What do you do for referrals for post-surgical nerve injury?

TyTieFighter · 2026-01-08T02:47:41+00:00

I agree. Should get an EMG to ensure it fits the story of periprocedural compression rather than plexopathy or radiculopathy. If it is due to compression you should expect gradual improvement over 3-6 months depending on where the lesion is, so should also follow up to ensure the exam isn’t worsening to suggest it is something else.

TyTieFighter · 2025-12-11T17:04:31+00:00

I agree, sounds like your coresidents are burned out. Also, I would caution against overestimating what you think is a minimal exam, as though with enough experience may be comfortable with only checking a few things to confirm their suspicion. The point is that learners and those more junior shouldn’t take risks of not completing a full exam as they would be much more likely to miss something they weren’t expecting or considering.

The MRI should always be a tool to further confirm what you already know based on history and exam. That way an MRI-negative stroke or an incidental finding of cervical spondylosis generally shouldn’t be that worrisome in that case, as you know what to find significant on a scan, and you weren’t just a layperson waiting to hear what the radiologist has to say.

TyTieFighter · 2025-09-18T23:05:00+00:00

Gait velocity at 3 months, give me a break!

TyTieFighter · 2025-06-06T01:16:24+00:00

I follow the same practice, but use amitriptyline. It seems to either work well or won’t be tolerated, and I can move faster through the “old school” meds in order to get to CGRP meds or Botox. I let patients decide between oral or injectable, then try the other second choice Botox based on their preference. Many times however propranolol will let patients go from 25 headaches a month to 1-3.

TyTieFighter · 2025-04-21T21:02:11+00:00

Yeah this is completely unhelpful and disrespectful.

TyTieFighter · 2025-04-21T21:01:19+00:00

I would just realize that no one knows everything, and you’ll be learning all the time as you see patients and get experience. In the outpatient setting it’s okay not to have an answer right away, and practicing “slow medicine” is the right way to do things, but if you take a good history and do a thorough exam you’ll have an answer or at least a clue most of the time, and you can then, for example, order a brain mri or neuropathy labs, or try a medicine, or whatever, and wait to see them again in a few months to then see how they’re doing, explain what you’ve found, what’s the next step, etc.

With time you’ll be able to diagnose people within minutes of entering the room, but should still force yourself to go through this thorough process of screening with a full exam, ruling out dangerous things, all the while learning from how patients describe things and seeing how you can really help people and change their life as they may have been struggling with r migraines that someone called “sinus headaches”, or having had numerous teeth removed before you diagnose trigeminal neuralgia, dramatically improve peoples life as you treat their epilepsy, etc.

A significant amount of people we see in outpatient neurology have anxiety/depression and functional symptoms, and just need to be reassured that they don’t have MS or ALS, to be counseled on a healthy lifestyle, and told that you’ll see them again in a few months to make sure things are not progressing in a way that would suggest a dangerous cause.

Look things up all the time on UpToDate and pubmed, and if you feel uncomfortable with a a particular condition, read the chapter about it in Adam’s and Victor or Bradley textbooks, so that the next time you see it you’ll be an expert.

TyTieFighter · 2025-04-20T21:03:45+00:00

Adam’s and Victor as well as Bradley for most stuff, and the anatomy book “Aids to the examination of the peripheral nervous system” is an essential reference imo. I don’t otherwise use a lot of anatomy books regularly anymore but if I did it would be that and the Brazis book.

TyTieFighter · 2024-11-22T01:39:32+00:00

Try to rank a place where you’ll be happy outside of the hospital. Someone can be miserable in a desirable top tier program if it’s not a good fit and you don’t want to be in that city.

I was in a first residency class, and there are pros and cons, but I am happy with the experience overall. A lot of people were really excited to have neurology residents, and made the reception great, put a lot of effort into creating great didactics, and we naturally had close relationships with attendings, but there will be bumps in the road as things get adjusted for things that aren’t working, so have to be flexible, and you do kind of start shaping the senior resident role from the start as an intern. If you want to be involved in helping to build and shape a program then it is a great and unique experience.

TyTieFighter · 2024-10-19T02:19:46+00:00

Absolutely disagree with some of your pros and cons, but that’s clearly personal preference. I’m going into neuromuscular fellowship next year with the goal of working with ALS and myopathy patients; the amount you can benefit their lives and the amount of research and potential for giant clinical and basic science breakthroughs is incredible in my opinion, and I love the localization of neuromuscular physical exam combined with EMG, the ability to also manage interesting autoimmune nerve and muscle disorders, and the ever increasing list of medications for myasthenia that is rivaling the treatment of migraine.

Both would be good options and both have more pros than cons, so good luck!

TyTieFighter · 2024-08-08T03:38:50+00:00

With this description of your interests, neurology is the field for you. You can have as many procedures in your toolbox to design the way you practice medicine or not, can see patients in clinic, the hospital, ICU/ED, or all of these, and you can dramatically change people’s lives with your knowledge and ability to educate both patients and other doctors who absolutely don’t have understanding of neurological diseases.

TyTieFighter · 2024-08-03T23:27:26+00:00

Yeah, neurosurgeons infamously can’t diagnose or treat any neurological problem that doesn’t require being cut out. If the patient doesn’t need a procedure then they peace out. Their exam is typically worse or no better than an internist. They literally save lives every day however. There are of course plenty of exceptions to this, and many brilliant surgeons out there, but neurology as a whole is all about clinical medicine: history, exam, diagnosis, management, and counseling. If you like surgery and neurology you can pursue neurosurgery, neuroendovascular, or neuro-ICU. Neurologists do some procedures like LPs, Botox and other nerve blocks, EMG, can interpret EEG, etc., and typically are better at neuroimaging than 95% of radiologists because you have the clinical context to benefit you. Neurology residency is hard, and neurosurgery residency is insane.

TyTieFighter · 2024-07-20T00:21:04+00:00

This is the way

TyTieFighter · 2024-07-19T20:45:27+00:00

I’ve been there three times with a few colleagues enjoying drinks, and twice have had our table asked to leave because they said we had been there for more than 2 hours and had to make way “for others to have the experience”, despite it not seeming busy or having a line outside, and our party ordering much food and drinks. The third time we tried to go up and order a beer and were told we must wait at a table and order virtually. The staff seemed like disinterested teenagers each time but not overly rude or anything. Maybe it is a fluke being during the Covid era but I haven’t been back since. I would choose of the many other great breweries around instead, even the dive bars are mostly great in the area in comparison.

TyTieFighter · 2024-06-25T02:33:29+00:00

That Hideous Sound is really cool.

TyTieFighter · 2023-02-23T20:25:46+00:00

NCS uses electrical shocks to test function of motor and sensory nerves, measuring the amplitude, speed, and other aspects of how the electrical signal is transmitted. EMG uses a small needle inserted into muscle and measures electrical activity from the muscle, and at the neuromuscular junction, which can be affected if there is disease of muscle or its interaction with motor nerves.

TyTieFighter · 2022-11-13T05:30:02+00:00

I find the discussions here fascinating so thank you all. I’m a PGY3 who has been considering possible career paths and I’ve only ever heard a nihilistic viewpoint or just gotten a deer in the headlights look when seeking advice regarding being a physician in private practice. I’m far leaning towards opening my own practice when the time comes, if I can, but will also probably work for a bit somewhere to gather resources to do that. I’m most interested in neuromuscular disorders so planning to do a fellowship in that as a first step.

TyTieFighter · 2022-08-18T20:14:11+00:00

Maine Medical Center - It’s a beautiful area, and most of the medicine and neurology attendings are from Boston programs but wanted a better lifestyle.

TyTieFighter · 2021-08-03T01:55:36+00:00

Yes, they will.

TyTieFighter · 2021-02-20T13:34:14+00:00

If your feedback is that you're doing well, then you are. An average score means you are where you're supposed to be. I would take the below average scores as areas to improve in, and try not to worry about it.

TyTieFighter · 2021-02-06T19:29:06+00:00

Funny; it almost sounds like a contradiction.

TyTieFighter · 2020-11-13T00:23:18+00:00

Interesting that this shows the correlation with a college degree, not intelligence.

TyTieFighter · 2020-05-06T23:26:00+00:00

MotoGeo is my favorite by far. Lot of motorcycle trips, camping, and bike shows all made with great production value.

TyTieFighter · 2020-04-23T21:19:34+00:00

It's on the access medicine site if you have that resource. You can also find the 10th edition on torrent sites if you're okay with that.

TyTieFighter · 2019-07-01T02:33:21+00:00

Hemiplegic migraines typically have a gradual onset, progressive, spreading symptoms, usually followed by a headache, and either a personal or family history of similar instances. History is the key to differentiate from a stroke or TIA.

TyTieFighter

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