Great news. Is he suggesting both styloids need removing?
He is a great surgeon
All the best on Monday 
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He’s unsure really, he’s starting on the right side because it’s nearly 6cm and completely calcified, and clearly causing issues.
says it’s tbd and will eventually be my decision on the other side, he takes a staged approach anyways.
Would likely be at least a couple months away because I’m flying from a distance and such.
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That is most excellent news, @jalexy12! I put your surgery date on my calendar when you first mentioned the 27th was a possibility. Good to know that you’re good to go for 10/27!! I’ll be praying for your surgery to provide significant symptoms reduction. 
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Hey @jalexy12 , I would say that the fact he agreed to go ahead with the surgery is a good sign. At the risk of repeating what you may already know, this condition is simply not fully mapped out yet, not just by individual specialists, but by the medical sector in general. We simply don’t know the full set of anatomical configurations that can cause symptoms - Dr Nakaji plainly mentioned how new edge cases are still being discovered (e.g. yours truly). It’s after all a condition where a difference of a few mms in your anatomical geometry can make the difference between “catching your finger in the door” or not, as he put it in one of my appointments. Combine this with the fact that the neck is a highly dynamic system, whose full range of motion and stressors seem to be very difficult to comprehensively recreate with current imaging techniques (as it seems you have just experienced), and you get a condition for which diagnosis and treatment still involve a bit of guesswork and uncertainty. Personally, fully getting to terms with this and trying to operate on a “hope for the best, prepare the worst” kind of mindset helped my mental health tremendously throughout this.
Nonetheless, considering his generally conservative approach, the fact that he is willing to go in seems to suggest that the risk/benefit analysis is in your favour, which is great. Also, I assume that since he said it’s likely classic eagles, it means he doesn’t plan to take from your C1 vertebra? It’s great if that’s the case. He mentioned, when we were discussing my case, that a surgery that just involves removing the styloid and fasciectomy (I don’t know if that is needed in your case), without C1 involvement (like I might end up needing on my left side), is much easier both in terms of surgical complexity and your recovery.
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So pleased that he’s agreed to do your surgery, and I’ll pray that you have a good recovery! Even if your collateral veins are compensating for now, it sounds as if they’re not with your head in certain positions, so this could get worse, & we’ve had quite a few members who get considerable pain from these veins, so hopefully the surgery will help you too 
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Very eloquently written opinion, @crumblecookie. I love what you said & the way you said it 
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Thanks! that’s my takeaway too
He mentioned that while my C1 / styloid are likely actually compressing my jugular, my C1 sits in a good position and probably doesn’t require any adjustment - thought he’ll see when he gets in there.
He mentioned some people have a C1 that pushes out pretty far on its own causing issues, whereas mine is in a good position. Seems like the styloid will be most of the issue there.
@Jules agreed on your post about the collaterals as well - while I think it may be making my body not completely shutdown, I think there’s a variety of scenarios where its failing to compensate when the collaterals are blocked.
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Holy shit, got out of surgery a bit ago. Facial numbness around ear, but other than that all is well.
Most striking thing by far - I was unable to tilt my head to the right and touch my shoulder for a long long time. I thought this was just instability as I got old, but I’m almost immediately able to fully tilt my head to the right and touch my shoulder.
My 6cm styloid was just getting in the way.
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Glad to hear you’re doing well. I have a consult with Dr. Mehta tomorrow and then Hopefully your same journey down to Arizona in November. Keep us appraised of your recovery. Crossing my fingers that you feel continued improvement over the next few weeks and months. Good luck and rest up!
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Thank you for reporting so soon after your surgery @jalexy12! Super AWESOME that you’ve already noted an improvement!!
You’re in the “honeymoon” period of post op i.e. the time when the surgical pain meds & anti-inflammatories are still hard at work. Those will wear off over the next couple of days, thus the need to ice your neck every couple of hours, sleep/rest w/ head elevation, & stay on your pain meds schedule for the next 5-6 days.
Several of our members who’ve recently had Dr. Nakaji do their surgeries, reported low pain levels even several days post op so you could be among that group as well. I hope your recovery moves steadily forward & you begin feeling better & better.
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It’s honestly a very impressive surgery site. The incision is incredibly small for the size of the styloid.
Historically my surgical problems have typically been lingering incision spots after the first week or so of surgical bruising, so I’m hopeful.
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I’m really glad the incision is impressively small. Icing consistently every couple of hours will help keep the bruising down. I’ve forgotten, does Dr. Nakaji put in a drain?
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Nope no drain. It feels like the strategy is small and minimally invasive, moving as much as possible after to keep everything moving.
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No drain = less pain! 
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So pleased that you’re not in too much pain & that you can move your head easier already! I hope improvements continue
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Great to hear you’re already feeling improvements! I just want to add another random piece of advice, and stress how helpful it was for my recovery that I fought to keep my head mobile in the first days post-op. For the first 18 hours or so, before I had my first comprehensive post-op meeting with Dr Nakaji (we did talk immediately after the surgery, but I remember very little), moving my head around was quite painful, so I instinctively tried to avoid movements that triggered it, despite intuitively feeling that movement might do it good. When I asked about this, he clearly stressed how important it was to try to move my head as much as possible to preserve my range of motion post-op. When I asked how hard I am allowed to push, he said that it’s normal for it to hurt and that shouldn’t deter me, but to apply common sense. I interpreted this as trying to avoid any movement that surpasses something like an 8/10 on my internal pain scale. Once I started regularly moving my head in all directions that existed within this pain envelope, the range of motion that produced little to no pain started expanding very quickly, despite coming off pain meds (except for 150mg aspirin a day to reduce the chance of clots).
Second thing that I feel really helped my recovery, and I saw very few posts mentioning this: it’s really important to follow a high-protein diet during post-op recovery. The figure I found in literature is that you should aim for about 2-3g/kg/day ( Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery - PMC ). Supplementing with protein powder was the only way I found to be able to match numbers close to this.
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Thanks for the solid tips! Ive found the movement helps a lot as well. This is actually what I’m finding the oxy most useful for at this point, I’m taking it and doing mini PT sessions moving around and such.
Biggest pain point right now is opening the jaw, which is probably a 7-8/10 without oxy, but can stretch it a bit when on pain meds
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Sore jaw joints are common post op, @jalexy12 & is the main reason we mention having a soft diet at the ready post op. I couldn’t chew effectively for a couple of weeks after my first ES surgery. My husband would cook a meal then put it in the blender w/ some broth or other liquid & make me a smoothie. They looked awful but tasted great! I also had more traditional smoothies w/ the fruit, veggies, protein powder, etc. If you’re strictly doing smoothies, adding some good fat to it like avocado or avocad oil, extra virgin olive oil, coconut oil, MCT oil, flax, hemp, &/or chia seeds, etc. will help it hold you longer i.e. keep you from getting hungry so fast between meals.
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I wouldn’t push it too far with trying to open your jaw for the first couple of weeks…
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