Well, as of tomorrow, I will officially be on vacation until July 1st. My wife and I haven’t been anywhere in the last four years, so we’re taking some time off before residency starts up again, and are going to tour around and live a little before I get back to the grind. As a benediction, I thought I would give you all some quotes to tide you over until July comes around. To the quotes!
Patient’s written response to the question, “What did you do before you became disabled?”
“I used to take care of my pets, but my precious little friend (Brewster the pug) died.”
Patient’s written response to the question, “How has your disability changed your lifestyle?”
“I used to be an amateur gourmet chef -according to mom- but now I can’t be one.”
Patient’s written response to the question, “Are you able to manage your finances?”
“If I had money I could. I had money, but my stupid ex-wife took it all.”
That same patient’s written response to the question, “How did you become disabled?”
“My wife torpedoed me with my doctor.”
If someone could explain that to me, I would much appreciate it
Me: “How does your diabetes keep you from working?”
Man: “After I got laid off, I figured the only thing I could do was porn…but now I can’t even do that.”
Me: “…”
Have a good rest of your week, I’ll be back soon!
-DD
Wednesday, June 16, 2010
Tuesday, June 15, 2010
Tuesday Quotes
Good morning! Sorry for no post yesterday – we had a full day in the office, and amazingly everyone showed up. I’m going to try and make Tuesday the new quote day, so it’ll hopefully offset some of the more serious entries I’ve put up in the past week. That said, on to the blog!
Me: “So tell me why you can’t work.”
Witch-looking lady: “My back hurts too much.”
Me: “What caused it to start hurting?”
Lady: “Well, I was attending the local Renaissance fair, and I was hit by a runaway horse.”
Me: “Do you see or hear things others don’t?”
Man: “Sometimes I see Charlie Brown…or at least I think it’s Charlie Brown, it could just be some crazy white kid.”
Me: “So what caused to you become depressed?”
Older lady: “My cat was eaten by a cougar.”
Me: “A cougar? Do you live out in the country?”
Lady: “No, I live in an apartment.”
Me: “So how do you know it was a cougar?”
Lady: “What else could’ve happened? One day my Kitty was there, the next day she wasn’t.”
Me: “…Well, ok then.”
Lady: “I mean, it could’ve been a Lynx or something…maybe a wolf.”
Me: “…”
Patient’s written response to the question “How does your condition limit your ability to work?”
“My head hurts so I smoke pot. When I smoke pot I can’t concentrate. So I can’t work.”
Have a good rest of your week!
-DD
Me: “So tell me why you can’t work.”
Witch-looking lady: “My back hurts too much.”
Me: “What caused it to start hurting?”
Lady: “Well, I was attending the local Renaissance fair, and I was hit by a runaway horse.”
Me: “Do you see or hear things others don’t?”
Man: “Sometimes I see Charlie Brown…or at least I think it’s Charlie Brown, it could just be some crazy white kid.”
Me: “So what caused to you become depressed?”
Older lady: “My cat was eaten by a cougar.”
Me: “A cougar? Do you live out in the country?”
Lady: “No, I live in an apartment.”
Me: “So how do you know it was a cougar?”
Lady: “What else could’ve happened? One day my Kitty was there, the next day she wasn’t.”
Me: “…Well, ok then.”
Lady: “I mean, it could’ve been a Lynx or something…maybe a wolf.”
Me: “…”
Patient’s written response to the question “How does your condition limit your ability to work?”
“My head hurts so I smoke pot. When I smoke pot I can’t concentrate. So I can’t work.”
Have a good rest of your week!
-DD
Thursday, June 10, 2010
Do you read me?
Good morning! Seeing as I don’t work on Fridays during the month of June, this will be my last entry until next Monday. If you’re new to the blog, this gives you some time to go back and read some of the old entries, if you just can’t enough Disillusioned Doctor. Otherwise, have a good and restful weekend. On a side note, I’d like to thrown in a little plug for an old friend from my theatre days. She and another gal have formed a Bio-pop group known as Suspicious Package, and you can see their newest video, Hummingbird, on MTV.com. So if you’ve got a minute, go check it out. That said, onwards!
Within the last month I’ve noticed a spike in the number of claimants reporting that their main reason for applying for disability is a problem with reading and reading comprehension. I’ve seen six patients so far this AM, and two of them have listed “Learning problems – can’t read” as their number one complaint. Both of the claimants stated that they dropped out of high school, and both also admitted that they received special reading tutoring throughout their secondary school career. When asked if they knew their “reading level,” one reported that he read at a 5th grade level, and the other reported that he read at a 7th grade level. After their exams, I thought about what I was reading at 5th and 7th grade - The Lord of the Rings, The Giver, Lord of the Flies, stuff like that. Now, I’ll throw out a caveat before I continue. I’m a self-professed Bibliophile, and always viewed language arts as one of my strong suits. Math, not so much, but I could at least read the textbook. I’ve done some research, and listed below is a smattering of books that are nationally listed as “Acceptable at a 5th grade reading level.”
1.) Old Yeller
2.) Harry Potter series
3.) Pippi Longstocking
4.) To Kill a Mockingbird
Likewise, here are some books that are a 7th grade reading level.
1.) Ann of Green Gables
2.) Cyrano de Bergerac
3.) The Jungle Book
4.) The Wizard of Oz
Now, while I’m definitely not an English teach, I know that if you can read at a level to understand Ann of Green Gables, or To Kill a Mockingbird, you should be able to understand simple written instructions for most jobs. The question arises, then, as to whether our school systems are actually teaching, in this case, reading at a level that would allow students to enjoy the above books. One could make an argument that the majority of schools simply pass kids along, regardless of their actual educational level, although I would like to think that someone, somewhere, would pick up on the kids that are still reading “Dick and Jane” in 9th grade.
President Bush passed a bill a few years back entitled the “No Child Left Behind Act,” which was supposed to make sure that situations like the ones listed above didn’t happen anymore. According to my family members who are educators (and that’s most of them), all it really did was dumb down the material for the kids that were doing well, thereby leading to boredom and thus increased classroom problems. I don’t’ know enough about the educational system to say who’s right and who’s wrong, but I do know this; if you try and add more milk to everyone’s milkshake just because one kid said his was too thick, everyone ends up with a milky mess and nobody’s happy.
It really is a sticky situation. Do you lower the expectations for everyone so nobody fails? Or do you let the folks at the bottom get washed away? I don’t know the answer, heck, maybe there isn’t an answer. What we need to consider, however, is what do we are going to do about the above people if we let them drift away. As it stands now, it looks like we’ll be handing them a check every month for the rest of their lives instead of spending that money to prevent the above situation, and to give them chance to be productive members of society. A quick fix usually doesn’t help things in the long run. The little Dutch boy can only keep his finger in the dyke so long before he has to pee.
And now for the disability quote of the day:
Manic lady: “I just hallucinated about a cake in your lobby. I was really good, you should try it.”
Me: “…What type of cake was it?”
Lady: [incredulously] “A crazy cake!”
Me: “…sounds yummy.”
Have a good weekend!
-DD
Within the last month I’ve noticed a spike in the number of claimants reporting that their main reason for applying for disability is a problem with reading and reading comprehension. I’ve seen six patients so far this AM, and two of them have listed “Learning problems – can’t read” as their number one complaint. Both of the claimants stated that they dropped out of high school, and both also admitted that they received special reading tutoring throughout their secondary school career. When asked if they knew their “reading level,” one reported that he read at a 5th grade level, and the other reported that he read at a 7th grade level. After their exams, I thought about what I was reading at 5th and 7th grade - The Lord of the Rings, The Giver, Lord of the Flies, stuff like that. Now, I’ll throw out a caveat before I continue. I’m a self-professed Bibliophile, and always viewed language arts as one of my strong suits. Math, not so much, but I could at least read the textbook. I’ve done some research, and listed below is a smattering of books that are nationally listed as “Acceptable at a 5th grade reading level.”
1.) Old Yeller
2.) Harry Potter series
3.) Pippi Longstocking
4.) To Kill a Mockingbird
Likewise, here are some books that are a 7th grade reading level.
1.) Ann of Green Gables
2.) Cyrano de Bergerac
3.) The Jungle Book
4.) The Wizard of Oz
Now, while I’m definitely not an English teach, I know that if you can read at a level to understand Ann of Green Gables, or To Kill a Mockingbird, you should be able to understand simple written instructions for most jobs. The question arises, then, as to whether our school systems are actually teaching, in this case, reading at a level that would allow students to enjoy the above books. One could make an argument that the majority of schools simply pass kids along, regardless of their actual educational level, although I would like to think that someone, somewhere, would pick up on the kids that are still reading “Dick and Jane” in 9th grade.
President Bush passed a bill a few years back entitled the “No Child Left Behind Act,” which was supposed to make sure that situations like the ones listed above didn’t happen anymore. According to my family members who are educators (and that’s most of them), all it really did was dumb down the material for the kids that were doing well, thereby leading to boredom and thus increased classroom problems. I don’t’ know enough about the educational system to say who’s right and who’s wrong, but I do know this; if you try and add more milk to everyone’s milkshake just because one kid said his was too thick, everyone ends up with a milky mess and nobody’s happy.
It really is a sticky situation. Do you lower the expectations for everyone so nobody fails? Or do you let the folks at the bottom get washed away? I don’t know the answer, heck, maybe there isn’t an answer. What we need to consider, however, is what do we are going to do about the above people if we let them drift away. As it stands now, it looks like we’ll be handing them a check every month for the rest of their lives instead of spending that money to prevent the above situation, and to give them chance to be productive members of society. A quick fix usually doesn’t help things in the long run. The little Dutch boy can only keep his finger in the dyke so long before he has to pee.
And now for the disability quote of the day:
Manic lady: “I just hallucinated about a cake in your lobby. I was really good, you should try it.”
Me: “…What type of cake was it?”
Lady: [incredulously] “A crazy cake!”
Me: “…sounds yummy.”
Have a good weekend!
-DD
Wednesday, June 9, 2010
Chimney Time
Good morning. I hope you all enjoyed the quotes from yesterday, with all the crazies coming in recently it was rather difficult to pick which ones to feature. That said, I’ll try to keep up the Quote Boat tradition, at least until July. Speaking of, as of July 1st, I’ll be returning to residency, so the vibe of the blog might change a little. Although I’m planning to still see disability patients for a little extra cheddar, I’ll begin introducing a lot more OB/GYN related stories and insights – so stick around, a little change will do you good.
Yesterday was a rather frustrating day. Being a taxonomist at heart, I always try and break down the claimants into groups and subgroups of conditions – for what reason, I don’t know, I think it just satisfies a small part of me that’s a little OCD. Anyway, there were a good number of “self inflictors” yesterday; people who decide to hurt their bodies, be that by drug use, overeating or whatever, and then when their body fails on them, attempt to receive Disability to help continue their habit. The second patient of the day was one such claimant.
She was a tall, thin, leathery lady who walked into the office, midriff showing and carrying a Coach purse. She sat in the waiting room while I reviewed her chart, and I noticed that while she was waiting, she took a couple of calls on her iPhone. Not your usual claimant, at least by economic terms, but whatever. Anyway, I called her back, and she handed me a list of what was wrong with her. Lovely. For your viewing pleasure, here is the list.
1.) Chronic obstructive pulmonary disease
2.) COPD
3.) Angina
4.) Chest pain
5.) Emphysema
6.) Chronic back pain
7.) Pain in back
Pretty impressive, right? I mean, it’s not like there are repeated conditions on that list or anything…Anyway, after talking for a little bit, it turns out that she only has chest pain (otherwise known as angina) if she starts coughing too much, and if she keeps coughing, she’ll eventually develop pain in her back from bending over. Makes sense…but here’s the kicker. She was diagnosed 10 years prior with COPD, and told at that time if she wanted to live to see her 60th birthday, she needed to quit smoking her pack of cigarettes a day. I asked her if she still smoked and she responded yes, “Two packs a day.” Ok, so not only did she not quit smoking, she decided to smoke more! I asked her, “Why did you decide to smoke more if your lungs were so bad then?” She responded, “Oh, I figured that doctor didn’t know what he was talking about, but I guess he did.” Yep, he did. We moved on to the physical exam, and her lungs were atrocious, it’s amazing any air was moving through those brochi at all. When I asked her to “take a deep breath,” she immediately burst into a coughing fit, and proceeded to cough up a huge amount of junk. I handed her a Kleenex, she spit it out and showed the resultant lung butter to me, of course, saying “this is what causes me to hurt so bad.” I mumbled something, and tried to purge that image from my mind. For some reason, phlegm really bothers me…I can deal with other excretions, no problem. But lung junk, no thank you. She left the office, and I guess as a treat, left the Kleenex for me to clean up. Thank you very much.
I know I harp on smoking a lot on this blog, I know, but it see people in here every day that can’t breathe because they’ve been puffing on cigarettes all their lives. I could go into the same diatribe about over eating, drug use or tanning – the moral of the story is the same. Your bad habits can really hurt your body. Most of us, however, know that what we’re doing is not good – it might feel good at the time, but we know in the long run it’ll catch up with us. Live and let live, right? This lady stands out in my mind, however, because she not only kept smoking, but increased her pack per day intake. Well, I guess tobacco executive’s kids have to go to college, too, and if she does get disability, it’s not like she’ll be around much longer to receive her checks.
And now for the disability quote of the day:
Man: “It’s like there’s a party in my head, and everyone’s invited – Mike Tyson, Russell Simmons, Andre 3000 – but they sent me out to buy beer.”
Claimants written response to the question, “Why did you stop working?”
“I flashed too many people and got fired.”
Until tomorrow,
-DD
Yesterday was a rather frustrating day. Being a taxonomist at heart, I always try and break down the claimants into groups and subgroups of conditions – for what reason, I don’t know, I think it just satisfies a small part of me that’s a little OCD. Anyway, there were a good number of “self inflictors” yesterday; people who decide to hurt their bodies, be that by drug use, overeating or whatever, and then when their body fails on them, attempt to receive Disability to help continue their habit. The second patient of the day was one such claimant.
She was a tall, thin, leathery lady who walked into the office, midriff showing and carrying a Coach purse. She sat in the waiting room while I reviewed her chart, and I noticed that while she was waiting, she took a couple of calls on her iPhone. Not your usual claimant, at least by economic terms, but whatever. Anyway, I called her back, and she handed me a list of what was wrong with her. Lovely. For your viewing pleasure, here is the list.
1.) Chronic obstructive pulmonary disease
2.) COPD
3.) Angina
4.) Chest pain
5.) Emphysema
6.) Chronic back pain
7.) Pain in back
Pretty impressive, right? I mean, it’s not like there are repeated conditions on that list or anything…Anyway, after talking for a little bit, it turns out that she only has chest pain (otherwise known as angina) if she starts coughing too much, and if she keeps coughing, she’ll eventually develop pain in her back from bending over. Makes sense…but here’s the kicker. She was diagnosed 10 years prior with COPD, and told at that time if she wanted to live to see her 60th birthday, she needed to quit smoking her pack of cigarettes a day. I asked her if she still smoked and she responded yes, “Two packs a day.” Ok, so not only did she not quit smoking, she decided to smoke more! I asked her, “Why did you decide to smoke more if your lungs were so bad then?” She responded, “Oh, I figured that doctor didn’t know what he was talking about, but I guess he did.” Yep, he did. We moved on to the physical exam, and her lungs were atrocious, it’s amazing any air was moving through those brochi at all. When I asked her to “take a deep breath,” she immediately burst into a coughing fit, and proceeded to cough up a huge amount of junk. I handed her a Kleenex, she spit it out and showed the resultant lung butter to me, of course, saying “this is what causes me to hurt so bad.” I mumbled something, and tried to purge that image from my mind. For some reason, phlegm really bothers me…I can deal with other excretions, no problem. But lung junk, no thank you. She left the office, and I guess as a treat, left the Kleenex for me to clean up. Thank you very much.
I know I harp on smoking a lot on this blog, I know, but it see people in here every day that can’t breathe because they’ve been puffing on cigarettes all their lives. I could go into the same diatribe about over eating, drug use or tanning – the moral of the story is the same. Your bad habits can really hurt your body. Most of us, however, know that what we’re doing is not good – it might feel good at the time, but we know in the long run it’ll catch up with us. Live and let live, right? This lady stands out in my mind, however, because she not only kept smoking, but increased her pack per day intake. Well, I guess tobacco executive’s kids have to go to college, too, and if she does get disability, it’s not like she’ll be around much longer to receive her checks.
And now for the disability quote of the day:
Man: “It’s like there’s a party in my head, and everyone’s invited – Mike Tyson, Russell Simmons, Andre 3000 – but they sent me out to buy beer.”
Claimants written response to the question, “Why did you stop working?”
“I flashed too many people and got fired.”
Until tomorrow,
-DD
Tuesday, June 8, 2010
Quote Boat, toot toot
Good morning! As I said yesterday, today’s entry will be a revenant of the Friday Night Quotes series that existed when I worked on Fridays (I like that, ‘when I worked on Fridays’). One quick side note before we begin. If you have any questions about what I’m writing, be it medical or otherwise, please leave a comment – I enjoy knowing what you all are thinking about the blog. So, without further ado…raise anchor, it’s time for the Quote Boat to set sail!
Me: “So you wrote ‘special issues’ in the space describing why you can’t work. What does that mean?”
Man: “Well, it’s sensitive…I’ve got this problem…with my balls.”
Me: “Ok…what type of problem?”
Man: “Well, to put it mildly, I’ve got donkey balls.”
Me: “Donkey balls?”
Man: “Yeah man, have you ever seen a donkey’s balls? They’re huge. Mine are too. Like, too big.”
Me: “…”
Man: “Do you want to see them?”
Me: “No, no, that’s ok. I’ll take your word. So…how do your testicles prevent you from working?”
Man: “They just hurt and bang things all the time. It’s really painful.”
Me: “I bet…well, let me ask you some other questions.”
[As it turns out, the gentleman above had a GIANT hernia into his scrotum, thereby giving the appearance of said “donkey balls,” but in reality, what he perceived were his testicles were really his intestines…yuck]
Me: “So do you hear or see things other people don’t?”
Girl: “Well, sometimes I hear my own voice, but only if I’m speaking and nobody’s around.”
Me: “…”
Me: “How does your knee pain keep you from working?”
Younger woman: “If I try and run backwards really fast, they really hurt.”
Me: “What about if you walk forwards slowly?”
Woman: “Oh, they’re ok then.”
Man: “I’ve got this condition that keeps me from swallowing well…and it makes me really depressed.”
Me: “You’re depressed because you can’t swallow?”
Man: “No, I’m depressed because I can only swallow if I turn my head to the left, and there’s nothing to look at in that direction.”
Me: “Have you considered moving your chair?”
Man: “Oh, I couldn’t do that. I always sit at the head of the table, I’m the man, after all.”
Hope you enjoyed those, have a good rest of your day!
-DD
Me: “So you wrote ‘special issues’ in the space describing why you can’t work. What does that mean?”
Man: “Well, it’s sensitive…I’ve got this problem…with my balls.”
Me: “Ok…what type of problem?”
Man: “Well, to put it mildly, I’ve got donkey balls.”
Me: “Donkey balls?”
Man: “Yeah man, have you ever seen a donkey’s balls? They’re huge. Mine are too. Like, too big.”
Me: “…”
Man: “Do you want to see them?”
Me: “No, no, that’s ok. I’ll take your word. So…how do your testicles prevent you from working?”
Man: “They just hurt and bang things all the time. It’s really painful.”
Me: “I bet…well, let me ask you some other questions.”
[As it turns out, the gentleman above had a GIANT hernia into his scrotum, thereby giving the appearance of said “donkey balls,” but in reality, what he perceived were his testicles were really his intestines…yuck]
Me: “So do you hear or see things other people don’t?”
Girl: “Well, sometimes I hear my own voice, but only if I’m speaking and nobody’s around.”
Me: “…”
Me: “How does your knee pain keep you from working?”
Younger woman: “If I try and run backwards really fast, they really hurt.”
Me: “What about if you walk forwards slowly?”
Woman: “Oh, they’re ok then.”
Man: “I’ve got this condition that keeps me from swallowing well…and it makes me really depressed.”
Me: “You’re depressed because you can’t swallow?”
Man: “No, I’m depressed because I can only swallow if I turn my head to the left, and there’s nothing to look at in that direction.”
Me: “Have you considered moving your chair?”
Man: “Oh, I couldn’t do that. I always sit at the head of the table, I’m the man, after all.”
Hope you enjoyed those, have a good rest of your day!
-DD
Monday, June 7, 2010
Reading time
Good Monday! I hope everyone had a good weekend. It was a little stressful around my household, but all-in-all, things went pretty well. I’ll give you a little update on the wife before we venture into the sordid mess that is disability land. Overall she’s doing fairly well. She was diagnosed with subclinical hyperthyroidism in the hospital (which explains the cardiac arrhythmias and feelings of shortness of breath), and is having a follow up appointment/blood test with her doctor later this week. Depending on what her lab values show, as well as her symptoms, she may or may not be placed on medication. I’ll keep you all updated as time progresses. Anyway, onwards!
I’ve been seeing a lot of “continuing disability review” claimants recently. Maybe it’s that time of year, maybe it’s the weather, I don’t know, but it seems like at least two or three claimants a day are individuals who are on disability that are in need of their “yearly check-up.” As banal as these reviews are, it does give me an interesting perspective into what conditions are “good enough” to receive a monthly check. You would think that there would be a good amount of variance in the diseases that warrant disability, but you would be wrong. First of all, I have yet to see someone whose main complaint was/is low back pain. In fact, the majority of continuing review claimants have a “mental disability,” most of which, in my opinion, are often dubious at best. We’ll use a patient that came in earlier today for an example.
First a little background. One of the main differences between this office and the place I used to work is the way in which the space is set up. We have a central waiting room, with three exams room and a secretary’s office surrounding it. Due to the way my door opens, I am able to observe a large number of our patients before they’re seen, and can watch them interact with each other, our secretary, and the old copies of Good Housekeeping my wife found for our office reading material. At the old office, however, my back was to the waiting area, and I couldn’t observe the claimants at all. Now, the gentleman I’m discussing looked like your “typical” disability patient, and was wearing the newest in summer fashion - a ratty tank-top, tight jean shorts, knee high tube socks and flip-flops (or thongs, as my mother would say). His hair was unkempt, dirty, and he said, flipping through the Good Housekeeping magazines, his beady eyes tracking the play of words on the page. He then went on to discuss the subject of the article with his companion, and they had an animated conversation about dinner rolls or something along those lines. I reviewed his chart, and it read “Continuing Disability Review – claimant has ‘mental issues.’” Alrighty, that’s specific. Anyway, I called him back, and after a little questioning, he stated that he was on disability because he “couldn’t read good.” I thought about asking him if he couldn’t do other things good as well, but figured the reference would be lost on him. Anyway, he stated that he never progressed past an 8th grade reading level, and although he had graduated high school, he couldn’t keep a job because he couldn’t read well enough, Now I’m no expert on reading, but can’t most people in the 8th grade read well enough to, oh, I don’t know, do construction? Or lawn care? Or politics? Regardless, he was otherwise totally healthy. Furthermore, he had not done anything productive with his disability money – look for a job, further educate himself, etc. He did however remark that he smoked 2 packs of cigarettes a day, drank every weekend, and had a nice vacation in Mexico last month.
I know I’ve talked about this before, but it really irritates me. You and I are sacrificing a portion of our income so that people who are less fortunate can get by with day-to-day living. I’m fine with that, Lord knows there are tons of people out there who need that $400 check more than I do. What I’m not fine with is people who use their “disability” to avoid working, smoke cigarettes and go on vacation. Now, maybe he has a wealthy family or spouse, or maybe he took his hard-earned disability money and got lucky playing slots, I don’t know. The fact of the matter is that that money is not going towards what it should be, namely helping these people get off disability (if possible), and back into the work force. I’m sure you could make the same argument about Welfare, but I’m not going to go there…today. Anyway, I later found out that this gentleman, from a medical standpoint, was found to be not disabled. He appealed it, however, and an Administrative Law judge granted him disability. I mean, why do I even do this if my recommendations, along with the expert panel at social security, can just get overturned by someone with no medical experience? It makes me sick. Anyway, the moral of the story today is, if you want to get disability, don’t get injured, hire a lawyer.
Have a good rest of your day, more disability quotes tomorrow,
-DD
I’ve been seeing a lot of “continuing disability review” claimants recently. Maybe it’s that time of year, maybe it’s the weather, I don’t know, but it seems like at least two or three claimants a day are individuals who are on disability that are in need of their “yearly check-up.” As banal as these reviews are, it does give me an interesting perspective into what conditions are “good enough” to receive a monthly check. You would think that there would be a good amount of variance in the diseases that warrant disability, but you would be wrong. First of all, I have yet to see someone whose main complaint was/is low back pain. In fact, the majority of continuing review claimants have a “mental disability,” most of which, in my opinion, are often dubious at best. We’ll use a patient that came in earlier today for an example.
First a little background. One of the main differences between this office and the place I used to work is the way in which the space is set up. We have a central waiting room, with three exams room and a secretary’s office surrounding it. Due to the way my door opens, I am able to observe a large number of our patients before they’re seen, and can watch them interact with each other, our secretary, and the old copies of Good Housekeeping my wife found for our office reading material. At the old office, however, my back was to the waiting area, and I couldn’t observe the claimants at all. Now, the gentleman I’m discussing looked like your “typical” disability patient, and was wearing the newest in summer fashion - a ratty tank-top, tight jean shorts, knee high tube socks and flip-flops (or thongs, as my mother would say). His hair was unkempt, dirty, and he said, flipping through the Good Housekeeping magazines, his beady eyes tracking the play of words on the page. He then went on to discuss the subject of the article with his companion, and they had an animated conversation about dinner rolls or something along those lines. I reviewed his chart, and it read “Continuing Disability Review – claimant has ‘mental issues.’” Alrighty, that’s specific. Anyway, I called him back, and after a little questioning, he stated that he was on disability because he “couldn’t read good.” I thought about asking him if he couldn’t do other things good as well, but figured the reference would be lost on him. Anyway, he stated that he never progressed past an 8th grade reading level, and although he had graduated high school, he couldn’t keep a job because he couldn’t read well enough, Now I’m no expert on reading, but can’t most people in the 8th grade read well enough to, oh, I don’t know, do construction? Or lawn care? Or politics? Regardless, he was otherwise totally healthy. Furthermore, he had not done anything productive with his disability money – look for a job, further educate himself, etc. He did however remark that he smoked 2 packs of cigarettes a day, drank every weekend, and had a nice vacation in Mexico last month.
I know I’ve talked about this before, but it really irritates me. You and I are sacrificing a portion of our income so that people who are less fortunate can get by with day-to-day living. I’m fine with that, Lord knows there are tons of people out there who need that $400 check more than I do. What I’m not fine with is people who use their “disability” to avoid working, smoke cigarettes and go on vacation. Now, maybe he has a wealthy family or spouse, or maybe he took his hard-earned disability money and got lucky playing slots, I don’t know. The fact of the matter is that that money is not going towards what it should be, namely helping these people get off disability (if possible), and back into the work force. I’m sure you could make the same argument about Welfare, but I’m not going to go there…today. Anyway, I later found out that this gentleman, from a medical standpoint, was found to be not disabled. He appealed it, however, and an Administrative Law judge granted him disability. I mean, why do I even do this if my recommendations, along with the expert panel at social security, can just get overturned by someone with no medical experience? It makes me sick. Anyway, the moral of the story today is, if you want to get disability, don’t get injured, hire a lawyer.
Have a good rest of your day, more disability quotes tomorrow,
-DD
Friday, June 4, 2010
"I'll take a clonic tonic, please"
Good morning! I hope everyone has a happy Friday, and has a restful weekend planned. I’m looking for to (finally) having a Saturday off tomorrow, so this will be the last entry of the week. Sorry I didn’t post anything yesterday, we had a bit of a family emergency – my wife is 13 weeks pregnant, and has recently developed some odd cardiac symptoms. After seeing her OB yesterday, we were admitted to the hospital, and underwent a nice cardiac workup, including EKG, telemetry and, later this AM, an echocardiogram. Hopefully everything will turn out well; I’ll keep you posted. Onwards!
One of the (few) great things about doing these disability physicals is that I get to see so many patients with weird diseases. Seriously, the amount of pathology that walks through the office doors would make a medical student salivate. Even better, since I don’t have to treat the diseases, I simply get to ask questions (sometimes just to satisfy my curiosity – how often do you get to ask a patient with connective-tissue disorders if they can touch their right forearm with their right hand?) and examine the results of the disease.
This AM, in addition to the usual back pain patients (one of which was named Gary Wayne) I had the pleasure of talking to a lady with Myotonic-type muscular dystrophy, a condition that I personally have never seen, but had definitely heard about in medical school. In addition to the normal muscle weakness that pervades any of the muscular dystrophies, myotonics literally can’t let go of held objects without exerting massive amounts of energy. In some cases, the disease progresses to the point where a person would be unable to release an object, say, during a game of Hot-Potato, or, on a more serious note, a hot potato. As you might imagine, this could cause some interesting social situations – “Could you pass me that salt? I can, but I won’t be able to let go.” Or in my case, when I asked the patient this morning to squeeze my hands to test grip strength, causing a visible bruise as her grip crushed my wedding ring into my adjacent fingers. All joking aside, muscular dystrophy can cause problems not only with the musculoskeletal system, but also with breathing (the diaphragm is a muscle, you know), and unfortunately, this patient’s disease had progressed to the point where she was having increasing difficulty with respiration. Without going into more specifics, I do feel that this patient was one of the 20% that actually need (or will need) disability, and I sincerely hope that she receives it.
As much as I joke about the people that come through these doors, there are a bunch of patients out there that really need help. In this past week, I’ve seen four teenagers with varying degrees of Cerebral Palsy, all of which could use some assistance, even if that means just having someone to help them with daily chores. Many of the disease that I see are not crippling by themselves, but when combined with other pathologies, or even environmental factors, they become severe enough to really affect quality of life. My heart tends to be softer when it comes to younger claimants, especially kids with congenital conditions. There are so many people out there that destroy their body by smoking, drinking excessively or by sticking objects where they don’t belong, and then expect the public to write them a monthly check for their bad habits. It makes me even madder when I see people for continuing disability evaluations, and they’re still not on medication or receiving medical treatments, but they smoke 2 packs a day, and drink a 12-pack every weekend. We all have our vices - I mean, I love eating, and you better believe that I would love to a get a monthly check from the people of this fair city to eat whatever I wanted. If that was my only income, however, I would like to believe that I would spend it on things like…oh, I don’t know, rent, medication for my kids, and maybe (just maybe) treatment to get me back into the work force. That said, if you would like to send me money every month so I can eat, well, I’m not going to turn it down.
And now for the disability quote(s) of the day:
Me: [Palpating a woman’s neck] “Do you have any pain when I touch your neck?”
Woman: “Oh no, that feels so good. My husband has been dead for seven years, and you’ve just given me goose bumps.”
Claimant’s written response to the question, “How does your condition limit your ability to work?”
“I used to make really big meatballs. Now my hands hurt so much I can only make small meatballs. Then my husband gets very angry with my small meatballs.”
Have a good weekend,
-DD
One of the (few) great things about doing these disability physicals is that I get to see so many patients with weird diseases. Seriously, the amount of pathology that walks through the office doors would make a medical student salivate. Even better, since I don’t have to treat the diseases, I simply get to ask questions (sometimes just to satisfy my curiosity – how often do you get to ask a patient with connective-tissue disorders if they can touch their right forearm with their right hand?) and examine the results of the disease.
This AM, in addition to the usual back pain patients (one of which was named Gary Wayne) I had the pleasure of talking to a lady with Myotonic-type muscular dystrophy, a condition that I personally have never seen, but had definitely heard about in medical school. In addition to the normal muscle weakness that pervades any of the muscular dystrophies, myotonics literally can’t let go of held objects without exerting massive amounts of energy. In some cases, the disease progresses to the point where a person would be unable to release an object, say, during a game of Hot-Potato, or, on a more serious note, a hot potato. As you might imagine, this could cause some interesting social situations – “Could you pass me that salt? I can, but I won’t be able to let go.” Or in my case, when I asked the patient this morning to squeeze my hands to test grip strength, causing a visible bruise as her grip crushed my wedding ring into my adjacent fingers. All joking aside, muscular dystrophy can cause problems not only with the musculoskeletal system, but also with breathing (the diaphragm is a muscle, you know), and unfortunately, this patient’s disease had progressed to the point where she was having increasing difficulty with respiration. Without going into more specifics, I do feel that this patient was one of the 20% that actually need (or will need) disability, and I sincerely hope that she receives it.
As much as I joke about the people that come through these doors, there are a bunch of patients out there that really need help. In this past week, I’ve seen four teenagers with varying degrees of Cerebral Palsy, all of which could use some assistance, even if that means just having someone to help them with daily chores. Many of the disease that I see are not crippling by themselves, but when combined with other pathologies, or even environmental factors, they become severe enough to really affect quality of life. My heart tends to be softer when it comes to younger claimants, especially kids with congenital conditions. There are so many people out there that destroy their body by smoking, drinking excessively or by sticking objects where they don’t belong, and then expect the public to write them a monthly check for their bad habits. It makes me even madder when I see people for continuing disability evaluations, and they’re still not on medication or receiving medical treatments, but they smoke 2 packs a day, and drink a 12-pack every weekend. We all have our vices - I mean, I love eating, and you better believe that I would love to a get a monthly check from the people of this fair city to eat whatever I wanted. If that was my only income, however, I would like to believe that I would spend it on things like…oh, I don’t know, rent, medication for my kids, and maybe (just maybe) treatment to get me back into the work force. That said, if you would like to send me money every month so I can eat, well, I’m not going to turn it down.
And now for the disability quote(s) of the day:
Me: [Palpating a woman’s neck] “Do you have any pain when I touch your neck?”
Woman: “Oh no, that feels so good. My husband has been dead for seven years, and you’ve just given me goose bumps.”
Claimant’s written response to the question, “How does your condition limit your ability to work?”
“I used to make really big meatballs. Now my hands hurt so much I can only make small meatballs. Then my husband gets very angry with my small meatballs.”
Have a good weekend,
-DD
Wednesday, June 2, 2010
Quack quack
Good morning. Happy hump day to all, and to all the medical students out there getting ready to take Boards, good luck! I’m going to try and keep the entry today light, although there is something that I definitely want to discuss, and it might be a little heavy, so just stay with me. On to the blog!
It was another fibromyalgia day yesterday, although interestingly, the majority of the claimants complaining of said disease were males (FM is a predominantly female condition). My last patient of the day was a 21 y/o male, who stated that his main complaints were Chronic Fatigue Syndrome, Fibromyalgia and (can you guess it?) depression. His mother accompanied him, and he shuffled into the office, all sweaty and nervous. I had glanced over his chart prior to calling him back, and it said that he received all of his treatment from the Institute of Fibromyalgia and Chronic Fatigue Therapy (name changed), located in another city, and run by a PhD Psychologist and a dentist. As you might imagine, I found this to be rather odd, seeing as dental health and a musculoskeletal disorder have very little in common, at least to my knowledge. He stated that “if I lift anything heavy, I’ll be tired for like 20 minutes afterwards.” Likewise, he stated that he was often too tired to do chores or drive, so he had his parents and friends take him where he needed to go. Sounds nice, right? After some additional questioning, the claimant stated that he received treatment at the Institute once a month, and admitted that he received all of his medication in the mail. This fact alone would have had my “spider senses” tingling, but when I looked at his medication sheet, I definitely realized something was amiss.
As I’ve said before, FM is usually treated with SSRIs, with the occasional pain medication thrown onboard for good measure. Well, this kid had no anti-depressants on his sheet, heck he hardly had any conventional treatments at all. What follows is a list of the medications, and their usage, for his condition.
1. Mobic – chronic pain
2. Tylenol – pain
3. Azithromycin 500mg– to keep the bugs down
4. Midol – pain
5. Depo testosterone injection – hormone issues
6. Natural Cortisol – hormone issues
7. Ambien – hormone issues/sleep
8. Centrum Silver – multivitamin
Ok, well, you might have already noticed some…irregularities, namely the Centrum silver (he’s 22) and the Midol (he’s a he, although it’s basically just Tylenol and a mild diuretic, anyway). As for the other medications…Azithromycin is an antibiotic (it’s the medication in a Z-pack), which is normally taken over five days. In some instances that therapy may be continued longer, but it is definitely not a daily medication. Then there’s the hormone issue – Ambien does not affect hormone levels at all, it works on neurotransmitters in your brain to make you drowsy. Likewise, unless he had some underlying endocrine disorder which he failed to mention in the “do you have any medical conditions” part of the interview, there’s absolutely no reason that he should be taking supplemental hormones like testosterone (a sex hormone) and Cortisol (an adrenal hormone released during periods of stress). In fact, by adding extra hormones, he could possibly be decreasing the amount of hormones he naturally produces, thereby giving his side-effects such as (get ready for this) fatigue, decreased mood and weakness. Hooo boy (or hautbois) I think we might have found the cause of his problems! Never mind the fact that most people feel like crap taking antibiotics, even if it’s only for a week, and 500mg is above the loading (or largest) dose for a Z-pack. Man oh man.
Needless to say, when I performed the Fibromyalgia point tenderness test, he reported 2/18 points tender (you need 11 to be clinically diagnosed). As for the rest of his physical exam, well, it was as normal as can be. I guess the lesson to learn today is to be careful who you get your care from. There are a bunch of people out there who will sell and tell you anything to get a buck. If your “doctor” starts telling you that you have a disease, but you can only order your medication through the mail, I’d be a little suspicious of their training. There was a chiropractor in town a few years ago that stated that he could tell a person’s health by the Red Beaker Test – a test in which he had the patient hold a beaker of red liquid, and based on the way it jiggled, he could tell if you had gallbladder problems, heart disease or even infertility. He offered the test for the low, low price of $25, and wouldn’t you know, it didn’t really tell anything. Amazing, right? I have no idea how much this kid (or his parents, for that matter) was paying each month for treatment, but as the saying goes, “there’s a sucker born every minute.”
And now, for the disability quotes of the day:
Me: “I’m going to need you to bend at the waist to test the range of motion of your back.”
Older, buxom woman: “You’re not going to look down my shirt, are you?”
Me: “Oh no, ma’am, I’m just looking at your spine.”
Woman: “Well you can look, I won’t mind. At my age, it’s all the action I get.”
Me: “I’m going to test your grip strength. Please take my hands and squeeze them.”
Dude: [Squeezing gently] “I’d squeeze harder, but I might make you explode with the force of my grip.”
Me: “I’ll keep that in mind.”
Caveat emptor,
-DD
It was another fibromyalgia day yesterday, although interestingly, the majority of the claimants complaining of said disease were males (FM is a predominantly female condition). My last patient of the day was a 21 y/o male, who stated that his main complaints were Chronic Fatigue Syndrome, Fibromyalgia and (can you guess it?) depression. His mother accompanied him, and he shuffled into the office, all sweaty and nervous. I had glanced over his chart prior to calling him back, and it said that he received all of his treatment from the Institute of Fibromyalgia and Chronic Fatigue Therapy (name changed), located in another city, and run by a PhD Psychologist and a dentist. As you might imagine, I found this to be rather odd, seeing as dental health and a musculoskeletal disorder have very little in common, at least to my knowledge. He stated that “if I lift anything heavy, I’ll be tired for like 20 minutes afterwards.” Likewise, he stated that he was often too tired to do chores or drive, so he had his parents and friends take him where he needed to go. Sounds nice, right? After some additional questioning, the claimant stated that he received treatment at the Institute once a month, and admitted that he received all of his medication in the mail. This fact alone would have had my “spider senses” tingling, but when I looked at his medication sheet, I definitely realized something was amiss.
As I’ve said before, FM is usually treated with SSRIs, with the occasional pain medication thrown onboard for good measure. Well, this kid had no anti-depressants on his sheet, heck he hardly had any conventional treatments at all. What follows is a list of the medications, and their usage, for his condition.
1. Mobic – chronic pain
2. Tylenol – pain
3. Azithromycin 500mg– to keep the bugs down
4. Midol – pain
5. Depo testosterone injection – hormone issues
6. Natural Cortisol – hormone issues
7. Ambien – hormone issues/sleep
8. Centrum Silver – multivitamin
Ok, well, you might have already noticed some…irregularities, namely the Centrum silver (he’s 22) and the Midol (he’s a he, although it’s basically just Tylenol and a mild diuretic, anyway). As for the other medications…Azithromycin is an antibiotic (it’s the medication in a Z-pack), which is normally taken over five days. In some instances that therapy may be continued longer, but it is definitely not a daily medication. Then there’s the hormone issue – Ambien does not affect hormone levels at all, it works on neurotransmitters in your brain to make you drowsy. Likewise, unless he had some underlying endocrine disorder which he failed to mention in the “do you have any medical conditions” part of the interview, there’s absolutely no reason that he should be taking supplemental hormones like testosterone (a sex hormone) and Cortisol (an adrenal hormone released during periods of stress). In fact, by adding extra hormones, he could possibly be decreasing the amount of hormones he naturally produces, thereby giving his side-effects such as (get ready for this) fatigue, decreased mood and weakness. Hooo boy (or hautbois) I think we might have found the cause of his problems! Never mind the fact that most people feel like crap taking antibiotics, even if it’s only for a week, and 500mg is above the loading (or largest) dose for a Z-pack. Man oh man.
Needless to say, when I performed the Fibromyalgia point tenderness test, he reported 2/18 points tender (you need 11 to be clinically diagnosed). As for the rest of his physical exam, well, it was as normal as can be. I guess the lesson to learn today is to be careful who you get your care from. There are a bunch of people out there who will sell and tell you anything to get a buck. If your “doctor” starts telling you that you have a disease, but you can only order your medication through the mail, I’d be a little suspicious of their training. There was a chiropractor in town a few years ago that stated that he could tell a person’s health by the Red Beaker Test – a test in which he had the patient hold a beaker of red liquid, and based on the way it jiggled, he could tell if you had gallbladder problems, heart disease or even infertility. He offered the test for the low, low price of $25, and wouldn’t you know, it didn’t really tell anything. Amazing, right? I have no idea how much this kid (or his parents, for that matter) was paying each month for treatment, but as the saying goes, “there’s a sucker born every minute.”
And now, for the disability quotes of the day:
Me: “I’m going to need you to bend at the waist to test the range of motion of your back.”
Older, buxom woman: “You’re not going to look down my shirt, are you?”
Me: “Oh no, ma’am, I’m just looking at your spine.”
Woman: “Well you can look, I won’t mind. At my age, it’s all the action I get.”
Me: “I’m going to test your grip strength. Please take my hands and squeeze them.”
Dude: [Squeezing gently] “I’d squeeze harder, but I might make you explode with the force of my grip.”
Me: “I’ll keep that in mind.”
Caveat emptor,
-DD
Tuesday, June 1, 2010
Hypertension Dimension
Good Tuesday! I hope everyone had a wonderful Memorial Day, ours was spent traversing from family to family, but overall it was a lot of fun. My work schedule in June is going to be a little different – this week I’m working today, Wednesday, Thursday and Friday. Starting next week, however, I’ll be in the office on Monday, Tuesday, Wednesday and half days on Thursday, so expect blog entries on those days. Anyways, onwards!
Since the last few entries have been more lighthearted, I thought that I would talk about something a little more medical today. I’ve had a plethora of patients recently that have all had severely elevated blood pressures, and (of course) they’re not on any type of medication. Most of them also smoke, say that they can’t afford any medication because it’s so expensive, and of course, and can’t go to a doctor because they can’t afford that, either. Let’s look at the first and second excuse.
A pack of cigarettes is around (last time I checked) $5. So if you smoke 1 pack of cigarettes a day, your habit just cost you $150 for that month. Lisinopril (a common first line high-blood pressure medication) is $4 for a month’s supply. Now, I’m no math expert, but 4$ for 30 days worth of medication…$5 for 20 cigarettes that you smoke in one day….well, I guess it’s your lungs and your life. What I don’t understand is people that smoke two or three packs of cigarettes a day – when do they have time to do anything else? I guess if you light up the second you wake up, and then smoke yourself to sleep that night you could do it, but otherwise, man, that’s a lot of time spent puffing.
As for the last excuse, most cities have some sort of free-clinic(s) system set up - mine is no different - but like I’ve said before, it doesn’t matter how many free clinics there are, if the patients can’t get to them, they won’t use them. Now, you might say, “what about buses or trolleys?” Unfortunately, Mass Transit in this city is about as prevalent as actually disabled people applying for disability, so that’s out. The same goes for adequate sidewalks (not that most of these people could walk more than a block at a time anyway.) So, what do we do? Some cities have proposed a type of “mobile free clinic” that serves “needy areas.” What, however, defines needy? Should it just be limited to lower income populations, or should anyone be able to get, say, blood pressure medication or their eyes checked for free? Without delving in the whole socialized medicine debate, my own personal belief is that basic health services should be available to everyone regardless of economic status. As for more than that, well, that’s the subject of another blog.
So, in summation, we have a large number of people with high blood pressure who…
A:) Can’t afford to see a doctor to have their blood pressure checked and receive a prescription
B:) Can’t afford said prescription (maybe because they smoke, maybe other reasons)
C:) Are unable to travel to a free clinic to receive free medication
D:) And definitely can’t afford the resultant hospital bill when they stroke out or have a heart attack
What do we do with this problem? Aside from putting hypertension medication in the water, I feel that the only way we’re going to do something about this conundrum is to really increase the availability of basic care options throughout the city. That said, it doesn’t matter how many free clinics we have if people aren’t going to take responsibility for their own health. Maybe it seems like common sense, but if you have lung problems, don’t smoke. If you have heart problems, don’t smoke. If you want to get pregnant, don’t smoke. In fact, the only people who should be smoking out there are people who want to have that “aged” look without having to wait for time to roll by.
Sigh, I know a lot of times I sound like a broken record on this blog, but really people, please cherish your bodies – it’s the only one you’ve got. That said, wear some sunscreen, too. And exercise…oh forget it, you get the picture!
And now for the disability quote of the day:
Me: “So I see you’re on disability currently, why?”
Dude: “Because I got made fun of in school.”
Me: “There has to be something more than that.”
Dude: “Well, I was only reading at an 8th grade level in 12th grade. But I graduated anyway, so they can TAKE THAT, SUCKERS!”
Me: “Ok ….”
Dude: “Yep, I’m getting rich off of being clinically stupid.”
Prevention is the best form of medicine,
-DD
Since the last few entries have been more lighthearted, I thought that I would talk about something a little more medical today. I’ve had a plethora of patients recently that have all had severely elevated blood pressures, and (of course) they’re not on any type of medication. Most of them also smoke, say that they can’t afford any medication because it’s so expensive, and of course, and can’t go to a doctor because they can’t afford that, either. Let’s look at the first and second excuse.
A pack of cigarettes is around (last time I checked) $5. So if you smoke 1 pack of cigarettes a day, your habit just cost you $150 for that month. Lisinopril (a common first line high-blood pressure medication) is $4 for a month’s supply. Now, I’m no math expert, but 4$ for 30 days worth of medication…$5 for 20 cigarettes that you smoke in one day….well, I guess it’s your lungs and your life. What I don’t understand is people that smoke two or three packs of cigarettes a day – when do they have time to do anything else? I guess if you light up the second you wake up, and then smoke yourself to sleep that night you could do it, but otherwise, man, that’s a lot of time spent puffing.
As for the last excuse, most cities have some sort of free-clinic(s) system set up - mine is no different - but like I’ve said before, it doesn’t matter how many free clinics there are, if the patients can’t get to them, they won’t use them. Now, you might say, “what about buses or trolleys?” Unfortunately, Mass Transit in this city is about as prevalent as actually disabled people applying for disability, so that’s out. The same goes for adequate sidewalks (not that most of these people could walk more than a block at a time anyway.) So, what do we do? Some cities have proposed a type of “mobile free clinic” that serves “needy areas.” What, however, defines needy? Should it just be limited to lower income populations, or should anyone be able to get, say, blood pressure medication or their eyes checked for free? Without delving in the whole socialized medicine debate, my own personal belief is that basic health services should be available to everyone regardless of economic status. As for more than that, well, that’s the subject of another blog.
So, in summation, we have a large number of people with high blood pressure who…
A:) Can’t afford to see a doctor to have their blood pressure checked and receive a prescription
B:) Can’t afford said prescription (maybe because they smoke, maybe other reasons)
C:) Are unable to travel to a free clinic to receive free medication
D:) And definitely can’t afford the resultant hospital bill when they stroke out or have a heart attack
What do we do with this problem? Aside from putting hypertension medication in the water, I feel that the only way we’re going to do something about this conundrum is to really increase the availability of basic care options throughout the city. That said, it doesn’t matter how many free clinics we have if people aren’t going to take responsibility for their own health. Maybe it seems like common sense, but if you have lung problems, don’t smoke. If you have heart problems, don’t smoke. If you want to get pregnant, don’t smoke. In fact, the only people who should be smoking out there are people who want to have that “aged” look without having to wait for time to roll by.
Sigh, I know a lot of times I sound like a broken record on this blog, but really people, please cherish your bodies – it’s the only one you’ve got. That said, wear some sunscreen, too. And exercise…oh forget it, you get the picture!
And now for the disability quote of the day:
Me: “So I see you’re on disability currently, why?”
Dude: “Because I got made fun of in school.”
Me: “There has to be something more than that.”
Dude: “Well, I was only reading at an 8th grade level in 12th grade. But I graduated anyway, so they can TAKE THAT, SUCKERS!”
Me: “Ok ….”
Dude: “Yep, I’m getting rich off of being clinically stupid.”
Prevention is the best form of medicine,
-DD
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