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sup /b/
neurosurg here
ama
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some big ass drain there
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i have muscle spasms and twitches

sometimes i wake up in a panic from sleep...i jolt straight up and it's scary for a second or two

for a while i was seeing flashes in my vision (with eyes open) but they subsided

i get tension headaches alot, mainly on the left side of my head, toward the rear

diagnose me plz. neurologist says it's nothing
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why do the X-rays? no clue
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>>682708404
sorry to hear that, anon
if you don't dig your neurologist, you should get a second opinion.
since nothing you describe can be fixed with a knife, i can't give you a definitive diagnosis
>>
How hard is it to cut blood off at the carotids? Is it possible to accidentally do it? What would happen if you completely blocked one? Would you pass out before you get brain damage?
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>>682708991
if you have it exposed, super easy.
pic related
if you are just pressing on your neck, pretty tough. accidentally? nope.
completely blocked: if acute, devastating stroke; if slowly develops, may be asymptomatic if you have adequate collateral circulation
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>>682708885
ok thanks

yeah i went to one covered my my insurance and he was kinda shit. didn't ask me many questions, cut me off while speaking, was in his office for literally 15 seconds before he was rushing me out
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anon here has a halo. looks like they're gearing up for some open procedure. this is a pic of someone in rekt thread the day after.
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>>682709618
sounds like a dick. get a real doc, anon. good luck
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What are signs of brain damage?
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>>682708991
>>682709555
down the road? see how cutters are full of shit, anon?
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>>682709555
So it would be pretty hard to checking my pulse or just pushing on it?
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>>682710004
kinda broad question, anon. anything more specific than that?
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>>682707906
how serious is pineal gland calcification? i drink a fuckton of water 0.3ppm flouride and flouride toothpaste should i be worried (21 yrs old)
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>>682710414
impossible. google 'carotid massage'
if you are worried, use your opposite hand (right hand feels left pulse): if you compromise blood flow to the left hemisphere, the right body will go weak and the offending hand will drop.
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>>682710609
that's like my favorite question, anon. i learned about that concern when i was preparing for my boards. before that, i had no clue it was on peoples' radar.
my opinion, and obv i'm biased, is that pineal gland calcification is of no concern. you routinely see it on CTs. there is no correlation to fluoride exposure in the medical literature. that being said, people will claim it is bad with the same vehemence as antivaxxers. we get exposed to so much shit (presuming you are 1st/2nd world anon) that we don't even know what kind of damage we're doing.
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>>682711198
What's that supposed to mean? What substances should I be looking for to 'decalcify' just incase? I know that either way I more or less won't feel or think any differently but subconciously it will make me feel better. Am in canada so water here is pretty legit
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>>682711504
Not him, but Stay away from dryer sheets bro
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>>682711504
my question for you is this: what is your concern? why do you worry about pineal calcification? why do you want to undo this?
my point is that 'pineal calcification' is not anything to worry about. it's voodoo.
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>>682710747
You have brought me piece of mind thank you.
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>>682711747
well I've been meditating and clearing my head out of problems a lot in the recent years. however approx 3 weeks ago my brain all of a sudden feels slower or not as clear, its hard to explain. But I feel a lack of 8hr+sleep per day is to blame, or my excessive drinking of flouride added water (i legit drink a shitton of water every day, sometimes 1-3 ppm)
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post that prefontal cortex it makes me cringe like its a testicle
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what is the going rate for a brain transplant nowadays?
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>>682711917
no worries

>>682712160
keep doing what you do, /b/ro, but don't fixate on the ppm of your water. seriously. it's not the culprit. look for something simpler as opposed to something that does not exist.

pic not related
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>>682707906
is that your grapefruit?
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>>682711648
Wh-what's wrong with them?
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>>682707906
What caliber?
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>>682712415
bout tree fiddy

>>682712870
big enough

pic not related
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>>682712463
thanks 4 the reassurance m8 i think i understand what you mean
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lets say a patient strokes and you begin cpr. You tell your friends to massage all of his or her muscles to help increase venous return. Is it possible to decrease the rate at which neurons will start to die?
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>>682707906
I had a CAT scan about six months ago (it's a long story) Anyway, the doctor said that my brain looked normal. How can this be? I'm a fucked up, alcoholic, semi-autistic weirdo. How the hell did he not find SOMETHING wrong?
>>
also, if you hadn't seen this video yet..a homeless man appears to have a large hole in his head where maggots are eating at his brain. Could you describe what he might be experiencing psychologically?

http://www.liveleak.com/view?i=5d9_1462292376#PY1bC9BJTWEY3Yoi.01
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>>682713921
depression!
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>>682713243
cool

>>682713289
muscle massage to increase venous return? never heard of that, anon. wasn't covered in ACLS, etc. where did you pick up that trick?
as far as rate of neuron death, the important question is what neurons are dead (or at risk of death). you can find some Time=Brain images that work in powerpoint but simply quantification is not clinically relevant.

youtube related
https://youtu.be/0DQPD5TTS5Y
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>>682713012
how did they even find out there was an aneurysm?
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Timestamp with unquestionable proof you're a neurosurgeon.
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>>682707906
I was told I have 7 spots on my brain and they could possibly be causing my migraines. Dat true?
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>>682713837
the picture is not the be-all end-all
you can be all kinda fucked but the picture looks fine.
the picture can also look fcuked and you can be a model citizen.
until you abuse your body for a couple of decades, the CT won't show anything

>>682713921
psychologically? we'd have to ask him, anon. but presumably his psyche is different from ours as we would not let such a situation progress. we would take a shower.
although see >>682712463
this person could have ended up similarly
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>>682714502
I second this, you can't just roll in with some bullshit pictures. Epidural hematomas, carotid endarterectomies, and MCA aneurysms can be understood by preclinical medical students. How do I know this?
>rhetorical question
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>>682714481
the intraop view looks clean so it was likely incidental. when they rupture, there is blood. it looks angry inside and the patient is sick. sometimes you take a pic for some other reason (i got a headache or whatever) and you see it before it ruptures. at that size, you would treat before it ruptures.

>>682714502
see pic
hopefully it satisfies your reasonable suspicion

>>682714592
can you take a pic of your MRI and post it?
generally speaking, migraines don't have any structural cause that would show up on imaging
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What kind of phone does someone as smart as you use and why? Apple or Android?
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>>682715075
Nice. How about some Step 1 review tips? Dedicated 6 week period begins next week. Mapped out 12 day cycles to complete first aid and pathoma 3x by exam day. Also, I've gone through UWorld once already and am making a victory pass
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>>682707906
Im having a little trouble distinguishing cervical from thoracic medulla on mri, yeah I know, check dorsal columns and anterior horn, but still don't feel 100%, any tips?
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where are you from OP? Could you tell what qualifications do you have? What schools have you finished?
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>>682715888
Not OP, but DIT videos are good, longest is like 30 min, and if you speed it up, they're awesome as a review
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>>682715702
i resisted apple forever but finally drank the kool aid. sold my android. still miss google now, but i think i'll survive.

>>682715888
just hammer that shit in, anon. brute force memorization. it's just another test and ultimately it is worthless and of no measure of what kind of doc you'll be, but it's an easy metric that is used for screening. you don't want it to be an issue if you opt for a more competitive match. ace it and forget it. what are you leaning towards at this point?

>>682716366
C from T medulla? you mean just distinguish axial view of C and T cord? yeah, post columns will tell you. tips: fucking hammer that shit in your brain by looking at endless images. no compromise, anon, no short cuts
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>>682716687
western hemisphere.
it's a small community, so you'l forgive me for maintaining my anon status

got a page to answer. if it 404s before i return, was fun. bump with questions if you want to keep the thread alive.
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Ok doc here's my rundown
28
Raging alcoholic from 18-22
1pack/day smokerx10 years
6' 215lbs
Hx Borderline Htn and Hyperlipid
Firefighter/Paramedic for work since 20
So for a few years I've always had outward pressure feeling in left rear of skull. Chalked it up to clusters or tension headache.
Lately in last 6 months have weird occasions,few seconds in duration, where I feel like something gets stuck in my brain, almost like an air bubble, then goes away. Also have occasions where one whole side of my head and face goes numb for a few seconds. Also have random pains behind left eye . Also had about 3 near syncope episodes in last few months (think anxiety/vasovagal tho). What is causing these stuck and paresthesia feelings?

Separate note, injured left lower back about 6 months ago, never got 100% but got better for a while. Now it spasms alot from bottom of rib cage down to asscheek. Sometimes have random sharp stabbing pains in left leg too, along outer thigh, Tib fib, and sometimes in foot. Never all 3 at once? Thoughts? I've been suspicious I have MS in the past but I'm also a self-diagnosed basket case and feel like I can never find a doc who doesn't think I'm healthy just because CBCs are all normal and I'm young.
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>>682716716
Have you had any prion cases?
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>>682717330
Not OP, but TIA maybe?
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>>682716694
Torrented DIT, it's good but if I wanted to get anything out of it, I should have started earlier. Some compiled info being passed around my class said it wasn't as associated with higher scores than First Aid & UWorld. Was considering sketchymicro and sketchypharm but it adds too much to the average day (which takes all day to begin with)

as for OP's reply, which I can't link thanks to Fortune's interface, I've heard it's all about brute force so long as I use a few high yield resources and make multiple passes. Thanks for the pep talk; people build it up like its huge but you're right, it's just another day at prometric. Leaning towards ENT but if I can't produce the step scores, it doesn't mean anything. Keep on doing what you do OP, people like you give me hope that shit will work out
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>>682717685
I dunno man I mean I'm 28 I'm unhealthy but not obese or super out of whack vitally. No paralysis with them really, just feels like something getting stuck near my skull/scalp, usually frontal and on the sides of midline. I feel a lot of popping and crackling in my head too like something is tearing.
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Was doing rotations with a doc that is 100% /pol/ certified. We were cutting out someone's gall bladder and he's going on about the god damn jews. How common is thus among people practicing medicine?
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>>682718235
Definitely UW and FA are the best sources, but like I said, one you've got that down you'll easily finish DIT in a wk and it'll just add to what you know. Step 1 sucks man, it really does, but after that it's easy peasy Japanesy, also Goljans audio is floating around the torrents and it makes for easy points, I would listen to it in the car whenever I drove
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>>682717685
In addition the paresthesia feels like when you get a good euohoric rush like when you're listening to a song you love that you really relate to and it gets to the best part, except for it is literally could cut it in half on one side vs how a euphoric rush is usually the whole head.
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know anything about nbome and its damaging effects?
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I don't know if this falls under the expertise of a neurosurgeon, but I skipped a lumbar disc a little over a year ago and I was pretty much crippled until January. PT has helped a lot but I still have intense sciatica and I physically can't run. Am I fucked for the rest of my life? What do?
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>>682719820
*slipped
>>
Bump for life
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>>682714592
>>682715075
Don't have them handy.
TBI from mortar explosion in army
Plus concussions from kickboxing
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sup /b/oys
back

>>682717330
good on you for not raging with the EtOH now
think about cutting back the smoking
stay fit
those three things will help everything you described to some degree. you know that. good common sense.
the 'stuck' feeling sounds odd and an obvious explanation doesn't jump out. any triggers? associated anything? that with the transient paresthesias and the near syncope could be anxiety/vasovagal, but it's worth meeting with your doc to make sure you're BP isn't out of control. TIAs like anon below suggested is on the list. see your doc and get it sorted.
for the back spasm and the LLE pain, try doing some stretching/core strengthening/exercise. it'll get back to 100%. if it lingers, see a physical therapist.
good luck
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>>682717483
yes.
they are a pain in the ass bc everything must be disposed of instead of sterilized and put back into regular circulation. so you get worthless instruments and everyone is paranoid and wearing space suits. it's annoying. did 4 biopsies that were neg and one that was actually positive. of course, doesn't mean anything bc they still die like a dog.

>>682718235
good luck w the test, anon
kill it and then move on

>>682718329
that sucks. /pol/ is among us, although i've not encountered any professional. maybe they just hide it.

>>682719462
what's nbome, anon?

>>682719820
you'll get better, /b/ro. most do without surgery. if the pain gets worse of you feel like your quality of life is totally jacked, meet with a neurosurg to figure if the OR is right for you. otw keep stretching and toning it down while you recover. good luck
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>>682722377
The transient paresthesias aren't associated with the near syncope or the air bubble feelings. All 3 are separate and random. I'm like 90% sure that is anxiety. The paresthesia are random. The air bubble feelings are probably stress centered too. The left lower back definitely spasms more when anxious. I think I'm just really tense and anxious especially in my back & neck & that is probably 95% of my problems, but figured while I had free expertise I'd take it. My BP is anywhere from normal/borderline to stage 2 Htn depending on the machine/person taking it but everything else other than my weight is always normal limits. I do have occasional non-perfusing pvcs but they did a full CBC x-ray & echo to rule out PE or cor pulmonale. Thanks for the advice.
>>
I also want to be a doctor, but barely a sophomore, really freaking out about how I'm gonna get into med school b/c I failed a class when I was taking dual credit so I have a shitter GPA, any advice bros?
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>>682723418
Meant D-dime x-ray echo not cbc
>>
Years practicing?

How has your perspective changed now that you have opened domes vs. back when you were anormal fag?
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>>682722096
you still kickboxing, anon? if you have had multiple concussions already, and TBI from a mortar, and you get migraines, you may want to tone down the full contact sparring. if it's not your livelihood, keep training but minimize your exposure to head shots. that could allow you to get the headaches under control but still do the shit you enjoy.

>>682723418
maybe address the anxiety, anon? not with meds but just get your life sorted. you don't need me telling you how to live, but if there are stressors that you can minimize/accept/avoid, do that. also, train more. it clears the mind, will keep the BP good, encourage you to stop smoking and help the back/leg spasms

>>682723916
dude. why you freaking? one bad grade won't tank your chances. meet with your school's advisor to hash out how to make your application look good, roll your dice, and give it a go.
>>
Hey, what is the worst that would come from above average ventricle size?
>>
How many VP shunts do you place a week? ICU RN here, hate those things but love em at the same time. Better than mannitol'ing the fuck out of people.
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>>682724605
Yeah I am trying I really don't want to go on meds either because then I have to give work a note for benzo+ test exempt and then I'll just feel like they're judging me too, which fear of judgement/acceptance is like 95% of my anxiety.
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>>682707906
God damn fam i bet that was fun to operate on.
Emeregency medicine physician here
>>
>>682707906
What is the best method to removing an acoustic nueroma/ vestibular schwannoma?
>>
>>682724604
good question, anon
the whole process is funny
sophomore bro up there, freaking out about even getting into med school
step one prepping anon there, in the mix but unsure of what path to choose
what i realized is that you need to make a decision with incomplete information (go to med school; choose whatever speciality for residency, etc), and then once you get where you thought you wanted to be, it's not quite what you imagined. but there you are. i guess that's what life is all about.
the only significant way my perspective has changed is that i know (as opposed to suspect) that life is short and we all die, so best to live large/well. sounds cliche but shits true anon

>>682724631
death? why do you ask?

>>682724952
in a week, not many currently. in my career, VPS/EVD numbers in the hundreds.
in terms of bang for buck, they are great
but i agree, they also blow donkey nuts in their own way
just don't clamp that shit and walk away when they go to MRI. i've had people die that way.
but i know you wouldn't do that, anon, because you're a /b/tard like us

>>682725147
yeah, you don't need that headache/bullshit, anon. you also don't need the med. just train, get the life sorted, stop smoking.
i know, and cure cancer too.
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>>682725155
sup ER /b/ro
what level trauma you at? any craziness this week?

>>682726285
depends on size/location, anon, as well as facial/acoustic function
don't forget gamma knife, too; removal is no longer the only option
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>>682726366
RN fag again,

We have to double check everything when it comes to IICP stuff in ICU, too many people have had issues. We had a patient go from a GCS of 14 to a 5 because a dumbass wasn't paying attention. Supratentorial herniation though FM.
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>>682727061
samefag, by double check I mean "Co-sign" with another RN.
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>>682727061
scary shit
if you're not in a high volume center, it's risky bc the staff doesn't have the experience
you think it's possible to train people? or are some just not up to the attention to detail?
>>
I have an Arachnoid Cyst, will I die?
>>
>>682726658
Let's say hypothetically the tumor is growing through the left facial nerve and hopped to the acoustic nerves, and it's just slightly too large to gamma. Patient shows only slight droop and a slight loss of hearing.
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>>682727304
Wanna know the truth? It was because the previous nurse forgot to set the frequency in meditech and so the next nurse simply forgot she needed to check and document ICP.
>>
>>682727553
man im being terrible, we have protocols in place for ICP readings kind of like sliding scale insulin or titrating pressors. Do this if yada yada reading. Its fool proof given you actually take the measurement and do what you need to.
>>
If a terminal brain cancer patient waved the right to sue, would you do a really dangerous procedure to try and save them?
>>
>>682726366
Cheers. Life is short, rn in icu/ecmo game, its bleak to the point of comedy how short life is. I always wonder what surgery knows about life that goes unspoken, most our surg guys are very cool but are so busy its like they never stop to process the job of surgery. That expereince is limited to so few people it makes me curious, you all do the same thing from oil paintings hundreds of years ago, just with evidence.
>>
>>682727450
we will all die, anon
will your cyst be the cause? only rarely
don't sweat it

>>682727517
it's going in the bucket, anon
approach depends on size and how much is intracanalicular, as well as what kind of ENT assist you have

>>682727553
fuck
that sucks
but it should have been communicated on sign out and the RN should have known it requires q1h charting, etc
they get written up/disciplined? or was it buried?

>>682727890
only if the benefits outweighed the risks, anon
if it is experimental, it should only be done in the setting of study
some lone wolf neurosurg guy did some shit with e coli (no pun intended) in GBM patients last year in calif. guess what? they died. shocker. but bc he behaved criminally, he was blamed and suffered.
>>
How do I get off my regions black list ??? Not drug seeker
>>
What made you masochistic enough to pursue one of the worst possible medical specialties? 80 hour + work weeks as an attending? No thank you.
>>
Paramedic Anon reporting in,
So doc, are you plagued by the rampant stupidity of nurses as well? I'm often dumbfounded by the shit they say.
>nursing home patient, guys in full rigor
> "give him oxygen he be alright?"
>are you fucking kidding me
>>
>>682728479
She had to do a shit-load of retraining and couldn't work with pts on critical drips for a while. Basically she ended up with the med/surgy patients (small bowel obs/GI bleeds, ect..)
>>
>>682728479
Would the baha imlpant be suggested to restore partial hearing?

What area you in Anon?
>>
OP please commiserate with me on the sheer arrogance and anachronism inherent in roughly 80% of all OR nurses
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>>682728972
>rampant stupidity of nurses
You clearly are just meeting the nurses that couldn't make the cut in the real medical settings. There is a reason they are doing LTC.
>>
How much do you make a year?
>>
Tell me how to get off hospital perma ban list
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>>682728972
Medics, 80mg Lasix for chf. No dip shit he's septic, nice work, sorry you cant dip in here.
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>>682729520
how the fuck would that even happen?
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>>682728441
cheers
pic related
the history is fascinating
some pts ask about the latest/greatest/newest laser/stem cell/dr oz lie/spaceman treatment. i tell them, the old methods in most cases are still the best.

>>682728704
not sure, anon. is this something to flag people that get lots of narc scripts? got bad news for you: the feds are looking to make it even tougher for docs to prescribe opioids

>>682728722
we all choose a path, anon
i dig mine, but i wouldn't encourage anyone to pursue it
i remember one attending tell me when i was a student, 'if there is anything else you want to do, do that.'

>>682728972
hahaha
sigh
sup paramed /b/ro
there's stupid nurses, there are also stupid docs. some people are just stupid.
what i learned is to trust nobody and remember that the hospital is full of a thousand paid assassins. when my family gets admitted, i'm That Guy, squeaky-wheeling in a gentle way.

>>682729021
she's lucky. i hope she never forgets what she did to somebody.
as i was taught: it's not the 99 things you do right, it's the one thing you do wrong.
>>
>>682729612
Coming in with fake conditions and asking for pain meds, probably.

>>682729520
Have a real condition and don't ask for pain med.
>>
>>682708404
Do u have seizures?
>>
>>682729612
Drug seeker / AMA too many times. It happens, we have a "shit list" too. Basically you only get admitted if you can prove that you are having an issue and you get non-narcotic pain medications. Yes if you have good kidney fx and you're not having a GI bleed toradol works amazingly.
>>
>>682729127
an ENT would be able to answer that, anon

>>682729156
/b/ro, i've been in some shit ORs
but where i am, they're good people
what have you witnessed?

>>682729384
more than i need but not enough to compensate for the grey hairs/blood/sweat/tears/whine whine whine of life.
it's not about the ducats, anon. if that's the goal, you chose unwisely.

>>682729520
sounds like a green text story, anon.
we're listening
>>
>>682728972
>>682729332
The only real nurses are floor nurses. Even then, it's only more likely to find a good one there.

There's an air of entitlement and arrogance on bad nurses that you can practically taste. Tell them to fuck off if you're a patient. I've even seen doctors do it. It's phenomenal to see them knocked down a few pegs.
>>
>>682729757
I have been this year 12 times I don't seek drugs I just puke blood
>>
Do you guys know why a nurse would be trying to inject me with a sodium chloride solution after a blood draw?
I refused it but never figured out why she attempted this.
>>
>>682729156
I'm just curious why there are more than 1 OR nurse... we just use a circulator and the rest are scrub/surg techs for 99% of the procedures.
>>
>>682730130
Habit, probably. If you draw off an IV you need to flush it with saline to prevent clotting.
>>
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>>682707906
Hello

My cousin has AVM and he is getting treatment in Baltimore because other doctors say there is nothing they can do for him.

I have scan of his brain on my laptop but I'd have to black out his name. He's on the make a wish foundation so I don't think it looks good but what do you know about it?
>>
>>682730245
sounds like a bad situation, anon
what kind of treatment they planning? staged embolization?
post a pic with the name blacked out. pick an axial view the looks the worst. if there is a 3D recon or an angio, just pick the view that looks the most fucekd.
>>
>>682730473
ok hold on

Im going to the laptop
>>
Do nurses try to fuck you
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