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All Ears

General health problems such as ear infections, pink eye and influenza affect nearly every person eventually. Rod Moser, PA, PhD, shares information and advice here on the most common general health disorders, their symptoms, treatments, and prevention.

Thursday, September 03, 2009

The 12 Most Annoying People at the Movies
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I like going to the movies, in spite of the fact that movie tickets are over priced, and you need a home equity loan to get popcorn and sodas anymore, it is nice to see first-run movies on the big screen. I usually lie to my wife about movie start times because she is chronically late. Arriving late at a newly-released movie could be a major problem - only seats in the front, or no two seats together. Of course when you arrive early, you have to wait another 30 minutes of previews and commercials until the feature film begins. Waiting for the move to start, I have pondered as to who are the most annoying people at the movies.

1. TALKERS. Probably the most annoying of all would be the (adult) talkers. It is okay for children to talk a bit, since it is important to ask questions, but when adults are carrying on an active conversation about non-movie issues, it drives me crazy. Even with the loud speakers in the movie, it can be difficult to drown them out. It seems that the more I try not to hear them, the more I hear them. When this occurs, I try to turn around and look at them (Why do they tend to be behind you?). Sometimes, they get the idea, and sometimes you do have to turn around and ask nicely if they could not talk. It is best NOT to turn around to see what gestures they are making.

2. ROCKERS. Movie seats rock. Why? Do we really need to rock in our chairs while watching a movie? Those seats are designed to lean backwards to make you more comfortable, but I don't think the intention is for perpetual motion during the films. Rockers tend to be seated in front of you. Children like to rock in their chairs.

3. BIG and TALL. Tall people have the right to attend movies, but whenever possible, they should seat themselves in the back; certainly not in front of me or in front of one of my little grandchildren who will immediately crawl on to my lap so they can see. Now, I am not a small person by any means, but I do not hang over into the adjacent seats. The morbid obese really need to have some consideration for others and try to keep their stuff on their sides.

4. BUFFER SEAT PEOPLE. American movie theaters are filled with buffer seats - single empty seats between couples. In the days were we had ushers with flashlights walking around, there were no buffer seats. We had to sit next to anyone and everyone, including smokers in my day. Buffer seats are usually piled high with coats, purses, and those huge empty popcorn buckets. "Is this seat taken?" One member of the annoyed couple will gather up their stuff, pile it on their lap, and glare at you for the rest of the movie. I am sure they are thinking why I had to sit there and not up front in one of those empty seats under the screen.

5. ARM STEALERS. There are no hard and fast rules as to who owns the seat arm. Usually the first one that arrives claims the seat arms next to the buffer seats. When someone sits in the buffer seat, they have to tightly fold their arms against their chests, waiting anxiously for the arm-owner to scratch their nose, reach for some popcorn, or leave their seat. It is then and only then that you can quickly snatch and claim your seat arm. Your arm will eventually fall asleep since you will not move it again, no matter how uncomfortable you become. Two strangers cannot touch arms.

6. LOUD EATERS. Popcorn could be considered a quiet food, IF the eater would just chew with his mouth closed. How hard is that? If you can't chew quietly, for whatever anatomical or psychological reason, don't eat, or buy Gummy Bears. Someone cracking and snapping gum with the mouth open can drive me nuts. I once sat next to a man that whipped out a heavily-onion laden sandwich. He would literally moan as he devoured it. I quietly wished I had brought some garlic kettle chips, corn nuts, and pork rinds.

7. LEG JIGGLERS. Some people do have restless leg syndrome, but that is supposed to be a nighttime issue. There is really no reason for a responsible adult to twitch there legs like an Irish dancer. A mindless leg jiggler sitting twelve seats away can jiggle the entire row, like a seismic wave. A leg jiggler seated directly behind you can literally knock your glasses off. Granted, I may have an extra sensitive butt to this type of rhythmic torture, but sometimes, I have to move seats, becoming one of those hated buffer seat guys.

8. SNACK BAR ADDICTS. I have completely given up buying movie popcorn. I want popcorn, but I will not pay extortion. For those people who choose to buy popcorn; most will have it all eaten before the movie starts. The big bucket popcorn people will go out for their free refills, walking right in front of you. They will wait patiently until there is a good scene, and then slowly crab-walk in front of you, dragging their ample buttocks inches from your face. As soon as the movie gets good again, they will return with their stash, usually crunchy food, piled high in one of those cardboard trays.

9. STRAW USERS. We have to use straws in the movie, lest we block the person behind us chugging down a tall Coke. Straws should not be used to repeatedly slurp the last bit of moisture in a cup, even if the ice melts to provide more liquid. Straws should never be used as a musical instrument, pulling it in and out of the plastic lid, like some sort of bizarre cello.

10. CELL PHONE USERS. Do people consider themselves so important that they cannot turn off their cell phones for an hour or two? Yes, you might get a call from the babysitter informing you that she can't find your two-year-old, but that would be rare. I have sat behind someone with a bright-screen cell phone who seemed to be watching a movie, at the movie. People will actively text. Some will try and talk softly - "I can't talk now, I am in the movie. No way. She said that! Oh, she is such a bee-atch!"

11. RECLINERS. If you are lucky enough not to have someone sit in the buffer seat directly in front of you (the one next to me), it does not mean you can use the seat as an ottoman. If your legs are so long that they will not fit comfortably in front of you, then perhaps you should stay home and rent movies. Some recliners feel they are being courteous by removing their shoes first, apparently unaware of their malodorous feet.

12. PEOPLE WHO ARE INTOLERANT OF SNORERS. If a movie does not particularly appeal to me, I will quickly fall asleep, and yes, I may loudly snore. At least, I don't talk in my sleep. It annoys me to no end if they wake me up. My granddaughter woke me up during a Harry Potter film. I don't remember which one.

There are so many more that I could discuss: the silent farters, the movie critics, the experts who have seen the film before ("Watch this scene coming up; it is so cool."), the idiots who don't pay attention ("Who is that guy again?"), people who smell like cigarettes or booze, the scratchers (goodness knows why or what they are scratching), and the criers (usually, my wife).

I think that I prefer renting DVDs...less people to annoy me, cheaper popcorn, and I can sleep when I want. If I miss a scene, I can just play it back.

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Posted by: Rod Moser_PA_PhD at 7:35 AM

Wednesday, January 28, 2009

The MEDICAL Darwin Awards
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After over three decades of medical practice, I have seen quite a few interesting cases. Today, someone sent me the new Darwin Awards - a dubious award where the "winner" was either killed or seriously injured doing something really, really stupid. The medical profession really doesn't have awards like this, so I thought I would share some of my own - my top ten medical "Darwins":

1. Laying an Egg
A home-schooled young man was bored one day and decided to see what it would be like to lay an egg. So, in a moment of discovery, he inserted one of those plastic Easter eggs up his curious butt. In spite of his efforts to lay this egg, it became permanently stuck. After a few days of "constipation", he was seen. A laxative was recommended. It did not work. I saw him and examined his rectum, only to feel a smooth plastic object. Initially, he denied inserting anything, but after several attempts to remove this mysterious object, he finally ended up in the operating room where both halves of this plastic egg were removed. He had to undergo a colostomy for several months after having a large section of his colon removed.

2. The Baby Jesus
He was only four years old. He informed his mother that he put a "toy" in his nose. On examination, I noted the bottom of two tiny feet in his left nostril. Using a foreign body forceps, I grasp those little feet and gave birth to a tiny figure of a baby. "That's the Baby Jesus from my miniature manager!" cried the mother. No one really knows what motivates a child to insert objects into various body orifices.

3. Homemade Pole Saw
Pole saws are expensive, so this enterprising man decided to duct tape a regular chain saw to a large stick so he could cut some of the limbs higher in the tree. He started the chain saw, locking it into high gear. He was proud of his new invention, but the vibrating chain saw came loose from the duct tape. He attempted to catch it, but realizing this was not a good idea, landed on the ground. The running chain saw landed in his lap. Fearing the worst, he presented to my clinic in a panic. After cutting off his partially-shredded pants, I informed him that the vital organ of his concern was still there, but maybe a bit smaller. He looked down and told me that it was always that size. He was happy.

4. Bees for Arthritis
His hand was huge; nearly twice the size of a normal hand. He read an article that many people were using bee venom to treat arthritis. Since he had arthritis in his shoulder, he attempted to catch a bee in his hands and holding it to his shoulder. The bees, unaware of the location of his arthritis, repeatedly chose to just sting him on the hand.

5. The Growing Skin Lesion
Skin cancer was prevalent in his family, so Dad was very concerned when he noticed a growing, brown skin lesion on his 8 year old son's neck for the last month. Upon examination, it did not appear as a cancer. Taking a wet and soapy gauze pad, I simply removed this mysterious lesion. It was dirt. Patient cured. Dad embarrassed.

6. Dangers of Smoking
Children see parents smoking, so they naturally want to see what it is like. After being caught stealing a cigarette, two enterprising young kids decided that they would make their own tobacco. The boys picked an impressive number of leaves from the wooded area behind their home, including some bright-colored red ones. They carefully selected and dried the leaves, and rolled a big doobie using a piece of typing paper. Coughing and hacking away at this noxious homemade cigarette, the real danger came a few days later when they were covered head to toe in poison oak. Two boys learned a valuable lesson about plant identification and the dangers of smoking. I have to admit, that I was one of those boys. I have never smoked (anything) since that fateful day when I was ten.

7. What Do You Say to the New Grandmother?
She was 16 year old and overweight. My PA wife was seeing her in the clinic because of abdominal pain and vaginal discharge. Upon examination, it was quickly determined that the discharge was amniotic fluid - this teen was delivering a baby and didn't even know she was pregnant. While waiting for the paramedics to transfer her to the hospital, my wife had to inform the puzzled mother that she was also going to be a grandmother today.

8. Home Vasectomy
He was a physician (and his own patient). Why pay someone else for a vasectomy when you could simply do it yourself? So, while sitting on the toilet at home, this misguided medical professional attempted to inject lidocaine into his scrotal area in preparation for the "first cut". It was unbelievably painful to do this on yourself. After the first cut, the wound started to bleed profusely. He felt a little woozy and passed out. He woke up a few minutes later, on the bathroom floor, in a pool of his own blood. Several years later, he had the job finished by another physician, who questioned the one-sided scar. A half vasectomy is really worthless.

9. Fart Attack
She was eight years old and doubled-over in abdominal pain. Her anxious mother felt she had appendicitis. Upon examination, it was discovered that she did not have signs of appendicitis, but rather had a large amount of intestinal gas. "I cannot believe that this is just gas," said the mother. No sooner than those words left her lips, that the longest, loudest fart erupted from this little girl. At one point, I thought she lifted a bit from the examining table and hovered. "I feel so much better, Mom". Case closed.

10. Never Show a Mother How to Insert a Rectal Suppository
When a child is vomiting, anti-nausea medications are often administered rectally - by suppository - to help control those symptoms. A young mother expressed that she had no clue how to insert them in her two-year old. In one of my teaching moments, I decided that I should show her how to do. Taking a suppository from our office stock, I told her to place the child across her lap and pull down his diaper. "All you need to do is pull apart those little butt cheeks, and gently insert the suppository into the rectum." No sooner that I said "pull those little butt cheeks apart", a geyser of diarrhea shot into the air; hitting me in the face, beard, and dripping down my glasses. The mother was covered, too. When a medical provider is covered in crap, you get little sympathy from your nursing staff. You do receive a lot of inappropriate laughter. I was offered a change of clothes (OR scrubs) from another physician in our office - a size that would have fit a ten-year old. I am sure I received my share of stares when I went home to shower, wearing one of our paper examining gowns. In the world of primary care medicine, "[You Know what] Happens."

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Posted by: Rod Moser_PA_PhD at 7:00 AM

Tuesday, January 20, 2009

"ALL EARS"
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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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Posted by: Rod Moser_PA_PhD at 11:00 AM

Monday, December 22, 2008

Twas the Night Before Christmas - The Medical Perspective
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As a child, I was fascinated by this old poem by Clement Clark Moore. As a seasoned medical provider, I tend to look at most things from a "medical perspective" - analyzing the passages a bit more methodically.

"Twas the night before Christmas, and all through the house, not a creature was stirring, not even a mouse."

This really concerns me. Was the family somehow comatose, perhaps from carbon monoxide? When people and even mice are out cold, this is not a good sign. Hopefully, they weren't burning charcoal in those fireplaces.

"The stockings were hung by the chimney with care, in hopes that Saint Nicholas soon would be there."

Let's hope those stockings were hung with care. A stray spark from that fireplace could ignite those hanging stockings, especially the ones with COAL! As a child, my stocking alway had coal.

"The children were nestled all snug in their beds, while visions of sugar-plums danced in their heads."

I have had a lot of weird dreams in my life, but I can't say I have ever seen dancing sugar-plums. Sugar can sure zip-up kids before bed, but I am thinking "substance abuse". Could there be hallucinogenic drugs, mushrooms, and other mind-expanding substances involved here? Could those sugar-plums have turned to alcohol?

"Mama in her 'kerchief, and I in my cap, had just settled our brains for a long winter's nap."

So...I am imagining two people in bed. Mama is wearing only a handkerchief; Papa is in a baseball (?) cap. I think something is stirring...and it ain't a mouse! Looks like someone's getting his Christmas gift a little early.

"Then out on the lawn there arose such a clatter, I sprang from my bed to see what was the matter."

Isn't that always the case? You are getting down to some serious lovemaking, and something or someone interrupts you. It is usually the kids: "Mom, I keep dreaming about plums..." "Don't come in; go back to bed."

"Away to the window, I flew like a flash, tore open the shutters and threw up the sash."

And what did Saint Nicholas see? A naked man, wearing a baseball cap, standing in an open window - The Full Monty. If I were Santa, I would definitely hesitate about going into that house.

"The moon on the breast of the new-fallen snow, gave the luster of mid-day on objects below."

Note the clever use of the words "moon" and "breast" in this passage, as well as "objects below". I will leave that to your imagination. Imagination - isn't that what Christmas is all about?

"When, what to my wondering eyes should appear, but a miniature sleigh, and eight tiny reindeer."

Now, this would freak you out; perhaps make you question the expiration date on the egg nog you drank before bed.

"With a little old driver, so lively and quick, I knew in a moment, it must be St. Nick."

Or, perhaps you didn't pay your mortgage and some old man from Fanny Mae is coming to throw you out? Did you take undue advantage of those teaser interest rates? Did you make your car payment this month?

"More rapid than eagles, his coursers they came, and he whistled and shouted, and called them by name."

Now that's nice. First, St. Nick interrupts some good, 'ol, yule-time lovemakin'. Now, he whistles and shouts. Or, maybe St. Nick finally looked up and saw the flasher standing in the window.

"Now Dasher! Now Dancer! Now, Prancer and Vixen. On, Comet! On, Cupid! On Donner and Blitzen!"

What kind of names are those for reindeer? They sound more like exotic dancers. Oh, well...what goes on at the North Pole, stays at the North Pole.

"To the top of the porch! To the top of the wall! Now dash away! Dash away! Dash away all!"

If I were trying to fly a bunch of reindeer up on a roof, I think I would do the wall first; then the porch. You don't see many walls up on a roof.

"As dry leaves that before the wild hurricane fly, when they meet with an obstacle, mount to the sky."

??? What the hell does that mean? What obstacles are we talking about here, Mr. Moore? This passage has always been the big obstacle for me.

"So up to the house-top the coursers they flew, with a sleigh full of toys and St. Nicholas, too."

St. Nick apparently gives up on that wall/porch route. Now, he is getting somewhere.

"And then, in a twinkling, I heard on the roof, the prancing of pawing of each little hoof."

You are going to be doing some roof repair in the morning. Think about getting dressed.

"As I drew in my head, and was turning around, down the chimney St. Nicholas came with a bound."

Old homes usually had more than one fireplace and chimney. Apparently, St. Nicholas, in his rush to quickly get things accomplished, came down the one in the master bedroom. Or, maybe, just maybe, mama and papa were getting in on in the living room after the kids went to bed.

"He was dressed all in fur, from his head to his foot, and his clothes were all tarnished with ashes and soot"

I did not know that Santa only had one foot. It doesn't really surprise me, though. Looking at the way he takes care of himself, I am thinking "diabetes with a foot amputation". And, we certainly have a hygiene issue here.

"A bundle of toys he had flung on his back, and he looked like a peddler, just opening his pack."

Or, someone has broken into your house and is about to rob you...or worse. You definitely should have gotten dressed...

"His eyes how they twinkled, his dimples how merry! His cheeks were like roses, his nose like a cherry."

I am now thinking "pink eye"; maybe Fifths Disease, although this would be highly-unlikely in the elderly. That red nose? Alcoholism? Rosacea? Congenital deformity? I can't really get a good look.

"His droll little mouth was drawn up like a bow, and the beard on his chin was white as the snow."

The mouth: Bells palsy? Stroke? The beard is normal, of course. Many of us have white beards.

"The stump of his pipe he held tight in his teeth, and the smoke it encircled his head like a wreath."

St. Nicholas was a smoker. It isn't bad enough just to be obese, have one foot, diabetes, Bells Palsy, pink eye, Rosacea, etc., you gotta smoke too? That's probably what all of those ashes and soot are about - riding around in that open sleigh tokin' on your pipe. You might as well add lip cancer to that medical problem list.

"He had a broad round face and a round little belly, that shook when he laughed like a bowl full of jelly."

The face? He has got to be either hypothyroid or have Cushing syndrome. The belly? It could be a tumor, edema, ascites from advanced liver disease, or just a serious lack of sit-ups.

"He was chubby and plump, a right jolly old elf, and I laughed when I saw him, in spite of myself."

Yes, he laughed...in spite of the fact that he was still naked and wearing a baseball cap; his scantily-clad wife crouching behind the sofa. Clearly, Santa has an elevated body mass index (BMI) and apparently, doesn't really care about his overall health. I bet those reindeer would have something to say about his weight.

"A wink of his eye, and a twist of his head, soon gave me to know, I had nothing to dread."

There you are...standing buck-naked when a big, dirty, fat, one-footed, grinning, red-nosed, diabetic, stranger who just jumped out of your chimney, winks at you, and you think you have "nothing to dread"? Think again.

"He spoke not a word, but went straight to his work, and filled all the stockings, when turned with a jerk."

This is just too weird. He's not talking, but he is abruptly turning and jerking. Stroke with aphasia, maybe? Parkinsonism? Seizure disorder?

"And laying a finger aside of his nose, and giving a nod, up the chimney he rose."

If you are going to pick a booger, Nick...just pick it. Don't try and fake it by nodding and putting your finger "aside" your nose, like we all do when someone catches us. And, don't try and wipe in on the couch! I am standing right here!

"He sprang to his sleigh, to his team gave a whistle, and away they all flew like the down of a thistle."

Thistle down kind of floats in no particular pattern, a virtual slave to the the wind. This is really no way to get places quickly; especially when you seem to be in a hurry.

"But I heard him exclaim, 'ere he drove out of sight, Happy Christmas to all, and to all a good-night."

Not "Happy Holiday"? He apparently didn't hear me tell him that he needs a complete physical, some baseline blood work including a complete metabolic panel, nutritional consultation, smoking cessation classes, and neurological consult.

Now, where was I before I was so rudely interrupted? Where'd 'ya go, Mama?

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Posted by: Rod Moser_PA_PhD at 7:00 AM

The opinions expressed in the WebMD Blogs are of the author and the author alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD Blogs are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on WebMD. WebMD does not endorse any specific product, service or treatment. If you think you have a medical emergency, call your doctor or dial 911 immediately.