Neurodiagnostics is not just a job, it is a career!

How can you go wrong with a profession like this one?  I have been enthralled with this field since 1978 when I began a one-year EEG Technology program.  Back in those days, they did not call it “Neurodiagnostics” since the only modality there was in the clinical setting was EEG. There was always nerve conduction studies, but that was an on-the-job trained extra.   But look how the field has grown!  Skills we are likely to include:  EPs, LTM, IONM, ICU monitoring, Autonomic Testing, Transcranial Doppler and there are a great variety of job settings to choose from as well. 

I know many techs who connect with instrument companies, as I did back in the 90’s to provide new user training and installation services, which I did on occasion, by contract, in addition to my regular job. I have fond memories of all the great Nicolet folks from back then, and lots of great customers too!  Many techs went from consulting to full time employees of instrument companies, working in tech support, research and design, or sales.

We can also be found in research jobs, doing studies and compiling data for grant-based research that involves neurophysiology testing. 

Some of our business-minded techs have started their own companies to provide IONM services or EEG services, working by contract in a variety of labs and hospitals.  I have always admired the courage and stamina it takes to show up in a totally unfamiliar setting, in an O.R. with a surgical team that you’ve never met, to start a long IONM case after a long early morning drive to get to the site.

Some of our most gifted techs are inspired to share their love of the field by teaching full time as training program directors, instructors and clinical preceptors.

Some techs are able to specialize in one area of neurodiagnostics:  Some just love full time intra-operative neuro-monitoring.  Some love ambulatory EEG!  As I have mentioned previously, I love neonatal and pediatric EEG!

One of the areas I found most interesting was Long Term Monitoring for Epilepsy.  It was fascinating to observe the progress from a first admission through the pre-epilepsy surgery work-up, to the Phase II recording with grids and strips, to a successful surgical resection of epileptogenic brain tissue.  There were parts of the work-up which serve as the most amazing neuro-anatomy and physiology lesson ever!  I am referring to cortical stimulation and cortical mapping, and the correlation of seizure symptoms with a focal area of the brain.

So, if you are in this field already, my advice is “Go for it!”  Learn as much as you can, pass as many board exams as you can, and never stop learning!  If your enthusiasm is flagging in one area of neurodiagnostics, try something new!   If you are not a neurodiagnostic technologist, but want to be in an allied health field that is growing and will need more techs in the future, look into it!
We have a list of formal training programs on our website at this link: Neurodiagnostic School listings

You will find schools in some states, and on-line programs to help cover the need for states where there are no colleges that offer a neurodiagnostic curriculum.  Some programs are two-years long and offer an Associate's Degree, others are one-year and offer a certificate, and we are starting to see Bachelor Degree programs, in neurodiagnostics and in IONM.  

Here is a great career video that explains how interesting our work can be!:
https://www.youtube.com/watch?v=kZidT6PDP4o

The “Old-fashioned” way of doing things

Do you remember when a desk top, meant the top of your desk?  This is what my desktop looked like for a full week while my computer was out for repairs.  

I can recall when I actually worked at a desk that looked like this!  I had pads of paper, pens, pencils, a phone, a typewriter and a dictation machine in my office!  But I must say it was really hard to go back to this way of working!  I did have my tablet last week, so that I could keep up with e-mails, but it was a real challenge to work with documents on this device.  The first step was to sign onto my “Cloud back-up account” and retrieve the document I needed, then make changes and store it on a flash drive so that I could update my files when my “real” computer returned from it’s sabbatical.

This experience brought to mind all of the other work changes we have experienced, at least if you are as close as I am to being a senior citizen!  Oh, the joys of analog EEG systems!   Younger techs have likely heard the stories before, of how big and heavy those old machines were!  Can you imagine having to push buttons labeled “Fp1”, “Fp2”, “F7”, “F8” and so forth to connect electrodes in a montage several times during each recording as we changed montages?  There was a trick to punching those buttons as quietly as you could to prevent that "Pop" when the button went in, so that the noise did not wake up your patient.  Now you can get away without changing a montage at all during the live recording, thanks to the wonders of reformatting on digital equipment!  But back then, we had only one chance to choose the right montage to display abnormalities.  It was also crucial because if you had only 8 or 10 channels, you had to skip some electrodes in each montage.

And the other feature that everyone who ever worked with analog EEG will remember the most, is the ink and the pens!  We went home at night with nails and knuckles stained black, and we all had our favorite methods for removing ink from our white lab coats!

The other component was the paper!  A box with 1000 pages with seams at every 10 second segment.  You can bet that the only burst of spike and wave would occur just at that seam, when the pens lifted from the paper as the seam came up, and failed to draw the complete spike/wave complex!

It was all really great, but we are all firmly entrenched in our digital world and the benefits are tremendous!  The ability to include video on all recordings is wonderful!  Not having to find a way to store millions of pages of EEG on paper in some dark basement of a hospital is also wonderful!  And back then, we did not have cell phones to use, if we got stuck in that dreadful dungeon’s old elevator that resembled a movie prop from an Alfred Hitchcock film.   

With all the channels available in today’s digital EEG world, you can include every electrode, plus extra leads such as T1 & T2, plus all the monitors for EKG, eye movements, and respirations.  It is definitely a better world for neurophysiology, but I enjoyed the old days too!

Happy 2016 and we can look forward to more innovations!

Merry Neurodiagnostic Christmas and are you due to recertify an ABRET credential at the end of 2015?

I have to start this post with a picture of our black lab, Cooper, checking out his Christmas stocking.  He is counting the days until Christmas, when Santa will fill it with lots of treats!

Well, here it is, the Winter Solstice, the beginning of a holiday week and the end of another year!  Since the ASET offices will be closed extra days for the holiday, including the Thursday, Christmas Eve and Thursday, New Year’s Eve, I thought it would be helpful to provide information about the ABRET credential recertification process in case some technologists have questions over the holidays.  For those whose credential is due for recertification in 2015, the deadline is Dec. 31!  There is a 30 day "grace period" after the December 31st deadline, but there will be a $100 late fee added to the recertification fee.  If you do not recertify by Jan. 31 you will be required to re-take the exam for your credential!

First and foremost:  It is ABRET that administers the recertification process, not ASET.  We occasionally hear from someone who is searching through our website for a “Recertification” tab.  You won't find it on the ASET website!  All recertification activity is conducted through ABRET, www.abret.org and their office number is 217-726-7980.  Please call ABRET if you have questions about the process.  If you need to know how many CEUs you already have, that is an ASET function.  If you are a member of ASET, your CEU transcript can be viewed from the “welcome” page, when you sign on at www.aset.org, with your user name and password.  If you are not a member of ASET, you can complete a form to request a copy of your ASET CEU transcript from our website at this link:  ASET CEU transcript request form  There is a $25 fee for this service.

There is a credential manager program on the ABRET website, where you can complete recertification process, including documentation of the continuing education hours you have completed.  There is also a recertification fee. 

Here are some helpful resources and links:

To find out how many CEUs you need to recertify, based on the credential earned and the year it was awarded:  How many CEUs do I need to recertify?

To find out what kind of education and topics are acceptable: Acceptable continuing education

The ABRET credential Manager Program:   ABRET credential manager

And to read about the credential manager program, ASET published a “tech tips” article on how to complete the accreditation process, please look up the "Tech Tips" article from the Dec. 2014 ASET Newsletter.

My office will be closed from Dec. 23 to Jan. 4th, so I hope this last bit of information for 2015 is helpful to you!
Happy Holidays to all and Best Wishes for the New Year!  Faye

Why is continuous EEG in the Neonatal Intensive Care Unit so unique?

I worked in clinical EEG from 1978 to 2004, when I became a member of the ASET staff.  For fourteen of those years, I worked at Children’s Hospital in Boston, and I have always loved working with pediatric patients the most!  And of all the pediatric patients, my very favorites are the newborns!  I find it so fascinating to observe the maturation of the brain! 

Back in the 1980’s I worked at Memorial Hospital in Worcester, MA, where there was a very busy neonatal intensive care unit that provided care for almost all of the critically ill infants from miles around.  I was working in a one-person lab so I recorded every EEG requested in that unit, which averaged about 15 neonatal EEGs per month.  I was always happy to spend hours in the NICU, observing the medical staff, new parents, and many tiny patients.  I often did serial EEGs on premature infants and I was able to observe the remarkable changes in EEG patterns as the brain develops.  You can actually estimate the conceptional age of an infant pretty accurately by using EEG, since new patterns appear about every two weeks in the pre-term infant.  For example: the Delta Brush pattern is very distinctive and generally peaks at 31-33 weeks conceptional age.  I took great pride in understanding neonatal EEG patterns and became very familiar with them, since I observed so many over the years.

While all EEGs are an important component of the diagnostic process, continuous EEG for the critically ill newborn is vital and of the utmost importance!  Neurological complications can occur rapidly and can be difficult to recognize without EEG monitoring.  Urgent intervention can have such a huge impact on the future of a child:  not surviving a crisis, or incurring significant anoxia and brain damage can be a real possibility.  Our youngest and most fragile patients benefit the most from a high quality EEG recording: including lead placement that does not break the skin, artifact-free recording, systematic review of data being recorded, and prompt notification of significant changes in EEG patterns.

I think that recording EEG in the neonate requires a high level of skill, great care and patience, a delicate touch and strong communication skills as we need to work closely with so many others in this setting to apply leads, set-up a recording and maintain a continuous recording when you can’t be present to monitor the record all of the time. 

So, I am inviting you to participate in the extended webinar that ASET is offering this week, on Nov. 11 & 12, on the topic of “Continuous EEG in the Neonatal Intensive Care Unit”.  If you cannot spend 3 hours each day listening to the live presentations and discussion, then perhaps consider purchasing the recorded version which will soon be available.  For the full schedule of webinar presentations, and to sign-up for the webinar, please use this link:Webinar info

If you are new to the field and work in an institution where you will be recording neonatal EEG, this webinar will be essential to helping you work in this special environment.  If you don’t work with neonates but are planning to take the ABRET EEG Registry exam or their CLTM exam, you will need to know all about neonatal EEG to cover questions on the exam that have to deal with all aspects of EEG in this age group:  both normal and abnormal patterns, clinical correlations and the ACNS guidelines for recording neonatal EEG.  There is also a fairly new ACNS guideline for terminology used to report on neonatal EEG.  So, you see, this really is a world of its own and one that is worth exploring!

The view from here: treating epilepsy in Maine is in the news

I’ll start this blog entry with a personal touch, revealing a little bit about where I live and then I will discuss an interesting debate going on in my home state.

I am very fortunate to live on a salt water river in Maine, and these photos were taken from my front yard at sunrise and sunset.  I live for my time on the water and had lots of wonderful boat rides this summer.   Soon to come to an end as the boat will be coming out of the water this week!
The river at dawn...

 And at sunset

  Since I work from a home office that overlooks this river, I have extra perks along with my wonderful job working for ASET!  How can you get stressed out with seals swimming by and eagles soaring overhead!  I am very thankful that I have this job and have enjoyed serving as Director of Education for ASET for eleven years now!  One of the things I like best is the vast variety of calls I receive every day.  Many calls are from the general public, seeking information about how to pursue a career in Neurodiagnostics.  Some of the most interesting calls come from technologists from all over the country each with a unique situation, seeking information or assistance.  Some examples:  where to find a policy and procedure document for carotid endarterectomies, justification for a salary increase, establishing a patient to technologist ratio for an epilepsy monitoring unit, and docs calling desperately seeking to hire qualified technologists!

Epilepsy has been in the news here lately.  Some children with epilepsy have a prescription for Diastat,  to be given emergently during a severe seizure.  Parents typically send a dose to school to be kept on hand, but the current state law allows only the school nurse to administer the medication and it must be kept locked up in the nurse’s office.  Practically, this can lead to significant delays in accessing and administering the drug quickly.  A group of parents are actively seeking to change the law to allow teachers to be trained and authorized to give the drug as well and keep in in the classroom.

Maine has also been in the news regarding the approval to distribute medical marijuana to patients while in the hospital.  Because it breaks federal law, hospitals cannot consider allowing medical marijuana to be given to in-patients without the risk of losing federal funds.  So parents are put in a difficult situation if they have determined that this treatment has been effective for a child who has epilepsy when the child is admitted for treatment.  News stories feature parents who admit to secretly bringing the drug in and giving to their child, and therefore committing a criminal act.  The two largest medical centers in Maine do dispense a synthetic marijuana, called marinol, to patients but there is a debate about its efficacy.  A bill allowing hospitals in the state to distribute medical marijuana did pass in the state legislature but was vetoed by the governor. 

I will be following the debate about these two controversial treatments for epilepsy.  At the ASET annual conference in Weston, FL this summer, Dr. Jason Sebesto, from the local Mayo Clinic, gave a great presentation:  “Cannabinoids and the Treatment of Epilepsy”.  Since technologists often discuss medications and treatments with their patients as they take a history, it is helpful to have an understanding of alternative treatments and the legal issues that patients encounter.