stupidiot

TSK: She just came in for “eye infection”

Cranquis: So did anything happen to your eye before it turned red and itchy?

40-something female patient: NO IT’S NOT INJURED, IT’S JUST INFECTED.

Cranquis: Ok. Have you been around anyone with pink eye lately?

Patient: NO BUT WHEN I WOKE UP YESTERDAY MY CAT WAS LICKING MY EYE.

Cranquis glances at the chart – ‘ALLERGY: Cats’

Patient: SO I KNEW MY CAT WAS GOING TO INFECT MY EYE, AND I TOOK SOME OF MY BOYFRIEND’S ANTIBIOTIC PILLS BUT THOSE WEREN’T STRONG ENOUGH BECAUSE THE INFECTION IS SPREADING, LOOK! 

Patient lifts shirt to reveal hives on torso

Cranquis glances at the chart – ‘ALLERGY: Bactrim’

Cranquis: Were the antibiotics called Bactrim?

Patient: HOW DID YOU KNOW THAT?

Chief Complaint:

“I know I’m allergic to flagyl but I thought I had a kidney infection so I took like 5 or 7 flagyl and now I have a rash.”

History of Present Illness:

Patient states that she figured she would have to wait “two whole days” to see a doctor. She describes her presumed urinary tract infection as “a funny feeling down there” accompanied by some bilateral back pain. Not realizing that she could come give a urine specimen without an appointment, or that she could ask for a same-day walk-in appointment, she opted to look for whatever she could find in her house that she thought would treat her infection. She landed on Flagyl, which had been left over when a family member ignored common sense and their doctor’s advice and only took half their course of antibiotics, thereby breeding antibiotic resistant bacteria that will one day rule the earth and wreak havoc on the patient’s future great great grandchildren. Rather than taking an early appointment for the UTI, she opted to take her own treatment and decided to wait not one or two, but six days for an appointment, and now states her original symptoms have resolved and have been replaced by a severe rash. Patient treats the rash at home for three days with leftover anti-fungal cream.

Review of Systems:

Positive for “funny feeling down there,” back pain, pelvic discomfort, now resolved. Negative for burning with urination, blood in the urine, fever, nausea, or foul odor to the urine.

Physical Exam:

Patient has the absolute worst case of full-body hives I’ve ever seen. By far. Her hives have hives. She is unable to sit still due to severe itching.

Airway, heart, lungs clear.

Assessment:

1. Severe urticaria.

2. Patient did an extremely stupid thing that could have caused her death.

Plan:

1. Prescribe appropriate medications. Make follow up appointment.

2. Explained that Flagyl is not the drug a doctor would pick to empirically treat (that is, treating a presumed illness while waiting for a definitive culture) a UTI. Just because it’s an antibiotic doesn’t mean it treats all infections equally.

3. Explained to patient that she should never have antibiotics left over, and that whenever they are prescribed the full course should be completed to prevent breeding resistance.

4. Sit patient down, look her in the eye, and tell her to never EVER take Flagyl EVER again unless she wants her throat to close up and cause her to die.

5. Comfort patient when she panics when she realizes that she could have literally died because she was being, for lack of a better term, a complete and utter idiot.

TSK: Now remember, children -- Motrin and Ibuprofen are the same drug.

Cranquis: So what meds have you tried for your knee pain?

50-something Patient w/ knee arthritis: MOTRIN.

Cranquis: How many pills and how often?

Patient: ONE. JUST ONE.

Cranquis: Well I can tell you that 1 dose of 200mg of Motrin is nowhere near enough anti-inflammatory to make a difference in an adult patient.

Patient: EXACTLY. SO PRESCRIBE ME SOMETHING STRONGER.

Cranquis: Well, I could, but the prescription meds have greater side effects; why don’t you try taking a higher dose of Motrin for a few days? Or switching to Aleve?

Patient: NO I WANT A PRESCRIPTION, I’M NOT WASTING TIME ON THOSE PUNY DRUGS.

Cranquis *wishing Pt had used a Schwarzenegger accent just then*: Ok then, I’ll prescribe you Diclofenac, but it could be harder on your stom–

Patient: HOW MANY MG IS THAT?

Cranquis: 75.

Patient: DON’T TRY TO BE SNEAKY WITH ME DOC, YOU JUST SAID 200MG WASN’T ENOUGH AND NOW YOU WANT TO GIVE ME ONLY 75MG!

Cranquis: No, see, it’s a different drug, and th–

Patient: I NEED A STRONGER MEDICATION, SO GIVE ME SOMETHING WITH A BIGGER MG!

Cranquis *a pause*: …Oh, I know! How about a short-term prescription for ibuprofen, 800mg tablets?

Patient: NOW THAT IS MORE LIKE IT. GEEZ.

Cranquis

Naw, I’m scared to use those inhalers. I had a buddy who used those for years, and he died.
— 

50-something male with a COPD exacerbation and influenza… still smoking 2 packs/day… but really worried that Symbicort will kill him.

(He doesn’t get the flu shot either – it has all sorts of chemicals in it.)

Cranqsgiving, Day 13

(Happy Thanksgiving, everyone! “Coincidentally,” today is the final day of Cranqsgiving, too – so feel free to catch up on all of the #Cranqsgiving fun whilst digesting your assorted traditional foodstuffs.)

This Cranqsgiving, I’m cranqful for –

Parents whose priorities are so twisted, I don’t even know where to begin.

Cranquis: So, the best treatment for children with croup is oral steroids for 1 to 5 days.

Crunchy Granola Mother: Oh no, MORE chemicals? I’m already feeling so guilty because I broke down and gave him Tylenol last night for his temp of 101.

Cranquis: Well, y'know, I’m a dad too, and I always try to avoid medications in kids unless it’s necessary, but you can tell he’s having a little trouble breathing, and the steroids would really help keep that from getting worse.

CGM: Ok, ok, I’ll do it – just please promise me you won’t tell anyone that I’m giving him something that isn’t natural.

Cranquis (grinning slyly): Actually, your body naturally produces about 5mg of steroids daily, so technically

CGM: Oh! Ok, cool, yeah, so it’s “natural” medicine then! That makes me feel a lot better.

“Oh c'mon, Cranquis,” you say, “what’s the big deal here? You helped a nervous mom accept appropriate medication usage for her ill child – there’s nothing Cranqsgiving-worthy in that.”

HOW ABOUT THE FACT THAT MOM REEKS OF CIGARETTE SMOKE – GEE, ALL THE SECOND-HAND SMOKE YOU’RE PUMPING INTO YOUR CHILD’S LUNGS IS JUST NATURAL VAPORIZED TOBACCO PLANT! AND THE POLONIUM-210 EMITTED IN TOBACCO SMOKE IS JUST A NATURALLY-OCCURING RADIOACTIVE ISOTOPE, RIGHT??!

SO HERE YA GO, NATURE-LOVIN’ MOMMA, HOLD THIS PLATE OF ALL-NATURAL CRANQSGIVING TURKEY WHILE I CARVE IT CAREFULLY

TSK: My buddy w/ Fibromyalgia gets crappy advice

Buddy *text message*: Hey Cranquis, what do you think of this message I just got from my friend? “Fibromyalgia is a 100% spiritually rooted disease. What is happening in the physical is showing you what is happening in the spiritual. The roots of this disease are fear, anxiety, stress and often resentment. How does that hit you?”

Cranquis: Tell your ‘friend’: “Me slapping you is the physical manifestation of my spiritual condition when you tell me that my mind and spirit are strong enough to "fool me” into feeling physical pain, but too weak to properly cope with the hypothetical fear/anxiety/stress behind it. How does THAT hit you?

youtube

The funniest April 1st video of 2016.

TSK: 50-something male with a 15-something grasp of science

4-inch-long full-thickness laceration of the shin, from an old soda can kicked up by a lawn mower blade.

Tibia is visible through parts of the wound, which is contaminated with dirt and grass and who knows what.

Last tetanus shot “probably 20 years ago or more”; declines tetanus booster shot today – reason?

“My immune system is strong enough, those vaccines just weaken you." 

TSK: The verbal stylings of yet another Full Moon Shift patient (and spouse!)
  • 30-something male patient (who looks totally fine, by the way): So yesterday I started getting a cold...
  • Cranquis: What symptoms did you notice?
  • Patient: Um, well... you know how you feel when you're getting a cold? That's how I felt.
  • Cranquis: Ok, but specifically, did you get a cough, sore throat, runny nose, fever, what?
  • Patient's Wife (interjecting helpfully): Well, they were the usual cold symptoms. You know.
  • Cranquis: SUCH. AS.?
  • Patient: Like... hmm... like, the ones they show on the cold medicine commercials. Those.
vimeo

Dr. Trump breaks bad post-op news in an outstanding, really outstanding way. Everybody says they love the way Dr. Trump doctors. Except losers.

(Sad to say, I’ve known a few docs with bedside manner this awful…) 

Cranqsgiving, Day 4

This Cranqsgiving, I’m cranqful for —

Patients who make the problem way worse than it already was.

Day 1: Uncontrolled diabetic (last Hgb A1c >12% — good control is <6%) metal-worker gets a tiny metal sliver in his finger. Co-worker can’t get it out with “sterilized tweezers.”

Day 2: Finger still painful, now a little red around sliver. Wife can’t get it out with “sterilized razor blade.”

Morning of Day 3: Finger painful, redness slowly spreading. Patient pulls out the sliver… WITH HIS TEETH. (Yay, dental bacterial flora!)

Evening of Day 3: Patient comes to my Urgent Care 5 minutes before closing, requesting “some pills or something.” He is greatly shocked when I want to admit him to the hospital for his massively swollen, red, hot, unable-to-flex finger + painful forearm. “Are you kidding? I have to work in the morning!”

OH OK HOW ABOUT I JUST SUCK THE POISON OUT FOR YOU, THEN?

Cranqsgiving, Day 3

(Thanksgiving reminds us to be thankful. Cranqsgiving reminds you that I’m cranqful.)

This Cranqsgiving, I’m cranqful for – parents who invent signs of illness.

Mother: Well, I just know my toddler has a double ear infection.

Cranquis: Hmm, but you said she hasn’t been congested or coughing or feverish. What makes you think so?

Mother: When I pulled her ears during her nap, she woke up and started crying.

NO OF COURSE THE CHILD WAS FINE AND HAPPY – BUT HEY AT LEAST SHE COULD BE EXPOSED TO ALL THE SICK KIDS IN MY WAITING ROOM.

TSK: More like "CODE FLU" amirite?

Most patients are very understanding about waiting longer at the Urgent Care, if another patient with an emergent situation suddenly shows up.

MOST.

Then there’s the charming lady who got all snippy with me because I had to rush out of her room (in the middle of her visit for “cough and sore throat”) in response to a “Code Blue”. When I returned 15 minutes later:

Ms. Krabby (arms crossed, scowling): “WELL THAT TOOK LONG ENOUGH.”

Cranquis (apologetic): “Sorry about that, but you know how it is when an emergency arises.”

Ms. Krabby (not impressed): “Hmmph. Guess I should’ve opened the door and yelled ‘CODE BLUE in THIS room!’

Cranquis:

Well I tried cleaning the eyelids with hydrogen peroxide, but that made my eyes sting pretty bad, so I switched to rubbing alcohol, which also hurt. And the rash kinda got worse after that.
— 

40-something patient with blepharitis (rash on eyelids) – I now have no idea if his rash is just infectious, or also chemical contact dermatitis.

But I DO know he’s not the sharpest tool in the shed.

A Portable Pizza Necklace Will Never, Ever Let You Down

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Photo Source: STUPIDIOTIC

Behind the Medic: Zpak Alternatives

Been working on a Cranquis Mail reply about antibiotic overuse. Just had a great idea for some alternatives to the Zpak (azithromycin, an antibiotic often demanded by patients) – I need to patent these ASAP:

  • See?Pak – 6 combo tabs of azithromycin + a powerful laxative, designed to emphasize my warning that “antibiotics can have many side effects, including diarrhea.”
  • Zpak 90x – A homeopathic 90x dilution of azithromycin, for people who actually NEED an antibiotic but refuse to take anything that “isn’t natural.” (Note: dosing requires 180 tabs the first day, 90 tabs each day after, for a total of 90 days.)
  • Zpatch – Adhesive patch impregnated with topical azithromycin, to apply directly over the chest of people with viral chest colds. (“Studies proved Zpatch has equal efficacy as oral Zpak for people with your illness!”)
  • PlaZbo – Sugar pills packaged in old Zpak containers.
We know, as Emergency Medicine physicians, that the world is full of buttheads, right? Young buttheads, everywhere. We probably see a disproportionately-high percentage of them, so we tend to over-estimate it, but there’s no doubt they’re out there.
— 

Dr. Tom Morrissey, MD, Associate Professor of Emergency Medicine, University of Florida College of Medicine.

He speaks truth. He must be a hilarious attending physician for his residents!

TSK: Lemme 'splain this to you

Dear sir with continued (and worsening) prostatitis and prostatic hypertrophy symptoms for the past 10 months:

Remember that urologist I emergently referred you to 8 months ago for urinary retention and prostatic pain?

Guess what? As far the urologist is concerned, you must be doing better, because you didn’t return (in fact, you no-showed 3 scheduled appointments, including the ultrasound and cystoscopy appointments he had set up to further evaluate your problem). The urologist did not magically intuit that your symptoms had not improved after taking the meds he prescribed you – you didn’t come back, and the urologist has not been crying himself to sleep over it.

Guess what? Prostatitis can be very difficult to cure in some cases, and might not just “go away” after you take 1 or 2 courses of treatment. And prostatic hypertrophy isn’t something you just “cure” by taking tamsulosin for 2 weeks and then quitting it because “it didn’t do anything”.

Guess what? Delaying your follow-up care for 8 months in a bizarre passive-aggressive pissy fit is just increasing your chances of never recovering from these conditions, and suffering secondary complications too. You may need surgery now, actually. We’ll see what the urologist says when he sees you at the urgent appointment I made for you now (again).

And guess further what? It didn’t phase me one bit when you stomped out of my Urgent Care claiming that “nobody is trying to help you” with your problems – because you’ve obviously got problems that nobody can solve except yourself.