Could someone share the details of how Dr. Hepworth likes his dynamic CTVs completed?
My husband is getting one done so figured I’d get it to suite Dr Hepworth’s requirements so when he starts taking new patients we’ll have this step completed.
Someone sent this IJV US protocol to me recently & told me it came from Dr. Hepworth’s ofc.
IMG_9501.tiff.pdf (64.4 KB)
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Thank you!
Hi Isaiah and pk5,
Maybe it was me with the ultrasound protocol.
I don’t know if there is a similar thing for CT-V.
My CT-V was pretty much like normal CT-Angiogram only with adapted timing of the contrast injection with focus on vein depiction. My CT was also croped off somewhere at the forehead though it would have been better in my opinion if the whole head was depicted.
Protocol Ultrasound Hepworth.pdf (783.4 KB)
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One comment I have that’s not noted on the US instructions is that the valsalva maneuver is used periodically during the ultrasound i.e. the patient is requested to hold his/her breath for a few seconds intermittently on each side. I’m not sure at what point the US tech requires that to happen, but I noticed it’s not mentioned in the info @TheDude & I sent you.
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For what its worth…attached is my result from a Hepworth ordered ultrasound (bilateral internal jugular venous duplex ultrasound)
The right side has issues. There is blockage that creates an hour glass type blood flow - high before and after the blockage.
If you are want to get more info than the docs already provided…
He has trained people at these Denver, CO area imaging centers to do them per his instructions: Invision Sally Jobe, Health Images at Cherry Hills. Maybe they would share their instructions directly or to other imaging centers?
HepVenousUltrasound.docx (74.0 KB)
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“Maybe they would share their instructions directly or to other imaging centers?”
Great suggestion @juliezuber!
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If your ultrasound is positive, does Hepworth require a catheter venogram/angiogram in addition? Or is the ultrasound enough information? Thanks!
It depends on what your scans show, @jsisto. My CT scan showed bilateral compression w/ the right being worse than the left, & my US showed it, too, but Dr. Hepworth asked me to get an angio/venogram to be sure as the right side appears to be compression by soft tissue. The angio/venogram confirmed the left is compressed but cleared the right side of compression. Not sure how my right IJV can look so squashed & show up as having normal flow via a venogram, but alas, it did! Bottom line - I’m getting my left IJV decompressed next week. The right is a no go for now.
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Isaiah,
Is Hepworth doing the left IJV decompressed?
Jsisto,
Hepworth went by the scans I had done and jugular US. I didn’t have a catheter venogram/angiogram before my ES surgeries.
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@juliezuber - Dr. Hepworth is decompressing my left IJV. Again, I believe he had me get the angio/venograms because my right side looks substantially worse than the left in the scans I had, but my symptoms are dominantly on the left side so he wanted better clarity as to what is going on.
I’m hoping & praying there will be reduction in the chronic loud tinnitus I’ve had for 9 years & maybe some restoration of hearing in my left ear as it’s nearly deaf. I do acknowledge that the nerves have been under duress for a long time so if I do get any hearing restoration, it may take a while.
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Clearing your right side, might help the left.
My right looked worse (per the US and scan) but left had more symptoms (ear, varicose vein down the neck).
The brief window where the right jugular was working gave relief to the left side.
I think the left isn’t in good shape but hurts more when it has to do all the work (when the right jugular is blocked).
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I’m sorry your right IJV hasn’t stayed open. My right side looked very compressed in my MRV but when Dr. Yakes did the venogram, he was able to slide his catheter right through the area which indicated to him there was no compression. I do have pretty extreme tinnitus in my right ear but it pales in comparison to the left side. I’m glad Dr. Hepworth is sticking with you & has referred you for additional help with your right IJV.
Is your left IJV compressed? If so, maybe getting it decompressed would help your right side not struggle so hard?
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Will medicare not pay for a 3d ciss Mri? It might show someting causing the tinnitus. Like the artery sitting on the ear nerve.
I haven’t even thought about doing a CISS or FIESTA MRI as I feel fairly confident my tinnitus is a result of my IJV compression. I have no idea if Medicare would pay for that type of scan, but I’m suspicious they might not for something they consider as benign as tinnitus. I have other ES symptoms going on, too, so either my left styloid wasn’t cut short enough or it’s regrown a bit. I’m hoping Dr. Hepworth will cut it shorter. I have my pre-op tomorrow & will ask him what his plans are.
If my surgery on Wed. doesn’t help, I have the CISS or FIESTA scans to turn to for future exploration.
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Praying that you have good results from your surgery @Isaiah_40_31 ; of course we’d like to know how it went when you’re able, but take as much time as you need away from here to get better! 
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Thank you, @Jules! I will post something here as soon as my brain is clear enough to write something that makes sense. 
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Hope things go well for you, @Isaiah_40_31. Sending lots of prayers your way today! 
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@Isaiah_40_31 Sending you good thoughts for success today!
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You are in my prayers today, sweet girl! 
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