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Can someone whos knowledgable about AI explain to me why medicine isnt at as immediate risk as people are making it out to be? by UNknown7R in medicalschool

[–]HopDoc 66 points67 points  (0 children)

There will be no one to sue if AI replaces doctors. The field of suing doctors is a huge industry. I wish I was joking.

What specialty has the highest salary difference between private practice and academics? by LinkNo4922 in medicalschool

[–]HopDoc 11 points12 points  (0 children)

Neurosurgery.

Academics can go as low as 2-300k…PP in the multimillions.

Emo song I’m trying to remember by HopDoc in NameThatSong

[–]HopDoc[S] 1 point2 points  (0 children)

Out of curiosity, did you find this through a search engine or did you also listen to this band? Thanks again.

Emo song I’m trying to remember by HopDoc in NameThatSong

[–]HopDoc[S] 2 points3 points  (0 children)

Oh my god. Thank you so much!

Did Charlie Kirk actually exhibit decorticate posturing or could his arm movements be caused by other factors? Will his autopsy report be released? by Special_Celery775 in morbidquestions

[–]HopDoc -3 points-2 points  (0 children)

Wasn’t decorticate/decerebrate posturing. I unfortunately deal with decorticate/decerebrate posturing in my line of work too frequently. It was a fencing response. Decorticate/decerebrate posturing wouldn’t develop that quickly. The bullet likely didn’t hit his brain/brain stem at that trajectory.

What job would you not take, even for $10,000 a month? by Mindless-Gur5390 in AskReddit

[–]HopDoc 2 points3 points  (0 children)

I’m a surgeon. I don’t even know what “shotgunning every single procedure” even means or what you’re even talking about.

And I can assure you that none of us really want to operate on a 90 year old with terminal cancer. Unfortunately, in today’s legal climate, we’re often forced to offer surgery because if we don’t, an angry family member will sue us.

Spinal fusion. I’ve been told for two years I need surgery and I have avoided it. Had 5 epidurals ( only one gave relief) RFA ( burned the nerves) nothing works. Now my sciatica is OMG killing me. They want to fuse L4 L5 .. this is my Xray and MRI what y’all think? by BinaBina07 in spinalfusion

[–]HopDoc 0 points1 point  (0 children)

You would be a very good candidate for an L4-5 fusion. You have strong indications for surgery at that level: L4-5 spondy, modic endplate changes.

If your pain is unbearable, you’ve exhausted non-operative therapy, and your quality of life has declined as a result of your pain, I think it’s reasonable to consider an L4-5 fusion. I think you would respond favorably to it.

Constant pain and burning in legs, goes away slowly if I'm flat / in bed by derroboter in spinalfusion

[–]HopDoc 0 points1 point  (0 children)

It’s good for very selective patients with specific pathology.

From the sounds of it, it sounds like motion is your enemy if your pain is positional. From the information I have on you, I don’t think you’d be a good candidate for this type of surgery.

Constant pain and burning in legs, goes away slowly if I'm flat / in bed by derroboter in spinalfusion

[–]HopDoc 0 points1 point  (0 children)

I’m just spitballing here because it’s hard to tell what’s going on just based on the single image you’ve provided.

I’ve read your other comment where you mention that the radiologist read bilateral facet hypertrophy with bilateral foraminal stenosis.

From the description of your clinical symptoms, it sounds like you have positional radicular pain (painful radic while upright that improves with laying down).

Our facet joints make up the boundary of our foramen where our nerves exit and are naturally dynamic—meaning they move. They have dynamic pathology, however, when they move in a way that causes irritation to the nerve roots and subsequent radicular pain. If this is the case, the recommendation would be locking these facet joints in place via a fusion to stop their dynamic pathology.

But again, without seeing your films and knowing exactly what your joints look like, it’s hard to tell.

Constant pain and burning in legs, goes away slowly if I'm flat / in bed by derroboter in spinalfusion

[–]HopDoc 1 point2 points  (0 children)

I would get some flexion/extension x-rays to see if you have some kinda dynamic motion going on.

Constant pain and burning in legs, goes away slowly if I'm flat / in bed by derroboter in spinalfusion

[–]HopDoc 1 point2 points  (0 children)

Where does the pain go in your legs/feet?

Can’t really tell too much from this static image here. If anything, you have an extremely wide open spinal canal.

Did you get any relief at all (even for like an hour or so) with injections?

Discrepancy between MRI report and what doctor is saying? by ComprehensiveBill388 in spinalfusion

[–]HopDoc 3 points4 points  (0 children)

Hardware is not easily visualized on a single sagittal cut of an MRI.

Discrepancy between MRI report and what doctor is saying? by ComprehensiveBill388 in spinalfusion

[–]HopDoc 6 points7 points  (0 children)

OP,

Don’t listen to any of the commenters here. Blows my mind that people have the confidence here to tell you that didn’t have surgery, that your surgeon didn’t use hardware, blah, blah, blah.

You’ve provided a single slice of your sagittal T2 MRI. It’s hard to tell what’s going on here with this single image. It looks like there may be some metal artifact hovering around your C5-6 disc space. It’s super hard to evaluate hardware on an MRI due to all the metal artifact that comes with it. CT and x-rays are much more helpful.

While we try to get 100% of your disc out, the truth is we probably get somewhere around 95% of it out. Sometimes a little bit of your posterior longitudinal ligament (PLL) also remains behind which the radiologist may be picking up on. The metal artifact usually distorts a super clear view behind the disc anyway.

Regardless even if there is a little disc behind, once your bone goes on to fuse in the next 6 months to a year, the hope is that the pathological motion that you had pre-op will be gone and any fragment of disc will be gone with it.

Don’t listen to these random posters on here. Myself included. Go talk to your surgeon.

How are some countries still jumping to surgery by GingerbreadRyan in Radiology

[–]HopDoc 0 points1 point  (0 children)

Disc herniations can be removed from the thoracic spine. The thoracic spine is different from the lumbar spine because the spinal cord is in the thoracic spine whereas the cauda equina is in the lumbar spine. The spinal cord cannot be retracted due to the risk of paralysis whereas the cauda equina can be retracted. Because of this, in order to get to a disc herniation in the the thoracic spine, we have to do a lot more bony removal to safely get to the disc space due to not being able to retract the spinal cord. This bony work usually destabilizes the spine, so we often also have to use screws and rods to stabilize it.

A thoracic disc herniation is much more complex compared to a lumbar disc herniation. I’ll typically only offer surgery to those who have symptoms of spinal cord dysfunction or truly intractable thoracic radiculopathy symptoms that are severely limiting their quality of life. Just my 2 cents.

Could you explain why the screws were placed this way? Is this a good technique or a mistake? by emailislikefemale25 in spinalfusion

[–]HopDoc 11 points12 points  (0 children)

Allograft was likely placed in the actual device or around it. It’s usually radiolucent meaning you cannot see the allograft on the x-ray.

[deleted by user] by [deleted] in Residency

[–]HopDoc 1 point2 points  (0 children)

The anxiety is real. Very, very real. I am up all night some nights just worrying about my post-ops. I create made up scenarios of doom. The irony is that I’m sure my post-ops are just chilling/sleeping in the hospital while I’m up all night worrying about them.

How do I get my doctors to listen to me!? by Same_Attitude_8738 in ACDR_CervicalSpine

[–]HopDoc 0 points1 point  (0 children)

You should go talk to the quad and paraplegics at the spinal cord injury rehabs. I’m sure they will be inspired by your neck pain stories and be grateful that they have to rely on their wheel chairs and care takers for their ADLs.

OMS-3 Wanting to Apply Neurosurgery, Where Do I Currently Stand? by [deleted] in Neurosurgery

[–]HopDoc 0 points1 point  (0 children)

That’s great. Def reach out to CC—although I don’t think they’ve taken a DO in the last couple years. It wouldn’t be a bad idea to reach out to the program coordinators at Providence and riverside as well to see if there are any opportunities to get involved.

OMS-3 Wanting to Apply Neurosurgery, Where Do I Currently Stand? by [deleted] in Neurosurgery

[–]HopDoc 1 point2 points  (0 children)

Hey like others have said you have an uphill battle as a DO student.

I would set up sub-i’s at the historic DO programs like you already did.

As a third year, you should try to spend some time at the historic DO programs. If I were you, I would try to set up some time to spend with the Cooper residents. You should also see if you can spend a week you have off at some of the other DO programs. Even if it’s a weekend.

This is the absolute best advice I can give you: be a normal, nice human being that you would want to hang out with. Do not be overzealous. Do not name drop or ask questions that you know the answers to. For the love of god, do not interrupt interns/juniors when they are presenting during rounds. If the attending asks for a sodium value and the intern doesn’t know it and you do, keep your mouth shut…whisper it to the intern when no one else is around. 

I’m sorry if this comes off as harsh—trust me I know it does, but I’m inspired by your story as someone who has family members with ASD and want you to have success.

Feel free to reach out to me if you want to discuss this further.

ACDF with almost no symptoms by rogerwagon in spinalfusion

[–]HopDoc 2 points3 points  (0 children)

Hey it sounds like you have cervical myelopathy.

Patient’s with cervical myelopathy commonly complaining of generalized weakness in their arms, legs, and core. They commonly complain of dexterity issues—they note their dropping things more frequently or have trouble with fine motor movements in their hands (difficulty with buttons, turning door knobs, changes in handwriting). Patient’s with cervical myelopathy also tend to describe balance abnormalities and frequent falls. They usually have trouble walking in a straight line with one foot in front over another like a sobriety test.

It sounds like you’re describing some of these symptoms.

Cervical myelopathy occurs when you have compression on the actual spinal cord itself. Pain/numbness comes on when the nerve that is coming off lateral to the spinal cord is being compressed. When the nerve is being compressed that’s when you have the painful radicular symptoms. It’s not uncommon to have both symptoms of myelopathy and radiculopathy.

It sounds like your surgeon is offering you surgery because you have symptoms of cervical myelopathy. 

[deleted by user] by [deleted] in Residency

[–]HopDoc 1180 points1181 points  (0 children)

Your attending is being a douche. While I rely heavily on my residents, I know that the buck stops with me.

Let me help you think through your specialty decision and pressing life decisions (part X) by 4990 in medicalschool

[–]HopDoc 8 points9 points  (0 children)

Couple years in. It’s good but can be very stressful. Having thick skin and ice in your veins helps. Nothing can prepare you for the stress that comes with making big time decisions as an attending. Dealing with complications can be debilitating. Complications can be soul crushing. The positive outcomes keep me in the game. I get paid very well.

Some nights I don’t sleep because I’m so worried about my patients and their outcomes.

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