Let me count

Doing another fun-filled online survey this morning.


Screen #1: "Are you in solo or group practice?"

So I clicked on solo practice, and it moved to screen #2:

"Besides yourself, how many other doctors are in your solo practice group?"

Not hereditary

Dr. Grumpy: "Any major illnesses run in your family?"

Mrs. Olde: "Yes, my Dad was killed by a land mine."

It's covered by the HMO, I guess

She wasn't joking, either.


Mrs. Pain: "When I have the headache on the right side, I have my husband knock me, hard, on the left side of my head."

Dr. Grumpy: "Does that help?"

Mrs. Pain: "Kind of, because when both sides are hurting, I don't notice the right side as much."

Who needs specifics?

Reading another doctor's notes this morning, and I found this gem:

"Impression: High blood pressure. Verapamil isn't helping. I told her to stop it and take something else."

Hmmmm

Like most neurologists, I read EEG's (brainwave tests). Usually the study is accompanied by a note from the tech, listing the reason for the test, the patient's other medical issues, and their medications.

So one of the studies I read tonight had this note attached:

"Has history of seizures. EEG ordered to see if patient is safe to drive. She has diabetes, high blood pressure, and is blind."

I'm not following this

"It's a new problem, but sort of old. I mean, not new-new, but kind of an oldish new-old. I wouldn't say it's old-new, more new-old than anything else."

When dictation goes bad

This has to be one of the most bizarre dictation/transcription errors I've ever seen. It was in another physician's note. I have no idea what the original phrase could have been.

For my non-medical readers- a C-arm fluoroscopy is a large piece of metal equipment used for radiology procedures.

(click to enlarge)

Sunday morning, 10:17 a.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. Time: "Yeah, I have an appointment tomorrow, and I need to move it to Friday."

Dr. Grumpy: "Hang on..." (turns on iPod) "uh, you're appointment is on Friday, March 19th"

Mr. Time: "Oh. So is that the next Friday, or the following Friday?"

Dr. Grumpy: "It's Friday, March, 19th, 2010. I'll tell you the specific date to keep it clear."

Mr. Time: So when did you move it to Friday? How did you know I'd need to do that?"

Dr. Grumpy: "You must have. We don't do that."

Mr. Time: "Friday is good for me. Would Monday work better for you?"

Dr. Grumpy: "Friday is fine. See you then. Have a nice day."

Saturday afternoon

"Frank!!! What is this MESS?!!!"

I'm surveying our kitchen table. At 1:00 it was clean, having been wiped down after lunch.

When I wandered into the kitchen at 2:00, it was covered with a bizarre mixture of crayons, ink markers, scissors, tape, and green colored papers, all heavily smeared with pancake syrup.

"Dad, we were busy."

"Doing what?"

"Making St. Patrick's day cards for our friends."

"Why is there pancake syrup everywhere?"

"Because I forgot where the glue was, and thought we could use that instead."

He's mad I tell you! Mad!

Since Alice in Wonderland is in the news right now, I'm putting up 2 history posts in one day.

The Mad Hatter is well known in English literature. He was created by Lewis Carroll (real name Charles Lutwidge Dodgson) for the story Alice's Adventures in Wonderland. An interesting side note is that the character was most likely based on a furniture dealer, and not a hatter.

The phrase "mad as a hatter" actually predated the story, and has an interesting neurological history.

Mercury is a metal with multiple human toxicities. It can affect many organ systems, and in sufficient amounts can cause brain damage. When this occurs common symptoms are memory loss, confusion, and behavioral changes.

Mercury poisoning is uncommon in modern medicine, but before it had been identified as a toxin it was commonly used in the cloth industry, in the manufacture of felt.

A hatter, obviously, is someone who makes hats. And in 18th & 19th century England, felt was commonly used in hats. So hatters had a fairly high level of exposure to mercury, and after several years of plying their trade they sometimes developed brain damage, and went "mad". And that's where the phrase came from.




Alice in Wonderland has other neurological trivia. As many of my migraine patients will tell you, their headaches can be preceded by all kinds of visual changes. Typically these are flashing or sparking lights, dark spots, colors, or squiggly or zigzag lines. But some patients will see visual distortions, where things suddenly seem to grow or shrink in front of them. This perception change is now called Alice in Wonderland Syndrome.

It's known from his personal diaries that Lewis Carroll suffered from migraines with visual changes. It's unknown if he had the perception changes of things growing and shrinking, but who knows? Maybe one of the most famous books ever written was partially inspired by a migraine.

It's something to think about.

March 13, 1918

On this day in 1918, a U.S. Navy ship failed to arrive in Baltimore as scheduled.

No trace of the ship has ever been found. To this day, it remains a complete mystery, and the largest unexplained loss of life in U.S. Naval history (306 passengers and crew)

The ship was the collier U.S.S. Cyclops. A collier was a ship designed specifically to carry coal (the 1918 equivalent of an oil tanker), though on the last trip she had a cargo of manganese ore. The Cyclops was a reasonably large ship, 542 feet long (165m) and just under 20,000 tons. And she vanished without a trace.

The ship was en route from Brazil to Baltimore when she disappeared. Much has been made over the captain's (George Worley) health & temperament, and his possible pro-German leanings (this was during World War I) but nothing has ever been substantiated. An extensive check of German archives after the war turned up no evidence of the ship having been sunk or captured by hostile action.

Realistically, the ship likely sank in a storm, or due to major structural failure. I'm not a believer in the Bermuda Triangle or more exotic theories of things that vanish. Lawrence Kusche, in his excellent 1975 book "The Bermuda Triangle Mystery Solved" postulated a storm sinking the ship, which already had known mechanical problems.

In 1968 diver Dean Hawes reported finding wreckage of a ship that matched the Cyclops description off Norfolk. Subsequent attempts to locate this wreck have been unsuccessful. And there have been several.

There are a handful of mysteries I'd love to see solved in my lifetime. This is one of them.

More from the Department of Contradiction

I'd like to thank my reader Glen for submitting this screenshot.

He was trying to show a patient why she shouldn't be using quinine for her leg cramps, only to be betrayed by an ad in the lower right corner.

(click to enlarge)

BUSTED!!!

Mr. Seizure: "Sorry I'm late, I was driving around looking for a parking space."

Dr. Grumpy: "I thought I told you that you're not allowed to drive until April?"

Mr. Seizure: "Um, yeah, I mean, I was, uh, riding and, um, looking for an empty bike rack."

I finally did it

Okay, for all of you who have written in asking me to do Twitter, I finally have. I may be the last person on Earth to have signed up for it. I'd like to thank (or blame) ERP for inspiring me.

I'm going to use it for those moments that are too brief to warrant a full blog post. I promise not to use it to update anyone on my lunch choice, sock color, are other pointless trivia. I likely won't use it more than a few times a week, but who knows.

I am @docgrumpy. You can also, I think, look me up by my email address pagingdrgrumpy [at] gmail [dot] com

(for those of you rushing to add me to twitter, don't forget to check the previous post below- it's another patient gem).