Reasons to avoid cheap bras

Dr. Grumpy: "How did the car accident happen?"

Mr. Smash: "Well, this lady in front of me had this huge rack. I think she used it for towing stuff. And I guess something broke, and her rack flew off and smashed my front end. It was one of the biggest racks I've ever seen. I mean, it must have hit 2 or 3 other cars too before it stopped, and people were swerving, and everyone was watching her rack lying in the middle of the road. And she didn't care if she'd hurt anyone else. All she kept saying was that we'd ruined her rack, and that she'd paid a lot of money for it, too."

And the award for best actress in a hospital gown goes to...

This morning I did a hospital consult on a psychiatric patient with pseudo-seizures.

While I was talking to her she suddenly yelled the dreaded "Oh no! You're making me have a seizure! Here it comes!"

This was followed by a an acting job with yelling, thrashing, and moaning that looked more like Meg Ryan's famous deli scene from "When Harry Met Sally" then any kind of epilepsy I've ever seen.

"Oh God! Oh my God! Oh my God! I'm having a seizure! I'm seizing! Oh! Oh! Oh!"

After it was over she opened her eyes and said "Did you think I was having a seizure?"

I thought about telling her what I really thought she was having, but decided to keep my mouth shut.

Vocabulary homework

Dr. Grumpy: "Okay, next word, what does 'buffeted' mean?"

Craig: "Um, to eat a lot? Like at the chinese place with all the food you want?"

Sometimes it's fun

Seeing a sweet old lady this afternoon, named Elizabeth.


Dr. Grumpy: "Do you go by Elizabeth? Or do you have a nickname you prefer?"

Elizabeth: "Just Elizabeth. My parents were very poor, and couldn't afford a nickname."

A study of ONE FREAKING PATIENT!

I'd like to thank my reader, Dr. T., for submitting this gem. It may be 20 years old, but hey, people still get the hiccups.

And again, it's from Haifa, Israel. For reasons that remain mysterious, an unusual proportion of oddball research seems to be from there. A review of my past posts will show several Haifan studies.


Termination of intractable hiccups with digital rectal massage.

J Intern Med. 1990 Feb;227(2):145-6

Odeh M, Bassan H, Oliven A.
Department of Internal Medicine, Bnai Zion Medical Center, Haifa, Israel.

A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.


PMID: 2299306 [PubMed - indexed for MEDLINE]

More Allergies

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

Mr. Sure: "Naprosyn."

Dr. Grumpy: "What happens when you take Naprosyn?"

Mr. Sure: "My armpit deodorant doesn't last as long as it should."

How does pointless research get published?

In light of my many posts on obvious and/or stupid research, quite a few of you have written in with that question.

There are several answers, but the most common one is busy work. And I am my own best example.

I am not an academic/research person. I have nothing against those who are, it's just not my thing. One of my career goals was to die unpublished. I didn't ever want my name in any journal, anywhere.

But when I was doing my fellowship, the chairman was of the opinion that it was critically important that everyone get published at some point, regardless of the quality of the research involved. So he came up with an absolutely bullshit project for me. And I was faced with the options of doing it or failing the fellowship.

So I did the project. It was remarkably stupid and pointless. it consisted of me reading through MOUNTAINS of old charts, going back several years, and making notes. For the record, a lot of BS research is done this way. Some poor sucker in training is forced to tediously analyze endless piles of old charts or videos or patient forms or something, to come up with worthless information, under the threat of failing out of their program.

Let's face it. You can get pointless data out of anything: "Our chart review found that people who saw the original release of The Wizard of Oz in 1939 were more likely to have Alzheimer's disease in 2009 then those who'd seen the original release of Star Wars in 1977. This suggests an unidentified risk factor for dementia in seeing MGM films vs. those made by 20th Century Fox."

And these studies are generally cheap to do, because you're already paying the salary of the resident or fellow involved (even cheaper for med students, since they work for brownie points).

And there's always a crappy journal out there, trying to get advertising dollars and willing to publish anything to get readers.

So I found some meaningless data, and at a weekly division meeting I presented it. There were 4 attending physicians and 2 fellows in my subspecialty at the time. 3 of the attendings, and both of the fellows (including me) agreed the paper and it's findings were meaningless drivel.

Unfortunately, the only person who disagreed was the chairman. And since he was editor at the time of some desperate medical journal, he got my paper published there.

To make matters worse, he then got me a poster spot at the annual neurology meeting that year. So I had to go to this meeting, set up a poster with my worthless data on it and then STAND BY IT wearing a badge that identified me as the author.

So for the required 2 hours I stood there, trying to smile at all the big league academics going by. Most looked at my poster and politely didn't say a word. A few gave me sympathetic looks. 3 made comments about how worthless it was (I silently agreed). Only one said something kind.

I left the poster hanging in the meeting hall. I think I was the only person who didn't take theirs home. I assume it's in a landfill by now.

My shitty article got published a few months later, and several intelligent neurologists (who I assume were reading in a hot tub) found my paper to be such absolute garbage that they felt the need to write to the journal to complain. And the journal editor, my chairman, forwarded the letters to me to write a rebuttal.

How do you defend the indefensible? Hell, I agreed with them.

But by this point I'd completed the fellowship, and was an attending physician. And I didn't care. So I just tossed his requests in the trash.

So my sole contribution to the medical literature is out there. Fortunately, as the years go by, it will continually be buried under newer (though equally worthless) data.

And that's where at least some crappy research comes from. And I suspect most of it has similar origins. Some poor sap who's under pressure to publish something, anything, regardless of how stupid or obvious it is, or people trying to pad their resume, or someone with way too much time on their hands and absolutely no life (if you're in the last category, get a dog. Or join Facebook. Or do ANYTHING to waste your time in a more useful way), and crappy journals willing to publish anything.

And that's the way it is.

Sunday hot tub reading

Okay, I polished off a few more journals to help keep up-to-date this afternoon, and have learned that:


People who use excessive amounts of salt have increased risks of stroke and heart disease (WOW! I've never heard that one before!). British Medical Journal, November 24, 2009.

Excedrin Migraine is effective for some patients with migraines (when compared to placebo), but not for others. Paper presented at the 14th Congress of the International Headache Society.

People who have severe migraines on workdays are more likely to miss work due to migraines, than people who don't have migraines during those times. Another paper presented at the 14th Congress of the International Headache Society.

Dr. Grumpy's Rules, #1024

No good will EVER come out of returning a Sunday morning message that begins with:

"Yeah, I have an appointment with Dr. Grumpy this morning, and your office building is all locked up."

Breaking Medical News

I was relaxing in the hot tub today, catching up on cutting edge medical literature.

I learned that:

Patients on sedating drugs have a higher risk of falling than those not taking sedatives.

Patients with imbalance from inner ear problems are more likely to fall than those without balance problems.

(Archives of Internal Medicine, May 25, 2009)


I also learned:

People with a stroke, and poor blood flow to the area of brain involved, are more likely to have another stroke then people with normal blood flow to that area.

(Brain, April, 2009)

My readers write

This photo was submitted by reader Francine, who says she took it in a hospital ER.

For all the advice painted on the top and bottom of the machine, I have to say I don't see anything remotely healthy in there.


(click to enlarge)




And thank you Francine for sending this in!

Friday afternoon insanity

Dr. Grumpy: "Let me fill out an MRI form... Are you claustrophobic?"

Ms. Bright: "No. My period started yesterday."

Mystery solved

Last night I was at a dinner meeting for a research company. These things are always held at some swanky overpriced steakhouse.

Dr. Duffel is a local neurologist who drags around the biggest damn purse in the world. It's HUGE, and goes everywhere with her. For years many of us have wondered what's in it: a complete set of every neurology journal ever written? Jimmy Hoffa? the Bermuda Triangle?

So last night she came in late to the dinner, and sat down next to me. She put el monstro humungo purse on the floor next to me, so I had to move over a bit.

The meeting dragged on. One slide after another. The occasional cell phone ringing. The speaker droning. Food courses.

At some point I wandered out to stretch and empty myself of biologically-filtered Diet Coke. When I came back and sat down I stepped in a puddle on the floor. I figured someone must have spilled water or something while I was out of the room, and refocused my attention on the speaker.

A minute later a waitress came by to refill my Diet Coke, and stumbled over the giant purse.

And the purse started barking.

The waitress screamed and leaped back, dropping the pitcher on the purse, which only got it snarling at her.

Dr. Duffel jumped up, grabbed her cell phone (which hadn't rung), mumbled "I have to answer this outside" and dragged her growling purse out of the room. I'm pretty sure it wasn't her ringtone.

She never came back.

I rinsed off my shoes when I got home.

Whatever

Mrs. Sad: "Some days I feel like I have no one to talk to."

Dr. Grumpy: "What do you do when that happens?"

Mrs. Sad: "You mean when I have no one to talk to?"

Dr. Grumpy: "Yes"

Mrs. Sad: "I talk to someone about it."