Bueller? Bueller?

Seen in a chart:

Sympathy for the devil

Please allow me to introduce myself. I’m Dr. Grumpy’s evil arch-enemy, neurological disease.

I’ve been around for a long, long year, stole many a man’s (and woman’s) soul to waste.

In the last year I’ve been in the headlines for my trifecta of stars with Parkinson’s disease: Neil Diamond, Alan Alda, and Linda Ronstadt.

The funny thing is that you people often believe life decisions or habits or activities can change your risk of meeting me. That may work for my friend heart disease, or for certain types of cancers, but me? Don’t kid yourself. Plenty of the things I do don’t have a known cause or risk factors, regardless of what some guy on the internet or TV tell you (and I bet he's trying to sell you something, too, claiming to cure it).

Others believe that a virtuous life will keep me away, or that I’m a punishment from God for being evil. You want good and evil? How about Pope John Paul II and Adolf Hitler (both Parkinson’s disease)?  You American evangelicals think you’re immune? How about Billy Graham (Normal Pressure Hydrocephalus). You think I care?

I especially love it when you try to attach political significance to me, like I’m here to punish someone on the side you disagree with. Let’s talk about Glioblastoma Multiforme, probably the most dreaded form of cancer there is. Here are 2 names from across the aisle, Ted Kennedy and John McCain. Here's another pair: Lee Atwater and Beau Biden. Political affiliations and age don't matter to me. The last pair were 40 and 46 respectively.

Before I forget, let’s talk about Alzheimer's disease: Ronald Reagan. Rita Hayworth. Charlton Heston. Glen Campbell. James Stewart. Perry Como. Jackie Fisher. Charles Bronson. Peter Falk. E.B. White. Rosa Parks. Burgess Meredith. Norman Rockwell. James Doohan. Fred Trump (yeah, his dad).

How about entertainers (besides those I mentioned above)? Slim Pickens. Gene Siskel, Ethel Merman, and George Gershwin (all Glioblastoma). Michael J. Fox, George H. W. Bush, Muhammad Ali (all Parkinson’s Disease). Terry Garr, Annette Funicello, Ann Romney, Richard Pryor, Montel Williams (all Multiple Sclerosis). Sir Laurence Olivier (dermatomyositis). Robin Williams (Lewy-Body disease). Dudley Moore (Progressive Supranuclear Palsy).

Let’s move to Amyotrophic Lateral Sclerosis, AKA Lou Gehrig’s disease or Motor Neuron Disease. This is probably the most dreaded disease in all of medicine. Obviously, Lou Gehrig and Stephen Hawking are the most well-known, but here are some other names: Mao Zedong. Catfish Hunter. David Niven. Stephen Hillenburg (creator of SpongeBob).

Epilepsy, while not usually fatal, can still have an impact on one’s life. Believed to be something to ashamed of for years, many places used to have laws on the books forbidding people with seizures from marrying or having kids. Here goes: Hugo Weaving. SCOTUS Chief Justice John Roberts. Bud Abbott. Vladimir Lenin. Neil Young. Lindsey Buckingham. Lil Wayne. Former U.S congressman Tony Coelho. Prince. Florence Griffith Joyner. Fyodor Dostoevsky. POTUS James Madison.

This list, of course, only covers famous people I’ve affected. There are far more who aren’t famous, but who are just as important. Somebody’s parent, grandparent, child, spouse, aunt, uncle, cousin, friend, co-worker, and many others. If I’ve touched them, then I’ve touched you. And you probably still remember both of us.

Years ago, I first met Dr. Grumpy when he switched from internal medicine to neurology, and I remember him telling me that it was a real shock. Back in medicine he saw mostly old people sick and dying, but in neurology it had shifted to younger folks. That discrepancy still bothers him after more than 20 years of doing this job. And it always will. He has me to thank for that.

So don’t go around making me a political, religious, age, cultural, racial, national, or whatever issue. I don’t give a crap about any of those things. I’m a human issue. If you think you’re special, and have done something that will guarantee I leave you alone, you’re wrong.

Seriously bad things, like me, can happen to you. Or anyone. Sometimes it’s just shit luck.

You don’t like that? There’s only one thing you can do. If you have some cash you don’t know what to do with, donate it to a reputable organization working to eradicate one of the diseases I’ve mentioned. Because research leads to knowledge, which leads to treatment. That’s the only way you may be able to get ahead of me.

'Cause I'm in need of some restraint.

Monday night, 11:18 p.m.

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

Mr. Vasculopath: "Hi, you were my neurologist at the hospital last week, when I had a stroke."

Dr. Grumpy: "Yes, what's up?"

Mr. Vasculopath: "Well, I'm really worried. You prescribed Otquoobo to keep me from having another stroke, and I read about it on AllDrugsArePoison.com. It says it's really dangerous, and so I haven't started it, and now I'm worried I'm going to have another stroke, and I got all upset."

Dr. Grumpy: "Okay, let's talk about it. Are you okay right now?"

Mr. Vasculopath: "Yeah, I'm better. I just smoked a pack of cigs to calm down."

"Hey, what's that smell?"

Seen in a chart:

Mary's desk

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

Lady: "Hi, I need to make an appointment with Dr. Grumpy."

Mary: "Sure. What will you be coming in for?"

Lady: "I've been falling a lot - I fell today, actually - and want to get my balance checked out."

Mary: "Okay. Our next opening is Tuesday, at 3:45, then Thursday at 9:00. We also..."

Lady: "Oh, I'll need farther out then that."

Mary: "Any idea when? Like a week, or..."

Lady: "Not sure. I mean, I broke my leg when I fell today. I'm in ER, being admitted to the hospital right now. I'm supposed to have surgery tomorrow morning, so I'll be here for a few days, and then they say I'll need to go to rehab for a couple weeks."

Mary: "Why don't you just call back when you know when you'll be able to come in?"

Lady: "Am I allowed to do that?"

Mary: "Of course."

Lady: "That's a better idea. I'll do that, then."

Weekend on call

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

Nurse: "Hi, this is Susan. I'm a nurse on the 7th floor, calling in a consult on room 7147."

Dr. Grumpy: "Sure. What's the story?"

Nurse: "He's a 22 year old who took LSD a few hours ago, in the park next to the hospital, and has since been really confused. His friends brought him to ER. Dr. Newgrad wanted neurology to see him for the confusion."

Pause

Dr. Grumpy: "Are you shitting me?"

Nurse (laughing): "I wish. I tried to talk Dr. Newgrad out of the consult, and suggested we just put on some Grateful Dead in there until it wore off."

It's a guy thing

Seen in a chart:

Birthday gifts

One of Dr. Pissy's staff has a delightful 2 1/2 year old girl named Rachel.

This summer, due to her babysitter being on a family vacation, Rachel is at the office most days. I'm sure this irritates some people, but at our little dumpster fire of an office, we don't care. She's fun and adorable, and is a pleasant distraction from the everyday routine of medicine.

Currently Rachel is in a phase where EVERYTHING is related to her birthday, even things that are not. For example:

Dr. Pissy: "Those are nice shoes, Rachel."
Rachel: "I got them for my birthday."
 
Dr. Grumpy: "Is that a good corn dog, Rachel?"
Rachel: "Yes. I got it for my birthday."

Random Patient: "Is that a horse you're drawing a picture of, Rachel?"
Rachel: "It's for my birthday."

(for the record, Rachel's birthday is somewhere around Christmas)

Yesterday, I was getting ready to leave and went to get my briefcase. For some reason Rachel followed me down the hall, and I didn't hear her behind me.

I picked up my briefcase, turned around, and WHACK! my briefcase hit Rachel on the side of her forehead. It wasn't too hard, but enough to surprise and hurt her.

"WAAAAAAAAAAAAAHHHHHH!"

Her mother (and most of the front office) came charging back to see what happened. I was trying to comfort Rachel (without much success) and as soon as she saw her Mom, she ran to her.

Mom: "Rachel, did you get hurt? What happened?"
Rachel: "DR. GRUMPY HIT ME IN THE HEAD FOR MY BIRTHDAY!"

Helpful

Actual fax received at my office:

Annie's desk

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

Mr. Tush: "I'm really not happy about this whole situation."

Annie: "Okay, what is..."

Mr. Tush: "Now they're telling me that my insurance may not cover the colonoscopy at all, and I can't afford this, so really don't want to go ahead with it."

Annie: "I think..."

Mr. Tush: "LISTEN TO ME! I'm not done yet. This is stupid. I'd never have agreed to go ahead with the colonoscopy except the doctor told me it was needed. I'm not going to pay for this and I want to cancel the whole thing. It's crazy that you people..."

Annie: "Sir..."

Mr. Tush: "NO! YOU LISTEN FOR A CHANGE. I didn't really want the colonoscopy, and now I find out it may not be covered, and..."

Annie: "LISTEN!"

Mr. Tush: "WHAT?"

Annie: "This is Dr. Grumpy's office. He doesn't do colonoscopies. You've called the wrong office."


Pause


Mr. Tush: "Well, shit. Sorry about that."

Click

Cue the "Jeopardy" theme

Dr. Grumpy: "Do you have a medication list?"

Mr. Time: "Nope, I know everything I'm taking."

Dr. Grumpy: "Okay, what are you on?"

Mr. Time: "The first one begins with 'T' and has a lot of letters."

July 4, 1939

"Fans, for the past two weeks you have been reading about the bad break I got. Yet today I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and have never received anything but kindness and encouragement from you fans.

Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure, I’m lucky. Who wouldn’t consider it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrow? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I'm lucky.

When the New York Giants, a team you would give your right arm to beat, and vice versa, sends you a gift — that’s something. When everybody down to the groundskeepers and those boys in white coats remember you with trophies — that’s something. When you have a wonderful mother-in-law who takes sides with you in squabbles with her own daughter — that's something. When you have a father and a mother who work all their lives so that you can have an education and build your body — it's a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed — that's the finest I know.

So I close in saying that I might have been given a bad break, but I've got an awful lot to live for. Thank you."



-Lou Gehrig, terminally ill at age 36 with ALS (aka Motor Neuron Disease), in his retirement speech. He died less than 2 years later.

This is likely the worst disease in neurology, if not all of medicine. It's been 200 years since the first published report on it, and effective treatment remains a mystery.

If you're looking for a cause to give money to, consider the ALS Association.

Random pictures

All right, time to hit the mailbag for stuff you guys have sent in.


First we have this delightful hand lotion:

Then we have this playground equipment, apparently designed prior to Copernicus, or the discovery of the sun for that matter:

Here's a "trending" news item, apparently created by a random word generator in Wisconsin:

Here's a mystery question that a reader says was part of her on-line medical license renewal:

Then there was this guide to grilling that could have used an extra word:

Seen in a chart

The Master

In the 1980's Mojo Nixon claimed "Elvis is Everywhere." While anyone who visits Vegas might concur, I have to disagree.

Here, at Grumpy Neurology, Yoda is everywhere.

Sure, he may be in many disguises, but even a Jedi Master can't hide that characteristic language pattern from a trained DoC* like me.

The following are quotes I've encountered:

From patients:

"Twenty-one headaches I had in May. Many migraines that is."

"Make the seizures stop, can you?"

"I tried to talk, but speech-wise, I could not." 

"Much pain my back does have."

"Forgot you also this, Topamax, work it did not."


In an MRI report:

"Nothing abnormal does the MRI show."


From a nurse:

"Ativan received at 8:00, she did."


From a drug rep:

"Reduction in pain they will have, yes."


From my secretary:

"3:15 tomorrow his appointment is."


And (my favorite) was this patient interaction:

Dr. Grumpy: "You really need to stop overusing Excedrin."

Lady Rebound: "It's hard, but I'll try."

Mr. Rebound: "No! Do... or do not. There is no try."


*Disciple of Charcot

Blood pressure and other things

Mrs. Methodical: "My blood pressures have been good, too."

Dr. Grumpy: "I'm glad. What have they been running?"

Mrs. Methodical: "I have a list in my purse. Would you like to see it?"

Dr. Grumpy: "Certainly."

She rummaged in her purse for a minute, then handed me this:

GAAAAAHHHHH!!!

Dr. Grumpy: "Any side effects with the new pill?"

Mr. P: "Only one, it makes my urine smell like something terrible."

Dr. Grumpy: "Okay and what about..."

Mr. P: "I brought some, in case you want to smell it."

Pulls Tupperware container out of bag.

That's a wrap, folks

With the school year down to it's final 2 weeks, I'm shutting down the blog until the shouting here is over. Too much band stuff, year-end competitions, parties, and other stuff to deal with, besides my day job.

See you in a few weeks!

Texting with Frank

Mrs. Grumpy asked me to deal with dinner. Not knowing what the food status was at home, I made the mistake of asking Frank for help.

Some days... Sigh.

Phone

Mrs. Whiney was not happy.

She'd shown up 45 minutes late for her new patient appointment with no other explanation than "I have other things to do too, you know!"

Now she was not accepting that I wasn't going to see her and she'd have to reschedule for the next available slot, 2 weeks from now (and I thought I was being nice by letting her do that).

She'd berated Pissy's staff, who'd gotten Mary.

She'd been chewing out Mary, who'd finally walked away from the window and called me out from a patient room.

She was absolutely stunned when I told her I agreed with Mary, and she wasn't going to be seen today.

In an attempt to get me to give in she menacingly said "I. Want. You. To. Know. That. I'm. Calling. Dr. Stevens. And. Telling. Him. You. Treat. His. Patients. Like. This."

I smiled and wished her a good day. She pulled out her phone, knocked on the window, and asked if we could give her Dr. Steven's phone number. We ignored her.

Now it was time for her to make a scene for the rest of the lobby. And she made the critical mistake of getting her phone involved.


Mrs. Whiney: "Siri! Call Dr. Stevens!”

Siri: “There is no Dr. Stevens in your contact list.”

Mrs. Whiney: “SIRI! CALL DR. STEVENS RIGHT NOW!”

Siri: “Now playing 'Right Here Right Now' by Jesus Jones." (music starts)


Some elderly guy in my lobby and the drug rep he's never met before next to him start holding each other to keep from cracking up.


Mrs. Whiney: “SIRI! STOP THIS SONG AND CALL DR. STEVENS!”

Siri: “There is a chiropractor 1/2 mile north of you. Would you like directions?"


Drug rep starts snorting loudly and runs out of office, mumbling something about allergies.


Mrs. Whiney: “SIRI! CALL DR. STEVENS!”

Siri: “I found 3 pharmacies within two miles. Would you like me to call one of them?"


Mrs. Whiney throws her phone on the ground, picks it up, shoves it in her purse and yells "IT"S NOT FUNNY!" She storms out.

A few seconds passed before everyone in the office and lobby completely lost it and became hysterical. Including the patient who'd wandered out of my office to see why I hadn't returned.

Thrift

Dr. Grumpy: "How's the new medication working out for you?"

Mr. Pill: "Terrible! I'm nauseous all the time, have headaches, and throw up a lot!"

Dr. Grumpy: "Then let's stop it and..."

Mr. Pill: "I don't want to do that! I just bought a 90 day supply!"

Surprise!

As the school year begins wrapping up, we're moving into the next phase of the Wingnut High School marching band schedule: preparing for next season's football halftime show.

Yeah, you read that right. The next high school football season starts in 3-4 months, and so the twins and their friends are already working on the show.

So yesterday a flyer was sent home with the twins, listing all the stuff. Band camp dates. Meetings over the summer to start working on props. The theme of the show. Where to find the music to practice. Marching formations. Color guard maneuvers. Incoming freshmen orientation. Yadda yadda yadda.

About halfway down the page Mrs. Grumpy and I were surprised to find a paragraph that said “Practice marching sessions for the new steps and formations will be June 19, 25, and 29, July 7, 14, and 22, and August 12, 18, and 22. These will be held at Craig Grumpy’s house from 10 a.m. to 2 p.m. Bring your own water bottle. Lunch will be provided.”




CRAIG!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Coffee

Dr. Grumpy: "Are you much of a drinker?"

Mr. Collins: "Nope. Not at all. Just coffee, but I admit I'm a caffeine junkie. I drink it all day."

Mrs. Collins: "What are you talking about? You put Baileys in your coffee all day! You even keep it in that little thermos you sneak to work!"

Mr. Collins: "That doesn't count!"

Seen in a chart

Remember medical students: taking a good family history now includes covering test conclusions, free text, and practice management, but fortunately not retardation or cancer.