High maintenance

Yesterday afternoon I was in my office, waiting for a new patient. Mary came back, and told me I needed to come talk to the patient's wife at the counter. So I went up front.

Dr. Grumpy: "Can I help you, ma'am?"

Mrs. Wife: "Yes, my husband is down in the car."

Dr. Grumpy: "Is he okay?"

Mrs. Wife: "He's fine, but it's raining."

Dr. Grumpy: "Yes."

Mrs. Wife: "He hates rain."

Dr. Grumpy: "Uh-huh."

Mrs. Wife: "Look, can you come out to the lot and do the appointment in the car?"

Dr. Grumpy: "Why can't he come up here?"

Mrs. Wife: "He doesn't like the rain."

Dr. Grumpy: "Do you need an umbrella? I can loan you mine."

Mrs. Wife: "He doesn't use umbrellas. He's superstitious."

Dr. Grumpy: "I'm afraid I can't help you. I don't do car calls."

Mrs. Wife: "Can I reschedule to after the rainy season is over?"

Mary (pushing me aside, handing lady a paper): "No. Here are the numbers of other neurologists in the area. Try them."

Run that by me again

Mr. Confuseme: "My mother had Alzheimer's disease."

Dr. Grumpy: "How old was she at the time?"

Mr. Confuseme: "Like really old. She was almost dead. Maybe it was after that. Can you get Alzheimer's after that?"

The art of conversation

I went in to the hospital on Saturday to see a longtime patient of mine. As I was riding up to the 7th floor two guys, both with huge beards, got on the elevator with me.

Guy #1: "It's just shit. I mean, all that shit, ya know, and no real shit to show for it. I'm tired of this shit. Shit, I'm gonna tell her that, cause neither of us needs this shit, and it's just gonna cause more shit, and at some point, shit, it's time to find some other shit to work on. I just don't give a shit anymore."

Guy #2 "Yeah, no shit."

Mutant Kiwi Fruits

Last week I put up a post on the vaguely pedophilic ad for Kiwi fruit that I saw at Local Grocery.

In an unanticipated turn of events, my reader Merinz sent in this picture of a fruit that she picked off her own kiwi plant.

And I have nothing else to say.

Neuronerds in paradise

This week, folks, is the 2011 American Academy of Neurology meeting, being held in Hawaii. Of course, I'm not there. If I'm going to go on a vacation, it would be to GET AWAY from other neurologists.

But, a friend of mine who's there sent me this picture today. For those of you who didn't believe my post about how fanatical the neurobrotherhood is about reflex hammers, consider this: There are LOTS of totally awesome things to do in Hawaii. And what do neurologists do? We go ogle reflex hammers.

And WTF is a POS Taylor Hammer doing in there?!!! You people should be ashamed of yourselves!

(click to enlarge)

My readers write

Bruce writes in with today's post. He's a yak herder north of me, in the foothills of Mount Wannahockaloogie. Today, however, he's pretending to be a pediatric lung specialist.

Until recently I thought there were just 4 classes of smokers identified by their answer to the question "Do you smoke?":

1. The righteous nonsmoker who responds, "We do not, and anybody who lights up around my child will be shot on sight"

2. The rabid smoker "Yeah - and so what? Anyone who bugs me about my smoking is shot on sight". This guy always has the most interesting messages on his t-shirts.

3. The drive by smoker comes into clinic smelling like a Carolina tobacco barn. She doesn't smoke herself but her clothing stinks because her (husband, girlfriend, dog, neighbor) smokes. I have been tempted to suggest she take off all her clothing whenever she's around her (husband, girlfriend, dog, neighbor).

4. The nature-loving smoker is the most common type that I encounter. She only smokes outside; never around the kids. All the plants in front of her house are dying.

Recently I met a new variety, who also never smokes around the kids. He told me that "when we smoke we send the kids outside, so they don't breathe it in". I dared not ask what they did when they wanted to smoke while driving.

I also get very interesting responses when I ask if children have allergies. Not long ago I had parents refuse to give their wheezing boy any asthma medication because he was allergic to chemicals, like in medicine, but not allergic to anything organic. I refrained from discussing organic chemistry and that almost all modern medications are organic compounds. There was no future in that conversation.

I did, however, review the results of their son's allergy tests showing reactions to moulds, house dust mites, and the organic family cat. These concerned carbon-based life forms replied that all the results REALLY showed was an allergy to the chemicals used in making the needle used for skin prick testing.

I will retreat now, to my aluminum-clad safe room.

Pop quiz

Okay, it's time for another quiz. Get out your #2 pencils, and let's test your medical knowledge.


You have a history of heart problems, and been having crushing chest pain for the last week whenever you exert yourself, so you:

A. Go to the ER, like your cardiologist told you to.

B. Go to the ER, like your internist told you to.

C. Go to the ER, like your wife told you to.

D. Listen to some guy (who owns a furniture store) that you met at a cocktail party, who told you it's just a pinched nerve and you should go see a neurologist.


If you answered (D), it was a pleasure meeting you yesterday, sir. I'm sorry it was so brief, but if you hadn't run up the stairs to get to my office we likely wouldn't have had to call 911 as soon as you hit the lobby.

Thursday morning, 7:55 a.m.

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

Miss Shakin: "Hi. This is Cindy Shakin. I only have one dose left of my epilepsy medicine, and my mail order hasn't come yet. Can I get a few days of sample pills from your office until it gets here?"

Dr. Grumpy: "No problem. I'll put some up front with Mary for you. What time will you be in?"

Miss Shakin: "I have to work... Can I send my new boyfriend to pick them up?"

Dr. Grumpy: "Sure. What's his name?"

Miss Shakin: "Hang on..." (thunk as she puts phone down) "Hey! Wake up! Come on! You took all the covers. Hey, what's your name, anyway? No, I don't remember. I was drunk." (pause, comes back to phone). "He says his name is Dave. So a tall guy named Dave, with, um... dark hair, will be by today. Thanks."

"Hey, want some fruit?"

Yesterday afternoon I stopped at Local Grocery to pick up some tomatoes, and noticed this sign in the produce section.

I think the marketing people need a better slogan.

Yep

Mr. Kinetic: "Sometimes I'm more shaky, sometimes less."

Dr. Grumpy: "Any triggers? I mean, have you noticed anything that makes you more or less shaky?"

Mr. Kinetic: "Um, well, when I'm less shaky, then I guess I haven't been shaking as much."

Money at work

A few weeks ago Mr. Tachy called my office in a panic. He was at the gym, on one of those machines that monitored his pulse. At one point it said his heart rate was 210.

He panicked, and got off it. He felt like his heart was pounding. He was terrified.

He called my office (NO! I have no idea why he called his neurologist!). Annie sent him to ER. Of course, he didn't go. He drove to his internist instead.

His internist did an EKG, which was fine by that point, and some labs. All fine. So he sent him to a cardiologist.

The cardiologist did all kinds of expensive stuff, and couldn't find anything. So she referred him to a cardiac electrophysiologist. They did more expensive testing of the heart's circuitry, again without any answers.

So after several weeks, 3 doctors, lots of tests, and a crapload of money we knew what he DIDN'T have, but still had no idea why his heart had done that.

Yesterday he came to see me for the first time since this all happened. I asked him if he'd gone back to the gym yet.

"Yeah, I started last week. Guess what? It turned out the machine was broken. It read a pulse of 210 on everything, even when nothing was connected to it."

Afternoon interlude

Dr. Pissy: "Ibee, did you see that article a few months ago about diet soda being linked to stroke?"

Dr. Grumpy: "Yeah, several readers sent it to me."

Dr. Pissy: "What do you think?"

Dr. Grumpy: "It's concerning, but I'd have to see more solid data before I believe it. I mean, we've both seen plenty of research, like Saccharin in the 80's, that said it did something awful that later turned out to be incorrect."

Dr. Pissy: "I agree with you, but... I think I'm going to stop drinking Diet Coke. I've been wanting to give it up anyway. I've got a few cases left, but I'm just going to go cold turkey off it."

Long pause.

Dr. Grumpy: "Then can I have yours?"

Annie's desk, April 4, 2011

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

Mr. Goodyear: "Hi, Dr. Grumpy referred me to a cardiologist, and I made an appointment for tomorrow. I'm stuck out of town on business now, and there's no way I'll be able to make it. Can you call them and cancel for me?"

Annie: "Sure. What doctor is your appointment with?"

Mr. Goodyear: "I have no idea. It's on my desk at home. It was someone on the list."

Annie: "What list?"

Mr. Goodyear: "The one from Major Illness Insurance, of cardiologists on the plan."

Annie: "Hang on, let me look it up online... They have 38 cardiologists in our area. Do you have any idea who it may have been?"

Mr. Goodyear: "No. Can you just call all of them for me?"

Party on, dude

Mr. Astalt: "I used to be a heavy drinker, like 1 or 2 full bottles of vodka a day. But I want to be healthy, and don't do that anymore."

Dr. Grumpy: "How much vodka do you drink now?"

Mr. Astalt: "Maybe a quart per day."