CT neck non-contrast "styloid protocol"?

General
1

One of our forum members was recently in contact with Dr. Samji’s assistant. In the past, Dr. Samji and his assistant both told me that he only wants to see the CT scan (with contrast was better) and that he didn’t want to see the scan reports. He wanted to do the evaluation himself based on the scan. But it looks like they changed that now.

Dr. Samji’s assistant said in an email: “ So the only way to diagnose (mostly) Eagles syndrome is a CT neck non-contrast "styloid protocol" which means they actually measure the right and left styloid bone. If you have those measurements I'm happy to show Dr. Samji. We don't need any other part of the scan, just the report that clearly states the actual measurements of the styloid bones.”

This is new. I’ve never heard of this before. Has anyone heard of this? Do we have any of Dr. Samji’s current patients that had this or talked to him about it?

2

Dr. Samji did both of my surgeries (one in Nov. 2014 & the other in Aug. 2015). When I went for my appointment, he already had copies of my CT scan so that's what we discussed. As far as I know, the report didn't have any styloid measurements on it. He may be asking for more specific CT results because there have been more people coming to him who are "borderline" & having more specific info helps him to save those borderline people an office visit & it saves him some time. I'm just speculating here. I'm actually seeing another doc in that office now for a hearing problem (not the result of ES) & can ask about this when I'm in there next Monday.

3

Thanks Isaiah. That would be great. I was confused about the non-contrast CT scan being used when all this time I've been telling people to get a CT scan with contrast. And I've never heard of the "styloid protocol" either, so I didn't know if that's what we should be telling people now. Since Dr. Samji is one of the most experienced Eagles doctors, I thought if he was changing something, then it would be good for us to know - as well as why it was changing.

But I also heard from another forum member who contacted their office recently and she was told the standard thing about getting a CT scan with contrast and sending in the disc.

So I'm wondering if anything is changing in what we need to tell people when they ask about what they should get to diagnose Eagles.

4

It's very frustrating; and weird, as knowing if there's vascular involvement I would've thought would be helpful for a surgeon! Knowing that the jugular veins were compressed was the clincher for me (and my doctor) to decide on surgery. But Dr Samji knows what he's doing....

It would be good if Isaiah can find out !!

5

I recently saw Dr. Samji (Feb), and they ordered a Ct scan w/o contrast. He said he just needed to find out the measurements. I didn't ask further but then had the same confusion and thought then what if there's jugular vein or artery compression (which may help make my surgery decision, and in terms of how soon to have that surgery). I have completely trust in him though so it's comforting when he told me there's no immediate danger, just how long I think I can endure the pain symptoms.

However, last night, while out dining, I had an episode of near fainting, dizziness, ill-feeling, followed by vomiting (gagging spasm, nothing really came out.. sorry TMI). My siblings were with me thinking I had food poisoning. But to me I started feeling sick and dizzy right after I was doing some neck stretches to try to alleviate some pain in the shoulder, neck, and head. This is scaring me so much, and today I still feel dizzy, like I don't have enough blood oxygen to my heart/head. I am hoping to find an acupuncturist tomorrow to help get rid of the dizziness (they have always helped me in regard to this) and get blood circulating. Then I need to call Dr. Samji's office and schedule that surgery!

6


sorry lots of typo and grammar errors tonight... still dizzy.


bella said:

I recently saw Dr. Samji (Feb), and they ordered a Ct scan w/o contrast. He said he just needed to find out the measurements. I didn't ask further but then had the same confusion and thought then what if there's jugular vein or artery compression (which may help make my surgery decision, and in terms of how soon to have that surgery). I have completely trust in him though so it's comforting when he told me there's no immediate danger, just how long I think I can endure the pain symptoms.

However, last night, while out dining, I had an episode of near fainting, dizziness, ill-feeling, followed by vomiting (gagging spasm, nothing really came out.. sorry TMI). My siblings were with me thinking I had food poisoning. But to me I started feeling sick and dizzy right after I was doing some neck stretches to try to alleviate some pain in the shoulder, neck, and head. This is scaring me so much, and today I still feel dizzy, like I don't have enough blood oxygen to my heart/head. I am hoping to find an acupuncturist tomorrow to help get rid of the dizziness (they have always helped me in regard to this) and get blood circulating. Then I need to call Dr. Samji's office and schedule that surgery!

7

That sounds scary, bella. It does make you want to get that surgery quickly! I hope that you can get help quickly.

8

Bella, that is scary. I think it sounds like a good idea to get the surgery fairly soon.

Thanks for the information about what information Dr. Samj needed. He's one of most experienced Eagles doctors and I think it's good to know what he's looking for. I believe that I get what he's saying. All he needs to know is if you have Eagles and then he will operate when you get bad enough to want it.

When I had vascular Eagles on my right side, I went to the Cleveland Clinic and the doctor there didn't believe in vascular Eagles, but luckily he did the surgery on me anyway. And it cured the vascular symptoms right away. He told me after he did the surgery that the styloid had been compressing my carotid artery and jugular vein, but he still didn't even want to hear about what symptoms were resolved, which really disappointed me. But as I thought about it later, I thought - well, as long as I was fixed, that's the important thing. So I think that's the bottom line - just get someone who can fix it.

9

Thank you both! It is very scary... I moved my surgery date to 4/18 (I wish I could do it now!). I felt much back to normal after acupuncturist did work on me to encourage blood circulation and relief neck blockage (his term). But last night I had another episode of near-fainting, shaking, and nausea... and haven't recovered fully :'( My sister and bro-in-law are driving me up to San Jose tomorrow... we want to get me to closer to Dr. Samji, should any emergency happen at least I'm already near him. I am fearful of the long drive.

I will keep everyone updated about my surgery. Thank you!

10

Hi, I believe I'm the one you mentioned who was told to get the CT scan with contrast.

It was what I was told. But now they have changed their story. I had to wait for the CT scan with contrast because my doctor had me get an MRI with contrast and you aren't supposed to have contrast test closer than 6 weeks apart. So it was done two weeks ago. The radiologist did the test both With and Without contrast. My doctor gave me a call last week and told me to wait before I sent in the discs. He saw something he wanted to look at first. Apparently I have a submandibular salivatory gland that is large (and painful). My ENT hasn't seen anything like it and he said it was probably best that I have Dr. Samji handle it since it's unusual and could be caused by the possible Eagle Syndrome that still needs to be officially diagnosed. I did everything the Dr. Samji's office asked. They also told me to talk with my insurance company and the insurance gave the go ahead for to see Dr. Samji. I called Dr. Samji's office and in the phone message I was forwarded to the assistant or nurse recommended an email. I wrote and I now have a different directive - copy paste below:

>So the only 100% needed item is a CT neck NON-contrast styloid protocol which specifically measures the length of the left and right styloid bone. This is the only way to guarantee a diagnosis of "eagles syndrome" in our office. Once that scan is received with the report that states the measurements of the styloids then we book a new patient visit to discuss options.
Hope this helps,>
So to be clear - I received two separate and completely different instructions. I am currently getting my response letter edited by a medical professional friend. I then might have someone else who doesn't like me too much edit it LOL My family and friends are very angry right now. They all know the pain I'm in. I'm a professional musician and had my "last gig" two weeks ago to a packed house.
Last week I called the Doctor office in Phoenix and the new nurse he had was..... I asked how many time the doctor had performed Eagle Syndrome surgeries and her response was "lots of them". I asked kindly if there was a way to send in a CT scan and she told me I had to come in as a new patient. I explained that I was in Washington State and that I'd like to make sure I'm not wasting either of our times and she told me "that's your decisiion". I asked If she meant by "lots of them" 5?, 10?, 50? and then she yelled at me and said "Like I told you before - Lots of them, I'll have to ask on Monday and I'll call you back". -She didn't call back.
So getting a calloused response from Dr. Samji's office of "hope that helps" after I did what they asked is beyond disappointment. I'm flared up by the hard cry.
Bottom line there should be some sort of "protocol" from the office since a LOT of time goes by while fulfilling what they requested. Also there needs to be some training for the lucky ones who aren't sick to have some -!*&@#%$%&*! empathy. sheesh! (sorry I resorted to cartoon swearing)
I'll pray for your surgery Bella. I believe you have made good decisions and deserve and should ask for help from family to have a peaceful rest before surgery.
11

Bella- I'm pleased that you're able to have your surgery earlier; hopefully the next couple of weeks will pass quickly, and it sounds like you have a very helpful and supportive family!

Music Geek- I feel for you with all the waiting for results etc. and then not getting very helpful responses.... I love your cartoon swearing!! I hope that Dr Samji's office help you when you send your new letter- it is all incredibly frustrating and wears you down, but try to be strong. It sounds like your family and friends are really helpful too.

Thinking of you both...

12

Bella - that's great that you'll have your surgery in less than 2 weeks. Yay! Take it easy and just lay around and rest as much as you can. You're in our thoughts and prayers.

MusicGeek - oh, how frustrating!!!! It makes a hard situation even harder. Do you have the styloid measurements from the CT scan that was done? Can you just send Dr. Samji's office a soft copy of those and get an appointment? Hang in there. Keep going one step at a time. You're in our thoughts and prayers as well.

13

Hey there, MusicGeek!

My recommendation would be that you get your foot in the door at Dr. Samji's w/ your enlarged salivary gland as that sort of thing is also his specialty, & while you're there, address the ES situation (make sure to have scans with you). I was diagnosed w/ ES by another ENT who was practically salivating about getting to do my surgery as he had done a few in the past & my styloids were pretty long. My mother-in-law insisted I get a second opinion & through a series of God guided events, I ended up at Dr. Samji's ofc. When I called to make the appointment I told them I'd been diagnosed w/ ES. They asked me to bring in my scans, but what I had were hard copies like the old time x-rays not a disc or an online version. I ultimately had to call the radiology ofc & have them send the electronic version of my scans to Dr. Samji's ofc. They were done w/o contrast. Like you, I eventually had vascular symptoms. Dr. Samji wisely chose to operate on the styloid that was growing in the most precarious direction first which did relieve much of my vascular symptoms. It was about 3/4 of a year before I had my second surgery & my second styloid was long enough by then that it was impairing the function of my tongue & really stabbing into my throat (not through the skin) but I was choking a lot especially when taking a drink of something like water.

Even though you're having a tough time w/ Dr. Samji's medical assistant (no names mentioned here ;), if you persevere in your quest & get an appointment, it will be well worth your time & the travel expense. It's a great office & for the most part the people who work there are very kind & compassionate.

I am sorry for what you've been put through & do agree that the person you have had contact with could be more considerate & compassionate. She has clearly not had to deal with a problem like ES herself except on the appointment booking end.

I hope this helps!


MusicGeek said:

Hi, I believe I'm the one you mentioned who was told to get the CT scan with contrast.

It was what I was told. But now they have changed their story. I had to wait for the CT scan with contrast because my doctor had me get an MRI with contrast and you aren't supposed to have contrast test closer than 6 weeks apart. So it was done two weeks ago. The radiologist did the test both With and Without contrast. My doctor gave me a call last week and told me to wait before I sent in the discs. He saw something he wanted to look at first. Apparently I have a submandibular salivatory gland that is large (and painful). My ENT hasn't seen anything like it and he said it was probably best that I have Dr. Samji handle it since it's unusual and could be caused by the possible Eagle Syndrome that still needs to be officially diagnosed. I did everything the Dr. Samji's office asked. They also told me to talk with my insurance company and the insurance gave the go ahead for to see Dr. Samji. I called Dr. Samji's office and in the phone message I was forwarded to the assistant or nurse recommended an email. I wrote and I now have a different directive - copy paste below:

>So the only 100% needed item is a CT neck NON-contrast styloid protocol which specifically measures the length of the left and right styloid bone. This is the only way to guarantee a diagnosis of "eagles syndrome" in our office. Once that scan is received with the report that states the measurements of the styloids then we book a new patient visit to discuss options.
Hope this helps,>
So to be clear - I received two separate and completely different instructions. I am currently getting my response letter edited by a medical professional friend. I then might have someone else who doesn't like me too much edit it LOL My family and friends are very angry right now. They all know the pain I'm in. I'm a professional musician and had my "last gig" two weeks ago to a packed house.
Last week I called the Doctor office in Phoenix and the new nurse he had was..... I asked how many time the doctor had performed Eagle Syndrome surgeries and her response was "lots of them". I asked kindly if there was a way to send in a CT scan and she told me I had to come in as a new patient. I explained that I was in Washington State and that I'd like to make sure I'm not wasting either of our times and she told me "that's your decisiion". I asked If she meant by "lots of them" 5?, 10?, 50? and then she yelled at me and said "Like I told you before - Lots of them, I'll have to ask on Monday and I'll call you back". -She didn't call back.
So getting a calloused response from Dr. Samji's office of "hope that helps" after I did what they asked is beyond disappointment. I'm flared up by the hard cry.
Bottom line there should be some sort of "protocol" from the office since a LOT of time goes by while fulfilling what they requested. Also there needs to be some training for the lucky ones who aren't sick to have some -!*&@#%$%&*! empathy. sheesh! (sorry I resorted to cartoon swearing)
I'll pray for your surgery Bella. I believe you have made good decisions and deserve and should ask for help from family to have a peaceful rest before surgery.
14

You might call Dr. Samji's ofc and ask if they keep a cancellation list. People do postpone/cancel their surgeries for various reasons. I had to move my second surgery out 3 months from the scheduled date because I had a bike accident 1 week before my surgery date & received a concussion. Dr. Samji said no anesthesia for 3 months so my spot opened up instantly. I was so disappointed as I'd been counting the minutes till that surgery. I would hope they would at least keep your name in mind if you requested an earlier date in case of a cancellation.

It's wonderful that you have such great family support. What a blessing! I will also be praying for you, Bella.


bella said:

Thank you both! It is very scary... I moved my surgery date to 4/18 (I wish I could do it now!). I felt much back to normal after acupuncturist did work on me to encourage blood circulation and relief neck blockage (his term). But last night I had another episode of near-fainting, shaking, and nausea... and haven't recovered fully :'( My sister and bro-in-law are driving me up to San Jose tomorrow... we want to get me to closer to Dr. Samji, should any emergency happen at least I'm already near him. I am fearful of the long drive.

I will keep everyone updated about my surgery. Thank you!

15

OK, I already have an update! Thank you everyone for your condolences and prayers. ;-)

My dear poor ENT nurse had a family loss last night. That's why she didn't call me back. I totally understand -that sort of thing just makes you short circuit.

I think Isaiah 40:31 has a good guess and point. I've seen all sorts of sites during my research stating the Eagle Syndrome should be diagnosed more. Even a gland specialty site stateing what I had should be looked into as ES. The hospital where I had my scans had a sign that read: Walk ins Welcome! All a bit unerving. Judging from past hair salon experiences this is not a mark of excellence LOL. All joking aside it could add up to the internet creating a LOT of tire kickers before one has the staff to accomodate.

In the mean time I found out from my Chiropractor that it would be hard pressed to not have the images needed from the scans that were already done. Fortunately the radiologist took scans BOTH with and without contrast. I asked about why I wasn't receiving the IV at the test during the test and she explained then that she was doing both. On my disc it reads

Exam: Neck 01_Neck_IV (Adult)

I sent a letter back to Dr. Samji's office asking if they have a protocol for patients who were already acting in good faith based on what the office requested before . I also asked if perhaps Dr. Samji could speak with my ENT to clear up any vernacular. Here's the response.

<Whom did you speak to here giving you the verbal direction to the incorrect CT scan? We all use the exact same protocol language for Eagles patients so I would be curious to find out whom you spoke to, if you can recall.
1. Dr. Samji does his own measurements BUT the report showing the exact length of both styloids is a must (The radiologist is the person whom measures these, not the MD) before he see's you. So this will be needed to continue care here.
2. No, Dr. Samji wouldn't need to speak to them, the radiologist will know exactly what a CT neck NON-contrast styloid protocol is, its universal. Plus, you are not an established patient until after your first visit so we would not be able to discuss any of your history/scans etc without first becoming established with Camino ENT. That's a HIPPA law.
Hopefully this helps with an hiccups
step one: send disk and scan report with both styloid lengths to our office, then schedule a new patient "eagles visit". Make sure to specify eagles when you book as it gives you more time with the doctor.
Excited to start your care :)>
After speaking with my ENT's nurse she confirmed the HIPPA mandate. My ENT nurse and I came up with the game plan to have her ask the radiologist to do the measurements find the images needed for the "styloid protocol" request - and My ENT's office will send it to Dr. Samji's office c/o the assistant, along with my file notes with my permission - hoping that will give my situation more validity.
Thank you everyone for the kind messages. I hope this experience helps others :-)
OK time to "renew my strength" ;-)
16

Love your refernce to my Bible verse/screen name! Sounds like you're on the right track to get an appointment. Pls let me know if there's anything I can do to help. I live 20 minutes from Dr. Samji's ofc & am in there regularly seeing his associate because of my Menier's disease. I know they won't discu

ss your case w/ me directly because you're not a patient there yet, but if there's any way I can support you, please let me know.

:)

MusicGeek said:

OK, I already have an update! Thank you everyone for your condolences and prayers. ;-)

My dear poor ENT nurse had a family loss last night. That's why she didn't call me back. I totally understand -that sort of thing just makes you short circuit.

I think Isaiah 40:31 has a good guess and point. I've seen all sorts of sites during my research stating the Eagle Syndrome should be diagnosed more. Even a gland specialty site stateing what I had should be looked into as ES. The hospital where I had my scans had a sign that read: Walk ins Welcome! All a bit unerving. Judging from past hair salon experiences this is not a mark of excellence LOL. All joking aside it could add up to the internet creating a LOT of tire kickers before one has the staff to accomodate.

In the mean time I found out from my Chiropractor that it would be hard pressed to not have the images needed from the scans that were already done. Fortunately the radiologist took scans BOTH with and without contrast. I asked about why I wasn't receiving the IV at the test during the test and she explained then that she was doing both. On my disc it reads

Exam: Neck 01_Neck_IV (Adult)

I sent a letter back to Dr. Samji's office asking if they have a protocol for patients who were already acting in good faith based on what the office requested before . I also asked if perhaps Dr. Samji could speak with my ENT to clear up any vernacular. Here's the response.

<Whom did you speak to here giving you the verbal direction to the incorrect CT scan? We all use the exact same protocol language for Eagles patients so I would be curious to find out whom you spoke to, if you can recall.
1. Dr. Samji does his own measurements BUT the report showing the exact length of both styloids is a must (The radiologist is the person whom measures these, not the MD) before he see's you. So this will be needed to continue care here.
2. No, Dr. Samji wouldn't need to speak to them, the radiologist will know exactly what a CT neck NON-contrast styloid protocol is, its universal. Plus, you are not an established patient until after your first visit so we would not be able to discuss any of your history/scans etc without first becoming established with Camino ENT. That's a HIPPA law.
Hopefully this helps with an hiccups
step one: send disk and scan report with both styloid lengths to our office, then schedule a new patient "eagles visit". Make sure to specify eagles when you book as it gives you more time with the doctor.
Excited to start your care :)>
After speaking with my ENT's nurse she confirmed the HIPPA mandate. My ENT nurse and I came up with the game plan to have her ask the radiologist to do the measurements find the images needed for the "styloid protocol" request - and My ENT's office will send it to Dr. Samji's office c/o the assistant, along with my file notes with my permission - hoping that will give my situation more validity.
Thank you everyone for the kind messages. I hope this experience helps others :-)
OK time to "renew my strength" ;-)
17


Thank You Isaiah 40:31 !

Yes I know the verse well. I memorized it when I was 12 :-)

I'm very sorry about the Menier's. Wow! talk about being close LOL. Hubby and I are going to make the first visit a long weekend since we are in the Seattle area. They probably won't discuss any patient- but I guarantee they'll repeat my jokes once they get to know me ;-) Thank you very much you are a blessing :-)


Isaiah 40:31 said:

Love your refernce to my Bible verse/screen name! Sounds like you're on the right track to get an appointment. Pls let me know if there's anything I can do to help. I live 20 minutes from Dr. Samji's ofc & am in there regularly seeing his associate because of my Menier's disease. I know they won't discu

ss your case w/ me directly because you're not a patient there yet, but if there's any way I can support you, please let me know.

:)

MusicGeek said:

OK, I already have an update! Thank you everyone for your condolences and prayers. ;-)

My dear poor ENT nurse had a family loss last night. That's why she didn't call me back. I totally understand -that sort of thing just makes you short circuit.

I think Isaiah 40:31 has a good guess and point. I've seen all sorts of sites during my research stating the Eagle Syndrome should be diagnosed more. Even a gland specialty site stateing what I had should be looked into as ES. The hospital where I had my scans had a sign that read: Walk ins Welcome! All a bit unerving. Judging from past hair salon experiences this is not a mark of excellence LOL. All joking aside it could add up to the internet creating a LOT of tire kickers before one has the staff to accomodate.

In the mean time I found out from my Chiropractor that it would be hard pressed to not have the images needed from the scans that were already done. Fortunately the radiologist took scans BOTH with and without contrast. I asked about why I wasn't receiving the IV at the test during the test and she explained then that she was doing both. On my disc it reads

Exam: Neck 01_Neck_IV (Adult)

I sent a letter back to Dr. Samji's office asking if they have a protocol for patients who were already acting in good faith based on what the office requested before . I also asked if perhaps Dr. Samji could speak with my ENT to clear up any vernacular. Here's the response.

<Whom did you speak to here giving you the verbal direction to the incorrect CT scan? We all use the exact same protocol language for Eagles patients so I would be curious to find out whom you spoke to, if you can recall.
1. Dr. Samji does his own measurements BUT the report showing the exact length of both styloids is a must (The radiologist is the person whom measures these, not the MD) before he see's you. So this will be needed to continue care here.
2. No, Dr. Samji wouldn't need to speak to them, the radiologist will know exactly what a CT neck NON-contrast styloid protocol is, its universal. Plus, you are not an established patient until after your first visit so we would not be able to discuss any of your history/scans etc without first becoming established with Camino ENT. That's a HIPPA law.
Hopefully this helps with an hiccups
step one: send disk and scan report with both styloid lengths to our office, then schedule a new patient "eagles visit". Make sure to specify eagles when you book as it gives you more time with the doctor.
Excited to start your care :)>
After speaking with my ENT's nurse she confirmed the HIPPA mandate. My ENT nurse and I came up with the game plan to have her ask the radiologist to do the measurements find the images needed for the "styloid protocol" request - and My ENT's office will send it to Dr. Samji's office c/o the assistant, along with my file notes with my permission - hoping that will give my situation more validity.
Thank you everyone for the kind messages. I hope this experience helps others :-)
OK time to "renew my strength" ;-)
18

I'll send you a friend request & we can be in touch when you're in the area if you need anything.

MusicGeek said:


Thank You Isaiah 40:31 !

Yes I know the verse well. I memorized it when I was 12 :-)

I'm very sorry about the Menier's. Wow! talk about being close LOL. Hubby and I are going to make the first visit a long weekend since we are in the Seattle area. They probably won't discuss any patient- but I guarantee they'll repeat my jokes once they get to know me ;-) Thank you very much you are a blessing :-)


Isaiah 40:31 said:

Love your refernce to my Bible verse/screen name! Sounds like you're on the right track to get an appointment. Pls let me know if there's anything I can do to help. I live 20 minutes from Dr. Samji's ofc & am in there regularly seeing his associate because of my Menier's disease. I know they won't discu

ss your case w/ me directly because you're not a patient there yet, but if there's any way I can support you, please let me know.

:)

MusicGeek said:

OK, I already have an update! Thank you everyone for your condolences and prayers. ;-)

My dear poor ENT nurse had a family loss last night. That's why she didn't call me back. I totally understand -that sort of thing just makes you short circuit.

I think Isaiah 40:31 has a good guess and point. I've seen all sorts of sites during my research stating the Eagle Syndrome should be diagnosed more. Even a gland specialty site stateing what I had should be looked into as ES. The hospital where I had my scans had a sign that read: Walk ins Welcome! All a bit unerving. Judging from past hair salon experiences this is not a mark of excellence LOL. All joking aside it could add up to the internet creating a LOT of tire kickers before one has the staff to accomodate.

In the mean time I found out from my Chiropractor that it would be hard pressed to not have the images needed from the scans that were already done. Fortunately the radiologist took scans BOTH with and without contrast. I asked about why I wasn't receiving the IV at the test during the test and she explained then that she was doing both. On my disc it reads

Exam: Neck 01_Neck_IV (Adult)

I sent a letter back to Dr. Samji's office asking if they have a protocol for patients who were already acting in good faith based on what the office requested before . I also asked if perhaps Dr. Samji could speak with my ENT to clear up any vernacular. Here's the response.

<Whom did you speak to here giving you the verbal direction to the incorrect CT scan? We all use the exact same protocol language for Eagles patients so I would be curious to find out whom you spoke to, if you can recall.
1. Dr. Samji does his own measurements BUT the report showing the exact length of both styloids is a must (The radiologist is the person whom measures these, not the MD) before he see's you. So this will be needed to continue care here.
2. No, Dr. Samji wouldn't need to speak to them, the radiologist will know exactly what a CT neck NON-contrast styloid protocol is, its universal. Plus, you are not an established patient until after your first visit so we would not be able to discuss any of your history/scans etc without first becoming established with Camino ENT. That's a HIPPA law.
Hopefully this helps with an hiccups
step one: send disk and scan report with both styloid lengths to our office, then schedule a new patient "eagles visit". Make sure to specify eagles when you book as it gives you more time with the doctor.
Excited to start your care :)>
After speaking with my ENT's nurse she confirmed the HIPPA mandate. My ENT nurse and I came up with the game plan to have her ask the radiologist to do the measurements find the images needed for the "styloid protocol" request - and My ENT's office will send it to Dr. Samji's office c/o the assistant, along with my file notes with my permission - hoping that will give my situation more validity.
Thank you everyone for the kind messages. I hope this experience helps others :-)
OK time to "renew my strength" ;-)
19

Thank you everyone for your kindness and advice. It appears I’m still in the process of getting an appointment with Dr. Samji. The radiology department must have erased the non contrast version of my CT scan. She was able to measure my styloid processes. The painful side with the angry enlarged salivary gland is 3.1 cm and the other side that isn’t nearly as painful is 3.3 cm. it’s not that I want to have ES, I want to be relieved of this pain. I had to resign my big band two days ago. I would play with a severed arm if it were possible lol, but it has become evident that my playing is making me worse. My ENT nurse is sending the report even though it’s WITH contrast. My understanding is that contrast highlights soft tissue. I know I technically qualify as ES but the measurepments aren’t huge. With this pain I would assume I was a world record lol I’m not used to being an “underachiever” :wink: I’m wondering if the soft tissue of the salivary gland could be hiding part of the measurement.
I may take your advice Isaiaha 40:31
I’ve started a new topic but my iPad isn’t as compatible with this site as it should be. With the measurements I’m wondering if the body size and bone structure of the patient is taken into considerations? I’ve had four molars pulled as a teenager because of my small jaw and you wouldn’t know it to look at me. I’m a tiny bone structure - could this be why the minimal "positive " of ES is so very painful?
BTW my ENT office is sending the measurement with report regardless that the CT scan was with contrast. We shall wait and see how it is received.
I would love prayers. I have a huge non paying project that has been delayed several times because of my illnesses and I’m sure people are getting annoyed by now.

20

3.1- 3.3 cms is above the 'average' that a lot of doctors use of 2.5 cms, and it's not always the length which causes problems but the angle the styloid processes grow at. Depending on what angle they're growing, they can compress different blood vessels or nerves, or squash these structures between them and the neck vertebra processes.

I've had salivary gland problems too- that's how I got to be diagnosed when being scanned etc. for salivary stones. Unfortunately despite surgery I'm still having problems- I think it's down to an autoimmune problem but whether there's any link to the ES I don't know. I think it's possible that the irritation of the styloid has triggered the immune response, but that's my own personal opinion, and not something I've ever found any research on!

Will be praying that things go well with Dr Samji's office for you.