Ask a neurosurgery resident anything

[mentalhypoxia]

These things are bad. A single course, often you can get away with. Repeating an entire year, you will need a significant explanation for why you needed to repeat. Just as there are gold tickets to neurosurgery (the aforementioned Crushing Step 1, killer LORs, loads of great research, nailing SubIs) there are red flags (failing a course(s), repeating years, conduct disorders, institutional action).

I don't mean to put it this way, because this always offended me, but here's an analogy: You walk in to a stereo/car/clothes store and look around, everything seems to fit right in your mind and the sales people are friendly and helpful. Then it comes down to the price, if you have to ask the price: you can't afford it. If you have to ask "can I become a neurosurgeon with a felony conviction and failed year," you likely can't. That being said, absolutely, people consistently prove this wrong. Work hard, figure out what you messed up in, overcompensate and fix it!.

Thanks neusu. Found out I'll have to repeat just the course over the summer (after 2 weeks of crossed fingers and neurotic grade-checking) so I'm breathing a huge sigh of relief (I think it won't show up on my transcript either if I remediate and end up passing the course). And I understand your analogy, even though I don't like it either - neurosurgery is tough, and any blemish on your record must be well-compensated for. Thanks again! I really learned from this and won't let things slip again.

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[neusu]

Is endoscopy the future of neurosurgery?
And if so, will that make your life easier and better for patients?

Endoscopy absolutely has a role in the future of neurosurgery. We are developing better techniques to operate with less invasiveness (at least at the incision site) and accomplish more. That being said, open surgery will, likely, never go by the wayside.

 

[neusu]

Just wanted to post a Thank You for doing this!

Just wanted to post a You're Welcome

I'm glad you guys enjoy this.

 

[neusu]

Thanks neusu. Found out I'll have to repeat just the course over the summer (after 2 weeks of crossed fingers and neurotic grade-checking) so I'm breathing a huge sigh of relief (I think it won't show up on my transcript either if I remediate and end up passing the course). And I understand your analogy, even though I don't like it either - neurosurgery is tough, and any blemish on your record must be well-compensated for. Thanks again! I really learned from this and won't let things slip again.

Stick with it. If it is what you want there are worse things that could happen. Get involved in the deparment, do some research, take a year off if you have to, crush Step I and II.. The world is still your oyester. Certainly we care about anatomy or biochemistry or immunology grades.. but that is not the end-all-be-all of what we do.

 

[Lucca]

@neusu This thread has been going on for a while now. How has your attitude about medicine as a resident, physician, student, surgeon, and neurosurgeon changed over that time and from the beginning of your residency until now? Any regrets? Any moments, in hindsight, of total ecstasy?

 

[pbrocks15]

If you had the option would you...

1. Do research at a prestigious lab but will unlikely get a publication (cool project)

Or...

2. Do research at an unknown institution and likely get a publication? (Okay project)

 

[neusu]

@neusu This thread has been going on for a while now. How has your attitude about medicine as a resident, physician, student, surgeon, and neurosurgeon changed over that time and from the beginning of your residency until now? Any regrets? Any moments, in hindsight, of total ecstasy?

Tough question. I came in to this field wide eyed and idealistic. While I still have a lot of that deep down inside of me, it becomes hard to not become jaded after a while. So much of medicine, academic medicine in any case, is not taking care of patients, but instead fighting the system to get the right thing done. I would not say I really have any regrets, I try to do the right thing for my patients, even if it is the unpopular thing, and be there for them and their families when they are in need. Some of the major "wins" make the high points of residency higher than I imagined. At the same time, this field certainly knows how to humble you. Some of my most experienced and well known attendings will even comment to that effect after a particularly difficult case, or when things do not go as planned.

 

[BLACKCARBON44]

Hi, I am currently in 8th grade right now, and I want to become a neurosurgeon when I grow up. Do you have any tips or suggestions on what I can do to start early and be prepared?

 

[Lucca]

Hi, I am currently in 8th grade right now, and I want to become a neurosurgeon when I grow up. Do you have any tips or suggestions on what I can do to start early and be prepared?

Don't focus on medical specialties right now. At this point in your life focus on doing the best you can in high school, enjoying yourself, and dipping your toes in as many fields/subjects as possible to find your "niche" or what interests you the most, what you are truly passionate about. Join clubs, have fun, make friends, read a lot, and save the worrying about medicine for college. In high school just get As in all of your classes, perform well on your standardized tests and find something meaningful to dedicate your time to

 

[neusu]

If you had the option would you...

1. Do research at a prestigious lab but will unlikely get a publication (cool project)

Or...

2. Do research at an unknown institution and likely get a publication? (Okay project)

Not to undermine your question, but typically prestigious labs are more likely to have ongoing projects and are well published.

To actually answer your question though I'll have to give you two answers. 1) As an undergrad/med student I would prefer the experience that is more likely to get published. The saying in research is publish or perish. In essence, if you do research and it isn't published, you might as well have not done the research because no one really cares. That being said, the caveat is always how prestigious you are talking. Having a personal LOR from a Nobel Laureate would likely make up for not publishing. 2) In my current position, I'd probably choose the prestigious lab that is more fulfilling. I already have a fair number of publications and do not necessarily need to pad my CV with superfluous publications. The experience and connections made at the prestigious lab would serve me better at this point in my career.

 

[La Presse]

This has no relevance, but...who is your favorite Brontë sister? Everything else has been asked.

 

[ridethecliche]

How many times a day do you wish that you were ortho spine?

(I'm totally just kidding. Thanks for doing this!)

 

[neusu]

Hi, I am currently in 8th grade right now, and I want to become a neurosurgeon when I grow up. Do you have any tips or suggestions on what I can do to start early and be prepared?

First and foremost, do well in classes and on standardized tests. This is the bread and butter of being prepared for anything you would want to choose to do in life. Try to get a broad education, learn about things that interest you. Try not to fall in to the trap of focusing on something too early and too intensely. Burnout is a very real thing in medicine and neurosurgery as well. Having a well rounded and balanced life will help keep you sane.

With respect to neurosurgery in particular. Go to the cheapest/best school that fits you for college. Likewise for medical school. For each, it can help to go to a school that has a medical school and neurosurgery program, respectively. Having mentors at the next level who can help guide you and advise you along the way to reaching the next step is valuable. Do things that you enjoy, but also think about how you can expand your CV. All too often in life we put on blinders and think we'll be happy when we finally get to x or y point and forget to enjoy the steps along the way to where we want to be. Planning ahead is important, but planning to enjoy life as it comes makes it more worthwhile.

 

[The Buff OP]

Pesi or Coca Cola?

 

[neusu]

This has no relevance, but...who is your favorite Brontë sister? Everything else has been asked.

Emily ?

 

[neusu]

How many times a day do you wish that you were ortho spine?

(I'm totally just kidding. Thanks for doing this!)

Lol don't get me wrong, I love elective spine. There is something so fulfilling about the purchase of titanium screws in a pedical or pars or lateral mass. That being said, spine trauma is the worst. Don't get me wrong, I love operative spine trauma. We actually get to operate. The majority of spine trauma, though, is, much like the majority of traumatic brain injury, non-operative. As a junior resident, this means you have to look at the images, see there is "nothing to do," go see the patient, document your exam, talk to your chief/attending. Absolute waste of time. Yes, you can batch them. Yes, they need to be seen by a neurosurgeon. As the peon being sent to be seen 1000s of non-operative back pain, TBI, and spine I can certainly say the page for that is less than exciting.

So, given my personal inclination is to do cerebrovascular, I wouldn't mind if we gave up spine entirely!

Will I do it in my practice? Probably. The way things work are such that you con't just throw out your shingle as a surgeon and not do everything. Do I hope to tailor my practice away from spine? Absolutely.

 

[neusu]

Pesi or Coca Cola?

I had a snarky response all lined up but then I thought about it:

So in my life it went as such.. Grew up on coke, loved the stuff. Tried RC Cola at some point in HS, was the new thing (it's pretty good, try it). Decided to switch back to diet, Coke it is. Actually liked Diet Pepsi better. Drank that for a while. Maybe it was the school's contract's influence. In any case, now I don't drink soda, aside from soda water (not cola).

So the question is, what do I order when I order a drink e.g. rum and coke. Yes, I order coke. Since it's not a restaurant, they never ask "is pepsi OK?"

But then again, seriously how often am I at a bar ordering rum and coke? Obviously it's Krystal or Courvoisier! (there's the snark)

 

[ridethecliche]

Lol don't get me wrong, I love elective spine. There is something so fulfilling about the purchase of titanium screws in a pedical or pars or lateral mass. That being said, spine trauma is the worst. Don't get me wrong, I love operative spine trauma. We actually get to operate. The majority of spine trauma, though, is, much like the majority of traumatic brain injury, non-operative. As a junior resident, this means you have to look at the images, see there is "nothing to do," go see the patient, document your exam, talk to your chief/attending. Absolute waste of time. Yes, you can batch them. Yes, they need to be seen by a neurosurgeon. As the peon being sent to be seen 1000s of non-operative back pain, TBI, and spine I can certainly say the page for that is less than exciting.

So, given my personal inclination is to do cerebrovascular, I wouldn't mind if we gave up spine entirely!

Will I do it in my practice? Probably. The way things work are such that you con't just throw out your shingle as a surgeon and not do everything. Do I hope to tailor my practice away from spine? Absolutely.

I've actually had back surgery twice for LDH.

Hilariously, last week we had a patient with huge honking herniation. The fellow was like... I can't wait to operate on him. These are the best patients since they always get better!

Otherwise, yeah, it's a game of odds. I know what you mean about the trauma stuff as it usually involves bracing. Ever put a Halo on someone? I watched a fellow adjust one. The patient wanted to knock his teeth out! I actually ran the numbers for a paper we submitted on thoracolumbar burst fractures without neurological deficits and non-op fared significantly better in the short and long term outcomes.

The practice I do research in does a fair bit of spine onc as well (mets, chordoma, sarcoma, etc) and that's a totally different ball game as is deformity, which is also big here.

 

[neusu]

I've actually had back surgery twice for LDH.

Hilariously, last week we had a patient with huge honking herniation. The fellow was like... I can't wait to operate on him. These are the best patients since they always get better!

Otherwise, yeah, it's a game of odds. I know what you mean about the trauma stuff as it usually involves bracing. Ever put a Halo on someone? I watched a fellow adjust one. The patient wanted to knock his teeth out! I actually ran the numbers for a paper we submitted on thoracolumbar burst fractures without neurological deficits and non-op fared significantly better in the short and long term outcomes.

The practice I do research in does a fair bit of spine onc as well (mets, chordoma, sarcoma, etc) and that's a totally different ball game as is deformity, which is also big here.

Acute issues tend to resolve acutely. If I have a lady in my ER with a cauda equina and a massive disc, I take her to the OR and she's magically fixed (85% of the time neurological function improves if it's within 48 hours). If I have someone who has back pain for 30 years, and an acute exacerbation, and no imaging findings, I still have to admit him/her. Prescribe him/her enough dilauded overnight that they're happy, yet somehow convince them to leave the next morning with a new Rx for percocet.

I am the Halo master. I can put a Halo on solo (so long as there is a good nurse), traction, shot, traction, shot, reduce, shot, reduce, shot, reduction.. Lock-down.. If you know what you're doing, it's a 1-man job, the keys are to have the board under the head so you can put the posterior pegs in and not have to push in to the bed.. have enough weight around to put them in traction.. and know how to reduce a fractcure..

Spine onc is different, depends on the acuity and the pathology.. I've done a sacral cordoma or two.. Why are we even doing anything unless we take the whole hemi-pelvis out? Myeloma? Ha! Mets? depends on the met I guess, and the symptoms.. deformity is great, but not cancer.. We usually just cut **** out, put something up/down and call it a day.. those guys don't do well.. if it's deformed before we get there, we can fix it.. but likely their disease state is so far that our fixation won't fuse before they die

 

[ridethecliche]

Yeah. Most of the spine surgeons I know won't touch patients that have back pain/DDD. I know of one person who does ALIF's for them.

The gnarliest case I saw was a 16 hr surgery which was a revision for chordoma AND scoli. Patient's doing great now. Happy as a clam!

I was at a spine onc course a couple of weekends ago and one of the attendings said he had a case where the patient had an EBL of 20 liters. Insane...

 

[The Buff OP]

I had a snarky response all lined up but then I thought about it:

So in my life it went as such.. Grew up on coke, loved the stuff. Tried RC Cola at some point in HS, was the new thing (it's pretty good, try it). Decided to switch back to diet, Coke it is. Actually liked Diet Pepsi better. Drank that for a while. Maybe it was the school's contract's influence. In any case, now I don't drink soda, aside from soda water (not cola).

So the question is, what do I order when I order a drink e.g. rum and coke. Yes, I order coke. Since it's not a restaurant, they never ask "is pepsi OK?"

But then again, seriously how often am I at a bar ordering rum and coke? Obviously it's Krystal or Courvoisier! (there's the snark)

Hahaha, epic response. I have tried RC Cola next to the Shasta lol it's pretty good. I don't drink soda either, if I do it's Pepsi Max (boom!).

 

[mrh125]

How is your motor coordination? Does having shaky hands or a tremor negatively impact the capacity to do surgery in your mind? Have any of your colleagues had tremors and still managed to be successful at surgery?

 

[neusu]

Hahaha, epic response. I have tried RC Cola next to the Shasta lol it's pretty good. I don't drink soda either, if I do it's Pepsi Max (boom!).

Coke zero brah!

 

[neusu]

How is your motor coordination? Does having shaky hands or a tremor negatively impact the capacity to do surgery in your mind? Have any of your colleagues had tremors and still managed to be successful at surgery?

My motor coordination is above average. Having shakey hands does not negatively impact you during surgery. I have operated with attendings who shake like it's an earthquake and those who are steady as a board.

Surgery is a lot more than your tremor. Certainly, some aspects of neurosurgery amplify your tremor (e.g. any case under scope). I've watched my videos under scope, I don't have much of a tremor after I figure out what's going on/it's my job to go. I'll tell you, that aneurysm ruptures in your face your hands will shake, no matter who you are (spetzler aside)

that being said.. I've watched parkinson's attendings get it done and i've watched smooth criminal attendings **** it up..

as a student your ability to have a steady hand has about as much correlation with being a neurosurgeon as having a 2nd thumb..

 

[mrh125]

My motor coordination is above average. Having shakey hands does not negatively impact you during surgery. I have operated with attendings who shake like it's an earthquake and those who are steady as a board.

Surgery is a lot more than your tremor. Certainly, some aspects of neurosurgery amplify your tremor (e.g. any case under scope). I've watched my videos under scope, I don't have much of a tremor after I figure out what's going on/it's my job to go. I'll tell you, that aneurysm ruptures in your face your hands will shake, no matter who you are (spetzler aside)

that being said.. I've watched parkinson's attendings get it done and i've watched smooth criminal attendings **** it up..

as a student your ability to have a steady hand has about as much correlation with being a neurosurgeon as having a 2nd thumb..

Amazing post. Thanks for the response. When I wrote that post I was just imagining how a doctor loaded on energy drinks shaking up a storm could pull off surgery and the looks of all the other doctors at him as he did it. It's great to know that having shaky hands doesn't mean you're hopeless in surgery. I use to have hand tremors that were significant but now they're under control .

I have another question: were there any other surgical specialities you were exposed to and looked at before neurosurgery? And what would you recommend someone who is interested in surgery to do to get the best possible understanding of how things really go down?

 

[neusu]

Yeah. Most of the spine surgeons I know won't touch patients that have back pain/DDD. I know of one person who does ALIF's for them.

The gnarliest case I saw was a 16 hr surgery which was a revision for chordoma AND scoli. Patient's doing great now. Happy as a clam!

I was at a spine onc course a couple of weekends ago and one of the attendings said he had a case where the patient had an EBL of 20 liters. Insane...

Long-term back pain and DDD can be tough all around. There are patients out there who do well, but it's a matter of time until they likely fail again.

Chordoma surgeries are great, glad to hear the patient is doing well.

My record for a spine surgery is 18 U RBC. I forget the EBL off the top of my head, but it was monstrous.

 

[Guero]

If you had the option would you...

1. Do research at a prestigious lab but will unlikely get a publication (cool project)

Or...

2. Do research at an unknown institution and likely get a publication? (Okay project)

I try to stay out of the questions unless I have something very relevant to add. This is one of those times: I emphasize the first option as neusu advised on account of the LOR. It's not uncommon that your mentor in the lab, a grad/med/MSTP student or staff scientist, will write you an utterly amazing LOR that will be read and signed by the prestigious lab PI. These types of letters, depending on the PI's eminence, can singlehandedly pull you out of the stack and can even land you with a scholarship. So if given the chance, follow the "three As" neusu listed above, as they also duly apply to basic science, and try to shine.

For more info, PM me. GL

Carry on, good sirs.


Posted using SDN Mobile

 

[The Buff OP]

Coke zero brah!

If you only had one choice between these two "careers" which one would it be?

1. Kindergarten teacher
2. McDonalds Manager

 

[neusu]

Amazing post. Thanks for the response. When I wrote that post I was just imagining how a doctor loaded on energy drinks shaking up a storm could pull off surgery and the looks of all the other doctors at him as he did it. It's great to know that having shaky hands doesn't mean you're hopeless in surgery. I use to have hand tremors that were significant but now they're under control .

I have another question: were there any other surgical specialities you were exposed to and looked at before neurosurgery? And what would you recommend someone who is interested in surgery to do to get the best possible understanding of how things really go down?

As an undergrad I worked in neurology so I got to shadow both neurologists and neurosurgeons. I also had the opportunity to shadow a CT surgeon. During medical I rotated on General, Orthopedics, Neurosurgery, and ENT.

Gaining exposure depends on what stage in your career you look. As an undergraduate, there are plenty of shadowing opportunities either through pre-med clubs or contacts. As a medical student, you can usually set it up to follow an attending or resident for a day or more. During third year, you spend time on the surgical service. While different schools do this differently, you may be allowed the opportunity to spend part of your rotation on a sub-specialty service. During 4th year you can pick electives.

 

[neusu]

If you only had one choice between these two "careers" which one would it be?

1. Kindergarten teacher
2. McDonalds Manager

Naturally, being the intellectualist I am, I picked the Mc Donald's Manager

You are a manger. You have upward mobility. Certainly, you're a manger (be it shift, store, regional). This company likes to promote from within! FFS I am related to one of the current executives! Had i chosen this route, I'd likely be currently making 6-7 figures! (Instead of 4-5)

Kindergarden teacher:
Yay! Oh ****, you peed you're pants.. Let me find a female teacher who can escourt you to

 

[The Buff OP]

Naturally, being the intellectualist I am, I picked the Mc Donald's Manager

You are a manger. You have upward mobility. Certainly, you're a manger (be it shift, store, regional). This company likes to promote from within! FFS I am related to one of the current executives! Had i chosen this route, I'd likely be currently making 6-7 figures! (Instead of 4-5)

Kindergarden teacher:
Yay! Oh ****, you peed you're pants.. Let me find a female teacher who can escourt you to

*your. Stay in school, kids. lol Just messing with you.

 

[drabberbadge]

Naturally, being the intellectualist I am, I picked the Mc Donald's Manager

You are a manger. You have upward mobility. Certainly, you're a manger (be it shift, store, regional). This company likes to promote from within! FFS I am related to one of the current executives! Had i chosen this route, I'd likely be currently making 6-7 figures! (Instead of 4-5)

Kindergarden teacher:
Yay! Oh ****, you peed you're pants.. Let me find a female teacher who can escourt you to

As a neurosurgery resident, do you have time for social and pleasurable but non work related activities such as daily exercise, nights off to lay around home/ go out with friends, are you always busy?

 

[neusu]

*your. Stay in school, kids. lol Just messing with you.

Got me.

 

[The Buff OP]

Got me.

It happens. I have been doing lots of typos lately, too. I get embarrassed, but then again it's 1Am-3AM when I'm posting stuff.

 

[603pharmacy]

Are there options for Neurosurgeons to go into private practice? I personally haven't thought of Neurosurgery as a private practice specialty due to the amount of care and need from the patients post-op. If not private practice, then maybe your own practice inside of the hospital?

 

[Endure]

This may sound like a strange series of questions, but I'll go ahead anyway.

How did you learn to handle the immense responsibility that comes with being a neurosurgeon? Does becoming a skilled surgeon require bulletproof confidence and limited self-doubt? If applicable, how did you overcome the fear and anxiety of operating on such a delicate organ?

I'll be an MS1 in July and believe neurosurgery and neurology appeal to me the most. While I'm certainly open to other specialities, I've been incredibly passionate about neuroscience and the brain since I started college and believe it's what ultimately steered me towards a career in medicine.

My only concern is that my disposition may preclude me from a career in surgery. I'm driven, ambitious and motivated, but I'm also an little self-doubting and hesitant (in the beginning). My dexterity is workable and visuospatial skills strong, I just wonder whether I'm too second-guessing for a career in neurosurgery. The idea of tampering with anther person's brain seems terrifying.

 

[neusu]

Are there options for Neurosurgeons to go into private practice? I personally haven't thought of Neurosurgery as a private practice specialty due to the amount of care and need from the patients post-op. If not private practice, then maybe your own practice inside of the hospital?

The majority of neurosurgeons out there are in private practice. The size and ability of the hospital limits what range of surgery can be performed.

 

[porshiana]

I am curious about brain waves and things such as entrainment. Is there any legitimate evidence that entrainment works?
Also I've seen claims that when 2 people are in close proximity their brain waves can sync. Is there any proof. Ive been researching but can find no studies or evidence

 

[zunaa2015]

The majority of neurosurgeons out there are in private practice. The size and ability of the hospital limits what range of surgery can be performed.

I have heard of Neurosurgery resident's moonlighting before the 80 rule took effect. Is this something that can be realistically done nowadays, if so what is a ballpark figure for in-house vs non- in-house moonlight neuro residents? Also, when you do moonlight is it wise to moonlight within your chosen residency (neurosurgery) or is ED the most common place to moonlight at least for neuro-residents?

Thanks in advance.

 

[Boombalitsy]

Can someone give me an answer? I was getting prepped for a micro discectomy to relieve the pressure off of left tibial nerve root at L-S. Someone popped her head in the door and said, "His PTT was elevated [from my blood work taken at pre op]." It was 56.4 out of a range of 23.6-34.6. They did more blood and it was still elevated to about the same level, but my PT was normal, as was everything else. ANA was negative for lupus. I think it's 'Factor XII Deficiency, aka Hageman's Factor Deficiency.' I've tested positive twice (years apart) for syphilis (ewwww), but they were none reactive. The first time it happened the Dr. followed with an ANA for Lupus, but no Lupus. So, there again, I'm thinking FXII Deficiency which is pretty benign and the other clotting factors make-up for it... but I'm not med./pre-med, etc., so I don't know. If the labs do indeed verify that's what it is, will my neuro do the surgery. An nurse anesthetist friend of mine was saying poor clotting=bleeding on to spinal cord=compression=paralysis=bad day. So, does anyone know if a neurosurgeon will do spine surgery on me having a prolonged PTT due to Factor XII Deficiency? Please and Thanks!

 

[zunaa2015]

I have heard of Neurosurgery resident's moonlighting before the 8O rule took effect. Is this something that can be realistically done nowadays, if so what is a ballpark figure rate for in-house vs non- in-house moonlight neuro residents? Also, when you do moonlight is it wise to moonlight within your chosen residency (neurosurgery) or is ED the most common place to moonlight at least for neuro-residents?

 

[neusu]

I am curious about brain waves and things such as entrainment. Is there any legitimate evidence that entrainment works?
Also I've seen claims that when 2 people are in close proximity their brain waves can sync. Is there any proof. Ive been researching but can find no studies or evidence

I'll be honest, I had to look up entrainment. "Brain waves" as we measure them are a crude interpretation of cortical and sub-cortical neural activity. There certainly is an argument for biophysical feedback, meaning, using our ability to measure temperament, attitude, outlook, and physical things like heart rate, blood pressure, muscle tension, and "brain waves."

EEG certainly can be useful. In this setting, likely not.

 

[neusu]

I have heard of Neurosurgery resident's moonlighting before the 80 rule took effect. Is this something that can be realistically done nowadays, if so what is a ballpark figure for in-house vs non- in-house moonlight neuro residents? Also, when you do moonlight is it wise to moonlight within your chosen residency (neurosurgery) or is ED the most common place to moonlight at least for neuro-residents?

Thanks in advance.

Moonlighting is becoming a vestige of the past for many/most surgical residencies with the exception of research/electives residents. Previously, moonlighting at another hospital as a hospitalist, ED doc, whatnot was allowed as a resident when you were not on call at your program. Anymore, due to work hour restrictions and insurance issues, it has fallen by the wayside. It is much easier for the smaller hospitals to hire a PA or NP to cover the positions that moonlighting residents formerly did, both for consistency of availability and consistency of care. Don't get me wrong, moonlighting has historically been thought of as a great educational opportunity for residents. Nonetheless, it is all but gone aside from internal moonlighting and during the aforementioned years. Even this is only allowed at certain programs.

 

[neusu]

Can someone give me an answer? I was getting prepped for a micro discectomy to relieve the pressure off of left tibial nerve root at L-S. Someone popped her head in the door and said, "His PTT was elevated [from my blood work taken at pre op]." It was 56.4 out of a range of 23.6-34.6. They did more blood and it was still elevated to about the same level, but my PT was normal, as was everything else. ANA was negative for lupus. I think it's 'Factor XII Deficiency, aka Hageman's Factor Deficiency.' I've tested positive twice (years apart) for syphilis (ewwww), but they were none reactive. The first time it happened the Dr. followed with an ANA for Lupus, but no Lupus. So, there again, I'm thinking FXII Deficiency which is pretty benign and the other clotting factors make-up for it... but I'm not med./pre-med, etc., so I don't know. If the labs do indeed verify that's what it is, will my neuro do the surgery. An nurse anesthetist friend of mine was saying poor clotting=bleeding on to spinal cord=compression=paralysis=bad day. So, does anyone know if a neurosurgeon will do spine surgery on me having a prolonged PTT due to Factor XII Deficiency? Please and Thanks!

Were you operating or a patient?

Former, you should know the answer. Latter, ask your doc.

 

[Boombalitsy]

Were you operating or a patient?

Former, you should know the answer. Latter, ask your doc.

I'm the patient. I'm antsy in the pantsy to know, and it will be a while before I can "pen him down;" he is a neurosurgeon. So, I was just curious if they (neurosurgeons) do spine surgery one a person with the FXII Deficiency. I'm always in brutal agony. If they don't (sigh), it looks like I always will be.

 

[neusu]

This may sound like a strange series of questions, but I'll go ahead anyway.

How did you learn to handle the immense responsibility that comes with being a neurosurgeon? Does becoming a skilled surgeon require bulletproof confidence and limited self-doubt? If applicable, how did you overcome the fear and anxiety of operating on such a delicate organ?

I'll be an MS1 in July and believe neurosurgery and neurology appeal to me the most. While I'm certainly open to other specialities, I've been incredibly passionate about neuroscience and the brain since I started college and believe it's what ultimately steered me towards a career in medicine.

My only concern is that my disposition may preclude me from a career in surgery. I'm driven, ambitious and motivated, but I'm also an little self-doubting and hesitant (in the beginning). My dexterity is workable and visuospatial skills strong, I just wonder whether I'm too second-guessing for a career in neurosurgery. The idea of tampering with anther person's brain seems terrifying.

I'm a pretty practical guy. Most of the surgical cases I do, I rationalize the case as my personal involvement. We as surgeons do a wonderful job of keeping our feelings as humans out of the situation; we drape off the field, we minimize our time seeing the patient, we ameliorate our losses.

As an MS1, try on neurosurgery, see if you like it. We can teach a left handed monkey to operate. We need neurosurgeons who can operate and talk to people on a personal level.

 

[neusu]

I'm the patient. I'm antsy in the pantsy to know, and it will be a while before I can "pen him down;" he is a neurosurgeon. So, I was just curious if they (neurosurgeons) do spine surgery one a person with the FXII Deficiency. I'm always in brutal agony. If they don't (sigh), it looks like I always will be.

Yes, surgeons operate on people with factor xii deficiency. Wait until your appointment and discuss it with your surgeon.

 

[manofmen]

hey @neusu i was reading an article about flow and doctors, particularly surgeons who, in the operating room, experience states of 'flow.' i was wondering if you could describe your state of mind during a surgery and how that evolved from first starting out to now.

 

[neusu]

hey @neusu i was reading an article about flow and doctors, particularly surgeons who, in the operating room, experience states of 'flow.' i was wondering if you could describe your state of mind during a surgery and how that evolved from first starting out to now.

I suppose you could describe it that way. Generally, we strive for procedural efficiency. As a newer surgeon most of the time in the operating room is spent learning the order of things, what instruments are and how to properly use them, and what to do when things go wrong. With experience surgery becomes more routine. Each case is an opportunity to improve and do things better, smarter, faster, with increased safety and better outcomes.

 

[Boombalitsy]

Yes, surgeons operate on people with factor xii deficiency. Wait until your appointment and discuss it with your surgeon.

Thank you so much! I was afraid that I would be living with this radiculopathy for the rest of my life. I appreciate your response.