I’m on day 3 of recovery when I expected max post op swelling to be present & to be miserable as I’ve experienced in the past w/ this surgery. I’m actually feeling really good. Incision is itchy & ice feels nice, but I didn’t need my Rx pain med this morning, just took ES Tylenol & am fine. What a difference from prior ES surgeries!! I am taking Dexamethasone (steroid) which I’m sure is helping reduce post op swelling, but even w/ Prednisone in past surgeries, I didn’t feel this good on day 3 post op. I’m so thankful!!
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I totally agree with your question. It’s a good one to ask!
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So glad to get your reports. You’ve always been so helpful to the rest of us. A wonderful mixture of knowledge, faith, and encouragement. I’m praying your recovery continues to go well, and better than that, that the tinnitus and hearing issues will be resolved as your body adjusts to its new architecture. Blessings to you!
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I personally cant justify using a surgeon who doesnt believe that styloids can cause a vascular problem . Even if it doesnt appear to be a problem in a particular image it might be found during surgery. I am scared enough as it is with the incompetence i have had to deal with before i even get to surgery.
I think one of the surgeons calls it something using the words venous outflow. As long as they see it they can call it " Most Doctors Dont have a clue syndrome"
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You’re referring to VOO - Venous Outflow Obstruction, @JugularEagle. That’s the technical name that’s been given to IJV compression as it obstructs the outflow of blood from the brain through the IJV.
I agree completely & have learned a lot since I joined this forum in 2014. There’s a lot more information here now than there was then.
Made me laugh! 
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Thank you, @WillisWay! So happy to be here among so many supportive friends. You all have also helped me! 
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Hi Isaiah,
So sorry I hadn’t kept up to date so hadn’t realised that you were having surgery. Thank goodness it sounds as if things went well. I wish you all the very best for a full and trouble-free recovery (though feel quite ill imagining your soreness & swelling etc.)
Ha ha! Did laugh at your sheep comment. I’m on a sheep farm and sheep are a huge part of me - mentally, behaviourally, emotionally, psychologically and so on - but you really do have a bit in you! really interesting to hear that.
Hope you don’t mind me asking, but do you have any scan images that show your IJV compression that you could put up here? I’m interested to see as I can see some IJV compression on my CT with contrast & would like to compare. I’ll post up the latest with me re. ES soon, as it’s all relevant.
Take care!
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Thank you for your message, @Blodyn. I love sheep, all animals actually, so lucky you to be so involved with them! I grew up in a home w/ quite an animal, reptile, bird, fish, & bug menagerie. My mom had wanted to be a veterinarian but her parents wouldn’t allow it. She made up for it by nursing anything that came around needing help though we never had a sheep.
Here are my compression images for the left & right sides. I hope they’re helpful. Radiologists who read the scans reported no compression. 
(CTA) Red arrow is pointing at my left styloid, light blue is L IJV, yellow is C1 transverse process
(CTA) Red arrow is L styloid (previously shortened in 2015) & light blue arrow is IJV
This is from my MRV & shows compression of my right IJV (visible in the tiny yellow circle/marked by light blue arrows). Red arrow points to my parotid gland. I believe this compression is caused by soft tissue & hasn’t been terribly symptomatic. The dark blue arrows point to the collateral veins my body developed to compensate for the lack of jugular outflow.
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Gee, thanks Isaiah. Those scans are so interesting and I can see what you mean clearly. It sounds like Dr. Hepworth is a rare breed, he sounds excellent & gave you the confidence you needed to go ahead.
I’ll say something about my recent progress very soon. I think I have some IJV compression. Also wondering about Carotid Artery Dissection risk - have looked it up on here & read what’s there, though doesn’t seem like many members have experienced it. Wondering also if it can be seen on the CT with contrast scans.
I can’t say enough how helpful, educational, reassuring and supportive your comments are on this forum. Thank you. And hope you feel baaa-ter soon (nothing wrong with being a bit sheepish!) [special blind pet lamb, Blodwen (white flower), 8 months old is lying on my foot as I write - bleatin hoping you’ll get wool - I mean Well! - soon]
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Sorry me again - out of interest, is Dr. Hepworth a vascular surgeon, or what? It’s become clear to me that with ES issues various medical disciplines are involved or cross-over & seem to need a combination of ENT/Maxillo-facialVascular/Neurological/Orthopedic even!?
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Dr. Hepworth is an ENT & sinus specialist. He has obviously diversified his practice & also includes vascular decompression among his featured surgical skills.
I look forward to reading your update & am sorry you may also have some vascular compression. Early on, I believe only ICA compression by the styloids was noted. It seems styloid related IJV compression was a later discovery, though it may be I just didn’t see research papers about it until a while after the ICA research. ICA compression often causes stroke-like symptoms & TIAs which people w/ IJV compression typically don’t suffer so that’s one distinction between them. They do have some symptoms in common though.
Thank you for your compliment. I’m just paying forward the support given to me during my times of need in the past/present & am so thankful to be able to! I’m glad you’ve benefitted from the information shared on our forum, @Blodyn. Your last post was a little lift for me today . I also enjoyed the sheep related comments! Made me laugh! 
You have a fun sense of humor!!
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Thanks so much, Isaiah. Always good to have a bit of humour (well preferably a lot!). Thaks for the further comments, very helpful, as always. Back soon with more, but meanwhile wishing you rest and a full recovery 
!
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I have a very clear carotid artery dissection risk. It is very easy to see using the Radiant viewer. In the neutral position i have only a thin fat layer protecting it as pointed out by neuroradiologist. Neurovascular surgeon told me I am not at risk. He is clearly wrong. It is shocking that it hasnt already happened but it may be contributing to my lacunar strokes and brain bleeds.
I cant link at the moment but you can see it in my “Oh boy do i need help with my scans” thread.
Mine looks strange because I have a hairpin curve.
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Hi JugularEagle,
Thanks so much for your very interesting and helpful comments and your own story, which is pretty grim - but - sounds like you are getting there. Quite despairing how many folk on this forum either haven’t been listened to, or fobbed off, or not had ES or IJV compression or CAD etc. identified. You and others on this forum are certainly helping spread awareness & make others (including me) feel less alone with it all!
Back to your scans. Thanks for directing me back to your other post. Really interesting. Not experienced at all in interpreting all of them, but can clearly see your IJV compression and also your ICA looking like a tributary of the Mississippi! hence the risk of dissection which looks pretty high…I’ve been playing around and scrutinising a CT-with-contrast scan I had over the last month & will post o that soon, but am also keen focussing on the IJV and ICA.
Huge thanks again. Hope so much you can hang on in there & get the right assessment, conclusions and action. Good Luck (though not so much luck as your perseverance!)
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So glad to hear you’re doing well, @Isaiah_40_31! As several have mentioned, you’ve been so helpful to so many of us… I appreciate you, and have been thinking about and praying for you!
It was interesting to see your scans. I have similar compression of the left IJV against C1 (and still dealing with symptoms after styloid removal). I am curious… where exactly did he move the IJV to? Encouraging that he didn’t have to do a shave. And was he able to get a look at any nerve involvement?
I’m planning to do a post soon. I had a consult with Kjetil Larsen (very knowledgeable dude!) and am getting a cervical MRI on Thursday. The journey continues…
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@DeeCeeNorth - Could you share some insight you got from him as well as how much it costs? One of his videos was instrumental for me understanding the disaster that physical therapy was for me such as the Mckenzie chin tuck. So, i would like to do a consult with him
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Thank you for your well wishes & especially prayers, @DeeCeeNorth!
I haven’t gotten to talk to Dr. Hepworth since my surgery & post op will be with his NP. Supposedly I’ll get a copy of the surgical report which should detail more specifically what was removed & moved. I plan to make a follow-up telehealth appt w/ him before I leave the office after my post op.
As far as the IJV goes, I think once the styloid is sufficiently shortened, he moves the IJV partially into the space the styloid took up. He’s also been intermittently using sheep intestinal tissue (don’t know the medical term for it) as a protective cover on the sections of the IJV that are more vulnerable to re-compression. He said he might do that in my case, but I haven’t heard if he did or not.
In a quickie post op phone call he told my husband there was accessory nerve involvement, and he had to move the nerve, but miraculously, I don’t have a sore shoulder from that. We’ve had several members who’ve had the accessory nerve involved w/ IJV compression so it’s not too uncommon.
Over time, we’ve had some members who had VES & had styloidectomies with Dr. Hackman where the VES didn’t resolve. There are situations where removal of the styloids to close to skull base is enough to allow the IJVs to open. @Jules had this experience. In other cases, C1 &/or other soft tissues are greater contributors to compression than the styloid. If those aren’t dealt with, then compression remains & specific IJV decompression surgery needs to follow. I’m sorry to say this may be what’s happened in your case.
Make sure to inform yourself about the possible side effects of gadolinium if your MRI on Thursday is w/ contrast. I had only temporary problems from it after my MRV but others have had ongoing trouble. MRI contrast risks / Gadolinium toxicity
I’m also very interested to learn what your consult with Kjetil Larsen turned up for you.
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Wow! So sorry I’ve been MIA… so glad to hear you are doing well. I need to read through again to understand all you went through but glad you are on the other side ))).
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@Leah! Welcome back. You’ve been on my mind recently. How are things going for you? Have you gotten any new helpful information or diagnosis?
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Thank you ))). I am feeling much better, but with interventions. I am seeing a pain management doctor for occipital neuralgia type pain. Have had (3) bilateral ‘trigger point’ injections, twice at the base of the skull (a little maybe 1.5" above) and last time in upper cervical. They used lidocaine and prednisone and was immensely helpful. Suspect will be going for ablation if it doesn’t settle down. Would definitely recommend giving the injections a try for those that have skull base pain and wish I had known about this while waiting for surgery (first shots given at Neuro’s office and they would continue them, but was already on to seeking RFA for the occipital nerves at the pain management doctor).
I still have intermittent (daily) head pressure (and I ‘think’ it is pressure … can’t tell for sure if it is internal or external) and on both sides and/or alternates (ugh). I reduced my salt and that helped. Will ask the neurologist if can trial diamox as a data point, but aside from going back down the route for IIH, have done everything else. And that may come in the future, but am needing a break from exploratory dr appointments.
I did have high B6 (March) and some suspicions it has played a role in my dysfunction. It is a tough one as the neurologists recognize it can be a problem, but will say nothing to do but wait it out. There is a biopsy (lower leg) for Small Fiber Polyneuropathy which I have not had as those symptoms are improving. Was taking a B complex and multi (Trader Joes), so nothing unusual.
Symptom wise, besides my head, had weird nerve(y) feelings in legs, arms and torso, muscle weakness, clumsy hands, high heart rate (fluctuating), eye fatigue, heat intolerance, no sweating… a host of weird things that didn’t have before and wasn’t related to my styloid as best I could tell. (I was on gabapentin before and after surgery … so it would have masked some symptoms).
And am also being treated for MCAS (no positive testing still)… which can cause head issues among other things. But I am moving forward )). My case is not a great example as I do have other issues causing similar symptoms and they are hard to parse apart. However, I no longer feel like I have a fork in my neck 
and the tightness from styloid to hyoid is gone. Shoulder issues diminished to mostly nothing. I am grateful for the surgery with Dr. Hackman. My neck continues to be overly tight and that may just be my lot …I seem to have inherited a twisted C1/C2 … (as you know) … my son has the same and suspect my grandfather did as well. So working towards getting as functional as I can for me.
Hope you are feeling better each day ))). Am posting this as an update as well.
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