Never Use a Waterpic to Remove Earwax (And Don't Let Your Doctor Do It Either)

There is an interesting posting on the Ear, Nose, and Throat message board from MollieMae01: Water Pick Injury:

boltron / CC BY-SA 2.0

"My 2 year old daughter was being checked for an ear infection (She is in good health and has never had any ear problems or infections before. We also had her ears tested a few months ago by a specialist and they were fine.) and the nurse used a water pick to clean the wax out for clear viewing. My usually quiet daughter screamed like we were torturing her and when the nurse removed the water pick from her ear canal a substantial amount of blood followed."

During the California Gold Rush, huge amounts of rocks and dirt were removed from ancient bedrock by a technique called hydraulic mining (Placer Mining). Water was fired at high pressure to loosen compacted earth. As a matter of fact, my neighbor has an old hydraulic nozzle sitting in his yard as a display. Until this method was outlawed, millions of dollars of gold was extracted. Of course, the sludge clogged streams and rivers, causing devastating floods; the land was marred forever.

Hydraulic mining is not unlike the ear lavage. To safely extract impacted ear wax, it must first be softened, and then it needs to be washed out with a GENTLE stream of warm water. The key point here is "gentle".

The Waterpic was hot in the 1970's. Designed as an adjunct to dental hygiene, the Waterpic proved to be an effective tool, especially helpful for those with braces. It didn't take long before people started finding other, non-dental uses. These were untested and unapproved uses not condoned or encouraged. We had one in our family practice that we used to irrigate wounds, and yes, irrigate ears that were impacted with wax. The most important lesson that we learned was adjusting the force of the pulsating stream. High settings had the potential of splash-backs. You really didn't want to have contaminated water splash back in your eyes or mouth! If the high setting was used for cleaning out the ears, it could easily rupture the eardrum. I must say, that on the low setting, it seemed to be an effective irrigation tool as long as you were careful. The problem with this unapproved use was cleaning the instruments. Medical offices, as you know, are not the cleanest places on Earth. The Waterpic was primarily plastic, and plastic cannot be adequately sterilized between patients. In a busy medical office, you never knew what it was used for previously. After a short while, the Waterpic was permanently abandoned as an ear or wound irrigator. It probably ended up at Goodwill.

Speaking of unintended uses, Q-tips are not promoted as a tool to remove earwax, but yet, they are used for exactly that purpose. Some people - and you know who you are - are literally addicted to Q-tipping their ears every day after every shower. Many will go through their entire lives thinking earwax is dirt, or implies that you are an unclean person, and must be removed. Earwax is one of the most beneficial substances made by the body. It protects the delicate lining of the ear canal and it is antibacterial (prevents skin infections). It should NOT be removed, unless of course, it is deeply impacted. And, in most cases, earwax is deeply impacted BECAUSE people are using Q-tips to pack it in, just like loading a Civil War cannon.

Welch-Allyn, a respected manufacturer of fine medical tools and instruments, re-invented an ear irrigator several years ago for clinic use. It, too, had a pulsating stream, powered by the water pressure from our faucets. The clever design even created a vacuum to catch the extruded chunks of wax. Always a fan of new gadgets, I got one. After using it a few times, I found it cumbersome and messy. My old method actually worked better. It is now sitting in a box somewhere in our clinic. The special faucet adapter is still attached, but I doubt I will use it again. I guess that some clinicians really like it.

The trick in cleaning out the ears is really related to visualization. Unless you can actually see what you are trying to clean out, it is not wise to blindly dig in an ear, let alone try and wash it out with a stream of water. The rubber bulb syringe that comes with commercially-available ear-cleaning kits can work, but the stream is really a bit too large. I always have this fear that someone will fail to read the instructions and jam the bulb syringe in the ear and squeeze. This, of course, would be an automatic eardrum rupture. Since this is the same (or similar) bulb that parents use to suck snot out of their baby's noses, they may think that can suck out earwax. You cannot. If you try and suck out earwax with a bulb syringe, you will simple suck out (and rupture) the eardrum.

Since you can't really look inside your own ear, you will need a trusted friend or partner with a home otoscope. If you start inviting people over to your home, asking them to look in your ear to see if you have a wax impaction, you are going to lose a lot of friends. The Japanese - a culture that seems to be obsessed with clean ears - does have a fiberoptic video device for those who really want to peek inside their ears. I have never seen or used this home model video otoscope, but I suspect the resolution is not that good. Besides, there is always going to be an odd spatial orientation that you will need to overcome. I would love to be able to have a good video otoscope unit in my office so I can show patients their ears, but good ones are really cost-prohibitive. So, the bottom line: If you are going to be cleaning out your own, or anyone's ears, you need to have an otoscope to look FIRST.

A painful, potentially-infected ear should never be washed out...by anyone. In a medical setting, we often have to remove cerumen (earwax) in order to adequately examine the eardrum, but we use a wire loop or cerumen spoon. This is NOT the same as Grandpa digging wax out of his ear with a bobby pin or paper clip. Medical providers learn how to do this, and they have the ability to actually see (with an otoscope) what they are doing. Anyone who blindly digs in their ears with homemade instruments is really a fool. It is only a matter of time before you rupture your eardrum. Q-tips are also Weapons of Ear Destruction, causing many of the unintentional ruptures that I see in the office.

If I do need to lavage an ear, I have several instruments that I use. There is the metal syringe that can be autoclaved, and of course, my homemade ear lavage unit made from a 20-50 ml syringe and a piece of IV tubing or intracath - items not available at the local Walmart. It is really not the tools, but the skill of the person using the tool. I am not bragging, but I have never met a wax impaction that I couldn't beat. It may take me a while, and I may consider blasting from time to time, but in the end, I do get it out. Unlike ENT offices, I do not have an ear vacuum device. I could sure use one though, if my medical group would see fit to cough up the capital expenditure funds. Since my homemade unit costs less than a buck, they are less inclined to order one.

Unlike the old days, I would never use a Waterpic to wash out an ear. If your doctor has one, just say "No thank you." If you see one at Goodwill, don't buy it. If you have one at home and are tempted to use it, I hope I have changed your mind.

If you know what you are doing, have the right equipment, and common sense, ears can be safely lavaged out at home. Sometimes, it is best to leave the job to a medical professional.

Da...da...da...da. Da...da...da...da. Wax Man!

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Are You Right-Eared or Left-Eared?

Dean Shareski / CC BY-SA 2.0

What happened to in-flight entertainment? On my recent flights, there were no movies, no headphones for music, and no magazines. I long for the day when flight attendants would cruise the cabin, handing out a variety of magazines. Now, we have to buy our own magazines (at airport prices) and books, bring our own food/snacks, and supply our own entertainment.

The guy across the row from me was happily watching a video and wearing those noise-canceling headphones, periodically chuckling. As soon as the movie was over, he had one of those new electronic books, and started to read a novel. This man was prepared. I bought a TIME magazine at the news stand, but read it all waiting for my flight to leave. This is equivalent to eating all of your popcorn before the movie starts. I started leafing through those in-flight magazines (Spirit) and found an interesting article that I would like to share.

Did you know that 72% of people prefer to listen with their right ear? It is not really due to the fact that you are right-handed either. The left side of the brain specializes in language processing and is neurologically wired to the right ear. Consequently, the right side of the brain that deals with emotional cues is wired to the left ear. Two Italian researchers found that requests spoken into the right ear generates more positive responses than those uttered into left ears.

I find this very interesting, since I am one of those right-eared people. If I hear something subtle outside, I will turn my right ear to the noise. I tend to keep my wife on the right side when she is talking, too. She sits to the right of me when I am driving, and on the right when we are at the movies. When she nags me, she is usually on my right, but now that I have this information, I may turn my left ear in her direction. Of course, I do have tinnitus which is primarily in my left ear, so I suspect my right ear has more acute hearing.

We don’t have any young children in the house anymore, just dogs and puppies. We do have grandchildren, however, so I am going to try and voice those requests to pick up their stuff, or take a shower, etc. in their right ears, hoping of course, for those positive responses. I am going out on a limb here because I don’t think teenagers really respond to either ear, but I am going to try it on our 16-year-old granddaughter.

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Antibiotics for Middle Ear Infections - Love 'Em or Leave 'Em

Antibiotics have only been in the medical arsenal for about 75 years, starting with sulfa drugs in the 1930s and penicillin in the 1940s. There are now dozens of different and more potent antibiotics, but very few new ones are patented. Since their discovery, antibiotics have saved umpteen millions of lives, and still do everyday. However, antibiotics have been heavily used and abused from their debut. Slowly but surely, they are become less and less effective.

As a child, our local, small town GP used to give injections of penicillin for just about any reason, it seemed. If you had a sore throat or tonsillitis, you got a shot of penicillin. If you had a fever for unknown reasons, you got a shot of penicillin. If you were uncooperative in his office, fearing that you will get a shot of penicillin, you got a shot of penicillin. He was such a shot-doctor, that kids would not even go to his door for Halloween.

In the U.S. as in many other countries, antibiotics are controlled by medical prescriptions. However, in places like Mexico, you can simply walk into a pharmacy and buy them - assuming they are "real ones" and not fake, counterfeit substitutes. With a Canadian doctor's prescription, you can easily buy large quantities in Canada. It is not uncommon for Americans to smuggle antibiotics in huge amounts across the borders, primarily for personal use, or share among friends. Some people have literally become Amoxiholics!

Antibiotics are only used to treat susceptible bacterial infections. They are completely ineffective against viruses - the main cause of most diseases. If they are self-administered indiscriminately for viral illness, not only will they be ineffective, they can make things worse. Sub-therapeutic doses of antibiotics help create resistant strains - the dreaded Superbugs. Primitive microorganisms can rapidly adapt to most antibiotics, even when given appropriately. There are bacterial strains out there that are completely resistant to EVERY known antibiotic. You really don't want an infection from these guys.

One of the major reasons antibiotics are prescribed for children is for the treatment of otitis media - the middle ear infection. Surprisingly, the vast majority of middle ear infections in children will resolve spontaneously in a few days, WITHOUT antibiotics. So, why do clinicians keep giving them and parents keep demanding them? That is the billion dollar question. Controlled, scientific studies in the U.S. and Europe have proven time and again, that antibiotics are only needed for the treatment of otitis media in very young children with immature immune systems, immunocompromised children (children with diabetes, cancer, etc.), or in children that are very toxic-appearing. These are the children who are very ill, in extreme pain, and not fighting off their infections naturally.


In Europe, children with otitis media are not routinely treated with antibiotics for at least the first week. That does not mean they are not treated in other ways for these painful afflictions. Children are routinely given pain medications - usually more than just acetaminophen or ibuprofen - to make them more comfortable while Nature orchestrates the cure. In the U.S., the typical care involves the early use of antibiotics, even in cases where the child does not even have signs of middle ear infection, and mild pain medications.

Over 90% of European children get better, on their own, with just pain medications, and tend to have fewer recurrent middle ear infections and need for surgical tubes. The U.S. kids tend to get better, too, but with potent and expensive antibiotics on board that more and more clinicians feel are unnecessary. Old treatment habits are hard to break.

I had a posting on the Ear, Nose, and Throat message board recently by a person inquiring about the proper dose of amoxicillin for her two children. She felt that the doctor's dosage was way too high, and that she would prefer to give half-doses. I really wanted to tell her that antibiotics are not really needed at all in most cases; but of course I knew nothing about her children and cannot blindly tell her not to use them. I assume that her children were properly examined, and probably treated with the appropriate dosage of amoxicillin. For most clinicians, treating otitis media is really routine stuff. However, most clinicians have not jumped on the "no antibiotic" bandwagon.

When amoxicillin first came out, maybe twenty years ago, it was dirt-cheap - only a few dollars for a standard, ten-day course. Children were treated, based on body weight, at about 20-30 mg/kg per day, in three divided doses. Amoxicillin virtually replaced ampicillin - an antibiotic that had some nasty gastrointestinal side-effects (like explosive diarrhea) and had to be given four times per day, a dosage nightmare for busy parents. The bubble-gum flavored amoxicillin even tasted better. For nearly a decade this dosage seemed to work great. Later, studies started to show that amoxicillin can be given twice a day, even more convenient for busy parents, and for as little as five days instead of ten.

My wife and I used to teach an all-day pediatric class for child care providers. I remember putting my lunch in their refrigerator, only to be shocked by the dozens and dozens of bottles of amoxicillin, all lined up for the various kids.

As the years progressed, everyone started using amoxicillin (a lot), still the drug of choice for otitis media. Unfortunately, amoxicillin started to fail as resistant strains took over. Many clinicians would abandon using it after the first-failure, until studies showed that a higher dose was more effective. Now, the standard dosage for amoxicillin (in children) is 60-80 mg /kg - more than twice the original dosage.

There are now about two dozen different antibiotics that can be used for pediatric middle ear infections. Every day in my clinic, I encounter the otitis media frequent flyers, usually on their way to the surgery center for tubes. There is a better way, but it is going to take a partnership of parent and medical provider to change the way we treat these kids. We need to trust that our immune systems have protected us long before the advent of antibiotics, and will continue to do so, IF we give them a chance.

Parents can help by not insisting on antibiotics, especially when clearly told that the child does not have a middle ear infection at the moment. Sure, they may get one tomorrow or over the weekend, or while you are at Disneyland, but that never justifies giving antibiotics prematurely.

Medical providers need to stand their ground and resist antibiotic solicitation from worried parents. Instead of medication, a healthy dose of EDUCATION needs to be administered. Parents who have children with frequent ear infections need to have a home otoscope, and learn how to use it. Medical providers have an obligation to cooperate with these novice otoscope-users, and encourage, not discourage their use. Parents should choose a medical provider that allows for this type of participatory care.

I still feel that antibiotics are miracle drugs, but the real miracle is to know when and how to use them. The bugs are getting smarter, and we need to be smart, too - always staying one step ahead.

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Acoustic Insults

It has been a long time since I experienced "airplane ear", but this weekend reminded me that all of us are subject to sudden acoustic insults. I spent the last few days at a conference for the California Academy of Physician Assistants in Palm Springs, where I was invited as a speaker. I am proud to say that I started this organization 33 years ago in my living room; funded by $500 of my own money. The organization now has thousands of members and a $1 million budget. This literally blows my mind.

Once you have been in this profession over 25 years, you earn the title of a "Dino", short for dinosaur, of course. I have been a Dino for many years now, so a Co-Dino and I were asked to speak to a group of students. Both of us were PAs before they were born, so it really made us feel very old. Every year, we see fewer Dinos and more of the younger clinicians. This is excellent since the youth of an organization and profession are the leaders of tomorrow. Long after I am gone, this organization will continue to flourish with this new transfusion of fresh blood.

One of the entertainment venues at the conference was a PA Idol competition and dance. When I saw those refrigerator-sized speakers being put up, I made sure that I found a place far away. When the music started, the volume was unbelievable. I put tissue in my ear, but no sooner that I did this act of protection, people started to talk to me. All that I saw was mouths moving. I would usually give an affirmative nod. If they seemed pleased, the nod was appropriate. If they looked shocked, I would shake my head "No". When you think about it, I had a fifty percent chance of responding correctly, even though I had no idea what they were saying.

The bass notes made my head roar and body shake. I had to get out there. Walking outside, I was finally able to achieve some silence. As I expected, this brief acoustic insult exacerbated my tinnitus. My ringing had doubled in volume. I also had a little vertigo. Needless to say, I did not stay and watch the completion. This increased tinnitus continues, but if I stay busy, it does not interfere with my daily life.

On the flight home, I experienced barotitis - ear pain associated with atmospheric pressure change; also called "airplane ears". Periodically, my ears would clog from leaving home (2500 feet) to working in the valley (300 feet), but they would usually equalize after an hour.

This was not a typical flight: faster take-off and rise to cruising altitude, and a faster landing. I suspect all of this was done to make-up time. Our flight was delayed about 25 minutes for some reason. About fifteen minutes into the flight, my left ear felt like it was going to explode. All of my self-equalization techniques failed. My left ear was nearly deaf at this point, with my tinnitus interfering with any remaining hearing. Fortunately, this was only a one hour flight so my ear pain improved, along with my hearing as soon as we descended to a few thousand feet. When I arrived home, I used an electronic device called an EarPopper to further help equalize the middle ear pressure. It seemed to really help.

The last time that I had a barometric-related incident was about twelve years ago while landing in Detroit. For some unknown reason, the plane suddenly descended (I would sure like to know why). The drop was so rapid, I thought we were crashing. I was sitting in the worst seat of the plane - two seats in the back, under the engine, near the stinky bathroom, and with no window. I was sitting with an elderly woman, perhaps in her eighties. She must have noticed the blood draining from my face and obvious fear. I was clutching my painful ear (other people were doing this, too) with one hand, and the other sweaty hand was clutching the arm of the seat. She started to gently stroke my arm.

"Don't worry, Honey. You will be fine."

Of course, we landed safely, but it took four days to be able to hear normally again; my left ear ruptured from this incident.

After my experience this weekend, my left ear is acting up again with loud tinnitus and diminished hearing. That brief acoustic insult from the loud music, coupled by this barometric incident has taken a toll on my aging ears. Hopefully, things will quiet down in a few more days.

Acoustic incidents can happen so fast; so unexpected, that we often have little opportunity to extricate ourselves. I quickly left the blaring music, but I had no way of escape from the plane. The human body has a remarkable ability to recover from these events, so I will be happy when my pre-existing tinnitus goes back to its normal, constant whine and squeal.

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CTAs as WEDs - Weapons of Ear Destruction

willc2 / CC BY-SA 2.0

In the early days of the Iraq War, Special Forces were scouring the area around Baghdad, looking for WMDs, like poison gas, missiles, or Saddam's nuclear arsenal. Although puzzling at the time, our dedicated troops found tons of cotton-tipped applicators (Q-tips) earmarked and destined for the U.S. The goal was to flood the market and encourage Americans to clean their ears. A large number of people would be rupturing their eardrums, causing damage to their hearing, and setting themselves up for infections in the ear canal. This was a dastardly and evil plan, striking at the closed doors of our bathrooms. Had it been successful, people all over the Western World could become seriously addicted, cleaning and scratching at the inside of their ears at every opportunity. Soon, pencils, paperclips, and bobby pins would be substituted. The productivity of workers, with one hand dedicated to ear-cleaning, and the other free hand attempting to type, would drop. Eventually, our economy would suffer, the stock market would plummet, with only a few companies thriving, perhaps those companies that make these Weapons of Ear Destruction.

Little did Saddam know is that Americans and other countries are already hooked. Along with toilet paper and tissues, our medicine cabinets were well-stocked. Made of tightly-packed cotton and paper, Americans were not going to be taking any unnecessary chances should these commodities suffer.

Q-tips do not damage ears or rupture eardrums. PEOPLE damage ears and rupture eardrums. Perhaps due to social consciousness or even litigation, the makers of Q-tips have tried to warn the ear-cleaning addicted masses not to stick these things inside the ears. I am using the term "Q-tip" in the generic sense, and in no way am I pointing fingers at a particular company or their finely-made product. Anyone can make cotton-tipped applicators (CTAs) in a free-market, and there are imitations galore - imitations with wooden sticks long enough to protrude through the other ear, or tips that fall off inside your ears. A significant portion of an ENTs practice is diagnosing and repairing damage due from these CTAs - The Weapons of Ear Destruction.

Unlike the requirements for cigarette makers putting scary warning labels on the packages, CTA manufacturers can still package them like they did in the past. In some countries, smokers will see gross pictures of cancerous lungs and blackened /missing teeth on cigarette packages - perhaps aimed at those who cannot read the warning labels. I am proposing now that CTA manufactures put two pictures on their packages: One with a big circle with a line through it, showing a CTA inside an ear, and another showing the face of a puzzled person in pain, blood pouring down the side of their neck, holding a bloody CTA.

I have done my very best to discourage the use of CTAs and ear-cleaning on the WebMD Ear, Nose and Throat message board, and the All Ears Blog, but the message has apparently met deaf ears (as you might expect!). I have been anxiously waiting for some celebrity to take up the cause. When a celebrity gets a type of cancer or Parkinsonism, they become important spokespersons for the cause - raising awareness and raising money for education and research. Everyday, I watch the news hoping to hear about some ear-prominent person has been permanently injured. Prince Charles has prominent ears. So, does Ross Perot, Dumbo, and my favorite, Bugs Bunny. Now that I think about it, maybe this is why Bugs Bunny says, "What's up, Doc?" Elmer Fudd aways seems to be sneaking up on him, so maybe he doesn't hear very well? Perhaps he tried to clean out his ears with a carrot!

If Valerie Bertinelli can lose a ton of weight and thus promote Jenny Craig, maybe someone will surface for my "Ban the CTAs" campaign. I was going to write a letter to Jerry Lewis, but I think he is contractually tied up with another worthwhile project.

I could write some pseudo-science studies and publish them on the Internet. People believe what they read on the Internet, no matter how ridiculous or medically-unsupported. I suspect someone will be quoting my Saddam Hussein Q-tip Plot Revealed! When I read this story to my wife a few minutes ago, she said, "Is that true?" I rest my case.

I can try and link the use of CTAs to erectile dysfunction or obesity. For instance, "Researchers found that obese people clean their ears on a regular basis. Is there a link?" "Men with erectile dysfunction admit to regular Q-tip use." Once you get an article on the Internet, it will be quoted forever. People will then say that they lost 37 pounds in three weeks after giving up Q-tips. Actually, you CAN lose weight by using Q-tips to eat, instead of a knife, fork, or spoon. I will write a book and promote the Q-Tip Diet! Oprah, here I come.

The Federal Government is handling out a lot of cash lately, to auto companies, banks, and failed brokerages. The "Cash for Clunkers" campaign gave a few billion dollars so that people could upgrade their cars. Maybe I will write to President Obama (he has some pretty big ears that seem suspiciously clean on those close-ups) and ask for some money. As soon at this Mexican/Swine/H1N1 global influenza pandemic thing is history, maybe there will be some money left.

I already have some possible slogans and t-shirt ideas: "Skip the Tip." "Avoid the Wax Pack." "Here's to Ears!" "Don't Clean Children's Ears - They Don't Listen to You Anyway." "Don't be a Rear, Stop Cleaning Your Ear." Or my personal favorite: "Cleaning Cerumen - Not Part of Groomin'."

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"ALL EARS"

There are only so many things that I can discuss regarding the ears, but as you may have guessed, the All Ears blog is more than just ears. At first, I decided on the name, since a good listener should be "all ears." I think I am a good listener, although my wife would probably dispute that statement. I hear her, but I must admit, I do "tune her out" from time to time. I love her dearly, but her stories go on...an on...and on. Even when I say, "Cut to the chase..." or "Get to the point...", she continues on her complicated and convoluted stories. I have to take notes and reminder her that I am not her hairdresser. I guess I am not "all ears" all of the time.

For some reason, medical visits are timed - usually fifteen minutes or less. There are few things in life, other than sex, that we can accomplish in fifteen minutes or less, yet the medical establishment feels that all issues can be properly addressed in this time period.

In order for me to be "all ears" in the examining room, I do have to get the patient to cut to the chase, especially when I am running behind. I would love to listen to life stories and talk about peripheral issues, but sometimes we just have to talk about why I am seeing them today. I hate when my medical assistant says there is a sore throat in room #1. I have to remind her that it is a PERSON who happens to have a sore throat in room #1. Of course, sometimes, they are in room #2, not #1 - a different, albeit, annoying issue we often encounter in busy medical offices.

A seasoned clinician should be able to address a sore throat in fifteen minutes, right? Well, that depends on the person attached to the throat. If the person is a smoker, or elderly, or a teenager, or appears to be seriously ill, this may not a garden-variety sore throat. A prostitute with a sore throat is a different ball game. The sore throat can be a cancer, mononucleosis, herpes, or any number of diagnostic possibilities. The sore throat can even be a smoke screen. Many times, a person will make the appointment for a sore throat, when they really have other, more important issues they would like to discuss. I'm all ears at this point.

People are both fascinating and complicated. The more you learn about a person, the more you know what makes them tick. Good listeners have to ask good questions, and one of the most important questions to ask a patient is, "What do YOU think it is?" What are the underlying concerns? If a medical provider whisks through an office visit, only to take a quick look in the mouth, pronounces that you just have a virus, take two aspirin, and don't call me in the morning, they are not going to get to the true issue. This patient may be a long-time smoker who just lost a good friend from cancer. Unless you ask...unless you are all ears and listen, you will not discover the true reason for the visit. This "treat ‘em and street ‘em" approach has absolutely no place in medicine.

On WebMD's Ear, Nose & Throat message board, I encounter many people who walk away from a medical visit with a prescription for amoxicillin without really knowing why. The medical provider did not tell them their diagnosis or reason for the antibiotics. They do not know their prognosis, or when they should expect to feel better. They were told nothing. This is NOT a good medical visit and the fault lies with BOTH the patient and the provider. The patient was not assertive enough to get their needs met, and the provider was not caring enough to spend a few extra minutes to listen. If the practice of medicine was this easy and quick, we would have drive up windows like a fast-food restaurant.

"Would you like fries with your amoxicillin?"

"Pay at the first window; pick up your amoxicillin at the second window. Have a nice day."

When you are all ears, you have lots of stories to share. When time permits, I love to talk with my patients. I found out recently that one of my patients raises buffalo. A week ago, I was surprised by a bag of ground buffalo meat, some steaks, and ribs. Now, if that wasn't worth a few minutes of friendly talk, nothing is. A few years back, I had a fisherman as a patient that brought me in a thirty pound albacore tuna (frozen). Why? Because I listened to his stories.

Several years ago, I was given a huge box of home-grown vegetables and a LIVE TURKEY when I made a house call to a homebound patient. When I listened to her plight, I felt that a rare house-call was the most appropriate utilization of my time. I don't do them often, but if people keep feeding me, I think I will re-evaluate my practice - low overhead, work out of my car. It pays to listen.

The All Ears blog is really my stories. All of the stories are all true; perhaps the names have been changed to protect the innocent (or not). They are stories from behind the examining room door and stories of interesting lives. They are stories that are a window to my soul and a backdoor to my often-bizarre sense of humor. They are the random vignettes of my life so far. They are stories about kids, old people, boogers, turkeys, circumcisions, Chinese, bad drivers, laxatives, coal miners, a dozen dirty places, dolphins, births, deaths, onion sandwiches, sex, Santa Claus, vaccines, dogs we love, and wiener dances. There are over 300 of them in the archives if you would like to read them. Sometime, they are even stories about ears.

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