Back to Basics

Happy 2018 everybody! Hope not many of your flights are getting delayed too much.

Also, you are not going to believe what I am going to blog about this time. I have just completed a rotation in neurology. If you follow this blog, you know that I am pretty gung-ho about vascular surgery. I guess I tend to find inspirations at unexpected places.

I wasn’t used to it at first. Coming in at 7am, pre-rounding on patients for 3+ hours, table rounding with attending for another 1-2 hours, and finally formally rounding on patients who are now taking afternoon naps. This schedule is different from surgery, to say the least. The amount of sitting probably gave me a badonkadonk.

However, nothing is all bad. Neurology rotation was 3-4 weeks of getting back to basic science and pathophysiology. I spent tremendous amount of time looking at new concepts and relearning old ones (pathogenesis of thrombus formation, atherosclerosis, embolism, etc).

Why is it easier to perform endarterectomy on arterial lesion caused by thrombosis versus Takayasu’s (the latter is associated with transmural inflammation so hard to find a plane)?  Why does intracranial vasospasm primarily give posterior headache (Posterior circulation has more sympathetic input)? How come temporal arteritis rarely affect intracranial vessels ( they have extremely thin walls with much less elastic fibers in the media and adventitia and absent vasa vasorum compared to their extracranial counter parts)? Those are few out of the many new basic science concepts I was able to learn and make clinically relevant during my time on neurology. Not only did I gain new knowledge, rotating in a medical subspecially like neurology taught me to always keep an eye out on the basic pathogenesis of every clinical disease. Indeed, medicine helps surgeon (or in my case, surgeon-in-training) quite a bit; much more than I thought.

I was once told by a mentor that to be a good surgeon, you need to know 2 things – pathophysiology and anatomy. It’s nice to brush up on the pathophys, an area that is easily forgotten if you spend a tad too long wandering in the other territories of medicine.

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