The Israeli-Palestinian conflict is obviously a hot-button issue. And I'm not taking sides, nor am I proposing a solution. But here's where it affects me.There's a Parkinson's Disease medication called Azilect. It has some unique properties, and there's no generic, or direct competitors, currently available. It's manufactured by Teva, a company that does most of their business in generic drugs. It's the world's largest generic drug manufacturer, and if you've ...
Doctor Grumpy, MD
Why a neurologist turned down an interesting hospital case
Dr. Grumpy has lost his neurology mojo over time. Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape.Yesterday I turned away a good hospital case, and told them to find someone else. The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.28-year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). ...
People accuse doctors of not doing enough, or doing too much
Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.There are no easy answers. We're caught between doing what's best, without putting the patient through too much, and doing what's needed to protect ourselves from legal action.Let's take Mrs. Summer. She's a nice 78 year-old lady I saw in the office last week.Earlier this month she hurt her back. So she saw ...
The nightmare of medical research in the lay press
The World Health Organization recently announced that cell phones "may possibly" cause cancer.Now, I'm neither a researcher or statistician, and personally think the jury is still out on this one. I'm not going to take sides.But here is what I am pissed off about. Notice that the story said "may possibly" cause cancer. But the way we think, it somehow becomes "does cause cancer," and so we panic, and hold ...
The trend from drugs of value to medications of convenience
Pharmaceuticals are amazing stuff. You can bitch and moan about their costs, side effects, or the number of them you're taking, but what they've done to extend life and improve its quality is truly remarkable.And for all the bad raps they get, I salute the pharmaceutical industry, and those who work anonymously in labs around the world, to bring us these miracles.But ...
Your doctor isn’t superhuman and is allowed to call in sick
I mentioned having a migraine this past weekend, and was somewhat surprised by how many people commented and wrote to me, surprised that a doctor, let alone a neurlogist, would actually get migraines.What's up with that?I know this may be hard to believe, but we get health problems too.I see this odd view surprisingly often. People who somehow expect us to be beyond the health concerns of non-doctors.We may be ...
Redundant tests waste health care dollars
B12.Sounds simple, huh?1 letter, 2 numbers. One of the B vitamins. It's important in a number of body functions, particularly the nervous system and blood cell production. It's in pretty much all meats and vegetables, and multivitamins you can buy.To me, it's also a good example of what's wrong in health care.Let's take Mrs. Olde.She goes to her internist, and is complaining of feeling weak and tired. So he checks ...
Let Grandma go with dignity, and a family’s inability to do so
I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?Because.The consult was for an 88-year old lady with advanced Alzheimer's Disease. Her sad life was reduced to lying in bed staring at the ceiling. The patient had been seen by 2 other neurologists during ...
Some MRI places have good quality machines, others are obsolete
"Dave" showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.His internist had already thought of this, because he'd ordered the appropriate MRIs. And they'd all been read as normal, leaving me without a cause.Here is where the problem began. Everything about Dave's exam and story pointed ...
Best Doc in a magazine, the inside story
You've seen it, somewhere.Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of the best.Dr. Grumpy, for the record, is not biased against this. I've been named a "Best Doc" in my field several times.And I know most of the other neurologists on the ...
Being sick is not always abnormal
"You can't afford to be sick!"I hate these ads.You've seen them. They're in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It's an ad for some local clinic, always with a tagline like "You can't afford to be sick!" or "You don't have time to be sick!"And they list things they treat, like headache, sore throat, ankle sprain, runny nose, and skinned knees. They ...
Listening to nurses is key to being a good doctor
I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, depending on how sick you are. And the rest ...
Bartering and whether doctors should be paid with chickens
Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going ...
Futile care has human and financial costs
I haven't ever saved a life. No doctor has. We may prolong the inevitable, but we don't save anyone. We aren't immortal, and weren't meant to be. We die. All things do. Plants, animals, even stars. Death is as much a part of life as birth. And yet, at times people chase medical science as if we have immortality in all our gadgets and pills.Why am I writing this?A few ...
The drama of using tPA in stroke within the three-hour window
Before telling this story, I’m going to have to lay some background for my non-medical readers.The most obscene word in English, in my opinion, has three letters and is an acronym. It’s tPA (it stands for Tissue Plasminogen Activator).This drug gets a lot of press as a "clotbuster." It has the potential to break down clots and reverse a stroke. That potential, however, has a dark side. By breaking down ...
