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 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


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


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...


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."


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


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


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


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


"This is the doctor who stitched me up."


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


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


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



Monday, January 7, 2013


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!"



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)
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