Archive for the ‘Neurology’ Category

Dear Family

Monday, September 17th, 2012

Listen, just because you finally managed to drag Gramps in to the ER to see a doctor for the first time in years for an acute but mild problem, doesn’t mean it’s appropriate to ask me to have three specialists see him for a whole boatload of progressive, non-urgent problems.
It’s called make a friggin’ appointment with someone and drag his old bones to their office! Getting ER consults is expensive and when not indicated, are a waste of resources and a strain on our already overused health care system. They tend to order lots of expensive tests and scans, all of which can be more cheaply and appropriately done as an outpatient.

Maybe He Has a Switch Somewhere?

Saturday, May 19th, 2012

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.

Fun Night Interrupted

Thursday, May 17th, 2012

The evening was going great. The music was pumpin’ and the girls were bumpin’ and you were showing your stuff on the dance floor. Shakin’ your hips. Twisting yourself into a complex contortion. Hell, you’re on fire. You just did a line of some awesome blow and are really feeling it course through your veins.
Suddenly something is amiss. Your head feels funny. Your face feels numb – for some reason more on the right. Your arm doesn’t seem to want to move when you tell it too. Your balance ain’t good. Everything. Suddenly. Goes. Black.
You awake sometime later. You’re not at the party any more. You’re in what you think is a hospital bed, hooked up to all sorts of things. You have a splitting headache. You go to sit up and your realize that you can’t. Your right arm and leg don’t respond at all. You look down and see that they are there but you can’t feel them. Freaking out, you go to shout out to someone, but nothing comes out of your mouth but a vague, soft grunt. You see the saliva drool out of your mouth and drip onto the sheets. What the Hell happened? It couldn’t have been the coke could it?!?!
It’s going to be a long, painful, miserable life. What’s left of it.