Twerking Disease: The Definitive Medical Resource For Doctors.

Thanks to the Video Music Awards (VMAs) and Miley Cyrus, the entire world has been exposed to twerking.  The internet is filled with detailed commentary discussing the social, political and anthropological ramifications of twerking.  Search YouTube for twerking and you'll  find hundreds of twerking FAILS.  There are the twerking interventions and the twerking cats.  There are the twerking parodies and the twerking Vines.  There are even videos about twerking at Walmart.  The world has gone twerking crazy.

But, what is twerking?  Wikipedia describes twerking as a "type of dancing in which the dancer, usually a woman, shakes their hips in an up-and-down bouncing motion, causing the dancer's buttocks to shake, "wobble" and "jiggle." [1]  Oxford Dictionary Online, says to twerk is "to dance to popular music in a sexually provocative manner involving thrusting hip movements and a low, squatting stance." [2]  The Urban Dictionary describes twerking as "the rhythmic gyrating of the lower fleshy extremities in a lascivious manner with the intent to elicit sexual arousal or laughter in ones intended audience." [3]

These definitions are acceptable for lay folk but not for doctors and nurses.  After an exhaustive search on Google, I was unable to find any twerking literature written for the doctor or nurse as the intended audience.  So I searched UpToDate instead.  I was heartbroken to discover this second most definitive medical source for health care professionals was also woefully silent on the subject.  As a physician, I was saddened by the lack of information by physicians, for physicians. Twerking is an epidemic.   We owe it to ourselves to get educated about this potentially life threatening condition.   So I made this my day's mission. I researched the subject and talked to top medical experts on the subject and created the worlds first white paper resource on twerking.  It is my pleasure to present Twerking Disease:  The Definitive Medical Resource For Doctors.  This publication will hopefully shake the medical community into action.  I hope so.  I twerk'd my ass off writing it.

DEFINITION


Twerking is estimated to affect like, 69 million Americans, including  nine out of ten females with low self esteem and like, nine out of ten females with too much self esteem.  Dancing in a gay nightclub will  like, increase the risk of contracting twerking by like 100%. In addition, boys who think they look cool twerking to pick up chicks have a 99.99% chance of like,  striking out.  Further research has shown a 20 and 25 fold increased chance of contracting twerking by like,  attending a public or Catholic school respectively.  After teenage girls, cougars, demented women with boob jobs and gay men hanging out with straight women are most at risk of contracting twerking disease.

SIGNS AND SYMPTOMS


Patients usually present with a combination of signs and symptoms including back pain, beer goggles and acute exacerbation of looking ridiculous. Parents should be on the look out for locked doors, late night Twitter twerking and, of course, twerxting.   Clues to a twerking addiction may include a rapid increase in texting volume during peak music hours.  If your kids complain of neck pain, consider closet twerking as a cause of trying to check themselves out in the mirror with ass-inine positions.  For Cougars and demented old ladies with boob jobs, sudden spikes in flirting with doctors who are "too young to be my doctor" may be  a clue to worsening twerking symptoms.

Twerking-Twerxting



PHYSICAL EXAM


Ha!  Ha!  Ha!  Ha!  Physical exam.  That's a good one.

CAUSES


The main cause of twerking is a failure to vaccinate.  Decades of research has proven universal vaccination programs can prevent twerking in 99.99999% of the population.  That one person out of 100,000 who got twerking disease  after being vaccinated is the basis for the anti vaxxers crusade against universal twerxsination.  The CDC issued a nationwide alert two weeks before the Miley Cyrus VMA rampage detailing their grave concerns about an imminent twerking epidemic and the failure of a national public health vaccination program to eradicate twerking.   Unfortunately, that alert fell flat on its ass.  In August, 2013 a rare but humiliating variation of twerking, called Myley Cyritis, swept through America faster than the National Organization for Women (NOW) could boycott something.  Anything.    When asked for a comment on Miss Cyrus' twerking presentation, the President of NOW said, "Wow!  That's a women?"

DIFFERENTIAL DIAGNOSIS 


Twerking may be seen as a stand alone disease or as a complication of other disease processes.  Always consider the following diagnoses in your differential diagnosis of twerking:  frontal lob dementia, encephalopathy, genetic stupidity, lack of parenting, Enbril, wine coolers, typical teenager, Parkinson's (twerking jerking).

RISK FACTORS


If you think twerking is cool, you are at risk.

TWERKING RELATED DISEASE PRESENTATIONS


Twerking can have devastating consequences.  Physicians and other healthcare practitioners should be aware of variations in presentation for patients as well as  collateral damage twerking can bring to friends and family.

ANKYLOSING TWERKYLOSIS:  When your spine permanently fuses in the twerking position.

ATYPICAL TWERKING:  When you're just not sure what you're seeing, admit to the hospitalist under observation status.  

BOVINE TWERKIFORM ENCEPHALOPATHY:  A life threatening variant caused by eating McDonald's before a heavey night of twerking.  

JAPANESE TWERKILITIS:  When a Japanese teenager tries to twerk.

MILEY CYRITIS VARIANT:  Twerking associated with full facial malfunction, uncontrollable tongue spasms.  Can induce severe inflammatory eye disease in unsuspecting viewers.    

NEUROTWERKOCERCOSIS:  A brain disorder manifested by the inability to see how stupid one looks while twerking.  

OSTEOTWERKOSIS:  A form of osteoperosis caused by excessive twerking.

TWERKAHOLIC--  When you work so much, that the only way your daughter can get your attention is to twerk.

TWERKALARIA:  A variant of malaria, Bill Gates has added twerkalaria to his list of diseases he'd like to eradicate with his gobs of money.  

TWERKALICIOUS--  A variant of extreme twerking manifested by sucking on a lollipop in a provocative manner while twerking to the beat of the night.  

TWERKANGINA--  Chest pain after watching your daughter dance away her dignity.

"If you get chest pain after watching your daughter twerk, go to the ER immediately!  You may have terkangina."

Twerking-Twerkangina-Ecard



TWERKARIASIS:  A skin condition caused by constant irritation of one's dignity.

TWERKILIS:  An STD, usually contracted by twerking without wearing underwear.

TWERKILITIS:  When you feel so dirty after watching it, you have to take a shower to wipe away the inflammation.

TWERKINOSIS--  An STD, usually contracted after a heavy night of twerking and feeling insecure.

TWERKIOLITIS:  A breathing disorder manifested by heavy panting while twerking.

TWERKOCELE:  Formation of fluid collections in places never seen before the twerking epidemic.

TWERKOPY--  Passing out after watching your daughter twerk.

TWERKULOSIS:  Highly resistant to most drug therapy and mostly manifested as large lung lesions, twerkulosis is seen in travelers returning from third world countries and Hawaii.

SYSTEMIC TWERKIS ERYTHEMATOSUS:  When it looks like twerking or lupus but it isn't lupus because the answer is never lupus.

YouTwerk®:  A life threatening CNS disorder, usually caused by watching twerking videos on YouTube.

WHEN TO GO TO THE ER


Anytime you feel like it.  This is America.

"4 years of chronic nausea is not an indication to visit the ER at 2 am.  I'm an ER doctor.  As in emergency.  As in 4 years of anything makes me nauseated."

4 years of chronic nausea ER doctor crude medical ecard



TESTS AND DIAGNOSIS


Twerking and twerking related diseases are often diagnosed based on history and physical.  That means most cases will be missed because everyone knows history and physical is generated by computers these days and since a template for twerking and twerking related diseases has not been mandated by any government agency, most EHR systems do not yet offer them.  Twerking and twerking related diseases are the most under-diagnosed pathological conditions today. Even Watson, the computer that won Jeopardy, failed to recognize twerking.  After presenting Watson with a YouTube video with over 600 million views titled "How To Twerk", Watson promptly quit his job as super computer to become an extreme Twerker and live off his YouTube income for the rest of his life.

Twerking can be diagnosed in less than 0.001% of cases using nonFDA approved TWE-E-G and twerkemetry technology.  That means everyone with a suspected diagnosis of twerking will get both tests.  Twice.  Just to make sure.  In addition, flexible twerkoscopy, the act of inserting a flexible scope into the rectum to verify nothing made it in there during a night of heavy twerking, is occasionally performed during a twerking hospitalization, usually as a stat recommendation called in by the Night Nurse RN, MSN, M&M and PRN, because the hospitalist is too busy admitting 14 other twerkers in the ER after a performance from Miley Cyrus at her Hannah Montana: What the Fruck Happened To Me? tour.

TREATMENTS AND DRUGS


The best treatment for twerking and twerking related illness is to just stop.  Don't shake your ass.  Don't wiggle your thighs.  Don't arch your back like a little hoe-bag.   Don't slap that booty around like the piece of vagina you're trying to be.  Just stop.  Seriously.  WTF.  Just stop.  Enough already.  However, if you find yourself overcome with twerking emotions, agitation and withdrawal, one nonrandomized, retrospective observational trial of 25 twerkers from The Ethiopian Hospital For Poor People proved daily exercise, vaccination at birth and looking at yourself in the mirror to prove just how stupid you look can send twerking addicts into remission 96% of the time.  This study was published in Time magazine so it must be true.  In addition, the story was picked up by 95.8 THE BONE and was described by a self proclaimed expert twerker jockey between songs about booty slappin' and G-thangs.

     EXERCISE


Studies have shown most folks watching Richard Simmons in "Twerking to the Oldies" have been cured of their twerking addiction.

     MIRROR THERAPY


Consider buying a full length wall mirror for full therapeutic effect.  Alternatively, take a video of yourself twerking while checking yourself out in a mirror, put it on YouTube and let everyone leave nasty comments in a public display of humiliation.  This study has not been performed in Ethiopia because they are too poor to have mirrors, but, in theory, it should work.

     DRUGS


There are no known drug treatments for twerking.  Big Pharma, however, is working diligently to rebrand an old generic drug as a treatment for twerking so they can start charging your ass off.

PREVENTION


There are only three ways to prevent twerking:  vaccines, parenting and not watching Miley Cyrus.

     VACCINES


A twerking vaccine has been available every since 1952, the year the polio vaccine was invented.  Some reputable celebrities with years of internet based medical training believe twerking is a complication of the polio vaccine and have started a nationwide campaign to stop immunizing our children, pregnant women and nursing home residents.  In fact, Jennifer McCarthy was seen Tweeting this twerking comment:  Poor Miley:  Twerking AND Autism.  But no polio.  I'm right again.

          ANTIVAX FORUM COMMENTS


  • My husband and I cried for years after vaccinating our triplets with the polio vaccine.  We read all about these dangerous side effects on McCarthyExpertAdvice.com only after we mutilated our children.  We will have to live with this for the rest of our lives. Go Jenny!  We love you!
  • We will never vaccinate our kids again.  Their arm hurt after the shot.  F***ing drug companies.  They're just trying to make money off my kid.  
  • My chiropractor told me diet could prevent twerking.  My pediatrician is a quack.  I'm never going back again.
  • I talked to my neighbor about vaccinating my kids and they said, "Hell no!".  But then they had to leave and can another 100 jars of tomatoes in preparation for Doomsday, so I never got to hear why.  But I believe them.  No shots for my beautiful kids.  No sir.  No way.    

          NEWBORNS AND PREGNANCY


The CDC recommends vaccinating against twerking starting in-utero at 10 weeks gestation in the ER.  They hope to capture 100% of uninsured females going to the ER for abdominal pain but really just wanting a pregnancy test after heavy twerking the night before and missing their period for less than 24 hours.    For the stable, family oriented pregnant women who has never been to the ER, the CDC  recommends they continue their great parenting skills.  No vaccination is necessary.

          ELDERLY 


The CDC recommends vaccinating all Americans over the age of 65 or in a nursing home.  They recommend giving it as a combivalent vaccine to protect against Parkinson's and statin related twerking jerking.  It should be given in combination with the Zoster vaccine, the flu vaccine, the pneumonia vaccine and the new for 2013 Hospital Readmission Prevention vaccine in the hopes of preventing this butt-iful display of disinhibition.



          HEALTHCARE WORKERS


The CDC recommends vaccinating all healthcare workers to prevent outbreaks of creative hospital YouTube twerking videos set to catchy music and lame dance moves that appear benign but are actually made as clever marketing campaigns intended to infect the unsuspecting public.

     PARENTING


Parenting means to be a parent.

     STOP WATCHING MILEY CYRUS


Stop watching Miley Cyrus means to stop watching Miley Cyrus.

BREASTFEEDING


The CDC recommends not breastfeeding during twerking, unless you plan to post pictures of your experience on the Hot Twerking Breastfeeding Moms website  or unless you are trying to win the cover shot contest for Time Magazine's Twerking Mother of the Year Award.

TWERKING SEASON 


Americans are at greatest risk of twerking epidemics during music award shows on television or being within 100 miles of Miley Cyrus.

SIDE EFFECTS OF TREATMENT


Treatment of all twerking disorders will result in return of one's dignity.  There are no other known side effects of treatment.

COPING AND SUPPORT


There are no support groups for twerking.  Not every disease needs a support group, but every disease does deserve an online forum filled with self proclaimed experts just waiting to make you second guess everything you thought to be true and just in this world.  The best forum can be found at proudtotwerk.com.   It appears the most knowledgable member goes by the name ChronicTwerkStud, a highly respected never married member since 1995.   Despite this evidence, we recommend against searching for these support groups, but if you must, consider instead TwerkDC.com  as your trusted source for online twerking related research.  TwerkMD.com was unavailable, as it was apparently bought by a bunch of chiropractors with the hopes of gaining respect for their new cash only business venture called the Holistic Twerkupuncture, Twerkulation & Twerkness Institute with franchise rights available in every city with a home and garden show or county fair, the only known venues to advertise their services.

HOSPITAL ISSUES RELATED TO TWERKING


Hospitalists and other medical practitioners who work in the hospital setting should be aware of issues related to twerking.  During epidemic and pandemic situations, hospitals should have policies and procedures in place to handle the rapid increase in twerking volume that could put a significant strain on hospital resources, especially on weekends when many doctors and nurses are forced to function under limited twerking conditions.

     WHEN TO ADMIT TO ICU


Twerkers should be admitted to the ICU if they show signs or symptoms of fragile emotional lability.  Floor nurses just don't have the time to comfort them every five minutes with bedside empathy such as, "Everything is going to twerk out OK".  On the other hand, ICU nurses are trained in rapid Versed infusions at the slightest suggestion of forced conversation.

"Forget about all that lame nonsense nursing garbage we learned in school.  We're ICU nurses.  We've got Versed for anything that moves!"

Forget about all that lame nonsense nursing garbage we learned in school.  We're ICU nurses.  We've got Versed for anything that moves ecard humor photo.



"I twerked my ass off today and got the best patient satisfaction scores EVER!"

Twerking-Nursing-Ecard-Humor



     WHEN TO GET A PALLIATIVE CARE CONSULT


All twerkers deserve an opportunity to discuss their palliative care options on admission.

     CENTERS FOR MEDICARE & MEDICAID SERVICES(CMS)


Government officials estimate twerking and twerking related illnesses cost Medicare over 6.9 billion dollars a year, mostly from young females on Medicare for disability related to complications of fibromyalgia.  After disabled fibro, divorced Cougars and nursing homes residents who look older than their stated age are the second and third most costly twerkers for Medicare.  As such, CMS has promised 422 new demonstration projects at a cost of 12.6 billion dollars over the next ten years to try and save 50 million dollars a year by implementing untested and unproven national guideline driven twerking standards.  Specific policy issues are detailed below.

          READMISSION POLICY


A readmission penalty will be applied for all twerkers readmitted to the hospital with twerking or twerking related illness as the primary diagnosis within 30 years of their sentinel hospitalization.  This policy is in line with up and coming readmission policies for other medical conditions.  The penalty will be equal to a value greater than a complicated formula that has not yet been determined or 100% of charges, which ever is greater.

       

          DOCUMENTATION


Hospitals should plan on hiring dozens of additional clinical nurse documentation experts to fully comply with new twerking rules and regulations.

          COMPLICATING CONDITION/DRG


Twerking is considered a major complicating or comorbid condition (MCC).  Despite the etiology of the disease process, CMS decided not to make twerking an O.P.P condition.

          OSHA


Twerking shall not be allowed at the nurses station at anytime due to the potential transmission of body fluids.  However, OSHA does allow drinking coffee while twerking at the nurses station because they know everyone does it anyway, especially on weekends, holidays and whenever they efin  want to.

"If you read the fine print, it says no food or drink at the nursing station, except on nights, holidays and whenever I f***in' feel like it."

If you read the fine print, it says no food or drink at the nursing station, except on nights, holiday and whenever I feel like it nurse ecard humor photo.



          JOINT COMMISSION


The Joint Commission (JC) has no specific twerking standards except to comply with OSHA rules and regulations.  However, if they catch any staff twerking during an unannounced visit, the staff member will be treated to a night of heavy drinking and smooth talkin' romance by the, "I have to go on another unannounced trip, Honey.  I'll be back in week" JC consultant.

          TWERKING SEASON

All hospitals should post warnings at public entrances asking families not to bring infected twerkers to the hospital during elderly season.  They can, however bring concealed weapons into the hospital to protect themselves against doctors or nurses who tell patients they cannot leave the floor without their permission.  According to most state and federal statues, kidnapping is a federal offense.  In addition, twerkers are encouraged to smoke 'em up in the ABSOLUTELY NO SMOKING section of the hospital campus because hospital staff would rather have them out of sight and out of mind.

          PET THERAPY


Pet therapy volunteers are encouraged not to be afraid of twerkers, although it's understandable if they are.  If a twerker does request pet therapy, make sure the animal is spayed and neutered.

          AMERICANS WITH TWERKING ABILITIES ACT


All hospitals should comply with all federal laws regarding patients with exceptional twerking abilities.   This includes full length mirrors, ample space to shake that tang and an updated surround sound system with  booty thumpin' base.

     PHYSICIANS


All physicians and non-physician practitioners (NPPs) should be aware of work related twerking issues in the hospital setting.

          PROGRESS NOTE EXAMPLE


Documenting a hospital followup progress note (99231-99233) for twerking should follow the S.O.A.P note format most often used during evaluation and management encounters. Here is one example:
S.  Patient says her ass is jiggling. It started 3 days ago.  It involves the ass.  It only jiggles when she shakes it.  It goes away when she stops shaking it.  It is associated with loss of dignity.
O)  120/80 80 AF
       Ass appears symmetric.  Normal skin tone and turgor.  Ass turns red when slapped.  No craters, valleys, lumps or bumps are appreciated.  Breast exam normal too.
A)  Acute on chronic twerking complicated by lack of self respect.
P)  Discharge patient and tell her to go to the ER immediately for a pregnancy test and a pelvic exam.

          BILLING AND CODING


Physician should bill twerking encounters like they do any other hospital encounter.  Note, twerking is considered high risk disease management on the medical decision making risk table.

          ICD CODE


According to ICD standards, twerking and twerking related injuries are considered an external cause of injury by an environmental event and are given an E code.  The E code for dancing related injuries is E005.5.  Injury, specifically related to twerking is new in the 2013 ICD-9 book of numbers and has been given the code E005.69.  ICD-10 however has 42,000 additional subclassifications of twerking related injuries and will have 14 additional decimal data points.  For example, ICD-10 differentiates between twerking injuries related to tap-twerking while listening to the Golden Girls sound track and super-fast twerking while smoking pot at a strangers house at 3 am in a neighborhood near a strip club.

          PQRS


Starting in 2014, hospitalists will be able to submit PQRS data for twerking admissions.   Twerking now occupies quality measure number perfect 10.    Hospitalists may report G6968, G6969 or G6970 for their twerking quality improvement data.  G6968 should be reported if the twerker received an order for a one hour shower on admission, with special attention to the retrorectoneal region. G6969 should be reported when no order was given but only if the reason documented was because the patient had fibromyalgia and an allergy to water.  G6970 should be reported when no shower was ordered and no reason was given because none of this crap matters anyway.      

OTHER TWERKING RELATED ISSUES


     HANDICAP TWERKING TAGS


Talk to your doctor today about obtaining a special handicap twerking sticker.  They are only available by physician authorization.  Please do not park in spots designated for those afflicted with twerking and twerking related diseases.  These folks are sick and need all the assistance they can get.

     TALK TO YOUR KIDS ABOUT TWERXTING


There's just one rule here.  If you are caught twerxting, you lose cell phone privileges for life.  End of story.

     WORDS THAT RHYME WITH TWERKING


If you're trying to think of something clever to say about twerking, you need to know what words rhyme with twerking.  Here you are:  jerking, lurking, perking, shirking, smirking, working

     SLANG


Slang speech is a part of popular American culture.  Learning how to speak twerky is important if you want to have influence in your circle of friends, or if you want to get a lot of likes on Facebook.  Here are a few examples of twerky slang creeping into pop culture:  twerky jerky, do the funky twerky, twerk off, twerk it, twerkin' for a livin', I twerk'd my ass off, live hard twerk hard.


 DO YOU HAVE THE GOODS TO TWERK?


Twerking-Decision-Tree-Flow-Chart




[1]  Wikipedia 
[2]  Oxford Dictionary Online
[3]  Urban Dictionary

You can find all of these original Happy Hospitalist crude medical ecards on Pinterest.

This post contains humor that may only be understood by those in a healthcare profession or by those who know how to twerk it.  Read at your own risk.

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