Blokitis: An emerging disease amongst males

   by  Andy Todd 

Disclaimer: The the following is a satirical collage of observations and clinical experiences treating a particular type of New Zealand male patient, known as a “Bloke”. The intention is to educate men through satire. If you blokes are offended, you shouldn’t be so emotionally fragile. 🙂

Note: Most of the article is satirical, however the segments on neurological findings and treatment recommendations are not intended as satire, but as a sincere clinical approach to help people whose behaviors described below have become harmful to themselves or others.

“Blokitis” or “Bloke’s Disease” or “Alpha-Man-itis”:

An emerging disease amongst males.

By Dr. Sam Shay, DC, DACNB, FACFN, PGDip(Acu)

Functional Neurologist, Chiropractic neurologist, Acupuncturist, and general non-Bloke (aka “nerd”)

Updated June 14, 2014

Request for update to the DSM V for the addition of “Blokitis”, aka “Bloke’s Disease”, “Bloke-itis”, “Alpha-Man-itis”, “Alpha-itis”, “Domineering Disease”, “Jockitis”, “Jock’s disease”, or “Jock-itis”.

Definitions:

0. A ‘bloke’ is a term for an Australian or New Zealand male, akin to a North American “jock”.

   0. For purposes of this article, ”Alpha-Man-itis”, “Alpha-itis”, “Domineering Disease”, “Jockitis”, “Jock’s disease”, and “Jock-itis” are the equivalent to “Blokitis”.

   1. Note: For the purposes of this article, “Jockitis”, “Jock’s disease”, and “Jock-it is” do not refer to an untreated fungal infection of the groin.

1. A “Blokite” is a person suffering from Blokitis.

Relevance: Blokitis is a serious condition as the consequences can range from creating general nuisances in social gatherings to divorce, loss of employment, and/or emotional turmoil. Chronic Blokitis may cause severe cardiac consequences, such as fatal arrhythmias, if left undiagnosed and untreated.

Disease name: Blokitis, Bloke’s Disease, or Bloke-itis.

• Disease general description: The collection of behaviors and mental patterns of teenage to middle-age males which leave them vulnerable to injury, disease, and early death, based around their hyperactive left-brain activity with a particular fixation on physical prowess despite injury, pain, or dysfunction.

0. Different categories of Blokitis exist, usually classified by region and culture. Affects, behaviors, and preferences (e.g. rugby versus gridiron) vary between different classifications of Blokitis, yet the overall clinical presentation and neurological findings are very similar.

1. This article focuses on the New Zealand variant of Blokitis, as the author of the article lives and practices in New Zealand. The New Zealand variant of Blokitis has a particular affect best understood a hybrid of Mexican machismo and Canadian stoicism.

• Gender specificity: This disease mostly affects males. However, Blokitis has been known to afflict females on rare occasions, who are known as “Blokettes”. Male blokes usually react with amusement, confusion, and/or fear of Blokettes.

• Onset: Puberty

• Duration: Puberty into early 20s, with a downswing during the initial phases of marriage, followed by a very strong resurgence during a midlife crisis. Symptoms of Blokitis usually subside after the birth of a child, a significant job loss or a promotion, major injury, heart attack, and/or a family tragedy.

Symptoms:

0. Social

   0. Excessive interest in sports, sports paraphernalia, sports TV shows, and sports events.

      0. Obsession with fishing is a normal sequelae of Blokitis, particularly between sports seasons.

   1. Usually linked to low-grade alcoholism, especially during sporting events. Binge drinking on weekends is typical, worse in social groups of other Blokites.

      0. Blokitis is contagious, particularly in pubs on weekends when “rugby is on”.

1. Physical

   0. Mild hypertrophy of the right bicep from: a) showing it off too much, or b) from holding too many beer cans.

      0. Note: a Blokite usually has peculiar deficit in sensory perception of his own sarcolemmal (muscular) development, commonly perceiving the sarcolemmal volume of his own right bicep as much larger than it actually is.

      1. A Blokite’s neurological deficit causing him to misperceive the size of his own anatomy probably applies to other areas of his body too.

   1. Reported high tolerance for physical pain and/or under-reporting of physical pain. When high pain levels are reported, a Blokite will frequently solicit congratulatory guttural acknowledgements from other Blokites.

   2. A thick muscular neck, usually with large visible jugular veins.

      0. A large vein running superior to inferior along the forehead is also typical.

2. Emotional

   0. Strong emotions are only shown during sports events, especially excitement, disgust, ridicule, hostility, and anger.

      0. Selective emotional hearing related to the above-listed emotions: Typically unable to hear/understand/nuance other emotions, particularly coming from the female gender.

   1. Failure to understand the basic physics of sound propagation:

      0. For example, Blokites will curse loudly or shout advice to professional athletes and/or coaches who are: a) on TV and thus cannot hear the ‘advice’, or b) at a live sporting event but are too far away to hear the ‘advice’.

Clinical presentation:

0. A Blokite usually presents with significant physical injury, commonly of the low back, knees, or right upper extremity, causing functional deficit in social and work life (e.g. not able to play rugby). A Blokite usually shows up when other methods (e.g. painkillers and duct tape) have failed.

1. A Blokite usually refuses to fill out paperwork in full, defaulting to tick marks or single-word answers. When pressed for more information, ambiguous grunts are the usual verbal response.

2. During the discussion of his case history, the Blokite will:

   0. a) Recite a long list of physical achievements in sports, work, and personal life.

   1. b) Ensure the clinician knows how “busy” the Blokite is and therefore needs to get better immediately.

   2. c) Minimize all physical injuries suffered when younger, especially as a teenager to early 20s, such as sports injuries, car accidents, and teenage mishaps.

   3. d) Dismiss old injuries with a ‘knowing chuckle”, as if the injury is an inside joke or there is supposed to be some mutual understanding between the patient and the doctor that the injury is ‘normal’ and ‘amusing’.

      0. The Blokite also expresses the same ‘knowing chuckle’ when they refer to encounters with women in their past.

   4. _e) Commonly use minimizing phrases in reference to old or existing injuries such as “She’ll be right”, “Oh, but I’ve had that for years”, “It doesn’t bother me much”, or “You’ll just fix it right up”. A ‘knowing chuckle’ usually follows.

      0. A Blokite will commonly dismiss chronic unresolved injuries with “I’m just getting older”. The patient typically refuses to acknowledge the connection between repetitive or significant injury from prior Blokitis-related events with the chronic unresolved injury.

         0. In an extreme example, the author of this article had a 27-year-old Blokite complain of a right shoulder problem “because of age”. The author’s response to this Blokite’s assessment was, “Really? How much older is your right shoulder compared to your left?” The Blokite’s did not respond except with a nervous laugh. What followed was a discussion (minus the word “Blokite) about the supposed correlation between age and health. That discussion is paraphrased below.

            0. In the author’s opinion, breakdown and dysfunction of a body part do not have a positive linear correlation to age. Rather, “overuse/abuse over time” of a body part more accurately correlates to breakdown and dysfunction, not simply time itself.

            1. As a common example, Blokites more frequently complain about right shoulder (versus their left shoulder) problems due to “age”. Somehow Blokites do not realize that most of them are right-arm dominant, therefore they overuse/abuse their right shoulder over time much more than the left. Hence the higher propensity to chronic issues in the right shoulder from overuse/abuse over time, not just because of time itself.

   5. f) Inform the clinician that they expect to get better, not only quickly, but back to the level of physical performance and prowess from their peak athletic years.

   6. g) Refuse to discuss diet, especially beverages alcoholic in nature.

Note: the following sections ‘neurological findings‘ and ‘recommended treatments’ are not satire, but actual analysis and methodology of treatment for a low functioning right neocortex and post-concussive syndrome. The language may get technical for some, but have a read anyway. Satirical writing begins again under the section ‘prognosis’.

Neurological findings and recommended treatments: The simple version for the general public.

A Blokite has decreased right brain function that makes him left-brain dominant. Left-brain dominant behaviors prioritize action over thinking. When one acts without thinking, behaviors can range from ADHD, absent-mindedness, taking unnecessary risks, and even violent behavior. Hyperactive left brain activity can also create a higher risk for fatal arrhythmias (heart attacks) because the left brain controls the rhythm of the heart.

A Blokite may have head trauma, which damages their brain. Brain damage can cause restlessness, anxiety, aggression, and even depression which leads to numbing behaviors like alcoholism or other addictions.

Recommended treatments include:

1. Proper evaluation for brain imbalance, head injuries, misaligned joints of the spine and extremities, nutrition, sleep, exercise, diet, nutrition, toxic exposure, and other areas of health.

2. Balance out the brain (typically by strengthening the right side of the brain) through the modern science of neuroplasticity.ⁱ Neuroplasticity is the study of new brain growth and connections using brain activation activities. Ideally, neuroplasticity is aimed at the weaker functioning side, such as the weaker right brain of a typical Blokite. Brain activation may include using the 5 senses in novel ways to stimulate specific areas of the brain. Adjusting the spine for stuck joints is also very powerful way to activate the brain and stimulate new growth and connections. Without brain activation, neuroplasticity cannot happen.

   1. One of the easiest and most powerful methods of brain activation includes seeing a chiropractic neurologist. A registered chiropractic neurologist can properly evaluate brain imbalance and treat using specific chiropractic neurological adjustments of the spine, arms, and legs to activate the deficient side of the brain, as well as give brain-based activities to a patient to continue brain activation at home. Qualified chiropractic neurologists are found at http://www.acnb.org/DoctorLocator.aspx.

3. Increase oxygen to the brain through rib adjusting, using nostril expanders while sleeping, and nutritional evaluation to help absorb, deliver, and utilize oxygen in the cells. Without oxygen, the brain cannot grow and make new connections properly or quickly.

4. Nutritional therapy to decrease inflammation to the body and brain, increase anti-oxidants, help cell integrity and repair, decrease pain, and accelerate neuroplasticity in the brain. Without proper nutrition, the brain cannot grow and make new connections properly or quickly.

To skip over the clinician’s version of Neurological Findings and Recommended Treatments, click here to go directly to the satirical conclusion of this article…Prognosis.

Neurological Findings: The clinician version.

0. The patient presents with a general decrease in right neocortical function, including, but not limited to:

   0. Decreased emotional tone and decreased emotional range. Emotional range limited to anger, sullenness, aggression, and excitation.

   1. Marked higher priority in action over words or feelings. Prefers to be doing than discussing.

   2. Prone to outbursts of violence when feeling cornered, challenged, or unacknowledged.

   3. Attention Deficit Hyperactivity Disorder (ADHD). This would also explain the higher risk of accidents amongst Blokites as they do not always pay attention to everything around them.

      0. Note: As an interesting corollary, it appears that most ADHD diagnosis is amongst boys, not girls, particularly destructive ADHD. From clinical observation, generally young boys (who have a stronger left brain) are more prone to wanton destruction of clinic property, showing little remorse or emotional control than compared to their female counterparts (with a stronger right brain) who are quiet and more still.

   4. Prone to high risk behavior and physical stunts. The phrase “Hey, watch this!” are tragically the famous last words for many now-injured or now-deceased Blokites. Of note: there are no females as the primary protagonists in the show Jackass, only males.

   5. Higher risk of fatal arrhythmias due to the left neocortex being too dominant, risking irregularity in the atrioventricular node, which is primarily innervated by the left side of the neocortex.

   6. The patient’s right metacarpal phalangealⁱⁱ (MCP) extensors are graded as 4 out of 5 muscle strengthⁱⁱⁱ due to a decreased right brain function, as the right cortex controls the ipsilateral tone of the extensors above T6. To illustrate: the (usually smaller in stature) clinician uses their left (non-dominant thumb) to push the MCP joints into flexion of the right hand (dominant hand) of Blokite. The classical response from the Blokite is that right MCP joints fall into flexion, but not the left MCP joints, implying global weakness of the right neocortex compared to the left.

      0. Of clinical significance is the emotional response of the Blokite to the demonstration of right-handed weakness. Blokites usually express annoyance and frustration, sometimes masked with a nervous laugh, when the clinician, especially a smaller “nerdy” clinician, was able to use his left (non-dominant hand) to push down the patient’s right (dominant) hand.

1. Other neurological findings may also be due to damage caused by post-concussive syndrome^iv (PCS), which would trigger aggression, restlessness, and even depression amongst those with Blokitis.

   0. Possible post-concussive damage is strongly suspected amongst Blokites, due to prior high-impact sports, injuries, falls, and violence, which may have caused concussions, blackouts, or other head trauma.

      0. A SPECT scan may not always be practical to view physiologically under-active or over-active areas of the brain due to the lack of accessibility and affordability issues in certain countries (e.g. New Zealand) or in rural areas of a large country (e.g. United States). There is also some concern over the use of a radioactive isotope for the procedure. Therefore a detailed case history and neurological examination would be required to assess possible post-concussive damage in such instances where a SPECT scan is not practical or advisable. Other technology, such as a QEEG, is now becoming available to check for post-concussive syndrome.^v

   1. Alcohol consumption may be a compensatory mechanism to anesthetize depressive feelings contributed by PCS and compounded when a Blokite feels anxiety or restlessness when there is no work or physical activities to keep his mind occupied.

   2. Damage to the frontal lobes and other areas of the neocortex could trigger a downward spiral into more damaging, Blokitis-like behavior (high risk activities and alcohol). The patient’s ‘knowing chuckle’ about previous high-impact injuries and refusal to acknowledge the possible long-term sequelae from said injuries, only lowers the probability of complete recovery and increases the probability of repeating such brain-injuring behavior.

Recommended Treatments: The clinician version.

0. Engage neuroplasticity^vi of the right neocortex to counterbalance hyperactive left neocortical areas. Please note, there may be smaller, more specific areas of the left neocortex that also need assessment and treatment, but generally it is the right neocortex that requires the most amount of neurological rehabilitation in a Blokitis patient.

1. Neurological rehabilitation consists of a three-prong approach: a) afferentation, b) oxygenation, and c) nutritional intervention.

   0. a) Afferentation

      0. Definitions:

         0. Afferentation is best understood as neurological stimulation that engages neuroplasticity to regrow and repair the brain. Afferentation is typically done through biomechanical adjustments of a spinal segment or extremity, creating a tonic^vii (long-term) sensory stimulation from changes in the gain and sensitivity of the golgi tendon organ^viii.

         1. Other means of afferentation include phasic^ix (short-term) activities, including cognitive exercises, cranial nerve stimulation, and active or passive movements.

      1. The purpose of afferentation is to:

         0. a) Reduce nociception^x (noxious stimuli) to an already-taxed brain. Whether or not the patient experiences a misaligned spinal joint as ‘painful’ or not, nociception will trigger the hypothalamic-pituitary-adrenal^xi (HPA) axis to create a chronic stress response, thereby limiting the body’s capacity for long-term healing, growth, and repair.

         1. b) Increase proprioception^xii (motion signals) into the brain to engage neuroplasticity and the immediate early gene response^xiii to re-establish and/or grow new dendritic and other neurological connections within the cerebellum and neocortex. Proprioception can be loosely understood as the opposite of nociception, in that it calms down the HPA axis and creates the neurological/hormonal/physiological environment for the body to heal, grow, and repair.

      2. Afferentation includes, but is not limited to, treating injured joints of the spine and extremities to stimulate joint proprioceptors, muscle spindle cells (MSCs), and golgi tendon organs (GTOs) to increase proprioception and decrease nociception.

         0. Afferentation may include specific neurological rehabilitation activities specific to the brain areas damaged or deficient. Activities may include a combination of visual, auditory, olfactory, gustatory, vestibular, proprioceptive, or other sensory modalities as determined by a highly trained and competent functional neurologist and/or chiropractic neurologist. Qualified chiropractic neurologists are found at http://www.acnb.org/DoctorLocator.aspx

         1. Contralateral (opposite side) neurological afferentation (stimulation) of proprioceptive, optic, and auditory systems should be performed to stimulate the right neocortex.

         2. The one exception is olfaction (smell) which should be used ipsilaterally (same side) to engage neuroplasticity of the right neocortex.

         3. The patient should be biomechanically stimulated (e.g. chiropractic neurology-based adjustments to the spine and extremities) according to their cortical weakness. In the case of Blokitis, target the weak right cortex by adjusting on the contralateral side (left side) in order to specifically stimulate neuroplasticity in under-functioning portions of the right brain.

      3. Afferentation should be done in conjunction with metabolic rate indicators to limit or eliminate the possibility of “respiratory chain deficient neuron interaction” cited as a possible cause of transneuronal degeneration^xiv. Metabolic rate indicators include, but are not limited to; a) decreased oxygen saturation and increased pulse rate as measured by pulse oximetry, b) pupil dilation, c) increased sudomotor activity (sweating), d) limbic escapes (mood changes), e) dizziness, f) mottling of the palms, and g) general observation of patient’s affect.

      4. The patient should be biomechanically stimulated (e.g. chiropractic neurology-based adjustments) from the areas of least proprioceptive input to the most proprioceptive input in order to build up the integrity and strength of the neuraxis’ capacity to receive stronger stimulation to maximize the positive neuroplastic changes, while also limiting the possibility of exceeding a neuron’s metabolic rate.

         0. As such, biomechanical stimulation (proprioception) should generally done from distal to proximal, extremities first, then followed by spinal adjusting of the lumbar spine, followed by the thoracic spine, then lastly the cervical spine in order to gradually build up the nervous system’s capacity to receive more proprioceptive stimuli.

   1. b) oxygenation

      0. The purpose of oxygenation is to increase access to, and the utilization of, oxygen to help the neurons engage in aerobic^xv respiration. Neurons are unable to engage in anaerobic respiration like muscle cells. Without increased oxygen, a patient’s capacity for neuroplastic changes is limited.

         0. Oxygenation includes, but not limited to,

            0. The use of an oxygen cannula during:

               0. a) neurological rehabilitation activities (afferentation), or

               1. b) sleep, or

               2. c) normal daily activity if the patient’s brain is severely damaged.

            1. Use of air-way opening devices during sleep and/or neurological rehabilitation activities. These same devices are commonly used to treat snoring but are repurposed here to treat traumatic brain injury by allowing more oxygen.

               0. Devices include nasal breathing strips or other nostril widening devices as well as jaw-slings.

               1. Note; if a patient’s tonsils are enlarged, they may obstruct the airway. If they are significantly obstructing the airway, then every non-surgical method should be attempted to reduce the size of severely swollen tonsils before considering surgery. The tonsils are a part of the immune system, and their removal will have a negative long-term effect, even if only a small one. Only if the tonsils are so large that air obstruction is severe and irresolvable should they be considered for removal. The author of this article has recommended two people in his whole clinical career to talk with their medical doctor about a tonsillectomy. In both cases, the air obstruction was extremely severe, complete with a case history of years of severe sleep apnea, falling asleep at the wheel, and falling asleep on the job, which jeopardized not only their lives, but also the lives of others. In one case, the individual was a flight personnel, and their level of sleep deprivation put hundreds of people at risk.

               2. Similarly, a dropped palette on the right side of a Blokitis patient is typically seen, which may be causing air obstruction. However, the global drop in right palette is usually caused by the decreased function of the right neocortex, typically seen in Blokites. Before considering a surgical reduction in the palette drop, every attempt at neurological rehabilitation of the right neocortex should be performed to, among other things, raise up the right palette from increased right neocortical integration and function. Something as simple, convenient, and low-tech as dry gargling while singing increases the tone of the palette and will raise the palette, given enough practice.

            2. Rib adjusting, particularly the first rib, to increase air volume.

               0. As an additional benefit, rib adjusting also increases neuroplasticity from the increased proprioceptive input into the neuraxis. The rib joints are the only joints of the body designed to be moving twenty-four hours a day, seven days a week, for one’s whole life, because they are the only joints that are supposed to be moving during sleep. If the ribs are misaligned or stuck, there is a reduction in proprioceptive (motion) input and an increase in nociceptive (noxious) input into the neuraxis.

            3. Assessment of and nutritional intervention of oxygen absorption, transportation, and utilization within the blood, including but not limited to:

               0. Assessment for functional anemia from lack of blood cell production, poor blood cell oxygen carrying capacity, and or lack of full circulation.

               1. Assessment of mitochondrial function to utilize oxygen in the electron transport chain^xvi (ETC).

                  0. Additionally, the citric acid cycle^xvii should be evaluated to ensure there are enough constituents (e.g. NADH and Succinate) to feed into the electron transport chain.

   2. c) Nutritional intervention

      0. The purpose of nutritional intervention is to provide the necessary chemical constituents required for afferentation (brain rehabilitation and neuroplasticity) to be effective.

      1. Several aspects to nutritional intervention must be understood before giving specific recommendations:

         0. Afferentation without nutritional intervention risks overtaxing neuronal activity, leading to possible transneuronal degeneration.

         1. Nutritional intervention without afferentation is inefficient and non-specific to brain rehabilitation. The key to brain rehabilitation is to combine brain-stimulating exercises (afferentation) with nutritional intervention and oxygenation at the same timein order to get maximum effect.

         2. One could consider oxygenation as a form of nutritional intervention. However, oxygenation is considered separately because oxygen absorption into the body is through respiration, not digestion, therefore increasing oxygen requires a different set of protocols (mentioned above).

            0. It should be recognized that oxygenation and nutritional intervention are inseparable, particularly when nutritional intervention is required to optimize the citric acid cycle, in order to optimize the output of NADH and Succinate into the ETC, to then be processed to form ATP with the aid of oxygen as the final electron acceptor.

         3. Food-based nutritional supplementation (versus synthetic nutrients) is generally more absorbable and has additional necessary co-factors for utilization of said nutrients. Even though most food-based co-factors are not (yet) fully recognized or appreciated in the modern media or scientific circles, their importance and necessity should not be ignored or minimized.

      2. The scale and scope of nutritional intervention is too wide to be fully discussed in this article. Some general guidelines are below. Note: always check with a qualified health practitioner before engaging with nutritional intervention and ensure that your source(s) of nutrients are reputable, have high-quality, and high potency.

         0. EPA/DHA (essential fatty acids found in fish oils) to increase; cell membrane integrity and fluidity and also to improve nutrient delivery.

         1. Anti-oxidants taken with EPA/DHA to prevent oxidation; such as Vitamin A, C, & E, as well as selenium, CoQ10, and glutathione precursors.

         2. Anti-inflammatory nutrients including Vitamin D, turmeric, proteolytic enzymes, and essential fatty acids.

         3. A full-spectrum B-vitamin to support the electron transport chain.

         4. Broad-spectrum, food-based minerals that include, but are not limited to; selenium, zinc, magnesium, boron, and iodine.

         5. L-Theanine to reduce the possibility of exceeding the metabolic rate.

         6. Herbal therapy including willow bark, boswellia and devil’s claw to down regulate pain can be considered.

   3. Patient compliance is critical. If a patient with long-standing neurological damage does not have consistent clinical care to continuously stimulate new neurological pathways, then the results will be limited.

2. Supportive therapies:

   0. Alcoholic treatment support, if appropriate.

   1. Anger management support, if appropriate.

   2. Marriage counseling, if appropriate.

   3. _{Other areas of the patient’s life should be evaluated to optimize recovery, such as sleep, exercise, toxic exposure, the quality and rhythm of the patient’s food intake, bowel function, and other sources of mental/emotional stress.}

3. Summary of recommended treatments:

   0. Treatment of post-concussive syndrome requires a multi-modal, multi-factorial approach involving afferentation, oxygenation, and nutritional intervention under the skillful eye of a qualified, neurologically-based practitioner. To find a qualified chiropractic neurologist, go to http://www.acnb.org/DoctorLocator.aspx.

The following (prognosis and miscellaneous) is a return to satire.

Prognosis: poor to fair

0. Blokite compliance with treatment is variable, mostly very poor, for several reasons:

   0. a) Blokite definition of ‘recovery’: A Blokite typically defines “recovery” as a level of symptomatology that is tolerable enough to live with and brag about to other Blokites. However, a true recovery according to the clinician is based on a combination of resolutions of all the clinical objective measurements combined with improvements to the patient’s subjective experience. Yet, Blokites prefer their own definition, not the clinician’s.

   1. b) Patient impatience. A Blokite is extremely impatient when:

      0. a) held up even 1 minute for their appointment, or

      1. b) if their appointment takes even a minute longer than scheduled, or

      2. c) when their symptoms are not fully corrected within 2-4 treatments, regardless of how serious their condition is.

   2. _{c) Early self-dismissal. A Blokite} usually self-dismisses from care after 2-4 visits with either,

      0. a) a terse phone call stating that the clinician ‘failed’ to fix it, or

      1. b) shows up only to say that the clinician ‘failed’ to fix it, or

      2. c) does not show up for their scheduled appointment and does not call to cancel, or

      3. d) chronically reschedules appointments, as a passive-aggressive method of not coming in for further treatments, while terribly inconveniencing the clinician.

   3. Note: The level of agitation and blame on the clinician for not ‘fixing’ the physical problem within 2-4 visits is directly proportional to how long and intensely the patient has been suffering with the problem.

      0. The level of agitation and blame on the clinician for not ‘fixing’ the problem is also positively correlated to how embarrassingly the original injury occurred (e.g. patient got drunk at a party and fell off a balcony).

d) A Blokite will only continue necessary treatment beyond 2-4 visits only under the following two circumstances:

a) The clinician treating the Blokite is an attractive female, or

b) The clinician treating the Blokite is far superior Blokite (usually a former professional athlete, bodybuilder, ex-military, or ex-police officer) that commands authority and discipline, similar to a sports coach.

Miscellaneous

0. If a Blokite does “recover” (by their definition) within 2-4 visits, the Blokite hardly ever refers other patients back to clinic. If the Blokite does refer other patients, the referrals are usually other males suffering with Blokitis, much to the dismay of the nerdy clinician.