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What I Learned From My Neurology Rotation

Posted Oct 04 2012 6:01am

Hello world! I am finally back to blogging after a short hiatus while I transferred my blog over to a new host.  I’ve missed you!

In the past week, I’ve moved my life from Indianapolis down south to my parents house.  I will be here for 1 month doing my family medicine rotation.  My first day of family medicine was yesterday and I think it’s going to be a busy month!  But as usual, I think I will love it.

Since I’ve blogged I’ve had some great workouts and yummy eats.  I’ve been obsessed with Cara Cara oranges- a type of navel orange with deep red/orange centers and sweet juicy pulp!  I finished off the last of my turkey muffins as well.

 

 

Workouts have been 30-45 minutes of strength training (I am so super sore) followed by 35 min cardio every day.  The elliptical has been my main source of cardio lately, but I did have a great pyramid run on the treadmill last week:

Start at speed 5.5 and increase by 0.1 each minute until speed 7.5, then come back down 0.1 each minute back to 5.5.

Those 41 minutes were tough!

And now to the actual purpose of this post:

 

What I learned from my Neurology Rotation:

1.  Patient care matters most-

Neurology is a field with many difficult diagnoses.  Some of these diseases are deteriorating and slowly progressive with very little treatment.  When a patient is dealing with one of these diagnoses, the neurologist is a huge part of this persons life! They may see their neurologist every 3 or 4 months for the entire length of the illness.  This is a chance to have a special bond with your patient. Even though you cannot offer a cure, you can offer strength and hope. By being kind and giving your patient a hug, you might make their day or rejuvenate them. If you’re going to be a neurologist, you should do it for the patients and I think you should be a really nice person. One of my doctors was so wonderful, his patients couldnt wait to see him! I want to be a doctor like that.

2.  Time is brain!

In the inpatient setting, patients presenting with symptoms of a stroke are a medical emergency. Head or spinal cord trauma could be a surgical emergency.  If it has been less than 3 or 4 hours since the patient began having stroke symptoms, you can administer medication to help break up a potential clot in the brain. There are many risks with this medication however and so you have to think fast! The quicker you make decisions and start treating, the more brain you can potentially save.

3. Mental health affects physical health

I’ve learned this in all my rotations thus far but I feel compelled to keep talking about it. When you are suffering from depression, physical illness can seem more pronounced.  I have seen many patients in physical pain and dealing with psychological depression. I often wonder, which came first, the Depression or the pain? Is the pain making the depression worse? Or the depression making the pain worse? I have often found that treating the depression can have huge positive effects on physiological illness.  In Parkinson disease, depression is a very common side effect.  These patients shouldn’t have to cope with a debilitating neurological illness plus a chemical imbalance causing them to feel depressed.  I try to remember to look out for that because someone in good mental health may feel better physically.

4.  The human spirit is an amazing thing!!

Like I said in my first point, neurology is a field that holds many awful diseases.  I met countless patients with slowly progressive diseases like ALS and Huntingtons that will eventually strip them of their ability to perform daily tasks and live as they are used to. To my surprise, many of these patients are incredibly grateful and happy. It makes you remember how strong the human spirit is and how lucky we are.

5.  Don’t believe your patients… Sometimes-

In my internal medicine rotation , I learned to never believe a patient.  I had heard so many patients tell me they don’t use drugs only to have a positive urine drug screen the next day, I stopped believing those things!!  I fell in love with a patient who seemed so genuine I thought he and had just fallen on some bad luck, only to discover he was homeless and had been in and out of the hospital 8 times in the past year.  So when a young man presented with urinary retention and sudden blindness, of course I didn’t believe him!  This man was in his 20′s, slightly disheveled and seemed very depressed. He told me his story of countless illnesses and doctors appointments all within the last 2 months.  Along with his illnesses, he had had many extreme life stressors during this time as well.

My initial diagnosis was conversion or somatiform disorder.  Conversion is when a person subconsciously converts emotional stress into physical symptoms. They can do this to get things like attention, love, etc, but it is all subconscious.  Somatiform is a similar disorder and has requirements of one neurological complaint (blindness in this case), multiple pain symptoms, a GI complaint (this patient had diarrhea), and more.  I almost wrote this patient off as a psychiatric patient with no real physical problems.  Thank goodness our team investigated more because this man ended up having neuromyelitis optica- a subset of multiple sclerosis.  I learned a great lesson with this patient and actually became quite close with him and his family.

***Lastly: How I studied for the NBME.

I figure I should add how I went about preparing for these exams in case anyone reading this is about to start this clerkship.  For neurology I used 2 books: Blueprints and Pretest. Blueprints is more like a textbook and I probably read it 2 or 3 times (once taking notes and then 2 reviews of my notes).  Pretest is only questions.  I don’t think I did every single question in this book but I did most of them.  I felt very prepared and did very well.

 

Have a wonderful day everyone!

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