How else can one explain when an 80 year old guy on dialysis becomes 100% completely unresponsive all of a sudden? No response at all to deep painful stimuli.  Nada.  The episode was witnessed and there was no obvious seizure.  Blood sugar normal.  BP normal. Vitals other wise normal. Labs unremarkable. CT normal.

And then all of a sudden, he is awake again at his demented baseline about 2 hours later! He has no recollection what happened.

You know what you do? You discharge him. What the Hell else are you going to do? A billion dollar workup? Of course the problem is that there are a lot of doctors (and family members) who would do or want just that. Some things are just not worth investigation.  Let them be.

We are taught that “red flags” are things that when found in the history and physical of a patient’s assessment should alert you to sometime particularly serious going on. Rapid onset of sore throat with muffled voice is one for epiglottitis for example.

There are also red flags that I propose that show me that there is a very high degree of certainty that you are nuttier than a fruitcake.

1). You are lying there in your tight little blue striped Speedo underwear with dyed orange hair. Oh, and you are in your late 50′s and still live with your Mom who is sitting there next to you.

2). You open up the conversation with “Now Doctor, I normally have a VERY high tolerance for pain…”

3). You have your Ipad, Rolladex, and note pad and paper out and you flip through them and enter data continuously while I interview you.

4). You cry crocodile tears with every answer you give me.

5). You refuse to let your spouse (the patient) answer any questions him or herself – even though they are clearly capable of it.

6). You have an insane amount of horrible plastic surgery.

7). You have a psychiatric disease that is given a more “medical” sounding name in order for you to think you don’t need to see a psychiatrist.

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So, I was with a sense of disgust that I read THIS article over the weekend on women who are losing weight last minute before their weddings by using a 24/7 NG tube feed – where their calories are limited to 800 per day. This bothers me 1). Because they will immediately pile this weight back on as soon as the tube is yanked, 2) . That they are too lazy or uncommitted to controlling their caloric intake on their own, 3). That there are health care providers out there that will offer this service, and 4) That the wedding industry has become so over the top that everyone wants a fairy tale celebrity type wedding to the point that they will do anything to squeeze into a tiny dress they will never ever be able to wear again afterwards. Also, it is not without risk.

Do men get all amped up about it like this? I would say NO. We just want to get the dang ceremony over as soon as possible and go on the honeymoon!

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