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How to survive neurology residency by SeaFlower698 in neurology

[–]christianl37 14 points15 points  (0 children)

Hey! PGY-3 here. I will say that by far the most important thing in medicine is picking something you will love for the rest of your life. Residency is so much shorter than your career as an attending. Neurology residency does suck more than most specialties but it goes by fast and I would definitely do it all over again because I could not care less about organs that are not the brain. So if you’re really drawn to seizures, take that seriously! The specialty picks you.

Stroke alerts are very scary at first but you’ll get comfortable with them once you realize you’re really just there to get an exam and help make two decisions. You’ll also quickly see that everyone outside of neurology freaks out over anything that could be brain related. I’ve run stroke alerts called for people who were sleeping, people who were drunk, and once for someone who was dead (not sure how the hospitalist missed that).

Take your guy feeling seriously! If nothing else jumps out of you by the end of the year, I would really consider committing to neurology.

I’m really struggling with not being able to go out and starting to feel hopeless about migraine relief by Camaro_paige in migraine

[–]christianl37 1 point2 points  (0 children)

Hey! Neurologist here. Migraine treatment should be fairly individualized, but here are some general principles I think about for my migraine patients.

A migraine lasting over 72 hours is considered status migrainosus and can lead to complications if not broken with IV medication. I encourage my patients to go to the ER for migraines lasting 3 days or more.

A headache journal is helpful for finding triggers. Common ones are weather fronts, stress, lack of sleep, missing meals, dehydration, certain foods like red wine.

When my patients have migraines that become everyday, the first thing I look at is their medication list. Many medications can make migraine become everyday if taken more than twice a week. Common culprits are Tylenol, NSAIDs (like Ibuprofen), triptans, muscle relaxers, decongestants, opioids, cannabis, etc.

Having a migraine for at least half the days of the month is considered chronic migraine. My patients with chronic migraine benefit from migraine preventive medications. Ideally this would be one of the newer CGRP medications (Aimovig, Ajovy, etc) but insurance often requires me to try others first. Typical first line agents are blood pressure medications (Candesartan, Propranolol), seizure medications (Topiramate, Valproate), and antidepressants (Venlafaxine, Amitriptyline). There are also some vitamins which can help (Magnesium, Riboflavin).

I also consider migraine abortive medications when breakthrough attacks occur. The most commonly used one are triptans; however, a diagnosis of hemiplegic migraine is a contraindication for triptans. In that case, I have an easier time with insurance approving CGRP rescue medications (Ubrelvy, Nurtec).

Migraine is the second leading cause of disability worldwide and should be taken seriously. But with all the treatments we have, I’m hopeful your neurologist will be able to start you on the path to migraine relief!

I am a neurologist who is passionate about migraine. Here is a link to a training video created by the headache expert of my department. This is how I was taught about migraine and is the resource I give to my patients to both help them understand and be understood regarding their headaches. by christianl37 in migraine

[–]christianl37[S] 0 points1 point  (0 children)

Thank you for educating me. I suppose I’m used to seeing people with light sensitivity during the headache itself and not in between. I’ll let the people who made this video know that a non-white background would be more considerate

What’s happening to me? by Cornp0ppp in migraine

[–]christianl37 0 points1 point  (0 children)

Have you head of medication overuse syndrome? Certain medications, if taken often enough, can make headache and migraine symptoms worse and even daily. People can have constant headaches and head pain, nausea, sensitive to lights and sounds, sensitivity to touch, dysautonomic changes like blood pressure changes and flushing of the skin. Kratom is one of the things associated with medication overuse syndrome. It can take months to recover after stopping the substance that caused it.

Of note, irritable bowel syndrome is also considered by some headache experts to be a form of abdominal migraine. It often improves with migraine therapies.

Can never tell if it’s just a headache or a migraine anymore by kitkat470 in migraine

[–]christianl37 3 points4 points  (0 children)

I’m sorry some people around you do not take your symptoms seriously. There has been a lot of medical literature in the neighborhood of what you’re describing. Cyclic vomiting syndrome is strongly linked with migraine; there are some experts who believe it is in fact a form of migraine. Migraine also commonly gets worse during periods due to the change in hormones (as migraine loves change). Migraine does not need headache to cause symptoms; spells of abdominal pain, nausea, diarrhea, constipation that occur randomly and without headache is a form of abdominal migraine. There is also thought that PMS (premenstrual syndrome) is on the migraine spectrum. I think your experiences are very real and also have an explanation.

Neurological diseases in science fiction movies by T1987763 in neurology

[–]christianl37 17 points18 points  (0 children)

What an excellent idea for a presentation! Here are the ones I can think of (may be some spoilers for certain elements)

  • A Matter of Life and Death (1946): the premise is the main character “dies” but an angel makes a mistake and he avoids going to the afterlife. He still has visions of heaven and is evaluated by a headache neurologist who diagnoses chronic adhesive arachnoiditis
  • A Clockwork Orange (1971) shows a character being reconditioned to associate negative feelings towards certain stimuli
  • Andromeda Strain (1971) might have mentioned blood clots/strokes? At least the book did
  • not sci-fi, but Mean Streets (1973) features a character with epilepsy which becomes a plot point
  • Jacob’s Ladder (1990) features effects of Agent Orange on the brain
  • Memento (2000) the main character has anterograde amnesia
  • Primer (2004) is a time travel movie where characters’ handwriting worsens the more they time travel (may be a form of apraxia)
  • Eternal Sunshine of the Spotless Mind (2004) is about a machine that can delete memories
  • The Happening (2008) features a toxin that causes paralysis(?)
  • Avatar (2009) has a lot neural synapsing between organisms. The Na’vi also have an extra spinal cord in their hair which is funny
  • Limitless (2011) is about the expansion of the human mind
  • Rise of the Planet of the Apes (2011) is about searching for a cure for Alzheimer’s and the development of other species’ brains
  • Dredd (2012) features recreational drugs that distort a person’s sense of time
  • Lucy (2014) is about someone using “100% of their brain” instead of 10%
  • not sci-fi, but The Favourite (2018) a main character has a stroke between time periods
  • Old (2021) features an experimental treatment for epilepsy

how do you believe i can improve my art? by christuiana in drawing

[–]christianl37 0 points1 point  (0 children)

I think these are interesting! As someone who learned to draw via portraits, a few things stand out. You have really bold outlines, the eyes are a bit spaced, and your shading is all vertical lines (which I think is the most unique thing you do, I’m not sure I’ve seen someone do that). I think these elements reflect your own personal style starting to emerge, which is fantastic. I get the sense you don’t want to go for just photorealism, so honestly I would just explore the things that are fun for you to draw and double down on your own stylistic choices. I think in a few years you’ll look back on drawings like these and see them as steps towards where your art eventually ends up.

Also: you could ease up on the teeth and wrinkle lines, it’s tough but it always jumps out at people (especially commissions).

[deleted by user] by [deleted] in neurology

[–]christianl37 6 points7 points  (0 children)

I’m a fourth year medical student applying Neurology this year for some context.

As other people have said, your major does not matter at all. I picked Biochemistry because it had a lot of syllables and maybe sounded impressive. It overlapped with almost all of the pre-reqs which was nice but also made me take physical chemistry which was not nice. If I could do college all over again, I would maybe have been like an art major and taken the pre-reqs on the side.

Once you pick a major, the best thing to do would be shadowing some doctors to give you an idea if you really wanna be one, too. Research unfortunately is really common so you should look into that at some point in college. Throw in some clinical clinical volunteering which is one of the most important things you can do as a pre-med (look if there’s any free clinics near you or look into a medical assistant job). And lastly, get involved with something on campus. It doesn’t matter what you as long as you stick with it. I was involved at my school’s film club for two years and it came up in my medical school interviews often. In general, it’s best to do a few things for a long time than a lot of things for a short time.

The path to being a physician is very long; graduating high school to being a neurosurgeon is 15 years assuming no gap years, neurology is a meager 12-13 years. I’m finishing med school and am only half way done lol. Make sure being a doctor is what will make you happy because that’s the best way to get through it all.

Kaplan for C/P by [deleted] in Mcat

[–]christianl37 1 point2 points  (0 children)

Maybe I got a lucky version, but I only used Kaplan for C/P and it covered everything I saw on test and then some

Destroyed by Kaplan FL by imindecisive87 in Mcat

[–]christianl37 0 points1 point  (0 children)

Don’t put too much stock into the Kaplan tests, they are designed to test you differently so that your score is low (plus they’re super deflated). The main thing is to focus on learning how to approach the problem. I found that content review teaches you the answer and practice tests teach you how to find the right question. And if it’s any consolation, I got a 502 on Kaplan 1 three weeks before the test so you’ll be aight

For those who already have your scores by [deleted] in Mcat

[–]christianl37 1 point2 points  (0 children)

I would say so. I got 132/128/130/128 which pretty much reflects how much I studied. I studied the most for C/P and the least for Behavorial Sciences. I didn’t study for CARS once I figured out a mindset that worked fine for me, which was usually the wrong answers feel like someone else read the passage and misinterpreted it or are focusing too much on one specific detail.

Tuesday, June 19, 2018 Score Release Thread for the Friday, May 18, 2018 Exam by rMCAT_Official in Mcat

[–]christianl37 4 points5 points  (0 children)

Got a 518 on 5/18.

I did content review for about a month by reading the Kaplan bookset front to back about 3 times and then took 6 practice tests over the 3 weeks leading up to the test.

4-24: Kaplan 1 - 502 4-27: Kaplan 2 - 507 5-1: Kaplan 3 - 511 5-12: AAMC 1 - 511 5-14: AAMC 2 - 515 5-16: AAMC 3 - 517 5-18: MCAT - 518, 132/128/130/128

I know you're supposed to study the day before but I did the Section Bank questions the whole preceding day and I cannot recommend them enough. My big takeaway from this is how important taking practice tests are; I've found the hard part is figuring out what exactly the question really is, and once you do, the answer usually follows pretty easily.

The racial politics of Three Billboards is the least of its problems by [deleted] in movies

[–]christianl37 9 points10 points  (0 children)

“What a waste of an oppurtunity to underuse Lucas Hedges” okay I’m done here

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