Negative answers FAIL

Dr. Grumpy: "Do you use caffeine?"

Mr. Negative: "No, except for 2 cups of regular coffee each day."

Dr. Grumpy: "Do you take any medications?"

Mr. Negative: "Nope. Only Coumadin and Metformin."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "None, just Penicillin."

Don't just stand there! DO SOMETHING!

I hear that all the time. Apparently, standing by the bedside and giving medications isn't enough for some people.

There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.

And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.

But let me tell you some stories.

The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.

So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.

Guess what? A study found boring old pills beat snazzy stents!

Here's another example:

For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?

(crickets)

But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.

Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.

But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)

Um, no.

That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.

Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."

In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.

And in some cases that's quite far from the truth.

Yet more pictures from the road

I suppose only a neurologist would notice this guy's T-shirt:

Here we have a fashion statement, albeit for a good cause:

 

I don't understand this:

"I want you to remember this, Clark. The one man who hung you from his radiator grill."

More pictures from the road

This bio-hazard bag rode an elevator at our hotel for roughly 24 hours before disappearing. Maybe they wanted us to think we were aboard the Carnival Triumph.

I assume this bumper sticker's purpose is to confuse readers regardless of political leaning.

Catching up on some reading behind-the-wheel while Mrs. Grumpy was driving, I encountered this strange ad for an epilepsy drug. Apparently, if you don't like turning blue, it's easier to be green.

Pictures from the road

Because when you hit a bump on the freeway at 75 mph, nothing holds your overloaded trunk closed better than a few strips of tape.

"That looks safe, Ed. Now use some to re-attach the differential."

Heading out

Okay, folks. The bags are packed. Kids in the trunk rear seats of the minivan, and we are ready to head out for 2 weeks.

As they did last year, my family has forbidden me from writing regularly on this trip. Something about family time and other stuff.

So I'll be posting stuff here and there and as allowed by my superiors, but not daily.

Regular posting will resume on Monday, August 12th.

Traffic jam

Actual broadcast of a road construction news story in Saginaw this week.

I feel incontinent. Let's go for a drive!

Actual manufacturer's info for Botox:

Fool me once...

Wednesday, July 17

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

Miss Luthor: "Hi, I'm so sorry, I have an appointment in 1 hour, and I have to cancel it. I'm really sick today."

Mary: "I'm sorry. Would you like to reschedule?"

Miss Luthor: "Yes. Can I come in next Wednesday, at the same time?"

Mary: "Okay... Wednesday, July 24... Looks good! We'll see you then, and I hope you feel better."

Miss Luthor: "Thank you!"


Wednesday, July  24

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

Miss Luthor: "Hi, I'm so sorry, I have an appointment in 30 minutes and I have to cancel it. I can't get a ride today."

Mary: "Okay..."

Miss Luthor: "I'd like to reschedule to..."

Mary: "I'm sorry, but our office policy is that we don't allow 2 last-minute cancellations."

Miss Luthor: "But I really need to see the doctor! I've heard such good things about him!"

Mary: "I'm sorry, but that's our policy."

Miss Luthor: "Can't you make an exception? I told you! I'm really sick today!"

Mary: "I thought you couldn't get a ride today? You said you were sick last week."

Miss Luthor: "Okay, yes, you're right, I can't get a ride today. And I'm sick too! It's both!"

Mary: "Have a nice day." (hangs up)

We're talking A.D., right?

I was doing a survey recently, and this question came up:

1930? WTF?

I mean, let's do the math here. Realistically (unless you're Dougie Houser) if I qualified in neurology in 1930, it means I'd be 109 now. I'm not saying it's impossible, but pretty damn unlikely.

Of course, there are exceptions.

Patient quote of the day

"All my memories, without exception, are of things that happened in the past. I don't have any other kinds of memories, and I'm really worried about this."

Meow

Dr. Grumpy: "I don't like the sound of this... I want to admit you directly to the hospital. Let me make some calls."

Miss Felid: "Okay... But what about Mr. Fluffles?"

Dr. Grumpy: "Uh, what about him?"

Miss Felid: "Will you take care of him?"

Dr. Grumpy: "Can't your daughter go over to your house?"

Miss Felid: "But he's not there!"

She sets her large purse on the desk, and Mr. Fluffles looks out to see what's going on.

Dr. Grumpy: "Oh! I had no idea you had him here."

Miss Felid: "So can you take care of him?"

Dr. Grumpy: "Why don't I call your daughter?"

Miss Felid: "You've really hurt his feelings."

Random weekend pictures

 Time to hit the mailbag.

The first item is this gadget. In all honesty, I had no idea there was a market (especially in "scenic region") for an explosion-proof telephone

Next is this game, which was seen recently at the store. If your "favourite childhood memories" are from the late 1800's, the odds are your kids won't be impressed with it at this point in their lives.

Here we have a gift bag from a child's sports-themed birthday party. They probably should have folded the left margin a little more carefully.

Here's a product that I had no idea existed. I guess it can be used for cooking, for edible jet engines, and, uh, other practices.

And, lastly is this device. Which sounds like a bad pick-up line.

"Light & easy to handle." Snicker.

Great patient quotes

Dr. Grumpy: "Have you had anything stressful going on?"

Mr. Golf: "No. Look, doc, I'm retired. REALLY retired. If I tried to relax any more I'd be comatose."