Comparing apples to apples

Like most docs, I use Epocrates on a PDA for medication info. It's not perfect, but very helpful.

So today I had to look up something on Topamax and found this, under "Look/Sound alike drug names"

"Topamax may be confused with Topiramate"

They're the SAME FREAKING DRUG, for crap's sake!!!

(For those of you looking this up on your PDA, it's under "Safety/Monitoring")

Tuesday night, 7:15 p.m.

"Hi, Dr. Grumpy. My husband sees you for Parkinson's disease. Anyway, I'm in Calorie Counters, and we have a meeting tonight in the church down the road from your office, and our scale is broken, and I know you and Dr. Pissy have one in your hallway there, and I was wondering if you could meet us at your office and let us in to use your scale for a few minutes."

Mary's Desk, August 24, 2010

Mary: "Dr. Grumpy's office, can I help you?"

Mrs. Hiazakite: "HI! I need to get in to see Dr. Grumpy! I've heard he's wonderful!"

Mary: "Okay, we have a new patient appointment this Thursday at 2:00. Will that work?"

Mrs. Hiazakite:"I really wanted to get in today. Please? Pretty please? I'll bring you cookies!"

Mary: "That's nice of you, but I'm sorry. Thursday is our next availability."

Mrs. Hiazakite:"Will he give me some Percocet at least, like this afternoon? Just to tide me over?"

Mary: "We don't prescribe to patients that aren't established."

Mrs. Hiazakite:"That's totally unfair! Please! I said I'll bring you cookies!"

Mary: "I'm sorry, but you need to find a different doctor. I'm getting off the phone now."

(click)

That ISN'T normal?

I went to ER yesterday afternoon to see a consult, and found this in the chart.

For my non-medical readers: EMS = Emergency Medical Services (i.e. paramedics).

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Patient quote of the day

"My headaches and stuff are about the same. I didn't start that medication stuff you prescribed last time, because I wanted to try massage and exercise stuff to see if the head stuff got any better. But the headache type stuff is worse, cuz my husband and kids and stress and stuff have had all kinds of stuff going on, so I wanted to talk about more stuff with you, like the pills and stuff, because my head stuff is getting out of control."

Can't we all just get along?

Dr. Pissy and I have shared an office for 11 years. We joke, bitch, whine, and try to make the most of our bizarre days as we work through the schedule. Day in and day out. 11 years now.

And guess what? We're on opposite sides of the political fence.

And we discuss health care, and politics, and war, and peace, and all kinds of other stuff. And we've never had an unfriendly moment doing it. Sometimes we come up with ideas that might actually work, and be an acceptable compromise. Sometimes we don't.

I'm not saying we should be in charge of anything. I mean, hell, what do we know? Maybe our ideas wouldn't work.

What I want to know is why politicians end up as the jerk-offs they often are. They must start out like us, at some point. On both sides of the aisle. Willing to talk and work things out. I mean, most of them are married, so should be used to the negotiations and compromise of REALLY complex human relationships.

So why is it that, as soon as someone actually gets elected, they revert to a preschool level of immaturity? Instead of trying to work things out, all they can do is scream, pout, and point fingers at the other children (who do the same back at them).

Every government in history has been founded on the idea of compromise. Every marriage, friendship, business, and child-raising depends on it to work out differences. So where the hell did it go in the modern government?

Is this kind of idiocy and inability to work together really something that anyone sees as being good? People refuse to work together, and then run for re-election on that idea- that they acted like a child (except I think politicians like to call it "standing up for my principles").

I suspect part of the problem is vitriolic idiots from both sides on cable news, who aren't running for office (and therefore have nothing to lose), spewing idealistic shit that may sound good to their audiences, but in reality won't work. And any politician who actually tries to work out a problem reasonably gets chewed out by these clowns as being weak and worthless.

I think all these political types need to go back to the sandbox, and re-learn basic playground etiquette: Be polite, wait your turn, share, make friends, treat others as you'd like to be treated, and WORK IT OUT.

Most governments were founded on the idea of negotiation and compromise. So why is it considered better now to just scream, pout, and do absolutely nothing? Or (my pet peeve) putting pissy little issues at the forefront to distract attention from the fact that they aren't trying to actually solve anything. It's easy to scream, but a lot harder to actually work out a solution. I don't think any of us are paying you guys to be petulant crybabies.

As you guys know, the Grumpy family likes cruise vacations. The crews on these ships are a remarkable polyglot of races, nationalities, and cultures. And they work very well together, BECAUSE THEY HAVE TO. If not, the passengers are unhappy, or the ship breaks, and they all get fired (at the minimum). So why the hell can't our elected representatives (who get paid A LOT more)?

Screaming and yelling may get you favor with whatever local groups whose ass you're kissing, but isn't in the best interests of any group as a whole. No matter what country you live in, or what side you're on.

Haiku

Summer neuro call
Lightly sleeping with a live
Bedside hand grenade

On Call Non-Sequitur

Dr. Grumpy: "Are you a diabetic?"

Mr. Blackout: "No, but I drink decaffeinated coffee."

I'm not following this

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

Mr. Gait: "I'm allergic to Flagyl."

Lady Gait: "I thought I was the one who's allergic to Flagyl?"

Mr. Gait: "No, it's me. I get a rash."

Lady. Gait: "Are you sure? I thought it makes my lips swell?"

Mr. Gait: "No, that's Penicillin. That's what you're allergic to."

Lady Gait: "No, you're allergic to Sulfa, and one of the kids is allergic to Penicillin."

Mr. Gait: "Then who's allergic to Flagyl?"

Lady Gait: "Doctor, what's Flagyl?"

Hot August Night

Last night was "Meet the 4th grade teachers night" at the twins' school. For most families only one parents needs to go, but when you have 2 kids in the same grade, you both go and take notes.

This is never fun. Because it's pretty damn hot in the building. School ends at 3:00, and the district, to save money, turns off the air conditioning at 3:15. In the middle of freakin' Summer. So by 5:00 the classrooms are sweltering.

The teachers aren't too fond of this either, because they have to stay late in the hot room, and deal with that most dreaded creature of all, the crazed parent. I show up with nothing but my clothes and cell phone (which I silence) and most parents do the same.

But there are a terrifying minority who show up with detailed print-outs of their kids capabilities, restrictions, non-allergic and non-religious dietary requirements ("Suzy likes PBJ and chips, so I pack those. Make sure she eats 1/2 sandwich, THEN the chips, then the other sandwich half. Any other order is bad for brain growth. I read that in a magazine once"- Yes folks, I really did hear a parent say that last year).

So we file in. The room is hot. Many parents are pouring sweat, having just come from work in bulky business clothes. Then we have to find OUR kid's desk, and cram our big fat overweight adult butts into seats designed for a 9 year old.





So now, in addition to being hot, we were all miserably uncomfortable and complaining about back pain. Seeing an opportunity, I handed out some business cards.

As if it wasn't hot enough already, the door opened and Craig's teacher, Miss Reba walked in. And the room went from hot, to hot and steamy.

She was sizzling. Suddenly all the Dads who'd been bitching about having to go to this were quiet. Now they were pissed off their kid didn't have a desk closer to the front of the room.




Miss Reba, as seen by the male parents.

And then the fun began.

Miss Reba had organized a detailed Powerpoint presentation, which was shown on some sort of interactive board at the front of the room (I guess blackboards and chalk have finally gone the way of the dinosaur). To advance slides, she had to tap on the board. Unfortunately, the board didn't grasp this concept very well, and so her taps had a 25% chance of advancing to the next slide, 25% chance of going to the previous slide, and a 50% chance of doing nothing. When the last happened, she'd pound on it repeatedly, getting louder each time, until we were afraid the board would crack or fall down.

Come to think of it, I think many of us were hoping it would fall, and knock her out. Some would get to leave early, and the rest would fight over who got to resuscitate her. As a doctor sitting in the front row, I figured I had a good shot.

She was a fast talker, but had only 1 hour to cover the entire school year. As a result, she leaped from topic to topic, ending each slide's summary by saying "And I update my website daily, so you can see what the kids are doing. Please check it regularly."

As usual, parents asked some remarkably stupid questions:

"You said the kids wouldn't have homework over the weekends. What about Fridays? Will you be sending stuff home for them to do on Friday nights?"

"If I send lunch with my kids, can you tell them what the nutritional value is? I think it's important that they know these things."

"Do you watch iCarly?"

"Do we need to check your website? Or can I just make my kid do it?"

And my personal favorite:

Miss Reba: "In music next month, the kids will learn about strings. Check my website for the dates."

Zealousfreak parent: "You mean string theory? Like in advanced physics?"

Miss Reba: "No. I said it's a music class. As in string instruments. Like a violin."


At this point, Miss Reba uttered the most dreaded words in the history of parent-teacher relationships: ""Now, I'll need some parents to volunteer..." Suddenly all of the hormonally charged fathers were checking their cell phones. Mothers suddenly had urgent texts to send. Nobody, not even the single fathers, made eye contact with Miss Reba as she ran down the list of class party organizers, reading assistants, paper copiers, and other volunteers that were needed. Usually there's some hyperactive-mother-on-speed who immediately leaps out of her chair and signs up for all of this, but she wasn't here tonight. I began picking at my face and loudly mentioned that my Leprosy treatments kept me from working with kids.


After getting home, Mrs. Grumpy and I compared notes, and now she wants to kill me.

She'd filled up a notebook listing times, dates, subjects, schedules, and phone numbers from Marie's teacher.

I had a piece of scrap paper I'd pulled out of Craig's desk on which I'd written "Check website regularly."

Everybody sing!

Dr. Grumpy: "Where is the pain?"

Mrs. Mom: "Everywhere! It hurts in my head, shoulders, knees, and toes!"

Back-to-school

As a public service, I'm re-running this from last August for those of you who missed it the first time around. It's certainly relevant.


Dr. Grumpy's Guide to Life, Chapter 2: Shopping for school supplies

Okay, so this is the 2nd edition of my helpful newsletter (If you missed the 1st one on surviving your child's birthday party, click here).

Today's issue will focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people in there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amuck! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, text, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it's fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Good luck!

Grumpy, incognito

My casual look (or lack of fashion sense, as Mrs. Grumpy calls it) sometimes pays dividends. Today it got me out of a sales talk.

Mary had gone out to lunch with Dr. Pissy's staff, and I wandered up front to fax something. As I'm standing there, 2 well-dressed ladies in their 30's come in, and stare at me.

Dr. Grumpy: "Hi, can I help you?"

Stuffy #1: "Yes, we represent Neverfuckingworks computerized chart systems and..."

(offers right hand, Dr. Grumpy shakes it)

(Stuffy #2 whispers something into the ear of Stuffy #1)

Stuffy #1: "Anyway, here's some information about our chart system. Can you please give it to the doctor, or office manager, or someone important who works here?"

Dr. Grumpy: "Will do."

Stuffy #2: "What do you do here?"

Dr. Grumpy: "I clean the fish tank." (technically, this is true)

They turned to leave. As they did so, Stuffy #1 pulled some Purell out of her purse and frantically started scrubbing imaginary fish germs off her right hand.

Researchers at work

Now, I know bariatric surgery is somewhat controversial. Like all docs, I've seen my share of patients who didn't benefit from it, or had serious complications. But this post isn't a forum for that.

Let's look at this practically. If a person has bariatric surgery, they should be more likely to lose wieght, and have fewer long-term complications of obesity, then someone who doesn't have the surgery. Right?

Of course, somebody felt the need to study this. I assume this was done to be able to improve insurance coverage of the procedure.

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I'd like to thank my reader Jennifer for submitting this.