Show and Tell - not what you remember

Wow. And I thought the seashells I found at the beach were nifty when I brought them in.

Obviously, I wasn't even close.

How is this my fault?

Dr. Grumpy: "Any problems with the new medication?"

Mr. Bond: "Doc, sometimes I just like to have a martini, and the other night, when I really wanted one, I couldn't have one. It's very frustrating."

Dr. Grumpy: (reviews chart) "But James, there's no reason I see here why you couldn't have a martini every now and then."

Mr. Bond: (shakes head) "You don't understand."

Dr. Grumpy: "So what's the problem?"

Mr. Bond: "I was out of olives."

Patient quote of the day

"The pain went down through my legs. Not all my legs, I mean, but just the ones on the bottom of my body."

Sunday night, 11:17 p.m.

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

Mrs. Franklin: "Hi, you see me for nerve damage in my foot, and I'm on Neurontin."

Dr. Grumpy: "Yes. What's up?"

Mrs. Franklin: "Well, lightning struck my apartment complex an hour ago, and started a small fire in the laundry room. The fire department put it out, and everything is okay now."

Dr. Grumpy: "Are you okay? Was your medication lost?"

Mrs. Franklin: "Oh, everything is fine."

Dr. Grumpy: "Why are you calling?"

Mrs. Franklin: "I just figured this is the sort of thing my doctors should know."

Truth, NOT yak shit

The battle against cancer was set back recently, when politicians (not physicians) running for office decided that fear beats hope. False claims were made that the HPV vaccine (which has the potential to cure cervical cancer by preventing it from ever starting) causes mental retardation.

I'd therefore like to post this statement by the president of the American Academy of Pediatrics, Dr. O. Marion Burton. He is not a politician, but is an expert in the care of children.

I hope his statements carry more weight than those of politicians who are more interested in sound bites than truth.

"The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation.

There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.

The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body, and because it’s important to protect girls well before the onset of sexual activity.

In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer."

That's 4000 young women dying each year from an easily preventable disease. One of them could be your daughter - or mine. Marie will get the vaccine next year.

I did not receive any money or gifts to make this statement, nor do I own a financial interest in companies that make these vaccines. I don't know Dr. Burton, either. I'm posting this because, as a yak herder, I know manure when I see it, and believe it should be cleaned up.

Memories...

Like most residents, I moonlighted in various ER's and urgent cares around town.

One night I saw a guy in SERIOUS pain.

He was at Local Grocery, buying a can of soup.

When the pretty teenage girl cashier asked "Anything else you need?" He said "How about this, sweetie?" whipped his winkie out, and laid it on the checkout counter.

The cashier grabbed the soup can and smashed him flat.

The urologist I paged was laughing so hard that he had to hang up and call me back when he'd stopped.

I'll take your word on this one

Mrs. Epistaxis: "Sorry I'm a few minutes late. My mom had a bad nosebleed, and I had to drop her off at the ER."

Dr. Grumpy: "I hope she'll be okay."

Mrs. Epistaxis: "It was a mess. Here's a picture." (whips out iPhone with gory picture).

Dr. Grumpy: "That's okay, I believe you. How have you been?"

Mrs. Epistaxis: "I also have the kitchen towel she was using in my purse here..." (starts digging in purse)

The cup

It's just a coffee cup on our break room shelf.

Coffee cups collect at medical offices, until you have cabinets full of them, far out of proportion to the number of people who work there. Staff bring them in, then forget them. Old employees leave them when they move on. Drug companies used to drop them off.

So as time goes by, coffee cups multiply. After a while the less-used ones get migrated to the top shelf.

This cup sits on the top shelf, at the front. I put it there.

It was brought in by a patient. Not as a gift. He just preferred drinking coffee out of mugs, and didn't like paper cups or plastic/metal containers. So he carried around his own mug, would buy coffee and mix it up in paper cups, then pour it in his mug when he got to his office. Or, in this case, my office. Any place with a stable surface.

I saw him only once, for something minor. He was in his late-30's, married, 2 kids, a business professional. Nice guy. He explained his coffee issue to me as he set his mug on my desk. I thought it was funny, but hell, we all have our own neurosis. We talked about his leg pain, worked out a treatment plan, and agreed to meet back in a month.

The day after he left I found his coffee cup in the exam room. He'd left it behind in a hurry to get out and make it to a meeting on time. I washed it and set it on the top shelf, to give back at his follow-up.

3 weeks later I came in one morning and began leafing through the overnight faxes. One was from the state coroner's office, requesting records. Mr. Cup had died that night of a massive heart attack.

It's been 2 years. When I'm having a bad day, I go look at the cup.

How much do you know about Mom?

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

Mrs. Noclue: "My Mom died of cancer. I think it was prostate cancer."

Death by Magnet

Dear MRI facility,

My reader Jeanette was kind enough to send me the pamphlet you left at her office, showing the advantages of your new, non-claustrophobic, no-tube MRI machine.




I did a highly unscientific poll of claustrophobic patients since then, and all agreed that they'd rather get Valium and do a regular MRI than your "simulated lynching" technique.

But, since I often occasionally sit here and think about strangling my patients, I'll be sure to keep you in mind.

They drive me crazy

Mr. Ophth: "Since the fall I've had trouble seeing. Everything is blurry and out of focus."

Dr. Grumpy: "Did you hit your head?"

Mr. Ophth: "No, but I broke my glasses."

Annie's desk, September 12, 2011

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

Mrs. Clostridium: "Yeah, I was wondering if my Botox for migraines got approved yet."

Annie: "Hang on... No, your insurance denied it. You only have 2 migraine days per month, and it's only covered for patients who have 15 or more migraine days per month."

Mrs. Clostridium: "But I really want Botox. Can he give me something that will make me have more migraines?"

Sunday rounds

I got dragged in to the hospital yesterday for a consult.


Dr. Grumpy: "When did this start?"

Mrs. Stroke: "On Wednesday. I was doing some errands, and suddenly noticed I was dragging my right leg."

Dr. Grumpy: "Why did you wait until today to come to the hospital?"

Mrs. Stroke: "My daughter-in-law's baby shower was yesterday. They don't set themselves up, you know."

Medical news

Since I had to spend yesterday outside at a park, I dragged a pile of dusty old journals with me to do some reading. And I learned that:


Patients who have migraines with nausea are more miserable than patients who have migraines without nausea (though neither group liked having them).

Pain Medicine News, August 2011

The best predictor for improvement in a chronic migraine patient is that they have fewer migraines.

Neurology, February, 2011.



Cancer patients with frequent pain have a lower quality of life than cancer patients with no pain.

Pain Medicine News, April, 2010



People on higher doses of narcotics are more likely to accidentally overdose than people on low-dose narcotics.

Pain Medicine News, April, 2010