Flat Head News

A paper in Pediatrics has linked "flat head syndrome" with early neurodevelopment disadvantage. http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0052v1
Ever since the fear of SIDS led to the recommendation that babies be put to sleep on their backs (unlike when I raised my kids and the exact opposite was recommended), there has been a dramatic rise in "flat head syndrome" usually felt to be positional and correctable in the majority of cases with positional correction and other simple interventions.  At the same time a recent study have linked SIDS to a brain stem abnormality. http://www.sciencedaily.com/releases/2010/02/100202171811.htm
So one might ask if all this insistence on putting babies on their backs is really a good thing? Or, in fact, given that most Western babies are placed almost continuously on their backs and only a relatively small percentage get "Flat head syndrome", might these infants have some type of genetic predisposition to developmental delay and as such the syndrome is just that-a linked group of features rather than cause and effect.

Medical Education: Attention Long Overdue

JAMA recently published a review of a very important book (http://jama.ama-assn.org/cgi/content/extract/303/5/458): Radiology Education: The Scholarship of Teaching and Learning.  while the educational aspects of medicine have gotten increasing attention on many levels during the last decade, this book focuses on some critic elements.  In fact the book is organized around three key elements: Education for NonEducators (unfortunately, the majority of doctors who are training the next generation fall into this category), Educational Insights from Practitioners (finally some recognition that some teach better than others and may have an inside tract), and Radiology Education Global Outreach (synthesizing lessons learned from many educational milieu).
Those who direct residency training in all specialties should take note of this book and look long and hard about how to effect similar educational  innovation and introspection within their own training programs.

First Ladies of Neurosurgery: Karin Muraszko

Helicoptering: she introduced me to that phrase and I have since realized there are few that do it better!  Karin holds a special place within neurosurgery-she was the first woman in the US to gain the position of Chair with an RRC approved residency training program  at the University of Michigan.  http://www.med.umich.edu/opm/newspage/2004/neurosurgerychair.htm

Her journey there has been anything but easy but at every step of her enormously successful journey she has literally and figuratively "risen above" and in doing so, gained the ultimate advantage of "helicoptering", the ability to see the whole picture, to better understand how the little pieces come together as a whole, and to avoid getting mired in the minutae of the moment.http://www.icyou.com/topics/medical-fields/neurology/harder-brain-surgery+

While her list of accomplishments are many, I would like to comment specifically on one.  Karin has dedicated herself tirelessly to mentoring.  She has taken enormous amounts of time to guide, nurture, and assist more women than any other neurosurgeon (she also mentors men regularly but for better or worse, men have a surfeit of mentors available).  She has guided me through many difficult moments and I know she has done this for others.  Somehow, she always has the time to help with a difficult clinical problem, put a job decision in perspective, see an answer to an organizational dilemna. 

For more than 15 years she has also donated her time and resources to Project Shunt.

Detailed career highlights:
Graduated Yale, 1977
Graduated Columbia Medical School, 1981
President, Women in Neurosurgery (WINS), 1991
Associate Professor, 1996
Assistant Professor, University of Michigan Neurosurgery, 1990
Associate Professo, University fo Michigan Neurosurgery, 2004
Chair, Department of Neurosurgery (First woman in US), 2005
Society of NS, member 2005
Nina Starr Braunwald Award (AWS), 2005
ABNS, Director (First woman), 2008

Patients, patient families, women doctors, women surgeons, neurosurgery, the disadvantaged, the disabled-and more-all have benefitted from the dedication, compassion and expertise of this amazing First Lady of Neurosurgery!

Pop, Pop, Fizz, Fizz: No Relief

The stupidity of some involved in the wide world of medicine never ceases to amaze me.  Today I read that the makers of Maalox in their infinite wisdom created a product called Maalox Total Relief that actually contains a substance that may exaccerbate bleeding (http://www.google.com/hostednews/ap/article/ALeqM5iJ_Wvve3Fl8Wrb6Wf6zjVPRxsYJwD9DU61D81.  And we wonder why so many are calling for health care reform! and why there is such a strong "underground" patient movement (sometimes broadly referred to as Health 2.0 (see http://www.health2con.com/)).
As phsycians, we need to wake up, smell the roses: take control so we do provide RELIEF, not confusion.

More Outstanding Art

Dr. K Ko contributed the several pieces in addition to her fab art on the cover.  This is another favorite.

New Job

After four years of college, four more in medical school, two years as a Visiting Fellow at the NIH, seven (7) grueling years as neurosurgery resident, and 15 years in small specialty practice I threw caution to the wind and joined a multi-specialty practice as their first neurosurgeon. I don't think my story is unique.  In the recent newsletter from CANS, (http://www.cans1.org), one expert stated that solo and small group neurosurgical practices would soon be a thing of the past.  Late 2008/early 2009, I was already aware that  I needed to get ahead of the curve on this trend.  My immediate specialty community is highly competitive and perhaps overcrowded.  Being 50, I knew I had to be able to sustain my practice for another decade so when the fastest growing, most professionally competent multi-specialty group showed interest in recruiting me-it seemed a great opportunity.
What have I given up? Some autonomy, lots of administrative responsibility, working with some treasured employees, and perhaps some of my hard won referral base.
What have I gained? Well honestly, I am just one week into this but I already know that I will be spending a more time being a neurosurgeon and less being a paper-pusher.   This is a definite win-win for my patients.  I feel like I am riding the wave of medicine's future.
I am sure I will have more to say on this subject in the fullness of time.

In Search of

Why do we look back? What do we gain from digging into our past, exploring our roots, rehashing our mistakes, re-living horrible catastrophes of history? We are from our past, it is indelibly etched in our genes.  In medicine, we must learn from our mistakes and bad outcomes, in history, we must understand in hopes no to ever relive the horrors.  In families, we connect-to those we love and those we wished we knew. After my recent visit to my parents, I have finally arranged to journey back in time with my mother.  In June, we will use the opportunity of a course I am organizing in Munich (Novalis Circle: http://www.novaliscircle.org) as a jumping off point to Poland and Berlin-an exploration of our roots. My grandmother was born and raised in Poland and despite little formal education still had the amazing insight that allowed escape from Nazi Germany that makes this trip a celebration of hope, freedom, intelligence and determination rather than a desolate journey. For as long as I can remember, she has been my inspiration and my support.  Though her 97+ years ended nearly a decade ago, she remains a huge part of me-my conscience, my honesty, my compassion and much more.  Because of her, I am constantly in search of improving myself for my patients, of unadulterated honesty when it comes to bad outcomes, of constant intellectual questioning of what neurosurgery is and should be.I don't know what I will find in The Pale of Poland (for an overview: http://en.wikipedia.org/wiki/Pale_of_Settlement), in Halberstadt where she was married, or on the street where she worked in Berlin before her epic escape but I know it will bring me closer to this special lady and to my entire family and I will be a better person for it.

If Nana has her way, it will make me a better neurosurgeon, too.

JAMA Review

Just got word that JAMA will review Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do.  Since I happen to speak to the neurosurgeon who I believe did the review and he was nothing but filled with praise, I am hoping this helps further launch this exciting book.  The review will apparently feature one of the outstanding paintings by the talented Dr. Kay Ko.  I promise to post link once it appears. Maybe Oprah will find time for the book before she shuts down shop! One can dream.

Friends and Colleagues

Where would we be without friends? And when you are a minority (of any kind for any reason) so small that you are really more just an isolated individual rather than anything that approaches a "group" then friends are even more critical.  I have benefitted enormously over the years from my connections to some of the pioneering women in neurosurgery.  We met during the earliest days of WINS (Women in Neurosurgery) and though we have never lived in the same cities, our friendships have been invaluable.  Now we all realize how so important these connections have been and that finding some time to relax together during our very hectic meetings is priceless. If there is one thing that has helped me succeed in neurosurgery, it has been these connections. You can't wipe the smiles from our faces after one of our engaging, enjoyable dinners out.

Medical Challenge: Colleagues as Patients

He is young, has lovely children, and both he and his wife work with me on a regular basis so when I got the call on my way back from vacation, I didn't hesitate to do a reverse " house call".  He arrived MRI in hand and I looked in astonishment as this muscular, fit man and tried to make it a cohesive picture.  He did have minimal signs of myelopathy so I knew something had to be done.
I spent a long time with him and his wife-I tried in vain to have them see a second opinion (and choose them over me).  For me the surgery was a 9 on a scale of 10 in terms of difficulty, 8 out of 10 in chances of complications (many agonizing) with the added stress of knowing him so well and working with him every day.
I was touched by their trust.
Surgery went great! Complete decompression, benign tumor, no deficits...went home after just a few days.

Then the trouble began-not unexpectedly, the patient developed a CSF leak, very hard to manage.  Given the location of the tumor and the large defect in the dura laterally, a seal was impossible.  First time I patched and glued.  Second time I did lumbar drain.  Third time I did double patch, double glue, muscle graft and simultaneous lumbar drain.  Finally I put permanent lumbar drain in.  I think he may finally be over the hump.  If so, he will be able to return to work soon-I will see him, smile inwardly at his unwavering trust but still wonder if next time, I will insist close colleagues get care further afield.

FIRST LADIES OF NEUROSURGERY: CAROLE MILLER

In 1984 I seriously began immersing myself in neurosurgery as a 3rd and 4th year medical student.  I had already completed an intensive month in neurosurgery at both University of Maryland and UCS and in late summer flew in to Columbus, Ohio to complete my final experience at Ohio State.  OSU had been recommended to me for one reason: Carole Miller, M.D.  She was the fourth woman to become board certified in neurosurgery in the US and the first woman  neurosurgeon to become president of a national neurosurgical organization (NSA in 1988).  For me she was FIRST!  At that point, I had met few women professors or surgeons and certainly no owmen neurosurgeons.  While this fact never disuaded me from my love of neurosurgery, there were times when I wished I wasn't always existing within a sea of men.  If it weren't for Dr. Miller, I don't think Columbus would have been a destination of choice.  It was a medium sized city in the middle of Ohio with few others than thhe rambunctious football players on campus.  Every morning, I walked from my little dorm room across a dark and menancing campus to the hospital to make rounds before surgery.  The work was hard, the hours long and the learning strenuous.  After all these years, I don't specifically remember the very first time I met Dr. Miller but I do clearly recall the huge impact she had on me during my month.  She worked long hard hours, did research, surgery and an inordinate proportion of the resident and medical student teaching.  Everywhere I traveled within the hospital, it was clear she was highly respected.  At the time, I must admit to being a little scared of her-rightlyfully, she demanded perfection in the care of the patients.  She stressed that neurosurgery is a specialty where even the tiniest mistake can render horrendous results.
Initially, I was disappointed that she didn't "look after me", encourage me, or in any other way advise me.  I have since realized that in her astute way, she was helping me to understand that I had to pursue neurosurgery because I loved it and be willing to accept the challenges that would come from being one of the early women to do so.  At the end of the month, I sat with her for my exit evaluation.  She succintly appraised me of my strengths and weakness-deomnstrating insight that few other teachers had in more than 2 decades of schooling.
Years later, I had the pleasure of getting to know Dr. Miller in a less formal way, through WINS (Women in Neurosurgery).  We have had the opportunity to talk about those early years and I was surprised how clearly she remebered me and my month at OSU.  I will never forget them.  For me personally, Carole Miller was my First Lady of Neurosurgery-there may have been others who trained before her but in 1984 they didn't exist for me but Carole Miller did. 

Dr. Miller has recently been honored by the Naitonal Library of Medicine as a "Legend".  I encourage all to red more about this talented and accomplished neurosurgeon.http://www.nlm.nih.gov/locallegends/Biographies/Miller_Carole.html