Episode Transcript
[00:00:00] Foreign welcome back to the Stimulating Stuff Podcast. I'm your host, Rich Vogel, and I am back to podcasting today after nine long months. And it's all thanks to you, the listeners. So here's my story.
[00:00:25] Last year around this time, I was on a job search, and you know that if you listen to the pod and I was sharing my journey about the challenges of navigating the job market, and I started branching out, covering topics like psychology and leadership and public speaking.
[00:00:40] And then, you know, I just got really busy.
[00:00:43] So in the spring and summer of last year, I was looking for a job and.
[00:00:48] And that's a full time job. You spend a lot of time just applying to jobs, reading job descriptions, making resumes and cover letters to match the job that you're applying for.
[00:01:02] And you do that five or ten times a day, every single day, five to seven days a week. It takes a lot of time. And in between, I was trying to make money from consulting, so I took on two expert witness cases. I was building a course for asset that took me a better part of the year. I was as ASNM President.
[00:01:24] And in the context of all of that, I started to feel this sort of disillusionment with the field of neuromonitoring, which happens sometimes, particularly when you start looking for jobs outside of neurodiagnostics, because you start to feel, you know, undervalued and typecast as someone, at least in the neuromonitoring field. I felt undervalued and typecast as someone whose, you know, only value add is education, which I do love and I'm good at, but is not where I want to spend my career or whose value add is research, which I don't really love, I'm just okay at and have no desire to do as a sole job function. And really, it's definitely not valued by most neurodiagnostic organizations. It's so easy to become disillusioned, but that's a topic for a different day. So, anyway, still telling the story about how I got back to podcasting. So then I go to the ASNM annual meeting in Denver and I start hearing feedback on the podcast and people are coming up to me and they're telling me that they're still listening and people are raving about it and they're saying, you don't know how many listeners you have or how much people are talking about it, and regular listeners miss it. So I get back from the ASM annual meeting, right? And I log into the back end of my podcast to see what listenership looks like. And it's in the thousands worldwide. I mean, it's been growing despite the lack of tlc.
[00:02:59] I think that says something about this show's endurance. Maybe the message is enduring, I don't know. Or maybe the show's like a weed that actually requires work to kill.
[00:03:09] So here I am, back to work. Either way, it's all thanks to you.
[00:03:15] So thank you for encouraging me to come back to podcasting.
[00:03:19] So listen, do us both a favor and tell people about the pot. Tell them I'm back. Word of mouth is great, but go directly to your favorite listening platform and like and share. And also do the same on socials.
[00:03:32] Anyway, today I wanted to share my experiences from the ASNM manual meeting, which took place May 16th through 18th in Denver, Colorado. So for me, I'm recording this about a week and a half later, and I really just thought that I would share some of the experiences that I had, because I know that there are some of you who, well, obviously were there, but there are people who weren't for one reason or another. Maybe you couldn't make it this year and you want to hear about it, or maybe you stopped going because you got inured with the experience there. You know, I will tell you that the ASNM and the ASNM meetings have changed significantly over time.
[00:04:14] And some of the criticisms that have been levied on the ASNM over the years may have been justified back then, but aren't anymore. I'll give you some examples. So people have said, well, the ASNM, it's an old boys network with a stronghold on the board.
[00:04:29] Yes, there used to be an old boys network, and we've pretty much disbanded that. And there are people who try to involve themselves and take control over members of the board or influence them in some ways, but that's really not successful anymore. And those folks are basically retired at this point. So what's the difference?
[00:04:54] People say it's mostly attended by PhDs.
[00:04:57] False.
[00:04:59] Less than 5% of our membership have doctoral degrees, and the other 95% are really CNIMs or people who are working toward a CNIM.
[00:05:11] Also, another common complaint is that some people often say that it's the same people speaking on the same topics.
[00:05:20] And I will say that that's not true either. It has been up until a few years ago. But we've taken really significant steps to make sure that we have fresh names, fresh voices, fresh perspectives, really, from all over the world.
[00:05:35] So all that stuff has changed, and maybe that's why we broke our meeting attendance record for the third year in a row this year.
[00:05:44] So we have about 1300 members in the ASNM and we had about 350 attendees at this year's meeting from all over the US and from around the world.
[00:05:54] And by the way, while I'm talking about the number of attendees there, one thing that I wanted to mention is that if you were there and we didn't get to talk, meaning you and I, or we only talked for a few minutes in some brief conversation, I do want to apologize. I can say that it's not easy being president and certainly it adds stress and work being one of the meeting planners.
[00:06:18] For example, at this meeting I clocked four consecutive 19 hour work days and I don't want to sound like a pompous person, but when you are president, everybody wants some of your time and it's like two minutes here, three minutes there, five minutes there. Sometimes I have longer meetings and it all adds up. On top of all of that, believe it or not, I'm an introvert and so I really get my energy from smaller crowds and I get drained by larger crowds. So sometimes in that environment, even if I do have a few minutes, it's really not the thing that I most want to be doing in that minute.
[00:07:03] So let's talk about the meeting. The theme for this year's meeting was Innovations in Neurophysiological Monitoring, Shaping the future.
[00:07:12] This was a theme that could seem aspirational for a society that has been criticized, at least historically, for having a lot of repetitions in the speakers and topics. But we really did cover a variety of topics that are cutting edge and future leaning. So I thought I'd go through some of the program and share some perspectives.
[00:07:36] So the meeting is always Friday through Sunday, and we open Friday with sessions on perioperative planning where we discuss the realities of managing risk, adapting modalities for comorbidities, and aligning with or operations. So we had talks from Garrett Risley, Jeff Gertsch, Partha Thirumala and Joe Moreira and they all brought meaningful practice driven insights into this session. I will say that, you know, I don't like to pick favorites, but there was a really interesting topic that I thought. I won't say it's my favorite, but it was an interesting topic by Garrett Risley, who is a manager of perioperative services at one of the hospitals in Colorado. And he shared how different hospitals think about return on investments or ROI and their efficiencies and how much it costs to run an operating room per minute, which ranges from anywhere from $50 per minute to over $500 per minute. So you can imagine that, you know, if you're in one of those more expensive ORs and you show up 10 minutes late, well, you could have just cost the hospital $5,000.
[00:08:47] So those are the kinds of things that he talked about, and I thought that was really interesting. After that session, we looked into the future.
[00:08:55] There was a session on emerging directions in neural monitoring, and Greg Niznick explored how artificial intelligence could reshape the way we interpret data and respond to interoperative changes in the future.
[00:09:11] And Jess Barley discussed challenges in the future of neuromonitoring and shared ideas about what it would really take to move our profession forward, particularly when it comes to engaging and teaching the next generation of surgeons.
[00:09:24] And after those two talks, our panel, which included Rami Fotah and Ryan Rosenhan, they gave voice, I think, to some of the toughest questions that we need to be asking ourselves, really, with many of the questions focused on the role of AI.
[00:09:41] And their session in general sparked, I think, some of the most engaging discussions that we had in years.
[00:09:48] Unfortunately, I was not able to participate in the session on AI or even in the Q and A because I have a conflict of interest being CEO of Nervio, but I still was able to ask a question and at least engage from a business perspective. You know, that's the thing that kind of stinks about CME in general, is that sometimes the people who are the most knowledgeable are excluded from the conversation simply because they have conflict of interest. And I certainly get it, you know, you want to keep CME as neutral as possible.
[00:10:26] But also it is really unfortunate because I do have, you know, a lot of perspectives on AI and how it's going to impact neural monitoring and what the direction is. And particularly because Nervio is the only company out there that is developing AI for neuromonitoring and has been at it for. For. For years now. And anybody who's really working on this is either doing it for research or. Or years and years and years and thousands of cases behind us. So, you know, I do have some relevant perspectives, but there's a time and place for that, and it's certainly not in CME, and I get it.
[00:11:06] Anyway, that was a great, engaging discussion. After that, there was a lecture by Sean Callagy from Callagy Law on Navigating no Surprises act, which they call a strategic guide from neuromonitoring companies.
[00:11:19] And I thought that was really insightful as well.
[00:11:22] Later on Friday we turned to Pediatric Neuromonitoring and there were talks on modality and procedural differences between pediatrics and adults, and some interesting case presentations. The sessions included excellent talks by Chiara Ebinger, Vizmary Montez Pena and Mitali Bose, and the last session on Friday covered standards in communication and documentation, something that is sorely missing in neuromonitoring, probably the root cause of most medical malpractice cases, and something that's near and dear to my heart because I mentioned a few minutes ago that I spent the better part of the last year developing a course for Asset. That course is all about communication, documentation and medical legal considerations, so I think in the next few months that'll be available on Asset's website and I would encourage you to check that out Anyway, this session included talks by Callum Broderick Alan Ettinger, who finished his talk with a rap to the beat of the 1979 song "Rapper's Delight" by The Sugar Hill Gang. What?
[00:12:34] That was awesome, by the way, and Craig Carroll, who gave a great talk despite having to follow Dr. Ettinger's show stopping performance.
[00:12:45] On Saturday, we kicked things off with somewhat of a modality debate focused on carotid endarterectomy surgeries. So Cenira Diogo addressed the question, what do SSEPs add to carotid surgery? Just Justin Silverstein challenged the audience to consider the benefits and limitations of transcranial motors in CEA surgery. Greg Shaublin covered the lesser used modality of cranial nerve EMG, and Marilla Simon discussed how we can use EEG to its fullest potential in CEA surgery.
[00:13:18] Then after that came a series of guest lectures by local surgeons sharing their experiences and perspectives on interesting topics like like dorsal rhizotomy, robotics in spine surgery, and spinal tumor resections. So many thanks to Corbett Wilkinson, Mark Erickson and Todd Hankinson, respectively, for giving those talks. And of course I'd be remiss, not to mention the highlight of the meeting for me anyway, was Dr. Stephen Falowski's presidential lecture and as I said in one of my social posts, his talk, which was titled Neuromonitoring and Spinal Cord Stimulation Embracing the Present and Innovating the Future was nothing short of inspiring.
[00:14:03] Dr. Falowski shared his personal journey into the world of neuromonitoring and spinal cord stimulation surgery, highlighting the groundbreaking discoveries he's made along the way. His work has not only enhanced the efficacy of spinal cord stimulation, but has also been instrumental in cementing neuromonitoring as the gold standard for placement of spinal cord stimulator electrodes, really allowing these procedures to be performed under general anesthesia. It wasn't that long ago, maybe five or so years in which the gold standard for these procedures was to wake the patient up and not use neuromonitoring. And now it's completely flipped upside down, or I should say right side up, with neuromonitoring now being the gold standard for placement of these electrodes. It was a really good talk. And a lot of that, you know, changing what is the gold standard is a result of Dr. Falowski's work. So the insights that he shared on the neurophysiology of spinal cord and DRG stimulator implants, including stimulation patterns that optimize chronic pain treatment, were truly transformative. Dr. Falowski's dedication to advancing the field is really making a profound impact, and I'm deeply grateful for his contribution to this year's meeting. His passion for discovery and his belief in our profession, I think, was infectious.
[00:15:31] After the Presidential lecture, we had our business luncheon, which is what we call it, probably a vestige from years ago when we actually formally conducted business during the luncheon.
[00:15:44] But this is really what we use as an opportunity to recognize people, to celebrate the achievements of our peers.
[00:15:54] And so I wanted to take a minute to share some of the awards that we gave out and the people who won them in really no particular order. So I'll break it down into categories. So the first category is scientific and research, research excellence.
[00:16:11] So we gave out two awards for the top abstracts.
[00:16:17] First place went to Elton Ho, and second place went to Prabhu Raj.
[00:16:22] And then we had an Outstanding Publication award, which went to Justin Silverstein.
[00:16:28] Next, in the leadership front, we awarded fellowship to Michelle Mora, who is currently the president of ASNM. She was the incoming president when I was president. So we had a passing of the gavel there at this meeting.
[00:16:47] And we also awarded emeritus status to Ron Leppanen. The prestigious ASNM Founders Award, which I won in the past, went to Faisal Jahangiri. The very, very prestigious, the highest award that the ASNM gives out, which is the Richard Brown Award, really, a lifetime Achievement award went to Lawrence Wierzbowski. The ASM Service Award went to Katherine Jaquez. And the Outstanding Committee Member Award went to Danielle Stewart for her work in digital engagement.
[00:17:22] And the Rising Star Award went to Victoria Cellis.
[00:17:28] And then we had some sort of educational or career development awards.
[00:17:32] So the Mary Stecker Award went to Alexandra Galanti and Madeline Thornton, and the inaugural Friends of Todor Scholarship went to Jordan Toothacher. I'm sorry if I pronounce that name wrong. T O O T H A K E R.
[00:17:53] And many thanks to the folks who actually founded this scholarship, Carol Campbell, Claire Gale, David Hacker, James Watt, and Lawrence Wierzbowski.
[00:18:05] So all of these individuals that won these awards, they exemplify what makes ASNM great, right? It's the passion, the dedication, and a vision for this future of neuromonitoring.
[00:18:18] Speaking of which, at the end of the luncheon, I as I said a few minutes ago, I formally ended my presidency by passing the ceremonial gavel to Dr. Michelle Mora, who gave a beautiful and moving speech about finding inspiration during tough times.
[00:18:36] I think she had the entire room in tears, myself included, after the luncheon. So Saturday afternoon, that brought us into epilepsy and functional neurosurgery. So we had outstanding talks by Leslie, Kate, Daniel Kramer, and John Thompson on everything from DBS to local field potentials. And we also explored supratentorial challenges in brain mapping.
[00:19:00] So Catherine Seidel, a surgeon from Switzerland, gave a talk on corticocortical evoked potentials. Nina Sitt, a surgeon from Germany, gave a talk on brain mapping, and Keva Asadi from Miami gave a talk on mapping challenges in pediatrics.
[00:19:17] And that really closed out Saturday. And then Sunday we turned our focus to practical insights. So Martha Sellers gave a talk about noise reduction, James Watt showed us how to better use templates and software, and David Zimmerman and Tetsuya Oishi introduced an augmented reality simulation that was super interesting and I think really could transform, inform how we train future neurodiagnostic professionals. And then we closed out Sunday with a discussion on peripheral nerve recordings with Ernesto Lima, Kent Rice, Brooke Callahan, and Misha Frankel, offering their perspectives on topics that can sometimes be controversial.
[00:20:01] And along the way, we had a bunch of time dedicated to platform presentations where some of the top abstracts that were submitted were given podium time to share the results of their research.
[00:20:12] So it not only highlighted the quality of the work, but it also served as a springboard for deeper discussions in the dedicated poster hall during what we called this year the Sip n See... sip wine and see research.
[00:20:27] So I just want to use this as an opportunity to thank everyone who submitted abstracts and who participated in in the poster session, just by being there, by viewing the posters, by asking questions. And also thanks to everyone who visited my poster to learn more about how AI is advancing in neuromonitoring so as I step back from this ASNM Annual meeting, what stood out most to me over the course of the meeting was the energy, the spirit, the excitement, the engagement.
[00:21:01] People weren't just there to share knowledge or check their CEU box for the year. They were building bridges. They were asking hard questions. They were there to learn. They're exploring what's next, what's new together.
[00:21:14] This meeting, I think, affirmed once again what I've long believed, which is that neuromonitoring is not and does not need to be peripheral to surgery.
[00:21:28] It's central to surgery, central to outcomes. And our community. The technologists, physicians, non physician doctors, educators, researchers, everyone has a role in leading that charge.
[00:21:44] So I'd like to say thank you to every speaker, moderator, sponsor, exhibitor, attendee, and every one of you who traveled, presented, asked hard questions and made this meeting extraordinary. Thank you to our incredible planning team and the staff at Affinity Strategies.
[00:22:05] Kayla, Ari, Rosaleen, Skyler, I love you all. You're the best. You made the last year of my life so much easier by supporting me as ASM President.
[00:22:18] And last but not least, not least, thanks to all the ASNM members who continued to advance this profession with skill, passion, heart and sometimes necessarily grit.
[00:22:30] Okay, that's it for today. Thank you so much for listening. By the way, I received some great questions and comments via email, so I'll definitely be tackling them in the weeks ahead. In the meantime, please continue sending your comments, insights and thought provoking questions to to stimulating stuff podcastmail.com you know I always love hearing from you. I'm Rich Vogel and that was stimulating stuff.
