"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