Sunday, February 24, 2013

Sunday reruns

This picture was featured in a mailing I received. It's for a CME program on Parkinson's disease. It is, I swear, a DVD of 4 neurologists arguing. Yeah, because I'm just dying to watch that.



The distinguished faculty in the picture are named as (left to right) Drs. Sethi, Obeso, Olanow, and Stern.

Believe it or not, this is about as exciting as a party of neurologists gets. They sit around and discuss Parkinson's disease and other invigorating topics. And people wonder why I'm in solo practice.

I'm not convinced that's water in their glasses, either. Vodka, maybe.

Obviously, the star of the picture is Dr. Olanow. He looks like he's one step away from wearing a lampshade on his head. I'd like to think he's talking about his windsurfing trip over the summer, and how he accidentally ended up starring in an Absolut vodka commercial with the Sports Illustrated swimsuit models. More likely, though, he really is talking about Parkinson's disease. Only a neurologist can look so happy while talking about something that would scare everyone else away.

Let's try to guess what they're thinking:

Dr. Sethi: "Wow. Olanow has had too many already. He always gets the spotlight, and the hot drug reps. And what the hell did he do with my tie? As soon as I walked in he asked to borrow my tie because he forgot his, and now he isn't even wearing it. I have to remember to get the phone number for that Absolut girl who keeps refilling our glasses. I hope she saw that I drive a Porsche."

Dr. Obeso: "I have noooooo idea what they put in the vodka. I've only had 2 so far. I'm not touching it again. Holy crap, I hope I don't puke at the table. Olanow would never let me live that down. He'd probably show slides of it at next year's academy meetings. How come I'm the only one here who's wearing a tie?"

Dr. Olanow: "Man! Thish party is great! I better hit up Stern for cab fair back to the hotel, because I spent the travel stipend on the keg party last night. I hope nobody notices the tie I took from Sethi is missing. I gave it to that hot drug rep after writing my hotel room on it with her lipstick."

Dr. Stern: "I have to pee, and Olanow won't STFU. Maybe if I cross my legs. I didn't even see a bathroom when we came in. Maybe there isn't one. What do I do then? What the hell is he even talking about, anyway? Why does he need to borrow $20? He still hasn't paid me back from the last meeting. At least I have a good chance of getting laid tonight, because that sizzling drug rep gave me a tie with a room number written on it in lipstick."

Friday, February 22, 2013

Family matters

Dr. Grumpy: "Did either of your parents have any major illnesses?"

Mrs. Clueless: "I don't know. They were both adopted."

Thursday, February 21, 2013

Duuuuuuuuuuuuuuuuuuude

Dr. Grumpy: "What can I do for you?"

Mr. THC: "Well, a friend and I were smoking marijuana a few weeks ago, and I mean a lot of it. At one point, I took my pulse, and it was up to, like, 20,000 beats per minute."

Dr. Grumpy: "Is this why you're seeing a neurologist?"

Mr. THC: "Yeah, my internist sent me to a cardiologist, who sent me to you."

Dr. Grumpy: "Okay... So, 20,000 beats per minute really isn't physiologically possible. Maybe it was the effects of the marijuana."

Mr. THC: "That's what they said! But I know they're wrong! I counted them myself!"

Dr. Grumpy: "20,000 is a pretty big number to count up to in 60 seconds."

Mr. THC: "I was able to do it because time had slowed down, and that helped."

Wednesday, February 20, 2013

Drug rep quote of the day

"Wirth-Liss pharmaceuticals has an outstanding legacy of unparalleled neurological achievement, and I want to personally partner with you to help meet the lifelong goals of your epilepsy patients."

Uh, I hope you mean the prescription...

I'd like to thank the local pharmacy that faxed this note to my office last night.



Tuesday, February 19, 2013

February 19, 1942

On this day in history, Nazi Germany launched it's only successful invasion of North America. Sort of...

Winnipeg, in the Canadian province of Manitoba, is 4,307 miles from Berlin, Germany. Much farther than Hitler's more immediate enemies in Britain and Russia. Away from the Atlantic seaboard, it seemed an unlikely place for him to invade North America.

Yet, in the early-morning darkness of February 19, 1942 the city's residents were woken by gunfire. They looked out their windows to see warplanes painted with swastikas buzzing overhead, driving off the few Canadian fighters that rose to intercept them. German troops marched through the outskirts of the city, backed up by tanks. Air-raid sirens sounded, and the city was put under blackout.

Canadian defenders (composed of the Royal Winnipeg Rifles, Winnipeg Grenadiers, Veterans Guard of Canada, and others) formed in the center of the city, and were directed by telephone and signal lights. Anti-aircraft batteries opened fire on enemy planes, without success. As artillery thundered and rifles cracked, German forces gradually pushed the defenders inward. Explosions were heard in the distance, as the Germans blew up bridges that might have brought reinforcements to town.

The Canadian forces fought valiantly, but were hopelessly outnumbered. By 9:30 a.m. they'd all surrendered.


Victorious German troops drive through Winnipeg


Unopposed, Hitler's troops spread through the city. City leaders were rounded up, arrested, and taken to detention areas. Col. Erich Von Neuremburg (the German commanding officer) issued the following decrees:
  1. This territory is now a part of the Greater Reich and under the jurisdiction of Col. Erich Von Neuremburg, Gauleiter of the Fuehrer.
  2. No civilians will be permitted on the streets between 9:30 pm and daybreak.
  3. All public places are out of bounds to civilians, and not more than 8 persons can gather at one time in any place.
  4. Every household must provide billeting for 5 soldiers.
  5. All organizations of a military, semi-military or fraternal nature are hereby disbanded and banned. Girl Guide, Boy Scout and similar youth organizations will remain in existence but under direction of the Gauleiter and Storm troops.
  6. All owners of motor cars, trucks and buses must register same at Occupation Headquarters where they will be taken over by the Army of Occupation.
  7. Each farmer must immediately report all stocks of grain and livestock and no farm produce may be sold except through the office of the Kommandant of supplies in Winnipeg. He may not keep any for his own consumption but must buy it back through the Central Authority in Winnipeg.
  8. All national emblems excluding the Swastika must be immediately destroyed.
  9. Each inhabitant will be furnished with a ration card, and food and clothing may only be purchased on presentation of this card.
  10. The following offences will result in death without trial
    1. Attempting to organize resistance against the Army of Occupation
    2. Entering or leaving the province without permission.
    3. Failure to report all goods possessed when ordered to do so.
    4. Possession of firearms.
No one will act, speak or think contrary to our decrees.

Churches were closed, and all services banned. The few clergy who dared object were arrested and taken to detention camps. City buses were stopped by armed soldiers, and their passengers were searched. The city flag was replaced by the swastika, and Winnipeg itself was renamed "Himmlerstadt." German soldiers pulled books off library shelves and burned them in the street.


German soldiers confiscating papers from a newsman.

Surrounding communities were also affected. Crowds confronted German soldiers in the streets of Neepawa. Virden was taken over and renamed Virdenberg. Brandon and Selkirk were bombed by Luftwaffe planes.

As troops fanned out through Winnipeg they attacked newspaper sellers and destroyed their papers. They took over radio stations, filling the airwaves with martial music and excerpts from Hitler's speeches. The now-puppet local CBC broadcast a program called "Swastika over Canada." The Winnipeg Tribune was forced to publish an edition with a front page written in German. Canadian dollars were banned, and banks were forced to issue freshly printed Reichsmarks.

The German troops went into workplaces and restaurants and took meals from citizens. They also raided stores and police stations for heavy coats, as it was a chilly 18°F (-8 C).

At one local school the principal was arrested and replaced with a German headmaster. He distributed lessons to the students about the "Nazi Truth," explaining why Hitler's leadership was in Canada's best interests.

German soldiers leading arrested officials out of city hall.


Of course, none of this quite really happened.

The entire occupation, called "If Day," was an elaborate, and remarkably successful, campaign to sell war bonds. The planes were Royal Canadian Air Force fighters painted with swastikas. The German troops were volunteers in rented costumes. The explosions were just show pyrotechnics. The gun, artillery, and anti-aircraft fire were all blanks. Even the books that were burned were old ones that, due to wear, had been marked for disposal. The "Reichsmarks" were counterfeit German money on one side- and an ad to buy war bonds on the other.




The Winnipeg Tribune afternoon edition was satirically renamed the Lügenblatt (German for "lies sheet"). It included an "official joke" (approved by the authorities) which ordered readers to laugh or be imprisoned.



The event was announced in advance, but many were still taken by surprise. 4 years earlier a radio broadcast of "War of the Worlds" had caused widespread panic through the eastern U.S, and the Canadians didn't want a repeat. The days leading up to the "invasion" were filled with newspaper and radio warnings that it would be a staged event. Even people in neighboring Minnesota, which received CBC radio, were told.

As the invasion continued, a large map of Manitoba was posted at the intersection of Portage & Main streets in the city center. When money came in to buy war bonds from different parts of the province, areas were marked as having been "recaptured" from the Germans when they met their fundraising goals.


The "war map"

The idea was the brainchild of John Draper Perrin. People in the central regions of the country were far removed from the war, and he felt that a good fundraiser would be one that made them realize what life was like for civilians in occupied countries.

All-in-all, it was a very successful event. The cost of the staged invasion was $3000, and $3.2 million in war bonds were sold during its 24 hours. The total collection for the month-long campaign was $60 million. Vancouver was so impressed that it staged a smaller invasion, with similar success, and several American cities looked into doing their own.

The invasion ended at 5:30 p.m. with a ceremonial release of prisoners, victory parade, and speeches. The only real casualties of the day were a Canadian soldier who sprained his ankle, and a housewife who cut her thumb while cooking during the early-morning blackout.

Monday, February 18, 2013

Today's pop quiz

You've won $75,000 in the state lottery! To celebrate, you:

A. Go out to dinner, then pay off some bills.

B. Go on a cruise (preferably one with working toilets).

C. Buy that Prius you've had your eye on for years.

D. Buy some meth, marijuana, and bongs, then blow up your house.

3 Act Drama

Act I: Tuesday, February 5th.

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

Ms. Frantic: "I need to get in right away! The toes on my left foot are numb, and I went to ER! They told me I should see a neurologist."

Mary: "Okay... We can see you on Thursday, the 7th, or..."

Ms. Frantic: "THIS IS URGENT! I COULD BE DYING OR SOMETHING! I NEED TO GET IN TODAY!!!"

Mary: "Thursday is our next opening, I'm sorry."

Ms. Frantic: "That's crazy! I need help! I'm going to call another doctor!"

Click



Act II: Tuesday, February 12th

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

Ms. Frantic: "I called a week ago, and couldn't get in, and my left toes are still numb, and I really need to see a doctor!"

Mary: "Okay... We can see you this Friday, the 15th, or..."

Ms. Frantic: "WHY CAN'T ANYONE HELP ME? I NEED TO GET IN TODAY!!!"

Mary: "When you called last week you said you were going to find another doctor."

Ms. Frantic: "They couldn't get me in before Friday, the 15th, either, and I want to be seen today!"

Mary: "Sorry, but we can't get you in before then, either."

Ms. Frantic: "Why doesn't anyone care anymore?"

Click



Act III:  Morning, Friday, February 15th.

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

Ms. Frantic: "I changed my mind! I want that appointment you have for today!"

Mary: "I'm sorry, it's been filled. We can see you next Wednesday, the 20th."

Ms. Frantic: "How could you do this to me? You should have held that spot in case I called back! You know I need to see a doctor!"

Mary: "I thought you said you had an appointment with another neurologist for today?"

Ms. Frantic: "I do! At 2:30!"

Mary: "So why are you calling us?"

Ms. Frantic: "I didn't like the way his receptionist treated me when I called to confirm the appointment this morning."

Mary: "Okay, that's your business, but we can't see you before next Wednesday."

Long pause

Ms. Frantic: "Never mind. I think I'll just cancel the appointment. My foot got better, anyway."

Click


Sunday, February 17, 2013

Sunday reruns

At the hospital last week I saw a 20-something guy for a head injury.

He had a fight with his girlfriend outside a restaurant and said he was going to teach her a lesson.

So he began repeatedly banging HIS head against the concrete sidewalk until he was covered with blood. At some point police and paramedics pulled up, and to continue proving his point, he began banging his head repeatedly on the police car's windshield until it shattered.

He then went back to smashing his head on the sidewalk, which continued until he got tasered, and then needed Valium.

The admitting diagnosis was "Self assault"

Exactly what lesson his girlfriend learned from this is unclear, but I suspect it had something to do with getting another boyfriend.

Friday, February 15, 2013

Book 'em, Danno!

Wednesday night I was doing a survey about drug reps, and one of the questions asked where I encounter them:


I must say, I LOVE the correctional facility option. In my younger days I did see patients at a prison clinic, but don't remember a drug rep ever calling there. Yesterday I asked several reps, and none of them had ever heard of it, either.

Since I'm able to fill out this survey, I have to assume they don't think I'm the one in jail. Which leaves just one option. And I'm not driving down to the hoosegow to visit a rep.*

*The odds of a rep being incarcerated depends on the pharmaceutical company they work for.

Thursday, February 14, 2013

Mary's desk, Wednesday afternoon

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

Mr. Whirlaway: "Hi, does Dr. Grumpy treat seizures?"

Mary: "Yes, sir."

Mr. Whirlaway: "Does he make house calls?"

Mary: "Not routinely... What are the circumstances?"

Mr. Whirlaway: "Well, a friend told me Dr. Grumpy had helped his kid's epilepsy. I have a horse with seizures, and I don't like our current vet."

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.

Wednesday, January 30, 2013

Care

Dr. Hospital: "Hello?"

Dr. Grumpy: "Hi, this is Ibee Grumpy."

Dr. Hospital: "Uh, okay. Why are you calling me?"

Dr. Grumpy: "Well, you wrote a note in Mrs. Seizure's chart this morning, saying you wanted to discuss her case with me before sending her home."

Dr. Hospital: "Oh, I didn't really mean for you to call me. I just wrote that to cover my ass."

Tuesday, January 29, 2013

Done too soon

A lot of press has recently been given to the untimely death of Aaron Swartz. Regardless of his legal issues (and I'm not getting into them) he was obviously a brilliant mind, gone too soon.

But I want to tell you about one you may have never heard of.



John Kennedy Toole (born 1937), from an early age, was an unquestionably brilliant individual. He received excellent marks in high school, graduated with honors from Tulane university (to which he'd received a full scholarship at age 17) and got a masters degree from Columbia. He went on to become a professor at Hunter College in New York, becoming (at age 22) the youngest professor in the institution's history.

In 1961 he was drafted into the U.S. Army and stationed in Puerto Rico, teaching English to local recruits. There he began writing a remarkable novel. He left the military in 1963, and completed the book in 1964.

Over the next several years he submitted it to 3 publishers, all of whom rejected it. The disappointments led to him becoming despondent, than an alcoholic, and then paranoid. He was convinced he was being followed and frequently searched his home for electronic mind-reading devices. At one point he began having severe headaches, but refused to see a neurologist (speaking as a neurologist, the personality changes and headaches raise a number of diagnostic possibilities, but I'm not going to address that further).

In 1969 he went on a long drive across the country, finally ending in Biloxi, Mississippi. There, in March, he committed suicide by running a garden hose from his car's exhaust through the window. He left a suicide note which his mother read, then destroyed. He was 31 years old.

His rejected manuscript sat, untouched, on an armoire in his old room at his parent's house. In 1971 his mother tried again to have it published - only to collect 7 more rejections over the next 5 years (modern readers may remember that 2 major studios - United Artists and Universal - both rejected the script for Star Wars during this same time frame as having no potential for success).

In 1976 author Walker Percy was teaching at Loyola University New Orleans. Toole's mother wrote and called him, to the extent that he complained to his wife about her. He tried to dodge her, but at one point she actually pushed her way into his office with the single precious copy of the manuscript. He finally agreed to look at it, figuring it would be so awful that after a few pages he'd be done with it.

He was wrong.

As he wrote later, "I read on. And on. First with the sinking feeling that it was not bad enough to quit, then with a prickle of interest, then a growing excitement, and finally an incredulity; surely it was not possible that it was so good."

Walker Percy was, in the end, stunned by the book, and put his own efforts into getting it published. It finally went to press in 1980. In 1981 it won a Pulitzer Prize, 12 years after John Toole had taken his own life

The book is "A Confederacy of Dunces" and is, in my experience, a love-it-or-hate-it-work. I personally love it. It's the story of one of the most despicable protagonists in English literature trying to find a way to earn money in the early 1960's. It switches randomly between a number of wildly different threads, giving no real clue why. As the story progresses they become gradually tied together, finally ending in one hysterical scene which predated similar endings in Seinfeld by almost 30 years.

Some of you won't like the book. It's not for everyone. But for those who enjoy it, it's a masterpiece.

John Toole only had one other book published (after the success of Confederacy of Dunces) called The Neon Bible. It was written when he was a teenager, and is the only other work we have from this brilliant, but obviously sadly sick, individual. And we will never know what else he might have written if his life hadn't ended so early.


Monday, January 28, 2013

Friday afternoon

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

Mrs. Myelin: "This is Sarah Myelin! My MS made my left arm go numb yesterday! I need to see Dr. Grumpy, and get an MRI done, today!"

Mary: "Well, it's Friday afternoon, and we don't have anything till next week, let me... Wait, you sent us a letter last month saying you were transferring care to Dr. Oligodendro down at Humungous Neurology, Inc."

Mrs. Myelin: "Yes, he's my neurologist now. I saw him yesterday for this."

Mary: "Okay, so why are you calling us?"

Mrs. Myelin: "Because Dr. Oligodendro's staff couldn't get an MRI scheduled on me until tomorrow, and I want it today!"

Mary: "But if he's your neurologist now, you'll have to work with his office, not ours, for this."

Mrs. Myelin: "Look! I'm willing to go to ANY doctor who can get me an MRI today! If you can get me in today, and get an MRI today, then I'll come back to you!"

Mary: "Ma'am, this isn't a contest."

Mrs. Myelin: "Nobody cares about patients anymore. I'll just go to ER and get them to do it."

Sunday, January 27, 2013

Weekend reruns

This past weekend, for those of you who were fortunate enough to miss it, was (at least in my area) the Cub Scouts Pinewood Derby.

This annual event was actually once rated as one of the 100 greatest things about America (Reader's Digest magazine, 2006). I can only assume that the author had never been involved in one, or that in 2006 the country had absolutely gone to hell.

The point of this "friendly competition" is to build little cars and race them down a slanted track. Each 8-11 year old is given a standardized block of wood and 4 wheels, and can do what they want with them. Since the stakes are so high (winner gets a plastic trophy from Big Lots), the cars are carefully examined, weighed, and locked away 3 days before the race. This is to make sure that illegal modifications, like adding a jet engine, aren't carried out.

The whole part about this being a competition among the boys is absolute BS. It's between their testosterone charged fathers, living vicariously through the kids. Dads build the cars, and (occasionally) let junior make a few finishing touches (like putting a Pokemon decal on).

Of course, no one actually admits to this. So at each derby one of the finest moments is when the person in charge brings in the cars from the nuclear-bomb proof hiding location, and boys go ask dad which car is theirs. "Oh! That's mine? Cool job, Dad!"

(In our family, it's actually Mrs. Grumpy who does all this. I'm just a shill).

You can always tell the ones that the boys actually made themselves because they have uneven paint jobs, strange angles, and an odd number of wheels. Of course, they never win a race, because they're no match for the ones that some dad, who by day designs jet fighters for Lockheed, built (and claimed his kid did, using a wind tunnel testing facility that's coincidentally in the basement).

They ask you to arrive at 6:00 p.m. SHARP, which is a joke. The races never start on time.

So we arrived at the Wingnut Elementary School cafeteria at exactly 6:00, to find they'd just started setting up. To lend atmosphere (and help us forget that we were in a school cafeteria) some guys were hanging racing posters and pennants everywhere. A bunch of moms were off in one corner setting up a bake sale. And, most importantly, several dads were putting up the racing track, grading it with a computerized angle & level measuring device, as if it were made of gold.

While this is going on, to get you in a cheerful mood, they show fun racing moments on a large screen: cars and drivers in gory high-speed wrecks, flaming rocket boats hurtling out-of-control into screaming crowds, Indy cars exploding as they fuel up, and other humorous stuff.

Finally the races begin. This is kicked off by them blasting early 90's dance music. So if you've had a burning desire to hear C & C Music Factory, M.C. Hammer, and (not early 90's) ENDLESS replays of "The History of Rock & Roll, part 2"*, this is the place to be.

Each race features 4 cars, and they run them 3-4 times each, changing lanes each time. The race itself takes 5-10 seconds. Then they hand-carry the cars back to the starting point. Each is then reinspected (to make sure their owner didn't, say, use a blowgun to secretly attach a V8 engine while they were going down the track), carefully returned to the starting gate, and we begin again. And in the background 2 guys are still busy putting up racing poster decorations.

The race results are presented on a constantly-changing computerized time sheet, projected on the wall. This, I swear, measures finishing times TO SIX DECIMAL PLACES (i.e. 5.756381 seconds). Because, you know, that kind of space-travel level of precision is absolutely necessary when small wooden blocks are rolling down a track. And the dads obsessively stare at this like it's a topless dancer, while the kids play their Nintendo DS.

At some point your kids come to you asking for money. Why? Because they're selling pizza and various other junk food. They even asked you to bring something, because it's "for a good cause" (they never tell you what the good cause is. For all I know it's Botox for the counter lady). So you stop at Costco, pick up a HUGE box of Oreos, and give them to her. The Oreos are then marked up to 50 cents each, and the box is now worth more than an equivalent amount of plutonium. We discovered it was best to feed the kids before leaving our house, and making sure we have nothing but credit cards when we get there. "They only take cash? Sorry, kids."

This insanity goes on for 3-4 freakin' hours. Most people start to leave as soon as their kid is disqualified from the finals, but some parents (due to, say, their wives secretly signing them up to be involved in taking apart the damn track and not telling you about it until you ask if you can leave yet, for example) are stuck there until the bitter end. So you tap your feet and watch 2 guys continue to heroically put up racing posters.

Toward the end you start looking for something to do. Like helping the school janitor put away the folding chairs (he wants to go home, too). So if anyone stands up, you grab their chair and toss it in the closet, hoping they weren't planning on sitting down again. I figured if anyone fell and hurt themselves, I could hand out business cards.

Finally, it's over. If your kid didn't win, you don't care who did. As you're leaving, you notice the 2 guys are finally finishing putting up the last racing poster.


*Kind of ironic considering how Gary Glitter ended up, eh?

Friday, January 25, 2013

Great survey moments


I really wish there was a box where I could type "I don't remember."


Thursday, January 24, 2013

Beware of Annie

Dr. Grumpy: "Did the physical therapy help?"

Mr. Tweedy: "Actually, I never went... I just didn't have the time."

Dr. Grumpy: "I understand. So how are..."

Mr. Tweedy: "You're not going to tell Annie that I didn't go, are you?"

Dr. Grumpy: "Uh, well..."

Mr. Tweedy: "I don't want to make her mad."

Dr. Grumpy: "Okay, I won't."

Mr. Tweedy: "Promise? I'm scared of her."

Dr. Grumpy: "Are we talking about the same Annie? My assistant for 14 years, the one with 2 grandkids?"

Mr. Tweedy: "Yes, please don't tell her."


Wednesday, January 23, 2013

More great journals

My reader Alysia was so profoundly moved by the post on the Pharmaceutical and Medical Packaging News that she sent me a journal that comes to her office:

Hey! Is "commercialization" really a word? And does
the illustration have boobs?

I was so struck by a magazine titled simply "BONEZONE" that I asked some friends what the word made them think of. To no one's surprise, a medical journal wasn't one of them. But I did get some good answers, including:

"A hook-up bar."

"Dr. Grumpy's college bachelor pad."

"The new programming package on ESPN3, offering round-the-clock live coverage of professional athletes' orthopedic surgeries."

"The drug company lab where they tested Viagra."

"An ultra-cool artisanal arthroscopy suite."


Feel free to throw out your own ideas, and keep the ball rolling.

Thank you, Alysia!

Tuesday, January 22, 2013

Overheard in ER

Mr. Narc: "I need a refill on my Percocet."

Dr. ERP: "Sir, we've discussed this before. I'm not refilling your Percocet."

Mr. Narc: "DAMNIT! I am a close personal friend of Senator Daniel Webster! And I demand you give me more Percocet NOW! Or he will hear about this!"

Dr. ERP: "Okay, tell you what. You get Senator Webster on the phone, and I'll give you some Percocet. I voted for him, and have heard him speak many times, so I know his voice."

Long pause

Mr. Narc: "I'm leaving this dump."


Monday, January 21, 2013

Great Medical Journals

Dear Mr. Contaoi,

Thank you for offering me a free subscription to the prestigious "Pharmaceutical and Medical Packaging News."



Really. I am not making this up.

You have no idea how excited I am to get a complimentary year of your journal. Breaking news on drug packaging trends is crucial to a modern physician. I often lie in bed thinking about topics such as "Paper or Plastic: The Future of Drugstore Bagging" or "Which Side are You On? Bubble Wrap vs. Peanuts." Regrettably, I've always been deeply unfulfilled by the lack of such coverage in run-of-the-mill neurology publications.

Your kind offer is especially timely, as my subscriptions to "American Lunch Trays" and the Pulitzer Prize winning "Condom Wrappers Quarterly" have recently run out.

You'll be hearing from me soon, and I can't wait for my first issue.

Yours truly,

Ibee Grumpy, M.D.

p.s. You misspelled "development."

Friday, January 18, 2013

BREAKING MEDICAL NEWS!!!!!!!!!!!!



Patient quote of the day

"I've now moved here permanently. Until March. Then I'm moving back home."

Thursday, January 17, 2013

It's just a jump to the left

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

Mr. Gregorian: "Yeah, did I have an appointment with the doctor on November 17, 2010?"

Mary: "Let me check... Yes, you did. At 2:30."

Mr. Gregorian: "Was I there?"

Mary: "No, it says you no-showed."

Mr. Gregorian: "Okay, I want to cancel that appointment."

Mary: "Excuse me?"

Mr. Gregorian: "I need to cancel the November 17, 2010 visit. I won't be able to make it."

Mary: "But..."

Mr. Gregorian: "I'll call you back if I need to be seen again."

Wednesday, January 16, 2013

Helpful children

Every afternoon, about 5 minutes before I get to their school, I send a group text to all 3 kids saying "come outside" to let them know I'm almost there. It goes to all 3, because on any given day I have no idea whose phone is dead/turned off/left at home.

So I got there yesterday. Frank and Marie are standing outside. Marie says "Craig is inside" and they start loading their backpacks into the trunk. Frank and Marie get in the car, and we sit there in the blowing snow, waiting for Craig.

After a few minutes of waiting Marie says "Dad, do you want me to go tell Craig that you're here?"

Tuesday, January 15, 2013

Mary, bring me another drink.

Dr. Heller: "This is Dr. Heller, with Major Illness Insurance."

Dr. Grumpy: "Hi, I'm trying to get a neck MRI authorized on a lady with a Horner's Syndrome."

Dr. Heller: "Why do you need a neck MRI?"

Dr. Grumpy: "Because the nerves in question go from the brain down the spinal cord, then into the top of the chest, then back up through the neck to the eye. So they can be damaged by problems in the neck, and I need to get a look at the area."

Dr. Heller: "It's ridiculous that the nerve travels so far. It seems unnecessarily complex."

Dr. Grumpy: "Look, I didn't design the system."


Saturday, January 12, 2013

The Bionic...

"Steve Austin. Astronaut. A man barely alive. We can rebuild him. We can make him bigger, stronger, poopier, than he was."


Thank you, SMOD!

Friday, January 11, 2013

I'll make a note of it

Dr. Grumpy: "Any major illnesses in your family?"

Mr. Clear: "My mom had one of those things you die from."

Thursday, January 10, 2013

And now...

IT WAS A REALLY BAD DAY, OKAY?!!!



No, folks, I don't really feel that way. But after an insane morning I needed to vent to someone, and Siri was the nearest listener.

Wednesday, January 9, 2013

Mary's desk

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

Mrs. Etoh: "Yeah, I need to see Dr. Grumpy about my migraines, and a car accident."

Mary: "Okay... Generally he doesn't see legal cases. Are the 2 related?"

Mrs. Etoh: "Yeah, a migraine caused me to have a car accident, and I need someone willing to testify to that in court."

Mary: "I'm sorry, that isn't the sort of thing Dr. Grumpy does."

Mrs. Etoh: "Well, the police claim it was because my blood alcohol was 5 times the legal limit, so I need to find a neurologist to say it was falsely that high because of a migraine, and that I hadn't been drinking at all. Will he do that?"

Mary: "No. Have a nice day."

Tuesday, January 8, 2013

Modern theater

Dr. Grumpy: "How did you get injured?"

Mr. Powerpoint: "I was hiking in Costa Rica, when I fell, and severely lacerated my left arm."

(whips out iPhone)

"This is the mountain I was hiking on."

SWIPE

"Here's the rock I tripped over. That's my blood on it."

SWIPE

"Here's a shot of my arm. You can see the muscles hanging out and everything."

SWIPE

"This is the car my buddy took me in to get help. I made a mess. Greg didn't get his deposit back."

SWIPE

"This is the clinic we found in the nearest town."

SWIPE

"This is the doctor who stitched me up."

SWIPE

"Here's his assistant, when she had her mask off."

SWIPE

"Here's me and Greg going out for beer and shrimp afterwards."

SWIPE

"Here's Greg trying to change my gauze wrap after getting wasted."

SWIPE

"Here's..."

Monday, January 7, 2013

Seriously?

I fully support the NFL's new program "Fuel Up To Play!" with its goal of getting kids to focus more on exercise and healthy eating.

That said, they really could have come up with a better name.

Because my kids came home today with lunchbox stickers for the program that say "FUTP!"

And...

NFW

Lady with fidgety toddler: "I've been doing better on the new medication... Hey, can I borrow your iPhone?"

Dr. Grumpy: "Um, why? Do you need to make a call?"

Lady with fidgity toddler: "No, but Jessica broke mine yesterday, so I need to give her something to play with."

Friday, January 4, 2013

Whatever makes you happy

Dr. Grumpy: "How do you spell your first name?"

Mr. Caiman: "It's Albert, but I prefer to be called by my nickname."

Dr. Grumpy: "What's that?"

Mr. Caiman: "The Grey-Eyed Gator."

Thursday, January 3, 2013

Mary's desk, January 2, 2013

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

Mr. Valet: "Yeah, I have an appointment with Dr. Grumpy now, and I can't find a parking space."

Mary: "Okay... I'm looking out over the parking lot on the north side of the building, and there's quite a few open spots there. Try that side."

Mr. Valet: "I don't have time for that. I'm down by the east exit. Can you just come down and park it for me, while I see the doctor? Do you know how to drive a stick?"

Mary: "No, and that's not something I..."

Mr. Valet: "Then how about if you sit in it during my appointment, so it doesn't get towed?"

Wednesday, January 2, 2013

Nothing changes on New Year's Day

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

Mr. Call: "Yeah, I was in ER this morning, and they told me I should call your office for an urgent appointment."

Dr. Grumpy: "Okay, we're closed today for the holiday. If you call back tomorrow you'll be able to talk to Mary, my secretary, and she'll get you in."

Mr. Call: "But they said it's urgent. Can I come in today?"

Dr. Grumpy: "We're closed."

Mr. Call: "So? Can't you meet me at your office? Or a Starbucks or something?"

Dr. Grumpy: "No. If you have a serious emergency, you'll have to go back to ER."

Mr. Call: "It's not a serious emergency. I just want to be seen today."

Dr. Grumpy: "Sir..."

Mr. Call: "I'm reporting you to the state board!" (hangs up)
 
Locations of visitors to this page