Hi . I know that every one has different criteria as on how to decide for a dr to perform surgery but was just curious to know if anyone on the forum that has seen both Dr Costantino and Dr Hepworth decided to proceed w Costantino for a different reason than waiting times or insurance ?
Thank you very much
We have had some discussions about members’ experiences of both doctors before, here’s a link to one discussion:
Inquiring patients of Dr. Hepworth and Dr. Costantino for their surgical and patient experiences - General - Living with Eagle
Hopefully others with experience of the doctors will comment too!
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For me personally, I chose Dr. Nakaji over Dr. Costantino for a couple of reasons. 1. He is part of the group of doctors who are really trying to understand venous hypertension/venous outflow congestion. They are trying to sort out what the mechanisms that underlie the symptomology are and how to best treat. They are collectively working to develop ‘best practices’ for treating us and they are sharing information about what they are finding and continually updating their surgical approaches based on that data. He is really trying to understand the problem. 2. Dr. Costantino, who seems to be an amazing surgeon, is not part of this group. He has developed his own surgical plan that he applies versus making decisions about what to remove once he’s in the field. There is no outcome data so it is impossible to compare. I just felt more comfortable with Dr. Nakaji’s approach who left behind several things Dr. Costantino would have taken out because, while in the surgical field, didn’t find those things to be problematic. I was considering Dr. Hepworth as well, he is also part of the group of doctors trying to understand the problem, but the wait was just too long.
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I saw both. I have not had surgery yet. I have been getting other imaging and consultations done prior to surgery to rule everything out. If you can wait for Hepworth, I would. He is worth the wait. He is much more analytical in his thinking and found things Costantino did not. I, personally, did not think Costantino was very thorough.
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How did your surgery go? Was there anything Nakaji took out or did unplanned once he was inside
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The surgical plan based on imaging and IR angiogram was to remove the left styloid and resect C1. He tested movement of my neck in relation to IJV and found it was completely free without having to resect anything else. He is aware of all of the other potential culprits that could restrict IJV from his own experience plus the experience of all the doctors in the venous congestion group who have shared what they have encountered. Once in the surgical field he was able to see the the original surgical plan was enough. Hope that helps.
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Thank you for answering!
I have consulted with Constantino, Cognetti and am waiting for Nakaji!
I am in Canada…
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I made the same rounds. Good luck!
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@Carrie68
Hi!
Do you mind me asking how much was your consult with constantino and cognitti and how much did they quote you for surgery?
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I think the consults were about $350. No quote for the surgery as the plan would have been to get insurance authorization.
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Hi! Cognetti didn’t charge! I believe I only paid $100 US for Constantino!
Waiting for quotes as hoping for OOC assistance
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@Chrickychricky was the testing of your IJV done intra-op or pre-op?
He took my neck through a range of motion while I was on the table to make sure the IJV was free. He plans to do follow-up imaging if needed.
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Hi @Carrie68
Did you ever receive a quote from Dr. Constantino’s office for the surgery? I’ve had a hard time getting an estimate from them. I’m also from Canada. Wishing you the best of luck!
Hi!
No I did not and I gave up! I sent emails repeatedly!! It’s very unfair in my opinion
I am heading to Philadelphia as we speak for surgery with dr Cognetti & Dr heller on Friday
Styloid & C1 shave
Carrie
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That’s so exciting! Good luck. I tried to book a consult with Cognetti but the first appointment was in April. My husband has a consultation with Costantino on Nov. 21 but if we can’t afford the surgery then is it even worth the consult? Maybe I’ll try emailing them again and attempt to get a ballpark figure.
Keep us all posted on your surgery. I hope that you have a speedy and full recovery.
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Thank you very much!!
I would say you have a better chance of Cognetti and going on a Waite list than you do any chance with Constantino!!
I know of 3 other Canadians who Nevee got a quote…the hospital isn’t cooperating is what Shantel and Jules say!
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There are federal laws that were put in place to try to help patients. I havent looked at this in a long time. Hospital price transparency. Start throwing legal terms around at them and see if you can get something.
Keep in mind in the US pricing at a hospital is very complex so the quote you get is just an estimate.
There were some updates to the rules at the beginning of the year. This all started with Obamacare if I remember correctly. It doesnt matter if you arent a US citizen. Hospital still has to provide transparent pricing. Pretty sure they now must make it available online but you need CPT codes to get an accurate estimate
I think the No Surprises Act covers the Doctor costs as well.
I cant link but just saw a good article at Burr and Forman about this with No Suprises Act in title so you can google it to try to get an understanding of the issue.
However, a caveat to this is understanding that how can they give you a really good estimate unless they have seen you as a patient. A Doctor has no idea what you might need yet. The Nakaji patient had one CPT code used for one side and another for the other side. Not sure if she knew this beforehand.
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Praying for a successful surgery for yo @Carrie68 , hope all goes well 
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Thank you very much Jules!!
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