Overview for UBC Students
Medical students from UBC typically spend two weeks on the neurosurgical service. Each week they will be under the supervision of an individual neurosurgeon. Please find out who this is before your elective so that you know where you should meet them Monday morning.
You can contact the neurosurgery secretary, Sachiyo, at 604 875 4111 ex 23119 or email her at sachiyo.kaneko@ubc.ca If you know the neurosurgeon you are working with, then contact them directly.
My office secretary, Nicoline, can tell you about my schedule if you call her at 604 875 5894 or by email at nicoline.rickard@vch.ca
Students Studying with Dr. Honey
During the week with me, you can expect to spend time in the office (seeing new patients) and in the operating room as well. Students usually have academic half days on Tuesday and Thursday when you join the other medical students for lectures from various surgeons.
Please read this web site to learn about the kinds of medical conditions that we treat.
In the operating room, you will not be directly involved in the case. You may ‘scrub in’ to watch closely or watch the TV monitor which will show you what I am looking at under the microscope. We are happy to teach you and you should feel free to ask questions. We do not expect to you to stay in the operating room if we are in the middle of a long case. Come in – see the relevant anatomy – then go into the next operating room if you would like to see what they are up to.
It is a good idea to communicate with the chief resident so they know who you are and can tell you what is happening on the ward. I believe you will spend some time ‘on call’ to learn about managing ward problems and seeing emergency cases in the emergency room.
Good luck. We hope you enjoy your time with us.
Standard Orders for VGH
Please check orders with Dr. Honey. The following are standard orders but might need to be changed if patients have allergies.
Pre-operative STN DBS
DAT, NPO at midnight (may take meds with sip of water); AAT; NVS routine
IV saline lock; chlorhexidine shampoo and wash the night before surgery
Gown must not have metallic clips (MRI compatible)
Order all regular Parkinson’s and any other regular medications
No Parkinson’s mediactions after midnight
If on BP pills, take the morning of surgery with a sip of water
Bring morning dose of Parkinson’s meds to OR in bag (do not take it)
Send patient to MRI at6:45am (not to OR). Do not send with an IV pump.
Check allergy status and bring Ancef 2g IV with patient to MRI
Do not give ASA or blood thinners
Post-operative STN DBS
Sips to DAT; NVS q1h x 6 then q6h; AAT
reorder all regular medications (Parkinson’s meds are same as before surgery)
If allergy status OK then give Ancef 1g IV q8h for 24h
Post-operative CT head scan ‘STEALTH protocol’ to assess location of electrodes
Tylenol pl or #3 q4h prn PO; gravol 25mg IV or 50mg PO q4h prn
keep wounds covered with bandage
Discharge Instructions:
keep wounds dry for 10 days then ask Family Doctor to remove stitches
call Dr. Honey or Neurosurgeon-on-call if wound infected
no strenuous activity for 6 weeks
return to DBS Clinic for stimulation adjustment at around 6 weeks
Download a pamphlet on Deep Brain Stimulation
Post-operative MVD
Sips to DAT; bed rest overnight then AAT; NVS q1h x 6 then q6h
D/C art line, Foley and calf compressors once mobilizing
CBC and lytes in AM
Keep systolic BP below 140 with Lobetolol 5-10mg IV q 5 min (max 40mg/h hold if HR<55 or beta blocker contraindicated
If BR still>140, use hydralazine 5-10mg IV q5mins
Decadron 4mg IV BID x 24h then continue 2mg IV/PO BID
Rantidine 50mg IV q8h or 150mg PO BID
Morphine 1-2mg IV q1h prn; Tylenol pl/#3 q4h PO prn
Gravol 25mg IV q4h prn; Ondansetron 4mg IV q12h prn
keep wound covered with bandage and wrapped with tensor for 10 days
Discharge Instructions:
keep wound dry for 10 days then ask Family Doctor to remove stitches
keep tensor bandage over wound for 10 days then throw it away
no strenuous activity for 6 weeks
call Dr Honey or Neurosurgeon-on-call if wound infected or sudden worsening of headache after discharge from VGH
Download a pamphlet on Microvascular Decompression
Know Thyself
Which image below best represents you (and why)?
Image A is a close-up from a “tree of life” (in Botswana). The bushmen of the Kalahari believe this tree represents life for a number of reasons. If you look at the thorns they are almost 180 degrees from each other (unusual for thorns) with one pointing straight forward and the other back and downwards. They believe this is an allegory for life – as you move forward in life, remember that you are rooted in your past. The analogy to medical school is obvious, gain a good basis of knowledge before you move ahead in your career to help people. The concept is remarkably close to the ancient Greek aphorism “know thyself” which was inscribed on the Temple of Apollo at Delphi.
Image B Medical students often feel lost in the crowd like these zebras (Nambia). The zebras are deliberately trying to hide in a crowd with their stipes.
Image C is a dung beetle (South Africa) pushing a ball of elephant dung with its feet while doing a handstand. Remember how hard their life is when you are ‘on call’.
Image D is a leopard in a marula tree in South Africa. She is looking at her cub – sometimes there are perfect moments in life.
