Ask a neurosurgery resident anything

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neusu said:
Yes, surgeons operate on people with factor xii deficiency. Wait until your appointment and discuss it with your surgeon.
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Oh, and this is spine surgery we're talking about here, just to be clear.
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Hi neusu, I've followed this thread for a long time. One resident on this forum recently posted that neurosurgeons are defined as people by their job. I know this is a grim view (and maybe offensive) but it got me a little worried. Family matters are probably not talked about around the hospital, but to the best of your knowledge, how does the work affect peoples' ability to be fathers, mothers, or just social? How do you think it would affect your life if you had a family? Thanks again!
 
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Hello neusu,

Thanks for answers questions. I don't know if this has been asked before but how is bench neuroscience research, as opposed to clinical neurosurgery research, looked upon when applying to neurosurgery residency?

Thanks!!
 
trino said:
Hi neusu, I've followed this thread for a long time. One resident on this forum recently posted that neurosurgeons are defined as people by their job. I know this is a grim view (and maybe offensive) but it got me a little worried. Family matters are probably not talked about around the hospital, but to the best of your knowledge, how does the work affect peoples' ability to be fathers, mothers, or just social? How do you think it would affect your life if you had a family? Thanks again!
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No matter what residency you do, residency will dominate your life. There is no way around this. Certainly, some are more family friendly, and neurosurgery can be that way during the research or elective years.

Fundamentally, my view, and I am likely wrong with the current state of medicine, is that, as a physician, is that your duty is to your patients. If they are in need you need to be there. Certainly, having a practice arrangement for time off is helpful.

During residency, though, neurosurgery is one of the more difficult residencies to plan a family. It takes a special person to understand the trials and tribulations which we go through, let alone delay their own life for 7 years.

After residency life becomes more normal. I don't know any neurosurgeons who are their kid's baseball or soccer coaches, but they certainly try to make the games.
 
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death prophet said:
Hello neusu,

Thanks for answers questions. I don't know if this has been asked before but how is bench neuroscience research, as opposed to clinical neurosurgery research, looked upon when applying to neurosurgery residency?

Thanks!!
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Any publications > no publications

Bench research > clinical research
 
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Hey neusu how many hours does the average attending NS at your hospital work per week?
 
Vinny15 said:
Hey neusu how many hours does the average attending NS at your hospital work per week?
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While I'm not an attending, nor do I work attending hours, I can speculate as to what they do work. Most attendings seem to work from roughly 8 am to 5 - 6 pm unless it's their OR day which ends when it ends (1 pm or 12 am). They take call, at least where I am, infrequently, but their hours may be more during that period.

Private practice attendings dictate their own life/hours. I suspect most neurosurgeons work 60-80 hours/week.
 
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Do you happen to know who's the youngest board-certified neurosurgeon (or youngest that you know of)? Just curious.
 
What neurosurgery-related books have you read/would you recommend reading, to get a first-hand account of neurosurgery?

I've read "When the Air Hits Your Brain" by Frank Vertosick, "Another Day in the Frontal Lobe" by Katrina Firlik, "Brain Surgeon" by Keith Black, "Gifted Hands" by Ben Carson, "Monday Mornings" by Sanjay Gupta (more of a novel really but still lots of neurosurgery-related stuff).
 
mentalhypoxia said:
What neurosurgery-related books have you read/would you recommend reading, to get a first-hand account of neurosurgery?

I've read "When the Air Hits Your Brain" by Frank Vertosick, "Another Day in the Frontal Lobe" by Katrina Firlik, "Brain Surgeon" by Keith Black, "Gifted Hands" by Ben Carson, "Monday Mornings" by Sanjay Gupta (more of a novel really but still lots of neurosurgery-related stuff).
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The Frank Vertosick book is one of the best I've read - short, funny and candid. The part about the three longest years of an orthopedic surgeon's life: second grade...hilarious!!!!
 
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mentalhypoxia said:
What neurosurgery-related books have you read/would you recommend reading, to get a first-hand account of neurosurgery?

I've read "When the Air Hits Your Brain" by Frank Vertosick, "Another Day in the Frontal Lobe" by Katrina Firlik, "Brain Surgeon" by Keith Black, "Gifted Hands" by Ben Carson, "Monday Mornings" by Sanjay Gupta (more of a novel really but still lots of neurosurgery-related stuff).
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Unfortunately, or fortunately (I guess), I haven't read any neurosurgery books. Really, the only medical fiction book I have read is "House of God." It was rather humorous and, to some degree, accurate.
 
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death prophet said:
The Frank Vertosick book is one of the best I've read - short, funny and candid. The part about the three longest years of an orthopedic surgeon's life: second grade...hilarious!!!!
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I think I have the book at home, just haven't read it. Maybe I'll pick it up, given your rave review.
 
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I've read "House of God" as well, and I agree it was funny/somewhat dark, but I can see why reading medical novels isn't the most interesting given that's what you do most of the day too. The Vertosick book is also quite good, and as death prophet said funny as well. Interestingly, both Firlik and Vertosick went to the same residency program (although years apart), seems like that program produces authors.
 
So how many panties have dropped after learning you were a neurosurgeon? Excluding the times which were preceded by, "I have to do a rectal exam on you."

Also you mentioned earlier that an undergrad was helping with research--but exactly what is their role with clinical research? Does he understand any of it?
 
neusu said:
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.
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Do left handed monkeys have the intestinal fortitude to operate though...
 
Just read the whole thread (took me a while!), thanks so much for doing this.

I'm applying to medical school this cycle and I'm looking to get some research experience before med school (hopefully!) starts in a year. I have never done bench research and my knowledge of lab techniques is limited to med school prerequisites (fetal pig?). I started looking at neurosurgery research at nearby med schools and I really don't think I'm qualified to even clean glassware for them... I do have pretty good experience in clinical research (psychiatry) and theoretical research (clin. psychology, with pub). Would you recommend trying to join a clinical research NS lab, since I'd be more helpful there? How do you make that first step in NS research with no previous NS experience?

Also, how much does NS research rely on animal models? Do you work mainly on rodents? This may not be a popular view among those in medicine, but I'd be really uncomfortable doing research using primates/dogs/cats/pigs.

Thanks!
 
mentalhypoxia said:
I've read "House of God" as well, and I agree it was funny/somewhat dark, but I can see why reading medical novels isn't the most interesting given that's what you do most of the day too. The Vertosick book is also quite good, and as death prophet said funny as well. Interestingly, both Firlik and Vertosick went to the same residency program (although years apart), seems like that program produces authors.
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Makes sense. I'll take a look at some point in the future.
 
dirigo said:
So how many panties have dropped after learning you were a neurosurgeon? Excluding the times which were preceded by, "I have to do a rectal exam on you."

Also you mentioned earlier that an undergrad was helping with research--but exactly what is their role with clinical research? Does he understand any of it?
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First question: Generally the scenario goes one of two ways.. 1) We're chatting/flirting, she's already interested, and asks, "Sooo, what do you do?" I answer and 11 times out of 10 she'll think I'm messing with her. 2) It is brought up early in the conversation and she'll not care.

Second question: Undergrads can understand a surprising amount of a focused piece of a project. We'll generally use them for data collection or number crunching. The learning curve is rather steep, but they are generally pretty motivated or wash out quickly.
 
neusu said:
Any publications > no publications

Bench research > clinical research
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why is bench research > clinical research? a neurosurgery resident friend of mine mentioned when he interviewed for his current spot, there was a guy with a first author 1 nature pub, and he had 20+ clinical pubs. He told me the same thing...that the first author 1 nature pub was probably viewed more highly than his 20+ neuro/neurosurg. clinical pubs (some first author as well, but all clinical). Why is this?
 
Do you know who Dr. David Levy is?
 
@neusu When you guys have a trauma coming in and they need surgery fast do you guys take less time to scrub in or no matter what you guys still follow the normal scrub procedure(more time)?

Edit: Ooooh you are now Mr. Chief resident, nice.
 
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What is the lifestyle like of a neurosurgeon? Do you have time for family? Can medical school + residency be done while raising a child?
 
dudewheresmymd said:
why is bench research > clinical research? a neurosurgery resident friend of mine mentioned when he interviewed for his current spot, there was a guy with a first author 1 nature pub, and he had 20+ clinical pubs. He told me the same thing...that the first author 1 nature pub was probably viewed more highly than his 20+ neuro/neurosurg. clinical pubs (some first author as well, but all clinical). Why is this?
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For the most part, bench research is more "pure" than clinical research. It takes more thought to understand a concept, devise an experiment, conduct the experiment, interpret the data, and explain the results in a meaningful way. Bench research often costs more money because the actual lab space/equipment/personnel are devoted to research whereas many clinical studies are conducted on patients who already would have been treated. This requires significant investment either by the University or department and often is the result of outside grant funding. Likewise, research from the bench tends to lead to larger clinical breakthroughs and understanding than clinical research. There are more basic science researchers than clinical researchers. The journals are more widely read and, for the "big" journals, cited more often. This is more impressive.
 
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neusu said:
For the most part, bench research is more "pure" than clinical research. It takes more thought to understand a concept, devise an experiment, conduct the experiment, interpret the data, and explain the results in a meaningful way. Bench research often costs more money because the actual lab space/equipment/personnel are devoted to research whereas many clinical studies are conducted on patients who already would have been treated. This requires significant investment either by the University or department and often is the result of outside grant funding. Likewise, research from the bench tends to lead to larger clinical breakthroughs and understanding than clinical research. There are more basic science researchers than clinical researchers. The journals are more widely read and, for the "big" journals, cited more often. This is more impressive.
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Ah makes sense now. Thanks! Is a co-author bench paper better than a co-author clinical paper similarly? Or just first authorships?
 
Boombalitsy said:
So I have a wicked case of cervical dystonia (spasmodic torticollis). It was induced by a drug called lamictal. I've had the condition for about 2 1/2 years now. I get Botox injections every three months, but they just barely curb the dystonic "storms," and the last round just made my neck more stiff, but I still have the un-voluntary urges to contort my neck. They have tried klonpin, diazepam, and Xanax to help with the "storms." Xanax seems to work the best, but it's starting to get to the point where nothing is working. My neuro tried to give me Orap, but there's no way in hell I'm taking it. It's getting ridiculous. I'm in severe, chronic pain, and I can't get any relief. Does anyone have any suggestions? Please?
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Have you seen a functional/pain surgeon? There are procedures we can do for medical refractory torticollis.

Alternatively, have you tried walking bakwards?
 
What distinguish surgeons performing real complex (and rare) procedures from other?

My impression is that the one perfoming the most complex surgical cases are the one who is also performing the research on it. What is your impression? I can see two scenario:
1) Surgeon had the magic hands -> got the most complex procedure and started doing research.
2) The surgeon had an interest in the disease and therefore choosed to operate mainly on it. For example, John Cameron, with over 2000 Whipple procedures, choosed to do refine the procedure not because he had the great hands, rather he was interested to see how much one could refine/reduce the complications of the procedure.

Second, could you just describe what a typical learning curve could look like? Let's say you have completed residency and should start learning a procedure you have only seen but not done any practical step on.
 
No question but mad props for answering questions for 2 whole years!!
 
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When @mimelim and @neusu ignore my questions I be like...
355sec.jpg
 
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The Buff OP said:
@neusu When you guys have a trauma coming in and they need surgery fast do you guys take less time to scrub in or no matter what you guys still follow the normal scrub procedure(more time)?

Edit: Ooooh you are now Mr. Chief resident, nice.
Click to expand...

When there is a trauma that needs to go up NOW, we tend to move faster. Every patient still gets the pertinent ED stablization: ABCs, imaging, etc. We call the OR and make it clear they needed to be up there 30-minutes ago, and get them up as soon as possible. We scrub the same for every case as a standard precaution. Traditional scrubbing is less common now-a-days with the advent of waterless scrubbing.

The difference between our emergencies and other services emergencies is rather stark. Certainly vascular and trauma can have patients that need to be in the OR immediately or the patient will die. More often though, most "emergent" cases can be postponed hours to a day. With neurosurgical emergencies, by the time the issue is discovered it is often almost too late.
 
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neusu said:
When there is a trauma that needs to go up NOW, we tend to move faster. Every patient still gets the pertinent ED stablization: ABCs, imaging, etc. We call the OR and make it clear they needed to be up there 30-minutes ago, and get them up as soon as possible. We scrub the same for every case as a standard precaution. Traditional scrubbing is less common now-a-days with the advent of waterless scrubbing.

The difference between our emergencies and other services emergencies is rather stark. Certainly vascular and trauma can have patients that need to be in the OR immediately or the patient will die. More often though, most "emergent" cases can be postponed hours to a day. With neurosurgical emergencies, by the time the issue is discovered it is often almost too late.
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Thank you for your answer. :thumbup:
Dude, I think by now you are probably tired of answering questions. Many post ago you said you think you pretty much cover every question possible for neurosurgery, but they keep oncoming. :p
 
Are you required to be up to date on neurological studies? It seems like its a field (neuroscience) that is always coming up with something new. Are you held to some sort of monthly seminar requirement or is it just something you are expected to know during your freetime.
 
DrMomZion said:
What is the lifestyle like of a neurosurgeon? Do you have time for family? Can medical school + residency be done while raising a child?
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I may have touched on this in previous posts.

The lifestyle of a neurosurgeon tends to be rather busy and unpredictable. Regardless of the focus of the surgeon (trauma, vascular, tumor, spine, functional), emergencies come up and require a sudden schedule adjustment. As an attending, the practice arrangement can help alleviate the individual chaoticness by distributing the unpredictability among multiple surgeons. That being said, in this arrangement, you may be off when you're off, but when you're on, you are on for everyone.

I tend to use kids' baseball games as a metaphor for how busy and involved a surgeon is. In my experience, a neurosurgeon likely won't be the team coach because he simply can not devote enough time on a daily basis without exception to make every practice and so on. Can he plan ahead and make the games? More than likely. Even that, however, sometimes can prove problematic.

Medical school and residency can and is done while raising children. I have yet to see a single mother neurosurgery resident. It takes a huge sacrifice on the part of the partner of a neurosurgeon just to commit to being with him or her. The hours are long. The standard relationship things like going out to a dinner or a movie on weekends, having dinner each evening, or getting ready for bed and sleeping together each night can not be counted on. In the time spent together, the resident surgeon is often stressed, exhausted, and simply does not want to do anything substantial. Friends from college/graduate school/medical school are all moving along in their careers, have great jobs and houses and cars, and are starting families. Meanwhile, your husband or wife is now in his or her sixth or seventh year of residency, getting walked on by former classmates who went in to residencies that were 3 or 4 years and are now attendings. If you have kids and a job, as you imagine, it is a constant juggle. If you don't work, money is always tight because residency salaries, though better than previous days, still are not exceptional and things like rent, loan payments or a mortgage, and food take giant bites out of the paycheck. It is very trying for a young, healthy person to be put through such an experience during the most vital years of his/her life. Often things do not work out. An old mentor of mine cryptically would joke, "You can only have one marriage at a time.. Residency or a wife." While he was joking, there is a vein of truth to it all.
 
neusu said:
Have you seen a functional/pain surgeon? There are procedures we can do for medical refractory torticollis.

Alternatively, have you tried walking bakwards?
Click to expand...

No, I have not seen a functional/ pain surgeon. Mine is nothing near what was in that video. Mine is cervical, i.e. it's in my neck and shoulders. I get "un-voluntary" spasms and contortions of my posterior neck muscles. They are called un-voluntary b/c I can keep from contorting and twisting, but the urge gets so incredibly overwhelming that I have to. My neurologist sucks. She's only good for botox, which helps a little, but very little. Doctors don't know exactly what causes it. I think the only surgical treatment is one when they do some kind of denervation, essentially kill (for a while) the nerves that have the most action with the pretense of lessening the dystonic "storms."

They also have some kind of deep brain stimulation where they drill a teeny hole in your cranium and install some wires somewhere on your brain. No thank you there. I'm tired of taking Xanax and Klonpin for the spasms, and the botox works less and less every time (sigh). My primary provider just referred me out to a pain management specialist. Of course, I'm not asking for medical advice here because that is not what this forum is for.
 
neusu said:
Were you operating or a patient?

Former, you should know the answer. Latter, ask your doc.
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It wasn't factor XII Deficiency. I have antiphospholipid antibodies in my attacking my platelets. The hematologist said it's like APS, without the actual syndrome. So, the prolonged PTT was actually paradoxical, like a false positive. I actually clot more then I'm supposed to. For now, I do nothing, not even a low-dose aspirin, and I'm cleared for surgery.
 
Hi @neusu. A few months ago I let you know that I succeeded to find a shadowing position with a NS who does minimally invasive spine work. Just wanted to say that the smell of burning flesh and bone was not as bad as I was expecting.

The lifestyle in NS just seems so continuous and intense!
 
Perzt said:
What distinguish surgeons performing real complex (and rare) procedures from other?

My impression is that the one perfoming the most complex surgical cases are the one who is also performing the research on it. What is your impression? I can see two scenario:
1) Surgeon had the magic hands -> got the most complex procedure and started doing research.
2) The surgeon had an interest in the disease and therefore choosed to operate mainly on it. For example, John Cameron, with over 2000 Whipple procedures, choosed to do refine the procedure not because he had the great hands, rather he was interested to see how much one could refine/reduce the complications of the procedure.

Second, could you just describe what a typical learning curve could look like? Let's say you have completed residency and should start learning a procedure you have only seen but not done any practical step on.
Click to expand...

Generally, the distinguishing factor for doing complex procedures from routine are referral patterns and surgeon comfort level. For both of your examples the surgeon would likely get the complex cases. Any surgeon, regardless of "magic hands" or not, will need to build a reputation for being successful and a track-record of good outcomes.

Learning curve is dependent on the individual and the particular procedure being learned. Naturally, some are more adept than others at mechanical skills and muscle and procedural memory. Likewise, some procedures are rather easy to learn while others are rather difficult. For the former, often a short course or seminar can bring a surgeon up to speed. For the latter, often a fellowship in the particular field is necessary.
 
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Do you know practicing surgeons who have herniated lumbar discs? In your opinion, would someone with an asymptomatic herniated disc be fit for surgical specialties, specifically neurosurgery?
 
Donald Kimball said:
Do you know practicing surgeons who have herniated lumbar discs? In your opinion, would someone with an asymptomatic herniated disc be fit for surgical specialties, specifically neurosurgery?
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Why not? If you would perform a MRI on all students in a medical school, then 20-65% (depending on study) would show any disc pathology and some would definately be disc herniation. So that would make a lot of people excluded from a surgical career which is not the case.. Just pay attention to your posture and do exercise regularly. I guess there are several neurosurgeons that have had a great career happily not knowing they had a disc hernation :) Maybe I'm not reasoning correctly now and neusu might be able to answer this better.
 
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