MRI thoracic spine before a SCS trial
Hi folks
how many of you do a thoracic MRI before a SCS trial?
Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - August 19, 2020 Category: Universities & Medical Training Authors: med7343 Tags: Pain Medicine Source Type: forums
Building a new fluoroscopy suite and requirements
Hi everyone,
I am here to ask for a specific advice. Some background information...
I am the sole pain doctor in an ortho spine group in TX who had sought out a pain specialist with intentions of broadening the practice include pain management. I joined the practice last year out of fellowship and have so far been very happy with my job. They have been very happy with me as well. Because there was no pain practice prior to me joining, there was no fluoro suite. I have been taking all of...
Building a new fluoroscopy suite and requirements (Source: Student Doctor Network)
Source: Student Doctor Network - August 19, 2020 Category: Universities & Medical Training Authors: RamPain Tags: Pain Medicine Source Type: forums
Going back to Anesthesia, any advice?
Hey everyone,So I am one year out of fellowship. I wasnt happy with my current practice (>80% personal/auto injury ) and they proposed a large pay cut due to covid which I wasn't willing to accept. The pain job market in my area is very saturated and the hiring environment is not the best due to covid. I am going back to Anesthesia for at least a year until I figure out my next move. The salary and benefits are great for the time being and it was hard to turn down.
Any advice as far as...
Going back to Anesthesia, any advice? (Source: Student Doctor Network)
Source: Student Doctor Network - August 13, 2020 Category: Universities & Medical Training Authors: buckeye2132 Tags: Pain Medicine Source Type: forums
ULTRA-Frequent Fliers
Curious how docs out there deal with “ultra-frequent fliers.” First a story.
We have a guy, parapalegic after an MVC, wheelchair bound, who has had 16 ED visits this week alone. Over the last few years hear had close to 500 discrete visits.
This week he was here for abdominal pain, discharged, back 20 minutes later with chest pain, back 8 hours later with back pain, slept on the street corner in his wheel chair, came back in the next day for fever, discharged, came back the next day...
ULTRA-Frequent Fliers (Source: Student Doctor Network)
Source: Student Doctor Network - August 1, 2020 Category: Universities & Medical Training Authors: The Knife & Gun Club Tags: Emergency Medicine Source Type: forums
SCS Implant with nearby seroma
Wonderful patient with trial placed today. L2-S1 fusion. No issues getting in and up spine.
If I go to implant and cut open this seroma, should I do anything special other than extra irrigation?
I have drained seromas like this with a 22G before, and I figure with an extra Tuohy I can suck this dry pretty quick in a separate poke.
Planning to avoid it altogether, but if it happens, I want a plan. (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2020 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
PGY4 Elective Advice
Hey Gang,
As I'm starting my final year, I was wondering if anyone had elective advice before finishing residency. I searched and couldn't find much on this in the recent past. I've applied to Pain and (fingers crossed) will pursue that as a career, and I actually have quite a bit of elective time this year that is literally up to me to design (pretty amazing, right?). I've planned to do a fair amount of Sports/MSK/Spine time, as well as EMG's. I guess I was just wondering if any folks out...
PGY4 Elective Advice (Source: Student Doctor Network)
Source: Student Doctor Network - July 21, 2020 Category: Universities & Medical Training Authors: ErrantWhatever Tags: PM&R Source Type: forums
basic question about spinal stenosis
Stupid question. I don't quite understand how to distinguish clinically between spinal stenosis vs radiculopathy. I understand spinal stenosis refers to narrowing of the spinal canal and radiculopathy means impingement on the root. How these manifest clinically is where I get confused. I get that classically back pain with relief with forward bending/shopping cart sign point to lumbar spinal stenosis, but can't spinal canal stenosis also impinge on nerve root (e.g. at L4/5, the L5 root) and...
basic question about spinal stenosis (Source: Student Doctor Network)
Source: Student Doctor Network - July 21, 2020 Category: Universities & Medical Training Authors: thetuman Tags: Pain Medicine Source Type: forums
Cancelling surgical cases for medical reasons
Patient looked good in pre-op holding area. Ready to roll for Nevro implant. And then the labs came back. (Source: Student Doctor Network)
Source: Student Doctor Network - July 19, 2020 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
Saving the docs back
Other than table height, lighter lead etc. any tips on saving our backs. After a long day doing procedures my back really hurts. It’s muscular no doubt. I’m only 7 years in, could get to be a problem (Source: Student Doctor Network)
Source: Student Doctor Network - July 18, 2020 Category: Universities & Medical Training Authors: georgiamd Tags: Pain Medicine Source Type: forums
what to do about procedural errors
Was hoping for some advice or any words of wisdom.
Quick context:
I recently joined a midsized academic practice about 8 months ago. During the last few months, I've inherited many patients that used to be seen by my colleagues. After reviewing the charts of patients from 1 colleague in particular, I began to see many consistent errors in their previous imaging. The most common thing that I've picked up is incorrect spinal levels being injected, usually off by 1 level. Also other less...
what to do about procedural errors (Source: Student Doctor Network)
Source: Student Doctor Network - July 16, 2020 Category: Universities & Medical Training Authors: heathermed Tags: Pain Medicine Source Type: forums
Oral steroids risky
Do not Rx oral steroids for back pain. (Source: Student Doctor Network)
Source: Student Doctor Network - July 11, 2020 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
Using Butterfly IQ for injections
Has anyone tried using the Butterly IQ ultrasound probe to perform nerve blocks or joint injections?
I have done shoulder and hip joint injections using this probe, and while the anatomy showed up reasonably well, the needle (a regular BBraun 22g spinal needle) did not. I was able to get the injections done, but I am not sure how useful this device is for anything besides scanning.
Anyone else have any thoughts on this probe for regional blocks and/or interventional procedures? (Source: Student Doctor Network)
Source: Student Doctor Network - July 10, 2020 Category: Universities & Medical Training Authors: witothewi Tags: Pain Medicine Source Type: forums
Radiology encroaching on pain?
Musculoskeletal/ Spine Interventions
1) Genicular artery embolization for knee pain/ osteoarthritis and Genicular artery embolization for hemarthroses after TKA Geniculate Artery Embolization: New Treatment for Knee Osteoarthritis - UCLA Radiology, Los Angeles, Westwood, Manhattan Beach, Santa Monica, CA 2) Genicular nerve...
forums.studentdoctor.net (Source: Student Doctor Network)
Source: Student Doctor Network - July 4, 2020 Category: Universities & Medical Training Authors: gassedout2015 Tags: Pain Medicine Source Type: forums
Opioids and fusions
Animal models suggest opioids can inhibit bone fusion after spine surgery. I have a patient with multiple non-unions now, but I can't recall seeing this too often. I would think there are other reasons than opioids. Has anyone else seen failed fusion often and any idea why it occurred? (Source: Student Doctor Network)
Source: Student Doctor Network - July 1, 2020 Category: Universities & Medical Training Authors: pmrmd Tags: Pain Medicine Source Type: forums
Failed spine surgeon becomes failed pain doctor, accidentally burns down house while destroying evidence
Article here
Not sure why it took 3 years to arrest them. Apparently the wife accidentally burned their house down when she left the documents burning in the outdoor fireplace unattended. (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2020 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
