Monday, October 1, 2018

Formicidae

Frank is a college freshman this year, living in a dorm. Yes, you read that correctly.

So last Thursday I'm having a typically busy day of seeing patients when a text from him crosses the top of my screen.


Frank: Dad, I need to talk to you right now. There's a big problem here.

Dr. Grumpy: I'm with a patient right now. Can it wait 15 minutes?

Frank: Yes, but hurry.

After I finished my appointment with Mrs. Freenbeen, I called Frank.

Frank: "Um, hello? Who is this?"

Dr. Grumpy: "It's Dad. You told me to call you."

Frank: "Oh, that's weird. My phone said it was a call from a doctor's office. Are you sick?"

Dr. Grumpy: "No, I'm a doctor. I work here. What's up?"

Frank: "Oh, yeah. We have an emergency. Can you, like, go to the store after work and buy, like A LOT of ant bait traps and ship them to me overnight?"

Dr. Grumpy: "What's going on?"

Frank: "Me and Mike's dorm room is, like, FULL of ants. They're everywhere."

Dr. Grumpy: "I'm pretty sure you can buy bug poison at the Target across the street from you."

Frank: "Yeah, but then I'd have to pay for it."

Sigh.

Dr. Grumpy: "Why don't you let the building people know about this? They can have your room sprayed."

Frank: "Mike said he'd do that... Hey, Mike, did you talk to the RA about the ants?"

(mumbling in background)

Frank: "Never mind, Dad. Mike says the RA told him they'd have it sprayed later today. Hey, why do you think we have all these ants?"

Dr. Grumpy: "When was the last time you guys took out the garbage?"

Frank: "Um... I don't think we have. But, like, we only moved in on what, August 27th? How often should we be taking it out?"

That was a month ago. WTF.

Dr. Grumpy: "I'd say at least every week, if not more."

Frank: "That's stupid. There's still plenty of room under our beds for stuff. We moved the empty fast food and pizza boxes all under Mike's bed last week, after we put the dirty cafeteria dishes and forks in the bathroom sink."

Urp.

Dr. Grumpy: "Those things are what are attracting the ants!"

Frank: "Really? Why would they want that stuff?"

Thursday, September 27, 2018

History reruns - September 27, 1854





After the war of 1812 , the United States and Great Britain resumed commercial trade.

On both sides of the Atlantic, businessmen competed for their share of this increasingly lucrative business. Faster ships made more money, even if it meant going full speed into bad weather and poor visibility. Many ships vanished, forever listed as overdue, and presumed lost to bad weather and icebergs.

On the Eastern side, the driving force was Samuel Cunard. In the 1840's he came to dominate the Atlantic market, with the line that to this day bears his name. The British government backed him financially, so the ships could, in the event of conflict, be requisitioned by the navy (which they often were).

On the Western side, a number of American lines tried, with varying degrees of success. The U.S. government was less inclined to become involved in these matters, and so capital was harder to raise for building ships.

As sail gave way to steam, this changed. The Americans were concerned that Cunard's steamers could be converted to warships. Faced with both real economic and feared military competition, the government began backing various companies to try and win trade back from Cunard.

The man to lead this was Edward Collins. With government subsidies he built 4 large steamships (Arctic, Pacific, Baltic, and Atlantic), bigger, faster, and more luxurious than Cunard's ships, to challenge his rival. The plan was to run a tight schedule across the Atlantic.

The Collins Line ships, with their combination of sails and paddle wheels, were some of the fastest in the world at the time. They showed the Atlantic could be crossed in the remarkable time of 10 days, and in a few cases, 9.

Backed by their respective governments, Collins' and Cunard's lines competed intensely to dominate the 3000 miles of north Atlantic. Until 12:15 p.m. on this day.

As the Arctic steamed west, through a heavy Newfoundland fog, she collided with a small French ship, the S.S. Vesta. The Vesta, although much smaller, had a hull reinforced with iron.

In the first few minutes after the collision, many of the Vesta's crew assumed their damage was fatal, and abandoned ship (against orders) to try and reach the larger Arctic. They were wrong. The crew of the Vesta worked miracles and overcame the damage.

Captain James Luce of the Arctic was a veteran of the sea. Believing his own damage to be minimal, he turned the Arctic around to aid the Vesta, and launched 2 lifeboats to help evacuate it's passengers to the Arctic.

These orders were quickly canceled when one of the lifeboats reported the severity of the damage to him. The ship was badly damaged. Like the Titanic 58 years later, he had the legally required number of lifeboats. And they weren't nearly enough to hold everyone on board.

Cape Race was 4 hours away. With his duty to his own ship clear, Luce abandoned the Vesta, heading for land. His hope was to beach the ship before she could sink.

The wreck of the Arctic over the next few hours quickly turned into a nightmarish struggle for survival, very different from the civility seen in the Titanic. Captain Luce accepted that he and his 11 year old son (who was traveling with him) were going to die, and did his best to save passengers. He was betrayed by his crew and most of his officers.

His crew disobeyed orders, commandeered the lifeboats, and fled. A trusted officer and handpicked team of seamen were placed in a lifeboat so that passengers could be lowered down to them. As soon as they reached the water they rowed away, with plenty of space in their boat.

Without lifeboats, Luce and his few remaining crew did their best. They tore the wooden deck to pieces, frantically trying to build rafts. Doors were torn from hinges to be used for flotation. All furniture made of wood was assembled on deck in hopes of saving more lives.

Of 408 who sailed, there were 86 survivors (64 crew, and 22 passengers). Not a single woman or child lived. They're remembered by a monument in Brooklyn's Green-Wood Cemetery.

Captain Luce, surprisingly, survived. He and his son went down with the ship, but were ejected from the vortex as it sank. As they swam away, a large wooden paddle wheel cover broke loose from below the sea. It launched into the air like a rocket, then came down, killing his son. And yet, at the same time, it became a makeshift lifeboat for Luce and a handful of swimmers. They were picked up after a few days by a passing ship.

The loss was a disaster, both personally and financially, for the Collins Line. Besides Luce's son, the deaths included Collins' wife and 2 of their children.

Although mostly forgotten today, the disaster dominated headlines on both sides of the Atlantic for a month, until replaced by the Crimean War. It had the same effect then as the Titanic would in 1912. Safety specialists recommended specific East-West shipping lanes. Slower speeds and loud whistles in fog. Lifeboats for everyone. The majority of the recommendations were ignored until the aftermath of the Titanic.

2 years later, in 1856, the Arctic's sister, the S.S. Pacific, vanished en route from Liverpool to New York.

It was another blow for the Collins line. There was an economic recession, and the U.S. government was now willing to let Cunard have the Atlantic. Collins' subsidies were cut, and in 1858 his line folded. The surviving ships were auctioned off.

The wreck of the Arctic hasn't been found (to my knowledge no one has looked).

The Pacific was thought to have been lost to storms or icebergs in the north Atlantic. To the surprise of everyone, she was accidentally found in 1991 in the Irish Sea, only 60 miles from where she left Liverpool. Why she sank remains a mystery.

Cunard survives to this day, though is now owned by Carnival Lines.

Government subsidies for shipping, with the ships to be used in time of war, continued into this century in all the major powers.

The last American attempt to share the Atlantic trade lies, mostly forgotten, in Philadelphia. She is the liner S.S. United States, built with subsidies after World War II. The government paid for her huge size and (even to this day) remarkable speed, with the plan of using her as a fast troop transport in future conflicts. Her commercial career, like all liners, was doomed by the passenger jet. Multiple attempts continue to be made today to save her from the scrapyard.

Tuesday, September 25, 2018

Annie's desk

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

Mrs. Haddock: "Hi, I need a refill on my medication. It also has to be authorized through my insurance, because the last auth has expired."

Annie: "Okay, I can get started on that... you know, it looks like we haven't seen you since 2010."

Mrs. Haddock: "Wow. Time flies. Anyway, I'm going on vacation tomorrow, so can you please get this taken care of?"

Annie: "We can't refill meds on someone we haven't seen in 7 years, let alone get an insurance authorization. Who's been filling it?"

Mrs. Haddock: "My internist."

Annie: "Then you'll have to call him to get this refill, and make an appointment to re-establish with Dr. Grumpy if you want us to prescribe it."

Mrs. Haddock: "I haven't seen him in 6 months. He doesn't take my insurance anymore. It's National Illness, Inc."

Annie: "We don't take that, either, so we can't get an authorization for you."

Mrs. Haddock: "But I'm leaving TOMORROW! You need to call this in and get it authorized RIGHT NOW!"

Annie: "We can't do that, like I said, we haven't seen you in 7 years, and we're not contracted with your insurance."

Mrs. Haddock: "YOU'RE RUINING MY VACATION!"

click

Friday, September 21, 2018

The teenage mind

I'm sitting at my desk, about an hour before my first victim patient. My wife is at a meeting out of town, but fortunately the kids are old enough to drive themselves to school.

Then the text came in.

Craig: Dad. I'm locked out of the car. I need help.


What the hell? School started 20 minutes ago!


Dr. Grumpy: Ask Marie for her keys.

Craig: I can't. She's at school.


WHAT?!!! Okay, this isn't making sense.


Dr. Grumpy: Then where are you?

Craig: I'm at 7-Eleven.

Dr. Grumpy: Why are you at 7-Eleven twenty minutes after school started?

 Craig: It was an emergency! I had to get something for class! Do you have keys to the 4Runner?


Sigh.


Dr. Grumpy: Yes. Which 7-Eleven are you at?

Craig: The one at South Street and Central.


So I tell Mary I'm going to rescue Craig and will be back in a few. Fortunately, South & Central isn't too far from my office.

I get to South & Central, and Craig is nowhere to be seen.


Dr. Grumpy: Craig, I'm at the 7-Eleven at South & Central, and you're not here.

Craig: Well, I'm at a 7-Eleven. Maybe it's not that one.


I roll my eyes, take out my iPhone, and look up his location.


Dr. Grumpy: Craig, you're almost 3 miles away, at the 7-Eleven at 12th St. and Elm.

Craig: How was I supposed to know that? Please hurry, I'm going to get in trouble at school!


So I head over and find him there, standing outside the car. As I unlocked it he picked up two Slurpee's in a cardboard carrier and set them on the floor.


Craig: "Thanks, Dad. I'm sorry."

Dr. Grumpy: "It happens. What did you need for school, anyway?"

Craig: "The Slurpees."

Dr. Grumpy: "You left school to get 2 Slurpees? This whole thing was over a Slurpee?"

Craig: "Slurpees. I mean, yeah, Marie wanted one, too."

Dr. Grumpy: "Why didn't you get them at the 7-11 by the school?"

Craig: "I went there first, but they don't start making them until 10:00. But I remembered there was another 7-11 down here."

And he drove off.

Monday, September 17, 2018

Random pictures

Okay, time to hit the mailbag for stuff you guys have sent in:


First we have this picture, taken at an airport, where bicycles using the bathroom is, apparently, an issue:





Then there's this place's answer to "what should we get grandma for Christmas?"

"Wow! Verapamil, metformin, morphine... this place has the best gifts!"




While we're on the subject of places to get gifts, who can forget...






Then there's this product so you can "keep balling all night."






And, finally, there's this happy-go-lucky coloring book about everyone's favorite viral-disease-of-cheerfulness, RABIES.




Sunday, September 16, 2018

Holidays are coming!

So if you'd like to send in a horrifically tasteless submission for this year's Dr. Grumpy gift guide, please do so! My email is in the right sidebar.

Thank you!

IG

Thursday, September 13, 2018

Frail

Like most neurologists, I do EMG/NCV's. This is a test that involves needles and electrical shocks.

It's nobody's idea of a fun test, but we do get a lot of information from it, and for many disorders it's the best test there is for sorting things out.

As a result, it's not uncommon for me to get a fax from another physician's office asking me to do one on a patient. They send over the insurance info and all, and Mary calls the patient to schedule it.

About a week ago I received a fax from Dr. Livingston. It was an order sheet that said "Please do EMG/NCV on Mrs. Geri, possible hand pain." Mary called her number, reached her daughter, and set up the appointment.

Mrs. Geri came in a few days later. She was in a wheelchair, pushed by her daughter. Advanced Alzheimer's disease and incapable of doing anything other than mumbling gibberish. Frail, maybe 90 pounds. Occasionally she'd randomly wave one or the other hand back and forth.

I asked her daughter why Dr. Livingston wanted the test, and her daughter told me it was because of the intermittent hand waving. She hadn't complained of pain (or pretty much anything else).

And... I couldn't do it.

Sorry, Dr. Livingston. The $250 I'd get for putting this poor old lady through an unpleasant test that she couldn't understand seemed more like an exercise in greed and torture than a diagnostic medical procedure.

Not that I really blame Dr. Livingston. I'm sure he was just trying to find out why she'd occasionally wave her hands, but to me it was immaterial. Even if I found something, after putting this sad lady through unneeded discomfort, what would really be done with that knowledge?

I explained this to the daughter and sent them on their way. The billing sheet and her insurance info went into the shredder. I took a loss on the hour and sent Dr. Livingston a polite letter explaining why I hadn't done the test.

I'm sure he can find another doctor to do it. Maybe someone hungrier than I, or less willing to ask questions.

But I just couldn't do it.

Monday, September 10, 2018

Mary's desk

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

Ms. Caller: "Hi, I'd like to make an appointment with Dr. Grumpy."

Mary: "Okay, and what will you be coming in for?"

Ms. Caller: "I have Spritzgong-Fleagle Syndrome, and need to have an MRI done annually to check for new damage."

Mary: "Okay, let's see... This week is pretty busy, but I can get you in next Thursday, at 10:15."

Ms. Caller: "That won't work. I was hoping to get in this week so I can get the MRI done soon."

Mary: "Are you having new problems?"

Ms. Caller: "No, my regular neurologist will be back from vacation next week, anyway."

Mary: "Wait... you already have a neurologist?"

Ms. Caller: "Yes, I see Dr. Stevens, at Huge University Hospital. She specializes in Spritzgong-Fleagle Syndrome, but she's on vacation until next week."

Mary: "Then... why are you calling to see Dr. Grumpy?"

Ms. Caller: "I thought he could order an MRI, then I'd have it when I see Dr. Stevens next week."

Mary: "I'm sorry, but he doesn't cover for Dr. Stevens. You'd have to call her office to get the test done, or wait until she comes back."

Ms. Caller: "Thanks for wasting my time."

Click.

Thursday, September 6, 2018

Parenthood

Dr. Grumpy: "How's she doing with the new medication?"

Mrs. Daughter: "Calmer, but she still treats me like a child."

Mrs. Dementia: "Are we at the doctor's yet?"

Mrs. Daughter: "Mom, this is the doctor."

Mrs. Dementia: "How do you do? This is my daughter."

Mrs. Daughter: "He's met us before, mom."

Dr. Grumpy: "How are you feeling, Barbara?"

Mrs. Dementia: "Don't talk back to me, young man!"

Mrs. Daughter: "Mom, he's the..."

Mrs. Dementia: "You don't talk back to me, either! Go to your room, right now!"

Dr. Grumpy: "Barbara, it's okay."

Mrs. Dementia: "And you're grounded, young man!"

Monday, September 3, 2018

September

Reminding all the guys out there that it's Prostate Cancer Awareness month. So be sure to get checked. And here's some special guests to say more.


Thursday, August 30, 2018

Wednesday afternoon

I'm in line at the bank, and hear this conversation in front of me:



Teller: "Ma'am, I'm sorry, but we can't give you a cash withdrawal without any identification."

Ms. Deceit: "How about I just get the money today? I can come back tomorrow with ID."

Teller: "No, we need a form of identification before giving you the money."

Ms. Deceit: "Like I said, I left my purse at work, or I wouldn't be here in the first place."

Teller: "Well, you can certainly get it and return later."

Ms. Deceit: "Don't be silly. For that kind of trouble I might as well go to different bank. How about if I give you my cell phone number? You can call it right now, and I'll put my phone on the counter. When it rings that will prove it's me."

Teller: "We can't accept that. What we need is a photo ID and..."

Ms. Deceit: "A photo ID is easy. Don't you have a computer back there? I'll show you my Facebook page, so then you can see my picture and know I'm telling the truth."

Teller: "Ma'am, Facebook isn't an acceptable form of identification, and we'd also need to see..."

Ms. Deceit: "This is why I prefer online banking. Places with people in them, like this, just aren't customer-friendly."

(she leaves)

Monday, August 27, 2018

Phone calls

I'm with a patient. Mary interrupts me to say there's another doctor on hold, who needs to talk to me.


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

Dr. Call: "Hi, we have a mutual patient, Mrs. Memory."

Dr. Grumpy: "Hang on, let me pull up her chart... Okay. It looks like I haven't seen her since 2014."

Dr. Call: "Okay, you need to pull her driver's license. I don't think she's safe to drive."

Dr. Grumpy: "I really can't do that after 4 years without seeing her. Why don't you have her family call Mary to bring her in? I can see her tomorrow morning at..."

Dr. Call: "That's ridiculous. She needs to have her license cancelled today. Immediately."

Dr. Grumpy: "Why don't you call the state DMV? You can do it, too."

Dr. Call: "I'm very busy! I don't have time to do things like that! This is your problem!"

Dr. Grumpy: "I..."

Dr. Call: "Okay, since you don't seem to be able to, I'll take care of it. What is the DMV phone number?"

Dr. Grumpy: "I don't know it off the top of my head, but you can..."

Dr. Call: "I'll just have my staff do it. You're not very helpful."

She hung up.

Thursday, August 23, 2018

"Stand back!"

Seen in a bladder-flow report:


Monday, August 20, 2018

All I need is a miracle

Aimovig is the first FDA-approved drug specifically developed to prevent migraines.

It’s getting a lot of press. Some articles talk about it as a breakthrough, some on how it shows the pharmaceutical industry is now focusing on migraine as a real disease, some on how it represents a new era in diseases that affect predominantly women, and many other spins.

Of course, it isn’t alone. There are 2-3 similar agents on the launch pads to join it in the next year.

From my daily office view, the phone calls (and drug reps) come in, and inevitably I hear it referred to as “the miracle drug.”

“I want to try the miracle drug.”

“I saw an ad for that miracle drug.”

“Someone at work told me about this miracle drug.”

Amgen, to their credit (not that the FDA would allow it, anyway), has NOT claimed it’s a miracle drug. The information they provide doctors is the usual glossy graphics surrounding dry statistics and obligatory legal wording. (Note - neither Amgen, nor their competitors, or anyone else, has paid me to write this post. These are my own thoughts).

People seem to need to think a drug is a miracle, in spite of all evidence to the contrary. This isn’t a slight against Aimovig - it’s human nature. Just as people thought of the Titanic as unsinkable (a claim never in reality made by her builders, owners, or officers) there’s a desire to believe human intelligence has somehow overcome a problem and cured it.

It’s not like Aimovig is the first drug to get that label, either. Botox is a miracle drug. So was Imitrex in 1992. Interleukin-2 in the 1980’s. Penicillin in the 1940’s. Willow bark in 500 B.C. (that's where Aspirin came from, people). And too many others to list.

Are these bad drugs? Far from it. But, like every other drug ever discovered, they have a lot of limitations. They work for some conditions, but not others. They ALL have side effects (if someone tries to tell you a drug or supplement doesn’t have any side effects, they’re lying). And, most importantly, humans are not a biologically identical group. No medication will work for everyone. If you read the stats on any med you’ll see that approval is based on a percentage of people who respond to it - and it’s never 100%.

There is absolutely no way to predict with 100% certainty who will - or won’t - respond to any given drug. For that matter, there’s no way to know who will - or -won’t - have side effects, or even which ones.

This is a trial-and-error crapshoot, people. We make decisions based on facts, but an educated guess is still just that - a guess.

There is no such thing as a “miracle drug. " And there never will be.

You won’t hear me, or hopefully any other reputable physician, ever tell you that a drug or surgery or whatever is guaranteed to cure you, or has no chance of harming you. Medicine is about as imperfect a science as there is.

If someone is making such a claim to you, run away. They just want your money, and don’t care about helping you.

I’m not knocking Aimovig. For some people it will be life changing. For others it won’t do a damn thing. Still others will have an unpleasant side-effect. The jury on it and its cousins is still out, and will be for at least 2-3 more years.

But don’t go into any treatment plan, for anything, thinking it’s going to be a miracle. There’s nothing wrong with being hopeful, but you can still do that and keep reality in mind. Because in this field, there are no guarantees.




 
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