Dear Main Line Health,

A reader sent me a copy of your invitation to an "all girls" activity.

While I, personally, have never had a mammogram (although Craig once slammed a dictionary closed on my chest), I've shown this to several ladies. And they had a few comments on it.

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"What's with the fucking mocktails? If you're going to slam my boobs between 2 ice-cold metal plates, the least you can do is buy me a REAL drink!"

"The only reason they're offering a manicure first is so I don't claw the tech to death."

"Define 'light refreshments'. Are we talking a bag of pretzels or some GOOD chocolate?"

"Who the hell is that skinny? I don't think either of them has boobs!"

"Gee, do you think they meant 'just for the girls'" as a double entendre?"

"Bryn Mawr? Can't they afford to buy more vowels?"

"Notice how they show a patient getting a manicure, instead of getting her breasts squashed."

"I don't want to see some stuffy 'expert' in a white coat. Can't they hire Chippendales dancers?"

"Is this a combo thing? Because if someone is trying to do a manicure on me, and I'm having my breast crushed at the same time, I'm not going to be holding still."

Sorry, no cape

I mentioned having a migraine this past weekend, and was somewhat surprised by how many people commented and wrote to me, surprised that a DOCTOR, let alone a NEUROLOGIST, would actually get migraines.

What's up with that?

I know this may be hard to believe, but WE GET HEALTH PROBLEMS, TOO.

I see this odd view surprisingly often. People who somehow expect us to be beyond the health concerns of non-doctors.

We may be doctors, but we're also humans. Prone to the same illnesses, bad luck, and erroneous judgments the rest of mortals are.

When I have to take a sick day (rare), and Mary starts frantically canceling people, most of them are fine with it. But we get the occasional person who gets angry because I'm sick. In their minds, apparently, that's impossible. So I must be making it up to go golfing.*

In 12 years I've had 3 patients change neurologists because I was sick and had to reschedule their appointments.

As a neurologist, I also take care of (gasp) other doctors! I have patients, who are also doctors, with epilepsy, MS, Parkinson's disease, and more routine stuff. I've seen young doctor's die with brain cancer.

Being a doctor doesn't protect you from the things that ail others. Including bad karma.

On the flip side, sometimes we're surprised when something serious happens to us. At times there seems to be an unspoken belief that by devoting ourselves to caring for others, it should magically protect us from those same diseases we fight. Nope.

If anything, the high stress nature of our work makes us MORE likely to have shit happen. We often ignore our own issues because of the time needed to care for others. Most of us live sleep deprived, caffeine-overdosed, and on food that we'd never endorse to you.

I chew out patients for not exercising, or a poor diet, or forgetting to pick up their prescriptions. But I likely do the same stuff as much as, if not more often, than they do. After a long day at the office and hospital rounds, and picking up kids, and Mrs. Grumpy having an after-work meeting, when the hell do I have time to pick up my Lipitor and get something decent for dinner? So I put the pharmacy off for another day and grab a pizza. And hope that over the weekend I'll find time to exercise. My average work week is about 60-70 hours. I doubt that's conducive to longevity.

So yes, I get migraines. And if you think your doctor is superhuman, they aren't. Even if they try their best to make you think they are.

*For the record, I've never golfed on anything other than a miniature course.

Whiskey Tango Foxtrot, Over?

My 11:00 today was a guy I've seen for years. He's a retired pilot, and now flies for fun. He shares a small plane with a couple other guys. During the appointment his cell phone rang.


Mr. Wright: "So now the pain is going down my right leg, and..." (cell phone rings) "Hang on doc... Hello? This is Orville."

(pause)

"Wilbur? I thought you were going flying this morning?"

(pause)

"Fuck. What's your altitude?"

(pause)

"Can you see an airport, or highway, or something?"

(pause)

"I'm sorry. Yeah, it was making a weird noise yesterday when I was up. Didn't I tell you about that?"

(pause)

"I could have sworn I did. It was loud, though, when we were talking. Maybe you didn't hear me."

(pause)

"That's pretty far out there, but you may not have a choice. Can Dave pick you up if you land there?"

(pause)

"Then call him, for crying out loud! I'm at the doctor's." (hangs up) "And my right foot has some numbness along here."

Riding the rapids

Okay, for the purposes of safety, we at Dr. Grumpy, Inc. generally DO NOT recommend using a sex toy as a flotation device.

We also suggest keeping your pants on under these circumstances.

Not like this pair.

Thank you, Alison!

Insanity

Due to the insanity of surviving a bowling party, night at Local Buffet, and the morning aftermath of a sleepover of 4th grade friends from the twins, I don't have much to write today.

A group of them decided to go out on the trampoline at 5:00 a.m., in pitch darkness and 23° F, and set off our burglar alarm in the process. The resultant cacophony of sirens, screaming, and barking did not help the migraine I had.

At the moment we are trying to cook pancakes. There is some sort of bizarre Wii game going on. And the dogs are still barking.

I need a nap today.

We will return to our regularly scheduled program tomorrow.

Saturday

My twins turn 10 today.

My dad turned 70 last week.

Why is it that my own birthdays never faze me, but those of others do?

Friday afternoon follies

Dr. Grumpy: "I want to do an MRI. Are you claustrophobic?"

Mrs. Webster: "Very. I can't handle heights at all."

MARIEEEEEEE!!!!!!!!!!!!

Last night, I was checking math homework. The question was, "What is the perimeter of a square where each side is 5 meters long?"

And, for the answer, Marie had written "Yes."

So I called her back and showed her that "Yes" is not the answer. I explained how you find the perimeter. She went back to her desk, and a few minutes later came back and said she'd fixed it.

Now the answer said "No."

Role Reversal

Today a lady in her early 70's came in, accompanied by her daughter. Since she was here for foot numbness, I had her take off her shoes. She had a small tattoo on the right foot.


Daughter: "Mom! When did you get a tattoo?"

Mother: "Well, I, a few months ago, I..."

Daughter: "Mom, how could you?!!! You know what I think of..."

Mother: "Lisa! I'm an adult! I can do what I want!"

But he doesn't look a day over 400!

On rounds last night, I discovered this line in a new patient's chart:

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Questions I'm sorry I asked

Mrs. Migraine: "I'm not sure I want to start any medicines, because my husband and I are thinking about trying to have children."

Dr. Grumpy: "Okay, when do you think you'd be starting?"

Mrs. Migraine (blushes): "Um, like today, during his lunch break."

Dear Americhoice Healthcare

On your website, you feature this picture under "Our doctors", and I'm honestly not sure what you're trying to say.





1. Our doctors are afraid to show their faces.

2. Our doctors are afraid of getting kicked in the genitalia.

3. Our doctors wear scrubs coordinated to make them look like a roll of Life Savers candies.

4. Our doctors are protesting against the new TSA scanners.

5. You're in good hands with our gynecologists and urologists.

6. We're so germaphobic here that our entire staff wears gowns & gloves.

7. "See no evil, hear no evil, speak no evil, don't touch my crotch."

8. We desperately need a manicure, but are wearing gloves so you don't see.

9. Americhoice pays us so poorly we can't afford clothes.

10. We have glow-in-the-dark scrubs so bright that even the color-blind will notice them.

Thank you, Nicole!

Mary's desk, January 11, 2011

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

Mr. Timepiece: "Hi! This is Mr. Timepiece! It's 10:55, my appointment is at 11:00, and I'm running late!"

Mary: "Um, actually, sir, your appointment is at 3:00 today."

(pause)

Mr. Timepiece: "Then I'm running early! Never mind!"

(click)

Medical research

While doing some Sunday hot tub reading, I came across a remarkable article in last week's Neurology Today (January 6, 2011, page 18).

Basically they caused rats to have a stroke by occluding an artery, and half of them repeatedly had their whiskers petted during this. They found that rats who had their whiskers stroked ("mild tactile stimulation" in medical talk) had less damage from the event.

Interesting? Yes. But to use the cliché, "further research is needed."

I have a hard time suddenly extrapolating this finding to humans (for one thing, we don't have whiskers, at least not the sensory type rodents have). We may be physiologically similar to rats, but we aren't the same.

Someone who's having a stroke certainly gets their share of "tactile stimulation"- family members holding hands, doctors & nurses examining them, IV's getting put in, blood drawn, blood pressure cuffs, etc.

But I don't see anyone showing that the touch component alone makes a big difference in Homo sapiens.

Not even in this guy.

I'm also not so sure how this could be studied. Since we don't have sensory whiskers, what do you touch in humans? Hair? Limbs? Ear lobe? And how do you sort out real tactile stimulation vs. placebo tactile stimulation? Touch only the side the patient can't feel anything on, since they won't know?

On the other hand, after many years in the trenches giving the so called "miracle clotbuster" TPA, I must say this new treatment (in my opinion) appears to be at least as effective as TPA, and a helluva lot safer.