Thursday afternoon

A touching mother-daughter moment in my office:

"Mom, when I get to heaven I'm going to kick Dad's ass for leaving me alone with you."

Uh, Dan... on the screen behind you, Dan...

From Huffpost.

Medical science marches on

This spring Local Hospital installed a new hand washing system. Apparently the old system of soap and water wasn't doing what they wanted (what they wanted I'm not sure, because we were using it to wash our hands).

The new system they installed involves, okay, soap and water (revolutionary, huh)? But it also involves a new technology- the hand-washing entertainment system. REALLY.

Studies have recommended that you wash them for 15 seconds to kill/drown the majority of germs, and most people don't do the full quarter-minute. So, in order to keep you washing, it tries to keep you entertained. And what better way to do that than with a screen? After all, in the 4 million years since we split off from the rest of the primates, staring at screens is what our species truly excels at.

As soon as you pump soap onto your hands, the show begins. Almost always there's a timer on it, counting backwards from 15, to make sure you scrub for your allotted time.

Usually it also involves telling you the weather outside. Which is, if you think about it, a real "fuck you." If you're washing your hands at the nursing station it means you're working, and there's no way you're getting outside to enjoy the day no matter how nice it is.

It also features all kinds of other stuff. Here's some examples.

If you like sports, it keeps you updated on scores while you think about your buddies with the day off having a tailgate at the game:

Sometimes you get a bit of semi-wisdom fortune-cookie-ish sayings. Like you really need that while trying to get an unhelmeted motorcyclist's shit out from under your fingernails.

 

Cute sayings are also common fodder. Who needs a self-help book when you can just get a daily dose of happy-happy joy-joy by washing your hands?

 

Ever find yourself suddenly struck by a panic attack that you'll be on a quiz show and not know the answers (or, if it's Jeopardy!, the questions)? Fear not! The magic handwashing gadget is happy to share pointless trivia.

For those at other hospitals using this system, feel free to send me shots of your hand-washing entertainment. I'll edit out any identifying info if needed, and perhaps make this a regular feature if popular enough.

NOTE - Dr. Grumpy, Inc. will not be responsible for any water damage your phone may suffer in the mad rush to scrub poop & blood off your hands and get your phone out during the allotted 15 seconds.

Still a few bugs in the system

Last night I was doing a survey about a new medication, and encountered this question:

The Long and Winding Road

 

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Mr. Far: "Yeah, I have a new-patient appointment with Dr. Grumpy for 2:00."

Mary: "Oh! You must be Mr. Far. It's 1:30 now, but that gives you time to get started on your paperwork..." (hands over a clipboard) "and can I get a copy of your insurance card?"

Mr. Far: "Sure..." (take clipboard, rummages through wallet, hands card to Mary) "I left my house early to make sure I had plenty of time to get here."

Mary: "That's fine. If he's done with his current one early, he'll usually start with you."

Mr. Far: "I had no idea how far you were from my house."

Mary: "I'm sorry. I thought you lived in South Grumpyville?"

Mr. Far: "I do... It was a 30 minute drive here."

Mary: "Isn't that what I told you it would probably be?"

Mr. Far: "Yes... You were right. I just hadn't realized it was that far."

Mary: "Well, you made it here early, which is better than late. Here's your insurance card back, thank you."

Mr. Far: (puts card back in wallet) "My GPS even said it would be this far, so I left early to make sure I had enough time. Still... it seemed like a long drive."

Mary: "I'm sorry. Did you have a question about the forms? Or need a new pen? Let me get you another one..."

Mr. Far: "No, let me give this back to you" (hands clipboard and pen back) "I... I think this is too far for me. I'm just going to leave and try to find a neurologist closer to my house."

Mary: "Are you sure? I mean, you're already here, and have an appointment in a short while?"

Mr. Far: "Yeah, this is just too far for me to drive. Thank you, anyway." (leaves)

Sunday afternoon

So, as hunter-gatherer tribes have done for the past several million years, Craig and I went on our weekly hunting & gathering expedition to Costco yesterday.

One of the items I needed for our cave was a chair mat. I'm notoriously rough on these things, and 6-12 months is about average for me. So I grabbed one off the pile, and was carrying it by the handles

When I got to check-out, the guy took it from me and set it upright in the cart, saying this would make it easier to transport. So it looked like this:

Side view

Front view

Seemed like a good idea. This way, if I was attacked by stone-throwing members of the rival Samsclub tribe, I'd have a shield.

Until I tried to push the cart. When I discovered I had this view:

Yes, that's Craig in front of the cart, trying to help me navigate my way out without killing anyone or denting another family's dinomobile.

After a few minutes of struggling with this, some 10 year-old walked by and said, "Mister, why don't you just pull the cart instead?"

Craig still hasn't stopped making fun of me (though it's not like he thought of it, either).

Patient quote of the day

"My mom and I are the same age, but my Dad is younger than me."

Dear Job Recruiter,

Thank you for this ad I received in the mail yesterday.

Let me give you a few pointers:

1. Neuro-Hospitalists are just neurologists, like me. The only difference is that they only work in hospitals. Granted, I don't call myself a Neuro-Officist. Probably because some idiot would pronounce it as "Neuro-Orifice."And calling myself (more accurately) a Neuro-Hospital-Officist just sounds silly.

My point here is that we don't wear surgical hairnets. Or gowns. Or gloves. I suppose if you worked in a hospital you could wear scrubs all the time, but there's no point to the other surgical accoutrements. I do know one Neuro-Hospitalist (I'm not sure it needs to be capitalized either, but you started it) who didn't match into neurosurgery, but 15 years later still plays make-believe by rounding in scrubs with a surgical hat & booties. But that's not normal.

Also, if you're going out of the way to wear sterile surgical gear and look official, you just contaminated your gloves by touching the film.

2. Holding up X-ray films is so 1990's. It's all on a computer monitor now. If the hospital you represent is still using films, that's not a good selling point.

3. It's a freakin' X-ray of a skull. Now, I know you're just a job recruiter, and likely grabbed some stock footage, but this isn't what neurologists look at. We look at MRI's and CT's, NOT PLAIN X-RAYS!!! Especially of a skull. While the skull is of relevance to neurosurgeons and ENT's, my tribe is more concerned with what's inside it. Unless this hospital is still using pneumoencephalograms as a diagnostic tool, a neurologist won't be looking at skull films.

4. If a plain X-ray of a skull is the best neuroimaging this hospital can do, they need a lot of things more than they need a Neuro-Hospitalist.

Yours truly,

Ibee Grumpy, M.D.

Next week

I'll be back sometime next week guys. Thank you for your patience.

Thank you

No, I'm not back to writing. I just wanted to thank you all for your wishes. I'm genuinely touched.

It's been a bad week. I've likely cried more than I ever have. I'm not one of those "boys don't cry" types, but am still in shock. Maybe someday I'll write about it.

One of the most remarkable things (at least to me) about the brain is its ability to remember songs and lyrics, long after we last heard them, or even remembered they existed.

Although I haven't heard the album in over 35 years, somewhere during the week my brain dragged out a song from my childhood that I'd long since forgotten about, and been playing it nonstop in my mental background. It's from Free to Be You and Me (1972) and is "It's All Right to Cry." It was, ironically, sung by football great Rosey Grier.

Normally my earworms drive me nuts, but this one has been very soothing. Thank you, Mr. Grier, wherever you are.

And thank you all for your good wishes and understanding.

IG

Sorry

Due to a serious family emergency I'm going to have to stop blogging for while. I have no idea when I will be back. I will return though, I promise. Please be patient.

Rimshot

Mr. Stumbles: "My vision hasn't been the same since I fell. Really blurry."

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

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

While you're waiting for the doctor...

Dr. Grumpy: "Okay, we'll see what the test shows... Any questions?"

Mrs. Lipstick: "You have some unused space in your lobby."

Dr. Grumpy: "Oh, that depends on the day, and how many patients Pissy and I have."

Mrs. Lipstick: "I was thinking I could put a small table at the far end."

Dr. Grumpy: "For what?"

Mrs. Lipstick: "I sell Avon cosmetics, and could set up a small store out there. I think a lot of your female patients would appreciate the convenience."

Dr. Grumpy: "What? No. I'm sorry, but that's just not something we'd like here."

Mrs. Lipstick: "How much of a commission do you want? I'm sure we can make a deal."

Small talk

Dr. Grumpy: "How's your husband doing?"

Mrs. Latrine: "He eats, then he shits. It's like living with a goose."

Dr. Grumpy's book club

Today I'd like to review a few books I've enjoyed.

Disclaimer: I am not being paid to write this, nor am I related to any of the authors. I'm also not selling the books on Amazon (though am thinking of trying to unload Frank's Pokemon guides there if he doesn't get them out of the living room).

The first is a new novel written by the totally awesome Fizzy (writing as Freida McFadden), purveyor of high-quality medical cartoons. I am, I must admit, somewhat jealous. Writing a book about the insanity of my practice was always on my to-do list, but as the years went by it became pretty obvious that I'd never have time to do it. So the book became my blog, and is a work in progress until I hang it up.

Anyway, Fizzy wrote The Devil Wears Scrubs. (Available from Amazon here). It details what is likely the most terrifying part of a medical career: the first 1-2 months of residency. Yes, you may have the title "doctor," but that doesn't mean you have a clue as to what's going on. Far from it. And you are more terrified than you have ever been in your life.

The tribulations are familiar to anyone who's done a medical internship: malignant senior residents, brown-nosing co-interns, eccentric attendings, nurses that run the gamut from supportive to hostile, and, in her case, a psychotic roommate (the last didn't apply to me, as I lived alone). Other things she learns to deal with (which are still big issues as an attending on call) are desperately trying to find time to pee, grabbing something to eat before you die or the cafeteria closes, and getting 10-15 minutes of sleep every 24 hours.

I found it to be an accurate, and funny, portrayal of intern life (except I wasn't dating a hunky surgeon).

The second book I read a few years back, but have always meant to write about. Although written by a doctor, it has nothing to do with medicine.

It's by Dr. Doreen Orion, and is a true story called Queen of the Road. She and her husband, both psychiatrists, gave up their practices for a year and bought a bus to drive around the continental U.S. (and a little of Canada) with a dog and 2 cats. The book is an entertaining combination of travel adventures, humor, and personal observations, as well as commentary on shoes, unusual local attractions, a bitchy GPS system, and, at one point, a nudist colony (I SWEAR!). Dr. Orion and I also shared the same curiosity about frost heaves when we first saw a sign warning of them (she thought they were some sort of monster, I thought they were an illness induced from overeating ice cream).

I loved Dr. Orion's book. As a veteran of many North American road trips, as a kid, as a single guy, and now as a parent, I sympathize greatly with her musings and adventures.

The last book, of course, is the one I can never emphasize enough, especially to medical students and residents. It is the one I refer to as the Bible, and is written by my medical idol, Oscar London, M.D.

It's Kill as Few Patients as Possible, and is a collection of 57 essays. Brevity is the soul of wit, and in its few pages an aspiring physician will find a bounty of practical knowledge to use in a career. The book is a bit dated in some ways (drug reps no longer give away free pens), but it also has a certain retro charm. It is, for example only available in a format that the ancients called "paper." This connection, like the 2400 year-old Hippocratic Oath, helps tie us to the ancient physicians of yore. Those long-gone days when someone had to go find a huge copy of a PDR lying around a nursing station to look something up, use a Yellow Pages to find a pharmacy's number, and radiology images were printed on a silver-based substance called "film" (yeah, that was my residency).

Happy reading! It's a great use of your occipital cortex!

Huh?

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

Phone Lady: "Hi? What's your fax number? I want to make an appointment with Dr. Grumpy, and send him my records."

Mary: "It's 867-5309."

Phone Lady: "Great! What kind of doctor is he, anyway?"

Mary: "Uh, he's a neurologist."

Phone Lady: "Oh, never mind."

Weekend on call

DiaStat is an emergency anti-seizure medication in a liquid form, that's given rectally. It's for seizures that are hard to control. It's usually used when you're trying to avoid taking the patient to ER.

This holiday weekend, while on call, I was phoned by a lady who has a daughter with severe epilepsy. Her regular neurologist had already given the family a supply of DiaStat for emergencies.

So when they called to tell me the seizures were out of control, I had her mother give her a dose of DiaStat, without benefit. After I told her to give a 2nd dose, I got called again.


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

Mom Seizure: "Hi, I gave Lisa the 2nd dose like you told me to, then I gave a 3rd dose of DiaStat on my own, and she's still seizing."

Dr. Grumpy: "You're going to have to bring her to the ER, and I'll meet you there. I can't safely give her any more outpatient medication."

Mom Seizure: "I understand, but is there anything else you could do? We really don't want to take her to the hospital. Is there another medication? Or another way of giving DiaStat?"

Dr. Grumpy: "Nothing I'm comfortable with, she needs to get IV medication, and further testing, and..."

Pause

Dr. Grumpy: "What did you mean by "is there another way to give DiaStat?"

Mom Seizure: "Well, the instructions say to give it rectally. I could try doing that."

Pause

Dr. Grumpy: "What the... you haven't been giving it to her rectally?"

Mom Seizures: "No. I've been putting it in her ear."

Dr. Grumpy: "IN HER EAR???!!!!!!!"

Mom Seizure: "Well, since seizures start in the brain, I figured squirting it in her ear would get it there faster. I was afraid putting it in her rear end would be too far away from the brain."

Pause.

Dr. Grumpy: "You need to bring her to ER."

Lazy holiday post

Science marches on. And makes a mess!

Thank you, Tab!

Huh?

Cat-Vi was kind enough to send in this picture from a magazine:

 It raises a few points:

1. Eggs are not dairy products. Just because the grocery store sells them near the milk does not mean they come from cows. Or mammals in general (yes, I know monotremes lay eggs, but they aren't generally eaten).

2. Pie graphs are supposed to add up to 100%. Not 71%. Even if you're just showing the top 3, you still should have a 29% slice marked "other."

3. Your graph is flawed. It left out broccoli and cauliflower, which have a near-100% allergy rate among children.

 Thank you, Cat-Vi!

Quote of the day

Dr. Grumpy: "Any side effects with the medication?"

Mr. Colon: "Yeah, I'm constipated. I've been using Miralax, Sennakot, Colace, and some other stuff. You know how it goes. It takes a village to have a shit."

Skool nerse time

This is Mrs. Grumpy.

My, how did the Summer go by so quickly? Well here we are again, in the first week of school.

As always, I have the cherished task of sorting out the "medical information cards" you parents fill out. I'm sure in this day and age it could be done more effectively online, but apparently they tried that at another school last year, and the parents didn't bother. I guess the internet kiosk line at the bus station was too long.

So we're continuing with cards.

Since filling these things out is a surprisingly complex task for so many of you, I thought I'd offer a few pointers.

1. On the line where it says "name" write YOUR KID'S NAME. Not your name. Or his sister's name. Also, putting nicknames like "Raggy," "Dudette," and "Booger," while cute, do not help. Especially when you don't put on a last name. So, let's keep this in mind: Write your KID'S name, both first and last. Middle is optional, unless it's a name that ends in a Roman numeral (such as Harold Winthrop Higgleschweimer IV). Then it's required so the teachers know he's just killing time with school until he gets his inheritance.

2. On the line where it says "medications" please list any your kid is taking. Things your ex was taking at the time of conception that you believe explain junior's shitty math scores do not belong there. Nor am I looking for a list of EVERY FUCKING PILL BOTTLE IN THE HOUSE. Just what junior is presently on, not what he might get into because of crappy supervision by your baby-daddy's 9 year old watching him and playing Nintendo simultaneously.

3. Under allergies, please write your kid's allergies. That's all. How hard is that? Peanuts? Check. Penicillin? Good, you've got the point. So stop putting stuff in like "soap from a Motel 6," "the sunscreen my MIL bought," and (my favorite this year) "Disney backpacks."

4. I need a phone number where I can reach you in an emergency. 911 doesn't count, unless you work there. And even then, it's a stretch. Likewise, telling me that it changes from week-to-week doesn't help, and makes me wonder if CPS should be called.

5. A vaccination record is really helpful. Writing "I believe in Jenny McCarthy" doesn't make me think highly of you. But my REAL pet peeve here is those of you who are simply too damn lazy to actually look for the records, and just scribble "religious reasons" to save time in filling it out. If that many of you hadn't vaccinated your kids, most would be dead by now. I don't believe you, so get off your ass and look through the filing cabinet.

6. If junior takes pills, please bring them in a labeled prescription bottle. A plastic baggie that says "Give a blue pill to Joanie once a day" isn't helpful. Nor is dumping a handful of loose unidentifiable pills on the counter and mumbling "those are for Steve" as you rush out with a phone glued to your ear.

7. I am not the NSA. I am not trying to violate your privacy here. I really do need to know if your kid has epilepsy. Or diabetes. Or asthma. This is knowledge that can make the difference between Billy living or dying when he's brought to my office sick as shit. Writing "none of your business" or "PRIVATE!!!" on the medical history section doesn't make my job easier. If you're writing it because you're too lazy to call your ex and ask about medical history, grow a pair and and do it. This is about your kid, not you.

Have a great school year!

For more skool nerse stories, please see my page.

Pop quiz!

Time for another contest, class:

These gadgets were in an MRI-supply catalog that (for unknown reasons) showed up at my office. So let's forget I told you that.

Take out your #2 pencils, and try to come up with some creative answers as to what they might be. I've already started you off with three ideas. 

These items are:





A. The latest in BDSM equipment.

B. Props from the next Hannibal Lecter movie.

C. Um... stuff used in a new Olympic sport? From, uh, that country over on that other continent?

Kid quote of the night

"Dad, you can tell this book takes place in the olden days, because the girl has a tape recorder."

Thanks, Marie.

Mary's desk, August 26, 2013

Mr. Stapes: "Hello?"

Mary: "Hi, Mr. Stapes. It's Mary at Dr. Grumpy's office."

Mr. Stapes: "Can you speak up?"

Mary: "HI, MR. STAPES. IT'S MARY, AT DR. GRUMPY'S OFFICE."

Mr. Stapes: "Oh, hi, Mary. Wasn't I just there a short while ago?"

Mary: "Yes. I'm calling because you left your hearing aids in Dr. Grumpy's exam room."

Mr. Stapes: "What?"

Mary: "YOU LEFT YOUR HEARING AIDS IN DR. GRUMPY'S EXAM ROOM."

Mr. Stapes: "I'm sorry, I have to hand the phone to my wife. I can't find my hearing aids."

Sunday night

 

My cell phone rings.

Dr. Grumpy: "This is Dr. Grumpy."

Dr. Nerve: "Hi, Ibee" (pant, pant, pant, loud thumping noise) "I'm just calling to give you the post-call check-out" (thump, thump, thump) "In room 752 is the guy you saw Friday..."

Dr. Grumpy: "Are you okay? What's all that noise?"

Dr. Nerve: "I'm running" (pant, pant, thump, thump, thump) "on my treadmill."

Dr. Grumpy: "Why don't you call me later? I can barely hear you."

Dr. Nerve: "No! (pant, thump) "I'm determined to get back in shape!" (pant, thump, pant, thump) "Anyway, the guy in 752, Mr. Smith, had another seizure last night..." (pant, pant, thump...)

Dr. Grumpy: "What did his MRI show?"

Dr. Nerve: (thump, pant) "Hang on, let me get the list. I set it next to..." (thump) "AAAAAAAHHH!" (crash, thud) "SHIT!!!

click

Found in a shopping cart at Local Grocery

Patient quote of the day

"Why do I have to let you know whenever I have a seizure? You're not my fucking mother."

More survey fun

I've put up some of the weird/stupid/random questions I've seen on surveys in the past. Apparently these aren't limited to North America.

A reader from the other side of the planet (Australia) sent this excerpt from one he recently took:

It's the 4th item down that grabs my attention.

Let's face it: everyone has their own degree of what is and isn't comfortable. But if I've reached a point in my life where I'm having an autopsy, I'm pretty sure I'm not going to care one way or the other.

Thank you, Caillin!

Oh, I'm sure they're used to your type

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

Mr. Platelet: "Hi, I need you to call the pharmacist about my Plavix."

Dr. Grumpy: "What's wrong? I thought Annie called it in earlier today?"

Mr. Platelet: "Yeah, but they're trying to pull a fast one on me. They tried to give me something called Clopidogrel, and they're telling me it's the same. And I've never taken Clopidogrel!"

Dr. Grumpy: "It is the same. Clopidogrel is just the generic name."

Mr. Platelet: "It is?"

Dr. Grumpy: "Yeah."

Mr. Platelet: "Oh crap. Normally my wife picks it up for me, too. I've just never noticed."

Dr. Grumpy: "Same drug. Just go get it."

Mr. Platelet: "Um, can you call it in to another pharmacy for me? After the way I acted I'm too embarrassed to go back there now."

Pizzaball

The Grumpyville city summer sports leagues are always popular, with different divisions for all levels of talent.

Usually one of the best teams in town is 8 guys who all work at Local Pizza. The manager there is the husband of one of my patients. The Pizza Boys have a feared reputation in their division, as they've been friends since high school and play together year round. They've only rarely been defeated.

Until this month.

Mrs. Pizza came in for a routine visit, and I asked how her husband's team did this year.

She paused, then began laughing. Hysterically. When she finally calmed down she told me they'd lost EVERY. SINGLE. GAME. By huge margins, too.

I asked her how this could happen. Was one sick? Injured? Dead? These guys are good (at least by city league standards).

And she began laughing again.

Apparently, due to a busy day at the restaurant, they sent one guy's girlfriend to sign them up at the city park that runs the leagues.

She signed them up for division 5 (normally they play in division 3) by mistake.

Division 5 is guys who are either recently-retired from the NBA, or who came really close to getting into the pro leagues, but weren't quite good enough.

But they are, however, a helluva lot better than a bunch of guys who run a pizza joint.

I was laughing so hard it pretty much ended the visit.

Important details

Seen in a chart while on call this weekend:

FOR FUCK'S SAKE, NO!!!

Seen at Costco, in adjacent aisles, on August 18, 2013:

Once again, my pleas go unanswered.

"I love what you've done with the conning tower!"

While doing some reading about naval battles in the Mediterranean during WWII, I stumbled across this profile of a U-Boat commander.

It was the last line that gave me the giggles.

Patient quote of the day

"We've been trying to get pregnant for a year, but took a break last month to get married."

Downgraded? Wishful thinking? Fight in my lobby?

From the "Emergency contact" section of a patient information form a woman filled out yesterday:

Mary's desk

Mary: "Okay, so we'll see you next Tuesday at 8:15. Any questions?"

Mr. Letter: "I know your office complex pretty well, but where are you in relationship to the 1st floor post office?"

Mary: "There isn't a post office in our building."

Mr. Letter: "Yes there is. I was just in it last month to mail a package. It's on the west side of the first floor."

Mary: "Sir, I assure you, this is a medical building. There isn't a post office anywhere in here."

Mr. Letter: "They must have closed it. It's across from the elevator. How could you not see it?"

Mary: "We've been in this building for over 10 years, sir. There's no post office here. The nearest one is about 4 miles away."

Pause

Mr. Letter: "Are you sure Dr. Grumpy isn't in the building with the post office?"

Mary: "Yes sir. Do you want me to give you our address? You can see a map on our website..."

Mr. Letter: "Why don't you just cancel the appointment. I need to buy stamps and send a package to my cousin, so I'll just try to find a neurologist closer to a post office."

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."