I announce my candidacy for the President of these here United States for 2012. As both a cat and a physician I think I appeal to a broad base of felines and physicians. After carefully studying the wide-eyed swooning of brainless drones in this election, my platform consists of the following:

Free cat food for everyone, and cat nip.

Free health care ( and vet care).

Free housing in an old ladies house where you can do as you feel until she dies and the authorities find you.

Free Shots (kids and kittens).

Free beer.

cigs.

$5,000 cash for any kid running around your house, or near your house, with, or without, a baby daddy.

Government jobs for everyone.

Make teasing a cat with a toy a hate crime.

Legalize alley cat-alley cat marriage.

Abortion on demand, or not.

Mandatory solar cars or horse and buggies.

Severely increase the progressive tax rate on those making over $150,000, or whatever number I feel like, to 95%. (Except for me and my home-stumps with our cash conveniently in a nice little bank in the Caymans)

Me and my elite rich friends get to have all the bling and tell you groundlings what to do; just don’t act like us.

Disregard that previous statement. I was typing while I was thinking about how good it was going to be to be in power and control people while giving them crumbs and keeping them dependent while I stay rich, bi-atch.

I did it again. I will now stop typing. In closing vote for me in 2012 because I will make your life so easy. You won’t have to work for the American Dream. I’ll give it to you for FREE. Hell, I am the American Dream, bi-atch.

I am hoping I can woo Al Franken away from you brain dead…er cranially challenged Minn. dipsh**s to be my running mate. I’m a shoe in if he can win. If not him then that old windbag who always looks like he’s about to take a dump Murtha. WTF. Like shooting, then eating, fish in a barrel. Ah hell, I did it again, I keep typing what I’m thinking. As long as I don’t say it on the campaign trail there is no way I can lose.

S. CAT 2012, CHANGE WE CAN REALLY REALLY BELIEVE IN, AGAIN, BI-ATCH

I love this story.

If Obama wins, expect more of this. You ain’t gettin’ what I got. The Socialist States of America can kiss my ass. Oh, and your little whiny, snot-nosed liberal spawn are going to get what they deserve. You can give them their ’soccer participation trophies’…we don’t want them. Our children will EARN their trophies, thank you very much.

Mean spirited? Hey, you start screwing with what made this country great and we’ll fight back. WE’RE JUST GETTING STARTED.

Lofty’s back in the house!

Losing bets sucks. Losing them big really sucks. Here’s payment.

A “nightstick fracture” is classically produced when a person raises their forearm to shield themselves from a blow with a blunt object (a nightstick, billy-club, or baseball bat for instance).

This injury is particularly painful and usually requires surgical repair, or as we abbreviate in the ER, “ORIF” for “open-reduction with internal fixation”. This is because the radius and ulna have a proximal articulation that is very precise and will not work correctly without being very well aligned.

Since the advent of “tasers” and pepper-spray I see less of these than I did 15 years ago. And not everyone who sustains one of these fractures is fleeing from the police; some are the victims of robbery or plain old assault.

Based on the following video, however, I think we might see more of these soon. If you see a large crowd coming towards you wearing brown shirts I recommend running… fast.

“Altered Mental Status” is a challenging workup in the ER. These patients come in by ambulance or are hauled in by family because they are “not their normal selves”.

As a physician one must act quickly as some causes of altered mental status are life threatening. A CT scan of the brain is almost always ordered, and sometimes it provides an answer.

The scan above shows a meningioma and, similar to the XRays from a few days ago, is an ‘incidentaloma’ in this case. The patient above was near death when he arrived, was severely dehydrated, but should do well nonetheless. Unfortunately, as can be seen from his scan, he is very old, has severe cortical atrophy and, at baseline, is quite demented.

Without writing an exhaustive post about altered mental status it is amazing what slight alterations either in brain chemistry or brain structure can do. For instance, while the patient in question was comatose upon arrival other people with “altered mental status” are combative and require restraints.

If this meningioma was more toward the front of the brain and a bit lower one might see all manner of bizarre behavior as the frontal lobes act as the seat of personality and judgement. Occasionally, patients with frontal lobe tumors (or injury) exhibit frontal release signs, and I’m sure right now there is a medical student or neurology resident busily memorizing these.

Many times the cause of altered mental status is immediately obvious on history and physical exam (”two beers”), but occasionally patients manage to speak quite coherently for a bit before you realize that they are way, way off. In fact, it is a curiosity that many people are able to “cover” a bit as, theory has it, on some level they realize that they are confused but do not want you to realize it. This curiosity is called “confabulation“.

The real question is whether the patient will recover, and this leads to a long and complicated differentiation between “dementia” and “delirium” which is quite beyond the scope of this post.

Finally, “delusions” are fixed, strongly-held beliefs that are demonstrably false, and when these are combined with “psychosis” the results can be devastating. Witness the following…

Other forms of altered mental status are more subtle, perhaps the most difficult to diagnose is transient global amnesia… a temporary and quite complete loss of memory. This is a diagnosis of exclusion in the ER, and is related to the rarely seen fugue state, which is demonstrated in the following…

Ok. In a display of bipartisanship before the election, I carved two pumpkins for the M.D.O.D. crowd. Notice that I put Obama on the left and McCain on the right just for clarity. I’m giving my sister these pumpkins for a raffle at her school. I’m curious to see who brings the highest prize! Trick or Treat?!? You be the judge. Happy Halloween! -85

In an effort to get Etotheipi and Lofty (and you too Oldfart even though you have a good excuse) to quit hitting the bong and get back on the blog I’m posting this film to allow them to wax poetic about the diagnosis. Interestingly, the ‘wow’ part of this film is an ‘incidentaloma’, in other words, the abnormality on this film does not explain the patient’s presenting complaint.

I did take this as an omen when I saw it however, as these thingies on the film all make a nice “O” shape and this, honestly, this was the first thing I thought of, drawing all sorts of allegorical connections about how they are representative of the accretions of doomed-to-fail socialist, anti-American crap espoused by the real life Invisible Man. Emotion over substance, concentrated, morbid, warmed over elitist, ivy-league, never worked a real job piss.

My first patient tonight also got me thinking. He is the archetypal pitiful, dependent male, who, at age sixty, can not answer any of my questions about his medical history, instead saying, honestly, “ask mama“. Mama is mad at the hospital who saved his life because he’s sick again.

He arrived here two weeks after his life was saved, at taxpayer expense, after he left my ER against medical advice with appendicitis. He ended up, a day later, septic and near death at the Mecca, and was there and in rehab for 45 days. The bill to the taxpayer? $300,000 roughly.

He has not been taking any of his medicine on his ‘medson’ list, and is very ill again.

Fine. There have always been people like him and always will be. The reason for me mentioning his case is not to poke fun at him… there’s no fixing him unless I could put him in a time machine and enlist him in the Marines at age 18. But this is just the point at which I part company with the modern liberal.

The modern liberal, exemplified by the unsullied one, believes that government can make his life better. Yes, I am angry right now, and I’m angry not at my patient, but at my highly educated friends, many ivy-league graduates among them. They are the power behind what could be the most disastrous election since Carter, and they are children.

How else does one explain this… I exchanged emails with a friend the other day who admitted he was going to cast his vote for “O”. His reason? “The free market is dead“. Really? Who killed it?

This guy is the head of an academic department at one of America’s best hospitals. He has degrees from one of the most prestigious academic institutions in America. He is smart and an incredibly skilled physician. How, in the name of all that is holy, can one believe this?

The answer is to either stand to benefit immediately from the thievery OR to ignore history, let your emotion rule your intellect, to have a deeply buried hate for the common folk (and the American warrior), AND to live within the doors of the academy (oh, and listen to NPR, love that idiot Keith Olberman, participate in candlelight vigils, and to trap all your farts in a jar to prevent global warming).

To those of you who know me, I’m sorry, I can not continue to have friendly chats with you… I’m not going to send you a ‘festivus’ card this year. I have wonderful friends, many of whom have put their lives on the line for the very Constitution that the glorious one thinks is “flawed” (which is certainly true as men wrote it), but the audacity to believe one has the ‘fix’ is megalomaniacal.

The unsullied one and the gaffe-machine commonly called Joe Biden utter Fighting words. I wonder if they are being heard?

Could this be a preview of the 2012 Presidential Debate format?

I was thinking about Obama’s pledge to ’spread the wealth around’ and I don’t like it, BUT, I would be in favor of him ’spreading motivation around’ as I am particularly lacking it at this time (as are many that will vote for him). In this video I see a whole bunch of guys who are obscenely overstuffed with motivation and I don’t know where they got it from and it’s NOT FAIR! I am looking forward to my motivational injection should the glorious one carry the day (and this will indeed be ‘change’). HOO-FUCKING-YAH!