Torticollis And Trismus

The patient sat across the ambulance from me. I'd spent a few minutes trying to work out what was wrong with him, it certainly wasn't the 'difficulty in breathing' that we had been sent on.

His head was twisted, his teeth were clenched. His legs were twitching. His eyes were darting around, sweat dripping from his forehead.

He was obviously in some form of distress, but I was at a loss as to what was causing it.

Then he mentioned he'd taken some of his brother's medication.

Medication that could cause these physical symptoms as side effects. Suddenly it all fell into place – by taking the medicine that hadn't been prescribed to him (and a sizeable dose at that) he'd brought these symptoms on himself.

I looked at him across the ambulance, while distressing I reassured him that the symptoms would be temporary and were not life-threatening.

“You won't be taking medicines that haven't been prescribed to you again will you?”, I asked.

“Nnnnneeeerrrrrggghhhh”, was pretty much all he could say through clenched teeth.

—–

I saw him walking out of the hospital a few hours later, fully recovered. We cheerfully waved at him as we drove past on our way to another 'difficulty in breathing'.

—–

For those who didn't spot it, the post yesterday was a parody of a BBC news item – a few changed words and a final insane sentence, and yet still all too believable. I would imagine I'm on a 'list' now…

—–

For this week's Monday question, my mum always complains, after she breaks a fingernail, that 'that's the one I use to pick my nose, how am I going to to pick it now!”. And I'm sure that we've all had parents say, “If you fall and break a leg, don't come running to me”. My Nan taught me that the Salvation Army kidnap and brainwash children.

What weird things have your parents said to you? What strange things have they had you believing?

55 thoughts on “Torticollis And Trismus”

  1. We used to think that if you blew a whistle, or stepped on a snail, it would rain.Our parents would tell us to share “brotherly” (ice creams, dessert or whatever). My older brother had me believe that this meant that the brother got the most.

    Our parents also would explain thunder and lightning as “a warm and a cold cloud crashing into each other”. I think this was just because the real explanation is more difficult, and I have used it on my own kids.

  2. In memory of my lovely paternal grandmotherI was a child with plenty of 'faces' in my repertoire.”Don't pull a face like that. The wind might change and then you'll be stuck with it!”I avoid mirrors now ;0)

  3. my mother wasn't one for stories (she was far too practical) & my dad was around often enough (military) for me to figure out that the when he tilted his head to one side & spread out his hands, that a story was to follow. & he did tell the best stories of times overseas (snakes so long they covered a two-lane road in vietnam)!

  4. My dad had a load of stuff he would tell us, the best were that eating lots of sugar ie chocolate, would make your blood boil. That as I was a bad writer the ironmonger shop had a machine which gripped your hand with a pen in it and forced you to write properly and neatly over and over again and he convinced my sister that he was a war hero because of a wound to his arm which in reality was a scar from putting his arm through a window while playing football as a boy (he was in the catering corp as a national serviceman). We carried this nonsense on and informed our children that they had a little thread that only parents knew about so if they were naughty we would unravel them and knit new children.

  5. Hi there :-)I've got a question regarding the medication your patient took (the medicine that was only prescribed to his brother), what was it called???

    I had a strange case the other day (I'm a paramedic in the netherlands btw):

    A 19-year-old female with DIB but when we arrived the whole situation was completely paradox and please keep in mind that NO illegal substance was involved here at all:

    She was very hot and very “flushed” with her skin having a kind of light “dotted pattern” and being completely (dark) red yet very, very dry (no sweat what so ever and she had difficults swallowing and speaking).

    When we asked her questions she hardly made sense repeating our questions or asking (after 2 sec): “Sorry? What did you say?” and she was serious (no acting whatsoever, she was completely confused and disorientated).

    She seemed to see persons and hear voices that just weren't there (e.g. answered questions that weren't asked) while staring straight on or closing her eyes but her legs were twitching and she found it impossible to sit still or relax. She DID NOT suffer from ANY mental illness (which her parents confirmed and they also said: she wasn't her normal self at all etc.) but she showed clear signs of paranoia, delusions and hallucinations to the point that the doctors in resus thought of administrating haloperidol (

    ) and refer her to the psychiatrists.

    Her bp was 190/110 and her pulse 150.

    Her temperature was 39 degrees.

    She stayed in resus for 3 hours.

    It turned out that she had taken 20 tablets of NYTOL – ONE A NIGHT with 50mg DYPHENHYDRAMINE per tablet (), a sedative anti-histamine, i.e. she had 1000mg of dyphenhydramine in her system.

    I have never seen anything like that before…..

  6. * If the the wind changes, your face will stay like that* When you get to be a big girl and you get a tummy ache every month and a man tries to put his arm around you, hit him with your handbag (i've been married, divorced and have three children so that didn't work!!)

    * If you pick dandelions and get the stains on your fingers, you'll wet the bed

    * Red Hot Pokers (the flowers), DO burn your fingers!! (my auntie told me this to stop me picking the 'flowers' to sword fight with them. I once ignored her advice and a wasp stung my hand – to this day I will not touch red hot pokers!

    * If the cows are lying down in the field it's going to rain

    * When it thunders it's just the angels playing skittles

  7. I convinced my younger sister that goldfish at rest always point towards magnetic north and my brother that they responded to the infra red from the TV remote control if you pointed it at them and pressed the buttons (I think it was coincidence that it worked when we tried it out…).

  8. I was afraid of open water till I was about 10 cause my mother said that the waves would take me away…also made me believe that “Davy jones' locker” was an actual place…as silly as that is

  9. My Mum used to tell us that when she asked my Gran why the kids at the top of the town (the posh end) got so many toys for xmas and and they, down the bottom, (the poor end) got so few, she was told that Father Christmas started at the top end of town and by the time he got to the bottom he didn't have much left. I used to believe that Saturday morning cinema (now l'm showing my age!) was a treat from my parents. It was only many years later that I made the link between the only time my parents got the house to themselves and the arrival of new brothers and sisters. Although we didn't go, I assume the same was true of my friends who were sent to Sunday School.

  10. my late father told me a story once of when he went ice skating and due to lots of people falling over and the sharp ice skates, that there was always lots of people losing fingers and thumbs… I have a mental picture of fingers rolling around the ice.Now that would ake some interesting viewing on a sunday night…!

  11. “Dont make any recipe that has more than 3 eggs in it as it will be too expensive. “I still struggle to break that instruction even though I will happily spend lots of money of the other ingredients.

  12. Well, as a kid, I occasionally didn't finish my dinner. This was fine as it was always because I genuinely wasn't hungry – nothing to do with wanting to rush back out to play because we had to sit at table until everyone was finished, and we had a sensible and long-standing arrangement that I could only have dessert if I cleared my plate.But sometimes, when I was very small, my mum would divide up what was on my plate and say “there. You can leave *that* lot, but you have to eat all of *this* lot.”

    Was she trying to get my vegetables into me? No. Was she trying to make sure I tried a mouthful of everything? No. No, the criteria for portion-division was based on the expensiveness of the items (despite the fact the money was already spent). I could leave behind as much potato and pasta as I liked as long as all the meat was gone. Leaving carrots was acceptable; leaving mange tout was not. Leaving any of something like steak was an absolute sin.

    In fairness, much of this was due to her own upbringing when they had one rasher of bacon between sixteen of them or something.

    As an adult, when faced with a plate holding more food than I can eat, I still divide it up accordingly. I suspect it will be an effort of will not to inflict similar patterns on my own future offspring.

  13. Oh, and the radiators… as a small and inquisitive child, I found out that turning the knob at one end of a radiator made it be warmer. My mum explained to me at some length that the correct procedure when cold was to put another jumper on and that I must leave the radiators alone and NEVER TOUCH THEM because they were Very Expensive.So fast forward almost two decades and I'm aged 21, temporarily back at my mother's house after the breakdown of my marriage, and staying in my old room. Mum enters the room to find me and a friend, each fully-clothed and decent, but also huddled in a duvet on my bed while chatting. The conversation went something like:

    “Aren't you two freezing in here?”

    “Yes, but we're under the duvet.”

    *Mum checks radiator*

    “This is still at 1! Why haven't you turned it up, now that you're living here again?”

    *me opening and shutting mouth*

    “cos touching the radiator isn't allowed…”

    *friend and mother wet themselves laughing*

    Although mum did then get a little bit worried about how I'd become that strongly indoctrinated. I think I was just a very obedient child with a tendency to take things to heart.

  14. i was always told that apple pips would grow into trees in my tummy,also if you stick you toung out and the wind changes your face will get stuck that way. i

    'm sure there were lots more but these are the two that come to mind.

  15. “Don't cycle in the gutter – germs will come straight up out of the drains and infect you.”Johnthedog – Of course Santa starts deliveries from the top of hills – it's much easier for the reindeer – they can just 'coast' down the slope!

  16. Good subject for Monday questions Mr Reynolds, but as I was brought up by a mother who firmly believed that fun was morally wrong and that laughter comes from the devil, methinks I'll pass – would take to long, but instead I'll share a few I've used on my kids :-When in France would tell the kids I only had English change in my purse, and vice versa when being pestered for rides on those rocking car things they have at supermarketsThat the tooth fairy couldn't get to their pillow cos their room was too messy – which was true cos I didn't fancy breaking my neck in silence on a carpet of lego & marbles, plus had forgotten to stop at the shops to get change(My own fault as to counterract my upbringing I wanted their childhood to be fun so was very bad at imposing chores)Skip forward a few years – that if their toyroom wasn't tidyish Santa wouldn't come

  17. My mum use to say that if we swallowed chewing gum it would wrap itself around our hearts and we would die.I am now a 41 year old cardiology nurse and yet I still get a shiver of fear if I should happen to swallow gum!

  18. Not from my parents but from Woodcraft Folk of which I was a member as a child.The older Woodies told the younger ones when we were camping that mummy and daddy sheep were very clever and taught the baby sheep to tuck in their legs and roll across cattle grids, which was why they're only ever used to keep cows in and not pigs so we should always be very careful to shut gates when rambling through the countryside.And when I got to be one of the older kids I did join in with convincing the younger ones that this was the case.

  19. I used the old “no ice cream when he's playing his tune” one too on my little boy. I also have a copy of “Great Lies To Tell Small Kids” for inspiration:a particular favourite – One in ten fish are afraid of water 🙂

  20. My Dad use to tell us if you undid your belly button your bottom would fall off.Latterly i'm covinced it came from a comedy show he watched, but at the time i was fascinated by the idea…

  21. My dad once bizarrely told me he could jump over our house – and I informed my teacher of this fact one afternoon.My cousin was generally the source of mis-information, including:

    – convincing me that he and his sister wore wigs because they could make their hairline move by rubbing their scalp up and down

    – Concorde would get from our house 'down south' to the midlands instantly. His reckoning was that concorde travelled at the speed of sound and when I rang my Nanny in the Midlands I could hear her voice instantly on the telephone. Therefore the speed of sound was travelling from my house to Nanny's in an instant, so clearly so could Concorde.

    – he also told me I was adopted. Despite being the absolute spitting image of my father, I decided to interrogate my parents just to be sure.

  22. I don't know what any of the above has to do with torticollis and trismus, which together make up some of the symptoms of drug-induced dystonia. That's what your bloke had, as I'm sure you're aware. Also known as extra-pyramidal side effects. I have a chronic condition that often requires a (fully justified) ride in one of your vehicles, and I'm usually cannulated for a shot of morphine. I've always had a dystonic reaction to prochlorperazine, and am terrified of it. It's sheer hell, and when your tongue goes into spasm and is getting dragged to the back of your throat DIB is a fair summary. So I always tell anyone approaching me with a syringe that if it's got Stemetil in it they can throw it away. Unusually, I have a similar reaction to metochlopramide, but this is less credible than prochlorperazine/Stemetil. So if you get a middle aged woman with chest pain yelling at you that the only safe anti-emetic for her is cyclizine, I'm visiting friends down south and I'm *not* looking for an extra buzz – I'm telling the truth. I'd rather heave my guts out on IV morphine/diamorph than go through five minutes of dystonia. I'm sure you know that procyclidine and similar anti-Parkinsonism drugs reverse dystonia, but they're not carried on ambulances. Maybe they should be.

  23. As a wee girl I was convinced, because Dad said so, that the trains crossing the Forth bridge from Edinburgh to Fife (and back again of course) went up and down the cantilevers. Like a big rollercoaster.I was eleven before I saw a train crossing and worked it out. Either I was exceptionally stupid or exceptionally gullible.

  24. Yes! Or brown paper. My sister was always travel sick and I remember her sitting on brown paper whenever we went on long journeys. I think the Jack and Jill nursery rhyme made me believe it was true

  25. My mother is one of 10 children, they all have blue eyes except for the youngest. My mum went to great lengths to convince my youngest aunty she was adopted, she told her she was found in a basket left on the steps with a note asking them to take care of her. My mum even wrote the note out, dipped it in tea, grilled it and scrunched it to make it look old. All the girls are the image of their mum including my youngest aunty but she believed her from the age of 6 to the age of 8

  26. Not exactly a lie my parents told me but I once asked my dad why there were no cars on the Forth Bridge – I actually said “Forth Rail Bridge”. It took a good 10 to 15 minutes before I understood (I was very young, about 7)

  27. Not my parents, but my Nana used to drive me crazy as a kid with the saying “there's no such word as can't”. As in 'you mean you WON'T'.I used to get so infuriated, and my reply was “oh, okay, jump off the roof and fly then -you mean you 'WON'T?”

    -which likely got me clattered for being cheeky.

  28. Lol, I used to say that kind of thing to my sister (she's a red head and we all have mousey brown hair). I think the story went along the lines of us finding her abandoned on a train track and my mum decided to take her in because she felt sorry for her. My lil sis says that she believed it for quite some time!

  29. My dad told me once that he'd played goalie for Arsenal – of course I was dead chuffed about that and spread it around the whole primary school.Years later when I was about 15/16yrs I recanted this story to him and he nearly died with laughter.

    He still brings it up now in front of his friends for a laugh – I point out that it taught me early on to ask Mum to confirm/contradict anything he says (and I still do!) : )

  30. Strangely enough I've seen it more with Metoclopramide than with Stemetil, but even then it is fairly rare.Except for yourself of course.

    There is actually a move away from automatically giving metoclopramide with morphine here in London – as long as you give the morphne slow enough it shouldn't cause nausea.

    I'm not sure if the cost of training and carrying procyclidine would be worth it for the very rare occasions we come across someone having a occular-gyric crisis.

    I wouldn't think that refusing the anti-emetic would result in an 'extra buzz' though, so you wouldn't be under suspicion for saying that.

  31. I am simple and did not not know what my Grandad was doing when he went to see a man about a dog ! and we are all simple Tom as we all like these questions !!

  32. my grandmother told me that if i stuck my bottom lip out in a pout, a little bird would come by and poop on it.my dad told me that i needed to eat more burnt toast and other burnt foods if i wanted to be tan like him (he's olive skinned but i'm fair like my mom). it wasn't until i was literally in my teens that i realized that he just couldn't cook and needed to find an excuse to get me to eat what he'd burned on the stove.

  33. Here's a few that my mum and grandparents use to say to me as a child:-Don't step on a crack or you'll break your mother's back

    -Don't stick your bottom lip out or a bird will come and poop on it.

    -Don't to whistle in the house (or barn) because it would call the devil

    -Never sweep after dark, either inside or outside, as someone you love will die by morning!

    The funny thing is I still won't do these now even though I know they are probably just would sayings to keep children in good behavior.

  34. I think the strangest thing my Dad would say to us was at the dinner table when we would whine and carry on about having to eat brussels sprouts or liver.”Shut your mouth and eat your dinner!!”

    Which is difficult at best.

  35. Not trying to be Tom but before I became chronically ill (recurrent DVT and PE, caused by antiphospholipid syndrome, and SLE if anyone's interested) I was both a nurse and, in another life, a pharmacy worker. Pharmacology remains my enduring interest both from the academic viewpoint and the quantity and variety of drugs I've been given. I had my first dystonic reactions to Fentazin, (perphenazine?) an anti-emetic that isn't used much now. It wasn't recognised as such but the symptoms recurred when I was given chlorpromazine. This time I was attended by a doctor who'd done a psychiatric elective, and he recognised the symptoms as being similar to those suffered by patients on high doses of anti-psychotics. Indeed, it was usual to give orphenadrine, benztropine or procyclidine (broadly anti-Parkinsonism drugs) to patients on high doses of phenothiazines, particularly the depot preparations. He was giving me procyclidine IV very slowly and once I could open my mouth we had an interesting chat about dystonia/torticollis/extrapyramidal reactions/oculogyric crises (thanks, Tom, I'd forgotten that term!). It's scary how few nurses, and even junior doctors, could recognise dystonia on the first few occasions it affected me. They're a bit wiser now, but I was once given adrenaline when someone wrote me up for Stemetil and I only realised when my tongue began to stiffen. I was treated like a lunatic, what with my rolling eyes, torticollis and impeded speech, until I wrote PROCYCLIDINE. NOW. OR I SUE. on every bit of paper within reach. So I'd guess that Tom's patient had taken a high dose of a phenothiazine. Haloperidol, chlorpromazine, promazine, trifluoperazine…… thank God they finally took thioridazine off the market a few years ago. Not only did it cause extra-pyramidal side effects, it was also widely implicated in causing tardive dyskinesia. I remember we used to shovel thioridazine down all the geriatric patients and there was a lot of unrecognised tardive dyskinesia as a result. It's an irreversible condition and manifests as lip smacking and chewing motions, extensive tics, tremor and agitation. Extensively disabling. All the phenothiazines can trigger it but thioridazine was so widely used that it was responsible for a great deal of TD.So the message is; it's not clever to take someone else's medication, or even a large dose of OTC stuff, as your patient found out. It was interesting to hear from Tom that metachlopramide (not a phenothiazine) isn't routinely given with IV morphine where he is. I'm on a maintainance dose of oral morphine sulphate and not troubled with nausea, but it can be the very devil to get a ward nurse to give IV morphine without an anti-emetic. There are some nurses up here who should have it drummed into them that patients know their own chronic illness and are no way challenging their authority by questioning just what's going to go down that nice needle. From a grumpy 'frequent flyer' who wishes she wasn't!

  36. Yeah though but I still ask if I can have a cake.Because you have to ask, if you want a cake.

    And I get irrationally angry when my brother and sister don't ask.

    Me- 28. Sister- 26 and married. Brother- 21. INDOCTRINATION.

  37. Ack. Refusing the antiemetic for me would result in horribleness. My GA 6 months ago- I needed ondansetron and cyclizine and o2 when I was recovering; I do not react well to opiates. Wasn't actually sick though but went an interesting shade of white and couldn't open my eyes for the nausea. No epidurals for me in labour.Interesting re the dystonic effects of antiemetics though, as we give them a lot in my job, something I will be mindful of.

  38. My parents had me believing for years there was an invisible old man who created the universe in six days and who then killed his son (who was also himself) to save my soul from eternal damnation.

  39. My late mother loved nothing more than a good laugh at someone else's expense. Apparently, a wasp will never, ever, sting you right on the tip of your nose.Try it.

    I did.

  40. My great aunt used to tell me that since there were children starving in Africa, I should eat everything on my plate, as if doing so would somehow relieve their suffering. To this day I blame this for the fact that I am overweight and that I cannot help but pick and pick until my plate is clean.

  41. my dad claimed that when he was a baby, his mother was told by “the doctor” that cats carry “germs” on their fur. he, my dad, could never be argued out of that one.he also believed that bathrooms should never be heated at all, because the bather would inevitably, faint, slip beneath the water and drown. although we were allowed to lock the door in summer, in winter if we dared to import the paraffin heater, he insisted the door be left wide open, thus negating the whole exercise.

    my ma had a whole raft of superstitions inherited from her ma. item, never bring may blossom or peacock feathers into the house. something dreadful would happen. I once caused her to have hysterics, literally, by trying to import some may. as to the feathers, she could never agree that the only bad luck around seemed to have accrued to the peacock, not the householder. item, never give anyone a present of an object with sharp edge(s). someone once gave me a pair of ice-skates, and ma insisted on giving the donor a halfpenny, otherwise “it will cut the friendship”. item, if you spill any salt, throw a pinch over your shoulder to propitiate the devil.

  42. The only one that hasn't been mentioned by others is that you shouldn't cross knives – so when you put two knives on a plate, in the sink or on the side, they mustn't cross or there will be an argument in the house.Doesn't apply in the bottom of the washing up bowl when it's filled with water or indeed in the knife drawer, however. 😀

  43. My mum swears that a dropped knife must be picked up by someone other than the person ho dropped it, and then no thanks must be offered to the person who picked it up.There is something about a dropped fork meaning a stranger is coming or some such nonsense.

    What a load of old wibble.

    Oh, and a gypsy tried to curse me yesterday. In Yiddish.

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