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shaky hands: okay to do microsurgery?

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GoBlue02

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I was closing the conj today for the first time ever and noticed that my hands were pretty shaky. When I tried to hold an instrument very still at home later, I noticed that I do have a bit of a mild tremor. Does this happen to most people under the microscope for the first time? Am I screwed and should I consider other things? Also, any advice to improve the problem would be greatly appreciated. Thanks.

Ophtho PGY-2 in Cali
 

V05

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It is not uncommon to shake, especially for your first time at something! I am sure you were a little nervous.

I have the following suggestions:
1) Stabilize your wrists and/or elbow- try wrist/elbow rests to see if they help
2) Get an attending whom you are the most comfortable with if possible
3) Practice in microsurgery so you know all the steps when you are in the OR
4) Try to cut out caffeine the AM of surgery
5) If you get very nerouvs, some feel sublingual beta-blocker helps the first few times you do a procedure.

Hope that helps.
 

7ontheline

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You are screwed. I suggest quitting ophthalmology now and taking up psychiatry.
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Seriously though, this happens to everybody. I'm a fellow and my hands still shake occasionally when things get hairy or frustrating. Try to do your best to take a moment and regain your calm and move on in a deliberate, but steady fashion. V05's tips are very good.
 
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fatman41

Is it odd for someone to go all the way until April of PGY-2 before closing the conj or being under the microscope? It seemed like on my aways I saw PGY-2s removing pterygia/conj lesions within the first few weeks of PGY-2, and for sure by August. Which of these experiences is more typical?
 

eyerepairman

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Is it odd for someone to go all the way until April of PGY-2 before closing the conj or being under the microscope? It seemed like on my aways I saw PGY-2s removing pterygia/conj lesions within the first few weeks of PGY-2, and for sure by August. Which of these experiences is more typical?

One program that I interviewed at was so top heavy procedure-wise that only PGY-4 did anything in surgery. My program had a tradition of at least 1 cataract case had to be given to the first years by Christmas.
 

dk23

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Thanks for the tips! Is the wetlab the best way to practice microsurg or do you guys have any other devices or ways to practice that you found translate well to real OR time?
 

brendang

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Is it odd for someone to go all the way until April of PGY-2 before closing the conj or being under the microscope? It seemed like on my aways I saw PGY-2s removing pterygia/conj lesions within the first few weeks of PGY-2, and for sure by August. Which of these experiences is more typical?

this is how we roll down here -- but it seems like things will get better come july! (just part of being "the first year", i guess...)
 

ckyuen

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stop all caffiene on OR days. I still don't drink coffee on OR days. I know others who do, but they also take about twice as long as I do to complete a phaco, and post op corneal edema is much greater than mine. I second beta blockers. I had head cold when I was doing an extracap as a pgy-3 I took pseudophed two to make sure my head would be clear for surgery. It sure was clear but my hands were all over the place, took some timolol put it sublingual and it sure helped to calm things down. Also agree with wrist rests, they are great to prevent you from getting wet.
 

Olddog1

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stop all caffiene on OR days. I still don't drink coffee on OR days. I know others who do, but they also take about twice as long as I do to complete a phaco, and post op corneal edema is much greater than mine. I second beta blockers. I had head cold when I was doing an extracap as a pgy-3 I took pseudophed two to make sure my head would be clear for surgery. It sure was clear but my hands were all over the place, took some timolol put it sublingual and it sure helped to calm things down. Also agree with wrist rests, they are great to prevent you from getting wet.

Be careful with B-blockers, they really are not meant for young, healthy people. Case in point: When I has a medical student one of the residents took a beta blocker before operating with a very intense attending. The operating microscope swung into position, he hit the floor. His baseline heart rate was likely around 60.
 

PDT4CNV

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I was closing the conj today for the first time ever and noticed that my hands were pretty shaky. When I tried to hold an instrument very still at home later, I noticed that I do have a bit of a mild tremor. Does this happen to most people under the microscope for the first time? Am I screwed and should I consider other things? Also, any advice to improve the problem would be greatly appreciated. Thanks.

Ophtho PGY-2 in Cali



It will get better the more you work under the microscope. Part of it is just developing your fine motor control. The rest is just anxiety. Don't worry about it.
 

GoBlue02

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Thanks for all of the reassurance. It means a lot. I have noticed that I have a very mild tremor at home, but I think I will be able to overcome it...especially after I noticed a 55yo retina doc at my program who shakes way more than I do :scared: and is very successful. I guess if all else fails I could do medical retina anyway, right?!
 

kassie

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Drink a beer! :laugh:

Seriously, I'm not in the eye OR yet, but in my microsurgery days in the lab, a good nights sleep, a good breakfast, a cup of chamomile tea and PRACTICE PRACTICE PRACTICE made my days fast, easy, and high quality.
 

Andrew_Doan

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All the residents that I staff shake... even the seniors when doing a procedure that is new. Small tremors will subside with time!

The residents shake more when I tell them they have 30 minutes before
I take over... ;)
 

NDeyeMD

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I had a peds attending who told another resident to put a drop of timolol in each eye on the day he operated. He almost passed out the first day he operated. He says the small amount that is systemically absorbed is the perfect amount to calm a small tremor.
 

buckler

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Hi, I am repeating a residency in the States and was a retina attending in my country. Some quick advice, dont worry about it too much. As you get more cutting under your belt, the tremors will gradually subside. Some basic rules that I follow.

Dont forget to breathe when you are operating. As you start out, excessive concentration may predispose you to some amount of apnoea.

Rest the dorsum of the pinkie and ring finger on the patients forehead, I find that the most common cause of tremors is when green horns try to suture in mid-air.

Try to hold your instrument as you would a pen, the essesential movement coming from the distal phalanges.

Dont work out 24 hours before a procedure as heavy weights tend to give you a tremor that gets magnified 10X and higher under the OM.
Forget about doing foearms in the gym as all your fine motor skills depend on your forearm muscles and you do not want a permanent tremor in those muscles.
 

FlightDoc80

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I've seen some residents take low dose betablockers to decrease tremors.
 
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