I totally just woke up from a 3 hour nap, and it was delicious. Three hour naps only happen when I'm exhausted by the way, and considering this week felt like a whole month I'm not really surprised.
Anyway, now that I'm relatively rested I can write about my neurosurg shadowing, which was really really cool. I got there in the middle of clinic hours, so the doctor was with a patient and I waited in the workroom. I never really thought about how these things worked, but the place looked like a normal doctor's office with multiple exam rooms and one of the rooms was a physician workroom. That's where I was. So the doctor walks in after about 10 minutes and immediately goes to one of the computers to look at a CD of scans. There was a 3rd year rotating student following the doctor as well. I kinda stood there awkwardly for a while, which is what I do well. Once the scans were up and working, the doctor told me to come look at the scans, and I seriously didn't stop thinking or learning for the next two hours.
That patient had a recurrent tumor growth right behind his temple. The tumor was a little larger than a quarter and was right next to his optic nerve. Scans from a couple years before showed that the tumor was not growing. We all went and the doctor talked to the patient about his options. The amazing thing for me was that the patient seemed completely normal. You'd think the tumor would affect something, but not so much. He was also incredibly nice and didn't really seem too phased by the whole thing, he just wanted to know what to do. Apparently, the thing to do in this case is not take out the tumor, but get scans done twice a year and only operate if the tumor begins to grow. Which is crazy talk. The man had a giant tumor in his head. I guess operating put his vision at too much risk, but I think it's amazing that someone can live perfectly fine with a brain tumor.
Then we went straight back to the workroom and prepared for the next patient. This patient had some sort of spinal damage with a fancy name I don't remember. The one symptom was a strong, painful spasticity due to a lack of inhibition of a motor reflex arc (simple and cool nerves, wiki it). So they could give the patient a pill that would increase inhibition and decrease the spasticity, but I guess this has a bunch of side effects. Instead they implanted a pump into the person's torso (above the hip, below the rib on the side) that delivered the drug directly to the damaged site, which only required 1/1000 of the original pill dosage. This patient needed to have the pump refilled with the drug. This was my first experience watching someone have something poked into them, in this case the needle that delivered the drug to the pump (the pump pretty obviously sticks out of the stomach, so it's pretty easy to do). Again, this patient was actually joking around and really cool about everything, which is amazing considering how debilitating the condition was.
The third patient was really cool. This one had undergone the Gamma Knife surgery for a tumor in the auditory canal (just inside the brain). Gamma Knife is non-invasive and pinpoints gamma radiation at a tumor and kills it. The tumor then just stays there and is slowly reabsorbed. I don't quite know how this works, because gamma radiation was the really bad one they told us never to mess with, but apparently they use it for surgery now. The check up showed the tumor was still there, but smaller and everything was ok. The patient had this tiny hearing aid because the tumor was in the auditory canal and messed some stuff up. The hearing aid was bluetooth enabled though. It was like the coolest thing ever. . .I'm kinda looking forward to hearing loss now.
Patient 4 was in for a 1-month check up after a major surgery to repair a herniated disc. Fun-new fact: apparently they also don't immediately do surgeries on herniated discs because most of them are treatable with medicine. Only the really bad ones have to have surgery. This patient actually looked really good and didn't really have much pain, along with a goofy sense of humor that I really appreciated.
Patient 5 came to have some modifications done on a drug regimen. My brain had stopped absorbing much information at this point so I'm not sure what was causing the pain, but it was in the patient's legs. The doctor basically upped the dosages of most of the meds because the patient reported an average pain level of 6, which is a completely subjective pain measurement, but it's really the only way to do it. Patients in that much pain are generally pretty accurate about how they feel. Oh and the scale is from 1-10, with 10 being the worst pain you've ever endured, so 6 is pretty high. The drug regimen is pretty crazy too, I think the patient is taking roughly 20 pills throughout the day. The doctor upped the dosages to try to get the pain down even more (3 or less is optimal) and a surgical alternative is available, but that also seemed like a last resort.
Overall I learned a crazy amount of information in a short two hour period. The doctor even threw a couple of questions my way, which I couldn't answer from the sheer shock of being put on the spot by a neurosurgeon. Talk about surreal. I lucked out too and the neurosurgeon was a really good doctor. He was incredibly warm with all the patients and informed them thoroughly about everything he was doing. I want to shadow other doctors, but I think I might tag along with this one a couple more times and learn more from him. Hopefully he doesn't hate me...
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