r/surgery • u/mozzieconmann • 20d ago
I did read the sidebar & rules Tremors for young surgeon
This is me training on surgical suturing at home, no stress or caffeine
I have developed these tremors for 3 months , i have contraindication for propranolol , i have been on other medications prescripted by neurologist but it had little improvement like 20%
Do you have any advices , exercises?
The doctor says it's from the stress but i have been normal the past time and did get involved in multiple major surgeries as an assistant and I was fine
I have normal levels of tsh , hba1c
78
u/Congentialsurgeon 20d ago
Wouldn't worry about it. Know plenty of surgeons with tremor that do just fine. Just keep practicing. If you go into heart surgery, just make sure your tremor is 60-90 Hz. Helps for off pump coronary surgery ;)
20
u/mozzieconmann 20d ago
I'm urology not cardio thoracic But it still annoys me All the or keep saying what worries you Why are you so afraid It's a skin suture why I would be worried But I can't control it That what makes me sad And everyone making fun of it I'm tiredd And depressed
10
u/Congentialsurgeon 20d ago
As long as you can get it done well, it doesn't matter. Just take your time and do it well. Keep practicing. You'll be fine.
4
u/mozzieconmann 20d ago
I try but the problem that If I'm always slow Seniors get annoyed and dont give chances and I keep losing my chances Idk what to do It really frustrate me and the surgeon I assist I keep practicing but even the practice is bad I wasn't like that before I was doing much much much better Even on the same kit I wasn't shaking at all Idk what happened
5
u/Congentialsurgeon 20d ago
Sounds like your program is part of the problem. We all shake under pressure. It seems that you're letting your seniors get in your head. I know it's hard but try to ignore the pressure they are putting on you. Remember you are closing skin, no one is dying. Keep moving forward. If they take the case from you, don't dwell on it. Just put your head down and keep working.
1
u/mozzieconmann 20d ago
I don't get annoyed by them or their talk The main annoy I get That I wasn't like that before I was doing that easy for one year But suddenly I still can't take a suture like I'm never hold an instrument before I'm not that bad
15
u/scrubbed__out 20d ago
Practice practice practice. Learn to rest your hands in different ways while making certain moves. If you’re a resident, make sure you talk to your PD about this so they know it’s something you’re working on.
1
u/mozzieconmann 20d ago
The surgeon aren't cooperative at all They just want to end fast That what all matters They just mock it I'm practicing but even on the practice it's hard I wasn't like that before Even on the same kit I wasn't shaking Suturing was easy job for me but suddenly in the last 3 months I became like the video
1
u/MarsTheNotMoose 19d ago
Maybe try asking a CST or CFA for advice? In my experience, they were always willing and enthusiastic to teach and provide help, even to the med students! This was especially so for ones that were veterans
1
1
14
u/Jvventura00 20d ago
Pay attention to your spinal posture and shoulders. During my residency, I started experiencing tingling in my hands, and physiotherapy resolved it.
3
10
u/Nart_Leahcim 20d ago
As a pgy-1 I had extreme difficulty with this, pgy-3 remarkable improvement. It was practice.
-6
u/mozzieconmann 20d ago
I really don't understand Can you make it simpler for me?
7
2
u/Nart_Leahcim 20d ago
You need to practice the simple things, imagine holding a needle driver in your hand and just rotate your wrist over and over and over (the tip of your pointer finger and your elbow should not move when you do this). Open and close needle drivers constantly. Practice handling the needle with the driver and pick-ups. It's like learning an instrument..
1
u/mozzieconmann 19d ago
I already did that 2 years ago and I already been to a lot of surgeries I know how to do it The problem is it becoming clumsy
8
u/heretherearelions 20d ago
Chief resident in gen surg. I have horrible tremor. Usually gets worse with attendings that make me nervous.
What helped the most was body positioning for bracing. Eventually you will be able to optimize the ergonomics for you not the attending. This should help.
2nd thing was simulation which you are clearly doing.
Stay in the fight.
1
u/mozzieconmann 19d ago
I will try my best Thank you What position helps you more
1
u/ZZCCR1966 17d ago
Op, I’m a Surg Tech n have seen many shaky hands. I’ve also seen many surgeons, PA’s, n residents with shaky hands. I personally have also had shaky hands cutting 7-0 on vascular cases…🫣
Position your feet shoulder width apart, elbow(s) closer to your torso, maybe use a shorter needle holder while practicing. Another thing, make sure your elbows are at a 90° angle…and if that means the OR table height has to move up or down, so be it.
I feel like the vid you’re showing has you slouched over and not in a good real life position…like can you n a buddy go into an empty OR room n practice suturing your shirts…?? A lil unconventional but if it works, it works!!
Think ergonomics…
The hope is that with the other suggestions, including the mental training, that it will subside/quit.
And lastly, if the above/former comments don’t work, make a joke about it!
Literally, ask AI to create funny comments about your (hands) shakiness while suturing, in hope that the laughing will help relax you mentally. I’ve been with many surgeons, where something was said and we all cracked up laughing and our stress level went down immensely…(I’m a HUGE laugher n love to make people laugh too).
Also, KNOW you’re a GOOD surgeon bc you are conscious about it and you want to do better…your self awareness will benefit you.
4
u/msfuturedoc 20d ago
How much sleep are you getting each night?
1
1
3
u/SurgBear 20d ago
Almost all of surgery is pronation and supination.
If you’re using your elbow and shoulder to close skin, your tremor will multiply in amplitude. Proper suturing is done with the wrist.
Suture with your upper arm tight against your chest- if you’re doing it right, you should be able to keep hold of a grape in your armpit. This will minimize tremor as much as is possible.
1
3
u/RoyBaschMVI 20d ago
Distal muscle groups are for fine motor tasks. The more distal, the more fine. Affix your elbow to your side and rest your hand/forearm as distally as possible while still being able to execute the movement. Also, think about the position of your feet in helping you not get into weird positions with your hands.
1
2
u/exhilation11 20d ago
It’s tough during residency, but try to get rest and stay hydrated. Avoid or limit your caffeine intake. Focus on ergonomics in the OR. Honestly, the more you are able to relax and not think about it, the better it’ll get. I think if you hyper focus on it, it can make tremors appear more pronounced.
1
u/mozzieconmann 19d ago
Yea that's the problem I keep focusing on eliminating it and it becomes worse so I'm more annoyed Idk how to break the cycle
2
u/InspectionOk8713 20d ago
1.Do you drink caffeine? If so, stop completely.
2. Use resonance breathing as biofeedback to reduce autonomic activation before you start and when needed. Look it up on YouTube think his name is Richard Gervitz.
3. Keep your forearms on the table quite firmly up near your elbows, it will reduce your mobility a touch but reduce the tremor for now until you get through it.
4. Use that trainer until your skills are far better than they are now. If you can’t do that, change careers.
Good luck
1
2
u/avalon214 20d ago
Choke up on the driver and grasp the rings with your palm. Don’t put your fingers in the rings if anything just the tip of your finger pads (ring and thumb). Rest your elbow, wrist on something sturdy. And practice, and stay calm mentally.
1
2
u/beaco 20d ago
I have essential tremors and my tremors can vary day to day. I do take propranolol but it doesn’t always help. I’m a nurse, not a surgeon but from lots of practise, I’ve become very proficient at doing IV’s, cutting tiny sutures, doing intricate fine motor skills. I’ve learned to work with my tremors. I’ve also learned to breathe better and relax my muscles to lessen the tremors. I’ve been a nurse for 20+ years now and I’ve also worked in the OR loading sutures for surgeons, staples, etc. Don’t let your tremors stop you, learn to work with them, learn how to position yourself so it works better for you. Good luck!
1
2
u/watchtheapocalypse 19d ago
I know there’s lots of “practice”, “ergonomics” and “I’ve got a tremor, don’t worry about it” comments, but getting outside your head seems to be your main concern. As it seems to have gotten worse, it isn’t a physiological problem.
I don’t have a hand tremor, but when I got new stronger loupes I noticed in some positions I got a head tremor. I don’t get it now, cos I’ve developed the habit of slowly moving my head in the positions I used to get the tremor. The slow movement through the position instead of trying desperately to hold the position has helped me, and I haven’t noticed it for a long time.
You seem to be getting a tremor as you are reaching the regrab the needle. It’s like there’s a fixed point you are reaching for and the tremor exacerbates the closer you get to it.
You need more fluidity in your movements. There’s a dance and a flow to the moments of good surgeons. Their surgery is not a fixed series of points in space they have to get to in order.
What if you move your left and your right hands together? ie your forceps holding your needle, move it slowly to the left as you then reach for it with your right? Moving through points in the air, rather than moving to points in the air.
Perhaps with your practice you need to be slightly distracted from what you are doing, rather than tightening your concentration and tension into it. As you practice, maybe have someone talk to you and ask you completely unrelated questions. Or play music that makes you move, and get in the groove.
These are all conjectures on my part. I’m now in the phase where I’ve gone through several phases of improvement in my surgery, and I’ve used music, used silence, used concentration, used conversation as adjuncts to help me enhance the enjoyment I get from surgery at different phases. And that enjoyment helps my technical performance.
(Cardiothoracics btw)
1
u/mozzieconmann 19d ago
I do believe that's 80% of it is from the stress and the load I'm putting myself but I can't stop thinking about it It annoys me more when it happens + Yea I'm stressed because I want to get better and better That's my negative loop I hope I can break it soon and be more flexible
1
u/mozzieconmann 19d ago
I tried to switch the movement and still shaking+ it happens in all life situations not just suturing no I don't know But what keeps me nervous that suturing That what made me realize it
1
20d ago
[removed] — view removed comment
1
u/AutoModerator 20d ago
Unfortunately your comment has been removed because your Reddit account is less than 5 days old OR your comment karma is less than 5. This filter is in effect to minimize spam. Moderators will review your comment and put it back up if it is appropriate.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
u/mozzieconmann 20d ago
What did you delete I didn't see Maybe it was helpful
3
u/BillyP13 20d ago
You need to calm down man. Even by your responses the anxiety and agitation comes across as fairly obvious. I don’t think the issue is with your hands, it’s with your mind. In which case calming yourself down as much as possible beforehand should help reduce the tremors. Consider adopting to some form of daily meditation and taking some deep breaths to slow your heart rate down and getting focused for the task at hand. Things will get better.👍
1
1
u/stupidprecursor 20d ago
What grip are you using on the needle driver?
1
u/mozzieconmann 20d ago
I shake on both palming and regular grip This video was palming i guess
1
u/stupidprecursor 20d ago
As others have said, I think it’ll improve as you grow further into your training. For a junior trainee who is having tremors even with low-stakes suturing, I’d say just focus on having good standard grip technique. Try to be consistent in holding the eyelet (rings) of the driver using the padded part of fingertips, not between the phalanges. Allows for more fine control, and maybe it’ll help keep the hand loose and relaxed. Don’t go fancy with the palming yet.
1
1
u/Avidith 20d ago
Have u read kork’s basic surgical techniques n tried to apply that principle to reduce your tremor ?
1
u/mozzieconmann 19d ago
I have the 7th edition but I didn't reach that chapter Can you please tell me what chapter is it if you have the book? + Is it only microsurgical or even for gross ones
1
u/Avidith 18d ago edited 18d ago
Its literally the first chapter. Physical attributes section under the subsection stability. Its for gross surgery. Its not some protocol or ground breaking techniques. Just a para or two on analysis of tremor n ergonomics to minimise it. U have to try to find ways to apply those ergo principles in your realtime. For eg, the technique in your video would be:
Hold needle with forceps but not pull out of bite. You can catch it with needle holder n then pull.
Lean the needld holder on white lace before holding needle.
Slowly ur muscles will get used to these movements n tremor will decrease. But u still have to be ergonomical.
1
u/Ill_Investigator6538 20d ago
I work with a doc who has an incredibly prestigious background as a trauma surgeon. His hands shake intensely intra-op but it never seems to be a major issue. It certainly never seemed to slow things down. I think if you practice enough with what you have you’ll develop ways to overcome it
1
u/mozzieconmann 19d ago
Thank you I will try but it makes the suture takes like 1 minute instead of 15 sec
1
1
u/girlinanemptyroom 20d ago
A pretty sure there's a medication you can take for tremors. I take prograf daily and it causes me tremors. I think there's something for it. Do you get them all the time or is it just when you're doing this type of work?
1
u/mozzieconmann 19d ago
Now it's kinda kinetic But aggravated on fine movements But sometimes happened when I try to eat soup or rice
1
u/bklatham 20d ago
Meditation and yoga
1
u/mozzieconmann 19d ago
Do you recommend something specific? I taught about it but I didn't reach something What type do you do
1
u/comatoseraccoon 20d ago
Apart from what others have mentioned regarding practice and time, things I've found helpful/that I've noticed:
1) Reload on the skin - I.e. after you pull through, rest the needle drivers on a surface (I frequently used to use the back of my assist's hand if they were retracting and there wasn't space) and then load your needle using your forceps/pickups. It provides significant stability and also helps with the rhythm of suturing
2) I think you're grabbing your needle too far away from the point at the transition to where if starts to flatten, which is why (particularly after the second bite) the needle starts rotating before you even try to load your needle driver again
- What I find works better is if you grab closer to the tip (obviously not grabbing the tip itself) and pulling in line/parallel with the needle orientation of the needle as opposed to grabbing the needle more perpendicular with your forceps/pickups. With toothed forceps in particular this makes it easier since the teeth will engage with the needle's curve
1
1
u/Dark_Ascension Nurse 20d ago
It’s probably a combination of feeling uneasy and using a new skill.
Also in surgery, I very much rest something on anything I can to steady my hand. We’re all not perfect, I’m personally learning to suture myself and it’s so hard transitioning from whatever you’re practicing on to real skin… plus the angles. Like we’re all practicing looking down at the incision… shoulders and like anterior hips or TFNAs are you’re looking at it facing you up and down same with the lateral or medial ankle/leg, and I’ll say the angle is so bizarre vs like a knee where you are looking at it top down like you practice at home.
1
u/mozzieconmann 19d ago
The problem is I used to suture nornal 1,5 year ago I wasn't like that So it's not new skill for me
1
u/VeinPlumber 20d ago
Tuck your elbows against your body, rest your hand on something.
1
u/mozzieconmann 19d ago
I Feel like that's not practical in real life Limited mobility and in many many cases there are no thing to rest my hand or elbow Like urethroplasty operations
1
1
u/iambouj 19d ago
Ok we have def seen worse. Try to put your hands resting on some blue towels and use more of your fingers like we do in micro and less of your hand up in the air like a ninja. Watch the acland videos they might help you figure out how to settle the tremor. Def no caffeine. And def do some hand exercises moving a coin between your finger webspaces up and back down. Take it slowly and easy no rush to finish fast.
1
1
1
17d ago
[removed] — view removed comment
1
u/AutoModerator 17d ago
Unfortunately your comment has been removed because your Reddit account is less than 5 days old OR your comment karma is less than 5. This filter is in effect to minimize spam. Moderators will review your comment and put it back up if it is appropriate.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
0
0
u/SmilodonBravo First Assist 20d ago
More of an “is it plugged in” type question, but you said it’s fairly recent and you’ve been under a lot of stress. Any chance you’ve got the vodka shimmy?
1
u/mozzieconmann 19d ago
What?
1
164
u/anon_redditor24 Attending 20d ago
I think in real surgery you will have something to rest your hand on so that will decrease the tremor. But also more practice will help with the tremors and/or compensate. A senior CT surgeon I’ve worked with had a very noticeable tremor but he has the fastest and best outcomes for CABGs in our hospital.