all right so I'm Dr Brian Anderson I'm a neurosurgeon uh we're just getting here bright and early uh Central Valley Medical Center in Nephi Utah uh it's a smaller Community Hospital I started doing cases here about a year ago uh I kind of grew up in this part of the state and so it's been fun to come back and start uh doing cases closer to where I grew up uh this morning we've got four surgeries hopefully shouldn't be too long of a day so we'll get ready start start getting to work I see the staff coming in my device reps are showing up uh so everybody is getting ready to go there's a lot of moving Parts on a surgery day like this I'm one of those moving Parts but there's a lot of other people have to be here for me to be able to do what I need to do so I'm going to head back I'm going to get changed uh into my hospital scrubs and uh head to the preop area where I'll be able to talk to the patients make sure there's no concerns from the staff and hopefully get uh going to a nice efficient start this morning so we'll see you minute okay now we're ready to go we're going to head to pre op and start talking to the patient make sure everything's good to [Music] go all right you been talking smack on me probably mostely we and talk to first patient hey how's it going ma'am you ready I'm ready I am ready uh we've talked about things a lot any questions concerns no I think I understand what's going to happen okay perfect we never know for sure how that lead's going to play for us so uh usually the first thing I try to start it assume it's going to be easy and if it's not then we escalate from there so I'll probably just pay uh kind of expose that one lead and uh place a stylet back inside of it if it advances on its own and lets us do that then that's what we'll do we'll just slide it right back up where it belongs and that'll be it well we'll get in there we'll get it done uh get you healed up and get you home okay okay sounds [Music] [Music] good okay getting the ORS all set up uh like I said there's a big team involved and so everybody's got their part everybody's got their role so he'll get a chance to see uh how that works I think anesthesia is finishing up their work with the patient and he'll be rolling back here shortly so uh so our first case is a spinal cord stimulator revision so neuromodulation is a big part of my practice it's what I do uh neurom modulation involves kind of implanting small computers in people uh placed uh within the central nervous system to help manage different conditions different pathologies for me a lot of that's going to come down to pain so a lot of my patients today or spinal cord stimulator type patients where we're treating pain so for this first patient he had a system placed it was working really really well for him one of the electrodes or one of the wires that was placed migrated a bit and if it migrates enough then it loses its ability to treat his pain and so uh we just need to go in and kind of replace that back where it belongs he had over 90% pain relief and so we want to make sure we can recapture that for him long term made a big difference in his life we're here with Lisa who's the O manager she the boss down here so uh anything that goes on fortunately I don't have to deal with all of it she's going to take care of it uh so we actually did have one cancellation a patient got sick over the weekend and uh we had to remove them from the schedule but that's okay cuz we still got multiple other cases so everything else looks good yep so we've got uh two other stimulator trials today we've had this stimulator revision and then a laminotomy and micro disectomy at the end okay perfect so still for four cases no concerns reps are here Stop's ready to go we're all prepped and prepped and ready okay excellent let me know if something changes sounds [Music] good these cases use a lot of uh x-ray a lot of fluoroscopy and stuff to place and guide these wires and so uh I often times or I always I pretty much have to wear lead for these types of cases so uh it's kind of heavy gets old makes me hot makes for a long day sometimes uh but helps keep keep me safe and protected so that's what we [Music] do so looks like everybody's ready to go team's kind of getting pulled together uh the O is kind of a nice complicated but hopefully simple uh chore choreographed dance uh everybody kind of plays their part everybody has their role and so you'll get a chance to see a lot of that uh in action everybody kind of needs to be on their aame uh for a case like this I often times think it's you know I kind of forget what it's like to not know what this environment feels like uh but for most people it's very foreign place and so sometimes when you when you see what goes on in there it almost seems too simple maybe it seems like people are having too much fun and that it should be super serious and scary all the time but obviously this is a job and just like if you're a banker or mechanic or a school teacher anything else you have your normal and you have your routine days and for the people in this room this is a routine day and they have a good time they seem like they're not nervous because they're not they do this every day and they're not very concerned about what's going on cuz they know as long as everybody does their job things go nice and smooth looks like they've got things about ready we'll get ready to get started probably going to be replacing the one lead and that's it everything else will stay in there we'll just put it back together uh new lead new anchor most likely in Trot needle okay so in the O there's a lot of people involved like I mentioned so we have of course we have anesthesia it's going to keep the patient asleep uh keep them comfortable keep them safe keep all the vital signs nice and stable for us uh my assistant uh Josh nurse practitioner uh who's going to help me assist me during the case we're going to have our radex uh who we're going to be running our fluroscopy machines uh it's a very very important part of this case uh in particular uh we're going to have or our circulator going to keep everything flowing exactly right anything we need or don't have in the room they're going to run and grab it that they're just going to basically do everything charting everything make sure everything happens smoothly uh we're going to have our scrubs we're going to be running this case making sure I have everything I need uh don't even hardly have to ask for it most of the time they anticipate what I need we have our device rep uh for this case that we're going to we're going to need uh their support cuz we're implanting things in patients so they're going to get us everything that we need so you'll see all this stuff happening uh kind of fluidly throughout the case and that's what allows us to do this over and over and very safely and predictably we're good to go it's time to begin okay perfect [Music] [Music] okay so we're done with our first case everything went well uh ended up having to do a little more Hardware replacement than we expected but expected it's a big word cuz you never know what you're going to come into patient will come here in to pack you uh as soon as they roll out uh but I'm going to go talk to the family real quick and let them know how things went so all done obviously uh everything went fine no big no big surprises there was one impedance this morning each one of those contacts we do a little Diagnostics on and one of the impedances was off uh from what it normally is doesn't really affect how it works but sometimes can be an issue with emor compatibility and things like that so ironically enough it was not the migrated lead we assumed that it would be the migrated lead that had the impedance that was out but it wasn't it was actually the other lead yeah it's good thank you okay excellent we'll see you again little bit all right one of my favorite things about operating in a smaller hospital is that you get to see everyone who makes this all happen and so uh one of the administrators big boss right has been graciously enough to help me get started up here so Randy happened to be down here and and so we decided we'd grab him and uh see how he's doing today see if there's anything I need to be doing differently we're grateful to have Dr Anderson here uh he does a great job for us I'm from a small town Dr Anderson's from a small town we want to keep people close to home so they don't have to travel and uh they can be here locally and take care of their needs which is great yeah yeah it's big again it's a big load uh Healthcare is getting more and more complicated and so uh for these types of facilities to be able to flourish in today's world is not easy so I think it speaks to their leadership and what they've been able to do so I'm grateful anything I need to do to change or anything I can do to help great job and we're happy you're here okay excellent thanks so appreciate it have a good day [Music]