Beats my hot tub articles

Mr. Shakes: "Is there anything new out there, doc? I try to keep up on changes in the field."

Dr. Grumpy: "Oh, what do you read?"

Mr. Shakes: "The obituaries."

Um, I, uh, my answer is...

I was doing an internet medical study this morning. It featured this question:


You are a (please check only one):

A. Neurologist
B. Cardiologist
C. Other medical practitioner
D. Male
E. Female

February 3, 1959

(briefly going off my usual topics)

The day the music died.

On this day in 1959, a plane crash claimed the lives of singers Buddy Holly, Ritchie Valens, JP "The Big Bopper" Richardson, and pilot Roger Peterson).

Don McLean, in one of the greatest songs ever written, summarized the tragedy, and in a truly remarkable collection of words told the story of American music from the 1950's to 1969.


A long, long time ago...
I can still remember
How that music used to make me smile.
And I knew if I had my chance
That I could make those people dance
And maybe they'd be happy for a while.

But February made me shiver
With every paper I'd deliver.
Bad news on the doorstep;
I couldn't take one more step.

I can't remember if I cried
When I read about his widowed bride,
But something touched me deep inside
The day the music died.

So bye-bye, Miss American Pie.
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinking whiskey and rye
Singing, "this'll be the day that I die.
"This'll be the day that I die."

Did you write the Book of Love?
And do you have faith in God above,
If the Bible tells you so?
And do you believe in rock and roll,
Can music save your mortal soul,
And can you teach me how to dance real slow?

Well, I know that you're in love with him
`Cause I saw you dancin' in the gym.
You both kicked off your shoes.
Man, I dig those rhythm and blues.

I was a lonely teenage broncin' buck
With a pink carnation and a pickup truck,
But I knew I was out of luck
The day the music died.

I started singin',
Bye-bye, Miss American Pie.
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die.
This'll be the day that I die"

Now for ten years we've been on our own
And moss grows fat on a rolling stone,
But that's not how it used to be.
When the Jester sang for the King and Queen,
In a coat he borrowed from James Dean
In a voice that came from you and me,

Oh, and while the King was looking down,
The Jester stole his thorny crown.
The courtroom was adjourned;
No verdict was returned.
And while Lennon read a book on Marx,
The Quartet practiced in the park,
And we sang dirges in the dark
The day the music died.

We were singing,
Bye-bye, Miss American Pie.
Drove my chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die.
This'll be the day that I die."

Helter Skelter in a summer swelter.
The Byrds flew off with a fallout shelter,
Eight miles high and falling fast.
It landed foul on the grass.
The players tried for a forward pass,
With the Jester on the sidelines in a cast.

Now the half-time air was sweet perfume
While the Sergeants played a marching tune.
We all got up to dance,
Oh, but we never got the chance!
`cause the players tried to take the field;
The marching band refused to yield.
Do you recall what was revealed
The day the music died?

We started singing,
"bye-bye, Miss American Pie."
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die.
"This'll be the day that I die."

Oh, and there we were all in one place,
A generation lost in space
With no time left to start again.
So come on: jack be nimble, jack be quick!
Jack Flash sat on a candlestick
'Cause fire is the devil's only friend.

Oh, and as I watched him on the stage
My hands were clenched in fists of rage.
No angel born in hell
Could break that Satan's spell.

And as the flames climbed high into the night
To light the sacrificial rite,
I saw Satan laughing with delight
The day the music died

He was singing,
"Bye-bye, Miss American Pie."
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die.
"This'll be the day that I die."

I met a girl who sang the blues
And I asked her for some happy news,
But she just smiled and turned away.
I went down to the sacred store
Where I'd heard the music years before,
But the man there said the music wouldn't play.

And in the streets the children screamed,
The lovers cried, and the poets dreamed.
But not a word was spoken;
The church bells all were broken.
And the three men I admire most:
The father, son, and the holy ghost,
They caught the last train for the coast
The day the music died.

And they were singing,
"Bye-bye, Miss American pie."
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die.
"this'll be the day that I die."

They were singing,
"bye-bye, Miss American Pie."
Drove my Chevy to the levee,
But the levee was dry.
And good old boys were drinkin' whiskey and rye
Singin', "this'll be the day that I die."

Mary's Desk, February 2, 2010

Mary: "Dr. Grumpy's office, this is Mary."

Ms. Doofus: "Yes, I need to make an appointment to see Dr. Grumpy."

Mary: "Okay, let's see... We can see you tomorrow afternoon at 3:00?"

Ms. Doofus: "That won't work. I need mornings, before 9:00. I do a day-care center out of my house, and have about 20 kids until 6:00 p.m."

Mary: "Hmm, our mornings are filled until next week, how about next Monday at 8:00 a.m.?"

Ms. Doofus: "I'd really like to get in this week."

Mary: "I'm sorry, but afternoons are all we have left this week."

Ms. Doofus: "Well, I guess I can do tomorrow. There's only 20 kids, can I bring them and have your staff watch them for me?"

Reasons to avoid cheap bras

Dr. Grumpy: "How did the car accident happen?"

Mr. Smash: "Well, this lady in front of me had this huge rack. I think she used it for towing stuff. And I guess something broke, and her rack flew off and smashed my front end. It was one of the biggest racks I've ever seen. I mean, it must have hit 2 or 3 other cars too before it stopped, and people were swerving, and everyone was watching her rack lying in the middle of the road. And she didn't care if she'd hurt anyone else. All she kept saying was that we'd ruined her rack, and that she'd paid a lot of money for it, too."

And the award for best actress in a hospital gown goes to...

This morning I did a hospital consult on a psychiatric patient with pseudo-seizures.

While I was talking to her she suddenly yelled the dreaded "Oh no! You're making me have a seizure! Here it comes!"

This was followed by a an acting job with yelling, thrashing, and moaning that looked more like Meg Ryan's famous deli scene from "When Harry Met Sally" then any kind of epilepsy I've ever seen.

"Oh God! Oh my God! Oh my God! I'm having a seizure! I'm seizing! Oh! Oh! Oh!"

After it was over she opened her eyes and said "Did you think I was having a seizure?"

I thought about telling her what I really thought she was having, but decided to keep my mouth shut.

Vocabulary homework

Dr. Grumpy: "Okay, next word, what does 'buffeted' mean?"

Craig: "Um, to eat a lot? Like at the chinese place with all the food you want?"

Sometimes it's fun

Seeing a sweet old lady this afternoon, named Elizabeth.


Dr. Grumpy: "Do you go by Elizabeth? Or do you have a nickname you prefer?"

Elizabeth: "Just Elizabeth. My parents were very poor, and couldn't afford a nickname."

A study of ONE FREAKING PATIENT!

I'd like to thank my reader, Dr. T., for submitting this gem. It may be 20 years old, but hey, people still get the hiccups.

And again, it's from Haifa, Israel. For reasons that remain mysterious, an unusual proportion of oddball research seems to be from there. A review of my past posts will show several Haifan studies.


Termination of intractable hiccups with digital rectal massage.

J Intern Med. 1990 Feb;227(2):145-6

Odeh M, Bassan H, Oliven A.
Department of Internal Medicine, Bnai Zion Medical Center, Haifa, Israel.

A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.


PMID: 2299306 [PubMed - indexed for MEDLINE]

More Allergies

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Sure: "Naprosyn."

Dr. Grumpy: "What happens when you take Naprosyn?"

Mr. Sure: "My armpit deodorant doesn't last as long as it should."

How does pointless research get published?

In light of my many posts on obvious and/or stupid research, quite a few of you have written in with that question.

There are several answers, but the most common one is busy work. And I am my own best example.

I am not an academic/research person. I have nothing against those who are, it's just not my thing. One of my career goals was to die unpublished. I didn't ever want my name in any journal, anywhere.

But when I was doing my fellowship, the chairman was of the opinion that it was critically important that everyone get published at some point, regardless of the quality of the research involved. So he came up with an absolutely bullshit project for me. And I was faced with the options of doing it or failing the fellowship.

So I did the project. It was remarkably stupid and pointless. it consisted of me reading through MOUNTAINS of old charts, going back several years, and making notes. For the record, a lot of BS research is done this way. Some poor sucker in training is forced to tediously analyze endless piles of old charts or videos or patient forms or something, to come up with worthless information, under the threat of failing out of their program.

Let's face it. You can get pointless data out of anything: "Our chart review found that people who saw the original release of The Wizard of Oz in 1939 were more likely to have Alzheimer's disease in 2009 then those who'd seen the original release of Star Wars in 1977. This suggests an unidentified risk factor for dementia in seeing MGM films vs. those made by 20th Century Fox."

And these studies are generally cheap to do, because you're already paying the salary of the resident or fellow involved (even cheaper for med students, since they work for brownie points).

And there's always a crappy journal out there, trying to get advertising dollars and willing to publish anything to get readers.

So I found some meaningless data, and at a weekly division meeting I presented it. There were 4 attending physicians and 2 fellows in my subspecialty at the time. 3 of the attendings, and both of the fellows (including me) agreed the paper and it's findings were meaningless drivel.

Unfortunately, the only person who disagreed was the chairman. And since he was editor at the time of some desperate medical journal, he got my paper published there.

To make matters worse, he then got me a poster spot at the annual neurology meeting that year. So I had to go to this meeting, set up a poster with my worthless data on it and then STAND BY IT wearing a badge that identified me as the author.

So for the required 2 hours I stood there, trying to smile at all the big league academics going by. Most looked at my poster and politely didn't say a word. A few gave me sympathetic looks. 3 made comments about how worthless it was (I silently agreed). Only one said something kind.

I left the poster hanging in the meeting hall. I think I was the only person who didn't take theirs home. I assume it's in a landfill by now.

My shitty article got published a few months later, and several intelligent neurologists (who I assume were reading in a hot tub) found my paper to be such absolute garbage that they felt the need to write to the journal to complain. And the journal editor, my chairman, forwarded the letters to me to write a rebuttal.

How do you defend the indefensible? Hell, I agreed with them.

But by this point I'd completed the fellowship, and was an attending physician. And I didn't care. So I just tossed his requests in the trash.

So my sole contribution to the medical literature is out there. Fortunately, as the years go by, it will continually be buried under newer (though equally worthless) data.

And that's where at least some crappy research comes from. And I suspect most of it has similar origins. Some poor sap who's under pressure to publish something, anything, regardless of how stupid or obvious it is, or people trying to pad their resume, or someone with way too much time on their hands and absolutely no life (if you're in the last category, get a dog. Or join Facebook. Or do ANYTHING to waste your time in a more useful way), and crappy journals willing to publish anything.

And that's the way it is.

Sunday hot tub reading

Okay, I polished off a few more journals to help keep up-to-date this afternoon, and have learned that:


People who use excessive amounts of salt have increased risks of stroke and heart disease (WOW! I've never heard that one before!). British Medical Journal, November 24, 2009.

Excedrin Migraine is effective for some patients with migraines (when compared to placebo), but not for others. Paper presented at the 14th Congress of the International Headache Society.

People who have severe migraines on workdays are more likely to miss work due to migraines, than people who don't have migraines during those times. Another paper presented at the 14th Congress of the International Headache Society.

Dr. Grumpy's Rules, #1024

No good will EVER come out of returning a Sunday morning message that begins with:

"Yeah, I have an appointment with Dr. Grumpy this morning, and your office building is all locked up."

Breaking Medical News

I was relaxing in the hot tub today, catching up on cutting edge medical literature.

I learned that:

Patients on sedating drugs have a higher risk of falling than those not taking sedatives.

Patients with imbalance from inner ear problems are more likely to fall than those without balance problems.

(Archives of Internal Medicine, May 25, 2009)


I also learned:

People with a stroke, and poor blood flow to the area of brain involved, are more likely to have another stroke then people with normal blood flow to that area.

(Brain, April, 2009)