Fellowshipping: Month 6

I cannot believe my sixth month of fellowship is over and that I am officially halfway done with my fellowship! 

In all honesty, I'm a little scared to know I just have another 6 months left of training. At times, I've felt like I have learned a lot; but most of the time, I feel that there is still so much for me to learn and that I can't possibly be ready in another 6 months time. Time is flying and still ticking, so I've got to keep on moving too. So far, I've received a lot of good feedback from my colleagues (so my supervisor says). But there's still some doubt in me. I guess that's what they call the infamous impostor syndrome. 

I spent my 6th month of fellowship training continuing on at the spine center when outpatient and the general neurosurgery floor while inpatient. Although some things have started to get repetitive, I have still learned something new every day. 

During my month at the spine side, I have really begun to put things together and understand how some things work. For the most part, we typically prefer that patients who come in have tried other alternative treatment options. Why? Because surgery is really a last resort option unless, of course, it is an emergency. 

Some alternative therapies we recommend for our patients with neck pain and low back pain include acupuncture, chiropractor manipulation, physical therapy, and injections (trigger point injections, epidural steroid injections, facet injections, etc). The type of injection we recommend is dependent on what we believe to be the cause/source of the pain, which is why it is important for patients to be evaluated. In conjunction to this are the findings on MRI or CT and the x-rays as well as the physical exam. Putting all these pieces together really helps the surgeon to tease out who will get relief from surgery versus who will not. 

Another learning point is how closely the neurospine people work with the pain management, orthopedics, and physical medicine and rehabilitation (PM&R) departments, as well as orthotics. Having worked in the beginning of my training on the cranial side, I have noted how closely those surgeons worked with the neurology department and neuropsychology. 

Conditions/terms/diagnostic studies I've learned about this month:

• Arthrodesis
• Anterolistesis
• Retrolistesis
• Scheurmann's disease
• Klippel-feil
• Schwanomma (of spine)
• Bertolli's syndrome
• FABER/FADIR test (on physical exam)
• Yeoman's test (on physical exam)
• Trigger point injections
• Posterior lumbar interbody fusion (PLIF)
• Transforaminal lumbar interbody fusion (TLIF)
• Electromyography/nerve conduction studies (EMG/NCS)
  
• CT myelography
• CT myelogram

My time at the spine side came to a close today, and I'm looking forward to a block of solid inpatient floor time with a sprinkle of OR days here and there. I'm curious to see how much more I'll grow in this next month with the solid block, since I've been working outpatient and inpatient in tandem since day 1 of my fellowship. I'm also nervous and excited to see how my off rotation to the trauma/ED goes!

Nicole G.

@nextwithnicole // @nursenicoleg