Wednesday, February 13, 2013

Memories...

Menopause has had a lot of names over time. One of the old ones, not used as much today, is climacteric.

When I was doing my internship, there was an eastern European guy named Pedrus in my class. Pedrus had just immigrated, but had a decent grasp of English.

Occasionally, though, he'd encounter something that he only knew in the medical-speak of his home country. When that occurred he'd grasp at the closest-sounding English phrase he knew, and use that.

One night he was on call, and I picked up his admissions the next morning. One of the patients was a lady in her 60's.

Pedrus, in his note on her past GYN history, had written "the patient began her climax at age 51, and it has since continued."

Tuesday, February 12, 2013

The marketing mindset

Last night I was at a market research interview, and we had this exchange. I have no idea what it means.


Suit guy: "Doctor, please look at this graph, showing speed of onset after the patient uses the drug's inhaler. What are your thoughts?"

Dr. Grumpy: "Well, it's pretty consistent, regardless of pulmonary function, but obviously the patient will have to be trained to use it properly."

Suit guy (makes notes): "And here, do you think this instruction sheet is self-explanatory?"

Dr. Grumpy: "Yes, but it would be nice to also have a demo unit in the office, to show patients how to use it."

Suit guy: (makes notes) "Who was your favorite superhero in childhood?"

Dr. Grumpy: "Doctor Fate."

Suit guy: (makes notes): "This page shows the side effect profile compared to placebo, with frequency of drug discontinuation on the left..."

Monday, February 11, 2013

AYFKM?

Dr. Grumpy: "Okay, sir, we'll check some labs, and I'll see you back after they're done... Any questions?"

Mr. Gravid: "No."

Lady Gravid: "Yeah, I have one."

Dr. Grumpy: "Go ahead."

Lady Gravid: "Do you mind if I look through your patient charts before we leave?"

Dr. Grumpy: "Uh, yeah, I do. They're medical records. I can't allow that."

Lady Gravid: "Oh, I don't need to read them, I just want to look at patient names."

Dr. Grumpy: "Okay, but I still can't allow that. Sorry."

Lady Gravid: "Please? We're trying to think of baby names, and I don't like any I've seen so far."

Sunday, February 10, 2013

Random Sunday pictures

First, we have this pen. Doesn't say if it needs batteries.





Next, in the same theme, we have this picture. Taken in Philadelphia ("The City of Brotherly Love") this was found drawn on somebody's car hood following yesterday's blizzard.






For those of you who can't handle Diet Coke, tea, or coffee to perk up, you can now shower with caffeinated soap.*

*I should note that its efficacy is likely dubious. Transdermal absorption of caffeine generally requires it being held in place for several hours, and even then you'll only get a small amount.



Here's this place, which bans cardiovascular systems, or cardiologists, or something.

Sheesh. So much for coming here for Valentine's Day.



And last, I think we could all use a lesson from Bert: There are some neighborhoods that are best avoided.

"That's the last time I go pigeon watching after dark in south Sesame."

Saturday, February 9, 2013

Now making house calls!

While I'm still going to be available here, those of you who are Kindle fiends can now subscribe to me on Amazon!

Yes, for only 99 cents a month (less than you'd pay for your daily Starbuck's "half double decaffeinated half-caff, with a twist of lemon" you can now have Dr. Grumpy automatically delivered to your Kindle. All the humor! All the whining! All the artisanal history lessons!

You even get a 14 day free trial!

You can sign up here.

Friday, February 8, 2013

Guest post: God and smoking

I'm tired, uninspired, and swamped today, so I'm putting up this story sent in by Brent.


Dr. Brent: "You know Mr. Nightshade, smoking isn't good for you.  It causes all kinds of health problems and it's expensive.  You really should try to stop smoking."

Mr. Nightshade: "Yeah, I know."


Next visit, a few months later.


Dr. Brent: "So Mr. Nightshade, how are you doing with smoking?"

Mr. Nightshade: "I quit."

Dr. rent: (rather shocked and dumbfounded) "Wow! That's great! What finally made you decide to stop smoking?"

Mr. Nightshade: "God told me to stop smoking."

Dr Brent: "Err, that's wonderful that you stopped smoking."


Next visit a few months later:


Dr. Brent: "So, Mr. Nightshade, how are you doing?"

Mr. Nightshade: "I'm fine, but I'm smoking again."

Dr. Brent: "Oh, why's that?"

Mr.Nightshade: "God told me to stop smoking, so I stopped smoking. But the more I thought about it, the madder I got. I like to smoke, so why should God tell me to stop smoking?  It made me really mad. I wasn't going to let God tell me what I can and can't do, so I started smoking again and I told him to be quiet."

Thursday, February 7, 2013

February 7, 1910

HMS Dreadnought

On this day in history, what is possibly the greatest prank ever was pulled off. And its victim was none less than one of the world's most venerable military forces, the Royal Navy.

To set the backdrop:

In 1910 the HMS Dreadnought was the first of a whole new type of battleship. She was, at the time, the most advanced, powerful, weapon of war ever built. The 1910 equivalent of a top-secret nuclear ballistic missile submarine.

The joke started in the mind of Horace de Vere Cole, a poet and notorious prankster. An example of his humor was this: An old schoolfriend had just been elected to Parliament. While walking together through London, Cole challenged him to a foot race, then let him get ahead. Unbeknownst to the friend, Cole had slipped his gold watch into his jacket pocket, and as he chased him yelled, "Stop! Thief!" The friend was detained by police until Cole explained it was a joke. Another time he purchased theater tickets for all his bald friends- and he'd chosen their seats specifically so that their heads spelled out an obscenity when viewed from the balcony.

But I digress.

Cole recruited 5 friends from a circle of writers and artists to help him, including Virginia Stephen - who'd later become famed novelist Virginia Woolf.

On February 7, 1910, HMS Dreadnought was moored in Portland Harbor, Dorset. Cole had a forged telegram, allegedly from the UK government's foreign office, sent to her commander. It said they'd be receiving a visiting delegation of princes from Abyssinia (now Ethiopia), and to offer them all courtesies.

4 of Cole's accomplices put on heavy blackface make-up, glue-on beards, and elaborate theatrical costumes. Cole went as "Herbert Cholmondeley" of the UK's foreign office, and the 6th participant (Adrian Stephen, Virginia's brother) went as a translator.


The fake Abyssinian delegation: Virginia Woolf is on the far left, her brother Adrian in the bowler hat at center, and Horace de Vere Cole at the right.


With this group behind him, Cole marched into London's Paddington Station and, claiming to be a government officer, demanded a train be immediately prepared to take them to the Dreadnought. The impressed railway employees gave him a VIP coach with private staff.

Meanwhile, in Weymouth, frantic British officers organized an honor guard to greet the train. To their horror, nowhere in the Royal Navy's music list or flag collection was there anything for Abyssinia. So the band was given the national anthem of Zanzibar instead, and hung the Zanzibar flag, hoping the visitors wouldn't notice (they didn't).

The group was welcomed with full military honors, and inspected the anchored fleet. The highlight came when they boarded and toured the magnificent Dreadnought herself. Enemy spies had spent years trying to ascertain her technical details, and here the Royal Navy was willingly escorting a group of costumed literary goofballs on board and showing them around.

As they walked up the gangplank it started to rain, and to their horror the make-up began to run. Cole rushed the group inside before anyone noticed, explaining that royalty shouldn't get wet.

During the tour, the Abyssinian princes excitedly chattered in a nonsensical foreign tongue, which was a random, improvised, combination of Greek, Latin, and gibberish. Adrian Stephen made up questions as they went along, and "translated" them (and the answers) back and forth. The group exclaimed "Bunga! Bunga!" at things that were particularly impressive. This so struck nearby sailors that it entered British lexicon for a time, and was recently (2011) resurrected in Italy referring to the behavior of Prime Minister Silvio Berlusconi.

While on the train ride, Cole had created names for each of the 4 "princes," but forgot who was who during the tour. So their names changed from minute-to-minute. The naval officers didn't notice. At one point they were guided by an officer who was a cousin of Virginia and Adrian Stephen, and who also knew Cole personally, yet he didn't recognize them (and Adrian & Cole weren't even in costume!).

As their tour ended the members tried to bestow the "Order of Abyssinia" medal on several officers (actually a cheap trinket Cole had bought en route). The Dreadnought's cooks had prepared a special meal for them, but they declined to eat, with Cole stating that for religious reasons they were concerned the food wasn't prepared correctly (the real reason was that eating or drinking would ruin the make-up and fake beards).

The group were again saluted by the honor guards and Zanzibar national anthem as they left, boarding the train back to London.

A few days later Cole leaked the story, complete with photos, to the London newspapers. It became front page news. The Royal Navy was horrified, and the mighty Dreadnought was promptly dispatched on "machinery trials" until the mess blew over. British sailors were greeted in the streets with "Bunga! Bunga!" and Parliament tightened regulations on ceremonial visits. The navy threatened to have the perpetrators caned, but in the end no one was punished.

Several months later the real Emporer of Ethiopia, Menelik II, came to England, and the navy turned down his request to visit the fleet to avoid embarrassment (perhaps they still hadn't found a flag or national anthem).

A final note came in 1915, during World War I. The Dreadnought rammed and sank a German U-Boat, and after returning to port her captain received an anonymous telegram that simply said "Bunga! Bunga!"

Wednesday, February 6, 2013

WTF?

Last night a paid survey "exclusively for neurologists" showed up in my mailbox, so I clicked on it.

One of the qualifying questions was how many of each of these disorders I treat in a month:

Needless to say, I didn't qualify


Seriously, people, I'm a freakin' neurologist. How much effort did you put into this survey?

Tuesday, February 5, 2013

Worries

Dr. Grumpy: "Have a seat... I'm Dr. Grumpy... What can I do for you?"

Mr. Frio: Hi... You know, I got a cup of water in the lobby when I came in. I was thirsty and all."

Dr. Grumpy: "Uh, huh..."

Mr. Frio: "It was really cold. I mean, maybe too cold."

Dr. Grumpy: "I'm sorry, I..."

Mr. Frio: "I wasn't expecting warm water, don't get me wrong. But I wonder if it's safe that the water is that cold."

Dr. Grumpy: "I'm sure it's safe. Now, to get back to why you're here..."

Mr. Frio: "I like cold water as much as the next guy, but this was really cold. Colder than I think it needed to be. You should look into this. Someone could get hurt."

Dr. Grumpy: "I'll let Mary know, she's the person in charge of that."

Mr. Frio: "Thank you."

Monday, February 4, 2013

I'd say that's 10/10

Yesterday afternoon I got dragged into ICU to see a consult. Some of the nurses were laughing over a chart, so I asked what was up.

Apparently Mr. Camp began having chest pain earlier in the day, which had quickly escalated. He was now in ICU, because pretty much any movement or excitement was causing chest pain. So they were slathering him with nitrates while the hospital called in the surgical team to do an urgent coronary artery bypass.

Anyway, in the pre-op orders the cardiologist had written (in all caps and underlined): "PATIENT IS NOT ALLOWED TO WATCH THE SUPER BOWL!!!"

Sunday, February 3, 2013

Kid Super Bowl quote of the night

Craig: "The team I pick has always won. Except for last year. And the year before. And the year before that. And before that doesn't count, because I didn't watch the Super Bowl."

More artisanal crap

All right, it's again time to hit the artisanal mailbag.


First we have one of many (and you guys send in a lot of similar stuff, so I guess it's everywhere) containers of edible weeds, which were grown from dirt using sunlight, water, and photosynthesis, only to have some clown claim it to be artisanal:




Next, apparently any idiot driving a car is, at least to Geico insurance, a "skilled artisan."

"I shwear, offisher, I'm a skilled artisan."







What do you with stale bread? These days you label it as "artisanal stuffing" and toss it in the discount bin:





Likewise, when those artisanal diet foods don't sell like hotcakes, you mark them down and hope some sucker takes them home.




Now even TV listings are artisanal, I guess




Apparently WAY too many people are answering "strongly agree" on surveys like this, or we wouldn't have to deal with this crap:





And, lastly, it's good to see at least some of these products are going bye bye.



Remember, if you can't get enough of this stuff, you can visit my hand-crafted Artisanal Overload page, showing my thus-far complete archives of it.

Friday, February 1, 2013

Sigh

Mrs. Apap: "I take Excedrin all day long."

Dr. Grumpy: "Have you ever heard of rebound headache?"

Mrs. Apap: "No, is it like Red Bull?"

Thursday, January 31, 2013

Better living through chemistry

Recently a new drug perampanel (AKA Fycompa) became available for epilepsy patients.

Every drug has a LONG list of side effects (Annie calls it "the scandal sheet"), but this one's is more interesting than most:

"Serious or life-threatening psychiatric and behavioral adverse reactions, including aggression, hostility, irritability, anger, homicidal ideation and threats, have been reported in patients taking FYCOMPA"

HOLY CRAP! Did I just read that correctly? Hmmm....

Let's look at the FDA's own information, as given in the manufacturer's filed paperwork:


"... has summarized the narratives of 23 physical assaults, suicidal ideations, homicidal ideations, and damage to property in the Epilepsy and Nonepilepsy studies. Preferred terms included homicidal ideation, belligerence, aggression, affective disorder/psychotic disorder, personality change, irritability, aggression/impulse control disorder, anger, adjustment disorder, agitation, abnormal behavior, and personality disorder."


Now, with that said, I want to remind you that if you look at the side effects of ANY drug, you'll find scary shit on all of them. I'm sure I'll put patients on Fycompa, and most will likely do fine.

But still, I really like this line from the FDA forms:

"The Sponsor has reported that no homicides were committed by a subject while taking perampanel."

Wouldn't you just LOVE to be able to stand up in front of a government panel and say that with a straight face? "Yeah, I mean, there were a few people who became violent on our drug, but it's not like they killed anyone or something."


So with that backdrop, it falls to the marketing wizards to make this drug look good. Their job is to promote strengths and minimize weaknesses. So what image should they use to distract people from the side effect of violent behavior. Hmmm... Flowers? Butterflies? Or maybe...




A boxing glove! Yes, they really picked a boxing glove. I swear, I am not making this up.



And, since the glove is green, perhaps they should consider this spokesman:


 "HULK TAKE FYCOMPA! MAKE HULK MAD!"*


*Hulk is copyrighted by Marvel Comics, along with the Avengers, Spider Man, Dr. Strange, the Fantastic Four, and a bunch of others I don't want to mess with. Or prescribe Fycompa to. **

**Thank you, SMOD, for the Hulk idea.
 
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