nipple twist
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MINNEAPOLIS, MN – Citing expert opinion and personal experience, the American Academy of Neurology (AAN) has put forth new recommendations on the pain stimulus – a technique used by health care providers to assess a patient’s level of consciousness – stating that the sternal rub should be abandoned in favor of the titty twist or purple nurple to elicit pain.

titty twist
A patient whose GCS increased from 5 to 15 after a titty twist: “OH DEAR GOD! My nipples are burning!!!”

“Hello, have you ever been a victim of a titty twist?!” asked AAN spokesperson Mitchell Izumi, a proponent of both the titty twist and its variant the titty smack.  “It hurts!  Like, a lot!!!  If that doesn’t bring you out of consciousness, I don’t know what will!”  He paused and walked away rubbing his chest.  “Please excuse me, just talking about it makes my nipples sore.”

“Look, if you twist a patient’s nipples and twist them hard, to the point they’re purple and bleeding and they’re still not responding?  I’m sorry, you’re prognosis is poor, probably hospice bound,” said University of Chicago neurologist Charles Edelweiss, a world’s expert in nippular pain stimuli.  “It is particularly effective at identifying patients faking a coma, the so-called pseudocoma.”  Edelweiss says he uses the titty twist on a daily basis, even on patients who are awake or, better, interns who are asleep.

How to perform a titty twist or purple nurple depends on the performing health care provider’s ambidexterity.  Though a bilateral maneuver is preferred over the unilateral approach, in either case the nipple or nipples should be twisted “at least 360 degrees” and pinched as “hard as humanly possible” as if “trying to rip them off entirely.”  Ripping off the nipple entirely is considered “ideal.”

Critics of the sternal rub cite the lack of reproducible and reliable results as their major drawbacks.  When developing new pain stimuli, the AAN thought back on childhood memories, particularly ones involving older siblings.  The titty twist edged out both the wedgie and dead arm simply because in the case of the wedgie the patient might not be wearing underwear and in the case of the dead arm the patient might already be dead.

“The AAN has warned patients of the future change in how pain will be elicited,” explained Izumi.  “Patients, if you wake up from a coma and your nipples are sore and purple, now you know why: a health care provider just saved your life.”

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