Jackass.

10:05 - No Mr. Jackass.

10:10 - No Mr. Jackass.

10:15 - Phone rings. It's Mr. Jackass's secretary. She's calling to say that he's in the lobby of my building, but is tied up in a VERY IMPORTANT telephone meeting, and can't come up right now. Mary told her that we don't see new patients who are more than 20 minutes late. She says she'll tell him.

10:17 - Mr. Jackass, cell phone glued to head, shows up. Signs in. He looks at Mary and says, "There. I'm here. Now let me finish my meeting" and sits down in the lobby. Argues with someone on the phone.

10:18 - I go to door, call him back. He doesn't even look up, just gives me the "I'm on the phone, leave me alone" gesture.

10:20 - My 11:00 (a follow-up visit) shows up early. So I take her back. Mr. Jackass gives me dirty look when I call her back, but continues his meeting.

10:35 - Mrs. Follow-Up and I finish her appointment, and I walk her out. I give Mary the "Mr. Jackass is toast" gesture, 15 minutes after I should have.

10:40 - Mr. Jackass hangs up his phone

He goes up to the front desk and tells Mary that "He'll see Dr. Grumpy now". Mary tells him that he's missed his appointment, and can no longer be seen. He starts yelling at her, saying he was here on-time, and in my office by 10:20, like we told him. Demands to talk to the office manager.

I was standing out of sight behind a shelf, because I expected this to happen and wanted to hear it. So I made my appearance. He immediately laid into me about the fact that HE WASN'T BEING SEEN ON TIME BECAUSE HE'D BEEN SITTING IN MY LOBBY FOR A WHILE AND WAS A BUSY GUY WITH STUFF TO DO.

I told him that it's our office policy that we don't see, or reschedule, new patients who are more than 20 minutes late. He insisted he wasn't late. I told him he was, and pointed out that when I tried to call him back for his appointment he'd refused to come back because he was on the phone.

So he demanded to talk to Dr. Grumpy.

And I introduced myself.

For perhaps 10 seconds it was so quiet you could have heard a pin drop.

Then he picked up his phone, pressed a key, and said "Yeah, it's me. Patch me back into the meeting". And walked out the door.

At 11:45 the ER called me. He'd gone over there and told them he needed to be evaluated for a stroke. They asked me to come over and see him. I said no.

And to all a good night.

Mr. Jackass, Part Deux

Yes, he showed up... sort of.

Gotta see patients right now (blogging isn't my day job, though I wish it was), but thought I'd at least end the guessing.

I'll post full details later tonight or tomorrow, Grumpyites!

Dear Insurance Bozo

Your patient recently had an extensive work-up (as an inpatient, no less) for her migraines. I wasn't involved in it, but it looks like she was in the hospital for 5 days, and had several MRI's, a spinal tap, and a bunch of other tests. I'm sure her bill was pretty damn high.

She came to see me yesterday for her headaches. She doesn't want any more tests, and doesn't want to go to ER, either. So it sounds like she's trying to save you guys some dough, too, at this point.

So it was really a surprise to find that you bozos refused to authorize my prescription for a CHEAP FUCKING GENERIC drug (which according to drugstore.com is priced at 11 cents a pill) to help her feel better, and stay out of the ER. Instead, you told me it was "experimental" (although it's been a standard treatment for over 20 years) and faxed me 5 pages of forms overnight to get it authorized.

You guys can eat my shorts. I prescribed a drug that's $1.25/pill, now, and you bozos actually cleared it. Way to save some money there.

Wait'll your CEO finds out how this is gonna impact his bonus this year. He won't be happy.

OMG!

Thank you, Mrs. Monday-Attwo, for faxing over some information in advance about your symptoms.

I've seen a lot of neurology, and I'm sure what you have is called a Bell's Palsy. It's a common, usually self-limited, droop on one side of your face.

There are still neurological conditions out there that I haven't heard of, but I don't think you have one of them.

I'm not sure where you're getting your information from. Maybe you didn't hear the ER doc correctly. Maybe the ER nurse was in a hurry and her handwriting on your discharge instructions was sloppy. Maybe English is your second language.

But, as far as I know, this condition that you listed on your fax doesn't exist.

It says "Bell's Pussy".

If you do indeed have such an unusual condition, I recommend you either see my esteemed GYN colleague ER's Mom, or take your cat to a vet, depending on the circumstances.

See ya Monday!