I get soooo tired of hearing about neuros that make up their own rules to diagnose MS, or misunderstand the McDonald Criteria, or who are just plain arrogant and dismissive. One day I woke up with this playing in my mind:

Patient walks into doctor's exam room and nurse asks, "Why are you here?"

Patient - "I've been diagnosed with ADS - Appendage Dropoff Syndrome."

Nurse, "Okay, the doctor will be in shortly."

Doctor - "Good Morning, I'm Dr. Pfufinek. What can I do for you?"

P - "Well, I was diagnosed two months ago with ADS, but now my insurance has changed, and I'm worse, so I'm coming to you for care"

Dr. - "How was the diagnosis made?"

P - "Well, first my pinky and ring finger on the left fell off. Then, a month later my left nostril fell off. And shortly after that I lost my right earlobe."

Dr. - "I don't diagnose ADS until 4 appendages have dropped off."

P - "Well, that is four, a nostril, an earlobe and 2 fingers!"

Dr. - "I would count the two adjacent fingers as one appendage."

P - "Okay, that's why I'm here. Yesterday my right arm dropped off, and I'm really worried! That makes 5 appendages, or four by your count. Shouldn't I be on some Disease Modifying Drugs to slow all this down?" The Patient lays the arm down on the doctor's desk.

The Doctor puts on gloves and distastfully sets it aside. "Hmm...Does your urine glow in the dark?"

P -"No, but the McDougal Criteria don't require urine to glow in the dark. And besides, only 80% of confirmed cases have it"

Dr. - "I won't make the diagnosis without glowing urine. Besides you're too old"

P - "But, there is no upper age limit. Lots of people older than me have been diagnosed with ADS. I've already been diagnosed and I'm getting worse. I'm desperate! Every morning I count everything to see that it's all still there!"

Dr. - "Ahhhhh, I see. You're anxious....Do you have a history of anxiety?"

P - "Only since things started falling off on me."

Dr. - "I think you should have a psychiatric evaluation. This all is just probably a stress reaction.

P - A STRESS REACTION!!!! MY ARM JUST FELL OFF!!!

Dr. - "Hmmph! Have you had all of the mimics excluded? "

P - "I think so, I was checked for Farm Equipment Accidents, Gangrene, Motorcycle Crashes, Recurrent Ninja Attacks, Machine Shop Malfunctions, and evidence of Werewolf Infestation. And of course, I was checked for Absentmindedness, but there was no evidence that I merely mislaid something and didn't notice."

DR. - "Is that all?"

P - "I think so. What about a DMD?"

DR. - Well, I don't think you're bad enough off yet to begin treatment. And there is no evidence that your disease is progressing.

P - What!! MY ARM JUST FELL OFF!!!

Dr. - "Any number of things could have caused that."

P - I don't understand how you can say that. Other people with less disease than I have get the DMD's. That's the current recommendation. How can you say I'm not "bad enough?"

Dr. - "You can still walk and have full full use of your left arm, except for the two fingers. They really aren't that much help anyway. But, you should be evaluated for Leprosy. Many people don't know that this, too, can mimic ADS. It's rare, but someday I will find a case. I have a contact at a leper colony in Brazil." The doctor walks to the door, "Nurse, Please quarantine our patient here and make preparations to ship him immediatley to Brazil."

The Patient is led away in shock and bewilderment.

Sound familiar to anyone?

Quixxle