What the hell?

Dr. Grumpy: "So we'll see how the medication change works. Any other questions?"

Mr. Baker: "Have you tried the Local Grocery cinnamon coffeecake?"

Dr. Grumpy: "Um, I, uh..."

Mr. Baker: "They're HUGE! How do you think they can afford to sell them for only $3.99?"

Dear Fleet Enema Company,

Thank you for your recent press release about a new product. Marketing people are truly an amazing group.

I have absolutely no idea how humanity managed to survive so far without it, but now that it's here, the planet can keep rotating safely. We can all be secure in the knowledge that there's finally an enema available for "elective cleansing", "before or after anal intimacy."

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Thank you to my reader Amy for submitting this.

Skool Nerse Time

This is Mrs. Grumpy.

Attention Miss Hogtie, the 3rd grade teacher:

I don't mind treating grown-ups for minor injuries, either.

But when you come to me looking for something you can put on rope burns, that are ONLY around your wrists and ankles, AND which we all know occurred during your recent trip to Vegas with your boyfriend, DON'T try to make up some crap about how you had an accident weeding your backyard. We both know what you REALLY did.

Just take the aloe lotion, and spare me the details.

March Madness starts tomorrow! Lets get snipped!

I'd like to thank my reader Joey for submitting this ad. For my non-American readers, March Madness is the college basketball championship tournament. It's played out over 3 long weekends, and the first weekend, in particular, is non-stop games on TV from Thursday morning to Sunday night.

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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.

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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.