Pain control is very important. Over the past decade or so, you’d have to have been in a hydromorphone coma to have missed all of the hullabaloo. We have scores now, and we pay much more attention to pain control than before. In the old days they made patients chew on a towel. Now pain control is so important that it has been called “the fifth vital sign.”

I’ve been thinking there must be additional important things we could be asking our patients and measuring besides the usual lowly vital signs like temperature and blood pressure. There must be a sixth, seventh, or even eighth vital sign.

I’ve observed that my patients are usually hungry. No matter the time of day, they always seem to be eating. Cheetos and Mountain Dew are a popular combination – particularly for patients with abdominal pain and children who vomited 3 hours prior. Some object to this wholesome snack, but I have no problem since most of the food groups are represented: dairy (there is cheese), grains, sugar, caffeine, and preservatives.

Since the entire nation seems to always be hungry, the only logical course of action is to create a hunger scale. This scale allows caregivers to make a judgment about how much food will satisfy the hunger in any given patient.

If we stick to the standard 1-10 scale, a 1 might indicate that a person has eaten recently but wouldn’t mind a small snack such as a pint of Haagen- Dazs or a large Snickers bar. A 5 might need something more substantial such as a turkey sandwich, a generous side dish, soda, and dessert. A 10 would be more of a challenge and may require ordering out. A Chinese family dinner plus fortune cookies or a 16-inch loaded pizza with cheesy bread should do the trick. More may be needed if family is in tow.

Now, some of our patients don’t quite get the 1-10 thing, so pictures will be necessary. I believe that the smiley face/frowny face scale would not work, and patients might be confused if you are asking about pain or hunger.

Traditionally when someone is very hungry, they say that they could eat a horse or a cow. There’s a start. That is an antiquated expression, however, in use prior to the supersize generation. I think that a cow should equal a 6 – a horse could be substituted depending on religious preference. Working down the scale, a pig (tapir can substitute) would be next followed by goat, dog, chicken, and ferret. Working up, hippopotamus would be next and then elephant, mastodon, and finally dinosaur.

Some change in culture will be needed to implement this hunger scale. We all had to adjust to the fact that a sleeping patient with normal vitals can have 10/10 pain. I’m all with that. So now everyone must adjust to the fact that a 300-pound man with fresh mayonnaise in his beard can still have 10/10 or dinosaur (please refer to the scale) hunger.

Attitude adjustment time. It is not your station in life to pass judgment about how hungry a man can be. You’re going to have to adjust to the cultural norms or we’ll be using your picture instead of the dinosaur on my nifty new scale. Hunger is everywhere. A girl with a BMI of 37 recently told me that she had to fast from lunch until dinner twice in the same week. This is a national crisis, and you are part of the problem if you are not using this scale.

I’m making an introductory offer to ACEP members to buy genuine laminated Dave’s Hunger Scale cards for $10 each. But wait; if you act before the next issue, I’ll double your order. As an added bonus, I’ll include the numbers of the local fast food restaurants plus directions for the Heimlich maneuver on the back of this useful clinical tool.

The card may become obsolete one day, as there is a risk that folks may get so heavy they’ll need motorized scooters, “big boy” wheel chairs, and bariatric CT scans. Oh … I guess that already happened, so no need to worry. Use the scale on every patient. What’s the worst that could happen? It’s not like an epidemic of opiate overdoses happened after we started using the pain scale.

Be happy.

Dr. Baehren practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.